Morio Kuramochi

Takayasu's Arteritis Clinical Report of Eighty-four Cases and Immunological Studies of Seven Cases

The manifestations of Takayasus arteritis of the aorta were studied in 84 patients. The extent of the involvement of the aorta was classified on aortographic examination in 54 patients and from the clinical manifestations in 30. Involvement of the aorta was classified as: (1) arch type in 47 cases; (2) extensive type (whole aorta and its branches involved) in 27 cases; and (3) descending thoracic and abdominal type (only descending thoracic and abdominal aortas involved) in 10 cases. The three types resembled one another in clinical manifestations and laboratory findings except for ischemic signs which varied with the type of lesion and a slight difference in the ratio of male to female patients. Generalized, cardiac and pulmonary symptoms were noted by about two thirds of the patients in the early stage. About one third complained of local pain. The erythrocyte sedimentation rate and C-reactive protein were high values during the active stage of this disease. The hemagglutination test using tannic acid-treated erythrocytes was positive in five of seven cases. It is not clear yet that circulating anti-arterial antibodies are the direct cause of Takayasus arteritis.

Biphasic effects of repeated alcohol intake on 24-hour blood pressure in hypertensive patients.

BACKGROUNDnThe association between alcohol and blood pressure (BP) may be related to the temporal sequencing of alcohol use and BP measurement. We investigated the effects of single and repeated intakes of alcohol on 24-hour BP.nnnMETHODS AND RESULTSnFourteen male habitual drinkers with essential hypertension were placed sequentially on a 4-day control phase: a nonalcoholic drink with the same calories as alcohol was given at dinner (5 PM to 6 PM) and a 7-day drinking phase: alcohol (ethanol, 1 mL/kg) was given at dinner under standardized conditions. Ambulatory BP measurements were performed on day 3 of the control phase and on days 1 and 7 of the alcohol phase. The average 24-hour systolic and diastolic BPs on day 1 were significantly lower than those in the control phase and on day 7. Between 6 PM and midnight, both systolic and diastolic BPs on days 1 and 7 (121 +/- 2/73 +/- 1 and 126 +/- 4/75 +/- 2 mm Hg, respectively) were significantly lower than those in the control phase (139 +/- 4/83 +/- 2 mm Hg). Between midnight and 8 AM (6 to 14 hours after the last drink), both systolic and diastolic BPs on day 7 (138 +/- 4/83 +/- 2 mm Hg) were significantly higher than those in the control phase (131 +/- 4/79 +/- 2 mm Hg) and day 1 (129 +/- 3/77 +/- 1 mm Hg). Between 8 AM and 3 PM, BPs showed no difference among the three phases.nnnCONCLUSIONSnA single intake of alcohol has a depressor effect on BP that lasts for several hours after drinking, while repeated intakes for 7 days have both depressor and pressor effects according to the differences in time intervals after the last drink. This study suggests that the chronic effects of alcohol on BP might be overestimated when based on casual BP measurements alone.

Alterations in renal Na+K+ATPase activity and [3H]ouabain binding in Goldblatt hypertensive rabbits.

To evaluate the role of renal Na+K+ATPase in the presence of Goldblatt hypertension, the enzyme activity and [3H]ouabain binding were examined in cortical and medullary homogenates from two-kidney, one clip (2K1C), one-kidney, one clip (1K1C), unilaterally nephrectomized and normal rabbits. Four weeks after the surgery, systolic blood pressures (SBPs) of 2K1C and 1K1C rabbits were increased significantly to 128 +/- 3 and 129 +/- 2 mmHg, respectively. In contrast, SBPs in the normal controls and unilateral nephrectomized (1K) animals were 83 +/- 2 and 86 +/- 3 mmHg, respectively. In the 2K1C rabbits, atrophy (91%) occurred in the kidney on the ischaemic side and hypertrophy (110%) occurred in the contralateral kidney. Na+K+ATPase activity and number of [3H]ouabain binding sites were reduced in the homogenates of the ischaemic kidney of 2K1C rabbits. In the 1K1C rabbits, marked hypertrophy of the kidney (155%) occurred, and the activity of Na+K+ATPase and the number of [3H]ouabain binding sites increased slightly in the cortex and medulla, compared with the normal controls. 5-Nucleotidase, a plasma membrane marker enzyme, remained unchanged in both groups of hypertensive rabbits. Dissociation constant (KD) values for [3H]ouabain binding did not differ significantly in the renal homogenates of of 2K1C and 1K1C, compared with findings in the normal controls. The inhibitory activity of plasma was measured by studying [3H]ouabain binding to Na+K+ATPase of renal tubular basolateral membrane vesicles purified by Percoll gradient. The inhibition was more pronounced with plasma from 2K1C, 1K1C and 1K rabbits than from the control animals. Our findings suggest that in the Goldblatt hypertensive model, changes in Na+K+ATPase activity were due to alterations in glomerular filtration rate (GFR).

The effect of changes in sodium load on plasma and urinary catecholamine in a patient with uncomplicated pheochromocytoma

褐色細胞腫の1例において, 1日食塩摂取量を増減し,高塩期および低塩期において尿中ノルエピネフリン(U-NE),尿中エピネフリン(U-E)の1日排泄量を測定した.又各期で生食点滴静注(1l/2hours),フロセマイド40mg静注負荷を行ない,それぞれ血漿ノルエピネフリン(P-NE),血漿エピネフリン(P-E)および血圧を経時的に測定した. U-NEは高塩期787±94ug/日に比し,低塩期1520±336μg/日と高値を呈した.生食負荷により, P-NEは低下した(低塩期では負荷前4741pg/ml,後120分値1854pg/m1).フロセマイドにより血圧, P-NEは低塩期で著明に上昇した.以上より,褐色細胞腫患者においても, Naおよび体液量の変化に対し,尿中および血中カテコールアミンはよく反応することが示唆された.

MYOTONIC DYSTROPHY ASSOCIATED WITH THYMOMA -REPORT OF AN AUTOPSY CASE-

筋強直性ジストロフィーに胸腺腫を合併した極めてまれな剖検例を経験したので報告する.患者は46才の女性で,家族歴では姉と妹に筋強直性ジストロフィーを認める.既往歴では流産,死産があり,現病歴では小児期からgrasping myotoniaがあり, 37才の時myotonic dystrophyと診断された.昭和49年9月呼吸困難を主訴として入院した.患者は, hatchet faceで,甲状腺腫があり,四肢は著明な筋萎縮を呈していた.左肺野で呼吸音を聴取できず,脾臓は腫大していた.胸部レントゲン検査で前縦隔腫瘍と左側胸水貯留が明らかにされ,著明な呼吸機能障害が認められた.免疫学的にabsolute lymphocytopenia,血清Ig-G, Ig-A, Ig-Dに低値の傾向, DNCB感作試験陰性などpan-immunosuppressionの所見を呈した.また糖尿病をはじめとする内分泌機能の異常も認められた.全身麻酔のもとで縦隔鏡検査が施行されたが,その際に原因不明の心停止を起こして死亡した.剖検により上皮型細胞成分優位の混合型胸腺腫があることが判明し,甲状腺右葉にはfollicular adenomaを認めた.筋強直性ジストロフィーに胸腺腫を合併した剖検例としては,後藤らの報告1)に次ぐ第2番目の記載となる.

Effect of Blood Pressure and Coronary Stenosis on Cardiac Hypertrophy

冠動脈狭窄・心筋虚血が心肥大発生の重要な因子となりうるか否かについて検討するため, 老年者連続剖検例418例の心剖検所見を分析した.当然予想されるように, 生前の血圧と心肥大との間には密接な関係があり, 最大血圧180mmHg以上または最小血圧100mmHg以上の群では心肥大を呈するものが過半数を占め, 心重量/身長比が2.0を越えるものは, それぞれ54.8%, 56.6%であった. また, 心筋に著明な虚血性病変のみられたものでは, 冠動脈狭窄度, 血圧値に関係なく心肥大例が多くみられた.これに反し, 心筋病変の著明なものをのぞくと, 冠動脈狭窄度と心肥大との関係は明らかではなく, 内腔面積の狭窄が75%以上の高度狭窄が2枝以上に存在するものにおいても心重量/身長比が2.0を越えるものは45.5%であり, この値と有意な冠狭窄のないものにおける33.7%との間には有意な差は認められなかった.以上の所見から, 冠動脈狭窄・心筋虚血は, 心筋に著明な病変を生じないかぎり心肥大成立の一義的な因子とは考えがたいと結論した. ただし, 高度高血圧例のみを取上げると, 高度冠硬化例に心肥大の多い傾向が認められており, 高度高血圧の存在下においては, 冠硬化の合併が心肥大の付加的因子となる可能性も否定できない.