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Objective We investigated the relationship between the right cardiac system and increased pulmonary artery systolic pressure (PASP) in the elderly. Patients and Methods Echocardiography stable state data were available for 163 of 200 consecutive autopsied patients. Of these, PASP could be estimated by extrapolation from the maximum pressure gradient in tricuspid valve regurgitation from echocardiograms in 73 cases; however, 22 cases with secondary changes attributable to left cardiac insufficiency had to be excluded. We studied the remaining 51 patients in detail (16 men, 35 women, age 68-103 years; mean, 87.7±8.1). We investigated the following: echocardiographic and pathologic variables, age, sex, body mass index, the survival time (from echocardiography to autopsy), and the presence or absence of chronic pulmonary disease. Results The average PASP was 39.8±10.3 mmHg, elevated compared with young persons. Linear regression analysis showed a close correlation of PASP with age (r=0.35, p=0.011), thickness of the right ventricle (RV) outflow tract wall as an index of RV hypertrophy (r=0.35, p=0.013) and the survival time (r=−0.36, p=0.0083). By multiple regression analysis, PASP was correlated with the thickness of RV outflow tract (p=0.0037) even after adjustment for other factors including chronic pulmonary disease. Conclusions PASP is elevated in the elderly and it is correlated with the thickness of the RV outflow tract wall as an index of RV hypertrophy.

Background Many elderly persons without heart failure have high plasma concentrations of brain natriuretic peptide (BNP). We investigated the prognostic implications and potential causes of these increased levels. Methods We enrolled 111 persons aged 80 years or older who had no history of hospitalization for cardiac disease, a cardiothoracic ratio ≤55% on chest radiographs, and a serum creatinine level ≤2.0 mg/mL. All subjects had participated in a regular health screening program at our hospital, and were followed for up to 24 months. We studied the correlation of plasma BNP concentration with age, nutritional state, and activities of daily living. Cox proportional hazards models were used to determine the association between BNP levels and clinical outcomes (cardiac hospitalizations, mortality), adjusted for other risk factors. Results During follow-up, 8 subjects (7%) were hospitalized with cardiac disorders, and 21 (19%) died. Each 50-pg/mL increase in the plasma BNP concentration was associated with a 1.6-fold increase in the risk of cardiac events (95% confidence interval [CI]: 1.2 to 2.1) and a 1.4-fold increase in total mortality (95% CI: 1.2 to 1.6). Plasma BNP concentration correlated positively with age ( r = 0.31, P = 0.001), serum creatinine level ( r = 0.23, P = 0.02), and the activities of daily living ( r = 0.36, P = 0.0001). Conclusion In very elderly persons, the plasma BNP concentration may be a biochemical marker of an increased risk of cardiac morbidity and total mortality.

Large 24-h blood pressure (BP) variability and an excessive drop in BP during nighttime are associated with a higher risk of cardiovascular events. Data are lacking regarding the prognostic significance of variability in BP measured during office visits. We analyzed the relationship between office BP variability and the risk of brain infarction in elderly patients receiving antihypertensive therapy. Patients who experienced their first-ever stroke at the age of 60 years or over were registered in the study. At least 2 sex- and age-matched control patients were registered for each case patient. Office BP at each clinic visit and known cardiovascular risk factors were recorded. The BP variability was defined as the variation coefficient (VC) of office BP. In this report, we analyze the data of brain infarction patients. The VC of both systolic and diastolic BPs was significantly higher in the brain infarction patients than in the control patients. Higher office BP variability was associated with a higher risk of brain infarction after adjustment for BP level and other confounding factors. Regarding diastolic BP, the association of brain infarction with the maximal value for the difference of office BPs taken at any consecutive two visits (Max-deltaBP) or the difference between the highest and lowest values of office BP (BP-range) recorded during a 1-year period prior to the event was also significant. In conclusion, a retrospective case-control study suggested that office BP variability was an independent predictor of brain infarction. Either the Max-deltaBP or the BP-range may be surrogate indices of diastolic BP variability.

The efficacy of ofloxacin for the treatment of lower respiratory tract infection was evaluated in aged patients with chronic lung disease. Results are the following: improvement of leukocytosis and arterial oxygen tension was observed; peripheral blood cell analysis showed a decrease in natural killer cell counts and in helper/suppressor T cell ratio; superoxide production by peripheral blood white cells was decreased after treatment; interleukin-2 production was rather increased. We concluded that improvement in the immunological parameters indicated the efficacy of ofloxacin for lower respiratory tract infection in aged patients with chronic lung disease.

Net Na+ and K+ fluxes were measured in Na+ -loaded red cells from 19 normotensive control subjects, 22 essential hypertensive patients, and 8 secondary hypertensive patients. The ratio of Na+/K+ net fluxes was significantly lower in essential hypertensive patients than in normotensive control subjects. However, by the addition of the patients' own plasma, the net Na+ efflux rate was significantly increased in essential hypertensive patients, which caused the increment in the ratio of Na+/K+ net fluxes. This resulted in disappearance of the difference between normotensive and hypertensive subjects in the ratio of cation fluxes. It was possible that the abnormalities of cation transport in red cells from essential hypertensive patients might be compensated for by humoral factors in the plasma.

The concept of left atrial systolic time intervals anil Doppler echocardiography were used in a quantitative assessment of left atrial function in relation to the presence or absence of a fourth heart sound and to left ventricular hypertrophy in 47 patients with hypertension. Left atrial systolic time interval indexes included atrial pre-ejection period (the time between the onset of an electrocardipgraphic P wave and the onset of left ventricular inflow during atrial systole [A wave]), corrected atrial pre-ejcctlon period (the airial pre-ejection period divided by the duration of the P wave), and atrial ejection time (the time between the onset and cessation of the A wave).Twenty-one patients with a fourth heart sound on the phonocardiogram had a shorter atrial pre-ejection period (81 ± 10 versus 89 ± 14 ms p < 0.05) and a corrected atrial pre-ejection period (66 ± 17 versus 83 ± 18 ms, p < 0.01), as well as a longer atrial ejection time (147 ± 15 versus 126 ± 13 ms, p < 0.001) than did 26 patients without a fourth heart sound. The ratio of atrial pre-ejection period to atrial ejection time and that of corrected atrial pre-ejection period to atrial ejection time was smaller in patients with than in patients without a fourth heart sound (0.56 ± 0.08 versus 0.71 ± 0.11, p < 0.001; 0.46 ± 0.16 ms−1versus 0.67 ± 0.17 ms−1, p < 0.001, respectively). Left ventricular wall thickness (the sum of interventricular septal thickness and left ventricular posterior wall thickness) evaluated by two-dimensional echocardiography correlated positively with left atrial ejection time (r = 0.42, p < 0.01) and negatively with corrected atrial pre-ejection period (r = −0.34, p < 0.02), the ratio of atrial pre-ejection period to atrial ejection time (r = − 0.35, p < 0.02) and the ratio of corrected atrial pre-ejection period to atrial ejection time (r = −0.40, p < 0.01).It is concluded that quantitative evaluation of left atrial function obtained by left atrial systolic time intervals correlates with the presence of a fourth heart sound and with left ventricular wall thickness.

Recently, growing interests had been devoted largely to disseminated intravascular coagulation (DIC), because of its frequency and clinical importance. It has been known that shock is a frequent complication of DIC, although it has not been elucidated whether shock is a cause of DIC rather than a result. This study was made to clarify relationship between DIC and shock in 699 consecutive autopsied cases, almost all of whom was over age sixty, in Tokyo Metropolitan Geriatric Hospital.The diagnosis of DIC was established when coagulation analysis revealed presence of consumption coagulopathy. Among these cases, 106 had evidences of DIC and 30 had clinical and pathological findings highly suggestive of DIC although the coagulation findings were not specific. Shock was complicated in 38 of the former and 10 of the latter.Eight of these 48 patients with DIC complicated with shock revealed consumption coagulopathy simultaneously with the development of shock. 24 cases had not clea r-cut evidences of DIC immediately after the development of shock in coagulation findings, although they showed marked coagulation abnormalities indicating DIC after the shock developed. 44% of conditions associated with the shock in these patients was gram-negative septicaemia. The other underlying pathologic conditons in these cases consisted of cancer, peptic ulcer, acute myocardial infarction and pneumonia.Onset of shock was observed in 16 cases in whom diagnosis of DIC had been already established by coagulation analysis. 11 cases of these had cancer with metastases, primary organs of which were stomach, colon or biliary tracts. 70% of these patients were febrile.Acute renal failure, purpura, petechiae, melena, coma, epileptic seizure, systemic peripheral gangrene and/or red cell fragmentation in peripheral blood smear were main symptoms in DIC with shock. Four cases, excluding two cases in whom DIC developed following development of acute myocardial infarction, showed ECG findings indicating development of acute myocardial infartion, although myocardial infarction was evident in only one cases by postmortem examination.Presence of fibrin thrombi was confirmed in 36 cases out of the 48 autopsied cases with DIC accompained with shock. Terminal hemorrhagic necrotizing enteropathy was observed in 15 of those cases. Hemorrhage from adrenal was observed in 4 cases.From these results, it is concluded that shock does frequently cause DIC and that shock in gram-negative septicaemia is especially important because of its high incidence to result DIC.

褐色細胞腫の1例において, 1日食塩摂取量を増減し,高塩期および低塩期において尿中ノルエピネフリン(U-NE),尿中エピネフリン(U-E)の1日排泄量を測定した.又各期で生食点滴静注(1l/2hours),フロセマイド40mg静注負荷を行ない,それぞれ血漿ノルエピネフリン(P-NE),血漿エピネフリン(P-E)および血圧を経時的に測定した. U-NEは高塩期787±94ug/日に比し,低塩期1520±336μg/日と高値を呈した.生食負荷により, P-NEは低下した(低塩期では負荷前4741pg/ml,後120分値1854pg/m1).フロセマイドにより血圧, P-NEは低塩期で著明に上昇した.以上より,褐色細胞腫患者においても, Naおよび体液量の変化に対し,尿中および血中カテコールアミンはよく反応することが示唆された.

Fabry病(angiokeratoma corporis diffusum)は希な遺伝性の糖脂質代謝異常症である.本症例は16才の男子で,発熱,四肢末端の熱感を伴つた疼痛発作,発汗低下,皮膚の血管腫,角膜の混濁を認めた.尿検査では蛋白(±)の他には異常を認めず,腎機能も正常であつたが,腎生検組織像で尿細管は全く異常なく,糸球体にのみfoam cel1が存在し,初期のFabry病が強く疑われた.なお,細小血管にはフィブリノイドと思われるPAS強陽性物質の沈着がみられた.そこで,尿沈渣の薄層クロマトグラフィーを行ない,尿中へのceramide trihexosideの出現,増加,また,血清中のα-galactosidase活性の著減を証明してFabry病との診断を確定し得た.本例においては,一般にあまり有効でないとされているステロイドが著効を示しているが,このことは,腎臓にみられた血管病変との関連で注目される.

Plasma concentrations of immunoreactive (IR)-atrial natriuretic polypeptide (hANP) were measured by radioimmunoassay in 9 essential hypertensive patients after alteration of salt intake and acute saline infusion. Daily salt intake was altered every one week in the order of 15g/day, 3g/day, and 7g/day. On the last day of the first week, 1500 ml of 0.9% saline was infused intravenously over one hour. Plasma concentrations of IR-hANP tended to decrease, although not significant, by salt restriction. Further, there were significant positive correlations between changes in plasma concentrations of IR-hANP and those of several variables such as body weight, systolic blood pressure, and creatinine clearance. Plasma concentrations of IR-hANP rose significantly (p less than 0.05) from 50.7 +/- 20.1 (Mean +/- SEM) pg/ml to 119.0 +/- 48.8 after acute saline infusion. Although there was significant correlation between mean blood pressure and the increase in sodium excretion by saline infusion, this increase was unrelated to the rise in plasma concentrations of IR-hANP. These results suggest that the release of ANP is stimulated mainly by expansion of extracellular fluid volume in hypertensive patients. However, natriuretic and hypotensive effects attributable to the changes of ANP release could not be elucidated.

This study was performed to determine whether there is any difference in cation transport of red blood cells from normotensive subjects and hypertensive patients in Japan. Net Na+ efflux and net K+ influx rates were measured in sodium-loaded red cells from 19 normotensive subjects, 22 essential hypertensive patients, and 8 secondary hypertensive patients. The ratio of Na+/K+ net fluxes and the net cation flux rate were compared between these groups. The ratio of Na+/K+ net fluxes was significantly lower in essential hypertensive patients than in normotensive subjects. Parameters such as age, sex, blood pressure, plasma renin activity, and plasma aldosterone concentration were also examined in 2 groups of essential hypertensive patients, divided on the basis of their Na+/K+ net fluxes. However, there is no significant difference between the groups. These results suggest that the ratio of cation flux is related to hypertension independently of these parameters.

To evaluate left ventricular (LV) and left atrial (LA) function in patients with borderline and established hypertension, 7 indexes of LV systolic function (cardiac index, end-diastolic volume index, ejection fraction, LV network, mean VCF, Vmax and peak dp/dt), 7 indexes of LV diastolic properties (specific compliance, LV mass index, LV wall thickness, stiffness constant, time constant T, end-diastolic pressure and peak negative dp/dt) and 3 indexes of LA function (volume index, chamber stiffness constant and muscle stiffness constant), all obtained form the data of cardiac catheterization and cineangiogram, were analyzed in patients with normotension (N, n=12), borderline hypertension (BH, n=13) and established hypertension (EH, n=17). LV systolic function was not impaired in the BH and EH groups. In the BH group, LV diastolic function was not affected, but LV wall thickness and stiffness constant were significantly greater in the EH group than in the N group. There was no significant difference in LA volume index among the 3 groups, but a significant increase of LA chamber stiffness constant was found only in the EH group as compared to the values of the N group. On the other hand, LA muscle stiffness constant was significantly greater in the BH group than in the N group, and significantly greater in the EH group than in the BH group. From these results it seemed that LV systolic and diastolic functions were not impaired in patients with borderline hypertension, and that LV systolic function was not affected, but LV diastolic function was possibly impaired in patients with established hypertension. Moreover, it was suggested that LA compliance was impaired already not only in patients with established hypertension, but also in patients with borderline hypertension.