Prognostic significance of blood pressure and heart rate variabilities: the Ohasama study.

To investigate the association between cardiovascular mortality and short-term variabilities in blood pressure and heart rate, we performed a long-term prospective study of ambulatory blood pressure monitoring in Ohasama, Japan, starting in 1987. We obtained ambulatory blood pressure and heart rate in 1542 subjects >/=40 years of age. Blood pressure and heart rate variabilities were estimated as a standard deviation measured every 30 minutes by ambulatory monitoring. There were 67 cardiovascular deaths during the follow-up period (mean=8.5 years). The Cox proportional hazards model, adjusted for possible confounding factors, demonstrated a significant increase in cardiovascular mortality, with an increase in daytime systolic ambulatory blood pressure variability. A similar trend was observed in daytime diastolic and nighttime ambulatory blood pressures. Cardiovascular mortality rate increased linearly, with a decrease in daytime heart rate variability. Subjects in whom the daytime systolic ambulatory blood pressure variability was larger than third quintile and the daytime heart rate variability was lower than the mean-SD were at extremely high risk of cardiovascular mortality. The blood pressure and heart rate variabilities obtained every 30 minutes by ambulatory blood pressure monitoring were independent predictors for cardiovascular mortality in the general population.

[Clinical effect of intra-arterial carboplatin-combined chemotherapy for advanced uterine cervical cancer and increased tissue platinum levels with Lipo PGE1 administration before chemotherapy].

Combination chemotherapy including carboplatin was administered intraarterially from the internal iliac artery as neoadjuvant chemotherapy to nine patients with advanced uterine cervical cancer. Two or three courses were repeated at intervals of 3 weeks. And to investigate whether the administration of Lipo PGE1 with the action of vasodilation before intra-arterial chemotherapy increases tissue levels of anticancer agents, 7 out of 9 patients were treated with Lipo PGE1, followed by arterial infusion chemotherapy. After infusion, tissue platinum (Pt) concentrations were measured by flameless atomic absorption spectrophotometry. Three of 9 patients with measurable tumor had a complete response and 6 had a partial response. Tissue Pt concentrations reached maximum levels 2-6 hours after intra-arterial chemotherapy. Tissue Pt levels of the patients with pretreatment of Lipo PGE1 were significantly higher than those without pretreatment (p < 0.01). It seems likely that Lipo PGE1 administration before intra-arterial chemotherapy is useful for the enhancement of tissue levels of anticancer agents as well as the clinical effects.

[A case of left atrial myxoma with remarkable elevation of serum alkaline phosphatase level].

A 53-year-old woman was admitted suffering from high grade fever. Laboratory findings revealed leukocytosis, high CRP, high erythrocyte sedimentation rate and remarkable elevation of serum alkaline phosphatase level. Echocardiogram demonstrated left atrial tumor which was later diagnosed as myxoma. Although remarkable elevation of serum alkaline phosphatase level often indicates malignant disease, tumor makers were normal level and whole body computerized tomography couldn't detect other noncardiac diseases. Because of patient's deterioration due to sustained high grade fever, the left atrial tumor was excised. After the excision of the left atrial myxoma, patient's clinical signs and symptoms disappeared, and the serum alkaline phosphatase level was gradually normalized. We conclude that the cause of remarkable elevation of serum alkaline phosphatase level was the left atrial myxoma.

Hb Kanagawa [alpha 40(C5)Lys----Met]: a new alpha chain variant with an increased oxygen affinity.

An abnormal hemoglobin was suspected in a 70-year-old Japanese male with cerebral infarction and erythremia with high performance liquid chromatography assay of Hb A1c. The hemoglobin variant migrated to the anode more rapidly than Hb A. Structure determination studies, including amino acid analysis of the abnormal peptide and DNA sequencing of a partially cloned alpha-globin gene, demonstrated that it is a new hemoglobin variant which has been named Hb Kanagawa [alpha 40(C5)Lys----Met]. This variant showed an increased oxygen affinity, decreased heme-heme interaction, and a lowered 2,3-diphosphoglycerate effect relative to normal.

Pathologic features of Behçet's syndrome: a review of Japanese autopsy registry data.

The data recorded from 170 autopsies of patients with Behçet's syndrome in Japan during the period from 1961 to 1976 were analyzed. The patients had been in the second to the eighth decade of life, and the ratio of males to females was 5 to 2. A wide spectrum of pathologic findings was observed, with involvement of neurologic, ophthalmic, cardiovascular, pulmonary, gastrointestinal, visceral, genitourinary, and mucocutaneous systems. Some of the common acknowledged clinical features of the syndrome, such as oral ulcers, synovitis, retinal and cutaneous vasculitis, and venous occlusions, were underreported. This apparent discrepancy in an autopsy series may be due to the effects of treatment or the healing process, as well as to the possible incompleteness of the postmortem examination. The accessibility of recorded data in a national autopsy registry offers a unique opportunity for review of the pathologic features of Behçet's syndrome.