Teruo Hiyama

Exercise training in female patients with a family history of hypertension

Abstract The purpose of this study was to determine whether there are differences in the effects of exercise training between those with a parental history of hypertension and those without such a history. A group of 39 middle-aged hypertensive women were submitted to a 4-month exercise training programme. On the basis of their family histories, 18 individuals were classified as those having a positive parental history of hypertension (group P) and 21 individuals as those without such a history (group N). Both groups participated in a supervised training programme with the intensity set at the level producing the threshold lactate concentration for 90–120 min twice a week, together with self-determined aerobic exercise three times a week. Vital age was estimated to determine the health-fitness status. At the end of the training, group N exhibited reductions in the systolic and diastolic blood pressures at rest (12.6/8.0 mmHg) and increases in the peak oxygen uptake [V˙O2peak 21.1 (SD 5.2) vs 25.2 (SD 5.7) ml · kg−1· min−1] and oxygen uptake corresponding to lactate threshold [13.7 (SD 2.4) vs 17.0 (SD 2.0) ml · kg−1 · min−1; P < 0.05]. Group P also showed reductions in the resting blood pressures (8.9/2.9 mmHg; P < 0.05), with no change in V˙O2peak (P > 0.05). There were no changes in the blood lipid and haematocrit variables in either group. The vital age decreased by approximately 4 and 7␣years (P < 0.05) for groups P and N, respectively. These results would indicate that exercise training is a useful, nonpharmacological tool for the treatment of essential hypertension, especially in patients with no family history of arterial hypertension.

Assessment of exercise-induced alterations in body composition of patients with coronary heart disease*

SummaryThe porpose of this study was to determine the effects of exercise habituation on body composition and anthropometric characteristics in cardiac patients. The subjects, comprising 20 patients with coronary heart disease, aged 43–69, participated in our supervised exercise programme for 38.0 (SD 12.5) weeks while in hospital. The intensity of most exercise was set at the lactate threshold. Analyses of the data indicated that small but significant reductions were observed in body mass (mb) [−1.4 (SD 1.8) kg], abdominal girth [−1.4 (SD 2.6) cm], chest girth [−1.3 (SD 1.8) cm], body mass index [−0.6 (SD 0.7)], and skinfold thicknesses at all the sites measured. As expected, fat-free mass, derived from either bio-electrical impedance (BI) or a skinfold technique with commonly used regression equations, remained essentially unchanged, while there were significant decreases in body fat (BF) and %BF. The absolute amount of change in mb (i.e. Δmb) was significantly associated with Δabdominal girth (r=0.506), ΔBF estimated by the BI technique (r=0.476), and ΔBF estimated by the skinfold technique (r=0.451). Although the period of the exercise programme [38.0 (SD 12.5) weeks] varied greatly among subjects, it was found not to be associated with Δmb and alterations in body composition. We concluded that aerobic exercise induced significant decreases in BF and many anthropometric variables, independent of the duration of exercise, and that a combination of abdominal girth, BI and/or skinfold measurements would be advantageous in estimating primarily exercise-induced alterations in BF in cardiac patients.

A Case of 24 Years Longevity of an Ionescu-Shiley Bioprosthesis in the Mitral Position:

Valve dysfunction, attributed to primary tissue failure several years after implantation of Ionescu-Shiley bioprostheses, has led to re-operation in most cases. We report a rare case of this bioprosthesis showing stenosis and regurgitation after implantation in the mitral position 24 years previously. No cusp tears, but severe calcification and well-grown neointima over the Dacron cloth of the inner surface were observed. This may explain how the valve functioned for such a long period of time. We replaced it with a Carpentier-Edwards pericardial bioprosthesis.

Severe Hemolysis after Mitral Valve Plasty: A Case Report of Reoperation with Mitral Valve Replacement.

症例は78歳女性.6年前に僧帽弁閉鎖不全症に対し,他院にてDuranリング使用で弁形成術を受けた.2年前から労作時息切れが生じしだいに増悪した.僧帽弁閉鎖不全は中等度であったが,著明な貧血が進行し,血清ハプトグロビンの著明な減少とLDH上昇により,溶血性貧血と診断した.溶血は進行性でLDH2,000以上となり貧血と相まって臨床症状も悪化した.逆流する血流がリングやプレジェットなどの人工物に当たり溶血していると判断し,保存的に改善は不可能と考え再手術を行った.術中所見では,術前診断のとおりでリングの一部は組織から遊離し,内皮で覆われていなかった.25mmのCarpentier Edwards牛心嚢膜生体弁による弁置換術を行い,経過良好で退院し,溶血は消失した.僧帽弁閉鎖不全症に対する弁形成術後の再手術には,原疾患進行による閉鎖不全再発,高度溶血などの理由が報告されている.若干の文献的考察を加えて報告する.