[Systemic arteriovenous thrombosis].
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Behcet Syndrome↗
Biomedical subjects
S Hifumi
Publications and source records attributed to S Hifumi.
[Effects of inhaled and intravenous furosemide on bronchial hyperresponsiveness in patients with chronic congestive heart failure].
We studied the effects of inhaled and intravenous furosemide (40 mg) on bronchial responsiveness to acetylcholine (ACh) in patients with chronic congestive heart failure. The measurement of bronchial responsiveness was performed by inhaling doses of ACh and calculating the provocative concentration of ACh needed to cause a 20% fall in FEV1.0 (PC20-ACh). Intravenous furosemide (N = 11) had a marked diuretic effect (urine output 1014 ml (SEM 156) in 2 hours), but had no effect on resting pulmonary function and PC20-ACh. In contrast, inhaled furosemide (N = 10) had no effect on urine output and resting pulmonary function, but caused significant increase in PC20-ACh from 2.74 (GSEM 1.28) to 8.47 (GSEM 1.22) mg/ml (p less than 0.05). We conclude that inhaled furosemide, but not intravenous furosemide reduces bronchial hyperresponsiveness to ACh in patients with chronic congestive heart failure. The mechanism of this effect appears to be related to the ion transport system of airway epithelium.
Administration, Inhalation↗
Prothrombin fragment F1 + 2 and thrombin-antithrombin III complex are useful markers of the hypercoagulable state in atrial fibrillation.
It is well known that atrial fibrillation (AF) is one of the most important diseases that predispose patients to thrombosis. We have attempted to identify patients with AF in the hypercoagulable state by measuring molecular markers such as thrombin-antithrombin III complex (TAT) and prothrombin fragment 1 + 2 (PTF) and determining the effect of antithrombotic therapy on these markers; 83 patients with AF were studied. Increased levels of plasma TAT and PTF were more frequently observed in patients with AF and associated mitral stenosis than in patients with AF alone. In cases of AF without mitral stenosis, plasma levels of TAT and PTF were significantly lower in those patients receiving antithrombotic agents (aspirin or warfarin) than in those receiving no antithrombotic agents. Furthermore, plasma levels of PTF were significantly lower in patients given warfarin than in those receiving aspirin. These results suggest that (1) patients with AF and mitral stenosis who are not given warfarin are in an extremely hypercoagulable state and (2) some patients with AF without mitral stenosis who are not given antithrombotic agents are also moderately hypercoagulable. In vivo activation of blood coagulation was more effectively controlled in patients receiving warfarin than in those taking aspirin.
Aged↗
Plasma immunoreactive endothelin, but not thrombomodulin, is increased in patients with essential hypertension and ischemic heart disease.
To ascertain an involvement of vascular endothelial cells in cardiovascular disease, we have determined plasma levels of two endothelium-derived substances, endothelin (ET) and thrombomodulin (TM), in essential hypertension (EH) and ischemic heart disease. Plasma ET was determined by radioimmunoassay (RIA) after extraction. Plasma TM levels were determined by enzymunoimmunoassay. Plasma ET levels were significantly elevated in patients with EH involving target organ damage, vasospastic angina pectoris (VSA), and acute myocardial infarction (AMI), especially in those associated with cardiogenic shock. There was a weak but significant correlation between plasma ET levels and serum creatinine concentration in patients with EH. Plasma ET levels were elevated even before the coronary spasm in patients with VSA, whereas they did not show any further increase during the spasm. In contrast, plasma TM levels in patients with EH and VSA did not show a significant difference from that in normal subjects. These results suggest that ET plays an important role in the pathophysiology of EH and ischemic heart disease, and also that increases in plasma ET cannot be simply attributed to a leakage of the peptide from the injured endothelial cells.
Angina Pectoris↗
Multiple risk factors in coronary artery disease patients with abnormal glucose tolerance.
Two hundred twenty five anginal symptomatic patients (37-75 years) undergoing selective coronary angiography were studied to clarify the importance of risk factors for coronary artery disease (CAD). Serum lipids, apolipoproteins, fasting blood glucose, hemoglobin A1 and A1c, serum insulin levels, hypertension, smoking and obesity were examined as coronary risk factors in 64 newly diagnosed non-insulin dependent diabetic patients (60 +/- 1 (+/- SE)yr), 88 impaired glucose tolerant (IGT) patients (58 +/- 1 yr) and 73 non-diabetic patients (62 +/- 1 yr). Diabetic and IGT patients showed significantly higher coronary atherosclerosis indices than non-diabetic patients (p less than 0.05). In the diabetic and IGT groups, the plasma triglyceride concentrations were significantly higher in the patients with coronary atherosclerosis (CAS) than in either patients without CAS (p less than 0.05) or non-diabetic patients with CAS (p less than 0.05). The prevalence of hypertension in the diabetic patients with CAS was higher than in the non-diabetic patients with CAS. These data suggest that hypertriglyceridemia and hypertension might be important as risk factors in the development of coronary atherosclerosis in persons with an abnormal glucose tolerance.
Adult↗
[A case report of reversible collateral vessels between right and left coronary artery].
We report a case of reversible collateral flow between the right coronary artery (RCA) and the left coronary artery (LCA). A 55 year-old woman was admitted to our hospital because of chest oppression. Cardiac catheterization revealed 99% stenosis to seg. 1. We found good collateral vessels from LCA to RCA. We performed PTCA (Percutaneous Transluminal Coronary Angioplasty) on this lesion. PTCA was successful and this lesion improved (99%----40%). After PTCA, collateral vessels had disappeared. After one year, the patient had chest oppression on effort again. We performed cardiac catheterization and found 90% stenosis to seg. 6. So we performed PTCA on the new lesion. During balloon inflation, we found good collateral vessels from RCA to LCA (reversible collateral flow). We considered that reversible collateral flow was important for myocardial protection.
Angina, Unstable↗
Anginal attack following a sodium bicarbonate and hydrocortisone injection.
A case of a 73-year-old man with variant angina who developed chest pain and shock following an injection of sodium bicarbonate and hydrocortisone is reported. The electrocardiogram (ECG) during the chest pain attack revealed ST elevation in leads II, III and aVF. It returned to a normal pattern 10 min later. Coronary angiography, performed 2 hours after the anginal attack, showed no significant coronary arterial stenosis. One month later, an injection of ergonovine (16 micrograms) into the right and left coronary arteries induced spasms in segments 4 and 13, with ischemic ECG changes. Possible causes of the anginal attack are a coronary arterial spasm induced by the allergic reaction to hydrocortisone and/or serum alkalosis due to the sodium bicarbonate injection triggered by hyperventilation.
Aged↗
[The necessary conditions of chronic total occlusion of all three coronary vessels--the relationship between portions of coronary occlusion and collateral vessels].
This study was performed to define the conditions present in chronic total occlusion of all three coronary vessels. Each left descending coronary artery (LAD), left circumflex branch (LCX) and right coronary artery (RCA) was totally occluded angiographically in 5 patients (mean age 64, male 3, female 2). Four of them had history of myocardial infarction. Anginal type was effort angina in all patients, and two cases showed unstable angina. Good collateral supply was found in the distal portions of occluded vessels from proximally located branches, such as Conus branch, Right ventricular branch, Septal branch and Left atrial circumflex branch. Almost all of the occlusions were located at mid portions (13/15: mid, 2/15: proximal). Ejection fractions (EF%) of the 5 patients were 70%, 69%, 60%, 28% and 22% respectively. EF was correlated with the degree of collateral supply and one of them (22%) ended in sudden death. These findings suggest that the mid portion occlusion, good collateral supply and a long history of angina pectoris are important factors involved in chronic total occlusion of the three coronary vessels.
Adult↗
Survival after sudden cardiac arrest in hospital.
Although there are many reports on sudden cardiac arrest occurring outside the hospital, little is known about the precise prognostic factors that determine the outcome after cardiopulmonary resuscitation. Clinical information before and immediately after sudden cardiac arrest is frequently incomplete because the event occurs outside the hospital. We studied 90 consecutive patients with sudden and unexpected cardiac arrest who were resuscitated in the general ward of our hospital. Twenty-five (28%) were discharged from the hospital. Multivariate analysis revealed that the promptness of initiation of CPR, age, severity of cardiac dysfunction, time and the type of arrhythmia are of significance in relation to survival. To evaluate long-term survival after hospital cardiac arrest, we analyzed long-term follow-up data accumulated during a 16 year period. In the group of 25 patients in our study, there have been a total of 10 deaths (40%). Five of the 10 deaths resulted from recurrent cardiac arrest and 1 was a noncardiac death. There was a high rate of recurrence of cardiac arrest in the first year following resuscitation, especially among the cardiomyopathy patients.
Adolescent↗
[Two-dimensional echocardiographic and left ventriculographic evaluations of left ventricular diverticula].
Twenty cases of left ventricular diverticula were gleaned from 4,300 consecutive angiocardiographic records (13 males and seven females whose age ranged from 17 to 78 years with a mean of 52 +/- 16 years). Their findings were compared with those of 16 patients with left ventricular aneurysms due to myocardial infarction. In only one patient was a diverticulum first detected by two-dimensional echocardiography before left ventriculography was performed. None of the patient had an associated midline thoracoabdominal defect. Five patients had premature ventricular beats, two of whom had ventricular tachycardia. Three patients complicated mitral valve prolapse and three atrial septal defect. Of the 20 patients, four each had two diverticula, as opposed to 16 others who each had a single diverticulum. The diameter of the diverticula ranged from eight to 70 mm. The sites of 14 diverticula were along the inferior wall; five in the anterior wall; four in the apex. Morphologically 15 diverticula were bulky outpouchings, six were tongue-like, and three hammocking. All diverticula exceeding 15 mm in diameter and originated near the mitral ring could always be detected in the short-axis view of two-dimensional echocardiography. However, those originating in the apex or of a tongue-like configuration could rarely by detected. Comparative two-dimensional echocardiographic analyses of 16 diverticula, 16 left ventricular aneurysms, and 16 normal left ventricular walls disclosed that the left ventricular aneurysmal wall had a higher echo intensity, but the diverticula had the same wall echo intensity as the normal left ventricular wall. Left ventricular end-diastolic wall thickness in an aneurysm (7.6 +/- 1.5 mm) was lower (p less than 0.01) than the normal left ventricular wall (11.1 +/- 1.3 mm), but it did not differ from the normal left ventricular wall in any case of diverticulum (10.2 +/- 1.5 mm). The percent wall thickening ratio in aneurysms (-3.6 +/- 10.7%) was lower (p less than 0.01) than the normal left ventricular wall (39.8 +/- 10.9%), but it did not differ from the normal left ventricular wall in diverticula (45.8 +/- 16.6%). Regional fractional shortening in the diverticula (41.3 +/- 9.2%) did not differ from that in the normal left ventricular wall (34.5 +/- 5.2%). In conclusion, a small diverticulum without a midline thoracoabdominal defect is not rare, and two-dimensional echocardiography is the diagnostic method of choice in many cases based on the echo features described above.
Adolescent↗
[A case of prolonged atelectasis after pneumonia with Mycobacterium fortuitum isolated from bronchoalveolar lavage fluid].
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Aged↗
Effects of a thromboxane synthetase inhibitor (OKY-046) and a lipoxygenase inhibitor (AA-861) on bronchial responsiveness to acetylcholine in asthmatic subjects.
The effect of a selective thromboxane synthetase inhibitor, OKY-046, and a selective 5-lipoxygenase inhibitor, AA-861, on bronchial responsiveness to acetylcholine was studied in 23 asthmatic subjects. The provocative concentration of acetylcholine producing a 20% fall in forced expiratory volume in one second (PC20 FEV1) was measured before and after oral administration of OKY-046 (3000 mg over four days) and AA-861 (1100 mg over four days) and inhalation of OKY-046 (30 mg) in 10, 10, and nine asthmatic subjects respectively. Baseline values of FEV1 and forced vital capacity (FVC) were not altered by oral OKY-046, oral AA-861, or inhaled OKY-046. The geometric mean value of PC20 FEV1 increased significantly from 0.55 to 2.24 mg/ml after oral OKY-046, but was unchanged after inhalation of OKY-046 and after oral administration of AA-861. These results suggest that thromboxane A2 may play a part in bronchial hyperresponsiveness to acetylcholine.
Acetylcholine↗
Effect of 9 alpha-fluorocortisol on the excretion of urinary digoxin-like substance in normotensive men.
In order to investigate the possible role of mineralocorticoid in the regulation of digoxin-like substance (DLS), 9 alpha-fluorocortisol (9-F) was administered to 6 healthy men and urinary excretion of DLS was measured. The administration of 0.6 mg of 9-F caused slight increases in body weight and blood pressure and significant decreases in urinary Na excretion, plasma renin activity and plasma aldosterone, which indicate the expansion of extracellular fluid (ECF) volume by 9-F administration. Urinary excretion of DLS decreased significantly from the baseline level of 43.3 +/- 2.6 (SEM) to 29.8 +/- 5.1 (SEM) ng/day; digoxin equiv. after 9-F. These results suggest that a large dose of mineralocorticoid may suppress DLS despite an increase in the ECF volume.
Blood Proteins↗
An adult case of mixed connective tissue disease associated with perimyocarditis and massive pericardial effusion.
We report the case of a 55-year-old woman with mixed connective tissue disease (MCTD), who developed perimyocarditis associated with massive pericardial effusion. The diagnosis of MCTD was based on clinical and serological findings. We confirmed myocarditis by right ventricular endomyocardial biopsy. The pericardial effusion gradually disappeared after the administration of prednisolone. Although there have been several reports of cardiac disease in adult MCTD, few cases of adult MCTD having perimyocarditis associated with massive pericardial effusion have been reported.
Biopsy↗
[Effects of vasodilators on pulmonary hypertension].
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Adult↗
Effect of sodium intake on the excretion of urinary natriuretic factor in essential hypertensives.
A simplified method for the determination of natriuretic factor in the urine as measured by digoxin-like substance was studied. Digoxin-like substance in the urine was estimated by RIA using anti-digoxin antibody after being extracted by reversed phase cartridge column but without gel filtration. The values found by radioimmunoassay (RIA) yielded a significant correlation with those of the inhibitory effect of Na-K-ATPase activity which was measured by biochemical assay as described by Hamlyn et al. Using this RIA method, the effect of salt intake on natriuretic factor in urine was studied in patients with essential hypertension. The natriuretic factor on a high sodium diet (NaCl 20 g/day for three days) increased approximately 1.5 times, as compared to those on a low sodium diet (NaCl 3 g/day) (p less than 0.05). The Natriuretic factor showed a positive correlation with urinary Na excretion (P less than 0.050) when the patients were placed on ad. lib. sodium diet. From these results, it is suggested that secretion of natriuretic factor in the urine might be regulated in part by salt intake.
Aldosterone↗
[The role of prostaglandins for norepinephrine clearance in borderline hypertension].
Studies were done to determine the role of endogenous prostaglandins (PGs) for norepinephrine (NE) clearance in 10 male borderline hypertensives (BHT) (age: 20-28) and six age-matched male normotensives (NT). Two experimental protocols were followed in these subjects: 10 min orthostasis with blood sampling (protocol I), and 100 ng/kg/min of L-NE infusion for 60 min at supine position. Blood was collected from indwelling catheter at every min for 10 min after stopping the NE infusion (protocol II). Plasma NE was measured by THI method using HPLC. Disappearance curve of plasma NE was analyzed following the two compartment open model. The orthostasis and the steady state NE infusion were repeated after 150 mg/day of indomethacin (Ind) for three days. There were significant increases in plasma NE after orthostasis in both groups: from 180.8 +/- 28.0 pg/ml to 346.2 +/- 78.0 pg/ml (p less than 0.05) in NT and from 120.1 +/- 12.8 pg/ml to 289.6 +/- 20.3 pg/ml (p less than 0.001) in BHT, but there were no significant differences between the two groups. Ind pretreatment did not alter these responses. The calculated half-time of the first exponential phase (T 1/2) was 1.50 +/- 0.07 min in NT which decreased to 0.98 +/- 0.10 min (p less than 0.05) after Ind pretreatment. In BHT, T 1/2 was 1.03 +/- 0.08 min (p less than 0.01 vs NT), which was not significantly changed after Ind. These results may suggest that endogenous PGs have some role(s) in NT for NE clearance, probably exerting inhibitory action on neuronal uptake. In BHT, neuronal uptake of NE is increased, probably due to an adaptation mechanism to elevated blood pressure.
Adult↗
[A case of primary biliary cirrhosis associated with hemolytic anemia].
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Anemia, Hemolytic↗