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We report a case of idiopathic pericarditis in a 71-year-old woman without a friction rub or electrocardiographic changes suggestive of pericardial inflammation. She noticed dyspnea and palpitation on exertion about 40 days before admission. After admission, pericardial effusion and inflammatory reactions, such as elevated C-reactive protein, were found. Moreover, gallium-67 citrate scintigraphy revealed abnormal isotope accumulation over the cardiac silhouette. Therefore, she was diagnosed as having "active" pericarditis. The finding with the gallium scan became negative with steroid therapy. In this case, a gallium scan was very useful in assessing and monitoring the course of pericardial inflammation.

A 72-year-old female who underwent the extirpation of metastatic intraspinal tumor showed an extremely wide variation of blood pressure with recurrent episodes of syncope due to paroxysmal hypotension. Treatment of the patient with salt supplement and L-threo-3, 4-dihydroxyphenylserine, an exogenous precursor of norepinephrine, markedly improved the syncopal attack as well as the daily activity.

Percutaneous transluminal coronary angioplasty has been reported to improve several clinical parameters. Functional papillary muscle dysfunction, which is also known to induce mitral valve regurgitation, is reversible after revascularization. We described a patient, with a 95% stenosis of proximal right coronary artery, whose mitral valve regurgitation disappeared after successful percutaneous transluminal coronary angioplasty.

A randomized prospective study was carried out and the therapeutical effects of intensive medical management in the acute stage of unstable angina were compared with those of urgent coronary bypass surgery on patients admitted to Kanazawa Medical University Hospital, who showed an ST elevation or depression during their attacks. Seventy patients with unstable angina were evaluated clinically, angiographically and hemodynamically: 41 of them had a transient ST elevation (26 treated medically; 15 surgically) and 29 had a transient ST depression (15 treated medically; 14 surgically). The hospital mortality rates were 12.2% for the medical group (3.8% in patients with an ST elevation; 26.7% in an ST depression) and 17.2% for the surgical group (6.7% in an ST elevation; 28.6% in an ST depression). These differences were not significant. The incidence of myocardial infarction among in-patients was 7.3% in the medical group (0% in the patients with an ST elevation; 20% in an ST depression) and 13.8% in the surgical group (13.3% in an ST elevation; 14.3% in an ST depression). These differences were also not significant. On their coronary angiograms, single vessel disease was significantly frequent in unstable angina with an ST elevation and so was triple vessel disease in patients with an ST depression. Left ventricular function was markedly improved in patients with an ST elevation after coronary bypass surgery. However, in unstable angina with an ST depression, there was no amelioration of left ventricular contractility and relaxation. It is concluded that by medical or surgical treatment, patients with unstable angina showing an ST elevation during their attacks had a fairly better prognosis than those showing an ST depression; the left ventricular function of the ST elevation group was improved considerably after AC bypass surgery, while those of the ST depression group showed no improvement.

Nifedipine, the Ca++ antagonistic coronary vasodilator, was administered by oral, sublingual and enema routes. 1) In 6 severe hypertensive patients (systolic pressure greater than or equal to 200 mmHg, diastolic greater than or equal to 120 mmHg), nifedipine, administered orally, induced prompt and reliable fall of arterial pressure (systolic pressure: -28% of control level, diastolic: -27%). 2) In 10 patients with hypertensive emergencies, including malignant hypertension, intracranial bleeding, hypertensive encephalopathy and acute hypertensive heart failure, sublingual and enema administration of nifedipine were performed with excellent hypotensive efficacy. 3) Pressure began to fall within 5--15 min, 30 min and 30--60 min after sublingual (or dissolved), enema and oral (capsule), respectively, and reached its lowest levels in the next 10--20 min. The fall of pressure lasts for 2--4 hours. 4) In the combination of nifedipine with alpha-methyldopa, antihypertensive response in short-term was increased about +11% over nifedipine alone and lasted for 8 hours. In combination with beta-blocker (propranolol), hypotensive efficacy increased +39% over nifedipine alone, but the effective duration of this combination was the same as nifedipine alone. 5) Side effects, including dryness of the mouth and burning sensation in face and legs, were observed in few patients.

The effects of angiotensin II, thyroxine and 17 beta estradiol on plasma renin substrate concentration in rats and renin substrate production by perfused rat livers were investigated. The addition of angiotensin II (1-10 microgram) to the perfusion system did not affect the synthesis of renin substrate. After treatment with thyroxine (2.5 mg/kg/day), plasma renin substrate concentration, plasma renin activity, plasma aldosterone concentration and the rate of renin substrate synthesis were all significantly increased. 17 beta estradiol (2 mg) raised both plasma renin substrate concentration and the amount of renin substrate production by the liver. Isoelectric focusing profiles of renin substrate of liver perfusate and of plasma from estrogen-treated rats were different from that of liver perfusate from normal rats. But the profile of renin substrate in plasma was essentially similar to those to liver perfusates both in normal and estrogen-treated rats.

The blood pressures (BP) and anthropometric values of 1,014 Japanese rural school children aged 12-17 years old were measured at one-year interval. The strongest correlation for systolic BP (SBP) was weight and for diastolic BP (DBP) it was age. Larger values of weight, body mass index, triceps skinfold thickness and smaller increment of height showed significant discriminative powers in differentiating the subjects who had been above the age-sex specific 80th percentile value (H-H group) from those who had been below the 20th percentile value (L-L group) for both SBP and DBP. Subjects with a family history of hypertension (FHH) had higher SBP than those without a FHH, and were more prevalent in H-H group for SBP. These results indicate that larger body size and more mature stature are determinants of higher levels of BP during adolescence, and that FHH affects SBP only in this period.

A case of Fabry's disease with pulmonary regurgitation is reported, and the cause of valvular involvement, the electrophysiological mechanism of the short PR interval, and the usefulness of the endomyocardial biopsy method in an attempt to establish the diagnosis in Fabry's disease have been discussed.

Hemodynamic response of nifedipine in 11 patients with congestive heart failure was examined. Thirty minutes after sublingual administration of nifedipine, CI and SVI were increased together with a decrease in PAEDP and TSVRI. The increase in CI was proportional to the decrease in TSVRI. Twenty-four hours after continuous administration of nifedipine, however, six of 11 patients did not show the improvement of left ventricular function. These results indicate that sublingual administration of nifedipine is effective in the short-term therapy of the patients with a markedly decreased cardiac output and an increased systemic vascular resistance.

Hemodynamic changes during the cold pressor test were examined in Type I labile (juvenile labile) hypertensive patients, Type II labile (middle aged labile) hypertensive patients, established hypertensive patients and normal subjects. In normal, Type I labile hypertensive and established hypertensive subjects, the pressor response during the test was accounted for chiefly by a rise in peripheral resistance. In Type II labile hypertensive patients, an increase in blood pressure during cold stimuli was accompanied by an augmented cardiac output. Therefore, Type II labile hypertension is separated clearly from other types of hypertension with respect to hemodynamic changes during the test. In Type II labile hypertensive patients, however, diazepam reduced an increase in cardiac output during the test, resulting in hemodynamic changes similar to those of normal subjects. After atropinization, the hemodynamic pattern of Type I and established hypertensives changed similar to that of Type II labile patients during the cold pressor test. It is concluded that an excessive cardiac output caused by the cold stimuli is a distinctive hemodynamic characteristics of Type II labile hypertensive patients, and this distinctive hemodynamic characteristics might be due to the decreased parasympathetic tone.

Body surface potential mapping (BSPM) was performed to evaluate the infarct size and the viability of myocardium in the infarct area in 20 patients with anterior myocardial infarction (MI). BSPM was performed at the early acute phase, 1 week, 1 month and 2 months after onset of the symptoms. The departure areas were obtained according to the potential distribution below the mean normal range and were compared with the value for creatine phosphokinase (CPK), hemodynamic parameters, ejection fraction measured by radionuclide ventriculography, extent score (ES) and severity score (SS) of thallium-201 single photon emission computed tomogram. Two months after the infarction, the ergometer exercise was performed and departure areas before and after exercise were compared. With the departure map technique, the departure areas in all cases were found in the anterior region of the thorax; From 1 week to 2 months after MI, the departure areas were significantly reduced. One week after MI, the departure areas had a positive significant relation with peak CPK and sigma CPK. One month after MI the departure areas also had a positive relation with ES or SS. One week and 1 month after MI, the departure areas had a negative relation with the left ventricular stroke work index or the left ventricular ejection fraction. After exercise test in the chronic phase, the departure areas were significantly enlarged. In conclusion, the departure map is useful in evaluating the location, sequential changes of size of anterior MI including the ischemic area around the infarct site and the left ventricular function. It is suggested that the enlarged departure areas after exercise might be the ischemic areas provoked by exercise.

A 38-year-old woman with coronary arterial aneurysm, which resulted in myocardial infarction, was reported. By coronary arteriography, an aneurysm of the left anterior descending branch was found, but no arteriovenous shunt could be revealed. The patient has neither clinical history of severe febrile inflammatory disease nor any coronary risk factors. The etiology of her coronary arterial aneurysm was considered to be congenital. The patient underwent aorto-coronary saphenous vein bypass graft surgery successfully. We believe that this is the first case report in Japan on congenital aneurysm of the coronary artery without arteriovenous fistula, which was diagnosed during life by coronary arteriography.