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Biomedical subjects

K Dote

Publications and source records attributed to K Dote.

At least 19 recordsLinked to original sources
PubMed2005

Myocardial performance index for assessment of left ventricular outcome in successfully recanalised anterior myocardial infarction.

OBJECTIVE: To investigate whether the myocardial performance index (MPI) can predict left ventricular functional outcome in patients with early recanalisation after anterior acute myocardial infarction (MI) and to determine when the index should be measured. DESIGN: MPI was measured serially by two dimensional Doppler echocardiography after successful percutaneous coronary intervention (PCI). Left ventricular function was evaluated by echocardiography and left ventriculography. To assess coronary microvascular damage, the coronary flow velocity pattern was measured immediately after PCI with a Doppler guidewire. SETTING: Hiroshima City Asa Hospital. PATIENTS: 32 consecutive patients with their first anterior acute MI who had complete occlusion of left anterior descending coronary artery. INTERVENTIONS: Successful PCI within six hours of symptom onset. MAIN OUTCOME MEASURES: Left ventricular anterior wall motion score index (A-WMSI), left ventricular end diastolic pressure (LVEDP), left ventricular ejection fraction (LVEF), and left ventricular end diastolic volume (LVEDV). RESULTS: There was a significant negative correlation between MPI on day 2 and the coronary diastolic deceleration time (r = -0.66, p < 0.002), as well as a significant positive correlation with the coronary diastolic deceleration rate (r = 0.74, p < 0.0001). MPI on day 2 was significantly correlated with the short and long term changes of A-WMSI and with the short term changes of LVEDP. Furthermore, MPI on day 2 was significantly correlated with the short and long term changes of LVEF (r = -0.52, p < 0.003, and r = -0.64, p < 0.0008, respectively) and of LVEDV (r = 0.51, p < 0.003, and r = 0.41, p < 0.05, respectively). CONCLUSIONS: Doppler derived MPI on day 2, representative of the early coronary microvascular state, can predict the left ventricular functional outcome after early successful recanalisation of a patient's first anterior acute MI.

Aged↗
PubMed2001

New pain following cordotomy: clinical features, mechanisms, and clinical importance.

OBJECT: The clinical features, possible causes, and contributing factors associated with novel spontaneous pain following unilateral cordotomy were investigated to clarify the mechanism and clinical importance of this pain. METHODS: Forty-five patients who underwent cordotomy for severe unilateral cancer pain were included in this study. New pain occurred in 33 (73.3%) of 45 patients. Pathological conditions of tissue demonstrated on imaging corresponded to new pain in eight patients, referred pain in five, and neither of these in 15 patients. New pain was centered opposite the site of the original pain in a mirror-image location in 28 patients and rostral to the original pain in five patients. It was temporary in seven patients, weaker than the original pain in 25, and as severe as the original pain in one patient. The incidence of moderate or severe pain was significantly higher in patients with confirmed tissue disease (six of eight patients) than in those without (six of 20 patients). An important contributing factor to the occurrence of new pain was the achievement of analgesia by performing the cordotomy. CONCLUSIONS: The present results indicate that new pain occurs frequently after unilateral cordotomy. Nonetheless, cordotomy may still be indicated for unilateral uncontrollable pain because new pain, when present, was weaker and more easily controlled than the original pain in nearly all cases. The authors speculate that new pain may represent a type of referred pain from the original painful area or may arise from sensitization of contralateral spinal nociceptive circuits due to metastasis or tumor infiltration, and that new pain is potentiated by the interruption of descending inhibitory pathways.

Adult↗
PubMed2000

Biological functions of extravasated serum IgG in rat brain.

During blood-brain barrier opening serum IgG could be extravasated. The function of intraparenchymal IgG, however, is unknown. Its biological effects in the acute phase were currently investigated. From rat autoserum IgG was purified and injected into the cortex. Similarly, IgG-Fab fragment was prepared and administered likewise. As for the control group, only vehicle was injected. Animals were sacrificed on days 1, 2 and 4 after the infusion and were histologically evaluated. On days 1 and 2, the infusion of IgG caused significant intraparenchymal infiltration of neutrophils which expressed LFA-1-alpha. It also induced CR3 up-regulation in microglia and endothelial ICAM-1 expression. On day 4, these findings had disappeared. HE stained brain sections and the TUNEL method did not reveal significant nerve cell death in IgG injected animals during the experiment as compared to the controls. IgG-Fab did not cause significant changes either. Extravasated IgG has been viewed to have biochemical functions. Its Fc fragment seemed to cause microglial and endothelial activation, followed by leukocytic infiltration. This sequence itself was not neurotoxic. Therefore, it is suggested that extravasated IgG is one of the inducers that modulate cellular responses in the acute phase of brain damage.

Acute-Phase Reaction↗
PubMed1998

Ischemic preconditioning suppresses the noradrenaline turnover in the rat heart.

OBJECTIVE: The mechanism by which ischemic preconditioning protects the heart is presumed to be related to the reduction of energy consumption during a subsequent myocardial infarction. Since the sympathetic nervous system enhances cardiac function and energy consumption, we investigated the relation between ischemic preconditioning and the turnover rate of noradrenaline (NA) in the rat heart. METHODS: The effect of 3 cycles of 5-min occlusions of the rat left coronary artery on changes in arterial blood pressure and heart rate provoked by a subsequent 30 min of ischemia were examined until 60 min after reperfusion. The effect of 3 cycles of occlusions on the infarct size was also evaluated 60 min after reperfusion by comparing the infarcted area with the area at risk in these animals (6 per preconditioned and sham-operated group). The tissue concentration of NA during sustained ischemia was determined in the left ventricle, the intraventricular septum, and the right ventricle in the preconditioned and sham-operated groups. Changes in the turnover rate of NA after 3 cycles of occlusions were also evaluated by assessing the alpha-methyl-p-tyrosine-induced depletion of NA (n = 7 per group). RESULTS: A series of transient occlusions reduced the infarct size 60 min after a sustained ischemia for 30 min. Arterial pressure and heart rate were not affected. The concentration of NA was decreased in the left ventricle 60 min after the onset of sustained ischemia in both the preconditioned and sham-operated groups. The treatment with alpha-methyl-p-tyrosine decreased the NA concentration in all regions of the heart in the sham-operated group after 60 min. However, the treatment with alpha-methyl-p-tyrosine did not deplete the NA concentration in both the occluded and nonoccluded regions in the preconditioned group. CONCLUSIONS: Transient ischemia ameliorated the heart injury induced by a subsequent sustained ischemia, as assessed histologically. The activity of the sympathetic nervous system in all regions of the heart was reduced by transient ischemia in the left coronary vascular bed. These findings suggest that the inhibition of the sympathetic nervous system by the treatment of ischemic preconditioning takes part in the cardiac protection.

Animals↗
PubMed1998

Hypothermia increases the threshold for ischemic preconditioning.

OBJECTIVES: Both hypothermia and ischemic preconditioning are known to provide tolerance to myocardial ischemia and reperfusion. The aim of this study was to determine whether hypothermia during the ischemic preconditioning period attenuates the protective effect of ischemic preconditioning. METHODS: Experiments were performed in buffer-perfused isolated rabbit hearts. All hearts underwent 45 minutes of regional ischemia, followed by 2 hours of reperfusion. Ischemic preconditioning was elicited by either one or four periods of 5 minutes of regional ischemia. Hypothermia (25 degrees C) was induced beginning either 20 or 50 minutes before the 45-minute period of regional ischemia; normothermia (38 degrees C) was restored 10 minutes before the 45-minute period of regional ischemia. Except for the hypothermic periods noted, hearts were maintained at 38 degrees C. RESULTS: Normothermic ischemic preconditioning with either one or four cycles of 5 minutes of coronary occlusion resulted in a profound reduction of infarct size (58% reduction with one cycle, p < 0.05; 95% reduction with four cycles, p < 0.01). Hypothermic ischemic preconditioning with one cycle of 5-minute coronary occlusion resulted in no reduction of infarct size but hypothermic ischemic preconditioning with four cycles of 5-minute coronary occlusions resulted in a 94% reduction of infarct size (p < 0.01). Myocardial glycogen and lactate levels were maintained near control levels during hypothermic ischemia. CONCLUSIONS: From these data we conclude that hypothermia during the preconditioning period increases the threshold for eliciting the infarct limitation of ischemic preconditioning.

Animals↗
PubMed1998

[Percutaneous drainage of a bulla with tuberculous infection in a patient].

A 63-year-old man complaining of low grade fever and dry cough was admitted to our hospital. Chest X-ray showed infiltrative shadows and a bulla with a fluid level in the left upper lung field. Bacteriological examination of sputum and bronchoalveolar lavage fluid did not yield any diagnostic results. Percutaneous aspiration of the bulla under fluoroscopy was performed. Bulla with tuberculous infection was considered because a high ADA level was detected in the fluid of the bulla. A culture of the bulla fluid was positive for mycobacterium tuberculosis (TB), which was sensitive to all anti-mycobacterial drugs. The fluid in the bulla gradually increased, and occupied the entire space of the bulla three months later. Percutaneous aspiration of the bulla was performed again and a fluid smear was positive for TB. It was thought that systemic administration of anti-mycobacterial drugs had been ineffective, so percutaneous drainage and subsequent injection of anti-mycobacterial drugs into the bulla was performed. The fluid in the bulla subsequently disappeared and the bulla shrank gradually. Percutaneous drainage of a bulla with tuberculous infection should be considered in those who do not respond to medical management.

Antitubercular Agents↗
PubMed1996

[Two cases of tubercle bacilli infected pulmonary bulla].

Two cases of tubercle bacilli infected bulla are reported. Case 1; A 78-year-old man visited our hospital complaining of fever and chest pain. The chest radiograph revealed the bulla with air fluid level in the left upper lung field. Mycobacterium tuberculosis was detected in the fluid obtained by percutaneous lung aspiration. He was treated with anti-mycobacterial drugs and showed improvement. Case 2; A 66-year-old man visited our hospital complaining of fever, chest pain and dry cough. The chest radiograph revealed the bulla with air fluid level in the left upper lung field. A diagnosis of tubercle bacilli infected bulla was considered because of high level of ADA in the fluid obtained by percutaneous lung aspiration, and anti-mycobacterial drugs were administered. His symptoms were improved and the frequent chest radiograph showed gradual absorption of the fluid. It is suggested that ADA and bacteriological examinations of the fluid obtained by percutaneous lung aspiration are useful for early diagnosis of tubercle bacilli infected bulla.

Aged↗
PubMed1996

[Clinical characteristics of pulmonary embolism without definitive predisposing factors].

Patients with pulmonary embolism may have no definitive predisposing factors for thrombi. The clinical entity of chronic pulmonary embolism is also uncertain. This study clarified the clinical characteristics of pulmonary embolism without definitive predisposing factors. During the last 10 years, 36 consecutive patients were diagnosed as having pulmonary embolism (mean age 61 years, female 75%). Twenty-four patients (67%) had definitive predisposing factors ("definitive" group). Patients without definitive predisposing factors had the following characteristics. The onset of symptoms was out-hospital and insidious. The main symptom was exertional dyspnea without acute episode compatible with an embolism. In four patients (33%) there was a delay of over 2 years form the onset of symptoms to the diagnosis. Three patients had been treated for depression. Thrombolytic therapy caused an inadequate fall in mean pulmonary artery pressure from 41 +/- 11 to 24 +/- 8 mmHg and in three patients it remained over 30 mmHg. Deep vein thrombosis were found in four of nine patients in whom venography were performed 10 days after thrombolytic therapy, but only one patient showed thrombus in the "definitive" group. During the convalescent stage, all patients were treated with prophylactic warfarin. Home oxygen therapy was indicated in three patients and an inferior vena caval filter was implanted in two patients. One third of patients with pulmonary embolism in our institute had no definitive predisposing factors. In these patients, even with thrombolytic therapy, recovery of pulmonary hypertension was often insufficient and deep vein thrombosis persisted. Clinicians should be aware of this disease to avoid undue delay in its diagnosis.

Aged↗
PubMed1995

[Predictors for the massive thrombi occurring in the right coronary artery related to acute myocardial infarction].

Acute myocardial infarction (AMI) related to the right coronary artery (RCA) is associated with a lower reperfusion rate and higher reocclusion rate in the acute phase than AMI related to the left coronary artery. The greater susceptibility of the RCA to development of large thrombi makes successful reperfusion more difficult to achieve. This study investigated predictive factors for massive thrombus in the RCA before the selection of the treatment to achieve better rates of reperfusion. We classified 51 patients with AMI related to RCA into the massive (linear intraluminal radiolucency > 3 cm) thrombus group (9 patients) and the non-massive thrombus group (42 patients). 1) HISTORY: Patients in the massive thrombus group had a greater incidence of hypertension than the non-massive thrombus group, with more left ventricular hypertrophy (p < 0.05). There were no significant differences in other coronary risk factors. 2) RCA morphology: The maximum RCA diameter was significantly greater in the massive thrombus group than that in the non-massive thrombus group [proximal to the right ventricular branch, 4.2 vs 3.2 mm (median); distal to the right ventricular branch, 4.2 vs 3.4 mm, p < 0.05]. 3) Conditions of onset: The elapsed time was significantly longer in the massive thrombus group (15 hours) than that in the non-massive thrombus group (2.5 hours, p < 0.05). More massive thrombus cases were observed in summer (p < 0.05), but there was no evident correlation between massive thrombus formation and the onset time of day, weather, Hct and coagulation factor at the onset, left ventricular ejection fraction or left ventricular end-diastolic pressure.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1995

[Estimation of respiratory functions by analysis of expired gas and blood gas during artificial ventilation and general anesthesia].

One-hundred and seven patients undergoing elective surgery were studied to analyze the correlations between preoperative spirometric values and respiratory parameters during general anesthesia. They were grouped according to 3 criterions; preoperative %VC of less than 80%, FEV1.0% of less than 70%, V50/V25 exceeding 4.0. Following the induction of general anesthesia and of mechanical ventilation, expiratory flow (VE), FECO2, PaCO2 and PaO2 were measured to calculate respiratory parameters including VCO2-SR, VD/VT-Bohr, VD/VT-physiological (phys), a-ETDCO2, Volume Pressure Index (VPI) and A-aDO2. Six respiratory parameters were compared between the groups, and correlations between preoperative spirometric values were studied. Those with lower %VC had higher values in VCO2-SR and in VPI, and those with lower FEV1.0% had higher values in VCO2-SR, in VD/VT-phys and in a-ETDCO2. Significant correlations were also observed between these parameters. Preoperative V50/V25 and A-aDO2 during general anesthesia did not correlate with any of the parameters studied. We conclude that VCO2-SR, VD/VT-phys, a-ETDCO2 and VPI during general anesthesia are useful to detect the patients with restrictive and/or obstructive lung dysfunction, although they are not sensitive enough to detect those with small airway disease.

Aged↗
PubMed1992

[Complications of emergency coronary angioplasty for acute myocardial infarction].

To assess the incidence and consequences of complications occurring during emergency percutaneous transluminal coronary angioplasty (PTCA) for acute myocardial infarction (AMI), we studied 347 patients who underwent PTCA within 24 hours after the onset of AMI. Acute occlusion occurred in 29 patients (8.4%), of whom 16 patients underwent successful repeat PTCA. All of them survived until hospital discharge. The in-hospital reocclusion rates of these 16 patients were comparable to those of patients who had not experienced acute occlusion (18.8 vs 12.8%, ns). In the remaining 13 patients, reperfusion were not successful after acute occlusion, and 6 died. Side branch occlusion occurred in 21 patients (6.1%). Left circumflex artery occlusion occurring during PTCA for the proximal left anterior descending artery was fatal in 3 patients. Right ventricular branch occlusion during PTCA for the middle of the right coronary artery resulted in intractable right ventricular infarction in one patient, and he died. Among 14 patients who underwent repeat angiography, 13 had a patent side branch which had been occluded during PTCA. One patient had coronary rupture and died. During PTCA of the proximal left anterior descending artery, acute occlusion of the artery without reperfusion or occlusion of the left circumflex artery was often fatal. However, the prognosis of acute occlusion was relatively good, if repeat PTCA was successful and most of the occluded side branches remained patent in the chronic state.

Aged↗
PubMed1991

Intraaortic balloon pumping as the postangioplasty strategy in acute myocardial infarction.

To assess the usefulness of intraaortic balloon pumping (IABP) in acute myocardial infarction (AMI), 114 patients with anterior AMI undergoing emergency percutaneous transluminal coronary angioplasty (PTCA) for total occlusion of the left anterior descending artery were studied. After successful PTCA 66 patients were treated with conventional therapy (group I), and 48 patients were treated with IABP for 25 +/- 8 hours (group II). The reocclusion rate was significantly lower in group II (2.4% vs 17.7% p less than 0.05). An increase in ejection fraction in group II compared with group I was marginally significant (4.5 +/- 12.2% vs 9.2 +/- 13.0%, p = 0.08). Vascular complications occurred in two patients, but there were no deaths from IABP. These results suggest that after successful PTCA for acute myocardial infarction, IABP prevents reocclusion and may add strength to reperfusion in the improvement of left ventricular function.

Angioplasty, Balloon, Coronary↗
PubMed1991

Evaluation of preload reserve during isometric exercise testing in patients with old myocardial infarction: Doppler echocardiographic study.

To estimate the preload reserve in response to an increase in afterload in patients with old myocardial infarction, the relation between the Doppler echocardiographic inflow velocity pattern and left ventricular end-diastolic pressure was investigated during isometric handgrip exercise testing. The study population consisted of 16 normal subjects and 40 patients with old myocardial infarction. The 40 patients were subdivided into two groups according to left ventricular end-diastolic pressure at rest: group I (22 patients), less than 18 mm Hg; group II (18 patients), 18 mm Hg or more. At rest, the ratio of peak velocity in atrial contraction phase to peak velocity in early diastolic filling phase (A/E) was significantly higher in the patients with old myocardial infarction than in normal subjects; values in the two subgroups of myocardial infarction did not differ significantly. The A/E ratio and left ventricular end-diastolic pressure increased significantly during exercise in group I. Conversely, the change in left ventricular end-diastolic pressure during exercise in group II was significantly greater than that in group I, and was associated with a decrease in the A/E ratio. Thus, an atrial compensatory mechanism operated effectively in response to the increase in afterload in patients with a normal left ventricular filling pressure, whereas this compensatory mechanism deteriorated in patients with elevated left ventricular filling pressure due to a limited preload reserve.

Blood Flow Velocity↗
PubMed1991

[Myocardial stunning due to simultaneous multivessel coronary spasms: a review of 5 cases].

Five patients with typical myocardial stunning were presented. They had chest pain and had electrocardiographic abnormalities matching the symptoms of acute myocardial infarction (AMI) but had no coronary artery stenoses on angiogram (CAG). The prevalence of cases with these clinical manifestations was 1.2% among 415 consecutive AMI patients who were examined invasively. The electrocardiographic abnormalities varied; ST elevations were observed in 4 patients, R waves decreased transiently in one, and Q waves developed in one patient. Typical left ventriculogram (LVG) was akinesis in the apical, diaphragmatic and/or anterolateral segments, but hyperkinesis in the basal segments. This akinesis was transient and resolved in 7 days. CAG revealed diffuse multi-vessel spasms in 2 patients, which were also observed in additional 2 patients after ergonovine administration. The intracoronary administration of nitroglycerin disclosed no coronary artery stenoses in any of the patients.

Aged↗
PubMed1991

[Long-term prognosis after reperfusion therapy with emergency coronary angioplasty for acute myocardial infarction].

The influence of emergency coronary angioplasty (PTCA) for acute myocardial infarction on long-term survival was investigated. We followed 141 patients treated with emergency PTCA and 202 patients treated with thrombolytic therapy alone for a median of 1,157 days and a median of 2,133 days, respectively. All were initially completely occluded at the infarct-related coronary artery (IRCA). Actuarial survival curves were compared and independent predictors of late cardiac death were determined using Cox's proportional hazard model between overall patients and patients whose IRCA was at the proximal site of the left anterior descending artery (LAD). 1. Actuarial survival curves were similar in 2 groups. 2. Independent predictors of late cardiac death in overall follow-up patients were advanced age over 65 years (p < 0.03), a history of previous myocardial infarction (p < 0.03), severer stage of the Killip class on admission (p < 0.003), and the infarct-related proximal LAD (p < 0.01). 3. Among patients with the proximal LAD, the actuarial survival curve was better in those treated with emergency PTCA than in those treated with thrombolytic therapy alone (p < 0.01). 4. Among patients with the proximal LAD, independent predictors of late cardiac death were advanced age over 65 years (p < 0.03), treatment with thrombolytic therapy alone (p < 0.03), left ventricular ejection fraction < or = 40% (p < 0.06), and occluded IRCA on predischarge angiograms (p < 0.08). Among patients with the occluded proximal LAD, those treated with emergency PTCA showed better long-term survival rate than did patients with thrombolytic therapy alone, and this may be explained by higher successful reperfusion rates in the former than in the latter.

Aged↗
PubMed1991

[Prediction and prevention of reocclusion after coronary thrombolysis for acute myocardial infarction based on analysis of the coronary morphology with angiography].

Morphology of the affected coronary artery in acute myocardial infarction was qualitatively analyzed to predict the incidence of reocclusion after intracoronary thrombolysis. In 274 patients with 75% or more residual stenosis after successful thrombolysis, the morphology of the stenosis underlying the acute thrombus was graded as 75% or more (type A, n = 195), or less than 75% (type B, n = 79). Eighty-one patients with type A stenosis and 39 of 79 patients with type B stenosis were treated with immediate PTCA following thrombolysis. In 154 patients treated without PTCA, the severity of type A stenosis on chronic angiography remained unchanged after thrombolysis (87 +/- 7%-->86 +/- 14%); whereas, regression of the stenosis was noted in patients with type B stenosis (85 +/- 6%-->53 +/- 32%, p < 0.001). After thrombolysis, reocclusion occurred in 31 of 117 patients with type A stenosis, but in only 2 of 40 patients with type B stenosis (26.5% vs 5.0%, p < 0.02). Reocclusion was prevented by PTCA in patients with type A stenosis (26.5% vs 8.6%, p < 0.01), but not in patients with type B stenosis (5.0% vs 10.3%, p = ns). Qualitative analysis of coronary morphology after thrombolysis can facilitate the prediction of the occurrence of reocclusion and may provide a framework for selection of therapy.

Angioplasty, Balloon, Coronary↗