Association between Sarcopenia and Overactive Bladder in Elderly Diabetic Patients.

OBJECTIVES: To determine the association between sarcopenia and overactive bladder (OAB) in elderly diabetic patients using the Japanese version of SARC-F called SARC-F-J. DESIGN: Cross-sectional study. SETTINGS AND PARTICIPANTS: The study included 329 elderly diabetic patients (aged ≥65 years) who regularly visited the outpatient clinic at Community hospital in Japan. MEASUREMENTS: The condition of OAB was evaluated using the OAM symptom score, which involves a self-administered questionnaire, and sarcopenia was evaluated using the self-administered SARC-F-J questionnaire comprising five items. The odds ratio for OAB due to sarcopenia was calculated using multiple logistic regression analysis, with OAB as the dependent variable and sarcopenia as the explanatory variable. RESULTS: A total of 329 patients (186 males, 143 females) were included for analysis in the present study. Of these patients, 22.9% had sarcopenia and 18.7% had OAB. After adjusting the variables, the odds ratio for OAB due to sarcopenia was 4.46 (95% confidence interval [CI], 1.14-17.36, P = 0.031) and 2.09 (95% CI, 0.52-8.26, P = 0.293) for males and females, respectively. CONCLUSION: This study found that sarcopenia was significantly associated with OAB in elderly diabetic male patients based on SARC-F-J. Moreover, the possibility of the development of OAB should be considered during the medical examinations of elderly diabetic male patients with sarcopenia.

Clinical Utility of Diagnostic Laboratory Tests in Dogs with Acute Pancreatitis: A Retrospective Investigation in a Primary Care Hospital.

BACKGROUND: Acute pancreatitis (AP) occurs frequently in dogs, but most previous studies examining the diagnosis of AP have used data from secondary care hospitals. HYPOTHESIS/OBJECTIVES: The aim of this study was to investigate the clinical utility of diagnostic laboratory tests in dogs with AP in a primary care hospital. ANIMALS: Sixty-four dogs with clinical signs suggestive of AP diagnosed with nonpancreatic disease (NP) or AP. METHODS: Medical records were retrospectively reviewed, including diagnostic laboratory tests considered potentially useful in the diagnosis of AP. The diagnostic accuracy of amylase and FUJI DRI-CHEM lipase (FDC lip) were investigated using receiver operating characteristics (ROC). In addition, we verified whether diagnostic laboratory tests were useful for evaluating duration of hospitalization and as biomarkers for monitoring recovery. RESULTS: Activities of amylase and FDC lip were significantly higher in the AP group than in the NP group (P = .001, P < .001, respectively). The sensitivity of FDP lip activity for diagnosing AP was 100% (95% confidence interval [CI], 87.7-100%); the specificity was 89.5% (95% CI, 66.9-98.7%). Area under the ROC curve for FDC lip activity was 0.98 (95% CI, 0.93-1). High alanine aminotransferase (ALT) activity was associated with extended duration of hospitalization (P = .04). A significant difference in C-reactive protein (CRP) concentration before and 5 days after treatment was found (P = .001). CONCLUSIONS AND CLINICAL IMPORTANCE: Measurement of FDC lip activity appears useful for diagnosing AP. High ALT activity might be associated with prolonged duration of hospitalization, and CRP might be useful as a biomarker for monitoring recovery from AP.

Effect of beta-adrenergic receptor blockade on atrial natriuretic peptide in essential hypertension.

Plasma levels of atrial natriuretic peptide (ANP) were measured in 32 untreated subjects with essential hypertension and in 31 patients undergoing long-term treatment with beta-blockers. Patients receiving beta-blockers had significantly higher mean plasma ANP levels (72.0 +/- 36.0 [SD] pg/ml) than did untreated hypertensive subjects (39.8 +/- 15.8 pg/ml; p less than 0.01) and healthy normotensive controls (33.9 +/- 16.6 pg/ml; n = 61, p less than 0.01), while the mean plasma ANP concentration in untreated hypertensive subjects was not statistically different from that in control subjects. Administration of atenolol, 50 mg/day, for 4 weeks to 10 untreated subjects resulted in a significant (p less than 0.001) rise in plasma ANP levels (from 38.8 +/- 9.5 to 68.7 +/- 20.6 pg/ml). In 31 patients undergoing long-term treatment with beta-blockers, multivariate regression analysis revealed that age, pretreatment mean blood pressure, and plasma concentration of cyclic 3',5'-guanosine monophosphate (cGMP) were significant predictors of plasma ANP levels. These results suggest that beta-adrenergic receptor blockade in patients with essential hypertension elevates plasma ANP levels with a concomitant rise in cGMP concentrations, and that increased ANP in plasma may play a role in the compensatory mechanism that operates in response to beta-adrenergic receptor blockade.

Reflectance spectrophotometric measurement of in vivo local oxygen consumption in the cerebral cortex.

A simple method was developed to measure in vivo local oxygen consumption quantitatively in the brain cortex. Reflectance spectra of tissue hemoglobin at the brain's surface were measured for assessment of both local tissue hemoglobin content and its oxygen saturation. Local oxygen consumption was calculated from the spectral changes of tissue hemoglobin during complete cessation of blood flow by compression of the cortical surface in the suprasylvian gyrus with the tip of an optic probe. This procedure was performed without any brain damage and only took approximately 5 s. The calculated local oxygen consumption during this short period of compression remained constant for a few seconds. Then, it decreased rapidly, although the local tissue hemoglobin was not completely deoxygenated. The value of local cerebral oxygen consumption obtained by this method was 3.02 +/- 0.61 mL O2/100 g brain/min; it was not influenced by the change in systemic blood pressure. The effect of pentobarbital on cerebral oxygen consumption was also studied. At the stage of burst and suppression on electrocorticogram, cerebral oxygen consumption decreased significantly (p less than 0.001) to 1.03 +/- 0.07 mL O2/100 g brain/min.

Effects of steroid treatment on release of cardiac myosin light chain II in acute myocardial infarction in dogs.

The effect of methylprednisolone sodium succinate (MP) on release of myosin light chain II (LCII) from the myocardium was studied in experimental myocardial infarction (MI). Acute MI was produced in conscious, closed-chest dogs by ligating the left anterior descending coronary artery beyond the first diagonal branch. MP, 30 mg/kg, was administered intravenously just before and 24 hours after MI. After MI, LCII levels in the serum were determined serially up to 240 hours. MI size was determined histologically 10 days after MI. In the MP group, LCII levels in the serum within 72 hours were lower than in the control, and cumulative LCII release for 3 days decreased from 530 +/- 159 to 310 +/- 101 ng/ml (mean +/- standard deviation) (p less than 0.001). However, the peak LCII level appeared later (control vs MP, 63 +/- 27 vs 122 +/- 25 hours, p less than 0.001), and the peak LCII level and cumulative LCII release for 10 days were not decreased by MP treatment. MI size also was not reduced by MP (11.0 +/- 4.4% vs 11.8% +/- 4.5% of the left ventricle, difference not significant). Since the rate of disappearance of LCII is rapid and was not affected by MP, these results suggest that MP treatment early after acute MI delays breakdown of myosin filaments, but cannot prevent it.

Intracranial metastasis of a spinal cord astrocytoma--case report.

The authors report a case of cerebral metastasis from a spinal cord astrocytoma. The first metastatic tumor was controlled by radiation therapy. A second metastatic brain tumor was detected 2 years later, but attempts to control it through subtotal removal and chemotherapy failed. Metastasis from a spinal cord tumor to the brain is a rare event.

Abscess within a glioblastoma multiforme--case report.

A rare case of abscess within a glioblastoma with an unusual presentation occurred in a 46-year-old female who developed right hemiparesis and seizure. Computed tomography and magnetic resonance imaging demonstrated hemorrhage which mimicked hemorrhagic infarction. However, the lesions developed ring enhancement. Aspiration showed one to be an abscess, which collapsed by drainage but later re-expanded. The mass was removed, and histological examination revealed glioblastoma.

[A case of huge neurofibroma expanding extra- and intracranially through the enlarged jugular foramen--CT scan findings and surgical approach].

The surgical approach to the jugular foramen has been considered to be very difficult and troublesome, because of the location in which important structures, such as the internal jugular vein, internal carotid artery and lower cranial nerves, converge in the narrow deep space. A case of huge neurofibroma, which extended from the tentorium cerebelli through the dilated jugular foramen to the level of the vertebral body of C3 was presented. A 12-year-old girl was admitted with complaints of visual disturbance and palsy of the V-XII cranial nerves of the left side. Plain skull film showed prominent widening of the cranial sutures and enlargement of the sella turcica. Horizontal CT scan with contrast showed symmetrical ventricular dilatation and a heterogeneously enhanced mass, which was situated mainly in the left CP angle. Coronal CT scan with contrast revealed a huge mass and enlarged jugular foramen, through which the tumor extended to the level of the vertebral body of C3. Occlusion of the sigmoid sinus and the internal jugular vein of the left side was noticed in the vertebral angiography. Two-stage approach, the first one for removal of the intracranial tumor and the second one for extracranial tumor, was performed for its huge tumor. Several authors have reported excellent surgical approaches for the tumors situated in the jugular foramen. By our approach, modifying Gardner's original one, a wide operative field was obtained to remove the tumor around the jugular foramen with success. Our approach for the jugular foramen was described with illustrations.

[Age-associated morphological change in interventricular septum].

To investigate the morphological features of the interventricular septum (IVS) in the senile heart, we examined 123 normotensives (59 males and 64 females), ranging in age from 22 to 91 yrs using 2D echocardiography. End-diastolic IVS thickness was measured at the mid-portion (M) and at the thickest portion within 15 mm distal to the aorto-septal junction (basal portion, B) on left parasternal long-axis tomogram. The sigmoid shape of the basal portion was evaluated in terms of aorto-septal (AS) angle. M showed no correlation with age, whereas B increased significantly with age in both sexes (males, r = 0.42, p < 0.01; females, r = 0.51, p < 0.01). B/M ratio, therefore, also increased with age (males, r = 0.49, p < 0.01; females, r = 0.39, p < 0.01). The AS angle decreased with age in both sexes (males, r = -0.33, p < 0.01; females, r = -0.51, p < 0.01). There was a significant inverse correlation between B/M ratio and AS angle (males, r = -0.31, p < 0.05; females, r = -0.50, p < 0.01). We conclude that the B/M ratio is a novel index reflecting heterogenously distributed hypertrophy in the IVS associated with age.

[Immunological detection of fecal occult blood-follow up study on patients with positive testing].

To evaluate its clinical utility in the early detection of colorectal diseases, we carried out the immunological fecal occult blood test in 922 patients and monitored the clinical course of the 87 patients in whom it was positive. Thirty-five (40.2%) of these patients underwent subsequent X-ray and colonoscopy, and colorectal cancer was detected in 8 (20%). Our findings confirm the clinical usefulness of this test.

[Assessment of tissue and intracellular pH following cold-induced vasogenic brain edema--in vitro and in vivo study].

Acid-base balance is closely related to the brain function and various methods have been applied to estimate the intracellular, extracellular or tissue pH. Umbelliferone, a fluorescent pH indicator, has been used to study either intracellular or tissue pH. In the present study, umbelliferone was used for histochemically estimating the tissue pH in the rat brain. The pH nomograms were made from the difference between fluorescent intensities at 450 nm on both excitations at 370 nm and 340 nm at different tissue water contents and different umbelliferone concentrations. Linear correlations were noted under each condition but 0.125% w/v umbelliferone provided the best estimation of tissue pH because of the least influence of water contents. Using this concentration of umbelliferone, a histochemical study was done to estimate the sequential changes in tissue pH following cold-induced vasogenic brain edema in rats. The results revealed a clear delineation of brain edema and the mild alkalosis in the edematous tissue, which probably reflects the pH of leaked plasma fluid. While the pH in the cortex around the lesion was neutral in the histochemical study, it was acidic in the in vivo study. This discrepancy is probably due to the former indicating the tissue pH while the latter the intracellular pH. Thus, the alkalosis in the edema fluid and the intracellular acidosis in the cortex around the lesion were noted in the cold-induced vasogenic edema.

[Clinical validity of lumbar subarachnoid pressure measurement].

To evaluate the clinical usefulness for measuring lumbar subarachnoid pressure (LSP) as an index of intracranial pressure, the relation between LSP and epidural pressure (EDP) was studied by the cisternal saline infusion and bolus injection in 12 cats at the range of pressure up to 50 mmHg. In the steady state infusion (0.238 ml/min, 0.476 ml/min), the data from LSP and EDP were correlated very well and the LSP value was at least above 80-90% of EDP value at any pressure level. In the bolus injection (0.4 ml), the degree of pressure rise and the time course of both LSP and EDP were quite similar at any pressure level. However, the compliance calculated from the pressure change of LSP and EDP revealed to have a different tendency according to the baseline pressure level at bolus injection. Below 10 mmHg of EDP, the compliance calculated from LSP was usually higher that of EDP. This was considered due to the distensibility of spinal theca. But above 10 mmHg of EDP, the compliance of both LSP and EDP became almost equal and then gradually decreased as the elevation of baseline pressure at bolus injection. This was considered to be the result of disappearance of the distensible effect of spinal theca. In this study, two polyethylene tubes of different size (I. D. 0.45 mm, 0.58 mm) were used for spinal drainage tube to compare the pressure dumping effect of tube. However, on both tubes, the pulse pressure of LSP was usually smaller than that of EDP, with each having almost constant difference.(ABSTRACT TRUNCATED AT 250 WORDS)

[The sequential changes of energy metabolism following cold-induced brain edema--a histochemical study].

The changes of energy metabolism on vasogenic edema have been largely examined using biochemical quantitative assay. However, the relationship between the sequential changes and blood-brain barrier (BBB) breakdown is not well understood. In the present study, the sequential changes of energy metabolism and potassium in relation to BBB breakdown following the cold-induced brain edema were investigated histochemically. Adult male Wistar rats, weighing 200-250g, were anesthesized with pentobarbital and a burr hole was made in the left parietal region. For evaluating the breakdown of BBB, 2.5% Evans blue (EB) was injected 30 min. before injury, except in the 5 min. model in which it was injected at the time of cold injury. An iron-bar precooled in liquid N2 was placed over the surface for 30 seconds and they were frozen in situ in liquid N2 at 5 min., 2 hrs., 6 hrs., 12 hrs., and 24 hrs., after producing the lesion. The frozen brain was sectioned using a precooled saw in the coronal plane. The brain section was placed in liquid N2 bath and illuminated with 366 nm light (UV) from a 200 watt mercury lamp and Corning filter 5840. NADH fluorescence was recorded photographically through Corning filter 3387 and 5562. Regional ATP and potassium content were investigated histochemically in thin sections with luciferine-luciferase method and Macallum's technique, respectively. At 5 min. after cold injury, leakage of EB was limited within the lesion. Potassium and ATP were decreased in the lesion. NADH fluorescence was increased slightly in the cortex around the lesion.(ABSTRACT TRUNCATED AT 250 WORDS)

[Spontaneous reversion to sinus rhythm in a case of lone atrial fibrillation of fifteen years duration].

A 69-year-old male visited our clinic in 1973 because of atrial fibrillation noted during an annual check-up for the aged. Blood pressure, heart rate and CTR in chest X-ray films showed 110/80 mmHg, 150/min and 55%, respectively. There were no signs of valvular heart diseases, and a diagnosis of lone atrial fibrillation was convincing. Since then, repeated ECGs recorded twice or more a year had shown atrial fibrillation until 1988, when sinus rhythm with both first degree AV block and low P-wave amplitude appeared. The motion pattern of the anterior mitral leaflet on M mode echocardiography was abnormal with almost complete disappearance of the A-wave, whereas the motion pattern of the tricuspid valve was normal.

[Trends in antihypertensive drugs used for elderly patients].

The admission of antihypertensive medications in the elderly (65 y.o. or more, 269 pts) was compared to that in younger cases (less than 65 y.o., 348 pts). All were outpatients who visited our clinic in 1990. The number of patients on a single therapeutic regimen was almost equal in both age groups. Once-a-day regimens were more common in the young (56.9% vs 48.3%, p less than 0.05), and three times-a-day regimens were more common in the elderly (14.7% vs 23.1%, p less than 0.01). The choice of antihypertensive drugs in patients with single therapy or combined therapy in the young was beta blockers in 49.7%, Ca blockers in 39.4%, diuretics in 30.7% and ACE inhibitors in 17.8%, and those in the elderly were Ca blockers in 46.1%, diuretics in 44.2%, beta blockers in 33.8%, and ACE inhibitors in 16.4%. The patients were subdivided into three groups according to the time of the initial visit to the clinic; initial visit during 1969-1979 (phase 1), 1980-1984 (phase 2) and 1985-1990 (phase 3). In the young, choice of beta blockers and diuretics was most popular in phase 1. However, the choice of diuretics decreased in phase 2, and in phase 3 beta blockers were used in 50.4%, Ca blockers in 43.2%, ACE inhibitors in 22.3% and diuretics in only 17.3%. In the elderly, diuretics were most popular followed by Ca blockers and beta blockers in phase 1 and phase 2. In phase 3 Ca blockers were selected in 58.2% followed by both beta blockers and ACE inhibitors in 28.4% then diuretics in 23.9%.(ABSTRACT TRUNCATED AT 250 WORDS)

[Echocardiographic assessment of cardiac basal hypertrophy represented by increased base to mid thickness ratio (B/M ratio) in the ventricular septum and its relation to age].

The basal part of the interventricular septum may easily become hypertrophic because it is exposed to strong hemodynamic stress compared to the other portions of the left ventricle. We measured the end-diastolic interventricular wall thickness both at the base and in the midsection by 2D echocardiography in 122 normotensives, and examined whether the basal thickness increases with age. The basal thickness (B) increased with age in both sexes. In males the thickness averaged 10.1 mm in the 50-59 age group, 10.2 m in those aged 60-69 and 11.4 mm (p < 0.01) in those 70 or older compared to 9.4 mm in those aged 49 or younger. In females it was 8.1 mm (p < 0.05) in the 50-59 age group, 8.3 mm (p < 0.05) in those aged 60-69 and 10.0 mm (p < 0.01) in those 70 or older compared to 6.8 mm in those 49 or younger. Concerning the midwall thickness (M), there were no significant changes among the respective age groups in either sex. As a result, a close correlation was found between the B/M ratio, a new and simple index for basal hypertrophy, and age (R = 0.46, p < 0.01 in males and R = 0.43, p < 0.01 in females). Comparison of the B/M ratio between the two age groups 49 or younger and 70 or older was as follows; 1.08 vs 1.30 (p < 0.01) in males and 1.01 vs 1.27 (p < 0.01) in females. Increase of basal hypertrophy in the aged was clearly indicated by the B/M ratio.

[Establishment of permanent atrial fibrillation and time course of the amplitude of the f wave].

Atrial fibrillation is one of the arrhythmias that increase with increasing age. In this study we compared transition intervals from sinus rhythm to permanent atrial fibrillation and the time course of the f wave amplitude immediately after the transition between 32 younger (less than 65 years) and 44 elderly patients (greater than or equal to 65 years) in whom transition from sinus rhythm to permanent atrial fibrillation was confirmed on serial ECG recordings. Each group was classified into three categories according their underlying diseases: hypertensive heart disease, valvular disease, and lone atrial fibrillation. In patients with hypertensive heart disease or lone atrial fibrillation, there was no significant difference in the transition intervals between the younger and the elderly groups. In both groups the transition intervals were significantly (p less than 0.05) longer in patients with lone atrial fibrillation than those in patients with hypertensive heart disease (44.6 vs. 12.5 months in younger and 26.8 vs. 12.9 months in elderly). A significant positive correlation (r = 0.58, p less than 0.01) was observed between the final P wave and the initial f wave amplitude on establishment of permanent atrial fibrillation in all patients. In the younger group, the initial f wave amplitude of patients with valvular disease (0.27 +/- 0.04 mV, mean +/- SE) was significantly larger than those of patients with hypertensive heart disease (0.15 +/- 0.03 mV, p less than 0.05) and of patients with lone atrial fibrillation (0.16 +/- 0.01 mV, p less than 0.05). The f wave amplitude of valvular disease was significantly decreased after 1 year (0.22 +/- 0.03 mV, p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

[Perceived quality of life and social factors in elderly hypertensive patients].

We conducted a cross-sectional study of elderly outpatients with hypertension to examine the relationship between quality of life (QOL) scores and social background factors. The subjects consisted of 516 outpatients (267 females), age of 60 or over, at nine clinics of major hospitals which participated in the National Cardiovascular Center Research Project. The perceived QOL was evaluated by the QOL scale originally based on Japanese patients with cardiovascular diseases. The scale consisted of the following 5 subscales; difficulty due to disease, psychological stability, independence, satisfaction in daily living and vitality. The background factors included family structure, socioeconomic factors and work status, and physical activity of daily living (ADL). After adjusting for age, sex, administered drugs and complicating conditions such as ischemic heart disease and/or apoplexy, a significant odds ratio of a low score of difficulty due to disease, psychological stability, satisfaction in daily living and vitality was found in the impaired physical ADL group with low socioeconomic class, and a significant odds ratio of low score of independence were found in the impaired physical ADL group who had lost jobs due to illness and had no children.