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Liver function tests were carried out in 40 patients with Takayasu's syndrome. The alkaline phosphatase level was elevated in 73% of patients, the SGOT level in 59%, and the lactic dehydrogenase level in 84,6%. In contrast, creatinine phosphokinase levels were elevated in only 23.5% and bilirubin levels were normal in all patients. Histological abnormalities were present in 3 out of 5 patients in whom a biopsy had been performed. These abnormalities may shed light on the aetiology of this syndrome.

A case of type IV Takayasu's arteritis in whom a renal autotransplant was performed is presented. Extensive cardiovascular measurements were made, which enabled the assessment of vascular responsiveness to various anaesthetic manipulations. The management of the condition is discussed and certain recommendations made in light of the experience gained.

The clinical features and course of aortitis syndrome were studied in 11 women older than 40 years of age. The patients were Japanese women, mean age 57 +/- 6 years old, who were followed for 6.9 +/- 3.8 years. Data from 24 young patients were used for comparison. In the older patients, systemic hypertension (73%), calcification of the aorta (73%), left ventricular hypertrophy (92%) and cardiomegaly (82%) were frequent, whereas the erythrocyte sedimentation rate was normal in 5 patients and only slightly accelerated in 6. C-reactive protein was positive in 2. The incidence of cardiac involvement and inflammatory signs was significantly different from findings in the young patients. Aortic regurgitation (AR) (55%) was significantly more frequent and renal artery stenosis was not observed. Other arterial lesions revealed a pattern similar to those seen in the young patients. An irregular luminal surface, kinking and calcification were present in the lesions in the older patients. The survival rate at 5 years was 80%. Five of 6 patients with AR had congestive heart failure, 4 of whom died. One died after a stroke. Thus, aortitis syndrome in older patients has a long course. There is usually an associated AR, renal artery stenosis is rare and other arterial lesions do not change a great deal. The prognosis may be good, but depends on the association of AR.

In our ongoing studies of the interrelationship between platelets and the vascular wall we found that an accurate estimate could be made of the clinical condition and more effective therapy prescribed when we monitored alterations in the plasma levels of TXB2. For this purpose we devised a radioimmunoassay with I125-TXB2-Tyramide. Patients with ischemic heart disorders, cerebral apoplexy, diabetes mellitus, Buerger's disease, Takayasu disease etc., all had statistically high levels of TXB2 as compared with healthy controls. In particular, patients with myocardial infarction, cerebral thrombosis and/or hemorrhage all revealed increases in levels of TXB2 and these levels increased in parallel with a worsening of the clinical condition, and there was always a re-increase in TXB2 level before a recurrence of an attack. As plasma TXB2 levels clearly reflect thrombogenic disorders, the assessment of these levels on a routine basis, enables a more accurate diagnosis, an indication of possible recurrences, and more effective chemotherapy and rehabilitation.

Pregnancy increases the risk of focal ischemic cerebrovascular events, apparently to about 13 times the expected rate outside of pregnancy in the case of cerebral infarction. The distribution of the underlying pathophysiologic mechanisms causing the cerebrovascular symptoms in pregnant patients differs considerably from the distribution in the general population. Although most focal ischemic lesions that occur during pregnancy seem to be the result of arterial occlusion, cerebral venous thrombosis is still a prominent factor in causing such lesions. Arterial occlusions tend to occur during the second and third trimesters of pregnancy and during the first week after delivery, whereas the venous occlusions tend to occur one to four weeks after childbirth. When possible, treatment of patients with focal ischemic neurologic symptoms is based on a precise definition of the underlying pathophysiologic mechanism and its appropriate treatment. When this is not possible, patients are treated according to categorization based on the temporal profile of the focal deficit.

The eight new items concerning pericarditis (acute pericarditis, acute or chronic pericardial effusion, and constrictive or sero-constrictive pericarditis) were demonstrated based on the clinical observation of 115 patients. Pericarditis, a disease of remote antiquity, still has many fascinating and unrecognized aspects, which will be uncovered by the meticulous observation of the patients.

Hemodynamic and volume characteristics, and/or peripheral plasma renin activity were investigated in 19 patients with Takayasu's arteritis who included 8 hypertensive patients with renal arterial disease and 11 normotensive patients. In hypertensive patients, mean arterial pressure had an inverse correlation with cardiac index, a direct correlation with total peripheral resistance index and no correlation with blood volume. These hemodynamic and volume characteristics were different from those of hypertension with renal arterial disease previously reported. High plasma renin activity was presented in not only hypertensive patients with renal arterial disease but normotensive patients. The investigation of high plasma renin activity in Takayasu's arteritis must be also directed to the mechanism except renal arterial lesions.

Three patients with aortitis syndrome ehibited paroxysmal hypertension which seemed to result from baroreceptor dysfunction. All of the patients had signs of active inflammation of aortitis syndrome and stenotic carotid and subclavian arteries. During the attacks, the blood pressure rose to at least 230 mm. Hg systolic and the heart rate exceeded 100. However, with prolonged administration of steroid hormones, the attacks ceased. In two patients with dilated thoracic aortas and aortic regurgitation, the attacks of paroxysmal hypertension occurred without apparent precipitating factors and were followed by anginal pain with marked ST depression. The sympathicotonic state resulting from the disturbance of the baroreceptors was considered to be responsible for the attacks. In another patient, the attacks occurred in the course of treatment with a steroid hormone and were provoked only by voluntary micturition. This post-micturition hypertension was presumed to be an expression of abnormal overshooting following a fall in blood pressure after voiding.

Twenty eight subjects with noisy circulation sindrome (NCS) defined as cases at least, with 4 murmurs in different arteries were studied. They were divided in groups A, B, C formed by 9 normal children, 9 peripheral vascular atherosclerosis adults and 10 Takayasu's arteritis cases, respectively. In the whole population a complete chronometric arterial auscultation and in groups B and C an arteriography of at least 3 arteries with murmurs, were performed. Groups A, B and C had 40, 50 and 37 arterial murmurs, respectively, which were predominantly localized in supraortic trunks, pelvic and phemoral arteries, and supraortic and abdominal regions, respectively. 100, 19.1 and 21.1% of

Takayasu's aortitis is an arterial inflammatory disease of arteries of unknown etiology. Fainting is a common symptom and has been attributed to ypersensitivity of the baroreflex. We studied baroreflex sensitivity in 11 patients with Takayasu's aortitis and compared it with that of eight control subjects of comparable age. Baroreflex sensitivity was assessed by determining the slope of a regression line relating the rise of systolic arterial pressure to the prolongation of the R-R interval of the electrocardiogram during a transient rise of arterial pressure induced by an intravenous injection of phenylephrine. The average baroreflex slope of patients with Takayasu's arteritis (4.0 +/- 0.8 msec/mm Hg) was significantly less than that of control subjects (10.7 +/- 0.8 msec/mm Hg, P less than 0.001). Reduced baroreflex sensitivity in patients with Takayasu's aortitis may be due to the hardening of the arteries where baroreceptors lie, or to hypertension and/or cardiac disease which was present in most of the patients included in this study. Patients with Takayasu's aortitis who complained of fainting also showed the reduced baroreflex sensitivity. This indicates that fainting in this disease is not likely to be caused by the hyperreactivity of the baroreceptors as is commonly postulated.

The data on clinical course and long-term medical treatment of 215 patients with non-specific aortoarteritis are presented. Out of 180 patients who underwent antinflammatory treatment improvement was observed in 72.7%, fatal outcome occurred in 7.2%, while in the group of 35 patients who had no treatment or had irregular treatment 28.5% died. The patients were treated by steroid hormones, heparin, trentale, indocid. The treatment was long-term, sometimes up to 2 years.

Although pulmonary artery disease in Takayasu's arteritis has been described since 1940, it has received little attention. The clinical, hemodynamic, and angiographic features of the pulmonary involvement were studied in 22 patients with systemic arterial disease. Pulmonary involvement was found in 50 percent of the cases. Moderate pulmonary hypertension was a common finding (73 percent). Lesions were generally localized to the large and medium pulmonary vessels. None of the patients had pulmonary symptoms, but in 63 percent there were clinical, radiologic and electrocardiographic findings suggesting pulmonary hypertension or right heart strain. We believe that the pulmonary circulation should be routinely studied in patients with Takayasu's arteritis and that pulmonary involvement should be included in the classification of the disease.