Malignant neoplasms in the aged are usually slow growing in their biological behavior. However, chemotherapy is difficult in the aged with neoplasms as well as surgical treatment because of weakness in host reaction. In the cases of young patients with cancer complete remission or sometimes cure induced by chemotherapy is relatively easy even in advanced cases as they have strong host resistance and enough capacity of successive treatment. On the contrary the aged cancer patients have a reduced resistance or immunity in hosts and sometimes unsatisfactory treatment schedules such as dose reduction. Therefore, it is difficult to achieve a complete remission and to expect a curability in the aged though the survival is relatively prolonged in natural course. Moreover immunity in cancer patients is also temporarily suppressed by induction chemotherapy. In general, it is necessary to prevent aging and to hold elevated immunity level in such patients. Therapy by immunopotentiators generally give a good influnence to cancer patients, especially in the use after complete remission, in order to prevent their relapse as maintenance therapy. At the same time the therapy may be used in prevention of their second malignancy. It is presumable that the immunopotentiator or biological response modifier is useful to prevent aging in imunity and to suppress carcinogenesis. Since ten years immunopotentiators such as streptococcal agent and organic germanium have been applyed by us in mice before the procedure of carcinogenesis with methylcholanthrene in the purpose. As a result, delayed carcinogenesis was observed clearly in the experimental group. The prophylaxis on carcinogenesis would be necessary in precancerous stage or even healthy condition in future. Thus there is a difficult problem in therapy of the aged patients with cancer at present, so that the importance of prophylaxis against carcinogenesis or prevention for cancer development should be emphasized.
Our Medical Association has been making medical examinations on people over 65 since 1972. This time we made a cross-sectional observation from April 1980 to May 1982. Blood pressure, ECG., chest X-ray, complete blood count, biochemical analysis of blood (12 kinds) and obesity were examined. Results were explained to the individual by our district Doctors. Diet for diabites, hypertension and obesity were explained by the Nutritionist. The subjects were categorized by age in every 5 years. Furthermore, subjects in each category were assigned to 5 subgroups according to underlying circulatory disorders. (A) Those without any circulatory disorders. (B) Hypertensives without medical history. (C) Hypertensives with medical history. (D) Those with heart disorders. (E) Those with cerebrovascular disease. The results may be summarized as follows. 1. Female had more disorders than the male. Older they get the examination rate decreased. 2. Blood pressure was well controlled. 3. (a) Cholesterol was higher in the female. (b) HDL-Cholesterol showed no sex difference. (c) Neutral fat was higher in the female. 4. The male had higher red blood cells and hematocrit. 5. ECG disorders increased according to the age. In group (A) circulatory disorders were detected in 40-45% of the male and in 30-35% of the female. In the other groups, this prevalence was higher. 6. Among the 40 dead cases, brain and heart disorder were the most frequent accounting for 16 deaths. In the apoplexy cases, only one item among the 15 was positive. Among the heart disorders, all had abnormal ECG. 7. The observation which were listed in the 5th and 6th summary suggested the important strategy for the promotion of health administration.
In order to examine the function of the hypothalamic-pituitary-thyroid axis in the patients with senile demontia of Alzheimer type (SDAT), plasma TSH responses after thyrotropin-releasing hormone (TRH) administration were studied in 11 healthy volunteers under 48 years old (young subjects), 16 intellectually unimpaired volunteers above 60 (aged subjects) and 32 patients with SDAT. Early in the morning after an overnight fast, 500μg TRH was injected intravenously, and blood samples were obtained before administration and at 30, 60, 120 minutes after administration. TSH was measured by the double antibody radioimmunoassay. T3, T4 were within normal range in all subjects. The results were as follows. 1. In all the three groups, men showed significantly lower TSH responses than women. 2. With the administration of TRH, plasma TSH increased from 3.3±0.2μU/ml (mean±SE) to 12.7±2.2μU/ml in the young subjects, from 4.7±0.5μU/ml to 21.0±2.4μU/ml in the aged subjects and from 4.1±0.4μU/ml to 18.4±1.7μU/ml in the patients with SDAT. Though no significant differences in the basal TSH levels were detected between the three groups, the aged subjects and the patients showed higher TSH responses than the young subjects. 3. Out of 32 patients with SDAT, 4 patients showed blunted TSH responses (i.e. Δmax TSH<5μU/ml)and 16 patients showed delayed TSH responses (i.e. the 16 patients indicated the peak values at 60 or 120 minutes after administration). These results were discussed from the neuroendocrinological standpoints. It was supposed that the patients had multidimentional disturbance of neurotransmissions and that it influenced the neuroendocrine function of SDAT.
Serum zinc concentrations were determined with atomic absorption spectrophotometric method in 665 cases (285 men and 380 women) which had normal values in all 14 chemical analysis; GOT, GPT, LDH, alkaline phosphatase, r-GTP, total protein, albumin, choline esterase, total and direct bilirubin, total cholesterol, uric acid, BUN and plasma glucose. Age-related change was not found in serum zinc level. Serum zinc was slightly higher in men than in women in every age group. Normal range of serum zinc was 60-120μg/dl in our series. Oral zinc tolerance tests were performed in healthy subjects under 45 years old (8 cases, young group) and over 70 years old (7 cases, elderly group). Although the serum zinc level before oral administration of 220mg of zinc sulfate (containing 50mg of zinc) showed no difference between two groups, the elevation of serum zinc was significantly higher in the young group compared to the elderly group after 30 minutes (p<0.01), 60 minutes (p<0.05), 120 minutes (p<0.05) or 180 minutes (p<0.05). Excretion of zinc into duodenal aspirates during pancreozymin-secretin tests did not differ between in the young and the elderly group. Mean value of the total excreted zinc in 70 minutes during the test was 0.18mg. It is suggested that the subclinical zinc deficiency state can be easily occur in the aged as the result of the decreased rate of intestinal absorption of zinc.
We have investigated clinically the recurrence of gastric ulcer in the aged population and have compared those cases with G. I. bleeding. Our hospital has experienced total of 367 cases of gastric ulcer from 1981 to 1985 of this number, we have chosen to study 74 cases over 65 years of age. The percentage of elderly subjects among all patients with gastric ulcers has remained constant during the period of this study. The most frequent location for the gastric ulcer was in the higher portions of the stomach. Those patients with oral-side bleeding also had hypoacidity. In comparing cases associated with bleeding to those without bleeding, there was no significant differences in clinical pathophysiology. Recurrent gastric ulcers were found in 16% of the bleeding patients, all were male and without significant differences in history of G. I. bleeding. The most frequent location for ulcer recurrenced was on the angulus of the stomach. Endoscopic hemostasis by local injection of absolute ethanol was successful in all cases. Bleeding did not recur in these patients. The need for emergency operation for G. I. bleeding decreased during the 5 year period of this study.
The prognosis of dementia has generally been regarded as poor, and its five year motality rate is reported to be about 80%. Recently, Barclay and Rogers have reported that the pattern of rCBF reduction is different between multiinfarct dementia (MID) and dementia of the Alzheimer type (DAT). We studied the relationship between prognosis, brain atrophy and cerebral blood flow in thirty-five demented patients (22 MID and 13 DAT) by using bi-dimensional brain atrophy indices and the 133Xe inhalation method. The mean follow-up period was 18 months. MID group showed signifcantly lower rCBF than DAT group at start point. Three patients of DAT and eight patients of MID were died. In MID, two patients died because of recurrent cerebrovascular accident, and others died because of infectious disease, renal failure, and unknown causes. In DAT, patients were died because of infectious disease, cardiac failure, and sudden death. The rCBF reduction in the bilateral parietal regions related with poor prognosis of DAT. In MID, the reduction of rCBF were more marked and diffuse pattern than that of DAT and patients who showed lower rCBF had poor prognosis. Motality rate was getting higher with advancing brain atrophy in DAT, but MID showed no such relationship. These results indicated that the quantitative evaluation of the brain atrophy and rCBF measurement may be useful not only to diagnose the type of dementia but also to suppose the prognosis of the demented patients.