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Biomedical subjects

T Sumiyoshi

Publications and source records attributed to T Sumiyoshi.

At least 73 records · Page 4Linked to original sources
PubMed1992

The response to drug therapy in unstable angina on the basis of coronary angiography findings.

Among 366 unstable angina pectoris patients at our hospital, myocardial infarction was common (15.7%) in those with attacks of chest pain lasting for at least 20 min. There was also a high incidence (30.3%) when chest pain continued after the start of inpatient treatment. To investigate the etiology of unstable angina, coronary arteriography was performed in both the unstable and stable stages in these patients and the results were compared. The role of coronary spasm and coronary thrombosis in unstable angina was investigated, and the efficacy of continuous infusion of either diltiazem or isosorbide dinitrate as treatment for these patients was compared. Coronary arteriography in the unstable stage showed, no clear differences in the morphology of the stenotic site and the degree of stenosis between the patients with and without infarcts when urokinase or isosorbide dinitrate were injected into the coronary arteries. When drug treatment was effective, the angina was stabilized without any improvement in the degree of stenosis or the morphology of the involved coronary vessel. Thus, it was difficult to predict the response to treatment from coronary arteriography performed in the unstable stage. Diltiazem was more effective than isosorbide dinitrate, and it appears that some action other than coronary dilatation was involved in achieving the remission of unstable angina.

Angina, Unstable↗
PubMed1992

[The acute and chronic effects of bunazosin on exercise capacity estimated by the anaerobic threshold in patients with chronic congestive heart failure].

To study the effect of bunazosin on exercise capacity in patients with congestive heart failure (NYHA II-III), anaerobic thresholds (AT, VO2, ml/min/kg) were measured before (control) and after initial 1 = 2mg administration of bunazosin (acute phase; N = 14) and after two weeks of bunazosin therapy (3mg/day, 1mg t. i. d., chronic phase; N = 6). AT were determined by Wasserman's V-slope method during ergometer exercise test with a ramp loading (10 watt/min). AT increased significantly from control during both acute (14.2 +/- 2.7 to 16.9 +/- 3.6 ml/min/kg p < 0.005) and chronic (13.6 +/- 2.5 to 16.7 +/- 1.0 p < 0.05) phase. Additionally, work (watt) attained at AT increased significantly from control during both acute (33.6 +/- 19.2 to 52.6 +/- 30.2 p < 0.005) and chronic (35.8 +/- 25 to 49.3 +/- 15 p < 0.05) phase. Pressure-rate-products (PRP, x 10(2) mmHg/min) at AT increased significantly from control during the acute phase (119 +/- 35 to 240 +/- 50 p < 0.005) alone. In the chronic phase, PRP decreased significantly at the work level equal to AT during control (from 207 +/- 41 to 187 +/- 39 p < 0.05). These data suggest that bunazosin has favorable acute and chronic effects on exercise capacity in patients with congestive heart failure.

Adult↗
PubMed1991

Usefulness of the newly proposed International Classification of Epilepsies, Epileptic Syndromes, and Related Seizure Disorders (1989): a trial on adult patients in a neuropsychiatric clinic.

The utility of the "International Classification of Epilepsies, Epileptic Syndromes, and Related Seizure Disorders," proposed by ILAE in 1989, was investigated in a neuropsychiatric clinic with a patient population numbering 300. Two hundred and three patients (67.7%) had localization-related epilepsies (LRE), including one idiopathic case. Sixty-six patients (22%) had generalized epilepsies, 50 idiopathic, 2 Lennox-Gastaut syndrome, and 14 symptomatic. Thirty-one patients (10.3%) with generalized tonic-clonic seizures occurring only during sleep had the epilepsies undetermined whether they are focal or generalized. In the symptomatic LRE cases, 34 cases could not be classified, and 7 of the cases with frontal lobe epilepsies were difficult to subtype. Eleven of the symptomatic LRE cases had some independent seizures, multiple foci in surface EEGs and were intractable. These cases may be defined as "multifocal epilepsies."

Adult↗
PubMed1991

[Clinical and anatomical features of acute myocardial infarction associated with double rupture of the interventricular septum and ventricular free wall].

Four patients with acute myocardial infarction (MI) complicating double rupture; interventricular septum and ventricular free wall ruptures, were studied. All patients had histories of hypertension, and pre-infarction angina pectoris of short duration less than 8 days without previous MI. The sites of infarction were anteroseptal in 2 patients and inferoposterior in the other 2. Only one case was complicated with mild pump failure (Killip class II). Blood pressure was adequately controlled after the onset of MI in all patients. Interventricular septal rupture occurred between 2 and 10 days after the onset of MI. Free wall rupture occurred between 2 and 22 days after MI. Types of free wall ruptures were oozing in 2 patients and blow-out in the other 2. Surgical repair was performed in 2 patients with the oozing type rupture, who however died soon after surgery. The autopsy findings were as follows: 3 patients had left ventricular free wall ruptures and one had right ventricular free wall rupture. One of the patients with left ventricular free wall rupture showed a secondary rupture of a pseudo-ventricular aneurysm. Postmortem coronary angiograms revealed 3 patients with single-vessel disease and one patient with double-vessel disease, indicating that coronary arterial lesions and complicated heart failure were not severe in these 4 patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1991

[Non-supervised home exercise programs in a convalescent phase of acute myocardial infarction: their effectiveness and the usefulness of the heart rate at the anaerobic threshold].

The effectiveness of 2 different exercise programs in the convalescent phase of acute myocardial infarction (AMI) was assessed. One hundred and five patients with AMI were enrolled for one of these 2 non-supervised home exercise programs immediately after discharge from the hospital. Before discharge and one month later, they underwent submaximal graded treadmill exercise tests with the application of expiratory gas analysis. All patients were assigned to perform 2 km of walk-jog exercise daily for one month. The heart rate during exercise, duration of exercise and the total steps during 24 hrs were measured. Eighty patients (group A) underwent the exercise program in which their heart rates were maintained at 100-110 beats/min during exercise; while 25 patients (group B) underwent the other program in which their heart rates were maintained at 90-100% of those obtained at their anaerobic threshold (AT). The ventilatory AT was calculated by the standard technique using the Horizon System. In group A, AT increased from 13.4 ml/min/kg to 15.1 ml/min/kg (p < 0.01) after the exercise program and in group B, from 12.8 ml/min/kg to 14.9 ml/min/kg (p < 0.01). In group B, AT increased in all patients, while it remained unchanged in 30% of the patients in group A (p < 0.01). In conclusion, a non-supervised home exercise program can be effective and easily instituted for rehabilitation in a convalescent phase of AMI. The program using 90-100% of the heart rates at the anaerobic threshold seemed to be more suitable for obtaining better effects on exercise tolerance than that using 100-110/min heart rate.

Aged↗
PubMed1991

[Medical therapy in patients with left main coronary artery stenosis].

To elucidate the long-term prognosis of medically-treated patients with left main coronary artery (LMCA) lesions, 119 consecutive patients with LMCA lesions undergoing coronary angiography were analyzed retrospectively. Among these, 3 patients died soon after angiography and were excluded from this study. Among the remaining 116 patients, 22 were treated medically (Group M) for the following reasons: profound left ventricular (LV) dysfunction (3 patients), effective pharmacological treatment (10), and patients' refusal of surgical therapy (9). Among 94 patients who underwent coronary artery bypass graft (CABG), 83 patients survived (Group S). During the follow-up period, cardiac events occurred in 5 patients in Group M; cardiac deaths in 3, non-fatal myocardial infarction (MI) in one and late application of CABG in one. Two-year cardiac event-free rate after diagnosis was 77%, which remained unchanged thereafter. The cumulative survival rate was 83%. The incidence of cardiac events in Group M was higher than that in Group S (p < 0.01). However, cardiac event rates were similar between these 2 groups for patients with good collateral circulations to the left coronary arteries, no preceding MI and LV end-diastolic pressure less than 15 mmHg. We concluded that the Japanese patients with severe LMCA lesions who respond favorably to pharmacological intervention have unexpectedly good prognoses, however, obstructed collateral circulation to the left coronary system, the presence of preceding MI and high LV end-diastolic pressure were all high-risk factors for medically-treated patients.

Adult↗
PubMed1991

[Clinical significance of ST segment shifts during chest pain in predicting the pathogenesis of impending myocardial infarction].

To know whether the pathogenesis of impending myocardial infarction(IMI) could be predicted by the direction of ST segment shifts during an ischemic chest pain, we studied 62 patients with IMI and undergoing emergent coronary angiography(CAG). They were selected from a consecutive number of 474 patients with unstable angina. IMI was defined when patients had more than 2 episodes of chest pain at rest under intensive pharmacological interventions after their CCU admission, and at least one of those was not relieved by nitroglycerin given intravenously. They were divided into 2 groups according to ST segment shifts during chest pain; 35 patients with ST elevation (G-1) and 27 patients with ST depression (G-2). The time of CAG was individually determined in each patient according to the severity of illness. Those with acute MI within 3 months before the study and 24 hours following the chest pain just before CAG were excluded from the study. New onset angina accounted for 49% in G-1 and 4% in G-2(p less than 0.01). Average history length of IMI, frequency of symptoms after CCU admission, and interval from the last symptom to CAG were similar in each groups. Single vessel disease was more predominant in G-1 than in G-2 (54% vs 11% p less than 0.01). Intracoronary thrombus(IT) in an ischemia related artery(IRA) was found in 97% of G-1 and 22% of G-2(p less than 0.001), while complex lesions(CL) proposed by Ambrose as another genesis of IMI were in 26% of G-1 and 74% of G-2(p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Angina, Unstable↗
PubMed1990

Management and evaluation of non-supervised home exercise program in a convalescent phase of acute myocardial infarction.

Out of 636 patients with acute myocardial infarction (AMI) admitted to our institution, 183 patients enrolled in our non-supervised home exercise program immediately after their discharge from the hospital. The first 40 patients were randomized to control and training group, while the remaining 143 patients were included in the training group. Before and after the trial, all patients underwent cardiopulmonary exercise testing; submaximal graded treadmill exercise test with the application of expiratory gas analysis. In the training group, patients performed 2 km walk-jog exercise everyday for 1 month, keeping their heart rate (HR) at 90-100% of that in the anaerobic threshold. HR during exercise was monitored by patients themselves, using HR-meter. The anaerobic threshold significantly increased in the training group; while control group had no significant changes. VO2 and HR significantly increased at the same Borg's indices. Psychological improvement was also obtained in the training group compared to control group. It is concluded that non-supervised home exercise program is effective and easily applicable in the convalescent phase of AMI.

Aged↗
PubMed1990

[Percutaneous transluminal angioplasty of the subclavian artery].

We reported a case of subclavian artery stenosis successfully treated by percutaneous transluminal angioplasty (PTA). He suffered from left arm claudication and proximal subclavian artery stenosis. The stenosis and symptoms disappeared soon after PTA. No complications occurred. Patients with hemodynamically significant stenoses, symptoms and signs should be considered for PTA.

Angioplasty, Balloon↗
PubMed1990

[Detection of restenosis after successful percutaneous transluminal coronary angioplasty (PTCA)--usefulness of exercise thallium scintigraphy].

We studied the efficacy of stress thallium scan in detecting restenosis after primary successful PTCA. There were 21 patients with angina pectoris and 16 patients with previous myocardial infarction. The sensitivity and the specificity of stress thallium scan in detecting restenosis were superior to those of stress electrocardiography or chest pain complained in follow-up period. In multi-vessel disease, we could assess the vessel developing restenosis more easily than stress electrocardiography. Initial thallium %UPTAKE RATIO was significantly improved after PTCA but redecreased in patients developing restenosis. In patients showing residual redistribution despite of not developing restenosis, we could judge vessel patency by gradually improving initial %UPTAKE RATIO after PTCA. Thus, stress thallium scan proved to be useful in detecting restenosis after PTCA.

Aged↗
PubMed1990

Exercise-induced ST-segment elevation in leads over infarcted area and residual myocardial ischemia in patients with previous myocardial infarction.

The purpose of this study was to evaluate the clinical significance of exercise-induced ST elevation in patients who had previous myocardial infarction. Electrocardiographic leads were placed over the infarcted area in 65 patients who had previous myocardial infarction (PMI; isolated left anterior descending coronary artery disease). All patients also had stress thallium scan. Exercise-induced ST changes in leads placed over patients' infarcted areas were compared with the extent of both their myocardial ischemia [thallium ischemic score (TIS)] and the area of their infarcted tissue [defect score (DS)]. The latter was derived from a circumferential profile analysis. In patients who had PMI less than three months after the onset of myocardial infarction (n = 36), the left ventricular ejection fraction (LVEF) and the extent of abnormal left ventricular wall motion did not significantly differ from those in patients with exercise-induced ST elevation (greater than 2 mm, n = 26; less than 2 mm, n = 10). In patients who had PMI more than three months after the onset of myocardial infarction (n = 29), patients with high exercise-induced ST elevation (greater than 2 mm, n = 15) showed left ventricular dyskinesis more frequently than those with low ST elevations (less than 2 mm, n = 14). In addition, the former showed higher DS and lower TIS than the latter. In patients who had PMI less than three months after onset (n = 26), 73% of those with ST elevations with prominent upright T waves (n = 15) also had transient thallium defects in their infarcted areas. They also had higher LVEF and TIS than those with low ST elevations (less than 2 mm, n = 11). These results indicated that exercise-induced ST elevations in leads placed over the infarcted areas are to be interpreted differently depending on the degree of recovery of injured myocardial tissue.(ABSTRACT TRUNCATED AT 250 WORDS)

Coronary Circulation↗
PubMed1990

[Clinical variables that can cause the underestimation of the viable myocardium in the infarcted area: results of the sequential exercise thallium-201 myocardial scintigraphy].

Clinical variables that can cause the underestimation of the viable myocardium were examined in the sequential exercise thallium-201 study before and after PTCA. Among 60 patients who had documented myocardial infarction with single coronary artery disease, 43 patients had successful PTCA. Compared to the initial images after PTCA, the 4 hour-delayed images before PTCA had larger and more severe defect in the infarcted area of 14 patients (33%). This underestimated group had shorter period from the infarction to the stress study. (3.4 +/- 2.4 M vs. 7.1 +/- 9.2 M; p less than 0.05), and attained more maximal heart rate during the stress study. The numbers of the patients who had severe stenosis (greater than or equal to 99%) were more in the underestimated group (79% vs. 34%; p less than 0.01). The patients who have recent myocardial infarction, especially within three months, are likely to be underestimated their viable myocardium in the infarcted area, and this variable is dependent from their workload during the stress study and the severity of the stenotic lesion which also affect the estimation of the myocardial viability.

Angioplasty, Balloon, Coronary↗
PubMed1989

[Efficacy of home exercise program in a convalescent phase of acute myocardial infarction evaluated by Borg's indices, expiratory gas analysis and blood lactate].

The Borg's indices, the rate of perceived exertion have been widely accepted to evaluate subjective symptoms semi-quantitatively in exercise tests. We applied the indices to evaluate the efficacy of our home exercise program in patients with acute myocardial infarction. Eighty-five patients were entered in our home exercise program after their discharge from the hospital. This program consisted of everyday 2 km walk-jog exercise for 1 month keeping their heart rate at 100-110/min during the exercise. Before and 1 month after their discharge, they underwent treadmill exercise tests with expiratory gas analysis and a measurement of blood lactate. In the treadmill tests performed before and after the training, VO2 and heart rate increased linearly with Borg's indices, however VE and blood lactate had disproportionate increases after Borg's 13 which is considered to be the anaerobic threshold (AT). In fact, AT measured individually by expiratory gas analysis and blood lactate, appeared at Borg's 13 in 53% of the patients. After 1 month physical training, VO2 and heart rate significantly increased at the same Borg's indices, but there was no significant changes in blood lactate at the same Borg's score before and after the training. These results suggest that, in patients with acute myocardial infarction, exercise performance significantly increased at any score of subjective symptoms and that Borg's indices may reflect the blood lactate levels. It is concluded that Borg's indices, closely related to the dynamics of blood lactate, are not only useful in quantifying subjective symptoms but also to estimate the efficacy of physical training.

Adult↗