Glomerular thrombosis in spontaneously hypertensive rat. II. Immunofluorescence microscopy. III. Effect of heparin.

This study describes immunofluorescence microscopy (IFM) of kidneys of untreated (or saline-treated) spontaneously hypertensive rats (SHR) and compares the findings with those in age-matched, untreated normotensive Wistar Kyoto rats (WKY), and heparin treated (150 units aqueous heparin subcutaneously twice daily for 30 days) SHR. The rats varied in age from 30 to 112 weeks (before treatment) and were divided into young (< 52 weeks) and old (? 52 weeks) groups. Separate sections from the kidneys of all rats were stained with fluorescein-isothiocyanate-conjugated rabbit antisera against rat γ-G (IgG, IgM, and IgA), IgG, fibrinogen (Fib), third component of complement (C₃), and albumin. The kidneys were evaluated also by light microscopy (LM) in all of the rats and by electron microscopy (EM) in half of the rats. A semiquantitative assessment of IFM findings on a 0 to 4+ scale and scoring of LM findings on a 0 to 39 scale were made. The glomerular lesions were more striking and uniform than the arterial vascular lesions in old SHR. The glomeruli of old SHR (av: 93 weeks) were positive for all the fluorescence materials except albumin. Fib was most marked (3+ to 4+) involving 50 to 75% of the glomeruli in 75% untreated (or saline treated) old SHR. Thrombi were found in the glomeruli also by LM and EM (large amounts of fibrin and platelet aggregates). The arterial vessels were unimpressive by IFM with the exception of those with arteritis in which 3+ to 4+ Fib was found. These findings in untreated (or saline treated) old SHR contrast with the inconspicuous LM, EM, and IFM findings in young SHR and WKY of all ages. Heparin-treated old SHR had significant (P < 0.05) decreases of glomerular fibrinogen (IFM), percentage glomeruli with thrombi (LM), and absence of fibrin and platelet aggregates in the glomeruli studied by EM. In these old SHR, the mean arterial pressure (MAP) was significantly (P < 0.05) lower than the MAP in untreated old SHR. Thus, this study indicates that glomerular thrombosis is a significant renal lesion in old SHR and heparin can alter the glomerular thrombosis and arterial blood pressure. Further study, however, would be necessary to elucidate the mechanisms of the above beneficial effects of heparin.     

淡色库蚊和致倦库蚊对广东株班氏丝虫易感性的研究

本文用南京株和合肥株淡色库蚊以及广东株致倦库分别人工感染广东株周期型班氏丝虫，并对其易感性进行比较，用一名微丝蚴密度为２４条／６０μｌ的班氏丝虫微丝蚴血症者血液感染南京株淡色库蚊３３４只，合肥株淡色库蚊１３９只和致倦库蚊２４１只，Ｌ３阳性率分别为１２．５７％、．５．７６％和５．８０％。     

Primary aldosteronism. A study in contrasts.

Two patient with primary aldosteronism, one with a solitary adrenal adenoma and the other with bilateral nodular hyperplasia, are described. Both patients showed the classic features of primary aldosteronism in electrolyte and hormone patterns, but there were important differences in the biochemistry of their excised adrenal tissue. In addition, the injection of plasma from the patient with bilateral adrenal hyperplasia into the sheep's transplanted adrenal gland elicited a definite aldosterone secretory response, but there was no aldosterone response to the injection of plasma from the patient with a solitary adrenal adenoma. The findings support the hypothesis that an extra-adrenal stimulus may contribute to the pathogenesis of bilateral adrenal hyperplasia.     

甲,乙,丙型肝炎病毒重叠感染

４９３名健康献血员和１９２例ＨＢＶ感染者，用ＥＬＩＳＡ法检测抗－ＨＡＶ－ＩｇＭ和抗一ＨＣＶ，发现献血员之ＨＣＶ感染率为１．６２％。ＨＢＶ感染者的ＨＡＶ、ＨＢＶ二重感染率为１６．７％，ＨＢＶ、ＨＣＶ二重感染率为３．１３％，ＨＡＶ、ＨＢＶ、ＨＣＶ三重感染率为０．５２％。重叠感染者，３２例ＨＡＶ和ＨＢＶ二重感染者，ＨＢｅＡｇ２８例转阴，与１５３例单纯ＨＢＶ感染者５７例转阴比较，有显著性差异（ｐ〈０．０５     

Improved coronary vasodilatatory capacity by H.E.L.P. apheresis: comparing initial and chronic treatment

Hypercholesterolemia impairs endothelial function and subsequently decreases coronary vasodilatatory capacity. We examined the quantitative effects of one single LDL apheresis on vasodilatatory capacity. Using N-13 ammonia as a tracer for dynamic quantitative positron emission tomography (PET), mean myocardial perfusion measurements were carried out before and 20 h later after LDL apheresis, both under resting conditions and after pharmacological vasodilatation with dipyridamole. LDL apheresis was carried out using the heparin induced extracorporeal LDL precipitation (H.E.L.P.) procedure. We examined 47 patients (12 women and 35 men), with angiographically-proven coronary artery disease. All of them suffered from hypercholesterolemia. Of the patients, 35 received a chronic weekly H.E.L.P. procedure (group A), while H.E.L.P. procedure treatment was started for the first time in 12 patients, who were subsequently enrolled in a chronic apheresis program (group B). H.E.L.P. apheresis was combined with cholesterol lowering drugs in all patients. Both groups underwent positron emission tomography twice (prior to LDL apheresis and 20 h later). In group A, LDL cholesterol levels decreased from 175 +/- 50 mg/dL to 60 +/- 21 mg/dL immediately after H.E.L.P. (77 +/- 25 mg/dL before the second PET). Corresponding values for fibrinogen levels were 287 +/- 75 mg/dL to 102 +/- 29 mg/dL (155 +/- 52 mg/dL), minimal coronary resistance dropped from 0.56 +/- 0.20 to 0.44 +/- 0.17 mm Hg x 100 g x min/mL (P < 0.0001). Plasma viscosity decreased by 7.8%. In group B, LDL cholesterol decreased from 187 +/- 45 mg/dL to 75 +/- 27 mg/dL (85 +/- 29 mg/dL) and fibrinogen from 348 +/- 65 mg/dL to 126 +/- 38 mg/dL (168 +/- 45 mg/dL). Minimal coronary resistance was reduced from 0.61 +/- 0.23 to 0.53 +/- 0.19 mm Hg x 100 g x min/mL (P < 0.01). Plasma viscosity was observed to decrease by 7.6%. The strong LDL drop in patients under chronic H.E.L.P. treatment has a significant impact on coronary vasodilatatory capacity within 20 h leading to an improved overall cardiac perfusion. Nearly the same effect can be seen in patients after their first H.E.L.P. treatment.     

Staphylococcus aureus bacteremia. Current clinical patterns.

One hundred and five cases of bacteremia due to Staphylococcus aureus were reviewed to assess the current clinical spectrum of serious staphylococcal disease. Mortality was 21 percent, lower than previously reported. Patients could be separated into two groups according to the presence of identifiable primary staphylococcal infections; 63 bacteremic patients had such lesions, the remaining 42 lacked them. The latter group contained 24 of 26 cases of endocarditis. Illnesses in that group were marked by the presence (in 38 of 42 patients) of staphylococcal foci occurring secondary to bacteremia. Such foci were responsible for five of seven instances of relapse or treatment failure encountered in that group. Secondary staphylococcal foci occurred in only five of 63 patients with primary infections, and the response of this group to conventional therapy for bacteremia was satisfactory. This study suggests that endocarditis has become an unusual complication of identifiable primary staphylococcal infection. A clinical classification based on the presence of such lesions therefore separates bacteremic patients likely to be cured by conventional antibiotic therapy (those with primary infections but no secondary foci) from others (those with secondary foci, suggesting endocarditis) who should receive a more prolonged course of antibiotics.     

白花丹参对自发性高血压大鼠心肌病变的影响

目的观察长期应用白花丹参水提物对自发性高血压大鼠心肌病变的影响及其机制。方法24只12周龄SHR大鼠随机分为3组：SHR组、白花丹参高剂量组（SMH）和白花丹参低剂量组（SML）。以WKY大鼠为阴性对照。灌胃给药12周后,记录24h清醒动脉血压、左心室重量指数（LVMI）,测血浆中一氧化氮合酶（cNOS）、一氧化氮（NO）、内皮素（ET）,左心室组织切片用HE和VanGieson染色,全自动图像分析系统进行分析．结果与WKY大鼠相比较,SHR组的血压、LVMI、心肌细胞直径（TDM）、心肌细胞面积（CA）、心肌组织胶原体积比例（CVF）和心肌血管周围胶原面积与管腔面积的比例（PVCA）显著升高[（190±19）／（143±11）mmHg、（4．71±0．54）mg／g、（32．35±5．87）μm、（560．53±90．62）μm^2,（8．13±0．71）％和（6．01±0．22）％],血浆ET水平显著升高,cNOS、NO、超氧化物歧化酶（SOD）均显著降低[（289．39±26．38）ng／ml、（54．41±6．25）μmol／L、（5．509±0．054）U／ml、（90．05±10．27）U／m1]。而白花丹参组,除收缩压外,各指标与SHR组比较差异均有统计学意义（P〈0．05）。结论白花丹参具有抑制自发性高血压大鼠心肌病变的作用。其机制可能与改善ET—NO系统和改善内皮功能障碍有关。     

Current therapy of hypertension. A pharmacologic approach.

Adequate treatment of hypertension requires that the physician understand the pharmacologic actions of antihypertensive agents. Although no drug is without adverse reactions, it should be possible to choose an agent or combination of agents which can effectively lower blood pressure and be tolerated by the patient. The indications, proposed mechanisms of actions and adverse effects of the following antihypertensive drugs are discussed: thiazide diuretics, spironolactone, triamterene, trimethaphan, Rauwolfia alkaloids. guanethidine, bethanidine, methyldopa, clonidine, pargyline, propranolol, hydrazaline, minoxidil, guancydine, diazoxide and sodium nitroprusside.     

Current concepts on physiological control of gastric acid secretion. Clinical applications.

Gastric acid secretion by the parietal cell is a single digestive process involving a continuous interplay between nervous and hormonal stimuli. Gastric acid hypersecretion and hypergastrinemia may represent pathologic disturbance of the normal "gastric phase" of acid secretion (excluded antrum syndrome) or abnormal gastrin secretion from a nongastric source as in the Zollinger-Ellison syndrome. Diagnosis of these two syndromes preoperatively is dependent on immunoassay for serum gastrin. A fall in serum gastrin level after the injection of secretin will distinguish the excluded antrum syndrome from the Zollinger-Ellison syndrome. Which hormone or hormones cause the acid hyposecretion of the watery diarrhea hypokalemia achlorhydria syndrome is still uncertain. Potential candidates include secretin, glucagon (alone or combined with gastrin), vasoactive intestinal peptide and gastric inhibitory polypeptide. Secretin has undergone trials as therapy in peptic ulcer whereas glucagon is under investigation for the treatment of acute pancreatitis because of its dual actions as (1) an enterogastrone and (2) an inhibitor of pancreatic secretion.     

Human plasma triglyceride labeling after high sucrose feeding. II. Study on triglyceride kinetics and postheparin lipolytic activity.

Kinetic studies of the very-low-density lipoprotein triglycerides (VLDL-TG) turnover by endogenous labeling with glycerol-2-3-H were performed in 13 patients in the postabsorptive state, first after 10-14 days on a low-sucrose high-starch diet, then again after 10-14 days of isocaloric high-sucrose low-starch diet (HSD). After HSD, a significant decrease in the fractional turnover rates of VLDL-TG was observed, as well as a modest but significant increase in its pool size, but the net turnover rates remained unchanged. Using Michaelis-Menten formulation, we have further calculated the Vmax and Km's of the removal system for VLDL-TG and found that the Vmax and Km's do not differ significantly between the two dietary periods. These results suggest that the removal mechanism for VLDL-TG has not changed after 10-14 days on the HSD, at least when the patients are studied in the postabsorptive state. Measurements of postheparin lipolytic acitivty under fed condition in 17 patients (including the 13 patients above) have shown a decrease after HSD. However, a defect in the removal of plasma-TG related to decreased activity of tissue-lipoprotein lipase in the fed state has not been conclusively uncovered by the kinetic studies performed in the postabsorptive state, and cannot contribute significantly to the expansion of VLDL-TG pool.     

The orthogonal electrocardiogram in normal women. Implications of sex differences in diagnostic electrocariodgraphy.

Normal limits of the orthogonal electrocardiogram and vectorcardiogram in adult women, ranging in age from 18 to 90 years, are presented. A comparison of results is made with those of normal age-matched men, and sex differences are analyzed from a total of 960 normal records (510 men and 450 women). For the majority of scalar and vectorial items, significant sex differences were found which in women included shorter QRS duration, smaller vector loops, and decreased P, Q, R, S, and T deflections. The upper normal limits of R_x, R_y, and R_z amplitudes were 11 per cent, 20 per cent, and 30 per cent less, respectively, in women than in men.The sensitivity and specificity of electrocardiographic criteria, for high and low voltage, were significantly affected by these sex differences in amplitudes. For example, as a discriminator between normals and subjects with left ventricular hypertrophy, the upper normal limit of R_x + R_z amplitude sum was 3.10 millivolts in men but 2.50 millivolts in women. Hence, the use of the limit derived from males in a female population would decrease its sensitivity drasticially. Similar discrepancies existed in the sensitivity and specificity of electrocardiographic criteria for low voltage. Since the lower normal limit of R_x amplitude was 0.51 millivolt in men but only 0.35 millivolt in women, a substantial number of normal women would be misclassified as having right ventricular hypertrophy or chronic obstructive pulmonary disease if the limit derived from males was used as a criterion.The absence of Q waves in Leads x and y was a common finding in each age and sex group and carries no diagnostic significance. While initial anterior QRS forces in Lead z were present in all normal men, they were smaller and even absent in 1 per cent of normal women. Hence, greater difficulties in electrocardiographic diagnosis of anteroseptal myocardial infarction in women may be encountered.Mean vectors at the end of QRS (point J) and early part of the ST segment were more inferiorly and anteriorly directed in men than in women. T waves in Lead z were always negative in men, but flat or positive T waves were observed in some of the normal women. Sex differences in the level of point J and the ST segment may have important bearings on the interpretation of exercise electrocardiograms.The shorter QRS duration in women signified the importance of sex-specific limits for ventricular conduction delays.     

Brucella canis. A cause of undulant fever.

Brucella canis, recognized in 1967 as a cause of canine abortion, is an uncommonly recognized human pathogen. Our patient, a 48 year old man, probably acquired his infection by contact with an infected dog. His clinical course was characterized by intermittent fever and bacteremia over a 4 month interval. His course, which expands the clinical spectrum of human infections due to Br. canis, is discussed in the context of the other reported instances of community and laboratory acquired cases.     

Echocardiography.

We have discussed the evolution of selected areas of echocardiography in an attempt to illustrate the capabilities and limitations of this method of study. As information has accumulated, some concepts of the specificity of certain echocardiographic patterns have had to be revised. Awareness of the potential for false positive and false negative results has increased rather than decreased the usefulness of the echo method. Equipment deficiencies which existed in past years have largely been corrected, thereby reducing the likelihood of repeating some of the earlier mistakes. Two years ago, we suggested that more patients with left ventricular disease should be studied, the results from different laboratories should be compared, a large number of patients with congenital disease should be evaluated, and the limitations of the technic be more precisely defined. Obviously much has been accomplished in all of these areas. Much more can be done. There is every reason to believe that the next few years will bring many new and important developments in diagnostic echocardiography.     

Immunodeficiency, malabsorption and secretory diarrhea. A new syndrome.

Described here is a patient with severe watery diarrhea associated with common variable immunodeficiency. Malabsorption for fat, bile acids, vitamin B12 and xylose was demonstrated, but the patient failed to respond to all the usual therapeutic maneuvers. The diarrhea responded only to high dose steroid therapy. Intestinal perfusion studies showed a hitherto undescribed, presumably acquired, glucose-stimulated water, sodium and chloride secretion in the jejunum and ileum, whereas normal fluid and electrolyte transport occurred from bicarbonate and mannitol solutions. Glucose absorption itself was normal and no hormonal, morphologic or biochemical defect was demonstrated to account for the phenomenon. The patient was also interesting when compared with other patients with common variable immunodeficiency in having normal plasma cells in the intestinal mucosa and an extensive family involvement.