Suicide among Chinese schizophrenics in Hong Kong

A descriptive study of suicides in 74 Chinese schizophrenic out-patients (43 male) is presented. The mean age at death was 31.3 years. The mean duration of illness was 8.5 years and 50 of the 74 died within ten years of onset of illness. Only five lived alone; 35 were openly employed and 20 were married at the time of death. Twenty had a history of depression, and 27 had attempted suicide previously. More females had been depressed or had attempted suicide than males. Over half were last admitted for reasons other than schizophrenic symptoms alone and ten died within one month of discharge. Eight of 71 patients followed up expressed suicidal ideas at the last psychiatric contact, but only 15 were symptomatic. Jumping was the commonest method used. Analytical studies are needed to identify risk factors in Chinese schizophrenics.

Role of acetylcholine in induction of repetitive activity in human atrial fibers

The actions of acetylcholine and its interactions with epinephrine were studied in human atrial tissues by recording transmembrane potentials and contractile force. Acetylcholine (0.55-5.5 microM) reduced force, shortened the duration and shifted to more negative values the plateau of action potentials, abolished phase 4 depolarization, and suppressed the activity of spontaneous fibers. During the recovery, often there was a rebound increase in some parameters of the action potential and in force. Epinephrine (0.3-2.8 microM) induced oscillatory potentials and aftercontractions and acetylcholine abolished them. However, during the washout of acetylcholine in the presence of epinephrine, the oscillatory potentials and aftercontractions were larger than before acetylcholine, and repetitive activity was often induced. The inhibitory and excitatory effects of acetylcholine were mimicked by methacholine (5.1 microM) and abolished by atropine (1.5 microM). The postacetylcholine rebound was also potentiated by theophylline (0.6-2 mM) but was not blocked by propranolol (1-3.4 microM), prazosin (1 microM), and diltiazem (0.1 microM). It is concluded that in human atrial fibers acetylcholine has inhibitory as well as excitatory effects that are exaggerated in the presence of epinephrine and are mediated by the activation of the muscarinic receptor. The interaction between acetylcholine and epinephrine involves an antagonism at an intracellular level.

[A new operation for the management of gastric varix bleeding]

Gastric varices is a special oriental type manifestation of gastroesophageal collaterals in portal hypertension patients. It has gained more attention in recent years following the popularity of endoscopy and sclerotherapy. Catastrophic bleeding from ruptures of gastric varices is a life threatening emergency. Gastric varices are generally located at the greater curvature side of the cardiofundic region. Neither a Sengstaken-Blakemore balloon tube nor a Linton balloon tube can stop the bleeding. This area is also beyond the field of sclerotherapy. Surgery is the only definite therapy. Devascularization procedures as described by Dr. Hassab sometimes fail to control active bleeding and also fail to adequately decongest the whole varices area. The radical resection procedures such as terminal esophagectomy, proximal gastrectomy or cardiectomy as proposed by Japanese groups interrupts the normal esophgo-gastric continuity and is also too invasive for a cirrhotic patient. In between, besides terminal esophago-proximal gastric devascularization and splenectomy, we use a TA-90 stapler to perform an oblique cardiofundectomy to resect en bloc the tortuous gastric varices area. From Nov. 1983 to May 1988, at the Veterans General Hospital-Taipei, 16 patients received this new operation to manage gastric varices bleeding. Ten of them were on an emergency basis and 6 were elective surgery. Only one patient in the emergency group died. All catastrophic bleeding in the emergency group was dramatically controlled and all other patients recovered rapidly. With a follow-up range from 6 months to 4.5 year and an average of 19 months, there was no recurrent bleeding and no hepatic encephalopathy.(ABSTRACT TRUNCATED AT 250 WORDS)

Arrhythmogenic effects of theophylline in human atrial tissue

We studied the effects of theophylline on the transmembrane action potential and the contractile force of human atrial fibers obtained from the hearts of 15 patients, undergoing corrective open-heart surgery. Atrial fibers were perfused with Tyrode solution and driven electrically at a constant rate of 60 beats per min. Theophylline (0.1-1 mM) steepened the diastolic depolarization, increased the amplitude of oscillatory potential during diastole and facilitated the development of spontaneous slow response action potentials. These arrhythmogenic effects of theophylline were suppressed after diltiazem (0.1-0.3 microM) pretreatment. The present findings provide the electrophysiologic evidence that abnormal atrial automaticity as a result of triggered activity may be the underlying cause for atrial ectopic activity and multifocal atrial tachycardia in patients taking theophylline.

Postoperative deep vein thrombosis in the Taiwanese Chinese population

Reports of the incidence of postoperative deep vein thrombosis in the Chinese population of Taiwan are few in the literature. Over a 3 year period, the fibrinogen degradation products test, the pulse volume recorder, and venography were used to study 220 patients undergoing major operations at the Veterans General Hospital in Taipei, Taiwan. Deep vein thrombosis was found in 17 patients (7.7 percent). A comparison of the three diagnostic methods showed that the sensitivities of the fibrinogen degradation products test and the pulse volume recorder were 56.3 percent and 93.7 percent, respectively; the specificities, 97.4 percent and 95.7 percent, respectively; and the accuracies, 85.5 percent and 95.5 percent, respectively. These results support the combined use of the fibrinogen degradation products test and the pulse volume recorder for screening and diagnosing deep vein thrombosis.

Somatostatin effects in isolated human atrial fibres

Effects of hypothalamic hormone somatostatin on the action potential and contractile force of 54 human atrial preparations obtained at cardiac surgery were studied with standard microelectrode techniques. In the atrial fibres responding to electrical stimuli with fast response action potentials in 4 mM [K]0 Tyrode solution (maximum rate of phase 0 depolarization greater than 50 V/s), somatostatin (10(-7) to 10(-6) M) reduced slightly the duration of action potential and decreased twitch force dose-dependently. In spontaneously active atrial fibres, somatostatin (10(-7) to 10(-6) M) abolished the action potentials in the preparations with low maximal diastolic potential (MDP, -48 +/- 2.8 mV), but induced only mild suppressive effect in the preparations with high MDP (-70 +/- 2.4 mV). When the fibres were depolarized in 27 mM [K]0 Tyrode solution, somatostatin decreased the maximum rate of depolarization and amplitude of the slow response action potentials induced by electrical stimuli. The delayed afterdepolarizations or triggered action potentials induced by high-frequency electrical drive in the presence of epinephrine were also suppressed by somatostatin. The above findings suggest that somatostatin may suppress the abnormal automaticity and the triggered activity in human atrial fibres through a reduction of cellular calcium.

Electrophysiological effects of low pH in human atrial fibres

In the studies of the electrophysiological properties of human atrial fibres obtained at cardiac surgery, it has often been reported that the diastolic potential, the maximum upstroke velocity of the phase 0 depolarization (Vmax) and the amplitude of action potential are relatively low. The same findings were also obtained in our previous study when the tissue preparations were perfused with a Tyrode solution which, as usually described in literatures on cardiac cell studies had a NaHCO3 concentration of 12 mM and was aerated with a gas mixture of 95% O2-5% CO2 at 37 degrees C. Recently we found that the relatively poor electrical activities of the human atrial fibres were related to the low pH value (around 7.06) of the perfusate used. Raising the pH value of the perfusate either by increasing the NaHCO3 concentration or by reducing the CO2 in the bubbling gas mixture significantly improved the electrical activities of the fibres. There is evidence that the suppressive effect of low pH on the electrical activities is due to the hindering action of H+ on the transportation of other cations across the plasma membrane.

Electromechanical effects of caffeine in isolated human atrial fibres

Effects of caffeine on the action potential and contractile force of human atrial fibres obtained at cardiac surgery were studied with standard microelectrode technique. In 4 mmol . litre-1 [K]o, the only significant action produced by 0.3 to 3 mmol . litre-1 caffeine on the electro-mechanical activity of relatively normal atrial fibres was a slight shortening of the action potential duration at 50% repolarisation. When the fibres were depolarised in 27 mmol . litre-1 [K]o or in atrial fibres showing slow responses in 4 mmol . litre-1 [K]o, however, caffeine could increase the upstroke of slow response and the force. In 18% of atrial fibres showing slow responses in 4 mmol . litre-1 [K]o, caffeine induced spontaneous discharges and potentiated afterdepolarisations. The positive inotropic and the arrhythmogenic effects of caffeine could be diminished by pretreating the fibres with propranolol or Ca antagonists (diltiazem and verapamil). In fibres beating spontaneously in normal [K]o, caffeine accelerated spontaneous rhythms initially and then depressed them. Propranolol potentiated the later depression but did not block the initial acceleration. The results suggest that caffeine increases the transmembrane Ca influx and enhances the release of Ca from the intracellular stores in human atrial fibres. As a consequence, caffeine could induce arrhythmias in atria from certain individuals.

Positive inotropic effect of acetylcholine in isolated human atrial fibers

We studied the effects of acetylcholine on the transmembrane action potential and the contractile force of isolated human atrial fibers obtained at cardiac surgery. In 3 of 12 preparations, 10(-7)-10(-6) M acetylcholine induced a substantial increase in the contractile force following a brief initial decrease. Atropine diminished both the initial negative and the later positive inotropic effects induced by acetylcholine while propranolol abolished only the later effect.

Adrenergic mechanisms in the hepatic microcirculation in the rat

The in vivo hepatic microvascular bed of the rat was observed microscopically in the transilluminated liver and the diameter of the hepatic sinusoids was measured by serial photomicrography. Intraportal infusion of tyramine induced concentration-dependent constriction of the hepatic sinusoids, but also dilatation of the sinusoids when the dose was small. These effects were attributed to the release of endogenous noradrenaline which activated either alpha- or beta-adrenergic receptors and caused constriction, or dilatation, of the sinusoids respectively. Adrenaline and noradrenaline induced similar changes in the hepatic sinusoids as tyramine, while phenoxybenzamine induced dilatation, and propranolol constriction, of the sinusoids. All the above responses were abolished by pretreatment with reserpine. A possible noradrenaline-mediated basal vasomotor tone in the hepatic sinusoids for autonomic control of the blood flow in the sinusoids was postulated.

Circulatory changes in cold-acclimation and cold stress

1. The cardiovascular changes of conscious cold-acclimated (CA) and warm-acclimated (WA) rats during exposure to 5 degrees C or 28 degrees C were studied. 2. The cardiac output, heart rate and stroke volume of Ca rats exposed to 5 degrees C and of WA rats during cold stress were significantly greater, and their calculated total peripheral resistance significantly less than those of WA rats ats exposed to 28 degrees C. These results show that circulatory changes participate in cold acclimation and cold stress. The circulatory changes in the two conditions were compared and the mechanism of the observed differences were discussed. 3. CA rats exposed to 28 degrees C showed a striking decrease of oxygen consumption and arterio-venous O2 difference, but significant circulatory changes were decreased heart rate and cardiac index only, indicating that the response was mainly metabolic.

Hepatic sinusoidal responses to intraportal injections of phenylephrine and isoprenaline in the rat

1. Specific alpha- and beta-adrenoreceptor agonists, phenylephrine and isoprenaline, were injected intraportally into the intact rat liver under direct microscopic observation by an in vivo transillumination technique. 2. The diameter of a hepatic sinusoid and the intra-sinusoidal erythrocyte velocity were quantitatively measured, and the sinusoidal volume flow was calculated from these two parameters. 3. Results show that phenylephrine causes a sinusoidal constriction and an increased sinusoidal blood flow, whereas isoprenaline causes the opposite effects on the sinusoids. 4. All the sinusoidal responses to phenylephrine and isoprenaline were dose-dependent and were possibly related to the direct effect of these drugs on the sinusoids.

Effect of the ligation of hepatic artery on the microcirculation in the cirrhotic liver in the rat

The significance of the hepatic arterial supply in the intrahepatic microcirculation in normal and carbon tetrachloride-induced cirrhotic livers was studied by dye injection method and by ligation of the hepatic artery. The in vivo distribution of dye injected into the hepatic artery evidenced the presence of arterio-venous shunts in the cirrhotic liver. When the hepatic artery of the cirrhotic liver was ligated, the elevated portal venous pressure dropped significantly, and the fast-flowing population of microvessels and sinusoids in the bimodal frequency distribution plot disappeared. The fast-flowing microvessel and sinusoids appeared to be the "arterial" microvessels and sinusoids, and they were converted into the slow-flowing venous channels after hepatic arterial ligation. The transmission of arterial pressure via the A-V shunts may be of greater significance in the pathophysiology of portal hypertension than previously believed.