Tomoyuki Katayama

Serum zinc concentration in acute myocardial infaction.

The serum zinc concentration was examined in 61 patients with acute myocardial infarction who were admitted within twenty-four hours after the onset. Forty-two of 61 patients were admitted within twelve hours. The zinc level fell sharply as early as within three hours after the onset. The minimum values were attained two or three days after infarction and then rose to normal values within five to ten days. There was a mild degree of change and early recovery in 9 patients who underwent major abdominal surgery. The pathologic factors that could influence these two conditions are discussed. In those patients whose serum zinc concentrations were remarkably lowered, clinically estimated severity was far graver, and prognosis seemed to be much worse. It should be asked whether zinc supplementation would be of therapeutic benefit to patients with acute infarction.

Detection of myocardial infarction extension or reattack by serum myoglobin radioimmunoassay

We evaluated serum myoglobin levels in patients with acute myocardial infarction and investigated their diagnostic significance on episodic reattack on the course of acute infarction. Myoglobin was measured by radioimmunoassay, and the upper limit of normal was 50 ng/ml. Raised myoglobin levels were present in 52 of 53 patients (98%) with documented acute myocardial infarction admitted within 12 hr and in 16 of 20 patients (80%) admitted between 12 and 24 hr after the onset. Maximal values occurred 11.1 +/- 5.0 (mean +/- SD) hr and returned to the normal ranges 1.6 +/- 1.1 days after the onset. Because of its early normalization and high sensitivity to new necrosis, myoglobin might be a useful biochemical marker for diagnosis of infarct extension or reattack. Forty-seven episodic reelevations were classified into three groups (definite, probable and possible) according to the rating system indicating reattack of myocardial infarction. The incidence of definite and probable reattack or extension was 21%, and possible 19%. Reelevation of serum myoglobin occurred on an average of 5.0 days after the initial attack, within the first 3 days in 53% and on the second day in 31%. These results might suggest that an unexpectedly large cohort of myocardial infarction shows reattack in its early days of initial suffering.

Pure infundibular pulmonary stenosis induced by radiation therapy. A case report

A sixty-one-year-old woman developed acquired infundibular pulmonary stenosis eleven years after radiation therapy to the mediastinum. On catheteri zation, there was a 48 mmHg gradient between the right ventricle and the pul monary artery. Postmortem examination revealed remarkable narrowing of infundibulum. Histologic examination strongly suggested that muscular hyper trophy of the right ventricular outflow tract had been induced by a high dose of radiation therapy.

Restrictive cardiomyopathy following acute myocarditis : a case report

A fifty-five-year-old man developed intractable heart failure four weeks after upper respiratory infection. His central venous pressure was as high as 300 mmH2O. Two-dimensional echocardiogram revealed no muscular hypertrophy of the ventricles, no pericardial thickness, and no pericardial effusion. On catheterization, hemodynamic data were compatible with restrictive cardiomyopathy. Transvenous endomyocardial biopsy of the left ventricle was performed. Histologic examination strongly suggested that cardiomyopathy developed after acute myocarditis.

Clinical significance of initial systolic hypertension after myocardial infarction

To clarify the clinical significance of acutely raised systolic blood pressure (SBP) after myocardial infarction, 60 patients who were admitted within six hours after onset were studied. Initial systolic hypertension was shown in 26.6% of patients. Time-corresponding plasma epinephrine and norepinephrine levels were abnormally high in 61% and 86% of patients respectively. These high values of catecholamines were not, however, specific to systolic hypertension. On the contrary, an inverse correlation was observed between systolic blood pressure and plasma epinephrine value. It appeared that the anxiety and stress of chest pain do not contribute to raising blood pressure through catecholamine liberation. In the high pressure group (SBP ≥ 160 mmHg), only 3 of 16 patients were classified into severer grades (III or IV) of Killips classification. This proved to be statistically significant. A similar result was obtained in Lowns grading. Only 1 of 16 patients showed severe ventricular tachyarrhythmia. It appeared obvious from these data that patients who showed initial systolic hypertension are well protected from severe congestive heart failure and from life-threatening ventricular tachyarrhythmia in acute myocardial infarction.

An Autopsy Case of Long Survival with Intermediate Type of Endocardial Cushion Defect—A Case Report

Endocardial cushion defect is a complicated anomaly that involves the atrial and ventricular septa and atrioventricular valves. The condition varies widely from ostium primum atrial septal defect to common atrioventricular (AV) canal, and because of its complicated anomaly, survival beyond the sixth decade is extremely rare among patients with intermediate and complete types.’~ This presentation describes a patient with intermediate-type endocardial cushion defect who survived to the age of fifty-one.

Pure infundibular pulmonary stenosis induced by radiation therapy

は じめに: 従来,心 臓は放射線に対 して抵抗 性があ り,障 害が起 こ りに くい臓器 とされてい た1).し か し近年,照 射量や対象疾患の増加に伴 い,放 射線治療後の心疾患の報告が注目されてい る1).放射線による心疾患 としては心外膜炎2)が比 較的 よく知 られているが,心 内膜 ・心筋の肥厚性 変化の報告は極 めて少ない.す なわ ち,1983年 Wardaら3)が 線維性肥厚による弁性狭窄(大 動脈 弁)を 第1例 として報告 してお り,ま た心筋の肥 厚性変化 としては,1986年Velebitら4)が 手術例で はあるが,放 射線治療後に認められた右室流出路 狭窄例を世界最初の例 として記載 している.わ れ われは最近経験 した1例 を剖検所見を含めて報告 す る. 症例: 61才,女 性.主 訴: 失神発作.現 病 歴:幼 少時 より心雑音や心不全症状を示した こ とはな く,ま た,30才 で肺結核に罹患 し,大 学病 院に入院したが当時のカルテにも心雑音の記載は ない.35才 の時左乳癌の定型乳房切断徳と,同 部 の6000radの 術後照射を うけた.そ の後順調で41 才までは8階 の職場まで毎日エレベーターを使わ ずに階段を登 るほどの運動能力があった.46才 よ り労作時の胸痛 と呼吸困難が出現するよ うにな り 総合病院を受診,こ の時初めて心雑音 と心拡大を 指摘 された.そ の後症状増悪 し52才時,失 神発作 のため当科入院,後 天性肺動脈漏斗部狭窄症 と診 断された. 入院時現症: 脈拍毎分92整,末 梢静脈圧245 mmH20と 高値を示 した.第3肋 間に4/IV度 の駆 出性雑音のほか肝腫大 と著明 な腹 水が認め られ た. 検査成績: 心電図は完全右脚 ブロック,心 エ コ-図 では多量 の心膜液 を認め穿刺液は血性で