Hiroki Akamatsu

Response of right ventricular systolic function to exercise stress: Effects of pulmonary vascular resistance on right ventricular systolic function

To elucidate factors influencing responses of right ventricular systolic function to exercise stress, we evaluated the right ventricular ejection fraction and peak ejection rate with two different loading conditions, atrial septal defect and mitral stenosis, at rest and during exercise by means of gated equilibrium blood pool radionuclide ventriculography. In both atrial septal defect and mitral stenosis, strong correlations between changes in the right ventricular ejection fraction with exercise and pulmonary vascular resistance at rest (r = −0.97, p < 0.001; r = −0.86, p < 0.0005: respectively) were found. Significant correlations between changes in the right ventricular peak ejection rate with exercise and pulmonary vascular resistance at rest (r = −0.85, p < 0.05; r = −0.75, p < 0.01: respectively) were found in atrial septal defect and mitral stenosis. Both the right ventricular ejection fraction and peak ejection rate were lower during exercise than at rest when pulmonary vascular resistance at rest was more than 200 dynes·sec·cm−5·m2 in both atrial septal defect and mitral stenosis. In conclusion, right ventricular systolic function responding to exercise stress was influenced by the pulmonary vascular resistance in both atrial septal defect and mitral stenosis.

A Case of Intussusception due to Carcinoma of the Sigmoid Colon in Association with Water-electrolyte Imbalance and Severe Hypoproteinemia.

成人の腸重積症は全体の約5%を占めまれである.臨床症状としては腹痛, 腹部膨満, 下血などが多い.今回われわれは多量の粘液下痢のために水分電解質異常および著明な低蛋白血症を呈したS状結腸癌による腸重積の1例を報告した.症例は64歳の男性.入院時多量の粘液下痢による脱水のために全身状態は不良であった.下痢が消失した後に施行したS状結腸内視鏡では明らかな病変を認めず, 外来で経過観察していた.3か月後に同様の症状にて再入院.大腸内視鏡検査にてS状結腸癌による腸重積と診断しS状結腸切除術を施行した.腸重積で粘血便が主訴となることは多いが, 自験例では重積部位が肛門に近く多量の粘液が結腸による再吸収を受けずに体外に排出され, 大腸絨毛性腫瘍におけるdepletion syndromeに似た病態を呈したものと考えられる.重積時には内視鏡検査により容易に診断されるが, 本症例のように自然解除した場合には注意が必要である.