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Biomedical subjects

M Uwatoko

Publications and source records attributed to M Uwatoko.

7 recordsLinked to original sources

[Evaluation of coronary blood flow using digital subtraction technique and cine coronary angiography: a preliminary report].

To evaluate coronary circulation in ischemic heart disease, digital image processing with cine coronary angiography was performed. Using time-density curves obtained from individual pixels, images showing the distribution of contrast density and transit time were obtained. To record angiograms, contrast medium was injected into the coronary artery in a steady manner during right atrial pacing. Frames in the end-diastolic phase immediately before the P wave were selected, and digitized into a 512 x 512 x 8 bit matrix using a system composed of a video camera, an analog-to-digital converter, and a computer. These digitized images were then stored in a disk memory. A mask image was prepared before the injection of contrast medium. Subtraction was performed using the mask image and a series of images following contrast injection. The subtracted images were of sufficient quality to permit clear observation of the individual coronary arterial branches. Time-density curves were then determined from these subtracted images. From these curves, time from the onset of contrast injection to its peak density (Tp), time from the peak density to the half peak density (T 1/2) and the attenuation factor of the curves (tau) were derived. Their distributions were expressed as color images. Examples of a normal control and a case of inferior infarction were demonstrated. Blood flow function images with good spatial resolution were thus obtained. This method is useful for evaluating coronary blood flow.

Angioplasty, Balloon↗

T loop in posterior myocardial infarction: a useful clue to vectorcardiographic diagnosis.

In order to differentiate posterior (posterolateral) myocardial infarction (PMI) from the anterior shift of the QRS loop in "normal variant" cases using a vectorcardiogram, the T loop as well as the QRS loop in the transverse plane (TP) were analyzed in 34 elderly Japanese males with angiographically-proven PMI and in 197 elderly Japanese males with normal coronary arteries and ventricles. T loops in the TP were longer, narrower and more anterior in PMI cases. After this analysis, we propose new criteria for PMI: (A and B) A: maximal T vector equal or anterior to 60 degrees in TP B: at least two of the following three: maximal QRS voltage/maximal T voltage in TP equal to or less than 3.0; QRS-T angle equal to or less than 75 degrees in TP; width/length of T equal to or less than 0.15 in TP. These new criteria for PMI are more specific (p less than 0.01) and more sensitive (p less than 0.05) than Hoffman's criteria.

Adult↗

Analysis of the evolution of coronary artery disease--evaluation of 227 cases by restudy of coronary arteriography.

Some 227 patients who showed a 50% or greater narrowing of at least one major coronary artery in the first study underwent recatheterization at a mean interval of 35.6 months. Coronary arterial lesions and the degree of narrowing [i.e., normal (absent), 25%, 50%, 75%, 90%, 99% and complete occlusion (100%)] were classified in accordance with the AHA reporting system. When the lesions in the second study showed a change of equal or more than 2 in the above 7 stages in comparison with the first study, either progression or regression was determined. Of the 227 patients, progression occurred in 73 (32%) and regression was found in 7 (3%). In the aggravated group in symptom, progression was noted in 58%, and even in the stabilized group, progression was observed in 22%. As a result of the second study, 15 (21%) out of 73 patients showing progression underwent surgical treatment, and more than half of these cases (9/15) were constituted by the stabilized group. During the above follow-up periods, myocardial infarction occurred subsequently in 14 (19%) out of 73 patients showing progression. Up to the present time, sudden deaths occurred in 8 patients, and 5 out of 8 patients were also of the stabilized group. The authors wish to emphasize from these findings the necessity of aggressively pursuing restudy even in stabilized cases showing symptoms of ischemic heart disease.

Adult↗

[The effects of intravenous urokinase administration in patients with acute myocardial infarction].

The effects of intravenous urokinase administration were assessed in patients with acute myocardial infarction (AMI). Of 146 patients with AMI, 101 were admitted within 12 hours of onset of chest pain, and classified in four groups according to the method of administering urokinase. PTCR group (15 cases); PTCR was performed within six hours of onset, using less than 960,000 I.U.; Group A (20 cases); 1.5 million I.U. administered in one hour or 960,000 I.U. in 30 min; Group B (48 cases); 240,000 I.U. in two hours; and 4) Group C (18 cases); 240,000 I.U. in 12 hours. In groups A, B and C, urokinase was administered intravenously. The remaining 45 patients did not receive urokinase, and served as a control group. In the chronic stage, infarction-related coronary arteries were patent at rates of 93% in the PTCR group, 82% in group A, 76% in group B, 62% in group C, and 46% in the control group. In the PTCR group and in group A, alpha 2-plasmin inhibitor showed a steep decline to the lowest level on the day after urokinase administration, as did the summation of elevation of ST segments in conventional twelve-lead electrocardiograms. Peak CK times, which represent the duration (hours) from onset to the peak serum CK value increased in the following order: 13.3 +/- 4.8 in the PTCR group, 17.3 +/- 4.9 in group A, 17.3 +/- 6.9 in group B, 20.7 +/- 6.7 in group C and 22.5 +/- 6.4 in the control group. These data suggest early recanalization of occluded coronary arteries in the group A, and intravenous administration of high doses of urokinase in the early phase of AMI seemed to contribute to salvage the ischemic myocardium. However, assessment of ventricular wall motion by two-dimensional echocardiography failed to confirm appreciable improvement in the PTCR group and group A in comparison with the other groups.

Adult↗

A case of normal coronary infarction after intracoronary thrombolysis with urokinase.

We report the case of a 50-year-old male who had classical ECG signs of inferior wall myocardial infarction. Intracoronary thrombolysis resulted in fragmentation of a thrombus in the lumen of the right coronary artery. Angiography 1 month later showed no abnormalities at the site of previous thrombus. Ergonovine stress did not produce spasm. We conclude that (1) a mild cardial infarction can occur with an occlusive thrombus arising in angiographically normal coronary arteries; (2) transient change in minimal atheromata or spasm may induce such thrombi; and (3) thrombolytic therapy may be able to expedite recanalization of the occluded artery and salvage the myocardium.

Coronary Angiography↗

Vectorcardiogram in multiple myocardial infarctions--Correlations between vectorcardiographic and angiographic findings.

To determine the value and limitations of vectorcardiograms (VCGS) for diagnosing multiple myocardial infarctions, correlations between VCG and angiographic findings were analyzed in 307 cases with severe asynergies due to coronary narrowings on left ventriculograms. While the presence of anterioseptal hypokinesis, corresponding to a nontransmural infarction of the anteroseptal wall, lowered the sensitivity of vectorcardiographic diagnosis for inferior and posterior myocardial infarctions, that of inferoposterior hypokinesis did not lower its sensitivity for anterior myocardial infarction. Severe asynergy, corresponding to a transmural infarction, reduced the VCG sensitivity for diagnosing myocardial infarction occurring in the opposite side of the left ventricle.

Coronary Angiography↗