The effect of an alpha adrenergic blocker bunazosin on cardiac compensatory reactions was studied on Wistar rat myocardial infarction model. Heart weight/body weight ratio was increased and left ventricular peak dp/dt, the first time derivative of the ventricular pressure, was decreased in untreated myocardial infarction rats. Myosin heavy chain V3 component, plasma atrial natriuretic peptide (ANP) and atrial and ventricular ANP mRNA were increased in these animals. Bunazosin treatment suppressed all these changes while systolic blood pressure was lowered following the treatment. Hydralazine, a vasodilator with direct effect on vascular smooth muscles, equally lowered systolic blood pressure. However, decrease in left ventricular peak dp/dt, changes in the myosin heavy chain isozyme pattern and elevation of plasma ANP and cardiac ANP mRNA were not affected by hydralazine. The present observations suggest that the beneficial effect of alpha adrenergic blocker bunazosin on decompensated heart may result not only from cardiac unloading but also from direct alpha blocking effect on myocardial cells.

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This study was designed to elucidate the molecular mechanism of sarcolemmal Ca²⁺-ATPase activity in vascular smooth muscle cells. For this purpose, the effect of protein kinase C (PKC) -dependent phosphorylation on Ca²⁺ uptake and ATP hydrolysis was examined in microsomal and sarcolemmal Ca²⁺-ATPase preparations isolated from bovine aortic smooth muscle. Treatment with PKC enhanced a portion of the Ca²⁺ uptake inhibitable by 10μM vanadate by up to 30% in microsomes. On the other hand, Ca²⁺-dependent ATPase activity in the purified Ca²⁺-ATPase preparation and the Ca²⁺ uptake by proteoliposomes reconstituted from sarcolemmal Ca²⁺-ATPase were stimulated by up to two fold. However, the above changes were evident only at Ca²⁺ concentrations between 0.1 and 1.0μ M. Whenever PKC stimulated Ca²⁺-ATPase activity, the sarcolemmal Ca²⁺-ATPase was phosphorylated to a level of 1 mol per of the enzyme. A good linear regression was demonstrated between the Ca²⁺-ATPase phosphorylation and the degree of enzyme activation. The above results indicate that the activity of the sarcolemmal Ca²⁺-ATPase in vascular smooth muscle is regulated through direct phosphorylation by PKC.

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Forty three patients with acute myocardial infarction, who underwent angiographically successful direct percutaneous transluminal coronary angioplasty in the left anterior descending artery, were followed for 3 months. Q waves diagnostic of myocardial infarction observed on admission disappeared in later tracings in 5 of 19 cases. On the other hand, Q waves not present on admission appeared during follow up in 13 of 24 cases. The disappearance rate of Q waves was 18% for 3 months. The rate was much higher than the corresponding figures for patients under traditional conservative management. The left ventricular ejection fraction was significantly greater in patients without significant Q waves 3 months after the acute episodes than in those with preserved Q waves. Left ventricular function did not improve during follow up in patients with persistent Q waves. Thus, preserved R waves or the disappearance of Q waves on electrocardiograms after direct percutaneous transluminal coronary angioplasty indicate successful salvage of myocardium and future recovery of cardiac function.

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Clinical and epidemiological experiences indicate a frequent association between diabetes mellitus and essential hypertension. However, the cause-effect relation has not been made clear between these diseases. The author examined the interrelations between glucose tolerance and obesity, hypertension and hyperlipidemia by a mass screening study. By 75g oral glucose tolerance test results, 1, 781 participants were divided into 4 groups : normal, borderline, impaired glucose tolerance, and diabetes mellitus. The incidence rate of diabetes mellitus in obese subjects was 28.2%, though it was 13.7% in non-obese subjects. Among non-obese subjects the incidence rate of diabetes mellitus was significantly higher in hypertensives than in non-hypertensives. The incidence of diabetes mellitus among obese subjects was slightly higher in hypertensives than in non-hypertensives, though the difference was not statistically significant. In both obese and non-obese subjects, the incidence of diabetes mellitus was higher in hyperlipidemic subjects than in non-hyperlipidemic subjects, irrespective of blood pressure level. These results indicate that obesity, hypertension and hyperlipidemia independently increase the risk of glucose intolerance and play important roles in the development of diabetes mellitus.

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The outcome of acute myocardial infarction has been significantly changed by the introduction of invasive coronary reperfusion procedures. However, the myocardial saving effect of reperfusion is difficult to evaluate in the early phase because of the presence of stunned myocardium. Is it possible to predict the future recovery of regional wall motion early after reperfusion? We assessed regional myocardial glucose metabolism in relation to the late effect of reperfusion. In a dog reperfusion model, there was a good linear correlation between the regional myocardial metabolic rate of glucose (MMRG) determined 12 hours after the termination of reperfusion using 18-F fluorodeoxyglucose (FDG) and positron emission tomography and the amount of surviving myocardium (r=0.86, p<0.01). The MMRG was normal or increased in the area where regional contraction was regained 4 weeks after reperfusion, but was decreased in the area which remained akinetic or dyskinetic in the late phase. When the normal lower limit was set as the mean minus 2 standard deviations in the control group, normal MMRG indicated viable myocardium and later functional recovery, while lower MMRG suggested permanent functional loss. Thus, myocardial viability seems to be appropriately evaluated by the determination of MMRG.

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Some protease inhibitors have been reported to influence the extent of neurite outgrowth and survivals in various types of cultured neurons. In this paper, I have studied effects of several protease inhibitors on the neurite outgrowth and survival of cultured neurons of the rat.
For the trophic effect assay, hippocampal neurons and dorsal root ganglion cells were cultured in chemically defined medium. In order to evaluate the number of surviving hipptcampal neurons semiquantitatively, enzyme immunoassay (EIA) for MAP 2 was carried out using anti-MAP 2 antibody. There was a good correlation between the MAP 2 level obtained by the EIA and the number of neuronal cells counted unedr phase contrast microscopy. Therefore, quantified anti-MAP 2 bindings, primarily reflecting neuronal survival in culture, were used as an index of the neurotrophic activity of protease inhibitors. Neuronal cells were cultured in chemically defined medium containing the following protease inhibitors at various concentrations ; soybean trypsin inhibitor (STI), leupeptin, diisofluorophosphate (DFP), α₂-maroglobulin (α₂M) and α 1-antichymotrypsin (ACT). Among these protease inhibitors, only ACT and α₂M showed trophic effects on cultured hippocampal neurons. Anti MAP2 bindings increased with increasing concentrations of ACT ranging from 0.125μg/ml to 4 μg/ml. The addition of α₂M at the optimal dose (100μg/ml) to the culture medium caused a four-fold increase in anti-MAP2 bindings of the cultures of hippocampal neurons. On the other hand, the protease inhibitors tested showed no trophic effects on dorsal root ganglion cells.
Under phase-cotrast microscopic observation, only ACT increased both the length and numbers of neurites in cultured neurons. The maximal effect on the increase in neurite length was detected at a concentration of 8 μg/ml.
This study has revealed that ACT enhances both survival and neurite outgrowth of hippocampal neurons. It is suggested that ACT, an associated protein of senile plaque amyloid, may act as a trophic factor in the brain of Alzheimer type dementia.

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The present study was performed in order to assess whether myocardial glucose utilization determined by ¹⁸F-deoxyglucose (FDG) accurately reflects the amount of survived myocardium in an old myocardial infarction. FDG was administered intravenously to 15 dogs 4 weeks after 3-hour occlusion of the left anterior descending artery and the animals were killed 2 hours later. Then, the excised hearts were divided into 12 portions and the radioactivity of each portion was determined. A linear positive correlation was demonstrated between FDG uptake per unit of survived myocardium and the extent of myocardial cell necrosis. A decrease in FDG uptake per unit of tissue sample was observed only when the percent area of cell necrosis was more than 50%, and there was a significant second-order polynominal regression between FDG uptake and the extent of myocardial cell necrosis. The FDG uptake was decreased in the dyskinetic region, but not in the akinetic region with moderate extension of myocardial cell necrosis. The above findings suggest that myocardial cell viability may be overestimated by FDG uptake.

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To assess the capacity of hospitals to cope with a wide-spread disaster, information on facilities was obtained from a mailed questionnaire. Forty (74%) of 54 facilities answered the questionnaire. A total of 16, 734 patients was transferred to these hospitals by ambulance in a year. Forty-six percent of hospitals had less than 100 beds. In most hospitals, a doctor and a nurse were on night shift, and laboratory and x-ray examinations were possible for 24 hours. When the life line in a district was cut due to a major disaster, 19 facilities were not considered to maintain their own food supply for hospitalized patients. Medical materials such as gauze, disinfectants and certain other materials were stocked for seven days or more. Nineteen of 40 facilities had the place for a helicopter landing near the hospital. However, an emergency radio was installed only in two facilities. Eighty percent of facilities had a private electric generator. However, in 75% of the facilities, fuel of the generator was stocked for six hours or less. Therefore, local governments should make plans to supply medical materials and establish task-forces for disasters.

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To assess myocardial viability in the region of a persistent defect, reinjection thallium201-scintigraphy was performed in 80 patients with coronary artery disease. Reinjection ²⁰¹Tl myocardial images were obtained by additional injection of ²⁰¹Tl (37MBq) after making conventional ²⁰¹Tl delayed images. The myocardial viability was evaluated by regional left ventricular wall motion. Of 75 segments with persistent defects on conventional ²⁰¹Tl stress images, new fill-in, increased ²⁰¹Tl uptake was observed in 33 segments on the reinjection images. The abnormal wall motion score evaluated by left ventriculography was significantly better in fill-in (+) regions (1.70±0.87) than in fill-in (-) regions (2.60±1.05, p<0.01). After successful angioplasty, ²⁰¹Tl uptake was improved in 9 of 17 segments in fill-in (+) regions and 3 of 18 segments in fill-in (-) regions (P<0.01). After angioplasty, wall motion improved in 7 of 17 segments in fill-in (+) regions and 2 of 18 segments in fill-in (-) regions (P<0.01). ²⁰¹Tl reinjection is useful for the assessment of myocardial viability and for selecting candidates for revascularization.

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This study was designed to assess the need for liver transplantation in Gunma prefecture. To estimate the number of patients who died of end-stage liver disease, we investigated the Gunma version of vital statisitics in Japan from 1985 to 1990. The following result were obtained : Twenty six patients per year died of diseases that were absolute indications for liver transplantation ; these included alcoholic cirrhosis (8.2 persons on average), primary biliary cirrhosis (1.6), congenital biliary atresia (1.2) and acute hepatic failure (15.2). Three hundred and ninety patients per year died of disease that might have responded relatively well to liver transplantation ; these included viral related liver cirrhosis (228) and hepatic malignant neoplasm (162). In Gunma prefecture, the annual number of patients with an absolute indication for liver transplantation was 26 while those with a relative indication for liver transplantation numbered 390.

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Two patients with the thrombosed Björk-Shiley prosthesis due to imcomplete anticoagulant therapy underwent successfull re-placement of the prosthetic valve accompanying with tricuspid annuloplasty. Prosthetic valve dysfunction occurred at 6 and 11 years, respectively, after the first operation. We report these patients since chronic dysfunction of the mechanical prosthetic valve is relatively rare.

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A 26-year-old man was admitted to our hospital because of fever, nausea, abdominal pain and diarrhea. From physical and laboratory findings, in addition to family history, he was diagnosed as having hereditary spherocytosis with severe hemolysis and renal dysfunction due to salmonella enterocolitis. Administration of antibiotics and intravenous fluid resulted in prompt improvement of hemolysis and renal dysfunction.

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A case of acquired immunodeficiency syndrome (AIDS) associated with fulminant hepatitis and non Hodgkin lymphoma is reported. A 34-year-old man (a Japanese of in Brazil) suffered from severe general fatigue, a 38-39°C fever up and a tumor in the left axillary region. He was recommended to receive treatement in Japan on account of tumor biopsy. He was found to have severe hepatic injury after returning to Japan. He was admitted with jaundice and disturbed consciousness. Laboratory data revealed high levels of bilirubin, LDH, ALP and transaminase, as well as decreased prothrombin activity. Consciousness deteriorated (grade II, hepatic encephalopathy). Therefore fulminant hepatitis was suspected. On the 7 th day, he died of multiple organ failure. After death, we received a biopsy specimen obtained in Brazil, and diagnosed complications of non Hodgkin lymphoma. Furthermore, we diagnosed AIDS because HIV- 1 and ATLV- 3 antibodies were positive.

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A case of thyroid adenoma with severe dyspnea, who underwent emergency operation with the use of ECMO, is reported. A 58-year-old woman complained of rapid enlargement of goiter, cough and severe dyspnea with orthopnea, and was admitted as an emergency. X-ray of the neck revealed shift and stenosis of the trachea. Anaplastic carcinoma of the thyroid was suspected, but no definitive diagnosis was made. As intratracheal intubation was thought to be dangerous, ECMO was applied by percutaneous cannulation into the bilateral femoral veins in the sitting position under local anesthesia. Right hemithyroidectomy was performed in the supine position. The resected tumor was 7.2×6.0×5.1cm (140g) with a hematomatous appearance. The historgical diagnosis was microfollicular adenoma of the thyroid associated with massive hematoma. Dyspnea disappeared completely in the immediate postoperative period. ECMO support might be feasible for thyroid surgery in which of intratracheal intubation is impossible.

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