The determination of the isoenzyme of Creatine Phosphokinase (CPK) in patients with high serum CPK levels was performed to investigate diagnostic capabilities of acute myocrdial infarction. Serum samples were electrophoresed and CPK-MB was detected under ultraviolet light due to the production of NADH. Peak CPK-MB isoenzyme which is specific for the myocardium were 2.3 to 89 IU 16 to 24 hours after the onset of acute myocardial infarction. Peak CPK levels were 46 to 872 IU and found to be at the same time as that of CPK-MB. Peak CPK-MB levels in the large myocardial infarction on autopsy were 6 to 22.3 IU and 2.8 to 6.2 IU in the cases of middle sized infarction on autopsy. True size of myocardial infarction was not correlated with peak CPK-MB. LDH isoenzyme I/II was increased after myocardial infarction and elevated to 1.2 at 20 hours after infarction. CPK isoenzymes were determined in the 22 cases without myocardial infarction and CPK-MB was found in 10 cases. These cases were hypoglycemic myopathy, cardiac arrest, hypothyroidism with myocardial ischemia and others showing some degree of myocardial ischemia. CPK-MB in these cases were lower than that of myocardial infarction. Only CPK-MM were present in the cases of arteriosclerosis obliterans, intramuscular injection, disseminated intravascular coagulation and others. These findings showed the usefulness of detection of CPK-MB in the diagnosis of acute myocardial infarction.
Aortic calcification was examined by the routine chest and abdominal lateral film on 1828 male and 1093 female patients aged 40 to 79. The incidence of calcification somewhere in the aortic arch, the abdominal aorta or both increased with advancing aged and did not show sex difference in any age groups. However, the incidence of calcification, that was calculated separately in the aortic arch or in abdominal aorta, showed remarkable sex difference. Calcification in the aortic arch was found in 267 (14.4%) of 1828 males versus in 199 (18.2%) of 1093 females and that in the abdominal aorta was found in 449 (24.6%) of 1828 males versus in 204 (18.7%) of 1093 females. The sex differences were stastically significant (p<0.025 for the aortic arch and p<0.0005 for the abdominal aorta). When aortic calcification was divided in three groups (aortic arch alone, abdominal aorta alone and both of them), the incidence of calcification in the abdominal aorta alone was greater than that of others and was decreased with advancing age in male (71.9% in 40-49 age-group, 56.0% iu 50-59 age-group and 51.1% in 60-69 age-group). In feman, the incidence of calcification in the aortic arch alone was greater than that of others and was decreased with advancing age (60.0% in 40-49 age-group, 47.9% in 50-59 age-group and 30.9% in 60-69 age-group). And the incidence of calcification in both was increasing with advancing age in both sex. Calcification of the aortic arch appeared earlier in female than male and calcification of the abdominal aorta appeared earlier in male than in female.
It has been indicated that premature atherosclerotic cardiovascular diseases are accelerated in the presence of elevated level of low density lipoprotein (LDL) or reduction of high density lipoprotein (HDL) concentration. By means of sequential ultracentrifugation of plasma from 15 maternal infant pairs, VLDL (d<1.006g/ml), LDL (1.006<d<1.063g/ml) and HDL (d>1.063g/ml) were fractionated and analysed for cholesterol (Ch), triglyceride (TG), phospholipid (PL) and apolipoprotein B (Apo B). Apo B was measured by electroimmunoassay. Umbilical cord (U) plasma-Ch, TG, PL and Apo B were 73±16, 51±10, 110±21 and 48±16 (mean± S.D.) mg/100ml, respectively. In cord blood, the concentrations of Ch, TG and PL in each lipoprotein density class were less than one half of those in normal adults or mothers. No sex differences were observed in the concentrations of Ch, TG, PL and Apo B either in plasma or in each lipoprotein fraction. In cord blood, HDL was the predominant Ch, TG and PL carrying lipoprotein. VLDL-Ch, TG and PL were extremely low concentration. U-LDL-Ch and U-HDL-Ch were 28±7mg/100ml and 43±9mg/100ml, respectively. In two of fifteen infants, LDL-Ch were higher than 41mg/100ml which is the value used for diagnosis of neonatal familial type II hyperlipoproteinemia by Kwiterovich, P.O., Jr. et al. In three of fifteen infants, HDL-Ch exceeded a preselected cut off limit of 50mg/100ml for diagnosis of neonatal familial hyperalphalipoproteinemia by Glueck, C.J. et al. and the highest level of cord blood HDL-Ch in the present study was 62mg/100ml. Japanese cord blood contained higher levels of HDL-Ch and lower levels of LDL-Ch than those in Sweden, USA and Australia. HDL-Ch/LDL-Ch ratio were 1.58 in Japan, 1.14 in U.S.A., 0.89 in Australia and 0.69 in G.D.R. HDL-Ch/LDL-Ch ratio in Japanese cord blood was the highest in the values reported in the literature. The relationships between maternal and infant lipoproteins were more significant in HDL than in VLDL or LDL. The positive correlation between maternal HDL and infant HDL may indicate the possibility of placental transfer of intact HDL particle.
There have been a number of epidemiologic studies which have demonstrated the negative correlation between the high density lipoprotein cholesterol (HDL-ch) level and the incidence of coronary heart disease. However, no data are available concerning the HDL-ch level in Japanese, among whom the incidence of coronary heart disease is one of the lowest in the world. In the present study we examined the HDL-ch level in Japanese and Western people living in Japan. The results were as follows: 1) The mean HDL-ch level (±S.D.) in healthy Japanese was 56±16mg/dl for 244 males and 61±15mg/dl for 234 females. Females had significantly higher levels of HDL-ch than males, and no age difference was observed in both sexes. 2) There was a negative correlation of HDL-ch with obesity, triglycerides and prebeta lipoprotein percentage, and a positive correlation with alcohol consumption and alpha lipoprotein percentage. 3) The mean value of atherogenic index (total-ch-HDL-ch/HDL-ch) was 2.9±1.3 for males and 2.6±1.2 for females. 4) HDL-ch in cord blood was 39±12mg/dl for male babies and 40±12mg/dl for female babies. 5) HDL-ch in Western people living in Japan was 55±13mg/dl for 40 males and 60±11mg/dl for 17 females. 6) HDL-ch was low in patients with hyperlipoproteinemia, coronary heart disease, diabetes mellitus, ischemic cerebrovascular disease, liver diseases and renal failure on hemodialysis. 7) It might be suggested that the high level of HDL-ch in Japanese is one of the reasons for the lower incidence of coronary heart disease in Japan and the difference in HDL-ch level between Japanese and Western people is likely due to environmental factors.
A total of 101 stroke patients were treated with physical and occupational therapy during an average of 5.6 month hospitalization. Most of these patients were elderly with an average of 70 and ranging in age from 60 to 79. There were 55 males and 46 females with approximately equal numbers with left and right hemiparesis. The functional status measured by Brunnstrom recovery stage (Br. stage) and ADL of hemiplegic upper and lower extremities was evaluated on admission and discharge. In ADL activities, rehabilitation outcome of upper extremities was non-functional. assistant and functional hand. Ambulation status for lower extremities into three categories: those who were unable to walk, those walking aids, and those walking with no aids with/without assistive devices. Computerized tomography was carried out and evaluated into following four groups: 1) region (s) of internal capsul-basal ganglia-thalamus, 2) cortical and/or subcortical lesion of widespread region 3) cortical and/or subcortical lesion of local region 4) undetected region. Analysis of these cases were as follows: 1) Br. stage did not changed so much but ADL activites were increased during hospitalization. 2) Involuntary movements and dysmetria were identified as poor prognostic signs in a first group. 3) Severe weakness, perceptual or cognitive dysfunction, poor motivation, night delirium and urinary incontinence were clearly identified as poor prognostic in a second group.
Epidemiological studies of myocardial infarction (MI) in recent years have directed attention to several coronary risk factors usually associated with high incidence. Several risk factors already reported included in cigarette smoking, obesity, hypertension, diabetes mellitus and hyperlipemia. The purpose of this report was to analyse the role of risk factors, and their sex and age differences by comparing retrospectively clinical data between the MI group and the control group. The material consisted of 660 cases with MI (538 males and 122 females) and 18117 normal cases (14524 males and 3593 females). They were subdivided into the following three groups: the younger age group (29-40 year age group), the middle age group (50-60 year age group) and the older age group (70-80 year age group). Risk factor analyzed were cigarette smoking, obesity, hypertension, diabetes mellitus and hyperlipemia. The frequency of cigarette smoking, hypertension, diabetes mellitus and hypercholesterolemia was significantly higher in the MI group than in the control group in both males and females. This data indicated that such risk factors were more important on the development of MI. The frequency of overweight (weight experience 20% or more above their ideal weight) showed no significant differences between the MI group and the control group. The frequency of elevated serum triglycerides was significantly higher in the MI group than in the control group only in males below the age of 50. Obesity and elevated serum triglycerides were thought not to be important risk factors. Both were thought to be indirected risk factors, because obesity could induced to hypertension and hypercholesterolemia, and there were many hyperlipemia of such a type that both cholesterol and triglycerides elevated in the MI group. As to sex difference of risk factors, the degree of the significant difference in the number of diabetes mellitus, hypercholesterolemia between the MI group and the control group were larger in males than in females. This data indicated that these risk factors have less important roles in females, and the result may suggest that endocrine factors related to the menopause such estrogen have an influence on the development of MI. As to age difference of risk factors, comparing with the control group, the number of people who had risk factors analyzed in this study were more in the younger age group than in the older age group in both sexes. This data would indicated that risk factors have a more important role in the younger age group.
Early effects of egg yolk ingestion on serum lipids and lipoproteins were studied. After 12 hours overnight fast, 6 healthy male subjects of the third to fourth decade of life received 3.4gm of egg yolk per kgm of body weight, which contains approximately 58mg of cholesterol and 840mg of triglyceride. 1) The basal level of cholesterol of very low density lipoproteins (VLDL) containing chylomicrons was 10±2mg/dl (mean±SEM), and that of low density lipoproteins (LDL) was 82±10mg/dl. Four hours after ingestion, the cholesterol of VLDL containing chylomicrons significantly increased to the maximum of 18±2mg/dl (p<0.01), and the LDL cholesterol significantly increased to the maximum of 89±11mg/dl (p<0.05). The serum cholesterol significantly increased from the basal level of 165±13mg/dl to the maximum of 175±12mg/dl 4 hours after ingestion (p<0.001), and its increase was due to those of VLDL containing chylomicrons and LDL. The cholesterol level of intermediate density lipoproteins (IDL) was 10±3mg/dl before ingestion, and continued to increase thereafter. The IDL cholesterol level 10 hours after ingestion was 14±3mg/dl, and significantly greater than the basal one (p<0.001). The cholesterol level of high density lipoproteins (HDL) unchanged significantly. 2) The basal level of triglyceride of VLDL containing chylomlcrons was 41±7mg/dl, and significantly increased to the maximum of 124±16mg/dl 4 hours after ingestion (p<0.001). The serum triglyceride significantly increased from the basal level of 73±8mg/dl to the maximum of 159±16mg/dl 4 hours after ingestion (p<0.001), and its increase was due to those of VLDL containing chylomicrons. The basal level of IDL triglyceride was 5±1mg/dl, and that of LDL triglyceride was 8±1mg/dl. The IDL triglyceride significantly increased to the maximum of 7±1mg/dl 4 hours after ingestion (p<0.01), and the LDL triglyceride significantly increased to the maximum of 11±2mg/dl 6 hours after ingestion (p<0.01). However, their increases were less than those of VLDL containing chylomicrons. The HDL triglyceride level unchanged significantly. 3) The sum of the levels of cholesterol and triglyceride of VLDL containing chylomicrons was 51±8mg/dl before ingestion, and significantly increased to the level of 142±17mg/dl 4 hours after ingestion (p<0.001). However, 10 hours after ingestion its level was 30±6mg/dl and significantly less than the basal one (p<0.01). Its change was greater than those of any other lipoprotein fractions. 4) The cholesterol/triglyceride ratio of VLDL containing chylomicrons was 0.3±0.1 before ingestion, and significantly decreased to the minimum of 0.2±0 4 hours after ingestion (p<0.05), and continued to increase thereafter. That of IDL significantly increased from 2.2±0.7 before ingestion to 3.3±0.9 10 hours after (p<0.05). Those of IDL and HDL unchanged significantly. It was concluded that after ingestion of egg yolk, serum cholesterol and triglyceride increased. Especially with regard to cholesterol, those of VLDL containing chylomicrons, IDL, LDL increased. The IDL cholesterol continued to increase for 10 hours after ingestion.