Left atrial systolic time interval in hyperthyroidism.

The author noninvasively examined effects of thyroid hormone on left atrial function by using the left atrial systolic time intervals (LASTI) with its parameters as left atrial ejection time (LAET), left atrial preejection period (LAPEP), and LAET/LAPEP, as measured by pulsed Doppler echocardiography. The hyperthyroid (HTH) and normal control (NC) groups consisted of 21 and 25 subjects, respectively. He also considered serum triiodothyronine (T3) concentrations, age, heart rate, systolic blood pressure, left ventricular preload, afterload, contractility, diastolic function, P wave duration, PR interval, and left ventricular preejection period (LVPEP) as factors that might influence LASTI. LAET, LAET/LAPEP, and LVPEP in the HTH group were significantly shorter than in the NC group. LAET showed no significance with serum T3 concentration, but did with LVPEP in partial correlation analysis. These results demonstrated that a short LAET in the hyperthyroid state is controlled by a rapid rise in the left ventricular pressure.

Cardiovascular effect of oral calcium supplementation: echocardiographic study in patients with essential hypertension.

Oral calcium (Ca) supplementation mildly reduces blood pressure. The authors studied the effects of Ca supplementation on the cardiovascular system in patients with mild to moderate essential hypertension. Twelve patients aged forty-nine to seventy years (7 men and 5 women, mean age with 60.3 +/- 7.2 years) participated. The investigators orally administered Ca (1.0 g/day for one week) under hospitalization, adding to a dietary intake of Ca (0.6 g/day). Left ventricular function and systemic arterial compliance were evaluated by M-mode and pulsed Doppler echocardiographies before and after seven days of Ca supplementation. Left ventricular contractility and afterload were not changed. Preload indicated by end-diastolic volume was significantly decreased after Ca supplementation (109.6 +/- 8.5 vs 107.3 +/- 8.2 mL, P < 0.05). Myocardial relaxation evaluated by IIa-mitral valve opening time (87.7 +/- 6.7 vs 82.1 +/- 6.2 ms, P < 0.01) and maximum descending rate of the left ventricular posterior wall (10.6 +/- 1.0 vs 12.4 +/- 1.0 cm/s, P < 0.01), and atrioventricular net compliance assessed by the descending slope of rapid filling flow in the left ventricular inflow tract (2.63 +/- 0.24 vs 2.26 +/- 0.17 m/s2, P <0.05), as well as systemic arterial compliance (2.05 +/- 0.20 vs 2.73 +/- 0.26 mL/mmHg, P < 0.01) were significantly improved by Ca supplementation. Oral Ca supplementation improved the disturbed left ventricular diastolic function and systemic arterial compliance.

Augmentation of baroreceptor reflex function by oral calcium supplementation in essential hypertension.

1. We studied the effect of oral calcium supplementation (1.0 g/day) for 1 week on baroreceptor reflex function and the lability of blood pressure in association with the changes in autonomic nervous activity in 14 hospitalized patients with mild to moderate essential hypertension (nine males and five females, mean age of 56 +/- 11.2 (s.d.) years). 2. Baroreceptor reflex sensitivity (BRS) was determined by the change in R-R intervals in response to the pressor response induced by phenylephrine injection. We measured coefficient of variation of R-R interval (CVR-R) and urinary excretion of catecholamines to evaluate the mechanism of change in BRS. We also used coefficient of variation of blood pressure (CVBP) and error of single cosinor analysis as parameters for lability of 24-h blood pressure. 3. The means of 24-h systolic and diastolic blood pressures showed no significant changes after calcium supplementation for 1 week. BRS and CVR-R were significantly increased by calcium supplementation. Daily excretions of norepinephrine and epinephrine corrected by creatinine were unchanged. Both CVBP and error of 24-h systolic blood pressure showed a significant decrease after calcium treatment. 4. These results indicate that oral calcium supplementation augments baroreceptor reflex function, in part through an enhancement of parasympathetic nervous activity, resulting in reduction of the lability of blood pressure in patients with mild to moderate essential hypertension.

Augmentation of the renal tubular dopaminergic activity by oral calcium supplementation in patients with essential hypertension.

We studied the effect of oral calcium supplementation on renal tubular dopaminergic activity in patients with mild to moderate essential hypertension. Fifteen patients aged 45 to 68 years (nine men and six women, mean age 59 +/- 7 [SD]) participated in the study. We orally administered calcium (1.0 g per day for 1 week) during hospitalization. The change in 24-h blood pressure (BP), measured by ambulatory BP monitoring, and excretions of electrolytes and catecholamines were investigated before and after 1 week of oral calcium supplementation. The mean values of 24-h systolic and diastolic BP showed no significant changes by calcium loading. Daily urinary excretion of free dopamine, sodium clearance (CNa), fractional excretion of sodium (FENa), and urinary volume were significantly increased by oral calcium supplementation. Urinary excretions of epinephrine and norepinephrine and creatinine clearance showed no significant changes by oral calcium treatment. CNa and FENa showed significant correlations with urinary excretion of free dopamine. These results suggest that oral calcium supplementation induces natriuresis partly through augmentation of renal tubular dopaminergic activity.

Left ventricular cardiac structure and diastolic function in isolated systolic hypertension in the elderly.

We examined the left ventricular cardiac structure and the diastolic function in patients with isolated systolic hypertension (ISH; SBP > or = 160 mmHg and DBP < 90 mmHg) in the elderly. We studied 17 patients with ISH, 24 age-matched patients with essential hypertension (EHT; DBP > or = 90 mmHg) and 17 normotensive controls (NT; SBP < 140 mmHg and DBP < 90 mmHg). EHT were divided into two groups based on the mean wall thickness (MWT) of the left ventricle. Group 1 patients (EHT-I, n = 12) had a MWT < 10 mm and group 2 patients (EHT-II, n = 12) had a MWT > or = 10 mm. We measured left ventricular end-diastolic dimension (LVDd), end-systolic dimensions (LVDs), left ventricular mass index (LVMi) and left ventricular isovolumic relaxation time (IRT) to assess the left ventricular cardiac structure and the diastolic function by M-mode echocardiography. LVDd was significantly smaller in ISH than in NT, EHT-I and EHT-II (P < 0.01). Relative wall thickness was greatest in ISH because of both the decreased chamber size and the increased left ventricular wall thickness. LVMi in ISH was similar to that in EHT-I, but IRT in ISH was significantly longer than that in EHT-I (P < 0.05). These results suggest that ISH in the elderly shows a left ventricular concentric hypertrophy and a severely impaired diastolic function.

Response of plasma renin-angiotensin system to a single captopril administration in patients receiving long-term treatment with captopril.

1. The responses of angiotensin II (AII), AIII, aldosterone and plasma renin activity (PRA) to a single dose of captopril were investigated in hypertensive patients receiving long-term (more than 1 year) captopril therapy (CT patients) and compared with those of non-treated hypertensive patients (NT patients). 2. Baseline levels of AII and aldosterone were significantly lower in CT patients than in NT patients. AIII tended to be lower and PRA was slightly higher in CT than in NT patients, but these differences were not significant. 3. A single administration of captopril (50 mg orally) significantly decreased plasma levels of AII, AIII and aldosterone as well as blood pressure in both CT and NT patients. 4. These results demonstrate that chronically repeated administration of captopril to hypertensive patients effectively reduces the daily blood pressure and concomitantly the plasma AII level to acceptable levels in patients with no experience of ACE inhibition.

[A case of "pure" progressive autonomic failure in an elderly male].

A 68-year-old man was admitted to our hospital because of postural hypotension in July 1991. He was also suffering from anhydrosis, urinary disturbances, constipation and impotence. He had not developed signs of Parkinsonism, cerebellar or peripheral neuropathy four years from the onset. Various autonomic function tests showed sympathetic and parasympathetic dysfunction of mainly postganglionic origins. Thus we diagnosed this patient as "pure" progressive autonomic failure ("pure" PAF). "Pure" PAF is a new entity described by Bannister and Oppenheimer in 1982. It shows symptoms of autonomic failure without other neurological disturbances which manifest as Shy-Drager syndrome. Treatment with L-DOPS increased his blood pressure level and attenuated his symptoms due to orthostatic hypotension.

Direct effect of thyroid hormone on left ventricular myocardial relaxation.

The left ventricular diastolic indices of the hyperthyroid (HTH) patients without cardiac disease (n = 31) were compared with those of the normal controls (NC) (n = 49) using echocardiography. The HTH group had a significantly shorter IIa-mitral valve opening time (IIa-MVO), and a significantly larger maximum descending rate of the left ventricular posterior wall (maxPWDR), peak E and peak A than the NC group. IIa-MVO, maxPWDR, peak E and E/A showed significant simple correlation with T3 in the HTH group. To elucidate spurious correlation among these indices and T3, partial correlation analysis among these indices and its influencing factors were calculated. IIa-MVO, maxPWDR and peak E showed significant partial correlation coefficients with T3, but peak E had a lesser partial correlation with T3 than with age and left ventricular end-diastolic volume. Fourteen of the hyperthyroid patients were reexamined after antithyroid treatment. Their diastolic indices were found to be normalized compared with pre-treatment values and showed no significant difference with those of NC group. Augmented myocardial relaxation in patients with hyperthyroidism correlated with the thyroid hormone level, and IIa-MVO and maxPWDR were more effective indices of left ventricular myocardial relaxation than peak E and E/A in hyperthyroidism.

Two cases of adult T-cell leukemia associated with acute pancreatitis due to hypercalcemia.

We report two cases of adult T-cell leukemia associated with acute pancreatitis and hypercalcemia. After sudden onset of epigastralgia, acute pancreatitis and hypercalcemia were found in both patients. There were no diseases that could explain the acute pancreatitis except for hypercalcemia probably due to adult T-cell leukemia. Thus we considered that hypercalcemia due to adult T-cell leukemia had led to acute pancreatitis. This is the first report of such a complication in adult T-cell leukemia.

A rare case of infective aneurysm involving all three sinuses of Valsalva complicated by left single coronary artery.

Infective aneurysm showing dilatation of all three coronary sinuses of Valsalva due to infective endocarditis is extremely rare. We present the first report of such a case complicated by left single coronary artery. The patient was a 55-year-old man with a past history of untreated diabetes mellitus, cerebral infarction, aortic regurgitation and high-grade fever. He was admitted with a complaint of easy fatigability. In a treadmill exercise test, asymptomatic ischemic depression of the ST segment was observed. Two-dimensional echocardiography revealed marked dilatation of all three sinuses of Valsalva, and a mural thrombus within the dilated right sinus of Valsalva. On magnetic resonance imaging, an abnormal signal in the markedly dilated right sinus of Valsalva was revealed. Coronary arteriography showed left single coronary artery (L1 type by Sharbaugh's classification). The histopathological features of the affected aorta were thought to represent the healing stage of infective endocarditis. With regard to the myocardial ischemia in this patient, it was thought to have arisen mainly through aortic regurgitation and coronary atherosclerosis due to single coronary artery, and partly influenced by untreated diabetes mellitus.

Effectiveness of chemoembolization therapy for metastatic right atrial tumor thrombus associated with hepatocellular carcinoma.

A rare case of hepatocellular carcinoma (HCC) was complicated by metastatic right atrial tumor thrombus (RATT), which diminished in size on echocardiograms and showed necrotic change on computed tomography (CT) scans after chemoembolization therapy.

[Report of a case of lung cancer with metastasis to the myocardium which showed electrocardiographic findings similar to acute myocardial infarction and intramyocardial mass on echocardiography].

A 61-year-old man was admitted to our hospital with complaints of cough and left back and chest pain. He had suffered from left tuberculous pleurisy at the age of 20 years. Chest X-ray film and CT revealed atelectasis of the left lung, a left hilar mass and an irregular left atrial wall. Depressed P-Ta segment in the inferior limb and anterior chest leads and an abnormal P wave were found on ECG. Transbronchial lung biopsy showed squamous cell carcinoma. After radiation therapy, the patient complained of chest oppression. ECG revealed a normalized P-Ta segment deviation, markedly elevated ST segment in the inferior limb and lateral chest leads and a depressed ST segment in the anterior chest leads. These findings persisted until his death. An obscure appearance of the pericardium and an echogenic intramyocardial mass in the posteroinferior and lateral wall were evident by echocardiography. The patient died due to heart failure. Postmortem needle biopsy showed scattered intramyocardial tumor cell nests with keratinization. CPK, GOT and LDH were within normal limits throughout the course, but CPK-MB was slightly increased. Cardiac metastasis with an ECG appearance similar to that of acute myocardial infarction has been rarely reported. Our present case showed peculiar feature including 1) ECG findings similar to atrial and ventricular myocardial infarction, and 2) an echogenic intramyocardial mass and an ill-defined pericardium on echocardiography. These findings suggested direct invasion of squamous cell carcinoma of the lung to the ventricular myocardium.(ABSTRACT TRUNCATED AT 250 WORDS)

[Bronchioloalveolar carcinoma diagnosed by bronchoalveolar lavage].

A case of bronchioloalveolar carcinoma of the lung is reported. A 63-year-old man identified during a chest mass-survey program, came to our hospital for a precise examination. He had no subjective complaints though his plain chest X-ray film showed a diffuse alveolar pattern in the bilateral hilar regions mimicking a butterfly shadow. Further, cytological examinations of both the sputa and specimens from brushings obtained on bronchoscopy failed to demonstrate malignant cells, and only a cytological examination of the fluid obtained by bronchoalveolar lavage (BAL) revealed the presence of a malignancy. Thus, BAL would seem to be a simple and reasonable method for the detection of suspected malignant cells in bronchioloalveolar carcinoma.