Nagoya Journal of Medical Science

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.

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.

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.

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.

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.

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.

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.