PubMed Health⌕ Search

Biomedical subjects

S Sueda

Publications and source records attributed to S Sueda.

At least 37 records · Page 2Linked to original sources
PubMed1999

Investigation of the most effective provocation test for patients with coronary spastic angina: usefulness of accelerated exercise following hyperventilation.

This study sought to compare the clinical usefulness of the hyperventilation plus cold stress test or the hyperventilation combined with accelerated exercise test with other single tests in patients with coronary spastic angina. The study examined 24 patients (23 men, mean age 66 years) with angiographically confirmed coronary spastic angina and less than 50% stenosis. Moreover, none had spontaneous ST segment elevation before the study. Under no medication for at least 24 h prior, 4 procedures were performed from 09.00 h to 11.00 h: (i) a hyperventilation test for 5 min (HV(5)); (ii) HV(5) combined with a cold stress test for the last 2 min (HV(5)+CS(2)); (iii) a treadmill exercise test based on Bruce's protocol (TM(3)); and (iv) a treadmill exercise test accelerated at 1 min intervals according to Bruce's protocol immediately after HV(5) (HV(5)+TM(1)). The rate of appearance of chest pain and ischemia-induced ECG changes due to HV(5)+TM(1) were significantly higher than the other 3 tests. HV(5)+CS(2) was not superior to HV(5) alone. The incidence of provoked ST segment elevation due to HV(5)+TM(1) was higher than with the other 3 procedures. Thus, in patients with coronary spastic angina, no spontaneous ST segment elevation and near normal coronary arteries, HV(5)+CS(2) was no more useful than HV(5) alone. It is recommended that the newly designed HV(5)+TM(1) combination test be used for documenting evidence of ischemia in patients with coronary spastic angina, low disease activity and near normal coronary arteries.

Acetylcholine↗
PubMed1999

Limited efficacy of magnesium for the treatment of variant angina.

Some patients with variant angina show both ST segment elevation at rest and exercise-induced ST segment elevation. Magnesium deficiency has also been observed in patients with variant angina. This study investigated the correlation between the degree of magnesium deficiency and the efficacy of intravenous administration of magnesium in patients with variant angina. Fifteen patients with angiographically confirmed variant angina were assessed for magnesium deficiency and whether intravenous administration of magnesium (19.2 mEq/l) suppressed exercise-induced ST segment elevation. All 15 patients were studied with a magnesium retention test (0.2 mEq/kg over 4 hr) to analyze magnesium deficiency. In our study, magnesium retention rate in patients with variant angina was not higher than that of controls (57 +/- 24% vs 45 +/- 10%, NS). All 15 patients had anginal attacks during accelerated exercise combined with hyperventilation after placebo infusion, whereas only 8 patients had anginal attacks after magnesium administration. ST segment elevation occurred in 14 patients after placebo infusion, but in only 4 patients after magnesium administration. There were no correlations between disease activity, degree of magnesium deficiency or failure of suppression of ST elevation by the intravenous administration of magnesium. Intravenous administration of magnesium can suppress exercise-induced coronary spasms in some patients with variant angina, but the degree of magnesium deficiency did not correlate with the suppressions of exercise-induced ST elevation after magnesium administration. Intravenous administration of magnesium had limited efficacy in patients with variant angina and exercise-induced ST segment elevation.

Acetylcholine↗
PubMed1999

Eight-year trend of new patients at Clinic for Disabled Patients, University Hospital, Faculty of Dentistry, Tokyo Medical and Dental University.

The trend of new patients was investigated at the Clinic for Disabled Patients, University Hospital, Faculty of Dentistry, Tokyo Medical and Dental University for eight years from 1989 to 1996. The purpose of this study was to explore the future role of this specialized clinic. The study revealed the following information: 1. A total of 1,388 new patients, corresponding to 173.5 new patients per year on average, visited the clinic. 2. The percentage of patients aged 30 or more increased. As a result, the mean patient age rose from 40.4 in 1989 to 47.6 in 1996. 3. Referrals accounted for more than 80% of new patients. Medical doctors referred more patients to our clinic than dentists did. 4. While the percentage of disabled patients tended to decrease, the percentage of medically compromised patients increased. 5. The predominant complaint was dental caries. Patients with cardiovascular diseases also complained of gingival bleeding and ill-fitting dentures. The growing percentage of medically compromised patients and the increasing mean age of patients over the eight-year period seems to reflect advances in medical science and the aging society. These tendencies could be more remarkable in the future. Therefore, much closer cooperation between dentists and medical doctors will be required.

Adolescent↗
PubMed1998

A case of variant angina pectoris with similar findings on both rest and matched exercise thallium-201 studies.

A patient with variant angina showed similar findings on both the rest and matched exercise 201Thallium (201Tl) myocardial perfusion scintigrams. The 65-year old man was admitted to hospital because of rest angina. His electrocardiogram during the attack disclosed ST segment elevation on inferior leads. However, emergency coronary arteriogram showed no fixed stenosis. Intracoronary injection of acetylcholine induced a spasm on the distal right coronary artery, but not in the left coronary artery. In the rest 201Tl study, septal perfusion was low on the early image, although partial redistribution of this site was observed on the delayed image without the appearance of chest pain or electrocardiographic ischemic change. Similary, in the 201Tl exercise study undergone 2 weeks later, septal redistribution was diagnosed because the early image had decreased septal perfusion. Both the exercise 123I-metaiodobenzylguanidine study and the rest 123I-betamethyl-p-iodophenyl-pentadecanoic acid study showed inferior abnormalities on the early and delayed images. Although a coronary spasm was not induced in the left anterior descending artery with the acetylcholine test, septal redistribution was observed on the delayed image of both the rest and exercise 201Tl studies. The mechanism of the redistribution on the rest 201Tl study was unclear.

Aged↗
PubMed1998

[Usefulness of intracoronary injection of acetylcholine and ergonovine in patients with variant angina].

The correlation was examined between the angina-producing arteries predicted to be responsible for the sites of ST segment elevation during spontaneous ischemic attacks and the arteries in which spasm was induced by intracoronary injection of either acetylcholine or ergonovine in patients with variant angina. From 1991 January to 1996 June, 42 patients with variant angina, 40 men and 2 women with a mean age of 61.6 years old, underwent the acetylcholine provocation test within 2 weeks of observation of the last ST segment elevation. After discontinuation of antianginal agents for at least 24 hours, a bolus of acetylcholine was injected in incremental doses of 20, 50 micrograms (occasionally 80 micrograms) into the right coronary artery and of 20, 50 and 100 micrograms incrementally into the left coronary artery to provoke coronary spasm. Intracoronary injection of ergonovine was added in nine patients, in whom intracoronary injection of acetylcholine failed to document coronary spasm on the arteries predicted to be responsible for the sites of ST segment elevation during anginal attacks. Ergonovine was injected in total doses of 40 micrograms into the right coronary artery and of 64 micrograms into the left coronary artery. Positive spasm was defined as induction of more than 99% reversible stenosis. The correlation between the arteries predicted to be responsible for the sites of ST segment elevation during attacks and the vessels in which spasm was induced by acetylcholine test was 78.6% for all patients and 80.0% for all sites of ST segment elevation. By adding the ergonovine test after the acetylcholine test, the correlation increased to 95.2% for all patients and 95.6% for all sites of ST segment elevation. The correlation observed agrees with previous studies in which the ergonovine test was performed in patients without induced spasm by intracoronary injection of acetylcholine and that the super-imposed ergonovine test is useful for diagnosing patients with variant angina.

Acetylcholine↗
PubMed1998

[Usefulness of thallium-201 myocardial scintigraphy during hyperventilation and accelerated exercise test in patients with vasospastic angina and nearly normal coronary artery].

The usefulness of thallium-201 (201Tl) myocardial scintigraphy was studied in 109 patients with vasospastic angina who had nearly normal coronary arteries (degree of stenosis < 50%). Coronary spasm was confirmed by pharmacologic agents in all 109 patients from January 1991 to June 1996. The appearance rate of visual redistribution on 201Tl myocardial scintigraphy was compared between four groups, 34 patients performing graded bicycle ergometer exercise starting at a work load of 50 W with increments of 25 W every 3 min [Ergo (3) group], 14 patients performing hyperventilation for 5 min [HV (5) group], 31 patients performing bicycle ergometer exercise with increments of 25 W every 1 min after 5 min hyperventilation [HV (5) + Ergo (1) group], and 30 patients at rest (Rest group). The value of the visual redistribution rate on 201Tl myocardial scintigrams in the HV(5) + Ergo (1) group (65%) was higher than that in the patients of other groups [Ergo (3) 41%, HV (5) 43%, Rest 33%]. However, there were no significant differences between the four groups. Stress 201Tl imaging after hyperventilation and accelerated exercise is useful to disclose ischemic evidence in about two thirds of patients with vasospastic angina and nearly normal coronary arteries, whereas about 40% of patients had visual redistribution on 201Tl myocardial scintigrams by performing standard procedures.

Acetylcholine↗
PubMed1998

[Characteristics of spasm-induced vessels in patients with vasospastic angina and a history of syncope].

One hundred and eighty-seven consecutive patients with vasospastic angina and coronary spasm provoked by intracoronary injection of acetylcholine and/or ergonovine were treated from January 1991 to June 1997. Fifteen of these patients, 14 men and one woman (mean age of 63 years old), had a history of syncope. There were no significant differences in the distribution of induced spasm vessels, single spasm vs multiple spasms, variant angina pectoris and organic stenosis (< 75%) between patients with and without a history of syncope. There were no significant differences concerning the distribution of the sites of induced spasm in the circumflex artery and left anterior descending artery between the two groups. However, coronary spasm in the proximal portion of the right coronary artery (segment 1 or 2 according to the functional classification of American Heart Association) occurred more frequently in patients with a history of syncope [80.0% (12/15) vs 45.3% (78/172); p < 0.05]. Twelve of the 96 patients with coronary spasm in the proximal portion of the right coronary artery had a history of syncope, so these patients require careful management.

Acetylcholine↗
PubMed1998

[Clinical differences between variant and non-variant angina pectoris].

The differences in clinical characteristics were studied between variant angina pectoris with ST segment elevation during ischemic attacks and non-variant angina pectoris without ST segment elevation. Spasm provocation test was performed with either acetylcholine or ergonovine in 192 consecutive patients with vasospastic angina from January 1991 to June 1997. Thirteen patients were excluded because of insufficient data. Fifty-five patients had variant angina and 124 patients had non-variant angina. Coronary risk factors, serum cholesterol level, triglyceride level, high-density lipoprotein cholesterol level, history of syncope, the rates of second or third atrioventricular block and ventricular tachycardia or fibrillation, the incidence of organic stenosis (> or = 50%), the number of vessels with provoked spasm, the dose of acetylcholine and ergonovine used, and duration from the first appearance of chest pain were compared between the 2 groups. Patients with variant angina had more fixed stenosis (p < 0.01), required more percutaneous transluminal coronary angioplasty procedures, lower doses of intracoronary administration of acetylcholine for the induction of coronary arterial spasm and shorter duration from the first appearance of chest pains (p < 0.01) than patients with non-variant angina. However, there were no differences in other factors between the 2 groups. Variant angina pectoris has the same clinical characteristics as non-variant angina pectoris, although variant angina tends to cause higher spasmophilic activity and more fixed stenosis.

Acetylcholine↗
PubMed1998

[Absence of induced spasm by intracoronary injection of 50 micrograms acetylcholine in the right coronary artery: usefulness of 80 micrograms of acetylcholine as a spasm provocation test].

This study investigated whether the maximal dose of 50 micrograms acetylcholine for the induction of coronary spasm in the right coronary artery is adequate. The acetylcholine test was performed in 388 consecutive patients to evaluate spasm from January 1994 to December 1997. Coronary spasm in the right coronary artery was induced in 43 patients, 37 men and 6 women with a mean age of 63 +/- 8 years by intracoronary injection of 80 micrograms of acetylcholine rather than 50 micrograms. These included 15 patients (35%) with rest angina, 23 patients with ischemic heart disease other than rest angina and 5 patients (12%) with non-ischemic heart disease. Acetylcholine was injected in incremental doses of 20, 50 and 80 micrograms into the right coronary artery. Positive spasm was defined as induction of more than 90% reversible narrowing associated with either usual chest pain or ischemic electrocardiographic changes. Clinical and angiographical characteristics was studied in these patients. Fifteen (35%) patients had rest angina and 4 patients had variant angina with ST elevation in the inferior leads. Two thirds of the patients had coronary spasm in the distal portion of the right coronary artery and one third of those disclosed spasm focally. Coronary spasm was induced in 38 (15%) of 246 patients with ischemic heart disease and in 5 (4%) of 142 patients with non-ischemic heart disease. The prevalence of positive spasm in patients with ischemic heart disease was significantly higher (p < 0.01) than in patients with non-ischemic heart disease. A dose of 80 micrograms of acetylcholine, more than the maximal standard dose, might be clinically useful for the induction of spasm in the right coronary artery if coronary spasm of this artery is strongly suspected.

Acetylcholine↗
PubMed1997

[Is coronary spasmodicity unchangeable?: a study with acetylcholine or ergonovine in patients with ischemic heart disease].

Fluctuations of spasmodicity have been reported in affected vessels in patients with vasospastic angina, but the incidence of spasmodicity induced by pharmacologic agents on both vessels with spasm and vessels without induced spasm has not been investigated. Repeated spasm provocation tests by acetylcholine or ergonovine were performed at 13.1 +/- 9.9 month intervals (3-50 months) in 111 vessels of 50 patients with ischemic heart disease, consisting of 19 old myocardial infarction and 31 angina pectoris, who did not undergo angioplasty or have signs of advancing atherosclerosis. Spasm was defined as present when more than 90 percent stenosis was accompanied by the appearance of usual chest pain or significant electrocardiographic changes. Ninety-six vessels (86.5%), 65 without spasm and 31 with spasm, revealed coincident responses and the remaining 15 vessels contrary reacted. The coincidence rate of spasmodicity in patients at intervals of within 24 months (90.2%) was significantly higher (p < 0.05) than that at intervals of over 24 months apart (70.4%). The spasm coincidence rate was 67.3% in the vessels with provoked spasm by either the first or second tests. Only one (0.9%) out of the 111 vessels showed obvious progressive atherosclerosis during this study. The majority of vessels showed identical spasmodicity within 2 years. In conclusion, coronary spasmodicity might remain unchanged for at least 2 years despite medication with calcium channel blockers and isosorbide dinitrate.

Acetylcholine↗
PubMed1990

[A 38-year-old survivor with complete transposition of the great arteries].

A 38-year-old woman with complete transposition of the great arteries (CTGA) was reported. She was admitted to Ehime University Hospital because of dyspnea on effort. She was diagnosed as CTGA with large ventricular septal defect (VSD) and pulmonary stenosis (PS) by magnetic resonance imaging. Survivors above 30 years of age are very rare in CTGA. The reason why this patient is still alive at the age of 38 seems to be due to PS that decreases pulmonary vascular resistance and VSD that mixes blood gas appropriately in the ventricle.

Adult↗
PubMed1989

[Report of a case of lung cancer with metastasis to the myocardium which showed electrocardiographic findings similar to acute myocardial infarction and intramyocardial mass on echocardiography].

A 61-year-old man was admitted to our hospital with complaints of cough and left back and chest pain. He had suffered from left tuberculous pleurisy at the age of 20 years. Chest X-ray film and CT revealed atelectasis of the left lung, a left hilar mass and an irregular left atrial wall. Depressed P-Ta segment in the inferior limb and anterior chest leads and an abnormal P wave were found on ECG. Transbronchial lung biopsy showed squamous cell carcinoma. After radiation therapy, the patient complained of chest oppression. ECG revealed a normalized P-Ta segment deviation, markedly elevated ST segment in the inferior limb and lateral chest leads and a depressed ST segment in the anterior chest leads. These findings persisted until his death. An obscure appearance of the pericardium and an echogenic intramyocardial mass in the posteroinferior and lateral wall were evident by echocardiography. The patient died due to heart failure. Postmortem needle biopsy showed scattered intramyocardial tumor cell nests with keratinization. CPK, GOT and LDH were within normal limits throughout the course, but CPK-MB was slightly increased. Cardiac metastasis with an ECG appearance similar to that of acute myocardial infarction has been rarely reported. Our present case showed peculiar feature including 1) ECG findings similar to atrial and ventricular myocardial infarction, and 2) an echogenic intramyocardial mass and an ill-defined pericardium on echocardiography. These findings suggested direct invasion of squamous cell carcinoma of the lung to the ventricular myocardium.(ABSTRACT TRUNCATED AT 250 WORDS)

Carcinoma, Squamous Cell↗
PubMed1987

[Bronchioloalveolar carcinoma diagnosed by bronchoalveolar lavage].

A case of bronchioloalveolar carcinoma of the lung is reported. A 63-year-old man identified during a chest mass-survey program, came to our hospital for a precise examination. He had no subjective complaints though his plain chest X-ray film showed a diffuse alveolar pattern in the bilateral hilar regions mimicking a butterfly shadow. Further, cytological examinations of both the sputa and specimens from brushings obtained on bronchoscopy failed to demonstrate malignant cells, and only a cytological examination of the fluid obtained by bronchoalveolar lavage (BAL) revealed the presence of a malignancy. Thus, BAL would seem to be a simple and reasonable method for the detection of suspected malignant cells in bronchioloalveolar carcinoma.

Adenocarcinoma, Bronchiolo-Alveolar↗
PubMed1984

A catheter-induced syncopal attack in a case of hypertrophic obstructive cardiomyopathy.

A 48-year-old man with hypertrophic obstructive cardiomyopathy (HOCM) was studied by serial cardiac catheterization during incidentally induced syncope. His hospital admission was for repeated syncopal attacks and chest pain. His electrocardiogram showed giant negative T waves (greater than 10 mm) in V3, V4 and V5 leads, and his M-mode echocardiogram disclosed typical asymmetric septal hypertrophy, systolic anterior movement of the mitral valve, and a midsystolic semiclosure of the aortic valve. During cardiac catheterization, we incidentally induced syncope and recorded the serial pressure changes. During syncope, systemic blood pressure dropped without appreciable changes in pulmonary arterial and right ventricular pressures. Although blood pressure was maintained by administering etilefrine and hydrocortisone, syncope persisted. After administration of propranolol, he recovered from syncope. He was on sinus rhythm throughout the examinations. The ejection time (ET) obtained from the aortic pressure curve was extremely short (160 msec) during syncope and prolonged (300 msec) after recovery without significant change in the heart rate. We believe that the prompt intravenous administration of propranolol was very effective in relieving myocardial spasm as a possible cause of syncope.

Cardiac Catheterization↗