Hideo Takezawa

Effects of diltiazem on cardiovascular responses during exercise in systemic hypertension and comparison with propranolol

Sixteen patients with uncomplicated systemic hypertension were treated with placebo, diltiazem (180 mg/day) and propranolol (60 mg/day) for 1 month each. Each patient performed multistage symptom-limited treadmill exercise tests during each period of administration. There was no significant difference in maximal exercise duration between placebo, diltiazem and propranolol. Diltiazem significantly decreased both systolic and diastolic blood pressure (BP) and heart rate at rest, during submaximal exercise at the same work load and maximal exercise. Propranolol produced similar changes in systemic BP and heart rate at rest and during exercise. However, the reductions in systolic BP, heart rate and pressure-rate product with diltiazem during exercise were smaller than those with propranolol at small doses, suggesting that diltiazem in its usual therapeutic dose was almost devoid of beta-blocking activity. Thus, diltiazem may be of benefit to hypertensive patients because it reduces systemic BP even during exercise. It is particularly useful when systemic hypertension occurs in association with coronary artery disease because of its effects of coronary artery dilatation and heart rate reduction.

Effects of nifedipine on left ventricular diastolic function in patients with asymptomatic or minimally symptomatic hypertrophic cardiomyopathy.

We investigated the effects of nifedipine on left ventricular diastolic function in 17 asymptomatic or minimally symptomatic patients with hypertrophic cardiomyopathy by simultaneously measuring left ventricular pressure and volume with a catheter-tipped manometer and biplane cineangiography. Studies were performed before and 20 minutes after sublingual administration of nifedipine (20 mg). Heart rates were held constant (79 +/- 12 beats/min, mean +/- SD) by right atrial pacing. Left ventricular volumes and instantaneous rates of left ventricular volume were derived from frame-by-frame (20-msec) analyses of left ventricular biplane angiograms. Left ventricular peak systolic pressure (from 122 +/- 21 to 108 +/- 13 mm Hg, p less than 0.01 vs. control) and mean aortic pressure (from 96 +/- 15 to 87 +/- 11 mm Hg, p less than 0.01) decreased significantly with nifedipine. With afterload reduction, left ventricular ejection fraction (from 0.69 +/- 0.12 to 0.74 +/- 0.08, p less than 0.01) and cardiac output (from 6.4 +/- 2.0 to 7.2 +/- 2.2 l/mm, p less than 0.05) increased significantly. However, there was a slight but significant increase in left ventricular end-diastolic pressure (from 15 +/- 8 to 18 +/- 8 mm Hg, p less than 0.05). Nifedipine did not improve left ventricular relaxation as assessed by the time constants of isovolumic pressure decay (t1/2, from 39.8 +/- 6.6 to 39.4 +/- 7.7 msec, NS; t1/e, from 53.8 +/- 9.0 to 54.4 +/- 10.7 msec, NS).(ABSTRACT TRUNCATED AT 250 WORDS)

Aneurysm of the left aortic sinus caused by Takayasu's arteritis: Compression of the left coronary artery producing coronary insufficiency

A 45 year old Japanese woman with an aneurysm of the left aortic sinus is described. The main trunk of the left coronary artery was displaced upward, and the proximal portion of the circumflex branch was markedly compressed and displaced posteriorly, causing subendocardial infarction and angina. The diagnosis of Takayasus arteritis was made based on: 1) age, sex and nationality of the patient; 2) inflammatory signs followed by weakness of the right radial pulse; and 3) typical angiographic findings. Five previously reported cases are reviewed.

Vasospastic angina in thyrotoxicosis--case reports.

We encountered 2 patients with thyrotoxicosis accompanied at its onset by progressive angina. The ST segment was elevated in one patient and depressed in the other patient during the spontaneous attacks. Coronary arteriographic findings were normal during control, and spasm was induced by ergonovine. No patients had chest pain even without antianginal medication after successful treatment of thyrotoxicosis. The coronary artery may become sensitive to spasm during thyroid hormone excess even in cases without significant coronary artery disease and previous chest pain.

Swallow syncope after aneurysmectomy of the thoracic aorta

SummaryA case of swallow syncope is presented and 30 previously reported cases from the literature in English are reviewed.A 67-year-old male developed syncope on swallowing 3 months after the resection of an aneurysm of the descending thoracic aorta. Electrocardiographic monitoring during eating demonstrated sinus bradycardia and sinus arrest with loss of consciousness. Neither Valsalvas maneuver nor carotid massage could produce bradycardia or syncope. Intravenous administration of edrophonium produced sinus bradycardia and the drinking of water by the patient after edrophonium administration brought about sinus bradycardia and sinus arrest with loss of consciousness. Sinoatrial node and atrioventricular node functions, evaluated by an atropine test, overdrive suppression test, and His bundle electrocardiogram were normal. No pathological changes were observed following a barium swallow. The patient was treated with a permanent pacemaker.

Incidence and Clinical Course of Right Ventricular Infarction: Assessment with Radionuclide Ventriculography

The incidence and prognosis of right ventricular infarction were studied by radionuclide ventriculography (RNV) in 50 consecutive cases of acute myocardial infarction. RNV was performed within thirty-six hours of symptoms and one month after onset. Right ventricular infarction was absent in all 25 patients with anterior infarction. It was found in 15 of the 25 patients with inferior infarction, accompanied by a marked reduction in right ventricular ejection fraction (28 ± 8%), but was notably alleviated one month later with normalization of right ventricular ejection fraction (39 ± 7%) and wall motion. These phenomena seem to be specific in right ventricular infarction.

Successful Treatment of Acute, Severe Aortic Regurgitation Caused by Takayasu's Arteritis: A Case Report

Acute, severe aortic regurgitation due to dilatation of the aortic root was studied in a 16-year-old Japanese female with Takayasus arteritis. The patient was admitted because of acute pulmonary edema followed by systemic illness characterized by fever, anorexia, and general fatigue. The echocardiogram and aortogram demonstrated acute, severe aortic regurgitation due to dilatation of the aortic root. She was successfully treated with aortic valve replacement and steroid. Microscopic examination of the aortic wall demonstrated granuloma tous lesions with multinucleated giant cells. Now, three years later, she remains asymptomatic and hemodynamically stable.

Acid-base disturbance in patients with fulminant hepatic failure.

SummaryForty-two arterial blood pH and gas determinations were carried out on 11 patients with fulminant hepatic failure. The most common type of acid-base disturbance was that of respiratory alkalosis in 22 cases (52.4%). This was partially compensated in 13 subjects (31.0%) while an accompanying metabolic alkalosis was present in 9 (21.5%). Partially compensated metabolic acidosis was observed on 15 occasions (35.7%), all of which were in patients with laboratory evidence of impaired renal failure. The mental status of the patients was evaluated in each of the categories of acid-base disturbances. Some degree of correlation was evident between the PCO2 and the magnitude of base excess and that of the severity of the encephalopathy. The lower PCO2 and greater negative base excess values tended to be nearly always present in totally comatose subjects. By contrast, there was no clear cut relationship between blood pH and mental state.

A study on the relationship between the prognosis of chronic active hepatitis and the HBV associated antigen/antibody systems

SummaryThe relationship between the prognosis of the disease based on liver histology and HB virus (HBV) associated antigen/antibody systems was investigated in twenty seven patients with chronic active hepatitis (CAH). These patients were followed up over extended periods with mean duration of 44.3 months. On initial liver biopsy five of twelve patients with CAH with spotty or focal necrosis were HBs antigen (HBsAg) positive, as were also five of six patients with sublobular necrosis and six of nine patients with lobular disorganization. Most of the HBsAg negative patients were anti-HBs or anti-HBc positive: HBV associated antigen or antibody was completely undetectable in only three of the twenty seven patients. There was no difference in the frequency of progression to liver cirrhosis (LC) between the sixteen HBsAg positive and the eleven HBsAg negative patients with CAH. On the other hand, progression to LC occurred in only one of seven HBe antigen (HBeAg) negative patients, compared to four of nine HBeAg positive patients, who were HBsAg positive. There were four patients who were HBeAg positive initially but then became HBeAg negative in the course of observation. LC developed in two of these four patients.These results suggest that in HBsAg positive patients with CAH the presence or absence of HBeAg and the variation in its level can provide useful indicators of the prognosis of the disease.

Erythropoiesis in long-term hemodialysis patients

長期透析患者における腎性貧血改善機序は明確にされていない. 腎性貧血が改善した症例と腎性貧血が持続している症例での造血能と造血能関連因子の差違について検討し, 腎性貧血の原因を考えてみた. 対象は非透析慢性腎不全患者5例 (1群), Ht値が20-29%の血液透析患者9例 (2群) とHt値が40%以上となった血液透析患者5例 (3群) の計19例である. 対象患者と腎不全, 貧血がない対照を同時に骨髄穿刺し, erythroid burst-forming unit (BFU-E) とerythroid colony-forming unit (CFU-E) をIscoveらの変法で測定した. 1群と3群のBFU-EとCFU-Eは血清無添加時, 患者骨髄細胞に対照血清添加時, 対照骨髄細胞に患者血清添加時の3条件共対照骨髄細胞に対照血清添加時 (コントロール) のBFU-E, CFU-Eと変わりなかった. じかし, 2群ではBFU-EとCFU-E共に患者血清添加時には著明に低下し, 患者骨髄細胞に対照血清添加時はコントロールと変わりなかった. 全例におけるBFU-EとCFU-EはHbやHtとは正の相関を, BUN, Cr, ribonucleaseとは負の相関を示した. 血清エリトロポエチンは3群間で有意な差はなく, Hb, Ht, CFU-E, BFU-Eとの相関はなかった. 2群のribonucleaseは3群に比較し有意に増加していた. 以上より長期血液透析患者の貧血の重症度は造血能抑制因子の多寡により決定されていると考えられ, 患者骨髄細胞には異常なく, 血清エリトロポエチンの影響は少ないと思われた. 造血能抑制因子として種々の分子量のuremic toxinが関与しているが, 透析可能な小分子量のuremic toxinも重要な因子であると思われた.