Functional outcomes and patient satisfaction after vascularized osteocutaneous scapula flap reconstruction of the mandible in patients with benign or cancerous tumours.

Pre- and postoperative longitudinal assessment of oral functions including masticatory force, masticatory ability with solids, speech intelligibility, and subjective satisfaction was conducted for patients who underwent vascularized osteocutaneous scapula flap reconstruction after mandibulectomy. Postoperative changes in oral function and patient satisfaction were examined in relation to tumour type (i.e., cancerous vs. benign). A change in masticatory force was associated with a reduction in the number of occlusal support zones after surgery and clearly differed by tumour type. Despite all patients showing reduced masticatory force postoperatively, all were satisfied with the improvements in eating and chewing, which were greater in patients with benign tumours than in those with cancerous tumours. Although both groups of patients expressed satisfaction with the aesthetic appearance after surgery, patients with cancerous tumours were more satisfied. However, both groups showed decreased speech intelligibility scores and lower satisfaction with speech after surgery. Preoperative support in the form of reassurance and helping to alleviate anxiety about postoperative appearance would be beneficial for all patients, with additional support provided based on the specific tumour type.

Comparison of the T2 relaxation time of the temporomandibular joint articular disk between patients with temporomandibular disorders and asymptomatic volunteers.

BACKGROUND AND PURPOSE: T2 relaxation time is a quantitative MR imaging parameter used to detect degenerated cartilage in the knee and lumbar intervertebral disks. We measured the T2 relaxation time of the articular disk of the temporomandibular joint in patients with temporomandibular disorders and asymptomatic volunteers to demonstrate an association between T2 relaxation time and temporomandibular disorder MR imaging findings. MATERIALS AND METHODS: One hundred forty-four patients with temporomandibular disorders and 17 volunteers were enrolled in this study. An 8-echo spin-echo sequence for measuring the T2 relaxation times was performed in the closed mouth position, and the T2 relaxation time of the entire articular disk was measured. Patients were classified according to the articular disk location and function, articular disk configuration, presence of joint effusion, osteoarthritis, and bone marrow abnormalities. RESULTS: The T2 relaxation time of the entire articular disk was 29.3 ± 3.8 ms in the volunteer group and 30.7 ± 5.1 ms in the patient group (P = .177). When subgroups were analyzed, however, the T2 relaxation times of the entire articular disk in the anterior disk displacement without reduction group, the marked or extensive joint effusion group, the osteoarthritis-positive group, and the bone marrow abnormality-positive group were significantly longer than those in the volunteer group (P < .05). CONCLUSIONS: The T2 relaxation times of the articular disk of the temporomandibular joint in patients with progressive temporomandibular disorders were longer than those of healthy volunteers.

Perineural spread of adenoid cystic carcinoma in the oral and maxillofacial regions: evaluation with contrast-enhanced CT and MRI.

OBJECTIVES: The objective of this study was to compare the accuracy of contrast-enhanced CT (CECT) and contrast-enhanced MRI (CEMRI) in the detection of perineural spread (PNS) of adenoid cystic carcinoma (ACC) in the oral and maxillofacial regions. METHODS: This study consisted of 13 ACCs from 13 patients, all of which were histopathologically diagnosed. Both CECT and CEMRI were performed in all patients before the treatment. The images of each patient were retrospectively evaluated for the detection of PNS. The definitions of PNS included abnormal density/signal intensity, contrast enhancement or widening of the pterygopalatine fossa, palatine foramen, incisive canal, mandibular foramen and mandibular canal, and enlargement or excessive contrast enhancement of a nerve. RESULTS: 11 out of 13 cases were proven to exhibit PNS histopathologically. 8 of the 11 cases for which PNS was histopathologically proven exhibited PNS on MR images. Six of the eight cases for which PNS was exhibited on MR images also exhibited PNS on CT images. The sensitivity, specificity and accuracy for the detection of PNS were 55%, 100% and 62% on CT images and 73%, 100% and 77% on MR images, respectively. Although the accuracy of PNS on MR images was slightly superior to that on CT images, there were no statistically significant differences between the detection of PNS on CT images and on MR images. CONCLUSIONS: CT and MR images are equally useful for the detection of PNS of ACC in the oral and maxillofacial regions.

Pathologic and imaging findings of an oncocytoma in the deep lobe of the left parotid gland.

Oncocytoma is a rare salivary gland tumour consisting of oncocytes with many hyperplastic mitochondria. It usually occurs in the parotid gland. Because the features of oncocytoma resemble those of other benign and low-grade-malignant salivary gland tumours, clinical diagnosis is often challenging. This report presents the pathologic and imaging findings of an oncocytoma arising in the deep lobe of the left parotid gland in a 66-year-old man. Oncocytoma was diagnosed on the basis of histological, magnetic resonance imaging, and scintigraphic findings. The tumour showed accumulation of technetium-99m pertechnetate and decreased signal intensity on both T1- and T2-weighted magnetic resonance images.

Therapeutic effect and mechanism of repetitive transcranial magnetic stimulation in Parkinson's disease.

The therapeutic effect of repetitive transcranial magnetic stimulation (rTMS) on clinical performance was assessed by a double-blind study in 9 patients with Parkinson's disease (PD). Nine other patients underwent sham stimulation as controls. The modified Hoehn and Yahr (H&Y) staging scale, the Schwab and England Activities of Daily Living (ADL) scale, and the Unified Parkinson's disease rating scale (UPDRS) were used to assess changes of clinical performance. Patients were assessed prior to and following 2 months of rTMS. In addition, the mechanism of rTMS was investigated by dopamine and homovanillic acid (HVA) in the lumbar cerebrospinal fluid (CSF) of 17 patients before and after therapeutic rTMS for three or four months. rTMS was applied manually to the frontal areas 60 times per session, i. e., 30 times per side using a large circular coil, a pulse intensity of 700 V, and a frequency of 0.2 Hz. Sessions were continued once a week for 2 months. The 9 control patients showed no changes of symptoms between the initial evaluation and that after 2 months of sham rTMS. In contrast, all 9 patients receiving rTMS showed a significant decrease of the modified H&Y and UPDRS scores after 2 months, while the Schwab and England ADL Scale scores increased significantly. In the second CSF sample from patients receiving rTMS, HVA showed a significant decrease These results suggest that rTMS is beneficial for the symptoms of Parkinson's disease and that it may act via inhibition of dopaminergic systems.

[Telomerase activity in oral squamous cell carcinoma and leukoplakia].

Telomeres, the physical ends of eukaryotic chromosomes, are important to stabilize the chromosome and have a unique simple repetitive DNA sequence, TTAGGG in humans. In most normal somatic cells, telomere length becomes 50-100 bp shorter with every cell division, and the cells finally go into senescence, while most cancer cells have been reported to maintain the length and thus are immortalized. Telomeres are replicated by a special transcriptase, called telomerase, which is composed of a template RNA (hTR) and at least two component proteins: hTERT (hEST 2/hTRT) and hTEP 1 (hTLP 1/hTP1). In the present paper, I examined the status of telomerase activities in oral squamous cell carcinomas (OSCCs), precancerous lesions, and also cell lines established from OSCCs, by using a non-radioactive PCR-based TRAP (telomeric repeat amplification protocol) assay. Telomerase activities were detected in 23 of 30 OSCCs, 8 of 17 leukoplakias, 0 of 5 normal tissues, and in 8 of 8 OSCC cell lines and 0 of 5 normal human keratinocyte cultures. These results indicated that telomerase activity might have some association with carcinogenesis and might be used as a tumor marker in OSCC.

Hyperbaric nitrogen prolongs breath-holding time in humans.

UNLABELLED: Either an increase in PaCO(2) or a decrease in PaO(2), can affect respiratory stimulation through respiratory centers, thus influencing breath-holding time (BHT). This study was designed to determine whether and how hyperbaric air could influence BHT in comparison with hyperbaric oxygen in humans. We studied 36 healthy volunteers in a multiplace hyperbaric chamber. BHT, pulse oximeter, and transcutaneous carbon dioxide tension were measured at 1 and 2.8 atmosphere absolute (ATA) in two groups. Group A (n = 20) breathed air. Group O (n = 16) breathed oxygen with a face mask (5 L/min). BHTs were 108 +/- 28 s at 1.0 ATA and 230 +/- 71 s at 2.8 ATA in Group A, and 137 +/- 48 s at 1.0 ATA and 180 +/- 52 s at 2.8 ATA in Group O. Transcutaneous carbon dioxide tension in Group A (59 +/- 2 mm Hg) was higher than that in Group O (54 +/- 2 mm Hg) at the end of maximal breath-holding at 2.8 ATA. The prolongation of BHT in hyperbaric air is significantly greater than that in hyperbaric oxygen. IMPLICATIONS: Breath-holding time is significantly prolonged in hyperbaric air than it is in hyperbaric oxygen. The mechanism involves the anesthetic effect of nitrogen suppressing the suffocating feeling during breath-holding.

Gender differences in body fat of low- and high-body-mass children: relationship with body mass index.

The primary objective of this study was to determine gender differences in total body fat mass (TBFM) and body fat distribution (subcutaneous fat mass, SFM; and internal fat mass, IFM) in a cross-sectional sample of 280 children. Measurements of the body composition of 141 boys and 139 girls, all apparently healthy and aged 3-6 years were made using bioelectrical impedance. Determinations of impedance were made using a four-terminal impedance analyzer (TP-95K; Toyo Physical, Fukuoka, Japan). Lean body mass (LBM) was calculated using a previously published equation [Goran MI, Kaskoun MC, Carpenter WH, Poehlman ET, Ravussin E, Fontvieikke A-M (1993) Estimating body composition of young children by using bioelectrical resistance. J Appl Physiol 75: 1776-1780]. SFM was calculated using a modification of the equation derived by Skerjl [Skerjl B, Brozek J, Hunt EE (1953) Subcutaneous fat and age changes in body build and body form in women. Am J Phys Anthrop 11: 577-580] and Davies [Davies PSW, Jones PRM, Norgan NG (1986) The distribution of subcutaneous and internal fat in man. Ann Hum Biol 13: 189-192]. The main modifications of the equation in the present study were the introduction of: (1) mean thickness of adipose tissue over body surface/2, and (2) skin mass. IFM was calculated as the difference between TBFM and SFM. The body mass index (BMI; kg/m2) was calculated from the formula: body mass/height2. For each gender, the subjects in the lowest and highest 25th percentiles were designated as "low body mass" and "high body mass", respectively. In the present study, no gender differences in absolute TBFM, SFM and IFM were observed in either of these groups. In contrast, gender differences in relative TBFM (%Fat) and SFM (SFM/mass) were evident in girls. However, the four subgroups were similar in terms of relative IFM (IFM/mass). The TBFM was independently related to SFM, IFM and %Fat in both genders after adjustment for BMI; however, there was no significant association of SFM with IFM after adjustment for BMI in any group. Even after adjustment for BMI, IFM was independently related to %Fat in both genders, although SFM was not independently related to %Fat in any group except low-body-mass boys. This study shows that relative TBFM and SFM are higher in high-body-mass groups and tend to be higher in girls than in boys, and that the higher %Fat in high-body-mass girls than in high-body-mass boys appears to be associated with internal adipose tissue deposits. External adipose tissue mass does not appear to be related to the higher %Fat levels in high-body-mass girls. In addition, subcutaneous fat mass appears to be higher in low-body-mass girls than in low-body-mass boys, although this observation needs confirmation using more valid measures of subcutaneous fat such as computerized tomography and magnetic resonance imaging.

The turnover of body water as an indicator of health.

Water homeostasis is essential for healthy living. Body water turnover, meaning the replacement of body water that is lost in a given period of time, has been examined in a number of previous studies, and a review of their results has yielded the following findings. Children up to 15 years of age show higher body water turnover than adults, although it is not clear how the aging process influences body water. Among people of similar age, the rate of body water turnover seems to be higher in those who exercise than in those who are sedentary. Therefore we hypothesized that healthy individuals have a higher body water turnover than unhealthy individuals whose metabolic balance, as indicated by water turnover, has broken down, and that a prolonged condition of excessively slow body water turnover may be associated with a lower level of metabolism. If so, body water turnover can be an indicator of human health. However, there is a paucity of information regarding water turnover rates in individuals with various physical characteristics. This study indicates the need for further investigation of body water turnover levels associated with significant changes in physiological condition and metabolic state.

Relationship between intracellular Ca2+ store and protein kinase C in agonist-induced contraction of hypertensive rat aortae.

The roles of intracellular Ca2+ store and protein kinase C (PKC) in vascular contractile responses independent of Ca2+ influx were studied using aortic rings from spontaneously hypertensive rat (SHR) and Wistar-Kyoto rat (WKY). The functional sizes of agonist-sensitive intracellular Ca2+ store were estimated as the peak response to agonist after PKC inhibition with calphostin C (Cal-C), a PKC inhibitor. The participation of PKC in 5-hydroxytryptamine-, phenylephrine-, and endothelin-1 (ET-1)-induced contractions in aortae of SHR was equal to, or greater than that in WKY. In contrast, compared with WKY, SHR aortae possessed a greater size of endothelin-1-sensitive Ca2+ store, a similar size of 5-hydroxytryptamine-sensitive Ca2+ store, and a smaller size of phenylephrine sensitive Ca2+ store. Based on these data, both PKC activation and functional size of intracellular Ca2+ store differ between SHR and WKY and these differences are selective among agosists.

[Therapeutic effect of repetitive transcranial magnetic stimulation in Parkinson's disease].

The therapeutic effect of repetitive transcranial magnetic stimulation (r-TMS) on clinical performance was studied in 8 patients with Parkinson's disease (PD). Seven patients were used as controls and underwent sham stimulation. The modified Hoehn and Yahr (H & Y) Staging Scale, Schwab and England Activities of Daily Living (ADL) Scale and Unified Parkinson's Disease Rating Scale (UPDRS) were used to assess changes in clinical performance. Eight patients were assessed prior to and following 3, 6 and 9 months of R-TMS. R-TMS was applied manually 60 times (30 times each side) to the frontal areas using a large circular coil, a pulse intensity of 700 V, and a frequency of 0.2 Hz. Sessions were performed once weekly for 9 months. The 7 control patients showed no differences in clinical symptoms between initial evaluations and evaluations after 3 months of sham R-TMS. In all 8 patients, the modified H & Y staging and UPDRS scores decreased significantly, and the Schwab and England ADL Scale increased significantly after 3, 6 and 9 months of R-TMS therapy. These results suggest that R-TMS is beneficial for the treatment of Parkinsonian symptoms.

Low impact aerobic dance as a useful exercise mode for reducing body mass in mildly obese middle-aged women.

The purpose of this study was to test the hypothesis that a low impact aerobic dance is a useful exercise mode for weight loss in obese middle-aged women. Sixty Japanese women, aged 50.9 +/- 6.7 years (initial %fat = 35.2 +/- 5.3%), participated in our 3-month weight-loss program consisting of diet and exercise prescription. To compare the effectiveness of exercise modes, the subjects were divided into the following two groups: aerobic dance group and jogging and/or cycling group. As a result, body mass (-3.1 and -3.3 kg respectively) and %fat (-6.1 and -5.3% respectively) significantly decreased (P < 0.05) in both groups, while fat-free mass remained essentially unchanged. Aerobic power such as maximal oxygen uptake and oxygen uptake corresponding to lactate threshold significantly increased (P < 0.05) in both groups. Significant difference in the alterations in these variables between groups could not be seen. The data of this study indicates that our weight-loss program with a low impact aerobic dance is as useful as jogging or cycling in improving body composition and aerobic power for mildly obese middle-aged women.

Benidipine counteracts sodium-induced alterations in systemic and regional hemodynamics.

We compared hemodynamic and humoral responses to benidipine and nifedipine during different sodium intakes in essential hypertensives. The study had a single-blind crossover design. Doppler flowmetry and laboratory examinations were performed. During low sodium intake, both benidipine and nifedipine significantly reduced mean arterial pressure to the same extent. Benidipine increased cardiac index, superior mesenteric and renal flows, whereas nifedipine had no effect on either cardiac index or regional blood flows. In the salt-sensitive patients whose mean arterial pressure increased more than 5 mmHg during high sodium intake, sodium loading increased cardiac index and terminal aortic flow, but decreased superior mesenteric and renal flows, while plasma noradrenaline concentrations remained unchanged and plasma arginine vasopressin increased significantly. These hemodynamic responses to sodium in the salt-sensitive patients were more effectively inhibited by benidipine than by nifedipine, although neither of them had any influence on sodium-induced changes in plasma noradrenaline or arginine vasopressin concentration.

Salt enhances responsiveness of terminal aortic vascular bed to sympathetic activity.

OBJECTIVE: Haemodynamic and laboratory examinations were performed in 27 essential hypertensives. The participation of the sympathetic system was estimated from the percentage decrease in regional vascular resistance caused by 1 mg prazosin, during varied salt intake (50-80 mEq sodium per day for 9 weeks, followed by 220-250 mEq sodium per day for 10 days), with or without benidipine. RESULTS: During low salt intake, terminal aortic and renal resistances were decreased by prazosin, but superior mesenteric resistance remained unchanged. In the saltsensitive patients, whose mean arterial pressure increased more than 5 mmHg with salt repletion, salt loading increased superior mesenteric and renal resistances but did not change terminal aortic resistance. This salt-induced vasoconstriction of renal and superior mesenteric arteries is not related to an increase in sympathetic activity, because both plasma noradrenaline concentrations and the percentage decrease in these regional vascular resistances by prazosin remained unchanged after salt loading. On the other hand, terminal aortic area demonstrated an increase in responsiveness to noradrenaline (increased response to prazosin) with salt loading in spite of unchanged terminal aortic resistance. This salt-induced increase in sympathetic responsiveness in the terminal aortic area was inhibited with the addition of benidipine, which abolished development of salt-induced hypertension and its accompanying haemodynamic responses.

[Motor evoked potentials of transcranial magnetic stimulation for Parkinson's disease].

We studied motor evoked potential (MEP) elicited by transcranial magnetic stimulation (TMS) in 37 patients with Parkinson's disease (PD). TMS was used at high energy capacity (800 Volts) in all patients and normal subjects under resting position. MEPs were recorded from the abductor pollicis brevis and the abductor hallucis. Magnetic stimulator equipped with an 8-shaped coil and a flat type coil was used for TMS. The data were statistically evaluated using a paired Student t test. The latency of MEPs were slightly shorter in PD patients than that in normal subjects. There were significant differences between HV. (Healthy volunteers) and group B (Hoehn & Yahr's stage III) (p = 0.012), HV, and group C (Hoehn & Yahr's stage IV.V) (p = 0.002), group A (Hoehn & Yahr's stage I.II) and C (p = 0.005) respectively. The duration of MEPs became longer depending on the severity of PD evaluated by Hoehn & Yahr's disability rating. Significant correlations were found between HV, and group C (p = 0.001), group A and C (p = 0.015). The amplitude of MEPs also increased with the severity on the rating. There were significant differences between HV, and group C (p = 0.0002), group A and B (p = 0.0004), group B and C (p = 0.0009) respectively. These changes of MEP findings indicated the dysfunction of pyramidal motor pathways in PD. Thus, the disability in patients with PD can be well evaluated by MEP measurement.

Lisinopril reverses left ventricular hypertrophy through improved aortic compliance.

We treated with nifedipine or lisinopril 38 essential hypertensive patients with left ventricular hypertrophy. The study had a single-blind crossover design; nifedipine or lisinopril was given for the first 24 weeks, and then patients were crossed over to the other antihypertensive agent for another 24 weeks. Both nifedipine and lisinopril significantly decreased mean arterial pressure to the same extent. Although lisinopril decreased left ventricular mass index more rapidly than nifedipine, 48 weeks of antihypertensive treatment with nifedipine or lisinopril reduced the extent of left ventricular hypertrophy to the same level. Stepwise multiple linear regression analysis revealed that the reversal of left ventricular hypertrophy may be mainly due to a reduction in mean arterial pressure during the 24-week nifedipine treatment and due to an improvement of aortic compliance during the lisinopril treatment. Both nifedipine and lisinopril are effective in the reversal of hypertensive left ventricular hypertrophy; however, the agents have disparate actions on hemodynamic factors.

Activation of protein kinase C as a modulator of potentiated UK-14304-induced contractions in dog mesenteric artery and vein.

We assessed the role of protein kinase C (PKC) in the mechanism responsible for the potentiation of UK-14304-induced contractions produced when isolated dog mesenteric vascular rings were pretreated with threshold concentrations of 12-O-tetradecanoyl-phorbol-13-acetate (TPA), KCl, or endothelin-1 (ET-1). In dog mesenteric artery. UK-14304 produced a biphasic concentration-response curve in the presence of TPA, KCl, or ET-1, with the curve portion at lower concentrations being alpha 2-adrenoceptor dependent and the portion at higher concentrations being alpha 1-adrenoceptor dependent. Calphostin C (10(-6)M), a PKC inhibitor, abolished amplified UK-14304-induced contraction in the TPA-pretreated tissues. In the KCl- and ET-1-pretreated tissues. 10(-6)M calphostin C antagonized amplified UK-14304-induced contractions by approximately 20% in both parts of the concentration-response curve. In contrast, in dog mesenteric vein, amplified UK-14304-induced contractions by TPA, KCl, and ET-1 were entirely dependent on alpha 2-adrenoceptors. Calphostin C (10(-6)M), which in control experiments had no effect on KCl-induced contraction and antagonized responses to TPA by 60.1%, inhibited UK-14304-induced contraction by 18.3%. Amplified UK-14304-induced contraction was antagonized by 10(-6)M calphostin C by 21.8% in KCl-precontracted tissues, 58.1% in ET-1-precontracted tissues, and 66.3% in TPA-precontracted tissues. In the ET-1- and TPA-pretreated dog mesenteric veins, 10(-6)M calphostin C decreased maximal tensions of enhanced UK-14304-induced contractions to the same level as the UK-14304-induced maximal tension inhibited by 10(-6)M calphostin C in untreated dog mesenteric vein. Therefore, TPA can be a precontracting agent that amplifies UK-14304-induced contractions through PKC activation in both dog mesenteric artery and vein. PKC predominantly mediates the contraction amplification mechanisms after exposure to ET-1 in dog mesenteric vein and does not play a major role in the amplification of UK-14304-induced contraction by KCl in both dog mesenteric artery and vein. These data show that a common mechanism need not underlie amplification of adrenergic responses in mesenteric artery and vein.

Nilvadipine increases cerebral blood flow in elderly hypertensives: comparison with nifedipine.

We compared haemodynamic and humoral responses to nifedipine and nilvadipine in 25 elderly hypertensives. The study had a single-blind crossover design. Doppler flowmetry and laboratory examinations were performed before and after nifedipine and nilvadipine. Both nifedipine and nilvadipine significantly reduced mean arterial pressure to the same extent. Nilvadipine increased cardiac output, carotid flow and vertebral flow whereas nifedipine had no significant effect on either cardiac output or regional blood flows. Nilvadipine increased plasma atrial natriuretic peptide and decreased plasma noradrenaline. In the nilvadipine group, the relations between changes in these humoral parameters and those in cardiac output suggest that an elevation of pre-load may play a role in increasing cardiac output. The effects of nilvadipine on cerebral perfusion might provide additional benefits for the elderly hypertensives.

Index of assessing functional status in elderly Japanese men.

We attempted to propose the equation of assessing the functional status of elderly adult Japanese men. A number of physical and motor performance measurements were collected from a group of 104 male volunteer subjects (mean age 76.4 +/- 5.8 years). Factor analysis with varimax criterion was applied to all the data. Five factors extracted were interpreted as follows: (1) coordination of the body, (2) flexibility of the trunk, (3) static balance, (4) muscular strength and endurance, and (5) cardiorespiratory fitness. Furthermore, the factor score was computed for each individual by each factor. Each of the five factors were weighted in accordance with its relative contribution to the total variance (or the size of eigenvalue). The weighted combination of factor scores was summed to generate an index of functional status (IFS). Next, IFS scores were computed for each individual and normalized to T scores. Then, a multiple linear regression analysis was performed with the factor analytically derived IFS scores as the dependent variable: IFS = -0.625X1 + 0.604X2 + 0.346X3 + 0.223X4 + 0.465X5 + 0.082X6 + 0.114X7 + 0.199X8 + 0.019X9 + 0.071X10 + 19.76; where X1 = walking around two chairs in a figure 8 (sec), X2 = manipulating pegs in a pegboard (num), X3 = vertical jump (cm), X4 = sit and reach (cm), X5 = estimated maximal oxygen uptake (ml/kg/min), X6 = balancing on one leg with eyes open (sec), X7 = grip strength (kg), X8 = trunk flexion from a standing position (cm), X9 = leg muscle endurance in a semi-squat position against a wall (sec), and X10 = balancing on one leg with eyes closed (sec) Thus, information on the 10 variables from five domains was statistically combined to a single score. The above equation was cross-validated in the other group of elderly men (n = 54). The mean IFS obtained for this group (50.0 +/- 8.3) was not significantly different from the validation group (50.0 +/- 10.0). It is apparent that the IFS has the potential to serve as another useful measure of high order, daily living activities.(ABSTRACT TRUNCATED AT 250 WORDS)

Lisinopril improves aortic compliance and renal flow. Comparison with nifedipine.

We compared the systemic and regional hemodynamic effects of nifedipine and lisinopril in 26 elderly hypertensive patients with the use of the pulsed Doppler ultrasound technique. Nifedipine is a dihydropyridine calcium antagonist, and lisinopril is an angiotensin-converting enzyme inhibitor. The study had a single-blind crossover design: nifedipine and lisinopril were given for 8 weeks each after washout periods of 4 weeks. Both nifedipine and lisinopril significantly reduced mean arterial pressure to the same extent (P < .01); cardiac output remained unchanged in both nifedipine- and lisinopril-treated groups. Lisinopril increased renal flow significantly (P < .01), but nifedipine did not. Common carotid, vertebral, celiac, and superior mesenteric arterial and diaphragmatic and terminal aortic flows did not show a significant change with either nifedipine or lisinopril. The specific action of lisinopril on the thoracic aorta was a marked improvement of aortic compliance compared with nifedipine, which might be partly responsible for an increase in renal flow. Lisinopril may provide more desirable regional hemodynamic effects and additional benefits for elderly hypertensive patients.