Metoclopramide, which is commonly used in general internal practice for gastrointestinal disorders, is known to induce parkinsonism at a low but as yet undetermined rate. We studied the incidence of parkinsonism after the treatment with metoclopramide. Two (1.3%) of the 150 patients orally administered the agent for more than 2 weeks developed parkinsonism in 1982. The actual incidence, however, was estimated to be 0.26% since they were two among all the parkinsonian patients we have treated for the past 5 years. Both of these patients were over 70 years of age. However, some patients over 80 who underwent long-term metoclopramide treatment did not develop the disease, suggesting that individual factors are largely involved in the pathogenesis.
Pseudogout is well known to be a great mimic of other rheumatic disorders. When accompanied by fever, it can also mimic systemic diseases. We describe, here, six elderly patients of pseudogout with fever as the most prominent manifestation. Six patients were all women, aged from 74 to 89 years, with a mean of 80 years. They had systemic temperature of more than 38°C and peripheral white blood cell counts of more than 10, 000per cubic millimeter. The erythrocyte sedimentation rate ranged from 65 to 164 millimeters in the first one hour. Attacks affected single joint in 2 patients and two or more joints in 4 patients. The characteristic roentgenographic changes of chondrocalcinosis were found in all cases. The weakly positive birefringent crystals in synovial fluid were demonstrated in all patients examined, four of six patients, using the compensated polarized light microscopy. All these patients were initially misdiagnosed as acute infection of other organs (pneumonia, pyelonephritis, biliary tract infection, etc) because of fever and leukocytosis. Therefore, five of the patients had been treated with antibiotics. After failing in antibiotics therapy, joint manifestations were reassessed and the diagnosis of pseudogout was established. Nonsteroidal anti-inflammatory agents were, then, administered in stead of antibiotics, resulting in rapid fall in fever and diminishing of arthralagia. Fever is not well recongized as an accompaniment of pseudogout. This general lack of awareness may lead to considerable diagnostic confusion, over-investigation, and delaying of the initiation of appropriate therapy. The greater awareness of this association, fever and pseudogout, in conjunction with a thorough joint examination should be necessary, especially in the elderly.
To evaluate increased bone uptake of radionuclides at lumbar vertebra in elderly subjects, comparative study of bone scintigram with CT findings and autopsy finding of bone were performed. Incidence of abnormal increased bone uptake were 59% in neoplastic disease group, while 50% in benign disease group, respectively. Bone uptake of radionuclides to thoracic and lumbar vertebrae revealed marked high incidence even in both group. 13 out of 25 cases which revealed bone uptake at lumbar vertebrae in malignant disease group showed metastatic bone lesions and the rest of these cases did not show no apparent macroscopic metastatic bone lesions. In comparative study with CT findings of 18 cases, most cases revealed osteosclerotic and osteoperotic changes of bone and fracture on CT imaging at the sites where bone uptake of radionuclides were observed. Thus, these evidence support that ageing process of bone must be considered as important factors to evaluate bone scintigram imaging in elderly subjects.
Polymyalgia rheumatica (PMR) is a clinical syndrome of unknown cause that rarely occurs in persons less than 50 years old. Although the underlying pathological abnormality in PMR is not known, the association with vasculitis linked with the immunological abnormality is well established. The syndrome is characterized by aching and stiffness in the proximal portion of the extremities and torso, along with evidence of an underlying systemic inflammatory reaction. The latter is manifested by loss of weight, low grade fever, arthralgia and laboratory findings such as high ESR and increase of serum acute phase reactant. The clinical features and the laboratory findings of 6 aged patients with polymyalgia rheumatica, identified in our hospital during 9 year period 1975 to 1984, according to Hamrin's criteria, were characterized, comparing with those of the cases previously reported. Clinical and laboratory findings generally were similar to those in earlier studies except the lower frequency of temporal arteritis; Temporal artery biopsy (2 cases) or muscle biopsy (4 cases) were done and negative results. 2 cases among 6 cases, associated with dementia of vascular type or ptosis with external ophthalmoplegia, were also described in detail and discussed as to the possibility of the association of vasculitis. Immunological exams also did not support the previous studies suggesting that PMR might be linked with immunological abnormality.
In the present study, we have investigated the relationships between nutrients intake and both serum total cholesterol (TC), and HDL cholesterol (HDL-C) in the aged. We carried out a three-day nutritional survey by means of the weighing method, and measured TC and HDL-C in 85 institutionalized elderly of a home for the aged (38 men and 47 women). The results obtained were as follows: 1) The value of TC was significantly higher in women (204.2±29.5mg/dl) than in men (178.8±29.4 mg/dl). Positive correlation between TC and age was found only in men. HDL-C also tended to be higher in women (53.4±15.1mg/dl) than in men 50.8±14.3 mg/dl). However, there was no significant correlation between HDL-C and age. 2) TC was positively correlated with intake of total fat and animal fat in women (r=0.254, r=0.378, p<0.05); there was no significant correlation found in men. Significance of age adjusted partial correlation was also found in women. 3) Positive correlation was found between HDL-C and intake of animal fat and animal protein in men (r=0.529, r=0.381, p<0.01). Age adjusted partial correlation was also significant between nutrients intake and HDL-C in men.
As the result of the 400 cases of gastric ulcer in the aged (above 60 y.o.), endoscopically diagnosed at our clinic in the recent 8 years, the following was concluded. 1) Gastric ulcer in the aged in the active and the healing stage. a) The frequency of epigastralgia was 49.6%, which was lower than that of the middle aged (61.1%) and the younger aged (74.2%). Hematemesis and melena was 15.6%, higher than that of the middle aged (9.2%) and the younger aged (7.6%). Cases without complaints were 26.2%. b) The frequency of epigastric pain in the group above 70 y.o. was 40.8%, lower than that in the 60s (52.9%). However, the frequency of hematemesis and melena of the cases above 70 y.o. was 19.7%, which was higher compared to that in the 60s (14.1%). c) The cases with strong or medium epigastric pain was only 8.2%, whereas in the middle aged it was 12.2%, and in the younger aged 21.1%. d) The frequency of epigastric pain was 58.6% in the cases with gastric ulcer in the middle or lower corpus, and 52.7% in the cases with ulcer in the gastric angle. On the contrary, in the cases with gastric ulcer in the upper corpus, the rate was 33.3%. Hematemesis and melena was observed in the following rates: in the upper corpus 20.0%; in the antrum 8.3%; in the gastric angle 3.6%. e) The frequency of epigastric pain of large ulcers was 66.7%, medium scaled ulcers 58.8%, small ulcers 38.8%. On the contrary, hematemesis and melena of large ulcers was 20.4%, medium scaled ulcers 13.4%, small ulcers 5.8%. f) Hematemesis and melena of gastric ulcers in the aged was observed often in the winter season, with the frequency of 29.6%. 2) Gastric ulcers in the aged in the scarring stage also had various subjective symptoms; the frequency of epigastric pain was found to be 18.2%, and cases without complaints was 59.1%.
A total of 282 elderly subjects in a geriatric clinic were studied to determine the relationship between serum uric acid levels and obesity (body mass index), hypertension, cerebral infarction, heart disease, diabetes mellitus, hyperlipoproteinemia, renal function, serum lipid concentrations, packed cell vulume, blood cell count, alcohol consumption or somking. 151 women and 131 men were included. Indicators of renal function included the levels of blood urea nitrogen and serum creatinine and uric acid and creatinine clearances. Serum uric acid levels were higher in men than in women. No significant increases in plasma uric acid among different age groups in men were apparent, but the serum uric acid values for women tended to increase with age. Patients receiving diuretics (thiazide and non-thiazide) had higher serum uric acid levels. The response to diuretics revealed an increase with age in women. Hypertensive men showed higher serum uric acid levels than did the normotensive men, and he uric acid levels in diabetic women were higher than those of non-diabetic women. The serum uric acid levels correlated significantly with the body mass index, serum creatinine and triglyceride concentrations in both sexes, and with packed cell volume in men. Uric acid clearance tests for 19 men aged 60 and over revealed decreases in urinary uric acid excretion and uric acid clearance. These results indicate that the serum uric acid concentration is related to obesity (body mass index), renal function and packed cell volume, and that both production and excretion of uric acid are decreased in elderly subjects.
Effects of age on cerebral blood flow and cerebrovascular resistance were investigated in 388 (192 men and 196 women) neurologically normal subjects by the Xe-133 inhalation method. The cerebral blood flow was computed as the fast component (F1) of two-compartmental analysis and as the initial slope index (ISI). Both the mean F1 and ISI values started to decrease in the forties in men and in the sixties in women; thereafter, they continued to decrease proportionally to the advancing age until the fifties in men and until the eighties in women. There were no male patients who showed F1 values of under about 40ml/100g/min nor ISI values of under 35, both of which might be the threshold of maintenance of neural tissues. The mean cerebrovascular resistance started to increase in the fifties both in men and women; thereafter, they continued to increase proportionally to the advancing age until the eighties.