Hideo Tsuneyoshi

Prediction of pulmonary arterial pressure in adults by pulsed Doppler echocardiography.

Doppler echocardiography was used to estimate pulmonary artery (PA) pressure in 45 adult patients with various kinds of heart disease and the patterns were compared with those of 32 normal control subjects. Doppler signals obtained in the right ventricular (RV) outflow tract just proximal to the pulmonary valve and electrocardiogram were recorded simultaneously. Doppler velocity time intervals were measured as follows: RV preejection period, acceleration time from the onset of the RV ejection flow velocity to the peak, and RV ejection time. Thirty patients had PA hypertension and 16 patients had a low cardiac index. The best correlation with PA pressure was achieved by the RV preejection period/acceleration time index (r = 0.89 vs mean pressure). Sensitivity and specificity for predicting PA hypertension were 93% and 97%, respectively. Acceleration time correlated best with the logarithm of PA mean pressure (r = 0.88). Patients were separated into 2 groups according to cardiac index. In those patients with a cardiac index of less than 2.5 liters/min/m2, both RV preejection period/acceleration time and acceleration time were significantly correlated with PA mean pressure (r = 0.87) and log (PA mean pressure) (r = -0.87), respectively. However, the slope of the regression line for acceleration time and log (PA mean pressure) was significantly steeper than that for patients with a cardiac index of greater than or equal to 2.5 liters/min/m2 (p less than 0.05), whereas the relation between RV preejection period/acceleration time and PA mean pressure in the 2 groups could not be differentiated statistically from each other. Other intervals and ratios were less quantitative because of late systolic turbulent flow and individual variability.(ABSTRACT TRUNCATED AT 250 WORDS)

Familial Amyloid Polyneuropathy with Marked Hypertrophy of the Peripheral Nerves

Autopsy findings in a 40‐year‐old male with heredofamilial amyloidosis and polyneuropathy are reported. He had been suffering from progressive autonomic as well as sensorimotor dysfunctions. Prominent amyloid deposit was found in the kidney, heart, thyroid, and testis, and less in the interstitium and small vessels of almost all organs. The peripheral nerves, some showing prominent hypertrophy, were most severely involved by amyloid deposit in a form of stellate mass, which ultrastructurally consisted of radially arranged amyloid filaments. In the hypertrophied nerves and ganglia, in addition to amyloid, massive accumulation of acid mucopolysaccharide (AMPS) was seen filling up the interstitial space, which was the cause of hypertrophy. Ultrastructurally, AMPS was seen as finely granular substance. An extracted amyloid from the kidney showed 8 nm filament on negative staining and was estimated of having a molecular weight of 14,000.

Comparison of functional responses of canine coronary artery and saphenous vein.

SummaryFunctional responses of canine circumflex coronary arteries and saphenous veins before and after grafting surgery were assessed following physiologic and pharmacologic intervensions. Developed tension of ringed segments of vessels was recorded isometrically. Dose-dependent responses to norepinephrine revealed significantly greater responses of saphenous veins than coronary arteries (maximal responses were 2.79±0.45 and 0.44±0.34 g, respectively; p<0.001). Sensitivity to norephinephrine [as evaluated by 50% effective dose (ED50) value] was 3.3 times greater in the saphenous veins (p<0.001). STA2, a synthetic thromboxane A2 analog (see Methods), produced similar contractions of both vessels [maximal responses were 2.13±0.37 g in saphenous vein and 1.64±0.85 g in coronary artery; p < not significant (NS)], while sensitivity to STA2 of saphenous veins was 3.1 times greater than that of coronary arteries (p<0.001). In contrast to the foregoing responses, coronary arteris demonstrated significantly greater responses to potassium than saphenus veins (maximal responses were 2.16±0.71 g and 1.40±0.56 g, respectively; p<0.001). Moreover, coronary arteries revealed 1.6 times greater sensitivity than saphenous veins (p<0.001). When saphenous veins were transplanted into the femoral artery, the segments of the grafts (2 weeks or 3 months after surgery) revealed 4.0 and 1.7 times greater sensitivity (denervation supersensitivity) to norepinephrine and potassium than those of the control veins (p<0.01, respectively). Contractile tension response, however, decreased by at least 50% 3 months after surgery, most probably due to a thickened vessel wall and a reduced compliance. Thus, the functional characteristics of the saphenous vein, which were totally different from those of the coronary artery, seemed to be preserved even after grafting except for denervation supersensitivity, which may modify the differences between the two vessels. Those differences may be relevant to the control of the coronary circulation after coronary bypass surgery.