On the follow-up study of about 3, 000 persons who have had a set of thorough examinations, it was clarified that the cerebrovascular accident (CVA) occurred in 18 cases. It is considered to be very important that the predicition of CVA will be made from the data of thorough examinathions. For this purpose, the establishment of the formula by means of digital computer was required to differentiate two groups with or without the high probability of the occurrence of CVA (CVA-group and non-CVA-group) In the consideration of the following three conditions: 1) Multiple items of the examinations had to be dealt with. 2) Almost all informations from the examinations were expressed as the serial numbers. 3) The discrimination was restricted to two groups. The application of the linear discriminant functions was adopted as the best way As the internal samples which were used for making a formula, 15 subjects were selected from 18 subjects of CVA-group and 45 subjects of non-CVA-group with the same ages as the 15 subjects were also selected at random. Ten items from all the examinations were selected according to the calculated weight of affectiveness to CVA by computer. Since the number of CVA group may be insufficient when all the 10 parameters were applied for the establishment of a formula by means of the linear discriminant functions, a set of 4 dimensional linear discriminant functions was derived from the combinations of the 10 parameters. The formula was as follows: F=0.00058(0.020X1+0.066X2-0.035X3+0.020X4) +0.074X5+0.097X6+0.00082(2.04X7+0.25X8 +0.037X9+0.011X10)+0.023X11 X1……systolic blood pressure X2……diastolic blood pressure X3……maximum pressure of central retinal artery X4……mimimum pressurre of central retinal artery X5……eye ground findings X6……ECG findings X7……albuminuria X8…maximum urine specific gravity in Fishberg's test X9……fasting blood sugar X10……serum cholesterol level X11……length of observation (in year) Mean discriminant value and variance of CVA-group were 13.84 and 2.142, respectively. Those of non-CVA-group were 10.69 and 1.752, respectively. It was cnofirmed by the external samples, which had not been used to make the formula, whether the formula would give the best discrimination. The rejection limits were calculated with 0.05 level of significance. The lower rejection limit of CVA-group was 9.96 and the upper rejection limit of non-CVA-group was 13.66. It is interesting to observe that the 2 cases of non-CVA-group, which were misjudged, would have the attacks in future and it would be expected that this study of automatic prognostic diagnosis by means of electoronic computer contributes to the prophylaxis for CVA.
Practical significance of subjective symptoms is quite high for clinical diagnosis of arteriosclerosis, because of the shortage of reliable laboratory tests. It is especially true for the screening of a population as a preventive action for cerebro vascular accidents or coronary heart diseases. The purpose of this paper is to clarify which complaints are highly correlated with arteriosclerotic signs in a rural community, Akabane Town, Aichi prefecture in Japan. Inquiry was made in 1714 males and females, aged 40 to 79yr, in the town, concerning their subjective symptoms and medical history through a questionaire fermat. They were also examined of their body build and cerebro-and cardio-vascular functions by means of urinalysis, 12 leads electrocardiogram, serum cholesterol measurement, ocular fundus camera and blood pressure measurement. All subjects were classified into one of five groups based on their possibility of arteriosclerosis through the laboratory test besides subjective symptoms. Age and sex adjusted relative frequencies of each subjective symptom in arteriosclerotic subjects were calculated to the control subjects. It was clearly demonstrated that subjective symptoms, such as “transient faintness”, “tongue staggered”, “chest oppression”, “dyspnea”, “intermittent claudication”, or “hot flashes” were significantly correlated with arteriosclerotic signs. On the other hand, the well known complaints, such as “headache”, “ dizziness”, “weakened memory” were not proved as arteriosclerotic in this study. A series of subjective symptoms were highly increased with advancing ages; “tongue staggered”, “decreased activity”, “unsteady walk”, “intermittent claudication”. The frequencies of these complaints in the seventies were five times or more of those in the forties. On the other hand, There were remarkable sex difference in the frequencies of complaints, “hot flash”, “edematous hands or feet”, “numb hands or feet” and “dizziness” were double or more frequent in females, while “hard to please”, “frequent calls for urination” and “chest oppression” were more frequent in males than in females. Overall frequencies of a subjective symptoms were as high as fifty per cent, “shoulder or neck stiffness”, and also “weakend memory”, “numb hands or feet”, “heavy head”, “headache”, and “dizziness” being complained by twenty per cent or more of the subjects. Reevaluation of the significance of subjective symptoms was stressed especially for the screening of arteriosclerosis as an causative factor of cerebrovascular accidents and coronary heart diseases.
Fluorescence fundus photography is an excellent method to observe small vessels. We used this method to investigate the reaction of peripheral vessels to drugs, and also to discern the kind of blood vessel subjects to observation. Two groups of drugs, Methoxamine, Angiotensin and Serotonin, which contract the smooth muscle to elevate blood pressure and Sodium nitrite, Bradikinin etc. which relax the muscle to depress the pressure, were used. Using rabbits and men, it was observed that the drugs which elevate the pressure contracted peripheral vessels and those which depress the pressure dilated the vessels. In the peripheral vessels, smooth muscles exist in the metarteriole and some of the central channel. Accordingly, by this method, it is possible to investigate change of micro vessels, the metarteriole and furthermore, the central channel.
The relationship between fatty acid and blood coagulation has recently received widespread attention concerning the development and prevention of thrombosis. We have obtained evidence indicating the effect of polyunsaturated fatty acids improving the metabolism in patients with diabetes mellitus. In this report, 54 cases of diabetes mellitus were given 9 capsules of linolic acid preparation orally for 1 month. Each capsule contains 500mg of ethyllinolic acid, 0.5mg of vitamim E acetate and 0.25mg of vitamin B6. Screening tests for blood coagulation such as recalcification time, partial thromboplastin time, prothrombin time and thrombin time were conducted. No marked changes were noted in the hypercoagulable state seen in patients with diabetes mellitus.
Fibergastroscopic examinations were carried out in 8277 patients in order to study the changes in endoscopic findings in diseases of the stomach according to age. Properties of gastric ulcer changed according to age. Although the cases of single ulcer outnumbered those of multiple ulcer in every age group, multiple ulcers were rather frequently seen after middle age. As for the relation of the shape of ulcer with age, there was a constant tendency of increase in the number of irregular ulcer with age, with concomitant decrease in round ulcer. A tendency of increase in size of ulcer in advancing age was also suggested. Influence of age was rather definite on the location of the ulcer. When the level of the ulcer is classified into 6 groups, antrum, angle, lower corpus, middle corpus, upper corpus and cardia, a tendency of ulcers to go upward was noted with advance in age. Ulcers above the level of upper corpus occupied only 3-4% of cases below the age of 50 but 15-23% of cases above 50. This tendency is more readily recognized upon calculation of the ratio of number of ulcers above and below the angle or the ratio of ulcers above middle corpus ao those below lower corpus, tentatively called indices of ascendence, I and II. Both indices of ascendence sharply increased with advance in age. Such difference according to age was more pronounced in males than in females. Ulcers outside of the common site of occurrence, the lesser curvature, became increasingly frequent with advance in age. More ulcers were found in the posterior wall in advanced age.
Out of 657 cases of cerebrovascular disease admitted to Mihara Memorial Hospital in past 10 months, 319 patients were subjected to the angiographic investigation. The positive pathognomonic findings definitely affirmative of the clinical manifestation were obtained in 147 cases (46%) and in 55 cases (17.5%) the supportive abnomalities were elicited. In 61 cases of the typical cerebral hemorrhage in clinical picture, 16 cases of the intracerebral hematoma and 16 cases of the aneurysm or the A-V malformation were identified. In 171 clinically diagnosed cerebral thrombosis, the complete occlusion amounted 44 (35 in the middle cerebral artery, 8 in the internal carotid artery and 1 in the anterior cerebral artery) and more than 50% stenosis was obrerved in 12 cases (9 in the middle cerebral, 2 in the internal corotid and 1 in the anterior cerebral). Also in 68 clinically suggestive of the existence of the cerebral atherosclerosis, 44 cases disclosed various sclerotic pictures without any specific pathogenesis exclusively. On the contrary, 7 middle cerebral occlusions and 1 intracerebral tumor were ruled out among the 35 cases of clinically diagnosed cerebral hemorrhage. In addition among 171 cases of the clinically understood cerebral thrombosis, 10 cases of the intracerebral hematoma, 5 cases of the aneurysm, 1 case of the cerebral tumor and 3 cases of the subdural hematoma were screened out. Eleven cases of aneurysm and 2 cases of the A-V malformation were picked up in this series whereas only 3 aneurysms and 2 A-V malformations were verified in 26 clinically diagnosed subarachnoid hemorrhage even by the repeated trial with various projections. The complications due to four vessel angiography in this series were all transit and not significant. In 319 bilateral percutaneous carotid angiography and in 191 bilateral percutaneous retrograde brachial angiography for 319 patients, 1256 arterial punctures were performed and 13 complications were recorded (7 cervical subcutaneous hematoma, 3 transient chill, 1 transient weakness, 1 respiratory distress and 1 shock status). As a conclusion, the value of the four vessel angiography for the evaluation of the clinical picture of the cerebrovascular disease can not be overestimated from our clinical experiences even with the detail and deliberate bed-side examinations. In addition among our 319 cases, there were cases for the indication of the surgical intervention upon the retrospective analysis of the cases which could'nt be detected without the routine four vessel angiography.
Tardy paralysis of the ulnar nerve is a chronic affection caused by a variety of pathologic processes in the region of the elbow. Three cases of this disease were reported here, in view of its frequent occurrence in adult or elderly life. In two cases, 62-year-old man and 52-year-old woman, old fracture of the humerus was the causative factor, while in one case, 65-year- old woman, paralysis was caused by multiple cartilagenous exostoses around the elbow. In all of the cases, the intervals between the injuries and the onset of the symptoms were more than forty years. One of the characteristic feature of this condition is a profound atrophy of intrinsic muscles of the hand with relatively little or late impairment of sensation. Several diseases such as cervical myelopathy, hypothenar neural atrophy, or motor neuron diseases should be differentiated from this condition. Early diagnosis is necessary because of the gratifying results of adequate surgical treatment in the early stage.