Duration of exposure to sevoflurane affects dose-response relationship of vecuronium

The purpose of this study was to quantify the relationship between the dose-response curve of vecuronium and duration of exposure to an end-tidal concentration of 1.7% sevoflurane in 67% nitrous oxide and oxygen. Forty adult patients, in groups of 10, were allocated randomly to receive vecuronium by a cumulative dose method at intervals of 15 min (group 15), 30 min (group 30), 60 min (group 60) or 90 min (group 90) after starting inhalation of sevoflurane. Neuromuscular function was monitored by acceleromyographic train-of-four (TOF) responses of the adductor pollicis muscle to ulnar nerve stimulation. Dose-response curves were constructed by least-squares regression analysis and the effective doses of vecuronium (ED50, ED90 and ED95) were estimated and compared between groups. Mean (SEM) ED50, ED90 and ED95 were 16.8 (0.5), 32.6 (1.7) and 40.9 (2.4) micrograms kg-1, respectively, in group 15; 10.6 (1.0), 20.8 (1.7) and 26.2 (2.2) micrograms kg-1, respectively, in group 30; 11.2 (1.1), 21.7 (1.6) and 27.3 (1.8) micrograms kg-1, respectively, in group 60; and 11.0 (1.1), 21.7 (1.6) and 27.5 (1.9) micrograms kg-1, respectively, in group 90. The values obtained in group 15 were significantly higher than those in the other three groups (P < 0.05). The results indicate that the duration of sevoflurane anaesthesia influences the dose-response of vecuronium and 30 min inhalation of 1.7% end-tidal concentration is sufficient to achieve a stable potentiating effect.

Improved hypolipidemic effects of xanthan gum-galactomannan mixtures in rats

This study describes the effects of mixtures of xanthan gum and galactomannan, guar gum, or locust bean gum, on the lipids in plasma and liver in non-diabetic and diabetic rats. Non-diabetic rats were fed cholesterol-free diets with 3% guar gum, locust bean gum, or xanthan gum (3G, 3L, and 3X), or a mixture of xanthan gum and guar gum or locust bean gum (1:2, w/w) (2G1X, 2L1X) for 2 weeks. Rats fed diets not containing these polysaccharides were used as controls. The total cholesterol in plasma and the triacylglycerol in liver were significantly lowered in rats fed the 2G1X diet. The 3G, 3X, 3L, and 2L1X diets showed no significant effect on the total cholesterol and triacylglycerol in plasma and liver. In the streptozotocin-induced (STZ) diabetic rats, the total cholesterol in plasma was lowered in rats fed the 3G, 3X or 2G1X diet for 4 weeks, and the 2G1X diet was more effective than the 3G and 3X diets. The triacylglycerol in plasma in STZ diabetic rats was also significantly lowered by the 2G1X diet. These results showed that a mixture of xanthan gum and guar gum has an improved hypolipidemic effect on non-diabetic and STZ diabetic rats. The effects of the 2G1X diet on the diabetic symptoms in STZ diabetic rats, suppression of food and water intakes, decrease in glucose in urine, and lowering of plasma glucose, were also observed.

Disability management after stroke: its medical aspects for workplace accommodation

PURPOSE

Return to work (RTW) after stroke is one of the critical issues for both employer and employee. Early RTW is a manifestation of social restoration for the disabled stroke as well as an effective way to reduce social costs related stroke.

METHOD

This paper discusses the medical problems referred to RTW after stroke for workplace accommodation. Reviewing the literature, factors influencing RTW after stroke are addressed.

RESULTS/CONCLUSION

The process of RTW is extremely individual in each case, and affected by multiple factors. Therefore, it is necessary to individually evaluate precise impact of each factor on RTW.

Vecuronium-induced neuromuscular blockade in a patient with cerebral palsy and hemiplegia

We evaluated vecuronium-induced neuromuscular block in both arms of a patient with cerebral palsy and hemiplegia. A remarkable resistance to vecuronium was observed in the hemiplegia side compared with cerebral palsy side. Complete recovery from neuromuscular block should be assessed in the cerebral palsy side that shows a delayed recovery.

[Preoperative questionnaire survey about anxiety of patients for scheduled operation]

Preoperative patients have various kinds of anxiety. However we do not know much about their psychological burden. Therefore, we investigated types of their anxiety with questionnaires prior to operation and analyzed them according to their anesthetic method, type of surgery and age. Concerning anesthetic methods, patients' anxiety varied depending on their histories of anesthesia, anesthetic method previously received and age. Concerning the type of surgery, patients scheduled to undergo abdominal and cardiac surgery had more intense anxiety. Patients scheduled for gynecological surgery were anxious about the accident which might be induced by anesthesia. A large number of patients scheduled for orthopedic surgery were anxious about postoperative pain. Concerning patients' age, patients whose ages ranged from 10s to 50s were anxious about pain. While, in patients over 60s, their anxiety was focussed on giving trouble to their surrounding people. Patients whose age was 10 to 19 had anxiety about their anesthetic method. Anesthesiologists should recognize that preoperative patients have various kinds of anxiety. It is important for us to examine the patients appropriately according to their psychological and physical condition.

The Ras-MAPK pathway is important for olfaction in Caenorhabditis elegans

The Ras-MAPK (mitogen-activated protein kinase) signal transduction pathway is well known to control cellular proliferation and differentiation in response to extracellular signals, but its other functions are less understood. In Caenorhabditis elegans this pathway regulates several developmental events, such as vulval induction and progression of meiosis, but its function in the nervous system is unknown. Here we report that the Ras-MAPK pathway is involved in olfaction in this organism. Mutational inactivation and hyperactivation of this pathway impairs efficiency of chemotaxis to a set of odorants. Experiments in which let-60 ras was expressed using a heat-shock promoter and a cell-specific promoter show that a normal activity of LET-60 Ras is required in mature olfactory neurons. Application of the odorant isoamylalcohol to wild-type animals leads to the activation of MAP kinase in olfactory neurons within 10 seconds. This induction is dependent on the function of the nucleotide-gated channel TAX-2/TAX-4 and the voltage-activated calcium channel subunit UNC-2. These results suggest a dynamic regulatory role for the Ras-MAPK pathway in perception and transmission of sensory signals in olfactory neurons.

[Anesthetic management for a patient with spondyloepiphyseal dysplasia congenita]

An 11-year-old girl with spondyloepiphyseal dysplasia congenita in the spine was scheduled for virectomy under general anesthesia. She had slight scoliosis in the thoracic and lumbar spine, moderate funnel chest and slight thoracic kyphosis. Preoperative laboratory data were within normal range and her intelligence was normal. Her Mallanpathi's score, however, was Grade 3 and effective mandibular length/posterior depth of mandible ratio was 3.48 on the lateral view of head X-ray. From these data, difficult intubation was expected. Although anesthesia was induced uneventfully using thiamylal and vecuronium, her vocal cord was not visualized under laryngoscope. Using cricoid pressure procedure, slightly left-shifted vocal cord was exposed. However a 26 Fr. size endotracheal tube without cuff was too large and finally a 22 Fr. tube was inserted. During the operation patient's general condition was stable and the operation was finished without any episodes. She did not have any complications in the postoperative period. In a case of SDC, pathological changes in laryngotracheal resion should be examined and evaluated preoperatively and difficult intubation should also be always taken into account.

Gender-related differences in scores of the Barthel Index and Frenchay activities index in randomly sampled elderly persons living at home in Japan

The purpose of this study was to examine for gender-related differences in activities of daily living (ADL) and lifestyle of elderly persons living at home, and to support our hypothesis that the gender-related difference in lifestyle of stroke patients derives from their lifestyle prior to the stroke. Participants were randomly sampled elderly persons living at home. Questionnaire sheets including subject profile, Self-Rating Barthel Index (disability index), and Self-Rating Frenchay Activities Index (activity index) were mailed and collected, and the data were analyzed with the t-test and General Linear Model (factorial model with interaction). A total of 752 subjects were recruited, and their average age was 67.1 years. No significant gender-related differences were evident in the disability index including self-care and mobility domains (t-test, P > 0.05). In contrast gender-related differences in the activity index were significant (t-test, P < 0.05) for three factors; gender, age group, and living conditions, and in a covariate disability index (GLM, P < 0.05). Because randomly selected elderly persons in this study exhibited a prominent gender-related difference in lifestyle, we believe the lifestyle difference in stroke patients that we have previously described derives primarily from their premorbid attitude to daily life.

Augmentation of vecuronium-induced neuromuscular block during sevoflurane anaesthesia: comparison with balanced anaesthesia using propofol or midazolam

We have quantified the potentiating effects of 1.7% sevoflurane (n = 12) on vecuronium-induced neuromuscular block and compared the results with those obtained during balanced anaesthesia with propofol (n = 12) or midazolam (n = 12) in 36 patients. Neuromuscular function was monitored using an accelerograph and the train-of-four responses of the adductor pollicis muscle to ulnar nerve stimulation. Vecuronium 0.1 mg kg-1 was administered as an intubating dose, and maintenance doses of 0.02 mg kg-1 were administered on three occasions when T1/T0 had recovered to 25%. Thereafter, spontaneous recovery was monitored until complete. Times to 25% recovery of T1/T0 (DUR25) after an intubating dose of vecuronium did not differ between groups (mean 44.2 (SD 18.7) min for sevoflurane, 38.3 (7.5) min for propofol and 35.5 (9.5) min for midazolam). DUR25 values after each maintenance dose were 29.8 (9.5) min, 30.3 (10.4) min and 31.6 (10.7) min during sevoflurane anaesthesia, and were significantly longer than values for propofol (21.7 (6.0) min, 21.5 (5.8) min and 21.9 (5.8) min) and midazolam (20.0 (5.9) min, 19.3 (7.7) min and 19.8 (8.0) min) (P < 0.05) in each case). Recovery index25-75% and interval from T1/T0 = 25% to T4/T1 = 0.7 after the final dose of vecuronium were significantly prolonged by sevoflurane (28.3 (13.2) min and 42.7 (16.4) min) compared with propofol (17.6 (6.1) min and 26.6 (9.8) min) or midazolam (16.3 (9.4) min and 26.0 (10.2) min) (P < 0.05 in each case).

Teas and other beverages suppress D-galactosamine-induced liver injury in rats

We compared the effects of various types of beverages (teas, coffee, and cocoa) on D-galactosamine-induced liver injury by measuring plasma alanine aminotransferase (ALT) and aspartate aminotransferase (AST) activities in 7-wk-old male Wistar rats. The effects of five fractions extracted with different organic solvents from green tea, different types of dietary fibers, and some short chain fatty acids were also investigated. All of the beverages tested significantly suppressed D-galactosamine-induced enhancement of plasma enzyme activities when powdered beverages were added to the diet (30 g/kg) and fed to rats for 2 wk. Plasma ALT activities were 1155 +/- 82 [micromol/(min.L), control], 289 +/- 61 (green tea), 626 +/- 60 (roasted green tea), 471 +/- 84 (puerh tea), 676 +/- 69 (oolon tea), 423 +/- 76 (black tea), 829 +/- 53 (coffee), and 885 +/- 89 (cocoa). The profile of AST activities was similar. The caffeine-containing fraction from green tea had no significant effect, whereas the other four fractions, including the soluble fiber fraction, significantly suppressed liver injury. In addition to tea fibers, many other types of dietary fiber (hemicellulose, chitin, chitosan, alginate, pectin, guar gum, glucomannan, and inulin, but not cellulose) had liver injury-preventive effects when added to the diet (30 g/kg), suggesting that liver injury-prevention may be one of the general effects of dietary fibers. Of three short-chain fatty acids tested (acetate, propionate, and butyrate), only acetate prevented liver injury when added to the diet (15 g/kg), supporting the possibility that the liver injury-preventive effect of dietary fibers may be mediated at least in part by certain organic acids. These results suggest that several beverages possess preventive effects on certain types of liver injury, such as that induced by D-galactosamine, and that different constituents of high and low molecular weights contribute to the liver injury-preventive effects of green tea.

In vitro digestibility and fermentability of levan and its hypocholesterolemic effects in rats

This study describes the in vitro digestibility and fermentability of high molecular weight (ca. 2,000,000) levan and its effect on the metabolism of lipids in growing rats fed cholesterol-free diets. Levan was synthesized from sucrose using bacterial levansucrase immobilized on a honeycomb-shaped ceramic support. Although body weight gain, weight of visceral organs, morphologic changes in the digestive tract, and the serum triacylglycerol and glucose concentrations were not affected by feeding levan diets for 4 weeks, a significant hypocholesterolemic effect was observed. Serum cholesterol level was decreased to 83% or 59% by feeding a 1% or 5% levan diet, respectively. The hypocholesterolemic effect was accompanied by a significant increase in fecal excretion of sterols and lipids. High molecular weight levan, though not hydrolyzed by the salivary amylases, was hydrolyzed by artificial gastric juice and was changed to a low molecular weight (ca. 4,000) levan with a small amount of fructose, but did not produce any fructooligosaccharides. Low molecular weight (ca. 6,000) levan was not hydrolyzed by either pancreatic juice or small intestinal enzymes. This suggests that, in vivo, low molecular weight levan derived from the high molecular weight material is not further digested and reaches the colon intact. The fermentation of low molecular weight levan (ca. 6,000) by several strains of bifidobacteria was not observed. These results showed that the hypocholesterolemic effect of levan may result from the prevention of intestinal sterol absorption, and not from the action of the fermentation products of levan.

Functional disabilities of disabled workers in vocational aid facilities and a social welfare factory

We evaluated functional disabilities of disabled workers at vocational aid facilities and a social welfare factory to reveal whether evaluation of the functional disabilities is useful for occupational health care activities. Subjects were 121 persons with a physical disability working at Fukuoka Colony (FC workers) and 35 persons with mental retardation working at Nanomi Kogei (NK workers). The Self-Rating Barthel Index, Self-Rating Frenchay Activities Index, and Satisfaction in Daily Life (SDL) were used for the evaluation of basic activities of daily living (ADL), lifestyle, and subjective domain of quality of life, respectively. The FC workers were almost independent in basic ADL: had a high capability in self-care activities and moderately disturbed capability in mobility activities, and had a more active lifestyle than the NK workers. The total SDL score indicated that the FC workers were less satisfied with overall daily life, although not significant, and were less satisfied with the SDL items of physical health, gait, house facilities, and having a job than the NK workers. Because these results indicated the features of disabled workers and gave an occupational health physician valuable information about disabilities, the evaluations used in this study can be regarded as useful for occupational health care activities.

Circadian rhythms in the incorporation and secretion of 3H-proline by odontoblasts in relation to incremental lines in rat dentin

Circadian incremental lines are universally found in the dentin of animals. They are believed to be caused by functional changes in odontoblasts over 24 hrs. However, the mechanism of rhythmic dentin formation has not yet been elucidated. In the present study, we investigated whether there is a 24-hour rhythm in the collagen-synthetic and secretory activities of odontoblasts by radioautography with 3H-proline as a tracer. Six different groups of rats were injected with 3H-proline at 0000, 0400, 0800, 1200, 1600, or 2000 after the animals had become acclimated to a 12/12-hour light-dark illumination cycle for 2 wks. One hour after the injection, the maxillary incisors were removed and processed for radioautographic study. The silver grains of 3H-proline were most intense over odontoblasts and predentin during the environmental light period, while the nadir occurred during the dark period. The peak value was approximately two-fold higher than the minimum value. Moreover, in the dentin from rats that had been infused with 3H-proline continuously for 10 days by means of osmotic minipumps, silver grains of 3H-proline were heavily distributed over the dark hematoxylin-stained incremental lines. Thus, we demonstrated that odontoblasts show circadian rhythm with regard to collagen synthesis and secretion. These rhythms in odontoblastic function may be responsible for circadian incremental lines in dentin.

Abscopal regression of hepatocellular carcinoma after radiotherapy for bone metastasis

Spontaneous regression of hepatocellular carcinoma is a rare phenomenon. Abscopal regression of tumours resulting from the effect of irradiation of a tissue on a remote non-irradiated tissue is also rare. The case of a 76 year old Japanese man with hepatocellular carcinoma that regressed after radiotherapy for thoracic vertebral bone metastasis is described. Serum levels of tumour necrosis factor-alpha increased after radiotherapy. The findings suggests that such abscopal related regression may be associated with host immune response, involving cytokines such as tumour necrosis factor-alpha.

Iontophoretic application of prostaglandin E1 for improvement in peripheral microcirculation

OBJECTIVE

The pharmacological effects of iontophoretically applied prostaglandin E1 (PGE1) on the peripheral microcirculation were investigated.

MATERIAL AND METHOD

PGE1 concentrations permeated through hairless mouse skin iontophoretically were measured by HPLC at hourly intervals. 19 patients with arteriosclerosis obliterans were given PGE1 (20 microg) iontophoretically on the dorsum of the foot. As a control, normal saline was applied iontophoretically on another day. The increase rate in cutaneous blood flow as measured by laser Doppler flux (LDF) level was investigated. 5 of these 19 patients received PGE1 (20 microg) solution intravenously on another day. The increase rate in cutaneous blood flow as measured by laser Doppler flux (LDF) level was compared between iontophoresis and intravenous drip infusion.

RESULT

PGE1 was transported across hairless mouse skin with iontophoresis in a time-dependent manner, while it did not permeate by passive transport. The percent increase in LDF level was significantly higher in the PGE1 group than in the control group(32.7+/-20.2% vs. 10.3+/-15.5%, p.001). The percentual increase in LDF level was significantly higher with iontophoresis than with intravenous drip infusion (43.7+/-19.5% vs. 11.7+/-28.3%, p < 0.05).

CONCLUSION

The results indicated that iontophoretically applied PGE1 was effective in improving the impaired microcirculation due to peripheral arterial occlusive disease. This technique may be useful in managing severely ischemic legs.

Evolution of the apolipoprotein E receptor 2 gene by exon loss

The apolipoprotein E receptor 2 (apoER2) gene consists of a mosaic of exons, which may have been assembled by "exon shuffling." Analysis of apoER2 transcripts in several species reveals a lost repeat in the ligand-binding domain of primate apoER2. A pseudo-exon found in the primate apoER2 genes corresponds to the lost repeat but contains a crucial deletion that leads to a translational frameshift. The pseudo-exon sequence in primary transcripts of the human apoER2 gene is shown to be abolished by exon skipping due to two nucleotide substitutions at the 5'-splice donor adjacent to the pseudo-exon. These data suggest the occurrence of exon loss in the evolution of the primate apoER2 gene.

cDNA cloning of a new low-density lipoprotein receptor-related protein and mapping of its gene (LRP3) to chromosome bands 19q12-q13. 2

We report herein the cDNA cloning of a novel member of the low-density lipoprotein receptor (LDLR) family termed LDLR-related protein 3 (LRP3). Human and rat LRP3 cDNAs encode a 770-amino-acid type 1 membrane protein with the following regions: a putative signal sequence, two isoleucine/leucine/valine-rich regions with an RGD sequence, two ligand-binding repeat regions, a putative transmembrane region, and a proline-rich cytoplasmic region with a tyrosine-based internalization signal. Fluorescence in situ hybridization of human chromosomes revealed that the human LRP3 gene mapped to chromosome bands 19q12-q13.2. LRP3 transcript was detected in a wide range of human tissues, with the highest expression in skeletal muscle and ovary. Despite the presence of the ligand-binding repeats, CHO cells transfected with LRP3 did not bind beta-migrating very-low-density lipoprotein or receptor-associated protein.

[A clinical and portal hemodynamic analysis for obliteration of gastric-renal shunt communicated with gastric fundic varices]

To clear the efficacy of treatment for large porto-systemic shunts, changes of liver function and portal hemodynamics after obliteration of gastric-renal shunt (GRS) or gastric-inferior phrenic vein shunt (GIS) communicated with gastric fundic varies in 24 patients treated with balloon-occluded retrograde transvenous obliteration (B-RTO) were studied. 1) The wedged hepatic venous pressure and the hepatic venous pressure gradient were statistically not significant changed after obliteration of GRS or GIS. 2) Serum albumin value was significantly increased (p < 0.005) and ICGR15 was significantly improved (p < 0.005) at one year after treatment in patients that, not only whose GRS or GIS were larger than 10mm in diameter, but also whose superior mesenteric arterial venography before treatment showed hepatofugal flow. 3) At a mean follow-up abdominal angiography of 23.3 months in 20 cases, GRS or GIS was yet obliterated respectively. And more, superior mesenteric arterial venography revealed hepatopetal flow alone in 43% of patients that, whose superior mesenteric arterial venography before treatment showed hepatofugal flow. 4) During a mean follow-up of 32.5 months, gastric fundic varies were not recurrent in all patients, but the other hand, cumulative red color sign positive esophageal varies apparent rates were high (16.7% at before treatment, 38.4% at 2-years, 54.4% at 4-years). According to their hemodynamic characteristics, cumulative red color sign positive esophageal varies apparent rates in patients with another collaterals besides GRS or GIS before treatment (26.7% at before treatment, 61.1% at 2-years, 74.1% at 4-years) were significantly higher (p < 0.05) than those in patients without another collateral except GRS or GIS (0% at 2-years, 16.7% at 4-years). We conclude that, 1) Increment of portal flom and improvement of liver function can be expected by obliteration of GRS or GIS in patients that, whose superior mesenteric venous blood flow into large GRS or GIS. 2) After obliteration of GRS or GIS, the incidence of aggravation of esophageal varies in patients with another collaterals besides GRS or GIS before treatment is high, while that in cases without another collateral is low.

Diurnal variation in tooth movement in response to orthodontic force in rats

The purpose of this study was to determine whether there is any difference in orthodontic tooth movement when the orthodontic force is applied at different times of the day. Twenty-four rats were divided into three experimental groups based on the time of day that maxillary expansive force was applied; i.e., the force was applied continuously throughout the entire experimental period of 21 days in animals in the whole-day group; animals in the dark-period group and the light-period group received force only during the dark period (19:00-07:00) or the light period (07:00-19:00), respectively. Maxillary expansion in the light-period group was about 2 times greater than that in the dark-period group on day 21. There was no significant difference in expansion between the light-period group and the whole-day group. An experiment that used chronologic labeling with NTA-Pb revealed that there was greater formation of new bone on the tension side in the light-period group than in the dark-period group. There was no significant difference in the width of the palate among the three groups. These results indicate that there is a diurnal variation in tooth movement in response to orthodontic external force and that the application of force during the animal's rest period may be more effective than that while it is active.

[Suppressive effect of isoflurane on somato-sympathetic reflexes in cats]

Effects of isoflurane on the reflex activity of the sympathetic nervous system were investigated in 35 cats by observing alteration of the amplitudes of somato-sympathetic medullary reflex potentials. A and C-reflex potentials, which are induced from lumbar sympathetic trunk by electric stimulation of ipsilateral femoral nerve are known to arise from A-fiber group and C-fiber group, respectively. One or two percent isoflurane in oxygen was administered for 30 minutes, because it is known that I MAC of isoflurane in cats is 1.61%. The amplitude and latency of the potentials were measured during and after inhalation of the test drug, and the results were presented as percentage change from that at prior levels of inhalation as control. The results were as follows. (1) The amplitudes of A- and C-reflex potentials were suppressed dose-dependently in rats with intact brain. (2) The amplitudes of both potentials increased by decerebration at midbrain level. (3) In decerebrate cats, the amplitudes of both potentials at each inhaled concentration were suppressed to the similar levels at inhalation of 2% isoflurane in intact cats, although a slight difference between intact and decerebrated cats was observed with A-potentials during inhalation of 1% isoflurane. (4) The latencies were prolonged slightly in A-reflex potentials, only in intact cats at both concentrations. (5) Blood pressure decreased during inhalation of the test drug in every condition, but their dose-dependencies were evident only in intact cats. (6) Selective suppression of C-reflex potential by inhalation of isoflurane could not be demonstrated. These results suggest that isoflurane has a strong suppressive effect on sympathetic reflex center in medulla oblongata with was demonstrated by greater degree of suppression of the reflex responses in decerebrate cats than that in intact animals. It was concluded that the effect of isoflurane on sympathetic nervous system is similar to that of halothane.

Green tea suppresses D-galactosamine-induced liver injury in rats

Dietary supplementation with powder of a green tea extract suppressed the enhancement of plasma alanine aminotransferase and aspartate aminotransferase activities induced by D-galactosamine, but not by carbon tetrachloride, in a dose-dependent manner in rats. The minimum dose to cause a significant effect was 1 to 2%. Drinking green tea also suppressed plasma enzyme activities. These results indicate that green tea had a liver injury-preventive effect.

Dietary methionine level affects linoleic acid metabolism through phosphatidylethanolamine N-methylation in rats

The effects of dietary methionine level on the profiles of fatty acids and phospholipids and on the plasma cholesterol concentration were investigated to confirm whether the methionine content of dietary proteins is one of the major factors that cause differential effects on lipid metabolism. The effect of dietary supplementation with eritadenine, which is shown to be a potent inhibitor of phosphatidylethanolamine (PE) N-methylation, was also investigated. Rats were fed six diets containing casein (100 g/kg) and amino acid mixture (86.4 g/kg) differing in methionine content (2.5, 4.5, and 7.5 g/kg) and without or with eritadenine supplementation (30 mg/kg) for 14 d. The ratio of arachidonic to linoleic acid of liver microsomal and plasma phosphatidylcholine (PC) was significantly increased as the methionine level of diet was elevated, indicating that dietary methionine stimulates the metabolism of linoleic acid. The PC/PE ratio of liver microsomes and the plasma cholesterol concentration were also increased by dietary methionine. These effects of methionine were completely abolished by eritadenine supplementation The S-adenosylmethionine concentration in the liver reflected the methionine level of diet. These results support the idea that the differential effects of dietary proteins on lipid metabolism might be ascribed, at least in part, to their different methionine contents, and that methionine might exert its effects through alteration of PE N-methylation.

[A study of post-operative delirium in elderly patients]

We investigated the post-operative delirium in elderly patients of over 65 years of age. This investigation consisted of two studies, a prospective study and a retrospective study. In the prospective study, we evaluated the incidence of post-operative delirium and the incidence of post-operative delirium was estimated pre-operatively using State-Trait Anxiety Inventory (STAI) and Mini Mental State Examination (MMSE) in 24 patients scheduled for elective surgery under general anesthesia in the period from Nov. 1995 to Oct. 1996. In the retrospective study, we selected patients with post-operative delirium from 1600 patients who had undergone scheduled and emergency operation under general anesthesia in the same period as in the prospective study and analyzed the incidence of post-operative delirium and background of these patients. Twenty four patients in the prospective study were excluded from the retrospective study. In the prospective study, although post-operative delirium was observed in 2 cases (8.3%), no specific changes were observed in anxiety state and the ability of recognition. In the retrospective study, post-operative delirium was observed in 22 cases (1.37%). In these patients, several factors such as blood transfusion, emergency operation, dehydration, thrombosis of the superior mesenteric artery, history of ischemic heart disease, brain infarction and atrial fibrillation were thought to be major risk factors triggering post-operative delirium. In this study we could not conclude that STAI or MMSE are useful to estimate the incidence of post-operative delirium preoperatively. However, our result suggests that we should be careful about the incidence of post-operative delirium in elderly patients with pre-operative risk factors as mentioned above.

Factors affecting the variability of the torque curves at isokinetic trunk strength testing

OBJECTIVES

To evaluate the relation between variability of the torque curves and factors such as age, gender, measurement speeds, and period from low back pain (LBP) onset at isokinetic trunk strength testing.

DESIGN

Observational.

SETTING

Hospital.

PATIENTS

One hundred forty-three consecutive LBP patients (acute, subacute, and chronic) who received physical therapy, and 200 healthy volunteer subjects.

MAIN OUTCOME MEASURES

The variability of the torque curves is an indicator of consistency of effort, and was measured as the coefficient of variance (CV) at different measurement speeds in isokinetic trunk flexion/extension strength testing.

RESULTS

The CV was lower in men than in women at the faster measurement speed. LBP patients had higher CV values than healthy subjects. The CV was different according to gender and measurement speed, but not different according to age and periods from LBP onset.

CONCLUSION

The CV was affected by measurement speed and gender, but not by age or period from LBP onset. Because the CV was higher in LBP patients than in healthy subjects, this value may be usable as an adjunctive index of LBP.