Association between Sarcopenia and Overactive Bladder in Elderly Diabetic Patients

OBJECTIVES

To determine the association between sarcopenia and overactive bladder (OAB) in elderly diabetic patients using the Japanese version of SARC-F called SARC-F-J.

DESIGN

Cross-sectional study.

SETTINGS AND PARTICIPANTS

The study included 329 elderly diabetic patients (aged ≥65 years) who regularly visited the outpatient clinic at Community hospital in Japan.

MEASUREMENTS

The condition of OAB was evaluated using the OAM symptom score, which involves a self-administered questionnaire, and sarcopenia was evaluated using the self-administered SARC-F-J questionnaire comprising five items. The odds ratio for OAB due to sarcopenia was calculated using multiple logistic regression analysis, with OAB as the dependent variable and sarcopenia as the explanatory variable.

RESULTS

A total of 329 patients (186 males, 143 females) were included for analysis in the present study. Of these patients, 22.9% had sarcopenia and 18.7% had OAB. After adjusting the variables, the odds ratio for OAB due to sarcopenia was 4.46 (95% confidence interval [CI], 1.14-17.36, P = 0.031) and 2.09 (95% CI, 0.52-8.26, P = 0.293) for males and females, respectively.

CONCLUSION

This study found that sarcopenia was significantly associated with OAB in elderly diabetic male patients based on SARC-F-J. Moreover, the possibility of the development of OAB should be considered during the medical examinations of elderly diabetic male patients with sarcopenia.

Clinical Utility of Diagnostic Laboratory Tests in Dogs with Acute Pancreatitis: A Retrospective Investigation in a Primary Care Hospital

BACKGROUND

Acute pancreatitis (AP) occurs frequently in dogs, but most previous studies examining the diagnosis of AP have used data from secondary care hospitals.

HYPOTHESIS/OBJECTIVES

The aim of this study was to investigate the clinical utility of diagnostic laboratory tests in dogs with AP in a primary care hospital.

ANIMALS

Sixty-four dogs with clinical signs suggestive of AP diagnosed with nonpancreatic disease (NP) or AP.

METHODS

Medical records were retrospectively reviewed, including diagnostic laboratory tests considered potentially useful in the diagnosis of AP. The diagnostic accuracy of amylase and FUJI DRI-CHEM lipase (FDC lip) were investigated using receiver operating characteristics (ROC). In addition, we verified whether diagnostic laboratory tests were useful for evaluating duration of hospitalization and as biomarkers for monitoring recovery.

RESULTS

Activities of amylase and FDC lip were significantly higher in the AP group than in the NP group (P = .001, P < .001, respectively). The sensitivity of FDP lip activity for diagnosing AP was 100% (95% confidence interval [CI], 87.7-100%); the specificity was 89.5% (95% CI, 66.9-98.7%). Area under the ROC curve for FDC lip activity was 0.98 (95% CI, 0.93-1). High alanine aminotransferase (ALT) activity was associated with extended duration of hospitalization (P = .04). A significant difference in C-reactive protein (CRP) concentration before and 5 days after treatment was found (P = .001).

CONCLUSIONS AND CLINICAL IMPORTANCE

Measurement of FDC lip activity appears useful for diagnosing AP. High ALT activity might be associated with prolonged duration of hospitalization, and CRP might be useful as a biomarker for monitoring recovery from AP.

[Differentiation of hypertrophic cardiomyopathy and hypertensive cardiac hypertrophy using the patterns of interventricular septum hypertrophy]

The patterns of interventricular septal hypertrophy were analyzed on two-dimensional echocardiograms to differentiate hypertrophic cardiomyopathy (HCM) from hypertensive cardiac hypertrophy. The control group comprised 110 patients without cardiovascular disease who were matched for age and gender with the hypertension group. The hypertension group comprised 110 patients with uncomplicated essential hypertension, and the HCM group comprised 32 patients in whom the wall thickness of the interventricular septum was 12 mm or more at the mid-portion and no underlying heart disease responsible for cardiac hypertrophy was detected. The interventricular septal thickness was measured both at the thickest portion within 15 mm distal to the aortoseptal junction (basal portion: B) and at the mid-portion (M) in the end-diastolic image on the left parasternal long-axis tomograms, and the B/M ratio was calculated in each patient. The B/M ratio was 1.07 +/- 0.16 in the control group, 1.19 +/- 0.18 in the hypertension group, and 0.83 +/- 0.12 in the HCM group. Compared with the control group, the B/M ratio was significantly high in the hypertension group (p < 0.05) and significantly low in the HCM group (p < 0.01). These results indicate that hypertrophy of the interventricular septum is dominant at the basal portion in hypertensive patients but at the mid-portion in patients with HCM.

Abnormal Q wave, ST-segment elevation, T-wave inversion, and widespread focal myocytolysis associated with subarachnoid hemorrhage

A 74-year-old Japanese woman with subarachnoid hemorrhage was admitted to our hospital. During her hospitalization, serial electrocardiograms showed the combination of abnormal Q waves, ST-segment elevation, and T-wave inversion, which strongly suggested acute myocardial infarction. However, postmortem examination revealed widespread focal myocytolysis of the myocardium which was unrelated to vascular distribution.

Diversity of the synthetic-state smooth-muscle cells proliferating in mechanically and hemodynamically injured rabbit arteries

Vascular smooth muscles contain at least three types of developmentally regulated myosin heavy-chain (MHC) isoforms; SM1, SM2, and SMemb. By investigating the expression of the three MHC isoforms, we previously demonstrated in rabbits that smooth muscles proliferating in the neointima of arterio- and atherosclerotic lesions regain an "embryonic" phenotype. In the present study, we examined if neointimal cells are morphologically similar to embryonal smooth muscles and if dedifferentiation of neointimal smooth muscles is a reversible process. Vascular injury was produced in rabbits either by endothelial cell denudation of the aorta or by poststenotic dilation of the carotid artery. We have demonstrated in this study that the proliferating neointimal cells expressed SM1 and SMemb, but not SM2, indicating smooth muscles of an "embryonic" phenotype. The dedifferentiation of neointimal smooth muscles was found to be reversible; at 4 to 8 weeks after injury, a majority of the cells reexpressed both SM1 and SM2, but not SMemb. By electron microscopy, we have revealed smooth-muscle phenotypes determined by MHC isoforms to correspond to the morphologic phenotypes as an increase in membranous organelles, and a decrease in myofilaments was associated with the reexpression of SMemb. Interestingly, we also found that in the medial wall at 4 to 8 weeks after ballooning injury, a number of SM1-negative cells proliferated rapidly, replacing normal smooth muscles. These cells were negative against SM1 and SM2 but positive for SMemb. These SM1-negative cells contained abundant membranous organelles and few myofilaments. These cells did not express SM1 or SM2 even after 8 weeks postinjury. We conclude from these results that the proliferating synthetic-type smooth muscles after vascular injury are composed of SM1-positive cells that are morphologically similar to embryonal smooth muscle and that maintain ability to redifferentiate, and SM1-negative cells that contain few myofilaments and remain dedifferentiated.

[Perceived quality of life and social factors in elderly hypertensive patients]

We conducted a cross-sectional study of elderly outpatients with hypertension to examine the relationship between quality of life (QOL) scores and social background factors. The subjects consisted of 516 outpatients (267 females), age of 60 or over, at nine clinics of major hospitals which participated in the National Cardiovascular Center Research Project. The perceived QOL was evaluated by the QOL scale originally based on Japanese patients with cardiovascular diseases. The scale consisted of the following 5 subscales; difficulty due to disease, psychological stability, independence, satisfaction in daily living and vitality. The background factors included family structure, socioeconomic factors and work status, and physical activity of daily living (ADL). After adjusting for age, sex, administered drugs and complicating conditions such as ischemic heart disease and/or apoplexy, a significant odds ratio of a low score of difficulty due to disease, psychological stability, satisfaction in daily living and vitality was found in the impaired physical ADL group with low socioeconomic class, and a significant odds ratio of low score of independence were found in the impaired physical ADL group who had lost jobs due to illness and had no children.

Prediction of early development of chronic nonrheumatic atrial fibrillation

The purpose of this study was to identify predictors of development of chronic nonrheumatic atrial fibrillation within one year of onset, thereby minimizing the risk of embolic complications and death. We retrospectively studied 137 patients with new-onset nonrheumatic atrial fibrillation. Chronic atrial fibrillation developed in 30 patients at the end of one year (chronic group). Atrial fibrillation remained paroxysmal in 107 patients (paroxysmal group). Clinical characteristics, electrocardiograms, and echocardiograms at the time of the onset of atrial fibrillation were compared in the two groups. Patients in the chronic group were significantly older than patients in the paroxysmal group (70.1 +/- 8.2 vs. 62.4 +/- 11.0 years, p < 0.01) and had a significantly higher incidence of congestive heart failure (13% vs. 3%, p < 0.05) and diabetes mellitus (37% vs. 19%, p < 0.05). The chronic group also exhibited higher cardiothoracic ratio (52.0 +/- 5.7% vs. 47.6 +/- 5.0%, p < 0.01), greater f-wave amplitude in lead V1 (1.48 +/- 0.91 vs. 1.06 +/- 0.45 mm, p < 0.05), larger left atrial dimension (41.0 +/- 6.4 vs. 34.2 +/- 7.6 mm, p < 0.01), and lower left ventricular ejection fraction (71.4 +/- 5.6% vs. 75.5 +/- 8.2%, p < 0.05). The presence of four or more of the following seven factors strongly predicted the development of chronic nonrheumatic atrial fibrillation within one year (88% to 100%): age > or = 65 years, congestive heart failure, diabetes mellitus, cardiothoracic ratio > or = 50%, f-wave amplitude > or = 2.0 mm, left atrial dimension > or = 38 mm, and ejection fraction < or = 76%.

[Echocardiographic assessment of cardiac basal hypertrophy represented by increased base to mid thickness ratio (B/M ratio) in the ventricular septum and its relation to age]

The basal part of the interventricular septum may easily become hypertrophic because it is exposed to strong hemodynamic stress compared to the other portions of the left ventricle. We measured the end-diastolic interventricular wall thickness both at the base and in the midsection by 2D echocardiography in 122 normotensives, and examined whether the basal thickness increases with age. The basal thickness (B) increased with age in both sexes. In males the thickness averaged 10.1 mm in the 50-59 age group, 10.2 m in those aged 60-69 and 11.4 mm (p < 0.01) in those 70 or older compared to 9.4 mm in those aged 49 or younger. In females it was 8.1 mm (p < 0.05) in the 50-59 age group, 8.3 mm (p < 0.05) in those aged 60-69 and 10.0 mm (p < 0.01) in those 70 or older compared to 6.8 mm in those 49 or younger. Concerning the midwall thickness (M), there were no significant changes among the respective age groups in either sex. As a result, a close correlation was found between the B/M ratio, a new and simple index for basal hypertrophy, and age (R = 0.46, p < 0.01 in males and R = 0.43, p < 0.01 in females). Comparison of the B/M ratio between the two age groups 49 or younger and 70 or older was as follows; 1.08 vs 1.30 (p < 0.01) in males and 1.01 vs 1.27 (p < 0.01) in females. Increase of basal hypertrophy in the aged was clearly indicated by the B/M ratio.

A new model for infective endocarditis of the mitral valve in rabbits

To produce an experimental model of infective endocarditis without inserting catheters into the heart, we injected a bacterial suspension into rabbits in which mitral complex lesions had been induced by electrical stimulation of the cervical vagus. Typical infective vegetations grew on the surface of the mitral valves 1 week later. The formation of vegetations was related to the timing of the inoculation. Streptococcus viridans injected just after vagal stimulation produced vegetations in 10 of 17 animals (58.8%), but the same bacteria injected 14 days after vagal stimulation did so in only 2 of 11 animals (18.2%). The incidence of infective endocarditis was significantly higher after early inoculation compared with delayed inoculation (p < 0.01). The susceptibility to infection depended on the species of bacteria injected. Both S. viridans and Pseudomonas pseudoalkaligenes injected just after vagal stimulation produced vegetations in 10 of 17 (58.8%) and 6 of 13 (46.2%) animals, respectively, but Staphylococcus epidermidis injected just after vagal stimulation did not produce vegetations in any of the 10 animals. S. viridans injected into nine normal animals never produced vegetations. These findings indicate that infective endocarditis develops after intravenous injection of bacterial suspensions alone in rabbits with mitral complex lesions.

[Age-associated morphological change in interventricular septum]

To investigate the morphological features of the interventricular septum (IVS) in the senile heart, we examined 123 normotensives (59 males and 64 females), ranging in age from 22 to 91 yrs using 2D echocardiography. End-diastolic IVS thickness was measured at the mid-portion (M) and at the thickest portion within 15 mm distal to the aorto-septal junction (basal portion, B) on left parasternal long-axis tomogram. The sigmoid shape of the basal portion was evaluated in terms of aorto-septal (AS) angle. M showed no correlation with age, whereas B increased significantly with age in both sexes (males, r = 0.42, p < 0.01; females, r = 0.51, p < 0.01). B/M ratio, therefore, also increased with age (males, r = 0.49, p < 0.01; females, r = 0.39, p < 0.01). The AS angle decreased with age in both sexes (males, r = -0.33, p < 0.01; females, r = -0.51, p < 0.01). There was a significant inverse correlation between B/M ratio and AS angle (males, r = -0.31, p < 0.05; females, r = -0.50, p < 0.01). We conclude that the B/M ratio is a novel index reflecting heterogenously distributed hypertrophy in the IVS associated with age.

Cellular and molecular bases for the immunopathology of the myocardial cell damage involved in acute viral myocarditis with special reference to dilated cardiomyopathy

Cell-mediated autoimmunity has been strongly implicated in the pathogenesis of the myocardial cell damage involved in viral myocarditis. To investigate the cellular and molecular bases of both target cells and effector cells for cell-mediated cytotoxicity involved in viral myocarditis and dilated cardiomyopathy, we first examined the expression of major histocompatibility complex (MHC) antigens and a cell adhesion molecule, intercellular adhesion molecule-1 (ICAM-1) in myocardial cells of a murine model of viral myocarditis and in patients with acute myocarditis and dilated cardiomyopathy. Secondly, we analyzed the characteristics of the infiltrating cells in the heart, especially the expression of a cytolytic factor, perforin. We found that Coxsackievirus B3 (CVB3)-induced murine acute myocarditis resulted in enhanced expression of MHC (class I) antigens and ICAM-1 on myocardial cells, and that perforin was abundantly expressed in NK (natural killer)-like large granular lymphocytes (LGL), which represent the main infiltrating cell type in the early stage. Immunoelectron microscopic study showed killer cells directly damaging cardiac myocytes by the release of perforin. Perforin was also expressed in the infiltrating cells in the heart of a patient with acute myocarditis. Both MHC antigens and ICAM-1 were clearly expressed in the hearts of patients with acute myocarditis and dilated cardiomyopathy. These data provided direct evidence that cell-mediated cytotoxicity plays a critical role in the myocardial cell damage involved in viral myocarditis.

Abscess within a glioblastoma multiforme--case report

A rare case of abscess within a glioblastoma with an unusual presentation occurred in a 46-year-old female who developed right hemiparesis and seizure. Computed tomography and magnetic resonance imaging demonstrated hemorrhage which mimicked hemorrhagic infarction. However, the lesions developed ring enhancement. Aspiration showed one to be an abscess, which collapsed by drainage but later re-expanded. The mass was removed, and histological examination revealed glioblastoma.

[Immunological detection of fecal occult blood-follow up study on patients with positive testing]

To evaluate its clinical utility in the early detection of colorectal diseases, we carried out the immunological fecal occult blood test in 922 patients and monitored the clinical course of the 87 patients in whom it was positive. Thirty-five (40.2%) of these patients underwent subsequent X-ray and colonoscopy, and colorectal cancer was detected in 8 (20%). Our findings confirm the clinical usefulness of this test.

[Trends in antihypertensive drugs used for elderly patients]

The admission of antihypertensive medications in the elderly (65 y.o. or more, 269 pts) was compared to that in younger cases (less than 65 y.o., 348 pts). All were outpatients who visited our clinic in 1990. The number of patients on a single therapeutic regimen was almost equal in both age groups. Once-a-day regimens were more common in the young (56.9% vs 48.3%, p less than 0.05), and three times-a-day regimens were more common in the elderly (14.7% vs 23.1%, p less than 0.01). The choice of antihypertensive drugs in patients with single therapy or combined therapy in the young was beta blockers in 49.7%, Ca blockers in 39.4%, diuretics in 30.7% and ACE inhibitors in 17.8%, and those in the elderly were Ca blockers in 46.1%, diuretics in 44.2%, beta blockers in 33.8%, and ACE inhibitors in 16.4%. The patients were subdivided into three groups according to the time of the initial visit to the clinic; initial visit during 1969-1979 (phase 1), 1980-1984 (phase 2) and 1985-1990 (phase 3). In the young, choice of beta blockers and diuretics was most popular in phase 1. However, the choice of diuretics decreased in phase 2, and in phase 3 beta blockers were used in 50.4%, Ca blockers in 43.2%, ACE inhibitors in 22.3% and diuretics in only 17.3%. In the elderly, diuretics were most popular followed by Ca blockers and beta blockers in phase 1 and phase 2. In phase 3 Ca blockers were selected in 58.2% followed by both beta blockers and ACE inhibitors in 28.4% then diuretics in 23.9%.(ABSTRACT TRUNCATED AT 250 WORDS)

Heterogeneity in smooth muscle cell population accumulating in the neointimas and the media of poststenotic dilatation of the rabbit carotid artery

Rabbit smooth muscles contain at least three types of myosin heavy chain (MHC) isoforms; SM1, SM2 and SMemb (NMHC-B), the expression of which is developmentally regulated. We have recently reported that smooth muscles with the embryonic phenotype accumulate in the neointimas produced by endothelial denudation or high-cholesterol feeding. In this study, we examined MHC isoform expression in the neointimas and the media of poststenotic dilatation of the rabbit carotid artery, and determined the phenotype of the smooth muscle cell in the dilated segment. We report here that neointimal cells in the dilated segment are smooth muscle cells with the embryonic phenotype as previously reported in our ballooning-injury study. The medial smooth muscles, however, are composed of heterogeneous population of smooth muscles which differ in stage of differentiation as determined by the MHC isoform expression. These results indicate that MHC isoforms are useful molecular markers to identify abnormally proliferating smooth muscles in diseased arteries and to understand the process of atherogenesis occurring following vascular injury.

[Spontaneous reversion to sinus rhythm in a case of lone atrial fibrillation of fifteen years duration]

A 69-year-old male visited our clinic in 1973 because of atrial fibrillation noted during an annual check-up for the aged. Blood pressure, heart rate and CTR in chest X-ray films showed 110/80 mmHg, 150/min and 55%, respectively. There were no signs of valvular heart diseases, and a diagnosis of lone atrial fibrillation was convincing. Since then, repeated ECGs recorded twice or more a year had shown atrial fibrillation until 1988, when sinus rhythm with both first degree AV block and low P-wave amplitude appeared. The motion pattern of the anterior mitral leaflet on M mode echocardiography was abnormal with almost complete disappearance of the A-wave, whereas the motion pattern of the tricuspid valve was normal.

[Establishment of permanent atrial fibrillation and time course of the amplitude of the f wave]

Atrial fibrillation is one of the arrhythmias that increase with increasing age. In this study we compared transition intervals from sinus rhythm to permanent atrial fibrillation and the time course of the f wave amplitude immediately after the transition between 32 younger (less than 65 years) and 44 elderly patients (greater than or equal to 65 years) in whom transition from sinus rhythm to permanent atrial fibrillation was confirmed on serial ECG recordings. Each group was classified into three categories according their underlying diseases: hypertensive heart disease, valvular disease, and lone atrial fibrillation. In patients with hypertensive heart disease or lone atrial fibrillation, there was no significant difference in the transition intervals between the younger and the elderly groups. In both groups the transition intervals were significantly (p less than 0.05) longer in patients with lone atrial fibrillation than those in patients with hypertensive heart disease (44.6 vs. 12.5 months in younger and 26.8 vs. 12.9 months in elderly). A significant positive correlation (r = 0.58, p less than 0.01) was observed between the final P wave and the initial f wave amplitude on establishment of permanent atrial fibrillation in all patients. In the younger group, the initial f wave amplitude of patients with valvular disease (0.27 +/- 0.04 mV, mean +/- SE) was significantly larger than those of patients with hypertensive heart disease (0.15 +/- 0.03 mV, p less than 0.05) and of patients with lone atrial fibrillation (0.16 +/- 0.01 mV, p less than 0.05). The f wave amplitude of valvular disease was significantly decreased after 1 year (0.22 +/- 0.03 mV, p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Expression of major histocompatibility complex class I antigen in murine ventricular myocytes infected with Coxsackievirus B3

Evidence has accumulated that T cell-mediated autoimmunity plays an important role in the pathogenesis of viral myocarditis. T lymphocytes are known to recognize antigen-presenting cells, such as virus-infected cells, being restricted by syngeneic major histocompatibility complex (MHC) antigens. To clarify in more detail the immunological mechanisms involved, we induced acute viral myocarditis in C3H/He mouse ventricles with coxsackievirus B3 (CVB3) and examined, by immunofluorescence, the expression of MHC class I and II antigens, previously reported not to be expressed by normal cardiac myocytes. Furthermore, to confirm the expression of MHC class I (H-2Kk) antigens at the cellular level, we treated cultured cardiac myocytes with interferon gamma and examined the antigen expression by immunofluorescence and Northern blot hybridization, using an antisense RNA probe for MHC messenger RNA. Our observations demonstrated 1) CVB3-induced myocarditis resulted in the enhanced expression of MHC class I (H-2Kk) gene product on the surface of cardiac myocytes but low or undetectable levels of MHC class II or H-2Dk gene products, and moderate focal transient (days 5-7) expression of both MHC class I (Kk + Dk) region gene products and MHC class II antigens were induced on capillary endothelial cells; 2) murine fetal cardiac myocytes cultured in vitro in the presence of interferon gamma similarly were shown to express marked levels of MHC class I (H-2Kk) but low to undetectable levels of the H-2Dk gene product; however, weak to moderate MHC Class II antigens were expressed by these cultured myocytes; and 3) the expression of MHC antigens in cardiac myocytes was modulated at the transcriptional level.(ABSTRACT TRUNCATED AT 250 WORDS)

Intracellular assembly of newly synthesized canine cardiac myosins

To investigate how newly synthesized cardiac myosins are assembled into myofilaments, we analysed the distribution of newly produced alpha-myosin heavy chain isozyme in sarcomeres by immunoelectron microscopy using a monoclonal antibody (CMA19), which is specific for alpha-myosin heavy chain. Isozymic changes in myosin heavy chains from beta to alpha type were induced in canine ventricular muscles and cultured ventricular myocytes by administration of 1-thyroxine. We incubated the glycerinated ventricular muscles or cultured ventricular myocytes with the enzyme (horseradish peroxidase) labelled Fab fragment of CMA19. After the reaction with 3, 3'-diaminobenzidine and osmification, we prepared ultrathin sections of the ventricular muscles or cultured ventricular myocytes and analysed their staining patterns by electron microscopy. There was apparent heterogeneity in the staining intensity of the myofilaments among different cells, among different myofibrils and even intramyofibrillarly. Higher magnification revealed that there were scattered foci of strong reaction which appeared to be foci of assembly of the newly synthesized alpha-myosin heavy chain. Immunocytochemical study also showed heterogeneous reactions within myofilaments and that there were scattered foci of myofilament assembly, which were closely associated with polyribosomes producing newly induced alpha-myosin heavy chain. These data suggest that newly synthesized cardiac myosins are assembled into myofilaments from the sites of synthesis, that is polyribosomes. This may explain the heterogeneity of the assembly pattern of newly synthesized cardiac myosins at the subcellular level.

Intracranial metastasis of a spinal cord astrocytoma--case report

The authors report a case of cerebral metastasis from a spinal cord astrocytoma. The first metastatic tumor was controlled by radiation therapy. A second metastatic brain tumor was detected 2 years later, but attempts to control it through subtotal removal and chemotherapy failed. Metastasis from a spinal cord tumor to the brain is a rare event.

Hydroxyproline in all parts of the rabbit heart in hypertension and in its reversal

To investigate the response of cardiac collagen to arterial hypertension and its reversal, we measured the hydroxyproline concentration in all parts of the rabbit heart in three groups: a chronic hypertension group (n = 11), a reversal group (n = 9) and an age-matched control group (n = 10). Left ventricular overload was produced by one-kidney, one-clip Goldblatt hypertension and its reversal was produced by clip release. The wet weight of every part of the left side of the heart was increased by hypertension and all parts except for the papillary muscles showed regression with reversal. However, the response of collagen was quite different among the various parts of the heart. The wet weights of the left atrium, left ventricular free wall, interventricular septum, and anterior and posterior papillary muscle in the hypertension group were 144 (P less than 0.01), 140 (P less than 0.01), 134 (P less than 0.01), 144 (P less than 0.01) and 129% (P less than 0.01), respectively, and those in the reversal group were 92, 113 (P less than 0.05), 107 (P less than 0.05), 142 (P less than 0.05) and 126% (P less than 0.05) of those in the control group, respectively. Hydroxyproline concentrations in the respective parts in the hypertension group were 79 (P less than 0.05), 91, 98, 121 (P less than 0.05) and 120% (P less than 0.05) and those in the reversal group were 86, 93, 94, 107 and 110% of those in the control group.(ABSTRACT TRUNCATED AT 250 WORDS)

Age-related reduction in the number of rabbit erythrocyte Na, K-ATPase

The number of Na, K-ATPase units, assessed by [3H]-ouabain binding assay, was significantly less in erythrocytes from 17 mature (30-week) rabbits than in those from 17 young (16-week) ones (0.179 +/- 0.010 vs. 0.263 +/- 0.014 pmol/10(9) cells, p less than 0.01). Consistent with this finding, the erythrocyte sodium concentration was significantly higher in mature rabbits as compared with young animals (17.1 +/- 1.30 vs. 10.8 +/- 0.68 mmol/liter, p less than 0.01). When the assays were repeated in 8 of the young rabbits 8 weeks after the initial determination, both variables were found to be similar to the levels from mature animals. The data suggest that the activity of erythrocyte sodium pump declines with aging or growth of donor rabbits, as a result of a reduction in the number of Na, K-ATPase units.

Effects of monotherapy and withdrawal of antihypertensive drugs in the treatment of hypertension

The final number of antihypertensive drugs used in the long-term treatment of a given patient is not always predictable at the start of therapy. By reviewing clinical records, we retrospectively examined the relationship between pretreatment blood pressure and the final number of drugs administered in 282 patients with mild to moderate hypertension who had been treated for 5 years or more (average 9.7 years). After years of treatment approximately one third and one half of 137 patients with a pretreatment diastolic blood pressure of between 90 and 104 mmHg were well controlled with combined therapy and monotherapy, respectively. The drugs had been withdrawn in the remaining 17% for 12 months or more. Lower pretreatment systolic blood pressure and lower pretreatment QRS voltage were signs favorable for withdrawal of the drugs. Combined therapy was required in more than half the patients with higher pretreatment diastolic blood pressure.

Hematocrit increase by mental stress in hypertensive patients

Hematocrit (Hct) changes during mental stress were studied in 21 patients with mild hypertension. A 10 min arithmetic stress test increased blood pressure from 129 +/- 2/80 +/- 2 mmHg (mean +/- SEM) to 167 +/- 5/98 +/- 3 mmHg, and heart rate from 64 +/- 2 to 81 +/- 3 (p less than 0.001). Concomitantly, a significant (p less than 0.001) increase in Hct was observed (from 41.5 +/- 0.7% to 42.2 +/- 0.8%), and increments of Hct (-0.1% to 2.2%) were significantly (r = 0.61, p less than 0.01) correlated with those of systolic blood pressure. Plasma levels of norepinephrine (NE), epinephrine (E) and atrial natriuretic peptide (ANP) also showed a significant increase after mental stress. All these changes disappeared after a 60 min recovery period. The results suggest that mental stress increases Hct promptly, which may be due to concomitant increases in plasma NE, E and ANP levels. Hct elevation resulting from mental stress may be clinically relevant, at least, in hypertensive patients who are at risk of occlusive vascular diseases.

[Assessment of tissue and intracellular pH following cold-induced vasogenic brain edema--in vitro and in vivo study]

Acid-base balance is closely related to the brain function and various methods have been applied to estimate the intracellular, extracellular or tissue pH. Umbelliferone, a fluorescent pH indicator, has been used to study either intracellular or tissue pH. In the present study, umbelliferone was used for histochemically estimating the tissue pH in the rat brain. The pH nomograms were made from the difference between fluorescent intensities at 450 nm on both excitations at 370 nm and 340 nm at different tissue water contents and different umbelliferone concentrations. Linear correlations were noted under each condition but 0.125% w/v umbelliferone provided the best estimation of tissue pH because of the least influence of water contents. Using this concentration of umbelliferone, a histochemical study was done to estimate the sequential changes in tissue pH following cold-induced vasogenic brain edema in rats. The results revealed a clear delineation of brain edema and the mild alkalosis in the edematous tissue, which probably reflects the pH of leaked plasma fluid. While the pH in the cortex around the lesion was neutral in the histochemical study, it was acidic in the in vivo study. This discrepancy is probably due to the former indicating the tissue pH while the latter the intracellular pH. Thus, the alkalosis in the edema fluid and the intracellular acidosis in the cortex around the lesion were noted in the cold-induced vasogenic edema.

Relationship between plasma levels of atrial natriuretic peptide and cyclic guanosine monophosphate in patients with heart diseases

The relation of plasma levels of atrial natriuretic peptide (ANP) to those of cyclic 3', 5'-guanosine monophosphate (cGMP) was studied in 43 patients with various heart diseases. Plasma levels of both ANP and cGMP were significantly (p less than 0.001) elevated in 34 patients with chronic heart diseases, and a significant positive correlation was observed between the two variables (r = 0.706, p less than 0.01). Clinical improvement of congestive heart failure resulted in a concomitant decrease in plasma ANP and cGMP levels in 6 patients. In 3 patients with paroxysmal atrial fibrillation, plasma levels of ANP and cGMP increased markedly during arrhythmia. These results indicate that increased circulating ANP may stimulate cGMP production in target cells, which in turn raises plasma levels of cGMP in humans.

Reflectance spectrophotometric measurement of in vivo local oxygen consumption in the cerebral cortex

A simple method was developed to measure in vivo local oxygen consumption quantitatively in the brain cortex. Reflectance spectra of tissue hemoglobin at the brain's surface were measured for assessment of both local tissue hemoglobin content and its oxygen saturation. Local oxygen consumption was calculated from the spectral changes of tissue hemoglobin during complete cessation of blood flow by compression of the cortical surface in the suprasylvian gyrus with the tip of an optic probe. This procedure was performed without any brain damage and only took approximately 5 s. The calculated local oxygen consumption during this short period of compression remained constant for a few seconds. Then, it decreased rapidly, although the local tissue hemoglobin was not completely deoxygenated. The value of local cerebral oxygen consumption obtained by this method was 3.02 +/- 0.61 mL O2/100 g brain/min; it was not influenced by the change in systemic blood pressure. The effect of pentobarbital on cerebral oxygen consumption was also studied. At the stage of burst and suppression on electrocorticogram, cerebral oxygen consumption decreased significantly (p less than 0.001) to 1.03 +/- 0.07 mL O2/100 g brain/min.

Effect of beta-adrenergic receptor blockade on atrial natriuretic peptide in essential hypertension

Plasma levels of atrial natriuretic peptide (ANP) were measured in 32 untreated subjects with essential hypertension and in 31 patients undergoing long-term treatment with beta-blockers. Patients receiving beta-blockers had significantly higher mean plasma ANP levels (72.0 +/- 36.0 [SD] pg/ml) than did untreated hypertensive subjects (39.8 +/- 15.8 pg/ml; p less than 0.01) and healthy normotensive controls (33.9 +/- 16.6 pg/ml; n = 61, p less than 0.01), while the mean plasma ANP concentration in untreated hypertensive subjects was not statistically different from that in control subjects. Administration of atenolol, 50 mg/day, for 4 weeks to 10 untreated subjects resulted in a significant (p less than 0.001) rise in plasma ANP levels (from 38.8 +/- 9.5 to 68.7 +/- 20.6 pg/ml). In 31 patients undergoing long-term treatment with beta-blockers, multivariate regression analysis revealed that age, pretreatment mean blood pressure, and plasma concentration of cyclic 3',5'-guanosine monophosphate (cGMP) were significant predictors of plasma ANP levels. These results suggest that beta-adrenergic receptor blockade in patients with essential hypertension elevates plasma ANP levels with a concomitant rise in cGMP concentrations, and that increased ANP in plasma may play a role in the compensatory mechanism that operates in response to beta-adrenergic receptor blockade.

[Clinical validity of lumbar subarachnoid pressure measurement]

To evaluate the clinical usefulness for measuring lumbar subarachnoid pressure (LSP) as an index of intracranial pressure, the relation between LSP and epidural pressure (EDP) was studied by the cisternal saline infusion and bolus injection in 12 cats at the range of pressure up to 50 mmHg. In the steady state infusion (0.238 ml/min, 0.476 ml/min), the data from LSP and EDP were correlated very well and the LSP value was at least above 80-90% of EDP value at any pressure level. In the bolus injection (0.4 ml), the degree of pressure rise and the time course of both LSP and EDP were quite similar at any pressure level. However, the compliance calculated from the pressure change of LSP and EDP revealed to have a different tendency according to the baseline pressure level at bolus injection. Below 10 mmHg of EDP, the compliance calculated from LSP was usually higher that of EDP. This was considered due to the distensibility of spinal theca. But above 10 mmHg of EDP, the compliance of both LSP and EDP became almost equal and then gradually decreased as the elevation of baseline pressure at bolus injection. This was considered to be the result of disappearance of the distensible effect of spinal theca. In this study, two polyethylene tubes of different size (I. D. 0.45 mm, 0.58 mm) were used for spinal drainage tube to compare the pressure dumping effect of tube. However, on both tubes, the pulse pressure of LSP was usually smaller than that of EDP, with each having almost constant difference.(ABSTRACT TRUNCATED AT 250 WORDS)

[The sequential changes of energy metabolism following cold-induced brain edema--a histochemical study]

The changes of energy metabolism on vasogenic edema have been largely examined using biochemical quantitative assay. However, the relationship between the sequential changes and blood-brain barrier (BBB) breakdown is not well understood. In the present study, the sequential changes of energy metabolism and potassium in relation to BBB breakdown following the cold-induced brain edema were investigated histochemically. Adult male Wistar rats, weighing 200-250g, were anesthesized with pentobarbital and a burr hole was made in the left parietal region. For evaluating the breakdown of BBB, 2.5% Evans blue (EB) was injected 30 min. before injury, except in the 5 min. model in which it was injected at the time of cold injury. An iron-bar precooled in liquid N2 was placed over the surface for 30 seconds and they were frozen in situ in liquid N2 at 5 min., 2 hrs., 6 hrs., 12 hrs., and 24 hrs., after producing the lesion. The frozen brain was sectioned using a precooled saw in the coronal plane. The brain section was placed in liquid N2 bath and illuminated with 366 nm light (UV) from a 200 watt mercury lamp and Corning filter 5840. NADH fluorescence was recorded photographically through Corning filter 3387 and 5562. Regional ATP and potassium content were investigated histochemically in thin sections with luciferine-luciferase method and Macallum's technique, respectively. At 5 min. after cold injury, leakage of EB was limited within the lesion. Potassium and ATP were decreased in the lesion. NADH fluorescence was increased slightly in the cortex around the lesion.(ABSTRACT TRUNCATED AT 250 WORDS)

Peculiar mitral valve and papillary muscle lesions induced by vagus manipulations in rabbits. An experimental model for nonrheumatic mitral regurgitation

Peculiar lesions of mitral valves and papillary muscles developed in 50 to 80% of rabbits after clipping (N = 38), crushing (N = 15) or electrical stimulation (N = 44) of their cervical vagi. Both right and left vagus manipulations induced similar cardiac lesions. The earliest manifestation was bleeding of the mitral leaflets, which was followed by swelling and fibrosis of the papillary muscles. Ventricular arrhythmias and systolic murmurs were frequently associated with the vagus manipulations. During or just after electrical stimulation of the vagus, ventricular premature contractions (VPCs) were observed in 30 of 44 animals. Twenty-nine of these 30 animals with VPCs (96.7%) were found to have mitral valve and/or papillary muscle lesions at autopsy, whereas only 5 of 14 animals without VPCs (35.7%) had the cardiac lesions. These results indicate that the occurrence of these ventricular arrhythmias during vagus manipulations was closely related with the mitral valve and papillary muscle lesions.

Exercise-induced QRS axis shift and its clinical significance

Exercise tests occasionally induce a QRS axis shift. Reviewing single Master's two-step test electrocardiograms of 1810 patients, we examined the incidence of the QRS axis shift and the relations of the QRS axis shifts to ischemic heart disease. The QRS axis shift was 30 degrees or more to the right in 38 (2.1%), 15 to 29 degrees to the right in 304 (16.8%), less than 15 degrees to the right or to the left in 1375 (75.9%), 15 to 29 degrees to the left in 81 (4.5%), and 30 degrees or more to the left in 12 patients (0.7%). The frequency of positive Master's tests and clinical ischemic heart disease were both significantly greater in the patients with QRS axis shifts of 30 degrees or more to the right (15.8% and 26.3%, respectively) and the patients with those of 30 degrees or more to the left (33.3% and 50.0%, respectively) than in the patients with shifts less than 15 degrees (6.5% and 8.5%, respectively). These results indicate that the exercise-induced QRS axis shift is a useful clue for the diagnosis of ischemic heart disease.

Carotid bruits and their clinical significance

Vascular murmurs were routinely sought over the carotid arteries in 1,777 outpatients of 40 years of age or older who attended the cardiovascular clinic of our institute, and carotid bruits were heard in 82 patients (4.6%). The prevalence of carotid bruits increased with age from 5/467 (1.1%) in patients aged 40 to 49 years to 26/150 (17.3%) in those aged 70 to 79 years. Calcification of the carotid arteries was examined by posteroanterior films of the cervical spine in 447 patients 60 years of age or older and carotid calcification was found in 20 (42.6%) of 47 patients with carotid bruits and in 50 (12.5%) of 400 patients without them. The incidence of carotid calcification in the former group was 3.4 times that in the latter (p less than 0.01), although the incidences of hypertension and glucose intolerance were not related to the presence or absence of carotid bruits. A history of cerebral bleeding or infarction was found in 19 (23.2%) of 82 patients with carotid bruits, as compared with 64 (3.8%) of 1,695 patients without them (p less than 0.01). However, the location of the cerebrovascular lesions did not necessarily correlate with the laterality of the carotid bruits. These results indicate that patients with carotid bruits show an increased risk of stroke and that these bruits are a general and non-focal sign of severe atherosclerotic cerebrovascular disease.

Effects of steroid treatment on release of cardiac myosin light chain II in acute myocardial infarction in dogs

The effect of methylprednisolone sodium succinate (MP) on release of myosin light chain II (LCII) from the myocardium was studied in experimental myocardial infarction (MI). Acute MI was produced in conscious, closed-chest dogs by ligating the left anterior descending coronary artery beyond the first diagonal branch. MP, 30 mg/kg, was administered intravenously just before and 24 hours after MI. After MI, LCII levels in the serum were determined serially up to 240 hours. MI size was determined histologically 10 days after MI. In the MP group, LCII levels in the serum within 72 hours were lower than in the control, and cumulative LCII release for 3 days decreased from 530 +/- 159 to 310 +/- 101 ng/ml (mean +/- standard deviation) (p less than 0.001). However, the peak LCII level appeared later (control vs MP, 63 +/- 27 vs 122 +/- 25 hours, p less than 0.001), and the peak LCII level and cumulative LCII release for 10 days were not decreased by MP treatment. MI size also was not reduced by MP (11.0 +/- 4.4% vs 11.8% +/- 4.5% of the left ventricle, difference not significant). Since the rate of disappearance of LCII is rapid and was not affected by MP, these results suggest that MP treatment early after acute MI delays breakdown of myosin filaments, but cannot prevent it.