Longitudinal Cohort Study: Electrocardiogram and blood pressure were taken biannually along with history taking, physical examination and other laboratory studies. 6, 690 subjects were included in this study in whom at least 7 out of 9 biannual check up examinations were performed. At the end of the study period, their ages ranged from about 40 to 90 years. The incidence of atrial fibrillation was about 0.2% in the forties and early fifties and increased to 0.6% by the late fifties. The incidence of atrial fibrillation was then increased almost linearly up to 2.5% at the end of the eighties. Likewise, incidence of CRBBB and LBBB was also increased with age even after the age of sixty; 1.0% at the fifties to 7.5% at the eighties in CRBBB and 0.05% at the fifties to 1.4% at the eighties in LBBB, respectively. Holter ECG Study: Holter ECG was recorded in 164 healthy subjects aged 14 to 87 years in whom no arrhythmias were found in the routine 12 leads ECG at entry to the study. In 96.9% of the subjects APC was recorded in the 24-hour Holter ECG irrespecitve of their age. The total number of APCs in 24 hours significantly increased with age, especially after age sixty. The incidence of couplet or short run APCs was 21.4% under age sixty and 74.2% above age sixty. Electrophysiologic Studies in Patients with Paroxysmal Atrial Fibrillation (Paf): Repetitive atrial firing (RAF) elicited by premature atrial stimulation, and prolonged intra-atrial electrogram (PAE) with multiple (more than 7) spikes recorded during sinus rhythm were taken as indicators of atrial vulnerability. RAF and PAE was observed in more than 60% of Paf patients with or without sick sinus syndrome (SSS), but only approximately 25% in the control group (without SSS). It was also noted that in patients with SSS, who were generally of old age, RAF was observed in about 63% even without Paf. These results suggest that the atrial vulnerability might be an expression of the common electrophysiologic properties of the atrial muscle in the elderly with atrial arrhythmias and/or SSS. Syncopal Episodes due to Transient Severe Hyperkalemia in the Elderly: Two patients with mild to moderate chronic renal failure developed transient severe hyperkalemia (9.9, 7.3 mEq/L, respectively), severe sinus bradycardia with sinus arrest and syncopal episodes. These transient findings almost completely improved in a few days by kayexatete and bicarbonate, and temporary back-up atrial pacing. Hyperkalemia was disproportionately severe compared to BUN and serum creatinine. Plasma aldosterone concentraiton was at low to low normal levels in spite of severe hyperkalemia and only poorly responded in both ACTH and Angiotensin II tests. Hypoaldosteronism was suspected as the major mechanism for these clinical manifestations in each of two elderly patients.
To evaluate the effect of aging on exocrine pancreatic function, fecal chymotrypsin activity (FCA) was measured by a photometric method in 62 healthy controls (20 to 87 years old, average 51.0 years), 42 patients with non-pancreatic diseases (31 to 83 years old, average 56.1 years), 40 controls in an old-age home (63 to 92 years old, average 77.6 years), 20 patients with definite chronic pancreatitis (17 to 72 years old, average 53.5 years) and five patietns with pancreatic cancer (60 to 76 years old, average 65.4 years). Exocrine pancreatic function showed a significant decrease with aging as indicated by: (a) a significant inverse correlationship between aging and FCA in the 62 healthy controls (r=-0.56, p<0.001), in the 42 patients with non-pancreatic diseases (r=-0.59, p<0.001), and also in the 40 controls in an old-age home (r=-0.52, p<0.001); and (b) a significantly lower FCA in the 21 healthy controls aged 65 or more (designated as the B group of healthy controls) than the 41 healthy controls aged less than 65 (designed as the A group of healthy controls). The 40 controls in an old-age home showed significantly lower FCA than the B group of healthy controls. This result was ascribed to the fact that the former group consisted of significantly older subjects than the latter. No significant difference was found in FCA between patients with chronic pancreatitis, those with pancreatic cancer, the B group of healthy controls, and the controls in an old-age home. When m-2SD values (14.5U/g) in the A group of healthy controls was set as the lower normal limit, 60% of patients with pancreatic cancer, 55% of patients with chronic pancreatitis, 52.4% of the B group healthy controls and 62.5% of the controls in an old-age home showed abnormally low levels of FCA. These results suggest that in the elderly, FCA determination is not useful for the diagnosis of pancreatic diseases. However, it is useful to discover moderate to marked exocrine pancreatic dysfunction and to follow up patients with pancreatic diseases.
In the present study, Holter ECG (24 hours continuous monitoring) was applied for detection of arrhythmia in patients with cerebral infarction to elucidate the relationship between arrhythmias and types of cerebral infarction. The subjects were 111 patients (80 males and 31 females) with cerebral infarction who were admitted to our institution during the acute stage. Their average age was 65.4 years old. They were divided into the following three groups: Group L; patients having a large low density area on CT including the cortex, group S; those having a small low density area in the basal ganglia, and group N; those having no low density area on CT. Holter ECG was taken at least three weeks after onset in all cases. Fourteen of them were also examined in the acute stage, and these findings were compared with those taken in the chronic stage. Three Holter ECGs recorded incidentally before the onset of stroke were used for comparison. Based on the basic rhythms recorded on the Holter ECG, the subjects were divided into sinus rhythm and atrial fibrillation cases. The total number of ventricular premature contractions (VPCs), were determined in each case. There was little difference in the number of total VPCs among the records taken in the pre-onset, acute and chronic stages. There also was no relation between the total number of VPCs and the age, history of hypertension, and the site of infarction on CT. There was no consistent relationship between the total number of VPCs in cases with atrial fibrillation and CT findings. In cases with a sinus rhythm, comparing the S group and N group, a higher rate of occurrence was seen in the L group, specifically in cases with a total number of VPCs 1, 000 or more. In general, since emboli are frequent in cases of cortical infarction there was a relationship between the total number of VPCs and the occurrence of emboli, as in the case of atrial fibrillation.
Reticulocytes were measured on an automated reticulocyte counter in five groups; healthy adults, nonelderly patient with low hematopoiesis, adults with anemia, healthy elderly persons and elderly patients with anemia. The reticulocyte percent, absolute reticulocyte count, and reticulocyte composition as classified by fluorescence intensity (highly, moderately, and slightly fluorescent cells) were calculated. The healthy adults had a reticulocyte count of 0.70±0.55%, an absolute reticulocyte count of 4.36±1.90×104/μl, 2.33 ±1.95% highly fluorescent cells, 18.73±5.07% of moderately fluorescent cells, and 78.82±6.55% of slightly fluorescent cells. Patients with low hematopoiesis had lower counts except for the percentage of slightly fluorescent cell. Aged persons without anemia showed no differences in reticulocytes from healthy adults. Howerver, elderly patients with anemia had a low reticulocyte count; there was no tendency towards an increase in the percentage of highly fluorescent cells or a decrease in the percentage of slightly fluoresecnt cells. Their reticulocyte percent was not significantly higher than healthy controls, suggesting that anemia observed in the aged arises from low hematopoietic activity in the bone marrow.
Platelet aggregation induced by adenosine diphosphate (ADP), adrenaline and collagen was studied in various age groups of healthy Japanese. Plasma levels of prostanoid, cyclic nucleotide and lipid (triglyceride and cholesterol) were investigated. Platelet aggregation in females was rather high in all groups compared with males in each age group, although there was no stastical difference. Age dependent increase was not observed. Platelet aggregation response to 1γ of adrenaline was either high or low and the levels of collagen-induced platelet aggregation in the low responder group was also significantly lower than those of the high responder group. Positive correlation was obtained between ADP-induced platelet aggregation and serum cholesterol levels. These data suggest platelet aggregation was not influenced by aging but other biochemical or physical conditions of individuals.
Fracture of the neck of the femur (FNF) is a common disorder in the elderly. A total of 618 cases consisting of 117 males and 501 females, whose age was 65 years or more, were enrolled in a prospective study. A total of 45 cases among them revealed pulmonary complications. These were divided into the following three groups: Group 1 (4.7%) who had respiratory disease(s) or symptoms prior to the fracture; Group 2 (1.9%), diagnosed as having pulmonary thromboembolism (PTE). In Group 3 (0.6%), PTE was a possible diagnosis but it was not distinguished from pneumonia in precise. In the patients of group 2 and 3, respectively, the following respiratory symptoms were observed: dyspnea (31.3%), productive cough (25%), syncope (12.6%), chest pain (6.3%), tachycardia (46.7%), and tachypnea (50%). An abnormal chest roentgenogram was found 56.4% in both group 2 and 3. Seven patients in group 2 showed remarkable reduction of PaO2 on admission, however these all recovered within 7 days without any thrombolytic treatment. The prevalence of PTE caused by FNF in the elderly was close to that in younger cases, but the clinical symptoms were less in the former.