Shuji Kashiro

Prognostic value of Doppler transmitral flow velocity patterns in acute myocardial infarction.

Doppler transmitral flow patterns are partially dependent on age. We investigated the correlations between the age-adjusted transmitral flow patterns, hemodynamic indexes, and the coronary and clinical outcome in 206 patients with acute myocardial infarction (AMI) and 102 normal control subjects. The peak flow velocity at atrial contraction was significantly lower in 50 of the 206 patients (24%) (low-A group) than in the 102 normal controls. Pulmonary capillary wedge pressure was significantly higher in the low-A group than in the remaining 156 patients with AMI (20 +/- 7 vs 11 +/- 5 mm Hg, p <0.001), and the cardiac index and left ventricular ejection fraction were significantly lower (2.2 +/- 0.6 vs 2.9 +/- 0.7 L/min/m2, p <0.001; 38 +/- 15% vs 52 +/- 13%, p <0.001). The incidence of cardiogenic shock was significantly higher in the low-A group than in the other patients with AMI (42% vs 19%, p <0.001). Regression analysis demonstrated a significant association between decreased atrial filling velocity and increased in-hospital mortality as well as the incidence of heart failure in AMI (p <0.001). The 5-year mortality rate was also significantly higher in the low-A group (p <0.001). The age-adjusted transmitral flow pattern in AMI can identify patients with left ventricular dysfunction, which can lead to a poor prognosis.

Rectal administration of perforated nifedipine capsules to maintain an effective level of longer duration

Masamichi Ishikawa, M.D., Naji Yokota, M.D., Akio Sawazaki, M.D., Shuji Kashiro, M.D., Shunkichi Hirata, M.D., Michio Okada, M.D., and Kyozo Ishikawa, M.D. Tokyo, Japan longitudinally with an l&gauge injection needle (Fig. 1). In both groups, the plasma level of nifedipine was measured at 15 minutes, 30 minutes, 1 hour, 2 hours, 4 hours, and 8 hours after drug administration. The blood pressure and heart rate were monitored for 6 hours after drug administration. Based on the results obtained in the healthy volunteers, similar investigations were undertaken in the patients with angina pectoris. Each patient was given 10 mg nifedipine orally four times a day (after every meal plus at 9:00 P.M.). The plasma level of nifedipine was measured at 5:00 and 7:00 A.M. the next morning. In addition, under the same conditions, the nighttime dose was administered rectally instead of orally, and the plasma level of nifedipine was measured similarly. The plasma nifedipine levels were determined by gas chromatography using a non-radioactive electron capture detector (Yanaco G 2800-EN, Tokyo, Japan). The minimum detectable concentration was 0.5 rig/ml. Statistical analysis was performed by the paired t test. All values are expressed as the mean + 1 standard deviation.