Yuichi Yamauchi

Type A behavior is associated with an increased risk of left ventricular hypertrophy in male patients with essential hypertension.

OBJECTIVE To determine whether type A behavior, which is associated with a risk of coronary heart disease, affects left ventricular hypertrophy in patients with essential hypertension. DESIGN Cross-sectional study of 88 untreated patients with mild to moderate essential hypertension (33 men, mean +/- SEM age 54 +/- 1 years). METHODS We measured the type A behavior score using a standardized questionnaire, left ventricular mass index using M-mode echocardiography and 24 h mean ambulatory blood pressure (recorded every 30 min). Beat-to-beat blood pressure was also measured using a Finapres device in patients at rest and during mental stress (counting backward) to determine the blood pressure response to stress. RESULTS The left ventricular mass index was correlated with the type A behavior score (r = 0.214, P < 0.05), age (r = 0.266, P < 0.05), 24 h mean systolic and diastolic blood pressures (r = 0.391, P < 0.001, and r = 0.382, P < 0.001, respectively), systolic blood pressure both at rest and during stress (r = 0.255, P < 0.05, and r = 0.215, P < 0.05, respectively), and the variability of both systolic and diastolic blood pressures at rest (r = 0.253, P < 0.05, and r = 0.321, P < 0.01, respectively). Stepwise multiple linear regression analysis demonstrated that age was associated with an increase in the left ventricular mass index for both sexes (P = 0.004 for males, P = 0.003 for females). The type A behavior score predicted a greater increase in left ventricular mass index in men (P = 0.018) but not in women. The 24 h mean systolic blood pressure was associated with a greater increase in left ventricular mass index in women (P < 0.001) but not in men. CONCLUSION Type A behavior is an independent risk factor for left ventricular hypertrophy in male patients with essential hypertension.

Psychophysiological Study on Fasting Therapy

The Tohoku University method of fasting therapy was performed on 380 patients. The clinical results revealed an efficacy rate of 87%. With regard to psychosomatic diseases, irritable colon syndrome, neurocirculatory asthenia, mild diabetes mellitus, obesity and borderline hypertension were good indications for this therapy. In order to clarify the therapeutic mechanism, several clinical examinations were administered before, during and after therapy. EEG data was analysed according to the power spectral method. The peak frequency decreased as fasting progressed, while it increased as re-fed continued. Percent energy of alpha waves after fasting therapy was significantly higher than that of the pre-fasting stage. The dexamethasone suppression rate of urine 17-OHCS after fasting therapy was significantly lower than that of the pre-fasting stage. It seems that ketone nutrition may work as a strong stressor in the brain cell, temporarily placing all biological mechanisms in a stress state and then activating the natural healing power inherent to the human body, thereby bringing about homeostasis.

Psychobehavioral factors involved in the isolated office hypertension : comparison with stress-induced hypertension

Objective To investigate the psychobehavioral factors involved in the isolated clinic blood pressure elevation and hypertension induced by mental stress. Design and methods We studied 73 untreated patients with essential hypertension defined as World Health Organization stage I or II (28 men and 45 women, mean age 55 ± 11 years). The amount of isolated clinic blood pressure elevation was examined in terms of the difference between clinic and daytime ambulatory blood pressures. Blood pressure (measured using a Finapres device) and R–R interval (measured electrocardiographically) were continuously monitored with subjects at rest and under mental stress (counting backward) to examine the cardiovascular response to the stress. Psychobehavioral characteristics such as anger, anxiety, tension, type A behavior pattern, and nervousness were evaluated and scored using structured interviews and self-reporting questionnaires. Results The anger score was inversely correlated to the clinic–ambulatory blood pressure difference for the systolic (r = −0.308, P < 0.01) and diastolic (r = −0.233, P < 0.05) blood pressures. The score for type A behavior pattern tended to be inversely correlated to the clinic-ambulatory blood pressure difference for diastolic blood pressure (r = −0.209, P < 0.1). The nervousness score was positively correlated to stress-induced increase in the systolic (r = 0.249, P < 0.05) and diastolic (r = 0.232, P < 0.05) blood pressures. The clinic-ambulatory blood pressure difference was not related to the blood pressure rise induced by mental stress (r = 0.170 for systolic blood pressure; r = 0.112 for diastolic blood pressure). Conclusion The isolated clinic blood pressure elevation and hypertension due to mental stress were related to different psychobehavioral factors.

Fasting Therapy for Psychosomatic Disorders in Japan

It has been well known in Japan that fasting therapy has an excellent effect on various kinds of psychosomatic diseases. From 1967 to 1977 the therapy was carried out on about 382 cases of psychosomatic diseases in our clinic with an efficacy rate of 87%. The following diseases were considered as suitable indications for the therapy; irritable colon, behavioral disturbance of eating, functional disorders of the G-I tract, neurocirculatory asthenia, labile hypertension, variable psychosomatic symptoms of puberty, conversion hysteria and many kinds of neurosis with somatic complaints. The mechanism of effectiveness of the therapy is discussed from the psychological and biological aspects. It is concluded that the regulating mechanisms of the autonomic nervous system and endocrine system may change the whole functioning of the body including the brain, resulting in a spontaneous deconditioning of maladaptive bodily and mental behavior and an improved homeostatic adjustment to life.

服薬コンプライアンス尺度(第1報) : 服薬コンプライアンス尺度の作成

The failure of patients to comply with treatment regimens recommended by their physicians is a significant clinical problem. Researches on the assessment of compliance have, however, been precluded by methodological difficulties such as lack of adequate measures. The purpose of this study was to develop a self-administered questionnaire to evaluate drug compliance. First, questionnaire containing a 52-items complied by two doctors, a pharmacist and a nurse, was tested on 81 outpatients, all volunteers, attending the departments of psychosomatic medicine and internal medicine. Four items were temporarily removed for later analysis because they directly inquired about drug compliance (drug compliance items). The other 48 items were analyzed and three factors consisting of 26 items were further studied: expectation on taking medicine, rejection to taking medicine and seeking knowledge of drugs. Chronbacks alpha coefficients representing internal consistency of the three factors were sufficiently high (ranging from .75 to .84). Furthermore, we preformed a simplified pill count to validate the 4 drug compliance items. There was a weak to moderate correlation between the result of pill count and each of 4 drug compliance items. A new self-administered questionnaire of 30 items was thus developed and named the Drug Compliance Scale.

Clinical Application of Xylitol in Diabetes

As a result of the pioneering experiments of Dr. Lang and his coworkers [1], and the subsequent clinical investigations of Prellwitz and Bassler [2], andMehnert, Summa, and Forster [3], it became apparent that the disappearance of intravenously administered xylitol was essentially the same in normal and diabetic subjects. The production of xylitol in large quantities since 1964, made it possible to explore the use of this pentitol in clinical conditions, particularly diabetes mellitus, in which animal studies suggested a possible beneficial effect.

Psychosocial factors associated with peptic ulcer in aged persons

The relationship between psychosocial factors and the occurrence and aggravation of peptic ulcer was studied in elderly people Thirty nine (14 male) ulcer patients and 79 (30 male) elderly people aged 65 years and over and living in the community were tested. Information on health status, medication, lifestyle, and psychosocial status was obtained by means of interviews using a questionnaire and from the clinical records of the ulcer patients. The same questionnaire was distributed to the residents. Logistic regression analysis adjusting for age disclosed that peptic ulcer was significantly associated with having an occupation and low exercise practice in men. However, the relationship weakened below statistical significance after adjusting for some physical risk factors besides age. Low education was significant but low instrumental support fell short of statistical significance with peptic ulcer in women even after adjustment for several physical risk factors besides age. Thus, the specific psychosocial factors might be independently associated with the occurrence and aggravation of peptic ulcer in at least elderly women.

Comment Difference in Metabolic Effects of D-Ribose and Xylitol in the Diabetic State

It has been shown that the uptake and utilization of administered D-ribose or xylitol is considerably rapid in man [1, 2]. D-Ribose and xylitol are known to be converted to ribose- 5-phosphate and xylulose- 5-phosphate, respectively, in the Pentose Phosphate Pathway. Taking these facts, coulped with our previous studies on xylitol [3], the present study was performed to see the difference in metabolic effects of D-ribose and xylitol in normal subjects and in diabetic patients. A few animal experiments were carried out to observe the effects of pentose and pentitol on the metabolism of isolated tissues.