Parasympathetic hypofunction, sympathetic hyperfunction and portal hemodynamics were closely related with gastric motility in cirrhotic patients. In addition, gastric motility was decreased, at least in part, by the ingestion of food in cirrhotic patients because of abnormalities in autonomic functions and portal blood flow following a meal.

ransient left ventricular apical ballooning [1][2][3][4][5][6] in patients with normal coronary angiography results is characterized by transient left ventricular (LV) dysfunction and chest symptoms, together with electrocardiographic (ECG) changes that mimic those of acute myocardial infarction (AMI). Generally, the prognosis for transient LV apical ballooning is good, because in most patients ventricular function improves with conservative therapy. Nevertheless a very small number die from cardiogenic shock. We report a patient, treated for transient LV apical ballooning, who died from LV free wall rupture. Such an occurrence has not been reported previously in association with transient LV apical ballooning. Case ReportA 79-year-old woman was admitted to hospital in September 2003 with sudden onset of chest pain. Her level of consciousness was clear, her pulse rate was 84 beats/min, and blood pressure was 124/80 mmHg. Auscultation of the heart and lungs was normal. An ECG showed sinus rhythm with ST-segment elevation in leads I, aVL and V1-5, depression in leads III and aVF, and abnormal Q wave in leads V1-4 (Fig 1). Echocardiogram at the time of admission revealed akinesis in the LV apical wall. Laboratory data showed increased creatine kinase concentration (768 IU/L). An acute AMI was suspected, and the patient underwent emergency cardiac catheterization. However, coronary angiography did not reveal a stenotic lesion in any coronary artery (Fig 2A,B) (Fig 2C,D), and the LV ejection fraction was 31%. A diagnosis was subsequently made of transient LV apical ballooning, and she was only treated with diuretics.On the fifth day following admission, another ECG indi-

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It is suggested that the down-regulation of catecholamine may be one of the causes of postprandial hypotension in the elderly. The response to secreted catecholamine and the compensatory response to decreased blood flow in the systemic circulation were impaired in the elderly group, which finding may explain the high incidence of postprandial hypotension in the elderly subjects.

Diabetes mellitus is a disease which must be controlled over the lifetime of a patient. We investigated the issues of stress and coping for diabetes mellitus which may influence self-management. In addition, we examined the association of these factors with blood glucose control, in order to review self-management instructions for diabetes mellitus. The study included 153 patients with diabetes mellitus. The patients were divided into two subgroups: good-control group, comprising patients with glycohemoglobin (HbA1c) values less than 7.0%; and poor-control group, comprising those with HbA1c values of 7.0% or more. All patients responded to a questionnaire regarding stress tolerance, Jalowiec and Power's coping scale and awareness of diabetes mellitus. Stress tolerance was not significantly different between the good-control and poor-control groups. No significant gender differences in coping score were evident for the good-control group. However, in the poor-control group, the coping score in men was significant higher than that in women. The problem-oriented coping score for men in the poor-control group was significantly higher than that for the good-control group (p < 0.01). In a comparison of awareness of diabetes mellitus, the proportion of patients who replied that they were rigidly following diabetes treatment was higher in the poor-control group than the good-control group. Patients with diabetes mellitus may have a knowledge of the disease and a strong will to resolve problems. This is especially true for male patients in that their will appeared to be stronger, but they may not have the resolve to establish appropriate behavior patterns. In the future, methods for evaluating self-management should be included in diabetes education.

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Background:The relationship between 1/f¯uctuation of the heart rate variability and Helicobacter pylori infection was evaluated, in order to clarify whether autonomic nervous dysfunction is a necessary condition for chronic peptic ulcer formation. Methods: The subjects were 11 patients with recurrent chronic peptic ulcer and 20 age-matched normal subjects. Holter ECGs were recorded over 24 h, and the 1/f ±x¯u ctuation of the heart rate was computed. The 1/f ±x¯u ctuation of the heart rate is a novel index of autonomic function that has been shown to re¯ect a patient's pleasant mood. For 1/f ±x¯u ctuation, the slope of the regression line (±x) was determined and cosine ®tting of the absolute slope of the regression line over a 24-h period was performed.

The protective effect of PIA on microvascular function was attenuated in patients with acute hyperglycaemia, resulting in unfavourable functional recovery.