Changes of hematocrit, hemoglobin, serum protein levels and red blood cell counts were studied in 21 subjects with cerebral infarction and in 16 subjects with intracranial hemorrhage over 60 years of age. Of 16 cases with intracranial hemorrhage 12 were hypertensive intracerebral or intracerebellar bleeding, and 4 subarachnoid hemorrhage. In all cases the diagnosis was confirmed by autopsy. Patients with disseminated intravascular coagulation and cerebral embolism were excluded from this study. Measurements were repeatedly performed within several days before stroke, at the onset of stroke and the succeeding periods. In cerebral infarction the mean value of hematocrit immediately after stroke was significantly higher than that of several days before stroke. The mean values of hemoglobin, serum protein levels and red blood cell counts measured immediately after cerebral infarction were also significantly higher than those within 4 days before stroke. In cases of intracranial hemorrhage, however, there were no significant differences in hematocrit, hemoglobin, serum protein levels and red blood cell counts between the measurements before and after stroke. It is suggested that rapid rise in hematocrit level may play a role in the development of cerebral infarction. There were no significant differences in the mean values of hematocrit between the cases with cerebral infarction and age-matched control subjects. The mean values of hematocrit, hemoglobin levels and red blood cell counts in cases of cerebral infarction were found to be significantly higher than those in cases of intracranial hemorrhage before or immediately after stroke, while there were no significant differences in serum protein levels between the cases of cerebral infarction and intracranial hemorrhage. Both in cerebral infarction and intracranial hemorrhage, the values of hematocrit, hemoglobin levels and red blood cell counts showed the tendency of increasing for about one week after stroke, thereafter decreased; whereas the serum protein levels decreased rapidly after stroke. It is concluded that an elevation of hematocrit will be one of risk factors in cerebral infarction.
Achilles tendon xanthoma is an early clinical feature of hypercholesterolemia. To assess the diagnostic value of radiological examination of the Achilles tendon, its thickness was determined in 36 normal subjects having serum cholesterol level less than 250mg/dl and triglyceride less than 150mg/dl, 60 non-familial hyperlipidemic (23 combined hypercholesterol- and hypertriglyceridemic patients, 12 hypercholesterolemic and 11 hypertriglyceridemic patients), 13 secondary hypercholesterolemic (7 nephrotic syndrome, 6 hypothyroidism) and 20 familial hypercholesterolemic patients. The results were as follows: 1. The Achilles tendon was slightly thicker, although insignificant, in normal males (6.6±0.3mm) than in normal females (6.1±0.2mm). 2. The Achilles tendon thickness in non-familial hyperlipidemic patients was 6.1±0.2mm in combined hypercholesterol-and hypertriglyceridemic, 6.4±0.2 mm in hypercholesterolemic and 6.0±0.3mm in hypertriglyceridemic patients, and was not different from those in normal subjects. 3. The Achilles tendon thickness in secondary hypercholesterolemic patients (6.6±0.3mm in nephrotic syndrome, 6.8±0.5mm in hypothyroidism) was slightly thicker, although insignificant, than in normal subjects. 4. The Achilles tendon thickness in familial hypercholesterolemic patients was 13.2±0.9mm and significantly thicker than in normal, non-familial hyperlipidemic and secondary hypercholesterolemic subjects (p<0.01). 5. A significant positive correlation was found between the Achilles tendon thickness and the serum cholesterol level. There was no relationship between the Achilles tendon thickness and serum triglyceride level, body weight and age. 6. In familial hypercholesterolemia there was a significant positive correlation (r:0.475, p<0.05) between the Achilles tendon thickness and age. 7. Four patients with familial hypercholesterolemia had pain and tenderness in their Achilles tendons. The predominant lipids in the hypertrophied Achilles tendon were cholesterol ester, free cholesterol and phospholipids. From these data it was concluded that the measurement of the Achilles tendon thickness seemed to be usefull in discriminating familial hypercholesterolemia from normal control, non-familial hyperlipidemia and secondary hypercholesterolemia.