The periventricular hyperintensity (PVH for short) is the high intensity area seen in the white matter around the lateral ventricle of the brain on MRI, which is thought to partly correspond to the periventricular lucency on X-ray CT. With X-ray CT, it is believed to express the hydrocephalic or ischemic changes. MRI is more sensitive to the tissue contrast, so more accurately the presence and the extent of PVH can be diagnosed by MRI. The frequency of patients with PVH on MRI was investigated and discussed in relation to aging or cerebral ischemia. Subjects for study were 244 of normal cases and 112 of patients with diagnosis of various ischemic cerebrovascular diseases. None of these subjects was younger than 10 years old. Normal cases consisted of the normal volunteers or other patients of normal MR images and did not include the patients with neurological sign or the patients of demyelinating disease, connective tissue disease, or dementia. The NMR-CT used was the about 0.14 Tesla resistive type. The Carr-Purcell-Meiboom-Gill method, one of the multispinecho sequences, was chosen for the pulse sequence of imaging. Confirmation of PVH around the lateral ventricle was performed and percentage of patients with PVH against all patients was calculated on each decade. These results showed that in normal cases the frequency of PVH was as low as about 5% under 40 years old and that it increased significantly with age over 40 years old. In patients with cerebral ischemia, the frequency of PVH increased significantly more than that in normal cases on each decade. By the regional study, the frequency was higher around the anterior horn and the body of the lateral ventricel, especially around the anterior horn in both normal cases and patients with cerebral ischemia. Conclusion derived from these results was that PVH was releated to factors common to both aging and cerebral ischemia. One cause of PVH could be the direct reflection of ischemic lesions, such as lacunar infarcts or edema, because the periventricular white matter is thought to be an end and border zone of the arterial blood supply and a region which often falls into ischemia. Another reason for the increase of PVH with age or cerebral ischemia might be the increase of extracellular fluid caused by hypofunction of the lesser pathway of cerebrospinal fluid circulation. This pathway represents the absorption by the parenchymal vascular system, and its function is obstructed by cerebral arteriosclerosis, small infarction, or other age changes. In summary, we belive that PVH is apparently related with cerebral ischemia or other age changes and that it should be regarded as an important finding suggestive of the cerebral aging.
The serum levels of biochemical components, lipids and pituitary, adrenal and gonadal hormones in 22 centenarians (3 males and 19 females) in Fukuoka prefecture were measured and compared with those in normal healthy individuals aged 20-90 years. The mean values of serum protein concentration and albumin/globulin ratio showed a gradual decrease with advancing age, while blood urea nitrogen (BUN) levels tended to increase slowly from 90 years of age. No significant differences in serum levels of creatinine, uric acid, glutamic oxaloacetic transaminase (GOT) and alkaline phosphatase (ALP) were observed between the centenarians and the control group aged 70-79 years, though serum lactic dehydrogenase (LDH) levels were significantly low in the female centenarians, not in the males, compared with the control group. In males, the serum levels of total cholesterol were significantly lower in the centenarian group than in the control group aged 70-79 years. The serum levels of triglyceride and high density lipoprotein-cholesterol showed no significant alterations with age in both sexes. The serum levels of apolipoprotein A-I and A-II showed a progressive decline with increased age. Serum luteinizing hormone (LH) levels increased from the 6th decade of life in both sexes, reached the peak values at the 8th decade in males and at the 7th decade in females, and declined thereafter. Conversely, in females, serum LH levels in the centenarians were significantly higher than those in the individuals aged 90-99 years. However, serum growth hormone (GH) levels showed no significant change in the males and females over 70 years of age. No aged-related alterations in the serum levels of prolactin (PRL) and thyroid stimulating hormone (TSH) were observed. Serum cortisol levels remained unchanged in advanced old age; however, serum dehydroepiandrosterone (DHEA) sulfate showed a gradual decline from 20 years of age, although there were no significant changes over 70 years in both sexes. In males, serum 17-hydroxyprogesterone and testosterone, which declined progressively from 60 years of age, showed no significant difference in the mean levels between the centenarians and the individuals aged 70-79 years.
Blood flow of the rectal mucosa was repeatedly measured as hydrogen gas clearance with contact electrode method in five cases of pseudomembranous colitis on vancomycin therapy. During the active stage, when multiple pseudomembranes were observed throughout the colon, mucosal blood flow was extremely decreased. As the healing process went on, blood flow recovered step by step. Numerous descriptions concerning the pathogenesis of psuedomembranous colitis were available. In recent years, the involvement of toxin produced by clostridium difficile had been stressed as a cause. Considering debilitated and/or aged persons are predisposed to the disorder, participation of other factors should be implicated in the formation of pseudomembranes. The fact that blood flow of the rectum was extremely decreased especially in acitve stage may suggest the participation of reduced perfusion in the formation of pseudomembranes. It should be emphasized that our data are valuable in evaluating the classifical theory of vasospasm as the cause of pseudomembranous colitis.
Effects of cerebral blood flow, arterial blood pressure and serum total cholesterol values on age-related brain atrophy were studied in 17 males and 26 females with no neurologic disturbances, ranging in age from 36 to 86 years (mean age, 63.4 years). Brain atrophy index (cerebrospinal fluid space volume/cranial cavity volume ×100%) for each subject was serially measured 3-6 times (mean 3.7 times) during 12 to 92 months (mean, 46.6 months) using computed tomography (CT). Increase in brain atrophy index per year (annual brain atrophy index) was calculated as an indicator of the speed of brain atrophy. From the first brain CT scanning to 79 months thereafter (mean, 28.1 months), cerebral blood flow (ISI) by 133Xe inhalation method, arterial blood pressure by auscultation, and serum total cholesterol values were measured. ISI values were inversely correlated with annual brain atrophy index with statistical significance: annual brain atrophy index (%/year)=0.922-0.00995×ISI, r=-0.366, p<0.02. The rest four factors (systolic and diastolic blood pressure, mean arterial blood pressure and serum total cholesterol values) were all inversely correlated with annual brain atrophy index without statistical significances.
In order to investigate whether a high-dose, rapid intravenous infusion of urokinase (UK) is a safe and efficient therapy in aged patient with acute myocardial infarction (AMI), electrocardograms, serum enzyme activities, hemodynamics, 201-Tl myocardila scintigrams and radionuculide angiocardiograms were studied in two groups of patients over 60 yeras of age who were admitted within 6 hours of the onset of symptoms of AMI. Eighteen patients received conventional therapy (C group) and 15 patients received a high-dose rapid infusion of UK (960, 000 IU) intravenously (UK group). The numbers of male patients and patients with anterior wall infarction were slightly greater in the C group than in the UK group. Mean age, time from the onset of symptoms to admission, and distribution of Killip's classification on admission did not differ between the two groups. Bleeding complications were not observed in the UK group. The mortality rate after 7 days from the onset of AMI tended to be lower in the UK group (13%) than in the C group (44%). Sum of ST elevation and QRS score on admission, peak CPK and CPK-MB levels, time to peak levels, hemodynamics (cardiac index, pulmonary capillary wedge pressure and stroke work index) on admission and on the 5th or 6th day after admission, and left ventricular ejection fraction in the convalescent phase did not differ between the two groups. The decreasing rate of sum of ST elevation on the 2nd day after admission was significantly greater in the UK grop than in the C group (-68.1±5.6% vs -41.6±7.4%, p<0.05) and sum of ST elevation decreased serially until the 7th day after admission in the UK group. QRS scores on the 5th day after admission were significantly lower in the UK group than in the C group (2.0±0.7 vs 4.6±0.8 p<0.025). Defect scores assessed qualitatively from 201-Tl myocardial scintigrams were significantly lower in the UK group than in the C group (7.7±1.6 vs 12.9±1.1 p<0.025). Thus, thrombolysis with a high-dose rapid infusion of UK was safe and effective in limiting myocardial injury in aged patients with acute myocardial infarction.
In order to evaluate a clinical significance of radionuclide cisternography (RC) in geriatrics, RC using 111In-DTPA was performed in 201 patients. In most of them the study was undertaken to rule out normal pressure hydrocephalus (NPH). Cisternographic images were classified into six major groups on the basis of degree of ventricular filling: (1) no ventricular reflux (VR) (Type I); (2) transient VR (Type II); (3) delayed VR (Type III); (4) gradually increasing VR (Type IV); (5) low concentration persistent VR (Type V); (6) high concentration persistent VR (Type VI). These cisternographic findings were compared with CT findings, cerebrospinal fluid pressure and clinical symptoms. Some degree of ventricular reflux could be observed in about 50% of the 201 patients. However, Type VI which was most compatible with classical NPH was observed only in 6% of all cases and Type V was in 9%. Incidence of each type of positive ventricular reflux did not show any difference between patients with CVD and those without CVD. In patients with history of SAH, on the other hand, Type VI pattern cisternography was observed in forty percent of the subjects. In patients showing type VI cisternography the lateral ventricle was significantly enlarged on CT images and cerebrospinal fluid pressure was significantly elevated compared with patients of Type I. Anterior horn of the lateral vetricle was also dilated in those patients. Clinical implication of ventricular reflux on radionuclide cisternography in elderly patients was discussed in conjunction with relatively small incidence of true NPH.
In order to elucidate the characteristics of aspiration pneumonia in the aged, 27 subjects with aspiration pneumonia were studied. The patients were hospitalized to Tokyo Metropolitan Police Hospital between 1980 and 1986. We then categorized the patients into two groups according to their age. The aged group consisted of 18 subjects (16 males and 2 females) who were 65 years old or above and the younger group consisted of 9 subjects (6 males and 3 females). Concerning to aspiration contents, aspiration of the vomited material was more frequent (9 subjects) in the aged, while food aspiration was found more commonly in the younger group. Survey of the underlying disease revealed that neurological disorders were the most frequent. This was especially notable in the aged group with 11 subjects of cerebrovascular disease. Some of the characteristic clinical manifestations in the aged were high fever defined by the presense of body temperature over 38°C (14 subjects) and leucocytosis with leucocytes in excess of 10, 000/mm3 (12 subjects). Thus, in contrast to the previous reports suggestive of less prominent signs of inflammation, our present study indicated severe inflammatory responses with aspiration pneumonia of the elderly. Bacteriological study revealed high prevalence of a Gram negative infection. Pseudomonas aeruginosa, Klebsiella pneumoniae and Enterococcus were commonly found species which were responsible for aspiration pneumonia in this population. The mortality rate was high with 55.6% in the both groups. Those who aspirated gastric contents showed mortality of 75.0% and the patients with PaO2 less than 60Torr showed high mortality (84.6%). The greater size of pneumonic infiltrate on a chest roentgenogram was indicative of poor prognosis. Immediate steroid administration was tried in 6 subjects, only to fail in 5 patients, casting some doubts on the benefits of this treatment. Through these observations, we conclude as follows. (1) Both aging and underlying neurologic pathology should be regarded as important risk factors for the development of aspiration pneumonia. (2) The aspiration of gastric contents, hypoxemia below 60Torr, and larger area of consolidation on a chest film were all predictive of poor prognosis.
The purpose of this study is to clarify the clinical significance of negative U waves (NU) in patients with aortic regurgitation (AR). Out of 126 patients with AR, 57 patients (36 men and 21 women) with sinus rhythm and without AS (3), MS (17), atrial fibrillation (18), and unclear U waves were served as subjects. Ages ranged from 17 to 83 years with an average of 51.11 apparantly healthy subjects were choosen as control (6 men and 5 women, average of 43 years). NU were noted in 42 of 57 AR patients (73.6%) in contrast to 3 of 17 patients (17.6%) with AR and MS and no one in control group. AR patients were divided into 3 groups according to the polarity of T and U waves (TPUP, TPUN, TNUN) and left ventricular function obtained from M-mode UCG were studied including normal control (NC). LVEF decreased in order from NC (71.2±3.8%), TPUP (66.9±5.4%), TPUN (63.5±6.7%) to TNUN (53.1±10.9%). Mean Vcf also took the same tendency; that is, 1.27±0.12, 1.16±0.12, 1.02±0.14 and 0.81±0.15circ/sec, respectively. There are positive correlations between SV1+RV5 and LVDd (r=0.480) and also IVST+PWT (0.497); amplitude of T waves and amplitude of U waves (r=0.533, p<0.01); amplitude of U waves and EF (r=0.496, p<0.01) and mean Vcf (r=0.659, p<0.01). As to the relationship to ages; amplitude of U waves decreased in order with statistically significant changes from younger age group (n=17, 0.05±0.02mV), middle age group (n=23, -0.04±0.02mV) to older age group (n=17, -0.07±0.04mV). There were significant negative correlations between age and EF (r=-0.478, p<0.01) and age and mean Vcf (r=-0.595, p<0.01). Therefore, we conclude that negative U wave in patients with aortic regurgitation increase in frequency with ageing and is the sign suggesting both decreased myocardial and pump function of the left ventricle.