In order to clarifty the changes of arterial blood flow patterns due to aging, analysis of arterial blood flow patterns with the directional ultrasonic Doppler method were performed in 58 healthy normotensives of ages 15 to 75 with an average of 43.9 years (male 43, female 16). Blood flow patterns were recorded in the common carotid, brachial, radial, femoral and dorsal arteries. The results were obtoined as follows: (1) The peak velocity (forward) in the common caratid, brachial, radial and femoral arteries decreased with age, espcially in the common carotid artery it decreased markedly. (2) The inclination of firstl forward flow in the common carotid, brachial, radial and femoral arteris also decreased with age. (3) The appeearance time (the time from Q wave in ECG to the beginning of the first forward flow phase) shortened with age in the brachial, radial, femoral and dorsal arteries. (4) (a) In the common carotid, brachial and radial arteries the appearance of the midsystolic reverse flow phase in the young was more frequent than in the old and the peak velocity of the midsystolic reverse flow phase in the young was higher than in the old. (b) The peak velocity of reverse flow phase between latesystole and early diastole decreased with age in the femoral artery. (5) (a) In the common carotid artery the ratios S2/S1, I/S1, D/S1 and d/S1 increased and D/S2 decreased with age. (b) In the brachial and radial arteries the ratio S2/S1 increased with age. (c) In the femoral artery the ratio R/S and D/S decreased with age. The results described above was suggested that analysis of blood flow patterns with directional ultrasonic Doppler method is helpful in the evaluation of changes in cardiovasular system due to aging.
From 1963, we are treating hypertensive patients at The Jyohoku Hospital Clinic and a mass medical examination for circulation diseases are carried out on them in every summer. To study the significance of examination findings, such as blood pressure, albuminuria, glucosuria, electro-cardiogram, etc. to the cerebrovascular accidents, we selected 277 patients who have been undergoing regular treatment and thoroughly examined over 5 years. The hypertension of these patients was essential and the age of these were ranged from 50 to 74 years. During the course of this study, cerebrovascular accidents occured in 29 cases of these patients. (22 cases of infarction, 7cases of hemorrhage.) 41 of 277 patients have died. 16 patients died from cerebrovascular accidents. (40 per cent of all death) 9 patients died from ischmic heart diseases, (22 per cent of all death) Similarly 9 patients died from malignant tumors. (22per cent of all death) The analysis of relationship between the findings and the accidents were carried out by the multivariate regression method, because these examination findings are related to each other. The calculation was carried out by computer. The conclusion is following: 1) By the estimation of partial correlation coefficients, the factors which had significant positive relationship with cerebral infarctions are following: i) Glucosuria, ST-T depression, and arteriosclerotic changes of the eye ground at the first period of the course of this study. ii) The fluctuation of blood pressure occurred often over the blood pressure at the first period. iii) 180 and/or 100mmHg and more blood pressure during the course of the study. But the obesity (over Broca's index+20%) had significant negative relationship with the accidents. 2) In the same way, cerebral hemorrhages are related significantly to initial proteinuria and hyertensivec changes of the eye ground at the first period of this study, and 180 and/or 100mmHg and more during the course. Conseqently, supervising of the complications which had presented initially at the first period of the course of this study is important, in addition to the need for the continuous close treatment of hypertension.
A 10 year follow-up study was carrid out from Au gust, 1962, on 1662 persons above the age of 40 years residents of a rural area. 1) During the follow-up period, 169 cases of cerebral vascular disease were seen. Annual mean incidence rate was 10.2/1000 (12.5/1000 for male, 8.4/1000 for female) Death occurres during the initial or recurrent stroke in 113 cases or 40.4% of the total death. Annual mean death rate was 6.8/1000 (male 8.6/1000 female 5.4/1000) 2) Cerebral hemorrhage was seen in 59 cases (35%), cerebral thrombosis in 94 cases (56%), subarachnoid hemorrhage in 7 cases (4%), cerebral embolism in 1 case (0.6%) and miscellaneus 8 cases (4.7%). The ratio of cerebral hemorrhage to the cerebral thromblsis was 0.63 (male 0.47, female 0.86). This ratio was 0.67 in the first and 0.59 in the last five years of the study showing a tendency of declune in the latter half, 3) From among 551 hypertensive persons 121 cases (22%) suffered from cerebrovascular disease. This was an incidence 5 times higher than that in the normotensive subjects, or 29 cases (4%) from among 716 persons. 4) The risk of the occurence of hypertension was especially prominent in the 5th and 6th decades. Among the subjects over 70 years of age, There were clorer interrelations between cerebral hemorrhage and raised diastolic pressure in winter, and also between cerebral thrombosis and increased systolic pressure in winter and increased diastolic pressure in summer. 5) There is an obvious decline in the risk of cerebrovascular disease by controlling the blood pressure.
The outcome of 151 cases surviving from the acute stage of cerebral infarction was followed for five years. Fifty-six cases (37 per cent) died; 19 cases in the firt, 9 in the second, 10 in the third, 6 in the fourth, 12 in the fifth year. Deasth was caused by cerebrovascular disease in 23 cases, by heart disease in 5, by infectious disease in 10 and by malignant neoplasm in 9. The survival rate in any decade of age was lower than that expected of the corresponding age group in the general population and the ratio of the observed to expected survival rate decreased with advancing age. In patients under 60 years of age, the survival rate was lower in those with systolic blood pressure over 160mmHg than in thsoe under 160mmHg, while it was not influenced by systolic blood pressure level in patients aged 60 and over. In patients over the age of 60, the following factors were related to low survival rate; previous episode of stroke, disturbance of consciousness at the time of onset, severe neurological residuals, moderate or severe abnormality in electroencephalogram. Among those the latter two findings seemed to more correlate with poor prognosis. However, none of these factors did not affect survival rate in patients under the age of 60. Diastolic blood pressure electrocardiogram and funduscopic finding had no effect on the late prognosis.
The purpose of this report is to present two cases of locked-in syndrome due to infarction in the basis pontis and a case with basilar thrombosis, with special reference to disturbance of consciousness. The two cases showed patterns of clouding of consciousness resembling akinetic mutism, they could, however, communicate their wills by ocular movements. These patients were clnically considered showing locked-in syndrome. At autopsy, bilateral infarction involving the basal pontine regions with marked atherosclerosis of the basilar artery were found. The third case showed a deep coma persisting for 4 days at the terminal phase with irregular respiration and tetraplegia. At autopsy, there were bilateral infarctions involving the upper half of the pons, and midbrain peduncles together with tegmental areas. The basilar artery was completely occluded. The clinical findings of basilar artery thrombosis was considered not so remarkably different from that of basilar artery stenosis.
An autopsy case of Werner's syndrome is presented. The patient was 29 years old male. Since his adolescenec he gradually developed hoarse voice, solar callosity, gray hair, alopecia and juvenile cataracts. During the hospitalization for hypertention, diagnosis of Werner'f syndrome was made, based on his characteristic clinical manifestations. Despite intensive treatment with diuretics and cardiotonics, he died of cardiac and renal failure. In the family history, his parents were consanguineously married, but none of siblings revealed similar abnormalities. On laboratory examinations including endocrinological function tests, no contributory data were obtatined except for the those suggesting of cardiac and renal failure. In the autopsy findings, his countenance appeared older than his age due to alopecia with gray hair and atrophy of the facial skin. At the lower abdomen and the lower limb the skin was atrophic with slight hyper pigmentation. Solar callosity, artificial left eye, postoperative status of the right eye, loss of the axillar and the pubic hair and atrophy of the testes and the penis were also observed. In the cardiovascular system, moderate myocardial hypertrophy, aortic atherosclerosis and generalized arterio-and arteriolar sclerosis were found. Especially in the arteriole of the brain, pancreas and prostate, the pseudocalcification and the Mönckeberg's sclerosis were noticed. Marked arteriolosclerosis with the findings of the malignant nephrosclerosis were noted in the kidney. The endocrine organs, including the pituitary gland, thyroid, adrenal gland, pancreas and testes, were atrophic. The bone showed trabecular atrophy. The vocal cord was also atrophic and the submucosa tissue was fibrous. The thymus showed a complete involution He had no malignancy. Review of the literature on autopsy oases of this syndrome revealed scleroderma-like skin atrophy, arteriosclerosis and atrophy of the endocrine and genital organs, as in the present one. Significant histological change is usually seen in the skin, blood vessels, eye, bone and vocal cord. Atrophic tendency of the visceral organs including the endocrine organs is also demonstrated. Based on these clinical and pathomorphological findings, the role of the connective tissue in the pathogenesis of this syndrome is emphasized. The correlation between the connective tissue and ageing was discussed.