[in Japanese]

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Fifty three patients with liver cirrhosis and other chronic liver disease were divided into three different groups according to severity (group I: non-cirrhotic group, group II: compensated cirrhotic group, group III: decompensated cirrhotic group) and were studied with regard to their autonomic nervous and general nervous activity.
To estimate the patients' autonomic nervous activity, they were examined on the following items: 1) their subjective symptoms, 2) orthostatic dysregulation, 3) coefficient of variation in R-R interval in ECG (CV_R-R) at rest, 4) minimum heart rate (MHR) at night, CV_R-R at MHR at night, disparity in MHR between day and night (all three of these items measured using the Holter ECG), 5) serum adrenalin, noradrenalin, cyclic AMP, and cyclic GMP.
Meanwhile, general nervous activity was evaluated by measuring the reaction time to sound and light stimuli and by performing a number connection test. Cardiac function was also measured using radionuclide angiography to study its relationship to autonomic nervous disturbance in patients with chronic liver disease.
The results of autonomic nervous function tests, especially CV_R-R at rest, MHR at night, CV_R-R at MHR at night and the disparity in MHR between day and night, indicated a marked lowering of autonomic nervous function in group III. In the serological examination, serum noradrenalin and cyclic GMP levels were significantly higher in groups II and III. The evaluation of general nervous function showed that the reaction time to sound and light stimuli was significantly slower in group III than in group I. The cardiac function test revealed no statistically significant differences between the groups.
In conclusion, autonomic nervous disturbance in patients with chronic liver disease seems to increase gradually as the disease progresses and to emerge as a distinct clinical symptom chiefly at the decompensated stage of liver cirrhosis.

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Paradoxical motion of the posterior wall of the left ventricle (LV) in the standing position was studied in 70 healthy subjects using echocardiography. Echocardiographic studies were performed in two body positions: supine and standing. Paradoxical motion (PM) of the posterior wall was defined as outward systolic motion for longer than 50% of systolic duration. Studies in the supine position showed normal systolic motion (NL) in all 70 subjects. However, studies in the standing position showed PM of the posterior LV wall in 46 subjects (66%) (PM group), and NL in 24 subjects (NL group), In the standing position, peak outward motion was much greater (4.8±1.7mm vs 2.7±1.1mm) in the PM group. Duration of the outward motion was also much greater in the PM group (67.4±11.9% vs 45.4±6.4%) . PM was significantly more frequent in male subjects, in taller subjects and in subjects with lower body weight. At the time of the peak outward motion, there were strong correlations between posterior wall excursion and septal excursion, and between posterior wall excursion and mitral ring excursion. In the PM group, the % increase in heart rate from the supine to standing position was greater, and the % decrease in LV end-diastolic dimension, LV end-diastolic volume, stroke volume and cardiac index were greater. Standing calf venous volume measured by plethysmography was also much greater in the PM group.
We conclude that this phenomenon presumably relates to an enhanced posterior motion of the entire heart in systole and to an altered contraction pattern of the posterior wall in the standing position. It is seen as having an important role in the interpretation of tests of LV function carried out in the standing position.

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In Japan, there is still much controversy surrounding the merits and demerits of informing patients of a cancer diagnosis. With respect to this point, the Research Institute of Vaccine Therapy for Tumors and Infectious Diseases of Nippon Medical School conducted a survey from Jan. 1989 to Jan. 1990. The following responses were obtained from 546 patients and 599 families. 66.7% of the patients and 31.7% of the families desired to have a direct explanation of a malignant diagnosis, so they could plan accordingly. In this respect, quality of life was seen as a key factor.
Conversely, those not wishing to know of a malignant diagnosis did not want to cause the patients undue trauma and stress. Some comparisons were made with the present situation in the U.S. where informed consent for cancer therapy is generally accepted.

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In order to quantify changes in epileptic discharges during the course of phenobarbital (PB) therapy, 8 children with generalized tonic-clonic seizure (GTC) corresponding to sleep epilepsy as defined by Janz were given PB, and their all-night EEGs were obtained by means of a polygraph with simultaneous measurement of the blood concentration of PB. EEGs were recorded before the treatment commenced and 3 days, 14 days, one month, 6 months, one year, 1.5 and 2 years after the beginning of the treatment.
For each child, the number of epileptic discharges during sleep was determined. The incidence of epileptic discharges (total number of epileptic discharges during sleep divided by total sleep time) was calculated, and changes during the course of the treatment were examined.
In addition, the findings (pattern of epileptic discharges) obtained through standard short-time EEG recordings were compared with those obtained through all-night EEG recordings in terms of the incidence of epileptic discharges during the first S1-S2 after the subject had fallen asleep and the incidence of epileptic discharges during all stage of S1 and S2 while asleep. There were two different patterns of changes in the incidence of epileptic discharges. In 5 of the 8 children, the incidence was decreased at the initial stages of treatment, but it began to increase about one month later, returning to the baseline level (re-incresed type).
In the remaining 3 children, the incidence decreased favorably after the beginning of treatment, reaching nil within one year (simple decrease type).
The incidence of epileptic discharges was found to be decreased in all 8 children after 3 days of treatment, when the blood PB concentration had not reached the effective level. Standard EEG and all-night EEG revealed similar patterns of epileptic discharges.

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An attempt was made to estimate noninvasively portal pressure (PP) in patients with chronic liver disease, using the theory of quantification, a kind of multivariate analysis.
Forty-one patients with liver cirrhosis and 22 patients with chronic hepatitis in whom hepatic venous catheterization had been performed were studied. Seventeen parameters (age, sex, mean blood pressure, red blood cell count, platelet count, prothrombin time, lactate dehydrogenase, alkaline phosphatase, total bilirubin, albumin, y-globulin, indocyanine green retention at 15 min, blood urea nitrogen, hepatomegaly, splenomegaly, ascites and edema) were selected for the estimation of PP. The estimated PP correlated significantly with the data obtained by hepatic venous catheterization with a high correlation coefficient of 0.835 (p<0.01). An investigation using the theory of quantification was also undertaken to determine which of the 17 parameters selected above was most useful in estimating PP. Among the 17 parameters indocyanine green retention at 15 min, red blood cell count, prothrombin time, hepatomegaly and splenomegaly seemed to contribute significantly to the estimation of PP.
When the formula was applied to 31 successive patients with chronic liver disease (external samples), the correlation between the estimated and measured PP was 0.455 (p<0.01).
These results indicate that the formula is clinically useful in estimating PP in patients with chronic liver disease.

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The purpose of this study is to increase understanding of the prognosis of coronary artery disease (CAD) patients whose anginal symptoms have been removed by medical therapy, and to evaluate the prognostic and clinical significance of silent myocardial ischemia (SMI).
Cardiac events including cardiac death, acute myocardial infarction, PTCA/CABG and unstable angina were examined in 253 CAD patients who underwent ambulatory Holter monitoring, treadmill exercise testing and coronary angiography. The subjects were classified into two groups: 93 patients with exertional angina (AP) without previous myocardial infarction and 160 patients with old myocardial infarction (MI) . SMI was diagnosed by Holter monitoring. Cox's proportional hazard regression model and the survival curves using the Kaplan-Meier method were used to analyze 9 variables in patients with AP, including Holter monitoring parameters, exercise parameters and angiographic findings, and 12 variables in patients with MI, including the same parameters as in AP patients. The cardiac event rate was 19% in patients with AP and 18% in patients with MI. The independent and common predictors of unfavorable outcome in both groups were severe coronary lesion and SMI. The incidence of SMI was 30% in AP patients and 38% in MI patients, the same incidence as reported in previous studies. The cardiac event rate in patients with SMI was higher than in those without SMI for both groups (28% vs 9% and 32% vs 9%; p<0.05) . However, the most frequent cardiac event was different in the groups with SMI: PTCA/CABG in AP patients and re-infarction in MI patients. The significant predictors of cardiac events in patients with SMI were severe coronary lesion, short exercise duration, severe asynergy and exercise-induced angina in patients with AP and lower ejection fraction and maximum ST depression on Holter monitoring in patients with MI.
In conclusion, it was ascertained that SMI is a significant and independent marker of unfavorable outcome in patients with CAD and that the cardiac event rate in patients with SMI was significantly higher than in those without SMI. However, severe complications such as acute myocardial infarction were more frequent in MI patients than in AP patients. Therefore, it was suggested that the use of re-vascularization procedure (PTCA/CABG) should be considered as soon as possible in patients with SMI, regardless of whether anginal symptoms are present or not. It should also be noted from the standpoint of medical therapy that even in CAD patients with SMI the significant predictors of cardiac events differed between the patients with a history of MI and those without a history of MI.

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Pharmacologic action of antiarrhythmic agents in hypoxia was studied with the microelectrode using the guinea pig papillary muscle. Tyrode solution saturated with 95% O₂ and 5% CO₂ provided normoxic condition and that with 95% N₂ and 5% O₂ hypoxic condition. The parameters measured were as follows: 1) V_max: the maximum rate of rise of the action potential, 2) ERP: effective refractory period, 3) ERP/APD_90%: the ratio of effective refractory period to action potential duration at 90% repolarization. [1] When the papillary muscle was perfused more than 15 minutes with the hypoxic solution, irreversible changes ensued inevitably. Accordingly, a perfusion with the hypoxic solution for 15 minutes was succeeded by that with the normoxic solution for 30 minutes. This was then followed by another perfusion with the hypoxic solution. [2] Flecainide was examined in 7 cases. The rate of the depression of V_max by flecainide was significantly (p<0.01) increased in hypoxia (16.3±4.2%) than in normoxia (7.4±2.0%) . There were no significantly differences in the rate of the change of ERP between both conditions. The rate of ERP/APD90% was significandy (p<0.01) increased by flecainide during hypoxia (2.2±0.8%) than during normoxia (0.1±2.1%) . [3] The depression of V_max and the in crease of ERP/APD90% by flecalnide accurred in a dose-dependent manner in normoxia.
It was concluded that the depression of V_max by flecainide over the concentration of 2μg/dl were ascribed to its inhibitory effect on the fast Na channel and that its depressive effects were enhanced during hypoxic condition. This inhibitory action was regarded as the main antiarrhythmic action of flecainide.
From the above results, it is expected that flecainide could be effective in the treatment of ventricular arrhythmias in the ischemic heart disease.

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