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Biomedical subjects

M Nobuyoshi

Publications and source records attributed to M Nobuyoshi.

At least 109 records · Page 6Linked to original sources
PubMed1988

Restenosis after successful percutaneous transluminal coronary angioplasty: serial angiographic follow-up of 229 patients.

To further understand the temporal mode and mechanisms of coronary restenosis, 229 patients were studied by prospective angiographic follow-up on day 1 and at 1, 3 and 6 months and 1 year after successful percutaneous transluminal coronary angioplasty. Quantitative measurement of coronary stenosis was achieved by cinevideodensitometric analysis. Actuarial restenosis rate was 12.7% at 1 month, 43.0% at 3 months, 49.4% at 6 months and 52.5% at 1 year. In 219 patients followed up for greater than or equal to 3 months, mean stenosis diameter was 1.91 +/- 0.53 mm immediately after coronary angioplasty, 1.72 +/- 0.52 mm on day 1, 1.86 +/- 0.58 mm at 1 month and 1.43 +/- 0.67 mm at 3 months. In 149 patients followed up for greater than or equal to 6 months, mean stenosis diameter was 1.66 +/- 0.58 mm at 3 months and 1.66 +/- 0.62 mm at 6 months. In 73 patients followed up for 1 year, mean stenosis diameter was 1.65 +/- 0.56 mm at 6 months and 1.66 +/- 0.57 mm at 1 year. Thus, stenosis diameter decreased markedly between 1 month and 3 months after coronary angioplasty and reached a plateau thereafter. In conclusion, restenosis is most prevalent between 1 and 3 months and rarely occurs beyond 3 months after coronary angioplasty.

Aged↗
PubMed1988

Randomized, double-blinded multicenter study. Comparison of intracoronary single-chain urokinase-type plasminogen activator, pro-urokinase (GE-0943), and intracoronary urokinase in patients with acute myocardial infarction.

Coronary recanalization rates and changes in the coagulation and fibrinolysis system were evaluated in a randomized fashion in patients with acute myocardial infarction after intracoronary administration of single-chain urokinase-type plasminogen activator (pro-urokinase: GE-0943) or urokinase. Three groups of patients were studied: group H (n = 50), 6,000 units pro-urokinase i.c.; group L (n = 44), 3,000 units pro-urokinase i.c.; and group U (n = 54), 960,000 IU urokinase i.c. Coronary recanalization rates determined angiographically after 45 minutes of intracoronary infusion averaged 90% in group H, 59% in group L, and 61% in group U. The differences were statistically significant between group H and the latter two groups. Pro-urokinase affected plasma proteins of the fibrinolytic system to a lesser degree than urokinase. Bleeding complications were present in one patient in group L, in none in group H, and in five in group U. Thus, intracoronary administration of 6,000 units pro-urokinase is more effective in coronary thrombolysis and causes less systemic fibrinogenolysis than intracoronary administration of urokinase.

Adult↗
PubMed1987

Arterial changes after percutaneous transluminal coronary angioplasty: results at autopsy.

Light and electron microscopic examinations were performed on 20 coronary artery sites from nine patients who had undergone percutaneous transluminal coronary angioplasty. Twelve successfully dilated sites without prior thrombosis showed evidence of a tear in the luminal surface (with or without fracture of an atheroma) even at 140 days after angioplasty. The tear split through a relatively undistensible intima in 9 (75%) of the 12 sites. Two successfully dilated sites with prior thrombosis showed an intraintimal tear with a widely lacerated fibrous cap and thin mural thrombus. After dilation, the occluded prior nonthrombosed site showed marked protrusion of a separated plaque. An occluded prior thrombosed site after dilation revealed intraintimal canal-like hematoma. Four sites that occluded after balloon passage revealed a dissecting hematoma in three and plaque disruption in the other.

Aged↗
PubMed1987

Quantitative relationship between left ventricular function and serum cardiac myosin light chain I levels after coronary reperfusion in patients with acute myocardial infarction.

To estimate the extent of myocardial infarction after coronary artery reperfusion, serum levels of cardiac myosin light chain (LC) I and creatine kinase (CK) were determined serially in 49 patients with acute myocardial infarction. Intracoronary thrombolysis was successful in 25 patients (reperfusion group), and 24 patients were treated in a conventional manner (control group). The peak level of CK appeared significantly earlier in the reperfusion group (11.3 +/- 3.1 hr, mean +/- SD) than in the control group (21.6 +/- 7.2 hr). Cumulative release of CK was significantly related to angiographically determined left ventricular ejection fraction 1 month after the attack in both groups (r = -.50; -.45, respectively). However, the amount of cumulative release of CK in the reperfusion group was greater compared with that in those with the same left ventricular ejection fraction in the control group. Peak appearance time of LCI was almost equal in the two groups (3.8 +/- 1.4 vs 3.9 +/- 1.2 days). Peak levels of LCI were related to the left ventricular ejection fraction in the reperfusion group (r = -.63) and in the control group (r = -.74), and the slopes of their regression lines were similar. The cardiac index obtained on the day of onset in the two groups was related to peak levels of LCI but not to total release of CK. These results suggest that serum levels of LCI reflect the changes in left ventricular function after acute myocardial infarction, regardless of the presence of coronary reperfusion. Thus, serial determinations of LCI in serum facilitate noninvasive assessment of the effects of intracoronary thrombolysis on infarct size.

Adult↗
PubMed1987

Randomized double-blind trial of intracoronary urokinase for acute myocardial infarction: multicenter study.

The efficacy of intracoronary urokinase (UK) in an acute myocardial infarction has not been firmly established in a randomized fashion. Two hundred and ten patients were randomized to UK therapy (107 patients) and placebo (103 patients). Successful recanalization was achieved in 74% of the UK group vs 17% in the placebo group (p less than 0.01). The success rate was dose dependent up to 960,000 I.U. Clinical course was favorable and left ventricular enddiastolic pressure was reduced significantly in the UK group compared with the placebo group (p less than 0.05). Ejection fraction one month after the study was better in the reopened group than in the occluded group. Thus, early administration of UK can establish coronary reflow in a high proportion of patients and appears to favor the clinical course.

Aged↗
PubMed1987

[Precordial ST-segment elevation caused by right coronary artery occlusion].

Among 57 consecutive patients undergoing percutaneous transluminal coronary angioplasty (PTCA) of the right coronary artery, eight patients showed precordial ST-segment elevation in leads V1-3 during the procedure. The mechanism of this ST elevation was investigated reviewing the coronary angiographic findings. All patients had angina pectoris, but none had evidence of myocardial infarction. The balloon inflation time was limited to 60 sec, and 12 lead electrocardiograms were recorded every 15 sec. In the eight patients who had precordial ST-segment elevation, six had the anatomically dominant right coronary artery, and two had proportioned (balanced) left and right coronary arteries. Six patients, however, had functionally dominant left coronary arteries because of good collaterals supplying the right coronary artery from the left coronary artery. Thus, functionally, six had the dominant left coronary artery, one had proportioned coronary supply, and only one had the dominant right coronary artery. In all eight patients, the most proximal portion of the right coronary artery was occluded during PTCA, obstructing both the conus branches and the right ventricular branches. This often induced precordial ST-segment elevation in cases with the functionally dominant left or proportioned coronary artery. This ST-segment elevation seemed to represent right ventricular ischemia, as the inferior wall was protected from ischemia by good collaterals. However, precordial ST-segment elevation was rare in the functionally dominant right coronary artery even when the most proximal portion of the right coronary artery was occluded. This fact seemed due to masking of electrocardiographic manifestations of right ventricular ischemia by the dominant electrical forces of inferior wall ischemia.

Adult↗
PubMed1987

[Coronary arterial spasm and symptomatology in ischemic and non-ischemic heart diseases: study of the ergonovine maleate provocative test in 3,000 consecutive patients].

We performed coronary angiography and ergonovine maleate provocative tests (EM test) for 3,000 consecutive patients to clarify 1) the incidence of coronary arterial spasm and significant fixed organic stenosis in ischemic and non-ischemic heart diseases, and 2) the relation of these angina-inducing mechanism(s) to rest (R), effort and rest (E & R), and effort (E) angina. Coronary arterial spasm was defined as total or subtotal occlusion induced by ergonovine test, and fixed stenosis was defined as stenosis with more than 70% narrowing of luminal diameter measured after administration of isosorbide dinitrate. Subjects consisted of 3,000 consecutive patients and were categorized in four groups including 1,145 patients who had typical angina pectoris (Group I: rest angina 653, effort angina 230, and combined rest and effort angina 262), 398 patients with myocardial infarction (Group II), 648 patients with atypical chest pain (Group III), and 809 patients who eventually had diagnostic catheterization for heart diseases other than of ischemic nature (Group IV). Results were as follows: 1. The incidence of coronary artery spasm was 22.2% in Group I, 22.9% in Group II, 1.2% in Group III, and 3.7% in Group IV. 2. In Group I, there was a close relationship between the mechanism of angina and the type of occurrence of typical chest pain; coronary artery spasm was more likely observed in rest angina, organic stenosis was observed in effort angina, and the combined type was observed in cases with both spasm and organic stenosis. Furthermore, the occurrence of coronary artery spasm was significantly more frequent in cases with single vessel disease compared with those with multivessel disease (50.7% vs. 26.7%, p less than 0.005). 3. In Group II, the most frequent angiographic evidence was fixed organic stenosis, and there was no relationship between spasm and the numbers of diseased vessels. 4. In Groups III and IV, the most common entity causing coronary artery spasm was hypertrophic cardiomyopathy. In conclusion, two major mechanisms of angina pectoris, i.e., coronary artery spasm and organic stenosis, are closely related to the symptomatology of this disease, such as rest, effort and combined rest and effort types.

Adult↗
PubMed1986

[Percutaneous transluminal coronary angioplasty: technical and anatomical considerations].

Four hundred and sixty-four coronary obstructive lesions of 321 patients were dilated by elective percutaneous transluminal coronary angioplasty (PTCA) from October 1981 to September 1984. The overall success rate was 72% (334 of 464 vessels). With respect to the sites of procedure, the success rate was 74% (192 of 260 lesions) in the left anterior descending artery (LAD), 74% (71 of 96 lesions) in the left circumflex artery (LCx), 66% (67 of 102 lesions) in the right coronary artery (RCA), 75% (three of four grafts) in bypass graft, and 50% (one of two lesions) in the left main trunk. The success rate related to the total number of diseased vessels was 79% (157 of 200 lesions) in one-vessel disease, 62% (110 of 177 lesions) in two-vessel disease, and 77% (63 of 82 lesions) in three-vessel disease. Considering the learning curve, the success rate was 52% to 56% for the initial 150 lesions, and 80% thereafter. Complications of elective PTCA were three deaths (0.9%), nine emergency A-C bypasses (2.8%), seven myocardial infarctions (2.2%), and three hemopericardia (0.9%). The success rate of PTCA was evaluated in regards to the morphology of the target lesion. There was no difference between narrowing more than 99% and narrowing less than 99%, though the success rate of diffuse stenosis was lower than that of the tubular or short lesion. The existence of previous myocardial infarction and ulcerating plaques did not relate to the success rate. Calcification or tortuosity significantly decreased the success rate. Length of anginal history did not relate to the success rate.(ABSTRACT TRUNCATED AT 250 WORDS)

Angioplasty, Balloon↗
PubMed1985

Coronary thrombolysis with urokinase infusion in acute myocardial infarction: multicenter study in Japan.

The efficacy of intracoronary administration of urokinase was evaluated in 514 patients with acute myocardial infarction (anterior, 296 patients; inferior, 195; lateral or posterior, 18; and anterior and inferior, five). The time between onset of chest pain and coronary arteriography was 0.5 to 81.0 hr with an average of 5.0 hr. Initial administration of nitrates resulted in recanalization of the coronaries in 9.3%. Subsequently, urokinase was infused into the coronary arteries, and coronary thrombolysis was successfully achieved in 66.8%. The success rate was low in a group with average infusion speed of more than 30,000 units/min or with a total dose of urokinase of 480,000 units or less. Complications, mainly arrhythmias, were present in 111 patients (33.2%) of the 334 who had successful thrombolysis and in 18 patients (10.8%) of the 166 with unsuccessful thrombolysis, but serious hemorrhage was rare and no fatal case was reported. Patients who had successful thrombolysis had less in-hospital mortality than those who did not (6.3 vs 13.3%). Thus, coronary thrombolysis can be achieved effectively and relatively safely with a sufficient amount of intracoronary urokinase administration in acute myocardial infarction.

Adult↗
PubMed1985

Significance of adventitial inflammation of the coronary artery in patients with unstable angina: results at autopsy.

A quantitative analysis of adventitial inflammation of the coronary artery with intimal lesions is described in 12 patients who suffered coronary death and had had unstable angina (crescendo angina) at rest (group 1). After autopsy in these patients we examined epon-embedded cross sections by light and electron microscopy, paying particular attention to the adventitia, and compared these results with those in six patients who had had angina but died of noncardiac causes (group 2) and those in 22 patients who did not have angina (group 3). Of the 132 segments from group 1 patients, 39 (30%) were narrowed 76% to 100% by atherosclerotic plaque (group 2, 27%; group 3, 1%), and 23 (17%) had occlusive thrombi. Of the 264 sections (two from each segment) from group 1 that were examined, 98 (37%) (group 2, 15%; group 3, 9%) revealed clustered infiltration of inflammatory cells in the adventitia, half of which were associated with vascular nerve involvement. These findings in the adventitia may be related to the vasospastic component of unstable angina.

Angina Pectoris↗
PubMed1984

Effect of transluminal coronary recanalization on left ventricular regional wall motion and clinical course in acute myocardial infarction.

We performed percutaneous transluminal coronary recanalization (PTCR) in 90 patients within 12 hours of onset of acute myocardial infarction (AMI). Fifty seven patients had total occlusion and 33 patients had subtotal occlusion of the involved coronary artery. Reopening of the occluded coronary artery by injection of isosorbide dinitrate (ISDN) was achieved in 24.4%. Continuous infusion of Urokinase was effective in 82.7%. Comparison of conventional therapy with PTCR showed that ejection fraction was higher in patients with PTCR than in those with conventional therapy, and that wall motion shortening was better in the former than in the latter. Relationship of regional wall motion shortening to the time interval from the onset of AMI showed that wall motion shortening was better it recanalized within 3 hours to and was fine within 6 hours, but poor after 6 hours of onset of AMI.

Adult↗
PubMed1984

Multicenter studies of 2% nitroglycerin ointment in patients with heart failure.

Nitroglycerin ointment (NTGO) was applied to the precordial area in 88 patients with heart failure arising from acute myocardial infarction (AMI) or other types of heart disease, and its effects on hemodynamic parameters were determined. After NTGO was applied, patients' systolic blood pressure (P less than 0.001), double product (heart rate X systolic pressure, P less than 0.001), pulmonary capillary wedge pressure (P less than 0.001), and systemic vascular resistance (P less than 0.001) decreased significantly. These changes began 30 to 60 minutes after NTGO was applied and lasted two to six hours. Based on these hemodynamic changes, we conclude that NTGO is beneficial for patients with heart failure due to AMI or other heart disease.

Administration, Topical↗
PubMed1983

Unstable angina and coronary arteriographic findings with special reference to coronary vasospasm.

The organic stenosis of the coronary artery and vasospasm induced by ergonovine maleate (EM) were examined by cine angiography in 106 cases with unstable angina. They were divided into 5 groups: new angina at rest (27 cases), new angina of effort (15 cases), changing pattern from effort to rest (41 cases), crescendo-type angina at rest (20 cases) and changing pattern from rest to effort (3 cases). The following results were obtained: The incidence of a 75% or more organic stenosis was significantly lower in new angina at rest (52%) and crescendo-type angina at rest (55%) than in changing pattern from rest to effort (95%) (p less than 0.005). The incidence of a 90% or more organic stenosis was significantly lower in new angina of effort than in changing pattern from effort to rest (46% vs 88%, p less than 0.01). On the other hand, the incidence of a 50% or more spastic narrowing provoked by EM was 94% in new angina at rest, 90% in crescendo-type angina at rest, 56% in new angina of effort and 64% in changing pattern from effort to rest. In all 3 cases of changing pattern from rest to effort, total obstructions due to coronary spasm were found. However, there were no significant differences among these groups.

Adult↗