Takashi Takano

Effect of small deep hemispheric infarction on the ipsilateral cortical blood flow in man.

The effect of small, deep ischemic lesions on the ipsilateral cortical circulation was investigated in 10 patients with persistent mild or moderate neurological deficits due to infarcts in the internal capsule. rCBF studies by the 133Xe intracarotid injection method were performed 14-180 days after the onset of the infarction. The rCBF functional image was made up from the data of 133Xe dynamic images measured by an Anger-type gamma camera and the rCBF values were calculated by the initial slope method. The average value of mean rCBFs (mCBF) in 10 patients was 44.9 +/- 7.1 ml/100g/min (average PaCO2; 39.9 +/- 4.3 mm Hg). In the rCBF functional images, a focal hypoperfusion area was observed in all cases and localized around the central sulcus, especially in the precentral and central areas. Significant decreases of mCBF and the tendency to decrease of the rCBFs in the hypoperfusion focus were noted in the patients with the larger infarcts in comparison with those with the smaller ones. These results suggest that a small, deep ischemic lesion such as a capsular infarct may have remote effects on the ipsilateral cortical circulation, due probably to the damage of a number of fibers passing through the lesion.

Subclavian steal in Takayasu's arteritis. A hemodynamic study by means of ultrasonic Doppler flowmetry.

Blood flow in the vertebral artery and the upper extremity was studied in five cases of Takayasus arteritis with subclavian steal by use of ultrasonic Doppler flowmetry and finger plethysmography. The diagnosis of subclavian steal was made by observation of flow reversal in the vertebral artery on the subclavian steal side during grip exercise and, in addition, the vertebral flow change with brachial artery occlusion. The blood flow increase of both internal carotid and non-affected (non-subclavian steal side) vertebral arteries during a common carotid compression was almost normal in patients with Takayasus arteritis in this study. During carotid compression on the side of the subclavian steal, ipsilateral vertebral blood flow greatly decreased, and the amplitude of the ipsilateral finger plethysmogram decreased slightly or moderately. It is suggested that there are significantly important factors in suppressing symptoms of vertebrobasilar ischemia in these patients with Takayasus arteritis with subclavian steal. These factors are believed to be (1) good function of the circle of Willis, (2) good blood supply to the brain stem, and (3) collateral circulation to the distal subclavian artery not via the vertebral artery.

Role of prostacyclin in the response of cerebral blood flow to CO2

The prostacyclin (PGI2) formation in cerebral vessels, as reflected by the difference in concentration of internal carotid arterial and internal jugular venous radioimmunoassayed 6-keto-prostaglandin F1 alpha (6-keto-PGF1 alpha), was determined under normocapnic and hypercapnic conditions in 5 patients with mild cerebral thrombotic infarction. There was no evidence that endogenous PGI formation in cerebral vessels was stimulated at mild hypercapnia, while an increase of cerebral blood flow (CBF) induced by hypercapnia was observed. These results suggest that endogenous PGI2 may not be a mediator for the response of CBF to CO2.

An Application of Linear Discriminant Function for Survival and Mortality in Cerebral Hemorrhage

死亡率において最高位にある脳血管障害の予後, 特に生命予後を知ることは治療上からも重要なことである. 今日まで, ある程度経験的にある種の神経症状, たとえば意識障害, 発熱, 呼吸障害などが存在すると生命の危機があるといわれてきた. もちろん予後は病巣部位, 出血の広がり, 合併症などにより左右されるが, これらすべてを包含しての解析は不可能に近い. 本論文は, 脳出血発作当初の臨床症状, 臨床検査所見のうち比較的情報の得やすい項目を選び, そのなかから生死と関連深い項目を相関分析により抽出して, その項目をパラメーターとして脳出血発作後1ヵ月以内の生命予後に関する一次判別関数を導いたものである.対象は大阪大学医学部第一内科および関連病院に入院の脳出血患者63名 (男44, 女19) でそのうち死亡例は19名 (男13, 女6) で平均年令は61才であった.まず生命予後すなわち生存するか死亡するか, と関連があると一般に考えられる項目, すなわち年令, 意識障害, 嘔吐, 痙攣, 尿失禁, 瞳孔異常, 対光反射異常, 共同偏視, 病的反射, 呼吸障害, 尿蛋白, 尿糖, 脈拍, 体温, 収縮期および拡張期血圧, 血沈, 白血球数およびその分類のうち好中球比率の18項目をとりあげ症状については, 一度でもあれば“あり”とし0, 1式に数量化 (“あり”を1,“なし”を0) し, 連続量はそのままで, 生死との間で相関分析とX2検定を行なった.計算の結果生死と相関の高かった項目は, 意識障害, 尿失禁, 瞳孔異常, 対光反射異常, 脈拍, 体温, 血圧, 白血球数で, このうち特に尿失禁, 脈拍, 体温は0.1%の危険率で有意という高い相関性を示した. 次にこのうちの8項目をパラメーターとして脳出血の生命予後を判定する一次判別関数を導いた. この式の正診率は, Internal Sample で88.9%, External Sample で83.9%であった. この式は医師の主観を除外し客観的に簡単な項目で生死を判別し得るものであると考える.