Renal hypouricemia due to an isolated renal defect of urate transport

A 22-year-old man was found to have low serum urate concentration (1.1-1.7 mg/dl). His urate clearance was markedly increased (26.9-35.5 ml/min) and was not decreased after administration of pyrazinamide, but was even more increased after administration of benzbromarone. No other renal tubular abnormalities were detected. The young man has one sister and two brothers. His sister also has hypouricemia and hyperuricosuria. We suggest that the present case had a genetically determined renal abnormality affecting tubular presecretory reabsorption of urate.

A case of four coronary artery fistulae originating from three vessels associated with aneurysm

A case of an aneurysm associated with four coronary artery fistulae originating from three vessels is reported. The patient, a 52-year-old woman, had chest heaviness and palpitations. Coronary arteriography revealed the four fistulae originating from three coronary vessels with an aneurysm draining into the left ventricle and the main pulmonary artery. The patient's symptoms were relieved after fistulectomy and the aneurysmectomy, suggesting that a coronary steal phenomenon through the fistulae was the cause of her symptoms. This case is of interest because of its rarity, since this is the first case report of an aneurysm associated with four coronary artery fistulae from three vessels.

[Quality of life after resection of the stomach]

The quality of life after operation was analyzed using a questionnaire from 283 patients who received gastrectomy between 1972 and 1983 at Kobe University Hospital. Kruskal-Wallis analysis and Dunn's multiple comparison analysis were used to analyze multiple factors consisting of background, therapeutic and prognostic factors when the level of social activity is considered as the final evaluation. Categorical principle component analysis was used to examine the relationship among each factor and to verify the former results. The background factors played an important role for the outcome (i.e., longer survivors and/or patients with beign disease had better outcomes and patients over 60 years and/or with body weight less than 50kg had worse outcomes). In the analysis of therapeutic factors, it was suspected that suitable resection under suitable curability and/or suitable reconstruction method in the total resection of the stomach contributed to a better outcome. Also, therapeutic control of diarrhea after gastrectomy was suspected as being important among the many prognostic factors.

Alteration of chloral hydrate metabolism in rats with carbon tetrachloride-induced liver damage

The metabolism of chloral hydrate (CH) was investigated in the isolated perfused rat liver system. The experiments were performed on rats that were administered carbon tetrachloride (CCl4) subcutaneously for 15 weeks to induce chronic liver damage and on untreated rats. Clearance of CH from the perfusion system was lower in damaged liver than in control liver. In both groups, 50-70% of the added CH was excreted into perfusate as trichloroethanol (TCE) and trichloroacetic acid (TCA) within 120 min. The TCE/TCA ratio was 1:1.3 in the control group compared to 2:1 in the damaged liver group. The findings suggest that CH metabolism in the liver is affected by chronic damage.

On the ionic mechanism of cyproheptadine-induced bradycardia in a rabbit sinoatrial node preparation

The effects of cyproheptadine (0.1-10 microM) on the membrane potentials and currents of rabbit sinoatrial node were examined with the double-microelectrode voltage clamp technique. Cyproheptadine reduced the heart rate, maximum rate of depolarization and action potential amplitude. It also decreased the slope of phase 4 depolarization. On the current systems, cyproheptadine decreased the slow inward current (Isi), the time-dependent potassium outward current (Ik) and the hyperpolarization-activated current (Ih). The reduction of Isi was the major effect. Furthermore, Isi was progressively decreased by repetitive membrane depolarization during administration of cyproheptadine, an effect suggestive of frequency-dependent block of Isi. These electrophysiological observations indicate that cyproheptadine has a calcium antagonistic property, and additionally, decreases Ik and Ih in rabbit sinoatrial node.

Cardiac involvement in a patient with limb-girdle muscular dystrophy

A case of limb-girdle muscular dystrophy with cardiomegaly, electrocardiographic abnormalities, and paroxysmal ventricular tachycardia was described. Some of the interesting electrocardiographic features were discussed, and the importance of serial electrocardiograms for the detection of cardiac involvement is emphasized, since acute disturbances in cardiac rhythm may indicate that the patient is in immediate danger of sudden death.

Electrophysiological study of cibenzoline in voltage-clamped rabbit sinoatrial node preparations

Effects of cibenzoline (0.1-30 microM) on membrane potentials and currents were investigated in rabbit sinoatrial node cells using conventional microelectrode and double microelectrode voltage clamp methods. Cibenzoline reduced the heart rate, the maximum rate of rise and the action potential amplitude in a dose-dependent manner. At the same time, the action potential duration at half-amplitude was prolonged, and the slope of phase 4 depolarization was decelerated. The voltage clamp experiment revealed that cibenzoline (7-30 microM) depressed the slow inward current, the time-dependent potassium outward current and the hyperpolarization activated current. Neither the kinetic variable of the time-dependent potassium outward current nor the decay time of the outward current tail was altered by the drug perfusion. The results suggest that cibenzoline exerts a depressant effect on the electrical activity of sinoatrial node cells and that the depression of the currents induced by cibenzoline is due to a reduction in conductances of the current systems.

Inhibition of Ca2+ inward current in rabbit sinoatrial node by bunazosin, an alpha-adrenoceptor antagonist

The electrophysiological effects of bunazosin, a novel alpha-adrenoceptor antagonist, were examined on isolated spontaneously beating sinoatrial node preparations of the rabbit by means of a double-microelectrode voltage clamp method. Bunazosin (above 10 microM) reduced the beating frequency, and the maximum rate of rise and the amplitude of action potentials. The slope of the diastolic depolarization (phase 4) was also decreased by the drug whereas the action potential duration at 50% repolarization was prolonged. Bunazosin decreased the slow inward current (Isi) and the time-dependent potassium outward current (IK). However, the major effect was the reduction of Isi. The results indicate that bunazosin, an alpha-adrenoceptor antagonist, depresses the action potential and automaticity of the sinoatrial node by inhibition of Ca channels.

Approach for quantifying the overall function of the ascending central neural integration to release vasopressin in rats

Electrical stimulation of the intermediate portion of the solitary nucleus (SOL) is known to consistently elicit a pressor response and increase in the release of vasopressin (VP) in rats, when the cervical spinal cord and vago-sympathetic trunks are cut. The aim of the present study was to provide a methodological assessment for this technique, in order to quantify the central neuroendocrine function to release VP. Experiments were conducted on rats with cervical cordotomy and vagotomy, under 60% N2O anesthesia and artificial ventilation. The animals were maintained at their normal arterial blood pressure by infusing phenylephrine, which itself exerted little influence on the arterial plasma VP concentration (pVP) during SOL stimulation. In order to prevent blood loss, cross circulation with a donor rat was utilized in the blood sampling for pVP determination. We confirmed that this technique itself did not significantly affect the pVP level. A monopolar stimulus at a frequency of 50 Hz was found to produce the pressor response most effectively. The current spread of the stimulation (0.5 ms duration; 1 s on/1 s off; up to at least 120 microA) did not induce a false-positive pressor response mediated by other structures adjacent to the SOL. We suggest that electrical stimulation of the SOL in rats with cervical cordotomy and vagotomy, for observing the pressor response and/or increase of pVP, represents a rapid approach for screening the overall function of the ascending efferent part of the reflex mechanisms to release VP.

Release of vasopressin by electrical stimulation of the intermediate portion of the nucleus of the tractus solitarius in rats with cervical spinal cordotomy and vagotomy

The cervical spinal cord and vagi were severed in anesthetized and artificially ventilated rats. Monopolar electrical stimulation of the intermediate portion of the nucleus of the tractus solitarius (NTS) resulted in subtle increases in concentration of plasma vasopressin (pVP) and in arterial pressure. We suggest that electrical stimulation of the NTS in rats undergoing such surgical preparation to observe the pressor response and/or increase in pVP, represents a rapid approach for screening the neurosecretory function of the central neural integration to release vasopressin.

Production of VIP- and PHM (human PHI)-related peptides in human neuroblastoma cells

We demonstrated the production and release of a peptide structurally identical with porcine and bovine VIP-28 in human neuroblastoma NB-OK-1 cell line. In the cells, VIP-like immunoreactive (IR-VIP) components of 8 K dalton (Kd), 11 Kd, 18 Kd and 30 Kd were also detected and the 8 Kd and 18 Kd components were apparently released into the culture medium, indicating the possibility of less extended or limited processing of the VIP precursor in the cultured cells of tumor origin. The cells were also shown to produce, simultaneously with the VIP-28, a PHI/PHM-like immunoreactive (IR-PHI/PHM) component which coeluted with synthetic PHM-27, not PHI-27, in reverse-phase high performance liquid chromatography (HPLC). In addition to the PHM-27-like component, another IR-PHI/PHM component was detected in the cell extract which eluted in HPLC immediately before synthetic PHM-27 and crossreacted with PHI-27 amino-terminal specific antiserum but not with PHI-27 central-portion specific or PHM-27 carboxyl-terminal specific antiserum. The presence in NB-OK-1 cells of this IR-PHI/PHM component related to the amino-terminal portion of PHI/PHM suggested possible alternative(s) of post-translational processing of the VIP precursor in the cells in terms of the production of PHM-27-related peptides.

The relevance of cardio-pulmonary-vascular reflex to regulation of the brain vessels

In 11 cordotomized (C2) rats with the vagi cut, monopolar electrical stimulation at a current intensity of 73 +/- 21 (S.E.) microA (n = 6) to the intermediate region of the solitary nucleus elicited an increase (p less than 0.05) in regional blood flow (iodoantipyrine technique) of 71% and 43% in the frontal cortex and caudate nucleus, respectively. The findings suggest that some of the cardio-pulmonary and cardio-vascular reflex mechanisms are involved in the regulation of the blood vessels of the brain.

Intrarenal beta-adrenergic stimulation enhances excretion of urinary lysosomal enzyme in anesthetized dogs

The effects of intrarenal administration of isoproterenol on excretion of urinary enzymes were examined in dogs. Urinary N-acetyl-beta-D-glucosaminidase (NAG) and glutamyl transpeptidase (gamma-GTP) originated from lysosomes and the brush border membrane of the kidney, respectively. NAG excretion was elevated for 10 min by isoproterenol (0.2 microgram/kg/min) without a drastic change in glomerular filtration rate and renal blood flow. This elevation was inhibited by pretreatment with d,l-propranolol (0.6 mg/kg bolus injection 0.3 mg/kg/30 min) but less so by d-propranolol. Urinary gamma-GTP excretion was little affected by isoproterenol. In light of these findings, the possibility that beta-receptors may be involved in the excretion of NAG has to be considered.

Quantitative evaluation of the pattern of shunt flow in the right ventricle and pulmonary artery of dogs with experimental ventricular septal defect

Cineangiographic studies in patients with ventricular septal defect (VSD) have occasionally demonstrated that part of the blood across the defect is ejected immediately into the pulmonary artery (PA) passing through the outflow tract of the right ventricle (RV), but without being trapped in it. We attempted to make a quantitative evaluation of the flow of a partial shunt pathway (a direct VSD-PA pathway) that drains that part of the blood from the defect. Our method depended on a thermal dilution technique to obtain the ejection fraction of the RV and to observe a simultaneous pair of dilution curves at the roots of the aorta and PA after introduction of tracer into the left atrium. An analytical process was specially designed by incorporating a stable one-pass deconvolution technique. The method was applied to eight anesthetized dogs with acutely produced experimental VSD on the entrance of the outflow tract of the RV. The flow through the direct VSD-PA pathway was, in most cases, greater than 50 and up to 85% (mean of the eight, 57 +/- 5% SE) of the total left-to-right shunt flow. This would imply that less than 50%, and down to as little as 15%, of the total amount of shunt flow contributed to extra work of the RV in these cases. In addition, the impact on the pulmonary vasculature due to such a large amount of pulsatile flow through the direct VSD-PA pathway may accelerate the development of hypertrophy of the pulmonary vessel wall.

Circulatory pressure-volume relationship and cardiac output in DOCA-salt rats

We studied the total vascular pressure-volume relationship and cardiac output (CO) in conscious rats receiving DOCA-salt or sham treatment. The mean circulatory filling pressure (MCFP) was measured by briefly inflation an indwelling balloon in the right atrium, and the MCFP-blood volume (BV) relationship over +/- 10% of BV was determined by rapid blood infusion or withdrawal. CO was measured in separate experiments using Fick's principle. Arterial pressure-volume relationship was also determined in additional experiments on anesthetized rats. Compared with sham rats, the mean arterial pressure was unchanged at 1 week, increased at 2 weeks, and increased further thereafter in the DOCA-salt rats. The BV was unchanged at 1 week, expanded at 2 weeks, unchanged at 5 weeks, and contracted at 8 weeks. There were no significant changes in MCFP, total vascular compliance (the inverse of the slope), nor unstressed volume (extrapolated volume axis intercept) at 2, 5, and 8 weeks. Total vascular capacity, assessed as BV at MCFP of 7.6 mm Hg, increased at 2 weeks, was unchanged at 5 weeks, and decreased at 8 weeks. Arterial compliance decreased at 5 and 8 weeks. CO remained unaltered at 1, 2, 5, and 8 weeks. These results suggest that the altered total vascular capacity may serve to maintain a normal CO against a rising afterload in the conscious DOCA-salt hypertensive rats, and that the decreased total vascular capacity may be a secondary hemodynamic feature with progression of hypertension.

The inactive to active renin ratio in the kidneys and the plasma in diabetic nephropathy

We examined the inactive to active renin ratio in the renin granules of the cadaver kidneys and the plasma in patients with diabetic nephropathy. The inactive renin in the break-through fraction when the plasma or the renin from the renin granules was put into a pepstatin column was determined. The inactive renin in this fraction was activated by trypsin. Concerning plasma, the inactive to active renin ratio was 90 in the patients and 9 in the normal subjects. On the other hand, this ratio was 0.29 in the patients' kidneys and 0.28 in the control kidneys. These results suggest that the increase of the inactive to active renin ratio in plasma of diabetic nephropathy does not result from the change of the renin storage in the kidneys.

The existence of inactive (trypsin-activated) renin in dog plasma and renin granules from the kidney

Trypsin-activated renin (inactive renin) was detected in the break-through fraction when dog plasma or renin extracted from renin granules (stored renin) was applied to a pepstatin column, respectively. The appearance of the renin activity by trypsin treatment was not due to acid protease. Production of angiotensin I from homologous renin substrate by the trypsin-activated renin was proportional to the time of incubation. The trypsin-activated renin had an affinity for the pepstatin column. The maximum amount of trypsin-activated renin was obtained with incubation for 15 min at 37 degrees C at 1000 micrograms/ml in plasma or at 100 micrograms/ml in case of stored renin. The ratio of inactive to active renin was calculated to be 1.6 or 0.002 in plasma or stored renin, respectively, under conditions of a standard sodium diet.

The storage form of human renal renin

We isolated renin granules from cadaver kidneys using discontinuous sucrose density gradient centrifugation, and investigated the storage form of the renin from these granules. Approximately 23% of the total renin activity in the original homogenate was obtained from the surface phase between 1.6 and 1.7 M sucrose (Fraction 6). Granule renin extracted from the granules in Fraction 6 was separated into active and inactive renin using pepstatin affinity chromatography. Only the active renin had an affinity for pepstatin. The inactive renin, albeit activated by trypsin, was little activated by acidification. The proportion of inactive renin was about 25% of the total granule renin (active renin + inactive renin). Trypsin concentrations over 10 micrograms/ml resulted in a decrease in the renin activity of the trypsin-activated renin, but the enzymatic activity of active renin was decreased by trypsin. With gel filtration, the inactive renin revealed a single peak, and the molecular weight (MW) was 48,000. The active renin had a MW of 44,000. The inactive renin could be activated by trypsin without an apparent change in molecular weight.

Total venous capacity in two-kidney, one clip Goldblatt hypertensive rats

To assess possible time-related changes in total venous capacity, mean circulatory filling pressure (MCFP) and blood volume (BV, Evans blue) were determined in conscious rats with early, intermediate and chronic phases of two-kidney, one clip Goldblatt hypertension. MCFP, and index of whole-body venous activity, was measured while the circulation was arrested by the brief inflation of a balloon inserted into the right atrium. Compared with shamoperated control rats, Goldblatt rats showed unchanged MCFP and BV in early phase, unchanged MCFP with marginally (0.05 less than p less than 0.10) decreased BV in intermediate phase, and significantly (p less than 0.05) increased MCFP with unchanged BV in chronic phase. Thus, decreased total venous capacity, which is reflected in increased MCFP relative to BV, occurred with a continuation of hypertension. MCFP/BV curves, obtained by measuring MCFP before and after rapid BV change, appeared to shift toward the pressure axis in all Goldblatt groups. There were no significant differences in total vascular compliance, which is the inverse of the slope of this curve and is an index of total venous compliance, between Goldblatt and control groups at any time-period studied. These results suggest that decreased venous capacity observed in chronic hypertensive rats may be a secondary hemodynamic state and may not be related to decreased venous compliance.

Cross-cultural differences in parent-child assessment: U.S.A. and Japan

Videotaped family interactions illustrating parent-child behaviour from American and Japanese clinical samples were assessed by psychiatrists and medical students in Hawaii and Tokyo, to study the effects of culture on the evaluation of behaviour. The results suggest that cultural factors significantly influence the assessment of inter personal behaviour, particularly highly overt and culturally patterned behaviour, e.g. parent-child roles and functions.

Hypertension, hypokalemia and hypoaldosteronism with suppressed renin: a clinical study of a patient with Liddle's syndrome

A 24-yr-old woman with hypertension, hypokalemic alkalosis, low plasma renin and hypoaldosteronism was studied. Plasma aldosterone, renin and potassium returned to normal and blood pressure fell after sodium restriction or the administration of triamterene. Thiazide therapy also normalized her blood pressure while dexamethasone, spironolactone and furosemide did not improve her symptoms. Plasma aldosterone levels were low and responded poorly to a short term ACTH injection, but responded well to the maximal adrenal stimulation by ACTH-Z. Plasma levels of cortisol, corticosterone and deoxycorticosterone were within the normal range. Adrenal scintigram with 131I-adosterol and abdominal computed axial tomography did not reveal the presence of a sizeable adrenal tumor. In addition, the urinary kallikrein excretion was low after sodium restriction and showed no response to saline infusion. These findings suggest that the excessive secretion of unusual mineralocorticoids may not exist in this case. From these observations and the results of the therapeutic responses to the diuretic agents, we conclude that the primary cause of the disorder of this patient seems to be a renal defect in the distal tubule in handling sodium and potassium which is similar to that in Liddle's syndrome.

Pathophysiological studies on hypertension induced in rats by kidney extract and salt

The renin-angiotensin-aldosterone system, electrolyte and water balance, body fluid, and neurogenic tone and reactivity of the vasculature were studied in hypertension induced in uninephrectomized rats by repeated injection of renin-rich kidney extract and 1% saline drinking. The control rats were injected with physiological saline. Various measurements were made in conscious rats on the 10th day of the treatment. As compared with the control, plasma renin concentration and serum sodium increased significantly, while plasma aldosterone and renal excretory function did not differ. Blood volume (BV) expressed as per body weight increased significantly, but absolute BV, absolute or body weight-related plasma volume and hematocrit were not significantly different. The hypotensive effect of 1-Sar-8-Ile-angiotensin II was negligible 12 hours after the preceding injection of kidney extract. It was small but significant 1 hour after the injection. Increase in water turn-over and fractional sodium excretion occurred during the development of hypertension. Spironolactone did not significantly modify the developmental course. We observed increased depressor response to hexamethonium and increased reactivities to noradrenaline and angiotensin II (A II); these response curves relatively resembled those of spontaneously hypertensive rats. Hypertensive vascular changes were seen in the kidney and heart by histology. Thus, it was suggested that a direct vascular action of A II played a partial role in this hypertensive process while aldosterone played little role. The significance of BV increase and possible contribution of A II's other actions were discussed.

[Treatment of Diphyllobothrium latum and Taenia saginata infections with aminosidine (author's transl)]

Recently, it has been known that the aminosidine has marked anthelmintic efficacy against tapeworm. In this investigation, aminosidine was used for treating 14 cases with Ciphyllobothrium latum infection and 5 cases with Taenia saginata infection. Aminosidine was administered orally in a single dose of 50 mg/kg, followed by a purge after the treatment. Fourteen patients with D. latum infection and 5 patients with T. saginata infection expelled long strobila in all cases. Although only 7 scolices of 18 worms of D. latum were found in the stool and no scolex of T. saginata was found, follow-up examination for a long period showed no evidence of remaining infection with one exception of D. latum. Mild nausea, vomiting and abdominal pain were observed in only one of 19 cases given aminosidine. But in the other 18 cases, no side effects were encountered. It was concluded that aminosidine is safe, effective therapeutic agent for the treatment of cestodiasis in man.

Cryoactivation of inactive renin in human plasma

The mechanism of the increase in renin activity in human plasma which had been kept -5 degrees C for 4 days (cryoactivation) was investigated. From the results of clinical studies, it is likely that the controling mechanism of inactive renin has something in common with that of active renin. The experimental data showed that the increase in renin activity of human plasma by cryoactivation was closely correlated to the increase obtained by incubation with trypsin (r = 0.88, p less than 0.001, n = 10). Soybean trypsin inhibitor, aprotinin and di-isopropylfluorophosphate (DFP) inhibited cryoactivation, indicating that the cryoactivation is due to the action of a trypsin-like serine enzyme. Trypsin which had no effect on plasma renin activity in the presence of the same amount of soybean trypsin inhibitor at 37 degrees C, activated the renin activity during cold incubation, suggesting that the dissociation of the trypsin-inhibitor complex may have taken place at a low temperature. Endogenous trypsin inhibitor is also likely to lose its affinity to endogenous trypsin-like enzyme at a low temperature.