Catecholamines are used to improve hemodynamics of heart failure. Due to differences in the pharmacological effects and types of receptors upon which they act, it is necessary to pay attention to adaptation, selection, and the dose of catecholamines based on the pathology of the patient.
Although digitalis has been among the most commonly prescribed drugs for the treatment of heart failure for a long time, the DIG trial indicated that digitalis did not reduce the overall mortality and cardiovascular death. However, it did reduce the rate of hospitalization both overall and for worsening heart failure. Digitalis is also effective for control of heart rate at rest, but not during exercise. By contrast, as its efficacy depends on the positive inotropic activity, digitalis is effective for control of the heart rate at rest in patients with atrial fibrillation with heart failure, LV dysfunction, or for underlying disease. In combination with a β-blocker, either may be effective in patients with or without heart failure. These findings define more precisely the role of digitalis in the management of chronic heart failure and atrial fibrillation.
Diuretics are essential for the treatment of cardiac failure. Currently, carbonic anhydrase inhibitors, loop diuretics, thiazide diuretics and potassium sparing diuretics are generally used for diuretic therapy. However, their efficacy and issues have been pointed out, and the appropriate use of diuretics has been reported to influence the patient’s prognosis. Tolvaptan, a vasopressin V2 receptor antagonist, has drawn attention as a new diuretic in recent years. We will discuss various diuretics in this article.
Phosphodiesterase type III inhibitors are used for the treatment of severe heart failure and have two cardiovascular effects, reduction of vascular resistance, and increasing myocardial contractility to improve hemodynamic status. The combined therapy with dobutamine is more effective. It is recommended for acute or chronic heart failure with a β-blocker. We use them for the prevention of spasm of grafts, during coronary artery bypass grafting. For organ protection, phosphodiesterase type III inhibitors are also used for acute aortic dissection.
Atrial natriuretic peptide (ANP) was isolated and identified by Matsuo and Kangawa in 1984. ANP has a diuretic effect, and vasodilation, reduced preload, afterload, various actions through inhbition of the renin angiotensin system, suppression of myocardial hypertrophy, and inhibition of fibrosis have been observed. During cardiac operations performed in our department, we have achieved satisfactory results in overcoming the disadvantages of cardiopulmonary bypass (CPB) by administering a low dose (0.02-0.05γ) intravenous infusion of ANP at the initiation of CPB.
The rapid development of pharmacological treatment for pulmonary arterial hypertension is progressing because of the discovery of the mechanism of interaction between pulmonary vascular endothelial cells and smooth muscle cells. Three types of pulmonary specific vasodilators, prostaglandin I2, endothelin receptor antagonist, and phosphodiesterase type-5 inhibitor have been introduced and are markedly effective in the clinical stage.
We examined the presence of introduction letters and test results in an institution that conducts second breast cancer screenings. We investigated the 6,071 new patients who visited our hospital for the past seven years. Of these, 2,379 patients exhibited an abnormality during the first breast cancer screening. Of these, 78.7% were provided with an introduction later. Regarding imaging of the breast cancer, 33.2% had mammograms, 11.9% had ultrasonograms, 3.7% had MRI images, and 4.3% had CT images. Regarding obtaining of biopsy specimens, 2.6% and 0.8% underwent aspiration biopsy cytology and core needle biopsy, respectively. The patients who noted an abnormality during the first breast cancer screening tended to return for follow-up and confirmation. It is important to build a system that allows detailed test results to be communicated from the primary medical institution to the second medical institution.
Exposure to hypoxia results in compensatory processes, including increasing the number of circulating red blood cells and neovascularization, which can increase the efficiency of oxygen delivery, extraction and use. The present study investigated the mechanisms of hematopoiesis in response to chronic hypoxia (10% oxygen exposure) in mice by assessing fluctuations in the peripheral blood cell count, the number of hematopoietic progenitors in the bone marrow and spleen, and serum erythropoietin (EPO) concentrations. Hypoxia induced an exponential increase of serum EPO levels, leading to erythropoiesis. However, no appreciable changes were observed in the number of blood cells, including granulocytes, macrophages, B-lymphocytes and mast cells. The number of fibroblast colony-forming units (CFU-F) in the bone marrow decreased during the first two days, and increased, thereafter, for more than two weeks, suggesting that hypoxic conditions affect the hematopoietic microenvironment cells that are responsible for the regulation of hematopoietic cell proliferation and differentiation.
Objective: We report the annual operation statistics of department of Surgery at the Nihon University School of Medicine in 2012, and we examine the future problems. Material and Method: We investigated the type and number of operations in the Divisions of Digestive Surgery, Cardiovascular Respiratory and General Surgery, and Pediatric Breast and Endocrine Surgery at Itabashi Hospital of Nihon University School of Medicine, and Surugadai Nihon University Hospital, from January to December 2012. Results: The total number of operations decreased from 2, 996 in 2011 to 2,859 in 2012. While the numbers of operations for digestive surgery and respiratory surgery increased, other surgeries decreased, and the numbers of conservative treatments increased. The operations for cancer increased in all Divisions of the Department of Surgery. Conclusion: We propose that it is important to cooperate with the doctors in internal medicine to increase the number of operations.
We studied the late effects of treatment on endocrine function in 22 survivors of acute lymphoblastic leukemia (ALL) and malignant lymphoma (ML), with no previous overt endocrine complications. All subjects were older than 15 years old and had undergone treatment from 1970 to 2007. Six patients (27.3%) were diagnosed as having latent endocrine disorders, including decreased secretion of growth hormone in 3 cases, latent primary hypothyroidism in two cases and latent central hypothyroidism in one case. None of the patients exhibited abnormalities in either adrenal or sex hormones. There was no significant difference in the current age (p = 0.64) or age at treatment (p = 0.84) between the patients with and without endocrine disorders. It is helpful to notice latent endocrine disorders at the subclinical stage as Late Effects of treatment of endocrine function in childhood cancer survivors. This early detection and intervention leads to further improvement of the QOL for childhood cancer survivors.
We examined the efficacy of a unique experimental approach to brain protection with mild hypothermic circulatory arrest, using rapid cooling and re-warming in a swine model. Methods: In 30 male pigs, total cardiopulmonary bypass was established. The animals were divided into three groups. Group A underwent slow cooling and 20 minutes of deep hypothermic arrest (20°C) followed by slow re-warming up to 36°C. Group B underwent mild hypothermica rrest (20°C) and slow re-warming. Group C underwent mild hypothermic arrest using rapid cooling and re-warming. Laboratory data, cerebral blood flow and oxygen intakes were assessed at 4 points throughout the examination. After examination, specimens from cerebral cortex and hippocampus were investigated microscopically. Results: Platelet counts were signi- ficantly better in group C than in group A at the end of re-warming. By contrast, cerebral blood flow and platelet counts were worst in group A compared with the other groups. There were no significant deferences in the pathological findings in brain tissues using Kluver-Barrera stain between the 3 groups. Conclusion: Moderate hypothermic circulatory arrest and rapid re-warming was considered quite effective for preventing blood coagulation disorder.
We report our clinical experience of hypodermoclysis (HDC) in elderly patients at the end of life in a long-term care unit. The subjects were 92 patients who died during hospitalization in the long-term care unit between the 2007 and 2010. The underlying conditions included cerebrovascular disease in 48 cases (52.2%), dementia in 11 cases (12%), and malignant tumor in 5 cases (5.4%). The patients were divided into the HDC group (24 cases) and the intravenous infusion (IV) group (68 cases), and the duration of infusion, infusion dose, and clinical progress were compared retrospectively. The median age was 85 years in the HDC group and 84 years in the IV group. Dementia was common in the HDC group, and the two groups did not differ significantly with respect to the cause of death. The duration of infusion was 36.5 (5-107) days in the HDC group and 34.5 (3-158) days in the IV group, with no significant difference between the groups. The infusion dose was 500 (250-700) ml/day in the HDC group and 750 (500-1200) ml/day in the IV group, with the dose being significantly lower in the HDC group. Peripheral edema was evident in 9 cases (37.5%) in the HDC group and 39 cases (57.4%) in the IV group, with no significant difference between the groups. There were no adverse events in either group. Intravenous catheterization was difficult in 10 cases, and consequently, these patients were shifted to HDC. HDC exhibited the same life-prolonging effects and safety as IV in elderly patients at the end of life in the long-term care unit.
The author previously established a molecular tree based on the cDNA-derived primary structures of globins in two giant tortoises, Geochelone nigra and G. gigantea. The divergence time was estimated to be 15-21 million years ago. In the present study, the author reexamined the divergence time of these two species using another source of genetic information--globin-introns--including those from the Chaco tortoise (G. chilensis), a close relative of G. nigra. The previously determined divergence time was supported by the findings of this intron study. However, the inter-relationships based on the intron nucleotide sequences of the globins from the three Geochelone species remain controversial, because it is difficult to determine which of the three is the ancestral species. In addition, the nucleotide sequences reveal the following interesting characteristics: (1) an abnormal GC dinucleotide sequence located at the 5'-splicing site of the second intron of αD globins instead of a consensus GT--this finding is common to all studied Geochelone species; (2) a repeated sequence 5'-GCCCCGCGCCCCGC-3' found only in the first intron of the G. nigra a A globin gene, is a unique feature distinguishing the Galapagos giant tor-toise from the other Geochelone tortoises that have non-repeated GCCCCGC sequences.