Fujio Terasawa

Studies on the control of coronary circulation Part I. The effect of the stimulation of the nerves on the coronary circulation. Part II. The humoral effect on the coronary circulation

Abstract 1. 1. A study was made of the coronary vasodilatative effects of coronary venous blood samples obtained following the stimulation of the sympathetic and vagal nerves, and of norepinephrine, acetylcholine, and ATP. 2. 2. In the coronary venous blood samples, obtained either during or 15 seconds after the stimulation of the sympathetic nerves, some vasodilatative substances were demonstrated. They may play one of the important roles in sympathetic coronary vasodilatation. The exact nature of the vasodilatative substances are unknown, but they may be the metabolites released following the sympathetic stimulation. 3. 3. The coronary vasodilatative effect of norepinephrine differs in nature from that of acetylcholine, ATP, and effective coronary venous blood. It may result mainly from hemodynamic and metabolic action due to the modification of the heart. The action of norepinephrine on coronary vessels seems to be identical with that of the sympathetic nerves.

Pericardial Lesions in the Elderly Patients An Autopsy Study

老年者の心包疾患を調査する目的で, 浴風会病院の連続剖検例1000例 (男345例, 女655例, 平均年齢79.4歳) について心包病変を検索し, 臨床症状, 検査成績, 他臓器病理所見との対比を行ない, 次のごとき結果を得た.1. 心包病変は79例に認められ, その内訳は頻度順に, 心包液貯留 (100cc以上, 急性および慢性心包炎各1例を含む) 35例, 心包癒着16例, 心包血腫16例, 悪性心包炎5例, 急性心包炎4例, 心外膜下血腫3例, 慢性心包炎2例であった.2. 心包液貯留例のうち20例は片側200cc以上の胸水貯留を, 27例は全身性浮腫を伴っていた. また32例に心不全あるいは低アルブミン血症があり, この両者が心包液貯留の主な原因と考えられた.3. 心包癒着例のうち3例は結核性心包炎が, 2例は心筋梗塞に伴う心包炎が癒着の原因であった. 残りの11例中9例でも, 同時に広範な胸膜癒着が認められ, 結核性心包炎が原因であった可能性が示唆された. 心包の石灰化は2例にみられたが, 収縮性心包炎は1例もなかった.4. 悪性心包炎はいずれも肺癌, 乳癌あるいは結腸癌の浸潤または転移により生じ, 急性心包炎は全身性または胸腔内の細菌感染症の合併症であった.5. 心包血腫は11例が心筋梗塞後の心破裂, 5例が大動脈瘤の心包内破裂によるものであった. 心破裂の男性例は, 陳旧性心室瘤部で破裂した1例のみであり, 新鮮心筋梗塞後の心破裂10例は全例女性であった. これは剖検時確認された女性の新鮮心筋梗塞計35例の28.6%にあたり, 従来の報告に比し高頻度であった.以上のように, 老年者の心包病変は, 心筋梗塞, 心不全, 感染症などに続発するものが多いこと, また老年女性の心筋梗塞は, 心破裂の危険が大きいことが示された.

Effect of Blood Pressure and Coronary Stenosis on Cardiac Hypertrophy

冠動脈狭窄・心筋虚血が心肥大発生の重要な因子となりうるか否かについて検討するため, 老年者連続剖検例418例の心剖検所見を分析した.当然予想されるように, 生前の血圧と心肥大との間には密接な関係があり, 最大血圧180mmHg以上または最小血圧100mmHg以上の群では心肥大を呈するものが過半数を占め, 心重量/身長比が2.0を越えるものは, それぞれ54.8%, 56.6%であった. また, 心筋に著明な虚血性病変のみられたものでは, 冠動脈狭窄度, 血圧値に関係なく心肥大例が多くみられた.これに反し, 心筋病変の著明なものをのぞくと, 冠動脈狭窄度と心肥大との関係は明らかではなく, 内腔面積の狭窄が75%以上の高度狭窄が2枝以上に存在するものにおいても心重量/身長比が2.0を越えるものは45.5%であり, この値と有意な冠狭窄のないものにおける33.7%との間には有意な差は認められなかった.以上の所見から, 冠動脈狭窄・心筋虚血は, 心筋に著明な病変を生じないかぎり心肥大成立の一義的な因子とは考えがたいと結論した. ただし, 高度高血圧例のみを取上げると, 高度冠硬化例に心肥大の多い傾向が認められており, 高度高血圧の存在下においては, 冠硬化の合併が心肥大の付加的因子となる可能性も否定できない.

Seven Cases of Anisocoria Observed in Cardiac Patients : One of the Autonomic Manifestations from the Heart

It has been said that anisocoria had been rarely observed in cardiac disease, although it had been frequently found in pulmonary disease. Anisocoria associated with angina pectoris is expected to be one of the important objective findings which represent the irritation of afferent cardiac nerve. Seven cases of cardiac patients associated with anisocoria are described in this paper. Case Number 1 was a 32 year old man diagnosed as combined valvular disease caused by the acute rheumatic fever. Two years before admission he complained of anginal pain or precordial discomfort frequently. At the time of admission he was in the state of congestive heart failure. But neither anginal attack nor anisocoria was observed. Serum examination of syphilis was negative. After the administration of digitalis and diuretics the sign of congestive heart failure improved. Thirtyfive days after the admission he complained of severe anginal pain, which radiated to the left shoulder. Precordial discomfort continued for the following two days. About 12 hours after the attack anisocoria was perceived. Besides the dilation of the left pupil, no other abnormal neurological findings were observed. Three days later anisocoria disappeared. This careful observation demonstrated a certain relationship between anginal pain and anisocoria. Dilation of the left pupil seemed to be resulted from the stimulation of the left cervical sympathetic fibers which might be irritated reflexly by the impulse from the afferent cardiac nerve. Anisocoria was also observed in case of acute attacks or anginal stages of other six cases who had myocardial infarction.