Longitudinal association between polypharmacy and development of pruritus: a Nationwide Cohort Study in a Japanese Population.

BACKGROUND: Although polypharmacy is known to cause side-effects due to drug-drug interactions, dermatological symptoms triggered by polypharmacy are not fully addressed. OBJECTIVE: To investigate whether polypharmacy is associated with the risk of pruritus. METHOD: A cohort study was performed to examine cross-sectional and longitudinal relationships between polypharmacy and pruritus in a general population. Data were collected from the Norm Study conducted in 2016 and 2017, which is a nationwide survey based on a self-administered questionnaire with Japanese representative participants aged 16-84 years. Presence of polypharmacy which was defined as concurrent use of ≥5 prescribed drugs. Primary outcomes were the presence of severe pruritus at baseline for the cross-sectional analysis and the development of severe pruritus after one year for the longitudinal analysis. Multivariable modified Poisson regression analyses were performed to estimate risk ratios (RRs) and 95% confidence intervals (95%CIs) with adjustment for potential confounders (age, gender, smoking habits, drinking habits, depressive symptoms, moderate activities based on IPAQ score and presence of 11 comorbid conditions including skin disease). RESULTS: The study included 3126 participants (mean age, 48.7 years); nearly half (49.8%) were male. In all, 332 participants (10.3%) had polypharmacy in the cross-sectional analysis. Participants with polypharmacy were more likely to present with severe pruritus at baseline than those who were not using drugs (adjusted RR = 1.52 [95%CI 1.15-2.01, P = 0.003]). The longitudinal analysis (n = 1803) was limited to those without severe pruritus at baseline; participants with polypharmacy at baseline were more likely to develop severe pruritus after a one-year follow-up period than those not using drugs (adjusted RR = 1.46 [95%CI 1.14-1.87, P = 0.002]). CONCLUSION: Polypharmacy was associated with the presence of pruritus at baseline and may predict the future risk of developing pruritus.

[Myocardial imaging in acute myocardial infarction using beta-methyl-p-(123I)-iodophenylpentadecanoic acid: comparison with 201Tl imaging and wall motion].

Myocardial imaging using beta-methyl-p-(123I)-iodophenylpentadecanoic acid (BMIPP) was performed in 11 patients with acute myocardial infarction. The left ventricular images were divided into 12 segments, and myocardial imagings with BMIPP were compared with coronary angiography (CAG), thallium-201 myocardial scintigraphy (TL) and wall motion obtained by two-dimensional echocardiography (WM). When the culprit lesion was at the proximal point of the left anterior descending artery (LAD), all segments showed depressed uptake. In 3 cases with single vessel disease of the LAD, inferior wall of the basis showed reduced uptake of BMIPP despite the location of the culprit lesion. In cases with discordant uptake between the two tracers, BMIPP frequently showed more severely depressed uptake than TL in the subacute phase, although the uptake of BMIPP correlated with that of TL (tau = 0.82, p less than 0.001). In such cases, the discordance was related to the improvement in WM from the acute phase to the convalescent phase. BMIPP uptake correlated with WM in the subacute phase (tau = 0.50, p less than 0.001). BMIPP showed more severely depressed uptake while WM showed mild asynergy in most cases in which discordance was found between the BMIPP and WM findings. However, there was no correlation between the change in WM from the acute to subacute phases, or the uptakes of BMIPP and TL alone. We concluded that the myocardial condition can be evaluated in detail in acute myocardial infarction by comparing the findings of BMIPP with those of TL and WM.

[Left ventricular wall motion mimicking stunned myocardium in hypertrophic obstructive cardiomyopathy with normal coronary arteries: a case report].

A 63-year-old woman was admitted to the coronary care unit of Hyogo College of Medicine because of cardiogenic shock. She previously had been hospitalized in the Gynecology Department for the treatment of recurrent uterine cancer. She had poor appetite due to chemotherapy which was given for 10 days prior to her admission. On admission, echocardiography and cardiac catheterization revealed hypertrophic obstructive cardiomyopathy and extensive left ventricular wall motion abnormalities. Coronary arteriography showed no coronary artery disease. Left ventriculography as well as echocardiography performed on the 21st post-admission day revealed that the wall motion abnormalities had completely resolved and the systolic anterior motion of the mitral valve (SAM) was no longer evident. The systolic pressure at the apex of the left ventricle was 200 mmHg on admission. The increased ventricular pressure and the simultaneous resolution of the wall motion abnormality and SAM suggest that marked obstruction of the left ventricular outflow tract is more likely to be involved in transient ventricular wall motion abnormality rather than acute myocardial ischemia. The mechanism of the SAM in the present case seemed to be related to a Venturi effect which was augmented by the decreased preload due to hypovolemia. In addition, papillary muscle contraction seemed to pull the mitral valve toward the interventricular septum during systole.

[Indication for coronary revascularization in patients without redistribution on 201Tl myocardial scintigraphy].

To determine the indication for coronary revascularization (A-C bypass and PTCA), we performed thallium(Tl)-201 scintigraphy and contrast left ventriculography (LVG) in 25 cases who had A-C bypass surgery and 22 cases who had PTCA. The Tl uptake in the delayed image (Tl score = normal: 3, mild hypoperfusion: 2, severe hypoperfusion: 1, defect: 0), the presence of redistribution, and regional wall motion by LVG (LVG score = normal: 3, reduced: 2, none: 1, dyskinesis: 0), were compared with each other before and after revascularization. Sensitivity, specificity and accuracy of myocardial viability as evaluated by each index were; the presence of redistribution; 96%, 35%, and 60%; Tl score much greater than 2; 83%, 33%, and 66%; Tl score much greater than 1; 81%, 75%, and 81%; LVG score much greater than 2; 80%, 29%, and 63%; and LVG score much greater than 1; 79%, 33%, and 74%; respectively. It was difficult to evaluate the myocardial viability only by the presence of redistribution. However, any case with redistribution was a prime candidate for coronary revascularization. The Tl score much greater than 1 was the most reliable indication using the individual index. Although the diagnostic accuracies of the Tl and LVG scores were superior to the presence of redistribution, there was no individual index of myocardial viability common to all cases. If there were clinical necessity and angiographic indication, coronary revascularization could be tried in all cases except those whose Tl and LVG scores were both 0. In conclusion, myocardial viability can be evaluated scintigraphically only by the delayed image and by the presence of redistribution. As a conventional indication for coronary revascularization, the Tl score is relatively useful for predicting improvement after revascularization.

Baroreceptor reflex to neck suction and its modification by diltiazem in man.

The carotid sinus baroreceptor reflex was studied in 15 healthy young men by a variable pressure neck suction chamber. Neck suction produced a reduction in blood pressure and an increase in RR interval, which were augmented by an increase of stimuli. Both responses occurred promptly and were attenuated with time. The reproducibility of the response was examined in 6 subjects. There were no differences in either hypotensive or bradycardiac responses between 2 runs separated by 1 hour, indicating good short-term reproducibility. In a long-term reproducibility study involving 2 runs separated by 2 weeks, hypotensive responses showed similar changes, whereas bradycardiac responses showed a wide variation. Based on this good reproducibility of responses, the effects of diltiazem on baroreflex function were studied in 9 men. Following the administration of diltiazem (20 mg, P.O.), the hypotensive responses to neck suction stimuli were significantly augmented compared to preadministration responses. On the other hand, diltiazem did not have a significant influence on heart rate responses. Thus, the present study shows that the neck chamber method is a feasible approach to studying the influence of given interventions on baroreflex function and demonstrates an enhancement of baroreflex-mediated hypotension by diltiazem.