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Biomedical subjects

K Ueshima

Publications and source records attributed to K Ueshima.

At least 37 records · Page 2Linked to original sources
PubMed2000

Acetabular labrum in hip dysplasia evaluated by radial magnetic resonance imaging.

OBJECTIVE: To numerically express morphologic conditions and signal intensity in the acetabular labrum of the weight-bearing portion of hip joints in patients with hip dysplasia. METHODS: Using a radial magnetic resonance imaging (MRI) technique, where the planes are set radially centered on the midpoint of acetabulum, and which depicts the entire acetabular rim and acetabular labrum, we investigated 60 hip joints of 35 patients with hip dysplasia. RESULTS: The acetabular labrum was larger in dysplastic hips than in normal hips, and the size increased in the posterosuperior portion. All patients had portions with signal intensity changes within the labrum and had impairment on the labrum. When osteoarthrosis due to hip dysplasia was observed, signal intensity changes increased. The changes of intensity varied among the portions observed, and were stronger in the anterosuperior portions than in the superior and posterosuperior portions. CONCLUSION: Radial MRI numerically depicts morphologic conditions of acetabular labrum; the data were usable to evaluate the size difference in acetabular labrum due to hip dysplasia and the degree of impairment.

Acetabulum↗
PubMed1999

Effect of magnesium sulfate pretreatment and significance of matrix metalloproteinase-1 and interleukin-6 levels in coronary reperfusion therapy for patients with acute myocardial infarction.

Magnesium (Mg) inhibits the influx of calcium in vascular smooth muscle cells. The purposes of this study were to test the hypothesis that an intravenous administration of magnesium might effect the complement response and to determine the effects of a magnesium pretreatment of patients with acute myocardial infarction (AMI) on the incidence of reperfusion injuries. Thirty-eight AMI patients were treated with coronary reperfusion therapy within 6 hours of onset. They were randomly divided into two groups: group pretreated with intravenous magnesium sulfate (0.27 mmol/kg) (magnesium group, n = 19), and nonpretreated controls (placebo group). The reperfusion injuries observed within 1 hour after the coronary reperfusion included arrhythmias, aggravated chest pain, and ST segment elevation in 12-lead electrocardiograms. Coronary recanalization was performed in 36 patients. The incidence of reperfusion arrhythmia was significantly lower in the magnesium group than in the placebo group (17% vs 78%, p<0.001). At the postreperfusion stage, there was a tendency for the degree of ST segment reelevation in the magnesium group lower than in the placebo group (2.5 +/- 2.3 mm vs 4.7 +/- 3.8 mm, p = 0.07). No marked difference was observed in the incidence of chest pain aggravation between the two groups (67% vs 73%, ns). The peak serum levels of interleukin-6 (IL-6) were significantly lower in the magnesium group than those in the placebo group (38.9 +/- 25.0 vs 92.3 +/- 76.5 pg/mL, p = 0.016). The peak serum levels of matrix metalloproteinase-1 (MMP-1) were lower than those in the placebo group (16.2 +/- 4.8 vs 19.7 +/- 9.0 ng/mL, p = 0.09), but the difference was not significant. A positive correlation was observed between the peak MMP-1 values and the peak IL-6 values (r = 0.57, p = 0.001) in all patients. Increased serum ionized Mg2+ may inhibit arrhythmic recurrence and the production of IL-6 and MMP-1 after reperfusion and prevent the increase of myocardial lesions caused by calcium overload on myocytes. The increased IL-6 production may induce MMP-1, leading to tissue organ injury. Pretreatment with magnesium sulfate may protect the myocardium of AMI patients from reperfusion injuries.

Adult↗
PubMed1999

What are the predictors of restoration of sinus rhythm after combined treatment with surgical repair for organic heart disease and the Maze procedure for atrial fibrillation?

BACKGROUND: Recently, combined treatment using the Maze procedure for organic heart disease and atrial fibrillation has been reported, but there have been few studies of cardiac rhythm after combined treatment. Predictors of cardiac rhythm after combined surgical treatment have been unknown. METHODS: Thirty patients who underwent cardiac surgery with the Maze procedure were retrospectively enrolled in this study. Two groups consisted of the patients with restoration of sinus rhythm after surgery (SR: n=15, 6 males and 9 females, mean age of 64 years), and the patients with maintenance of atrial fibrillation (AF; n=15, 5 males and 10 females, mean age of 61 years). Before cardiac surgery, all patients underwent exercise testing with measurement of atrial natriuretic peptide (ANP) before and after exercise testing, two-dimensional echocardiography, and right and left heart catheterization. RESULTS: The mean maximal heart rate and the ANP level after exercise testing in SR were significantly higher than those in AF. The left atrial dimension and right atrial and pulmonary capillary wedge pressures were significantly higher in AF than in SR. These findings indicate that subjects in SR exhibited less impaired atrial function which were evaluated by exercise testing with measurement of ANP, echocardiography, and cardiac catheterization. CONCLUSIONS: The atrial function of patients with sinus rhythm after the Maze procedure may be less impaired than that of patients remaining in atrial fibrillation.

Aged↗
PubMed1998

[Assessment of enlarged left atrium with 99mTc-tetrofosmin SPECT and echocardiography].

This study was performed to clarify the possibility of visualization and quantification with 99mTc-tetrofosmin (Tf) myocardial scintigraphy in cases with a large atrium demonstrated by trans-thoracic echocardiography (TTE). Myocardial SPECT was evaluated in 4 patients with mitral stenosis and 15 patients with mitral regurgitation. Left atrium was identified in 12 out of 19 cases from an antero-posterior projection. The Tf uptake ratio of the left atrium, which was defined as the ratio of ROI count of the left atrium divided by the ROI count of the left ventricle, showed a good correlation with the left atrial area obtained by both trans-thoracic and trans-esophageal echocardiography (r = 0.88 and 0.91, respectively), These data suggest that Tf myocardial SPECT is a useful method of evaluating left atrial enlargement.

Aged↗
PubMed1998

[Supervised cardiac rehabilitation for the patients with the disturbance of the motor function after cardiac surgery: the significance of physical therapists' participation].

There are sporadic instances of patients with the motor function disturbance of non-cardiac origin after cardiac surgery, and these patients may need prolonged post-operative cardiac rehabilitation. We established our cardiac rehabilitation program for post-operative patients and a total of 124 patients underwent the post-operative cardiac rehabilitation program (male 73, female 51, average age 60). Among them, 12 patients (9.7%) received the physical therapy for the disturbance of motor function post-operatively. These 12 patients were retrospectively studied. Physical therapies performed were the exercise therapy to improve the range of motion to prevent contracture in 3 patients with peroneal nerve palsy and drop foot, the exercise therapy for pre-operative or post-operative hemiplegia in 6 patients, the instruction of exercise for lumbago in 1 patient with spinal cord disease, respiratory physical therapy in 1 patient, and myotherapy for arthritis in 1 patient. Treatment with physical therapy was very useful in rehabilitating these patients. Active participation of physical therapists in cardiac rehabilitation for patients with the disturbance of motor function after cardiac surgery is possible. It is expected that their participation may improve the quality of life in this subset of patients.

Adult↗
PubMed1997

Effect of the maze procedure for atrial fibrillation on atrial and brain natriuretic peptide.

We studied plasma levels of atrial and brain natriuretic peptides at rest and after exercise before and after intracardiac surgery with and without the maze procedure in patients with chronic heart failure secondary to valvular heart disease. The present study found that an increased response of both cardiac natriuretic peptides is attenuated with resulting water retention after the maze procedure.

Atrial Fibrillation↗
PubMed1997

Improvement in lower limb vasodilatory reserve and exercise capacity in patients with chronic heart failure due to valvular heart disease.

AIMS: Reduced skeletal muscle blood flow during exercise is an important factor contributing to exercise intolerance in patients with chronic heart failure. Reactive hyperaemic blood flow is the maximum flow response necessary to protect tissue against ischaemia and hypoperfusion. We examined the vasodilatory response of the lower limb to ascertain whether response was increased with the improvement in exercise capacity observed after intracardiac surgery in patients with chronic heart failure due to valvular heart disease. METHODS AND RESULTS: Calf blood flow in 23 patients was measured by venous occlusion plethysmography at rest and after a 5 min period of femoral occlusion. Immediately after this evaluation, peak oxygen uptake and anaerobic threshold were assessed by a symptom-limited cardiopulmonary exercise test using a bicycle ergometer. Both baseline calf blood flow and peak calf blood flow during reactive hyperaemia were significantly increased after surgery (baseline calf blood flow; from 2.6 +/- 0.2 to 3.8 +/- 0.4 ml.min-1 per 100 ml calf volume, P < 0.05: peak calf blood flow; from 17.5 +/- 1.3 to 25.4 +/- 2.6 ml.min-1 per 100 ml calf volume, P < 0.01). There was a significant correlation between changes in peak calf blood flow and improvement in exercise capacity (peak oxygen uptake; r = 0.42, P < 0.05; anaerobic threshold; r = 0.68, P < 0.0010). CONCLUSION: These results indicate that exercise tolerance is improved with increased lower limb vasodilatory capacity after recovery from chronic heart failure.

Aged↗
PubMed1997

[Semi-supervised exercise using a step machine at home after myocardial infarction].

Home exercise programs for patients with myocardial infarction effectively improve their ability to exercise as well as quality of life. However, there are no efficient methods for monitoring the patient's clinical status or conveying the physician's instructions to the home setting. To resolve these problems, we developed a computer-based, automated, telemetry system comprised of central and peripheral computers and telephone line. Five myocardial infarction patients were evaluated for peak oxygen uptake (peak VO2) and anaerobic threshold (AT) before hospital discharge. At home, the patients performed 10-min exercise using a step machine. Patient data including blood pressure, pulse rate, and electrocardiogram before and after exercise were stored in the peripheral computer, and the central computer automatically retrieved the data through the phone line. If the current heart rate was less than the heart rate at AT, extreme changes in blood pressure were noted or dangerous arrhythmias appeared, appropriate instructions were indicated on the display of the peripheral computer. Following these instructions, the patients continued home exercise programs for 6 months. Peak VO2 and AT increased significantly in all patients (peak VO2: baseline 24 +/- 3.3 ml/kg/min, 6 months later 33.3 +/- 3.7 ml/kg/min, p < 0.01, AT: baseline 15.2 +/- 2.7 ml/kg/min, 6 months later 18.5 +/- 2.8 ml/kg/min, p < 0.01). The computer-based automated telemetry system combined with a step machine facilitated effective prescription and monitoring of exercise programs at home.

Adult↗
PubMed1996

[Onset of dyspnea on exertion in elderly and young patients with congestive heart failure].

We previously reported that dyspnea on exertion in patients with congestive heart failure was not associated with pulmonary function ar rest, but was associated with the appearance of the anaerobic threshold and with the respiratory compensation point during exercise. Here we described a study of the influence of aging on the onset of dyspnea on exertion in elderly and in young patients with congestive heart failure. A total of 53 patients were studied: 35 were less than 65-year-old (average age, 47-year-old; 19 men and 16 women) and 18 were more than 65-year-old (average age, 70-year-old; 13 men and 5 women). All patients underwent maximal graded exercise testing on a bicycle ergometer. The workload increased according to a ramp protocol, and perceived exertion was evaluated with the Borg scale. The anaerobic threshold, the respiratory compensation point, and the peak VO2 were recorded. Values of 13 (somewhat hard) and 17 (very hard) on the Borg scale were considered to mark the start of dyspnea on exertion and an increase in dyspnea on exertion respectively. In the young patients, dyspnea on exertion began at about the time that the anaerobic threshold was reached, and it increased at about the time that the respiratory compensation point was reached. In contrast, elderly patients dyspnea on exertion began 70 seconds after the anaerobic threshold was reached, and it increased 30 seconds after the respiratory compensation point was reached. The VO2 at the start of dyspnea on exertion and the VO2 at the anaerobic threshold correlated more closely in the young patients than in the old patients. The same was true of the VO2 at the time that dyspnea on exertion increased and the VO2 at the respiratory compensation point. These findings suggest that elderly patients with congestive heart failure are less sensitive to the stimuli that cause dyspnea than are young patients.

Adolescent↗
PubMed1995

Impaired cholinergic peripheral vasodilation and its relationship to hyperemic calf blood flow response and exercise intolerance in patients with chronic heart failure.

This study examined the peripheral endothelium-dependent vasodilatory response to acetylcholine and the endothelium-independent vasodilatory response to nitroprusside in 19 patients with chronic heart failure and eight controls. These peripheral blood flow responses were compared with hyperemic calf blood flow changes after maximum leg exercise and 5-min femoral occlusion. The peripheral blood flow response to forearm intra-arterial infusion of acetylcholine and sodium nitroprusside, and reactive hyperemic calf blood flow changes were measured by plethysmography. All peripheral blood flow responses were significantly reduced in patients with chronic heart failure (P < 0.05). Reduction of acetylcholine-mediated changes in peripheral blood flow was correlated with exercise-induced calf blood flow response (r = 0.51, P < 0.05), but not with occlusion-induced calf blood flow response (r = 0.02, NS). Sodium nitroprusside-mediated changes were not correlated with any reactive hyperemic blood flow responses (exercise: r = 0.27, NS; occlusion: r = 0.11, NS). When the patients were divided into two subgroups based on the median exercise-induced calf blood flow change, the subgroup with the lower calf blood flow response showed a reduction in exercise capacity (anaerobic threshold: 11.8 +/- 0.6 vs. 14.6 +/- 1.0 ml/kg/min; P < 0.05). These findings suggest that endothelial dysfunction is related to a decrease in exercise-induced skeletal muscle blood flow and exercise capacity in patients with chronic heart failure.

Acetylcholine↗
PubMed1995

Myxoma of the mitral valve detected by echocardiography and magnetic resonance imaging.

Myxomas of the mitral valve diagnosed during life are exceedingly rare. We employed transthoracic and transoesophageal echocardiography and magnetic resonance imaging enhanced by gadolinium-diethylene-triamine-pentaacetic acid in a patient with palpitations. After these examinations clearly demonstrated a myxoma on the atrial side of the posterior mitral valve leaflet, urgent surgery was performed. When a small tumour of the mitral valve exists, these examinations are useful not only for detecting and characterizing the tumour, but also for deciding the optimal surgical management.

Adult↗
PubMed1995

Exercise capacity and prognosis in patients with chronic atrial fibrillation.

To evaluate the response of patients with chronic atrial fibrillation (AF) to exercise and to demonstrate if prognosis could be predicted, 200 male patients (64 +/- 1 years) with AF were identified retrospectively who underwent resting echocardiography and symptom-limited treadmill testing. They were classified by underlying disease into three subgroups: hypertension or no underlying disease (LONE; n = 102), ischemic heart disease (IHD; n = 45) and history of congestive heart failure or valvular disease (CHF-VD; n = 53). Maximal exercise capacities for LONE, IHD and CHF-VD were (mean +/- 1 SEM) 8.0 +/- 0.3, 6.4 +/- 0.4 and 6.0 +/- 0.3 metabolic equivalents, respectively (p < 0.01), and resting left ventricular ejection fractions were 61.7 +/- 1.6, 60.1 +/- 2.2 and 49.5 +/- 1.9%, respectively (p < 0.01). Stepwise multiple regression analysis demonstrated that, except for group classification (R2 = 0.13, p < 0.01), no clinical, exercise or morphologic variables could predict exercise capacity. After a mean 39.1-month follow-up (range 1-78), 17 of the 200 had died from cardiovascular causes. The rate of cardiac death using Kaplan-Meier survival analysis was significantly greater in CHF-VD patients (p < 0.01). However, Cox hazard function and Kaplan-Meier survival analysis demonstrated that neither echocardiographic measurements of cardiac size or function at rest, nor exercise or clinical variables were significant predictors of outcome. AF patients with a history of CHF and/or VD demonstrated a reduced exercise tolerance ad a worse prognosis than those without morphologic heart disease or those with IHD.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

Acid secretory and duodenal ulcerogenic responses induced by mepirizole in anesthetized rats. Relation to body temperature.

The role of body temperature in the acid stimulatory mechanism by mepirizole, a duodenal ulcerogen, was investigated in urethane-anesthetized rats. Subcutaneous administration of mepirizole (60 and 200 mg/kg) increased acid secretion in a dose-dependent manner and resulted in duodenal lesions within 8 hr. The acid secretory and ulcerogenic responses induced by mepirizole were inhibited completely by vagotomy and significantly reduced by subcutaneous pretreatment with atropine (1 mg/kg), hexamethonium (10 mg/kg), or clonidine (1 mg/kg). During anesthesia, body temperature was decreased to 34 degrees C in control rats but further reduced to 31 degrees C after administration of mepirizole. When body temperature was maintained at 36 degrees C during a test period, mepirizole caused significantly less effect on acid secretion and produced less damage in the duodenum. In addition, intracisternal administration of antiserum of thyrotropin-releasing hormone (TRH: 5 mu1/rat) also significantly inhibited acid hypersecretion and development of duodenal lesions in response to mepirizole. When acid output induced by mepirizole was plotted against duodenal lesion score from one group to another, a significant linear relationship was found between these two values (r = 0.814, P < 0.05). We conclude that mepirizole induced vagally mediated acid secretion and duodenal lesions in anesthetized rats. These responses may occur centrally in association with lowering of body temperature, which potentiates the acid stimulatory effect of mepirizole, probably through a TRH-dependent mechanism.

Animals↗
PubMed1994

Induction of gastric lesions and hypoglycemic response by food deprivation in streptozotocin-diabetic rats.

Overnight fasting causes hemorrhagic lesions in the stomach of streptozotocin (STZ)-induced diabetic rats, but the pathogenetic mechanism remains unknown. The present study was performed to investigate the pathogenesis of such lesions developed in STZ-diabetic rats after starvation, mainly in relation to blood glucose changes. A single injection of STZ (70 mg/kg, intraperitoneally) induced hyperglycemic conditions one week after the administration, and high blood glucose levels (BGL: > 350 mg%) remained up to three weeks later. The STZ-diabetic rats developed gastric lesions with the marked reduction of BGL after 18 hr of fasting, depending upon the duration of diabetes; the lesion score and delta BGL reduction in the 3-week-old STZ rats were 32.0 +/- 7.8 mm and > 250 mg/100 ml, respectively. Acid secretion in the pylorus-ligated rats was not significantly changed in the STZ-induced diabetic conditions for the initial two weeks but slightly decreased at three weeks when compared with normal rats. Fasting of normal rats for 18 hr did not cause either BGL reduction or any lesion in the stomach. In the 3-week-old STZ animals, the severity of gastric lesions increased with the duration of fasting (4-18 hr) and was again closely associated with the degree of delta BGL reduction. These lesions induced by 18 hr of starvation in 3-week-old STZ rats were significantly inhibited by pretreatment with insulin (4 units/rat/day) for the last one week to maintain BGL within normal ranges or by intravenous infusion of 25% glucose during fasting period. Both of these treatments significantly prevented BGL reduction in response to fasting.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1994

Influence of right coronary artery stenosis on exercise test responses and survival in patients with left main or left main equivalent disease.

Forty-two patients with angiographically documented left main coronary artery (LM) disease (luminal occlusion > or = 50%) and 30 patients with left main equivalent (LMEQ) disease (> or = 70% luminal occlusion of both the proximal left anterior descending artery and proximal left circumflex artery) were studied to determine the role of right coronary artery (RCA) involvement on exercise test responses and survival. Significant (> or = 70%) RCA stenosis was present in 30 (72%) of the 42 LM patients and 16 (53%) of the 30 LMEQ patients. No significant differences were observed between LM and LMEQ patients in any clinical or exercise variables or survival. Thus both groups were combined for analysis of the influence of RCA involvement (i.e., LM/LMEQ with RCA versus LM/LMEQ without RCA disease). Greater ischemic responses were observed in the LM/LMEQ group with significant stenosis of the RCA. The presence of RCA stenosis was associated with significantly greater horizontal or downsloping ST-segment depression during exercise (2.4 +/- 1.2 mm vs 1.3 +/- 1.4 mm; p < 0.001), and prolonged recovery time until normalization of the ST segment (3.2 +/- 1.4 min vs 2.0 +/- 1.9 min; p < 0.01). The LM/LMEQ without RCA disease group behaved like the subgroup with two-vessel disease, and responses of the LM/LMEQ group with RCA disease were similar to the group with three-vessel disease. The annual survival in LM/LMEQ with RCA disease was worse than that in LM/LMEQ without RCA disease (average annual mortality rates = 7.5% vs 1.0%, respectively; p = 0.05). Infarct-free survival in LM/LMEQ with RCA disease was also lower than that in LM/LMEQ without RCA disease. Thus although patients with LM and LMEQ were similar in terms of survival and exercise responses, the presence of RCA stenosis was associated with significantly greater ST-segment depression, a prolonged recovery time until normalization of the ST segment, a fivefold increase in the death rate, and higher morbidity from myocardial infarction over a 5-year period of follow-up. Involvement of the RCA should be considered when making decisions concerning medical-surgical management of patients with severe coronary artery disease.

Aged↗
PubMed1994

The role of capsaicin-sensitive sensory neurons in healing of HCl-induced gastric mucosal lesions in rats.

BACKGROUND/AIMS: Capsaicin-sensitive sensory neurons are important in protecting the stomach against damage. This study investigated the role of these sensory neurons in the healing of gastric lesions. METHODS: Rats fasted for 18 hours were given 1 mL of 0.6N HCl orally for induction of gastric lesions; they were then fed normally from 1 hour later. On various days after HCl treatment, the area of lesion, acid secretion, mucosal DNA synthesis, mucosal H+ permeability, and blood flow responses were measured. RESULTS: Ablation of sensory neurons by capsaicin pretreatment did not affect the development of gastric lesions in response to HCl but significantly delayed the healing of these lesions. The damaged mucosa secreted less acid and had minimal changes in DNA synthesis but showed a marked increase in H+ permeability, resulting in luminal acid loss accompanied by an increase of mucosal blood flow. Sensory deafferentation did not have any influence on such changes in the damaged stomach, except the mucosal hyperemic response to acid. CONCLUSIONS: Capsaicin-sensitive sensory neurons may contribute to the healing of gastric lesions by mediating the mucosal hyperemic responses associated with acid back-diffusion and by facilitating acid disposal in the mucosa.

Animals↗