The clinical and pathological data of the cases of the recurrent myocardial infarction vesus those of the non-recurrent myocardial infarction were analyzed retrospectively. The hemodynamic parameters in acute phase, the treatment in chronic phase, and coronary risk factors were compared in 53 cases of recurrent infarction and 64 cases of non-recurrent infarction (mean age of both groups 74 years) of the myocardial infarction. The incidence of subendocardial infarction tended to be more frequent in recurrent infarction than in the first infarction. Recurrent myocardial infarction showed more severe cardiac pump failure, although the infarct size estimated from the peak serum creatine phosphokinase was smaller than the peak serum creatine phosphokinase of the non-recurrent infarction. The hemodynamics of the cases in which the infarct site was not the same with the first infarction site, was worse than the cases which recurred at the same site. There was no significant difference in use of the major cardiac drugs in chronic phase between the non-recurrent and recurrent group. The incidence of angina pectoris (χ²=17.5, p<0.01) and hypertension (χ²=6.13, p<0.05) after the first infarction in recurrent group were significantly more frequent than in non-recurrent group. The sum of the coronary risk fasctors after the first infarction in recurrent group were significantly greater than in non-recurrent group (χ²=10.36, p<0.01). The infarct size and coronary artery stenosis were examined in 296 autopsy cases (64 cases as recurrent group, mean age 78 years, and 232 cases as non-recurrent group, mean age 79 years). Large infarction (length of the necrosis more than 5cm) and the proportion of three vessel disease tended to be more frequent in recurrent group than in non-recurrent group. Therefore, in order to avoid recurrent myocardial infarction, special emphasis should be placed on the treatment of postinfarction angina and the correction of coronary risk factors, especially hypertension after the first infarction.

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Clinicopathological studies were carried out on 225 cases of the gastric cancer by dividing them into two groups, i.e., those of over 65 years old (A group) and of less than 65 years old (B group), and results were as follows: 1) Abdominal pain was most frequently found as an initial symptom in both groups followed by asymptom. Therefore, regardless of showing symptoms, UGI series should be performed. 2) Of operated cases of early gastric cancer, type IIcs were most frequently seen in both groups and more than half cases in group A were type IIc. 3) Of operated cases of advanced cancer, localized type and infiltrative type were frequently seen in group A and group B, respectively. 4) As to histological types, differentiated carcinoma and undifferentiated carcinoma were frequently seen in group A and in group B, respectively. Incidence of signet ring cell carcinoma in group B was signifficantly higher than that in group A.

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To elucidate the significance of aging in patients with mitral valve prolapse (MVP), 53 patients (age: 21-77, 22 men, 31 women) who were diagnosed as having MVP by two-dimensional echocardiography were devided into three groups according to their age; (1) young group (19 patients; 39 years or younger), (2) middle-aged group (18 patients; 40-59 years), and (3) elderly group (16 patients; 60 years or older). These three groups were compared in their initial clinical findings and were followed up for 24.7±15.4 months to evaluate the incidence of complications. In the young group, 8 patients (42%) were asymptomatic whereas 13 (72%) of 18 middle-aged patients and 15 (94%) of 16 elderly patients were symptomatic. Prevalence of dyspnea was 9% in the young, 31% in the middle-aged, and 40% in the elderly group. In the young group, 12 (63%) of 19 patients had late-systolic murmur and 4 (21%) pan-systolic murmur, whereas 10 (56%) of 18 middle-aged and 8 (50%) of 16 elderly patients had pan-systolic murmur. Left atrial (LA) size assessed by echocardiography was significantly larger in the middle-aged (4.0±0.7cm) and the elderly patients (4.4±0.7cm) compared to the young patients (3.1±0.5cm). Left ventricular (LV) end-diastolic dimension was also larger in the middle-aged (5.5±0.7cm) and the elderly patients (5.4±0.4cm) compared to the young patients (4.7±0.5cm). During follow-up period, 7 patients (one young, 2 middle-aged, and 4 elderly patients) developed congestive heart failure. Two patients died of heart failure and 4 patients successfully underwent mitral valve replacement. Most of the middle-aged and elderly patients were symptomatic either with dyspnea or palpitation, and half of them showed pan-systolic murmur. The size of the LA and LV was also larger compared to that in the young patients. These findings were suggestive of subclinical heart failure secondary to significant mitral regurgitation in the middle-aged and elderly patients. In particular, the elderly patients with MVP should be followed-up carefully since they seem to have greater possibility of developing significant heart failure.

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We studied the selective brain atrophy in nine autopsied brains of senile dementia of Alzheimer type (SDAT), comparing with 25 age-matched controls. We measured area of cortex, white matter, sulci and ventricle in temporal and fronto-parietal lobe, in the coronal brain slice through the mammillary bodies, using a computed planimeter method (DIGIPLAN MOP system). To investigate cerebral atrophy of autopsied brain semi-quantitatively, we introduced new index named SULCAL INDEX (SI). SI is expressed by: (area of sulci and ventricle)÷(area of sulci, ventricle, cortex and white matter)×100(%). Cortical thickness in temporal lobe was calculated from area and perimeter of temporal cortex. (Fig. 1) Results: Statisitically significant differences were found in the two groups in relation to temporal lobe's SI (Fig. 2), fronto-parietal lobe's SI (Fig. 3) and cortical thickness in temporal lobe. (Fig. 4) Especially, temporal lobe's SI was statistically far greater in the SDAT. But, white matter ratios (the ratio of white matter area to sum of white matter and cortex area) in fronto-parietal lobes in the two groups were not significantly different. (Fig. 5) Cerebral weight and temporal lobe's SI in the SDAT significantly related to age. (Tabel 2, Fig. 6)

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Eight patients, including one autopsy case, of Werner's syndrome were examined to find out clinical and pathological characteristics of arteriosclerosis in the syndrome. Moderate atheromatous lesions (accumulation of lipids, proliferation of cells and extracellular matrix components, and spotty calcification within the intima) of the aorta, coronary artery and basilar artery were found in the autopsy case, and the lesions did not seem to be essentially different from so-called atherosclerosis. Eight patients of the syndrome were all found to have one or more of the following risk factors of the development of atherosclerosis; abnormal lipid metabolism, diabetes mellitus, hyperuricemia, hypertension and smoking. It was also revealed clinically that they had all suffered from more advanced arteriosclerosis than expected as their ages. However, it is still unclear that the pronounced atherosclerosis seen with the patients of the syndrome is only due to the presence of the above mentioned risk factors, which are common in them, or there may be other unknown factor(s) for the development of atherosclerosis in Werner's syndrome.

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In 35 diabetic patients with or without vascular complications of this disease dividing into three groups; non vascular complication, retinopathy and atherosclerosis such as myocardial infarction, the plasma β-thromboglobulin (βTG) was measured before and after the administration of 100U/Kg of commercial porcine heparin. Significant raise of heparin induced β-thromboglobulin was observed in both of non vascular complicated group and atherosclerotic group that had a significant high level of fasting βTG. Patients with proliferative retinopathy were not of significant release to heparin, although their fasting βTG were in significant increase. Re-examination was carried out after low dose aspirin (81mg/day)for 6∼8 weeks in combination with ordinary diabetic treatment. Normalization of fasting βTG was observed in both of retinopathy and atherosclerotic groups. In non complicated group, the release of βTG induced by heparin much improved after aspirin intake. And little improvement of heparin induced hyperl-βTG-emia after aspirin intake in patients with atherosclerosis was observed. Significance of these findings suggested that α-granule release detecting by βTG would be markedly stimulated by heparin and that the benefit of aspirin might be to protect “easily stimulated” platelet by heparin in diabetics.

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We have studied prevalence of dementia types in nursing homes and a geriatric hospital. We divided dementia into 4 categories, and then clinically investigated each category. Our geriatric hospital and the satellite nursing homes were divided into 4 types; home with modarate fee, home for the elderly, special nursing home for aged, and geriatric hospital. Over 60s, excluding the severely ill and mentally retarded, were selected, and Hasegawa's dementia rating scale was administered. We diagnosed dementia in those who could not get a score over 21 points or in those who met the criteria of DSM-III. Next, neurologists examined the patients, and the etiology of dementia was estimated by synthetic clinical diagnostic procedure including history, course, neurological findings, CT scan, etc. In a total of 747 cases we diagnosed 316 cases (42.3%) of dementia. The prevalence of dementia has close relation to aging and the more elderly the patient the higher the prevalence of dementia. The lower the score of ADL (activities of daily living), the higher the prevalence of dementia. The severity of dementia had some relation to the type of the nursing home. We subdivided the demented patients by etiology into 4 categories-51.6% Vascular type, 21.8% Alzheimer type, 9.2% Mixed type and 17.4% the Others. The prevalence of Vascular and Alzhemer type was higher among females, and as for Alzhemer type, there was even a greater prevalence among 70-89 year old females. Selecting patients who could get over 10 points by Hasegawa's dementia rating scale, we compared the rate of correct answers in each question. For the question “What is the date?” the vascular patients got a significantly higher rate of correct answers and for questions such as “subtruct 7 form 100” or “say some numbers backwards” Alzheimer patients scored higher. Neuropsychiatric findings had shown that there were specific symptoms in each types of dementia. And it was interesting that physical complications were seen high late in demented patients.

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In 66 aged patients, with normal serum creatinine level (≤1.2mg/dl) and having underlying disease, the measured creatinine clearance (Ccr) value was compared with the predicted Ccr value. The best correlation was obtained by the formulae of Yasuda. In each group of bed-ridden patients, severe infection, and parenteral alimentation patients, the measured Ccr value was lowered about 80% in comparison with the predicted Ccr value. The simultaneously measured urinary 3-methylhistidine was also lowered. This estimated serum creatinine level tended to understimate renal insufficiency when accompanied by decreasing systemic muscle volume.

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A colony of Wistar rats with a hereditary defect in L-ascorbic acid-synthesizing ability was established in 1973. We have examined the pathophysiological findings of this rat mutant (ODS rats) in acute and chronic vitamin C deficient states. In experiment 1, ODS rats aged 63 days showed severe body loss and atrophy of thymus, spleen and bone. In experiment 2, ODS rats aged 285 days showed osteoporotic and emphysematous changes in bone and lung, respectively. Moreover, we found some pathological changes in these rats similar to those found in elderly people, that is, corneitis and findings suggesting the presence of immune deficiency due to atrophic change of T and B-lymphocytes in thymus and spleen. From these findings, vitamin C deficiency might have an etiological relationship with the above mentioned geriatric diseases.

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