[in Japanese]

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[in Japanese]

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The human species had acquired the relatively longest lifespan among the animals by developing their intelligence. There are various data which indicate that the cerebral cortical function does not decline with age, e. g. in the healthy persons the glucose utilization is well preserved in the cortex by PET study, and dendritic arborization of the hippocampus is also well developed in the aged, especially in the persons with good intelligence. The capacity to develop the nerve process could be observed also in vitro study by culture of aged nerve cells. On the other hand, in order to prevent a decline of intelligence, several risk factors for brain aging should be controlled: cerebrovascular disease, senile dementia, disorder of sensory organs, e.g. vision and hearing, somatic and sociopsychological changes, and nutritional unbalance.

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In order to clarify the age-related changes in the dopaminergic control on the hypothalamic-pituitary function, dopamine (DA) was constantly infused intravenously to 14 young and 23 elderly male subjects at a dose of 4μg/kg/min. And the procedure was repeated in 5 aged subjects with serum testosterone (T) level below 403ng/dl after pretreatment of TP (10mg/day, im, 3 days). Results; (1) In the younger group, DA infusion resultes in a significant increase of serum GH and gradual decrease of serum PRL, but DA did not show any significant effects on serum LH level. Whereas, in the elderly group, DA induced signicicantly greater elevation of serum GH than in the young group and lowered serum LH significantly by 29.5+4.5% at 150min as compared with the mean basal values. Furthermore in the aged subjects with serum T below 403ng/dl, serum GH and LH responses to DA were greater with statistical significance than in the young group (P<0.05, P<0.01, respectively). (2) Serum LH response to DA was significantly reduced after TP treatment in 5 aged subjects with serum T below 403ng/dl. Conclusion; (1) These data suggest that the dopaminergic effects on the pituitary hormone secretion are decreased with aging in men. (2) T may participate in the dopaminergic control of the hypothalamic-pituitary axis and modulate its effects.

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To investigate the age-related changes in the dopaminergic effects on the hypothalamic-pituitary axis, administering domperidone (Dom, a competitive dopamine antagonist at peripheral receptor sites) and synthetic TRH to 10 younger and 15 elderly male subjects, the pituitary and adrenal responses to Dom and TRH were compared between these two groups. Results: (1) 6 days after oral administration of Dom (30mg/day), serum PRL levels significantly increased from pretreatment value of 11.8±2.1 to 36.9±5.4ng/ml in the younger group and from 11.7±1.1 to 20.1±2.8ng/ml in the elderly one (P<0.01, P<0.05, respectively). There was statistical significance in ΔPRL increment between these two groups (P<0.05). (2) 30min after iv injection of Dom (0.1mg/kg), serum PRL remarkably elevated in both of younger and aged group, and serum PRL response to Dom was significantly lower than in the younger one (Δ area: 57.6±11.0 vs. 105.2±19.9ng/2hrs, P<0.05). (3) There was no significant difference in serum PRL response to iv injection of synthetic TRH (500μg) between younger and aged groups. (4) There were no significant changes in the serum levels of LH, FSH, GH, cortisol or aldosterone after Dom administration. Conclusion: these data suggest that the central dopaminergic regulation of the pituitary hormone secretion is reduced with aging.

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Echocardiographic examinations were performed on 701 asymptomatic males, aged 40 to 59, with over a ten year period examinations in geographically, occupationally different three populations: farmers in Akita; manual workers in Osaka; and clerical workers in Osaka. The subjects were classified into seven blood pressure groups by the changes in blood pressure and ST-T change on ECG for the past ten years. The following results were obtained. (1) LV end-diastolic diameter (LVDd) did not differ significantly in the hypertensive groups as compared with the normotensive group in the two population groups from Osaka. However, in the Akita farmers, LVDd was significantly smaller in the hypertensive groups with hypertension for the past ten years or ST-T change on ECG as compared with the normotensive group. The thickness of the interventricular septum (IVST) and of the LV posterior wall (LVPWT) and the ratio of LVPWT to the LV radius had a significant and progressive increase with the progression of hypertension and ST-T change on ECG in each population group. Concentric LV hypertrophy parallels the progression of severity of hypertension. Asymmetric septal hypertrophy (IVST/LVPWT ≥1.3) was shown in 4.3% in the hypertensive group with ST-T change on ECG, but groups of normotension, borderline hypertension and hypertension without ST-T change on ECG showed no asymmetric septal hypertrophy. These findings demonstrate that both IVST and LVPWT were secondary to a progressive increase in pressure load. Left ventricle had symmetric hypertrophy, except for the hypertensive group with ST-T change on ECG. (2) The Akita farmers, in each blood pressure group, had the greatest LVDd, IVST and LVPWT in comparisons to the manual and clerical workers from Osaka. For the two Osaka groups, these three variables were greater for the manual workers. These comparisons indicate that the more physically active population has the greater LV dimension in each blood pressure group. Large differences of LV dimension were found among the three population groups in normotensives, but these differences were obscured with the progression of hypertension. But both IVST and LVPWT were greater in the more physically active population as compared to the population with less physical activity even with the progression of hypertension. These results suggest that strenuous physical labor has a harmful influence on left ventricle of hypertensives.

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Out of 731 persons who underwent ultrasonographical (USG) examination at general physical check in the Fukuoka University Hospital, abnormal USG findings were detected in 259 persons (35.4%). Among the USG findings, fatty liver (11.9%), splenomegaly (4.5%), cholesterol polyp in the gallbladder (4.2%), renal cyst (4.1%) and cholecystolithiasis (4.0%) were the common abnormalities. In addition two cases with malignant tumors, one with metastatic liver carcinoma and one with renal cell carcinoma, were detected and these received curative operation. Abnormal USG findings were more common in the age group over 70 years old. Among the abnormalities, average age of the cases with liver cyst or liver dysfunction pattern were significantly higher than that of the cases with normal study. In the comparison of obesity index and laboratory detas among the cases with various USG findings, obesity index, serum levels of total cholesterol, triglyceride and γ-GTP were significantly higher in the cases with fatty liver than those in the normal cases, and serum HDL-cholesterol level was significantly low. In the cases with fatty liver, diabetes mellitus was found 2.4 times as frequent as in the cases without fatty liver. As the conclusion, it was confirmed that abdominal USG examination is useful for the screening of various abnormalities such as cholecystolithiasis, fatty liver, liver cirrhosis and malignant tumors of the liver, pancreas and kidney. In addition USG examination, especially the detection of fatty liver, is seems to be useful in the precise observation of metabolic abnormalites such as overnutrition, hyperlipidemia and diabetes mellitus.

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Fifteen patients over 70 years old with acute nonlymphocytic leukemia (ANLL) were treated with aclarubicin (ACR) alone. They were 6 acute myelocytic leukemia (AML), 5 acute monocytic leukemia (AMoL), 2 acute myelomonocytic leukemia (AMMoL) and 2 erythroleukemia (EL). The ratio of male to female was 13:2 and age varied from 71 to 84 years old (median: 76). All cases were untreated and 2 cases with AML showed hypoplastic marrow, on admission. ACR was administered by intravenous drip infusion at a dose of 14mg/m²/day for 7-10 days repeated after the recovery of myelosuppression. Five of 12 evaluable patients (42%) achieved a complete remission (CR); 3 of 4 AMoL (75%), 2 of 2 AMMoL and none of AML. The days required for achieving CR ranged from 24 to 97 days (median: 28) and total doses of ACR used was from 140 to 400mg (median: 200). The duration of CR was from 1.3 to 11.3 months (median: 7.5) and the survival time was from 6.6 to 15.6 months (median: 10+) in patients with CR. Although side effects on digestive system such as nausea, vomiting and anorexia were seen in all patients, they were controllable. No patients showed cardiac toxicity. On the bases of these results, ACR is expected for the clinical management of ANLL over 70 years old, especially for AMoL and AMMoL in the aged.

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The clinical spectrum of 71 patients with ostium secundum atrial septal defect and the age of more than 40 years old were reviewed and the results were compared with those of 48 younger patients. The number of patients with limited physical activity increased with the advancing age. All but 3 patients under the age of 30 years were classified as NYHA functional class I. The incidences of disabled patients classified as NYHA class III or IV were 11.1% in the fourth decade, 13.3% in the fifth decade, 29.6% in the sixth decade, 45.5% in the seventh decade, respectively. All 3 patients over the age of 70 years were classified as class IV. The cardiothoracic ratio, the right ventricular systolic pressure and echocardiographically determined left atrial dimension correlated positively with the age. Incomplete or complete right bundle branch block was present in 81.2% in younger age group and in 95.0% in older age group. Atrial fibrillation was associated in 9 cases over the age of 50 years. The follow-up results of 47 cases with the age of 40 years or older for more than 2 years were generally favorable. All 14 operated patients were doing well. Six patients without any medical supervision worsened. In spite of medical care, 3 patients died, while 2 patients judged as inoperable worsened.

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Effect of aging on immediate allergic reactions was examined in 300 patients with bronchial asthma (147 females and 153 males). Skin reaction to allergens, serum total IgE levels, specific IgE antibodies against each allergen and bronchial challenge test by allergen were evaluated in these patients. 1. The incidence of positive immediate skin reaction to allergens such as house dust, ragweed, Aspergillus, Alternaria, Cladosporium and Broncasma decreased with aging. On the other hand, the incidence of positive skin reaction to Candida albicans was higher in cases aged between 41 and 50 years and in cases more than 61 years of age compared to that in the other groups classified by age. Time course of skin reaction induced by house dust was not different among the groups classified by age. While, fairly marked difference in late allergic reaction (5hr after intradermal administration of allergen) induced by C. albicans was found between cases aged 41-50 and cases more than 61 years of age. The incidence of positive late skin reaction to C. albicans was significantly higher in cases aged 41-50 than in cases more than 61 years of age. 2. Serum IgE levels was highest in cases aged between 0 and 30 years (715±555IU/ml). The levels of serum IgE decreased with aging, being 638±548IU/ml in cases aged 31-40, 447±400IU/ml in cases aged 41-50 and 322±343IU/ml in cases aged 51-60.3. The incidence of positive RAST scores (more than 2+) to house dust was highest (77.8%) in cases aged 0-30, and decreased with aging. The incidence was 64.3% in cases aged 31-40, 31.2% in cases aged 41-50 and 20.0% in cases aged 51-60. On the other hand, the incidence of positive RAST scores to C. albicans was highest in cases aged 41-50. 4. The incidence of positive bronchial reaction to inhaled house dust decreased with aging. While, the incidence of positive bronchial reaction provoked by inhaled C. albicans was highest in cases aged 41-50.

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