Yuichi Hiyoshi

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.

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.

Clinico-pathological Study on Benign Nephrosclerosis Observed in the Autopsy Cases in Hisayama Study

昭和36年より46年までの満10年間における久山町追跡対象者剖検例222例を用いて, 腎硬化性病変を臨床病理学的に検討し, 次の結果を得た.1) 腎硬化性病変のうち, 腎重量, 糸球体虚血性変化の程度, 中小動脈狭窄度は, 加齢に伴い増強または減少し, しかも各年代においては高血圧群の方が強かった. 一方細動脈狭窄度およぶ硝子様肥厚の程度は, 加齢との関係が明らかでなく, 高血圧群の方が著明に強かった.2) 細動脈硬化性腎硬化は年齢に関係なく, 常に拡張期性高血圧群に多発していたが, 動脈硬化性腎硬化は,むしろ血圧に関係なく高年齢層に多発する傾向にあった. また高血圧が持続する群に腎硬化症は高い発現頻度を示した.3) 久山町糖尿病剖検例の大多数は latent chemical D. M. であった. 35例の剖検例のうち著明な糖尿病性腎硬化症は4例に過ぎなかった. しかし糸球体虚血性変化の程度および細動脈硝子様肥厚の程度は, 対照群に比べて糖尿病群が有意に高度であった.4) 久山町追跡対象者にみられた間歇的蛋白尿の頻度は, 加齢に伴い増加し, また高血圧群の方が高かった. 剖検例のうちでは腎硬化性病変を有する例において, 間歇的蛋白尿の頻度が高かった. 持続的蛋白尿の頻度は, 腎硬化性病変を有する例でも糖尿病群のみに有意に高かった.5) 細動脈硬化性腎硬化例の予後は, 合併する脳血管性障害, とくに脳出血により左右された. しかし腎硬化にもとづく腎不全死亡例はなかった.以上より老年者における腎硬化性病変の成立には, 加齢, 高血圧の他に軽度耐糖能異常の関与も無視できないと考えられた.

Classification and Incidence of Renal Diseases in the Old

昭和36年11月から46年10月までの満10年間における福岡県久山町全剖検例377例と, 昭和44年度日本病理剖検輯報所載の23,904例中, 腎に病変がみられた4,009例とを対象として, とくに老年者腎疾患の頻度を検討し以下の結論を得た.1) 久山町剖検例では腎硬化症 (細動脈硬化性, 動脈硬化性) が高頻度にみられ, ついで間質性腎炎 (腎盂腎炎を含む) が多かった. 剖検輯報例では間質性腎炎, 腎硬化症, 糸球体腎炎の順序で多くみられた.2) 久山町剖検例では腎主病変の頻度は1.6%で, 原疾患は間質性腎炎, 水腎症, のう胞腎であった. 糸球体腎炎は1例もみられなかった. 剖検輯報例における尿毒症の頻度は1.3～4.2%で, 若年者層では糸球体腎炎による頻度が高いが, 高年齢層では間質性腎炎, 水腎症によるものが増加した.3) 腎硬化症は, 久山町剖検例でも剖検輯報例でも, 高齢者になるほどその頻度は増加し, 老年者の主要な腎病変と考えられた. しかし悪性腎硬化は久山町剖検例では1例も認められず, 剖検輯報例では高齢者群で著減していた.4) 腎孟腎炎を含む間質性腎炎および水腎症は, 年齢を問わず高頻度に認められる腎疾患であったが, 尿路閉塞に伴う上行性感染は, 久山町剖検例でも剖検輯報例でも若年者層に多く, 高齢者では種々の疾患に合併していた.5) 久山町剖検例では, 高齢者に腎硬塞が多くみられたが, その原因として動脈硬化性疾患によるものが多かった. 剖検輯報例でも高齢者では, 動脈硬化性疾患に合併する腎硬塞の頻度が高く, 若年者層では心膜炎に合併する頻度が高かった.