Effect of Intensive Salt‐Restriction Education on Clinic,Home, and Ambulatory Blood Pressure Levels in Treated Hypertensive Patients During a 3‐Month Education Period

The authors tested the hypothesis that low‐salt diet education by nutritionists would lower blood pressure (BP) levels in treated hypertensive patients. The amount of urinary salt excretion and clinic, home, and ambulatory BP values at baseline and at 3 months were measured in 95 patients with hypertension. After randomization to a nutritional education group (E group, n=51) or a control group (C group, n=44), the C group received conventional salt‐restriction education and the E group received intensive nutritional education aimed at salt restriction to 6 g/d by nutritionists. From baseline to the end of the study, 24‐hour urinary sodium excretion was significantly lowered in the E group compared with the C group (6.8±2.9 g/24 h vs 8.6±3.4 g/24 h, P<.01). Morning home systolic BP tended to be lowered in the E group (P=.051), and ambulatory 24‐hour systolic BP was significantly lowered in the E group (−4.5±1.3 mm Hg) compared with the C group (2.8±1.3 mm Hg, P<.001). Intensive nutritional education by nutritionists was shown to be effective in lowering BP in treated hypertensive patients.

The association between excessive salt intake and blood pressure (BP) elevation is well‐known, and some interventional studies such as the International Study of Electrolyte Excretion and Blood Pressure (INTERSALT) demonstrated that the amount of salt intake was associated with BP levels.¹ In an international study of 101,945 individuals from 17 countries, it was found that the estimated sodium intake of 3 g/d to 6 g/d was associated with lower incidences of cardiovascular events and death compared with higher or lower levels of salt intake.² In a study of a mildly hypertensive population, clinic and ambulatory BP levels were significantly lowered by low salt intake compared with those in the control group.³ In the same study, lower salt intake was associated with lower excretion of urinary albumin and a lower pulse wave velocity (a measure of arterial stiffness) compared with those in the control group. Taken together, these findings support the importance of salt restriction for the improved control of BP and protection from end‐organ damage, provided that the salt restriction is successfully performed.In the 2014 guidelines from the Japanese Society of Hypertension (JSH), salt restriction to <6 g/d is recommended for all hypertensive populations.⁴ However, this recommendation is mostly based on observational studies⁵ or interventional studies in which the diets of patients were completely controlled, sometimes under hospitalized conditions.⁶ For example, in the Dietary Approaches to Stop Hypertension (DASH) trial,⁷ a low‐salt diet was given to the patients during the study period. Few studies have examined whether intensive nutritional education in an outpatient clinic, especially education on dietary salt restriction, can lower not only clinic BP but also home and ambulatory BP levels. Thus, in the present study, we tested the hypothesis that intensive nutritional education focused on salt restriction and provided by nutritionists in an outpatient clinic lowers clinic, home, and ambulatory BP in treated hypertensive patients.     

New functional polar maps for estimating regional cardiac function using ECG-gated technetium-99m-tetrofosmin SPECT

OBJECTIVE: The purpose of this work was to develop functional parameters to analyze regional cardiac function using ECG-gated 99mTc-tetrofosmin SPECT. Our goal was to develop a methodology that used slice thickness correction, the generation of a time-activity curve and a polar map. METHODS: Fourteen normal patients without evidence of coronary artery disease were studied. One hour after intravenous injection of 740-1110 MBq (20-30 mCi) 99mTc-tetrofosmin, ECG-gated SPECT data were acquired by dividing a cardiac cycle into 12 frames. The SPECT data were reconstructed from 11 of 12 frames into 3 views. The reconstruction of these images was repeated after performing slice thickness correction. Excluding the effect of different apex-to-base lengths at any frame during a cardiac cycle, 10 short-axis images with the same slice thickness were obtained. Each short-axis image was divided by 40 radii into 40 segments. The time-activity curve was generated from the total counts included in each segment plus both neighboring segments. Subsequently the curve fitting was performed using the second Fourier function. RESULTS: From fitted curves and their differentials, we calculated end-systolic count, end-diastolic count, percent count increase, uptake, peak contraction rate, peak distention rate and contraction time. CONCLUSION: The functional polar maps visually demonstrated regional myocardial function. This method is expected to be helpful for assessing regional cardiac function using 99mTc-tetrofosmin.     

Comparison of99mTc-tetrofosmin uptakes on planar images with those in excised rats organs with those in excised rats organs

The radioactivity in the organs adjacent to the heart causes interference with the quantitative assessment of myocardial uptake of tracer on scintigraphy. In order to investigate how much the functions of these organs affect myocardial uptake seen in imaging, we compared the myocardial uptake measured by means of a gamma camera with the actual activity in the excised organs. Methods: Thirty-three rats were imaged at 5, 10, 15, 30, 45, 60, 90 and 120 min after the administration of 99mTc-tetrofosmin, and % injected dose per pixel (%ID/pixel) for each organ was assessed on planar images (PI measurement). Percent injected dose per gram of tissue (%ID/g) in the heart as well as lungs, liver, gastrointestines and blood was measured by means of a well scintillation counter (WC measurement). Comparison between PI and WC measurements was performed with % uptake, the PI-to-WC ratio and heart-to-organ ratios. Results: Our WC measurement showed an increase in cardiac uptake until 30 min (1.67 +/- 0.31%) postinjection and subsequent gradual decrease, whereas PI measurement showed maximum activity of 1.81 +/- 0.52% at 15 min postinjection. There was a prominent difference between the two measurements, particularly at 10 min, with a PI/WC ratio of about 1.6 times. Our WC measurement showed maximum pulmonary uptake at 15 min (0.87 +/- 0.31%) and a gradual decrease over 15 min, whereas PI measurement showed maximum uptake at 10 min (1.14 +/- 0.38%). There was hardly any variation in activity observed later than at 10 min. Our WC measurement showed hardly any variance in hepatic activity from 5 min (0.77 +/- 0.19%) to 30 min (0.69 +/- 0.27%) with a subsequent gradual decrease. The percent uptake in PI measurement was generally greater than that in WC measurement, and high values were found at 10 min and 15 min with PI/WC ratios of about 3.3 times and 2.3 times, respectively. Conclusion: Percent uptakes in PI measurement were greater than those in WC measurement. The difference between the two measurements was prominent in the early phases. The cardiac uptake in PI measurement was significantly greater than that in WC measurement at 10 min. It was considered that this discrepancy between the two measurements was caused by the Compton scatter from the organs adjacent to the heart.     

Operative results of distal aortic arch aneurysms--approaching methods, bypass techniques and complications

Ten patients underwent repair of aneurysms of the distal aortic arch from 1985 to 1989. There were 8 men and 2 women: aged 58 to 77 (average age 67 years). Seven patients had sacciform aneurysms which were closed by graft patch aortoplasty, and three patients had fusiform aneurysms which were corrected by inserting tube grafts. Seven aneurysms operated since 1988 were approached through median sternotomy continued with left anterior thoracotomy, so called door open method. This approach presented good view of the diseased aorta, and effective for preventing recurrent and phrenic nerve palsy. We used temporary bypass for 4 patients, cardiopulmonary bypass for 4 patients (separate carotid artery perfusion for 2 patients) and centrifugal pump for 2 patients during aortic cross clamping. One patient died intraoperatively from intractable bleeding and two patients died postoperatively from brain damage due to embolic episodes during the operations. These patients showed the severely irregular intima in the aortic arch and were complicated with rupture of the aneurysm or dissections arising from the aneurysms. It should be noticed that careless manipulation of the aortic arch and the brachiocephalic vessels cause cerebral complications in such cases.     

Left ventricular papillary fibroelastoma associated with chief complaints of palpitation,general fatigue,and feverish

Papillary fibroelastoma is one of the commonest benign tumor in the heart. In almost all of cases, symptoms never develop and the tumors are usually discovered coincidentally. Even though papillary fibroelastoma is a benign tumor, surgical extirpation is usually indicated for reason of productive serious complications. The tumors may cause left ventricular outflow obstruction, cerebral embolic infarction, myocardial infarction and even sudden death. The case we reported here is unusual case, because the patient developed symptoms and complaints such as palpitation, feverish and general fatigue. We measured tumor markers, interleukin 6, serotonin and histamine, but none of those was elevated in the blood samples. Surgical removal of the tumor attached to the base of posterior papillary muscle was carried out without causing mitral incompetence, and the pathological findings were compatible with papillary fibroelastoma. After the operation, the both symptoms and complaints disappeared unexpectedly.     

A study on crosstalk correction in dual energy acquisition of 123I-MIBG and 201TlCl in myocardial SPECT]

In the simultaneous dual energy acquisition, energy spectrums of two radionuclides crosstalk each other and this phenomenon is a cause of the poor quality of images. In order to obtain the image of high quality in dual energy acquisition of 123I-MIBG and 201TlCl, a crosstalk correction method was originated. The crosstalk from 201Tl to 123I window (R1) and the crosstalk from 123I to 201Tl window (R2) were determined by the cardiac phantom studies. R1 and R2 showed almost constant value throughout the myocardial wall. The crosstalk correction was performed using R1 and R2. After the crosstalk correction, the defect region placed in the cardiac phantom was detected more clearly both in visual interpretation and in quantitative analysis. The crosstalk correction method with R1 and R2 was applied to some clinical cases. By the crosstalk correction, the quality of image was improved and a false defect caused by crosstalk disappeared in a clinical case. The crosstalk correction was considered to be useful for improving the quality of image on dual energy acquisition.     

Hemolytic evaluation using polyurethane microcapsule suspensions in circulatory support devices: normalized index of hemolysis comparisons of commercial centrifugal blood pumps

Abstract:  We have been developing some types of microcapsule suspensions with polyurethane membranes to evaluate the absolute hemolytic characteristics of the centrifugal blood pumps used in circulatory support devices such as artificial hearts. In order to facilitate/realize hemolysis testing on centrifugal blood pumps that have hemolysis levels as low as those of commercial centrifugal blood pumps, we eliminated capsules with diameters less than 72.2 µm, amounting to 15.4% of all capsules in the conventional suspension (crude suspension [CS]), and adjusted the capsule volume ratio to correspond to a hematocrit of 40%. In this way we succeeded in enhancing the sensitivity of the suspension to microcapsule destruction 61 fold. We used this new suspension (fine suspension [FS]) to perform hemolysis tests on four types of commercial pump with mock circulation systems. Under conditions of 500 mm Hg and 11.2 L/min, we successfully determined the hemolytic characteristics (normalized index of hemolysis [NIH]) of some of the centrifugal blood pumps; the results showed some correlation with those of hemolysis tests on bovine blood and suggest that microcapsule suspensions with polyurethane membranes are useful as standard test solutions for the absolute evaluation of centrifugal blood pumps.     

Effects of reserpine treatment on the dopamine receptor binding of [3H/11C]nemonapride in the mouse and rat brain

We investigated the effect of reserpine treatment on the striatal uptake of a radiolabeled dopamine D₂-like receptor ligand nemonapride (NEM). In mice, the uptake of the [³H]NEM in the striatum, cortex and cerebellum was enhanced by the reserpine pretreatment. Neither the ratio of striatum to cerebellum nor that to cortex was affected by the reserpine pretreatment. In rats,ex vivo autoradiography showed no effect of the reserpine treatment on the striatal uptake of [¹¹C]NEM or the striatum to cortex ratio. The results suggest that the receptor binding of NEM was not significantly influenced by reserpine-induced depletion of endogenous dopamine probably because of its high affinity for the receptors.     

A technique for the prevention of hoarseness during surgery for distal aortic arch aneurysm.

Hoarseness occurs frequently after surgery to repair distal aortic arch aneurysms when using only a median sternotomy approach. We describe a useful technique which protects the left recurrent laryngeal nerve during this procedure and reduces the incidence of postoperative hoarseness.     

Primary small-cell carcinoma of the breast: a case report

We report a case of small-cell carcinoma of the breast. The patient was a 54-year-old Japanese woman with a left breast mass. Mammography revealed a 1.2-cm microlobulated mass with partially ill-defined borders. Ultrasonography disclosed a hypoechoic mass measuring 1.8 × 1.2 × 1.2 cm with heterogeneous internal echoes and partially ill-defined borders. The shape of the mass was round and taller than it was wide in the orthogonal section to the longest axis of the mass. These imaging findings suggested a malignant tumor. Fine-needle aspiration cytology of the tumor also suggested a ductal carcinoma. Breast-conserving surgery was performed with axillary sentinel lymph node biopsy. A diagnosis of small-cell carcinoma of the breast was made based on the histologic and immunohistochemical findings. This rare breast tumor has been reported to be aggressive and associated with a poor prognosis; however, our patient is currently well and has had no clinical recurrence of the disease after 5 years of follow-up without radiotherapy or chemotherapy. Therefore, the prognosis may be better if the tumor is detected early and there is an absence of lymph node metastasis.