A 76-year-old woman was referred to our hospital for unresponsiveness and hypotension. She had developed constipation that had led to ileus and had received 34 g of magnesium citrate (Magcolol P ® ) orally the day before. She was lethargic, her blood pressure was less than 50 mmHg, and electrocardiogram (ECG) revealed sinus arrest with junctional escape rhythm. Her serum concentration of magnesium (Mg) was markedly elevated (16.6 mg/dl =13.7 mEq/l). Emergency colonoscopy revealed ischemic colitis. As her condition ameliorated, her renal function returned to normal. Hence, the present case suggests that severe hypermagnesemia can occur in the absence of pre-existing renal dysfunction in elderly patients with gastrointestinal diseases.

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Abstract. Carbohydrate antigen 125 (CA125) is a tumor-marker frequently associated with ovarian malignancies; however, benign gynecologic conditions (e.g. ovarian cysts) commonly cause a smaller increase in CA125 levels. This report describes an elderly Japanese woman with high CA125 levels and massive ascites caused by hypothyroidism. A 67-year-old woman presented herself with a weight gain of about 12 kg and abdominal distension. Her serum CA125 level was markedly elevated (822 U/ml) and abdominal CT revealed a right ovarian cyst and massive ascites. Hormonal laboratory data showed severe primary hypothyroidism with a serum TSH of 594 IU/L and a free thyroxin level of 0.05 ng/dl. Ascitic fluid was found to be exudate with a high protein content of 42 g/L. Cytological analysis and FDG-PET showed no evidence of malignancy. The ascites completely disappeared and serum CA125 normalized after adequate hormonal replacement therapy. These data suggest that hypothyroidism should be considered in patients with ascites and elevated serum CA125. (CA125) is an antigen related to ovarian cancer that was discovered by Bast et al. in 1981 [4]. Kabawat et al. showed that this antigen is present in tissue related to the coelomic epithelium [5]. Here we report the case of a patient with abdominal distension and an ovarian cyst whose ascites completely resolved and whose CA125 level normalized after treatment with levothyroxine sodium. A Case RepotClinical findings and laboratory studies A 67 year old woman had noticed weight gain of about 12 kg and abdominal swelling for three months. She consulted her family physician and was treated with diuretics and ARB, but her abdominal distension persisted. She was found to have an ovarian cyst and markedly elevated CA125, and was referred to our hospital for further evaluation. She denied any history of thyroid dysfunction, neck surgery or heart disease.The patient was cachectic. Physical examination revealed a height of 155 cm, a weight of 58.3 kg, and a temperature of 36.2°C. Blood pressure was 102/ 62 mmHg, and pulse rate 58 beats/min with regular rhythm. Her voice was slightly hoarse but her thyroid and lymph nodes were not palpable. Lungs were clear

and Ken-ichi KOBAYASHI Central muscarinic receptors play an important role in the regulation of cardiac vagal nerve activity. We studied the inhibition of central muscarinic receptors and sympathetic nerve function in humans, since very little information is currently available on this subject. We examined the effects of graded doses of atropine (five doses, range 0.001 to 0.016 mg/kg) on heart rate, arterial pressure, heart rate variability, and muscle sympathetic nerve activity in 13 healthy young volunteers. Atropine caused biphasic effects on heart rate and the high-frequency (HF) power of R-R interval variability. At lower doses (0.002 mg/kg for heart rate, 0.001 mg/kg for HF power), atropine decreased heart rate and increased HF power. In contrast, at higher doses, atropine increased heart rate and decreased HF power. Low-dose atropine significantly attenuated muscle sympathetic nerve activity, burst rate (bursts/min) by -30.5±6.0% and burst incidence (bursts/100 heart beats) by -23.8 ± 6.9% at 0.002 mg/kg. Systolic and diastolic arterial pressure did not change with atropine infusion. Low-dose atropine (0.002 mg/kg) did not significantly affect either low frequency (LF) power or LF/HF. These results suggest that central muscarinic receptors may modulate not only cardiac vagal nerve activity but also sympathetic nerve activity in the skeletal muscle vasculature.

A 30-year-old man was admitted to our hospital for left lobar pneumonia with septic shock. Acute left-sided heart failure became evident as sepsis developed. Echocardiography revealed diffuse severe hypokinesis of the left ventricle (LV) and a pulmonary artery catheter showed Forrester subset II hemodynamics. Along with amelioration of sepsis and decrease of the serumconcentrations of tumor necrosis factor-a and interleukin-6, LV hypokinesis improved. It is suggested that the patient's heart failure mayhave been due to functional depression of myocardial contractility resulting from a direct effect of the cytokines towards the cardiomyocytes, the socalled "septic myocardial depression". (Internal Medicine 42: 60-65, 2003)