HANEDA, K., TOGO, T., SATO, N., OGATA, H. and MOHRI, H. Late Results afterRepair of Complete Atrioventricular Canal. Tohoku J. Exp. Med., 1992, 166 (2), 201-208-Twenty-five patients with complete atrioventricular canal including 10 Down's syndrome patients repaired since 1972 were analyzed with respect to their physical activities, hemodynamics, ECG, reoperation and late mortality. Follow-up period ranged from 1 to 17 years with an average of 7.0 years. There was 1 late death. Actuarial survival rate was 0.86±0.13 (mean±S.D.) at 12 years. Fourteen patients (70%) of 20 evaluated were in New York Heart Association functional class I, and 4 (20%) were in class II and 2 (10%) in class III. In 23 patients without pulmonary stenosis, preoperative values of peak pulmonary to systemic pressure ratio (Pp/Ps) and pulmonary to systemic arterial resistance ratio (Rp/Rs) were 0.64±0.28 and 0.36±0.31, respectively. Postoperative Pp/Ps and Rp/Rs significantly decreased to 0.37±0.14 and to 0.20±0.14, respectively. In Down patients, postoperative Pp/Ps, Rp/Rs and pulmonary arterial resistance were significantly greater than in non-Down patients (0.50±0.07 vs. 0.25±0.05, 0.30±0.13 vs. 0.10±0.03 and 4.4±1.8 vs. 1.8±0.6 units•m2, respectively). Complete heart block developed in 1 patient postoperatively. Sick sinus syndrome was observed in 3 patients, transient Mobitz II A-V block in 2, ventricular premature contractions of Lown's Grade II in 1 and atrial fibrillation in 1. Five patients demonstrated severe mitral regurgitation equal to or more than Grade III and 2 of them underwent mitral valve replacement 6 months and 12 years after the initial operation. Most of the patients were leading in active school or social lives. However, progression of pulmonary vascular obstructive disease especially in Down's syndrome patients, mitral regurgitation and heart rhythm disturbances still create late postoperative problems.
UKIMURA, O., KOJIMA, M., ITOH, H., HOSOI, S. and WATANABE, H. Effects ofIntravesically Administered Verapamil HCl (Calcium Entry Blocker) on theBladder Function in Unanesthetized Rats. Tohoku J. Exp. Med., 1992, 166 (2), 209-215-The effects of intravesically administered verapamil HCl (calcium entry blocker) on the bladder function were investigated using an experimental model for unanesthetized rats. Intravesical verapamil HCl caused a marked suppression of maximum intravesical pressure accompanied by an increase of residual urine in a dose-dependent manner. The effect almost disappeared 90min after the elimination of verapamil HCl. It is tentatively suggested that the intravesical instillation of verapamil HCl could be a potent therapy for disorders of bladder function, such as uninhibited contraction.
MUNAKATA, M., IMAI, Y., HASHIMOTO, J., SAKUMA, H., SEKINO, H., ABE, K. and YOSHINAGA, K. The Influence of Antihypertensive Agents on CircadianRhythms of Blood Pressure and Heart Rate in Patients with Essential Hypertension. Tohoku J. Exp. Med., 1992, 166 (2), 217-227-The effects of once-daily administration of calcium (Ca) channel blockers, β-blockers and angiotensin-converting enzyme (ACE) inhibitors on circadian rhythms of blood pressure (BP) and heart rate (HR) were studied using the cosinor method. Sixty-two recruited patients with essential hypertension (WHO stage I or II) were divided into three groups based on the class of administered drugs. In the Ca channel blocker group (n=37, age 54±9.0 years), 18 patients were given YM 730 at a mean dose of 11± 4.0mg/day (mean±S.D.), 8 were given nitrendipine (11±6.7mg/day), and 11 were given nisoldipine (8±6.4mg/day). In the β-blocker group (n=15, age 42±13.5 years), 13 patients were given atenolol (44±11.0mg/day), 1 was given nadolol (30 mg/day), and 1 was given sustained-release propranolol (60mg/day). In the ACE inhibitor group (n=10, age 56±8.7 years), 7 patients were given enalapril (6±2.8 mg/day), and 3 were given lisinopril (20mg/day). Ambulatory BP monitoring (ABPM) was performed before and during treatment. Mean arterial pressure (MAP) and HR were monitored under ambulatory conditions every five minutes for 24hr with a finger volume oscillometric device. In all three groups, the mesor of MAP decreased significantly, while the amplitude and acrophase did not change during treatment. β-Blockers reduced the amplitude as well as the mesor of HR. Ca channel blockers increased the amplitude of HR without influencing the mesor. ACE inhibitors had no effect on the circadian rhythm parameters of HR. These results suggest that Ca channel blockers, β-blockers and ACE inhibitors lowered BP throughout the day without changing the circadian BP rhythm. However, the three drug classes may have different influences on the autonomic nervous system that regulates circadian cardiac rhythm.
SAITO, H., KANAYAMA, S. and TAKAHASHI, T. Right Angular Lesion andSelective Impairment of Motion Vision in Left Visual Field. Tohoku J. Exp. Med. 1992, 166 (2), 229-238-A 45-year-old right-handed man had, for more than 20 years, a depressed fracture of the right parietal bone and selective impairment of movement vision in the left visual field; an illusory overestimation of speed of moving objects and extreme sensitivity to moving stimuli. Visuo-spatial perceptions of immobile objects, and other visual functions were normal apart from slightly decreased stereoacuity. The extent of depressed fracture corresponded approximately to the right angular gyrus. Carbamazepine or phenytoin did not alter the symptoms. After the operation, his symptoms were restricted to peripheral parts of the left visual field, with transient overestimation of speed of moving objects in the right hemifield. It was suggested that the human angular gyri may be involved in the central mechanisms of movement perception, and shift of visual attention or gaze to moving stimuli in contralateral visual field, especially in its peripheral part.
INOMATA, N. Effects of Ethyl 4-Chloro-2-Methylphenoxyacetate on Bile Compositionin Golden Hamsters. Tohoku J. Exp. Med., 1992, 166 (2), 239-249-The effects of ethyl 4-chloro-2-methylphenoxyacetate (MCPA) on the cholesterol levels in the liver, serum and gallbladder bile, the composition of both biliary lipids and bile acids, and the hepatic enzyme activities relating to the bile acid formation were investigated in male golden hamsters. MCPA was administered orally to the animals at the doses of 200, 500 and 1, 000mg/kg/day for 2 weeks. Clofibrate (500mg/kg/day) was also tested for comparison, because of its similarity to MCPA in chemical structure and pharmacological actions. Body weight gain was slightly decreased, but liver to body weight ratio was increased in the MCPA groups of 500 and 1, 000mg/kg and also in the clofibrate group. In these groups, the cholesterol level in the liver was decreased but that in bile was increased. The composition of biliary bile acids was also changed in both the MCPA groups (500 and 1, 000mg/kg) and the clofibrate group, but in a different manner; the levels and proportions of secondary bile acids were increased in the MCPA groups, while those of cholic acid and deoxycholic acid were decreased in the clofibrate group. These results indicate that MCPA and clofibrate may affect cholesterol catabolism differently, although these two compounds contain the same chlorinated phenoxy acid moiety. The increased level of cholesterol in bile might lead to the formation of cholesterol gallstone, which is frequently found in patients with gallbladder cancer. It is inferred that exposure to MCPA could be a risk factor for gallbladder cancer, which was initiated with some chemical carcinogens, because it increased the levels and proportions of both cholesterol and secondary bile acids in bile.
SUZUKI, T., YAMANAKA, H., TAMURA, Y., NAKAJIMA, K., KANATANI, K., KIMURA, M. and OTAKI, N. Metallothionein of Prostatic Tissues and Fluids inRats and Humans. Tohoku J. Exp. Med., 1992, 166 (2), 251-257-We analyzed metallothionein (MT) in rat prostates by gel filtration and radioimmunoassay. The concentration of MT in the prostate, kidney and liver of cadmiuminduced rats was measured. The concentration of MT was also measured in normal prostate, benign prostatic hyperplasia, prostate cancer and the prostatic fluids from various prostatic diseases in humans. MT was detected in rat prostates by gel filtration and radioimmunoassay. The concentration of MT (μg/g wet tissue) was 0.3+0.1 (s.D.) in the ventral lobe, 30.4+24.0 in the lateral lobe, 5.2+0.9 in the dorsal lobe, 25.0±6.4 in the kidney and 2.0±1.5 in the liver of the rat control group. Change in MT content in CdCl2-induced organs increased quantitatively with the dose administered. The concentration of MT (μg/g wet tissue) in human prostate was 99.3±121.8 in the peripheral zone (PZ), 12.0±8.5 in the preprostatic region (PR), 7.3±3.1 in the central zone (CZ), 17.5±15.0 in benign hyperplastic nodules (A) and 4.2±0.5 in cancer tissue (CA). MT concentratiton in PZ was very high and that of CA, low (p<0.05). MT concentration in prostatic fluids (ng/mg protein) was 11.5±5.7 in normal patients, 3.8±2.3 in acute prostatitis, 6.5±3.7 in chronic prostatitis with pyuria, 39.6±3.9 in chronic prostatitis without pyuria and 16.9±3.0 in benign prostatic hyperplasia. We concluded that MT in the prostate is induced by heavy metals and secreted into prostatic fluid. Possibly, it is a marker of secretory function in the prostate.
MIZOI, K., YOSHIMOTO, T. and SUZUKI, J. Clinical Analysis of Ten Caseswith Surgically Treated Brain Stem Cavernous Angiomas. Tohoku J. Exp. Med., 1992, 166 (2), 259-267-Ten cases of surgically treated brain stem cavernous angiomas are reported in this paper, and their clinical and radiological features are reported. There were 9 males and 1 female with ages ranging from 9 to 69 years (average 36 years). Four of the cavernous angiomas were located in the dorsal pons, two in the middle cerebellar peduncle, two in the hypothalamus, and one each in the cerebral peduncle and the superior colliculus. All the ten patients came to medical attention because of the sudden onset of neurological abnormalities following brain stem hemorrhage. Six of the 10 patients showed neurological deterioration due to rebleeding at various intervals ranging from 10 days to 2 years. After intravenous injection of iodinated contrast materials, negative contrast enhancement was commonly seen. In a few cases, there was faint enhancement of the nodule at the periphery of the hematoma. Serial computed tomography (CT) scans over a period revealed an unchanged hyperdense mass lesion, which was thought to be a most characteristic and indicative CT feature of the cavernous angioma. On magnetic rersonance imaging (MRI), the combination of a mixed signal intensity with a surrounding rim of decreased signal intensity (hemosiderin rim) suggested the presence of a cavernous angioma. Enhanced MRI, using gadopentate dimeglumine, was thought to be more sensitive than contrast enhanced CT in detecting cavernous angiomas. All these cases underwent surgery with good results. Abnormal vascular tissue in the wall of the hematoma cavity was recognized at operation and pathological confirmation was obtained in all cases. These data indicate that brain stem cavernous angiomas can be surgically removed with acceptable morbidity.