At a short interval, two cold pressor tests (Double Cold Pressor Test named by authors.) were carried out to 123 persons of over 30 years old. The difference between the first and the second blood prssure response, the response of next year, the relationship of the response to examinations for cerebro-cardiovascular diseases, etc. were discussed. The results were as follows. 1. In the both cases of systolic and diastolic blood prssure, the difference between the rised blood pressure and the basal blood pressure at the first cold pressor test (ΔSBP1 and ΔDBP1) and the difference at the second test (ΔSBP2 and ΔDBP2) were not significanlty related to each basal blood pressure. 2. ΔSBP1 was significantly related to ΔDBP2 and ΔDBP1 was significantly related to ΔDBP2 in persons of over 30 years old. 3. ΔSBP1 was significantly related to ΔSBP at cold pressor test of next year in persons of over 30 years old. However, ΔDBP1 was significantly related to ΔDBP at cold pressor test of next year only in persons of 30∼59 years old. 4. The correlationship between ΔSBP2-ΔSBP2 and ΔSBP of next year-ΔSBP1 was significant in persons of over 30 years old. However, the correlationship between ΔDBP2-ΔDBP1 and ΔDBP of next year-ΔDBP1 was significant only in persons of over 60 years old. 5. Through the first to the second cold pressor test, the persons having the change of the degree of the two res ponses (ΔSBP1 and ΔSBP2) had the relatively significant prevalence of arteriosclerosis of eye ground. In the case of diastolic blood pressure response, such a relationship was not observed.
The purpose of this paper is to clarify hematological characteristics on peripheral blood figure and pathogenetic significance of liver dysfunction in the aged subjected to drug-induced acute bone marrow failure. Several points concerning the administration of drugs, as well as the changes of blood figures were investigated in 17 cases of the aged with acute bone marrow failure due to chloramphenicol (CP), thiamphenicol (TP), aminobenzylpenicillin (AB-Pc) and carbenicillin (CB-Pc). Furthermore, both renal and liver fuction prior to the occurrence of bone marrow failure were retrospectively investigated in these patients. The results obtained were as follows: 1. These patients consisted of 13 cases of CP and/or TP, 3 cases of AB-Pc and a case of CB-Pc. Injury of erythroid cells was most frequently observed (15 cases among 17 patients), and secondly injury of thrombocytes was observed (10 cases among 17 patients). Abnormalities of blood figures were mostly found out 7 to 15 days in CP and/or TP cases and 4 to 5 dyas in AB-, CB-Pc cases after the institution of drug administration. Discontinuance of drugs was immediately (mostly within 7 days) followed by rapid recovery of the injuried blood cells in all but three cases died directly or indirectly due to the drugs. 2. Comparative studies on both renal and liver functions between the group associated with acute bone marrow failure and the other group not associated with acute bone marrow failure after CP and/or TP administration were carried out in 646 patients received CP and/or TP administration. Abnormalities of GPT were significantly more frequently observed in the former group than in the latter group. 3. Simultaneous injuries of liver and bone marrow were observed in two TP cases and a AB-Pc case. However, such an acute bone marrow failure seemed to occur independently of liver injury. Both injuries were thought to be induced separately but simultaneously by drugs. In conclusion, various antibiotics including CP and TP are likely to induce acute bone marrow failure more frequently in the aged than in the other population. Abnormal elevation of GPT is postulated to play a role in an occurrence of drug-induced acute bone marrow failure.
This is a statistical report concerning a comparative histopathological study of autopsied pancreata free from decomposition between 159 cases of aged group above 60 year-old and 25 cases of chronic alcoholics. The alcoholics were composed of those who had daily consumed more than 360ml of alcoholic beverages for more than 8 years. The pancreatic specimens from both aged group and alcoholic one commonly showed periductal fibrosis, interlobular and/or interacinar fibrosis, and lobular atrophy. Mucus cell hyperplasia and squamous metaplasia of the ductal epithelum were noted frequently in the specimens of aged group than those of alcoholics. On the contrary, duct dilatation, inflammatory cell infiltration and venous dilatation were detected more often in the specimens of alcoholics in comparison with those of aged group.
Definite diagnostic criteria for familial hypercholesterolemia (FHC) have been established in the United States and Europian countries. However, it is uncertain whether the criteria are applicable for the diagnosis of FHC in Japan where the diet of the people is different from a conventional Western-type diet. In this report we studied the serum lipids of 55 patients of FHC with tendon xanthomas or Achilles tendons of increased thickness. The results were as follows: 1) The serum cholesterol levels of FHC were between 255 and 908mg/dl (Mean±SEM, 385±14mg/dl). 2) The serum triglyceride levels of FHC were between 54 and 307mg/dl (Mean±SEM, 128±9mg/dl). 3) The low-density-lipoprotein cholesterol levels determined in 7 patients of FHC were between 226 and 360mg/dl. 4) From the above data, the diagnostic criteria for FHC are either i) hypercholesterolemia greater than 250 mg/dl with tendon xanthomas or Achilles tendons of increased thickness, or ii) hypercholesterolemia greater than 250mg/dl in a first-degree relative of FHC.
During the last 4 years, we have investigated clinical features and prognosis of 21 cases of chronic subdural hematoma who were all of ages over 65 years old. The average ages was 77.1 years old and sex distribution was not observed. In this group of 21 patients, a history of trauma was noted in 95%, history of hypertension in 52%, diabetes mellitus in 19% and chronic alchoholism in 14%. Among initial symptoms or signs given by the family at admission to the hospital, the most remarkable findings was gait disturbance in 43% (weakness of under ext., hemiparesis, hemiplegia.), mental or personality changes in 24%, incontinentia in 28%, headache in 24%, dementai in 24%, altered consciousness in 24% and others symptoms such as seizure and vertigo in 5%. Diagnosis before admission were cerebral infarction in 43%, cerebral artherosclerosis in 14%, intracerebral hemorrhage in 14%, senile dementia in 10% and other several diseases as head injury, brain tumor, meningitis in 5%. As it was predicted by various different diagnosis before admission, differential diagnosis of chronic subdural hematoma in the elderly is difficult covered by senile dementia, cerebral vascular disease, concomitant other vascular disease and etc. The chief complaint on admission was disturbance of consciousness in 43%, mental disoder in 38%, symptoms of hemiparesis or hemiplegia in 71%, incontinentia in 28%, headache in 24%, speech disturbance in 24% and aphasia in 10%. Anisocoria and papilledema was noted only in 3%. By the lumbar puncture, it was shown that cerebrospinal fluid pressure was increased (over 180mmH2O) in 7 cases (33%) and decreased (under 120mmH2O) in 8 cases (38%). The CSF protein level was elevated over 50mg/dl in 5 cases (24%) in such cases with old apoplexia and cerebral infarction. Angiographic examination demonstrated conculusivelly the presence of a subdural space occupying lesion in almost all cases of a subdural space occupying lesion in almost all cases of our 17 patients. Improvement was recognized in findings of clinical featurs and results of CBF. In cases of good prognosis CBF recovered excellently after 3 months of operation. When compared with younger patients with chronic subural hematoma in the aged caused lesser compression upon cerebral tissue since their brain suffered atrophy, accompanying previous cerebral vascural disturbance and intracranial space was dilated.
Insulin response to an oral glucose load (50gm.) being observed in 1325 patients of ages 13 to 91 years, analysis of insulin response to glucose were performed mainly in relation to age. The insulin response to glucose was calculated as SIRI/SBS values, the ratio relating to serum insulin areas to the blood glucose areas during oral glucose tolerance tests. The results were as follows: 1) For the relationship between age and the insulin response to glucose, the SIRI/SBS values had to be transformed into decimal logarithm values. 2) For the purpose of the statistical assays between age and the insulin response to glucose, the SIRI/SBS values had higher significance than the ΔIRI/ΔBS or ΣIRI/ΣBS values, although the latter has been generally used. 3) Concerning non-obese groups, a positive correlations between age and the insulin response to glucose were admitted in each groups of Normal, Borderline DM and DM, while such correlations could not be seen in regard to obses groups. 4) Both the Young (ages 13-39 year) and Adult (ages 40-59 year) non-obsee DM groups showed apparently lower values than those in Normal as to the insulin response to glucose, whereas the Aged (ages 60-91 year) non-obese DM groups were hard to distinguish from Normal. 5) Less influence of a factor “obesity” to the insulin response to glucose was observed in the aged than in the Young or the Adult.
The relationship of Activities of Daily Living to blood pressure and to the results of blood samples was investigated among 317 old peoples (111 males; 206 females) in the Tokyo Metropolitan Nursing Home. Subjects were evaluated and classified into 13 groups based on ability to walk, eat, dress, bath and go to the toilet. Distribution of ADL among the 13 groups tended toward extremes of high and low with few intermediates. Mean age was 80.5 (from 60 to 101) and ADL scores did not vary according to age. Many chronic diseases were prevalent among the subjects. Bone and joints diseases were most frequent occupying 36.6% of all diseases, followed by apoplexy syndromes (32.5%) and mental disturbances (24.6%) etc. Bed-ridden subjects who wore diapers against incontinence were determined as having the poorest ADL and comprised 30% of all subjects. ADL scores were higher in females than in males. Subjects were divided into two groups according to ADL scores and differences in other clinical findings were compared between the lower ADL group and the higher ADL group. The mean cholesterol in both sexes and A/G, uric acid in females were significantly higher in the group with higher ADL. The mean value of total protein and systolic blood pressure in both sexes tended to be higher in the group with better ADL. The same tendency was found in the mean value of A/G, diastolic blood pressure in males. Though levels of hematocrit and hemoglobin were observed incresae according to high ADL scores in males, the opposite phenomenon was found in females.
Pressure sore is one of the most difficult problems in the care of the aged patient. In spite of the importance of this problem, many problems were not settled clearly till now. One of the most difficult points to study is a great influence of the subjective factores. For example, its occurence can be decreased and its progress can be improved, only when the pressure sore is interested by staffs. Therefore, the animal model for the pressure sore is devised using spinalized rabbits, in order to analyse objectively pathogenesis, the effect of treatment, etc. Methods: The gummi balloon filling up the cylinder cap of ca. 2cm diameter and ca. 1cm hight, was attached gently to the surface of the sheared skin of femoral region. The pressure of the balloon, filled with water, was increased by adding the water into it, and the increased pressure was kept constant during experiments. The pressure in the balloon is monitored continuously by Hg-manometer, and the pressure to skin surface was monitored by using pressure sensor and its recording system. Results: 1) The pressure of the skin surface against floor in spinalized rabbits was highest in sacral region, and its value was 40±10mmHg. Therefore, the experiments were performed under four different balloon pressure, that is, 150-90mmHg, 90-60mmHg, 60-40mmHg and 30-20mmHg. On the 4th day after beginning of increased pressure, pressure sore was developed in all 9 cases of 150-90mmHg group, in all 7 cases of 90-60mmHg group, but only 2 to 4 cases of 60-40mmHg group; and pressure sore was not developed in all cases of 30-20mmHg group. 2) The change of the skin surface was more obvious when the rubber sheat was placed between balloon and skin than that when the gauge was placed. 3) The pathologcial evidence of the pressure sore developed by pressure balloon method was principally the same of that developed spontaneously at the sacral region of spinalized rabbits and also of that developed in human being. 4) The bacterial flora and the response to local infections of the pressure sore developed in spinalized rabbits was different from those of human being. In conclusion, the pressure sore developed by the pressure balloon method in spinalized rabbits is useful as animal model for studying the pressure sore in human being except the infectious problem.