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• [Carbonic anhydrase]

  Authors: Y Ono, Y Ohta

  Kokyu to junkan. Respiration & circulation. 41(12):1139-45.

• [Management for deep venous thrombosis]

  Authors: S Ishimaru

  Kokyu to junkan. Respiration & circulation. 41(12):1155-8.

• [Determining factors of successful percutaneous transvenous mitral commissurotomy and eligible indications for the procedure]

  Authors: K Kebukawa, N Magosaki, K Sakai, J Umemura, T Ueda, H Kimura, C Hidai, T Suzuki, H Kasanuki, S Hosoda

  Kokyu to junkan. Respiration & circulation. 41(12):1165-71.

  The aim of this report is to investigate the factors which influence mean left atrial pressure (LAP) after percutaneous transvenous mitral commissurotomy (PTMC) and the characteristics of patients inThe aim of this report is to investigate the factors which influence mean left atrial pressure (LAP) after percutaneous transvenous mitral commissurotomy (PTMC) and the characteristics of patients in whom PTMC is most effective. Fifty one patients with symptomatic mitral stenosis underwent PTMC. The patients included 8 males and 43 females, aged 26-66 years (mean age of 46). These patients were classified into two groups according to LAP after PTMC: 31 cases with LAP after PTMC of 12 mmHg or less (group A) and 20 cases with LAP after PTMC greater than 12 mmHg (group B). The patients of group A were younger (44 +/- 6 vs 48 +/- 6 years, p < 0.05), and had atrial fibrillation (af) less frequently (35 vs 65%, p < 0.05), and had mitral valve calcification less frequently (29 vs 65%, p < 0.01). Before PTMC, LAP (19 +/- 6 vs 23 +/- 5 mmHg, p < 0.01) was lower and mitral valve area (MVA) (0.95 +/- 0.24 vs 0.81 +/- 0.15 cm2, p < 0.05) larger in group A. Symptoms graded according to the New York Heart Association functional classification system were similar in both groups before PTMC. After the procedure, final MVA (1.79 +/- 0.69 vs 1.40 +/- 0.50 cm2, p < 0.05) was larger and systolic pulmonary artery pressure (32 +/- 9 vs 39 +/- 7 mmHg, p < 0.01) lower in group A. Mitral regurgitation > or = 3-grade tended to complicate more frequently (3 vs 20%, NS) in group B.(ABSTRACT TRUNCATED AT 250 WORDS)

• [The mechanism of pleural liquid transudation and absorption following a new hypothesis]

  Authors: T Mutsuda, N Tanida, Y Hukui, S Saitou, T Sugimoto, H Miki, S Kita, K Harada

  Kokyu to junkan. Respiration & circulation. 41(12):1177-80.

  We have put forward a hypothesis that the pleural fluid is filtered at the arterial ends of the pleural blood capillaries and is absorbed mainly at the venous ends, partly at the lymphatic channels,We have put forward a hypothesis that the pleural fluid is filtered at the arterial ends of the pleural blood capillaries and is absorbed mainly at the venous ends, partly at the lymphatic channels, as it is in the other tissues. Then we have calculated the pleural liquid pressure following the Starling equation applying the ordinary value of factors. The result is that the calculated pleural liquid pressure is low enough to expand the lung.

• [Effect of enalapril on left ventricular hypertrophy and left ventricular function in patients with hypertension]

  Authors: S Kakinoki, S Takechi, M Hashimoto, I Sakuma, A Nomura, A Kitabatake, H Yasuda

  Kokyu to junkan. Respiration & circulation. 41(12):1185-9.

  The aim of this study was to study the effect of enalapril (E) on left ventricular (LV) mass, LV function and blood renin-angiotensin (RA) in patients with hypertension. Sixteen hypertensives wereThe aim of this study was to study the effect of enalapril (E) on left ventricular (LV) mass, LV function and blood renin-angiotensin (RA) in patients with hypertension. Sixteen hypertensives were included in this study (WHO I 8, WHO II 8, 49.5 +/- 10.5 yrs). They were examined for blood pressure and heart rate. Chest X-ray film, echocardiography (echo), X-ray computed tomography (CT) and RA before and after about 6 months of E administration were studied. The LV mass was calculated by CT. The LV function was measured by echo. RAS was unchanged during this study. LV mass was significantly reduced after E (121.4 +/- 25.6 vs 104.6 +/- 13.7 g/cm2). The LV systolic function was unchanged after E, but LV diastolic function improved. It was shown that the long-term administration of E improves LV hypertrophy and LV diastolic function without any change of RAS.

• [A case of obstructive sleep apnea syndrome with increased lung water during sleep]

  Authors: S Ikeda, T Imamura, T Sawai, T Naitoh, M Ohta, S Hata, S Hamabe, Y Miyahara, T Yamasa, K Hara

  Kokyu to junkan. Respiration & circulation. 41(12):1197-200.

  A 22-year-old man was admitted to the department of plastic surgery in our university with diagnosis of ankylosis and microgeniea. His complaints were snoring and somnolence in the daytime, so weA 22-year-old man was admitted to the department of plastic surgery in our university with diagnosis of ankylosis and microgeniea. His complaints were snoring and somnolence in the daytime, so we performed a Respigraph (Chest) that showed obstructive apnea during sleep. We diagnosed obstructive sleep apnea syndrome. So we observed pulmonary circulation and measured lung water using the double indicator dilution method (Nihon Koden, MTV-1100) during sleep. During the period of apnea, arterial oxygen pressure and mixed venous saturation decreased, reversely, mean pulmonary arterial pressure rose, lung water (ETV) and central blood volume increased. We considered that the increase of lung water during sleep apnea is caused by hemodynamic change due to hypoxia and increase of venous return. After operation, the value of blood gas assay and apnea index were improved.

• [A case involving coronary dissection caused after PTCA that was observed with intravascular echocardiography]

  Authors: T Seo, Y Koya, K Yamao, T Hayashi, K Kawaguchi, C Kotake, T Toda, K Kobayashi

  Kokyu to junkan. Respiration & circulation. 41(12):1205-8.

  We encountered a case that was observed on coronary angiography (CAG) during coronary dissection after coronary angioplasty (PTCA) in which the dissected cavity disappeared on CAG but thrombolyticWe encountered a case that was observed on coronary angiography (CAG) during coronary dissection after coronary angioplasty (PTCA) in which the dissected cavity disappeared on CAG but thrombolytic obstruction in the dissected cavity could be observed by intravascular echocardiography (IVUS). A 67-year-old woman was admitted with a diagnosis of acute myocardial infarction with ST elevation when experiencing chest pain. PTCR was performed for obstruction of the left circumflex artery (LCX) and the stenosis was improved to 90 percent. One month later PTCA was performed on an obstruction lesion in LCX and the feature of the dissected section at the same site was observed by CAG after PTCA. CAG showed that the dissected cavity had disappeared a year and a half later, but IVUS indicated thrombolytic obstruction in the dissected cavity.

• [A case of long-standing isolated traumatic tricuspid regurgitation with remarkably dilated right cardiac chambers and pancytopenia]

  Authors: O Ono, K Yoneya, Y Makita, H Asajima, T Anzai, S Muramoto, T Kaji, T Ono, A Kitabatake

  Kokyu to junkan. Respiration & circulation. 41(12):1213-7.

  We report a rare case of tricuspid regurgitation due to nonpenetrating chest trauma 33 years previously. A 79-year-old man suffered a blunt trauma due to a piece of wood at work in 1958. He sufferedWe report a rare case of tricuspid regurgitation due to nonpenetrating chest trauma 33 years previously. A 79-year-old man suffered a blunt trauma due to a piece of wood at work in 1958. He suffered multiple rib fractures on the right side and was admitted. Since then, he began having shortness of breath on exertion and was treated with medication. The patient was transferred to the Division of Cardiology, Hakodate National Hospital in 1984. A chest x-ray film revealed a marked cardiomegaly. Cardiac catheterization showed severe tricuspid regurgitation. Hepatomegaly and pancytopenia was observed. He was readmitted because of general fatigue in July 1991. Two-dimensional echocardiography demonstrated systolic excursion of septal and posterior tricuspid leaflets with ruptured chordae tendineae into the right atrium, and a remarkably enlarged right ventricule, right atrium and vena cava interior. Cardiac catheterization was performed. The right atrial pressure-wave form resembled the right ventricular pressure recording (ventricularization of the atrial pressure). Right ventricular cineangiography revealed severe tricuspid regurgitation, grade 4. Laboratory data showed pancytopenia. Thrombocytopenia progressed (3 x 10(4)/mm3), and a hemorrhagic tendency developed. The liver edge was palpable 4 finger breadths below the right costal margin. Pancytopenia due to congestive hepatomegaly and hypersplenism would have complicated this case.

• [Left ventricular wall motion: basic concepts and clinical aspects]

  Authors: M Akaishi

  Kokyu to junkan. Respiration & circulation. 41(12):1128-38.

• [New technology in oxygen measurement]

  Authors: K Morita

  Kokyu to junkan. Respiration & circulation. 41(12):1147-53.

• [Pleural indentation]

  Authors: H Isobe

  Kokyu to junkan. Respiration & circulation. 41(12):1159-62.

• [A clinical study on asthmatic patients who were readmitted after a short period of discharge]

  Authors: R Oosaki, Y Mizushima, A Kawasaki, K Hoshino, K Nakagawa, M Kobayashi

  Kokyu to junkan. Respiration & circulation. 41(12):1173-6.

  We conducted a clinical study on asthmatic patients who were readmitted within three months of discharge. During twelve years (1979-1991), the number of patients who were readmitted within threeWe conducted a clinical study on asthmatic patients who were readmitted within three months of discharge. During twelve years (1979-1991), the number of patients who were readmitted within three months was 139 cases (209 episodes) in our department. Patients with respiratory diseases made up 53% of the subjects. Among patients with pulmonary disease who were readmitted within three months, the number of patients with lung cancer was 25 cases and that with bronchial asthma 24 cases. Within a month period, the number of readmitted patients with bronchial asthma was the largest 59% (19 cases) and the number of patients with lung cancer came second (4 cases). As for the characteristics of these asthmatic patients, the intrinsic type (15 cases), those with a history of over one year of the disease (20 cases), and those with steroid dependency (10 cases) were most commonly observed. Readmission occurred frequently between October and April. Readmission occurred frequently because of asthmatic attacks due to infection of reduction of steroid. Among asthmatic patients who were readmitted within one month, the disease severity was mild to moderate in 11 out of 19 patients, but there was a tendency for this to become intractable thereafter. It is impossible to prevent all patients from seeling readmission within a short period of discharge. However, we think the doctor's careful education of the patients is an important factor to reduce the early readmission rate of asthmatic patients.

• [Effect of continuous intravenous administration of midazolam and ketamine on respiratory pattern]

  Authors: S Satoh, K Hoshi, S Matsukawa, Y Hashimoto

  Kokyu to junkan. Respiration & circulation. 41(12):1181-4.

  The purpose of the study was to investigate the effect of continuous IV administration of midazolam and ketamine on respiratory pattern in six adult volunteers. Midazolam 0.05 mg/kg and ketamine 0.5The purpose of the study was to investigate the effect of continuous IV administration of midazolam and ketamine on respiratory pattern in six adult volunteers. Midazolam 0.05 mg/kg and ketamine 0.5 mg/kg were given, and then 0.1 mg/kg/hr for midazolam and 1 mg/kg/hr for ketamine were administered continuously. We measured MV, RR and TV (OMR86036), and calculated duty ratio and mean inspiratory flow at the level of 0 and 5 cmH2O CPAP during spontaneous respiration of air with and without 5% CO2. Each parameter was obtained before and 1 hr after the start of IV administration of the drugs. With 5% CO2, MV decreased significantly from 15.5 +/- 1.5 l/min to 11.7 +/- 0.8 l/min at 0 cmH2O CPAP level and from 15.8 +/- 1.8 l/min to 12.6 +/- 1.5 l/min at 5 cmH2O CPAP level, and also mean inspiratory flow decreased significantly from 590 +/- 2 ml/sec to 421 +/- 30 ml/sec at 0 cmH2O CPAP level and from 606 +/- 53 ml/sec to 477 +/- 48 ml/sec at 5 cmH2O CPAP level. TV decreased significantly during sedation at both CPAP levels with or without 5% CO2, while RR and duty ratio tended to increase. It was thought that, when the respiration was stimulated with 5% CO2, the decrease in mean inspiratory flow greatly contributed to the fall in MV during administration of midazolam and ketamine.

• [Effects of intravenous injection of ioversol, a nonionic contrast medium, on circulating blood volume: comparison among different combinations of its dose and volume injected]

  Authors: I Sakuma, K Sakuma, M Fukao, Y Akaishi, H Asajima, M Sato, H Shudo, K Numazawa, S Kakinoki, A Kitabatake

  Kokyu to junkan. Respiration & circulation. 41(12):1191-5.

  Effects on circulating blood volume (CBV) of the intravenous injection of a nonionic contrast medium, ioversol, with various doses were assessed in order to find a way of injection with less effectsEffects on circulating blood volume (CBV) of the intravenous injection of a nonionic contrast medium, ioversol, with various doses were assessed in order to find a way of injection with less effects on systemic circulation. Ioversol was injected as a bolus to 20 mongrel dogs at doses of A: 3.75 ml/kg (n = 8) or B: 2 ml/kg (n = 6) of a solution containing 320 mg iodine per ml, or C: 2 ml/kg (n = 6) of a 240 mgI/ml solution. Colloid oncotic pressure (COP) of the bloods drawn before and 1, 2, 3, 5 min after the injection of ioversol was measured by a needle type osmometer, and changes in CBV were calculated using the COP values. Upon injection of ioversol CBV increased rapidly and then gradually returned to the preinjection levels. The change in CBV induced by ioversol was significantly less than those reportedly induced by an ionic contrant medium, iothalamate, and a nonionic medium, iopamidol, and comparable to that by another nonionic medium, iohexol. The degree of increase in CBV and the blood concentration of ioversol were related to the amount, but not the volume, of ioversol injected. Thus, ioversol proved to be one of the low osmotic nonionic contrast media with less effects on CBV. Furthermore, it is suggested that the amount, rather than volume, of contrast medium should be taken into consideration when the angiography of the patients with reduced cardiac function, children or aged patients is performed in whom the contrast medium-induced CBV expansion needs to be as less as possible.

• [Transvenous pacemaker implantation for sick sinus syndrome with mirror-image dextrocardia]

  Authors: K Koyama, S Suzuki, K Fukui, S Odagiri, Y Yamada, K Takeuchi, M Munakata, H Koie

  Kokyu to junkan. Respiration & circulation. 41(12):1201-4.

  A case of sick sinus syndrome with mirror-image dextrocardia which was associated with bilateral superior vena cava and an absent inferior vena cava with azygos continuation is reported. AA case of sick sinus syndrome with mirror-image dextrocardia which was associated with bilateral superior vena cava and an absent inferior vena cava with azygos continuation is reported. A 45-year-old woman was referred to our hospital with the chief complaints of dizziness and palpitation. The electrocardiogram showed a atrial fibrillation with a 4-second period of asystole. A permanent endocardial bipolar demand pacemaker was inserted through the left superior vena cava. Since anomaly of venous system is commonly associated with mirror-image dextrocardia, the angiogram is necessary prior to permanent pacemaker implantation.

• [A case report of acute mid-graft occlusion of the left internal mammary artery to the left anterior descending artery after PTCA]

  Authors: H Takenaka, S Yamazaki, M Hongo, H Yamada, S Okubo, M Isobe, M Sekiguchi, M Harada

  Kokyu to junkan. Respiration & circulation. 41(12):1209-12.

  A 66 year-old woman underwent coronary artery bypass grafting for postinfarction angina. A left internal mammary artery graft was joined to the left anterior descending artery. Coronary and graftA 66 year-old woman underwent coronary artery bypass grafting for postinfarction angina. A left internal mammary artery graft was joined to the left anterior descending artery. Coronary and graft angiography revealed a 90% stenosis in the anastomotic site of the left internal mammary artery. During PTCA with a 2.0 mm balloon catheter, acute occlusion of the graft body occurred. Intragraft injection of isosorbide dinitrate failed to dilate the graft. Thus, careful consideration should be given to several complications such as acute occlusion of the graft when PTCA for anastomotic site of the graft is performed.

• [Coronary thrombolysis]

  Authors: K Kamimatsuse

  Kokyu to junkan. Respiration & circulation. 41(11):1033-42.

• [Antihypertensive drugs and prevention of myocardial infarction]

  Authors: H Matsuoka

  Kokyu to junkan. Respiration & circulation. 41(11):1059-63.

• [Study of suitable analyzed signal duration and criteria for abnormal signal averaged electrocardiogram on frequency-domain analysis in patients with Duchenne's muscular dystrophy]

  Authors: M Kubo, S Matsuoka, Y Ushiroguchi, K Tatara, Y Matsuka, Y Kuroda

  Kokyu to junkan. Respiration & circulation. 41(11):1073-8.

  We investigated the optimal condition to detect abnormalities on the fast-Fourier transformation of the signal-averaged electrocardiogram (SA-ECG) by studying the effects of analyzed signal duration,We investigated the optimal condition to detect abnormalities on the fast-Fourier transformation of the signal-averaged electrocardiogram (SA-ECG) by studying the effects of analyzed signal duration, attenuation of low frequency components by using filtering processing and the criteria for abnormal SA-ECG. Subjects were 23 patients with Duchenne's muscular dystrophy (DMD) and were divided into two groups by the presence of ventricular tachycardia (VT). Age-matched healthy volunteers were obtained as controls. Abnormal SA-ECG was identified from the data in the controls as over 97 percentile of H/L ratio. Frequency domain analysis from last 40 ms of QRS wave to 80 ms of ST segment was most capable to distinguish the DMD patients with VT from the patients without VT, compared to analysis from last 20 ms. Whereas, analysis from QRS onset failed to detect VT patients. Although filter processing reduce the power of low frequency and increase the H/L ratio, sensitivity for predicting VT was not enhanced significantly. In conclusion, the frequency-domain analysis during the terminal 40 ms of the QRS complex and 80 ms of ST segment was most optimal condition to distinguish the DMD patients with VT.

• [Comparison of standard-dose epinephrine and high-dose epinephrine in cardiopulmonary arrest outside the hospital]

  Authors: H Nishizawa, H Miyazaki, K Ogawa, S Takita, K Hashimoto, M Sugiyama, Y Okutsu

  Kokyu to junkan. Respiration & circulation. 41(11):1083-7.

  We compared high-dose epinephrine (HDE) with standard-dose epinephrine (SDE) in improving the outcome of resuscitation after out-of-hospital cardiopulmonary arrest. The SDE group received epinephrineWe compared high-dose epinephrine (HDE) with standard-dose epinephrine (SDE) in improving the outcome of resuscitation after out-of-hospital cardiopulmonary arrest. The SDE group received epinephrine 1mg, and the HDE group received epinephrine 5mg respectively every 5 minutes until the return of spontaneous circulation. There were no significant differences between the SDE group and the HDE group in the rate of return of spontaneous circulation, rate of successful resuscitation and neurologic outcome. However, the rate of successful resuscitation tended to be higher in the SDE group. The ineffectiveness of HDE was considered to be due to the existence coronary artery diseases in the majority of patients, or increase in myocardial oxygen demand by the beta 1-adrenergic effects of epinephrine.

• [Two cases of Swyer-James syndrome]

  Authors: T Ishida, A Kusui, M Tomita, T Fukami, M Hatani, Y Katada, K Kogame, T Tomomatsu, K Shirasaka

  Kokyu to junkan. Respiration & circulation. 41(11):1095-9.

  Case 1: 55-year-old male was admitted to our hospital for further examination of increased transparency of X-ray in the left lower lung. He had history of pneumonia in his childhood. LeftCase 1: 55-year-old male was admitted to our hospital for further examination of increased transparency of X-ray in the left lower lung. He had history of pneumonia in his childhood. Left bronchography revealed mild cylindrical bronchi-ectasia in the proximal bronchi but poor filling by contrast in the peripheral bronchi. Case 2: 61-year-old male was referred to our hospital with palpitation and dyspnea. Chest X-ray film revealed hyperlucency of the left lower lung. The ventilation scan showed a marked decrease in ventilation to the left lung and air trapping was present in the left lung. The perfusion scan showed a matched decrease in blood supply to the left lung. In both cases, pulmonary arteriogram showed narrowed and withered-tree-like left pulmonary arteries. From these clinical findings, we diagnosed these two cases as Swyer-James syndrome. We are reporting two cases of Swyer-James syndrome and describing the clinical feature, differential diagnosis and etiology of the syndrome.

• [Lethal arrhythmias in a patient with coarctation of the aorta and severe heart failure: their control by combination of low dose amiodarone with procainamide for 3 years]

  Authors: K Shinmura, H Hasegawa, H Ishida, K Shimizu, Y Ebihara, T Koyama, S Iwanaga, S Honma, M Tani, S Handa

  Kokyu to junkan. Respiration & circulation. 41(11):1107-11.

  In 1970, a 19 year-old man was diagnosed as having coarctation of the aorta (CoA). But the patient and his family rejected further examination for CoA and high blood pressure was treated after thatIn 1970, a 19 year-old man was diagnosed as having coarctation of the aorta (CoA). But the patient and his family rejected further examination for CoA and high blood pressure was treated after that time. When the patient was 37 years old, he was admitted to our hospital because of congestive heart failure. During the 2nd admission for determining the operability of CoA in December, 1988, non-sustained ventricular tachycardia was detected. Immediately, intravenous administration of lidocaine or/and mexiletine were started. However, cardiac arrest occurred. After his recovery, lethal ventricular arrhythmias were still observed frequently despite administration of class Ia or Ib antiarrhythmic drugs. Oral amiodarone administration (600 mg) with procainamide (1000 mg) was started on 1st of May, 1989. Axillo-femoral bypass graft was performed during the 2nd admission because curable operation was abandoned because of severely impaired cardiac function. Subsequently, the patient was admitted 5 times due to exacerbated congestive heart failure. However, lethal arrhythmias were able to be controlled by the combination of low dose amiodarone (100-200 mg) with procainamide until he died of congestive heart failure on 9th of May, 1992. We reported a rare adult case with CoA and severe heart failure. Lethal arrhythmias in this case were well controlled by the combined administration of low dose amiodarone with procainamide regardless of severely impaired cardiac function.

• [A case of life-threatening ventricular arrhythmias probably due to psychotropic drugs]

  Authors: N Kondou, Y Hiasa, K Kishi, H Fujinaga, Y Ohishi, R Ohtani, T Wada, T Aihara

  Kokyu to junkan. Respiration & circulation. 41(11):1117-20.

  We present a case provoked life-threatening ventricular arrhythmias probably due to psychotropic drugs. The patient was a 55-year-old man who had previously twice operations of aortic valveWe present a case provoked life-threatening ventricular arrhythmias probably due to psychotropic drugs. The patient was a 55-year-old man who had previously twice operations of aortic valve replacement (AVR). The signs of cardiac failure were recurrently appeared from the end of 1991, and he had received promethazine and sulpiride for his depressive state. From cardiac catheterization, we planned his third AVR. The electrocardiographic (ECG) QTc interval was prolonged to 0.48 seconds on this admission. In March 1992 syncopal attack appeared suddenly, and his monitor ECG revealed frequent polymorphous ventricular tachycardia (VT) and Torsade de Pointes (Tdp). These arrhythmias stopped by emergent cardiac pacing. After discontinuing these psychotropic drugs, no ventricular arrhythmias appeared. Since the patient complained severe insomnia one month before operation, the diminished dose of psychotropic drugs (promethazine and levomepromazine) was readministered. Ten days after the operation, syncopal attack reappeared and his ECG recorded frequent VT and Tdp. During both syncopal attacks his serum potassium and magnesium were within normal limits. Two days later, he died from multi-organ failure. We concluded that life-threatening arrhythmias such as VT and Tdp might develop under the administration of mild psychotropic drugs (promethazine or levomepromazine), therefore, must better take a care of ECG changes in cases of using any psychotropic drugs.

• [Prospective mass study of the treatment of chronic heart failure]

  Authors: S Kimata

  Kokyu to junkan. Respiration & circulation. 41(11):1049-57.

• [Need for large sample size in clinical trial and statistical analysis of data from the trials]

  Authors: H Miyahara

  Kokyu to junkan. Respiration & circulation. 41(11):1025-32.

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