The guidelines for medical treatment of Takayasu arteritis established in 1987 by the Systemic Vascular Disorders Research Committee, Ministry of Health and Welfare of Japan are presented. The first part of the guidelines concerns treatment with adrenocorticosteroids and the second part concerns other medical treatment. A review of the literature referring to steroid therapy and other medical treatment of Takayasu arteritis is also included.

The effects of social disturbance, by management practice, on behavior and performance of lactating heifers in a dairy herd were investigated. Two groups of 51 primiparous heifers in mid-lactation were used. Nearly half of the heifers in each group, including the three highest-ranking (Dm), three middle-ranking (Md) and three lowest-ranking (Sb) animals, were selected by angular dominance value (ADV) and the remaining heifers selected randomly. On Day 0, heifers were exchanged between the two groups. Regrouping prolonged the duration of standing and increased the frequency of shorter bouts of lying (less than or equal to 15 min). At the feed bunk, the feeding of Sb was frequently interrupted by an attack of Dm. The average feeding time of Sb was significantly longer than that of Dm (P < 0.05). In the second week (Week 2) after regrouping, average milk production in regrouped heifers decreased significantly compared with the week before member exchange (Week - 1) (P < 0.05) but no difference was found with heifers who were not regrouped. Among regrouped heifers, Week 1 milk production decreased to 96.5% of that prior to the exchange (P < 0.05) in those showing a decrease in ADV of more than 5, Week 2 milk production of subordinates also decreased significantly (P < 0.05) but that of dominants did not, Serum cortisol response at 30 min after 200 IU of ACTH administration on Day 14 significantly increased in Dm (P < 0.05) but did not in Md and Sb. Regrouping distressed heifers, especially among heifers of lowered dominance rank and subordinates, affected their production. Management practices that disturb social stability in a dairy herd should be avoided.

Aortitis syndrome named in Japan is widely known as Takayasu's arteritis internationally. Based on the experiences accumulated since the report of eyeground changes by Takayasu, it has become clear that the clinical manifestations of the disease are quite variable, including pulseless disease, atypical coarctation of the aorta, renovascular hypertension, aneurysms, aortic regurgitation and coronary artery disease. Pulmonary artery involvement is not infrequently present. For an exact diagnosis, it must be kept in mind that two or more of these manifestations are combined in most of the patients. The data of several epidemiological studies are presented and some of the recent literature reviewed.

To investigate changes in left atrial morphology and dimensions during the cardiac cycle, the atrium was visualized by intravenous digital subtraction angiography (DSA). The study subjects consisted of 22 male patients whose average age was 54.5 +/- 8.6 years. They had ischemic heart disease without mitral valve disease and were in sinus rhythm. They were 11 patients with old myocardial infarction (OMI group) and 11 who had chest pain without evidence of infarction (AP group). DSA was performed in the continuous mode. Contrast material (35 ml) was injected at a rate of 18 ml/sec via a catheter in the superior vena cava and subtraction images were obtained at a speed of 30 frames/sec in the right anterior oblique projection. The left atrial and left ventricular margins were traced manually, their areas were calculated, and fractional changes in area were analyzed. The left ventricular ejection fraction (LVEF) was calculated by densitometry. Cardiac catheterization was performed in 16 patients and the left ventricular end-diastolic pressure (LVEDP) and mean pulmonary arterial wedge pressure (PAWP) were measured. The entire left atrium was clearly imaged using DSA. Phase analysis of the time-area curves in the right anterior oblique projection revealed that the left atrial area was maximal during left ventricular end-systole (%LA1 = 100%), it decreased during early left ventricular diastole (%LA2), and then increased slightly again during mid-diastole (%LA3). After left atrial contraction, the minimum area was obtained (%LA4). The left atrium showed a two-stage decrease in the area due to passive emptying and active contraction during left ventricular diastole. Passive emptying (%LA1-%LA2) was significantly less in the OMI group than in the AP group (6.3 +/- 3.6 vs 13.3 +/- 4.8%, p < 0.01, respectively). In all 22 subjects, passive emptying correlated with LVEF (r = 0.70, p < 0.001) and LVEDP (r = -0.58, p < 0.05). There was no difference in active contraction (%LA3-%LA4) between the 2 groups (26.0 +/- 5.7% in the OMI group, 28.2 +/- 8.4% in the AP group), and it did not correlate with LVEF or LVEDP. The ratio of passive emptying to active contraction [(%LA1-%LA2)/(%LA3-%LA4)] correlated with LVEF (r = 0.63, p < 0.01). These findings suggested that impaired left ventricular diastolic function and a relative increase in atrial contraction were present in patients with a lower LVEF. The %LA4 correlated with LVEDP and PAWP (r = 0.65, r = 0.63, p < 0.01, respectively). In conclusion, DSA proved to be a useful method for investigating left atrial morphology and function.

The effect of aging on cardiac function in patients with right bundle branch block (RBBB) was commonly unknown, so left ventricular function and right ventricular function were investigated, using first-pass radionuclide angiography. Twenty-six patients with RBBB and 28 normal subjects were studied at rest and during bicycle exercise. Patients with RBBB but normal cardiovascular systems aged 33 to 75 years were divided into those within 60 years (n = 17) and those over 65 years (n = 9). Using the same method, normal subjects aged 38 to 83 years were divided into those within 60 years (n = 18) and those over 65 years (n = 10). Mean age between normal subjects and patients with RBBB didn't differ significantly. The response of left ventricular ejection fraction in normal groups rose during exercise, but its exercise tolerance function declined with aging. Left ventricular diastolic filling in normal groups declined at rest and during exercise with aging. Left ventricular function in RBBB groups showed the same results as those of normal groups. The response of right ventricular ejection fraction and its exercise tolerance function in normal groups was not influenced by aging. However, in contrast, right ventricular function in RBBB groups decreased with aging. We suggest that the mechanism of decrease of right ventricular function in aging patients with RBBB may be caused by the change of right ventricular contraction which is affected by the aging process.

Mental stress results in sympathoadrenal stimulation that may elicit or aggravate myocardial ischemia and cardiac dysrhythmias in patients with coronary artery disease.1 A mental arithmetic stress test is a simple way to induce mild mental stress.2,3 Several studies have examined the effects of arithmetic stress on systemic and coronary hemodynamics3,4; however, few studies have been reported regarding neuroendocrine and metabolic responses to arithmetic stress.3,5 The purposes of this study were (1) to quantify the simultaneous neuroendocrine and hemodynamic responses to arithmetic stress, (2) to analyze the relation between these neuroendocrine and cardiovascular parameters in healthy volunteers, and (3) to provide insights into pathophysiologic mechanisms for the induction or aggravation of myocardial ischemia and cardiac arrhythmia during arithmetic stress.

To compare cardiorespiratory responses to standing arm ergometry and treadmill exercise, two graded exercise stress tests were performed in 30 patients with ischemic heart disease (IHD). Cardiac catheterization and expired gas analyses were also done. Standing arm ergometry was discontinued because of arm fatigue in 15 (50%) patients, whereas tread-mill exercise was stopped due to leg fatigue in 8 (27%) patients. Maximal increase in rate-pressure product and oxygen uptake, and magnitude of ST-segment depression during standing arm ergometry were significantly smaller (p < 0.01, p < 0.01 and p < 0.05, respectively) than those during treadmill exercise. Furthermore correlations of maximal change in rate-pressure product, oxygen uptake and extent of ST-segment depression were not close between the two exercise tests (r = 0.76, r = 0.67 and r = 0.54, respectively).Our results indicate that the ability to detect IHD with standing arm ergometry is lower than that with treadmill exercise and that it is not possible to predict accurately one's capacity for arm exercise from the treadmill exercise test.

Seventeen patients with a previous myocardial infarction were studied during pacing to characterize the clinical correlates of ST elevation, to analyze the relation between ST elevation and negative T-wave normalization and to investigate the mechanism of these electrocardiographic changes. Myocardial ischemia was evaluated by measurement of blood lactate, and wall motion was analyzed using cardiokymographs concurrently and serially. Results show that ST elevation and negative T-wave normalization were most marked in leads containing abnormal Q waves, that ST elevation greater than or equal to 1 mm during pacing was associated with a significant increase in left ventricular end-diastolic pressure and deterioration of left ventricular wall motion and that the magnitude of ST elevation and negative T-wave normalization was significantly correlated, but the latter appeared earlier and more markedly. In addition, there was no significant correlation between the extent of either ST elevation or negative T-wave normalization and myocardial lactate production. Thus, ST elevation and negative T-wave normalization are caused by abnormal left ventricular wall motion rather than myocardial ischemia. Negative T-wave normalization is a more sensitive marker of abnormal wall motion than ST elevation in patients with a previous myocardial infarction.

To evaluate mitral valve function and its long-term outcome after open mitral commissurotomy (OMC), we examined 39 patients using Doppler echocardiography. There were 13 males and 26 females; who were examined a total of 83 times after the surgery at about one year intervals (seven to 240 months, averaging 78 months). We measured the velocity of transmitral blood flow using the continuous wave Doppler method (CWD), and the transmitral pressure half time (PHT), mean velocity (m V) and peak velocity (pV) were calculated. The presence and severity of mitral regurgitation (MR) were assessed by color flow mapping. 1. PHT gradually increased and significantly correlated (r = 0.63, p less than 0.001) with the months passed after OMC. The regression line of PHT in postoperative months was "PHT = 0.70 x PMo + 83" (PMo = postoperative months). The mV and pV tended to increase gradually, but did not significantly correlate with the months passed after the surgery. 2. Among the 39 patients, 28 (72%) had MR, and their severity was classified as 1+ in two, 2+ in 19, 3+ in six and 4+ in one. Among 21 patients who had no MR before OMC, MR appeared in 12 (57%), and its severity was classified as 1+ in one, 2+ in nine and 3+ in two. All five patients with preoperative MR had MR postoperatively, and their severity was classified as 1+ in one, 2+ in two and 3+ in two. The presence of the preoperative MR of the remaining 13 patients was unknown.(ABSTRACT TRUNCATED AT 250 WORDS)

The clinical features of 20 patients with mildly dilated cardiomyopathy (MDCM) were investigated by electrocardiography and echocardiography. MDCM was defined as conditions with: 1) left ventricular end-diastolic dimension between 55 and 65 mm and 2) left ventricular fractional shortening between 10 and 25%. Nine patients (45%) had no histories of congestive heart failure. Eight patients had atrial fibrillation, and the other 12 patients were in regular sinus rhythm. Two patients had supraventricular premature contractions and five patients had ventricular premature contractions. One patient had paroxysmal atrial tachycardia. During the 40-months' span of this echocardiographic study, left ventricular end-diastolic dimension (60.8 +/- 3.8 mm to 57.3 +/- 4.6 mm) and left ventricular fractional shortening (17.2 +/- 4.6% to 22.7 +/- 7.1%) did not change significantly. One patient died suddenly. These results suggest that 1) some patients with MDCM have neither definite histories nor symptoms to suggest heart failure; 2) the hemodynamic conditions of patients with MDCM do not always deteriorate, but rather stabilize, and even improve during follow-up periods; 3) several types of arrhythmias can be observed, even in standard resting electrocardiograms; and 4) patients with MDCM may die suddenly.

A case with mitral valve prolapse was reported in which unusual movement of the posterior left ventricular wall was observed. The patient was a 45-year-old woman. Physical examination revealed loud multiple clicks at the apex. An electrocardiogram revealed T wave inversion in leads 2, 3 and aVF. Two-dimensional and M-mode echocardiography disclosed mid-systolic buckling of the mitral valve and late systolic 'dip' in the posterior wall of the left ventricle. An exaggerated excursion of the posterior wall during early diastole was also recorded by M-mode echocardiography. Pulsed and M-mode color Doppler echocardiography detected unusual anterograde flow near the mitral valve. This flow coincided well in timing with the early diastolic exaggerated excursion of the posterior wall. A discussion was made on the relation between abnormal left ventricular wall motion and mitral valve prolapse.