老研究者の覚え書 養育院時代(1) : 老年者の心筋梗塞症、冠(状)循環の形態学-血管造影法、心筋の構築-肉眼的剥離法、生理的老化心

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  • ロウ ケンキュウシャ ノ オボエガキ ヨウイクイン ジダイ 1 ロウネンシャ ノ シンキン コウソクショウ カン ジョウ ジュンカン ノ ケイタイガク ケッカンゾウエイホウ シンキン ノ コウチク ニクガンテキ ハクリホウ セイリテキ ロウカシン
  • Memorandum of an old researcher The Yoiku-in era, Part 1 : Myocardial infarction in the elderly, Morphology of coronary circulation - postmortem angiography, Myocardial architecture-macrodissection method, Physiological presbyocardia.

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1966年11月シカゴより帰国後、東京都養育院付属病院で心血管病理研究を再開した。1年8ヶ月間に60歳以上の連続剖検356例を経験し、老年特有の感染症、新生物など心疾患以外の5症例報告に関与した。老年者心筋梗塞MIを大量壊死M型52、散在壊死S型12 : 前壁28、後壁29、広汎(全周性)心内膜下Sub型8例に分類、M型は冠状動脈血栓と対応、責任病変はM大型で中枢側2枝、M中・小型で中間部の閉塞、S型は硬化板狭窄とくにSub型で中枢側高度の狭窄が特徴的であった。梗塞後心破裂は左室6、中隔4(右室1を合併)例。M型新鮮MI、女性優位、先行高血圧・陳旧性MIが特徴的で新・旧虚血病変の境界を連ねるジグザグ型穿孔がみられ、1例のみ中隔小型MIの"はじけ"破裂であった。穿孔例では、心筋に超新鮮虚血病変が観察された。本項に関連するパース短大紀要2002, 4(1) : 68-73.記事の訂正・陳謝を挿入した。連続261剖検例の臨床症状・心電図所見と心筋・冠状動脈病変との対比から、MIの最小径はMS型とも径1cm、1cm未満を冠(状)不全と定義するのが妥当と結論できた。92例の死後冠(状)造影所見から、左室心筋内では2分分岐に加えて、中動脈から直接分枝するヒゲ根細枝が密に分布すること、拡張醐巴大心で心内膜下血管密度の増加、収縮・弛緩時に血管走行がラセン化・脱ラセン化する現象などが観察された。5例で肉眼的剥離法による心室の外斜走筋・中層輪状筋・内斜走筋の分離に成功、左室側壁の連続薄切標本から、肥厚・拡張に伴う改築所見を提示した。生理的老化心の特徴を明らかにする目的で正常血圧・正常心電図・非心疾患・有意の冠(状)硬化なしの20-59歳21例と60歳以上15例剖検心の計測値の比較により、加齢に伴う心室容積減少、心房拡大、弁輪拡大、弁尖肥厚がみられた。最後に著者の「心臓形態学」「心臓病理学」のメデカルエンクトロタイムス誌上連載記事の紹介を付記した。

After come home from Chicago to Japan at November 1966, the author restarted clinicopathological researches on the senile cardiovascular diseases in the Tokyo municipal Yoiku-in nursing home hospital. During 1 year and 8 months, analysis of 356 serial autopsy cases, revealed aging-specific pathophysiologies of various diseases, and made participated to publish 5 case-reports on infection and neoplasma in the aged, of which subjects were other than the main cardiovascular projects.In the senile cardiac diseases, myocardial infarction (MI) was classified as 52 cases of massive necrosis (M) type and 12 of scattered necrosis (S) type ; 28 anterior, 29 posterior and 8 extensive (ringform) subendocardial(Sub) MIs. The coronary lesions corresponded to the MIs, were occlusive thromboses to M type and stenotic sclerotic plaques to S and Sub type MIs. Favorable sites of the responsible lesions were proximal portions of 2 main coronary branches for large M type, intermediate portions for middle to small M type, severe proximal stenoses of 3 main branches for Sub type, and widely distributed moderate stenoses for S type MI. Cardiac rupture after MI was observed at left ventricle in 6, at ventricular septum in 4 cases (included 1 right venticular rupture), and characterized by super-fresh large M type MI, a female predominancy, preceeded hypertensionand zigzag perforation between fresh and old ischemic zones, except a case with traction rupture of small septal MI. In addition, author's apology and correction of errors in Paz bulletine 2002, 4(1) : 68-73 cardiac rupture article, was inserted here. Using serial 261 autopsy cases, a comparison study of clinical signs, electrocardiograms and myocardial pathology, was attempted to make the authors' criteria for minimal size of MI as lem in diameter and for coronary insufficiency as less than Icon. Postmortem coronary angiography of 92 cases, revealed myocardial vascularization with rich brush type arteriolar branches from bifurcate-branching middle size arteries, and the vascular plexus was increased in the subendocardial space of the hypertrophic hearts with dilatation. Orientation of the intramural arteries showed spiralization atsystolic phase and despiralization at diastolic phase. Macrodissection method applied to 5 cases, made identify the outer oblique, median circular and inner oblique layers of myocardium, and serial thin-sectioned specimens of the left ventricular lateral wall, demonstrated remodeling of the myocardial architecture associated with hypertrophy and dilatation.Measurement of the hearts with normotension, normal electrocardiogram, normal coro-nary arteries and non-cardiac disease, was attempted for study of physiological presbyocardia, using 21 cases aged 20-59 year-old and 15 cases over 60 year-old. Decrease of ventricular volume, enlargement of atrial volume, dilataion of valvular rings and increased valvular thickness seemed to be aging changes of the heart. Lastly, two series of author's articles on cardiac pathology and anatomy published in Medical Electronics Journal during '61-63 and '69-70, were presented as references for readers.

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