Reversible Dysfunction of the Sinus Node during Acute Phase of Aseptic Meningitis

A fifty-two-year-old man who had reversible, severe dysfunction of the sinus node during acute phase of aseptic meningitis is reported. A diagnosis of aseptic meningitis was made on the basis of following clinical findings ; moderately high fever, meningeal signs and abnormalities of cerebrospinal fluid such as high pressure, an increase in white cell count, high protein content and negative culture of the fluid for bacteria, mycobacteria and fungi. During the acute phase of aseptic meningitis the patient developed marked sinus brabycardia with sinoatrial block and sinus arrest causing dizziness. The sinus rate began to increase gradually and sinoatrial block and sinus arrest disappeared as the clinical manifestations of aseptic meningitis subsided. The sinus rate was significantly raised by intravenous administration of atropine (1.0 mg). During the recovery phase of aseptic meningitis with normal pressure of cerebrospinal fluid, overdrive suppression test revealed normal values of the sinus node recovery time and the patient was in normal sinus rhythm at a rate of 60 to 70 beats/min. It is assumed that increase in the vagal tone resulted from a high intracranial pressure during the acute phase of aseptic meningitis may play an important role in the genesis of severe sinus node dysfunction in this patient

生活習慣による動脈硬化性心臓血管病の予防について

近年､わが国では不適切な生活習慣に基づく動脈硬化性心臓血管病が増加している｡不適切な生活習慣が長期間持続すると､肥満､糖尿病､脂質異常症､高血圧などが生じて動脈硬化の進展を促進し､その結果として虚血性心疾患､大動脈瘤､大動脈解離､末梢動脈疾患､脳血管疾患などの動脈硬化性心臓血管病が発症してくる｡その予防には､適切な食習慣や運動習慣､休養､禁煙､節酒 などの生活習慣を維持する必要がある｡本稿では､不適切な生活習慣による動脈硬化性心臓血管病の予防について概説した｡It is well known that the incidence of atherosclerotic cardiovascular diseases due to bad habits in daily life is recently on the increase in the Japanese people. Bad habits in daily life extending over a long period of time bring about obesity, diabetes mellitus, dyslipidemia and hypertension.These disorders accelerate the development of arterial atherosclerosis causing cardiovascular diseases such as ischemic heart disease, aortic aneurysm, aortic dissection, peripheral vasucular disease, cerebrovascular disease and others. In order to prevent the development of these athero-sclerotic cardiovascular diseases. It is essential to keep a good condition of lifestyle including good eating habit, appropriate physical activity, recess for coping stress, nonsmoking and moderation of drinking

栄養素選択的な摂食調節における視床下部弓状核のエストロゲン受容体の関与

性ホルモンであるエストロゲンは、摂食調節に関与する内分泌物質でもあり、このエストロゲンの受容体は、脳内では摂食調節に重要な神経核である視床下部弓状核に非常に多く発現している。また、摂食の調節は摂取するエネルギー量のみに規定されているものではなく、摂取する栄養素のそれぞれに対する選択的な調節機構も存在し、これはしばしば嗜好性という形で現れる。本実験では、マクロ栄養素（糖質、脂質及びタンパク質）のそれぞれに特化した３種類の食餌をラットに同時に与え、自由に選択摂食させる手法（self‐selection法）を用いて、ラットの個々の嗜好性を同定するという生理学的な検討に加え、そのラットの視床下部領域における摂食調節に関わるエストロゲン受容体の分布を組織化学的に検討した。これらマクロ栄養素に対する嗜好性とエストロゲン受容体の発現との相関を検証し、嗜好性に対するエストロゲンの作用を明らかにする。Estrogen, a gonadal hormone, has a function for control of intake. Estrogen receptors (ER) were distributed in hypothalamic arcuate nucleus (ARC), which is important in appetite. The control of food intake is not only based on the number of calories, but also on the each nutrient and its amount, that is indicated as the “preference". In this study, we used three experimental diets, a carbohydrate, a protein and a fat diet and allowed each rat ad libitum access to them. In addition to physiological investigation as an identification of the preferences of the rats with the diets, we examined histochemically about the distribution of ER in ARC. By verifying the correlation of the preferences to macronutrients and the distribution of ER, we tried to elucidate the effect of estrogen to the preferences

Electrophysiologic Characteristics of Electrically Induced Nonsustained Ventricular Tachycardia in the Late Stage of Canine Myocardial Infarction

To examine electrophysiologic characteristics of electrically induced nonsustained ventricular tachycardia (NSVT), open chest electrophysiologic study was performed on 21 dogs with 25-day-old anteroapical myocardial infarction. Six of the 21 dogs had reproducibly inducible NSVT and five had reproducibly inducible sustained ventricular tachycardia (SuVT) in response to programmed ventricular stimulation. Remaining 10 dogs had no reproducibly inducible ventricular tachycardia or ventricular fibrillation (VF) in response to programmed ventricular stimulation. Twelve NSVTs in the 6 dogs were characterized by beat-to-beat variations of cycle length and QRS morphology of surface lead and also by wide disparity of local activation of the left ventricle, whereas 10 SuVTs in the five dogs did not show these electrophysiologic characteristics except during the first three to four beats. Three of the 12 NSVTs transformed into VF. Cycle lengths of these three NSVTs showed progressive shortening before transformation into VF. None of the 10 SuVTs transformed into VF. Continuous disorganized electrical activity was recorded on endocardial electrograms of the left ventricle in four of the 12 NSVTs, but not in the 10 SuVTs. It is concluded that in the late stage of canine myocardial infarction nonsustained ventricular tachycardia is an unstable ventricular tachyarrhythmia with some differences in electrophysiologic manifestation from sustained ventricular tachycardia

Prompt and Long-term Prophylactic Effect of Closed Loop Stimulation against Paroxysmal Atrial Fibrillation in a Patient with Sick Sinus Syndrome

A 72-year-old woman with sick sinus syndrome (SSS), who had frequent paroxysmal atrial fibrillations (PAfs) and normal cardiac function, was admitted to our hospital due to syncope. PAfs frequently occurred during the first week after DDD pacemaker implantation (PMI), with closed loop stimulation (CLS) rate-adaptive mode off, but were completely suppressed during the second week, with CLS on, and had been well-controlled over three years thereafter. However, PAfs occasionally occurred under intense sympathetic activity during 6 months after PMI as well, and were effectively terminated by disopyramide which had anticholinergic effect. Thus, the development and maintenance of PAf were thought to be associated with destabilized cardiac autonomic activities, that is, sympathetic and parasympathetic dominance, respectively. Additionally, heart rate variability analyses after implementation of CLS revealed the restoration of sympathetic and parasympathetic components. Accordingly, CLS mode was considered to play a critical role in preventing PAf by reflecting autonomic activity in heart rhythm in this SSS patient

Effects of Intravenous Diltiazem on Supraventricular Tachyarrhythmias

The effects of intravenous diltiazem on supraventricular tachyarrhythmias were studied in 16 patients : 6 with paroxysmal supraventricular tachycardia using an accessory pathway retrogradely, 6 with atrial fibrillation, 3 with atrial flutter and 1 with chronic atrial tachycardia. Diltiazem (0.1 or 0.2 mg/kg) was administered intravenously over 5 minutes. Termination of paroxysmal supraventricular tachycardia was achieved in 6 out of 10 episodes during or just after the injection. Diltiazem slowed the ventricular conduction from 2 : 1 to 4 : 1 in atrial flutter, but sinus rhythm was not restored in either case. Diltiazem increased the ventricular response through an accessory pathway in a patient with atrial fibrillation associated with Wolff-Parkinson-White syndrome. Atrial rate in a case of chronic atrial tachycardia did not change significantly. There were no adverse clinical effects. It is concluded that diltiazem is effective in slowing ventricular rate in atrial fibrillation and flutter and in terminating paroxysmal supraventricular tachycardia. However, diltiazem may be contraindicated in atrial fibrillation associated with Wolff-Parkinson- White syndrome

グレリンの腹腔内投与が栄養素選択的な摂食調節に及ぼす影響

グレリンは２８個のアミノ酸から構成されるペプチドであり、その中枢あるいは末梢投与は、その後の摂食量を増加させることが報告されている。本研究ではグレリンの栄養素の嗜好性への影響を検討するため、３種類のマクロ栄養素食（糖質、タンパク質及び脂質）を同時に与えたラットにグレリン（０.５，１.０及び ５.０nmol/rat）を腹腔内投与し、投与から１、２、４及び２４時間後の摂食量を測定した。総摂食量はグレリンの投与量依存的に、生理的食塩水投与時と比べて増加した。その内訳を見ると、糖質食の摂食量が有意に増加していたが、タンパク質及び脂質食の摂食量に変化は見られなかった。血清グルコース、総タンパク質、中性脂肪、遊離脂肪酸、及びβ-リポタンパク質濃度はグレリン投与による影響は認められなかった。本研究はグレリンが代謝に影響することなく、糖質の摂食量を選択的に増加させたことを明らかにした。この結果は、グレリンが直接的に糖質に選択的な摂食調節に関与していることを示唆している。Ghrelin is a 28-amino acid peptide with an acyl side chain, n-octanoic acid. It was reported that ghrelin infusion centrally and peripherally increases food intake. In this study, to investigate the effect of ghrelin to preference on nutrients, we infused ghrelin (0.5, 1.0 and 5.0 nmol/rat) intraperitoneally to rats, which were fed simultaneously three macronutrient diets (carbohydrate, protein and fat), and measured food intakes at 1, 2 and 4hr after infusion. Infusions of ghrelin increased dose-dependently total food intake compared with saline infusion. Infusion of ghrelin increased significantly carbohydrate intake, although protein and fat intakes did not altered. Serum glucose, total protein, albumin, triglyceride, free fatty acid and β-lipoprotein levels were did not altered with infusion of ghrelin. This study defined that ghrelin infusion increased selectively carbohydrate intake without metabolic changes. This result suggests that ghrelin may participate directly with the selective control of carbohydrate intake

グレリンの脳室内投与が栄養素選択的な摂食調節に及ぼす影響

グレリンは２８個のアミノ酸から構成されるペプチドであり、その中枢あるいは末梢投与は、その後の摂食量を増加させることが報告されている。本研究ではグレリンの栄養素の嗜好性への影響を検討するため、３種類のマクロ栄養素食（糖質、タンパク質及び脂質）を同時に与えたラットにグレリン（１００、２００及び ５００ pmol/rat）を脳室内投与し、投与から１、２、４及び２４時間後の摂食量を測定した。２００及び ５００ pmol のグレリン投与は２時間後までの累積総摂食量を、生理的食塩水投与時と比べて有意に増加させた。その内訳を見ると、糖質食及びタンパク質食の累積摂食量が有意に増加していたが、脂質食の摂食量に変化は見られなかった。本研究はグレリンの脳室内投与が糖質及びタンパク質の摂食量を選択的に増加させたことを明らかにした。この結果は、グレリンによる栄養素選択的な摂食調節が行われるメカニズムにおいて迷走神経が関与している可能性を示唆している。Ghrelin is a ２８-amino acid peptide with an acyl side chain, n-octanoic acid.　It was reported that ghrelin infusion centrally and peripherally increases food intake.　In this study, to investigate the effect of ghrelin to preference on nutrients, we infused ghrelin centrally（１００, ２００ and ５００ pmol/rat）to three macronutrient diets（carbohydrate, protein and fat）fed rat and measeured food intake at １, ２, ４ and ２４ hours after the infusions.　The central infusion of ２００ and ５００ pmol of ghrelin increased cumulative total food intake until ２ h after infusion compared with saline infusion.　In regards to the three diets, carbohydrate and protein intakes were increased.　But the infusion of ghrelin did not alter fat intake.　In this study, we demonstrate the alternation of preference in nutrients, especially carbohydrate and protein, by central ghrelin infusion.　It is known that two types of nerve systems involve the orexigenic action of ghrelin；ghrelin neurons in arcuate nucleus and vagal nurves.　The differences of preferense of nutrients observed in this study may result from the differences of those nervous systems

Genetic Analysis of Cardiacβ Myosin Heavy Chain(MHC)Gene in Seven Families with Hypertrophic Cardiomyopathy in Japan

The purpose of this study was to identify the presence of either mutation or polymorphism in the cardiac β myosin heavy chain (MHC) gene of the Japanese who had familial hypertrophic cardiomyopathy (FHCM). We analyzed exons 3-25 of the cardiac MHC gene in seven unrelated Japanese families (17 affected and 10 unaffected individual with HCM), using the polymerase chain reaction (PCR)-single strand conformation polymorphism (SSCP) analysis. Our study showed that affected members of one family (proband; I.I.) had an identical pattern of aberrantly migrating band of exon 21.Similarly we found polymorphism and probable point mutation located on exon 3 of one patient with sporadic HCM (Pt;T.M.). Both proband;I. I. and Pt; T.M., developed lethal congestive heart failure with left ventricular (LV) dilatation as confirmed by autopsy. This suggest that PCR-SSCP analysis is an useful tool for clinical screening of HCM

Pacemaker-induced Superior Vena Cava Syndrome : Report of One Case and Review of the Literature

A 76-year-old man developed superior vena cava syndrome (SVCS) 20 months after the implantation of a dual chamber pacemaker, and was successfully treated with thrombolytic therapy followed by long-term anticoagulant therapy. The face and neck were markedly swollen, and superficial veins in the neck, upper arms and upper chest were prominently distended. Venography from bilateral cubital veins revealed a severe stenosis of the distal segment of the superior vena cava without the development of collateral channels. After an initial treatment with urokinase for 5 days followed by warfarin for 16 months, the symptoms and signs of the SVCS disappeared, and the digital subtraction angiography revealed a marked regression of the thrombotic stenosis. In view of the expected increase in the insertion of multiple leads in cases of dual chamber pacemakers or including fractured lead retention, more attention should be paid to the risk of the development of the SVCS in these cases