[Ischemic stroke with a special reference to alteration in blood pressure and cerebral circulation].
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Biomedical subjects
Publications and source records attributed to M Fujishima.
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To investigate the effects of long-term sodium restriction on mechanisms regulating cardiovascular function, Wistar rats at weaning (F0) were placed on a normal (0.4%) or low (0.05%) sodium diet. The first (F1) and second (F2) generations were derived from inbreeding within each group. The resting mean arterial pressure did not differ between the diet groups of F0 or F1 rats, but it was significantly lower in F2 rats on the low sodium diet. Plasma renin concentration was similar in the two groups in each generation, and the F2 rats on both diets responded to [Sar1, Ala8] angiotensin II with the same degree of decrease in arterial pressure. Plasma norepinephrine was not influenced by sodium intake in the F0 or F1 rats, but was significantly lower in F2 rats on the low sodium diet. The depressor response to hexamethonium was similar in the two F1 groups, while low sodium F2 rats exhibited a lesser response. These results suggest that rats bred successively on a low sodium diet have a suppressed sympathetic nerve function with no enhancement of the renin-angiotensin system, which in turn results in a lower arterial pressure.
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A case of familial adenomatosis coli with large intra-abdominal desmoid tumors is described. The patient initially complained of an abdominal mass, which was diagnosed as a desmoid tumor after surgical resection. Further examinations revealed numerous polyps of the colon which were histologically diagnosed as adenomas. Despite intensive medical therapy, the desmoid tumors rapidly increased in size and number, and resulted in abscess and cavity formation that involved the ileum. Although desmoid tumors are classically benign in nature, we consider these tumors to be a therapeutic problem in patients with familial adenomatosis coli.
To investigate the therapeutic effects of rice bran fiber (30 g/day) and cholestyramine (12 g/day) for Yusho, clinical signs and symptoms, and laboratory examinations were studied before, during and after 14 day-treatment in four patients with Yusho. The increases of bowel movements and abdominal distention were observed in two of these patients, although no effect was seen in physical findings. In peripheral blood cells, red blood cell counts decreased significantly, from 430 +/- 47 x 10(4)/mm3 (mean +/- SD) to 378 +/- 48 x 10(4)/mm3 (p < 0.01) after therapy. Hemoglobin as well as hematocrit levels were also reduced significantly afer the therapy. However, no significant effect of the treatment was observed in white blood cell counts or platelet counts. In biochemical parameters, a significant depression was observed in total cholesterol levels after the therapy (from 262 +/- 31 mg/dl to 179 +/- 33 mg/dl; p < 0.005). A significant elevations was observed in serum levels of alanine aminotransferase and sodium, while significant depressions were found in serum levels of cholinesterase, total protein, albumin, gamma-globulin, and potassium.
We investigated retrospectively age-related changes in BP and body composition in 44 men who had been hospitalised for up to 26 yrs as a result of carbon monoxide poisoning. The average age of the patients was 42.5 +/- 9.1 (SD) yrs on the first admission. The average period of hospitalisation was 19.5 +/- 5.9 yrs. The patients received mild salt restriction and daily exercise in the hospital. During the study period, nine patients developed hypertension and received antihypertensive treatment. The prevalence of hypertension in our study population was 205 per 1,000 and the incidence of hypertension (DBP > 95 mmHg) was 9.1 per 100 person years. Both prevalence and incidence appear to be lower than those in the general population. In the other 35 patients BP significantly decreased from 127.5 +/- 10.0 mmHg (SBP)/79.8 +/- 8.1 mmHg (DBP) at the time of the first examination to 120.8 +/- 16.3 mmHg/71.9 +/- 10.3 mmHg on the last examination. Body mass index did not change significantly during the study period. Hypertensive cardiovascular death was not observed throughout the study period. In conclusion, controlled diet, salt intake, physical exercise and isolation from the social stimuli achieved by a long-term hospitalisation may prevent increased BP and cardiovascular death.
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We have experienced two cases of huge hepatic hemangioma. Case 1 was a 51-year-old man complaining of abdominal fullness and was shown low density area in the right hepatic lobe by abdominal computed tomography. He was treated with segmentectomy of the right hepatic lobe. The resected specimen was histologically diagnosed as cavernous hemangioma. Case 2 was a 61-year-old man who showed no symptom and was shown 10 x 6.5 cm hemangioma by abdominal ultrasonography. He have been untreated. For 10 years, 29 cases of huge hepatic hemangioma, including our two cases have been reported in Japan. The female to male ratio is 5:1. The incidence of huge hepatic hemangioma was frequent in the fifth and sixth decades of life. The majority of patients complained of palpable abdominal mass and abdominal pain. The dominant site of huge hepatic hemangioma was the anatomical right hepatic lobe.
The validity of preoperative localizing procedures was studied in 36 patients with primary aldosteronism due to adrenal adenoma, all of whom were confirmed surgically. Adrenalectomy resulted in normalization of blood pressure and serum potassium. Furthermore, we reviewed the correlation between mass size and some clinical parameters as well as the accuracy of localization procedures. Adopted localization procedures included imaging techniques such as abdominal ultrasonography, computed tomography (CT), adrenal scintiscan, magnetic resonance imaging (MRI) and adrenal venography, and as a functional diagnostic procedure, adrenal venous sampling. Among imaging procedures, CT was the most effective to detect adrenal mass with as high accuracy as 88%, adrenal venography following with 83%. The correct localization was obtained in 60% by adrenal scintiscan and only 39% by ultrasonography. Although MRI was performed only in 2 cases, the smallest adenoma could be detected only by MRI, suggesting that MRI might be useful to detect microadenoma by increased signal intensity. Although adrenal scintiscan had been considered to be useful because of its functional diagnostic characteristics, the correct localization was as low accuracy as 60%, which was not improved by the administration of dexamethasone. To assess the accuracy of lateralization for adrenal venous sampling, we calculated the ratio of aldosterone concentration in adrenal vein to inferior vena cava. When the ratio was more than 10 or less than 1, the correct localization was made.(ABSTRACT TRUNCATED AT 250 WORDS)
We investigated the effect of a newly synthesized Ca2+ channel antagonist, NC-1100, on cerebral blood flow (CBF) and metabolism in spontaneously hypertensive rats. The rats received a bolus injection of 0.2 or 1.0 mg/kg NC-1100 i.v. and 1-h cerebral ischemia was then induced by bilateral carotid artery occlusion (group 1). The rats in group 2 were continuously infused with NC-1100 0.03 or 0.1 mg/kg per min, starting immediately after bilateral carotid artery occlusion, for the 1 h of ischemia and following 3-h recirculation. Group 1: during ischemia, CBF in all rats decreased to 6-8% of the resting values. At 1 h cerebral ischemia, brain tissue lactate increased 11.5-, 10.1- and 9.8-fold of the normal control given vehicle or NC-1100, 0.2 and 1.0 mg/kg, respectively. The ATP levels were better preserved by NC-1100 administration; 0.61 +/- 0.04 (mean +/- S.E.M.), 0.80 +/- 0.09 and 0.97 +/- 0.14 mmol/kg (P < 0.05 vs. vehicle), respectively. Group 2: during recirculation, CBF in NC-1100-treated rats returned to 83-90% of the resting values, but to only 65% in the vehicle group. Postischemic brain lactate at 3 h was less well preserved and ATP was dose dependently better preserved in NC-1100- than vehicle-treated rats. It is considered that pre- as well as postischemic administration of a Ca2+ channel antagonist, NC-1100, is beneficial to attenuate and also ameliorate the metabolic and circulatory derangement in the ischemic brain.
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We obtained a monoclonal antibody (MA-1) specific for macronuclei of the ciliate Paramecium caudatum and P. dubosqui. Immunoblotting showed that the antigen was a polypeptide of 50 kilodalton (kDa). During the process of nuclear differentiation in P. caudatum, the MA-1 antigens appeared in the macronuclear anlagen immediately after four out of eight post zygotic nuclei differentiated morphologically into the macronuclear anlagen. Afterwards, the antigens could be detected in the macronucleus through the cell cycle, and disappeared when the macronucleus began to degenerate in exconjugant cells. These results suggest that the antigens may play a role in the differentiation and function of the macronucleus.
To compare the effects of enalapril and captopril on blood pressure, serum creatinine (S-Cr), and potassium (S-K) levels, patients with malignant hypertension treated with either 5-10 mg of enalapril (eight cases) or 75-400 mg of captopril (eight cases) were investigated retrospectively. After 2 weeks of treatment, the average blood pressure fell from 214/138 to 132/89 mmHg on enalapril and from 240/145 to 147/95 mmHg on captopril. The percent change in mean blood pressure during the 2 weeks of treatment with enalapril (-35.6 +/- 4.0 SE%) was similar to that with captopril (-35.8 +/- 2.8%). S-Cr did not change in both groups, while S-K increased significantly from 3.9 +/- 0.2 to 5.2 +/- 0.2 mEq/l on enalapril and from 3.6 +/- 0.2 to 4.2 +/- 0.1 mEq/l on captopril. S-K at the second week was significantly higher in the enalapril than in the captopril group. The maximum S-Cr concentration during the treatment was correlated with the corresponding S-K concentration similarly in both groups. These results indicate that both enalapril and captopril increase S-K without deterioration of renal function in patients with malignant hypertension and that the way these drugs are used in clinical practice may be more likely to result in elevated S-K with enalapril.
Fourteen normotensive patients with liver disease (6 with cirrhosis and 8 with chronic hepatitis) and 7 healthy volunteers were given a single oral dose of nilvadipine 2 mg. In addition, nilvadipine 4 mg was administered orally twice daily for several months to 6 hypertensive patients with mild liver dysfunction and 18 hypertensives with normal liver function. A significant increase in plasma nilvadipine was found in the patients with cirrhosis as compared both to the normal and chronic hepatitis subjects; the time to peak concentration was similar among the three groups. The peak plasma nilvadipine concentration was closely correlated both with the serum albumin level and the retention of indocyanine green. Changes in blood pressure, pulse rate and various vasoactive hormones following a single oral dose of nilvadipine did not differ between the groups. Thus, an increase in plasma nilvadipine relative to the level in normal subjects was demonstrated in patients with cirrhosis following a single oral dose, as well as in patients with slight liver dysfunction following long-term oral administration.
The familial occurrences of biochemical and immunological abnormalities and histocompatibility antigens were studied in 18 healthy first-degree relatives of patients with primary biliary cirrhosis (PBC) in two families. In each of these two families, there were two members who suffered from PBC. All relatives had normal serum aspartate aminotransferase, alkaline phosphatase, bilirubin, total cholesterol, and immunoglobulins except the two, who had a mild elevation of alkaline phosphatase without cholestasis. Autoantibodies were present in some relatives; five (28%) for antithyroglobulin antibody and antithyroid microsomal antibody, one (6%) for antimitochondrial and antinuclear antibody, and one (6%) for rheumatoid factor. Abnormalities of T or B lymphocytes in peripheral blood were detected in two (11%) relatives. Impairment of concanavalin A-induced lymphocyte transformation determined by ethidium bromide fluoroassay was found in seven (39%) relatives, although an abnormal response for phytohemagglutinin was detected in none of the relatives. The HLA haplotypes were not necessarily associated with positive autoantibodies or impaired concanavalin A-induced lymphocyte transformation in these families. These findings suggest that impairment of concanavalin A-inducible lymphocytes (mainly suppressor T cells) is one of the contributing factors in the development of PBC.
Serial radiographic examinations of the small intestine, including double-contrast studies, were performed in 13 patients with ischemic jejunoileitis, nine with the stricturing form and four with the transient form. Thumbprinting was observed in five (38%) patients and thickening of the folds in four (31%) at the acute stage of the disease. Tubular narrowing with irregular contours and dilated proximal bowel was observed in six (46%) patients and appeared on day 27 or later. Pathologic findings of the resected specimen in eight patients with the stricturing form revealed annular stricture with relatively shallow ulcers; the irregular contours of the tubular narrowing on radiographs were consistent with a granular or nodular appearance and/or multiple fissures on pathologic study. Eccentric deformity and sacculation were demonstrated in only one patient with the stricturing form. In addition, double-contrast study revealed small ulcers in three (23%) patients. Our results indicate that radiographic findings accurately reflect the clinical course and pathologic findings in this disease.
One hundred thirteen patients with essential hypertension receiving single or multiple antihypertensive agents were enrolled in the study. All had had mild to severe hypertension before treatment, but their diastolic blood pressure (DBP) at study entry was lower than 90 mm Hg for all measurements. In half of the subjects, non-thiazide diuretics (n = 35) or angiotensin-converting enzyme inhibitors (ACEI, n = 37) were discontinued, and their remaining drugs were maintained throughout the study. The other patients (n = 41) continued all their medications. Forty-one percent of subjects remained normotensive for 12 months after withdrawal of diuretics, and 37% of patients with ACEI discontinuation remained normotensive, although the recurrence of hypertension after withdrawal of ACEI tended to be earlier than its recurrence after withdrawal of diuretics. Serum uric acid and creatinine concentration decreased after diuretic withdrawal, but not after ACEI withdrawal. Diuretic withdrawal resulted in an increase in serum potassium, but ACEI withdrawal induced a decrease in serum potassium. Withdrawal of diuretics or ACEI both significantly reduced plasma renin activity. The present study may be indicative of the ability to withdraw some medications in many patients being treated with multiple antihypertensive agents.