冠血栓症および心筋硬塞症の発生機序に関する病理形態学的研究
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概要
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According to the current concept, myocardial infarction is produced by either occlusion or severe narrowing of coronary arteries, and the cause of occlusion is attributed mainly to the thrombosis developed on the basis of atherosclerosis. There are, however, not a few cases which show myocardial infarctions not accompanied with coronary occlusions or thromboses. Even in the cases having coronary thrombi, discrepancy between the time of the occurrence of thrombi and that of infarctions is not in-frequently observed. The opinion of Branwood et al., that the coronary thrombosis was secondary to the infarction, seemed to be founded on the basis of these evidences. Baroldi et al. and Constantinides also expressed similar views. As the etiology of coronary thrombosis also, the opinion, that it is not developed on the ground of atherosclerosis, has been proposed by Paterson. Constantinides, Duguid, and other authors. In brief, the concept concerning pathogenesis of myocardial infarction and coronary thrombosis, which was convinced by many in-vestigators, has not yet been verified. Recently Yajima et al., based on the detailed histological observations of infarcted areas of myocardium, main coronary artery stems and intramyocardial arterial branches, have stated the opinion that some vigorous circulatory disturbance in the peripheral coronary arteries produced the infarction-like lesions on the one hand, and abruptly elevated blood pressure in the coronary trunks as its reflective action on the other hand, causing the intimal damage in coronary artery trunks followed by thrombi formation. This means that functional disturbance in coronary circulation instead of mechanical coronary occlusion should be the primary cause of myocardial infarction. In this viewpoint the author has investigated the relationships between the myocardial infarctions and coronary thrombi and those between coronary thrombi and their regional intimal damage in 33 autopsied cases with myocardial infarctions. Paraffin embedded blocks of extramural portions of coronary arteries of these hearts were cut crosswise in sections of 4μ thick, and stained with hematoxyline eosin, periodic acid methenamine silver (PAM), AZAN, elastica Van Gieson, and alcian blue-PAS. Some parts of the materials were examined with conventional and scanning electron microscropes.
- 社団法人日本循環器学会の論文
- 1972-11-20