The pulmonary carbon monoxide diffusing capacity (DLCO) by endtidal air sampling method in steady state has been studied in our pulmonary laboratory of Tokyo Metropolitan Geriatric Hospital for elderly subjects, including 19 males and 11 females (mean age 67.7 y.o. and 71.6 y.o., respectively). They were considered and selected as the normal in the findings of chest X-ray, spirometry, blood gas and others. Their DLCO were compared with those of young male volunteers (mean age 22.3 y.o.). DLCO was tested statistically on its dependency with expired minute volume (VE) and their significant correlation (P<0.01) was ascertained in regression formulae for both groups as was reported previously: normal esderly subjects: DLCO=1.19VE+0.13 (r: 0.71) and young volunteers: DLCO=1.18VE+9.33 (r: 0.69) There is no statistical significance in difference between male and female regressions of the elderly subjects. Then we can predict the normal value of DLCO for the elderly over 60 years at resting VE with the above regression formula, DLCO=1.19VE+0.13, and we can estimate %DLCO of the measured to the predicted value for the elderly subjects.
In order to clarify environmental effects upon the aging process, a comparative study has been made histologically and micrometrically on the pancreas obtained at autopsy from Hawaii and native Japanese, and the results were compared with those of the similar study on the liver. It was postulated that the weight of the pancreas, the acinar tissue and of the interstitial connective tissue, and number of the acinar cells decreased gradually with age in both Japanese. The acinar cells increased in size with age only in the native Japanese, but their nuclei increased in size in both groups. The islet tissue was not changed in volume with advancement of age. The fatty tissue was varied greatly in volume from case to case. The estimated weights of pancreas and of acinar tissue, and sizes of both acinar cells and nuclei in the Hawaii Japanese were greater in every age decade compared with the native Japanese. These differences were more markedly noticed in the younger aged, composed of Nisei and Sansei, but less marked in the older aged, Issei. These are considered to be due mainly to an environmental, especially nutritional condition. The estimated volume of interstitial connective tissue was almost equal in Hawaii and native Japanese. The decrease in number of acinar cells and increase in size of the nuclei were less marked compared with the results in case of the hepatic cells reported previously by the co-workers. For the discrepancy in the aging process between the pancreatic acinar cells and hepatic cells, some discussions have been made on difference in grade of the differentiation of these cells and further in their compensatory function.
The clinical spectrum of 33 aged patients (mean age, 78.1 years) with sick sinus syndrome is described, and therapeutic responses and mortality rate are reported. Electrocardiographic abnormalities varied from severe sinus bradycardia (Group I, 4 patients), sinoatrial block and/or sinus arrest (Group II, 14 patients) to sinus bradyarrhythmia associated with episodic supraventricular tachyarrhythmias (Group III, 15 patients). Symptoms were common and were produced by both bradycardia and tachycardia, but asymptomatic patients were more frequently encountered among patients in 9th decade and with senile dementia. Association of electrocardiographic evidences of atrioventricular block and/or bundle branch block was noted in 7 (21.2%), old myocardial infarction in 4 patients (12.2%). Etiologic relation between coronary heart disease and sick sinus syndrome in aged patients was not demonstrated. Drug therapy was effective in about a half of the patients, while the use of temporary cardiac pacing or implantation of cardiac pacemaker was required in 14 patients (42.4%). Cardiac pacing was life-saving in some cases. Survival rate after 3 years of follow-up period was 76.2%.
Clinical features of three patients with Werner's syndrome, one male and two females, of different pedigrees, were presented with special emphasis on the results of endocrinological examinations of these patients. All the patients fulfilled the somatic characteristics of Werner's syndrome, such as thin extremities, cataracts, early graying of hair, scleroderma-like skin atrophy and intractable ulcerations of the feet. Cardinal findings of endocrinological examinations were summarized as follows. Growth hormone response to insulin-induced hypoglycemia was decreased in all the three patients. Thyroid function evaluated by conventional laboratory tests was considered to be almost within normal ranges in all the patients, but in one case hyperresponse of serum TSH to the TRH stimulation was observed. As to the ACTH-adrenocortical axis, basal levels of plasma 11-OHCS and urinary 17-OHCS were almost normal and plasma 11-OHCS responses to the rapid ACTH stimulation were normal. However, diurnal rhythm of plasma 11-OHCS was impaired in two patients and Metyrapone test gave no or weak response of urinary 17-OHCS in two patients, suggesting possibility of certain defect of the hypothalamo-pituitary function. The male patient had hypogonadism with low serum LH and FSH. In testicular biopsy, however, marked atrophy of the seminiferous tubules and hyperplasia of the interstitial cells, being not compatible with secondary hypogonadism were found. Therefore. the authors cannot deny at all possibility of primary disoder of the testis. The role of parathyroid glands on the pathogenesis of calcium deposits in soft tissue and/or osteoporosis was not demonstrated in our cases. All the three patients showed various degrees of glucose intolerance with plasma IRI hyperresponses, but plasma IRI responded normally to tolbutamide in two cases examined. The results suggest the existence of insulin resistance in the peripheral tissues. No consistent change in the plasma renin activity and its response to furosemide were detected. Above-mentioned abnormalities in endocrinological tests were essentially similar to those as having been described in the past, though there were some discrepancies among the data obtained. From our data in the present cases and the previous literature of endocrinological studies on Werner's syndrome, it is difficult to explain the pathogenesis of the syndrome based on a monitical aspect that hormonal disturbance(s) primarily participate in “early aging phenomenom” of Werner's syndrome. Moreover, it should be pointed out that most hormonal changes found in the syndrome were different from those in the seniles.
Cerebrovascular disorders, especially cerebral bleeding, in the high-aged above 90 years of age were investigated neuropathologically on 39 autopsy cases in the Tokyo Metropolitan Yoikuin Hospital. Results were as follows: 1) Cerebrovascular disorders were observed in 27 cases (69%) in the autopsy cases. They consisted of 5 massive bleedings, 4 large softenings and 18 small softenings. 2) 5 cases of cerebral bleeding, male 1 and female 4, were classified as follows: combined type bleeding, temporal lobe hematoma, pontine bleeding, primary ventricular bleeding and subdural hematoma. All cases had hypertension and 3 cases showed cerebral arterosclerosis. 3) Neuropathological examination of a case of temporal lobe hematoma (92 year-old female) revealed marked congophilia in small blood vessels in the brain. From congo-red fluorescence, birefringence and electron microscopic finding, the congophilia was due to deposition of amyloid in the vascular walls. Small bleeding foci were also observed at such blood vessels. Distribution of congophilic angiopathy was prominent in the occipital and temporal lobes. It was highly suspected the relationship of this change to cerebral bleeding. 4) Frequency of congophilic angiopathy in the aged brains increased with aging and was 60% in the persons above 90 years of age. This finding suggests a high probability of cerebral bleeding due to congophilic angiopathy in the high-aged persons.