Moriyuki Takeshita

Cerebral and aortic atherosclerosis in Hisayama, Japan

This study of autopsy cases in the general population of the town, Hisayama, describes the incidence and severity of aortic and cerebral atherosclerosis in Japan. Atherosclerosis was more severe in the aorta than in the cerebral arteries of all age groups and its disparity became more conspicuous with age. In hypertensive cases, atherosclerosis was more severe in both the aorta and the cerebral arteries from and beyond the 6th decade of age. The severity of atherosclerosis in the aorta in those with systolic hypertension was lower under the age of 79 and higher after the age of 80 than in diastolic hypertension; the cerebral arteries were afflicted similarly by the two forms of hypertension. The serum cholesterol level correlated better with the severity of aortic than cerebral atherosclerosis.

Epidemiological and clinico-pathological study on renal diseases observed in the autopsy cases in Hisayama population, Kyushu Island, Japan

Abstract As part of the population study in Hisayama, frequency and type of renal disease was studied. The materials consisted of 270 autopsy cases, 81.2% of total deaths occurring during the period of 10 yr from 1961 to 1971 among 1621 subjects, covering approximately 90% of the total population aged 40 and over at entry. According to standardized criteria for the estimation of renal vascular changes, nephrosclerosis was observed with the highest frequency (34.1%), followed by interstitial nephritis (4.8%), renal infarcts (4.4%) and diabetic nephrosclerosis (3.7%) of total autopsy cases. No case was found to have glomerulonephritis or malignant nephrosclerosis. Death is directly attributed to renal disease in 2.2% of the cases. Glomerular scarring became prominent with increasing age accompanying a reduction in kidney weight, and was more marked in hypertensive than normotensive subjects at each decade of age. Arteriolar nephrosclerosis developed with high frequency (70.5%) in diastolic hypertensive persons aged below 70 and 50.0% in those aged over 70. Arterial nephrosclerosis was in general less frequently found than arteriolar nephrosclerosis except for the cases aged over 70. In 35 autopsies with diabetes mellitus, diabetic glomerular lesions (nodular or diffuse form) were frequently found (28.6%), although most of them had only slight abnormality in glucose tolerance test. Glomerular scarring and arteriolar hyalinization, however, were almost uniformly found in diabetic kidneys.

The relationship of serum uric acid to hypertension and ischemic heart disease in Hisayama population, Japan.

The association of serum uric acid (SUA) with hypertension, ischemic ECG change, diabetes mellitus, and drinking and smoking habits was studied by multivariate analysis among 1871 residents aged 40 and over in Hisayama, Japan. Blood pressure level and history of hypertension did not correlate with an increased level of SUA when other factors such as serum creatinine, obesity, beta-lipoprotein and leucineaminopeptidase were taken into account. Antihypertensive medication was a significant factor influencing SUA. The association of SUA with Minnesota code 4.1-3 (S-T depression) was insignificant in men and significant in women when other factors influencing SUA were taken into account. Glycosuria was negatively correlated with SUA, while alcohol ingestion has positive correlation. There was no correlation between the amount of tobacco smoked and the level of SUA.

Factors influencing the serum uric acid level. A study based on a population survey in Hisayama town, Kyushu, Japan.

Abstract Correlation of serum uric acid (SUA) with various biological variables was studied by using multivariate analysis among 2008 residents aged 40 and over in Hisayama, Japan. Sex was the most important factor influencing SUA, accounting for approximately one fourth of the total variations of SUA. The common factors influencing SUA in either sex were serum creatinine, obesity, leucineaminopeptidase and beta-lipoprotein. In addition, the menopause was also an important factor for females.

Long-term changes in blood pressure prior to the development of cerebral infarction—The Hisayama study☆

Abstract Long-term changes in blood pressure were studied to determine the relationship to hypertensive clinical manifestations, and to cerebral infarction. In the prospective cohort study in Hisayama, Japan, the initial 4yr were assigned for assessment of changes in blood pressure. During the subsequent 9 yr from 1965, cerebral infarction developed in 71 (44 men, 27 women) among 1181 subjects, 44-years old or older and fatalities were verified by autopsy. Blood pressure elevation to the hypertensive range contributed to the complications manifested by changes in ocular fundi and/or ECG, and increased the risk of cerebral infarction. However, in the women, a systolic blood pressure decrease greater than the mean − 1 SD, cerebral infarction developed more frequently than in those whose systolic blood pressure remained within mean ± 1 SD. Results of the multiple regression analysis indicated that blood pressure in women prior to cerebral infarction may cover a range of variability.

Clinicopathological study of the heart and coronary arteries of autopsied cases from the community of Hisayama during a 10 yr period—I. Ischemic myocardial lesions☆

Abstract A clinicopathological study of myocardial infarction was made in a Japanese community with autopsy rate of approximately 82% during 10 yr (from 1 November 1961 to 31 October 1971). Myocardial infarct (1 cm or more in 1 dimension) was found in 12.4 and 10.8% of 193 males and 167 females, aged 20 yr or over, respectively. Frequency of myocardial infarct among the autopsied cases remained almost constant in the 6th through 9th decade of life in both sexes. Approximately one half of the larger infarcts (5 cm or more in 1 dimension) and all of the smaller infarcts were found initially by postmortem examination. Unequivocal cardiac pain was found in one half of the patients with larger infarcts. Approximately one fourth of the larger infarcts and more than one half of the smaller infarcts were asymptomatic. This emphasizes the importance of close follow-up of cohorts in the epidemiological study of coronary heart disease.

Clinicopathological study of the heart and coronary arteries of autopsied cases from the community of Hisayama during a 10-year period. Part IV. QS waves in the precordial leads

During a ten-year period, from November 1, 1961, to October 31, 1971, 339 residents aged 40 years or over at death were nonselectively autopsied in a Japanese community, Hisayama town (mean autopsy rate: 84%). One or more standard 12-lead ECGs plus V4R and V7 electrocardiograms taken at periodic medical examinations were available for 308 of them. In 46 persons, QS waves were localized in one or more leads from V1 to V4. By transverse sectioning of the hearts, old myocardial infarction extending into the interventricular septum was found in nine of these 46 persons. Frequency of myocardial infarction cases in each category for QS localization was as follows: Lead V1 to V4, three of three; Leads V1 to V3, six of nine; Leads V1 and V2, three of 15; Leads V2 and V3, none of two; Lead V3, none of one; Lead V2, one of eight; and Lead V1, one of 25.

Clinicopathological study of the heart and coronary arteries of autopsied cases from the community of Hisayama during a 10 yr period—III. Heart weight☆

Abstract A clinicopathological study on heart weight was performed on 360 unselected, consecutive autopsied cases, aged 20 yr or over, obtained in a selective Japanese community with autopsy rate of approximately 82% of adult deaths. Body weight at the time of death, and deviation ratio of actual body weight from standard body weight, i.e. (actual body weight—standard body weight) × 100/standard body weight, decreased with increasing age. Heart weight declined with decreasing body weight and with decreasing relative body weight in the normotensive ( 139 89 mmHg or less) and hypertensive ( 160 95 mmHg or more) men and in the hypertensive women. This suggests that heart weight is a poor indicator for previous hypertension in the presence of emaciation. Median heart weight was significantly larger in males with systolic blood pressure of 180 mmHg or more than in those without, in the range of deviation ratio of between −10 and +10%. Men had heavier hearts than women.

Clinicopathological study of the heart and coronary arteries of autopsied cases from the community of Hisayama during a 10 yr period--II. Relationship between coronary atherosclerosis and blood pressure.

Abstract A clinicopathological study of coronary atherosclerosis was performed on adult autopsied cases of a Japanese community (about 7000 population) with autopsy rate of approximately 82%. Grading of atherosclerosis of the coronary artery was made by the degree of luminal stenosis. Atherosclerosis was found in the left anterior descending branch, in the right coronary artery, and in the left circumflex branch in decreasing order of severity. This trend was significant for females and also when both sexes were combined. The frequency of cases, where at least one of the three major coronary branches had luminal stenosis of 50% or more, increased significantly with age in both sexes, and was higher in males than in females in all 10 yr age groups of 40–99. Coronary atherosclerosis showed closer correlation to systolic blood pressure than to diastolic blood pressure.

AN EVALUATION OF GASTRIC CANCER SCREENING PROGRAM IN HISAYANA, JAPAN

SummaryGastric cancer screening was conducted on a cohort of 1,553 subjects aged 40 and over as of 1961 in Hisayama, Japan for 12 years from 1964 to 1975. One thousand one hundred and fifteen out of 1,553 subjects or 71.8% of the cohort were examined at least once. Sixty cases of gastric cancer were detected in the cohort; 24 cases (40.0%) by screening, 20 (33.3%) by clinics and 16 (26.7%) by autopsy. The incidence rate of gastric cancer of the cohort was calculated at 540.5 per 100,000 person years for males and 243.5 for females, respectively. The death rate of gastric cancer in the screened population was lower than that in the unscreened population, but the difference was not statistically significant.To further evaluate the screening program, persons dying from gastric cancer were compared for participation or non participation in the screening program. The risk of death from gastric cancer in the screened cases was compared with that in the unscreened cases using the Mantel Haenszel method for adjusting sex, age and the date of detection. It was found that the risk of death from gastric cancer among the screened cases was significantly lower than that in the unscreened cases (P=0.009). The risk ratio was calculated at 0.031. The results suggest that the gastric cancer screening program was effective in the community. Target population in terms of age for the screening was discussed in the paper.