The present studies on gallstones, made by macroscopic morphology and infrared absorption spectra, were carried out in order to clarify recent features of cholelithiasis in rural district. One hundred and sixty-one stones obtained from 152 patients who had cholelithiasis, and who were operated-on at our clinics during the past 10 years, were used for this study.
The average age of the patients was 62 years, and about half of them were over 65 years of age. The patients included 100 women and 52 men. The types and frequency of gallstones are classified as follows: cholesterol stones, 50.9%; pigment stones, 40.4%(black stones, 7.5%; bilirubin stones, 32. 9%) and rare stones, 8.7%. Considerin sexual differences, the frequency of cholesterol stones was nearly 2 times greater in women than in men; on the other hand, that of pigment stones was nearly 2 times higher in men than in women. Regarding the age groups of the patients, although the incidence of cholesterol stones was greater in the group under 64 years of age than in the 65-year-old group, the incidence of bilirubin stones was 4 or more times higher in the latter group than in the former.
From the above observations it is suspected that one of the major reasons for the low incidence of cholesterol stones in rural districts, is because of the high percentage of elderly patients with cholelithasis in these areas. The incidence of black stones was not significantly greater in rural districts.

A 29-year-old female with aortic regurgitation associated with aortitis syndrome and severe stenosis of bilateral carotid arteries was reported. She had no symptom of brain ischemia, although an aortogram revealed complete occlusion of the left common carotid artery and the left subclavian artery, and severe stenosis of the right common carotid artery. The intracranial major arteries were perfused totally by the right vertebral artery via collaterals. The transcranial Doppler method and perfusion cintigraphy revealed normal cerebral perfusion. Therefore, we performed conventional aortic valve replacement without reconstruction of carotid arteries. During cardiopulmonary bypass, the mean systemic blood pressure was kept higher than 60mmHg under moderate-hypothermic (tympanic temperature: 25°C) pulsatile perfusion with monitoring of the left middle cerebral artery flow velocity. The patient did not develop any cerebral complications during or after the operation.

Four patients with multiple dissecting aortic aneurysms treated surgically from 1960 to 1996 were evaluated clinically. The incidence of multiple dissecting aortic aneurysms was 3.2% of all surgically treated cases of aortic dissection. Only one case suffered from Marfan's syndrome. Morphologically, all cases showed chronic DeBakey II+III type dissection. Case 1 was treated by Bentall's operation for DeBakey II type dissection and the residual aortic aneurysm was not treated surgically. Case 2 underwent a two-staged operation: Bentall's operation first, followed by entry closure with plication of the DeBakey III type aneurysm. Case 3 underwent a two-staged operation: graft replacement of the ascending aorta combined with coronary artery bypass grafting in the first operation and graft replacement of descending and abdominal aorta in the second. Case 4 was treated by graft replacement of the hemiarch, resuspension of the aortic valve and entry closure of the DeBakey III type dissection. Among them, two cases (Cases 1 and 2) whose aneurysms were treated incompletely showed a rapid growth and rupture of residual DeBakey III type aneurysm. In conclusion, one-staged aggressive and complete operation should be done for the patients with multiple dissecting aortic aneurysms. When a two-staged operation is selected, more intensive follow-up of the residual aortic aneurysm is needed.

We have experienced 3 successful repair surgeries for insufficient bicuspid aortic valve. The operative procedure consisted of combinations of suture placation, raphe triangular resection, commisural annuloplasty, and patch closure of perforation due to infectious endocarditis. The postoperative course was uneventful and postoperative echocardiography showed residual regurgitation as only trivial or mild. Retrospective study done on 19 previous cases with insufficient bicuspid aortic valve demonstrated that this operative procedure could have been applied in 15 (79%) of the cases. These results showed that repair surgery for insufficient bicuspid aortic valve is useful and has a wide application.

Hyperpolarization of arterial smooth muscle by acetylcholine is considered to be produced by the release of an unidentified chemical substance, an endothelium-derived hyperpolarizing factor (EDHF). Several chemicals have been proposed as the candidate for EDHF. However, none of them fulfil completely the nature and property of EDHF. Ultrastructural observation with electron microscope reveals that in some arteries, gap junctions are formed between endothelial and smooth muscle cells. In small arterioles, injection of gap junction permeable dyes into an endothelial cell results in a distribution of the dye to surrounding cells including smooth muscle cells. These observations allow the speculation that myoendothelial gap junctions may have a functional significance. Simultaneous measurement of the electrical responses in both endothelial and smooth muscle cells using the double patch clamp method demonstrates that these two cell types are indeed electrically coupled, indicating that they behave as a functional syncytium. The EDHF-induced hyperpolarization is produced by an activation of Ca2+-sensitive K+-channels that are inhibited by charybdotoxin and apamin. Agonists that release EDHF increase (Ca2+)i in endothelial cells but not in smooth muscle cells. Inhibition of gap junctions with chemical agents abolishes the agonist-induced hyperpolarization in smooth muscle cells but not in endothelial cells. All these observations can be explained if EDHF is an electrotonic signal propagating from endothelium to smooth muscle cells through gap junctions.
Acetylcholine ; Apamin ; Arteries ; Arterioles ; Calcium ; Charybdotoxin ; Coloring Agents ; Endothelial Cells ; Endothelium ; Gap Junctions* ; Giant Cells ; Muscle, Smooth ; Muscle, Smooth, Vascular* ; Myocytes, Smooth Muscle ; Potassium Channels

The properties of voltage dependent Ca2+ current (VDCC) were investigated in interstitial cells of Cajal (ICC) distributed in the myenteric layer (ICC-MY) of guinea-pig antrum. In tissue, ICC-MY showed c-Kit positive reactions and produced driving potentials with the amplitude and frequency of about 62 mV and 2 times min(-1), respectively, in the presence of 1micrometer nifedipine. Single ICC-MY isolated by enzyme treatment also showed c-Kit immunohistochemical reactivity. These cells were also identified by generation of spontaneous inward current under K+-rich pipette solution. The voltage clamp experiments revealed the amplitude of - 329 pA inward current at irregular frequency. With Cs+-rich pipette solution at Vh=?80 mV, ICC-MY produced voltage-dependent inward currents (VDIC), and nifedipine (1micrometer) blocked VDIC. Therefore, we successfully isolated c-Kit positive single ICC from guinea-pig stomach, and found that ICC-MY potently produced dihydropiridine sensitive L-type voltage-dependent Ca2+ currents (VDCCL).
Interstitial Cells of Cajal ; Nifedipine ; Stomach

This study was designed to isolate Ca2+-activated K+ current (IKCa) and elucidate its physiological significance in freshly isolated interstitial cells of Cajal (ICCs) of guinea-pig stomach. Single ICC was freshly isolated by enzymatically dissociating from myenteric border of gastric antrum free of circular muscles, and conventional whole-cell voltage clamp technique including immunohistochemical techniques were employed to characterize the cells: In myenteric border of gastric antrum, ICC-MY (ICCs from myenteric border) were detected by immunohistochemical reactivity, and single ICC-MY which has many branches was immunohistochemically c-Kit positive. Under K+-rich and 0.1 mM ethylene glycol-bis (2-aminoethyl ether)-N,N,N',N'-tetraacetic acid pipette solution, ICC produced spontaneous inward current (-256+/-92.2 pA). When step-depolarizing pulse from -80 to +80 mV was applied at holding potential (Vh) of -80 mV, voltage-dependent outward currents were recorded with superimposed spontaneous transient outward currents (STOCs). Both STOCs and outward currents were reversibly affected by tetraethylammonium chloride (TEA) and iberiotoxin (IbTX); 2 mM TEA and 200 nM IbTX completely abolished STOCs and significantly inhibited outward K+ current over the whole potential range tested for current/voltage (I/V) relationship. In addition, TEA delayed repolarization phase of spontaneous inward current. The present results indicate the presence of IKCa in a single ICC, and it might be involved in regulation of repolarizing phase of spontaneous inward current in guinea-pig stomach.
Animals ; Calcium/*metabolism ; Guinea Pigs ; Membrane Potentials/drug effects ; Patch-Clamp Techniques ; Peptides/pharmacology ; Potassium Channels/drug effects/*physiology ; Proto-Oncogene Proteins c-kit/*metabolism ; Pyloric Antrum/cytology/*physiology ; Tetraethylammonium/pharmacology

In Akita Prefecture, there are nine hospitals established by the Akita Prefectural Federation of Agricultural Cooperatives for Health and Welfare (Koseiren). Half of the stroke patients in the prefecture were treated in these Koseiren hospitals, and half of the mass screening projects for the prevention of cardio vascular diseases were undertaken by these hospitals. A retrospective cohort study was done using mass-screening data (age, sex, past history of diabetes mellitus, blood pressure, body mass index, smoking and drinking habits) of 175,033 cases stored at these hospitals from 1988 to 1999, and the prefecture-wide stroke data of 2,520 initial stroke events registered from 1988 to 2003. The number of stroke cases was broken down into 1,428 cases of cerebral infarction (57%, CI), 693 cases of cerebral hemorrhage (27%, CH) and 399 cases of subarachnoid hemorrhage (16%, SAH). The subjects were also divided into five age groups:30-49, 50-59, 60-69, 70-79 and 80-89. Blood pressure (BP) was classified into six categories according to the JNC 6 criteria. Risk factors were determined using the Cox analysis. The hazard ratio for CI and CH was increasing with advancing age. CI showed a higher hazard ratio in men than women (hazard ratio for men was 1.8). The hazard ratio was increasing as BP became higher in any of three stroke subtypes, and especially CH showed the strongest correlation with BP. Uncontrollable risk factors were very closely associated with the attack of CI. On the other hand, BP (controllable risk) was closely linked with the attack of CH. Our results showed the prevention of CI was not easy. Controlling BP may be the most effective strategy for preventing hemorrhagic stroke (CH and SAH).
Cerebrovascular accident ; Cephalic index ; Blood pressure determination ; hazard ; Risk Factors

Background: We assessed the relationship between patient age and remifentanil dosing rate in patients managed under general anesthesia with spontaneous breathing using low-dose remifentanil in sevoflurane. Methods: The participants were patients with an American Society of Anesthesiologists Physical Status of 1 or 2 maintained under general anesthesia with low-dose remifentanil in 1.5-2.0% sevoflurane. The infusion rate of remifentanil was adjusted so that the spontaneous respiratory rate was half the rate prior to the induction of anesthesia, and γH 　(µg/kg/min) was defined as the infusion rate of remifentanil under stable conditions where the respiratory rate was half the rate prior to the induction of anesthesia for ≥ 15 minutes. The relationship between γH and patient age was analyzed statistically by Spearman's correlation analysis. Results: During dental treatment under general anesthesia using low-dose remifentanil in sevoflurane, a significant correlation was detected between γH and patient age. The regression line of y = − 0.00079 x + 0.066 (y-axis; γH , x-axis; patient's age) was provided. The values of γH provide 0.064 µg/kg/min at 2 years and 0.0186 µg/kg/min at 60 years. Therefore, as age increases, the dosing rate exhibits a declining trend. Furthermore, in the dosing rate of remifentanil when the patient's respiratory rate was reduced by half from the preanesthetic respiratory rate, the dosing rate provided was around 0.88 mL/h in all ages if the remifentanil was diluted as 0.1 mg/mL. EtCO2 showed 51.0 ± 5.7 mmHg, and SpO2 was controlled within the normal range by this method. In addition, all dental treatments were performed without major problems, such as awakening and body movement during general anesthesia, and the post-anesthetic recovery process was stable. Conclusion General anesthesia with spontaneous breathing provides various advantages, and the present method is appropriate for minimally invasive procedures.