Eiji Miyauchi

Noninvasive detection of endothelial dysfunction in elderly with NIDDM by ultrasonography.

We compared endothelial function noninvasively in 15 elderly patients with noninsulin‐dependent diabetes mellitus (NIDDM) with 12 nondiabetic elderly patients. Using high resolution ultrasound, we measured flow‐mediated dilatation (FMD) of the brachial artery and sublingual nitroglycerin (NTG)‐mediated dilatation. FMD was significantly impaired in subjects with NIDDM compared with control subjects. In NIDDM subjects, FMD with complications was lower than in subjects with noncomplications. However, there was no significant difference in NTG between NIDDM subjects and the control group. Hyperemic blood flow change was lower in NIDDM subjects, but not significant. These results suggest that elderly patients with NIDDM have impaired L‐arginine/nitric oxide (NO) pathways and the possibility of capillary rarefaction.

Urinary Excretion of Angiotensin Converting Enzyme in NIDDM Patients With Nephropathy

Twenty-four-hour urinary excretion of angiotensinconverting enzyme (ACE) was investigated in relation to that of albumin and β2-microglobulin (β2M) in 25 noninsulin- dependent diabetes mellitus (NIDDM) patients without nephropathy, 13 NIDDM patients with incipient nephropathy, 18 NIDDM patients with overt nephropathy, and 14 nondiabetic subjects. NIDDM patients without nephropathy and nondiabetic subjects were similar in albumin, β2M, and ACE excretion. NIDDM patients with incipient nephropathy had elevated albumin excretion (P < .01) and similar (β2M and ACE excretion compared with nondiabetic subjects. On the other hand, NIDDM patients with overt nephropathy had elevated albumin, β2M, and ACE excretion compared with nondiabetic subjects (P < .01). In all NIDDM patients studied, a positive correlation was found between ACE excretion and albumin excretion (r = 0.76, P < .001) or β2M excretion (r = 0.52, P < .01). These data suggest that elevated ACE excretion in NIDDM patients with overt nephropathy may be reflective of renal tubular damage.

High-performance liquid chromatographic separation of corticosteroids in plasma of rats. Its application to the determination of the circadian rhythm of 18-hydroxycorticosterone related to aldosterone and corticosterone.

An efficient separation of corticosteroids in plasma of rats was obtained by reversed-phase high-performance liquid chromatography (HPLC). Plasma corticosteroid assays with HPLC separation were used to determine the circadian rhythm of 18-hydroxycorticosterone (18-OHB) and its possible relationship to aldosterone or corticosterone in conscious rats under standard conditions (regular diet; 12-hour light and 12-hour dark cycle). Significant circadian rhythms of plasma corticosterone, 18-OHB and aldosterone were observed with peak values at 20.00 h and nadir values at 08.00 h. The mean ratio of plasma 18-OHB to aldosterone during 24 h was 2.4. The circadian rhythm of 18-OHB was also correlated with that of plasma aldosterone or corticosterone.

Effects of nitrendipine on left ventricular structure and function and aortic distensibility in elderly patients with isolated systolic hypertension

Abstract To determine the effects of antihypertensive therapy with nitrendipine on left ventricular structure and function, and ascending aortic distensibility in elderly patients with isolated systolic hypertension, nine elderly patients (mean age, 74 ± 7 years) with isolated systolic hypertension underwent complete Doppler echocardiographic examination before and after 12 weeks of treatment with nitrendipine (5 mg taken once daily). Blood pressure significantly decreased from 167 ± 6/84 ± 12 mm Hg to 144 ± 11/76 ± 12 mm Hg. No significant changes were found in stroke volume (60 ± 19 mL vs 55 ± 20 mL) and ejection fraction (67 ± 9% vs 68 ± 6%). The left ventricular mass index showed a tendency toward a decrease (155 ± 45 g/m 2 vs 135 ± 42 g/m 2 ) after nitrendipine therapy, but this change did not reach statistical significance. The peak mitral velocity in early diastole increased significantly from 63.9 ± 17.0 cm/s to 74.3 ± 22.6 cm/s after treatment with nitrendipine. Although cardiac output and systemic vascular resistance did not change after nitrendipine treatment, the distensibility of ascending aorta increased significantly as showed by the significant decrease in pressure-strain elastic modulus (from 3.85 ± 0.93 × 10 6 · dynes/cm 2 to 2.14 ± 0.36 × 10 6 · dynes/cm 2 ) and stiffness index beta (from 23.3 ± 5.3 to 15.1 ± 3.3). In conclusion, our results demonstrate that nitrendipine successfully controls blood pressure in elderly patients with isolated systolic hypertension. This antihypertensive action is associated with improvement in left ventricular diastolic function and an increase in aortic distensibility. The change in aortic distensibility may be responsible for the reduction of blood pressure during nitrendipine therapy in these patients.

Effects of low-dose quetiapine on psychotic symptoms in elderly patients with physical illnesses: Report of eight cases

Quetiapine, which is a new atypical antipsychotic agent, was administered at low doses (25–50 mg/day) for psychotic symptoms in eight elderly patients with physical illnesses. Delirium and hallucination were alleviated by the administration of low doses of quetiapine, and the cause–effect relationship between the administration and alleviation of symptoms was evident, particularly in one patient with delirium, because delirium was alleviated after administration began, was exacerbated after discontinuation of quetiapine, and was alleviated again after administration was resumed. Little improvement was observed in delusions or mood disorders. None of the patients showed exacerbation of physical symptoms or abnormalities in clinical laboratory tests. The results of this study suggest that quetiapine might be effective in reducing delirium and hallucination that often accompany physical illness in elderly people and could be used without adverse effects.