Factors related to impairment of activities of daily living.

OBJECTIVE: We examined the factors related to the impairment of activities of daily living (ADL). METHODS: ADL was evaluated by using ADL-20, which consists of 20 items from 4 major categories of activities; mobility, self-care, instrumental, and communication. The patients' gender, birth date, clinical diagnosis, past history, life styles, physical findings, laboratory data, and details of therapy were also recorded. Patients A total of 1,163 outpatients aged 50 years or older were included. Data from 1,093 patients were analyzed. RESULTS: We divided the subjects into two groups; Group I having full marks of ADL-20 (n=582) and group II exhibiting an impairment of ADL (n=511). Multiple logistic analysis revealed that in both sexes age and stroke were common independent factors related to the impairment of ADL. Other factors associated with impairment of ADL were smoking in men and presence of proteinuria in women. The presence of hyperlipidemia was associated with preservation of the ADL in women. CONCLUSION: The results demonstrated significant associations of smoking in men and the presence of proteinuria in women with the impairment of ADL in elderly Japanese outpatients. There appears to be a sex difference in the risk factors of impairment of ADL.     

Hypereosinophilic syndrome appearing as a focal defect on liver scan

The case reported here is of a 34-year-old man diagnosed as having hypereosinophilic syndrome. Blood tests showed a large increase in the number of eosinophils and a slight increase in aspartate aminotransferase and alkaline phosphatase. In scintigraphy of the liver with Tc-99m-phytate and with Ga-67-citrate, a focal defect was found in the outer part of the right lobe of the liver. Abdominal computed tomography showed a low density lesion in the same area. Histological inspection of the biopsy specimen showed heavy periportal infiltration with eosinophils. The results suggested that the focal defect seen in liver scintigraphy arose from a circulatory disturbance arising from infiltration by eosinophils.     

Significance of inferior ST segment changes in acute anterior myocardial infarction--relationship between the distribution of left anterior descending artery and concomitant ischemia of the inferior wall

The significance of inferior ST segment changes was studied in 23 patients with acute anterior myocardial infarction by the distribution of the left anterior descending artery (LAD) after percutaneous transluminal coronary recanalization. In 9 patients (Group A) LAD supplied the anterior wall of the left ventricle up to or including the apex but did not reach the inferior wall; in 8 patients (Group B) it continued beyond the apex onto the inferior wall of the left ventricle with well developed collateral circulation; in 6 patients (Group C) it continued beyond the apex onto the inferior wall of the left ventricle with less-developed or no collateral circulation. Thallium-201 scintigraphy and contrast left ventriculography showed that inferior myocardial ischemia was significantly more prominent in Group C than Group A. These results were consistent with coronary anatomy. Inferior ST segment was significantly more depressed in Group A with no concomitant inferior wall ischemia, than in Group C with concomitant inferior wall ischemia (maximal inferior ST segment change: -1.7 +/- 1.1; 0.8 +/- 1.7 mm, respectively; p less than 0.02). In Group A inferior ST segment was depressed in all 6 patients with lateral ST segment elevation, but it was depressed in only one of 3 patients with no lateral ST segment change. Lateral ST segment elevation tended to cause inferior ST segment depression. This study indicates that the inferior ST segment changes in patients with acute anterior myocardial infarction depend on concomitant ischemia of the inferior wall of the left ventricle by the distribution of LAD and the lateral ST segment changes.     

A tetrodotoxin-binding protein in the hemolymph of shore crab Hemigrapsus sanguineus: purification and properties.

The shore crab Hemigrapsus sanguineus hemolymph contains soluble proteins that bind tetrodotoxin (TTX) and are responsible for high resistance of the crab to TTX. The TTX-binding protein was purified from the hemolymph by ultrafiltration, lectin affinity chromatography and gel filtration HPLC. The purified protein gave only one band in native-polyacrylamide gel electrophoresis (PAGE), confirming its homogeneity. Its molecular weight was estimated to be about 400k by gel filtration HPLC, while it was estimated to be about 82k under non-reducing conditions and about 72 and 82k under reducing conditions by SDS-PAGE, indicating that the TTX-binding protein was composed of at least two distinct subunits. The TTX-binding protein was an acidic glycoprotein with pI 3.5, abundant in Asp and Glu but absent in Trp, and contained 6% reducing sugar and 12% amino sugar. The protein selectively bound to TTX, with a neutralizing ability of 6.7 mouse unit TTX/mg protein, but not to paralytic shellfish poisoning toxins. However, its neutralizing activity was almost lost by treatments with enzymes (protease XIV, thermolysin, trypsin, amyloglucosidase and alpha-amylase) and denaturing agents (1% SDS, 1% dithiothreitol, 8 M urea and 6 M guanidine hydrochloride), suggesting the involvement of both proteinaceous and sugar moieties in the binding to TTX and the importance of the steric conformation of the TTX-binding protein.     

Explantationsversuche mit Lymphknoten auf Plasma unter Zusatz von Milz-, Nebennieren- und Knochenmarksextrakt unter Nachprüfung der Versuche von Maximow und unter besonderer Berücksichtigung der Bildung granulierter Zellen

Ohne ZusammenfassungMit 13 Textabbildungen.     

Combined effects of an 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitor and angiotensin II receptor antagonist on nitric oxide bioavailability and atherosclerotic change in myocardial infarction-prone Watanabe heritable hyperlipidemic rabbits

We investigated the effects of co-administration of 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitor and angiotensin II type 1 receptor blocker (ARB) on nitric oxide (NO) bioavailability in genetically hyperlipidemic rabbits with our newly developed NO sensor. A total of 36 myocardial infarction-prone Watanabe heritable hyperlipidemic (WHHLMI) rabbits equally derived (n=6 per group) were treated with 1) vehicle (control), 2) hydralazine (15 mg/kg/d), 3) the HMG-CoA reductase inhibitor pitavastatin (P: 0.5 mg/kg/d), 4) the ARB valsartan (V: 5 mg/kg/d), and 5) pitavastatin+valsartan (P+V) together without or 6) with N(G)-nitro-L-arginine methyl ester (L-NAME) for 8 weeks. After treatment, acetylcholine (ACh)-induced NO production was measured as a surrogate for endothelium protective function, and vascular peroxynitrite (a product of superoxide and NO) was measured for assessing dysfunctional endothelial NO synthase activity. Plaque area was quantified by histology as well as optical coherence tomography (OCT). Intra-aortic infusion of ACh produced an increase in plasma NO concentration, which was significantly greater with all drug treatments than with the control. P+V increased ACh-induced NO by 4.1 nmol/L significantly more than either P or V singly. The vascular peroxynitrite concentration was 1.6 pmol/mg protein in the control group and significantly less than those in the P- and V-monotherapy-groups. The lowest peroxynitrite concentration was observed in the P+V group (0.4 pmol/mg protein), which was significantly lower than those in the P- and the V-monotherapy-groups. OCT and histology of the thoracic aorta revealed that the plaque area decreased significantly more with the combination than with the monotherapy. In conclusion, the combined treatment with an HMG-CoA reductase inhibitor and an ARB may have additive protective effects on endothelial function as well as atherosclerotic change.     

Urological management for stroke patients; relation between brain lesions and establishment of micturitional modality]

A total of 154 stroke patients, 96 males and 58 females, were analyzed to establish the micturitional modality according to the type of detrusor function and the level of activities of daily living (ADL). All patients had only one episode of stroke attack and were checked at least one month after the onset. Localization of cerebral lesion in each patient was evaluated by neurological findings and cerebral angiography in addition to computed tomography of the brain. In the patient groups classified according to the type of detrusor function, micturitional modality was established in 50% of the patients with the underactive type, 70% of those with the overactive type and in 88% of those with normal function. This suggests that the overactive and normal type of detrusor function may not affect establishment of micturitional modality. On the other hand, when classified according to the level of ADL, none established micturitional modality in patients with poor ADL. By contrast, in the patients on higher levels of ADL who were able to transfer themselves from or to a wheel-chair without any assistance it was established in 75%, and in those who were able to gait with or without a brace upon discharged from the hospital, in 91%. It is concluded that establishment of micturitional modality in stroke patients is closely related to the level of ADL or function of lower extremities, but not to localization of the brain lesion.