The effects of ageing on the autonomic nervous functions were investigated in 81 healthy subjects of various ages by means of the hemodynamic functional tests (Aschner's test, carotid sinus massage, cold pressor test, Valsalva maneuver, atropine test and postural change). The same procedures were also performed in 36 patients with Parkinson's disease and 26 with spino-cerebellar degeneration, as the autonomic nervous involvement is considered common in these diseases. 1) Reflex bradycardia in Aschner's test and in Valsalva meneuver: -the parameters of the parasympathetic nervous function gradually developed hyporeactivity with ageing. 2) Peflex tachycardia and reflex hypertension in the cold pressor test: -the indices of the sympathetic nervous function declined steeply in the fourth decade of life but showed little change later. 3) Orthostatic hypotension was prominent after the fifth decade. 4) The incidence of orthostatic hypotension in Parkinson's disease and in spino-cerebellar degeneration was not so high as compared to the age-matched healthy subjects. The above data strongly suggest that an evaluation of the changes with age is indispensable for a discussion on autonomic nervous functions in any disease.
Platelet aggregability was estimated in patients with cerebral infacrction (68 cases in the acute stage and 74 in the convalescent stage) and crebral hemorrhage (46 cases in the acute stage and 45 in the convalescent stage). The “acute stage” was difined as a period within a week after the onset of stroke, and the “convalescent stage” after four weeks. Platelet aggregability was evaluated on the basis of threshold concentrations of adenosine diphosphate (ADP) to induce the secondary aggregation. Patients were divided into three groups. In type I (lower sensitivity) secondary aggregation was seen after adding 4μM ADP, type II (moderate sensitivity) 2μM and type III (higher sensitivity) 1μM. In the acute stage of cerebral infarction and hemorrhage, the platelet sensitivity to ADP-induced aggregation was significantly lower than in the convalescent stage. When platelet aggregability was monitored continuously from the acute stage to the convalescent stage, the aggregability tended to enhance later, especialy in the cases with infarction of the carotid system, but this was not seen in the cases with infarction of the vertebro-basilar system. It might be considered that a lower sensitivity of platelet to ADP in the acute stage was due to the circulation of exhausted platelets. This fact should be taken into account when platelet suppressing therapy is cons idered in acute phase of cerebral infarction. When aggreganility of platelet in chronic phase was evaluated with reference to patients' age, type III was more frequently seen in older group (>65y.o.). This suggests that platelet aggregability may enhance with age.
The epidemiological investigation of the stool frequency was performed and the effect of ingesting commercially available bifidus yogurt on bowel movements was studied in 57 elderly with a mean age of 78 years ho were bed ridden. Forty of the 57 patients (70%) had less than one stool every other day and 22 (39%), who were sever constipated, had two or fewer stools weekly. The ingestion of bifidus yogurt for 10 or 20 days did result in a significant increase of stool frequency compared with the slight effects of nonfermented milk. In the case of nine elderly, stool frequency after 10 or 20 days administration of 100ml of bifidus yogurt increased progressively from 5.7±3.3 (mean±SD) to 7. 0±2.5 (p<0.05) and 8.1±1.6 (p<0.01), respectively. Furthermore, similar results were obtained in 10 constipated elderly with laxative use, the values of stool frequency changed from 2.1±0.3 (mean±SD) to 3.8±1. 9 (p<0.05) and 4.4±1.8 (p<0.01) under the same experimental design. To confirm the above observation, we also demonstrated the effectiveness of bifidus yogurt on the improvement of bowel movements in additional 26 elderly.
A single radial immunodiffusion (SRID) method was applied to determine the concentrations of apolipoprotein A-I (apoA-I) and apolipoprotein A-II (apoA-II). ApoA-I and apoA-II were purified and used to prepare monspecific antisera by immunizing rabbits. An aliquot of high density lipoprotein (HDL) was delipidated with an equal volume of tetramethylurea (TMU), and then diluted with 8M urea in 10mM Tris-HCl buffer, pH 8.0. Agarose SRID plates were prepared by using the specific antisera. 4μl of each sample were added in duplicate wells on the plates which were placed in a humid chamber for 48hr. The diameter of the ring-shaped immunoprecipitates was measured in 0.1mm units. The concentrations of apoA-I and apoA-II measured after delipidation with TMU and subsequent dissolution in 8M urea were 98 and 94%, respectively, of the concentrations yielded by delipidation with ether/ethanol and subsequent dissolution in 8M urea. The precipitate rings attained their final size within 24hr at room temperature. Intrassay coefficients of variation [(SD/mean)×100] within one plate for apoA-I and apoA-II analyses were 7.2 and 2.5%, and those between plates were 2.5 and 8.5%, respectively. Results presented in this paper show that the SRID method is acurate, technically simple, and applicable to measurement of these apolipoproteins (apoA-I and apoA-II) in human plasma HDL.
This study was proceeded with intention to detect the cerebral arteriosclerosis at the early stage. We measured the stiffness paramenter β distribution along the common carotid artery because the sclerotic grade of the carotid artery was going ahead of the cerebral arteriosclerosis. Materials consisted of 30 cases in the healthy group and 40 cases in the cerebral infarction group, whose ages ranged from 50 to 69 years old. Measured sites were four points (B, C, D, E) along the common carotid artery including the carotid sinus (E). Measuring parameter was the stiffness parameter β. β was a coefficient when the constitutional relationship of stress-strain was expressed in the exponential function. The more β increased, the more stiff the arterial wall. We could calculate β by the following equation clinically. β=(ln Ps/Pd)·Dd/(Ds-Dd), where Ps was the maximum pressure, Pd the minimum pressure and Ds and Dd were the diamters in Ps and Pd respectively. β did not have the pressure dependence within the physiological pressure range. Measuring system used in this study was the ultrasonic, phase-locked echo tracking system. We got Dd and ΔD from the waves of the diameter change during the cardiac cycle recorded by this system. Blood pressure (Ps, Pd) was measured on the upper arm by the indirect measuring method using the pressure transducer. Then we culculated, β by the equation mentioned above. In the practical use the error of, β was within±5%. Now we got the diameter distribution along the common carotid artery. The diameter of carotid sinus (E) was about 20% larger than that of the other sites in both groups and in both ages, and the diamter of the cerebral infarction group was larger than that of the healthy one. The diameter change (ΔD) had no clear defference among 4 sites. But ΔD of the cerebral infarction group was clearly smaller than that of the healthy one. Now we got β distribution along the common carotid artery. In the fifties of the healthy group, β of each site (B, C, D, E) were 9.34, 9.09, 9.93 and 11.18 respectively, and in those of the cerbral infarction group, β were 12.23, 11.81, 12.59 and 16.73. In the sixties of the healthy group, β were 11.39, 10.97, 10.03 and 13.06, and in those of the cerbral infarction group, β were 17.08, 14.82, 16.19 and 21.33. Namely, β of the cerebral infarction group was higher than that of the healthy group in any sites. We could clearly recognize the significant defference between both groups, and especially β in carotid sinus was 45-63% larger than that of the healthy group. In summary we could recognize the sclerotic change first in carotid sinus among the all sites of the common carotid artery. The cases with severe cerebral arteriosclerosis always had the severe carotid arteriosclerosis. So we concluded that the nonivasive measurement of characteristic β distribution along the common carotid artery was usefull as an indirect diagnostic method of cerebral arteriosclerosis.
Chages of white blood cell count, Benzoyl-L-Arginyl-pNA hydrolytic activity (Trypsin-like enzyme: T.L.E.) and serum amylase level in an aged group (45 cases over 60; average age, 76 years old) after E.R.P. were compared with those in a younger group (26 cases averaging 42 years). The change of hematorit after E. R.P. was reported for the aged group. White blood cell count and T.L.E. were slightly increased after E.R.P. in both groups. Serum amylase level 2 hours after E.R.P. was significantly increased over the pre-E.R.P. level in the aged group. But the degree of serum amylase increase in the aged group was only one third of that in the younger group (p<0.01). There was a significantly negative correlation (n=68, r=0.361, p<0.01) between the diameter of the main pancreatic duct and the serum amylase level after E.R.P. Judging from the slightly increased serum amylase level in the aged, sufficient contrast material could be injected to obtain a pancreatogram suitable for diagnosis. In contrast, the serum amylase level 5days after E.R.P. in the aged group was higher than the nomal range in the younger group. In the aged, hematorit was significantly increased after E.R.P., suggesting that E.R.P. brings about high blood viscosity, possibly because of the release of several pancreatic enzymes into the blood. A case of Mallory-Weiss syndrom which seemed to be caused by E.R.P. was reported in which a long 50-min examination had been accompanied by frequent vomiting. To perform safely E.R.P. in the aged, the endoscopist must pay careful attention to the general condition of patients before, during and after the examination, and efforts must be made to shorten the examination time.
The incidence of aorrtic calcification was compared between 2921 patients (1828 males and 1093 females) in Tokyo and 788 patients (436 males and 352 females) in Fukaya and outskirts of it. The patients were between the age of 40 and 79 years. Aortic calcification was diagnosed by a routine chest film and a lateral film of abdomen. The incidence of calcification of aortic arch was greater in Fukaya than in Tokyo, Statistically significant on 50-59 and 60-69 age-group, both male and female. However, the incidence of calcification of abdominal aorta showed no signoficant difference between Tokyo and Fukaya. When the incidences of aortic calcification were compared in subgroups divided by glucose tolerance test or blood pressure, same tendency was observed. The incidence of aortic calcification showed no difference between farmers and the others in Fukaya. The average of serum total cholesterol and HDL-cholesterol showed no difference between patients with aortic calcification and without calcification in Fukaya.
The validity of ISP test in the diagnosis of ischemic heart disease in the aged was evaluated in 150 autopsied cases, ranging in age at the time of death from 60 to 90 years old (79.0±8.0, mean±SD). ISP was infused at a rate of 0.02μg/kg/min for five minutes. The electrocardiogram was recorded before, during & until 5 minutes after ISP infusion. Bipolar lead of C5-C5R and standard 12 lead ECG were used. The additional ST segment depression of 0.5mm or greater of the iscchemic type was considered to be the positive test. The sensitivity in 60 severe coronary stenosis of 75% or more was 73.3% and specificity in 90 mild coronary stenosis was 81.1% After excluding 24 cases of myocardial infarction sensitivity was elevated to 80.0%. The severity of ST depression after ISP test was correlated with the number of the stenotic branches. Decrease in negative amplitude of initially negative T was more frequently observed in severe coronary stenosis than in mild coronary stenosis, but the difference was not statistically significant. R wave amplitude changes in C5-C5R were measured after ISP infusion. Increase or no change of R wave was slightly more frequent in severe coronary stenosis but not of diagnostic value. In myocardial infarction the severe stenosis of the coronary artery supplying non-infarction areas was found in 10 out of 13 ISP positive cases, while it was found in 2 out of 11 ISP negative cases. In other words, positive ISP test in prior myocardial infarction suggests multivessel disease. The reinfarction was more frequently observed in ISP positive cases than in negative cases In summary, ISP test, especially ST change after infusion, was useful in the assessment of coronary stenosis including myocardial infarction.
Serum levels of RNase, human pancreatic polypeptide (hPP), elastase 1, and amylase were measured in 323 normal human subjects aged from 18 to 116 years. In addition, Pancreozymin Secretin test (PS test) as a pancreatic exocrine function examination was performed in 372 human subjects aged 15 to 77 years without pancreas cancer, clinically definite chronic pancreatitis, and other pancreatic diseases. Serum activity of RNase elevated with aging, in particular, markedly elevated over 70yrs and a significant possitive correlation (r=0.61, p<0.001) was observed between serum RNase activity and age. As similar as the change in serum RNase activity, the level of serum hPP elevated with aging, and a singificant positive correlation (r=0.51, p<0.001) was also observed between serum hPP level and age. It is of interest that there was a significant correlation (r=0.44, p<0.001) between hPP and RNase. On the other hand, the activities of serum elastase 1 and amylase did not show any significant change with aging. As for PS test, the volume and amylase output in pancreatic juice were slightly decreased in second and eight decades respectively. However there were no significant changes in three factors in any decades of age. In conclusion, it was demonstrated that the activity and level of serum RNase and hPP were increased with advancing age. Age factor must be considered in the clinical determination of serum RNase activity and hPP level.