Effects of combined resistance and aerobic training program on myoelectric activity of Vastus Lateralis in patients with breast cancer during adjuvant chemotherapy period.

OBJECTIVE: Chemotherapy and/or radiation are normally the predominant therapies administered to cancer patients. Commonly, patients express complaints of fatigue during adjuvant treatment. Furthermore, regular practice of physical exercise during adjuvant treatment seems to have positive effects. The aim of this study was to investigate the effects of combined muscle strength, and a supervised aerobic training program on myoelectric activity of Vastus Lateralis during isometric test in patients with breast cancer undergoing adjuvant chemotherapy. PATIENTS AND METHODS: Thirty-two women with breast cancer (20 patients in the training group and 12 patients as controls) undergoing adjuvant chemotherapy participated in the study. They took part in a 6-week training period. A muscle-strength program included isometric contraction and electrical muscle stimulation (EMS). Aerobic training program consisted of supervised intermittent cycling exercise and home-based walking exercise. The outcome measures were Root Mean Square (RMS), Mean Power Frequency (MPF), Maximal Voluntary isometric Contraction (MViC), and Endurance Time (ET) of Vastus Lateralis, before and after the training period in the two groups. RESULTS: Compared to controls, a significant increase in MViC (p=0.001) and ET (p=0.005) in quadriceps accompanied by a significant decrease in RMS (p=0.007) and a significant increase in MPF (p=0.002) has been obtained in the training group. CONCLUSIONS: Supervised muscle strength and supervised aerobic training programs enhanced muscle activity and muscular performance in women with breast cancer during adjuvant chemotherapy treatment and optimized the decrease of muscular fatigue.

[A case of Avellis' syndrome with ipsilateral central facial palsy due to a small medullary infarction].

We report a 51-year-old man with mild left central facial palsy and left Avellis' syndrome due to a small medullary infarction. On admission, neurological examination revealed hoarseness, dysphasia, absent left gag reflex, palsies of the left vocal cord and left soft palate, and hypalgesia and thermohypesthesia on the right side of the trunk and extremities. In addition, he had a mild left central facial palsy. He had no nausea, vomiting, vertigo, hiccups, nystagmus, Horner's sign, facial numbness, or paresis or ataxia of the limbs. A T2 weighted MRI showed a small, high signal intensity area in the left dorsal region of the medulla and this lesion was presumed to involve the nucleus ambiguus and a part of the spinothalamic tract. These findings suggest that an aberrant supranuclear pathway, looping around the nucleus ambiguus to the facial nucleus exists in our patient.

Body temperature correlates with functional outcome and the lesion size of cerebral infarction.

INTRODUCTION: Experimental studies have demonstrated that mild hyperthermia exacerbates ischemia-induced neuronal injury. MATERIAL AND METHODS: We examined the relationship between body temperature and functional outcome in 183 patients suffering from cerebral infarction, and admitted within 24 h from the onset of stroke. Patients' functional capacities in daily life were evaluated by Rankin's score before the attack (RS0), on the day of admission (RS1), and 3 months after the onset of stroke (RS90). RESULTS: RS90 showed an independent correlation with RS0, RS1, age, infarct size and maximum body temperature recorded within the first 7 days from the onset of stroke by multivariate analysis. History of previous cerebrovascular accidents, atrial fibrillation, hemorrhagic transformation, infection, and a hypothalamic lesion showed significant associations with RS90 by the Mann-Whitney U-test, but not by multivariate analysis. Infarct size correlated with body temperature, atrial fibrillation, and hemorrhagic transformation. CONCLUSION: Body temperature correlated well with both functional outcome and infarct size in patients with an acute cerebral infarction.

Vascular risk factors for atherosclerotic lesions of the middle cerebral artery detected by magnetic resonance angiography (MRA).

OBJECTIVES: To examine the relationship between atherosclerotic lesions of the middle cerebral artery (MCA) detected on MRA and vascular risk factors. MATERIAL AND METHODS: We retrospectively assessed 279 patients (mean age, 69.0+/-11.3 years) who visited the Department of Neurology of Masuda Red Cross Hospital and underwent three-dimensional, time-of-flight MRA of the head between January 1996 and October 1998. Cases of cerebral embolism and internal carotid artery occlusion were excluded. Diagnoses were cerebral infarction (n = 152) and others (n = 127). We evaluated stenotic or occlusive lesions of the MCA (M1 portion), using MRA. Age, sex, history of hypertension, HbA1c, total cholesterol, fasting triglyceride, high density lipoprotein, lipoprotein(a), blood pressure, hematocrit, smoking and left ventricular hypertrophy (LVH) on ECG were included in the analysis. RESULTS: 36 patients (12.9%) had stenotic or occlusive lesions of the MCA on MRA. Univariate analysis showed that age, hypertension and HbA1c were significantly correlated with MCA lesions. Multiple logistic regression analysis showed that HbA C and hypertension were significant and independent predictors for MCA lesions. CONCLUSION: Hypertension and high serum HbAlc levels may contribute to the development of atherosclerotic lesions of the MCA in Japanese people.

Cell density of adrenomedullin-immunoreactive cells in the gastric endocrine cells decreases in antral atrophic gastritis.

AIMS: Adrenomedullin (AM) is a novel hypotensive and vasorelaxing peptide recently isolated from human phaeochromocytoma tissue, and is widely distributed in various organs. In this study we examined the localization of AM-immunoreactive (IR) cells in the gastric mucosa and AM-IR cell density in antral atrophic gastritis. METHODS AND RESULTS: Gastric mucosal tissues were taken from the gastric body and antral mucosa of 52 patients (27 men, 25 women; mean age 56.0 (range 20-86) years). Immunohistochemical analysis revealed that AM-IR cells were present in the pyloric glands, but not in the fundic glands, and that AM-IR cells were stained positively for chromogranin A and gastrin. The percentage of AM-IR cells vs chromogranin A- and gastrin-IR cells was 42 and 56%, respectively. The number of AM-IR cells decreased with the progression of severity of atrophic changes in the pyloric gland, and also of mononuclear cell infiltration. There was no correlation between the number of AM-IR cells and the degree of neutrophilic infiltration. Similar findings were also obtained for gastrin-IR cells. CONCLUSION: AM-IR cells are present in the endocrine cells including gastrin-IR cells in the pyloric glands. These results suggest that AM may contribute to gastrin secretion in the pyloric glands.

[A case of leiomyosarcoma of the jejunum with postoperative hepatic encephalopathy].

We report a case of leiomyosarcoma of the jejunum with postoperative hepatic encephalopathy. A 60-year-old man was operated for tumor of the abdomen. He was diagnosed as leiomyosarcoma of the jejunum with disseminated peritoneal metastasis, but no liver metastasis and cirrhosis. A palliative resection of the jejunum was performed. After operation, disturbance of orientation and apraxia with electroencepharographic abnormality and hyperammonemia developed. He was diagnosed as hepatic encephalopathy without lesion of the liver, and died 11 months after surgery. We consider that the portosystemic shunt and bleeding from the digestive tract due to invasion of metastatic lesions caused hepatic encephalopathy.

Adrenomedullin in the gastrointestinal tract. Distribution and gene expression in rat and augmented gastric adrenomedullin after fasting.

The aim of this study was to investigate the regional distribution, molecular forms, and gene expression of adrenomedullin in the rat gastrointestinal tract and to examine physiological changes in gastric adrenomedullin after 24-h fasting. The tissue concentration was measured by radioimmunoassay. The molecular forms were analyzed by high performance liquid chromatography. mRNA levels were quantified by Northern blotting and cells positive for adrenomedullin immunoreactivity were localized by immunohistochemistry. A high concentration of adrenomedullin was found in stomach, cecum, and colon (450-520 fmol/g wet tissue). Adrenomedullin immunoreactivity was also detected in duodenum, jejunum, and ileum (200-250 fmol/g wet tissue). Transcripts of the adrenomedullin gene were widely expressed throughout the gastrointestinal tract. The major form of adrenomedullin immunoreactivity in stomach and colon corresponded precisely with authentic adrenomedullin peptide. Adrenomedullin immunoreactive cells were present in the gastrointestinal endocrine system. The concentration and mRNA level of gastric adrenomedullin after fasting were significantly increased compared with findings in controls. Adrenomedullin is ubiquitous in the gastrointestinal tract, and may be produced by endocrine cells. The results suggest that adrenomedullin, through its potent vasodilating activity, may play some role, in the stomach including the regulation of the mucosal blood flow.

Distribution and expression of adrenomedullin in human gastrointestinal tissue.

Adrenomedullin (AM) is a biologically active peptide recently isolated from phaeochromocytoma. We report here the distribution and characterization of immunoreactive AM and gene expression of AM in human gastrointestinal tissue. Using a sensitive radioimmunoassay system for the peptide, immunoreactive human AM was detected in the stomach, duodenum, jejunum, ileum and colon. The AM concentration of these tissues was about 0.4-0.8 pmol/g wet tissue. Reverse phase and gel filtration high-performance liquid chromatographies showed that most of the immunoreactive AM in stomach and jejunum was identical to authentic human AM. By northern blot analysis, human AM mRNA was found to be expressed ubiquitously in the human gastrointestinal tissues. Furthermore, an immunohistochemical study revealed that immunoreactive AM cells were present in the gastrointestinal glands. These results suggest that AM may play some role as a gastrointestinal hormone.

99mTc-HMPAO brain SPECT imaging in a case of repeated syncopal episodes associated with smoking.

BACKGROUND: We report here a rare case of repeated syncopal episodes associated with smoking and findings of 99mTc-hexamethylpropyleneamine oxime (HMPAO) brain single-photon emission CT (SPECT) imaging. CASE DESCRIPTION: A 77-year-old man had four syncopal episodes during a half-month period. All four occurred when he stood up and walked immediately after smoking a cigarette, and syncope did not occur after cessation of smoking. Although upright testing revealed orthostatic hypotension, the patient did not complain of fainting on standing alone. Compared with brain SPECT in the supine position, perfusion was decreased in the posterior circulation structures after the subject smoked a cigarette or chewed nicotine gum. CONCLUSIONS: The combination of cerebral vasoconstriction due to smoking and orthostatic hypotension probably decreased cerebral blood flow in this patient, resulting in syncope.

Biotransformation of the novel inotropic agent toborinone (OPC-18790) in rats and dogs. Evidence for the formation of novel glutathione and two cysteine conjugates.

The metabolism of toborinone, (+/-)-6-[3-(3,4-dimethoxybenzylamino)-2-hydroxypropoxy]-2(1H)-quin - olinone, a novel inotropic agent, was studied in rats and dogs after intravenous administration. Chemical structures of the 13 metabolites were characterized by direct-probe FAB/MS and field desorption/MS, LC/FAB/MS, and various NMR measurements. After intravenous dosing of 10 mg/kg [14C]toborinone, fecal and urinary recoveries of the 14C dose were approximately 70% and 26-30%, respectively, in both rats and dogs. The predominant component of radioactivity was the unchanged toborinone in every biological specimen in rats and dogs. Although unchanged toborinone was predominantly observed, toborinone underwent extensive conjugations with glucuronic acid, sulfate, and glutathione, either directly or following phase I reaction. Metabolites resulting from oxidative N-C cleavage were minor both in number and in quantity in every biological specimen in rats and dogs. In rats, toborinone underwent O-demethylation to form M-7 and successive phase it reaction to yield the glucuronide M-1 and the sulfoconjugate M-2, and deconjugation to yield M-7, which was a primary metabolite accounted for 35.67% of the radioactivity excreted in the feces by 48 hr. Conjugates M-1 and M-2 were the major metabolites in rat plasma. In dogs, toborinone was metabolized via mercapturic acid pathway to yield the primary metabolites, cysteine conjugates M-10 and M-11 that accounted for 19.10% and 6.70% of the radioactivity excreted in the feces by 48 hr and that were detected species specifically in dogs. The glutathione conjugate M-13, which was isolated from in vitro incubations using dog liver, led us to consider a possible mercapturic acid pathway from the parent compound to M-10. Metabolites in dog plasma and those in urine in both rats and dogs were minor in quantity. The metabolic pathways of toborinone in rats and dogs are proposed herein.

Alcoholic myopathy: evaluation with magnetic resonance imaging--a case study.

Magnetic resonance imaging (MRI) of thigh and leg muscles was performed in a patient with alcoholic myopathy showing myalgia, hypercreatine kinasemia, and hypermyoglobinemia. High signal intensities in both T1- and T2-weighted images were widely distributed in the affected muscle groups, which most likely reflected lipid accumulation. Although he had hypermyoglobinemia, MRI and muscle biopsy did not show findings of rhabdomyolysis, such as necrosis, regeneration, and edema. We suggest that the high signal intensities in this case may have indicated "prerhabdomyolysis" related to alcohol abuse and that muscle MRI is useful in the evaluation of alcoholic myopathy, mainly predicting the onset of rhabdomyolysis.

Cigarette smoking is correlated with the periventricular hyperintensity grade of brain magnetic resonance imaging.

BACKGROUND AND PURPOSE: A new studies have observed a significant inverse correlation between cigarette smoking or lipid abnormalities and periventricular hyperintensities (PVHs) on T2-weighted magnetic resonance imaging (MRI) scans of the brain, which is surprising because smoking and hyperlipidemia are considered risk factors for cerebrovascular disease. We investigated the relation between smoking and lipid abnormalities and PVHs on T2-weighted MRIs. METHODS: MRI scans were performed in 253 patients over the age of 40 years, and PVHs were assessed retrospectively by use of a five-point scale. Patients who were receiving medical treatment for hyperlipidemia were excluded. Serum levels of total cholesterol, high-density lipoprotein (HDL) cholesterol, and triglycerides were determined in the fasting state by an automated enzymatic procedure. The low-density lipoprotein (LDL) cholesterol level was calculated by use of Friedewald's equation. Age, sex, hypertensive status, antihypertensive treatment, presence or absence of diabetes mellitus, and history of stroke were included in the analysis. RESULTS: Multiple linear regression analysis showed that age, hypertension, smoking, and antihypertensive treatment were significantly and independently correlated with the PVH score. The standard partial regression coefficients were .39 (P<.0001) for age, .33 (P<.0001) for hypertension, .16 (P=.0062) for smoking, and -.18 (P=.0124) for antihypertensive treatment. Hypercholesterolemia (total cholesterol level >220 mg/dL), HDL hypocholesterolemia (HDL cholesterol level <40 mg/dL, LDL hypercholesterolemia (LDL cholesterol level > 130 mg/dL), hypertriglyceridemia (triglyceride level >150 mg/dL), sex, diabetes mellitus, and a history of stroke were not correlated with the PVH score. CONCLUSIONS: Cigarette smoking was a weak but significant positive predictor of the PVH score and was independent of age, hypertension, and antihypertensive treatment. Lipid abnormalities were not related to the PVH score.

[A case of diffuse fasciitis and its MRI findings].

A 36-year-old woman with diffuse fasciitis and her MRI findings are reported. The patient developed pain and swelling in the calves, right forearm, and left arm, predominantly in the right calf muscle. Her body temperature was 38.4 degrees C, the ESR 104 mm/2 hours and white blood cell count 8,000/microliter without eosinophilia. The fascia and muscle were biopsied from her right calf. The light microscopy showed that the fascia was thickened and infiltrated with mononuclear cells with no eosinophils, mostly in perivascular areas. The muscle fibers were spared. MRI of legs revealed marked hyperintensities on T2 and mild hyperintensities on T1-weighted images in the fascia, superficial flexor muscles, especially soleus muscle, and Achilles tendons. Moderate dose of prednisolone was very effective and the abnormal signals on MRI almost disappeared within a month. T2 weighted MRI was very useful to detect the lesions and to evaluate the course of diffuse fasciitis.

Distribution and characterization of rat immunoreactive proadrenomedullin N-terminal 20 peptide (PAMP) and the augmented cardiac PAMP in spontaneously hypertensive rat.

Proadrenomedullin N-terminal 20 peptide (PAMP) is a novel hypotensive peptide processed from an adrenomedullin precursor. In this study, high concentrations of immunoreactive PAMP (ir-PAMP) were detected in rat cardiac atrium and adrenal gland by the radioimmunoassay (RIA) for rat PAMP. The mean plasma concentration of rat ir-PAMP was 3.8 +/- 0.3 fmol/ml. Analysis in atrium, adrenal gland and plasma with high performance liquid chromatographies showed that most ir-PAMP emerged as one major peak at the position exactly identical to that of the authentic rat PAMP. We further investigated the tissue and plasma concentrations of rat ir-PAMP in spontaneously hypertensive rat (SHR) to elucidate the role of PAMP in hypertension. The ir-PAMP concentration in heart tissue of SHR was found to be increased compared with that of the control rat. Especially, the atrial concentration of ir-PAMP of SHR (5.66 +/- 0.78 fmol/mg wet tissue) was significantly higher than that of the control (3.29 +/- 0.22 fmol/mg wet tissue). Cardiac PAMP might have a role for the protection from systemic hypertension.

Differences between treated and untreated hypertensive subjects in the extent of periventricular hyperintensities observed on brain MRI.

BACKGROUND AND PURPOSE: Several reports have stated that the periventricular abnormalities found on T2-weighted MRI or CT are associated with age and hypertension. However, there have been no reports on the effect of hypertension treatment on white matter abnormalities. We studied the association between cardiovascular risk factors and periventricular hyperintensities (PVHs) on T2-weighted MRI and the differences between treated and untreated hypertensive subjects in the extent of PVHs. METHODS: The extent of PVH observed on 238 MRI scans was assessed retrospectively in 238 patients older than 40 years with the use of a five-point (0 to 4) classification scale. Hypertensive subjects were divided into two groups: patients receiving no or irregular treatment and patients receiving regular treatment for hypertension. RESULTS: Age, hypertension, treatment of hypertension, and multiple cerebral vascular lesions on MRI correlated significantly and independently with the extent of PVH. Sex and diabetes mellitus did not correlate with PVH. The Mann-Whitney U test showed significantly more extensive PVH in subjects with no or irregular treatment of hypertension compared with normotensives (2.5 +/- 0.7 versus 1.9 +/- 0.6, P < .0001) and compared with subjects receiving regular treatment of hypertension (2.5 +/- 0.7 versus 2.1 +/- 0.5, P = .0019). The latter patients had more extensive PVH than normotensives, but the difference was not significant. Mean systolic and diastolic blood pressure differed significantly among the three groups. CONCLUSIONS: Hypertension and age were major predictors of the extent of PVH. Regular treatment for hypertension appeared to prevent the progression of PVH.

[Unilateral posterior spinal artery syndrome of the upper cervical cord associated with vertebral artery occlusion].

Upper cervical cord infarction in the territory of the posterior spinal artery is very rare. We present here an elderly man who developed right upper cervical (C1-2) posterior spinal artery syndrome associated with vertebral artery occlusion. A 62-year-old man suffered a right upper cervical (C1-2) posterior spinal artery syndrome. The onset was associated with neck flexion. Magnetic resonance imaging clearly showed an ischemic lesion. Cerebral angiography revealed occlusion of the distal end of an ipsilateral vertebral artery. The occlusion of the vertebral artery probably caused the cervical cord infarction. The neck flexion possibly induced thrombogenesis in the vertebral artery. Unilateral upper cervical posterior spinal artery syndrome associated with vertebral occlusion following neck flexion was suggested.

[Prospective study on the influence of social activity on development of dementia in the neurologically normal elderly].

We investigated the rate of development of dementia in 84 neurologically normal elderly subjects living in an old-age home (30 subjects, mean 77.2 years) or their own home 954, 73.7) prospectively. We examined cerebral blood flow (CBF), Hasegawa's scale (HS) and Kohs' block design test 6 to 9 years before this study (1991). HS and Kohs' IQ were significantly lower in the old-age home group than that in their own home group at that time. However, there were no demented subjects. Mortality was 21%, and we confirmed 9 dementia and 6 stroke cases during the period of observation. Twenty-seven percent of the old-age home group showed dementia in 1991. This rate was significantly higher than that for the elderly living in their own home (6.7%). Occurrence of stroke was also significantly higher in the former group than in the latter group. The subjects who developed stroke during observation showed a high incidence of dementia. Mean CBF measured on the first examination was significantly lower in dementia cases with stroke than in dementia cases without it. We performed MRI in 4 demented cases in 1991 (Fig. 1). Two cases showed no significant lesions and the other cases showed cerebral infarction which could cause dementia. These results indicate that life style and social environment may have significant effect on aging of the brain and on development of dementia in the elderly.

Pharmacokinetics and pharmacodynamics of intravenous OPC-18790 in humans: a novel nonglycosidic inotropic agent.

OPC-18790, a nonglycosidic intropic agent, is now under clinical development for treatment of congestive heart failure. Two separate studies (one placebo-controlled) were conducted to evaluate its pharmacokinetics and pharmacodynamics after intravenous administration to a total of 36 healthy male subjects. The drug was administered both rapidly as a .05-, .1-, .2-, or .4-mg/kg intravenous dose, and as a 1-hour infusion of .5, 1.0, 2.5, 5.0, 10.0, or 15.0 micrograms/kg/minute. Echocardiograms (ECHO) were evaluated before and immediately and 4 hours after the rapid administrations. Blood pressure (BP), heart rate (HR), and QTc in the electrocardiogram also were monitored in the rapid administration study. OPC-18790 was generally well tolerated by all subjects. Maximum peak plasma concentration and area under the curve increased linearly with dose in both studies. The t1/2, total body clearance of drug from plasma (CL), and the dose fraction excreted unchanged in the urine (fe) were comparable and dose-independent at the doses tested in both studies. The overall mean values of t1/2 alpha, t1/2 beta, CL, and fe were .08 +/- .01 hours, 3.64 +/- .22 hours, .46 +/- .01 L/kg, and 43.5 +/- 1.0%, respectively. Echocardiograms showed that, immediately after rapid administration of up to .4 mg/kg, OPC-18790 increased left cardiac function dose-proportionally (P < .05 to .01): the ejection fraction by 21.1% and fractional shortening by 26.5% compared with the predose values, blood pressure, heart rate, and QTc did not differ between subjects given OPC-18790 and these receiving placebo.(ABSTRACT TRUNCATED AT 250 WORDS)