Expansive suboccipital cranioplasty for the treatment of syringomyelia associated with Chiari malformation

In order to treat syringomyelia associated with adult type Chiari malformation, the authors developed a method of expansive suboccipital cranioplasty (ESC) that involves enlarging the small posterior fossa to obtain a sufficient flow of cerebrospinal fluid (CSF). The relative effectiveness of ESC with the obex plugged and not plugged was also examined, as well as other factors influencing the operative results. Twenty patients without arachnoid adhesion at the major cistern underwent ESC without opening the arachnoid membrane at the major cistern. After surgery, all improved with no recurrence and CSF flow study using magnetic resonance (MR) imaging showed significant improvement of the flow at the major cistern. Another 20 patients without arachnoid adhesion also underwent ESC but with obex plugging. Sixteen improved and one displayed only temporary improvement with recurrent syringomyelia due to postoperative arachnoid adhesions. The remaining three showed no change in spite of shrinkage of the syrinx on postoperative MR imaging. These three patients had displayed pre-operative symptoms over an approximately 10-year period involving almost the entire axial plain of the spinal cord, and presented a large syrinx before surgery. In 4 patients with arachnoid adhesions, all required intra-arachnoid procedures in addition to ESC. Intra-arachnoid procedures are not necessary to facilitate restoration of CSF flow in patients without arachnoid adhesions, because ESC can release the CSF flow blockage in the major cistern even without plugging of the obex. An associated arachnoid adhesion at the major cistern or a long-standing syringomyelia with irreversible damage of the spinal cord results in a poor operative prognosis. When posterior fossa surgery fails, insufficient decompression or postoperative arachnoid adhesions at the major cistern as the cause of treatment's failure should be evaluated by CSF flow studies using phase contrast MR imaging.

Adrenomedullin augments nitric oxide and tetrahydrobioptein synthesis in cytokine-stimulated vascular smooth muscle cells

OBJECTIVE

Immunostimulants increase nitric oxide (NO) and tetrahydrobiopterin (BH4) synthesis in vascular smooth muscle cells (VSMC) by coinducing expression of an isoform of NO synthase (iNOS) and GTP cyclohydrolase I (GTPCH). GTPCH is the first and rate-limiting enzyme in the synthesis of BH4, a cofactor of NO synthases. Given the adrenomedullin (AM) increases NO production, this effect of AM may involve modulation of BH4 synthesis in cytokine-stimulated VSMC.

METHODS

We investigated the effects of AM on the synthesis of NO and BH4, the expression of iNOS and GTPCH mRNA, and the promoter activity of iNOS and GTPCH genes in rat VSMC stimulated with interleukin-1 (IL-1).

RESULTS

IL-1 increased both NO and BH4 synthesis as well as the abundance of iNOS and GTPCH mRNA. AM significantly increased both NO and BH4 synthesis caused by IL-1 stimulation. AM also augmented the IL-1-induced increase in the abundance of iNOS and GTPCH mRNA. IL-1 activated the iNOS promoter activity as well as the GTPCH promoter activity in VSMC. AM alone had no effect on the activity of either the iNOS or the GTPCH promoter, nor did it potentiate the activation by IL-1 of either of these promoters.

CONCLUSION

These results suggest that AM increases IL-1-induced NO and BH4 synthesis by enhancing the expression of iNOS and GTPCH genes at the post-transcriptional level. Thus, the potentiating effect of AM on NO synthesis appears to be associated with an increased expression of both genes necessary for cellular NO synthesis in VSMC.

Risk factors for the incidence of hyperuricaemia: a 6-year longitudinal study of middle-aged Japanese men

BACKGROUND

Few longitudinal studies on the determinants of increase in serum uric acid (SUA) have been completed.

METHODS

In all, 1445 hyperuricaemia-free (<7.5 mg/dl SUA, no medication for and no past history of hyperuricaemia) male office workers aged 30-54 years of T Corporation in Osaka, Japan were re-examined for six successive years. Subjects who were found to be hyperuricaemic or had started medication for hyperuricaemia during repeat surveys were defined as incident cases.

RESULTS

Among the subjects (n = 1365) not receiving medication for hypertension, diabetes mellitus or renal disease, multivariate analysis using the Cox proportional hazards model indicated that the incidence of hyperuricaemia had significant relationships with body mass index (adjusted hazard ratio [HR] = 1.13 for a 2 kg/m2 increase; 95% CI: 1.02-1.26), mean blood pressure (HR = 1.07 for a 5 mmHg increase; 95% CI: 1.00-1.13), log triglyceride level (HR = 2.21 for a 10 mg/dl increase; 95% CI: 1.12-4.37), alcohol intake (HR = 2.33 for drinking 46.0 g of ethanol per day or more relative to non-drinking; 95% CI: 1.55-3.50) and smoking (HR = 0.65 for current-smoking relative to non-smoking; 95% CI: 0.46-0.92). Age (HR = 0.89 for a 5-year increase; 95% CI: 0.78-1.00) and haemoglobin A1c (HbA1c) (HR = 0.89 for a 0.5% increase; 95% CI: 0.78-1.00) achieved marginal significance.

CONCLUSIONS

Obesity, high blood pressure, high triglyceride level, and alcohol intake are contributory factors for the development of hyperuricaemia among middle-aged Japanese men. High HbA1c level and smoking may be negative factors for the incidence of hyperuricaemia.

Lifestyle and the development of dyslipidemia: a 4-year follow-up study of middle-aged Japanese Male Office Workers

To examine the lifestyle factors related to the development of dyslipidemia [low-density lipoprotein (LDL) cholesterol ≥ 150 mg/dL, high-density lipoprotein (HDL) cholesterol < 40 mg/dL, or triglyceride ≥ 250 mg/dL], 979 dyslipidemia-free Japanese male office workers aged 35 to 54 years were followed up for four years. The numbers of new incidence cases during the follow-up period were 216 for high LDL cholesterol level, 109 for low HDL cholesterol level, and 78 for high triglyceride level. From the Cox proportional hazards model, adjusted hazard ratios (HRs) for the incidence of high LDL cholesterol level were 0.62 [95% confidence interval (CI): 0.47-0.82] for consuming alcohol every day, 1.39 (95% CI: 1.10-1.77) for 5-kg/m(2) increase in body mass index (BMI), 1.45 (95% CI: 1.10-1.91) for snacking between meals every day, and 1.64 (95% CI: 1.18-2.30) for not eating vegetables every day. As for the incidence of low HDL cholesterol level, adjusted HRs for current cigarette smoking, consuming alcohol every day, and 5-kg/m(2) increase in BMI were 1.74 (95% CI: 1.17-2.59), 0.61 (95% CI: 0.41-0.89), and 1.79 (95% CI: 1.29-2.46), respectively. Adjusted HRs for the incidence of high triglyceride level were 1.73 (95% CI: 1.07-2.77) for current cigarette smoking, 1.74 (95% CI: 1.10-2.77) for 5-kg/m(2) increase in BMI, and 0.50 (95% CI: 0.27-0.90) for working 10 h per day or more. These results suggest that an increase in BMI, current cigarette smoking, and snacking between meals every day is closely associated with an increased risk of atherogenic lipid profiles. On the other hand, alcohol consumption and eating vegetables every day may have an anti-atherogenic effect on serum lipid profiles.

Associations between self-assessed masticatory disability and health of community-residing elderly people

OBJECTIVE

To examine the relationship between the self-assessed masticatory disability and the health of community-residing older people.

METHODS

Of 1473 randomly selected people aged 65 years and older living in Settsu, Osaka Prefecture, in October 1992, data on general health status, history of health management, psychosocial conditions, and dental conditions were obtained from 1405 people by interviews made during home visits. Follow-up for 54 months was completed for 1306 subjects (93.0%; 1072 living, 234 deceased).

RESULTS

Being over 75 years of age, having poor general health and poor dental status, not using dental health checks, not using general health checks, not participating in social activities, not feeling that life is worth living (no "ikigai"), and feeling anxious about the future were univariately and significantly associated with self-assessed masticatory disability. Logistic regression analyses indicated that being older than 75 years, having poor general health and poor dental status, not using dental health checks, and not participating in social activities were independently associated with self-assessed masticatory disability. The Cox proportional hazards model showed that being male, over 75 years of age, and in poor general health, as well as not using general health checks, and not participating in social activities were independently associated with mortality. Self-assessed masticatory disability was univariately and significantly related to mortality, but by itself was not a significant risk factor for mortality, because of the potential influence of other variables.

CONCLUSIONS

Certain health and psychosocial factors are closely associated with self-assessed masticatory disability among older people. Further investigations are needed to determine whether masticatory disability is a significant risk factor for mortality.

Effect of orally active prostacyclin analogue on survival of outpatients with primary pulmonary hypertension

OBJECTIVES

This study sought to investigate the effect of beraprost sodium (BPS), an orally active prostacyclin analogue, on the survival of outpatients with primary pulmonary hypertension (PPH).

BACKGROUND

Continuous intravenous administration of epoprostenol (prostacyclin) has been shown to improve survival in PPH. However, the effect of oral BPS on survival in PPH remains unknown.

METHODS

Fifty-eight consecutive patients with PPH who could be discharged after the first diagnostic catheterization for PPH were retrospectively divided into two groups: patients treated with BPS (BPS group, n = 24) and those without BPS (conventional group, n = 34). The baseline demographic and hemodynamic data did not significantly differ between the two.

RESULTS

Twenty-seven patients died of cardiopulmonary causes in the conventional group during a mean follow-up period of 44 +/- 45 months. In contrast, only 4 patients died of cardiopulmonary causes in the BPS group during a mean follow-up period of 30 +/- 20 months. In a subsample (n = 15) of patients in the BPS group, mean pulmonary arterial pressure and total pulmonary resistance significantly decreased, respectively, by 13% and 25% during a mean follow-up period of 53 days. Among the variables previously known to be associated with the mortality in PPH, the absence of BPS therapy and the reduced cardiac output were independently related to the mortality by a multivariate Cox proportional hazards regression analysis (both p < 0.05). The Kaplan-Meier survival curves demonstrated that the one-, two- and three-year survival rates for the BPS group were 96%, 86% and 76%, respectively, as compared with 77%, 47% and 44%, respectively, in the conventional group (log-rank test, p < 0.05).

CONCLUSIONS

The oral administration of BPS may have beneficial effects on the survival of outpatients with PPH as compared with conventional therapy alone.

Surgical treatment for chronic thromboembolic pulmonary hypertension under profound hypothermia and circulatory arrest in 24 patients

BACKGROUND

Chronic thromboembolic pulmonary hypertension (CTEPH) is a serious disease that induces hypoxemia and pulmonary hypertension, eventually leading to respiratory failure and right heart failure. We evaluated the results of surgical treatment in patients undergoing circulatory arrest under profound hypothermia.

METHODS

Between February 1995 and June 1999, 24 cases of CTEPH were surgically treated. The age of patients (11 males and 13 females) ranged from 21 to 71 years (mean 49+/-15 years). Because of hypoxemia, severe pulmonary hypertension (mean pulmonary artery pressure 45+/-7 mmHg ), and low cardiac output, the functional class of these patients was New York Heart Association (NYHA) III or IV. Following a median sternotomy, profound hypothermia was induced using cardiopulmonary bypass, and pulmonary thromboendarterectomy in the bilateral pulmonary arteries was performed under intermittent circulatory arrest. Surgery was performed emergently in four patients.

RESULTS

Of these 24 patients, 2 of 20 patients who underwent elective surgery and 3 of 4 patients who underwent emergent surgery died in the hospital. Symptoms of CTEPH markedly improved in 18 patients who survived the surgery. Pulmonary arterial pressure was decreased to 16+/-6 mmHg, and cardiac output was increased.

CONCLUSIONS

When CTEPH is resistant to medical treatment, surgical treatment is useful. When surgical indications are carefully selected, pulmonary thromboendarterectomy using intermittent circulatory arrest under profound hypothermia is quite effective for treating CTEPH.

Inhibition of mutant p53 phosphorylation at serine 15 or serine 315 partially restores the function of wild-type p53

The tumor suppressor protein p53 is a phosphoprotein and has growth and transformation suppression functions. Phosphorylation of wild-type p53 is known to modulate its function. To investigate the role of phosphorylation in modulating the functions of mutant p53, we constructed a series of phosphorylation site mutants based on mutant p53 Ala143 (p53-143) and p53 His175 (p53-175). When transfected into p53-negative Saos-2 cells, parental mutant p53-143 and p53-175 abolished both growth suppression and induction of apoptosis. However, DNA-activated protein kinase (DNA-PK) or cyclin-dependent kinase (cdks) phosphorylation site double mutants partially restored the growth suppression and induction of apoptosis and recovered the p53-specific DNA binding activity. We also observed a difference in sensitivity to calpain from parental mutants p53-175 and p53-175/15 or p53-175/315. These results suggest that the lack of phosphorylation at either the DNA-PK or cdks site in p53 mutants partially restores the wild-type functions by altering their conformation.

Serum uric acid levels correlate with the severity and the mortality of primary pulmonary hypertension

Serum uric acid (UA), the final product of purine degradation, has been proposed to be a marker for impaired oxidative metabolism and a possible predictor of mortality in patients with chronic heart failure. To elucidate whether serum UA correlates with the severity and the mortality of primary pulmonary hypertension (PPH), serum UA was assessed in 90 patients with PPH together with other clinical variables. Right heart catheterization was performed in all patients. Serum UA was significantly elevated in patients with PPH compared with age-matched control subjects (7.5 +/- 2.5 versus 4.9 +/- 1.2 mg/ml, p < 0.001). Serum UA negatively correlated with cardiac output (r = -0.52, p < 0.001) and positively correlated with total pulmonary resistance (r = 0.57, p < 0.001). Serum UA significantly decreased from 7.1 +/- 1.9 to 5.9 +/- 1.6 mg/dl with vasodilator therapy, associated with a reduction in total pulmonary resistance from 22 +/- 6 to 17 +/- 7 Wood units. During a mean follow-up period of 31 mo, 53 patients died of cardiopulmonary causes. Among noninvasive variables, serum UA was independently related to mortality by a multivariate Cox proportional-hazards analysis. The Kaplan-Meier survival curves according to the median value of serum UA demonstrated that patients with high serum UA had a significantly higher mortality rate than did those with low serum UA (log-rank test, p < 0.01). These results suggest that serum UA increases in proportion to the clinical severity of PPH and has independent association with long-term mortality of patients with PPH.

Pathogenesis of encephaloschisis in retinoic-acid-treated hamster embryos I: a morphometric study of the craniofacial structures

The severity of the developmental disorders of the paraxial mesoderm and neuroectoderm must objectively be compared to determine which of the two structures is more deeply involved in the pathogenesis of encephaloschisis. In the present study, hamster fetuses were obtained from dams that had been treated with retinoic acid, and divided into two groups: fetuses with encephaloschisis and those without apparent external malformations in the cranium and face. Mid-sagittal serial sections of the head were prepared, histologically processed, and utilized for the reconstruction of the profile of the head structures. Using this reconstructed profile, we measured the length of the skull base bone structures (basisphenoid and basiocciput), which develop from the paraxial mesoderm, brain structures (mesencephalon and metencephalon), which develop from the neuroectoderm, and facial bone structures (nasal septum and hard palate), which develop from cephalic neural crest cells. The measured length of each structure was compared between the treated and control groups. It was found that treatment with retinoic acid resulted in significantly (P < 0.05) shortened lengths of the skull base bone structures both in fetuses with encephaloschisis and those without apparent external malformations in the cranium and face. In the brain structure of fetuses without encephaloschisis, as well as in the facial bone structures, however, this shortness was not observed. These results suggest that developmental disorders in the paraxial mesoderm may play an important role in the pathogenesis of encephaloschisis.

Prognoses of primary pulmonary hypertension and chronic majorvessel thromboembolic pulmonary hypertension determined from cumulative survival curves

OBJECT

Primary pulmonary hypertension (PPH) has a grave prognosis, and chronic majorvessel thromboembolic pulmonary hypertension (TPH) also has a poor prognosis. The purpose of the study is to elucidate the inherent prognoses of two serious diseases.

METHODS

Thirty-two patients with PPH (aged 33+/-15 years, 1SD) and 48 patients with TPH (aged 50+/-14 years, 1SD) were used to determine survival curves using Kaplan and Meier's method from the baseline diagnostic catheterization. Definitive diagnosis was made by cardiac catheterization, ultrasonic echocardiography, ventilation-perfusion lung scanning, and pulmonary angiography.

RESULTS

Mean pulmonary artery pressure (PAm) at the initial examination was 56+/-16 (mean+/-1SD) mmHg for patients with PPH and 50+/-13 mmHg for those with TPH, and did not differ significantly between the two groups. Although these two diseases exhibited equally elevated pulmonary arterial pressures, possibly indicative of a poor prognosis, the survival curves obtained from the prospective study for the two diseases were quite different (p<0.001 by generalized Wilcoxon test, p<0.01 by Log-rank test). Mean survival was calculated to be 3.6 years for PPH and 6.8 years for TPH. Patients with TPH had a longer survival than those with PPH, despite the fact that the age at diagnosis of PPH was younger by 17 years on average than that of TPH.

CONCLUSION

The inherent prognoses of the two chronic pulmonary hypertensive diseases prior to the introduction of the recently developed new treatment options are shown and likely indicate that the pulmonary vascular lesions in PPH are consistently progressive, while those of TPH are not as progressive.

Thyroid hormone (3,5,3'-triido-L-thyronine) masking/inversion of stimulatory effect of androgen on expression of mk1, a true tissue kallikrein, in the mouse submandibular gland

We studied hormonal regulation of the expression of mkl, a true tissue kallikrein, in the submandibular gland (SMG) of ICR, C3H/ HeN, and F1 (mice from male C3H/HeN x female ICR and in the ones from male ICR x female C3H/HeN). In these mouse strains, mk1 was low in content in males, abundant in females, and increased remarkably by castration of males. In the case of ICR and both F1 mice, injection of 5alpha-dihydrotestosterone (DHT) reduced the mkl level of castrated and female mice. However, the mkl content in female C3H/ HeN mice (or castrated C3H/HeN) was further increased by DHT. To investigate the real action of DHT on mk1 expression, we examined the effects of adrenoectomy/glucocorticoid (dexamethasone, Dex) administration; DHT administration into castrated and adrenoectomized mice; ovariectomy/female hormone (17beta-estradiol, progesterone) administration; and hypophysectomy/combinatory administration of DHT, Dex, and thyroid hormone (3,5,3'-triiodo-L-thyronine, T3) on the mk1 expression in the SMG of ICR mice. Adrenoectomy or ovariectomy did not change the characteristic pattern of mk1 expression in male and female ICR mice. In hypophysectomized (Hypox) ICR male mice, the mk1 content was increased to the same level as in normal ICR females, and DHT administration into the Hypox mice further increased the mk1 level. However, combinatory administration of DHT + T3 or of DHT + T3 + Dex into the Hypox mice lowered the mkl content to the level of normal ICR males, whereas T3 single administration had no effect. Dex single administration into the Hypox mice increased the mkl level to an even higher than that observed with DHT administration. The mk1 level in Hypox mice was not significantly changed by coadministration of Dex with T3. From these results, we conclude that 1) mk1 expression is fundamentally stimulated by androgen (DHT) as are other mk isozymes, such as mk9, mk13, mk22, and mk26 in the mouse SMG, 2) the effect (stimulatory) of DHT on mk1 expression becomes, however, inverted (inhibitory) in the presence of T3. Although the serum T3 level of C3H/HeN female (0.52 ng/ml) was not significantly different from that of C3H/HeN males or ICR mice, coadministration of T3 into C3H/HeN females with a fixed amount of DHT (20 mg/kg body weight) dose dependently repressed the DHT-induced increase in mkl expression, suggesting the lower sensitivity of C3H/HeN females to T3.

Mutant p53 mediated induction of cell cycle arrest and apoptosis at G1 phase by 9-hydroxyellipticine

Wild-type p53 causes cell-cycle arrest at late G1 phase and induction of apoptosis by up- regulation of waf1 and bax, respectively. Although in many cancer cells p53 is frequently mutated and loses its functions, we have proposed that mutant p53 may be involved in the anticancer mechanism of 9-hydroxy ellipticine (9HE). It was shown using flow cytometry that 9HE (10 microM) caused induction of apoptosis in G1 phase of the cell cycle in mutant p53 (p53ala143, p53his175, orp53his273) transfected Saos-2 cells, but not in p53-deficient parental Saos-2 cells. Similar induction of apoptosis was observed 24-48 h after treatment with 9HE in mutant p53-containing SW480, SK-BR-3 and MKN-1, but not in p53-deficient KATO m cells. Using G1 phase cells isolated by centrifugal elutriation, it was confirmed that 9HE caused cell cycle arrest at G1 phase and subsequently induced G1 phase-restricted apoptosis. In accordance with the induction of arrest and apoptosis in G1 phase, 9HE caused up-regulation of waf1 and bax mRNA in mutant p53-containing cells, but not in p53-deficient parental Saos-2 cells. In control experiments, adriamycin (ADR) showed neither G1-restricted apoptosis nor elevation of bax mRNA. It is suggested that 9HE may cause G1 arrest and induction of G1 phase-restricted apoptosis by restoring the wild-type function of mutant p53 protein.

Synthesis of taxoids 5. Synthesis and evaluation of novel water-soluble prodrugs of a 3'-desphenyl-3'-cyclopropyl analogue of docetaxel

A novel 3'-desphenyl-3'-cyclopropyl analogue of docetaxel was synthesized from 10-deacetyl-baccatin III. The cytotoxicity of the new taxoid was evaluated against several human tumor cell lines, and it had ca. 20 times stronger activity against human colon cancer cell lines (WiDr and Colon 320) than that of docetaxel. This taxoid was converted to its water-soluble prodrugs that have 2'-substituted amino acid derivatives with spacer. The prodrugs had good solubility in saline and showed more potent antitumor activity against B 16 melanoma in mice than that of docetaxel.

Mortality in relation to urinary and faecal incontinence in elderly people living at home

OBJECTIVE

To examine the relationship between incontinence and mortality in elderly people living at home.

DESIGN

Of the randomly selected people aged 65 years and older living in Settsu city, Osaka in October 1992, 1405 were contacted and constituted the study cohort. Follow-up for 42 months was completed for 1318 (93.8%; 1129 alive, 189 dead).

MEASURES

Data on general health status, history of health management, psychosocial conditions and urinary and faecal incontinence were collected by interview during home visits at the time of enrolment.

RESULTS

From the Kaplan-Meier analysis, the estimated survival rates decreased with a decline in continence in both the 65-74 and 75 years and older age groups. From the Cox proportional hazards model, unadjusted hazard ratios of minor, moderate and severe incontinence for mortality, compared with continence, were 2.27, 2.96 and 5.94, respectively. Multivariate analysis yielded adjusted hazard ratios of minor, moderate and severe incontinence of 0.99, 1.17 and 1.91, respectively, leaving severe incontinence as the significant factor, when other indicators are controlled.

CONCLUSIONS

Incontinence is related to mortality and severe incontinence represents an increased risk factor for mortality in elderly people living at home.

Relationship between lifestyle and serum lipid and lipoprotein levels in middle-aged Japanese men

Cross-sectional associations between lifestyle factors [cigarette smoking, alcohol intake, overall obesity indicated by body mass index (BMI), eating breakfast, snacking between meals, considering nutritional balance, coffee drinking, physical exercise, and hours of work and sleep] and serum lipid and lipoprotein levels were examined in 1580 middle-aged Japanese men in Osaka, Japan. From stepwise regression analyses, significant correlates with low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol, and Log triglyceride levels were, in the order of relative importance: BMI, alcohol intake (negative), and age for LDL cholesterol level; BMI (negative), cigarette smoking (negative), alcohol intake, considering nutritional balance, and physical exercise for HDL cholesterol level; and BMI, cigarette smoking, working hours (negative), considering nutritional balance (negative), alcohol intake, and coffee drinking (negative) for Log triglyceride level. The cumulative percentages of variation for LDL cholesterol, HDL cholesterol and Log triglyceride levels were 4.2%, 15.4% and 14.7%, respectively. From stepwise regression analyses, excluding BMI as a factor in the model, snacking between meals emerged as a significant factor for LDL cholesterol level and HDL cholesterol level (negative). The cumulative percentage of variation for each serum lipid and lipoprotein level was decreased (1.5% for LDL cholesterol, 6.8% for HDL cholesterol, and 3.1% for Log triglyceride). These results suggest that BMI has the strongest association with serum lipid and lipoprotein levels and that good daily lifestyles may have an anti-atherogenic effect by altering serum lipid and lipoprotein levels in middle-aged Japanese men.

Serum uric acid: correlation with biological, clinical and behavioral factors in Japanese men

Cross-sectional associations between biological, clinical and behavioral factors and serum uric acid (SUA) levels were examined in 2,438 Japanese male office workers aged 20 to 59 years in Osaka, Japan. Stepwise regression analysis for SUA was carried out for all persons and repeated excluding those under medication for hypertension, hyperuricemia or diabetes mellitus. The results were essentially the same without change in the sequence of the seven most important variables. When 150 men under medication were excluded, independent correlates with SUA levels were, in order of relative importance, history of gout, log triglyceride, creatinine, hemoglobin A1c (negative association), body mass index, total protein, alcohol intake, age (negative association), and total cholesterol. 32.7 percent of total variation in SUA was accounted for by these variables combined. Our data suggest that weight and serum lipids control and avoiding excessive drinking may be beneficial in the prevention of hyperuricemia.

[A clinical study on long-term outcome in patients with syringomyelia associated with Chiari malformation]

To investigate the long-term outcome in patients with syringomyelia associated with Chiari malformation (chronic tonsilar herniation), we investigated the actual factors of the patient's problems by a questionnaire for the patient. Replies to the questionnaires were obtained from 44 patients with syringomyelia who had been treated with expansive suboccipital cranioplasty with dural plasty (with plugging of the central canal in 20 patients). In 25 cases (68%) in whom the motor dysfunction of the upper extremities remained, the symptoms improved in 16 cases (43%) and were unchanged in 9 cases (24%). In 18 cases (64%) in whom the motor dysfunction of the lower extremities remained, the symptoms improved in 10 cases (36%) and were unchanged in 8 cases (29%). In 31 cases (78%) in whom the sensory disturbance remained, the symptoms improved in 19 cases (48%) and were unchanged in 12 cases (30%). The motor dysfunction of the upper extremities persisted significantly in more patients having a duration of illness over 2 years than in patients with those less than 2 years. Sensory disturbance persisted significantly in more patients with a duration of illness over 3 years than in patients with that less than 3 years. These results suggest that firstly, sensory disturbance (disturbance of the posterior horn) is most apt to remain, then motor dysfunction of the upper extremities (disturbance of the anterior horn) and followed by motor dysfunction of the lower extremities (disturbance of the pyramidal tract). We conclude that patients should be treated before having irreversible spinal cord disturbance.

Visualization of functional improvement by 123I-IMP lung SPET after thromboendarterectomy for chronic pulmonary embolism

We report on six patients with chronic pulmonary embolism who underwent 123I-IMP and 99Tcm-MAA lung SPET before and after thromboendarterectomy. 123I-IMP lung SPET can assess the viability of lung parenchyma, because it is a non-particulate agent that accumulates in the endothelial membranes of pulmonary capillaries. Chronic pulmonary thromboembolism accompanied by pulmonary hypertension has a poor prognosis that may be improved only by thromboendarterectomy. We compared 123I-IMP and 99Tcm-MAA lung SPET in terms of functional improvement after such surgery. After thromboendarterectomy, all six patients were functionally improved, according to the criteria of the New York Heart Association. The pre- and post-surgery percentage of vascular obstruction did not differ significantly with 99Tcm-MAA lung SPET (44.8 +/- 11.2% and 32.5 +/- 15.6% pre- and post-surgery, respectively). In contrast, 123I-IMP lung SPET revealed a significant pre- versus post-surgery difference (15.5 +/- 9.5% and 3.3 +/- 5.9% pre- and post-surgery, respectively). 123I-IMP lung SPET could be useful for evaluating thromboendarterectomy because pulmonary parenchymal viability owing to arterial microvasculature can be estimated.

Lifestyle and the development of hypertension: a 3-year follow-up study of middle-aged Japanese male office workers

The association of lifestyle factors with the development of hypertension (blood pressure > or = 140/90 mmHg) over a 3-year follow-up period was studied in 949 hypertension-free Japanese male office workers aged 35 to 54 years. From the Cox proportional hazards model, age, alcohol intake, body mass index (BMI) and hours of work were independent factors associated with the development of hypertension. Adjusted hazard ratios for 5-year increases in age, daily consumption of alcohol, 5-kg/m2 increases in BMI and working 10 hours per day or more were 1.18 [95% confidence interval (CI) = 1.02-1.35]; 1.53 (CI = 1.14-2.05); 1.79 (CI = 1.38-2.33) and 0.58 (CI = 0.41-0.82), respectively. In the analysis using logistic regression, BMI was independently related to working 10 hours per day or more, controlling for other lifestyle factors. Adjusted odds ratio for 5-kg/m2 increase in BMI was 0.66 (CI = 0.49-0.88). These results suggest that the influences of long working hours on blood pressure are likely to be indirectly mediated through less overall obesity.

Increased plasma levels of adrenomedullin in patients with pulmonary hypertension

Adrenomedullin, a potent hypotensive peptide, reduces blood pressure and pulmonary vascular resistance, and increases pulmonary blood flow. The mRNA for adrenomedullin and its receptor is highly expressed in the lung, suggesting a regulatory role for adrenomedullin in the pulmonary circulation. To investigate the clinical significance of adrenomedullin in patients with pulmonary hypertension, we studied the relationship between plasma levels of adrenomedullin and pulmonary haemodynamics. Venous, arterial and pulmonary arterial blood samples were obtained during cardiac catheterization and plasma levels of adrenomedullin were measured by specific radioimmunoassay in 33 consecutive patients with severe pulmonary hypertension (12 cases of primary pulmonary hypertension, 21 with chronic thromboembolic pulmonary hypertension; age 49+/-16 years, mean pulmonary arterial pressure 50+/-15mmHg). In addition, plasma levels of adrenomedullin were measured before and after acute nitric oxide inhalation. The changes in plasma adrenomedullin during the follow-up period of 10.3+/-4.3 months were also evaluated (n=5). Sixty-two healthy subjects served as the control group. Adrenomedullin was measured in an antecubital vein in the controls. Plasma levels of adrenomedullin were significantly higher in the patients with pulmonary hypertension than in the control subjects (10.1+/-8.7 versus 4.9+/-1.1pmol/l, P<0.01). Plasma levels of adrenomedullin, expressed as their natural logarithm, were significantly correlated with mean right atrial pressure (r=0.71, P<0.01), stroke volume (r=-0.63, P<0.01), total pulmonary resistance (r=0.60, P<0.01), mean pulmonary arterial pressure (r=0.37, P<0.05), and the natural logarithm of plasma atrial natriuretic peptide (r=0. 63, P<0.01). Plasma levels of adrenomedullin did not change significantly after nitric oxide inhalation, but significantly increased in association with the elevation of the total pulmonary resistance during the long-term follow-up period. These results suggest that plasma levels of adrenomedullin increase in proportion to the extent of pulmonary hypertension.

Physical and mental correlates of hearing impairment in the elderly in Japan

Seven hundred and forty seven elderly people aged from 65 to 98 (209 male and 538 female) admitted to the Geriatric Health Service Facility were evaluated with pure-tone audiometry, Office of Population Censuses and Surveys (OPCS) personal care severity score, OPCS hearing severity score, Mini-mental State Examination (MMSE) and Self-rating Depression Scale (SDS). A single correlation study indicated that the hearing level significantly correlated with age, OPCS hearing severity score, MMSE total score and SDS total score. A multiple regression analysis showed that age, OPCS hearing severity score, and MMSE total score were significantly associated with the hearing level. We demonstrated here that the objective auditory function strongly correlated with the cognitive function measured by MMSE total score, suggesting that a regular audiological check-up and the early detection of the hearing impairment could contribute to the maintenance of the quality of life in the elderly.

Fluorine-18-fluorodeoxyglucose PET identification of cardiac metastasis arising from uterine cervical carcinoma

Cardiac metastasis of uterine cervical carcinoma is rare. We describe a patient with a past history of uterine cervical carcinoma who presented with metastasis to the heart, lungs and distant lymph nodes 3 yr after surgery and chemotherapy. Since the patient complained of chest pain and demonstrated electrocardiogram abnormalities, we performed echocardiography, electron beam CT and MRI, which revealed a tumor in the right ventricular wall. The tumor was assessed by 67Ga scintigraphy and 18F-fluorodeoxyglucose (FDG) PET scanning. The mean differential 18F-FDG uptake ratio of the tumor was 7.9, suggesting malignancy, which was later confirmed by myocardial biopsy. Information about the extent of the tumor and partial necrosis within it was provided by 18F-FDG PET. Although both radionuclide imaging techniques also detected metastatic lesions in the lungs and lymph nodes, 18F-FDG PET scanning detected small lesions more sensitively than 67Ga scintigraphy.