[in Japanese]

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Background: The strong association between obstructive sleep apnea syndrome (OSAS) and systemic hypertension is well recognized in some epidemiological researches.
Objective: To analyze the relationship between hypertension and obstructive sleep apnea.
Methods: All hypertensive patients (n=25) who were BMI>25kg/m² or had heavy snoring or excessive daytime sleepiness were examined with polysomnography (PSG). These subjects were classified according to data of apnea and hypopnea index (AHI). AHI was calculated as the total number of episodes of apnea and hypopnea per hour of sleep. An AHI≥5 to<20 indicated mild OSAS, 20≤to<40 indicated moderate OSAS, and≥40 indicated severe OSAS. These groups were then compared in terms of age, BMI, number of antihypertensive drugs used, blood pressure (BP) at out-patient clinic, lowest SaO₂, mean SaO₂, creatinine, uric acid, and lipids. PSG revealed all hypertensive patients (malel5, female10) to be OSAS patients (AHI>5). Patients (n=13) with moderate to severe OSAS (AHI>30/hr) were treated with nCPAP. 4 weeks after nCPAP was begun, blood pressure was measured between 10:00-12:00a.m. at our outpatient clinic.
Results: AHI was strongly associated with mean SaO₂ and systolic BP. There was a significant positive relationship between medications for hypertension and AHI (r=0.46, P<0.05). After nCPAP treatment for 4 weeks, systolic BP was significantly reduced from 139.4±18.3mmHg to 120.9±7.7mmHg (P<0.05). Our results demonstrate that nCPAP is useful for lowering blood pressure in such patients with drug-resistant hypertension and OSAS.

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The efficacy and safety of Biapenem (BIPM) for respiratory tract infection was investigated in 19 elderly patients at Nagasaki Medical Center. The dosage volume of administered BIPM was 6.7mg/kg/day. The result of the calculation using a population average parameter (2 compartment model) to estimate the concentration in blood of BIPM, with Cmax 18.40±4.35μg/ml, T_1/2/β1.58±0.37hr, CLtot 6.64±2.581/hr, and AUC was 49.98±14.00μg·hr/ml. There was no improvement of CRP after day 7, but WBC (P<0.0001) and temperature (P<0.001) improved to a normal level. As for renal function, Scr increased in one of the 19 cases. In the case of P. aeruginosa, with MIC₉₀ (16μg/ml), the probability (TA%) that %TAM would reach 50% was 8.6%, and the probability (TA%) that %TAM would reach 30% was 29.3%. In addition, with MIC₅₀ (1μg/ml), the probability (TA%) that %TAM would reach 50% was 56.2%, and the probability (TA%) that %TAM would reach 30% was 90.3%. In the case of an infectious disease by P, aeruginosa, it is thought that loading of dosage or increase in the number of times administered is necessary. However, administration of BIPM to the elderly whereby metabolism and excretion function are aggravated requires more careful administration, and examination of a further administration design is necessary.

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[in Japanese]

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A 79-year-old man with coumadine administration, who had mitral valve replacement and pacemaker implantation, was admitted for the treatment of gastric cancer. Sudden abdominal pain developed and contrast-enhanced computed tomography (CE-CT) showed superior mesenteric artery (SMA) occlusion. Although transcatheter administration of tissue plasminogen activator (t-PA) did not recanalize the occluded artery, we revascularized with a combination of thrombolysis and percutaneous transluminal angioplasty (PTA), which caused peripheral embolization with melena. The second attack occurred 14 days after the first attack and we performed a combination therapy of thrombolysis, thromboaspiration, and PTA to achieve sufficient recanalization with little peripheral embolism. Early recanalization with a transcatheter combination therapy may be an attractive treatment for the improvement of superior mesenteric ischemia with poor prognosis to minimize distal embolism.

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[in Japanese]

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Endocrine cell carcinomas are rare tumors in the gastrointestinal tract. Because of the high potential for metastasis in an early stage, the prognosis for endocrine cell carcinoma is poor. Adenoendocrine cell carcinomas are endocrine cell tumors in which an adenocarcinoma component is observed histologically. Here we report a case of adenoendocrine cell carcinoma of the rectum in a 68-year-old man. The tumor was identified originally by rectal examination and further bioptic examination was performed using colorectal endoscopy. Histopathological examination of the biopsy specimen resulted in a diagnosis of adenocarcinoma, and the patient underwent colectomy. Macroscopic findings showed a 3×5cm ulcerated carcinoma with heaped-up margins. In cross section, the tumor was gray-white in color and solid. Histopathologically, the tumor was characterized as invasive adenocarcinoma with a solid, ribbon-like, acinar growth pattern and with foci of goblet cell components. Immunohistochemical analysis revealed that keratin, AE1/AE2, Epithelial membrane antigen (EMA), Carcinoembryonic antigen (CEA), somatostatin and α-fetoprotein proteins (AFP) were expressed on the tumor cells, whereas Neuron-specific enolase (NSE), chromogranin A, gastrin, calcitonin and CD56 proteins were absent. Ki-67 protein was expressed weakly and sparsely in the nuclei of tumor cells. The sum of these findings resulted in our diagnosis of adenoendocrine cell carcinoma of the rectum.

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