Electrocardiographic changes following gastric surgery in the aged were investigated with special reference to the amount of blood transfusion. The subjects were composed of 59 patients with gastric cancer and 19 patients with gastric ulcer, operated on between 1972 and 1975. The postoperative electrocardiographic changes were classified into five groups; that is 1) electrocardiogram simulating myocardial infaction (ESMI) in 8.5%, 2) marked ischemic changes in 10.2%, 3) slight ischemic changes in 8.5%, 4) non-specific ST, T changes in 18.6% and 5) no change in electrocardiogram in 54.2% in the group of gastric cancer. In the group of gastric ulcer these electrocardiographic changes were Observed in 5.3%, 21.0%, 15.8%, 15.8%, and 42.1% respectively, and no difference was found in both groups. The patients received blood transfusion of more than 1000ml in perioperative period were susceptible to the ESMI or ischemic changes, and revealed these changes in 45.5% in the gastric cancer and in 71.4% in the gastric ulcer. The elevation of hematocrit after surgery was correlated with the severity of electrocardiographic changes. In the gastric cancer hematocrit elevated by 15.7 in ESMI, by 10.5 in marked ischemic changes and by 8.4 in slight ischemic changes. In the gastric ulcer the increases in hematocrit were by 9.0, 13.5, and 5.3 respectively. The post operative hematocrit was slightly higher in ESMI, but the hematocrits in the remaining four groups were at the same levels. GOT changes were within normal ranges, and LDH increased slightly in each group. The duration of the operation was similar in each electrocardiographic changes, but the emergency operation was frequently observed in the groups of ESMI and marked ischemic changes. Eighteen cases of gastric cancer and 7 cases of gastric ulcer died during the follow up period. These cases were frequently observed in groups of ESMI and marked ischemic changes. However, no significantly correlation was found between the electrocardiographic changes and coronary stenotic index. The proposed mechanisms responsible for the electrocardiographic changes were rapidly increased hematocrit and blood viscosity in poor risk patients, which might disturb the coronary microcirculation.
This study deals with a relationship between α2-macroglobulin (α2M) and diabetic retinopathy. Subjects of 227 diabetics and 145 normal control were chosen from our diabetic clinic, and the concentration of α2M in blood was measured by single radial immunodiffusion. As the results, α2M was significantly increased in patients with diabetes mellitus in the age-groups of second, third and forth decades in comparison with age matched normal. But no significant difference was found between diabetics and normal in the age-groups of fifth, sixth and seventh decades. In female with retinopathy, α2M was increased significantly more than non vascular complicated diabetes, but no difference was found in male groups. However α2M in diabetes underwent a change by aging process, and in male α2M of Scott I-II group was significalltly higher than in age matched non-complicated diabetics, and in female α2M of Scott III was also higher. Thus, no relationship between the severity and degree of Scott classification and the concentration of α2M was found. The retinopathy with persistent proteinuria was shown to be significant increase of α2M in comparison with negative proteinuria. In Scott IV and V group, significant difference in α2M was found between positive and negative in proteinuria, and α2M in retinopathy without proteinuria was shown to decrease towards the lower level of normal. It was suggested that the increase of α2M in diabetic retinopathy was mainly affected by complication of nephropathy. Therefore, diabetic retinopathy might deteriorated by the augmentation of antiplasmin activity due to increase of α2M, and/or by the reduction of antithrombin activity due to its decrease.
Serum cholesterol and triglycerides levels were measured in 1963 subjects over 65 years old (724 males, 1239 females), living in the Tokyo Metropolitan Homes for the Aged. Sex and age distribution of these lipids were observed and the relationship between these lipids and other clinical findings was also investigated. Other examinations consisted of nocturnal frequency of micturition, degree of arcus senilis, blood pressure, skinfold and electrocardiography. The results obtained are as follows: 1) When these lipids were observed in the whole population, cholesterol showed a normal distribution curve, while triglycerides showed a deviated curve to the right. This deviation was slightly normalized when the value of triglycerides was converted to a common logarhithm. 2) The mean value of cholesterol decreased with aging in females, while no remarkable change was found in males. The same tendence as cholesterol was obtained in triglycerides. 3) The mean values of these lipids were significantly higher in females than in males for all age groups. 4) These lipids correlated significantly with skinfold with skinfold in both sexes (P<0.001). There was a positive correlation between triglycerides and arcus senilis only in males (P<0.05), and a positive correlation was found between diastolic pressure and lipids in females. 5) Partial correlation coefficients between serum lipids and six other variables i.e. skinfold, arcus senilis, systolic pressure, diastolic pressure, age, and nocturnal frequency of micturition were evaluated, Skinfold showed r=0.21-0.30 with lipids in both sexes (P< 0.001), arcus senilis r=0.13 with triglycerides in males (P<0.01), and nocturnal frequency of micturition r=-0.09 with triglycerides in males (P<0.05). No significant correlation was found between lipids and variable other than skinfold, arcus senilis and nocturnal frequency of micturition. 6) Prevalence of abnormal Q wave and T abnormalities in ECG did not change with the lipid level. Atrial fibrillation was more common in subjects with a lower level of lipid than in those with a higher level. left sided high voltage showed a similar tendency, though this was not statistically significant.
It is well known that there is a close connection between acid mucopolysaccharide (AMPS) and arteriorclerosis. Many factors are concerned in arteriosclerosis, therefore the relation between AMPS and arteriosclerosis must be carefully investigated in consideration of each of these factors. This time, age, glucose tolerance and aortic arch calcification (AAC) were picked up as such factors concerning arteriosclerosis, and were studied in relation to serum AMPS or urine AMPS. AMPS was estimated according to the method of Kimura in 17 hypertensives, 51 patients with decreased glucose tolerance, 39 patients with sequelae of cerebrovascular attack and 49 other patients, totaling 156. Types of glucose tolerance were classified according to the criterion of the Japanese Diabetic Committee, by administering orally 500ml of 20% glucose solution. AAC was investigated by means of routine dorsoventral chest X-ray phot. The following results were obtained, considering age, glucose tolerance and AAC: a) The concentration of serum AMPS, and the concentration and amount of 24-hour urine AMPS are lower in the aged group (over 60 years of age) than in the young group (less than 40 years). Serum AMPS concentration of the middle aged group (40-59 years) stands between the two age groups. b) Serum AMPS concentration is of higher level in case of the decreased glucose tolerance than in case of the normal one, though the concentration and amount of 24-hour urine AMPS have no difference between the decreased glucose tolerance and the normal one. c) No difference of the serum AMPS concentration is found between AAC group and non-AAC group, though the concentration and amount of 24-hour urine AMPS are apt to be lower in AAC group than in non-AAC group. d) There is no correlation between the serum AMPS concentration and the 24-hour urine AMPS concentration nor the amount. The results are summarized as follows: The relationships of serum AMPS to aging, glucose tolerance or aortic arch calcification are not uniform, namely, these 3 factors are different from each other in the effect on arteriosclerosis. The same is the case with 24-hour urine AMPS. Ageing, glucose tolerance and aortic arch calcification have been regarded by many investigators as similar factors to arteriosclerosis. However, according to this biological results from the viewpoint of AMPS, these 3 arteriosclerotic factors do not play the same role in the mechanism of the phenomena of ageing.