It is known that the main etiology of dementia in old age in a geriatic general hospital is that of vascular type and on the other hand, dementia of Alzheimer type (senile dementia), is few. This study was performed to ellucidate the incidence of the senile dementia on the autopsied brains. Material came from 500 autopsied brains of over 60 year-old persons. Among them, 44 cases with abundant senile plaques in temporal lobes including Ammon horn (SP group) and 50 cases without senile plaques were selected and examined pathologically. Results were as folows:. 1) Incidnence of SP cases increased in higher ages and they showed dementia in 85%. 2) SP cases showed a prominent cortcal atrophy, while ventricular dilatation was much more in SP-negative cases. 3) Marked cerebral arteriosclerosis was observed in 57% of SP cases and 74% of SP-negative cases. Vascular lesions were noted in 65% of SP cases and in 75% of SP-negative cases. 4) Six SP cases without arteriosclerosis and vascular lesion were found in 2 males and 4 females of ages from 65 to 84 year-old. Decrease of the brain weight, senile plaques in cerebral cortex, especially in occipital and temporal lobes, loss of nerve cells in cortex, Alzhemier's neurofibrillay change, granulovacuolar degeneration, Hirano bodies, etc. were obsered. There were no hypertensives and their clinical diagnosis was other than the senile dementia. 5) Morphological classification on 101 cases of dementia in old age, except other etiology, revealed vascular type in 54% and senile dementia (pure form) in 16% and senile dementia with/without slight vasculr changes in 32%. It seemed, however, difficult to classify the cases with combined changes to the “mixed type” of dementia of both vascular and Alzheimer types.
Cerebral circulation in the aged with dementia was studied by means of ultrasonic Doppler method. The subjects in this study were thirty four elderly patietns with organic dementia (mean age 61.2 y.o.) and thirty six healthy persons in sixth decades. Each patient was clinically diagnosed as either primary degenerative (PDD) or arteriosclerotic dementia (ASD). The degree of dementia in these patients was classified into three categories (mild, moderate and severe) from the results of Osaka Intelligence Scale for the Aged. In all these subjects, bilateral internal catotid and vertebral flows were measured by ultrasonic Doppler technique and the velocity pulse waves were evaluated with respect to the mean value of maximal flow velocity, and to wave heights at the representative phases in each cardiac cycle such as initial systolic peak (S1), the second systolic peak (S2), incisure (I), diastolic peak (D) and end-diastole (d). Wave height ratios, S2/S1 and D/S2, were also considered to characterize the velocity wave pattern. These waveform parameters were studied in relation to the type and the degree of dementia and the following results were obtained. (1) Mean flow velocity of internal carotid artery tended to decrease according to the degree of dementia, whereas the vertebral flow showed no significant changes. (2) The left internal carotid flow velocity in demented cases was significantly lower than the right, and this was predominat in severe dementia and in ASD (3) The maximal flow velocity at post-systolic phases (I, D and d) in internal carotid artery decreased in relation to the degree of dementia. The wave height at S1 in cases of PDD was significantly greater than that of ASD. (4) Velocity waveform in internal carotic artery showed the following changes. D/S2 ratio decreased in accordance with degree of dementia. The value of S2/S1, which was correlated with age in normal subjects, showed the significant difference between the two clinical types of dementia; i.e. in ASD cases the S2/S1 values corresponded to those of the control group of the same age, whereas in PDD cases they showed those of the young normal group. In conclusion, in elderly patients with organic dementia cerebral hemispheric blood flow, especially in the left side, decreased chiefly in post-systole in cardiac cycle, and this was related to the degree of dementia. Difference of the systolic wave height ratio S2/S1 among PDD and ADS patiets was thought to suggest the hemodynamic difference in them, and also to have a diagnostic value.
An inverse relationship has been demonstrated between plasma high-density lipoprotein (HDL) cholesterol level and the incidence of coronary heart disease. Therefore, measurement of HDL cholesterol is of great importance. In the present study we compared three different methods for the estimation of HDL cholesterol in plasma samples. The methods were as follows. (1) Ultracentrifugation. Cholesterol was determined in the d<1.063g/ml fraction from 2ml of plasma after centrifugation at 100, 000G for 20hr. (2) Heparin-Mn2+ precipitation. To 2ml of plasma we added 80μl of a heparin solution (5000units/ml) and 100μl of MnCl2 solution (1Mol/l), and immediately mixed. After the sample had stood for 30min. in an ice bath, the sample was centrifuged (1500G, 30min., 4°C) and cholesterol was determined in the supernate. (3) Sodium phosphotungstate-Mg2+ precipitation. To 2ml of plasma we added 200μl of a sodium phosphotungstate solution and 50μl of MgCl2 solution (2Mol/l). After mixing in a vortex mixer, the sample was centrifuged (1500G, 30min., 4°C) and cholesterol was determined in the supernate. HDL cholesterol levels of 138 subjects were measured by two precipitation methods and for 32 of them the three methods were used simultaneously. The correlation coefficients were 0.939 between ultracentrifugation and heparin-Mn2+ precipitation methods, 0.919 between ultracentrifugation and phosphotungstate-Mg2+ methods, and 0.966 between the two precipitation methods. Our results showed similar results for the cholesterol content of HDL determined by the three methods. Both precipitation methods are simple and appropriate for routine clinical laboratory use.
It has been known that atherosclerosis suddenly develops after menopause in women, suggesting the presence of the interrelationship between atherosclerosis and estrogen deficiency. The purpose of this study is to investigate the interrelationship between arterial calcification and serum estradiol levels and bone mineral content in the aged. Seventy-seven postmenopausal women (age 47-82, mean 71 years old) and 59 mean(age 41-91, mean 70 years old) were subjected to thi study. Presence or absence of the arterial calcification was examined macroscopically by X-ray films, serum estradiol was measured by radioimmunoassay, and radial mineral con tent was measured by Bone Mineral Analyzer. The results were as follows; (1) Arterial calcification and serum estradiol; In women, the mean serum estradiol level (11.5±1.3pg/ml) in those with calcification of the abdominal aorta was significantly lower than that (15.7±2.5pg/ml) in those without it (p< 0.01), and serum estradiol level (8.4±1.4pg/ml) in those with calcification of the iliac artery was sifnificantly lower than that (16.1±1.6pg/ml) in those without it (p<0.001). In men, the mean serum estradiol level (19.2±2.5pg/ml) in those with calcification of the iliac artery was significantly lower than that (29.7±2.4pg/ml) in those without it (p<0.01). (2) Arterial calcification and radial mineral content (RMC); In women, RMC (0.46±0.02g/cm2) in those with calcification of the abdominal aorta was significantly lower than that (0.52±0.02g/cm2) in those without it (p<0.02), and RMC (0.44±0.02g/cm2) in those with calcification of the iliac artery was significantly lower than that (0.52±0.01g/cm2) in those without it (p< 0.001). In men, there was no relationship between arterial calcification and RMC. (3) Serum estradiol and RMC; In women, there was a positive correlation between serum estradiol level sand RMC (Y=0.0025X+0.4551, X=serum estradiol level Y=RMC, p<0.02). In men, there was no correlation between serum estradiol and RMC. These results suggest that in both women and men, decrease of endogenous estrogen might accelerate the arterial calcification, and that the estrogen might protect the artery from calcification through a direct action on the arterial wall. Only in case of women, increased bone resorption might partly contribute to the arterial calcification.
The hemodynamic and clinical characteristics of 21 hypertensive patients with high cardiac index of 4.0L/min/M2 or more (HH, mean age 72.5y) have been studied in comparison with those of 21 hypertensive patients with normal cardiac output (NH, 74.3y) and 17 cases of normotensive aged control (NT, 75.1y). Mean values of cardiac index in each group were 4.57, 2.85 and 2.72L/min/M2, respectively. Although there was no significant difference in blood pressure between HH and NH, heart rate of 86.6/min and stroke index of 54.2ml/beat/M2 in HH were significantly higher than those of NH and NT (p<0.02). Morevoer, total peripheral resistance in HH was significantly lower and appearance time was shorter than those of the other two groups (p<0.02). Increase in cardiac index after intravenous administration of isoproterenol in HH was 1.92±0.26L/min/M2 (mean±S.E.), which was significantly larger than those of NH and NT (p<0.05). Hypertensive complications in HH, accordng to the criteria of Hypertensive Committee of Tokyo University, were less than those of NH. There were no significant difference in hemoglobin. T3-RUS, plasma renin activity and total plasma volume between HH and NH. Antihypertensive effect of oral beta adrenergic blockade with propranolol or oxprenolol was evaluated in 9 cases of HH. Treatment of 12 weeks resulted in a reduction of 14mmHg in systolic and 10mmHg in diastolic pressure with a remarkable reduction of heart rate. It was concluded that there were a few aged hypertensive patients with hyperkinetic heart syndrome, which has been observed in younger hypertensives. They had a hyperresponsiveness to Isoproterenol and beta adrenergic blockade was effective in reduction of their high blood pressure. Hypertensive complication in these patients were mild.
Our study was executed with the intention of clarifying the relationship between arteriosclerosis of the gastric wall and gastric lesions. Clinical and histopathological studies were performed on 80 cases more than 60 years of age, consistd of 24 cases of gastric ulcer, 13 cases of duodenal ulcer, 16 cases of depressed type early gastric cancer, 13 cases of protruded type and 14 cases of no gastric lesions. Resected stomach was cut into 9 pieces for histological study, on the small curvature, anterior wall and posterior wall, dyeing with hematoxylin Eosin stain and Weighert's elastica Van Gieson stain. We graded the sevirity of arteriosclerosis of gastric wall according to Deguchi's classification and determined the degree of atrophy of the gastric mucosa in accordance with Hirahuku's classification modified by us. The results were as follows. 1) The relationship could be sugested between arteriosclerosis of the gastric wall and atherosclerosis of the aorta. 2) The degree of arteriosclerosis of the gastric wall was highest in both gastric ulce4 and duodenal ulcer and lowest in early gastric cancer. 3) In gastric ulcer, arteriosclerosis of the gastric wall was related with ulceration of gastric mucosa by leading the atrophy of gastric mucosa and by reducing the mucosal resistance. 4) In duodenal ulcer, arteriosclerosis of gastric wall is not related with duodenal ulceration, which is much indebted to gastric mucosal resistance 5) In early gastric cancer, gastric mucosa easily fall into atrophic change by only low grade arteriosclero sis of gastric wall and gradually transform into malignancy oweing to vigorous ability of regeneration and proliferation. 6) As one grows older, atrophic border and intermediate zone rise together on gastric mucosa but the width of intermediate zone increase becuase of slow disappearance of fundic glands.
Micromeasuring and histological studies on age changes in width of pancreatic duct have been made in several hundred ducts without pathological fiindgs in male Japanese autopsy materials. (age range 21 to 97 years) In every size of pancreatic duct, relative width of duct was slightly increased in cases above 70 years of age. However, this increase is not significant in statistics. In case above 80 years of age, significant increase in width of the ductules in the lobule was recognized. There could not be noticed any change in the structure of elastic fiber in wall of pancreatic ducts.