Factors participating in blood pressure elevation after discharge from the hospital in patients with essential hypertension.

We followed the changes in blood pressure (BP) after discharge from the hospital in 32 patients with essential hypertension whose BP was normalized on a diet containing 7g/day of NaCl during hospitalization. They were divided into two groups on the basis of BP changes: 18 patients whose BP values were elevated by more than 10% after discharge (group I; mean +16.9%, P less than .01) and the remaining 14 patients (group II; -3.6%, P = NS). Urinary Na excretion (UNaV) in Group I patients increased markedly after discharge (83 v 189 mu Eq/min, P less than .001) while it did not change in Group II (122 v 102 mu Eq/min, P = NS), resulting in a greater postdischarge UNaV in group I than in group II (P less than .01). The changes in BP were positively correlated with the overall changes in UNaV (r = 0.45, P less than .01). Plasma epinephrine after discharge was higher in group I than in group II (31 v 18 pg/mL, P less than .05). Thus, increases in NaCl intake seem to play an important role in BP elevation after discharge. Adrenal medullary function may partly contribute also to the BP elevation.

Preoperative endoscopic pancreatic stenting for safe local pancreatic resection.

Local pancreatic resection and enucleation have the advantage of preserving pancreatic parenchyma but pancreatic fistula often occurs postoperatively. We describe a case in which preoperative endoscopic pancreatic stenting prevented pancreatic fistula formation following local pancreatic resection. A pancreatic stent seems to prevent leakage from small pancreatic branch ducts not identified or ligated intraoperatively, via the pancreatic decompression effect. The present case demonstrates a novel indication for endoscopic pancreatic stenting.

Effects of sairei-to on the relapse of steroid-dependent nephrotic syndrome.

Sairei-To (Chai-Ling-Tang) was administered to four patients with steroid-dependent relapsing nephrotic syndrome. It was associated with prednisolone and immunosuppressive agents. Histological diagnosis was minimal change in three patients and mild focal glomerulonephritis in one patient. After the start of Sairei-To administration the relapse was markedly suppressed in three patients but not at all in the other. Although we could consider Sairei-To effective for steroid-dependent nephrotic syndrome in the present study, a larger study is necessary to confirm its efficacy.

Malaria and glucose-6-phosphate dehydrogenase deficiency in North Sumatra, Indonesia.

A screening test for glucose-6-phosphate dehydrogenase (G6PD) deficiency was carried out in North Sumatra, Indonesia by using a simple agar plate method. The prevalence of G6PD deficiency in male was 6.0% (9/151) in Nias prefecture, 3.9% (12/307) in Asahan prefecture and 0.9% (1/110) in Medan city (average 3.9%). The prevalence of malaria was investigated at the same time in Nias and Asahan. It was 8.6% (13/151) and 10.4% (32/307) in males. The parasite rate of Plasmodium falciparum in normal and G6PD deficient groups was 4.1% and 9.5%, respectively. There was no statistical significance between them. The usefulness of the system of detecting malaria and G6PD deficiency at the same time was discussed in relation to malaria control.

[Pharmacological study of 5'-DFUR oral administration and the clinical responses against gastrointestinal carcinoma].

In 4 out of 5 patients given 400 mg orally 5'-DFUR before surgery, intratumor 5-FU concentration showed over 150 ng/g. The concentration of either 5-FU or 5'-DFUR in the portal and peripheral blood of these patients exceeded the limits of assay. 5-FU concentration in peripheral blood was less than 0.05 micrograms/ml. White blood cell and platelet counts in the patients given 1,600 mg/day (no administration for 2 days/week) of 5'-DFUR for one month were essentially the same with those at the time of start of the treatment. Two of three patients showed minor response following the treatment with 5'-DFUR. Thus, administration of 1,600 mg/day of 5'-DFUR may be considered as an effective treatment of fluopyrimidine against advanced cancer. For the prediction of gastrointestinal side effect, assay of the 5-FU concentration in the portal blood seemed to be useful.

Total pancreatectomy combined with partial pancreas autotransplantation for recurrent pancreatic cancer: a case report.

We describe a patient presenting with a resectable carcinoma of the remnant pancreas at 3 years after undergoing a pylorus-preserving pancreaticoduodenectomy for invasive ductal carcinoma of the pancreatic head. We also performed a distal pancreas autotransplantation using a part of the resected pancreas to preserve endocrine function. Final histologic findings showed the second tumor to be an invasive ductal carcinoma consisting of a well-differentiated tubular adenocarcinoma with similar histopathologic findings as the first tumor. There were no microscopic lymph node metastases and no evidence of microvascular invasion (pStage IA [pT1, pN0, M0] and R0 according to the International Union Against Cancer TNM classification). The patient was discharged at 20 days after surgery without any trouble and followed by adjuvant chemotherapy with S-1. The carbohydrate antigen 19-9 value was again normalized after the second surgery. Twenty months after the second operation, the patient is alive without cancer recurrence. The pancreas graft is functioning with a blood glucose of 108 mg/dL, HbA1C of 6.2%, and serum C-peptide of 1.4 ng/mL.

Torsade de pointes induced by hypocalcemia in a postoperative patient with thyrotoxicosis.

A 29-year-old woman with a long-term history of Graves' disease was admitted for thyroidectomy. Torsade de pointes occurred after the subtotal thyroidectomy. The level of her serum calcium was lower than normal. After administration of calcium gluconate intravenously, torsade de pointes disappeared and was no longer recorded. It is assumed that her torsade de pointes was caused by hypocalcemia as a complication of subtotal thyroidectomy.