物理的循環分析法における大動脈内周と大動脈断面積について : とくに,Fruchtの観察にたいする批評
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One of our collaborators Y. Nakamura has pointed out in 1955 that Q used in the expression of Broemser-Ranke's and Wezler's physical analysis of the cardio-circulatory dynamics, can be more satisfactorily estimated by our x-ray kymographic pocedure, performed in the light of Bickenbach's or Hiramatsu's in Kanazawa, Japan. Moreover he has insisted upon that the measurement is better to be surveyed case by case without any use of calculated mean values in table. In the monograph "Kreislaufmessungen" (1958) edited by A. Weber and K. J. Blumberger, H. Linke showed the table as for Q and age mainly based upon Frucht's study (1952) which was statistically performed referring to the data gained at the autopsy by Suter. Although we have been, of opinion that there must exist a necessity to re-investigate Frucht's work with due regard to various sorts of the pathological state experienced in clinic, yet at that time our observations were too scanty to discuss Frucht's results. In this report there were estimated Q in 777 controls clinically free from any cardio-vascular diseases and in 221 cases with essential hypertension by means of our modification of Bickenbach's method. Our method concerning Q was already described by Y. Nakamura and Y. Inagaki (1955) in detail. In 8 % of all control group it was impossible exactly to estimate by this method owing to the interference of bodily shaking, respiratory movement and so on. In the pathological conditions, for example, highly stuated diaphragma due to ascites, meteorism or fatty deposite, aorta is used to be deviated to upon left side. Besides the marked aortic disorders, postpleuritic or postmediastnic adhesion, inclusive of mediastinal tumour, which enclouds Holzknecht's space, congenital or acquired anomalies of thorax and so on, turn not seldom the estimation into an impossibility. These cases unsuitable for the measurement were all excluded in this report. When pulse waves are repeatedly registered within relation short time, for instance, in order to follow up effects of drugs, Q must be corrected with due consideration into the blood pressure level just at the registration of the pulse wave. When the linear relationship, as shown in Fig. 3, between the blood pressure level and the pulse wave velocity c determined from polygram is assured, then those values are employed in Broemser-Ranke's expression. Thus, it may be safe to say that in Frank's second phase, as a rule, 0.1 cm^2 per 10 mmHg of the mean blood pressure must be corrected. In the cases with marked aortic sclerosis, 0.1 cm^2 per 15〜20 mmHg of the mean blood pressure must be corrected. However this manipulation can not be applicated in the case of the one pointed estimation. Frucht has demonstrated that there exists a certain correlation between aortic circumference U and body length L, and he has postulated an expression U=aL+b (a, b, constant). He has studied upon the fluctuation not only of U and L but also af a and b with special reference to age and sex. Assume Frucht's statement to be true in the biometry, I have studied our findings obtained by means of Y. Nakamura's method, with the disposal of expression. Σ^^n__1Ui=nb+aΣ^^n__1Ui and Σ^^n__1Li Ui=bΣ^^n__1Ui+aΣ^^n__1Ui^2 (n: number). Table 1 and 2 show the relationship of aortic inner circumference to length of body in male and female. The coefficients of declination are found so diverse and so various that it is very difficult to search anything integrated in these tables. The same statement can be referred to the constant of regression line between girth of chest and aortic inner circumference, although Frucht did not discussed upon this item (Tab. 3). The correlation coefficient, examined regardless of age, with respect to body length and inner circumference of aorta shows r=0.023±0.0317, consequently it is hardly possible to find any integrated correlation (Fig. 10). The same statement can be referred to the correlation cofficient with regard to girth of chest and aortic inner circumference. Therefor it is very sorry to conclude that Frucht's expression may not be able to be applied for the biometry of Q. Fig. 12 shows our survey of aortic inner circumference measured by Y. Nakamura's method in each ten years of age; the aortic inner circumference in male is found, as a rule, larger than that in female with a small exception possibly due to the insufficient number of cases. The slope of the curve is steep, especially in the youth, but beyond 50 years of age the slope begins to decrease in its amount, and at last avove 60 years of age it becomes almost horizontal (Fig. 13). In Fig. 14, the standard deviation of aortic cross-section (Q) is marked with their horizontal lines above and below the thick horizontal line of every column indicating the mean value of Q. Both in normal health and essential hypertension, the male (left side) generally discloses higher Q value than the female. Q of essential hypertension drawn with slanting lines is found always larger than that of normal health drawn with plotting lines, regardless of sex and age; as to the standard deviation the same tendency can be observed. With consideration to the thickness of the aortic wall the inner circumference U is taken for granted 90% of the diameter according to Bickenbach's method; this is verified by the comparative observation intra vitum et post mortem. Q estimated intra vitum by our method almost agrees with that measured post mortem (Tab. 4); in the latter case Q is corrected by means of re-inflating of aorta imposed with the inner pressure at the height of the blood pressure intra vitum estimated just in the x-ray kymography.
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