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Since distinct cholesterol and triglyceride concentrations in major lipoproteins and their subclasses may be related to atherosclerosis, we investigated the relationship of cholesterol and triglyceride concentrations in lipoprotein subclasses and the severity of carotid intima-media thickness (IMT), a surrogate marker of subclinical atherosclerosis. We studied 116 apparently healthy Japanese men (53 ± 9 years) without a history of cardiovascular diseases who were not taking any medication. Carotid IMT was measured by means of high-resolution vascular ultrasound. Plasma cholesterol and triglyceride concentrations in major lipoproteins and their subclasses were determined by HPLC with gel permeation columns. By univariate analyses, carotid IMT was the most closely related to age (r = 0.528, P < 0.001), followed by smoking habit expressed as pack-year cigarette consumption (r = 0.409, P < 0.001). In addition to total cholesterol and LDL cholesterol, carotid IMT was significantly associated with cholesterol and triglyceride concentrations in several LDL and VLDL subclasses. Stepwise multiple linear regression analysis revealed that age (β = 0.436, P < 0.001), smoking (pack-years) (β = 0.225, P = 0.007), and large LDL cholesterol (β = 0.175, P = 0.023) were independent predictors of determining carotid IMT (adjusted R(2) = 0.347, P < 0.001). These results indicate that large LDL cholesterol is an important, independent determinant of carotid IMT in healthy men.

症例は40歳,女性. 20年前より,左腋窩の皮膚変化に気づいていたが副乳腺だと思い放置. 1年前より腫瘤状となり, 1カ月前から増大し受診した.左腋窩に8×7.5cmの硬い腫瘤を認めた.マンモグラフィー,超音波検査,胸部CT検査で左腋窩部に大きな充実性腫瘍を認めた.穿刺細胞診はclass IIIbで,異所性乳癌を疑い腫瘍摘出術,腋窩リンパ節郭清施行.腫瘍は境界明瞭,黄白色,充実性,分葉状であった.病理組織学的検査ではstoriform pattern (花むしろ模様)を示す隆起性皮膚線維肉腫が主体で,細胞密度が増し,紡錘形細胞が束状増殖(herringbone pattern)する線維肉腫領域も伴っていた.免疫組織化学検査でCD34が隆起性皮膚線維肉腫領域で陽性,線維肉腫領域でも部分的に陽性であった. 3年半無再発であるが,本症は再発率が高いとされており,厳重な経過観察が必要である.

Cardiogenic shock developed in a 72-year-old Japanese woman during combination therapy with verapamil and atenolol for recurrent supraventricular arrhythmia. She had coronary atherosclerosis, liver cirrhosis and brady-cardia-tachycardia syndrome. Despite of the high-dose catecholamines and counterpulsation, she progressively deteriorated. Bolus administration of intravenous calcium chloride (CaCl2) immediately resolved her hemodynamic collapse.

保存的治療が奏効した特発性食道破裂の1例を報告した.症例は59歳の男性で, 嘔吐した直後の心窩部痛で発症した.発症から約7時間で来院し, 全身状態も安定していたが保存的治療を行った.来院時胸部単純X線写真やCTでは縦隔気腫と少量の胸水を認めたのみで気胸はなく, 同日の上部消化管X線検査 (以下, UGI) で造影剤の管外漏出を認めなかった.第3病日のUGIで下部食道から造影剤の管外漏出を認めたが, これは縦隔内に留まり胸腔内に流入しなかったため, 保存的治療を続行した.UGIと内視鏡で破裂部の治癒傾向を確認したうえで第64病日に食事を開始し, 第78病日に退院した.従来の特発性食道破裂に対する保存的治療報告例は, ほとんどが診断遅延例や, 全身状態不良例であったが, 発症後早期でも食道からの内容物の漏出が縦隔内の小範囲に留まり, 縦隔膿瘍や膿胸の合併がなければ, 本症に対する保存的治療が可能な症例もあると考えた.

Serum creatine kinase (CK) MM isoforms were determined by chromatofocusing in 22 patients with acute myocardial infarction undergoing intracoronary thrombolysis. In 13 patients with successful coronary recanalization within 3.6 +/- 1.0 (SD) h after onset, time to peak CK activity occurred 13 +/- 3 h after onset which was significantly shorter (p less than 0.01) than that in 9 patients without coronary recanalization (20 +/- 4 h). The proportion of CK MM-A, the myocardial isoform, in serum in the reperfused group at 6, 10, and 14 h after onset (53 +/- 9, 38 +/- 5, and 27 +/- 4%, respectively) was always significantly lower (p less than 0.01) than that in the nonreperfused group (69 +/- 7, 59 +/- 8, and 43 +/- 4%). During the same period, the proportions of CK MM-B and CK MM-C, the converted isoforms derived intravascularly from MM-A by circulating carboxypeptidase, in the reperfused group were always significantly higher (p less than 0.01) than those in the nonreperfused group. The ratios of MM-A% to MM-B% and MM-A% to MM-C% amplified the differences between the two groups. At 10 h after onset, these ratios clearly differentiated the reperfused and the nonreperfused group at the values of 1.0 (MM-A/MM-B) and 3.0 (MM-A/MM-C) with the diagnostic sensitivity of 85% and 92%, respectively. Thus, myocardial reperfusion was detectable noninvasively by analysis of serum CK MM isoforms during the early stage of acute myocardial infarction.

Sixteen dogs were subjected to acute, permanent coronary occlusion to assess the relationship between latency for the rise of serum creatine kinase (CK) activity and infarct size. Serum CK activity was measured every 30 min from 0 h to 6 h and serially afterwards until 72 h after coronary occlusion. The serum CK activity immediately before coronary occlusion (0 h) was 61 +/- 18 (SD, n = 16) (range 37-95) IU/l. It exceeded the normal threshold value (100 IU/l) at 3.7 +/- 1.4 (range 1.5-6) h, increased at a maximal rate at 7.0 +/- 1.2 h and reached a peak value of 1700 +/- 1308 (range 304-5109) IU/l at 11.0 +/- 1.8 h after coronary occlusion. The cumulative CK release (CKr) was 6556 +/- 5984 (range 454-21580) IU/l, indicating that various sizes of infarction were produced. In 7 dogs, the infarct size was determined anatomically with an enzyme staining technique. The latency of the CK rise was significantly (p less than 0.01, n = 16) and inversely correlated with the max dE/dt (r = -0.692), peak CK (r = -0.716) and CKr (r = -0.691). The CKr was correlated well (p less than 0.001, n = 16) with max dE/dt (r = 0.946), peak CK (r = 0.984) and the infarct size (r = 0.912, p less than 0.005, n = 7). Thus, the latency of the rise of serum CK activity was inversely correlated with myocardial infarct size.

十二指腸潰瘍緊急手術例111例 (穿孔101例, 出血10例) の手術術式を中心に検討を行った. 術式の内訳は広範囲胃切除術 (以下広範胃切) が75例と多く, 選択的迷走神経切離術兼幽門洞切除術 (selective vagotomy+antrectomy以下SV+A) を主体とする迷切付加手術は32例であった. 術式の年次別推移をみると, 1980年までは広範胃切が大部分でSV+Aの症例はなかったが, 1980年までに広範胃切を行った56例中2例 (3.6%) に吻合部潰瘍の発生をみたことから, 1981年以降は緊急手術においても迷切付加手術が望ましいと考えてSV+Aを基本術式とし, SV+Aが55%と過半数を占めるようになった.