Arachidonic acid and docosahexaenoic acid supplementation increases coronary flow velocity reserve in Japanese elderly individuals.

BACKGROUND: Arachidonic acid (ARA) and docosahexaenoic acid (DHA) are important components of phospholipids and cell membranes. There has, however, been no clinical report on the direct effects of ARA and DHA on coronary circulation. OBJECTIVE: To evaluate the effects of ARA and DHA on coronary circulation using the measurement of coronary flow velocity reserve (CFVR) by transthoracic Doppler echocardiography (TTDE). METHODS: A double-blind, placebo-matched study of 28 Japanese elderly individuals (19 men, mean age 65 years) conducted to compare the effects of polyunsaturated fatty acids (PUFA; ARA 240 mg/day, DHA 240 mg/day) and placebo on CFVR. Coronary flow velocity (CFV) of the left anterior descending coronary artery was measured at rest and during hyperaemia by TTDE to determine CFVR. RESULTS: There were no significant differences in CFV at rest or during hyperaemia in CFVR at baseline in the two groups (PUFA versus placebo 17 (7 SD) versus 16 (6), 62 (20) versus 59 (12), and 3.85 (1.04) versus 3.98 (0.83) cm/s, respectively). After three months' supplementation, CFV during hyperaemia was significantly higher in the PUFA than in the placebo group (73 (19) versus 64 (12) cm/s, p<0.01) although no significant difference was found between the two groups in CFV at rest (17 (7) versus 16 (4) cm/s). CFVR thus significantly increased after PUFA consumption (3.85 (1.04) versus 4.46 (0.95), p = 0.0023). CONCLUSION: Three months' supplementation of PUFA increased CFVR in Japanese elderly individuals, which suggests beneficial effects of PUFA on the coronary microcirculation.

Subchronic (13-week) oral toxicity study, preceded by an in utero exposure phase, with arachidonate-enriched triglyceride oil (SUNTGA40S) in rats.

Polyunsaturated fatty acids (PUFAs), such as arachidonic acid (ARA) and docosahexaenoic acid (DHA) are natural constituents found in human milk, fish oil or egg yolk. Until recently, infant formulas, though providing the essential fatty acid precursors for these PUFAs, did not contain preformed ARA or DHA. In this study the safety of SUNTGA40S as source of ARA, not only for use in infant formulas but also for nutritional products or food supplements, was evaluated in a subchronic study in Wistar rats, preceded by a 4-week pretreatment period of parental (F(0)) rats and exposure of the F(0) dams throughout mating, gestation and lactation. SUNTGA40S was administered at dietary levels of 0.5%, 1.5% and 5% (wt/wt) adjusted with corn oil to 5.76% added fat. An additional group received 3.65% (wt/wt) SUNTGA40S in conjunction with 2.11% (wt/wt) high DHA Tuna oil, providing an ARA:DHA ratio of 2.7:1. High-fat and low-fat controls received basal diet with or without 5.76% corn-oil supplement. The content, stability and homogeneous distribution of the test substances in the diet were confirmed under study conditions. The administration of SUNTGA40S, with or without DHA oil, did not affect health, growth, fertility or reproductive performance of the parental rats, nor pup characteristics (condition, weight gain, viability, number per litter or sex ratio). In the subchronic study with the offspring (F(1)) rats, no significant differences were found in condition, neurobehavioural observations, ophthalmoscopy, growth, urinalysis or macroscopic and microscopic findings between the test groups and the low-fat or the high-fat controls. In males of the 5% SUNTGA40S and the SUNTGA40S/DHA group, red blood cell counts, haemoglobin concentration and packed cell volume were lower and reticulocytes were slightly higher than in the high-fat and low-fat control groups. Cholesterol, triglycerides and phospholipids in plasma were lower than in the high-fat controls in both sexes in the 5% SUNTGA40S and the SUNTGA40S/DHA group and (for triglycerides only) in the 1.5% SUNTGA group. Due to the administration of extra dietary fat, food intake and prothrombin time (males only) were lower and alkaline phosphatase activity was higher in all the high-fat groups, including the corn-oil controls, as compared to the low-fat controls. The weight of the spleen was higher in males of the 5% SUNTGA40S and the SUNTGA40S/DHA group compared to both the low-fat and the high-fat controls. The effects noted in this study at high dose levels of SUNTGA40S are consistent with previously reported physiological responses to dietary intake of high PUFA containing oils. The present results provide evidence that SUNTGA40S is a safe source of arachidonic acid. Except during lactation when the intake in dams doubled, 5% Suntga40S in the diet was equivalent to an overall intake of approximately 3g/kg body weight/day in F(0) and F(1) animals.

Oolong tea increases metabolic rate and fat oxidation in men.

According to traditional Chinese belief, oolong tea is effective in the control of body weight. Few controlled studies, however, have been conducted to measure the impact of tea on energy expenditure (EE) of humans. A randomized cross-over design was used to compare 24-h EE of 12 men consuming each of four treatments: 1) water, 2) full-strength tea (daily allotment brewed from 15 g of tea), 3) half-strength tea (brewed from 7.5 g tea) and 4) water containing 270 mg caffeine, equivalent to the concentration in the full-strength tea treatment. Subjects refrained from consuming caffeine or flavonoids for 4 d prior to the study. Tea was brewed each morning; beverages were consumed at room temperature as five 300 mL servings. Subjects received each treatment for 3 d; on the third day, EE was measured by indirect calorimetry in a room calorimeter. For the 3 d, subjects consumed a typical American diet. Energy content of the diet was tailored to each subject's needs as determined from a preliminary measure of 24-h EE by calorimetry. Relative to the water treatment, EE was significantly increased 2.9 and 3.4% for the full-strength tea and caffeinated water treatments, respectively. This increase over water alone represented an additional expenditure of 281 and 331 kJ/d for subjects treated with full-strength tea and caffeinated water, respectively. In addition, fat oxidation was significantly higher (12%) when subjects consumed the full-strength tea rather than water.

Joint effects of HMG-CoA reductase inhibitors and eicosapentaenoic acids on serum lipid profile and plasma fatty acid concentrations in patients with hyperlipidemia.

HMG-CoA reductase inhibitors reduce serum total cholesterol concentrations and the risk of coronary heart disease in patients with hypercholesterolemia. Recently, it has been reported that patients with combined hyperlipidemia are also at risk of coronary heart disease. However, HMG-CoA reductase inhibitor therapy alone does not sufficiently reduce serum triglyceride concentrations. Epidemiological and clinical evidence has shown that fish oil can lower plasma lipid levels, especially triglycerides. Consequently, we investigated the effects of the combination of HMG-CoA reductase inhibitors and eicosapentaenoic acid, a major component of fish oil, on hyperlipidemia. We administered 900-1,800 mg/day of the ethyl ester of eicosapentaenoic acid to patients with hyperlipidemia who had been treated with HMG-CoA reductase inhibitors for 30 +/- 6 months (means +/- SE). Serum total cholesterol and triglyceride concentrations were significantly decreased 3 months after the administration of eicosapentaenoic acid (from 5.63 +/- 0.23 mmol/l to 5.02 +/- 0.20 mmol/l, P < 0.05; from 2.07 +/- 0.41 mmol/l to 1.08 +/- 0.17 mmol/l, P < 0.01, respectively). Serum high-density lipoprotein-cholesterol concentrations were significantly increased after the treatment (from 1.23 +/- 0.12 mmol/l to 1.34 +/- 0.13 mmol/l, P < 0.05). Plasma eicosapentaenoic acid concentrations and the ratio to arachidonic acid in plasma were also significantly increased 3 months after the treatment (from 101.9 +/- 8.1 mg/l to 181.8 +/- 23.9 mg/l, P < 0.001; from 0.640 +/- 0.075 to 1.211 +/- 0.170, P < 0.001, respectively). These results suggested that the combination therapy of HMG-CoA reductase inhibitors and eicosapentaenoic acid was effective for patients with hyperlipidemia.

[Home infusion therapy for cancer patients at a near-terminal stage--analysis of cases who died at home].

To improve the quality of life in cancer patients at a near-terminal stage, we assisted patients to stay home using a system for home infusion therapy (HIT) established at Osaka Prefectural Habikino Hospital in 1994. From April in 1995 to April in 1996, 25 patients were treated at home using the HIT system for longer than 7 days. Thirteen out of 25 patients still stayed at home even at a terminal stage and died in their residences. There was no difference either in the mean age or in the HIT duration between 13 patients who died at home and the remaining 12 patients who were readmitted to their hospitals before death. However, 47% of the patients who died at home had been told their diagnoses by doctors and realized their own prognoses, while only 17% of the patients who died in the hospital knew their diagnoses and prognoses. Seventy-seven percent of the patients who died at home were given home oxygen therapy (HOT), against 33% of the patients who died in the hospital. Furthermore, the patients who died at home were given more intensive care than the patients who died in the hospital, because the former had a larger family than the latter. In conclusion, HIT at a near-terminal stage and death at home may be more readily accepted by patients who know their diagnoses and prognoses and have a large family.

[Resection of tracheal carcinoma using partial cardiopulmonary bypass--report of a case].

A 43-year-old male was admitted to our hospital with chief complaints of stridor and dyspnea. Bronchoscopy revealed a tumor obstructing almost the whole lumen of the trachea. As it was impossible to insert an endotracheal tube into the distal site of the stenosis in the mediastinum, we used partial cardiopulmonary bypass to maintain gas exchange. The axillary artery and the femoral artery and vein were cannulated for the bypass using local anesthesia. During 105 minutes of bypass, the PaO2 value was good but the PaCO2 value increased up to 70 mmHg. After the trachea was opened, the anesthetic gas was administered across the operative field through the endotracheal tube and the cardiopulmonary bypass was discontinued. Tracheolaryngectomy and permanent tracheostomy with relocation to the right and caudal side of the brachiocephalic artery was performed successfully. The post operative course was very smooth. The patient has been well for 6 months since the surgery. Partial cardiopulmonary bypass proved to be useful for maintaining gas exchange during reconstructive surgery of the trachea. We treated a case of tracheal carcinoma by resection while using partial cardiopulmonary bypass. We believe this is the ninth such case reported Japanese literature.

[Clinical evaluation of myocardial protection by oxygenated crystalloid cardioplegic solutions with DBcAMP].

Possible enhancement of myocardial protection by adding DBcAMP and oxygenation of a crystalloid cardioplegic solution (CCS) was evaluated in a three group study. The patients having coronary bypass operation or valvular operation were divided into three groups, each consisting of 15 patients, and differing only in the type of CCS employed. Group I was protected by nonoxygenated CCS (PO2 190 mmHg, PCO2, 32 mmHg, pH 7.78, K 30 mmEq/L), Group II by adding DBcAMP to nonoxygenated CCS and Group III by adding DBcAMP to oxygenated CCS (PO2 790 mmHg, PCO2 26 mmHg, pH 7.87). Group III had significantly improved CI and double product (p less than 0.05) compared with Group II. However, CPK, CPK-MB, and myoglobin in the serum were similar in each group. Lactate and pyruvate ratio (L/P) in the coronary sinus bloods were improved to lower value after the pump than before the pump only in Group III. Base excess in the coronary sinus held on alkalosis after aortic declamp only in Group III. The refunction time was significantly shortest with Group III than with other groups (p less than 0.01, 0.05) and Group II was significantly shorter than Group I (p less than 0.05). It is concluded that oxygenation and adding DBcAMP to CCS are effectual for the myocardial metabolism and protect the myocardial damage during cardiac arrest.

Surgical management of the coronary artery to pulmonary artery fistulas; a case of a large ruptured aneurysm.

Three patients were treated for coronary artery-pulmonary artery fistula. Each was asymptomatic due to a coronary artery fistula. There was one instance each of myocardial infarction, mitral stenosis and a large closed ruptured aneurysm including a thrombus. All the fistulas were comprised of several small plexiform arranged vessels. The left to right shunt ratio was approximately 8 percent or less. A surgical operation was performed to close the drainage orifice of the fistulas through pulmonary arteriotomy under cardiopulmonary bypass in two patients while one patient underwent a ligation of a large abnormal vessel to the aneurysm followed by a resection of the aneurysm without cardiopulmonary bypass. A large saccular aneurysm of such fistulas is rare and a rupture of such an aneurysm is even more rare. The surgical management of coronary artery fistulas is also discussed herein.

[A case report of type II dissecting aneurysm after aortic valve replacement, successful repair by the modified Cabrol's method].

A case of type II dissecting aneurysm after aortic valve replacement was reported. The patient was a 66-year-old man, who was diagnosed as III degree aortic valve regurgitation without aortic dilatation, and performed aortic valve replacement with a 27A Omniscience prosthesis. Postoperative course was very smooth for 7 years, however he was admitted to our hospital of the sudden anterior chest pain. Computed tomography and aortography revealed marked dilatation and dissection of ascending aorta and occlusion of the right coronary artery. The operation of the modified Cabrol's method was performed, and he is well alive one and half a year after operation. Dissecting aneurysm in the late term after aortic valve replacement is rare, and its prognosis and re-operative results are very poor.

[A case of mitral stenosis associated with cardiac sarcoidosis and left ventricular aneurysm].

We report a rare case of mitral stenosis associated with cardiac sarcoidosis and left ventricular aneurysm. A 60-year-old female was admitted with complaint of palpitation and dyspnea on exertion. Chest X-ray revealed cardiomegaly and pericardial calcification, but no bilateral hilar lymphadenopathy. Electrocardiogram showed various arrhythmia. Coronary angiography showed no stenosis in any coronary arteries. Cardioangiogram showed left ventricular aneurysm at the apex and mitral stenosis. Laboratory findings showed no evidence of sarcoidosis. Open mitral commissurotomy and left ventricular aneurysmectomy was performed. Pathological findings of the myocardium showed a remarkable degenerative change and a granulomatous inflammation. Postoperative biopsied specimens of right scalene lymph nodes revealed sarcoid reaction. The postoperative course was satisfactory, but arrhythmia remained. The patient was treated with steroids and pacemaker implantation. She has been doing well for 2 year postoperatively. An operative case of mitral stenosis associated with cardiac sarcoidosis and ventricular aneurysm due to sarcoidosis is very rare and the prognosis in patient is very poor usually.

[A case of coronary-pulmonary artery fistula with saccular aneurysm].

Recently, due to the wide-spread use of coronary angiography (CAG), reports of coronary-pulmonary artery fistula have become more frequent. However, a case of coronary-pulmonary artery fistula with saccular aneurysm is very rare. We report a case of coronary-pulmonary artery fistula with saccular aneurysm which was discovered as an abnormal chest shadow. A sixty-two-year old female was admitted to our hospital with an abnormal chest shadow. CAG showed fistula from the left anterior descending coronary artery (LAD) proximal to the pulmonary artery (PA), and also from the LAD distal to the PA, with saccular aneurysm. Due to the risk of a rupture of the saccular aneurysm, we performed a resection. After this operation, no abnormal chest shadows appeared on the chest X-rays. CAG showed no saccular aneurysm and she is progressing favorably.

[A study of root resorption of deciduous teeth in dogs. Influence of successional tooth germ and occlusal force].

The role of successional tooth germ and occlusal force in root resorption of mandibular second deciduous molars was studied in 24 beagle dogs by means of radiographic and histologic evaluations. 70 days after birth their mandibular right third permanent premolar germs were surgically removed, and in 10 of the dogs the maxillary right and left second deciduous molars were extracted to decrease the occlusal force on the mandibular second deciduous molars. 1) When successional tooth germs were present, whether the occlusal force was normal or decreased, the alveolar bone and deciduous tooth adjacent to the tooth germ were resorbed, accompanied by eruption of the permanent tooth. After the resorption of the deciduous tooth reached half of the root, many odontoclasts were observed in the dental pulp of the deciduous tooth. The root resorption was hastened by internal resorption. 2) When successional tooth germs were removed, whether the occlusal force was normal or decreased, the root resorption was delayed. The resorption from the root surface progressed very slowly, but shortly after this resorption reached the pulp, internal resorption occurred and the deciduous tooth was resorbed in short time. 3) When the occlusal force was decreased, in the deciduous teeth in which successional tooth germs were present, the tooth resorption tended to delay to a later time. However in the deciduous teeth from which the successional tooth germs were removed, the processes of tooth resorption was very different in individuals, the difference between tooth resorption in normal occlusal force and in decreased occlusal force was not clear. 4) In all groups, shallow resorption on the deciduous root surface was observed before the successional tooth started to erupt, and this resorption was apart from the tooth germ. By repeating resorptive periods and resting periods, this resorption progressed according to the increase in age, and in the resting period, resorption was repaired by new deposits of cementum.

The surgical treatment of a thoracoabdominal aortic aneurysm with total preservation of the intercostal and lumbar arteries using a permanent bypass technique--a case report.

A 44 year old man underwent successful surgery for a thoracoabdominal aortic aneurysm using a permanent bypass graft and aneurysmoplasty. This technique reduces visceral ischemia to a minimum and the aneurysmoplasty, through total preservation of the intercostal and lumbar arteries, can avoid paraplegia caused by spinal cord ischemia. Our technique is recommended as it can be performed easily, safely, and effectively without heparinization, temporary shunts or bypass perfusion.

Left ventricular rupture following mitral valve replacement--a report of two cases.

Left ventricular rupture is a rare and usually fatal complication of mitral valve replacement, and we report herein, 2 successfully treated cases of type III left ventricular rupture. The laceration in the posterior ventricular wall was repaired by a wide buttressed mattress suture with teflon felt belts on either side, then covered with Oxycel and fibrin glue or a large patch and fibrin glue. Naturally, the operation must be performed carefully and gently, however, the most important etiologic factor of left ventricular rupture is the extremely friable myocardium due to aging and a long history of heart disease. Utilizing fibrin glue for successfully repairing the rupture proved very effective.

[Intrathoracic pacemaker implantation in children].

In order to minimize the complications, we introduced the intrathoracic implantation method since 1976. Until 1988, 12 children underwent this method. A pacemaker generator was exchanged in 8 patients, 12 times, because of battery exhaust. Compared with the conventional method (abdominal wall implantation), the complications such as electrode fracture, which was related to the implantation sites, were reduced. Furthermore it was very useful from the cosmetic viewpoint. Although an exchange of generator was very easily done at the first time, it was very difficult at the second time, due to rib fusion accompanying with children's growth.

[A case of bilateral coronary artery--pulmonary artery fistulas associated with mitral valve stenosis].

A case was reported of bilateral coronary artery-pulmonary artery fistulas associated with mitral valve stenosis. A thirty seven year old female was admitted with the complaint of exertional dyspnea and palpitation, which had lasted for the 3 years previous to her admission to our hospital. Electrocardiogram showed sinus bradycardia and no ST-T changes, but exercise ECG showed significant ST depression after 6 min of exercise. The DDR (9 mm/sec) and mitral valve area (0.61 cm2) were shown by UCG examination to have decreased, and the pressure at half time (360 msec) was shown by Doppler UCG to be prolonged. On cardiac catheterization, coronary arteriography showed fistula from RCA to PA, and fistula from LCA to PA, but no occlusive lesions were demonstrated. P/S blood flow ratio was 1.09, and O2 saturation was stepped up 3% in PA. She was operated on and given open mitral commissurotomy and closure of the fistula opening, via the PA. After surgical repair, no abnormality was found by exercise ECG, and no fistulas were shown on coronary arteriography.

[An investigation into the actual condition of children with blood diseases in the pedodontic clinic of Niigata University Dental Hospital].

Children with blood diseases do not infrequently visit the dental clinics. Therefore, it is important to recognize the actual condition of blood diseases in association with the oral treatment of patients. During the period from Sept. 1979 to June 1989, 68 patients who had blood diseases visited the Pedodontic Clinic of Niigata University Dental Hospital. This report is the investigation of the dental situation of these patients. The result were as follows: 1. The ratio of patients with blood diseases in our clinic was 0.7%. The patients with leukemia were most frequent. 2. Most of the first visit-patients with blood diseases were children aged 6, while the general patients group was younger. The ages of first visit-patients corresponded to the most frequent ages of primary diseases. 3. The majority of their chief complaints were "the treatment of decayed teeth for caries". Others were "the extraction of loose teeth for exchange" or "the diseases of oral soft tissues". 4. The patients visited our clinic from all over Niigata prefecture, some of which visited from a great distance and were introduced by Niigata University Medical Hospital. 5. As to the treatment of decayed teeth for caries, the patients with hemophilia had a large number of treated teeth as compared with the other diseases. In case of leukemia, anaphylactoid purpura and idiopathic thrombocytopenic purpura (ITP), the outpatients generally tend to be subject to more severe caries than the inpatients in Niigata University Medical Hospital. 6. The percentage of recall of patients with blood disease was lower than that of general children at the rate of about 20%.(ABSTRACT TRUNCATED AT 250 WORDS)

[The use of the aortic bypass in the surgery of the esophageal carcinoma invading the thoracic aorta].

During the period from 1980 to 1989, five patients with carcinoma of the esophagus invading the thoracic aorta were treated by resection of the involved aortic segment combined with esophagectomy. Various types of arterial bypass were applied in order to provide blood flow to the distal aorta during aortic clamping. These included one permanent aorto-aortic bypass, two axillo-femoral bypass and one subclavian-aortic bypass. There was one death within 30 days and one developed paresis. These arterial bypasses are beneficial to esophageal surgery because it is technically easy and it does not necessitate systemic heparinization which maybe associated with profuse bleeding.