Relationship between Joint National Committee-VI classification of hypertension and ambulatory blood pressure in patients with hypertension diagnosed by casual blood pressure.

BACKGROUND: White-coat hypertension has been diagnosed arbitrarily based on different criteria. In 1997, the Joint National Committee-VI (JNC-VI) reported a new classification of hypertension and strongly emphasized the importance of ambulatory blood pressure (ABP) monitoring. The report pronounced normal ABP values for the first time. HYPOTHESIS: The study's aim was to clarify the relationship between casual blood pressure (BP) and ABP of patients with essential hypertension in each stage of JNC-VI classification, and the prevalence of white-coat hypertension diagnosed by using JNC-VI normal ABP criteria. METHODS: Ambulatory blood pressure was monitored non-invasively in 232 patients with essential hypertension whose casual BP was > or = 140/90 mmHg. The patients were classified according to JNC-VI classification, and their casual BP was compared with ABP. The criterion of white-coat hypertension was defined as casual BP > or = 140/90 mmHg with normal ABP according to JNC-VI criteria (< 135/85 during daytime and < 120/75 during nighttime). RESULTS: Mean ABP increased as the stage advanced, and the differences between casual BP and ABP also increased. There were considerable overlaps in the distribution of ABP among stages. The prevalence of white-coat hypertension was 13% overall: 30% of the patients with isolated systolic hypertension, 19% of those in stage 1, 10% in stage 2, and 4% in stage 3. CONCLUSIONS: Classification of hypertension based on casual BP may not always correspond in severity to that based on ABP. Ambulatory blood pressure monitoring recommended by JNC-VI is very useful for the evaluation of hypertension to differentiate white-coat hypertension from true hypertension.

Circadian rhythms of cardiovascular functions are modulated by the baroreflex and the autonomic nervous system in the rat.

BACKGROUND: We assessed the hypothesis that the baroreflex and the autonomic nervous system are important in the control of the circadian rhythms of cardiovascular functions. METHODS AND RESULTS: We continuously measured blood pressure (BP), heart rate (HR), and locomotor activity in sinoaortic denervated (SAD), sympathectomized, and atropine-injected rats by use of a radiotelemetry system. The circadian rhythm of mean blood pressure (MBP) was selectively disrupted in SAD rats under 12-hour light-dark (LD12:12) cycles as a result of an increase in MBP during the light period and disappeared under constant darkness (DD). The locomotor activity and HR were not remarkably affected by SAD. The circadian rhythm of MBP was suppressed in sympathectomized rats by a decrease in the MBP during the dark period, and the abrupt changes in MBP when the lighting was altered were not seen under LD. Under DD, an MBP rhythm similar to that observed under LD was obtained. Sympathectomized rats also showed lower HR levels during the dark period than intact rats under LD cycles. In atropine-injected rats, the MBP and HR increased, especially during the light period, resulting in a reduction of light-dark differences in MBP and HR. The locomotor activity showed an apparent 24-hour variation in the sympathectomized and atropine-injected rats. CONCLUSIONS: The disruption of the baroreflex selectively eliminates the circadian rhythm of BP, and the circadian rhythms of BP and HR are modulated by the autonomic nervous system in rats. The circadian rhythms of BP and HR are regulated by different mechanisms involving the autonomic nervous system.

Three-dimensional structure of maize alpha-zein proteins studied by small-angle X-ray scattering.

alpha-zeins of maize (Zea mays) that are storage proteins contain nine or ten tandem repeats comprising of about 20 amino acids. Small-angle X-ray scattering (SAXS) of alpha-zeins was measured in 70% (v/v) aqueous ethanol containing beta-mercaptoethanol or without reagent in a protein concentration range of 2.0 to 40.0 mg/ml. The overall radius of gyration of whole particles, Rg, and the corresponding radius of gyration of the cross-section, Rc, of reduced alpha-zeins are 4.00 +/- 0.03 nm and 1.39 +/- 0.05 nm, respectively, in the 70% (v/v) aqueous ethanol containing 2% (v/v) beta-mercaptoethanol. Analyses using the Rg and Rc values indicate that reduced alpha-zeins exist as asymmetric particles with the length of about 13 nm in the solution. A structural model is developed under assumption that each of tandem repeats units forms single alpha-helix and they are joined by glutamine-rich 'turns' or loops, as employed by Argos et al., [Argos, O., Pedersen, K., Marks, M.D. and Larkins, B.A. (1982) J. Biol. Chem. 257, 9984-9990] and Garratt et al. [Garratt, R., Oliva, G., Caracelli, I., Leite, A. and Arruda, P. (1993) Proteins Struc. Func. Genet. 15, 88-99], and that the longest dimension of 13 nm comes from linear stacking of the anti-parallel helices of tandem repeat in the direction perpendicular to the helical axis. The resultant model is presented by an elongated prism-like shape with an approximate axial ratio of 6:1.

Solution X-ray scattering data show structural differences between yeast and vertebrate calmodulin: implications for structure/function.

We present here the first evidence, obtained by the use of solution X-ray scattering, of the solution structure of yeast calmodulin, a poor activator of vertebrate enzymes. The radius of gyration of yeast calmodulin decreased from 21.1 to 19.9 angstroms when excess Ca2+ ions were added. The profiles of the pair-distribution function suggested that yeast calmodulin without Ca2+ has a dumbbell-like shape which changes toward a rather asymmetric globular shape, from its dumbbell shape, by the binding of Ca2+. In the presence of a calmodulin binding peptide such as MLCK-22 (a synthetic peptide corresponding to residues 577-598 of skeletal myosin light chain kinase), the radius of gyration of yeast calmodulin decreased by 1.6 angstroms, and the molecular shape of it estimated from the profile of the pair-distribution function was globular but less compact than that of vertebrate calmodulin. These results for the structure of yeast calmodulin complexed with Ca2+ and with Ca(2+)-peptides are quite different from those of vertebrate calmodulin. Thus, the functional differences between yeast and vertebrate calmodulin which we reported previously [Matsuura, I., et al. (1993) J. Biol. Chem. 268, 13267-13273] have been interpreted on the basis of the structural differences between them. Moreover, the structural studies on chimeric proteins of chicken and yeast calmodulin suggest that Ca2+ binding at site IV is essential to form the full active dumbbell structure, which is characteristic of vertebrate-type calmodulin.

Effects of suprachiasmatic lesions on circadian rhythms of blood pressure, heart rate and locomotor activity in the rat.

To determine whether the circadian rhythms in blood pressure (BP), heart rate (HR) and locomotor activity are controlled by an internal biological clock located in the suprachiasmatic nucleus (SCN), we continuously measured these parameters in SCN-lesioned rats using a newly developed implantable radiotelemetry device and a computerized data collecting system. Although SCN-lesioned rats showed a weak but significant 24-h periodicity in BP and HR under light-dark (LD) cycles, BP, HR and locomotor activity became completely aperiodic under constant dark (DD) conditions. The amount of locomotor activity was significantly reduced in SCN-lesioned rats compared to that in intact rats. BP tended to be higher in SCN-lesioned rats, but the differences were significant only in the comparison of systolic blood pressure (SBP) under LD and DD (p < 0.05) and of mean blood pressure (MBP) under LD (p < 0.05). HR in SCN-lesioned rats was significantly lower under LD (p < 0.05), but not under DD. The standard deviation and the variation coefficient of MBP, as indices of short-term variability of this parameter, were significantly larger in SCN-lesioned rats than in intact rats, while those of HR and locomotor activity did not differ significantly between SCN-lesioned and intact rats. These results indicate that the SCN is important not only for generating circadian rhythms of BP, HR and locomotor activity, but also for buffering the short-term variability of BP in rats.

Circadian and estrous cycle-dependent variations in blood pressure and heart rate in female rats.

To determine whether cardiovascular functions are controlled by the endogenous circadian system and whether they change with the estrous cycle in female rats, we measured mean arterial pressure (MAP), heart rate (HR), and spontaneous activity (ACT) of female rats using an implantable radiotelemetry device and a computerized data-collecting system. Under a 12:12-h light-dark (LD) cycle, these parameters exhibited daily rhythms that were entrained to the photic cycle. The patterns of the daily rhythms varied with estrous cycles, and variations were particularly marked in the proestrous stage. During the dark period of this stage, ACT levels were significantly higher, but HR was significantly lower than in other stages. Although the peak MAP occurred within 2 h after the onset of the dark phase in three of the estrous stages, it occurred around midnight in the proestrous stage. Such estrous cycle-dependent variations were eliminated by ovariectomy. The implantation of 17 beta-estradiol produced a gradual increase in MAP and an abrupt decrease in HR. During constant darkness, all three parameters were free running, maintaining the same internal phase relationships with each other as during LD cycles. These results indicate that daily variations in these parameters were controlled by the endogenous circadian oscillating system, that they vary with the estrous cycle in female rats, and that estrogen may be responsible for these estrous cycle-dependent variations.

[Efficacy of tonsillectomy for improving skin lesions of Pustulosis palmaris et plantaris--evaluation of 289 cases at the Department of Otolaryngology of Sapporo Medical University].

In recent years, Pustulosis palmaris et plantaris (PPP) has been described as one of the representative second lesions of focal tonsillitis in Japan. We selected 289 cases of PPP, treated with bilateral tonsillectomy at our department over the past 12 years for this clinical evaluation. In 211 of those 289 tonsillectomy cases, follow-up was done for more than 3 months after operation. Prior to tonsillectomy, 196 cases suffered from PPP only, 90 cases had the complication of osteo-arthral lesions such as sterno-costa-clavicular hyperosteosis (SCCH), rheumatoid arthritis, and soon, whereas only 3 cases showed simultaneous lesions of Psoriasis vulgaris. The efficacy of tonsillectomy for improving the skin lesions was classified into 6 grades, mainly based upon individual evaluation by each patient as follows; disappeared, remarkably improved, improved, slightly improved, unchanged, and worsened. According to our 211 cases, post tonsillectomy improvement of skin lesions was very obvious, with disappearance occurring in 54.3% of cases and remarkable improvement in 21.4%. Age of onset and the duration from onset to tonsillectomy showed no association with effectiveness. However, the shorter the duration from onset to tonsillectomy, the fewer days were required for improvement of the skin lesions. The rate of improvement of PPP rose in conjunction with the number of days after tonsillectomy. We conclude that it requires 12 months, at minimum, to determine the efficacy of tonsillectomy as a treatment for PPP.

Estrous-related variations of blood pressure and heart rate in female rats.

In female rats, several biological variables change with a 4 or 5 day estrous cycle. To clarify whether blood pressure and heart rate show estrous-related changes, we measured three variables, i.e. mean arterial pressure (MAP), heart rate (HR) and spontaneous activity (ACT), using an implantable radiotelemetry transmitter and a computerized data collecting system non-invasively and chronically for more than 2 months. Under a 12-12 light-dark cycle, the three variables revealed clear daily variations and modulations by the estrous cycle which were most pronounced in the proestrous night. During the proestrous night, ACT showed a remarkable increase and a peak in the first half of the night, whereas MAP showed a gradual increase and a peak around midnight, and HR remained low without forming a peak. All modulations by the estrous cycle disappeared following bilateral ovariectomy. It is concluded that daily variations of blood pressure and heart rate are modulated according to the estrous cycle.

Immunologic characteristics of cytokines in otitis media with effusion.

Levels of cytokines, interleukin (IL)-1 alpha, IL-1 beta, tumor necrosis factor (TNF), and granulocyte-macrophage colony-stimulating factor (GM-CSF) were investigated in samples of the middle ear effusions (MEEs) from 144 ears with otitis media with effusion (OME) by enzyme-linked immunosorbent assay, followed by cytologic analysis. Middle ear effusions of the acute purulent type contained a significantly higher concentration of cytokines compared with normal control sera (p < .001). Cytokines were observed at lower levels in MEE in adults than in children. Tests of children at the chronic stage of MEE showed higher levels of TNF than IL-1 and GM-CSF. Meanwhile, IL-1 beta showed significantly higher concentrations in acute purulent types than in serous and mucoid types (p < .01). In cytologic analysis, the mean level of IL-1 beta was significantly higher in the neutrophil-rich group than in other groups (p < .05). Cytokines possess several biologic properties, some of which are associated not only with acute otitis media but also with chronic otitis media. This study showed that cytokines, especially IL-1 beta, contribute to infiltration into the middle ear by inflammatory cells. This implies that the persistent presence of cytokines in MEE could be a factor in prolonged OME.

Effects of nifedipine on left ventricular diastolic function in patients with asymptomatic or minimally symptomatic hypertrophic cardiomyopathy.

We investigated the effects of nifedipine on left ventricular diastolic function in 17 asymptomatic or minimally symptomatic patients with hypertrophic cardiomyopathy by simultaneously measuring left ventricular pressure and volume with a catheter-tipped manometer and biplane cineangiography. Studies were performed before and 20 minutes after sublingual administration of nifedipine (20 mg). Heart rates were held constant (79 +/- 12 beats/min, mean +/- SD) by right atrial pacing. Left ventricular volumes and instantaneous rates of left ventricular volume were derived from frame-by-frame (20-msec) analyses of left ventricular biplane angiograms. Left ventricular peak systolic pressure (from 122 +/- 21 to 108 +/- 13 mm Hg, p less than 0.01 vs. control) and mean aortic pressure (from 96 +/- 15 to 87 +/- 11 mm Hg, p less than 0.01) decreased significantly with nifedipine. With afterload reduction, left ventricular ejection fraction (from 0.69 +/- 0.12 to 0.74 +/- 0.08, p less than 0.01) and cardiac output (from 6.4 +/- 2.0 to 7.2 +/- 2.2 l/mm, p less than 0.05) increased significantly. However, there was a slight but significant increase in left ventricular end-diastolic pressure (from 15 +/- 8 to 18 +/- 8 mm Hg, p less than 0.05). Nifedipine did not improve left ventricular relaxation as assessed by the time constants of isovolumic pressure decay (t1/2, from 39.8 +/- 6.6 to 39.4 +/- 7.7 msec, NS; t1/e, from 53.8 +/- 9.0 to 54.4 +/- 10.7 msec, NS).(ABSTRACT TRUNCATED AT 250 WORDS)

[Coronary angiography in patients with U wave inversion during coronary artery spasm].

During ergonovine-induced vasospastic angina, U wave inversion without significant ST segment deviation on the precordial electrocardiograms was documented in four patients. Coronary angiography revealed incomplete spastic obstruction of the left anterior descending artery without delayed filling and runoff in three patients. In the remaining patient, the proximal left anterior descending artery was totally occluded and there were well-developed collaterals from the non-spastic artery. Thus, ergonovine-induced U wave inversion was related to the presence of coronary vasospasm, and angiography demonstrated less severe myocardial ischemia in such patients than in cases with ST segment elevation or depression, which is usually associated with subtotal or total obstruction of a major coronary artery without adequate collaterals. In their clinical courses, two patients had episodes of angina with ST segment elevations or depressions. It was suggested that vasospastic angina with U wave inversion alone is one aspect of a continuous spectrum of vasospastic myocardial ischemia.

Carcinoid tumour of the middle ear.

Carcinoid tumours belong to the rarer neoplasms of the middle ear. In 1980, Murphy et al. described the first case of a carcinoid tumour of the middle ear. Only five cases could be traced in the literature. The light and electron microscope features of a primary atypical carcinoid tumour of the middle ear are presented and compared with those described in the literature. Primary carcinoid of the middle ear appears to be derived from the epithelial lining of the middle ear. Distant metastases have not been reported. The duration and nature of the symptoms are of little diagnostic value. An atypical carcinoid tumour in the left ear of a 33-year-old woman is described.

Elevation of bone conduction threshold in children with middle ear effusion.

A retrospective study of children having otitis media with effusion revealed fluctuations in bone conduction thresholds as well as in air conduction thresholds. Previous investigations in this area presented both low- and high-tone bone conduction hearing loss which were reversible. We conducted a detailed study including complete otologic, audiologic and tympanometric evaluation of 27 (41 ears) children who had fluctuating bone conduction hearing loss. From these audiologic examinations, 3 types of bone conduction hearing loss could be classified: high-tone, low-tone and flat-type bone conduction hearing loss. We observed the shift of bone conduction thresholds in children after removal of middle-ear fluids by the appropriate medical management.

[Graft patency and myocardial viability after aorto-coronary bypass surgery evaluated by exercise 201T1 myocardial SPECT].

To evaluate graft patency and myocardial viability after aorto-coronary (AC) bypass surgery, 58 patients (29 with old myocardial infarction and 29 with effort angina) underwent symptom-limited exercise 201T1 myocardial SPECT using a bicycle ergometer before and after surgery. The results were as follows: 1. The overall angiographic graft patency was 87% (97 of 112 grafts). 2. According to the stress SPECT images, graft patencies were 98% for areas with postoperative improvement by 201T1 uptakes, 79% for areas with unchanged patterns, and 53% for areas with worsened patterns. In spite of patent grafts, among cases with worsened 201T1 uptakes the etiologies included perioperative infarction, anastomotic strictures, and poor run-off distal to the anastomoses. 3. Following patency of grafts, postoperative normalized perfusion patterns were observed in 69% (27 of 39 segments) of segments with persistent preoperative low uptakes and 25% (4 of 16 segments) of segments with persistent preoperative defects. Thus, exercise 201T1 myocardial SPECT proved a useful diagnostic means of assessing graft patency and effectiveness. However, after AC bypass surgery, 25% of the regions which had persistent defects before surgery exhibited normal perfusion patterns. These findings suggest that persistent defects may represent hypoperfusion of viable myocardium, and that we should carefully diagnose myocardial scars.

[Five cases of Parkinson disease with the past history of hand injury].

Incidental occurrence of Parkinson disease following to the history of peripheral trauma was reported in 1932 by Naville and Morsier. So far as we know not more than 50 cases with such an interesting outbreaks have been reported. In Japan no report has been published. We happened to have opportunities to observe five cases of Parkinson disease with similar past history of peripheral trauma comprising two males and three females. Their age at onset ranged from 40 to 74 years and all the five cases had histories of finger injury, including amputation in four cases, followed by insidious onset of tremulous movement at the same site of the trauma during the period between two months and 36 years. So far as we know, no evident explanation is made concerning to the etiological interrelation between onset of Parkinson disease and trauma of the fingers. It appears to be suggestive of the possible mechanism, in which chronic persistent facilitation from the site of trauma up to the diencephalospinal dopamine system, recently advocated by Lindvall and others, result in Parkinson disease beginning at the homolateral site of the previous peripheral trauma.

Incidence and clinical course of right ventricular infarction: assessment with radionuclide ventriculography.

The incidence and prognosis of right ventricular infarction were studied by radionuclide ventriculography (RNV) in 50 consecutive cases of acute myocardial infarction. RNV was performed within thirty-six hours of symptoms and one month after onset. Right ventricular infarction was absent in all 25 patients with anterior infarction. It was found in 15 of the 25 patients with inferior infarction, accompanied by a marked reduction in right ventricular ejection fraction (28 +/- 8%), but was notably alleviated one month later with normalization of right ventricular ejection fraction (39 +/- 7%) and wall motion. These phenomena seem to be specific in right ventricular infarction.