Role of Sympathoadrenal and
Renin-Angiotensin System in Hemodynamic
State after Coronary Artery Bypass Grafting
SHOOHEI HAYASE, TAKESHI SHIMIZU and MASAMICHI NAKAJIMA
pg(s) 1 - 15
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To evaluate the role of the sympathoadrenal and renin-angiotensin systems in postoperative hemodynamic
state, plasma concentrations of catecholamines, renin activity, angiotensin, and aldosterone as well as
hemodynamics were studied following coronary artery bypass grafting in 55 patients. The patients were divided
into four groups: 1) uneventful, 2) hypertension (HT), 3) hypotension for which cateeholamines were
administered (CAT), and 4) perioperative myocardial infarction (POMI). The mean cardiac index in the HT
group was higher than that in the Uneventful group and some patients in the HT group showed high adrenaline
level. A group of patients who had a hypertensive episode and then sustained low cardiac output state
(HT-to-LOS group) showed marked elevation of systemic vascular resistance index and noradrenaline level.
These findings suggest that the hypertensive episodes in the HT-to-LOS group may be primarily caused by the
activation of the sympathetic nerve system and that those of some patients in the HT group may be caused by
marked adrenal medullary secretion. Five patients (56%) in the HT group showed plasma renin activity of more
than 5.0 ng/ml/hr. and three patients (33%) showed angiotensin II of more than 100 pg/ml. Thus, postoperative
hypertension seems to be multifactorial in nature. The POMI group represented significant elevation of plasma
adrenaline concentration and significantly low sensitivity to catecholamines of the ventricle accompanied with
impaired left ventricular performance. Although the mean aldosterone level in the CAT group was significantly
higher than that in the Uneventful group, only a few patients of the CAT group demonstrated marked elevation
of aldosterone concentration which might cause a vicious circle to develop. Clinical significance of modest
increase of aldosterone concentration in other patients in the CAT group is questionable.
Evaluation of Skeletal Muscle with
Thallium-201 Scintigraphy in Myotonic
Muscular Dystrophy: A Case Report
SHUHEI YAMAMOTO
pg(s) 17 - 20
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A case of myotonic muscular dystrophy in which thallium-20l showed dystrophic change of skeletal muscle is
described. After i.v. injection of 2 mCi of thallium-201, the patient's whole body scintigram was reconstructed by
taking the geometric mean of the corresponding anterior and posterior pixel counts over the 512 x 512 matrix
formal. The scintigram showed manifest hypoperfusion at the site of muscle weakness. Thallium-201 whole body
scintigraphy was thought to be useful for noninvasive evaluation of skeletal muscular involvement in muscle
disease.
Effects of Adrenergic and Cholinergic Agents
and Leukotrienes on Mucociliary Transport
Force Measured by Using Frog Palate
KENICHI YAMAKI, YASUNOBU NODA, KENZO TAKAGI
and TATSUO SATAKE
pg(s) 21 - 30
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We have developed a new method to quantify the mucociliary transport force (MCTF). We validated the
method by examining the effects of isoproterenol (Iso), norepinephrine (NE), epinephrine (Epi), and
acetylcholine (ACh) on MCTF. In the first series of experiments, the effects of leukotrienes (LTs) on MCTF
were investigated. In accordance with previous studies, Iso, NE, and ACh induced increases in MCTF, but Epi
did not cause any significant effects. In the second series of experiments, LTC4 induced a significant increase in
MCTF and LTD4 induced a significant decrease in MCTF, although these effects were transient. Neither LTB4
nor LTE4 affected MCTF. The effects of LTC4 and LTD4 were inhibited by a LT antagonist, FPL55712. These
results indicate that we have developed a useful and sensitive method for quantitative determination of the
immediate and direct effect of agonists on mucociliary transport, and that selective agonists may be involved in
the defense mechanism of the lung to carry mucus plugs or locally produced debris Ollt of the airways.
The Scale Method as a Spectral Analysis
for Accommodative Fluctuation
MASARU MIYAO, MASAKO TANAHASHI, SEISHI TOMIYASU,
YASUHIRO AKAMATSU, HIROSHI KUNO, HIROKAZU IGUCHI,
TAKA'AKI KONDO, HISATAKA SAKAKIBARA, MASASHI FURUTA,
SHIN'YA YAMADA and YUICHIRO ONO
pg(s) 31 - 39
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A scale method of computer analysis was developed as an automatic spectral analysis system of the
accommodative fluctuations. The scale approach employed a computer to identify wave peaks. Using this new
system. spectral analysis of the fluctuations in accommodation measured by an infrared optometer was performed.
Both the power spectrum method and the scale method were used to perform a spectral analysis and a wave form
analysis. The spectrum peaks obtained by both methods were virtually coincidental. Twenty sec was adequate for the
measuring time examined from the viewpoint of data stability. Fluctuations in accommodation were measured in 17
adult males. The mean peak frequency band range in 18 eyes of the young group was 2.5-3.15 Hz, in contrast to
1.25-1.6 Hz in 16 eyes of the middle-aged group. The newly developed system was considered effective as a criterion
for visual load in VDT (visual display terminal) work and other high-level visual tasks.
Trends in Mortality from Primary Liver
Cancer, Cirrhosis of the Liver, Virus
Hepatitis, and Other Liver Diseases
1968-1984 in Japan
ZHU-MIN HUANG, RYUICHIRO SASAKI and KUNIO AOKI
pg(s) 41 - 52
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The trends in mortality from liver cancer and its allied liver diseases in Japan indicated substantial changes
over time. The age-adjusted mortality rates from all liver diseases for men were stable during the 17 years
1968-1984, but those for women showed a slightly declining curve. A slightly declining curve in the mortality
rates from liver cancer that paralleled that of those for liver cirrhosis was also observed in women. For other liver
diseases that excluded cancer, cirrhosis, and infections hepatitis, a continuous declining trend was observed for
both sexes. The decreasing trend, however, was more rapid in women than in men. The mortality curve for liver
cancer in men rose after 1975, but the curve for liver cirrhosis in men was seen to decline. The intersection of
these two trend curves in 1983 is a manifestation worthy of notice in the current study of liver diseases. The
increasing trend of liver cancer was demonstrated by calculation of the consistency of clinical diagnosis with
pathological findings by autopsy. Etiological factors yet to be determined may be attributable to the excessive
consumption of alcohol in certain age groups and to the particular circumstances to which people born in
1920-34 were exposed.
Vasovasostomy for Obstructive
Azoospermia due to
Herniorrhaphy in Childhood
KOJI MIYAKE, MASANORI YAMAMOTO
and HIDEO MITSUYA
pg(s) 53 - 59
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Vasovasostomies for eight cases of obstruction of the vas deferens following herniorrhaphy in childhood were
performed. Two pregnancies were obtained postoperatively. The following factors have been shown to be
associated with a favourable result: a vasal obstruction in the subcutaneous inguinal ring, a dilatation of the
proximal vas deferens, and the presence of sperm in the intravasal fluid that accumulates proximal to the
obstructive site of the vas deferens. In the two successful cases, the time intervals after herniorrhaphy were 16
years and 20 years, respectively, which were considered to be long delays between vas occlusion and its
reanastomosis.
The Relationship between Insulin Sensitivity
and Weight Reduction in Simple Obese
and Obese Diabetic Patients
TETSUYA ISHIGURO, YUZO SATO, YOSHIHARU OSHIDA, KUNIO YAMANOUCHI,
MAKIO OKUYAMA and NOBUO SAKAMOTO
pg(s) 61 - 69
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Tissue sensitivity to exogenous insulin was determined in 10 obese diabetic patients, in 15 patients with
simple obesity, and in 28 non-obese controls. Eight of the obese diabetics and five of the patients with simple
obesity underwent dietary restriction (1,000-1,600 kcal/day) and physical training for eight weeks. Insulin
sensitivity was evaluated by the euglycemic insulin clamp technique for 120 min. The amount of infused glucose
(glucose mctabolism: GM) is a measure of the overall tissue sensitivity to insulin. Differences in fasting blood
glucosc levels were adjusted by calculation of the glucose metabolic clearance rate (MCR). GM and MCR in the
obese diabetics and in the patients with simple obesity were significantly (P<0.001) lower than in the controls.
Inverse correlations existed between BMI and GM, between BMI and MCR, and also between fasting plasma
insulin levels and both GM and MCR, respectively. After physical training, significant weight reduction was
obtained. while MCR increased from 2.70 ± 0.26 ml/kg/min to 5.47 ± 0.88 ml/kg/min. Further significant
corrclation existed between reduction of BMI and increases in insulin sensitivity (GM and MCR). These results
suggest that a combined program of physical training with caloric restriction would decrease body weight and
increase peripheral insulin sensitivity, and would therefore be especially appropriate for the treatment of simple
obese and obese diabetic patients.