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Biomedical subjects

A Kanemaru

Publications and source records attributed to A Kanemaru.

At least 19 recordsLinked to original sources
PubMed2001

The effects of short-term blood pressure variability and nighttime blood pressure levels on cognitive function.

We investigated the relationship between 24-h blood pressure (BP) and cognitive function. We performed the Hasegawa Dementia Scale Revised (HDSR), the Mini-Mental State Examination (MMSE), and the Raven's Coloured Progressive Matrices Test (RCPM) in 88 subjects (71+/-9 years) with no history of stroke. Ambulatory BP was non-invasively measured using a TM2421 for 24 h in all patients. Whereas 90% of the scores converged into a narrow range between 25 and 30 points in the HDSR and the MMSE tests, the RCPM score was widely distributed, ranging from 9 to 36 points. The subjects were therefore divided into three groups of > or =25, 26-30, and 31-36 according to their RCPM scores. Subjects with lower scores were significantly associated with increased short-term BP variability during the daytime (p<0.05) and had a tendency toward higher nighttime SBP (p=0.05) compared with those with higher scores. Increased short-term variability of daytime BP and high nighttime systolic BP were associated with cognitive impairment as assessed by the RCPM. The RCPM, which can assess the capacity for judgment through visual information processing, may detect earlier stages of cognitive impairment related to high BP. To prevent a deterioration of cognitive function, strict control of nighttime BP and suppression of short-term BP variability are thus necessary.

Aged↗
PubMed2001

Bilateral paramedian thalamo-midbrain infarction showing electroencephalographic alpha activity.

A 57-year-old man became unresponsive and mute with bilateral ophthalmoplegia and quadriplegia. Magnetic resonance imaging (MRI) showed bilateral infarctions at the ventral midbrain and the dorsomedial nucleus of the thalamus. Serial studies with MR and vertebral angiography disclosed hypoperfusion and spontaneous reperfusion of the bilateral posterior cerebral arteries at their origin from the basilar artery. Electroencephalographically, a posteriorly distributed alpha rhythm was clearly recorded and it was reactive in response to external stimuli. The findings seen in the present patient suggest that the ventral midbrain and medial dorsal thalamus are not necessary to produce posterior electroencephalographic alpha activity.

Alpha Rhythm↗
PubMed2001

[Antihypertensive therapy in patients with stroke].

Most patients with acute ischemic stroke do not need antihypertensive therapy, because the rapid lowering of blood pressure (BP) may reduce cerebral blood flow due to impaired cerebral autoregulation. In patients with severe hypertension, or associated with other complications (hemorrhagic transformation, myocardial infarction, renal failure or dissection of the aorta), antihypertensive therapy should be done cautiously. In chronic phase, the optimal BP level for the prevention of stroke recurrence remains unclear. The presence of the J-curve phenomenon is still controversial. The several large scale trials are now in progress to determine the optimal BP level for the secondary prevention in stroke patients.

Antihypertensive Agents↗
PubMed2000

Prognostic value of nighttime blood pressure in the elderly: a prospective study of 24-hour blood pressure.

Although it has been suggested in several reports that 24-h ambulatory blood pressure (BP) is a better predictor than casual BP measured in a clinician's office of the incidence of cardiovascular (CV) events, little information is available concerning the prognostic value of nighttime BP in the elderly population. Therefore, to evaluate the clinical implications of the nighttime BP in the elderly, we prospectively followed-up 324 elderly individuals (mean age, 77.2 +/- 7.0 years) who had undergone ambulatory BP monitoring at an annual health examination over a mean follow-up period of 51.5 +/- 22.0 months, and the relationship between BP and CV events was analyzed using Cox's proportional hazard model. For the analysis, 310 participants, excluding 14 subjects who were withdrawn due to non-CV events, were classed into two groups, one consisting of 134 individuals who were undergoing treatment with an anti-hypertensive drug (medicated group) and another consisting of 176 who were not medicated (nonmedicated group). New cardiovascular events developed in 43 cases in the medicated group and in 14 cases in the non-medicated group during the follow-up period. In the medicated group, a linear relationship was observed between BP and the event rates. The hazard ratio for CV events adjusted for age, sex, and other cardiovascular risks was 1.28 (95% confidence interval [CI], 1.05 to 1.54, p< 0.05) for a 10 mmHg increase of 24-h systolic BP. Corresponding values in 24-h diastolic BP, nighttime systolic BP, and nighttime diastolic BP were 1.71 (1.19 to 2.46, p< 0.01), 1.34 (1.13 to 1.58, p< 0.01), and 1.67 (1.20 to 2.31, p< 0.01), respectively. In the non-medicated group, the event rate was least in the subgroup in the second-lowest quartile for nighttime systolic BP, with a slight non-significant increase in the subgroup of the lowest quartile. It was shown that insufficient control of nighttime BP in the elderly with hypertension is associated with the development of CV complications.

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PubMed1998

[Relationship between cognitive function and discharge place among stroke patients after rehabilitation].

One hundred and ninety-nine elderly stroke patients, who received rehabilitation treatment, were examined, to clarify the relationship between cognitive function and discharge place. The patients who moved to long-term care facilities showed more severe disabilities of basic activities of daily living (ADL), more frequent incontinence, and lower functional impairments (Brunnstrom stage), compared with those discharged to their home. Multivariate regression analysis was done with discharge place as the dependent variable. Independent variables were age, sex, kind of stroke, rehabilitation period, level of ADL and IQ on Kohs test, or performance IQ on the Wechsler Adult Intelligence Scale. Older age, higher levels of ADLs, and higher scores on Kohs test IQ or Wechsler Adult Intelligence Scale Performance IQ were all significantly linked with home discharge. These results suggest that non-verbal cognitive dysfunction may affect discharge place in elderly stroke patients after rehabilitation therapy.

Activities of Daily Living↗
PubMed1997

[Antihypertensive therapy of patients with cerebrovascular disease].

In the acute phase of the stroke, it must be prudent to reduce blood pressure (BP) because the rapid reduction might cause the exacerbation of the perfusion pressure to the brain. The target BP level should be higher than the level of primary prevention as the blood pressure regulatory function is disturbed in acute phase. In chronic phase, BP should be reduced so slowly through the several months so as not to cause the ischemia of the brain by rapid reduction of BP. However, the optimal target BP level should be the same degree as the primary prevention level as far as the speed of reduction is taken into consideration. The several large scale trials, are now in progress to determine the optimal BP level for the secondary prevention in the patients with prion stroke.

Antihypertensive Agents↗
PubMed1996

[Normalization of hypercholesterolemia in a female stroke patient after switching from enteral tube feeding to oral feeding].

A 70-year-old female was admitted to a general hospital in a rural area due to left putamenal cerebral hemorrhage in December 1994. She had right hemiplegia and was totally aphasic. In May 1995, she was moved to Tokyo where her son lives, and she was admitted to Tokyo Metropolitan Geriatric Hospital in order to prepare a home care system. her family's support (serving her favorite dishes) allowed enteral tube feeding to be halted. After one month she could absorb enough energy to maintain her serum albumin level. The total calories ingested orally was comparable to that of enteral feeding but the fat composition was 62% of that of enteral feeding (fat was 19.6% and 31.7% of the total calories in the two diets, respectively). Her cholesterol level decreased from 286 mg/dl to 197 mg/dl. Nutrient-balanced tube feeding is useful, but may disturb lipid metabolism in patients used to having vegetable-rich diets.

Aged↗
PubMed1995

A negative regulatory element in the promoter region of the rat alpha 2A-adrenergic receptor gene overlaps an SP1 consensus binding site.

Three subtypes of alpha 2-adrenergic receptors (alpha 2A, alpha 2B and alpha 2C) have been described that differ in their primary sequence and tissue-specific expression and are encoded by three distinct genes. Previous work has shown that the human alpha 2A-adrenergic receptor gene promoter consists of a TATA-box (TATAAA), palindromic sequence (CCCACGTGGG) and GC-box (GGGGCGG) motif. Sequence analysis of the putative promoter region of the rat alpha 2A-adrenergic receptor gene showed that these promoter regions are conserved in their sequence and relative location. We analysed the transcriptional activity of these regions using RINm5F, a rat insulinoma cell line that expresses the endogenous alpha 2A-adrenergic receptor gene. These results showed that the region from -484 to -92 has a negative effect on transcription, as deletion of this region in alpha 2A-adrenergic receptor gene-chloramphenicol acetyltransferase reporter constructs increased reporter gene activity. This region included the GC-box sequence which is a consensus binding site for the nuclear factor SP1, which is a positive activator of transcription. Gel-mobility-shift assays and supershift assays with an antibody that recognizes SP1 showed binding of the SP1 nuclear factor as well as other nuclear factors to this GC-box region. Additional nuclear factors bind to the downstream palindromic region. We suggest that positive- and negative-acting nuclear factors contribute to the activity of the alpha 2-adrenergic receptor promoter.

Animals↗
PubMed1992

Diminished nocturnal decline in blood pressure in elderly hypertensive patients with left ventricular hypertrophy.

To assess the circadian blood pressure (BP) changes in elderly hypertensive patients with left ventricular hypertrophy (LVH), the ambulatory BP was measured noninvasively every 30 minutes for 24 hours in those patients with LVH (n = 15) and without LVH (n = 23), and in normotensive elderly subjects (n = 11). Although the daytime systolic BP (SBP) was comparable in the two hypertensive groups, the nighttime SBP in patients with LVH tended to be higher than in patients without LVH (149.0 +/- 15.1 versus 138.4 +/- 20.1 mm Hg, p less than 0.10). The LV mass index correlated significantly with the nighttime SBP (r = 0.43, p less than 0.01), but not with the daytime SBP (r = 0.24, ns), with clinic SBP (r = 0.14, p = ns) or the SBP after handgrip exercise (r = 0.31, p = ns). The difference in the systolic BP between daytime and nighttime (D-N SBP) in patients with LVH (2.8 +/- 9.4 mm Hg) was significantly less than that in patients without LVH (12.8 +/- 16.0 mm Hg) (p less than 0.02). In addition, the D-N SBP correlated inversely with the left ventricular mass index (r = -0.33, p less than 0.05). It was concluded that hypertension in the elderly with LVH was associated with a diminished nocturnal decline in blood pressure.

Aged↗
PubMed1992

The cardiac functional reserve in elderly hypertensive patients with abnormal diurnal change in blood pressure.

OBJECTIVE: To evaluate the left ventricular function of hypertensive patients with abnormal diurnal change in blood pressure. DESIGN: We compared left ventricular structural and functional characteristics between hypertensive patients with a normal diurnal change in blood pressure (H2 group) and those with a nocturnal blood pressure increment (H1 group) using echocardiography. METHODS: The study group consisted of 36 hypertensives and 16 normotensives whose 24-h ambulatory blood pressure monitorings were measured non-invasively. The hypertensive group was subdivided into the H1 group, consisting of 11 patients (76 +/- 7 years), and the H2 group with 25 patients (73 +/- 7 years). The normotensive control group had a mean age of 73 +/- 6 years. Echocardiographic examinations were performed before and at the end of isometric exercise (handgrip for 3 min) and isoproterenol infusion (0.02 micrograms/kg per min for 5 min). RESULTS: The left ventricular mass index in the H1 group was significantly greater than in the H2 or control group. Left ventricular fractional shortening (LVFS) at rest in the H1 group was also significantly greater than in the other two groups. However, the peak late: early diastolic filling ratio, which indicated diastolic function, significantly deteriorated in the H1 group compared with the H2 and control groups. Furthermore, changes in LVFS after isometric exercise in the H1 group were more suppressed than in the H2 or control group. In addition, a significantly lower increment in LVFS after isoproterenol was observed in the H1 group compared with the H2 or control group. CONCLUSION: The H1 group had greater left ventricular mass and impaired left ventricular functional reserve than the H2 group.

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PubMed1992

[Postprandial hypotension in the elderly with and without hypertension].

To clarify the mechanism of postprandial hypotension in the elderly, blood pressure and humoral factors were measured before and after meal, water, and glucose ingestion in 20 healthy elderly. The elderly patients were divided into 10 normotensive and 10 hypertensive cases. A reduction in systolic BP after meals in the hypertensive group was significantly larger than that in the normotensive group (-12.0 +/- 4.1 vs. 4.0 +/- 3.2 mmHg, p < 0.05). Systolic BP in hypertensive group significantly decreased at 30, 45 and 60 minutes after meals compared to the value before meals. However, no significant reduction in systolic BP was observed in the normotensive group. A change in systolic BP after meal significantly correlated with that after glucose, but not with that after water ingestion, suggesting that glucose intake mainly contributes to the postprandial hypotension in the elderly. An increase in plasma renin activity and plasma catecholamine were observed after meals in the normotensive group, but not in the hypertensive group. An increase in systolic BP significantly correlated with an increase in PRA. It was suggested that an impairment of the sympathetic nervous system in the elderly with hypertension was involved in the mechanism of postprandial hypotension.

Aged↗
PubMed1992

[A study on 24-hour ambulatory blood pressure in normotensive elderly, living in a local home for the aged].

Ambulatory blood pressure (BP) was non-invasively monitored in 124 normotensive elderly, living in an old people's home at the annual health examination. Cases were divided into 41 cases < 75 years (group A, mean age 70.6) and 83 cases > or = 75 years (group B, 82.7) for analysis of the office BP and 24-hour BP. Whole-day systolic BP in group B was significantly higher than those in the group A (p < 0.02) although no significant differences were observed in diastolic BP and pulse rate. Separated analysis of whole-day BP into daytime and nighttime revealed that the nighttime systolic BP in the group B was significantly higher than those in group A (132.2 +/- 17.4% vs. 123.8 +/- 18.6 mmHg, p < 0.02) whereas no significant difference was observed in day-time systolic BP between two groups (136.6 +/- 14.9 vs. 132.1 +/- 14.4 mmHg, n.s.). The day-night difference in systolic BP tended to be less in group B than in group A (4.5 +/- 11.6 vs. 8.2 +/- 12.2 mmHg, p < 0.10). The prevalence of non-dippers, who had a higher nighttime systolic BP than daytime systolic BP were 24.4% of the group A and 30.1% of the group B. It was concluded that systolic BP during the nighttime increased with the ageing process after age 60, although that during daytime did not change.

Aged↗
PubMed1991

Cardiac performance in elderly hypertensive patients with left ventricular hypertrophy: responses to isometric exercise and beta-agonists.

To assess the cardiac functional reserve of elderly hypertensive patients with left ventricular hypertrophy (LVH) we studied cardiac function after isometric exercise and beta-adrenergic stimulation. Forty-five elderly hypertensive and 16 normotensive patients (NC group) were recruited for the study. The hypertensive patients were divided into two groups: those with LVH (n = 17) mass index (LV mass index greater than 130 g/m2; H1 group) and those without LVH (n = 28) (H2 group). Echocardiographic studies were performed before and after isometric exercise (handgrip) and isoproterenol (ISP) administration. We measured the LV mass index, fractional shortening (FS), isovolumic relaxation time (IRT), and the ratio of late and early diastolic transmitral flow velocity (A/E). The FS at rest in the H1 group was significantly higher than those in the H2 and NC groups. In the H1 group, the IRT was elongated and A/E was greater than in the NC group, which indicated the impaired diastolic function in the H1 group. After the HG stress, the FS in the H1 group significantly decreased whereas it did not change in the H2 or NC groups. The FS increased in all three groups after the infusion of ISP, although the increment of FS was smaller in the H1 group. In conclusion, (a) diastolic function was impaired whereas systolic function was supranormal at rest in the hypertrophied heart of the elderly hypertensive patients and (b) when exercise or pharmacological stress was loaded, the systolic function deteriorated, suggesting the impairment of cardiac reserve in those patients.

Aged↗
PubMed1991

Effects of aging on the cardiopulmonary receptor reflex in hypertensive patients.

In order to evaluate the effects of aging on cardiopulmonary receptor function in hypertensive patients, hemodynamic responses after unloading were studied in middle aged and older hypertensive patients. Twenty-one hypertensive patients were divided into 2 groups according to age. The younger group consisted of 9 patients less than 65 years old (mean age: 57.2 years) and the older group contained 12 patients more than 65 years old (77.2 years). Following 10 min rest, deactivation of cardiopulmonary receptors was obtained by reducing central venous pressure through the application of graded negative pressures of -10, -20, and -40 mmHg to the lower body. Blood pressure, pulse rate, and forearm blood flow were measured at baseline and at each level of negative pressure. Furthermore, plasma norepinephrine and plasma renin activity levels were measured at baseline and at -40 mmHg. Forearm blood flow was measured by venous occlusive plethysmography using a Silastic strain gauge applied around the forearm. Forearm peripheral vascular resistance was calculated by dividing the mean arterial pressure by the forearm blood flow. Baseline mean blood pressure, pulse rate, and peripheral vascular resistance were similar in both age groups. Following lower body negative pressure (LBNP), mean blood pressure and pulse rate did not change, suggesting the selective deactivation of cardiopulmonary receptors. The increase in peripheral vascular resistance at LBNP of -40 mmHg in the older group (20.0 +/- 6.2) was significantly lower than that in the younger group (15.5 +/- 8.9, p less than 0.05). Furthermore, the increase in peripheral vascular resistance after LBNP was inversely related to age (Y = -0.32X + 38.8, r = -0.43, p less than 0.05). Increases in plasma norepinephrine and plasma renin activity in the older group were not different from those in the younger group. It is concluded that the sensitivity of cardiopulmonary baroreceptor function in hypertensive patients deteriorates with increasing age.

Aged↗
PubMed1991

[L-asparaginase-induced hyperlipidemia in a case of acute lymphoblastic leukemia].

A 15-y-o girl who had relapsed acute lymphoblastic leukemia, followed by the two-years complete remission, was treated with a reinduction chemotherapy including methotrexate, vincristine, L-asparaginase and dexamethasone (MOAD). During the chemotherapy, a remarkable hyperlipidemia has developed. The plasma levels of triglyceride and total cholesterol reached 14,450 mg/dl and 1,750 mg/dl, respectively. The laboratory data strongly suggest that L-asparaginase could induce this hyperlipidemia of Friedrickson type V. We could successfully reduce the levels of triglyceride and total cholesterol to the normal range by LDL-apheresis, and treat the patient with the chemotherapy excluding L-asparaginase to attain the second CR.

Adolescent↗