The differential cardiovascular response to centrally administered carbachol seen in Brattleboro and normal Long-Evans rats

The cardiovascular effects of centrally administered carbachol were examined in conscious Long-Evans (LE) and Brattleboro (DI) rats. Carbachol induced a long-lasting increase in blood pressure and a decrease in heart rate in LE rats, whereas in DI rats no bradycardia was observed and the pressor response was significantly less than that in Long-Evans rats. Intravenous vasopressin antagonist, d(CH2)5 Tyr(Me)AVP, significantly attenuated the pressor response and eliminated the bradycardic response to carbachol in LE rats. However, the pressor response to carbachol in DI rats was still significantly less than that in LE rats treated with vasopressin antagonist. Intravenous phentolamine partially inhibited the pressor response to carbachol in LE rats and completely eliminated it in DI rats. These results suggest that hypertensive response to i.c.v. carbachol in normal rats is mediated both by an increase in central sympathetic outflow and in circulating vasopressin. The bradycardia seems to be mediated mainly by an increase in circulating vasopressin.

Daily variation of blood pressure in patients with Cushing's syndrome

The circadian rhythm of blood pressure (BP) was compared between patients with Cushing's syndrome and those with essential hypertension. In patients with essential hypertension, clear nocturnal falls in systolic and diastolic BP and heart rate (HR) were observed, and there was a positive correlation between HR and systolic or diastolic BP. On the other hand, in patients with Cushing's syndrome, there was no nocturnal fall in BP and instead a rise in some cases. In all cases with Cushing's syndrome there was a nocturnal fall in HR, and consequently no significant correlation between HR and BP in these patients. The present results imply that the normal circadian rhythm of blood pressure may be regulated at least in part by the hypothalamo-pituitary-adrenal system.

Hypotensive and bradycardic effects of centrally administered vasopressin in stroke-prone spontaneously hypertensive rats

The cardiovascular effects of centrally administered arginine vasopressin were studied in stroke-prone spontaneously hypertensive rats and Wistar-Kyoto rats. Arginine vasopressin was infused intracerebroventricularly into conscious rats at a rate of 2 pg/kg/min (4.6 microliter/hr) for 21 hours, and blood pressure and heart rate were monitored. Arginine vasopressin caused transient hypertension and tachycardia in Wistar-Kyoto rats, whereas it induced delayed hypotension and bradycardia in stroke-prone spontaneously hypertensive rats. The effects on the latter lasted for 24 to 72 hours after cessation of the infusion. Intravenous administration of arginine vasopressin at a rate of 2 pg/kg/min did not cause any change in blood pressure and heart rate in these rats. These results suggest that arginine vasopressin acts centrally to depress cardiovascular activities, at least in stroke-prone spontaneously hypertensive rats.

The synthesis of peptides with potential thymic hormone activity: the synthesis of endo-Arg38a-deacetylthymosin beta 10

A tritetracontapeptide corresponding to the entire amino acid sequence of endo-Arg38a-deacetylthymosin beta 10 was synthesized by a conventional solution method. Seven peptide fragments were assembled, followed by deprotection with 1 M trifluoromethanesulfonic acid-thioanisole-Me2Se in trifluoroacetic acid. In preliminary experiments the synthetic tritetracontapeptide increased the entire peripheral T-cell population and a helper T-cell subset when incubated in vitro with blood which was obtained from a uremic patient with pneumonia, but a suppressor/cytotoxic T-cell subset was unaffected under these conditions. The synthetic endo-Arg38a-deacetylthymosin beta 10 was as active as synthetic deacetylthymosin beta 10 in this in vitro assay.

A finger volume-oscillometric device for monitoring ambulatory blood pressure: laboratory and clinical evaluations

A new portable device for the indirect measurement of ambulatory blood pressure in the finger was successfully applied to normotensive and hypertensive subjects in and outside a ward setting. The device uses the volume-oscillometric technique and, equipped with a microprocessor, permits long-term ambulatory monitoring of indirect systolic and mean blood pressure at desired intervals (once every 1-10 min). Systolic and mean blood pressures obtained by this method were well correlated with those measured by the direct (Oxford) and arm-cuff methods. Systolic and diastolic blood pressure obtained by the volume-oscillometric device were almost identical with those recorded by an arm-cuff. Systolic blood pressure obtained by the volume oscillometric method was, however, significantly lower than that measured by the direct method. The new device has also been used to measure blood pressure during treadmill exercise and ice-water immersion. Mean values of blood pressure and the SD of these averaged for 24 hours, or for every hour, were reproducible when the measurements were repeated under the same condition. The present device is portable, causes minimal noise, can detect rapid change in blood pressure and causes less discomfort when compared to the conventional arm-cuff method. Regular measurements can be made with minimal sleep disturbance. This fully automatic volume-oscillometric device allows reliable 24-hour monitoring of ambulatory blood pressure not only in but also outside a ward setting, and as such is useful for studies of hypertension.

[Huge Virchow's metastasis in gastric cancer made resectable by hyperthermochemoradiotherapy]

A 75-year-old woman who had undergone gastrectomy for gastric cancer at the age of 61 developed a huge left supraclavicular tumor (15 X 10 X 10 cm) suspected of being Virchow's node. She was treated with hyperthermochemoradiotherapy (HCT-therapy). After 10 sessions of radiofrequency hyperthermia by a Thermotron RF8, irradiation with 52.8 Gy of 60Co and injection of 8 mg of MMC, the tumor mass decreased by 77% on CT. The histologically resected specimen revealed coagulation necrosis in almost all areas. This case, which was considered HCR-therapy-effective, was estimated as Grade 3 according to The General Rules for the Gastric Cancer Study (The 11th edition.)

[Experimental study on brain tissue of microfibrillar collagen hemostat (Avitene)]

Microfibrillar collagen hemostat (Avitene) is a new absorbable topical hemostatic agent, of which hemostatic mechanisms are adhesion to the bleeding site and platelet aggregation. Avitene was used to obtain hemostasis and compared with Gelfoam or Oxycel in the injured cerebral cortex in a rabbit. The animals were killed and the lesions were examined grossly and microscopically to evaluate its biocompatibility in the cerebral cortex. Histopathological examinations revealed that Avitene was biocompatible with cerebral cortex in a rabbit. Electroencephalographies did not show the epileptogenic focus when Avitene was applied on the cerebral cortex in a rabbit. It has been applied for the bleeding during surgery for several years. Its effectiveness of hemostasis has been well known. This study indicated that Avitene is very effective and safe to use as a topical hemostatic agent during craniotomy in a rabbit. Therefore, this agent may be useful in a patient with minor and diffuse bleeding in the neurosurgical field.

[Familial occurrence of intracerebral cavernous angioma]

A case of familial occurrence of intracerebral cavernous angioma is reported. The patients were a mother and her eldest son, a 48-year-old woman and a 28-year-old man, respectively. The mother, a hypovascular mass in the right frontal lobe was excised surgically, and in the son a well demarcated mass in the left temporal lobe was extirpated. Pathological examination in each case revealed cavernous angioma. Familial occurrence of intracerebral cavernous angioma is extremely rare. In the literature, 8 cases of familial occurrence have been reported, including our case, and in three out of the 8 cases the lesions were histologically confirmed. To our knowledge, this is the first case in Japan in which the diagnosis was established by surgical specimen. Of 17 cases in 8 family lines, multiple occurrence was observed in 7 cases. The clinical manifestations of the disease appear mostly in a form of adult epilepsy or intracerebral hematoma, and rarely sudden death associated with intracerebral hematoma. At present, CT scanning is widely used for diagnosis of the disease, and the lesions are surgically curable if they are located at the accessible sites. Although there has been no evidence of genetic basis, it is interesting that there is familial occurrence. From this point of view, we should carefully check the family tree of such patients.

Mechanism of antihypertensive effect of atenolol in patients with borderline hypertension during short-term treatment. A comprehensive study

Short-term treatment with 1-(p-carbamoyl-methylphenoxy)-3-isopropylamino)-2-propanol (atenolol, Tenormin) (100 mg/d for 5 days) was conducted in 12 patients with labile essential hypertension. Before and at the end of the treatment, cardiohemodynamics, renal hemodynamic and excretory function, and renal pressor (renin-angiotensin-aldosterone) and depressor (renal kallikrein-kinin and prostaglandin) systems were examined. Atenolol decreased cardiac output (CO) without affecting total peripheral resistance. Atenolol also decreased plasma renin activity, plasma aldosterone concentration, urinary excretion of kallikrein-kinin, and urinary excretion of potassium whereas it increased plasma potassium concentration. Urinary excretion of prostaglandin E and sodium was not affected by atenolol. Glomerular filtration rate decreased, but renal plasma flow remained unchanged during the treatment by atenolol. A significant positive correlation was found between the changes in CO and in systolic blood pressure (SBP) while negative correlation was observed between the changes in total peripheral resistance and in SBP. A significant positive correlation was also noted between urinary kallikrein excretion and renal plasma flow. The change in urinary kinin excretion was conversely correlated to that in SBP. This study demonstrates that the hypotensive mechanism of atenolol is very complex. Decrease in CO and inhibition of renin-angiotensin-aldosterone system may mainly be responsible for hypotension. It is likely that potassium retaining action of atenolol partly contributes to its hypotensive action. It is also hypothetized that renal kallikrein-kinin system may play a role in modulating the hypotensive action of atenolol.

Syntheses and effects of [Glu34]-thymopoietin II fragment 32-45 and its analogs on the impaired T-cell transformation in a patient with common variable immunodeficiency

[Glu34]-thymopoietin II fragment 32-45 and its three analogs were prepared by substitution of the amino acid residue at position 37. These peptides were synthesized by a conventional solution method, followed by deprotection with 1 M trifluoromethanesulfonic acid-thioanisole in trifluoroacetic acid in the presence of m-cresol. These peptides were tested for their effects on impaired T-cell transformation by phytohemagglutinin in the common variable immunodeficiency. The relative potency of the synthetic [Glu34]-thymopoietin II fragment 32-45 was one-half of that of synthetic thymopoietin II fragment 32-45. Among these tetradecapeptide analogs, one analog in which Val37 was replaced by Ile exhibited a potent activity which was more than that of the synthetic [Glu34]-thymopoietin II fragment 32-45. The relative potencies of Thr37 and Tyr37 analogs were one-third and one-half, respectively of that of the synthetic [Glu34]-thymopoietin II fragment 32-45.

Pharmacokinetics and pharmacodynamics of conventional and slow release forms of nifedipine in essential hypertensive patients

In patients with essential hypertension, the pharmacokinetics of nifedipine in 2 forms (capsule, 10 mg nifedipine dissolved in an organic solvent; slow release tablet, 20 mg nifedipine) and their pharmacodynamic effectiveness on arterial pressure were studied. The maximum plasma concentration was higher and achieved more rapidly after application of the capsule than after the retard tablet (p less than 0.01). The plasma half-time of nifedipine in the capsule was shorter than that in the retard tablet (p less than 0.05). The absorption rate of nifedipine from the capsule tended to be larger than that from the retard tablet. Plasma concentrations of nifedipine, measured 12 hr after the dosing of the retard tablet during chronic treatment, were not different from those after the acute administration of the retard tablet, suggesting that no accumulation of nifedipine occurs. The capsule of nifedipine elicited prompt and profound hypotension with short duration, while the retard tablet produced a hypotensive effect with relatively slow onset and long duration. Arterial pressure reduction was maintained throughout the day using 12 hourly dose of the retard tablet. During the chronic treatment the maximum hypotensive effect was observed 4 weeks after the start of treatment. Twelve hourly administration of the retard tablet is a convenient regimen for the long-term control of mild to severe essential hypertension.

Carpal tunnel syndrome in patients on long-term hemodialysis

Sixteen cases with carpal tunnel syndrome (CTS) were reported out of 412 patients on long-term hemodialysis due to chronic renal failure. Clinical symptoms included numbness in the area innervated by the median nerve in 100% of symptomatic hands and pain in the wrist and hand in 81%. This pain usually became severer at night and during hemodialysis. Muscle atrophy was noted in 41% of the hands. Nerve conduction studies revealed prolonged distal sensory latency, slowed sensory nerve conduction velocity across the wrist and normal distal motor latency in 18%, prolonged distal motor latency in 51% and no response in motor or sensory stimulation in 31%. Evidence of denervation on electromyography was seen in 36% of the hands. Patients were conservatively treated avoiding daily activities precipitating the condition with volar wrist splint only at night in 18% and in 90% with steroid hormone injection in the carpal tunnel. Median nerve release was performed in 18% of the hands. Amyloid deposit was demonstrated in 3 of 4 operated hands. Although the relation between long-term hemodialysis and the occurrence of the amyloid deposition in the carpal tunnel has not been established, the present data along with other recent reports strongly indicate that amyloid deposit in the carpal tunnel on hemodialysis patients could be one of the most possible cause of CTS.

Effect of weight loss on blood pressure and drug consumption in normal weight patients

The effect of weight loss on blood pressure and on antihypertensive drug consumption was examined in 81 nonobese subjects with essential hypertension who had been chronically treated with antihypertensive drugs. A hypocaloric diet was prescribed for 5 months. A weight loss greater than 2 kg in 5 months was considered significant. Quality and quantity of antihypertensive medications were scored according to a formula. In the subjects whose medication and weight did not change, mean arterial pressure remained unchanged, whereas it decreased significantly (-7.1 +/- 1.9 mm Hg) in those who showed significant weight loss (-3.28 +/- 0.34 kg) with no change in medication. Among the subjects whose antihypertensive medication remained constant during the diet program there was a significant correlation between the change in weight and mean arterial pressure (r = 0.45, p less than 0.01). Mean arterial pressure increased significantly (+5.1 +/- 1.7 mm Hg) in subjects whose weight remained unchanged with a decrease in medication, whereas it remained significantly lower than the control (by -3.1 +/- 2.0 mm Hg) in those whose weight decreased significantly (-4.57 +/- 0.69 kg) with the decrease in medication. The weight loss-induced decrease in blood pressure occurred independently of the initial degree of obesity and the initial level of mean arterial pressure. Urinary sodium excretion in the control period and at the end of the diet program did not differ significantly between subgroups. These results indicate that, even in subjects of normal weight with essential hypertension, weight loss can induce a fall in blood pressure that leads to a reduction of antihypertensive medication.(ABSTRACT TRUNCATED AT 250 WORDS)

Seroepidemiological studies on a non-A, non-B hepatitis specific antigen/antibody system (SO-antigen/anti-SO)

The patients and staff members of a haemodialysis unit were examined for their serological responses to SO-antigen, which was isolated from the urine of epidemic type non-A, non-B hepatitis patients at Tohoku University Hospital. To understand how SO-antigen or SO-antigen-related aetiology can be incriminated for the hepatitis found in the haemodialysis unit, the prevalence of SO-antigen/anti-SO system and hepatitis A and B virus-related antibodies was compared in the sera of patients and staff members. Although the SO-antigen was rarely detected in the serum, anti-SO antibody was frequently detected in the sera of patients and staff. A significantly higher prevalence was found in the serum of patients (15%, 54 out of 361) than staff members (7.1%, 13 out of 184) and volunteer blood donors (1%, 3 out of 305). The same prevalence percentages of HBV-related antibodies (either positive for anti-HBs or anti-HBc) and anti-HAV were observed among the patients, staff, and volunteer blood donors, irrespective of whether the sera were anti-SO positive or negative. Among the staff, anti-SO antibody was more frequently found in those with a history of acute hepatitis (16.7%, 3 out of 18) than in those without (6%, 10 out of 166). These prevalence ratios conformed with those of HBV-related antibodies, but the same prevalence ratios of antibody to HAV were observed between the staff with and without a history of acute hepatitis. These results indicate that the SO-antigen/anti-SO system or entity related to this immune system is distinct from HBV or HAV, and this immune system was found widely in the haemodialysis unit where type B and non-A, non-B hepatitis were also found frequently.