The concentrations of plasma total and HDL cholesterol and apoprotein A-I were determined for a month in 13 patients during the course of acute myocardial infarction (AMI). Since the fifth till fourteenth day after the onset, mean concentrations of plasma HDL cholesterol and apoprotein A-I decreased significantly from the levels of those in the first day. No significant changes were observed in the levels of total cholesterol and VLDL, LDL cholesterol (total cholesterol minus HDL cholesterol) during the course. The levels of VLDL, LDL cholesterol/HDL cholesterol ratio (cholesterol ratio) elevated since the seventh till fourteenth day. A negative correlation was seen between the lowest levels of HDL cholesterol and the highest levels of GOT or LDH in each patient. AMI patients were classified into two groups according to HDL cholesterol levels; one with decreased HDL cholesterol (over 30%) the other without the change during the course. The numbers of the patients who suffered from angina pectoris befor the onset of AMI were only different between the two groups: the occurrence of angina was 7/9 in the group with decreased HDL cholesterol and 0/4 in the other group. The results indicate that decrease in the levels of plasma HDL cholesterol during AMI reflects the severity of coronary sclerosis. The determination of the levels of plasma HDL cholesterol during AMI course is useful in order not only to estimate reliable cardiovascular risk factor, but also to understand the grade of pathological condition.
Whether the blood pressure disparities between both arms were related to the order of the pressure determinations was prospectively studied in 118 persons. Although in 12 persons the arm pressure recorded first was consistently higher than that of contralateral arm and in 25 the arm pressure recorded first was consistently lower, statistical analysis revealed that the order of blood pressure determination had no effect on the results of pressure disparities between both arms. Then, the blood pressures of both arms and right leg measured by indirect cuff method were examined retrospectively in 742 males and 565 females. Persons with pressure differences of more than 20mmHg between both arms or arm and leg were excluded from this evaluation, because they might have occlusive arterial disease. In normotensives (<140/90mmHg), the right arm systolic blood pressure was higher than the left arm one by 1.9±0.4mmHg in younger persons with age below 39, but in persons with age of 40 or older the pressure differences between both arms disappeared. In hypertensives (>160/90mmHg), the right arm blood pressure was higher than the left arm one by about 3mmHg except for age group of 70-79. The arm blood pressure in normotensives was higher than the leg one by 3.4±0.2mmHg in persons with age of 20-39, and the pressure differences were decreased in older persons. In hypertensives, as well as in normotensives, arm blood pressure was higher than the leg one only in younger persons.
Many hemoatology studies have shown that the erythrocyte count decreases while the size of the individual cell increases in the aged. However, recently, we showed there was no evidence of vitamin B12 or folate deficiency in the aged to explain the observed macrocytosis by deoxyuridine supperssion test. This study was performed to evaluate a rate of incroporation of 3H-Thymidine into nucleated bone marrow cells with aging. Fresh bone marrow cells were obtained from 15 young (20-38yr.), 11 middle-aged (47-61yr.) and 14 elderly (70-82yr.) men. We compared the uptake of 3H-Thymidine by 4×106 bone marrow cells among these three groups. There was no signifierence between the young (66997±18672 CPM/well, mean±S.D.) and middle-aged (59048±20512) groups. However, the 3H-Thymidine uptake was significantly lower in the old age group (42339±13089), though their proportions of bone marrow cell composition were within normal limit. These results suggest that the rate of DNA synthesis of bone marrow cells is reduced in the aged, although we showed the route of deoxyuridine to thymidylate in DNA synthetic pathway in the aged was intact, using deoxyuridine suppression test, previously. The mean ratio of 3H-Uridine to 3H-Thymidine uptake of the aged men was 0.60. It was significantly higher than that of young men (0.24). This indicates that bone marrow cells may be in a sort of unbalanced growth state in which RNA and protein syntheses continue while DNA synthesis is retarded, in the aged. The cytoplasmic component are thus excessively synthesized during the delayed cell division. Therefore erythrocytes decrease in number but increase in volume although there is no evidence of vitamine B12 and/or folate deficiency in the aged.
There is general agreement that serum triglyceride (TG) increases progressively throughout pregnancy. Increased serum total cholesterol (TC) during pregnancy has also been reported. The mode of rise in serum TC during pregnancy has been somewhat different in various reports. It is uncretain whether the weight loss after delivery influences serum TC or not. Forty-five normal women after 32nd week of pregnancy were studied who had obvious hypercholesterolemia (TC≥300mg/dl). The subjects were divided into two groups-Groups A and B-according to the maximal level of TC (TCmax) during pregnancy. In Group A (TCmax<350mg/dl) 22 subjects were examined, in Group B (TCmax≥350mg/dl) 23, respectively. The duration between 32nd and 40th week of pregnancy was separated into three periods: from 32nd to 34th week of pregnancy (Period I), from 35th to 37th (Period II) and from 38th to 40th (Period III). In each Group A or B TC, HDL-cholesterol (HDL-C), Atherogenic index ((TC-HDL-C)/HDL-C, AI) and TG were studied. In each Group A or B TC was measured at intervals of 4 to 6 weeks post-partum until TC was below 250mg/dl. Age of the pregnant woman, relative body weight before pregnancy, weight gain during pregnancy, degree of weight gain during pregnancy or birth weight of the child was not significantly different between Groups A and B. In Group A TC unchanged and in Group B TC increased from 362±37 (SD) mg/dl at Period I to 378±26mg/dl at Period III. At Period I HDL-C in Group B was significantly higher than that in Group A (81.1±19.9 vs 67.6±13.1mg/dl, p<0.02). At each Period II or III AI in Group B was slightly higher than that in Group A. But AT was not significantly different between Groups A and B at each period. TG in Group A increased gradually from Period I to Period III. In Group B TG increased progressively, especially TG at Period III was significantly higher than TG at Period I (385±190 vs 272±75mg/dl, p<0.02). In 16 of the 22 post-partum women in Group A (72.7%) TC was below 250mg/dl within 10 weeks after delivery and in the same duration 10 of the 23 subjects in Group B (43.5%) reached that level of TC. This difference was significant (72.7 vs 43.5%, p<0.005). The average weekly weight loss of the subject in each group whose TC was below 250mg/dl within 10 weeks post-partum was greater than that of the subject whose TC reached 250mg/dl more than 11 weeks post-partum (Group A: 1.2±0.4 vs 0.6±0.2kg, p<0.005, Group B: 1.0±0.2 vs 0.7±0.2kg, p<0.01). It was demonstrated that change in TC, HDL-C, AI or TG between Groups A and B was somewhat different. Although the reason of this difference was not clear, metabolic and endocrine factors might influence and diet might be additional factor. After delivery the rapid weight loss might bring rapid recovery of TC.
Subject groups whose life styles are markedly different were investigated to evaluate the effect of physical activity on serum creatine phosphokinase (CPK) levels. The subjects consist of three groups. The first group are 4310 rural subjects in Kochi, whose main industry is forestry. The second group are 3283 urban subjects with various occupations from Osaka. The third group are 460 Osaka textile workers. The first and second groups received mass screening examinations for four years, the third group for two years. The mean serum CPK levels of the rural group were found to be significantly higher than the two urban groups. When the rural group was further divided into three subgroups (subjects living in moderately developed districts, agricultural districts, and forestry districts) it was found that the mean serum CPK levels of the subjects living in the forestry district showed the highest values. These results indicate that the more strenuous the subject's work, the higher the serum CPK level. There were no significant changes in either individual or group serum CPK levesl over the four years of the study. It was also noted that the mean serum CPK levels of subjects receiving antihypertensive drugs were not significantly different from those of subjects without antihypertensive medication. The degree of physical labor seems to play an important and continuous effect on serum CPK levels.
In 96 patients with supratentorial cerebral infarction, the recovery of activity of daily living (ADL) was studied in relation to computerized tomography (CT) findings in the acute stage. The average age was 64 and 78 out of 96 were first attack cases. The cases were divided into 3 groups on the basis of the CT findings. The N group had no low density area on CT. The S group had a small deep infarct around the basal ganglia and the L group showed a large infarct with a damaged cerebral cortex. Dilatation of the ventricles was measured by the methods of Meese and Huckman. Cortical atrophy estimated by summation of width of Sylvian fissures or parietal cortical sulci, expressed in percentages. Measurements for CT were performed in the subacute stage to exculde the effects of cerebral edema. ADL was categorized in five stages using Rankin's criteria in the first week and after the eighth week. Among the 3 groups, the L group had the worst ADL when examined eight weeks later. On the contrary, the N group showed the greatest improvement. Patients under 60 years old showed better recovery at the eight week, while in most patients aged 70 or more the improvement was less evident. Dilatation of ventricles and severity of cortical atrophy increased in proportion to age, especially in cases of cerebral infarcts. In patients with ventricular dilatation or severe cerebral atrophy. ADL improvement was lower. Recovery was low in cases with narrow cortical sulci. Recovery of ADL in reattack patients was lowest and larger dilatation of the ventricles than first attack cases was recognized. The size of cerebral infarction, ADL in the first week, the dilatation of lateral ventricles, the severity of cortical atrophy and age were found to be important factors in functional recovery.
Postmenopausal or senile osteoporosis has been ascribed to endocrine imbalance, nutritional deficiency, physical immobilization and genetic disposition until immunological abnormality has recently been held responsible in view of the female preponderance, increase with age, prevalence around rheumatoid joint and lymphokine-stimulated osteoclast-osteoblast imbalance characterizing osteoporosis. Tuberculin reaction became increasingly negative with advancing age especially in osteoporotics. Negative tuberculin reactors were found more frequently in osteoporotics with compression fracture and low bone mineral content (BMC) than in non-osteoporotics of the same age. Administration of 0.5μg/day 1α(OH) vitamin D3 changed negative tuberculin reaction into positive in osteoporotics but not in non-osteoporotics. Total lymphocyte count and T-lymphocyte number were similar between osteoporotics and non-osteo-porotics but OKT4/OKT8 (helper/suppresser) ratio was significantly higher in osteoporotics than in non-osteoporotic controls of the same age. A negative correlation was found between OKT4/OKT8 and BMC. Administration of 0.5μg/day 1α(OH) vitamin D3 for 1 month decreased the elevated OKT4/OKT8 in osteoporotics. Correction by 1α(OH) vitamine D3 of high OKT4/OKT8 ratio and negative tuberculin reaction indicating decreased cell-mediated immunity characterizing osteoporosis may explain some of its therapeutic efficacy.
The blood pressure response to the treatment with either spironolactone (75mg/day) or trichlormethiazide (4mg/day) was studied in crossover fashion in 41 old hypertensive patients with mean age of 73 years. One drug was given for 4 weeks and after washout for 2 weeks, the other was given for 4 weeks. Plasma renin activity (PRA), plasma aldosterone concentration (PAC), hematocrit, plasma dry weight and plasma potassium levels were determined at the completion of each treatment period. Both drugs were equally effective in decreasing the blood pressure and they were more effetive in patients whose PRA before treatment had been below 1.0ng/ml/h (n=22) than in those with PRA above 1.1ng/ml/h (n=19). The PRA and PAC increased after both diuretics two to three times compared with basal value. When patients whose mean blood pressure had been decreased by more than 10mmHg during treatment were defined as responders, their PRA was significantly lower than that of nonresponders, before and during treatment, while PAC was not significantly different between these two groups. There was a significant negative correlation between PRA and fall in mean blood pressure during both drugs. The increase in plasma dry weight was significantly higher during the treatment with trichlormethiazide in the blood pressure nonresponder group compared with the responder group, and there was there was a weak negative correlation (r=-0.39, n=41) between increase in plasma dry weight and fall in mean blood pressure during trichlormethiazide. These results suggest that plasma volume depletion might negatively correlate to fall in mean blood pressure, and that the failure to respond to diruetics might be due to sustained elevation of PRA induced by plasma volume depletion. Plasma potassium decreased significantly after trichlormethiazide treatment. Hypokalemia below 3.0mEq/l occured 7 out of 41 patients (17%). The incidence was more frequent significantly in the bedridden patients.
Dysfunction of brain GABA metabolism is supposed to exist in patients with Alzheimer's disease, Huntington's disease and Parkinson's disease. Recently aged people are increasing in population, and they may be also supposed to have dysfunction of brain GABA metabolism. The purpose of this study is to clarify the effect of aging on brain GABA metabolism. For this purpose, we measured cerebrospinal fluid GABA (CSF-GABA) level which reflected dysfunction of brain GABA metabolism. The individuals consisted of normal volunteers and patients without neurological or psychiatric disease. There were 34 individuals (19 men and 15 women) and their mean age was 49 years. The brain atrophy in these individuals was only a little on CT scan. CSF-GABA levels were measured by radioreceptor assay (RRA). As a result, the mean CSF-GABA level (mean±SEM) was 131 ±7.5 pmoles/ml in control group (age: 20-39 years). The CSF-GABA level was significantly decreased in individuals over 50 years, compared with control group. The CSF-GABA level was only 50% of control in seventies and 30% in eighties. On the other hand, no significant decrease of CSF-GABA was seen in forties. a significant negative correlation between age and CSF-GABA (p<0.01) was found both in males and in females. These data suggested that dysfunction of brain GABA metabolism progressed with age and that various neurological or psychiatric symptoms caused by that dysfunction could more easily appear in aged people.