The prevalence of ulcerated plaques in the aortic arch in patients with stroke.

BACKGROUND AND METHODS. The cause of cerebral infarction is obscure in up to 40 percent of patients with this disorder who are studied prospectively. In this investigation, we determined the frequency of ulcerated plaques in the aortic arch and explored the part they may play in the formation of cerebral emboli. Using an autopsy data bank, we studied the prevalence of ulcerated plaques in the aortic arch in 500 consecutive patients with cerebrovascular and other neurologic diseases who were studied at autopsy. RESULTS. Ulcerated plaques were present in 26 percent of the 239 patients with cerebrovascular disease but in only 5 percent of the 261 patients with other neurologic diseases (P less than 0.001). After we controlled for age and heart weight, the adjusted rates were 16.9 percent and 5.1 percent, respectively (adjusted odds ratio, 4.0; 95 percent confidence interval, 2.1 to 7.8; P less than 0.001). Among the patients with cerebrovascular disease, the prevalence of ulcerated plaques in the aortic arch was 28 percent in the 183 patients with cerebral infarcts and 20 percent in the 56 patients with brain hemorrhage. The prevalence of ulcerated plaques was 61 percent among the 28 patients with no known cause of cerebral infarction, as compared with 22 percent among the 155 patients with a known cause of cerebral infarction (P less than 0.001). After adjustment for covariates, the prevalence was 57.8 percent among patients with no known cause of cerebral infarction and 20.2 percent among those with a known cause (adjusted odds ratio, 5.7; 95 percent confidence interval, 2.4 to 13.6; P less than 0.001). The presence of ulcerated plaques in the aortic arch was not correlated with the presence of extracranial internal-carotid artery stenosis, suggesting that these were two independent risk factors for stroke. CONCLUSIONS. Ulcerated plaques in the aortic arch may play a part in causing cerebral infarction, especially in patients in whom cerebral infarction has no known cause.     

急性脑血管病外周血小板上CD59的表达

目的探讨脑血管病急性期外周血血小板上攻膜复合体抵制因子(CD59)表达的变化。方法应用流式细胞仪检测急性脑血管病患者外周血血小板上CD59,观察脑梗死、脑出血患者与正常对照组的变化。结果脑梗死患者急性期外周血血小板上CD59表达明显降低,脑出血患者与正常对照无明显变化。结论急性脑梗死时,患者血小板活化,其膜表面糖蛋白CD59表达降低。     

Neuropathology of cerebrovascular diseases

Cerebrovascular diseases cause significant global economic burden to the healthcare systems, stroke being the third leading cause of death in the developed world. With the advent of newer imaging techniques, the majority of common cerebrovascular diseases are accurately diagnosed in life, but in some cases the precise aetiology of stroke is only determined after post-mortem examination. This review discusses the basic cerebrovascular anatomy, pathology of cerebral ischaemia/infarction and haemorrhage, various causes for cerebrovascular disease and lastly, an approach to post-mortem examination in a cerebrovascular death.     

Clinical Effects of Hypertension on the Mortality of Patients with Acute Myocardial Infarction

The incidence of ischemic heart disease has been increased rapidly in Korea. However, the clinical effects of antecedent hypertension on acute myocardial infarction have not been identified. We assessed the relationship between antecedent hypertension and clinical outcomes in 7,784 patients with acute myocardial infarction in the Korea Acute Myocardial Infarction Registry during one-year follow-up. Diabetes mellitus, hyperlipidemia, cerebrovascular disease, heart failure, and peripheral artery disease were more prevalent in hypertensives (n=3,775) than nonhypertensives (n=4,009). During hospitalization, hypertensive patients suffered from acute renal failure, shock, and cerebrovascular event more frequently than in nonhypertensives. During follow-up of one-year, the incidence of major adverse cardiac events was higher in hypertensives. In multi-variate adjustment, old age, Killip class ≥III, left ventricular ejection fraction <45%, systolic blood pressure <90 mmHg on admission, post procedural TIMI flow grade ≤2, female sex, and history of hypertension were independent predictors for in-hospital mortality. However antecedent hypertension was not significantly associated with one-year mortality. Hypertension at the time of acute myocardial infarction is associated with an increased rate of in-hospital mortality.     

同型半胱氨酸与动脉粥样硬化患者血管内皮细胞损伤相关性

目的 探讨动脉粥样硬化患者高同型半胱氨酸水平与血管内皮细胞损伤相关性.方法 循环酶法检测心肌梗死和脑梗死患者血清Hcy水平,ELISA法检测其ET-1、TM和vWF,对各组Hcy和血管内皮细胞损伤指标分别进行相关分析.结果 排除常见危险因素的差异后,心肌梗死组和脑梗死组分别与对照组相比较,血清Hcy、ET-1、TM和vWF水平均显著升高,差异均有统计学意义(P＜0.05).心肌梗死组和脑梗死组血清Hcy、ET-l、TM和vWF水平无统计学差异(P＞0.05).心肌梗死组和脑梗死组患者血清Hcy水平与ET-1、TM和vWF水平均呈明显相关性(P＜0.05).结论 动脉粥样硬化患者Hcy水平与血管内皮细胞损伤标志物ET-1、TM和vWF水平均显著相关,高同型半胱氨酸血症可能通过介导机体血管内皮细胞的损伤参与了动脉粥样硬化性心脑血管疾病的发生发展.     

Cardiac disorders predisposing to development of cerebrovascular diseases in the Japanese. Data obtained at autopsy

For a clear definition of the influence of cardiac disorders on the development of cerebrovascular diseases in the Japanese, we reviewed 1,162 consecutive autopsy records aged 20 years and over in the Department of Pathology, Kyushu University, Japan. All autopsies had been done between Nov. 1971 and Oct. 1981. Cerebral infarction was found in 101 out of 196 with any type of cardiac disorder. Frequencies of cerebral infarction in those with myocardial infarction, rheumatic heart disease, non-bacterial thromboendocarditis, and atrial fibrillation were higher than in those with no heart disease. These differences can be ascribed to the higher incidence of large and medium-sized cerebral infarction, including many cases of cerebral embolism originating from the heart. Only 3.4% of those with small cerebral infarction were assessed to be cases of embolism. Non-embolic cerebral infarction was more frequently noted in those with myocardial infarction and atrial fibrillation than in those with no heart disease. These differences were probably linked to concomitant progression of arteriosclerosis of the cerebral and coronary arteries. In this consecutive autopsy study, cerebral embolism was found in 35 cases, 10.9% of the total number of those with cerebral infarction.     

脑梗死相关蛋白与ACI患者脑血管狭窄程度的多因素分析

目的研究脑梗死相关蛋白在评估急性脑梗死（ACI）患者脑血管狭窄程度中的作用。方法选取2010—2012年在珠江医院因ACI住院的患者,选取脑动脉造影结果狭窄程度〉70％及闭塞者为试验组（n=29）,≤70％者及正常者为对照组（n=23）。检测所有患者外周血脑梗死相关蛋白含量。结果试验组患者超敏C反应蛋白（hs—CRP）、血栓前体蛋白（TpP）、脂蛋白α（Lpα）外周血中含量分别为（3．51±2．25）mg／L、（1797．08±162．35）μg／L、（363．81±218．34）mg／L,均较对照组明显升高,差异有统计学意义（P〈0．05）。D-二聚体（DDI）、纤维蛋白原（Fg）、血小板凝聚因子（vWF）的含量无明显变化。hs-CRP（P=0．029,OR=2．232）、TpP（P=0．032,OR=1．014）、Los（P=0．024,OR=1．009）与脑大动脉粥样硬化病变导致的脑血管狭窄程度相关,DDI（P=0．671）、Fg（P=O．248）、vWF（P=0．090）与脑血管的狭窄程度相关性不明显。高血压（P=0．029,OR=4．582）是脑血管狭窄的危险因素。结论hs—CRP、TpP、Lpα、高血压是脑大动脉粥样硬化病变导致的ACI患者脑血管重度狭窄的危险因素,血清中hs．CRP、TpP、Lpα含量升高同时伴有高血压的ACI患者脑血管重度狭窄的可能性增大。     

661例脑血管疾病的TCD、脑电图、脑电地形图观察

本文对经CT证实为脑梗塞、脑溢血和TCD诊断为脑动脉硬化、椎—基底动脉供血不足以及大脑前、中、后动脉供血不足的661例脑血管疾病进行脑电图、脑电地形图对照检查,结果为脑电图(EEG),脑电地形图(BEAM)对高血压病异常率为46％和48％,对脑动脉硬化为57％和58.7％,椎—基底动脉供血不足为48％和41％,脑梗塞为80％和92％,脑溢血为79.2％和90％,TIA为63％和75％。经卡方检验均有显著意义:BEAM、EEG X~2=85.36 X~2>0.01,P<0.01,BEAM定侧定位率明显高于EEG,且对急性脑血管病的诊断明显优于EEG,缺血性脑血管疾病的急性期诊断高于CT说明脑功能障碍早于形态学改变。TCD异常率为100％,在梗塞部位或出血区域TCD可以明确显示于脑部大动脉狭窄所引起的血流动力学改变,主要表现为血流速度和频谱形态的改变。     

经颅彩色多普勒微栓子监测与缺血性脑血管病进展相关性分析

目的:探讨微栓子监测与进展性缺血性脑血管病的临床相关性.方法:将151例急性脑梗死患者分进展性脑梗死(观察组)和非进展性脑梗死(对照组)两组,进行经颅彩色多普勒检查微栓子监测.结果:观察组微栓子信号检测阳性率为8.7%(6/69),对照组微栓子信号检测阳性率1.2%(1/82),两组比较差异有统计学意义(P＜0.05).结论:进展性脑梗死的微栓子信号检出阳性率高,急性期脑梗死患者微栓子信号检测,有助于脑梗死病程预测和预防性治疗.     

急性脑梗死的脑循环与磁共振血管成像的临床探讨

目的：观察急性脑梗死脑循环动力学改变与MRA的临床相关性。方法：54例急性脑梗死病人进行了脑循环动力学检查，同时做正常人38例对照，另外34例行MRA的检测。结果：54例病人的脑循环动力学结果中493例有不同程度异常改变，而MRA的34例中仅23例为异常。结论：脑循环动力学的改变阳性率高于MRA，而且脑循环动力学监测简便，费用低，操作简单，可以在临床推广使用。若两者结合应用则效果更好。     

氧疗对急性心肌梗死患者预后的影响

急性心肌梗死是冠状动脉急性、持续性缺血缺氧所引起的心肌坏死,其发病急、进展快,致残、致死率高。以往在治疗疑似急性心肌梗死的患者中,通常使用辅助氧疗,并在临床指南中也推荐使用,但近年来越来越多的研究人员发现,氧疗并不能给患者带来益处,相反滥用氧气会导致急性心肌梗死患者症状加重,甚至给部分患者带来危害。本研究将对氧疗与急性心肌梗死患者预后的影响进展进行综述,以期为临床工作提供一定的指导。     

Multiple aortocoronary bypass without artificial circulation

Results of 145 surgeries for direct myocardial revascularization without artificial circulation are presented. FC III and IV angina of effort was diagnosed in 80.6% and 13.5% of the patients respectively, acute coronary syndrome in 6.5%, past myocardial infarction in 63.8%. Mean left ventricular ejection fraction (EF) prior to surgery was 48.7 +/- 5.1%; it was below 40% in 28.8% of the patients. Three- and two-vessel coronary disease was documented in 54.7% and 35.3% of the patients respectively; 10% of them presented with the affected anterior interventricular branch, 14% with the stenotic trunk of the left coronary artery. Mean revascularization index increased from 22 to 76. The frequency of complete autoarterial revascularization amounted to 42.7%. Sequential and composite grafts were used in 93 and 257 cases respectively. No patient experienced perioperative myocardial infarction, acute disturbance of cerebral circulation, acute renal or cardiac insufficiency. Immediate postoperative hemorrhage requiring resternotomy developed in 0.9% of the patients, 1.2% with suppurative complications needed additional surgical treatment. It is concluded that myocardial revascularization on a beating heart is an efficacious and reliable method ensuring good results in the immediate and late postoperative period. Its success first and foremost depends on the previously gained experience that permits to operate patients with severe multi-vessel coronary artery disease and various concomitant disorders and thereby correct combined pathological conditions. The available data give reason to consider each patients in need of aortocoronary bypass as a candidate for myocardial revascularization on a beating heart regardless of the character and extent of coronary lesions and anatomical feature of the coronary bed.     

Serum cholesterol levels as a risk factor of cardiovascular disease

By summing up a series of epidemiological evidence a continuous elevation of total serum cholesterol, especially LDL-cholesterol, leads atherosclerosis and causes the narrowing or occlusion of coronary artery which introduces acute myocardial infarction or angina pectoris in the heart. In the brain, it is a risk factor for cerebral thrombosis. On the other hand, a lower level, 160 mg/dl or less of total serum cholesterol relates with the higher incidence of cerebral hemorrhage or subarachnoid hemorrhage, but still with the lower incidence of ischemic heart disease. It is concluded that the higher the total serum cholesterol level and the longer the period of continuous elevation is, the higher the incidence of ischemic heart disease. And there is a U-shape relationship between the level of serum cholesterol and cerebrovascular disease as a whole with a nadir around 160 to 200 mg/dl which means an optimal range of total serum cholesterol. A subject with total serum cholesterol over the optimal level may need some sort of modification in his daily life, in eating or physical exercise but not necessarily requires any pharmacological therapy.     

CARDIAC DISORDERS PREDISPOSING TO DEVELOPMENT OF CEREBROVASCULAR DISEASES IN THE JAPANESE

For a clear definition of the influence of cardiac disorders on the development of cerebrovascular diseases in the Japanese, we reviewed 1,162 cosecutive autopsy records aged 20 years and over in the Department of Pathology, Kyushu University, Japan. All autopsies had been done between Nov. 1971 and Oct. 1981. Cerebral infarction was found in 101 out of 196 with any type of cardiac disorder. Frequencies of cerebral infarction in those with myocardial infarction, rheumatic heart disease, non-bacterial thromboendocarditis, and atrial fibrillation were higher than in those with no heart disease. These differences can be ascribed to the higher incidence of large and medium-sized cerebral infarction, including many cases of cerebral embolism originating from the heart. Only 3.4% of those with small cerebral infarction were assessed to be cases of embolism. Non-embolic cerebral infarction was more frequently noted in those with myocardial infarction and atrial fibrillation than in those with no heart disease. These differences were probably linked to concomitant progression of arteriosclerosis of the cerebral and coronary arteries. In this consecutive autopsy study, cerebral embolism was found in 35 cases, 10.9% of the total number of those with cerebral infarction. ACTA PATHOL. JPN. 35 : 329–337, 1985.     

Angioscopic evaluation of coronary-artery thrombi in acute coronary syndromes.

BACKGROUND. Disruption of an atherosclerotic plaque in a coronary artery followed by the formation of a thrombus is believed to be the cause of both unstable angina and acute myocardial infarction. Although thrombolytic therapy is efficacious in patients with acute myocardial infarction, for unknown reasons it is far less effective in patients with unstable angina. We postulated that there might be differences in the composition of the coronary-artery thrombi in unstable angina and acute myocardial infarction. METHODS. To investigate the appearance of coronary-artery thrombi, we performed percutaneous transluminal coronary angioscopy in 15 patients with unstable angina and 16 with acute myocardial infarction. Angioscopy was performed within 48 hours after an episode of pain at rest in the patients with unstable angina and within 8 hours of onset in those with acute myocardial infarction. RESULTS. Angioscopy revealed coronary thrombi in all but two patients (one in each group). Of the 29 patients with thrombi, those with unstable angina were frequently observed to have grayish-white thrombi (10 of 14, 71 percent), but none were seen in the 15 patients with acute myocardial infarction (P less than 0.01). By contrast, reddish thrombi were observed in all 15 patients with acute myocardial infarction who had thrombi, but in only 4 of the 14 patients with unstable angina and thrombi (P less than 0.01). As assessed by coronary angiography, occlusive thrombi occurred frequently in patients with acute myocardial infarction (13 of 16 patients) but were not seen in any of the 15 patients with unstable angina (P less than 0.01). CONCLUSIONS. Coronary-artery thrombi play an important part in the pathogenesis of unstable angina and acute myocardial infarction. However, the appearance of the thrombi is different in the two conditions, possibly reflecting differences in the composition of age of the thrombi or the presence or absence of blood flow in the artery. This difference may account for the contrasting results of thrombolytic therapy.     

脑卒中病人的全血粘度与血液成份

３１例脑梗塞与３５例脑出血病人的全血粘度和血浆成份的测定结果表明，脑梗塞与脑出血病人的全血粘度、血球压积及纤维蛋白原含量都明显高于对照组，但在脑出血和脑梗塞病人之间却没有差异。血球压积和纤维蛋白原增高是脑卒中后的一种继发性改变。全血粘度增高不是引起脑卒中的原因，而是脑卒中的后果。     

同型半胱氨酸与老年人心脑血管病变关系的研究

目的　比较血清同型半胱氨酸 (HCY)、叶酸、维生素B12 等与原发性高血压、冠心病、脑卒中病变的关系 ,探讨其血浓度在预测老年人心、脑血管病变中的意义 .方法　对 2 2 4例患原发性高血压、冠心病、脑卒中患者和 10 6例健康体检正常的对照组应用荧光偏振法 (FPIA)分析血清HCY和用微粒子酶免疫分析 (MEIA)测定血清叶酸、VitB12 水平并比较各组间差异 .结果　心肌梗死组、脑溢血和脑梗死患者的血清HCY水平显著高于正常对照组 (p <0 .0 1) ,而叶酸浓度则明显低于正常对照组 (p<0 .0 1) .VitB12 含量仅在脑梗死组中低于正常对照组 .单纯原发性高血压组和心绞痛组的血清HCY和叶酸的含量与正常对照组比较无差异 .在冠心病、脑卒患者中血清HCY浓度与血清叶酸浓度呈负相关 (r=- 0 .6 0 8,p<0 .0 1;r=- 0 .6 87,p<0 .0 1) .结论　在老年人群中血清HCY浓度增高与低叶酸水平是冠心病、脑血管疾病的一个重要危险因素 .用荧光偏振 (FPIA)法检测血清HCY浓度可作为评价和预测心、脑血管疾病的一个敏感可信的指标     

Malignant neoplastic emboli to the coronary arteries: report of two cases and review of the literature

Two patients were seen with malignant neoplastic emboli to the coronary arteries. One, a 61-year-old woman with a malignant fibrous histiocytoma of the thigh and a solitary pulmonary metastatic lesion, died of an acute myocardial infarction due to a neoplastic coronary embolus after lobectomy. The other, a 51-year-old woman with bronchogenic adenocarcinoma, died of extensive cerebral metastases. At autopsy, she also was found to have had an acute myocardial infarction associated with a neoplastic coronary embolus.     

PAI-1启动子区插入/缺失(5G/4G)多态性与脑血管病的相关性研究

目的 初步探讨人类纤溶酶原激活物抑制物－1（plasminogen ativator inhibhitor-1,PAI-1)启动子区基因多态性与脑血管病的关系,及其在脑血管病发病过程中的作用。方法 通过多聚酶链反应技术和发色底物法（ELISA）,测定了96例脑卒中患者和60名健康对照者的白细胞PAI－1启动子区4G／5G多态位点的基因型及血浆PAI－1活性。结果 脑梗死（cerebral infarction,CI)组血浆PAI－1活性明显高于脑出血（cerabral hemorrhage,CH)组及对照组,脑梗死和脑出血组中均以纯合子4G／4G基因型患者的PAI－1血浆活性水平最高,5G／5G基因型最低,杂合子4G／5G基因型居中;4G纯合子基因型与其它二型之间比较差异无有显著性,4G／5G与5G／5G基因型之间比较差异无显著性。CI组4G／4G纯合子基因型与对照组比较差异有显著性（P＜0．05）,CI组基因型与CH组及CH组与对照组基因型比较差异均无显著性（P＞0．05）。CI组女性4G纯合子基因型患者血浆PAI－1活性与同型男性患者比较差异有显著性（P＜0．05）。结论 纯合子4G／4G基因型可能是CI发病的危险因素之一,4G纯合子个体可能具有较高的CI发病倾向,尤其可能与女性CI发病相关。     

Snake bite presenting as acute myocardial infarction, ischaemic cerebrovascular accident, acute renal failure and disseminated intravascular coagulopathy

An unusual presentation of a viperine snake bite presenting with ischaemic damage to the major organs like brain and heart leading to cerebrovascular accident and acute myocardial infarction along with acute renal failure and disseminated intravascular coagulopathy (DIC) is described in this report.