Sludge and stone formation in the gallbladder in bedridden elderly patients with cerebrovascular disease: influence of feeding method

Purpose. The incidence of gallbladder sludge or gallstone formation in bedridden patients with cerebrovascular disease (CVD) remains obscure. The aim of this study was to determine the incidence, relationship to feeding method, and mechanisms of gallbladder sludge and gallstone formation in elderly patients with CVD. Methods. Using ultrasonography, we determined the development of gallbladder sludge and gallstone over a 12-month period, the area of the gallbladder, the gallbladder contractile response to cerulein, and fasting levels of plasma cholecystokinin (CCK) in 40 bedridden elderly patients with CVD. The patients were divided into three groups based on the feeding method: oral ingestion (OI), nasogastric feeding (NF), and total parenteral nutrition (TPN). Results. Gallbladder sludge and gallstone were not observed in any of the 14 OI patients, but occurred in 6 and 1 of the 11 NF patients, and in 14 and 3 of the 15 TPN patients, respectively. Fasting gallbladder areas were significantly larger in the TPN group than in the other two groups. The TPN group showed a marked decrease in cerulein-induced gallbladder contractility. Fasting plasma CCK levels were lower in the TPN group than in the OI group. Conclusions. Our results indicate that elderly patients with CVD confined to bed over long periods are not necessarily at risk of gallbladder sludge or gallstone formation, and the development of these features may be associated with the feeding method. The predisposition of CVD patients on TPN to gallbladder disease is probably caused by failure of gallbladder contraction, resulting from insufficient secretion of CCK and impaired sensitivity of the gallbladder to CCK. Received: August 1, 2000 / Accepted: December 1, 2000     

Fluorescence analysis of biochemical constituents identifies atherosclerotic plaque with a thin fibrous cap

Vulnerable plaque generally contains a thin fibrous cap, lipid pools, and reduced internal plaque collagen. Arterial fluorescence analysis can differentiate atherosclerotic lesions from normal arteries; however, the contribution of the lipid core to atherosclerotic arterial fluorescence remains controversial. This study aimed to identify lipid core fluorophores and to differentiate the lipid core from normal artery and atheroma. The helium-cadmium laser-induced fluorescence spectra of cadaveric arteries and known chemical constituents were recorded. Lipid core fluorescence spectra exhibited marked red shifts and broadening compared with the fluorescence spectra of normal tissue and atheroma. Similar fluorescence spectra were obtained for lipid core and oxidized low density lipoprotein, for atheroma and collagen, and for normal artery and elastin. A classification based on collagen, elastin, and oxidized low density lipoprotein spectral decomposition could discriminate the lipid core (n=29), normal artery (n=74), atheroma (n=73), and preatheroma (n=10) with 86% accuracy. Fibrous cap thickness was correlated with the spectral collagen content index (r=0.65, P<0.0001), especially at a thickness of <200 microm. We conclude that a classification algorithm based on chemical spectral decomposition can accurately classify the fluorescence spectra of normal artery, atheroma, and lipid core and may be useful in identifying vulnerable atheroma in vivo.     

Renal disease progression in autosomal dominant polycystic kidney disease

Background

Autosomal dominant polycystic kidney disease is a lifelong progressive disorder. However, how age, blood pressure, and stage of chronic kidney disease (CKD) affect the rate of kidney function deterioration is not clearly understood.

Methods

In this long-term observational case study up to 13.9?years (median observation period for slope was 3.3?years), serum creatinine was serially measured in 255 mostly adult patients. The glomerular filtration rate was estimated (eGFR) using a modified Modification of Diet in Renal Disease Study method. The total kidney volume (TKV) has been measured in 86 patients at one center since 2006.

Results

As age increased, eGFR declined significantly (P?Conclusion The declining rate of eGFR was relatively constant and did not correlate with age or eGFR after adolescence. eGFR was already low in young adult patients with hypertension. As age increased after adolescence, eGFR declined and TKV increased similarly between normal and high blood pressure groups. eGFR starts to decline in patients with normal eGFR, suggesting that the decline starts earlier than previously thought.     

Comparative study of dobutamine stress echocardiography and dual single-photon emission computed tomography (thallium-201 and I-123 BMIPP) for assessing myocardial viability after acute myocardial infarction.

Discordance between the (123)I-labelled 15-iodophenyl-3-R, S-methyl pentadecanoic acid (BMIPP) and (201)Tl findings may indicate myocardial viability (MV). This study compared dobutamine stress echocardiography (DSE) and single-photon emission computed tomography (SPECT) using the dual tracers for assessment of MV and prediction of functional recovery after acute myocardial infarction (AMI). DSE and dual SPECT were studied in 35 patients after AMI, of whom 28 underwent percutaneous coronary intervention in the acute stage. Dual SPECT was performed to compare the defect score of BMIPP and (201)Tl. The left ventricular wall motion score (WMS) was estimated during DSE and 6 months later to assess functional recovery of the infarct area. The rate of agreement of MV between dual SPECT and DSE was 89% (p<0.01), and the sensitivity and specificity of DSE for dual SPECT in MV assessment was 86% and 93%, respectively. The positive and negative predictive values for functional recovery by dual SPECT were 76% and 67%, respectively, and by DSE were 90% and 79%, respectively. Four of 5 patients with positive MV by dual SPECT, but without functional recovery, had residual stenosis of the infarct-related artery. The WMS and defect scores of BMIPP and (201)Tl were significantly smaller in patients with functional recovery than in those without. Assessment of MV using DSE concords with the results of dual SPECT in the early stage of AMI. DSE may have a higher predictive value for long-term functional recovery at the infarct area. However, a finding of positive MV by dual SPECT, without functional recovery, may indicate residual stenosis of the infarct-related artery, although the number of cases was small. Combined assessment by dual SPECT and DSE may be useful for detecting MV and jeopardized myocardium. Furthermore, the results suggest that functional recovery of dysfunctional myocardium may depend on the size of the infarct and risk area.     

Effects of Monatepil, a Novel Calcium Antagonist with α1-Adrenergic Blocking Activity, on the Low-Density Lipoprotein Receptor in Human Skin Fibroblasts

To investigate the mechanisms of the hypolipidemic effect ofmonatepil, a new class of calcium antagonists with₁-adrenergic blocking activity, we examined theeffects of the drug on low-density lipoprotein (LDL) receptor activity andthe level of LDL receptor mRNA present in cultured human skin fibroblasts.At concentrations of 2 × 10^–5M, monatepilincreased the binding (248 ± 43% mean ± SD),internalization (374 ± 18%), and degradation (145 ±2%) of ¹²⁵I-LDL in human skin fibroblasts (n =3, p<0.05). Treatment of human skin fibroblasts with 2 × 10^–5 M of monatepil for 6 hours resulted in an increasein LDL receptor mRNA to 163% of the control level (n = 2), asshown by Northern blot analysis. Our results suggest that the hypolipidemicclinical effects of monatepil may be due to increased LDL receptoractivity.     

Cross-sectional comparisons of caries time trends in nursery school children in Sendai, Japan

Abstract The aim of this study was to clarify the trends in caries experience in the primary dentition of nursery school children in Sendai, Japan, over a period of 20 yr. An annual clinical dental examination of children aged 2–5 yr at 13 nursery schools in Sendai City was carried out in 1972, 1977, 1982, 1987 and 1992. Data obtained from all five surveys were compared in each age group respectively. The percentages of 2-, 3- and 4-yr-olds free from caries increased remarkably until 1977, while that in 5-yr-olds started increasing several years later. After such increments, percentages in all age groups except 3-yr-olds remained almost at the same level with slight fluctuations. The mean deft and deft values per child in 2-, 3- and 4-yr-olds decreased remarkably until 1977, but then remained almost at the same level thereafter. That in 5-yr-olds continued decreasing slightly during the 20-yr period. The marked reduction of caries experience in nursery school children shown during the 1970's did not continue through the 1980's or the beginning of the 1990's.     

Untersuchungen über den Ablauf der Muskelermüdung bei wechselnder Belastung und unter dem Einfluß von Giften und Ionen

Zusammenfassung Es wird die Bedeutung der Methode der Ermüdungskurven mit wechselnder Belastung für das Alles-oder-nichts-Gesetz erörtert und die Methode weiterhin angewandt zur Analyse der Wirkung einiger Pharmaka und Ionen auf den Muskel. Zugleich wird an Hand der Kurven ein Ausdruck für die Dehnbarkeit der Muskeln im kontrahierten und nicht kontrahierten Zustand gewonnen.In Versuchen mit Alkohol verschiedener Konzentration, mit Coffein, Acetylcholin, Natriumrhodanid, Säure, Alkali, Calcium- bzw. Kaliumüberschuß sowie mit calcium- und kaliumfreien Lösungen wurden charakteristische Veränderungen der Ermüdungskurven bei verschiedener Belastung sowie der Dehnbarkeit festgestellt.     

Comparison of serum HER2/neu with immunohistochemical HER2/neu expression for the prediction of biochemical progression in metastatic prostate cancer

Objectives:   To examine whether pretreatment serum human epidermal growth factor receptor 2 (HER2/neu) and immunohistochemical HER2/neu expression predict biochemical recurrence-free survival in advanced prostate cancer.
Methods:   We studied 75 untreated patients with metastatic prostate cancer and compared them to a control group of 97 patients without histologically diagnosed prostate cancer. Serum samples were collected for HER2/neu protein analysis before the patients started endocrine therapy. HER2/neu expression in the prostate tissue was evaluated using immunohistochemical analysis.
Results:   Serum concentration of HER2/neu in patients with prostate cancer was significantly higher than in those without cancer ( P  = 0.005). Based on the median HER2/neu value, a cut-off level of 12.5 ng/mL was established to separate low from high serum HER2/neu levels. The biochemical recurrence-free survival rate was significantly lower in patients with a high serum HER2 level ( P  < 0.001). HER2/neu overexpression was found in 18 patients (24%) by immunohistochemical analysis. Biochemical recurrence-free survival rates did not show a statistically significant difference between HER2/neu positive and negative groups. Multivariate analysis showed that the pretreatment serum HER2/neu value was an independent predictor of biochemical recurrence ( P  = 0.02).
Conclusions:   Pretreatment serum HER2/neu may represent a more valuable tool than immunohistochemical HER2/neu expression for the prediction of biochemical recurrence in metastatic prostate cancer patients.     

A total correction for tetralogy of fallot without the use of homologous blood

In 22 consecutive patients with tetralogy of Fallot (TF), a total correction was attempted without the use of a homologous blood transfusion from September 1995 to March 1997. The 22 patients were divided into two groups according to their surgical procedures; namely, either a simple correction (group I: n = 14) or a complex correction including the relief of peripheral pulmonary stenosis and/or the division of a previous systemic-pulmonary shunt (group II: n = 8). In 77% of all patients, surgery was performed without a homologous blood transfusion. No differences were found in the non-transfusion rate and the hematocrit (Ht) values between the two groups and, as a result, we thus confirm that this additional procedure is not a risk factor for surgery without a homologous blood transfusion. According to the correlation of the red blood cell volume before and after surgery, the preoperative Ht value corresponding to the postoperative Ht of 30% could be accurately predicted. The calculated Ht values were 41.0% in the patient weighing 15 kg, 42.5% in those weighing 10 kg, and 46.9% in those weighing 5 kg. These data suggest that a surgical correction without a homologous blood transfusion can therefore be safely performed in almost all patients with TF.