P1956Geriatric nutritional risk index as predictor for long-term survival and cardiovascular or limb events in peripheral arterial disease patients

Background

The geriatric nutritional risk index (GNRI) is a simple tool to assess the nutritional risk and associated with mortality. However, there are no reports focusing GNRI in peripheral artery disease (PAD) patients.

Purpose

The purpose of this study was to examine the effects of GNRI for long-term survival, cardiovascular and limb events in PAD patients.

Methods

A prospective cohort study was performed in 1219 PAD patients. Baseline GNRI was calculated from serum albumin level and body-mass-index. The patients were divided into four groups by GNRI level (G1: >98; G2: 92–98; G3: 82–91; G4: <82). The endpoints were overall survival (OS) and freedom from major adverse cardiovascular and limb events (MACE and MACLE).

Results

The median follow-up was 73 months. There were 626 deaths (51.4%) during follow-up. The rate of cardiovascular death among dead was 51.3%. The OS rates markedly depended on GNRI level (p<0.01). The 5-year OS rates were G1: 80.8%, G2: 62.0%, G3: 40.0%, G4: 23.3%, respectively. In multivariate analyses, GNRI, age, low ankle brachial pressure index (ABI), low estimated glomerular filtration rate (eGFR), and high C-reactive protein (CRP) levels were independent factors associated with OS (<0.05). GNRI, age, low ABI, diabetes mellitus, coronary artery disease, lower eGFR and higher CRP levels were associated with MACE and MACLE (p<0.05, respectively). Besides, statins improved OS, MACE, and MACLE (<0.01, respectively).

Conclusions

GNRI was an independent predictor for OS, MACE, and MACLE in PAD patients. Furthermore,statins improved OS, MACE and MACLE in patients with PAD.

Developments of Tape and Wire Fabrication Processes for High Tc Ba2YCu3O7-y Oxide Superconductors

The application of superconducting material to a magnet requires the winding tape or wire conductor with sufficient flexibility into a solenoid. Tape conductors of Ba2YCu3O7-y were successfully prepared by a new technique of surface reaction. Cu tape or Cu-electroplated Ag tape was coated with a fine mixture of Ba2CO3, and Y2O3 and then heat treated at about 900°C to form Ba2YCu3O7-y oxide layer with high density on both surfaces of the tape. Zero resistance state has been achieved at the temperature above liquid nitrogen temperature for Ag-substrate tape. The critical current density is about 40A/cm at 77K and zero magnetic field. Although, at present, the superconducting properties of these tapes are somewhat inferior to those of conventional powder metallurgy processed conductors, the surface reaction process has the potential feasibility of processing Ba2YCu3O7-y into a long-length ductile tape desirable for practical application.

Elevated arterial stiffness in postmenopausal women with osteoporosis

OBJECTIVES

Osteoporosis and increased pulse wave velocity (PWV) are cardiovascular risk factors. We investigated the relationship between PWV and bone mass in the lumbar spine in postmenopausal women.

METHODS

We studied the PWV in 95 women; 38 postmenopausal women with normal spinal bone mineral density (BMD), 32 osteopenic postmenopausal women, and 25 osteoporotic postmenopausal women. The brachial-ankle PWV (baPWV) was measured using an automated device. The BMD of the lumbar spine (L2-L4) was measured using dual-energy X-ray absorptiometry.

RESULTS

After adjusting for age and years since menopause, women with osteoporosis had a significantly higher baPWV than those with normal BMD (1500 +/- 220 cm/s versus 1340 +/- 215 cm/s; P < 0.05), but no significant differences in baPWV were seen between the osteoporotic and osteopenic groups or between the osteopenic and normal BMD groups. In univariate regression analysis, the baPWV was significantly negatively correlated with BMD (r = -0.450, P < 0.01), and significantly positively correlated with age (r = 0.601, P < 0.01), years since menopause (r = 0.577, P < 0.01), systolic blood pressure (r = 0.295, P < 0.01), and diastolic blood pressure (r = 0.264, P < 0.05), but was not with other variables. In multivariate regression analysis, the baPWV was significantly correlated with BMD (P < 0.05), but not with other variables.

CONCLUSIONS

Postmenopausal women with osteoporosis may have elevated arterial stiffness, suggesting that osteoporotic postmenopausal women may have a higher risk of cardiovascular disease.

Effects of torasemide on cardiac sympathetic nerve activity and left ventricular remodelling in patients with congestive heart failure

OBJECTIVE

To determine the effect of torasemide, a loop diuretic with antialdosteronergic properties, compared with furosemide on cardiac sympathetic nerve activity in patients with congestive heart failure (CHF).

METHODS

40 patients with non-ischaemic CHF (left ventricular ejection fraction (LVEF) < 45%) were randomly assigned to torasemide (4-8 mg/day; n = 20) or furosemide (20-40 mg/day; n = 20). All patients were also treated with angiotensin-converting enzyme inhibitor. The delayed heart to mediastinum count (H/M) ratio, delayed total defect score (TDS) and washout rate were determined from iodine-123 meta-iodobenzylguanidine measured before and 6 months after treatment. Left ventricular end diastolic volume (LVEDV), left ventricular end systolic volume (LVESV) and LVEF were also determined by echocardiography.

RESULTS

After treatment, in patients receiving torasemide, TDS decreased from 44 (8) to 36 (8) (p < 0.001), H/M ratio increased from 1.61 (0.19) to 1.77 (0.24) (p < 0.001), and washout rate decreased from 52 (12)% to 41 (14)% (p = 0.001). In addition, LVEDV decreased from 173 (22) ml to 147 (30) ml (p < 0.001) and LVESV decreased from 117 (19) ml to 95(24) ml (p < 0.001). Although LVEF tended to increase, the change was not significant (from 31 (7)% to 34 (7)%, NS). Conversely, these parameters did not change significantly in patients receiving furosemide. Moreover, percentage change of TDS was significantly correlated with percentage change of LVEDV (r = 0.473, p < 0.05) and of LVESV (r = 0.579, p < 0.01) after torasemide treatment.

CONCLUSION

These findings indicate that torasemide treatment can ameliorate cardiac sympathetic nerve activity and left ventricular remodelling in patients with CHF.

Comparative effects of valsartan and enalapril on cardiac sympathetic nerve activity and plasma brain natriuretic peptide in patients with congestive heart failure

OBJECTIVE

To evaluate the effects of valsartan on cardiac sympathetic nerve activity, plasma brain natriuretic peptide (BNP) concentration, cardiac function, and symptoms in patients with congestive heart failure (CHF) by comparison with those of enalapril.

METHODS

50 patients with CHF (left ventricular ejection fraction (LVEF) < 40%) were randomly assigned to valsartan (80 mg/day; n = 25) or enalapril (5 mg/day; n = 25). All patients were also treated with a loop diuretic. The delayed heart to mediastinum count (H/M) ratio, delayed total defect score (TDS), and washout rate were determined from (123)I-meta-iodobenzylguanidine (MIBG) images. Plasma BNP concentrations were measured before and after six months of treatment. The left ventricular end diastolic volume (LVEDV) and LVEF were also determined by echocardiography.

RESULTS

In patients receiving valsartan, TDS decreased from a mean (SD) of 43 (8) to 39 (10) (p < 0.01), H/M ratio increased from 1.70 (0.17) to 1.78 (0.22) (p < 0.05), washout rate decreased from 46 (11)% to 41 (10)% (p < 0.05), and plasma BNP concentration decreased from 237 (180) pg/ml to 143 (93) pg/ml (p < 0.05). In addition, LVEDV decreased from 172 (42) ml to 151 (45) ml (p < 0.05) and LVEF increased from 31 (7)% to 39 (10)% (p < 0.001). However, these parameters did not change significantly in patients receiving enalapril.

CONCLUSION

Plasma BNP concentration and (123)I-MIBG scintigraphic and echocardiographic parameters improved significantly after six months of treatment with valsartan. These findings indicate that valsartan can improve cardiac sympathetic nerve activity and left ventricular performance in patients with CHF.

Low-dose dobutamine stress 99mTc tetrofosmin quantitative gated SPECT performed during the acute phase of myocardial infarction predicts subsequent myocardial viability and detects stunned myocardium

This study evaluated the ability of low-dose dobutamine stress 99mTc tetrofosmin (DSTF) quantitative gated single photon emission computed tomography (QGS) performed during the acute phase of myocardial infarction to predict subsequent myocardial viability and detect stunned myocardium. Twenty-four patients suffering their first acute myocardial infarction (AMI) underwent coronary angioplasty after coronary angiography (CAG) immediately following admission. Follow-up CAG and left ventriculography (LVG) were performed 10 days and 6 months later. All patients underwent DSTF QGS to measure left ventricular ejection fraction (LVEF) at rest and during dobutamine infusion (10 microg.kg(-1).min(-1)) 14 days after angioplasty. No patient suffered coronary restenosis. After 6 months, the LVEF measured by LVG improved >5% in 12 patients (group A), and did not improve in the remaining 12 patients (group B). The culprit coronary artery, the peak serum creatine phosphokinase concentration, the recanalization time, and the LVEF during the acute phase were similar in the two groups. However, the increase in the LVEF was greater in group A than in group B during dobutamine infusion (deltaLVEF) as measured by DSTF QGS (11.2+/-3.8% vs 2.9+/-4.7%, P <0.001). If a cut-off value of 6.5% for the deltaLVEF was used to predict the improvement in LVEF during the chronic phase, then the sensitivity of this test was 83.3% and its specificity was 83.3%. It is concluded that DSTF QGS during AMI can be used to predict myocardial viability and detect stunned myocardium.

Effect of long-term hormone replacement therapy on angiotensin-converting enzyme activity and bradykinin in postmenopausal women with essential hypertension and normotensive postmenopausal women

OBJECTIVE

Hormone replacement therapy (HRT) reduces the incidence of cardiovascular disease in postmenopausal women. Three-month short-term HRT in postmenopausal women with essential hypertension increased the plasma concentrations ofbradykinin with decreased serum angiotensin-converting enzyme (ACE) activity, which may be partially responsible for the cardioprotective effects of HRT. The objective was to determine whether 12-month long-term HRT in postmenopausal women with essential hypertension would maintain the decreased ACE activity and increased bradykinin levels and whether long-term HRT would increase the plasma bradykinin concentrations of normotensive postmenopausal women who had shown no significant changes in the 3-month HRT study, despite their decreased serum ACE activity.

DESIGN

Twenty hypertensive and 15 normotensive postmenopausal women were treated with conjugated estrogens (0.625 mg/day) and medroxyprogesterone (2.5 mg/day) for 12 months. Twenty hypertensive and 15 normotensive postmenopausal women were used as controls. The controls were not treated with HRT. Serum ACE activity and plasma bradykinin concentrations were measured at baseline and at 12 months.

RESULTS

Long-term HRT in both hypertensive and normotensive postmenopausal women significantly decreased serum ACE activity from 15.5+/-0.7 IU/L and 16.0+/-0.9 IU/L, respectively, at baseline to 13.3+/-0.5 IU/L and 14.2+/-0.9 IU/L, respectively, 12 months after the start of HRT (p < 0.05 and p < 0.05, respectively). Long-term HRT in both hypertensive and normotensive postmenopausal women also significantly increased plasma bradykinin concentrations from 22.1+/-4.4 pg/mL and 19.2+/-3.0 pg/mL, respectively, at baseline to 86.7+/-21.2 pg/mL and 73.5+/-23.0 pg/mL, respectively, 12 months after the start of HRT (p < 0.01 and p < 0.05, respectively). No significant changes in serum ACE activity or plasma bradykinin concentrations were observed in the control groups.

CONCLUSIONS

Long-term HRT in hypertensive and normotensive postmenopausal women decreases their serum ACE activity and increases their plasma bradykinin concentrations. Thus, maintenance of elevated bradykinin with decreased serum ACE activity by HRT may be useful in reducing the risk of cardiovascular disease in both hypertensive and normotensive postmenopausal women.

Biomechanical analysis of vertical climbing in the spider monkey and the Japanese macaque

Climbing is one of the most important components of primate locomotor modes. We previously reported that the kinesiological characteristics of vertical climbing by the spider monkey and Japanese macaque are clearly different, based on their kinetics and kinematics. In this study, a more detailed analysis using inverse dynamics was conducted to estimate the biomechanical characteristics of vertical climbing in the spider monkey and Japanese macaque. One of the main findings was the difference in forelimb use by the two species. The results of a joint moment analysis and estimates of muscular force indicate that the spider monkey uses its forelimbs to keep the body close to the substrate, rather than to generate propulsion. The forelimb of the Japanese macaque, on the other hand, likely contributes more to propulsion. This supports the idea that "forelimb-hindlimb differentiation" is promoted in the spider monkey. The estimated muscular force also suggests that the spider monkey type of climbing could develop the hindlimb extensor muscles, which are important in bipedal posture and walking. As a result, we conclude that the spider monkey type of climbing could be functionally preadaptive for human bipedalism. This type of climbing would develop the hip and knee extensor muscles, and result in more extended lower limb joints, a more erect trunk posture, and more functionally differentiated fore- and hindlimbs, all of which are important characteristics of human bipedalism.

Renovascular hypertension observed in a patient with antiphospholipid-antibody syndrome

The antiphospholipid-antibody syndrome is associated with an increased incidence of arterial and venous thrombosis. Although renal infarction has been observed in these patients, stenotic lesions of the renal artery associated with the antiphospholipid-antibody syndrome have not been reported. A 47-year-old male with a history of hypertension for 7 years developed blurred vision secondary to thrombotic occlusion of the central retinal artery. Laboratory and radiologic examinations revealed renal dysfunction, a positive anticardiolipin antibody, and narrowing of the right renal artery. Successful percutaneous transluminal renal artery angioplasty resulted in normalization of the blood pressure and recovery of renal function.

The Dakin-West reaction of N-alkoxycarbonyl-N-alkyl-alpha-amino acids employing trifluoroacetic anhydride

The Dakin-West reaction of N-alkoxycarbonyl-N-alkyl-alpha-amino acids (1a-j) with trifluoroacetic anhydride in the presence of pyridine gave alpha-amido trifluoromethyl ketones (2a-j), in which probable intermediates were mesoionic 1,3-oxazolium-5-olates (munchnones). The diastereoselective reduction of 2a-f with NaBH4 gave the threo-aminoalcohols (5a-f), which may be explained by the Felkin-Anh model. This was confirmed by converting 5a-f into trans-5-trifluoromethyl-2-oxazolidinones (6a-f) in good yields.

An autopsy case of systemic hemangiomatosis with honeycomb-like liver and focal splenic sarcomatoid changes

An unusual autopsy case of systemic hemangiomatosis associated with honeycomb-like liver and splenic sarcomatoid changes is presented. The patient suffered from high-output ventricular heart failure secondary to hepatic arteriovenous shunting with hepatic failure, ending fatally due to disseminated intravascular coagulation and pulmonary bleeding. Postmortem examination revealed the characteristic distribution of vasoformative tumors presenting in the hematopoietic system including the liver, bone marrow, and spleen, with the liver appearing characteristically honeycomb-like. While these vasoformative tumors were mostly benign-appearing, partial shifts toward sarcomatoid change were observed in the splenic lesions.

Acute myocardial infarction due to vasospasm in a 13-year-old-boy

We describe an unusual case of acute myocardial infarction due to vasospasm in a 13-year-old boy. He was admitted to our hospital with severe congestive heart failure and shock. He had experienced a feeling of chest oppression with dyspnea while running, which grew worse. He then lost consciousness and was brought by ambulance to our intensive care unit. He had had similar but milder episodes of chest oppression months earlier. The family history revealed that his father had died suddenly from hypertrophic cardiomyopathy and that his grandmother also had hypertrophic cardiomyopathy. On admission, the patient was bathed in a cold sweat, his pulse was weak, and his blood pressure was too low to measure. Coarse crackling and wheezing were audible in both lung fields. Administration of catecholamine and intra-aortic balloon pumping failed to stabilize the hemodynamic variables, but percutaneous cardiopulmonary support proved to be lifesaving. Coronary arteriography performed during his convalescence showed on evidence of atherosclerosis. The acetylcholine provocation test ultimately revealed a diagnosis of acute myocardial infarction due to vasospasm.

3D analysis of human locomotion before and after caloric stimulation

Human locomotion was analysed in the sagittal and coronal planes using a position detector system composed of 2 infrared video cameras and a data processor. Normal healthy volunteers with 8 marker points on the body were asked to walk in place (WIP) and on a treadmill (WOT). Vertical and medial/lateral (M/L) translational movements were measured. Head angular movements in the sagittal (pitch) and coronal (roll) planes were also analysed. Pitch movements counteracted the vertical head movements. Head movement was remarkably attenuated in the vertical axis compared with that of the trunk. However, head M/L movement showed no difference with that of the lower part of the body. Ice water caloric stimulation was introduced to cause acute unilateral vestibular deficit. The stride length and step cycle became small after caloric stimulation in WOT, but not in WIP. The characteristic change in locomotive pattern was a large lateral sway of the hip joint occurring to the side away from calorization (right) during one foot standing (right foot) (t-test, p = 0.057). Measurement of M/L sway amplitude showed an increase only at the hip joint. As the changes in head and neck movements were not significant after caloric stimulation, it appears that the vestibulo-spinal reflex contributes little to maintaining the dynamic balance of the upper body. The importance of the hip joint for locomotion (hip strategy) was confirmed from the present data.

[Atherectomy in patients with arteriosclerosis obliterans: angiographic follow-up study of 186 lesions in 146 patients]

Atherectomy (ATE) is a new catheter-mediated technique for the removal of atheroma in patients with arteriosclerosis obliterans (ASO). ATE was performed using 7-10 Fr. Simpson Peripheral Athero Track catheters at 186 sites in 146 patients, whose lesions involved 49 common iliac arteries, 66 external iliac arteries, 68 femoral arteries and three other arteries. The initial success rate was 94.1%. The mean percent of the diameter stenosis was reduced from 79.0 +/- 1.2% (mean +/- SD) to 22.7 +/- 1.0%. There were two cases of perforation that required surgical treatment (1.1%). The complication rate was 4.4%. The 0.5-, 1-, 2- and 3-year patency rates were 87.6%, 79.6%, 62.5% and 62.5%, respectively. The rate of long-term patency in each segment of arterial lesions revealed that the patency rate in the common iliac artery was significantly higher than the rates in the external iliac artery (p < 0.05) and femoral artery (p < 0.01). The patency rates for long lesions (> or = 2.0 cm) and occluded lesions were significantly (p < 0.01) lower than those for short lesions (< 2.0 cm). Diabetic patients had a higher re-stenosis rate than nondiabetic patients (p < 0.05). In conclusion, ATE is an effective new method for the treatment of patients with ASO.

Organization of the epaxial muscles in terrestrial and arboreal primates

The erector spinae muscles of the patas monkey hamadryas baboon, and spider monkey were dissected and the origins and insertions were described in detail. In the two terrestrial monkeys, a well-developed thoracolumbar segment of the muscle was observed. This trait seems to correlate to the sagittal movement of this region required in the pronograde quadrupedal locomotion. On the other hand, the erector spinae muscle of the spider monkey is quantitatively not so well developed and the arrangement of the muscle bundles was simpler than in the terrestrial monkeys. The arboreal habit of the spider monkey seems not to demand powerful extension in the thoracolumbar junction, and spinal rotation seems to be more important.

Bilateral subclavian vein thromboses presenting as a superior vena cava syndrome demonstrated by radionuclide blood flow and In-111 WBC imaging

A superior vena cava syndrome was caused by venous thrombosis of both proximal subclavian veins. Collateral pathways were clearly demonstrated by radioisotope venography. Indium-111 labeled platelet thrombography was useful in localizing thrombotic lesions.

Simultaneous determination of granisetron and 7-hydroxygranisetron in human plasma by high-performance liquid chromatography with fluorescence detection

A highly sensitive high-performance liquid chromatographic method for the determination of granisetron, a novel antiemetic agent for cancer therapy, and its pharmacologically active and major metabolite in human plasma is described. Methylation of the metabolite with trimethylsilyldiazomethane was employed for sample pretreatment. As a result of this treatment, the originally non-fluorescent metabolite could be detected simultaneously with granisetron using fluorescence detection. Both the compounds and the internal standard added were isocratically well resolved from endogenous peaks in plasma on an ODS column. The concentrations of the compounds were proportional to the peak-area ratios over the practical determination ranges of 0.2-100 ng/ml for granisetron and 0.1-50 ng/ml for the metabolite. In tests, reproducibilities for granisetron at 1 ng/ml and the metabolite at 0.5 ng/ml as determined by the relative standard deviation (n = 3) were less than 3.98 and 7.23%, respectively, in a single run.

Use of a thermodilution renal vein catheter to measure renal blood flow in patients with essential hypertension

Our objective was to investigate the changes in renal hemodynamics, and the role of these changes in the pathogenesis of essential hypertension. We used a thermodilution renal vein catheter and measured left renal blood flow in 21 patients with essential hypertension. Arterial pressure was monitored concurrently. Cardiac output was measured in 11 patients to calculate total peripheral vascular resistance. Systolic, diastolic, and mean arterial pressure were 187 +/- 7 mmHg, 97 +/- 5 mmHg and 127 +/- 5 mmHg, respectively. Left renal blood flow was 8.01 +/- 0.38 ml/s. Left renal vascular resistance, calculated as mean arterial pressure divided by left renal blood flow, was 16.4 +/- 0.8 mmHg ml-1s, and was positively correlated with systolic, diastolic and mean arterial pressures (p < 0.05). However, no significant correlation was observed between arterial pressure and left renal blood flow. Plasma renin activity in left renal venous blood, measured in 15 patients, was not significantly correlated with renal hemodynamics. Cardiac output and total peripheral vascular resistance were 81.4 +/- 6.0 l/min and 1.68 +/- 0.18 mmHg ml-1s, respectively. Total peripheral vascular resistance was not significantly correlated with either left renal blood flow or renal vascular resistance. The data suggest that a rise in renal vascular resistance may parallel the rise in blood pressure, but not that of total peripheral vascular resistance.

A case of Caroli's disease: usefulness of color Doppler sonography for evaluating the malformation of the intrahepatic bile ducts

Caroli's disease is a rare congenital disorder with multiple cystic dilatations of the intrahepatic bile ducts. In addition to the nonobstructive localized dilatation of the bile ducts, intraluminar bulbar protrusions of the wall and bridge formation across dilated lumina have been demonstrated on sonography and computed tomography. We present a case in which color Doppler sonography clearly showed a blood flow signal toward the periphery of the liver in the protrusion of the dilated intrahepatic bile ducts. Color Doppler sonography is a useful noninvasive method for evaluating the malformation of Caroli's disease.

Functional analysis of the biceps femoris muscle during locomotor behavior in some primates

In order to investigate a correlation between morphological variations of the biceps femoris muscle and its homologues in four primate species (Japanese macaque, spider monkey, white-handed gibbon, and chimpanzee) and each type of species-specific locomotor behavior, I carried out both morphological and functional analyses of these muscles. The description of the level of insertion reveals interspecific variation is in the level of crural attachment, especially in species with a bicipital biceps femoris muscle. Electromyograms (EMGs) were induced from both the long and short head of the biceps femoris muscle during four kinds of locomotor behavior (horizontal quadrupedal walking, climbing on an inclined pole, vertical climbing, and bipedal walking). In the case of the monoceptual ischiocruralis lateralis muscle of the Japanese macaque, EMGs were induced from both the one-joint femoral part and the two-joint crural part. Though during horizontal quadrupedal locomotion the crural part of the monocipital-type muscle functioned to maintain the knee joint angle, it functioned to gain propulsive force when the kinematic load became larger, as in vertical climbing and bipedal walking. On the other hand, the long heads of the biceps femoris muscles were active in propulsion regardless of the kinematic load. But in bipedal walking, the long head muscle also acted with the short head muscle to maintain the knee joint angle. These functional features of various biceps femoris muscles of primates correlated with their species-specific locomotor behavior.

Effect of exercise on circulating atrial natriuretic peptide and left ventricular ejection fraction in healthy persons and patients with coronary artery disease

Radionuclide angiographic measurements of left ventricular ejection fraction were performed at rest and during exercise in 10 normal persons and 11 patients with coronary artery disease. Exercise was continued on a supine bicycle exercise table up to a symptom-limited maximum. Plasma levels of atrial natriuretic peptide (ANP) were also determined at rest and during exercise. Ejection fraction in the normal volunteers was 59 +/- 3% (mean +/- SEM) at rest and increased significantly (p less than 0.01) to 69 +/- 3% during exercise. Ejection fraction in the patients was 47 +/- 5% at rest and did not change significantly during exercise (51 +/- 7%). Plasma ANP in the normals rose significantly (p less than 0.01) from 62 +/- 16 pg/ml at rest to 454 +/- 94 pg/ml during exercise. Plasma ANP in the patients also rose significantly (p less than 0.01) from 231 +/- 102 pg/ml to 794 +/- 170 pg/ml. The response of plasma ANP to exercise was enhanced significantly (p less than 0.05) in the patients as compared with the normals in relation to ejection fraction by analysis of covariance. In both the normals and the patients, plasma ANP was inversely and significantly correlated with ejection fraction during exercise (r = -0.46, p less than 0.05, n = 21), however, not at rest. Because it has been reported that plasma ANP is correlated positively with pulmonary artery wedge pressure, the estimation of plasma ANP during an exercise stress test might be used for the evaluation of cardiac reserve in coronary artery disease.

Prostaglandins in enhanced pressor response in renal prehypertensive rabbits

The role of prostaglandins (PGs) in the pressor response to norepinephrine (NE) was examined in one-kidney, one clip rabbits with renal artery stenosis for 3-day's duration (3-day clipped rabbits) and in sham operated rabbits with one-kidney without renal artery stenosis. An exaggerated pressor response to NE, 800 ng/kg/min, was observed in the 3-day clipped rabbits, and it was abolished by angiotensin II antagonist, [Sar1, Ile8] angiotensin II (AIIA). Treatment with indomethacin, 10 mg/kg, induced hyperresponsiveness to NE in the sham operated rabbits and also produced a further increase in the response in the 3-day clipped rabbits: the enhanced responses with similar levels were not attenuated by AIIA in both groups. A subdepressor dose of PGE2, 800 ng/kg/min, abolished the hyperresponsiveness in the 3-day clipped rabbits, while subdepressor or depressor dose of PGI2, 10 or 20 ng/kg/min did not, but the concurrent infusion of AIIA with PGI2 attenuated it. These results indicate that PGs, in particular PGE2 might be involved in the enhanced pressor response to NE in the 3-day clipped rabbits in addition to the altered renin-angiotensin system.

Enhanced responses to pressor stimuli by intracerebroventricular infusions of angiotensin II in conscious rats

Effects of the intracerebroventricular (IVT) infusion of a subpressor dose (3 ng/kg/min) of angiotensin II (ang II) on the pressor responses to intravenous (IV) infusions of ang II and to IV bolus injections of norepinephrine (NE) were studied in conscious rats. This study was undertaken to determine whether activations of the brain renin-angiotensin system alter pressor responsiveness to IV infusions of ang II and IV injections of NE in the conscious state. Pressor responses to IV infusions of ang II and IV injections of NE were potentiated by the concurrent IVT infusion of the subpressor dose of ang II. Plasma renin activity (PRA), plasma corticosterone (B), and plasma prolactin concentration (PRL) were also measured before and during the IVT infusion of the subpressor (3 ng/kg/min) or the pressor (50 ng/kg/min) dose of ang II in order to determine the mechanisms for this pressor hyperresponsiveness to vasoconstrictor substances. The IVT subpressor dose of ang II increased PRA, but did not significantly change B and PRL. The IVT pressor dose of ang II decreased PRA and increased B, but did not significantly change PRL. These results suggest that the brain renin-angiotensin system plays an important role in pressor responsiveness to IV ang II and NE. Although the mechanisms are not fully understood, pressor hyperresponsiveness to IV ang II and NE by an intracerebroventricularly administered subpressor dose of ang II may be related to increased sympathetic outflow, because of the increment in PRA.

[Marked endocrine abnormalities in polyneuritis with skin hyperpigmentation, hypertrichosis, edema and increased lambda type immunoglobulin A: a case report]

A syndrome which is known as plasma cell dyscrasia with polyneuropathy and various endocrine manifestations or plasma cell dyscrasia with polyneuropathy, organomegaly, endocrinopathy, abnormal M protein and skin changes is very interesting because this syndrome has miscellaneous manifestations such as skin hyperpigmentation, hypertrichosis, polyneuropathy, M protein abnormality, plasma cell dyscrasia and endocrine disturbances. Miscellaneous endocrine abnormalities which have not been described so far are reported here. A 47 year old female was admitted with the chief complaints of edema and gait disturbance. Past and family histories were noncontributory. In April 1981, edema appeared in her face and legs. In June she noticed paresthesia in her legs. Edema increased gradually and she had difficulty walking. Her skin became pigmented and hairy. In October she was admitted because of polyneuropathy with increased cerebrospinal fluid protein without pleocytosis. Prednisolone was started. Walking improved slightly, but edema and paresthesia remained unchanged. Prednisolone was stopped at the end of the following March. In May 1982, she was admitted for further evaluation of edema and polyneuropathy. The patient was alert and cooperative. On standing the skin of her legs became cyanotic. There was hypertrichosis on the arms and legs. Her fingers were clubbed. A moderate swelling of the cervical lymph nodes was noted. There was mild hepatomegaly without splenomegaly. All tendon reflexes were lost. Plantar response was flexor. Muscular strength diminished mildly. She complained of paresthesia on the soles. Superficial sensation was normal. Vibratory sense decreased mildly. Cerebellar function and cranial nerves were normal. There was no sphincter disturbance. The examination of urine, stool and peripheral blood was normal.(ABSTRACT TRUNCATED AT 250 WORDS)