Relationship between insulin and blood pressure in Japanese obese subjects.

OBJECT: The association of obesity and hypertension is well recognized. However, the nature of the relationship between increased body weight and blood pressure (BP) elevation has remained obscure. PATIENTS AND METHODS: We evaluated BP, insulin sensitivity, insulin clearance and fasting plasma insulin concentration in 19 younger (over 40 years) and in 15 older (more than 40 years) obese subjects to determine the relationships between BP and other factors. Insulin sensitivity and clearance were determined with the euglycemic clamp technique. RESULTS: BP was not associated with insulin sensitivity although most of the subjects showed insulin resistance. In the younger obese group, a positive correlation between diastolic BP and body mass index (kg/m2) was found (r=0.740; p=0.043). In the older obese group, systolic and diastolic BP were correlated with fasting plasma insulin levels (r=0.705; p=0.003; r=0.574; p=0.025, respectively), and systolic BP was inversely correlated with insulin clearance (r=-0.715, p=0.003). CONCLUSION: These results suggest that insulin is an important factor in BP elevation in older obese subjects, but not in younger obese subjects.     

Inhibitory effect of free sialic acid on complement activation and its significance in hypocomplementemic glomerulonephritis.

The role of free sialic acid on complement activation was investigated. The serum levels of free sialic acid and total sialic acid were measured by previously described methods in 16 patients with acute post-infectious glomerulonephritis (AGN), 27 patients with systemic lupus erythematosus (SLE), 15 patients with persistent hypocomplementemic membranoproliferative glomerulonephritis (MPGN), and 13 healthy controls. A statistical study demonstrated an increased level of free sialic acid in patients with AGN and SLE in which the hypocomplementemia improved throughout the course and a decreased level of free sialic acid in patients with MPGN and SLE in which hypocomplementemia continued throughout the course. The levels of total sialic acid were significantly increased in patients with AGN and SLE and were significantly decreased in patients with MPGN. There was no correlation between the levels of free sialic acid and total sialic acid in patients with AGN, in whom the levels of both total and free sialic acids were increased. To examine the effect of free sialic acid on the complement cascade, lipopolysaccharide (LPS) was incubated with normal human serum (NHS) in the various concentrations of N-acetyl neuraminic acid (NANA), a member of the sialic acid group. The incubation mixtures were examined by enzyme immunoassay using monoclonal anti-iC3b antibody or anti-Bb antibody. Native C3 or Factor B in NHS broke down less following the addition of NANA. To elucidate the role of NANA on the hemolytic function of C3, a rabbit erythrocyte (Ra E) hemolytic assay was carried out. Ra E lysed completely in the presence of R3 with native C3. However, hemolysis occurred to a lesser degree in C3-depleted serum (R3) or R3 with NANA-treated C3. To investigate the influence of NANA on complement components, the levels of complement components were measured in the incubation mixture with various doses of NANA and NHS. The levels of C3 and C5 were significantly decreased after the addition of NANA, even though the levels of Factor H and Factor I were not markedly changed. These data indicate that NANA exerts an influence on the complement components even though it has no effect on the regulatory proteins of complement. Our in vitro findings, together with the in vivo data, suggest that free sialic acid might have an inhibitory effect on the activation of C3 and the following complement cascade, and might also have been responsible for the improvement of hypocomplementemia.     

Large bronchial cyst causing compression of the left atrium.

We describe here a case with a large bronchogenic cyst treated by surgical resection, who presented with evidence of left atrial overload on electrocardiogram (ECG). The 50-year-old male patient presented with the chief complaint of heaviness in the chest on exertion. An ECG revealed evidence of left atrial overload, and echocardiography and imaging revealed a mass having a maximum diameter of 9 cm on the cranial aspect of the left atrium, caudal to the tracheal bifurcation. The patient was treated by surgical resection of the cystic mass via right anterolateral thoracotomy. His postoperative course was satisfactory and the patient was relieved of his main symptom.     

Preliminary clinical use of a new bifurcated graft for peripheral vascular surgery

We describe herein a technique of performing a unilateral common ilio-bilateral femoropopliteal bypass using a small diameter bifurcated graft. The prosthesis, manufactured by Vascutek Ltd., is made of a gelatin-impregnated knitted Dacron graft with an externally ringed support. The diameter of the primary tube is 8 mm with a length of 25 cm, and the secondary tube has a diameter of 7 mm with a length of 75 cm. A total of six patients were operated on using this procedure, through an extraperitoneal approach. Postoperative angiographies showed excellent graft patency and Doppler ultrasound studies revealed a significant increase in the ankle-brachial pressure index in all patients. Using this newly designed small-diameter bifurcated graft, complete revascularization of multilevel occlusive disease can be performed with low operative mortality, and satisfactory relief of the ischemic symptoms can be achieved by the bilateral sequential proximal and distal bypasses.     

A study of urinary tegafur, 5-fluorouracil (5-FU) and uracil concentrations in the cases of gastric carcinoma for the confirmation of drug-taking compliance after UFT oral administration]

We have measured urinary tegafur (FT), 5-FU and uracil concentrations after UFT oral administration (300 mg daily for 7 days) to confirm drug-taking compliance in the 17 cases undergone gastrectomy. Urinary FT and 5-FU concentrations reached to the plateau 2 and 3 days after administration, respectively, and were maintained until the day after termination of administration. Subsequently, FT and 5-FU concentrations also decreased about 50% at 2 day, 20% at 3 day, 10% of the plateau values at 4 day after termination, respectively. The mean plateau value of urinary FT was 12.9 +/- 6.8 micrograms/dl, and that of urinary 5-FU was 0.67 +/- 0.50 microgram/dl. On the other hand, uracil concentration, was not different before and after administration because of the uracil being present endogenously. Therefore, it was suggested that measurement of urinary FT and 5-FU concentrations is useful for confirmation of UFT-taking compliance.     

Malignant lymphoma of lymphoplasmacytic/lymphoplasmacytoid and immunoblastic types

Sixty-four patients with extranodal non-Hodgkin's lymphomas of lymphoplasmacytic/lymphoplasmacytoid (LP) and immunoblastic (IBS) types were reviewed. The criteria distinguishing the latter from the former was a presence of basophilic and prominent nucleoli in a vast majority of the tumor cells. The numbers of LP and IBS types were 34 and 30, respectively. Intervals from appearance of tumors to initial treatment in LP and IBS were 15.7 +/- 25.3 and 6.0 +/- 12.3 months, respectively (p less than 0.1). Histologically LP had a low mitotic count (p less than 0.001) and contained a larger number of mast cells (p less than 0.05) than IBS. Proliferating cells in 4 patients with LP type had nuclei with a slightly irregular indentation similar to those of intermediate lymphocytic lymphoma. Follow-up study revealed the LP type to have a much more favorable prognosis than the IBS type (p less than 0.001) though 3 patients with LP showed unfavorable prognosis. Tumor cells in these tumors had a small to medium-sized, often convoluted nucleus. The present results showed that the distinction of LP and IBS by their morphology of nucleoli was prognostically meaningful. Furthermore it is suggested that tumors of the LP type are heterogeneous.     

A new method of hernioplasty for adult groin hernias centering on repair of the transversalis fascia

A new method of hernioplasty for adult groin hernias centering on repair of the transversalis fascia was assessed by a questionnaire conducted every five years on adult patients who had received the above operation. The efficacy of this method was evaluated in terms of the postoperative quality of life and prevention of recurrence of groin hernias. Over the last 9 years, 834 adult patients with 921 groin hernias, including bilateral lesions, have undergone the above procedure and overall, favorable results were obtained, with only one case of recurrence (0.1 per cent) being reported. Contralateral herniation, which has been often reported following Bassini's or Hatakoshi's method, was found in only one of our patients although the number of patients who complained of pain in the operated region was comparatively high, being 51 cases or 11.4 per cent.