Femoral Neck fracture of the elderly is becoming an increasingly important health problem in Japan these days. We carried out a retrospective case-control study of the fracture in order to explore the risk factors. Forty matched pairs of women were taken from the Tokyo Metropolitan Homes for the Aged and affiliated orthopedic service. Cases were defined as having experience of femoral neck fracture within three years without history of bone diseases. Twenty cases each were selected from home and hospital. An equal number of control was selected from home and the same hospital service matching for age (±5 years). The average age was 79.5 for cases and 78.9 for controls. Information on milk, bread, meat, fish and tofu (popular Japanese food made from soy bean and rich in calcium) intake, smoking, drinking and exercise habits, menstrual and reproductive histories, experiences of falls during past three years, types of daily clothing (kimono or western clothes) and daily footwear (sandals or shoes), mental health condition, height and weight, blood pressure, blood hemoglobin content, serum albumin, calcium, phosphate and alkaline phosphatase, the metacarpal index (MCI) and the maximum density of the metacarpal cortex (GSmax), number of remaining teeth, grasping power and balance test standing on one leg was obtained through personal interviews and by use of medical records. Cases more often ate meat (p<0.05) and less tofu (p<0.05). Moreover the cases experienced menopause earlier (p<0.01) and weighed less (p<0.06) than controls. Cases were more likely to be judged as having some degree of dementia (29% vs 2.5%, p<0.01) and a larger proportion of cases experienced“frequent” falls (i.e., more than 3 falls during 3 years prior to the fracture event or to the date of interview) (p<0.10). Mean serum albumin was lower (p<0.01) in hospital cases but not in home cases. The other items including MCI and GSmax appeared to have no significant differences between cases and controls. We did not measure their calcium nor protein intake quantitatively. But, as tofu is the major source of calcium in the Japanese elderly, it may be assumed that women who frequently ate tofu were taking more calcium than who did not. Early menopause and low body weight are both well known risk factors for this fracture and our observations coincided with the previous reports. Dementia can be either a cause or a consequence, or both of the fracture. Radiological indices of osteoporosis using the metacarpal bone seem to be insensitive to predict the risk of femoral neck fracture.

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Levels of serum catecholamines and urinary catecholamines were determined in 41 patients with acute myocardial infarction to study the effect of aging on the activity of the sympathetic nervous system and adrenal medulla. Plasma adrenaline concentration was elevated in 51%, and noradrenaline was elevated in 87.9% of the subjects. However, the incidence of abnormally high adrenaline concentration was significantly lower in patients above the age of 65 years (Group I, 20%) than in patients below the age of 64 years (Group II, 65.2%, p<0.05). The maximum level of plasma adrenaline was significantly lower in Group I (92.2±76.5pg/ml, mean±SD) than in Group II (215.5±130.9pg/ml, p<0.01). However, the maximum level of plasma noradrenaline was not different between Group I and Group II. The total excretion of adrenaline and noradrenaline in urine for 7 days from the onset of acute myocardial infarction were significantly lower in Group I (60.6±31.5μg and 107.0±69.4μg) than Group II (107.0±69.4μg, p<0.05, and 796.0±285.9μg, p<0.05). Heart rate on admission in Group I (63.2/min) was significantly lower than in Group II (75.7/min, p<0.05). However, systolic blood pressure, and cardiac index were not different between Group I and Group II. These findings suggest that the response of the sympathetic nerve system and adrenal medulla of the aged is inhibited in acute myocardial infarction.

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This study was performed to investigate the hemodynamic profile and the prognostic value of hemodynamic parameters in the aged with acute myocardial infarction (AMI). One hundred patients, admitted to CCU within 72 hours from the onset of AMI, were studied. These patients were divided into an older group (61 patients over 60 years) and a younger group (39 patients under 60 years). The initial hemodynamic parameters, measured with a Swan-Ganz triple lumen catheter, were compared between these two groups. An attempt was made through discriminant analysis using hemodynamic parameters to classify early deaths (within 30 days) and survivors (beyond 30 days) in the older group. The early mortality rate in the older group 26.2% as compared to 7.6% in the younger group. In the older group, the rate was 32.3% for patients over 70 years and 18.5% for patients in their sixties. Regarding hemodynamic profile, the older group, when compared with the younger, showed a significant decrease in mean arterial blood pressure (MBP), cardiac index (CI), left ventricular stroke work index (LVSWI) and slope of right ventricular function curve, but showed a significant increase in heart rate (HR) and total peripheral resistance index. In the patients of the older group who suffered from early death, MBP, CI and LVSWI were significantly lower, while HR and pulmonary arterial end-diastolic pressure (PAEDP) were significantly higher than the survivors of the same group. The discriminant function using initial hemodynamic parameters was derived as followed: z=-0.00219+(SBP×0.00133)+(DBP×0.00195)+(-MBP×0.00154)+(-PASP×0.0038)+(-RAP×0.00019)+(PAEDP×0.002)+(HR×0.00125)+(-CI×0.01446)+(LVSWI×0.00087)+(-RVSWI×0.00165), where SBP is systolic blood pressure, and DBP diastolic blood pressure, PASP pulmonary arterial systolic pressure, and RVSWI right ventricular stroke work index. Mahalanobis' generalized distance was 5.30413 and F value was 4.24449 (p<0.05). The calssification error rate of this function was subsequently applied to 19 elderly cases. The results suggested that the aged with AMI had a high mortality rate and showed depressed biventricular performance. The multivariate analysis using hemodynamic parameters might be clinically useful in predicting the prognosis of the acute phase of myocardial infarction in the aged.

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We studied the peptic ulcer in clinical cases and autopsy cases of the aged group at Yokufuh-en. 113 examination cases at the home for aged, 133 endoscopied cases at the hospital, and 318 autopsy cases were investigated. The results were as follows. 1) Peptic uler detected from 4 of 113 examination cases (3.6%), 26 of 133 endoscopied cases (19.5%), and 49 of 318 autopsy cases (15.4%). 2) Referring to duodenal ulcer, it was comparatively frequent also among the aged group, 2 of 113 examination cases (1.8%), 9 of 133 endoscopy cases (6.8%), and 17 of 318 autopsy cases (5.8%). 3) Sex ratio: The male was found to suffer more frequently from gastric ulcer than the female sex, in case of duodenal ulcer, the reverse applied. 4) Location of gastric ulcer: In 8 of 17 endoscopied cases (47%), the ulcer was located at corpus, but in 18 of 32 autopsy cases (56%), the angle was the site of ulcer. 5) Among the aged group, peptic ulcer presented little symptoms, and it was found from objective findings than from clinical symtoms. 6) G-I bleeding was one of severer complications in these cases. It was detected at 46.8% of gastric ulcer cases, and at 64.7% duodenal ulcer cases. In 41 of 318 autopsy cases (12.8%) died of G-I bleeding, and in 15 of these 41 cases (36.5%), peptic ulcer was the cause of death. 7) Out of 49 autopsy peptic ulcer cases, 21 cases (42.9%) complicated with carebral apoplexy, but acute cerebral hemorrhage were limited to 12 cases (24.5%). These complications were more frequent in duodenal ulcer cases than gastric ulcer.

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To investigate the current status of the accidental hypothermia (AH) in Japan, “Questionnaries on the death from cold and hypothermia” were sent to the members of Japanese Medical Association in Hokkaido, Aomori, Iwate, Yamagata, Niigata and Yamanashi, and to the hospitals in Tokyo and Kanagawa in 1984 and 1985. Of the 5, 743 questionnaires sent out, 1, 697 including 74 case reports were returned. Of the 74 cases reported, 30 cases of AH, in which the patients were alvie at the time of discovery, were further analyzed. The following results were obtained. 1. PROFILE. Age: 8 out of 30 cases (26.7%) were over 60 years old. Considering the percent of the aged among the general population, AH occurred more often in the aged. Sex: AH occurred nore often in young males than females, but the percent of female increased with the age. Environmental temperatures: Out of the 15 incidences that occurred outdoors, 13 were associated with wet conditions, such as rain, snow or falling into a pond. Among aged patients, All occurred indoors in 7 out of 8 cases. 2. THR CAUSES OF INCIDENCES. The causes of incidences were accident and disaster (13 cases), drinking (8), attempted suicide and related to diseases (10). In 7 of 8 aged subjects AH was associated with various diseases. 3. SIGNS AT THE TIME OF DISCOVERY, Body tempperatures: In all cases, body temperatures were above 20°C. Body temperature of all aged patients were above 30°C. Consciousness: Consciousness was disturbed in all patients with body temperatures below 30°C and also in all of those who died later. Circulatory functions (pulse rate and blood pressure): Hypotension and bradycardia were occasinally observed in those with body temperatures below 35°C and in all with body temperatures below 25°C. 4. TREATMENTS: Rewarming, artificial respiration and transfusion were performed in combination as the main treatment. For rewarming, electric blanket (with hot water pad), or hot water blanket were used. 5. PROGNOSIS: Out of 30 cases, 21 patients recovered, 2 unchanged and 3 died. Out of 30 cases, 21 patients recovered, 2 unchanged and one died. The period of hospitalization of the aged was longer than that of the young.

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One thousand cases were autopsied in Kurate Kyoritsu Hospital from 1964 to 1980, and there were 126 cases with malignancy in 631 autopsies at 70 years old or more. We examined clinico-pathologically the 83 cases died with malignancy, and the 43 cases having a carcinoma that were not directly related to the death. 1) Among the 43 male cases died with malignancy, the most common was lung cancer and gastric cancer (11 cases), followed by prostatic cancer (4 cases), gallbladder cancer, colo-rectal cancer and esophageal cancer (3 cases, respectively). Similarly among the 40 female cases the most common was lung cancer (13 cases), followed by gastric cancer (8 cases), gallbladder cancer and colo-rectal cancer (4 cases), renal cancer (3 cases). 2) Concerning the histological type, squamous cell carcinoma was 6 and adenocarcinoma was 2 in 11 male cases who died of lung cancer. Similarly squamous cell carcinoma was 5 and adenocarcinoma was 4 in 13 female cases. Adenocarcinoma was 8 and anaplastic carcinoma was 3 in 11 male cases who died of gastric cancer. Similarly adenocarcinoma was 5 and anaplastic carcinoma was 3 in 8 female cases. All cases with gallbladder cancer or colo-rectal cancer were adenocarcinoma, and all cases with renal cancer were also renal cell carcinoma. 3) The carcinoma that was not directly related to the death was observed in 43 cases. Among the 25 male cases, the most common was prostatic cancer (10 cases), followed by gastric cancer (5 cases), lung cancer (4 cases), thyroid cancer (3 cases). Similarly among the 18 female cases, the most common was thyroid cancer (9 cases), followed by gastric cancer, lung cancer and pancreatic cancer (2 cases, respectively). 4) There were 10 cases with double cancer, and the most common was the combination of lung cancer with gastric cancer. Aged patients are apt to complain of a few and atypical symptoms, so that the definite diagnosis may be too late. Aged patients with malignancy will be increased in number in the near future, and the early diagnosis and the appropriate treatments are necessary for them.

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Morphological changes in neocortical somatostain- and neuropeptide Y-immunoreactive cells in senile dementia of Alzheimer type (SDAT) were studied using light microscopic immunohistochemical methods. The density of somatostatin-immunoreactive cells in the neocortex did not decrease in case of SDAT compared with aged normal subjects. However, many somatostatin-positive fibers were often observed within senile plaques. The morphology of the swollen and bulbous fibers was similar to that of the swollen neurites present in senile plaques demonstrated by the silver impregnation method. Similar fiber abnormalities were observed in sections stained with antibodies to neuropeptide Y. Therefore, it is suggested that somatostatin and neuropeptide Y appear to contribute to the formation of senile plaques in human cortex.

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The clinical and pathological features of acute myocardial infarction were analyzed with respect to subjective symptoms in 153 autopsy proven cases (70 men 83 women, mean age 78.5 years). Although the chest pain was the most frequent symptoms of the acute myocardial infarction, the incidence was only 36 percent. Other major symptoms were dyspnea; 19 percent, shock; 17 percent, and disturbance of consciousness; 13 percent. The mean age of painless myocardial infarction group was 80.8 years, and significantly older than that of patients with chest pain, 76.1 years (p<0.01). The incidence of chest pain decreased with advancing age; the incidence of chest pain was 62.5, 38.7, and 29.0 percent in sixties, seventies, eighties, respectively. The incidences of diseases coincident with acute myocardial infarction in groups with and without chest pain were as follows; cerebrovascular disease (21.4 vs 46.3 percent, p<0.01), disseminated intravascular coagulation (12.5 vs 24.7 percent, ns), malignancy (14.2 vs 26.8 percent, ns), and diabetes mellites (30.4 vs 28.9 percent, ns), respectively. On autopsy, the posterior infarction was more frequent in painless myocardial infarction group than in patients with chest pain (36.3 vs 19.6 percent, p<0.05). Left coronary arteries were more significantly involved in the chest pain group (55.4 vs 34.0 percent, p<0.01), and the recurrence of myocardial infarction was more frequent (62.5 vs 49.5 percent, p<0.05) compaired with painless group. The size of myocardial infarction was not significatly different.

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We classified cardiac forms observed by inversion-method of endoscope into seven types and analyzed their characteristics in the aged over 60. The total frequency of type I and II, namely the closed type cardia, in the aged is less than in the middle-aged and young. On the contrary, the cases of type IV, V and VI, namely the open type cardia, are more in patients older than 60. We measured the lower esophageal remaining pressure and the lower esophageal sphincter pressure by the use of transducer method. These values in the aged (each -1.6±0.6(SE)cmH₂O, 36.9±2.5(SE)cmH₂O) are lower than those in the middle and young ages. The remaining gastric pressure of types I and II, and the lower esophageal sphincter pressure of types IV, V and VI are lower in the aged than younger patients. Serum gastrin and secretin value in control group and patients with gastro-dudenal ulcer were examined and the results were compared with age and cardiac forms. Serum gastrin level in the aged patients is lower than that in the middle and young control group and patients with gastro-duodenal ulcer. However, we did not find a significant difference between serum gastrin level and cardiac forms. On the other hand, we found no correlation and significant difference between serum secretin level, and age and cardiac forms.

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An 86-year-old male showed transient palpitation when was under medical treatment for prostatic cancer, stage D₂. The signs and laboratory findings were tachypnea, tachycardia, arterial hypoxia, abnormal electrocardiogram, mild right ventricular dilatation and mild pulmonary hypertension. Results of other laboratory examinations, such as the chest X-ray findings, serum enzymes and bilirubin determinations were within normal limits. Diagnosis was made on the basis of the typical defect in the picture of perfusion lung scans. The patient was treated with urokinase, followed by anticoagulant therapy with ticlopidine hydrochloride. He showed transient palpitation without any other clinical symptoms. The findings of the perfusion lung scans improved. Pulmonary thromboembolism is a relatively rare disease in Japan, and the symptoms are more nonspecific in old age. If a patient who has a risk of deep venous thrombosis of the thigh veins shows any acute nonspecific cardiopulmonary complaints, we must consider pulmonary thromboembolism.

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