[Serial change in serum concentration of type III procollagen N-terminal peptide after TAE in hepatocellular carcinoma, and analysis of gel filtration pattern of the peptide]

In the present study, we have measured the serum concentration of PIIIP in patients with various liver diseases, and studied serial changes in serum PIIIP after TAE and its gel filtration pattern in 10 cases of hepatocellular carcinoma undergone TAE. The following results were obtained. 1) Serum concentration of PIIIP was 12.3 +/- 6.1 ng/ml in normal controls and elevated significantly in liver cirrhosis, liver cirrhosis with hepatocellular carcinoma, chronic active hepatitis, and acute hepatitis. 2) There was no significant difference in the serum concentrations of PIIIP between liver cirrhosis and liver cirrhosis with hepatocellular carcinoma. The result suggested that serum PIIIP cannot be a specific marker of hepatocellular carcinoma. However, the serum PIIIP concentration was decreased 2 or 4 weeks after TAE in effective cases, whereas increased in ineffective cases. Thus, the measurement of serial change in the serum PIIIP after TAE was considered to be useful for evaluating the effectiveness of TAE. 3) In analysing the elution patterns of serum PIIIP by gel chromatography, the peak of 125I-PIIIP antigen decreased 4 weeks after TAE in effective cases, whereas, no change was observed in the elution profile by gel chromatography 4 weeks after TAE in ineffective cases. These results seem to be caused by necrosis of hepatocellular carcinoma by TAE, and suggest the possibility that PIIIP is produced in hepatocellular carcinoma tissue.

The possible role of endogenous digitalis-like substance in the regulation of circadian changes in urinary electrolyte excretion in man

The urinary volume (U.V.), Na excretion (UNaV) and K excretion (UKV) have been reported to show a circadian rhythm in man, but the mechanism of this rhythm has not been made clear. To investigate how atrial natriuretic peptide (ANP) and endogenous digitalis-like substance (DLS) participate in the circadian change in urinary electrolyte, the circadian changes in ANP and DLS (digoxin-like immunoactivity: DLI, Na-K-ATPase inhibitor: ATPI, ouabain binding inhibitor to Na-K-ATPase: OBI) were evaluated in 5 normal man. ANP, DLI and OBI showed no significant correlation with urinary electrolyte excretion, but there was a significant positive correlation between plasma ATPI and urinary Na excretion. From these results it is suggested that circulating Na-K-ATPase inhibitor (plasma ATPI) may be involved in the regulation of the circadian rhythm of urinary Na excretion.

[Two-dimensional echocardiographic and left ventriculographic evaluations of left ventricular diverticula]

Twenty cases of left ventricular diverticula were gleaned from 4,300 consecutive angiocardiographic records (13 males and seven females whose age ranged from 17 to 78 years with a mean of 52 +/- 16 years). Their findings were compared with those of 16 patients with left ventricular aneurysms due to myocardial infarction. In only one patient was a diverticulum first detected by two-dimensional echocardiography before left ventriculography was performed. None of the patient had an associated midline thoracoabdominal defect. Five patients had premature ventricular beats, two of whom had ventricular tachycardia. Three patients complicated mitral valve prolapse and three atrial septal defect. Of the 20 patients, four each had two diverticula, as opposed to 16 others who each had a single diverticulum. The diameter of the diverticula ranged from eight to 70 mm. The sites of 14 diverticula were along the inferior wall; five in the anterior wall; four in the apex. Morphologically 15 diverticula were bulky outpouchings, six were tongue-like, and three hammocking. All diverticula exceeding 15 mm in diameter and originated near the mitral ring could always be detected in the short-axis view of two-dimensional echocardiography. However, those originating in the apex or of a tongue-like configuration could rarely by detected. Comparative two-dimensional echocardiographic analyses of 16 diverticula, 16 left ventricular aneurysms, and 16 normal left ventricular walls disclosed that the left ventricular aneurysmal wall had a higher echo intensity, but the diverticula had the same wall echo intensity as the normal left ventricular wall. Left ventricular end-diastolic wall thickness in an aneurysm (7.6 +/- 1.5 mm) was lower (p less than 0.01) than the normal left ventricular wall (11.1 +/- 1.3 mm), but it did not differ from the normal left ventricular wall in any case of diverticulum (10.2 +/- 1.5 mm). The percent wall thickening ratio in aneurysms (-3.6 +/- 10.7%) was lower (p less than 0.01) than the normal left ventricular wall (39.8 +/- 10.9%), but it did not differ from the normal left ventricular wall in diverticula (45.8 +/- 16.6%). Regional fractional shortening in the diverticula (41.3 +/- 9.2%) did not differ from that in the normal left ventricular wall (34.5 +/- 5.2%). In conclusion, a small diverticulum without a midline thoracoabdominal defect is not rare, and two-dimensional echocardiography is the diagnostic method of choice in many cases based on the echo features described above.

The influence of halothane and thiopental on respiratory-related nerve activities in decerebrate cats

The effects of halothane and thiopental on the respiratory efferent activities in the phrenic, recurrent laryngeal and hypoglossal nerves were studied in decerebrate, paralyzed and artificially ventilated cats. Inhalation of halothane (2%, 90 s) and intravenous injection of thiopental (2-3 mg/kg) produced a similar change in the breathing pattern, characterized by an increase in respiratory frequency and a decrease in the respiratory burst discharge in the three nerves studied. Depression of the respiratory activity was greatest in the hypoglossal nerve, intermediate in the recurrent laryngeal nerve, and least in the phrenic nerve. Both drugs diminished the whole power spectral densities of the three nerves. Thiopental selectively attenuated the high frequency peaks of these spectra and shifted the peak frequencies to lower values. Bilateral section of the vagus and carotid sinus nerves had no effect on the action of thiopental on the respiratory neural activities, whereas it decreased, but did not eliminate, the action of halothane. The present results demonstrate that both halothane and thiopental produce a selective depression of the upper airway motor activities, with stronger effects on the hypoglossal nerve. Effects on the peripheral receptors and the central respiratory drives differ between the two drugs.

Serial electrocardiographic and angiographic changes of patients with hypertrophic cardiomyopathy

The characteristics of ECG findings as they relate to myocardial changes during long-term course of hypertrophic cardiomyopathy (HCM) were studied. Serial changes in ECG were compared with changes left ventriculogram and bi-ventriculogram in 15 patients with HCM without intraventricular conduction disturbance. Serial changes in ECG findings, with special reference to the negative T wave, were categorized in three groups; 1) 5 patients with increase or appearance of the negative T wave (A-1 group). 2) 4 patients with decrease or disappearance of the negative T wave (A-2 group). 3) 6 patients without significant changes in the T wave (B-group). A-1 group presented a marked increase in SV1 + RV5, and of the thickness of anterior and apical wall, and a decrease of the peak dV/dt/EDV (end diastolic volume-normalized peak filling rate), serially. End diastolic volume (EDV) and ejection fraction (EF) did not change significantly. The configuration of left ventriculogram changed from a round form to a spade-like form. A-2 group presented a marked decrease in SV1 + RV5, the thickness of anterior and apical wall, peak dV/dt/EDV and peak dV/dt/V (left ventricular volume of the time of peak filling-normalized peak filling rote). EF decreased serially, 2 cases of A-2 group presented the clinical picture of dilated cardiomyopathy in the end stage. In B group, SV1 + RV5, the wall thickness and left ventricular function did not change, serially. In conclusion, serial observations of ECG are useful for assessing alterations in wall thickness, LV-form and LV-function.

Falsely elevated plasma aldosterone concentration by direct radioimmunoassay in chronic renal failure

Plasma aldosterone concentration (PAC) in patients with chronic renal failure was measured by radioimmunoassay with and without dichloromethane extraction before the assay. Blood samples were obtained from patients with chronic renal failure who were undergoing maintenance hemodialysis, from patients with chronic renal failure who were not undergoing hemodialysis, and from age-matched normal subjects. With the three radioimmunoassay kits tested, the direct assays without extraction in normal subjects gave PAC values comparable to those obtained after the dichloromethane extraction; in contrast, in patients with chronic renal failure, the direct plasma radioimmunoassays yielded consistently higher values than those obtained after the extraction (p less than 0.001). When various plasma steroid metabolite fractions were separated by high-pressure liquid chromatography (HPLC) with a reverse-phase column, and each fraction was assayed for PAC with the three radioimmunoassay kits, high immunoreactivities were found in the polar fractions in the plasma from patients with chronic renal failure but not in normal plasma. The ratios of the immunoreactivities of these polar fractions to that of the aldosterone fraction, determined after HPLC separation, showed a significant positive correlation (r = 0.746, p less than 0.001) with serum creatinine concentrations in plasma from patients with chronic renal failure who were not undergoing hemodialysis. These results indicate that the values for PAC are falsely elevated in chronic renal failure when PAC is measured by radioimmunoassay kits without prior extraction. Furthermore, plasma from patients with chronic renal failure contains a polar substance(s) that cross-reacts with antialdosterone antibodies. This so far-unidentified substance increases with advancing renal impairment.(ABSTRACT TRUNCATED AT 250 WORDS)

Indium-111 transferrin imaging for the diagnosis of protein-losing enteropathy

For assessment of gastrointestinal protein loss, seven patients suspected of having protein-losing enteropathy were studied by gamma camera imaging using in-111 transferrin. Four patients with a value equal to or more than 20 ml/day on the alpha-antitrypsin clearance test or a high protein content on the gastric juice showed definite intestinal activity on an early image, demonstrating protein loss. The loss site could be determined by observing the movement of radiotracer within the bowel lumen on the subsequent images. The three patients with a value of less than 20 ml/day in the test showed no obvious intestinal activity throughout the study. Therefore, in-111 transferrin abdominal imaging appears to be useful for determining the loss site as well as for establishing the rapid diagnosis of protein-losing enteropathy.

Diazepam potentiates postsynaptic inhibition in bulbar respiratory neurons of cats

The purpose of this study was to assess the effect of benzodiazepine on inhibitory postsynaptic potentials (IPSPs) of medullary respiratory neurons in decerebrate, paralyzed cats. Diazepam (0.05 and 0.1 mg/kg i.v.) reversibly increased the IPSP waves occurring during the inactive phase of the respiratory cycle in all inspiratory and postinspiratory neurons examined. Input resistances of these neurons were reduced at that phase. The reversal potential for the IPSP wave was unaltered. Intracellular injection of chloride ions reversed the IPSP to depolarization, and diazepam produced a purely depolarizing effect. The drug effects observed during the active phase of each neuron include a decrease in the firing rate and a shortening of the burst activity. The firing threshold and shape of these spikes, however, remained unaltered. These results suggest that diazepam depresses the bulbar respiratory neuronal activities specifically by potentiating the periodic postsynaptic inhibition.

Microiontophoresis of flurazepam on inspiratory and postinspiratory neurons in the ventrolateral medulla of cats: an intracellular study in vivo

Effects of flurazepam on the periodic inhibitory postsynaptic potentials (IPSPs) and on the action of locally applied gamma-aminobutyric acid (GABA) were studied in bulbar respiratory neurons of decerebrate cats using concentric multibarrelled electrodes for intracellular recording and extracellular iontophoresis. Iontophoresis of flurazepam augmented spontaneous IPSPs and increased the hyperpolarization induced by GABA. Iontophoretic application of bicuculline suppressed the action of flurazepam. The reversal potential for spontaneous IPSPs was similar to that for the GABA-response. Intracellular Cl- injection shifted both the IPSP wave and the GABA response in a depolarizing direction. Flurazepam enhanced these depolarizing responses. These results suggest that GABA mediates the postsynaptic inhibition in bulbar respiratory neurons.

[A multicenter clinical trial of SMS 201-995 (octreotide acetate) in acromegaly and gigantism]

Sixty-four patients with active acromegaly and three patients with gigantism were treated with the long acting somatostatin analog SMS 201-995 (50-500 micrograms, sc, every 6-12 h or 150-880 micrograms daily by intermittent sc infusion, for up to 114 weeks). The fasting plasma GH levels were significantly suppressed (less than 50% of the values before treatment) in 49 patients and became normal in 18 patients. Suppression of GH secretion was associated with normalization of plasma somatomedin-C levels (14 out of 30 cases) and significant clinical improvement such as disappearance of headache and decrease of excessive sweating. Shrinkage of pituitary tumors as determined by computed tomography and/or magnetic resonance imaging studies occurred in 11 out of 40 cases. Side effects were minimal and tolerable. SMS 201-995 appears to be an effective agent for the treatment of acromegaly and gigantism.

[Monitoring of somatosensory evoked potentials during extracranial revascularization]

Intraoperative somatosensory evoked potentials (SEPs) were measured in 17 patients during 21 extracranial revascularization and related procedures. The operations included 13 carotid endarterectomies (CEAs), two cervical internal carotid ligations, one vertebral artery (VA) clipping, one VA-common carotid artery (CCA) transposition, and four temporary balloon occlusion tests (TBOTs). Three of the 13 CEAs (23%) showed reduced amplitude and delayed latency of primary cortical SEPs during clamping of the carotid artery, followed by their recovery after emplacement of the internal shunt. Flattening of SEPs during clamping of the CCA was observed in the case of VA-CCA transposition; however, SEPs returned to normal immediately after insertion of a balloon indwelling shunt into the CCA. One of the four TBOTs showed alteration of SEPs during balloon occlusion of the subclavian artery proximal to the origin of the VA. In the others, SEPs remained stable during the entire procedure. Only one transient intraoperative ischemic complication was encountered among the cases of CEA. It was detected through flattening of SEPs, which led to the discovery of an internal shunt obstruction. Carotid stump pressure was also measured in 12 CEAs and two TBOTs, and seven of these 14 had pressure less than or equal to 50 mmHg. Four of the seven had carotid stump pressure less than or equal to 30 mmHg, and three of these four also showed altered SEPs. SEPs remained stable if the collateral flow was sufficient during vascular occlusion and showed obvious alteration when the blood flow was reduced to below the threshold. The authors conclude that monitoring of SEPs during extracranial revascularization is very useful.

Possible association of aldosterone producing adenoma and non-functioning adrenal tumor

A 37-year-old woman presented with hyperaldosteronism, suppressed renin levels, and a left adrenal mass on CT scanning. Selective adrenal venous sampling indicated a marked rise of the aldosterone level in the right adrenal vein, while the level in the left vein was low. On laparotomy, an aldosterone producing adenoma (APA) of 12x10x5 mm in size was found in the right adrenal gland and was resected, while the left mass was left in situ. The post-operative course showed normalization of both the clinical and biochemical features of primary aldosteronism, with no sign of recurrence or of enlargement of the remaining adrenal mass in 2.5 years of follow up, suggesting the possible coexistence of a "non-functioning" tumor. This case demonstrates the importance of adrenal venous sampling for the localization of APA particularly since the presence of the APA may be masked by a visualized but unrelated adrenal mass.

Development of coronary heart disease in familial hypercholesterolemia

We studied the development of coronary artery disease in 10 homozygous and 692 heterozygous patients with familial hypercholesterolemia. Seventy-five (22%) male heterozygotes and 35 (10%) female heterozygotes were affected by myocardial infarction, which was first noted in men in the 3rd decade of life and in women in the 4th decade of life. Thirty-eight (70%) out of the deceased 54 heterozygous patients died of coronary heart disease. The mean age at death was significantly less in male heterozygotes (54 years) than in female heterozygotes (69 years). Five homozygous and 105 male and 56 female heterozygous patients received coronary angiographic evaluation. The regression equations between age (X) and coronary stenosis index (Y) obtained by assigning score (0 to 5) to each of 15 coronary artery segments were Y = 1.57X - 20.43 (r = 0.956, p less than 0.05) in the homozygotes, Y = 0.52X - 9.11 (r = 0.438, p less than 0.001) in the male heterozygotes, and Y = 0.47X - 12.54 (r = 0.343, p less than 0.01) in the female heterozygotes. From these data, we can assume that coronary artery stenosis detectable by angiography will occur after 17 and 25 years of age in male and female heterozygotes, respectively, and the treatment of heterozygotes with lipid-lowering drugs can be delayed until late adolescence.

A young type III hyperlipoproteinemic patient associated with apolipoprotein E deficiency

A 13-year-old female patient had noticed tuberoeruptive xanthomas since 3 years of age. Her serum, VLDL, and IDL cholesterol levels were high (348, 158, and 60 mg/dL, respectively), while LDL and HDL cholesterol levels were 56 and 62 mg/dL, respectively. VLDL-cholesterol/serum triglyceride ratio was extremely high (0.86), suggesting type III hyperlipoproteinemia (HLP). Her apo E was undetectable by the single radial immunodiffusion studies and SDS-polyacrylamide gel electrophoresis. Her parents showed hypertriglyceridemia and her two siblings were normolipidemic, and their apo E levels were normal. Genomic DNA digested with BamHI or EcoRI did not show gross differences in the restriction fragment length between the apo-E-deficient patient and normal controls. Thus, apo E deficiency may be characterized by early appearance of clinical manifestations of type III HLP and higher VLDL-cholesterol/serum triglyceride ratio.

Disopyramide induces insulin secretion and plasma glucose diminution: studies using the in situ canine pancreas

The mechanism of disopyramide-induced hypoglycemia, a life-threatening complication in the antiarrhythmic drug treatment, is still controversial. To elucidate this, we have evaluated plasma insulin (IRI) and glucagon (IRG) responses in the pancreatic vein (PV) of the in situ pancreas as well as responses of plasma IRI, IRG, and glucose in the femoral artery (FA) to disopyramide phosphate administration in anesthetized dogs. First, infusion of disopyramide at a dose of 50 mg for ten minutes directly into the pancreatic artery, but not the vehicle, increased significantly plasma IRI concentration in the PV (P less than .05 or less), where the IRI response started within three minutes and reached a peak of 2.8-fold preinfusion value at 30 minutes after starting the infusion (n = 7). Plasma IRI concentration in the FA also increased slightly but significantly (P less than .05). Plasma IRG concentration in the PV initially decreased significantly (P less than .05 or less) and in the FA at one point (P less than .05) during the infusion, and then increased significantly after cessation of the infusion, showing a peak of 1.9-fold preinfusion value at 60 minutes in the PV and the FA (P less than .05). Plasma glucose concentration in the FA decreased slowly and significantly after the infusion (P less than .05 or less) and fell by 16% of the baseline value at 60 minutes (P less than .05). Second, serum disopyramide concentration of 13.7 +/- 2.8 micrograms/mL at ten minutes, which corresponds to a twofold to threefold concentration of the human therapeutic level (n = 4).(ABSTRACT TRUNCATED AT 250 WORDS)

Biochemical characterization of a digitalis-like substance in human urine, partially purified by high pressure liquid chromatography

We have partially purified a digitalis-like extract from human urine by means of high pressure liquid chromatography (HPLC). Four fractions, giving positive activity for the cross-reaction in the digoxin radioimmunoassay, Na-K-ATPase inhibition or competition with ouabain binding to its receptor, were detected on HPLC. Among these fractions, the first (F-1) was shown to contain the principle fraction, sharing all the activities, and to exhibit quite similar characteristics to ouabain in the modes of Na-K-ATPase inhibition, ouabain displacement activity and positive inotropic action.

Impairment of modulating role of testosterone in growth hormone response to clonidine in essential hypertension

To investigate the effects of endogenous testosterone (T) on the responsiveness of plasma growth hormone (GH) to central alpha 2 adrenergic stimulation, we administered clonidine (0.15 mg, p.o.) to 16 male patients with essential hypertension (EHT) and 13 age-matched male normotensive controls (NT). Although the basal T level was correlated with the peak GH increment (r = 0.709, p less than 0.01) and with the area under curve of GH (r = 0.714, p less than 0.01) in the NT group, no such correlations were seen in the EHT group. The present study confirmed the potentiating role of endogenous T in GH responsiveness to clonidine in male NT. The lack of correlation between T and GH response in EHT suggests a neuroendocrine disturbance in modulation by T of the GH response to central alpha 2 adrenergic stimulation.

Electrophysiological properties of respiratory laryngeal motoneurons and effects of thiopental

Transmembrane potentials of the respiratory laryngeal motoneurons were recorded in decerebrate, vagotomized and paralyzed cats. Twenty inspiratory and thirteen postinspiratory neurons were identified. Periodic membrane potential (MP) fluctuations as well as patterns of postsynaptic potentials (PSPs) were characterized in each type of neurons by measuring the input resistance and injecting Cl- to reverse inhibitory PSPs. On the basis of PSP patterns, two subtypes of inspiratory neurons could be distinguished. Thiopental (2-3 mg/kg, i.v.) produced depolarization together with reduction of firing in most laryngeal neurons. Excitatory and inhibitory PSPs were both depressed and MP fluctuations became smaller in each phase of the respiratory cycle. Elevation of the firing threshold and separation of IS-SD spikes often occurred after thiopental. These results suggest that thiopental depresses the laryngeal motoneuron through inhibition of synaptic transmission and of spike generation.

Agonist-induced substance P receptor down-regulation in rat central nervous system

Rat brain slices were incubated with substance P (SP), and the SP receptors on the membranes from those slices were characterized by a 3H-SP binding technique. The number of substance P receptors measured in the extensively washed membrane preparations pretreated with 3 x 10(-5) M SP was reduced by 30% compared with that in nontreated membranes. This reduction was dependent on the incubation time and temperature. The metabolic inhibitors sodium azide and 2,4-dinitrophenol protected SP receptors from the reduction. The characteristics of 3H-SP incorporation into rat brain slices were similar to those of SP receptor down-regulation, that is, the 3H-SP incorporation was time, temperature, and energy dependent. Thus these results indicate that the processes of ligand incorporation and receptor down-regulation are closely associated phenomena. These observations may be important in elucidating the phenomenon of SP-induced desensitization.