The purpose of the present study is to assess the clinical usefulness of indium-111 platelets scintigraphy for detection of thrombi in aged patients who often can not receive a certain kind of invasive investigation because of advanced age, varieties of risk factor or complication. Autologous platelets were labeled with a neutral, lipidsoluble metal complex of In-111 and tropolone, and were used for radionuclide imaging study in 23 patients with mean age of 76 years old (range: 57-70yrs), who was clinically suspected for thrombosis anywhere in the body. Images were obtained at 3, 48, 72 and 120 hours after injection. Blood samples were also drawn from antecubital vein for nine days to calculate platelets survival. Sixteen patients (69.6%) of all had positive study for thrombi. Since some patients showed two or more different sites of abnormal deposition, 19 active thrombi were found as a whole. Four thrombi were observed in the intracardiac chambars, 5 in the intrapelvic vessels, 6 in the aorta, 2 in the carotid arteries and 2 in the veins of lower extremities. In 9 cases, abnormal platelets accumulation was found at the site clinically suspected for the presence of thrombosis, while in other 7 cases abnormal accumulation was observed at the clinically unsuspected lesions, most of which were thought to be related to aortic aneurysma or atherosclerosis. Recovery, labelling efficiency and purity were calculated as 81.8±17.4%, 63.4±12.4% and 96.4±5.1%, respectively. Recovery and labelling efficiency in a group with platelets count of more than 150, 000/mm3 were significantly higher (p<0.01) than that with platelets count of less than 150, 000/mm3. Purity was high and not significantly different between two groups. Kinetic of injected platelets was analysed according to the recommended methods for radioisotope platelest survival studies and weighted mean survival was estimated. Survival curves were also divided into linear decay and exponential decay types according to the better fittedness calculated based on sum of squares of residuals. There was no correlation between the types of survival decay curves and the presence of thrombosis. No significant correlation was obtained either between the presence of thrombosis and weighted mean survival. These could be explained by that the number of patients is small and by that patients with liver cirrhosis and portal hypertension without evidence of thrombosis were included in the group with exponential decay and short survival. It is generally accepted that In-111 labeled platelets scintigraphy shows less detectability in older thrombi than in fresh ones. But in our two cases with venous thrombosis obviously positive results were obtained in spite of old thrombi up to 25 days of clinical course and on anticoagulant or antiplatelet regimen. This might suggest that platelets are absorbed on to the surface of relatively old thrombi in appreciable numbers. Scintigraphy with In-111 labeled platelets was concluded to be a useful procedure for the aged to detect not only location of thrombi of expected lesion and even unexpected aneurysma or atherosclerosis but also the presence of venous thrombi.
We assessed the relationship between fibrillatory wave (f wave) amplitude and age with 206 consecutive electrocardiograms in patients with chronic stable atrial fibrillation (131 men and 75 women, aged from 34 to 88). The electrocardiograms were divided into four groups in terms of underlying disease. Thirty-seven cases with mitral stenosis were classified as group I, 9 cases with valvular disease without mitral stenosis and atrial septal defect as group II, 59 cases with hypertensive heart disease and coronary artery disease as group III, and 101 cases with no obvious heart disease as group IV. The maximal f wave was measured both in leads II and V1 according to the technique employed by Peter RH, et al. The maximal f wave amplitude was 0.20±0.11mV (mean±Sd) in group I, 0.20±0.14mV in group II, 0.14±0.08mV in group III and 0.13±0.07mV in group IV, respectively. The amplitude of the f wave in lead II was inversely related with age in group I (r=-0.38, p<0.05), III (r=-0.28, p<0.05) and IV (r=-0.30, p<0.01) significantly and there was significant inverse relationship between f wave in V1 and age in groups III (r=-0.57, p<0.001) and IV (r=-0.33, p<0.01). In group II, no significant relationship was observed because of small number of cases. This suggests that aging is one of important factors which affect the f wave size in patients with chronic atrial fibrillation.
This study was undertaken to investigate cardiac function noninvasively in the elderly patients under the chronic stage of cerebrovascular disease (CVD). Mechanocardiography was perfomed to compare systolic function (as ICT and ET/PEP) and diastolic function (as IIA-RF and IIA-O) in 42 patients and 40 controls. CVD included 33 of cerebral infarction and 9 of cerebral hemorrhage. The average ages were 74.4 in the elderly CVD patients (A), 55.9 in the middle aged CVD patients (B), 76.6 in the elderly controls (C) and 49.9 in the middle aged controls (D), respectively. ICT was within normal upper limits of 40.3±13.3msec in the A group, but it was prolonged to be 61.0±20.1msec in the B group. ET/PEP was limited within normal lower borders as 2.57±0.40 in the A group, while it was shortened to be 2.36±0.54 in the B group. IIA-RF and IIA-O were within normal range in the A group (222.0±47.4msec and 125.0±28.6msec, respectively), although they were lengthened to be 255.6±35.0msec and 169.5±36.6msec, respectively, in the B group. Hypertension and cardiomegaly were observed in the half of both A and B groups, diabetes appeared in many of the A group and moderate gait disturbances in many of the B group. The cardiac function was also related to the risk factors of CVD and gait disturbances. In conclusion, cardiac function was well preserved in the elderly patients of chronic stage of CVD as compared with the middle aged CVD patients. The decreased cardiac function in the middle aged CVD patients could be explained by the various risk factors, such as hypertension, extent of the cerebrovascular disease and gait disturbances.
For the purpose of elucidating the mechanism and preventing the occurrence of anemia often seen in elederly patients with kyphosis, we analyzed the medical records of 18 such cases. The ages ranged from 54 to 90 years old. Sixteen were female. Out of 12 patients with anemia, 10 were diagnosed as having iron deficiency anemia. In only 3 cases, however, the hemoglobin concentration was less than 9g/dl. Four out of the remaining 6 patiens without anemia were in iron deficiency condition. Esophagus, stomach, and duodenum were examined roentgenologically and endoscopically in 15 cases. Eight patients had esophageal hiatus herinia, 4 had gastric ulcer, 4 had chronic gastritis, one had gastroptosis, and one had duodenal ulcer. Only one patient was not demonstrated to have such a lesion. Oral iron therapy was done on 5 cases of iron deficiency anemia. The response to iron was good enough and the hemoglobin returned to a normal range in a short period of time, indicating that malabsorption of iron is not thought as a cuase of iron deficiency. No side effect was noted. The study described here clearly demonstrates that iron deficiency anemia is frequently complicated in elderly patients with kyphosis and that oral iron therapy is effective.
Micromeasuring studies have been made on the age changes of the surgically resected 180 major pectoral muscles (29-81 years) and 200 minor pectoral muscles (26-80 years). The microscopic defferentiation between type I and II fibers was made by the immunohistochemical demonstration of β-enolase in the paraffin sections with indirect antibody method. The age related decrease in weight of the muscles was marked after 60 years of age in the pectoralis major, but not significant in the minor. Number of both type I and II muscle fibers in the major and the minor pectoral muscles was significantly decreased after 60 years of age. On the other hand, size of type I fibers was increased markedly after 60 years of age in the pectoralis minor, but slightly after 70 years in the major. Size of the type II fibers was decreased significantly with age in the pectoralis minor, but did not significantly change in the major. The differences in the age changes between major and minor pectoral muscles are considered to be due to their functional situation.
To investigate the efficacy and safety of antihypertensive treatment with captopril (CAP) or carteolol (CAR) in elderly patients, 39 hypertensive patients over 60 years of age including 9 apoplectics and 7 diabetics were randomly allocated to either the CAP group (37.5mg/day) or the CAR group (15mg/day). Five cases dropped out. The mean age was 73.5 years in the CAP group and 71.9 years in the CAR group. Subjective symptoms were elicited by active questioning. Blood pressure was measured in a supine position and immediately after taking a standing position, using a COPALdigital sphygmomanometer. No significant differences were found between the CAP and CAR groups in supine systolic and diastolic blood pressures throughout the study. In CAP group, supine blood pressure significantly decreased from 186.2/96.9 to 161.0/88.1mmHg after 12 weeks of treatment, while in CAR group it also significantly decreased from 178.3/89.5 to 160.7/83.4mmHg. Systolic pressure changes on standing were -16.9 and -20.8mmHg before and 12 weeks after CAP treatment, respectively, whereas corresponding changes were -13.5 and -14.1mmHg in CAR treatment. Differences beteen CAP and CAR treatment groups and differences within both groups before and after treatment were not statistically significant. Serum creatinine levels were slightly but significantly increased in both treatment groups. The serum levels of total cholesterol, triglyceride, potassium and uric acid remained unchanged. Dopamine β-hydroxylase activities in serum significantly decreased in both groups. The number of cases complaining of black out on standing or dizziness did not increase. Congestive heart failure occurred in one case and wheezing in one case of CAR group, while one case of CAP group dropped out by the fall due to excessive decrease in blood pressure. It is concluded that treatment with either CAP or CAR is not only effective but also safe in elderly hypertensive as well as in younger ones if patients are under close observation.