We examined the hemodynamic responses to exercise and symptoms in 37 male patients with untreated essential hypertension, and compared the findings with those in 32 age-matched healthy male volunteers by performing a graded symptom-limited exercise test using a bicycle ergometer. The subjective feeling of intensity of exercise was determined using the Borg scale. In the relationship between Borg scores and blood pressure (BP), patients with hypertension showed higher systolic BP and diastolic BP relative to the Borg scores than the controls. Consequently, patients with hypertension showed significantly higher systolic BP with Borg scores < or = 3 (subjective symptoms < or = moderately hard) than the controls (177.8 +/- 27.0 vs. 143.7 +/- 17.9 mmHg, p < 0.0001). Similarly, significantly higher diastolic BP with Borg scores < or = 3 was observed in patients with hypertension than in the controls (101.6 +/- 12.0 vs. 82.6 +/- 11.6 mmHg, p < 0.0001). The pulse pressure with Borg scores < or = 3 was also significantly higher in patients with hypertension than in the controls (76.2 +/- 20.6 vs. 61.0 +/- 13.6 mmHg, p < 0.0001). Hypertensive patients showed a decrease in the high-frequency power of heart rate variability at initial low-load exercise. In conclusion, the present study revealed that there was a greater BP response relative to the Borg score in patients with hypertension than in the controls. Autonomic nerve activity may contribute to some extent to these different relations. A determination of the relationship between the subjective feeling of intensity of the exercise and BP levels caused by a given intensity of load is essential before exercise training in patients, at least in males, with hypertension to avoid increasing the risk of cardiovascular events in association with excessive exercise training.

Wetreated a rare case of malignant fibrous histiocytoma (MFH) of soft tissue that produced granulocyte colonystimulating factor (G-CSF). The patient, an 80-year-old woman,was admitted because of a feeling of abdominal fullness and leg edema. An elastic, hard, tender tumor was palpated in the right thigh. Histopathological examinations of the tumor revealed atypical and prominent pleomorphic spindle-shaped cells with funicular arrangement, which were compatible with the diagnosis of MFH.Prominent leukocytosis (up to 84,300/|il), a high serum G-CSF concentration (82 pg/ml) and positive immunohistochemical staining of the tumor tissue for G-CSFindicated that G-CSF was produced by the MFH. (Internal Medicine 40: 536-540, 2001)

Blood pressure (BP) decay data obtained from homeBP measurements in six patients with uncomplicated essential hypertension treated with a calcium blocker, amlodipine, were fitted to an exponential-exponential cosine function to determine the characteristic BP-lowering effects of amlodipine. An exponential-exponential cosine function fitted the morning and night systolic BP (sBP) decay data better than a simple exponential function. From the coefficients of the equation, the estimated BP lowering, time constant for BP decay and BP oscillation induced by amlodipine for morning and night sBP were approximately 23 and 25 mmHg, 10 and 6 days, and 12 and 12 mmHg, respectively. Diastolic BP showed a similar fitting though the fitting was weaker. The fitting results indicate that the BP decay, especially the sBP decay, induced by amlodipine occurred in an oscillative fashion, and the present analysis using home BP data may provide clinically useful information about the characteristic effects of amlodipine.