Effect of aging on basophil reactivity to anti-IgE and specific allergens (house dust and Candida albicans) was examined in patients with bronchial asthma (54 females and 32 males). Basophil reactivity to these agents was estimated by measuring histamine release from the cells. The results of histamine release was expressed by a percentage of total histamine content, and basophil reactivity was divided into the following three degrees, low, moderate and high, according to the degree of histamine release. 1. The degree of histamine release from basophils of asthmatics induced by anti-IgE was consistently high without any correlation to aging when their serum IgE levels were more than 501IU/ml. In cases with serum IgE levels of less than 300IU/ml, basophil reactivity to anti-IgE was decreased with aging. Mean % histamine release in cases under 40 years of age at onset (30.5±5.6%) was significantly higher than the release in cases more than 41 years of age at onset (18.6±2.8%). 2. Basophil reactivity to house dust extract was generally dependent on the levels of specific IgE antibodies against the allergen. The majority of cases with positive RAST scores (more than 2+) showed moderate or high basophil reactivity. On the other hand, in spite of positive RAST scores to the allergen, basophils of some cases with their ages of 61 years or over showed low reactivity, suggesting that basophil reactivity to hours dust was decreased with aging. 3. Basophil reactivity to Candida albicans was also high in cases with positive RAST scores, but some cases with a RAST score of 0+ or 1+ showed high or moderate basophil reactivity. Moderate or high reactivity of basophils was frequently observed in cases aged between 41 and 50 and cases more than 61 years of age.

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Since may 1982, over 170 cases of urolithiasis has been treated by percutaneous nephrolithotomy (PNL). In these cases, 14 patients elder than 60 years were noticed. We discussed some problems especial to aged peoples compared with youngers. A patient was laid on the fluoroscopic table in the prone position under epidural anesthesia. Percutaneous nephrostomy was made under fluoroscopic control. The endoscope was inserted through the nephrostomy, stone was fractured and removed by special stone forceps. Especially for large or hard stones, Mazzariello-Caprini forceps and Kocher's forceps were found unexpectedly useful. Overall cases consisted of 121 males and 51 females (sex ratio 2.4:1), and aged group consisted of 9 males and 5 females (sex ratio 1.8:1). The increase of female ratio was noticed in aged group. One ureteral stone case was failed stone removal by PNL, and operated traditional ureterolithotomy. One pelvic stone patient who had basically hypertension and arrhythmia died soon after PNL because of acute myocardial infarction. The residual stone over 5mm was noticed in 3 cases (23%). Average hospitalized days of aged group was 27.8, and the days after PNL was 21.5, compared with youngers the former was 5 days and the latter was 3.5 days longer. Because the extracorporeal shock wave lithotriptor is now beginning to work in Japan, PNL and ureteroscopic ureterolithotomy if performed widely, the traditional open operation is reducing day by day. But any method is selected, the anesthesia is necessary and the risk of the anesthesia is not diminished. As PNL is performed in the prone position and under epidural anesthesia, if the level of anesthesia goes upward, respiratory disturbance may occur. Reabsorption of irrigation fluid from mucosa or vein during endoscopic manipulation may result in circulatory overload. For the aged patients, who have decreased force or reserve of pulmonary, cardiac and renal function, these overload make the risk of PNL much higher compared with youngers. So the indication of PNL for the elderly should be selected strictly according to one's complications.

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To demonstrate correlation between occurrence of carcinoma and that of gallstone of the gallbladder and biliary tract, we reviewed the protocols of gallbladder and extrahepatic bile duct carcinoma and cholelithiasis of 4482 cases (male 2237, female 2245, mean ages 77.7 years old) autopsied at the Department of Pathology, Tokyo Metropolitan Geriatric Hospital, during 27 years from 1960 to 1986. Gallbladder carcinoma was found in 94 cases or 2.1%. The incidence was higher in the female than in the male (male 24, female 70, p<0.01). Gallstone of the gallbladder was found in 957 cases or 21.4%. In the male, the incidences of gallbladder carcinoma and stone increased with age until lower half of the nineties, whereas in the female, no such tendency was found after sixties. No significant differences were found in the incidence of gallbladder carcinomas combined with cholecystolithiasis among all age groups of both sexes. The incidence of gallbladder carcinoma was significantly higher in the cases with cholecystolithiasis than in those without stones (p<0.01). Furthermore, the incidence of gallbladder stones in the cases with stage 1 carcinoma was significantly higher than that of those without carcinoma (p<0.01). Cholesterol stones were more common than bilirubinate in the carcinoma patients (p<0.05). These results suggested the importance of cholecystolithiasis, especially that of the cholesterol stones as a background factor of gallbladder carcinoma. Extrahepatic bile duct carcinomas were 33 cases or 0.7% (male 19, female 14, no sex preference). The incidence was significantly higher in the cases with stones than in those without stones of the extrahepatic bile ducts (p<0.01). But the fact that samll stones were found in the upstream portions of obstuctions of the biliary tracts and no stones were fond at operations in the 11 operated cases suggested that the stones may be scondary to the obstruction due to cancerous growth.

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Using computed tomography, the authors studied brain atrophy during aging in 536 men and 529 women with no neurologic disturbances, ranging in age from 10 to 88 years. They measured cerebrospinal fluid (CSF) space volume and cranial cavity volume above the level of the tentorium cerebelli and calculated a brain atrophy index (BAI):BAI(%)=100%×(CSF space volume/cranial cavity volume). CSF space volume started to increase significantly in the group aged from 45 to 54 years, while the BAT started to increase significantly in the group aged from 35 to 44 years in both men and women. The BAT increased exponentially with the increasing age after 25 years, continuing to increase until 75 years or more in both men and women: logBAT=-0.260+0.0150×age, r=0.707, n=493, p<0.001 in men; logBAI=-0.434+0.0162×age, r=0.757, n=504, p<0.001 in women. Using the xenon-133 inhalation method, the authors studied age-related decline in regional cerebral blood flow (regional initial slope index; rISI) in 197 men and 238 women with no neurologic disturbances, ranging in age from 19 to 88 years. The rISI values in women declined almost linearly with the advancing age from the 50s to the 80s except the 70s. The rISI values in men declined with the advancing age from the 40s to the 60s, but remained unchanged thereafter until the 80s, suggesting the existence of a threshold of rISI values. We estimated the rISI values (probable threshold of brain atrophy), the frequency under which is equivalent to the volume of brain tissues atrophying in a decade, and obtained constant values as about 32 for men and about 37 for women in the 50s, 60s and 70s. If the frequency of rISI values in the brain is distributed according to a Gaussian function and mean of rISI values decreases linearly to the increasing age, then brain tissues having rISI values below the thresholds degenerate almost exponentially with the increasing age, leading to the exponential atrophy of the brain.

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We reported in our prior paper that iron deficiency anemia is frequently complicated in elderly patients with kyphosis. Since oral iron therapy was effective on such patients, the cause of iron deficiency anemia is possibly attributed to chronic blood loss from gastroduodenal lesions, such as esophageal hiatus hernia, gastric ulcer, chronic gastritis, and duodenal ulcer, which are associated with kyphosis, and not to malabsorption of iron in the intestinal tract. To further elucidate the mechanism, iron absorption test was performed on four elderly patients with kyphosis and esophageal hiatus hernia. The result clearly demonstrates that iron absorption is not disturbed in such patients.

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The effects of calcium antagonists (nifedipine, diltiazem and verapamil) on hemodynamics were investigated in elderly 36 hypertensives (systolic blood pressure exceeded 160mmHg) and 24 normotensives (systolic blood pressure below 159mmHg), aged 70 to 85 years. Nifedipine (10mg, sublingual) decreased blood pressure from 178±19/70±11 to 140±11/55±8 mmHg (mean±SD) in hypertensives and from 127±13/58±6 to 108±12/49±5mmHg in normotensives (preadministration to 30min after administration). The drug increased heart rate and cardiac output, and decreased total peripheral resistance in both hypertensives and normotensives. Diltiazem (0.1mg/min×30min, then 0.2mg/min, i.v. infusion) decreased blood pressure from 180±17/72±12 to 159±15/62±11 mmHg in hypertensives and from 130±14/51±7 to 126±15/48±9mmHg in normotensives. The drug reduced heart rate and total peripheral resistance, and increased cardiac output in hypertensives. Verapamil (0.1mg/min×30min, then 0.2mg/min×30min, i.v. infusion) decreased blood pressure from 180±12/74±12 to 149±20/62±9mmHg in hypertensives and from 126±11/57±5 to 111±9/49±5mmHg in normotensives. The drug reduced heart rate and total peripheral resistance, and increased cardiac output in hypertensives. Hemodynamic changes induced by calcium antagonists were greater in hypertensives than in normotesives. Nifedipine did not change P-R interval in electrocardiogram. Diltiazem and verapamil significantly prolonged P-R interval, but not produce second or third degree atrioventricular block. The fall in systolic blood pressure induced by nifedipine, diltiazem and verapamil was correlated with preadministration systolic blood pressure and also with total peripheral resistance, but not with cardiac output. Low dose calcium antagonists, compared with effective dose in middle hypertensives, were effective to reduce blood pressure in eiderly hypertensives. The favorable hemodynamic effects of calcium antagonists, which decreased blood pressure and total peripheral resistance and increased cardiac output, suggest that calcium antagonists may be efficacious in the treatment of elderly hypertension.

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First, the causes of death and the pathological features of myocardial infarction were examined in 574 autopsy cases (292 men 282 women, mean age 79.2 years) for eleven years. Myocardial infarction was observed in 19.3 percent of all autopsy cases and its incidence was unchanged in this period. Cardiac death was found in 94.5 percent of the cases died less than one month after the onset, and 19.1 percent of them were cardiac rupture. The incidence of cardiac rupture including papillary muscle rupture and ventricular septal rupture was 12.2 percent of all cases of acute myocardial infarction (AMI) and the incidence in each year has significantly decreased since 1981. The incidence of cardiac free wall rupture was 9.5 percent, being the most prevalent (50 percent) in large anterior infaction. The majority of cardiac free wall rupture (82 percent) occurred within the first 48 hours after the onset of AMI. Secondly, the influence of the drugs used and hemodynamics in the acute phase of AMI on cardiac rupture was examined in 320 cases (151 men 169 women, mean age 75.3 years) which admitted to our coronary care unit in the same period. The subjects were classified into following three groups; ruptured group comprised 25 cases of the cardiac rupture including papillary muscle rupture (2 cases) and ventricular septal rupture (6 cases). Non-ruptured group comprised remaining 295 cases. All-ruptured group was consisted of 38 cases (19 men 19 women, mean age 78.1 years) in which 13 cases of cardiac rupture admitting to the general wards were added to the ruptured group. The use of vasolilator drugs including calcium antagonist has been increased since 1980, and that of nitrate has tended to increase as well since 1981 when cardiac rupture has decreased. Thus, we compared the main drugs used whithin 7 days after admission, between the all-ruptured group and non-ruptured group. As a result, diuretic (χ²=5.84, p<0.05), nitrate (χ²=9.62, p<0.01) and vasodilator (χ²=7.06, p<0.01) were used more frequently in nonruptured group compared with that in ruptured group. The blood pressure and hemodynamics were not significantly different between ruptured and non-ruptured group, but Killip's I group was observed in 53 percent of cases with cardiac free wall rupture. We concluded that vasodilator therapy was effective on the protection of cardiac rupture due to not only the reduction of after-load but also the reduction of pre-load.

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To investigate the effect of aging on blood hematocrit, we examined hemoglobin concentration, hematocrit levels and red cell counts on 2010 outpatients aged 30 and more who had been treated at our clinic. In male, hematocrit levels were 46% in both 30-39 and 40-49 y. o., 45% in both 50-59 and 60-69 y. o., 44% in 70-79 y. o. and 42% in 80-89 y. o. patients and those in female were 40% in both 30-39 and 40-49 y. o., 41.5% in 50-59 y. o. and then gradually decreased to 40% in 80-89 y. o. patients. To evaluate hematocrit changes chronologically, we compared the hematocrit levels to those of 10 years ago in 935 patients. This chronological study confirmed the results of the corss sectional study stated above that hematocrit levels in male decreased with advancing ages and those in female showed small paek in middle ages. The hematocrit levels in our study were observed to be higher than those in the earlier study promoted by Shirakura et al whose subjects were living in an old people's home by 3.4∼4.5% in male and 3.2∼3.9% in female. These results indicate that hematocrit levels, especially in male, decreases with age, than those of previous reports in Japan. The cause of the differences may be accounted by differences of social life style in the subjects.

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The medical records and the death certificates of the past five decades, belonging to a local general clinic in a commuters town of Yokohama city, were surveyed among the outpatient to clarify the trend in the patterns of fatal disease associated with recent changes in the social and the medical environmental factors. This study was also conducted to suggest the functions and the appropriate role of a local clinic for medical care in a community. We observed that there was a decrease in the outpatient deaths from infectious diseases, with an increase in deaths from non-infectious chronic diseases. It was also found that the average age of death had risen remarkably over the last fifty years. In recent years, deaths from non-infectious diseases are not due to cancer but mostly due to cardiovascular diseases i.e. stroke, coronary heart disease, hypertensive heart disease and others. The survey showed that there was a tendency for aged patients with cardiovascular diseases to eventually return to the doctor at the local clinic. This was true even if they had been referred to other large specialized hospitals in an acute phase or they had taken further diagnostic procedudres or treatment at other hospitals. This result indicates the important role of a local clinic in developing an appropriate medical care system, in a community, for the prevention and the control of cardiovascular diseases at present and in the future.

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