著者
竹越 国夫 山之内 博 東儀 英夫 村上 元孝 亀山 正邦
出版者
一般社団法人 日本老年医学会
雑誌
日本老年医学会雑誌 (ISSN:03009173)
巻号頁・発行日
vol.13, no.6, pp.371-377, 1976-11-30 (Released:2009-11-24)
参考文献数
15

老年者の新鮮脳血管障害66例 (脳硬塞38例, 脳出血28例) 中, 41例にステロイドを使用し, 25例は対照群として, ステロイドの有効性を, 意識レベルの改善と生存を指標として検討した. 対象の年齢は, 平均76.2歳であった. 47剖検例については, 病巣部位, 病巣の大きさを確認した. ステロイドの使用方法について, 薬剤はプレドニゾロンが22例, デキサメサゾンが14例, その他5例であった. 薬剤の使用総量は, デキサメサゾン換算量で平均40.4mgであり, 一日最大使用量は, 平均10.0mgであった. ステロイドは, 発症後平均1.7日以内に使用開始し, 平均7.2日間使用した.結果は, 1) 脳硬塞において, 意識レベルの改善は, ステロイド使用群では23例中9例 (39%) にみられたのに対し, 対照群では15例中5例 (33%) にみられ, 両群間に有意の差は認められなかった. 4週生存率は, ステロイド使用群では70%であったのに対し, 対照群では80%であり, 両群間に有意の差は認められなかった. 入院時意識レベル別に検討した場合, 意識レベルの改善率と生存率において, ステロイド使用群と対照群の両群間に有意差は認められなかった.2) 脳出血において, 意識レベルの改善は, ステロイド使用群で18例中5例(27%)にみられたのに対し, 対照群では10例中1例 (10%) にみられ, 両群間に有意差は認められなかった. 4週生存率は, ステロイド使用群で56%であったのに対し, 対照群では10%であった. しかし, ステロイド使用群と対照群の間に, 意識レベルの条件が一致せず, 厳密に比較検討することはできなかった.3) ステロイドの副作用について, 消化管出血が, ステロイド使用群に3例, 対照群に1例みられ, 非ケトン性糖尿病性昏睡が, ステロイド使用群に1例みられた.
著者
松田 保 小河原 緑 平林 直子 関 俊子 横内 正利 村上 元孝 島田 馨 三船 順一郎
出版者
一般社団法人 日本血栓止血学会
雑誌
血液と脈管 (ISSN:03869717)
巻号頁・発行日
vol.9, no.2, pp.208-212, 1978

Recently, growing interests had been devoted largely to disseminated intravascular coagulation (DIC), because of its frequency and clinical importance. It has been known that shock is a frequent complication of DIC, although it has not been elucidated whether shock is a cause of DIC rather than a result. This study was made to clarify relationship between DIC and shock in 699 consecutive autopsied cases, almost all of whom was over age sixty, in Tokyo Metropolitan Geriatric Hospital.<br>The diagnosis of DIC was established when coagulation analysis revealed presence of consumption coagulopathy. Among these cases, 106 had evidences of DIC and 30 had clinical and pathological findings highly suggestive of DIC although the coagulation findings were not specific. Shock was complicated in 38 of the former and 10 of the latter.<br>Eight of these 48 patients with DIC complicated with shock revealed consumption coagulopathy simultaneously with the development of shock. 24 cases had not clea r-cut evidences of DIC immediately after the development of shock in coagulation findings, although they showed marked coagulation abnormalities indicating DIC after the shock developed. 44% of conditions associated with the shock in these patients was gram-negative septicaemia. The other underlying pathologic conditons in these cases consisted of cancer, peptic ulcer, acute myocardial infarction and pneumonia.<br>Onset of shock was observed in 16 cases in whom diagnosis of DIC had been already established by coagulation analysis. 11 cases of these had cancer with metastases, primary organs of which were stomach, colon or biliary tracts. 70% of these patients were febrile.<br>Acute renal failure, purpura, petechiae, melena, coma, epileptic seizure, systemic peripheral gangrene and/or red cell fragmentation in peripheral blood smear were main symptoms in DIC with shock. Four cases, excluding two cases in whom DIC developed following development of acute myocardial infarction, showed ECG findings indicating development of acute myocardial infartion, although myocardial infarction was evident in only one cases by postmortem examination.<br>Presence of fibrin thrombi was confirmed in 36 cases out of the 48 autopsied cases with DIC accompained with shock. Terminal hemorrhagic necrotizing enteropathy was observed in 15 of those cases. Hemorrhage from adrenal was observed in 4 cases.<br>From these results, it is concluded that shock does frequently cause DIC and that shock in gram-negative septicaemia is especially important because of its high incidence to result DIC.
著者
小竹 要 大江 国広 長谷田 恭子 吉野 公明 万見 新太郎 黒田 満彦 松田 保 竹田 亮祐 村上 元孝
出版者
一般社団法人 日本血液学会
雑誌
臨床血液 (ISSN:04851439)
巻号頁・発行日
vol.15, no.5, pp.487-494, 1974

Studies on platelet functions of 21 patients with renal insufficiency have been preformed. Platelet counts were significantly decreased in uremic patients, although severe thrombocytopenia less than 100&times;10<sup>3</sup> platelets/mm<sup>3</sup> was detected only in two patients. Platelet adhesiveness to glass was remarkably decreased in uremic patients. Platelet factor-3 availability was impaired in some of these patients, while platelet factor-3 activity was not decreased. Clot retraction was slightly defective in few patients. The significant correlation was not found between platelet adhesiveness and BUN, creatinine, uric acid or inorganic phosphate level in the serum of these patients. The abnormalities of platelet functions were partially corrected after dialysis.<br>In vitro, urea at high concentration showed an inhibitory effect on platelet aggregation. Guanidinosuccinic acid had less inhibitory effect on platelet aggregation, and creatinine had no inhibitory effect.
著者
山崎 義亀与 松田 保 黒田 満彦 内田 健三 嶋田 千恵子 大谷 逸子 村上 元孝 北川 正信
出版者
一般社団法人 日本血液学会
雑誌
臨床血液 (ISSN:04851439)
巻号頁・発行日
vol.14, no.1, pp.81-87, 1973

A 25-year-old male was admitted because of dark-red urine, jaundice and purpura. 5 days prior to admission, the patient noticed that the urine color became dark red, and purpuric rash and jaundice were noted by his wife.<br>Examination revealed scleral icterus, pallor, numerous petechiae and an ecchymosis. The sensorium was clear. The neurologic examination was normal.<br>The patient had hemolytic anemia, thrombocytopenic purpura, fever and proteinuria. Shortly after admission, fluctuating neurologic symptoms developed, and the patient was diagnosed as thrombotic thrombocytopenic purpura.<br>He was treated with prednisolone and heparin without benefits, and expired on the 14 th hospital day.<br>Hyaline thromboses of the vessels of liver and kidney were demonstrated by the examination of the specimens obtained by post mortem needle puncture.<br>Coagulation studies disclosed that partial thromboplastin time and prothrombin time were slightly prolonged, however, factor V activity and fibrinogen titre were not low. Fibrinogen degradation products determined by tanned red cell hemagglutination inhibition immunoassay were markedly increased, although euglobulin lysis time was not shortened.<br>Immunological analysis of serum proteins showed the increase of acute phase reactants, the decrease of &beta;<sub>1</sub>-AC and haptoglobin, and the appearance of fibrinogen degradation products.<br>These results were discussed in relation to the pathogenesis of the disease.
著者
村上 元孝 松田 保
出版者
大道学館出版部
雑誌
臨牀と研究 (ISSN:00214965)
巻号頁・発行日
vol.54, no.11, pp.p3506-3511, 1977-11
著者
松田 保 児玉 直子 秀野 啓子 小河原 緑 松崎 俊久 村上 元孝 山之内 博
出版者
一般社団法人 日本血栓止血学会
雑誌
血液と脈管 (ISSN:03869717)
巻号頁・発行日
vol.7, no.2, pp.146-150, 1976

Apparent blood viscosity was measured on freshly shed blood from 127 healthy subjects, ages 21 to 88, and patients hospitalized in Tokyo Metropolitan Yoikuin Geriatrics Hospital, over age 60. Determination of blood viscosity was performed at 37&deg;C using rotational viscometer at shear rates between 0.07 and 4.6sec<sup>-1</sup>.<br>Mean blood viscosity in 43 healthy older subjects over age 60 (mean age: 74&plusmn;6) was 45&plusmn;25cp at 0.07sec<sup>-1</sup> and 8&plusmn;2cp at 4.6sec<sup>-1</sup>, respectively. Yield stress was calculated from Casson plot at very low shear rates (between 0.44 and 0.07sec<sup>-1</sup>) by the method of least squares. Mean value of yield stress in the healthy older subjects was 0.011 dynes/cm<sup>2</sup>. Blood viscosity in the healthy subjects was significantly correlated with hematocrit values. Yield stress in these subjects was also correlated with hematocrit values and blood viscosity at very low shear rates. In these healthy subjects, blood viscosity, yield stress and hematocrit values were highest in the group at age 30-39. Blood viscosity and yield stress showed a slight decline with age in the healthy older subjects.<br>In the hospitalized patients, blood viscosity was higher than 70cp at 0.07sec<sup>-1</sup>, and/or higher than 11cp at 4.6sec<sup>-1</sup> in 107 measurements (86 cases) out of 1443 determinations from December 1973 to October 1974. These patients with blood high viscosity included 12 cases of cancer (one of them was accompanied with disseminated intravascular coagulation (DIC); three of them developed DIC thereafter), 5 cases of acute myocardial infarction, 4 cases of acute cerebral infarction, 5 cases of angina pectoris, 6 cases of old myocardial infarction, 18 cases of old cerebrovascular diseases, 11 cases of diabetes mellitus, and 5 cases of stress polycythemia or polycythemia vera. In these cases, viscosity at 4.6sec<sup>-1</sup> was significantly correlated with hematocrit values, whereas viscosity at 0.07sec<sup>-1</sup> was not. All patients with blood high viscosity and relatively low hematocrit values suffered from cancer. In 6 cases of acute myocardial, cerebral of renal infarction, in whom changes in blood viscosity, yield stress and hematocrits were investigated before and after the development of infarction, changes in blood viscosity and yield stress were parallel with hematocrits.<br>From these results, it was concluded that high hematocrits caused blood high viscosity and were regarded as one of the risk factors in the pathogenesis of thrombosis, although the other factors than hematocrits might also influence blood viscosity at very low shear rates.
著者
松田 保 村上 元孝
出版者
Japan Atherosclerosis Society
雑誌
動脈硬化 (ISSN:03862682)
巻号頁・発行日
vol.3, no.4, pp.447-455, 1976

Coagulability of blood was measured in 80 cases of acute myocardial infarction, 98 cases of acute cerebral infarction and 33 cases of acute cerebral hemorrhage. Platelet counts, activated partial thromboplastin times, prothrombin times, plasma fibrinogen content, levels of plasma antithrombin III, α<sub>2</sub>-macroglobulin and fibrin degradation products (FDP) determined within 1 month before the attack of myocardial infarction or stroke, and those measured within 48 hours or 3 to 7 days following the onset of these diseases were compared with data obtained from 370 healthy subjects over age sixty.<br>Concentrations of plasma antithrombin III were apparently decreased before and after the development of myocardial infarction. In ten autopsied patients with acute myocardial infarction, three cases with extremely low levels of plasma antithrombin III (less than 2 mg/d<i>l</i>) were complicated with disseminated intravascular coagulation (DIC), acute cerebral infarction and/or thromboembolism of lower extremities, while no thromboembolic episodes following myocardial infarction were observed in the other seven cases in whom plasma antithrombin III concentrations were more than 20mg/d<i>l</i>. Levels of the other thrombin inhibitor in plasma than antithrombin III, i. e. α<sub>2</sub>-macroglobulin, were increased immediately after the occurrence of cerebral hemorrhage. Plasma fibrinogen content was markedly increased after the development of myocardial infarction or cerebrovascular diseases. Activated partial thromboplastin times, prothrombin times and FDP did not significantly change before and after the development of these diseases. These data suggest that there may be a relation between development of myocardial infarction and the low levels of plasma antithrombin III. Increased levels of plasma fibrinogen, as a result of myocardial infarction or stroke, may not accelerate coagulation mechanism but act disadvantageously by elevating blood viscosity.<br>Relationship between activated partial thromboplastin times, prothrombin times, plasma fibrinogen content, levels of plasma antithrombin III, α<sub>2</sub>-niacroglobulin or FDP, determined within 1 month before death, and grade of atherosclerosis of aorta, cerebral, coronary or femoral artery, classified grossly with the naked eye, was investigated in 186 autopsied cases without cancer or DIC, retrospectively. There were no correlations between these parameters and the grade of atherosclerosis, except that levels of FDP were significantly increased in cases with severe atherosclerosis of femoral artery. From these results, direct evidences supporting thrombogenic hypothesis of atherosclerosis suggested by Duguid were not obtained. However, atherosclerotic lesion of peripheral artery may activate clotting processes and increase FDP.
著者
山之内 博 東儀 英夫 亀山 正邦 村上 元孝 松田 保
出版者
一般社団法人 日本老年医学会
雑誌
日本老年医学会雑誌 (ISSN:03009173)
巻号頁・発行日
vol.13, no.4, pp.207-214, 1976
被引用文献数
2

脳卒中発症前後のヘマトクリット (Hct) 値, ヘモグロビン (Hb) 値, 赤血球 (RBC) 数, 血清総蛋白 (TP) 値の変動について検討し, これらの値の変動と脳硬塞および頭蓋内出血発症との関係について考察することを目的に本研究を行なった.<br>対象は60歳以上の脳卒中例のうち, 急死あるいはこの研究の為の検査が不充分な症例を除外し, かつ剖検によって病変を確認しえた脳硬塞21例, 頭蓋内出血16例, 計37例である. Hct, Hb, RBC, TP値の測定は自動測定装置によった. 発症前値については発症4日以内 (直前値) と5日以上の値に分けて検討した.<br>結果; 1) 脳硬塞においては, Hct 値は発症前値 (37.2±3.3%) に比し, 発症日の値 (38.9±3.0%) は高かった. Hb, RBC, TP値についても同様の結果が得られた. しかし, 頭蓋内出血においては, 発症日における Hct, Hb, RBC, TP値は発症前値に比し, やや高い傾向がみられたが有意の差は認められなかった. 以上の結果より, 急激な Hct 値の上昇と脳硬塞の発症との間に何らかの関係が存在する可能性が推定された. 2) 脳硬塞では頭蓋内出血群に比し, Hct, Hb, RBC値が発症前, 発症日ともに有意の高値であった. しかし, TP値には両者で差が認められなかった. 脳硬塞発症前の Hct 値は同年代の対照群に比し有意の差が認められなかった. 3) 脳硬塞, 頭蓋内出血ともに Hct, Hb, RBC値は, 発症後数日間漸増する傾向がみられた. しかし,TP値は両者とも発症後急速に低下した.
著者
村上 元孝 松田 保 恩地 一彰 万見 新太郎 梅田 俊彦 西野 哲夫 平丸 三樹 高瀬 雅子 横山 鉄夫
出版者
一般社団法人 日本血液学会
雑誌
臨床血液 (ISSN:04851439)
巻号頁・発行日
vol.11, no.3, pp.388-396, 1970

Two families of congenital factor VII deficiency were described.<br>The propositus of the first family was 35-year-old female, who was admitted for anemia. Spontaneous epistaxis, limited to her youth, was main hemorrhagic symptom. The patient delivered two normal children without unusual bleeding. On admission, the physical examination revealed no abnormalities except for the presence of iron deficiency anemia. Results of liver function tests were normal. Coagulation data confirmed the diagnosis of pure factor VII deficiency. Her factor VII complex level was 5% of normal and factor X level was 100%. There was no history of bleeding in her family. However, her daughter was discovered to have factor VII deficiency. Her factor VII complex level was 27% and factor X level was 75%. Factor VII levels of father, three half siblings, husband and son of the propositus were within normal limits.<br>The propositus of the second family was 25-year-old female, who was admitted complaining of spontaneous nose bleeding, gum bleeding, subcutaneous hemorrhage and menorrhagia. The patient was hospitalized for right oophorectomy at the age af 22. The hematoma in the right ovary was found, however, no unusual bleeding was noted either during surgery or in the postoperative period. On admission, she appeared healthy except for a few ecchymoses. Liver function chemistries were normal. Laboratory data demonstrated factor VII deficiency with increased vascular fragility. Her factor VII complex level was 17% and factor X level was 80%. Mixture of this patient's plasma with that of the propositus of the first family did not result in shortening of the long one-stage prothrombin time, proving an identical deficiency in these patients. The family history revealed that the patient's paternal grandfather were siblings. One brother of the propositus, his daughter and grandmother on the father's side of the porpositus had bleeding tendency. Neither of her parents nor any other family members had any bleeding episodes. Coagulation studies on the brother of the propositus revealed that he had factor VII deficiency. His factor VII complex level was 12% and factor X level was 105%. Factor VII level of the other family members could not be measured.
著者
蔵本 築 松下 哲 三船 順一郎 坂井 誠 村上 元孝
出版者
一般社団法人 日本老年医学会
雑誌
日本老年医学会雑誌 (ISSN:03009173)
巻号頁・発行日
vol.14, no.2, pp.115-120, 1977-03-30 (Released:2009-11-24)
参考文献数
12
被引用文献数
1

老年者肺炎12例に於て肺炎と同時または稍遅れて前壁中隔硬塞を思わせる心電図変化を認めた. すなわちV1-V3, V4のQSまたはrの減高, ST上昇, 冠性Tが出現し, 肺炎の軽快と共に異常Qは約一週間, 陰性Tは1カ月以内に正常化し, その後剖検し得た8例にはいずれも前壁中隔硬塞を認めなかった. 臨床所見では狭心痛はなく, 呼吸困難, 咳痰, チアノーゼ, 意識障害等が見られ, 肺炎は2葉以上にわたる広範な病巣を示し, 胸膜癒着または胸水を伴った. 検査所見ではGOTの軽度上昇を4例に認めたにすぎず, BUNの一過性上昇, CRP強陽性, PO2低下と共にヘマトクリットは全例4~9%の著明な上昇を示した.剖検し得た8例では肺気腫を6例, 気管支炎を7例に, 剖検時肺炎を6例に認めた. 陳旧性後壁硬塞及び後壁心外膜下出血を各1例に認めた. 左冠動脈前下行枝の50%以上狭窄を7例に認め, 心筋小胼胝を5例に認めた.急性心筋硬塞様心電図の発現機序として慢性肺疾患によるQRS軸の後方偏位, 肺炎に伴う急性右心負荷, hypoxia, 中等度の冠硬化などの上にヘマトクリット, 血液粘度の上昇等が加わって心筋に広範な一過性虚血性変化を来たすものと考えた.