Effects of isometric exercise (handgrip) on the respiratory system]

Sixteen consecutive adult cases of Parinaud's syndrome are reviewed. Ten of the sixteen cases were due to brain stem infarction while four patients were suspected of harboring tumors. Parinaud's syndrome alone did not favor a diagnosis of tumor in the pineal region in this series. Associated neuroophthalmic findings are discussed.     

Effects of isometric handgrip exercise on coronary sinus blood flow in idiopathic cardiomyopathy

Rabbit proximal straight tubules from superficial nephrons were perfused in vitro in order to elucidate the mechanism of fluid and bicarbonate absorption. Both processes were greatly inhibited when sodium was replaced in the perfusate and bath by other cations, when ouabain was added to the bath, or when potassium was removed from the bath. We infer that these experimental manipulations inhibit active sodium tranport, and that active sodium transport is a primary process leading to fluid and bicarbonate absorption. Fluid absorption also decreased (but only by 22 to 36%) when bicarbonate was replaced by chloride in the perfusate and bath or when acetazolamide (10(-3)M) was added, suggesting that fluid and sodium transport depend in part on bicarbonate. We infer that the links between fluid, sodiu, and bicarbonate transport are complex and involve at least two mechanisms: 1) a sodium for hydrogen ion exchange mechanism located in the brush border membrane and 2) the transepithelial concentration difference for bicarbonate, which results from its absorption and which acts as an additional driving force for fluid and sodium absorption. Finally, bicarbonate absorption was unaltered when chloride was replaced by nitrate in the perfusate and bath, suggesting that chloride is not necessary for acidification in this nephron segment.     

Assessment of left ventricular function by isometric handgrip exercise after thrombolysis in patients with refractory unstable angina

The handgrip test has been proposed for the evaluation of the hemodynamic reserve in patients with coronary artery disease and to quantitate the impairment of left ventricular (LV) function. The present study was designed to evaluate the effect of thrombolytic therapy in patients with refractory unstable angina in order to test the hypothesis that a reduction in intracoronary thrombosis could ameliorate their hemodynamic response to the handgrip test. During left heart catheterization, 20 patients with refractory unstable angina of recent onset performed a handgrip test before (HG1) and 24-72 hours after (HG2) being randomized to receive recombinant tissue-type plasminogen activator or placebo, according to a double-blind parallel group design. HG1 induced an increase in heart rate (p < 0.001), in systolic pressure (p < 0.001), and a reduction in ejection fraction (p < 0.05). Changes in LV end-diastolic pressure during baseline handgrip were highly different in individual patients, resulting in a trend toward an increase. Similarly, a different individual response was observed in the behavior of the isovolumetric and relaxation indices. In comparison with HG1, no difference was detected during HG2 in the 2 treatment groups with respect to changes in LV volumes, ejection fraction, LV systolic and diastolic pressures, +dP/dt, (dP/dt)/P, -dP/dt, and tau index. In patients with refractory unstable angina of recent onset, the handgrip test performed before and after thrombolysis did not prove to be useful in assessing directional changes of LV performance, mainly because of the different individual response to the baseline handgrip test.     

Comparison of transesophageal Doppler methods with angiography for evaluation of the severity of mitral regurgitation

Doppler evaluation of mitral regurgitation remains difficult; thus, a head-to-head comparison of the diagnostic accuracy of Doppler methods was undertaken. Fifty patients with native mitral regurgitation underwent multiplane transesophageal echocardiography within 5 days of catheterization. Angiographic grade of mitral regurgitation and, in 20 patients with grade II-IV regurgitation, invasively determined regurgitant stroke volume were compared with color Doppler area, regurgitant jet diameter, ratio of systolic to diastolic peak pulmonary venous flow velocities, and (based on the proximal convergence zone) maximal regurgitant flow rate and regurgitant orifice area. Rank correlation coefficients of angiographic grade with Doppler parameters were 0.61 for color jet area, -0.61 for pulmonary venous flow velocity ratio, 0.69 for color jet diameter, 0.79 for maximal regurgitant flow rate, and 0.78 for regurgitant orifice area (all P < .01). Convergence zone-based parameters also correlated best (r=0.73) with invasively determined regurgitant stroke volume. Receiver operating characteristic curve analysis confirmed higher diagnostic accuracy for proximal jet width and proximal convergence zone parameters than for color jet area or pulmonary venous flow velocity ratio. Proximal convergence zone parameters and proximal color jet diameter best distinguished severe from mild forms of mitral regurgitation.     

Late postoperative outcome of plastic operation versus valve replacement for mitral regurgitation]

Between January 1980 and August 1991, 99 patients underwent operation for mitral valve regurgitation (MR). The ages of the patients ranged from 12 to 67 years, (49.4 +/- 11.9 years), and there were 39 males and 60 females. Pathological cause of regurgitation, which was determined by intraoperative inspection and histological findings of excised leaflets, was rheumatic in 46, degenerative in 38, infective endocarditis in 9, ischemic in 4 and unknown in 2 patients. Cardiac rhythm was atrial fibrillation in 73, normal sinus rhythm in 24 and junctional rhythm in 2 patients. Our principles for valve repair were (1) excision of responsible segment and repair for prolapsed leaflet due to torn chordae, (2) shortening of elongated chordae, (3) annuloplasty, and (4) repair of perforated leaflet. Finally, 19 patients endured plastic operation, and 80 patients underwent prosthetic valve replacement. The rate of plastic procedure was 62.5% (10/16) in degenerative MR with mural chordal lesions, 42.9% (3/7) in rheumatic MR without stenosis, 22.2% (2/9) in infective endocarditis and 100% (2/2) in MR with unknown etiology. Mitral valve repair was failed both in rheumatic MR associated with stenosis (39 patients) and in ischemic MR (4 patients). A ten-year survival rate after operation was 92.2 +/- 3.1% in patients with valve replacement and 83.6 +/- 10.0% with valve repair (N.S.), and a proportion of event-free survival in patients with valve replacement was similar to valve. Late postoperative cardiac catheterization revealed decreased left ventricular volume indices and increased left ventricular end-systolic stress/volume ratio in both groups compared to preoperative values, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)     

Repair of mitral regurgitation caused by prolapse of the anterior mitral leaflet

Mitral regurgitation caused by prolapse of the anterior mitral leafleft has been considered to be difficult for reconstruction. In Japan, these cases have been repaired mainly by replacement of chordae with artificial sutures. We have repaired them by Carpentier's technique. We report a series of 9 patients with pure mitral regurgitation caused by ruptured or elongated chordae of the anterior mitral leaflet. Two of them had lesions at both anterior and posterior leaflet. All patients underwent mitral valve repair by segmental transposition of the posterior leaflet. As for associated procedures, there were ring annuloplasty with Carpenter rings (9 cases), sliding technique (8 cases) reported by Carpentier, reinforcement by transposition of secondary chordae of the posterior leaflet (6 cases), commissuroplasty (1 case), and closure of leaflet perforation. All patients survived operations and all patients except one underwent left ventriculography postoperatively. In only 2 patients, residual mitral regurgitation classed as I/IV was observed. All patients returned home in New York Heart Association class I. Follow-up ranged from 7 to 45 months (mean follow-up 20 months). All patients were free from reoperation or thromboembolism. Although longer follow-up is necessary, this technique appears to be adequate for the repair of patients with anterior leaflet prolapse.     

Echocaediographic determination of the etiology of severe mitral regurgitation

The effects of 3 lipidosis-inducing drugs on the incorporation and turnover of palmitic acid-1-14C in lung phospholipids was studied. In rats treated with 1 dose of chlorphentermine or RMI 10.393, the incorporation of palmitate-1-14C into most lung phospholipid fractions was moderately decreased, but markedly lowered after 1 dose of Ro 4-4318. Eight doses of chlorphentermine and RMI 10.393 strongly inhibited the incorporation of palmitate-1-14C into lung phospholipids, whereas with 8 doses of Ro 4-4318 the incorporation was highly increased. Thirty hours after the last of 3 injections of the labeled palmitic acid the turnover of most lung phospholipids was considerably lower in chlorphentermine- and RMI 10.393-treated rats than in controls. Ro 4-4318, however, induced a highly increased turnover of most phospholipids. After 54 h, this effect had practically disappeared. Our studies showed that phospholipid storage after treatment with chlorphentermine and RMI 10.393 is mainly due to decreased degradation of phospholipids, whereas increased synthesis accounts for the effect of Ro 4-4318.     

The exercise test as a component of the total fitness evaluation

In this article, physical fitness has been defined as a dynamic state of energy and vitality that enables one to carry out daily tasks, to engage in active leisure-time pursuits, and to meet unforeseen emergencies without undue fatigue. In addition, physically fit individuals are described as being at low risk for hypokinetic diseases and being more able to function at the peak of intellectual capacity while experiencing "joie de vivre." The measurable elements of physical fitness have been categorized into two groups: skill-related fitness and health-related fitness. The former category includes agility, balance, coordination, speed, power, and reaction time. The latter includes cardiorespiratory endurance, body composition, and musculoskeletal fitness, which incorporates flexibility, muscular strength, and muscular endurance. It is highly recommended that clinicians provide comprehensive fitness testing for their patients because of the well-established health-related benefits that are related to each component.     

Diastolic murmurs in atrial septal defect (author's transl)

No correlation was found between the presence of a diastolic murmur in about 50% of patients with artrial septal defect and the calculated shunt volume. A significant correlation was found in respect to the age of the patient, the majority of the murmurs being found in young patients and especially in young patients with tachycardia. Similar murmurs were found in healthy persons and, hence, a functional stenosis of the AV-valve ring could be the reason for this diastolic murmur, which may occur more frequently in patients with atrial septal defect on account of an alteration in the blood stream patterns.     

Importance of the 'crossover' concept in exercise metabolism

1. The 'crossover' concept is a model of substrate supply during exercise which makes the following predictions. 2. Lipid is the major fuel (approximately 60%) for non-contracting skeletal muscle and the body at rest. 3. Energy flux, as determined by exercise intensity, is the major factor in determining the balance of substrate utilization during exercise. Thus, moderate and greater exercise intensities increase contraction-induced muscle glycogenolysis and glycolysis, increase recruitment of fast-twitch muscle fibres, increase sympathetic nervous system activity and down-regulate mitochondrial fatty acid uptake. 4. Glycogen and glucose utilization scales exponentially to relative exercise power output with a greater gain in glycogen than in glucose use at high power. The relationship between free fatty acid flux and power output is an inverted hyperbola. Consequently, at high power outputs, the role of lipid oxidation is diminished. 5. Factors such as endurance training, energy supply, as influenced by dietary manipulation, and prior exercise play secondary roles in determining the balance of substrate utilization during exercise. 6. Comparisons of the metabolic responses in subjects engaged in activities requiring vastly different metabolic rates or comparisons of subjects of different gender, age or training status require normalization of data to total energy flux.     

Acute mitral regurgitation caused by malignant lymphoma of the posterior mediastinum

An 82-year-old man was admitted to our hospital in September 1996 due to dysphagia and cardiomegaly. Physical examination detected the fourth heart sound and a Levine III/VI systolic murmur in the cardiac apex. Surface lymph nodes were not palpable. LDH 662 IU/I was detected by laboratory examinations, and ultrasound cardiography showed grade 3 mitral regurgitation. Computed tomography revealed a huge mass in the posterior mediastinum, pressing the heart from the posterior direction. Thereafter, a left pleural effusion developed and aspiration was performed. Cytological examination of the fluid showed clusters of lymphoid cells with a positive immunophenotype for CD10, CD19 and HLA-DR. Chromosome analysis revealed complex abnormal karyotypes including t(8;14) (q24;32). A diagnosis of B cell lymphoma was made, and combination chemotherapy consisting of cyclophosphamide, THP-adriamycin, vincristine, and prednisolone was initiated. The patient's mass disappeared promptly, and his mitral reguration subsided. We reported this case because malignant lymphoma of the posterior mediastinum is rare, and because we are unaware of any previous reports of malignant lymphoma causing acute mitral regurgitation.     

Foot blood-flow at isometric handgrip contraction in patients with an ischaemic disease of the lower extremities and in control subjects

At isometric contraction of forearm muscles, the mean systemic pressure and the foot blood flow are statistically significantly increased. These changes are encountered both in controls and in patients with an ischaemic disease of the lower extremities.     

Disappearance of mitral and tricuspid regurgitation in haemodialysis patients after ultrafiltration

We recovered an unusual bacterial strain from blood or sputum of three patients with septicemia, endocarditis, and/or respiratory failure. The three isolates were thin, curved, gram-negative, light brown, pigment-producing bacilli with variable catalase activity. They were asaccharolytic, oxidase-negative, nonmotile, and fastidious. Identification was not possible on the basis of these characteristics alone or in combination with cellular fatty acid profiles. Nucleic acid amplification and sequence analysis of the 16S rRNA gene revealed that all three isolates were identical and most closely related to the emerging pathogen Bordetella holmesii, diverging from the published sequence at three nucleotide positions (99.8% similarity). Isolation of a B. holmesii-like pathogen from sputum suggests that, in addition to producing septicemia, the organism may inhabit the respiratory tract like other Bordetella species.     

Importance of exercise capacity in the interpretation of a myocardial ischemic response to exercise testing. Multicenter Study of Myocardial Ischemia Group (MSMI)

Patients who were stable 1 to 6 months after a cardiac event underwent routine exercise testing with thallium scintigraphy. The prognosis of patients with good exercise capacity (Bruce stage 3) was similar whether or not ischemia was demonstrated and similar to patients with reduced exercise capacity and no ischemia, whereas the presence of both ischemia and a reduced exercise tolerance identified patients with a significantly poorer prognosis.