Circulation of both the liver and the mesentery is influenced through the portal vein, however, in both organs infarcts hardly occur because of their specific hemodynamics. The authors experienced an autopsy case of hepatic infarction associated with terminal hemorrhagic necrotizing enteropathy which had originated from nonocclusive infarcts of the jejunum in a 84-year-old woman. Autopsy: Four fresh coagulative necrotic foci, measuring 3-4cm in its diameter respectively, were located at the bilateral lobes of the liver. At the right truncus and left branch of the hepatic artery, thrombi were embolded. The thrombi seemed to be liberated from the mitral valve. In the other portion of the liver, marked centrolobular congestion was observed. The upper portion of the jejunum showed hemorrhage and necrosis. Cellular infiltration was not seen. Mesenteric arteries and veins were sclerotic, but no thrombi were found. The heart, weighing 500g, revealed left ventricular hypertrophy, and bilateral atria and ventricles were ectatic. The mitral valve showed fibrous endocarditis with calcification. Besides those, renal anemic infarct, fresh peptic ulcer of the stomach etc. were shown. From these observations, with the exception of the systemic circulatory failure based on the organic cardiac lesion, it is speculated that liver congestion from cardiac failure evoked hepatic infarction on one hand and intestinal infarct on the other hand. Both hepatic infarction and THNE in our case may have originated from the local circulatory failure through the portal vein.
Anterior pituitary function was evaluated in 150 normal volunteers (80 males and 70 femals), 20-79 year of age. Before and after administration of 500μg synthetic thyrotropin releasing hormone (TRH) intravenously, serumconcentrations of thyrotropin (TSH) and prolactin (PRL) were determined by each specific radioimmunossay. Similarly, serum luteiniting hormone (LH) and follicle stimulating hormone (FSH) were determined by a radioimmunoassay following injection of 100μg synthetic LH releasing hormone (LH-RH) intravenously. These subjects were divided into three groups, group I: aged 20-39, II: aged 40-59 and III: aged 60-79. The basal levels of serum TSH were not different in regard to age and sex. The maximum increment in seum TSH above the baseline (ΔTSH) after TRH administration decreased in males with advancing age but not in females, [males: 10.6±5.1μU/ml (mean±standard deviation) (I), 9.7±6.6μU/ml(II), 5.8±3.3μU/ml (III); females: 15.6±7.2μU/ml(I), 13.9±6.9μU/ml (II) and 16.7±8.8μU/ml(III)]. There were no differences in basal PRL levels among three groups. The maximum increment of PRL (ΔPRL) following administration of TRH to female subjects, was lower in group III than that in the other groups, but no differencences were observed in male subjects [males: 23.9±7.6ng/ml (I), 33.3±12.8ng/ml(II), 28.3±20.8ng/ml(III); females: 36.4±11.6ng/ml(I), 36.5±13.6ng/ml (II) and 16.7±7.4ng/ml (III)]. No cross correlation was observed between ΔTSH and ΔPRL. Male subjects showed a progressive increase in basal LH with advancing age but not in FSH[LH: 8.0±4.0mIU/ml(I), 11.6±5.1 mIU/ml(II), 19.3±8.9mIU/ml(III); FSH: 5.7±3.3 mIU/ml(I), 5.1±3.1mIU/ml(II) and 11.2±6.7ml U/ml(III)]. There were no differences in the maximum increments of LH and FSH (ΔLH, ΔFSH) after LH-RH in these three groups [ΔLH: 74.6±31.9mIU/ ml(I), 88.1±50.1mIU/ml(II), 68.0±4.0mIU/ml (III); ΔFSH: 6.2±4.6mIU/ml(I), 7.7±4.9mIU/ml (II), 6.2±4.8mIU/ml(III)]. In female subjects, both basal levels and maximum increments of LH and FSH were significantly higher in post menopausal women (V) than in normal menstrating women (IV) [basal LH: 7.9±5.6mIU/ml(IV), 74.6±28.5mIU/ml(V); basal FSH: 6.1±2.8mIU/ml(IV), 72.7±27.4mIU/ml (V); ΔLH: 66.8±29.5mIU/ml(IV), 165.7±56.4mIU/ml(V); ΔFSH: 4.9±1.7mIU/ml(IV), 38.5±25.7mIU/ml(V)]. The values of FSH/LH ratio at 30min and maximam increment after LH-RH were higher in aged groups of males and females.
For the past 12 years we have been practiced the health control of the administrator group, among which group the followup result of an extensive gastrectomy has been evaluated by age groups and the postoperative check points, especially for the geriatric groups was studied. The patients consisted of 72 in numbers and one or more years after the extensive gastrectomy with the periodical postoperative control at 6 month interval. The distribution of the age was 18 under 40 years old, 28 in their fifties and 26 over 60 years old, and they were 71 males and one woman. The operative methods were Billroth I, 71 cases and Billroth II, 1 case, respectively. Pathological classifications were divided into 5 cases of progressive cancer of the stomach, 16 cases of early cancer of the stomach, 23 cases of gastric ulcer, 6 of duodenal ulcer, 15 of gastric polypus, 6 of gastritis and 1 other case. The surgical follow-up studies revealed 7 cases of cholelithiasis but it is noteworthy that none of over 60 years old showed such an occurrence. The symptoms were little in the patients over 6 months postoperatively and no significant differences were noted by age. The situation and employment do not always bring an unfavorable effect, especially in the geriatrics. The postoperative changes of body weight became settled in 5 or more years after the operation. The younger patients progress favorably, while the older patients whose weights were lower than the standard weight ±5kg was not considered to be improved in their weights. However, the fluctuation of the amount of hemoglobin was settled down in most patients more than 5 year postoperative period, but the advanced age group tended to show the high incidence of hypochromia. The changes of serum proteins progress favorably in all ages without chronological differences. Those were considered to be greatly influenced by liver function disorders. Therefore, it is stressed that the patients over 60 years old should be carefully checked up in changes of their weight and hemoglobin, especially by the longterm periodical follow-up.
It has been well known that abnormal ECG appears on cerebrovascular attack (CVA). However, some of these abnormalities should be attributed to the underlying factors such as aging or hypertensive heart diseases. In order to assess the mechanism of abnormal ECG findings in CVA, the multiple ECGs were studied in 3 groups of the patients: a group of patients under cerebrovascular attack (CVAG), of hypertensive patients and a normotensive control group. Each group consists of 50 patients with the same age distribution. Bradycardia and prolonged QT were frequently seen in CVAG. Left ventricular hypertrophy and depressed ST seemed to be related to hypertension, and these findings were not related to the mortality rate in CVA. Arrhythmia was common in older patients, however it was also found in younger patients with CVA. When arrythmia appeared after CVA, the prognosis was poor. In subarachinoid hemorrhage, the inverted deep T wave and myocardial infarction like pattern were not found in the patients studied. On a patient of cerebral hemorrhage, ECG showed the pattern of subendocardial infarction, and autopsy revealed the subendocardial hemorrhage.
Pericardial lesions were demonstrated in 79 of 1, 000 consecutive autopsy cases of elderly patients over the age of 60 at Yokufukai Geriatric Hospital, Tokyo. The lesions observed were pericardial effusion of 100ml or more in 35, pericadial adhesion in 16, hemopericardium in 16, malignant pericarditis in 5, acute pericarditis in 4, subepicardial hematoma in 3, and chronic pericarditis in 2 cases. The pericardial effusion was frequently associated with pleural effusion or generalized edema, and considered mainly due to congestive heart failure and/or hypoalbuminemia. The pericardial adhesion was the result of pericarditis complicating myocardial infarction in 2 and tuberculous pericarditis in 3 cases. Definite etiology was not determined in the remaining 11 cases, but it is noted that pleural adhesion was also present in 9 of them. The malignant pericarditis was due to either extention or metastasis of the carcinoma of the lung, breast or colon. The acute pericarditis occurred as a complication of generalized or intrathoracic infection. The cause of hemopericardium was cardiac rupture following myocardial infarction in 11 and ruptured aortic aneurysm in 5 cases. Ten of these 11 cases of cardiac rupture were female: the incidence of cardiac rupture in myocardial infarction proved at autopsy was 1.5per cent in males and 12.5per cent in females.
The effect of aging to T-wave change induced by exercise was investigated. Subjects included 171 healthy volunteers of non-cardiac patients were normotensive (less than 160/95mmHg). They were divided into 3 groups, young-aged group (aged less than 39) included 31 male and 17 female subjects, middle-aged group (aged between 40-55) included 44 male and 32 female subjects and old-aged group (aged more than 56) included 30 male and 17 female subjects. Exercise test was performed by using bicycle ergometer. Frank's lead system was used for exercise electrocardiogram and 3 scalar tracings on X, Y and Z leads were recorded at a paper speed of 100mm/sec. The amplitude of T-wave was measured at every 20msec., starting at 100msec. from the beginning of the earliest Q-wave in 3 leads. Each instantaneous T vector at every 20msec. was obtained on frontal and horizontal planes and T-loop was constructed by connecting each instantaneous T vector on frontal and horizontal planes. The maximal T vector (T-max.) was measured spatially on the constructed T-loop before, during and after exercise. Systolic blood pressure was measured by cuff-method and left ventricular ejection time (ET) was measured from the right carotid pulse wave before and after exercise. (1) There was no significant diffierence in T-max. at rest among 3 groups. T-max. was decreased by exercise in young-aged and middle-aged groups, but was increased in old-aged group. (2) There was no significant difference in the heart rate response to exercise among 3 groups. The blood pressure response to exercise was significantly higher in old-aged group than in young-aged group. ET was shortend after exercise in all groups, but its shortening was less significant in old-aged group than in youngaged group. (3) It was speculated that the heart rate increase induced by exercise mainly contributed to the decrease of T-max. in young-aged and middle-aged groups and the other hemodynamic changes induced by exercise such as the increase in blood pressure and the augumented myocardial contractile state possibly contributed to the increase of T-max. in old-aged group.
Micromeasuring studies on size and number of the microbodies of the hepatic cells in 61 human biopsy cases (age range 21 to 81 years) have been performed and some comparative studies have been made with the micromeasuring data previously reported on the size and number of the mitochondria. Our cases have been classified into 5 age groups: under 49 years of age (group 1), 50-59 (group 2), 60-64 (group 3), 65-69 (group 4) and above 70 years of age (group 5). Number of microbodies per hepatic cell area, numerical ratio of mitochondria to microbodies, and roughly estimated average area of microbodies are 11.92, 10.83 and 0.178μ2 in the group 1, 15.92, 9.70 and 0.182μ2 in the group 2, 15.70, 7.57 and 0.216μ2 in the group 3, 15.04, 6.39 and 0.211μ2 in the group 4 and 13.17, 6.73 and 0.211μ2 in the group 5, respectively. In the younger aged, while the mitochondria were considered to be in resting state from their ultrastructure, the microbodies are generally smaller in number and size than those in the older age groups. After 50 years of age, the microbodies begin to increase in number. After 60 years of age, while the mitochondria decreased in number accompanied with increase of their cristae followed by increase in their size, the numerical increase of the microbodies is accompanied by the increase in size, being considered to be in the active state. In the older aged, while the mitochondria increase in size without distinct change in number, microbodies show a slight tendency to be decreased in number with out any change in size. Some interesting influences of age change of mitochondria on the functional activity of the microbodies have been discussed.
Vertigo or dizziness is one of the most common complaints in geriatric clinics. Among 2, 554 patients above the age of 49 who visited the Department of Geriatrics, University of Tokyo Hospital during the period from 1970 to 1973, 497 patients (19.5%) (male 17.1%, female 21.8%) had vertigo or dizziness, and it was the chief complaint in 156 (6.1%). Of these 497 patients, 15.5% had vertigo, 59.5% dizziness, and 6.0% both. In the remainder no details were available. The most important disorders which caused vertigo or dizziness were arterial hypertension (22.9%), anemia (8.9%), vascular disorders either in the vertebrobasilar system (7.4%) or in the carotid system (7.0%), cervical spondylosis (6.8%) and others. The patient ratio vertigo/vertigo+dizziness was the highest in vascular disorders of the vertebrobasilar system (59.1%), then in the disturbance of the inner ears (53.3%) and cervical spondylosis (38.2%). Then, clinical data were compared among three patient groups matched in age and sex; the group with vertigo (vertigo group), the group with dizziness (dizziness group), and the control group who had had no episodes of vertigo or dizziness. Of five symptoms common in the elderly (heavy headedness, paresthesia of the limbs, tinnitus, shoulder tightness and forgetfulness), all were more frequently seen in the dizziness group than in the control, while in the vertigo group only the first three symptoms were more frequent (p<0.001-0.01). As to physical and neurological status, blood pressure was higher in the dizziness group than in the control, and hemiplegia or tetraplegia was more commonly observed in the vertigo group than in the control (p<0.01). Of laboratory data, the concentration of total protein in the serum was generally lower in the dizziness group than in the other two, and the difference between the dizziness group and the control was significant in the seventh and eighth decades of age in females (p<0.05). Hemoglobin concentration and red blood cell counts were also lower in the dizziness group than in the other two. The minimum saggital diameter of the spinal canal measured in the plain roentogenogram of the cervical spine was significantly smaller in the vertigo group than in the control in males (p<0.01). From these results, the followings might be concluded: (1) Vertigo seems to be closely related to cerebral arteriosclerosis, especially in the vertebrobasilar system. (2) Dizziness, on the other hand, is often under the influence of such functional factors as blood pressure, concentration of serum protein, hemoglobin content or red blood cell counts, with less specific significance for the indication of the underlying disorders.