非侵襲的新指標である E' max/V 100 を用いた高血圧性肥大心の左室機能評価 : 非肥心， ST-T 変化を伴わない肥大心および ST-T 変化を伴う肥大心における比較検討

In forty-one essential hypertensive (EHT) patients with and without left ventricular hypertrophy (LVH), the left ventricular (LV) contractile performance was determined noninvasively using echocardiography. Classification was made with respect to the LVH, as measured by the sum of end-diatolic posterior wall thickness and interventricular septal thickness, and the presence of ST-T changes on electrocardiogram. Patients who had neither LVH nor ST-T changes formed Hl-subgroup (H1; n=22), those who had LVH without ST-T changes served as HZ-subgroup (H2; n =8), and those with LVH accompanied by ST-T changes constituted HS-subgroup (H3; n = 11), Sixteen normal volunteers served as normal control (N). LV systolic phase indices such as ejection fraction (EF), mean velocity of circumferential fiber shortening (mVcf) and end-systolic wall stress (ESWS), and diastolic indices such as isovolumic relaxation time (IVRT) and PR-AC interval were compared among each subgroup and normal subjects. All systolic and diastolic indices showed a depressed LV function in H3. Of these variables, the only IVRT could separate H2 from H1, suggesting deteriorated diastolic function at an early stage of hypertrophy. By altering LV systolic loading, peak systolic pressure-end-systolic volume relation, E’ max, and E' max-volume intercept at 100 mmHg peak systolic pressure ratio, E' max/V 100, were designated and these indices were used for the expression of the myocardial contractile state. E' max and E’ max/V 100 were significantly lower in H2 and H3 than in the control group, indicating depressed myocardial contractility. The value of these variables in Hl did not differ from N, indicating a normal level of inotropic state. E’ max/V 100 in H3, 0.13±0.04 mmHg/ml2, was significantly less than in H2, 0.23±0.05 (p<0.01), and the value in H2 was significantly lower than that in H1, 0.36 ±0.07 (p< 0.01), indicating a validity of E' max/V 100 to differentiate each EHT subgroup. It is concluded that in patients with LVH induced by pressure overload the LV function is declined, furthermore, LV contractile performance is more impaired when LVH is accompanied by ST-T changes. E’ max/V 100 is highly sensitive in identifying the presence of LV contractile impairment and may be a useful approach to the quantitation of LV. performance

ガスクロマトグラフィー法による肝胆道疾患の血清胆汁酸測定について : 空腹時血清胆汁酸および内因性胆汁酸負荷テスト

The methods and results of a gas-liquid chromatographic analysis of bile acids in serum are presented. The analysis of bile acids in serum involves enzymatic hydrolysis (cholylglycine hydrolase), preparation of propionated methyl ester derivatives of bile acid and gas chromatographic procedure with 2.5 % OV-1. Adequate separation of the individual bile acids, (cholic, chenodeoxycholic and deoxycholic acid) was achieved with vitamine E caprylate as an internal standard. A detector response was linear and recovery of radioactive taurocholic acid and non-radioactive vitamine E caprylate added to the serum was 82.10±6.86 and 80.96±1.62% respectively. The serum fasting bile acid concentrations of normal controls were 3.17±2.34 for total bile acids, 1.17±1.25 for cholic acid, 1.34±2.11 for chenodeoxycholic acid and 1.29±0.95 μg/ml for deoxycholic acid. The differences in the serum total bile acid levels, magnitude of the increase in the serum concentration between cholic and chenodeoxycholic acid and serum concentration level of deoxycholic acid which were all characterized in various hepatobiliary diseases seemed to be useful for the diagnosis and differential diagnosis of hepatobiliary diseases. However, these serum bile acid concentrations were frequently observed overlapped in some of the individuals among hepatobiliary diseases. An endogenous bile add tolerance test with 2 μg/kg caerulein injection demonstrated more distinction in serum bile acid levels between normal and chronic active hepatitis and between chronic active hepatitis and liver cirrhosis than indicated by a fasting total bile acid level alone. Percent chenodeoxycholic acid increased more than any other individual bile acids during the endogenous bile acid tolerance test suggesting the most important role of chenodeoxycholic acid