Effects of a long-acting formulation of propranolol on essential hypertension in the aged were studied in contrast with 24 hour electrocardiographic recordings, plasma propranolol concentrations and plasma renin activity. Thirty aged patients (age 77.6±6.1 years, male 9, female 21) were investigated before treatment and after 12 weeks on 60mg long-acting propranolol once a day. 1) The systolic and diastolic blood pressures were reduced significantly after treatment. 2) After a single oral dose with 60mg long-acting propranolol, mean plasma concentration of propranolol increased to reach the peak plasma level of 41.5±37.7ng/ml at 5hr and 28.6±30.5ng/ml at 24hr. On the last day treated with the drug for 12 weeks, mean plasma propranolol concentrations were 61.8±50.0ng/ml before and 99.8±66.7ng/ml at 5hr after administration. 3) Mean and minimal hourly heart rate were reduced significantly. However, the decrease of minimal hourly heart rate was significantly smaller than that of mean hourly heart rate. 4) The effect of the drug on systolic blood pressure was significantly related to the peak plasma propranolol concentrations after 12 weeks on 60mg long-acting propranolol. There was no correlation between the hypotensive effect of the drug and initial plasma renin activity, or the change of plasma renin activity. 5) In six patients the drug was withdrawn. One had severe bradycardia. Five developed symptoms of bronchial pneumonia. A long-acting formulation of propranolol should be used with discretion in the treatment of hypertension in the aged.
It is well known that there is some limitation in the diagnostic effectiveness of brain computed tomography (CT) of dementia. Some investigators suggested certain correlation between brain atrophy and degree of psychological imparement in demented patients, but others did not agree with these suggestions. Authors have felt that the number of samples is very important in statistical analyses, thus they collected a great number of appropriate samples of dementia: that is, 59 of Alzheimer disease (AD), 120 of senile dementia of Alzheimer type (SDAT) and 178 of vascular dementia (VD), and compared these CT findings with those of 100 non-demented people. Firstly, we observed no relation between aging and brain atrophy in any type of dementia while there was a certain relation in non-demented people. Secondly, the female brain could easily become atrophic physiologically and was more severely atrophic in case of dementia compared with the male brain. Thirdly, it was impossible to differentiate SDAT from VD only by measuring values of dilatation of ventricles (maximum width of the third ventricle and cella media index) and sylvian fissures (“sylvian index”). Finally, it was observed that there was deep relation between the results of clinical assessments and the degree of brain atrophy in SDAT, because individual specificity in the type of atrophy was not variable in this type of dementia. Moreover all functions: that is, motor, intellectual, and emotional functions in SDAT patients, were impaired in the same degree respectively. From these results, authors could know many available characteristics of atrophy in the brains of demented patients through the following easy methods of measurement: linear measure method and ventricular-brain method, because we could analyse a sufficient number of samples.
Lewy bodies in the sympathetic ganglia were examined morphologically. We have examined Lewy bodies in 3 different ganglia, namely, upper cervical, stellate and celiac ganglia. Lewy bodies were revealed to be present in 41 cases, including one Parkinsonian patient, out of 314 autopsied cases. Their morphological characteristics are as follows; 1) Lewy bodies are located mostly in the neurites, and scarecely in the perikarya, and therefore 2) their predominant figures are elongated or ovoid. 3) The transitional pattern from Lewy bodies to Lewy body-related swellings (Forno) are confirmed. 4) The halo areas of Lewy bodies are composed of intermingled fibrillary and granular structures electron-microscopically, and their cores consist of coarse granular material, which might have developed by gathering of the fibrils and granules in the halo. It is concluded that the characteristic figures of Lewy bodies of the sympathetic ganglia verifies their predominant site where Lewy bodies develop, and that there is no essential difference between Lewy bodies in the sympathetic ganglia and those in the central nervous system.
The present paper reports the age-related changes in the size of the corpus callosum for subjects (110 men and 92 women) ranging in age from 2 to 78 years on T1-weighted magnetic resonance images. In men, the size of the area of the midsagittal scetion of the corpus callosum (callosal area) gradually increased until the 20s, remained unchanged until the 40s (584±99mm2), and slowly decreased thereafter. In women, the callosal area strikingly increased until the 20s (640±85mm2), and rapidly decreased thereafter. The maximal width of the midsagittal section of the corpus callosum was estimated at the levels of the genu, body and splenium (genu width, body width and splenium width, respectively). Genu width was widest in the 30s in men (11.2±2.2mm), and in the 20s in women (10.6±2.5mm). Body width was widest in the 30s in both men (5.8±1.2mm) and women (6.2±1.2mm). Splenium width was widest in the 40s in men (11.9±2.1mm), and in the 20s in women (12.9±3.0mm).
In order to study age-related changes in postural sway, we examined the total length and the frequency analysis of the postural sway waves in 180 normal subjects, 95 males and 85 females, ranging in age from 30 to 69. The subjects maintained erect standing posture with feet together for 30 seconds with eyes open, and with eyes closed. The following results were obtained. 1) For subjects in their sixties, the total length of displacement with eyes open as well as with eyes closed showed a steep increase over subjects in their thirties. 2) The ratio of the total length with eyes closed to that with eyes open decreased in males in their sixties, and in the females over fifty. These facts suggest that the visual function might less contribute to the regulation of the static equilibrium in the aged. 3) Distribution of the frequency of the postural sway waves was examined by power spectral analysis in the lateral direction and in the antero-posterior direction. The distribution of frequency was expressed as percentage of the power of each frequency for the total power up to 4.033Hz. In both directions, the percentages with eyes open were higher than that with eyes closed in the frequency range below 0.109Hz. This suggests that body sway waves below 0.109Hz might be related to the visual regulatory function. The power spectrum below 0.109Hz showed a decrease in the aged, which suggests the decrease in visual regulatory function in the aged.
Many cases with vascular dementia have multiple lacunaes and diffuse demyelination in the white matter (vascular leukoencephalopathy; VLE). One of the major causes of VLE is chronic hypoxia. 2, 3-diphosphoglycerate (DPG) in red cells plays an important role in oxygen delivery in microcirculation. It decreases the oxygen affinity of hemoglobin and facilitates the unloading of oxygen from hemoglobin, displacing the oxygen dissociation curve to the right. In this study red cell DPG and P50 (PO2 at half saturation) in demented patients with VLE were compared with those in non-demanted, post-stroke patients (NDPS) who had localized brain lesions and in control cases. The results were as follows. 1) DPG was inversely proportional to hemoglobin concentration. DPG levels were significantly elevated in NDPS patients compared with controls, but was not different between VLE patients and controls. 2) P50 was inversely proportional to hemoglobin concentration. P50 was significantly reduced in VLE patients, but was not different between NDPS patients and controls 3) P50 was proportional to DPG levels. VLE patients had significantly lower P50 than controls, while P50 was different between NDPS and controls. The results suggest that DPG and P50 are compensatorily elevated in non-demented post-ischemic patients, while such compensation is lacking in demented patients with vascular leukoencephalopathy. In such demented patients the red cell oxygen affinity which causes tissue hypoxia has a tendeny to increase above the normal level. Decompensation of red cell DPG synthesis may have an important implication in the pathogenesis of vascular leukoencephalopathy.
One elderly case of transverse myelopathy and Gottron's sign associated with systemic lupus erythematosus (SLE) was reported. A 70-year old woman developed numbness and weakness of the legs, which was followed by the onset of acute transverse myelopathy. Two years later, she had arthritis, violaceous flat-topped papules (Gottron's sign) over the dorsal interphalangeal joints and discoid lesions on the face. The antinuclear antibody test was positive in a titer of 1:1280. A diagnosis of SLE was made. A brain computerized tomography (CT) and brain magnetic resonance imaging (MRI) revealed multiple small cerebral infarction. The Gottron's sign is a pathognomonic diagnostic sign of dermatomyositis, which rarely occurs in SLE.