Ryuichi Kikawada

Hemodynamic changes during hemodialysis.

35 patients with chronic renal failure were examined during the first 2 h of hemodialysis by invasive and non-invasive methods. The cardiac output was determined by the dye dilution technique in 11 of these patients and by Swan-Ganz catheterization in 5. In the patients without severe myocardial damage, the cardiac output during hemodialysis showed a significant increase (p less than 0.05), accompanied by a significant decrease of both mean blood pressure (p less than 0.05) and total peripheral resistance (p less than 0.05). Mean pulmonary artery pressure and pulmonary artery wedge pressure were reduced in all cases during hemodialysis. The increase in cardiac output during hemodialysis in patients with chronic renal failure may be attributed to the decrease in afterload.

Hemodynamic changes by recombinant erythropoietin therapy in hemodialyzed patients.

Recombinant human erythropoietin therapy was given to 15 patients undergoing long-term hemodialysis with normal cardiac function. None of the patients had hypertension before the erythropoietin therapy and had received no antihypertensive agents. Before and after the erythropoietin therapy M-mode and pulsed Doppler echocardiographic studies, measurements of plasma volume by radioiodinated human serum albumin, and measurements of atrial natriuretic factor were carried out. After 6 weeks of erythropoietin therapy, hematocrit increased from 20.0 to 33.0%. Cardiac output, stroke volume, left ventricular diastolic dimensions, and left ventricular wall stress were all significantly decreased. Total peripheral resistance, interventricular septal thickness, and left ventricular posterior wall thickness were significantly increased. In Doppler echocardiographic studies, the mean velocity of aortic ejection flow and left ventricular acceleration time were decreased. The blood volume derived from plasma volume and hematocrit was not changed, whereas plasma atrial natriuretic factor concentration was significantly decreased. These data suggest that recombinant human erythropoietin administration suppressed the hyperdynamic cardiac state that was required to maintain oxygen delivery to the peripheral tissues in severe uremic anemia.

Noninvasive evaluation of the ratio of pulmonary to systemic flow in ventricular septal defect by means of Doppler two-dimensional echocardiography

Left ventricular inflow volume (LVIV) and outflow volume (LVOV) were determined by pulsed Doppler echocardiography, and the ratio of pulmonary to systemic flow (Qp/Qs) was estimated as a ratio of LVIV to LVOV (LVIV/LVOV). Seventy-seven patients were studied, 47 control subjects and 30 patients with ventricular septal defect (VSD). LVOV was calculated from the left ventricular ejection flow velocity and left ventricular outflow tract diameter; LVIV was calculated from the transmitral flow velocity and mitral valve motion as traced by M-mode echocardiography. Cardiac input (COin) and cardiac output (COout) were calculated as the product of LVIV or LVOV and heart rate. Cardiac output was also determined by the dye dilution method (COdye) in control subjects. A close correlation was observed between COdye and COin (y = 1.18x - 243, r = 0.85, p less than 0.005, SEE = 1026 ml/min) and COdye and COout (y = 1.16x - 323, r = 0.90, p less than 0.005, SEE = 639 ml/min). LVIV and LVOV were highly correlated in control subjects (y = 0.95x + 5.3, r = 0.94, p less than 0.005, SEE = 6.6 ml). LVIV/LVOV was 0.97 +/- 0.1 (mean +/- SD) in control subjects, whereas LVIV/LVOV (1.87 +/- 0.88) was significantly higher in patients with VSD (p less than 0.01). In patients with VSD, LVIV/LVOV correlated with Qp/Qs determined invasively (y = 0.97, SEE = 0.23, n = 16). Thus with our method LVIV and COin can be accurately determined, and we suggest that Doppler-determined LVIV/LVOV is clinically useful for evaluating the shunt flow magnitude in VSD.

Changes of common fragile sites on chromosomes according to the menstrual cycle

SummaryThe frequencies of chromosomal breaks and sister chromatid exchanges (SCE) are influenced by pregnancy, oral hormonal contraceptives and the menstrual cycle. The changes in the number and sites of spontaneous and aphidicolin-induced breaks on chromosomes from peripheral blood lymphocytes during the menstrual cycle were examined in 8 healthy women. Menstrual cycle was determined by menstruation and the quantity of serum estrogen, progesterone and luteinizing hormone. The number of spontaneous breaks at the follicular phase, the interval phase (which includes ovulation) and the luteal phase were 3.1 ± 1.1, 2.7 ± 2.3 and 3.9 ± 2.6 per 100 mitoses, respectively. The frequencies of aphidicolin-induced breaks in the same phases were 95.8 ± 23.3, 90.6 ± 14.3 and 122.7 ± 20.1 per 100 mitoses, respectively. The higher frequency at the luteal phase was statistically significant compared with the other phases. In the luteal phase, bands 2q32, 3q27, 6q26 and 16q23 had higher frequencies of breaks (P < 0.05); however, breaks at band 9q32 decreased significantly. SCE showed considerable variation, but with no statistical significance.

Noninvasive evaluation of the magnitude of aortic and mitral regurgitation by means of Doppler two-dimensional echocardiography

Using transmitral flow velocity and left ventricular ejection flow velocity, we measured left ventricular inflow volume (LVIV) and left ventricular outflow volume (LVOV) by pulsed Doppler echocardiography in 73 patients who had mitral valve regurgitation (MR), aortic valve regurgitation (AR), or no valvular regurgitation. Doppler-determined regurgitant volume (DOPRV), Doppler-determined regurgitant fraction (DOPRF), total stoke volume, and forward stroke volume were calculated to compare the severity assessed by angiographic scoring and the regurgitant fraction determined by radionuclide angiography (RIRF). In 17 patients with MR, LVIV (84.4 +/- 20.4 ml) was significantly greater (p less than 0.01) than LVOV (52.5 +/- 15.7 ml). LVOV, which is equivalent to forward stroke volume, was lower in patients with MR (52.2 +/- 15.7 ml) than in normal subjects (67.0 +/- 15.7 ml). In 15 patients with AR, LVOV (121.7 +/- 61.1 ml) was significantly greater (p less than 0.01) than LVIV (75.1 +/- 28.1 ml) and LVOV, which is equivalent to total stroke volume, was greater in patients with AR (121.7 +/- 61.1 ml) than in normal subjects (64.0 +/- 14.4 ml). DOPRF correlated with RIRF (r = 0.79, p less than 0.01, n = 11). DOPRV (mild: 10.5 +/- 8.5 ml; moderate: 28.8 +/- 13.6 ml; severe: 74.5 +/- 36.7 ml) and DOPRF (mild: 13.7% +/- 11.5%; moderate: 33.1% +/- 14.2%; severe: 52.6% +/- 15.3%) increased markedly with the severity of regurgitation as assessed by cineangiography. In AR, total stroke volume influenced both forward stroke volume and regurgitant volume, and in MR, regurgitant volume influenced both total stroke volume and forward stroke volume. Total stroke volume in AR and regurgitant volume in MR may play a key role in valvular regurgitation.

A Comparison of the Effectiveness of Anisodamine and Norepinephrine on Hemorrhagic Shock in Rabbits

Hemorrhagic shock was experimentally produced in 123 rabbits which were divided into control groups and groups treated separately with anisodamine and norepinephrine. A comparison of their effect on t

[A case of pseudo-Bartter's syndrome due to longterm ingestion of furosemide--studies of renal diluting and concentrating ability].

症例は29才,女性. 14年間のfurosemide服用歴と浮腫増悪に対する習慣性の食塩制限を認めた.低K血症性アルカローシスの精査で入院.レニン・アルドステロン系の亢進,正常血圧, JG細胞過形成等からBartter症候群類似の病態を示したが,約420mEqのK欠乏にもかかわらず,ネフロン希釈部のCl再吸収は正常で, K欠乏補正後も不可逆性の濃縮障害を示した.腎組織はJG細胞過形成,間質の線維化,円形細胞浸潤,遠位尿細管基底膜肥厚を示した.本例は利尿薬長期服用,食塩制限, K欠乏により不可逆性濃縮障害を伴つたpseudo-Bartter症候群と考えられた.なお, Bartter症候群の鑑別に利尿薬中止後の希釈能検索の重要性が示唆された.

The effect of aging on blood pressure and hemodynamic parameters in 1650 cases of systolic and diastolic hypertension

最近11年間にこおける本態性高血圧および動脈硬化性高血圧1650例を対象に,血圧型分類を行ない,血行力学的立場から,その特徴と加令的変化にこついて検討した.収縮期高血圧は29才以下および60才以降で多かつたが,拡張期高血圧を伴う症例は各年令群で高率に認められ, 70才以上の老年群でも比較的多く認められた.血行力学的には,収縮期高血圧は高心拍出傾向,拡張期高血圧では末梢血管抵抗亢進傾向が強かつたが,いずれも強い圧負荷を受けていた.収縮期高血圧では,心拍出量が30才台以下で増加, 40才台以降では正常上限にあつたが,末梢血管抵抗の明らかな増大は伴わなかつた.圧負荷の程度は老年群にむかい軽減した.収縮期・拡張期高血圧では,血行力学的数値がいずれもほぼ正常範囲内にあつたが,圧負荷の程度は若年群で強く,老年群では比較的軽度であつた.拡張期高血圧では,末梢血管抵抗亢進とともに強い圧負荷病態が示されたが,これは70才台で最も強く, 80才以上では正常化した.各血圧型で示された老年群における圧負荷の軽減,すなわち心ポンプ機能の改善は,高血圧の経過中に受けた淘汰の結果によると思われる。老年者高血圧症例にいては,いずれの血圧型であつても,代償性心ポンプ機能亢進を伴つた症例のみが,高血圧患者として生存しえていると考えられた.

A case of Fanconi syndrome with type 1 renal tubular acidosis.

A 32-year-old woman of Fanconi syndrome with disorders of amino acid, glucose, uric acid and phosphate reabsorption system in proximal tubule and of renal acid excretion mechanism in distal tubule was reported. By the ammonium chloride loading test, urinary pH could only be decreased by 5.9, and excretion rates of NH4+ and titratable acids were 18.9 and 31.1 mEq/min, respectively. In the bicarbonate loading test, net renal reabsorption of bicarbonate was 2.86 mEq/100 ml GFR when plasma bicarbonate concentration was 29 mEq/L, and threshold of bicarbonate excretion was 24-26 mEq/L. These results suggest that hydrogen ion excretion disorder in distal tubules exists, while bicarbonate reabsorption ability in proximal tubule is normal.