Jiro Sugai

Range of ventricular ectopic complexes in healthy subjects studied with repeated ambulatory electrocardiographic recordings

The incidence and forms of ventricular premature complexes (VPCs) in apparently healthy subjects were studied to determine long-term reproducibility of day to day variation on Holter electrocardiogram. The study included 152 men and 68 women ranging in age from 20 to 78 years who were having routine check-ups that revealed no cardiovascular abnormalities. In addition to routine measurements, Holter electrocardiography was recorded during daily life, and the total number of VPCs occurring during 24 hours was visually calculated on replayed electrocardiographic tracings. Forms of VPCs and incidence of VPCs in 10-year age groups of the subjects were also recorded. No VPCs were observed in 56% of the subjects; 93% showed less than 50 VPCs and the other 7% of the 220 subjects had greater than or equal to 50 VPCs. Forty-one of the 220 subjects returned for routine follow-up 1 year later. Repeated Holter electrocardiograms at this time showed high reproducibility of less than 50 VPCs. A small number of multiform VPCs were reproducible but paired VPCs were not. Physiologic definition of VPCs in healthy subjects appears to be clinically significant.

Magnesium Content of Erythrocytes in Patients with Vasospastic Angina

SummaryThe possibility that a magnesium deficiency might be the underlying cause of vasospastic angina (VA) and the efficacy of Mg administration in its treatment were studied. Subjects included 15 patients with VA and 18 healthy subjects as the control group. The erythrocyte Mg content was measured by atomic absorption, and serum Mg was measured by conventional chemical assay. The efficacy of Mg administration was studied in seven patients with VA. The results were as follows: a) The mean erythrocyte Mg content was less in the group with frequent episodes of angina (1.59 ± 0.11 mg/ dl) than in the group without angina (2.11 ± 0.38 mg/dl, p < 0.01) and in the control group (2.22 ± 0.29 mg/dl, p < 0.01). There was no significant difference between the control group and patients of each group with respect to serum Mg. b) Coronary arterial spasm was induced by ergonovine maleate in seven patients and was completely inhibited by the administration of Mg sulfate (40–80 mEq, hourly) in six of these patients; in the remaining patient neither obvious ST change nor chest pain occurred. Thus, it was concluded that the measurement of erythrocyte Mg content is useful to determine how easily vasospasm might occur in VA and that the administration of Mg might be developed as a new therapy for spasm associated with a low erythrocyte Mg content.

A clinicopathological study of asymptomatic primary biliary cirrhosis in three aged patients

SummaryThe 3 cases suffering from asymptomatic primary biliary cirrhosis (aPBC) were all older than 70 and female. Case 1, 2 and 3 were respectively 77, 72 and 70 years old. The final diagnosis was made on the basis of clinical observation and liver biopsy. Case 1 was diagnosed as CAH-PBC mixed type from histological findings and classified as stage II-III according to Scheuer’s classification. Case 2 was stage I and exhibited morphological features of PBC with arteriosclerotic change. Case 3 was stage I and had dysplasia-like large nuclei in some hepatic cells. Clinically, all cases were AMA positive. Elevation of serum ALP and IgM values was recognized in 2 cases, but serum transaminase and ALP values were not elevated in Case 2 for 1 year. In the follow-up observation during 5 years, Case 1 remained asymptomatic except for gradual elevation of serum ALP value. AMA, which was positive at the time of diagnosis, is now negative after 5 years, but now produces high potency ANA. The incidence of PBC in those aged older than 70 in Japan accounts for only 2–3% of all PBC cases. According to some reports, the prognosis of PBC deteriorates with age. In 3 cases reported here, however, the clinical course did not deteriorate even in untreated cases. This suggests the possibility that some aPBC cases diagnosed at an age older than 70 may have a favorable prognosis.

Studies on sialyltransferase in serum from patients with rheumatoid arthritis.

In order to clarify the specificity of serum sialyltransferase in patients with rheumatoid arthritis (RA), we studies the serum which was free of platelet components, by isoelectric focusing. Isoelectric focusing was performed using isoelectric focusing apparatus (110 ml capacity) . 2.5% ampholine (pH 3-10) were used in a gradient of 0-50 w/v% sucrose. The starting amperage was 3.0mA and 800V. After 23 hours the voltage was adjusted to 1400V. Electrofocusing was conducted for 47 hours at 0-1°C. After electrofocusing 2.0-ml fractions were collected. 30-μl aliquots of each fraction were assayed for asialofetuin sialyltransferase activity using CMP- (9-3H) sialic acid as substrate. Isozymic forms were showed at pI 4.20, 4.65, 5.10, 6.20 and 6.80 in serum from patient with RA. Platelet lysate showed a large peak of ST activity at pI. 6.20.Concludingly, we found by isoelectric focusing that acid ST isozymic forms were in serum and that platelet-derived ST (pI 6.20) was contaminated in circulating plasma.

Atrial Contribution in VVI Pacing

Frequency of at random atrio-ventricular (A-V) sequence in VVI pacing was studied by using a simulated model and by applying 24-hour Holter ECGs for 12 paced patients with complete A-V block. A ratio of the number of QRS complexes preceded by P waves to the total number of QRS complexes (atrial contribution rate, ACR) was calculated. ACR was also calculated as a ratio of T-R interval to P-P interval when atrial rate was fixed. Under ventricular pacing at rate of 70/min and T-R interval of 500 msec, ACR was 46%, 62%, 74%, 79%, 87% and 94% at atrial rate of 59/min, 78/min, 88/min, 97/min 107/min and 117/min, respectively. On the exercise model, ACR was calculated as 61% to 81%. In the paced patients, maximal ACR of the day ranged from 47% to 93% with a mean of 72 ± 14%, minimal ACR ranged from 24% to 50% with a mean of 39 ± 8%, and mean ACR of the day ranged from 40% to 63% with a mean of 51 ± 7%. Higher ACR was seen in the daytime. Thus, at random A-V sequence occurs at substantial rates, especially during exercise. Nevertheless, atrial contribution should not be overemphasized in the majority of cases, as it is not a major factor in keeping cardiac output equal to hemodynamic demands.