Treatment for inpatients with anorexia nervosa: Comparison of liquid formula with regular meals for improvement from emaciation

Abstract A new refeeding program using only liquid formula was given to six anorexic inpatients (LF group) at the initial stage of hospitalization. These patients were compared with six other inpatients who regular meals (RM group). The LF group did not develop a phobia of gaining weight, while the RM group showed a vicious cycle of gastrointestinal discomforts leading to fat phobia and stagnation in weight gain. By comparison, the LF group had fewer gastrointestinal symptoms, which resulted in the disruption of this cycle and seemed to help motivate these patients to obtain a steady gain in bodyweight.     

A new method for measuring nocturnal tooth contacts

A new portable system for measuring nocturnal tooth contacts has been devised. This system was suitable for patients to take home and record tooth contacts by themselves. A micro photo sensor using optical fibres was applied to detect tooth contacts. The sensor and the target were accurately fixed to opposed molars, respectively on the same side, with removable metal attachments. Patients were instructed to set the attachment to their tooth each experimental night. In the present study, data was assembled for four or five nights in three subjects who were free of masticatory pain and dysfunction. Each subject showed an individual tooth contact pattern. It is suggested that this new system is useful and convenient for measuring nocturnal tooth contacts.     

Lipid risk factors for atherosclerotic carotid artery disease in patients on continuous ambulatory peritoneal dialysis

SUMMARY: We investigated the relationship between abnormalities of lipid metabolism and carotid atherosclerosis in 20 patients on continuous ambulatory peritoneal dialysis (11 men and nine women). Carotid ultrasonography was used to determine the combined thickness of the intima and media (I-M thickness). the apo A-I/apo B ratio showed a significant negative correlation with I-M thickness ( P <0.05). In the patients with carotid plaque, the triglycerides (TG) level and the remnant-like particle cholesterol level (RLP-C) were significantly higher than in the patients without plaque ( P <0.05), and high density lipoprotein (HDL) cholesterol and the apo AI/apo B ratio were significantly lower than in the patients without plaque ( P <0.05). Moreover, there was a strong relationship between the severity of plaque and TG, the apo AI/apo B ratio, and RLP-C. Thus, abnormal lipid metabolism may contribute to progressive atherosclerosis, while TG, the apo AI/apo B ratio, and RLP-C. levels may be useful indicators of atherosclerotic risk in peritoneal dialysis patients.     

The Physiological and Biological Significances of Human Atrial Natriuretic Peptide in Neonates

ABSTRACT. The purpose of our study was to analyze the physiological and biological significances of the high human atrial natriuretic peptide (hANP) levels during early post-natal period. The absolute values or changes of plasma hANP concentrations did not correlate with the absolute values or changes of body weight, blood pressure, urinary sodium/creatinine and urinary aldosterone/creatinine ratios. Gel permeation chromatography of samples from two neonates revealed the presence of two molecular forms of hANP, α and β, both in the plasma and urine. In the plasma, the β-hANP was predominant on the 3rd day of life and the α-hANP on the 6th day of life. The change from one form to another was independent of the absolute value of hANP. We obtained no evidence suggestive of a physiological role of the high plasma hANP concentration during the early post-natal period. However, because of biological differences between these two fractions, their distribution must be taken into account when attempting to interpret the high hANP values observed in neonates.     

OUTCOME OF PATIENTS WITH GRAVES' DISEASE AFTER LONG-TERM MEDICAL TREATMENT GUIDED BY TRIIODOTHYRONINE (T3) SUPPRESSION TEST

The value of the T3 suppressed 20-min uptake test for the prediction of post-treatment outcome was studied in 193 unselected patients with GRAVES' disease treated with thionamide drugs and T3. One hundred and twenty-nine of 193 patients were studied previously and followed thereafter (Group A). Sixty-four were newly treated patients: thirty-three (Group B) were treated at the same hospital as Group A; thirty-one (Group C) were treated at another hospital. In total, 126 patients out of 193 satisfied our criteria for suppression (total suppression rate, 65%). The suppression rate for new patients (55% in Group B, 52% in Group C) was similar to that for Group A in 1977 (49%) after comparable duration of treatment. The suppression rate for Group A increased with prolongation of the treatment period (49% in 1977 and 71% in 1981). As to the time course of suppression, it was observed that about two-thirds of the suppressed patients satisfied the criteria for suppression within 3 years of starting treatment. The number of suppressed patients per year decreased thereafter as the treatment periods increased. However, the yearly suppression rate did not decrease with time. The time course of suppression in each patient could not be predicted from the results of initial thyroid function tests. The overall remission rate among the 120 suppressed patients followed for 1–13 (mean, 4) years was 96%, which was almost equal to the value obtained in Group A in 1977 (95%) with the average follow-up period of 2 years. Among the 46 patients in Group A followed for 5–13 (mean, 7) years, no increase in relapse was observed with prolonged follow-up periods. Examination on the relationship between the duration of treatment and the post-treatment outcome     

Simulated Reye's Syndrome and Salicylate Therapy

A 4-year-old girl with juvenile rheumatoid arthritis developed fever, protracted vomiting, disturbance of consciousness and decorticate posture following the administration of salicylate. There were elevated levels of transaminases in serum, hyperammonemia and a fatty liver. However, the fatty droplets were different electronmicroscopically from that of Reye's syndrome. This observation emphasizes the importance of electronmicroscopic observation of the liver in the differential diagnosis between Reye's syndrome and aspirin-induced encephalopathy, because the clinico-pathological findings of intoxication are so similar.     

Left Atrial Catheter Ablation Promotes Vasoconstriction of the Right Coronary Artery

Background: Multiple cardiac ganglia are present in the left atrial (LA) region, and marked changes in autonomic nervous activity can occur after left atrial catheter ablation (CA) for atrial fibrillation (AF). Vasospastic angina involving the inferior wall of the left ventricle has been reported as a complication shortly after LACA.
Methods: We studied 20 patients with drug-refractory AF who underwent LACA, performed to encircle the left- and right-sided pulmonary veins, 1 to 2 cm from their ostia under fluoroscopic guidance. Quantitative coronary angiography was performed before and after LACA, and we analyzed the minimal lesion diameter (MLD) of the proximal segment of the coronary arteries, and the basal tone, the baseline percent constriction versus maximal dilation after nitroglycerin administration.
Results: No significant difference was observed in MLD or basal tone of the left coronary arteries after LACA. However, in the right coronary artery (RCA), the basal MLD was smaller (P < 0.01) and the basal tone was greater (P< 0.05) after than before LACA. No correlation was found between the baseline MLD or tone of the RCA and total amount of radiofrequency energy delivered or procedure duration. In 75% of RCA, the baseline MLD was smaller after than before LACA, which was significantly higher (P < 0.01) than observed in the left coronary arteries (38%).
Conclusion: Vasoconstriction was promoted in the RCA shortly after LACA, which may explain the variant angina reported after LACA.     

Disturbed blood flow induces erosive injury to smooth muscle cell‐rich neointima and promotes thrombus formation in rabbit femoral arteries

Summary. Background: Plaque erosion is a cause of atherothrombosis that preferentially occurs on smooth muscle cell (SMC)‐ and proteoglycan‐rich rather than lipid‐rich plaques. However, its underlying mechanisms remain unknown. Objective: To determine whether disturbed blood flow induces erosive injury and thrombus formation on SMC‐rich neointima. Methods: Three weeks after balloon injury, SMC‐rich neointima with increased tissue factor (TF) activity developed in rabbit femoral arteries that were narrowed with a vascular occluder to disturb blood flow after stenosis. Neointimal injury and thrombus formation were assessed at 15, 30, and 180 min after the vascular narrowing. Results: Endothelial detachment, platelet adhesion and neointimal cell apoptosis became evident at the post‐stenotic regions of all femoral arteries (n = 5) within 15 min of narrowing. Mural thrombi composed of platelet and fibrin developed after 30 min, and then occlusive thrombi were generated in three out of five vessels after 180 min. The identical vascular narrowing of normal femoral arteries also induced endothelial detachment with small platelet thrombi at post‐stenotic regions, but fibrin and occlusive thrombi did not develop. Computational simulation analysis indicated that oscillatory shear stress contributes to the development of erosive damage to the neointima. Conclusions: These results suggest that disturbed post‐stenotic blood flow can induce erosive injury in SMC‐rich plaques and promote thrombus formation that results in vascular events.