H Kai

BACKGROUND: This study aimed to determine if cholesterol-lowering therapy improves endothelium-dependent coronary vasomotion in patients with hypercholesterolemia. METHODS AND RESULTS: Nine patients with hypercholesterolemia were studied before and after cholesterol-lowering therapy with pravastatin (an inhibitor of HMG-CoA reductase) for 6 +/- 3 months, which lowered serum cholesterol from 272 +/- 8 to 187 +/- 16 mg/dL (P < .01). Control patients with serum cholesterol of 218 +/- 23 mg/dL also were studied twice in a similar interval (8 +/- 2 months) with no cholesterol-lowering drugs. Acetylcholine (the endothelium-dependent vasodilator) and papaverine and nitrate (endothelium-independent vasodilators) were infused into the study coronary artery. Changes in the diameter of the epicardial coronary artery and coronary blood flow were assessed by quantitative coronary arteriography and an intracoronary Doppler catheter. In patients with hypercholesterolemia, acetylcholine-induced vasoconstriction of the epicardial artery was less (P < .05) and the acetylcholine-induced increases in coronary blood flow were greater (P < .001) after than before pravastatin. In control patients, responses of the epicardial coronary artery and coronary blood flow to acetylcholine did not change over the follow-up period. The vasomotor responses to papaverine or nitrate were similar between the two groups, and no interval changes in their responses were noted in either group. CONCLUSIONS: These results suggest that cholesterol-lowering therapy with pravastatin may improve endothelium-dependent coronary vasomotion, which may possibly contribute to the improvement of myocardial perfusion as well as the regression of coronary atherosclerosis.

Two hundred patients with a previously untreated carcinoma of the thoracic portion of the esophagus and who underwent curative or noncurative resection were retrospectively evaluated. The patterns of recurrence were compared with the pathologic findings at operation. In 30 of 90 (33.3 per cent) patients in the curative resection group and 68 of 110 (61.8 per cent) of those in the noncurative resection group, there was a recurrence. Hematogenic recurrence was most frequent in instances of blood vessel invasion of the carcinoma detected at the time of the operation, and death occurred during the early postoperative period. Lymph node recurrence was most frequent in instances of lymphatic invasion or blood vessel invasion, or both, and the postoperative survival time in such patients was double that seen in those with a hematogenic-related recurrence.

The value of the cough reflex and its pressure and flow in the immediate postoperative period was measured in patients who underwent subtotal oesophagectomy and reconstruction for oesophageal cancer and other thoracic surgery. Twenty-two patients with subtotal oesophagectomy and reconstruction were found to have an extensive reduction in cough reflex and force, compared with those who had undergone pulmonary lobectomy. Damage to the vagal nerve caused by dissection of the paratracheal lymph nodes, and injury to the diaphragm during operation for oesophageal cancer appeared to be responsible for the inability to cough. It was of interest that the patients who showed a high value of cough reflex and force in the immediate postoperative period had few pulmonary complications. The postoperative measurement of cough ability may be a useful indicator for safe extubation of the intratracheal tube, as a means of preventing pulmonary complications after thoracic surgery. Continuous mechanical ventilation and frequent suction to remove retained secretions are strongly recommended for the patients who are unable to cough properly.

Postoperative complications, mortality and survival rates and nuclear deoxyribonucleic acid (DNA) content of cancer cells for 212 male and 47 female patients with carcinoma of the esophagus were studied. There were no differences in age, site and length of carcinoma, histologic type, invasion to the adventitia, metastases to the lymph node, staging and postoperative complications. However, survival time for female patients was significantly longer than in males. In studies of cell nuclear DNA content, the incidence of more favorable DNA type (relatively regular in DNA distribution) was relatively high while the incidence of the unfavorable DNA type (widely scattered DNA distribution) was relatively low in female patients when compared with male patients. These findings suggest that tumor factors warrant attention when studying the clinical differences in males and females with carcinoma of the esophagus.

The interrelationship between trypsin/trypsinogen and enterokinase (EK) was studied in rats following induction of trypsinogen hypersecretion by various agents. Both soybean trypsin inhibitor and para-aminobenzamidine increased intraluminal tryptic activities to a level about twice that found in the control rats. This resulted in an increase in the mucosal and the intraluminal contents of EK in the rat small intestine. On the other hand, in cholecystokinin-treated rats, although there was an increase of intraluminal trypsin, the increase was about 80% less than in the inhibitor-fed rats. Under this condition, there was no effect on the mucosal or the intraluminal EK. These results suggested that substantial increase in intraluminal trypsin/trypsinogen levels (two-fold over control) will increase the mucosal and the intraluminal concentrations of EK in the rat small intestine. Our observation extends previous reports that a decreased level of trypsin/trypsinogen, such as in pancreatic insufficiency, leads to a decrease in mucosal EK. These observations, when taken together, strongly support the modulating role of intraluminal trypsin/trypsinogen levels in controlling the EK concentrations in the small intestine.