Tadatake Takaya

ACE inhibitors and symptomless dysphagia

Manchester were invited to take part in a blood pressure and glucose tolerance survey (67% response). The FFQ was completed once, between 1992–1995, by 85 AfricanCaribbean men and 125 women (83% response), all of whom had at least three grandparents of African ancestry born in the Caribbean. The FFQ included foods contributing at least 90% of total energy, fat, carbohydrate, and protein, as developed from and later compared against threeday food diaries (n=41; diary: questionnaire correlation, Spearman’s rank r=0·55 for energy, for fat r=0·5). Interviewers determined frequency and usual portion size for 108 Caribbean and European foods. Nutrient composition was calculated from local recipe collection and food tables. We compared our results with those for people of similar ages in the National Diet and Nutrition Survey’s (NDNS) almost entirely white population sample, whose nutritional intake was assessed by the different method of 7-day weighed record (table). We found that African-Caribbeans consumed less energy from fat, particularly saturated fat, and from alcohol, and hence more from carbohydrate. Older African-Caribbeans aged 65–79 years (n=32) and 55–64 years (n=76) consumed 31·2% and 32·3% of total energy from fat (95% CI 29·1–32·9% and 31·1–33·5% respectively). However, in those aged 25–34 years (n=43) fat intake was 34·9% (33·5–33·6%; test for trend by age, p<0·01), reflecting less traditional Caribbean and more European foods such as cakes and biscuits. In NDNS, mean proportional energy from fat was 37·6 (37·3–37·9)% in men and 39·2 (38·9–39·5)% in women, which was similar across each age decade (n=189–385) from 16–64 years (3, p91). This average African-Caribbean diet already falls within national recommendations for fat intake as less than 35% of food energy (32·5% here) and less than 15% as saturated fat (11·8% here). Fruit and green vegetable intakes were also higher in African-Caribbeans here (data not shown). Although association alone cannot support causal relations, our findings are compatible with the lower CHD standardised mortality ratios of Caribbeans in the UK. NDNS used different dietary assessment methodology so comparison has to be cautious; however fat intakes and CHD rates have generally been higher in poorer inner-city populations increasing the contrast with results here. Our ACE inhibitors and symptomless dysphagia

Diastolic compliance of the left atrium in man: A determinant of preload of the left ventricle

SummaryDuring the ventricular slow-filling period, both the left atrium and left ventricle fill passively, and their respective internal pressures equalize, becoming evenly elevated. If the diastolic chamber compliance of the left atrium is smaller than that of the left ventricle, we expect the inflowing blood to be distributed more to the left ventricle than to the left atrium during this period. We examined the magnitude of the diastolic compliance of the left atrium and the left ventricle at the end of the slow-filling period.We studied 10 patients, mostly with a mild degree of coronary artery disease, in whom hemodynamic variables were almost within normal limits. To estimate the compliance of the left atrium, we recorded the left atrial pressure directly (by the Brockenbrough technique) and determined the left atrial volume by biplane cineatriography. We determined the diastolic compliance of the left atrium from the pressure-volume relations between the nadir of the x trough and the peak of the v wave by fitting them to an exponential equation, P=b · eaV (P = pressure, V = volume, a, b = constants). The diastolic compliance of the left ventricle was determined from the pressure-volume relations during the ventricular slow-filling period.The compliances of the left atrium and the left ventricle at the pressure at the end of the ventricular slow-filling period were 1.60±0.41 (mean ± SD) ml · mmHg−1 · m−2 and 4.22±1.12, respectively. The ratio of compliance of the left ventricle to that of the left atrium was 2.60±0.71.Since the diastolic compliance of the left ventricle is 2–3 times larger than that of the left atrium, we suggest that during the slow-filling period, the interaction between the left atrial and left ventricular diastolic compliances provides preferential delivery of blood to the left ventricle and acts as a determinant of volume at the end of the slow-filling period of the left ventricle.

Renoprotective Effect of the Addition of Losartan to Ongoing Treatment with an Angiotensin Converting Enzyme Inhibitor in Type-2 Diabetic Patients with Nephropathy

Angiotensin converting enzyme inhibitors (ACE-Is) and angiotensin II receptor blockers (ARBs) are frequently used for the treatment for glomerulonephritis and diabetic nephropathy because of their albuminuria- or proteinuria-reducing effects. To many patients who are nonresponsive to monotherapy with these agents, combination therapy appears to be a good treatment option. In the present study, we examined the effects of the addition of an ARB (losartan) followed by titration upon addition and at 3 and 6 months (n=14) and the addition of an ACE-I followed by titration upon addition and at 3 and 6 months (n=20) to the drug regimen treatment protocol in type 2 diabetic patients with nephropathy for whom more than 3-month administration of an ACE-I or the combination of an ACE-I plus a conventional antihypertensive was ineffective to achieve a blood pressure (BP) of 130/80 mmHg and to reduce urinary albumin to <30 mg/day. During the 12-month treatment, addition of losartan or addition of an ACE-I to the treatment protocol reduced systolic blood pressure (SBP) by 10% and 12%, diastolic blood pressure (DBP) by 7% and 4%, and urinary albumin excretion by 38% and 20% of the baseline value, respectively. However, the effects on both BP and urinary albumin were not significantly different between the two therapies. In conclusion, addition of losartan or an ACE-I to an ongoing treatment with an ACE-I, or addition of an ACE-I to ongoing treatment with a conventional antihypertensive were equally effective at reducing the urinary albumin excretion and BP, and provided renal protection in patients with type-2 diabetic nephropathy.

Histopathological Case of Uterine Carcinoid Tumor Metastasized to the Lung.

今回我々は, 転移性が疑われた肺腫瘍の診断をきっかけに, 子宮頸癌 (腺扁平上皮癌) にカルチノイド腫瘍が混在していたと考えられた一剖検例を経験した。その細胞像および組織像について検討したので報告する。症例は43歳の女性。不正出血が持続したために来院, 子宮頸部細胞診が施行された。細胞像は, 扁平上皮癌細胞と腺癌細胞が混在してみられた。子宮頸部の生検においても同様の所見を認め腺扁平上皮癌と診断された。広汎子宮全摘および所属リンパ節郭清術が施行され, 化学療法を行い定期的に経過観察されていたが, 術後約4年3か月経過時の胸部レントゲン写真において異常陰影を指摘され, 精査目的にて気管支鏡が施行された。気管支鏡検査時に採取されたポリープの病理組織像および電子顕微鏡所見より, 肺カルチノイドと診断された。同時に作製した捺印による細胞診像においてもカルチノイド腫瘍を強く疑う所見が得られた。このためretorospectiveに初診時の子宮頸部の細胞診像および病理組織像を検討したが腺癌および扁平上皮癌の所見を認めるのみでカルチノイド腫瘍を疑う所見は得られなかった。しかし, 神経内分泌マーカーであるNSE, chromogranine Aの免疫組織染色を施行した結果, 子宮頸部組織の腺癌様の一部分に陽性所見が認められたことより, 子宮頸部癌は腺扁平上皮癌に神経内分泌性の性状を有する腫瘍が混在していたものと考えられた。このことから組織診, 細胞診上, 低分化の腺癌および扁平上皮癌を疑う場合は, 子宮頸部のカルチノイドを含めた神経内分泌腫瘍も鑑別診断の一つとして考慮すべきであり, 免疫組織染色, 電子顕微鏡的検索を加えて確定診断することが重要であると考えられた。