The natural history of 28 cases with transient focal cerebral ischemic attacks was studied prospectively. The duration of follow up was 48 months in average, ranging from 9 to 144 months. During the follow up period, 6 cases (21.4%) died; 2 cases due to arterioclerotic heart disease, 2 gastric cancer, 1 acute renal failure, and 1 unknown cause. Cerebral thrombosis developed subsequently in 6 cases (21.4%), which was, however, not fatal. The time intervals from the initial transient episode to cerebral thrombosis were 3 hours, 20 hours, 1.5 months, 2.5 months, 4 years and 4 months, and 8 years.
As a factor in the development of anemia in the aged, commonly termed till now“a physiological anemia” due to the absence of direct causes of anemia such as deficiency of hematopoietic substance, V. B12 and iron, hemolysis, malignant tumor, and chronic disease, we have found sclerosis of the bone marrow arteries at autopsy and proposed the following sequence of events: disturbance of the blood circulation, fatty changes and development of anemia. Under the working hypothesis that artericsclerosis of the bone marrow artery is an important factor in the development of anemia in the aged, the present study was undertaken. As experimental animals, male albino rabbits weighing more than 2kg were used. The animals were maintained on 10g of lanolin and glucose along with bean-curd refuse daily and either subjected to an operation for the production of stenosis of the femoral artery or repeatedly injected intramuscularly with adrenalin, a vasoconstricting drug, to prepare arteriosclerotic rabbits. Peripheral blood examination, determination of serum total cholesterol and body weight measurements were pericdically performed. Animals were used for the experiment at a stage when anemia, hyperlipemia and atherosclerosis of the aorta at autopsy would be demonstrable. Results: Micropaque was injected into the bone marrow blood vessel of arteriosclerotic rabbits to study the pathological findings, flexion, tortuosity, and narrowing of the bone marrow blood vessel, consequently a decrease of blood flow through the bone marrow was suggested, showing a distinct difference from the normal group. At the site of narrowing of the arterial blood vessels, intimal thickening of the bone marrow artery, narrowing of the lumen, atrophy of the venous sinus and increase of perivascular fatty marrow were noted histologically as in the bone marrow of the aged. Only a small amount of opaque media entered. The mechanism for bone marrow hypoplasia or increase of fatty marrow in the aged might be explained by the occurrence of sclerosis of the arterial system leading to narrowing of the lumen and subsequent circulatory disturbance, anoxia of the hematopoietic tissue only supplied by the venous sinus and collective sinus, deficiency or interruption of the supply of hematopoietic substance, and eventually atrophy and hypoplasia of the hematopoietic site and fatty marrow corresponding to the terminal artery, since the whole blood stream via the nutrient artery of the bone marrow and artery capillary communicates with the main venous system exclusively through the venous sinus and collective sinus. These results would tend to indicate that the anemia in rabbits with experimentally induced hyperlipemia and arteriosclerosis resembles the anemia in aged human subjects especially as to the bone marrow findings. Sclerosis of the bone marrow artery appears to represent a factor in the development of such anemia.
The fundamental function of the reticuloendothelial system (R. E. S.) is phagocytic activity which constitutes three stages such as adsorption (engulfment), digestion and segregation (transaction). For testing the function of RES, kongo red clearance, Au198 colloid clearance etc. have been used, but recently, iron-chondroitin sulfate Fe59 colloid proved to be more useful for observing each stage of the process of phagocytic activity, because of this compound is separated into chondroitin sulfate and iron after intravenous injection. The former is taken up by kupffer stellate cell and the latter is released from RE cell. Since the function of RES is said to be degraded in the aged, the present study was attempted to clarify RES function with advancing age. For experimental animal, dd mice was used and divided in four groups as follows: 1) new born mice (10 days old), 2) adult mice (30 days old), 3) aged mice (365 days old), 4) hypercholestelemic or/and arteriosclerosis mice feeding with lanolin. Iron chondroitin sulfate Fe59 colloid was injected intravenously, 0.5mg/l μCi/20g. weight. In order to elucidate phagocytic and iron processing function of RES, plasma clearance and incorporation of Fe59 into erythrocytes were measured, and organ distribution of iron-chondroitin sulfate Fe59 was examined by radioactivity counting after autopsy following washed with saline solution. Autoradiograph was carried out by sacrificed at various time, and immersed in a mixture of solid carbon dioxide and aceton, then sagittal section were cut through the whole frozen mice and dried in a freeze room at -10°C. The autoradiographic exposures were made by apposition against X-Ray Film. The results were obtained as follows: (1) Disappearance rate of plasma clearance of Chondroitin sulfate Fe59 colloid of (1) and (2) groups is faster than that of (3) and (4), and incorporation of Fe59 into erythrocytes is higher and earlier than that of (3) and (4) groups. (2) The concentration of radioactivity in the liver of (1) and (2) groups are higher than that of (3) and (4) groups at 15 minutes after injection. (3) The disappearance rate of radioactivity in the liver revealed faster in the groups (1) and (2). at 6 hours after injection. (4) The concentration of radioactivity in the spleen is highest in the group (4), which may acount for the splenomegaly. (5) Autoradiogram displayed delayed uptake of chondroitin sulfate Fe59 in the heart in the group (4) and (3). (6) As conclusion, it is proved that function of RES is degraded with advancing age.
One hundred eithy-six male (average 73.7 years) and four hundred and three female (average 75.7 years) cases, mostly residents of Yokufukai (Home for the aged) were autopsied and were investigated on the significance of clinical findings of eyeground in the prognosis of the aged. The study was made from December, 1962 to June, 1970. Results and conclusions were as follows; 1) The narrowing and the irregularity in caliber of the retinal artery, bleeding and white spot in the retina, which were so called hypertensive findings of eyeground, were variable even in the aged 60 years or more, but the number of cases were few. 2) An increased in reflex of the retina, arteriovenous crossing, silver wire artery and white thread artery, which were so called sclerotic findings of eyeground, were not variable. These findings should be further investigated. 3) Sex difference in mortality rate was not observed. The mortality rate showed increased with age and increased with the increase in both the systolic or diastolic blood pressure. 4) The mortality rate with apoplexy and that with other cause of death were higher in those with higher grade of classification of eyeground findings. This tendency was most clearly observed in the sixth decades, however were not clear with progression of age. Therefore, the significance of the findings of eyeground for apoplexy were highly estimated in the sixth decades, and it's significance decreased as patients got older. 5) For knowing the prognosis of patients according to the findings of the eyeground, it is better to divide the group into three, namely negative, slightly positive and severly positive rather than by the 2 classification such as positive and negative. 6) By reason of the difficulty of it's judgement, there was a tendency to neglect the increase in reflex of the retinal artery, however this finding should be given importance with the narrowing and the irregularity in caliber of the retinal artery.
Macroscopic examinations were made on the aorta, the coronary and the cerebral arteries in 132 autopsy cases with long follow-up of the blood pressure and the total serum cholesterol. A significant positive correlation was demonstrated between the average of the annual systolic pressure and the severity of atherosclerosis in the aorta (r=+0.282, p<0.05), the coronary (r=+0.319, p<0.01), and the cerebral arteries (r=+0.434, p<0.01). On the other hand, the average of the annual diastolic pressure was related only to the severity of the cerebral atherosclerosis (r=+0.284, p<0.01). There was a significant positive correlation between the average of the total serum cholesterol and the severity of the stenosing atherosclerotic lesions of the coronary arteries (r=+0.284, p<0.01). However, the total serum cholesterol was unrelated to the severity of the atherosclerosis of the aorta and the cerebral arteries. It was also apparent that the atherosclerotic lesions in the three arteries do not progress parallel. Basing on the above results, the necessity for detailed study on the local factors for atherogenesis was finally pointed out.
A method for electrophoretic analysis of lipoproteins on cellulose acetate is descreibed. This method provides improved resolutions of lipoproteins. Eighty-eight samples of serum which had high triglyceride value (more than 120mg/dl) were analysed. The results were as follows; pre-β (+) 69, (-) 19, chylomicron (++) 7, (+) 16, (±) 19, (-) 46. It was concluded that this method is valuable for differentiating the genesis of hypertriglyceridemia, i. e., endogenous (hyper-pre-β) or exogenous (hyper- chylomicron).
The aim of present study is to attempt to elucidate the mechanism of endogenous hypertriglyceridemia and to classify them by means of post-heparin lipolytic activity (PHLA) and immuno reactive insulin (IRI) assay. PHLA was measured in 28 high and 35 normal triglyceride subjects by modification of Fredrickson's method, in which Triolein, Tricaprylin and Ediol were used as substrates. PHLA values were found to be not significantly different between high and normal triglyceride groups. However, PHLA×10-3/TG pool, which indicate the lipolytic activity per circulating plasma triglyceride content, were significantly reduced in high triglyceride group. The possibility appeared to exist that the activity may be influenced independently regarding two substrates by glucose loading only in high triglyceride subjects. Hypercholesterolemia and abnormality of glucose tolerance in these subjects seemed to have no relation to PHLA under the series of present investigation, but α-lipoprotein concentration correlated significantly with PHLA×10-3/TG pool. Based on these findings high triglyceride subjects can be classified from the aspects of regulatory mechanism into three categories, 1) overproduction type 2) impaired removal type 3) combined type, and each incidence under present investigation were 0/24, 11/24, 13/24 respectively. Most of Type IV subjects were found to belong to impaired removal type. Furthermore, the effects of high fat and high carbohydrate diet on PHLA of 12 normal and high triglyceride subjects were studied. PHLA values appeared to be increased following high fat feeding, which was accompanied with the decrease of triglyceride in serum and in very low density lipoprotein.