To evaluate the physiological characteristics of elderly hypertension, analysis of ECG patterns and measurements of left ventricular function by dyedilution method using ear piece photo cell were performed in 126 hypertensive subjects (mean age of 75) and 36 normotensive subjects (mean age of 77). ECG findings in hypertension were classified into 8 groups depending on the voltage of QRS complex and the changes of ST-T wave on left side chest leads. In male, cardiac index (CI) and stroke index (SI) showed relative increase, but total peripheral resistance index (TPRI) and cardiothoracic ratio (CTR) showed relative decrease when compared with female. The incidence of abnormal ECG in male was lower than that of in female. There was significant correlation between cardiac functions (CI, SI and TPRI) and age in male subjects both of hypertensive and normotensive ones. No correlation was found in female subjects. Heart rate (HR) and blood pressure (BP) had no correlation with age in both groups. Hypertensive subjects had smaller CI and SI and larger TPRI than normotensive subjects. However, no difference was observed between systolic hypertension and systolic & diastolic hypertension in terms of cardiac functions and of the incidence of ECG abnormalities. There was no correlation between level of BP and cardiac functions. Hypertensive subjects with severe ECG abnormality showed more disturbed cardiac function (smaller CI and SI, larger TPRI) than with moderate ECG abnormality. More significant disturbance of cardiac function was shown in hypertensive subjects with strain pattern than with ischemic ST-T change or “advanced strain pattern”. The proportional disturbance of cardiac function to the magnitude of STj depression was observed in hypertensive subjects with strain pattern.
The incidence and the site of bed-sores in various neurological diseases in the aged were studied clinicopathogically. The materials were consisted of 140 autopsy cases with neurological diseases over 62 years of age. 70% of these cases had bed-sores. In cerebrovascular diseases 69 out of 98 cases (70%) had bed-sores. In patients with hemiplegia bedsores were found on the affected side twice as frequently as on the other side. In the acute stage of cerebrovascular diseases patients with severe disturbance of consciousness showed the tendency to have bedsores in early periods of the disease. Multiple, large bed-sores were found frequently in cases with Parkinsonism and cervical spondylosis. In Parkinsonism the severity of bed-sores was roughly proportional to the severity of nerve cell loss in the substantia nigra. In a case of hemiparkinsonism bedsores were found only on the affected side. Bed-sores were not found in 3 out of 4 cases with amyotrophic lateral sclerosis (ALS). These 3 cases were typical ALS. Another case of ALS had bedsores. This case was atypical, because, aside from clinicopathological findings usually observed in typical ALS, he was severely demented and pathologically there were diffuse nerve cell loss and Alzheimer's neurofibrillary tangles in the cerebral cortex. It was suggested that both the incidence and the site of bed-sores were closely related to the site and the extent of pathological changes of the nervous system.
Electrocardiographic changes simulating acute anteroseptal myocardial infarction were observed in 12 aged patients with pneumonia. The electrocardiographic changes were consisted of QS patterns or decreasing r amplitudes in V1 through V3 or V4 with monophasic ST elevation and terminal T inversion. These changes appeared in conjunction or slightly delayed with the onset of pneumonia. The Q waves disappeared with the recovery from the pneumonia by about 7 days, while the negative T lasted for about a week to one month. Eight cases were autopsied and no anteroseptal myocardial infarctions were disclosed. The major clinical findings were dyspnea, cough, sputum, cyanosis, consciousness disturbances, and no anginal pain was observed. The pneumonia was extended more than two lung lobes and associated with pleural effusion or adhesive scars. In laboratory examination GOT elevated slightly in 4 cases. BUN elevated transiently in seven cases and CRP was strongly positive in all cases. Arterial PO2 decreased to less than 70mmHg and hematocrit elevated by 4 to 9% in all cases. Eight cases were autopsied. Major pulmonary findings were emphysema in six cases, bronchitis in seven cases and pneumonia in six cases. A case of old myocardial infarction in the posterior wall and a case of subepicardial hemorrhage in the posterior wall were observed, but no anteroseptal intarction was found in all cases. More than 50% of coronary stenoses in the left anterior descending branch were found in seven cases, and small myocardial scars were disclosed in five cases. The mechanisms responsible for the electrocardiographic changes simulating myocardial infarction might be attributed to the posterosuperior deviation of QRS axis from the chronic lung diseases, acute right heart overloading, hypoxia, coronary sclerosis, and the elevation of hematocrit as well as blood viscosity in acute pneumonia. Disturbances in myocardial microcirculation and oxygen supply as well as pulmonary factors were postulated.
The nature of senile change is a decrease in the number of parenchymal cells and reduced ability of physiological regeneration. In order to clarify the mechanism some micromeasuring studies have been made on the liver of different aged parabionts. Among many parabiotic pairs between old and young albino rats, long survived and healthy fifteen pairs were selected for the study of the liver. The results were: 1) No significant change in liver weight was noticed in the parabiotic rats. 2) The changes in the hepatic cells of younger parabiotic partners were conspicuous and significant, i.e., a decrease in the number of hepatic cells in a given area, a remarkable decrease in the estimated hepatic cell number, an increase in the volume of cells and their nuclei, and a striking increase in number of binucleate hepatic cells. These findings in the hepatic cells of younger partners were rather similar to those of single old control rats. In contrast with these changes seen in the younger partner, the alternations in the hepatic cells of older parabiotic partners showed, in general, to be little different from hepatic cells of single old control rats, but it could not be denied that the volume of cells and their nuclei became smaller, and that the findings in the hepatic cells of the older partners seemed to be directed a little towards those in the young controls. From the results, it is assumed that an ability of proliferation of the hepatic cells of the younger partners was suppressed by an extracellular fluid factor secreted from the hepatic cells of the older partners, so-called inhibitory factors for cell division, and that the increase in volume of the hepatic cells of the younger partners was due to hyperfunction to compensate their decrease inc ellular number and also the overload of the hepatic cells of the older partners.