Kunihiko Kinjo

We performed a cross-sectional survey of stroke and acute myocardial infarction (AMI) in Okinawa, Japan with a census population of about 1.2 million. A total of 3,644 cases of first-ever stroke and 898 cases of initial acute myocardial infarction (AMI) were detected. The age-adjusted annual incidence rate for stroke was 105 per 100,000 standard population of Japan, and that of AMI was 26. The case-fatality rate of stroke within 28 days of onset was 12.8%, and that of AMI was 22.2%. Of the stroke cases, 51.4% were diagnosed as brain infarction, 38.7% as brain hemorrhage, and 9.3% as subarachnoid hemorrhage. The diagnosis of stroke subtypes were confirmed by computed tomography or magnetic resonance imaging in 98.4% of all stroke cases. In Okinawa, the incidence rate of AMI was still considerably lower than that in the Western population, and the rate of stroke was similar to that in the Western population.

The purpose of the present study is to determine accurate incidence rates of stroke and acute myocardial infarction among the residents in Okinawa, where the census population was 1, 222, 398 in 1990 and mortality due to cerebrovascular and heart diseases is lowest in Japan. A co-operative study group including almost all hospitals and clinics in Okinawa was established for the survey. Between April 1, 1988 and March 31, 1991, 4, 756 cases of stroke and 1, 059cases of acute myocardial infarction were identified. The average age-adjusted annual incidence per 100, 000 population was 137 for stroke and 31 for acute myocardial infarction. In the population aged 40 years and older, the respective values were 315 and 72, indicating the stroke incidence to be 4.4 times higher than that of acute myocardial infarction. The incidence ratio for men to women was 1.7:1 for stroke and 2.9:1 for acute myocardial infarction. Among stroke cases, 51.3% were diagnosed as cerebral infarction, 35.7% as cerebral hemorrhage, 7.7% as subarachnoid hemorrhage and 5.3% as others. Computed tomography of the head was performed in 98.4% of all stroke cases. The case ascertainment, evaluated by comparing the registered cases and death certificates in a certain city, was almost complete. The incidence of acute myocardial infarction is still much lower than that of stroke in Japan. (Hypertens Res 1992; 15:111-119)

78 year-old male with parkinsonism and megacolon was reported. He was admitted to our hospital with complaints of frozen gait and festination, both of which had appeared at the age of 77 and was associated with an increasing abdominal distension. Because of the symptoms such as mask-like face, cog-wheel rigidity, frozen gait, and bradykinesia, and of the lack of definite pyramidal signs and dementia, a diagnosis of parkinsonism, idiopathic rather than secondary, was made despite the history of stroke occurred at the age of 69. A remarkable dilatation of entire colon including rectum was confirmed by roentgenologic examination. An administration of 1-dopa remarkbly improved the parkinsonian symptoms without any exacerbation of megacolon. Autonomic dysfunction derived from parkinsonism might have contributed to the development of megacolon in this case since he had never been treated with anticholinergic agents and other related drugs.