Relationship between brain atrophy estimated by a longitudinal computed tomography study and blood pressure control in patients with essential hypertension

To evaluate the relationship between blood pressure control and the progression of brain atrophy in the elderly, patients with essential hypertension and brain atrophy were longitudinally evaluated using computerized tomography (CT). The study evaluated 48 patients with essential hypertension aged 46-78 years, and 30 sex- and age-matched normotensive control subjects. The extent of brain atrophy as determined by caudate head index (CHI), the inverse cella media index (iCMI), and Evans' ratio (ER) was estimated twice at an interval of 5-9 years (mean, 6.9 years). The mean annual increases in CHI (deltaCHI), iCMI (delta iCMI), and ER (deltaER) were evaluated. Mean blood volume in the common carotid artery (BF) and the decrease in BF per year (deltaBF) were also determined. The deltaCHI, delta iCMI, and deltaER increased with age in the hypertensive subjects as well as the control group across all age groups evaluated. The deltaCHI, delta iCMI, and deltaER were significantly greater in the patients with essential hypertension in their 50 s as compared with the controls. In patients with essential hypertension aged 65 years or older, the deltaCHI, delta iCMI, and deltaER were significantly lower in the group in whom the blood pressure was controlled within the range of borderline hypertension than the groups in which it was controlled in the range of normal or mild hypertension. In the younger patients under the age of 65 with essential hypertension, blood pressure control did not affect the deltaCHI, delta iCMI, and deltaER. The deltaCHI, delta iCMI, and deltaER were significantly correlated with deltaBF in both groups. These findings indicate that control of systolic blood pressure within the range of borderline hypertension may delay the progression of brain atrophy in elderly patients with essential hypertension.

[Lung abscess resulting from esophageal carcinoma successfully treated with intraesophageal covered self-expandable metallic stent]

An 82-year-old man was admitted to our hospital with high fever and back pain. He already suffered from esophageal carcinoma and expandable metallic stent had been inserted because of esophageal stenosis. A chest x-ray film obtained on admission showed infiltrative shadows in the right lower lung filled. The diagnosis of lung abscess was made on the basis of aspirate findings. Despite closed drainage, antibiotic treatment, and fasting therapy, progressive pulmonary infiltrates developed. Esophagography and esophagoscopy revealed that an esophageal fistula due to an advanced esophageal carcinoma had caused the lung abscess. An additional covered self-expandable metallic stent (EMS) was placed on the surface of the esophageal carcinoma, close to the esophageal fistula. This promptly resolved the lung abscess. Our conclusion was that the covered-EMS can be effective for the palliation of esophagorespiratory fistulas.

Effects of right hemithoracic irradiation on ceftazidime penetration into the alveolar space in rats

The effect of thoracic irradiation on antibiotic penetration into the alveolar space was determined in a hemithoracic irradiation rat model to evaluate radiation-induced acute alveolar injury at various time intervals. The results of this investigation may be summarized as follows: (1) The transfer of ceftazidime (CAZ: Modacin) from blood to lung tissue, that is, the permeability of pulmonary capillary epithelium, and the transfer of ceftazidime from lung tissue to bronchoalveolar lavage fluid, that is, the permeability of the alveolar epithelium, peaked at 4 to 5 weeks after thoracic irradiation; (2) the time course of change in the absolute concentration of ceftazidime in lung tissue showed a significant increase not only in the irradiated lung but also in the contralateral non-irradiated lung 3 days or more after irradiation. The finding that the administration of antibiotics may cause a significant increase in drug concentration in lung tissue even in the contralateral lung at 3 days after irradiation suggests that the change induced at the alveolar level immediately after irradiation affects the non-irradiated lung field through an as yet unknown mechanism.

Leukotoxin (9, 10-epoxy-12-octadecenoate) impairs energy and redox state of isolated perfused rat lung

We investigated the perturbation of energy balance and redox state in leukotoxin (9, 10-epoxy-12octadecenoate) (Lx)- and endothelin-1 (ET-1)-induced lung injury, using isolated perfused rat lungs. To examine any relationship between these parameters, intracellular levels of adenine nucleotides, pyridine coenzymes and glutathione were determined by reversed-phase high-performance liquid chromatography (HPLC) in the freeze-dried tissues of isolated rat lungs. The tissue samples were perfused with a physiological salt solution containing either Lx only, Lx plus NG-monomethyl-L-arginine (L-NMMA), Lx plus NG-monomethyl-D-arginine (D-NMMA), Lx plus superoxide dismutase (SOD) or ET-1 only. In isolated perfused lung tissue, 10 mol of Lx caused permeability-increased lung injury, and 10 nM of ET-1, which caused a comparable increase in wet lung weight, evoked pulmonary capillary hypertensive lung injury. Lx-injured lungs showed decreases in the contents of ATP, NADPH, NADH, reduced glutathione (GSH), (2ATP + ADP)/2(ATP + ADP + AMP) ratio (energy charge) and NADH/NAD+ ratio, and increased the contents of ADP and AMP compared with the vehicle control and ET-1-injured lungs. Such effects of Lx were significantly attenuated by pretreatment with 0.4 mM L-NMMA or 500 units/ml of SOD, but not with 0.4 mM D-NMMA. On the other hand, the ET-1-injured lung evidenced decreased tissue GSH. These findings indicate that Lx shifted the lung redox state toward oxidation and that Lx-induced lung injury was involved in the imbalance of the energy and redox state via production of nitric oxide and/or superoxide anion.

Effects of repeated ether stress on the hypothalamic-pituitary-testes axis in adult rats with special reference to inhibin secretion

Effects of ether stress on the hypothalamo-hypophysial-gonadal axis in adult male rats were examined. To clarify the role of adrenal glucocorticoids in gonadal function, the effects of adrenalectomy and Dexamethasone treatment were also investigated. Ether stress increased the plasma concentrations of ACTH and corticosterone, but decreased the plasma concentrations of LH, FSH, inhibin and testosterone. The pituitary responsiveness to LH-RH for LH release and testicular responsiveness to the endogenous LH for testosterone release were maintained in stressed rats. Adrenalectomy caused an increase in the plasma concentrations of ACTH, but decreased the plasma concentrations of LH, FSH and testosterone. Dexamethasone treatment in adrenalectomized rats recovered the levels of plasma gonadotropins to control levels. The concentration of plasma inhibin did not change in adrenalectomized rats, but it was decreased compared to control rats by Dexamethasone treatment. Treatments of Dexamethasone in intact male rats resulted in a decline in plasma levels of testosterone and inhibin without a decrease in the levels of LH and FSH, indicating the direct effect of Dexamethasone on the testes. These results indicate that increased ACTH secretion in stressed rats is probably due to hypersecretion of CRH from the hypothalamus, which suppresses gonadotropin secretion via the inhibition of LH-RH. The decreased levels of testosterone may be caused by a stress-induced decrease in plasma LH concentrations and increased secretion of corticosterone in the ether stressed rats. The low levels of plasma inhibin in stressed rats was also probably due to the direct effect of corticosterone on the Sertoli cells.

[Effects of atherogenic risk factors on asymptomatic brain infarct]

This study was done to clarify the relationship between asymptomatic brain infarcts and risk factors for atherogenis. A total of 312 patients (151 men and 161 women) who had no neurologic deficits were enrolled. Their ages ranged from 41 to 83 years (mean age 63 years). The patients were divided into two groups: 158 patients without asymptomatic brain infarct and 154 patients with at least one asymptomatic brain infarct of at least 5 mm as diagnosed by magnetic resonance imaging. The patients with asymptomatic brain infarct were more likely than those without asymptomatic brain infarct to be 65 years old or older, and to have essential hypertension, diabetes mellitus, or atrial fibrillation. Among patients with hypertension the frequency of left ventricular hypertrophy or hypertensive ocular findings (Scheie's class H2) was significantly higher in those with asymptomatic brain infarct than in those without asymptomatic brain infarct. These results indicate that aging, essential hypertension (especially with left ventricular hypertrophy or hypertensive ocular findings), diabetes mellitus, and atrial fibrillation are associated with asymptomatic brain infarct.

Electrical stimulation on joint contracture: an experiment in rat model with direct current

OBJECTIVE

To examine whether electrical stimulation could decrease the degree of joint stiffness in a rat lower extremity model.

DESIGN

Rat knee joints were surgically immobilized in a flexed position for 3 weeks. Two groups of rats were stimulated with 20 microA and 50 microA constant direct current. Another group had surgical intervention and sham electrodes without electricity. The hind leg was extirpated and prepared for a sample with the femur-knee joint-tibia unit. Recording the knee flexion angle with extension torque, the degree of joint contracture was assessed biomechanically by measuring the bone-joint-bone sample as a cantilever. Measurement was performed with (1) spectral analysis of transfer function measurement using random mechanical noise with frequency range from 1 to 50Hz, and (2) dynamic stiffness and loss tangent with steady-state sinusoidal excitation (11 and 35Hz).

RESULTS

The results showed that no significant difference or trend was found in vibration analysis among three groups. However, spectral analysis of transfer function measurement revealed more deformation against load, and more viscous nature in the stimulation groups, especially in low frequency band, than in the sham group.

CONCLUSION

Electrical stimulation with constant direct current has a possibility of reducing the degree of joint contracture.

Localized osteoarticular change due to joint immobilization; biomechanical test and bone densitometry in rat's hind limb model

Bone change induced by knee immobilization was assessed on dissected femurs and tibias to clarify the influences upon the mechanical properties and their demands. Fifty-eight Wistar-Imamichi male rats (11-12 weeks old, body weight 350-450 g) were subjected to knee joint immobilization (150 degrees flexed position) on one side while the opposite side served as a control. Animals were killed in seven groups at time intervals of 1, 2, 3, 4, 5, 7, and 10 weeks. The hind leg was extirpated and prepared for (1) biomechanical analysis by the indentation method at the articular surfaces of the femoral condyle and head and at the subchondral bone of the proximal tibia, and for (2) dual-energy X-ray absorptiometry of the distal metaphysis of the femur. The biomechanical parameters measured induced dynamic stiffness and phase lag derived from forced oscillation (preload 3 N, cyclic load 2 N and 11 Hz, 35 Hz), and bone mineral density was analyzed. These were compared between the immobilized side and control side, and among the seven time groups. The biomechanical results showed an early change of osteocartilaginous properties at the femoral condyle, a late response at the tibial subchondral bone, and no change at the femoral head. The measurement of bone mineral density revealed that a very sensitive reaction started within 1-2 weeks. This study provides objective data demonstrating that disuse or lack of mechanical stress greatly affects the remodeling activity for homeostasis of joints, and dramatically impairs normal bone mineral density next to the immobilized joint in young animals.

Adrenal and gonadal function in hypothyroid adult male rats

The functional relationship between thyroid, adrenal and gonadal hormones was investigated using adult male rats. Hypothyroidism was produced by the administration of 4-methyl-2-thiouracil (thiouracil) in the drinking water for 2 weeks. Plasma concentrations of TSH dramatically increased, whereas plasma concentrations of tri-iodothyronine and thyroxine decreased in thiouraciltreated rats as compared with euthyroid rats. Hypothyroidism increased basal levels of plasma ACTH and pituitary content of ACTH. The pituitary responsiveness to CRH for ACTH release markedly increased, whereas the adrenal responsiveness to ACTH for corticosterone release decreased. These results indicated that hypothyroidism causes adrenal dysfunction in adult male rats. Pituitary contents of LH and prolactin decreased in hypothyroid rats as compared with euthyroid rats. In addition, hypothyroidism lowered pituitary LH responsiveness to LHRH. Testicular responsiveness to human chorionic gonadotrophin for testosterone release, however, was not different between euthyroid and hypothyroid animals. These results indicated that hypothyroidism causes adrenal dysfunction and results in hypersecretion of ACTH from the pituitary gland. Adrenal dysfunction may contribute to the inhibition of LHRH secretion from the hypothalamus, possibly mediated by excess CRH.

Clinical experiences with a convertible thermoplastic knee-ankle-foot orthosis for post-stroke hemiplegic patients

As rehabilitation for post-stroke hemiplegic patients has become widely accepted practice, there has been an increase in patients who are more difficult to treat. In the prescription rationale of orthoses for hemiplegics, the knee-ankle-foot orthosis (KAFO) for the lower limb has generally been underestimated because of its inhibitory effect on the normal walking pattern and also its interference with gait training. The authors had an experience of 28 hemiplegics with severe physical impairments who were fitted with a convertible plastic KAFO. Among these patients, there were 11 cases in which the KAFO was replaced by an ankle-foot orthosis (AFO) within 1.5 to 8 months (average 4 months) following initial prescription when they were able to control their knee actively. Ambulatory capability in these patients was superior to that of the remaining KAFO group. The Barthel index of the AFO group patients was higher than the KAFO group (p < 0.01). However neither age, sex, severity of hemiplegia, starting time of rehabilitation following onset of stroke, time of fitting with the orthosis, nor the functional recovery stage were critical factors between the two groups, only the incidence of major complications affected ambulatory capability.

[Immunodeficiency with thymoma (Good's syndrome) similar to sino-bronchial syndrome]

A 58-year-old man was admitted to our hospital because of recurrent pulmonary infections that began three years previously. Laboratory data showed hypogammaglobulinemia and a chest computed tomogram showed diffuse bilateral micronodular shadows and an anterior mediastinal tumor. Immunodeficiency with thymoma (Good's syndrome) was diagnosed. After undergoing a thymectomy, he received intravenous gamma-globulin injections once a month for prophylaxis. Good's syndrome occurs rarely in Japan. A solid tumor-like shadow is not necessarily observed in routine chest X-ray studies, and hypogammaglobulinemia is one sign of this syndrome. The hypogammaglobulinemia of Good's syndrome should be carefully differentiated from that of other immunodeficiency diseases such as common variable immunodeficiency, the acquired immunodeficiency syndrome, chronic lymphocytic leukemia, non-Hodgkin's lymphoma, and multiple myeloma (non-secretory type).

[Lung injury and pulmonary vascular endothelial cell injury]

Pulmonary vascular endothelial cells are an important barrier that helps keep lung tissue intact. These cells are exposed to potentially injurious cells and to harmful mediators that are produced in or released into the blood. The endothelial cells may then be stimulated and injured. Stimulated and injured pulmonary vascular endothelial cells can themselves produce and release injury-promoting mediators. Using isolated perfused rat lungs and cultured human pulmonary endothelial cells, we assessed the effect of neutrophil-derived injurious mediators, leukotoxin, and neutrophil elastase on the pulmonary endothelium. Both mediators caused high-permeability pulmonary edema in the isolated lungs and caused dose-dependent and time-dependent damage in the cell cultures. Injury due to leukotoxin was suppressed in the presence of LNMMA or superoxide dismutase and injury due to neutrophil elastase was suppressed by neutrophil elastase inhibitors. These data indicate that these mediators cause lung injury via different mechanisms and that they may synergistically evoke clinical lung injury.

Effect of direct current stimulation on triradiate physeal cartilage. In vivo study in young rabbits

Electrical stimulation with 8 microA direct current was applied to the triradiate physeal cartilage of young rabbits for periods of 3, 4, and 5 weeks. The effect was evaluated by morphometric measurement and histological observation. We tried to improve some previously described technical problems (e.g., movement of electrode during experiment) in this model of the growing acetabulum. Statistically significant differences in acetabular depth were found between the experimental and the control side in the 3-week group, but no obvious differences were found among the other measurements. Characteristic thickening of the growing physeal cartilage, especially proliferating cells, was found in the stimulated sides. Electricity affects the cell behavior in the triradiate physeal cartilage as well as the growth plate of long bone, but further study is still necessary to find more appropriate conditions to gain actual growth.

Changes of cytochemical properties in the Golgi apparatus during in vivo differentiation of the ameloblast in developing rat molar tooth germs

The cytochemical changes of the Golgi stacks occurring concomitantly with cell differentiation were examined in ameloblasts of developing rat molar tooth germs using osmium impregnation and cytochemistry with nicotinamide adenine dinucleotide phosphatase (NADPase), thiamine pyrophosphatase (TPPase), and acid phosphatase (Acpase). NADPase, TPPase, and Acpase activities were already present in the Golgi stacks of the inner enamel epithelial cells, the undifferentiated form of the ameloblast: NADPase activity existed in the medial Golgi cisternae, TPPase activity in the trans Golgi cisternae, and Acpase activity in almost all cisternae and strongly in the trans-most cisterna of the Golgi stack. At this stage, however, osmium deposits after impregnation were not observed in the cisterna of Golgi stacks but were present in some small vesicles. These vesicles were located throughout the cytoplasm. Osmiophilic cisternae in the Golgi stacks were apparent for the first time at the stage when the Golgi apparatus developed and migrated to the region distal to the nucleus with the progression of cell differentiation. These findings indicate that the cis subcompartment of the Golgi apparatus was incomplete in the inner enamel epithelial cells with regard to appearance of its cytochemical property, as compared with the medial and trans subcompartments. It is suggested that the cis compartment of the Golgi stack may be completed only in the last stage of the compartmentalized Golgi organization during differentiation of the ameloblast.

Distribution of calcitonin gene-related peptide and substance P-immunoreactive nerve fibers and their correlation in the periodontal ligament of the mouse incisor

The distribution of calcitonin gene-related peptide (CGRP)- and substance P (SP)-immunoreactive (IR) nerve fibers and their correlation in the periodontal ligament of mouse incisors were examined by indirect immunofluorescence. Both CGRP-IR and SP-IR thin nerve fibers were abundant in the apical and middle third of the periodontal ligament. In the lingual portion of the incisal periodontal ligament, these nerve fibers were localized in the alveolar half of the periodontal ligament and were observed as free nerve endings. No CGRP-IR and SP-IR specialized nerve endings, such as Ruffini-like corpuscles, were observed. In the labial periodontal ligament, CGRP-IR and SP-IR nerve fibers ran along the incisal axis. The distribution of CGRP-IR nerve fibers was very similar to that of SP-IR nerve fibers.

[Effect of a direct electric current on modification of bone and ligament repair processes--experimental investigation of a rabbit model]

Investigations of the effect of direct current on 1) fracture healing, and 2) ligament healing was conducted by applying 10 microA to 1) the defect of the fibula, and 2) that of the patellar ligament of adult rabbits. After time periods for stimulation all specimens were tested with combinations of roentgenological, histological, biomechanical and biochemical methods. The results were analyzed and compared with the non-stimulated, opposite side and with the normal tissue. The electricity produced 1) a more massive callus with normal histological features in an early stages at the fracture site, and 2) higher tensile stiffness and earlier change of the collagen types in the newly-formed tissue, though no significant differences were observed as to 1) the mechanical parameters of callus and bone material, and 2) histological findings of repairing tissue. Electrical stimulation was indicated not only on bone tissue but also on non-osseous tissues and their components.

Neuropeptide Y- and substance P-like immunoreactivities in the guinea pig parotid gland

These immunoreactivities were examined by double immunofluorescence, which demonstrated that many nerve fibres around the glandular acini and blood vessels contain neuropeptide Y and substance P. It appears that these substances may coexist in nerve fibres around acini, but that there may be two populations of fibres containing these peptides around the blood vessels.

Ontogeny of cholinergic ganglionic cells which take up L-3,4-dihydroxyphenylalanine and contain vasoactive intestinal polypeptide in the mouse tongue

During the prenatal development of the mouse tongue, the intralingual ganglion was investigated histochemically and immunohistochemically for acetylcholinesterase (AChE) activity, the capacity to take up L-3,4-dihydroxyphenylalanine (L-DOPA) and vasoactive intestinal polypeptide (VIP)-like immunoreactivity. AChE-positive cells were first observed at gestational day 12, and AChE-positive neurons which take up L-DOPA were found at gestational day 14, while VIP-like immunoreactive neurons were not seen until gestational day 16. The present results suggested that the cholinergic neurons within the mouse tongue can take up L-DOPA from gestational day 14 and synthesize VIP from gestational day 16.

Case report 685: Ossifying fibromyxoid tumor of the soft parts of the upper arm

We report an unusual case of an ossifying tumor arising in the deep soft tissue adjacent to the humerus of a 72-year-old woman. The tumor exhibited sarcoma-like features histologically, although its clinical course unexpectedly differed from that of a malignant tumor. We diagnosed this particular case as an ossifying fibromyxoid tumor of soft parts, which has been recently described by Enzinger et al.. This is another example of an ossifying soft-tissue tumor which simulates a malignant sarcoma.

Aversive taste stimuli increase CGRP levels in the gustatory insular cortex of the rat

Calcitonin gene-related peptide-like immunoreactivity (CGRP-IR) was surveyed immunohistochemically in the insular cortex of the rat, and the levels of insular cortical CGRP-IR were measured with the radioimmunoassay method following intraoral stimulation with various taste stimuli. CGRP-IR was localized in nerve fibers within the agranular and dysgranular insular cortices. The CGRP-IR levels in the rostral (gustatory) part of the insular cortex were increased significantly by strongly aversive taste stimuli such as quinine hydrochloride and conditioned taste stimuli (NaCl and sucrose) which animals had been taught to avoid. The results suggest that CGRP in the gustatory insular cortex is concerned with rejection or avoidance behaviors to aversive taste stimuli.

Influence of colchicine on the addition of a sugar to the enamel protein in secretory ameloblasts of cultured germs of rat molar tooth by 3H-galactose radioautography

The influence of colchicine on the addition of 3H-galactose to the enamel protein in secretory ameloblasts of cultured germs of rat molar tooth was investigated by light- and electron-microscopic radioautography. In tooth germs cultured without colchicine, the reaction products of 3H-galactose were observed over Golgi cisternae at early chase times and then localized over the enamel with time. In tooth germs cultured with colchicine, the silver grains were seen over the Golgi cisternae, condensing granules and accumulated secretory granules. Some grains also appeared with time over the pale granular material precipitated in the intercellular space with colchicine treatment. In quantitative analysis with light microscopic radioautography, values of silver grain counts over the unit area (100 microns2) on ameloblasts and enamel of colchicine-treated tooth germs were significantly lower at both 0 min and 30 min chase after 30 min pulse than those of control tooth germs, respectively. This finding indicates that colchicine diminished the incorporation of 3H-galactose into the secretory ameloblast of cultured tooth germs. It is suggested that colchicine decreases the activity of the Golgi apparatus with regard to the addition of sugar to the synthesizing glycoprotein in the secretory ameloblast.