Dietary Deficiency of Calcium and/or Iron, an Age-Related Risk Factor for Renal Accumulation of Cadmium in Mice.

The major route of cadmium (Cd) intake by non-smokers is through food ingestion. Cd is a non-essential metal absorbed through one or more transporters of essential metal ions. Expression of these transporters is affected by nutritional status. To investigate the risk factors for Cd toxicity, the effects of deficiency of essential metals on hepatic and renal accumulation of Cd were studied in mice of different ages. Mice were administered a control diet or one of the essential metal-deficient diets, administered Cd by gavage for 6 weeks, and killed; then, Cd accumulation was evaluated. Iron deficiency (FeDF) or calcium deficiency (CaDF) resulted in remarkable increases in hepatic and renal Cd accumulation compared with control-diet mice and other essential metal-deficient mice. Cd accumulation in hepatic and renal tissue was increased significantly at all ages tested in FeDF and CaDF mice. Renal Cd concentrations were higher in 4-week-old mice than in 8- and 25-week-old mice. Increase in intestinal mRNA expression of calcium transporter (CaT)1, divalent metal ion transporter-1, and metallothionein (MT)1 was also higher in 4-week-old mice than in other mice. Renal accumulation of Cd showed strong correlation with intestinal mRNA expression of CaT1 and MT1. These data suggest that CaDF and FeDF at younger ages can be a risk factor for Cd toxicity.

Gender differences in the clinical characteristics among Japanese patients with obstructive sleep apnea syndrome.

BACKGROUND: Gender differences in the prevalence of various manifestations of obstructive sleep apnea syndrome (OSAS) is not as great as previously believed. The aim of the present study was to clarify the clinical patient characteristics of Japanese women and men with OSAS. METHODS: A cross-sectional case-match control study was performed on patients from two sleep disorder centers. Two hundred forty-five women with OSAS were classified into premenopausal (n = 70) and postmenopausal (n = 175) groups. As well, 245 men matched for both age and apnea-hypopnea index (AHI) and another 245 men matched for age and body mass index (BMI) were established. We compared descriptive variables between genders in both the premenopausal and the postmenopausal female patient groups. RESULTS: As a whole, female patients had significantly higher BMI than AHI-matched male patients (p < 0.05) and a significantly lower value of AHI than BMI-matched male patients (p < 0.001). Female patients had lower Epworth Sleepiness Scale scores than BMI-matched male patients (p < 0.05). On logistic regression analysis, presence of hypertension was significantly associated with BMI (>or=25 kg/m(2)), AHI (>or= 15 to < 30 events/h; >or= 30 to < 60 events/h; >or= 60 events/h), and presence of both hyperlipidemia and diabetes mellitus. However, gender differences were not associated with the occurrence of hypertension. Female patients had significantly lower optimal levels of continuous positive airway pressure than male patients. CONCLUSIONS: Our results suggest that both the OSAS severity and the strength of pharyngeal closure is less in Japanese female patients than in male patients. Moreover, Japanese female patients are thought to have less daytime sleepiness than male patients but a similar rate of hypertension as male patients.

[Anesthetic management of patients with hypertrophic obstructive cardiomyopathy undergoing non-cardiac surgery].

BACKGROUND: A considerable amount of data are available regarding cardiac risk in patients with coronary artery disease undergoing non-cardiac surgery, but few data are available regarding risk for patients with cardiomyopathy. METHODS: Reports on the anesthetic management of patients with hypertrophic obstructive cardiomyopathy (HOCM) undergoing non-cardiac surgery were identified using Medline and the Igaku-Chuou-Zassi (Japana Centra Revuo Medicina) database (1981-2002). The data were analyzed in terms of patient characteristics, methods of intraoperative care, and clinical outcome. RESULTS: Sixty nine patients were included. The mean value of the left ventricular outflow tract pressure gradient (LVOTPG) was 63 mmHg. Twenty two cases were diagnosed as severe HOCM in terms of pressure gradient (LVOTPG > or = 50 mmHg) and clinical manifestations. Major complications, such as cardiac arrest and refractory shock, occurred in 10 cases. However, these perioperative risks were not correlated with severity of HOCM. CONCLUSIONS: Careful planning is inevitable in anesthesia for patients with HOCM. Although the rate of major perioperative complications is relatively low, they can occur unexpectedly and resemble the natural course of HOCM. In order to clearly elucidate risk factors for adverse perioperative outcomes, further analysis will be necessary as more cases are documented.

[The successful anesthetic management of a patient with pheochromocytoma using prostaglandin E1 and a novel, short-acting beta-adrenergic blocker: landiolol hydrochloride].

A 48-year-old male with a history of hypertension was scheduled to undergo resection of a tumor in the upper region of the left kidney. However, his operation was postponed once because pheochromocytoma was suspected from the tumor location, sweating, and insomnia in addition to hypertension. The measurement of plasma catecholamines confirmed the presence of pheochromocytoma. Anesthesia was induced with thiopental and fentanyl, while ventilating with 5% sevoflurane in oxygen, followed by tracheal intubation facilitated with vecuronium. Anesthesia was maintained with 33% nitrous oxide and 0.6-3% sevoflurane in oxygen, in conjunction with fentanyl and 1% mepivacaine through an epidural catheter (T11-12). An arterial catheter and a pulmonary artery catheter were inserted. From the beginning of the operation, prostaglandin E1 and landiolol were administered continuously. Systolic blood pressure and heart rate were controlled between 90-140 mmHg and 80-105 beats x min(-1), respectively. Systemic vascular resistance was stable between 700-900 dyn x s x cm(-5) throughout the procedure. The operation was completed uneventfully. The patient was transferred to the general ward, extubated, and was in a stable condition. Various combinations of vasodilating and antihypertensive drugs have been used intraoperatively during the resection of pheochromocytoma. Of these, prostaglandin E1 and landiolol hydrochloride are very promising for maintaining stable hemodynamics.