The survival rate and physical activities of 867 cases of femoral neck fracture discharged after hospitalization during the past 12 years were investigated. The average age was 78.82 years and the average period of observation was 4.12 years. The death rate was 51.9% in men and 42.1% in women, during 12 years. The survival rate decreased significantly during the first year of discharge. The survival rate of discharged patients with bone fractures was 65% after 5 years, and was lower than that of elderly living in a geriatric home. The physical activities of discharged patients with femoral neck fractures were significantly restricted compared to that of the general population aged 80 and over in Tokyo. Only a small number of patients changed their residence after being discharged from hospital.
The distribution of cerebral elesions documented by CT or MRI was investigated in 32 patients (mean age: 72±11 years) with vascular dementia (VD) (De(+) group) and 27 patients (mena age: 74±9 years) with multiple cerebral infarcts without dementia (De(-) group). All patients classified as De(+) group based on the criteria of DSM III had a score of 10 or less on Hasegawa index or Mini-Mental State, and those in the De(-) group had a score of 22 or more. Cerebral perfusion on the early SPECT (123IMP) was examined in 14 cases in the De(+) group and in 16 cases in the De(-) gorup, both of which presented multiple lacunar infarcts. For the comparison, 2 cases of Alzheimer's disease were included in the SPECT study. Patients with VD were subdivided into “limbic dementia” and multiinfarct dementia (MID) groups. In the former, some localized lesions were detected on CT. These were, 1) dominant side of medial thalamus, 2) dominant side frontal cingulate gyrus, 3) dominant or non-dominant side posterior cerebral artery territories, 4) dominant side watershed area of middle and posterior cerebral artery, or temporal stem. However, multiple lacunae, in addition to the localized lesion, were detected on MRI, and a larger hypoperfusion area were demonstrated with SPECT. Significant low perfusion on SPECT was demonstrated in bilateral frontal lobes in patients with MID compared with patients with multiple infarcts without dementia. On the other hand, hypoperfusion was revealed in the bilateral parieto-occipital and parieto-temporal area in 2 cases of Alzheimer's disease.
Multiple cerebro-cardio vascular risk factors were examined in 24 patients (mean age: 73±11 years) with multi-infarct dementia (MID) (De (+) group) and 27 patients (mean age: 74±9 years) with multiple cerebral infarcts without dementia (De (-) group). All patients in the De (+) group had a score of 10 or less on Hasegawa's index or Mini-Mental State, and those in the De (+) group had a score of 22 or more. There was no difference between the two groups in terms of hematocrit, serum BUN, creatinine, uric acid, PO2, ejection fraction on echocardiography, the incidence of atrial fibrillation, diabetes mellitus or ischemic heart disease. Total cholesterol was lower and the atherogenic index was higher in the De (+) group (p<0.1). There was no difference in history of hypertension between the two groups. However, casual systolic blood pressure and ambulatory mean daily systolic blood pressure (S-AMBP) were significantly lower in the De (+) group than the De (-) group (p<0.01 and p<0.05, respectively). The standard deviation of S-AMBP (S-AMBP-SD) was also significantly lower in the De (+) group than the De (-) group. The treatment and the optimal control range of hypertension of the elderly with multiple cerebral infarcts still remains controversial.
To clarify a relationship between coronary artery sclerosis and major causes of death in the aged, we analyzed the 3657 serial autopsy cases in the past 14 years at Tokyo Metropolitan Geriatric Hospital. The average age at autopsy was 77.7 years old. The subjects were divided into four groups according to the number of major coronary arterial branches with more than 75% stenosis, i.e., from 0-vessel disease (0-VD) to 3-vessel disease (3-VD), and the major causes of death were compared among these four groups. Death by acute myocardial infarction (AMI) and ruptured abdominal aortic aneurysm increased with advance of coronary sclerosis, whereas death by malignant neoplasm decreased (34.4% in 0-VD, 30.3% in 1-VD, 27.8% in 2-VD, and 18.9% in 3-VD). Death by pneumonia increased with aging (11.4% in sixties, 17.7% in seventies, 23.9% in eighties, 25.3% in nineties), and was considered to be an important morbility factor in the aged. Death rates due to AMI were 0.9% in 0-VD, 4.5% in 1-VD, 12.2% in 2-VD, and 29.5% in 3-VD. In 3-VD, it was especially high when left main truncus (LMT) was affected (40.7%). In 2-VD, it was higher when the left anterior descending artery (LAD) was affected (13.1%) compared with cases without LAD lesion (8.5%). On the contrary, death by congestive heart failure (CHF) occurred most frequently in 2-VD without LAD stenosis (7.3%). These facts suggest that occlusion of LMT or LAD tends to produce massive myocardial damage, causing death from AMI in the acute phase but that considerable numbers of patients with occlusion of the right coronary artery or left circumflex can survive the acute phase of AMI but subsequently succumb to CHF in the chronic phase.
The present study investigated the effect of bodily constitution and daily nutrient intake on serum level of total cholesterol (TC) in the aged. Amounts of dairy food intake for three days were measured and TC were determined 283 elderly subjects (140 men and 143 women) living in a local community. The results obtained showed that value of TC was significantly higher in women (218.1mg/dl) than in men (193.0mg/dl) and significantly positive correlated with age both men and women. TC was positive correlated with total fat intake in men, and with ideal body weight and total fat intake in women. After making adjustment for age in men, ideal body weight, total energy, intake of carbohydrate and protein and total fat in hypercholesterolemia were significantly higher than in normal subjects; in women, the ideal body weight and intake of total fat in hypercholesteolemia were significantly higher than in normal subjects. Age-adjusted partial correlation was significant between total fat intake and TC in men and between bodily constitution and TC in women.
Measurements of bone phantoms and human subjects were performed in order to aseess the precision of dual photon absorptiometry (DPA) and single photon absorptiometry (SPA), as well as the relation between the results of the two method. SPA measurements were done with a Norland Bone Mineral Analyzer (Model 278) using 125-I, and DPA measurements were done with a Lunar Bone Densitometer (Model DP-4) using 153-Gd. The coefficient of variation (CV) of SPA and DPA in the measurement of bone phantoms was 2.8% and 0.2%, respectively. Thus, the precision error of DPA was less than one tenth that of SPA. The reproducibility of DPA measurements in vivo was examined in 3 subjects. The total body and regional bone mineral density (BMD) of each subjects was measured twice within one month. The precision for the total body BMD was 0.5% while regional densities and CV values from about 1 to 2% depending on the site. Subsequently, we examined the association between the bone mineral density of the radius shaft measured by SPA and the BMD of various skeletal regions measured by DPA in 33 subjects (7 males and 26 females). The BMD of radius shaft correlated well with BMD of anatomical regions containing predominantly compact bone measured by DPA (radius BMD vs arm BMD; r=0.93, radius BMD vs leg BMD; r=0.92). In contrast, there was a lower correlation between radius BMD and BMD of trabecular bone (radius BMD vs pelvis BMD; r=0.85, radius BMD vs spine BMD; r=0.87). In conclusion, DPA is a much more accurate tool for the measurement of bone mineral density than SPA. Local measurements of BMD on the radius shaft correlated well with predominantly cortical regions in the peripheral skeleton measured by DPA, but not as well to the axial skeleton, which is more trabecular in composition.
Eighty five autopsy cases with electrocardiographic “poor R wave progression” (PRWP) were studied in order to investigate the diagnostic accuracy of this finding for anterior myocardial infarction (A-MI). At autopsy, A-MI was confirmed in 39 cases (45.9%). However, left ventricular hypertrophy, right ventricular hypertrophy, cardiomyopathy and normal heart without significant pathological findings accounted for 12.9%, 8.2%, 3.5%, 26.9%, respectively. We divided PRWP comes into the following 3 groups. Group I; QS pattern in lead V1 to V3. Group II; reversed R wave progression. Group III; in other PRWP. Pathological findings of A-MI were found 52.2%, 66.7%, and 28.9%, respectively. The incidence of small infarction (less than 5cm in longest dimension), nontranusmural infarctions and scattered infarctions were significantly higher in Group III compared with Group I or II (p<0.05). When the findings of either notching in the initial part of QRS or ST elevation or q wave in V4 were considered in Group I and III, the sensitivity and specificity of PRWP improved to 87.2% and 60.9%, respectively. Thallium-201 myocardial scintigraphy was performed in 29 cases of PRWP. Positive findings for A-MI were obtained in 15 of 18 cases pathologically confirmed to be A-MI and all 3cases who were not diagnosed for A-MI with scintigraphy turned out to be non-transmural infarction. The sensitivity and specificity of Thallium-201 myocardial scintigraphy for diagnosis of A-MI were 83.3% and 100%, respectively. Echocardiography was performed in 46 patients and its sensitivity and specificity for the diagnosis of A-MI were 76.9% and 85.0%, respectively. Thus, PRWP is an important finding suggesting A-MI if electrocardiographic accessory findings are considered and combined with Thalliunm-201 myocardial scintigraphy and echocardiography.
A total of 210 patients with gastric cancer treated during the past 10 years were analyzed retrospectively in relation to treatment and the clinical outcome in group A counting of patients over 65 years old, was compared with group B (40∼60 years old). In group A, operation or endoscopic laser treatment were performed in 60 (50%) patients and 39 (32.5%), respectively. In group B, 81 (90%) were treated by operation. Surgically treated cases included 29 cases of early gastric cancer and 27 of advanced in group A, and 53 early and 27 advanced cases in group B. The curatively resected rate was 76.8% in group A and 88.8% in group B. Postoperative complications occurred in 12 (21.4%) of group A patients and 11 (13.8%) of group B patients. The 5 year-survival rate was 83.3% and 50.0% for early and advanced stage group A cases, respectively. In group B, the 5 year-suvival rate was 94.1% for early stage and 44.4% for advanced cases. The usefulness and efficacy of endoscopic laser treatment were discussed with respect to alternative therapeutic modalities in aged high-risk and inoperable cases.
The purpose of this study is to investigate the pathophysiological mechanism of renal function disturbance in the early stage of acute myocardial infarction (AMI), and also to evaluate the newly defined cardiorenal subset for the prediction of early mortality (within 6 months) of AMI. Serial changes in serum creatinine (Scr), β2-microglobulin (Sβ-m), blood urea nitrogen (BUN) and creatinine clearance (Ccr) were investigated within 24 hours and between 36∼72, and 120∼468 hours after the onset of chest pain. These were compared with the severity of AMI, cardiovascular hemodynamics in 80 patients (elderly group: 37, younger group: 43 cases) in the early stage of AMI. The renal function in the elderly (≥65y.o.) and in non-surviving patients was lower than that of younger (<65y.o.) and surviving patients. In the normal subjects (n=30, 34∼84y.o.), there were significant correlation between the age and Ccr (r=-0.71), sβ-m (r=0.68), and BUN (r=0.44). When the results of renal function tests were correlated with cardiovascular hemodynamics in the elderly and younger patients, the following significant correlations were found: PCWP vs Ccr (r=-0.42), Scr (r=0.55), BUN (r=0.52) and Sβ-m (r=0.43) in elderly patients, and CI vs Ccr (r=0.56), Scr (r=-0.47), Sβ-m (r=-0.50), SVI vs Ccr (r=0.42), Scr (r=-0.64), Sβ-m (R=-0.54) in younger patients. The disturbance of renal function was more severe in patients with pulmonary edema (Killip III) or cardiogenic shock (Killip IV), compared to killip I and killip II patients. Although Ccr was less than 30ml/min in 6 out of 7 killip III cases. It was less than 30ml/min in only 4 out of 13 killip IV cases. These results suggest that disturbance of renal function in patients with killip IV might be caused by depressed cardiac function. Impaired renal function also played a pathophysiologically important role in the development of pulmonary edema in killip III cases. To investigate whether our proposed cardio-renal subset would be useful to predict early mortality in AMI cases, patients were classified into four subsets based on initial SVI and Scr: S-I(n=46):SVI≥28ml/beat/m2, Scr≤1.5mg/dl, S-II(n=2):SVI≥28ml/beat/m2, Scr>1.5mg/dl, S-III(n=20):SVI<28ml/beat/m2, Scr≤1.5mg/dl, S-IV (n=10):SVI<28ml/beat/m2, Scr>1.5mg/dl, The early mortality rates in subset I, II, III and IV were 4.3%, 50.0%, 45.0% and 100% respectively. It was demonstrated that disturbance of renal function found in the early stage of AMI developed from the result of the prerenal influence of depressed cadiac function or preexistent incipient disturbance of renal function, possibly related to ageing. The cardio-renal subset proposed in this study appears useful to predict early mortalaity in AMI cases.
To investigate the effect of aging on the renin-angiotensin system, plasma renin activity (PRA) and total renin activity (TRA) were measured in 30 normal subjects consisting of 16 under 60 years of age (10 males, 6 females, average age 41±2) and 14 aged 60 or more (3 males, 11 females, average age 77±3). Simultaneously, plasma active renin concentration (PARC) and plasma total renin concentration (PRTC) and plasma total renin concentration (PTRC) were also measured using newly developed direct radioimmunoassay using monoclonal anti-renin antibody. Inactive renin activity (IRA) and plasma prorenin concentration (PPRC) were calculated as the difference of TRA and PRA or PTRC and PARC, respectively. PRA and the PRA/TRA ratio were decreased significantly with aging (PRA; from 2.2±0.5 to 0.7±0.1ng/ml·h: mean±SE, p<0.01, PRA/TRA; from 8.1±1.3 to 6.7±1.0. p<0.01), but TRA and IRA were unchanged. On the other hand, both PARC and PARC/PTRC decreased significantly with aging (PARC; from 35±5 to 17±2pg/ml, p<0.01, PARC/PTRC; 288±61 to 234±52, p<0.05), but PTRC and PPRC did not change significantly. A significant positive correlation was found between PRA and PARC (Y=10.9C+10.0, r=0.933, p<0.001). PTRC correlated with TRA (Y=38.8X-64.4, r=0.905, p<0.001). These results indicate that the conversion of proprenin to active renin may be impaired by aging in normotensive subjecs.
The liver function of ten patients with Werner's syndrome, a well-known premature aging syndrome, was examined. Five patients were male and five were female, varing in age from 31 to 48 (average 41). All showed high serum levels of transaminase with GPT predominance (GOT: 68±40mU/ml, GPT: 110±48mU/ml, Means±S.D.), total protein (8.4±0.6g/dl), albumin (5.1±0.3g/dl) and cholinesterase (405±70IU/l) and were diagnosed as fatty liver by abdominal ultrasonography. Glucose intolerance was found in nine patients, hyperinsulinemia in eight and decrease in adipose tissue mass in all ten. The presence of these abnormalities may be possible etiopathic factors for increased triacylglycerol synthesis in the liver of the patients with Werner's syndrome, resulting in fatty liver.