Interaction between gender and uric acid on hemoglobin A1c in community-dwelling persons.

INTRODUCTION: Higher glycated hemoglobin (Hb) (HbA1c) is significantly associated with an increased risk of cardiovascular disease (CVD). Serum uric acid (SUA) levels are associated with glucose intolerance and type 2 diabetes. Whether gender-specific differences regarding the relationship between SUA levels and HbA1c exist is unknown. AIM: We recruited 1636 (men, 696 aged of 70 ± 10 years; women, 940 aged of 70 ± 9 years) participants and enrolled in the study during their annual health examination from a single community. We investigated the association between SUA levels and HbA1c within each gender. RESULTS: Multiple linear regression analysis showed that in men, SUA (ß = -0.091, p = 0.014) with prevalence of antidiabetic medication (ß = 0.428, p < 0.001) and eGFR (ß = 0.112, p = 0.016) were significantly and negatively associated with HbA1c, and in women, SUA (ß = 0.101, p = 0.002) with prevalence of antidiabetic medication (ß = 0.458, p < 0.001) were significantly and positively associated with HbA1c. Moreover, the interaction between gender and SUA (ß = 0.445, p < 0.001) as well as gender (ß = -0.465, p < 0.001), prevalence of antidiabetic medication (ß = 0.444, p < 0.001), eGFRCKDEPI (ß = 0.074, p = 0.014), and SUA (ß = -0.356, p < 0.001) was a significant and independent determinant of HbA1c. A significant interactive effect of gender and SUA on determinants of HbA1c was noted in patients not on antidiabetic medications, regardless of age, HbA1c, and renal function. CONCLUSIONS: The interaction between gender and SUA was associated with HbA1c independent of other metabolic factors in community-dwelling persons.

Baseline and changes in serum uric acid independently predict 11-year incidence of metabolic syndrome among community-dwelling women.

INTRODUCTION: Metabolic syndrome (MetS) is associated with an increased risk of major cardiovascular events. In women, increased serum uric acid (SUA) levels are associated with MetS and its components. However, whether baseline and changes in SUA predict incidence of MetS and its components remains unclear. METHODS: The subjects comprised 407 women aged 71 ± 8 years from a rural village. We have identified participants who underwent a similar examination 11 years ago, and examined the relationship between baseline and changes in SUA, and MetS based on the modified criteria of the National Cholesterol Education Program's Adult Treatment Panel (NCEP-ATP) III report. RESULTS: Of these subjects, 83 (20.4%) women at baseline and 190 (46.7%) women at follow-up had MetS. Multiple linear regression analysis was performed to evaluate the contribution of each confounding factor for MetS; both baseline and changes in SUA as well as history of cardiovascular disease, low-density lipoprotein cholesterol, and estimated glomerular filtration ratio (eGFR) were independently and significantly associated with the number of MetS components during an 11-year follow-up. The adjusted odds ratios (ORs) (95% confidence interval) for incident MetS across tertiles of baseline SUA and changes in SUA were 1.00, 1.47 (0.82-2.65), and 3.11 (1.66-5.83), and 1.00, 1.88 (1.03-3.40), and 2.49 (1.38-4.47), respectively. In addition, the combined effect between increased baseline and changes in SUA was also a significant and independent determinant for the accumulation of MetS components (F = 20.29, p < 0.001). The ORs for incident MetS were significant only in subjects with age ≥ 55 years, decline in eGFR, and no baseline MetS. CONCLUSIONS: These results suggested that combined assessment of baseline and changes in SUA levels provides increased information for incident MetS, independent of other confounding factors in community-dwelling women.

Health-related quality of life in patients with lower rectal cancer after sphincter-saving surgery: a prospective 6-month follow-up study.

This longitudinal descriptive study examined whether rectal cancer patients report changes in health-related quality of life (HRQOL) over a 6-month period after different types of sphincter-saving surgery (SSS): intersphincteric resection (ISR), ultra-low anterior resection (ULAR) and low anterior resection (LAR). It also compares HRQOL among the three groups of patients. Seventy-three patients from two hospitals in Japan completed questionnaires on HRQOL and defecation symptoms immediately before surgery and 1 and 6 months afterwards. Results showed that ISR patients had significantly worse HRQOL scores than ULAR and LAR patients and more defecation symptoms that persisted during the 6 months post-SSS. Thus, patients undergoing ISR require psychological and social support, including skills in competent self-management, during the early post-operative period. Furthermore, defecation problems substantially influence HRQOL. The first month post-SSS is particularly challenging. The assumption that HRQOL is better after SSS compared to living with a permanent stoma might not be valid.

Prognostic significance of FTO genotype in the development of obesity in Japanese: the J-SHIPP study.

OBJECTIVE: Susceptibility of fat mass and obesity-associated (FTO) gene polymorphisms to obesity has been reported in various populations. Polymorphisms in the melanocortin 4 receptor (MC4R) gene were recently explored as another susceptible locus. However, prognostic significance of these genetic variations has not been fully elucidated. Here, we investigated the involvement of FTO rs9939609 and MC4R rs17782313 polymorphisms in the development of obesity. Association with type 2 diabetes mellitus (T2DM) was also investigated. SUBJECTS: We analyzed 2806 community-dwelling middle-aged to elderly subjects (61+/-14 years). Clinical parameters were obtained from the subjects' personal health records, evaluated at their annual medical check-up. RESULTS: FTO genotype was significantly associated with current body mass index (BMI; TT 23.2+/-3.2, TA 23.7+/-3.2, AA 24.4+/-3.2 kg m(-2), P=2.5 x 10(-6)) and frequency of obesity (26.6, 32.0, 43.0% respectively, P=2.0 x 10(-4)). Age- and sex-adjusted odds ratio for obesity was 1.30 (P=0.004) in TA and 2.07 (P=0.002) in AA genotype. During the 9.4 years comprising the follow-up period, 214 new cases of obesity were diagnosed among 1718 subjects whose retrospective data were available. A allele frequency of the FTO genotype was significantly higher in subjects who developed obesity (22.2, 15.8%, P=0.001), Age-, sex- and initial BMI-adjusted odds ratio for the development of obesity was 1.46 (95% confidence interval, 1.04-2.04) (P=0.031). However, association studies and meta-analysis of T2DM did not actively support the involvement of FTO genotype. No significant differences were observed between the MC4R genotype and BMI (P=0.015), and the frequency of obesity (P=0.284). CONCLUSION: FTO genotype is an independent risk factor for future development of obesity.

Isolation, characterization, and localization of the spanning protein from skeletal muscle triads.

A monoclonal antibody has been developed against the putative junctional protein or spanning protein (SP) from skeletal muscle triads. By immuno-affinity chromatography, we have purified this protein. The native protein has a molecular mass of 630-800 kD, as determined by gel filtration and rate zonal centrifugation. Within the limits of the methods used, the basic unit of the SP appears to be a dimer. In electron micrographs, it is shown to exhibit a circular profile with a diameter of approximately 100 A. In thin section analysis, the protein is frequently observed as parallel tracks of electron-dense particles bordering a translucent core. We suggest that the basic unit of the junctional structure is a dimer of 300-kD subunits and that four such entities constitute the intact SP. The purified protein has been used to develop polyclonal antibodies. By immunoelectron microscopy using immunogold probes, the SP has been localized to the junctional gap of the triad. By attaching the SP to an affinity resin, three proteins have been identified as forming associations with the SP. The Mrs of the proteins are 150, 62, and 38 kD; the 62-kD protein is calsequestrin.

Inhibition of 5-hydroxytryptamine receptor prevents occlusive thrombus formation on neointima of the rabbit femoral artery.

BACKGROUND: Thrombus propagation on disrupted plaque is a major cause of acute coronary events and serious complication after coronary intervention. 5-Hydroxytryptamine (5-HT) is a potent vasoactive and platelet-aggregating substance that is predominantly mediated by 5-HT2A receptor. However, the roles of 5-HT2A receptor in occlusive thrombus formation on disrupted plaque remain obscure. OBJECTIVE: We investigated the role of 5-HT2A receptor in thrombus formation using a rabbit model of repeated balloon-injury. METHODS: Three weeks after a first balloon-injury of the femoral arteries, luminal diameter, neointimal growth, and vasoconstriction by 5-HT in vitro were examined. Thrombus propagation and the role of 5-HT2A receptor after a second balloon-injury were evaluated using sarpogrelate, a selective 5-HT2A receptor antagonist. RESULTS: Three weeks after the first balloon-injury, luminal stenosis was evident in the femoral arteries, where the neointima expressed tissue factor and 5-HT2A receptor. The hypercontractile response of the stenotic arteries to 5-HT was significantly reduced by sarpogrelate. Balloon-injury of the neointima with substantially reduced blood flow promoted the formation of occlusive thrombus that was immunoreactive against glycoprotein IIb-IIIa, 5-HT2A receptor and fibrin. Intravenous injection of sarpogrelate significantly inhibited ex vivo platelet aggregation induced by adenosine 5'-diphosphate, thrombin and collagen alone as well as with 5-HT, and significantly prevented occlusive thrombus formation in vivo. CONCLUSIONS: The 5-HT2A receptor appears to play a crucial role in occlusive thrombus formation in diseased arteries via platelet aggregation and vasoconstriction. Inhibition of 5-HT2A receptor might help reduce the onset of acute coronary events and of acute coronary occlusion after the intervention.

Stereological analysis of transverse tubules and sarcoplasmic reticulum isolated from normal and dystrophic skeletal muscle.

Vesicles isolated from the transverse tubules and sarcoplasmic reticulum of normal and dystrophic chicken skeletal muscle were analyzed for enzymatic activity and examined following freeze-fracture. A stereological procedure was used to determine particle density distributions on the resulting membrane fracture faces. The particle densities measured in this investigation were compared with those of an earlier study on intact muscle. Isolated sarcoplasmic reticulum vesicles showed a characteristically high P-face (cytoplasmic leaflet) particle density (5108 +/- 169 particles/micron2) and a low E-face (luminal leaflet) particle density (505 +/- 57 particles/micron2). Transverse tubule fractions showed a high E-face particle density (2346 +/- 179 particles/mu2) as well as a substantial P-face particle density (1019 +/- 129 particles/micron2). The high transverse tubule E-face particle density represents a characteristic morphological feature in the same way that the very high P-face particle density is characteristic of sarcoplasmic reticulum membranes. The major morphological alteration in dystrophic membranes was a shift in the E-face particle density distribution of isolated transverse tubules to a lower average particle density. (The E-face particle density of sarcoplasmic reticulum fractions showed no differences.)

Calcium transport, ATPase activity and lipid composition in sarcoplasmic reticulum isolated from isogenic lines of normal and dystrophic chickens.

Two new lines of chickens with near identical genotypes (greater than 90% isogeneity), one demonstrating avian dystrophy, were used for isolation of sarcoplasmic reticulum vesicles. Vesicles from line 433 (dystrophic) displayed reduced Ca2+-ATPase activity, phosphoenzyme formation and steady-state calcium transport capabilities in comparison with vesicles from line 03 (normal). Lipid analyses show that dystrophic vesicles have greater amounts of cholesterol and lesser amounts of phosphatidylcholine. The results support the use of isogenic chickens in further studies of avian dystrophy. However, the results also suggest that current sarcoplasmic reticulum vesicle purification procedures dependent on differential calcium accumulation may not fully achieve the intended purpose.

Enzymatic activity of dystrophic chicken sarcoplasmic reticulum.

We have isolated sarcoplasmic reticulum from normal and dystrophic chicken muscle, using an improved isolation procedure. Dystrophic sarcoplasmic reticulum has a reduced level of calcium-sensitive ATPase activity, phosphoenzyme formation, and steady-state calcium transport. Anion-stimulated calcium transport by dystrophic sarcoplasmic reticulum is also reduced when measured under the proper conditions, and dystrophic sarcoplasmic reticulum shows no alteration in calcium efflux rate. Active calcium phosphate loading of the normal and dystrophic sarcoplasmic reticulum preparations indicates that a reduced percentage jof the dystrophic vesicles are capable of active calcium transport. The loaded dystrophic sarcoplasmic reticulum vesicles exhibit the same relative reductions in enzymatic activity as the starting sarcoplasmic reticulum preparations. However, the enzyme activities of normal and dystrophic sarcoplasmic reticulum are similar in the presence of detergent and exogenous phospholipid. On the basis of these results, we suggest that the lipid microenvironment of the dystrophic enzyme is altered.

Double cancer of the stomach, one AFP-producing tumor.

In recent years, many cases of alpha-fetoprotein-producing gastric cancer (AFPGC) characterized by increased serum levels of alpha-fetoprotein (AFP) and AFP positivity of the gastric cancer have been reported. Here we present a case of AFPGC coexistent with a different histological type of gastric cancer: The AFPGC was Borrmann type 1 advanced gastric cancer with multiple liver metastasis and appeared to produce both AFP and des-gamma-carboxy prothrombin (PIVKA-II). The second cancer was IIc type early gastric cancer and did not produce AFP. Despite receiving palliative chemotherapy, the patient died, due to hepatic failure, 45 days after admission.

Association of plasma homocysteine concentrations with carotid atherosclerosis in elderly Japanese.

OBJECTIVE: Homocysteine (Hcy) is a sulfhydryl amino acid. Its precursor, the essential amino acid methionine, is derived from dietary protein; recently a number of studies have suggested its relation to atherosclerosis. The present study was performed to clarify the relation between the plasma Hcy concentration and sclerotic lesions of the common carotid arteries. METHODS AND PATIENTS: We evaluated sclerotic lesions of common carotid arteries by ultrasonography in 120 elderly in-patients (77+ /- 9 years), and studied the relationship of the known risk factors for atherosclerosis including plasma Hcy. An ultrasonograph and 7.5 MHz linear type B-mode probe were used by a specialist to evaluate sclerotic lesions of the common carotid arteries. Blood was drawn from the patients while fasting for determination of plasma Hcy. Plasma Hcy concentrations were determined using a high-performance liquid chromatography assay. RESULTS: Logistic regression analysis using IMT as an object variable, adjusted by various risk factors including the plasma Hcy concentration, revealed that the relative risk in the group combining the second and the third highest Hcy groups was 6.49 (95% confidence interval (CI): 1.95-21.9) compared with the first group and the plaque presence showed a relative risk of 4.45 (95% CI: 1.53-12.9). CONCLUSION: The findings of this study confirmed that observations of an association between plasma Hcy concentration and common carotid atherosclerosis in Western populations is also present among the elderly Japanese.

An association between an antibody against Chlamydia pneumoniae and common carotid atherosclerosis.

OBJECTIVE: Chlamydia pneumoniae (C. pneumoniae) is an important pathogen for infections of the respiratory tract, and there are recently also a number of reports suggesting its relation with atherosclerosis. This study was performed to clarify the relation between C. pneumoniae infection and sclerotic lesions of the common carotid arteries. METHODS AND PATIENTS: We evaluated sclerotic lesions of common carotid arteries by ultrasonography in 147 in-patients (mean age, 70 years; 95% confidence interval, 68-72) in the internal medicine ward, and studied the relation of the known risk factors for atherosclerosis including C. pneumoniae infection. An ultrasonograph and 7.5 MHz linear type B-mode probe were used by a specialist to evaluate sclerotic lesions of common carotid arteries. C. pneumoniae infection was determined by measuring anti-C. pneumoniae IgG specific antibody level (IgG index) using enzyme-linked immunosorbent assay (ELISA) method with serum of fasting blood, which had been preserved at -70 degrees C. RESULTS: IgG index (p=0.0263), from multiple regression analysis using various risk factors as explanatory variables, was a significant independent contributing factor (R2=0.3465, p<0.0001) along with known risk factors such as male (p=0.0289), age (p=0.0007), Brinkman index (p=0.0067), hypertension (p=0.0443) and T-Chol (p=0.0220). CONCLUSION: This study confirmed that the observations of an association between antibody against C. pneumoniae and common carotid atherosclerosis in Western nations is also present in Japan. Our results suggests that C. pneumoniae infection is also an important risk factor for common carotid atherosclerosis.

Psychological stress and educational effect during bedside practice on psychiatric nursing.

The aim of this study is to analyze the educational effect and the factors of psychological stress of bedside practice on psychiatric nursing. The subjects studied were 76 nursing students in a nursing college. They answered a questionnaire and underwent the STAI-test before and after the periods of their bedside practice during psychiatric nursing. The results obtained were as follows; 1. The awareness structure of the nursing students was composed of 6 factors, that is, anxiety and detestation factor, understanding and acceptance factor, social alienation factor, denial factor, affirmation factor and closed society factor. 2. The changes in their awareness were observed before and after the periods of bedside practice. 3. The STAI-test showed that the nursing students frequently complained of anxiety before the bedside practice because they had only studied about the psychoses. 4. The nursing students who had strong anxiety also showed a deep fear and detestation. 5. Some nursing students who had had a deep anxiety before the bedside practice found their anxiety reduced because of the direct contact with psychotic patients. 6. Although the nursing students had psychological stress, they were also interested in the psychiatric nursing.

[Simple screening test for dementia in elderly persons the time and charge test].

Dementia, with its associated morbidity and mortality, has emerged as a leading public health problem with elderly persons and its early detection is of obrious importance for treatment in curable cases and referral of patients to optimal medical facilities with education support for family members. While the precision of detecting demented subjects by the existing screening methods has improved in recent years, they are still complex and time consuming in practice and therefore difficult to use. We have developed an screening method adapted for Japanese based on "The Time and Charge Test" of Froehlich and coworkers. The time test evaluates the understanding of clock hands indicating 11:10, and the charge test the ability selecting 100 yen from a group of coins consisting of one 50-yen coin, seven 10-yen coins and seven 5-yen coins. This test was conducted on 40 persons (two out of whom dropped out) living in Roken facility (a health facility for the elderly) and another 40 visiting a day care center for the elderly. The test results were studied using Mini-Mental State Examination and Hasegawa's Dementia Scale-revised version. The sensitivity of our test was 49.1%, the specificity 95.2%, the negative predictive value 40.8%, and the positive predictive value 96.6%. When a time limit 5 seconds for completing the task for the time test and 20 seconds for the charge test, the sensitivity was 87.7%, the specificity 57.1% the negative predictive value 63.2%, and the positive predictive value 84.7%. As for reproducibility, test-retest gave a value of 85.0%, and the inter-observer agreement was 89.5%. This simple method thus appears useful for screening for dementia.

[Blood pressure measurement by primary care physicians: comparison with the standard method].

OBJECT: To examine the usual methods of blood pressure (BP) measurement by primary care physicians and to compare them with the standard methods. DESIGN: Cross-sectional survey by self-administered questionnaire. SUBJECTS: Primary care physicians who graduated from Jichi Medical School and were working at clinics. Each standard method for 20 items was defined as the one that was most frequently recommended by 6 guidelines (USA 3, UK 1, Canada 1, Japan 1) and a recent comprehensive review about BP measurement. RESULTS: Of 333 physicians, 190 (58%) responded (median age 33, range 26 to 45 years). Standard methods and percentages of physicians who follow them are: [BP measurement, 17 items] supported arm 96%; measurement to 2 mmHg 91%; sitting position 86%; mercury sphygmomanometer 83%; waiting > or = 1 minute between readings 58%; palpation to assess systolic BP before auscultation 57%; check accuracy of home BP monitor 56%; Korotkoff Phase V for diastolic BP 51%; bilateral measurements on initial visit 44%; small cuff available 41%; > or = 2 readings in patients with atrial fibrillation 38%; > or = 2 readings on one visit 20%; cuff deflation rate of 2 mmHg/pulse 14%; large cuff available 13%; check accuracy of monitor used for home visit 8%; waiting time > or = 5 minute 3%; readings from the arm with the higher BP 1%. [Knowledge about BP monitor, 2 items] appropriate size bladder: length 11%; width 11%. [Check of sphygmomanometer for leakage, inflate to 200 mmHg then close valve for 1 minute] leakage < 2 mmHg 6%; median 10 (range 0-200) mmHg. Average percentage of all 20 items was 39%. Number of methods physicians follow as standard: median 8 (range 4 to 15) and this number did not correlate with any background characteristics of the physicians. Furthermore, we also obtained information on methods not compared with the standard. Fifty-four percentage of physicians used more standard methods in deciding the start or change of treatment than in measuring BP of patients with good control. About 80% of physicians use home BP readings in diagnosis or treatment of hypertension, but about half of physicians with ambulatory BP monitors use their measured readings. CONCLUSION: Primary care physicians used various techniques for routine BP measurement and no physician completely followed the standard. Such measurements may affect the diagnosis and treatment of hypertension, but measuring all BPs solely by the standard is not practical. We need to have a practical and efficient method of BP measurement for routine practice in the primary care setting.

[Health problems of elderly patients in a rural area].

The purpose of this study was to identify diseases frequently found in elderly populations in rural areas as well as to discuss the role of geriatric physicians in medical care for elderly patients. The study was conducted using ICHPPC-2-Defined (Japan version) which had been compiled by WONCA for the classification of diseases. The acute health problems treated by the clinic consisted of 183 types (2070 items) in 1916 patients seen during 19 months compared to 66 types of chronic problems consisting of 505 items in 179 patients. The most frequent acute complaints and health problems were acute infections of the upper respiratory tract, followed by diseases of the stomach and duodenum, then osteoarthritis and allied conditions. The most common chronic health problems were uncomplicated hypertension, osteoarthritis and allied conditions, osteoporosis, lipid metabolism disorders, complicated hypertension, cataract, and various other illnesses extending over all specialties of medicine. Geriatric physicians are required to have broad and multidisciplinary knowledge and skill to provide comprehensive and continual medical care for elderly patients in rural areas.

[Pulse pressure and common carotid arterial wall thickness assessed by ultrasonography].

This study was conducted on a total of 358 normotensive (mean blood pressure < 107 mmHg) inpatients (182 men and 176 women, mean age: 67.8 years) who had no cardiorenal or nutrition disorders that would affect blood pressure, lipid and glucose metabolism and who had not been given depressors or antilipidemic agents during the four years from September 1995 to August 1999. In addition to the known risk factors for atherosclerosis, the effects of pulse pressure and mean blood pressure on sclerotic changes of the carotid arteries were examined. These sclerotic changes were assessed by measuring the thickness of the combined intima-media of the common carotid artery (carotid arterial wall thickness) by ultrasonography (Hitachi EUB-565) and linear probe (7.5 MHz). When the patients were divided into three groups based on pulse pressure (PP1, lower than 51 mmHg: PP2, 51-65 mmHg; PP3, higher than 65 mmHg), the age of the group with higher pulse pressure was significantly higher (p = 0.0011), women more (p = 0.0315). However there were no differences in background factors such as body mass index, Brinkman index, lipid metabolism, uric acid, and glucose metabolism. There was observed a positive correlation between the mean blood pressure and the pulse pressure for both men and women (r = 0.31, p < 0.001, respectively). As for the relation between the pulse pressures and the blood pressure parameters, the systolic blood pressure, pulse pressure and the mean blood pressure were significantly higher in the group with higher pulse pressure (p < 0.001, respectively), but the diastolic blood pressure was significantly lower (p = 0.0275). As for the relation between the pulse pressure and the carotid wall thickness, the groups of both men and women with higher pulse pressures had significantly greater carotid arterial wall thickness (p < 0.001, p = 0.0042, respectively). Logistic regression analysis of the carotid arterial wall thickness (defined as hypertrophic if greater than 1.0 mm) as the object variable and various risk factors including pulse pressure as the explanatory variables revealed that pulse pressure and LDL-C were significant independent contributing factors for men. The age, Brinkman index, T-Chol and HDL-C were significant independent contributing factors for women. For all subjects men, the age, Brinkman index, pulse pressure, TG and LDL-C were significant independent contributing factors. These facts suggest that pulse pressure is an important risk factor for thickening of the carotid arterial wall.

[Risk factors related to the wall thickness of the common carotid artery in elderly patients].

We used ultrasonography to evaluate atherosclerotic lesions in the common carotid arteries of 147 inpatients (82 men, 65 women; mean age, 72.2 years). We sought to determine the relation between these lesions and various risk factors for atherosclerosis, as well as the utility of ultrasonography in quantitative evaluation of atherosclerotic disease. A 7.5 MHz transducer was used and atherosclerotic lesions were evaluated on the basis of the thickness of their intimal-medial complex, which we term wall thickness. The relations between these measurements and age, sex, blood pressure, smoking history, lipid metabolism, diabetes mellitus, and atherosclerotic disease were studied. Wall thickness of the common carotid arteries correlated with age (men: r = 0.45; women: r = 0.38). Brinkman Index (r = 0.25), systolic blood pressure (r = 0.44), diastolic pressure (r = 0.18), and high-density lipoprotein cholesterol (HDL-C, r = -0.23). Multiple regression analysis with these risk factors as explanatory variables showed that age, Brinkman Index, systolic blood pressure, HDL-C, and diabetes mellitus contributed significantly to increased wall thickness. Wall thickness was significantly greater in patients with atherosclerotic disease such as cerebral infarction and ischemic heart diseases. These findings indicate that appropriate treatment for multiple atherosclerotic risk factors may be necessarily in the elderly.

[Relation between atherosclerotic risk factors and abdominal wall fat thickness].

We used ultrasonography to assess the accumulation of visceral fat and its relation to known risk factors for atherosclerotic disease, and examined its relation with atherotic changes in the common carotid artery. The subjects were 315 consecutive inpatients (173 men, 142 women; mean age, 68.3 years) hospitalized during a 21-month period. Those with a history of epigastric surgery or nutrition disorders that might affect fat thickness were excluded. A 7.5-MHz transducer was used to evaluate the maximum thickness of preperitoneal fat (Pmax) at the anterior surface of the liver, and the minimum thickness of subcutaneous fat (Smin) of the abdomen. The fat/height ratio was calculated. Age, gender, smoking status, blood pressure, total cholesterol, triglyceride, HDL-cholesterol, LDL-cholesterol, atherogenic index ((total cholesterol-HDL-cholesterol)/HDL-cholesterol), blood sugar, serum insulin, and uric acid were examined as confounders. Pmax/height was found to be related to systolic blood pressure, diastolic blood pressure, total cholesterol, triglyceride, HDL-cholesterol, LDL-cholesterol and atherogenic index, and was positively associated with the thickness of the common carotid arterial wall. Pmax/height may be a useful means to evaluate known risk factors for atherosclerotic disease.

[A case of pituitary apoplexy approving as severe headache and nausea].

The causes of pituitary apoplexy are unclear. We report a case of pituitary apoplexy presenting with headache and nausea. On June 17th, 1997 a 74-year-old woman had complained of retro-orbital headache, fever and vomiting. A cold was diagnosed for which she recurred medication. In addition to the previous symptoms she was getting to lose appetite. She was admitted to our hospital for further examination and treatment on June 21. On admission neurological examination showed left pupil mydriasis, the left eye had no light reflex and the right eye had only a slight response to the light. She could hardly move both eyeballs up. Laboratory data showed a normal white blood cell count and the CRP was 16.2 mg/dl. Lumbar puncture showed 97 mg/dl total protein and 82 cells per microliter, most of which were lymphocytes. We diagnosed viral infection based on the evidence of clinical symptoms and lumbar puncture data. The patient was treated with gamma-globulin and improved. From the 16th day of sickness we recognized symptoms of oculomotor paralysis and the syndrome of inappropriate antidiuretic hormone. On the 23rd day of sickness we strongly suspected pituitary apoplexy based on transaxial MR images. After absorption of intra-tumor hemorrhage, the oculomotor symptoms recurred. We finally reached a diagnosis of pituitary apoplexy based on pathological material, MR images, symptoms and laboratory data. We must think of pituitary apoplexy when we see an aged out-patient with severe headache, nausea, vomiting and oculomotor paralysis. It was difficult to diagnose this disease in the early time course of the disease.