Kypho (scolio) sis in the elderly is known to cause body height reduction, and this may result in inaccurate estimation in the calculation of various predicted values based on body height in lung function test. A total of 91 patietns without any known cardiopulmonary diseases were studied for the relationship between body height, arm span and predicted values of lung function tests. In addition, the kyphotic angle was evaluated for the quantitative assessment of the kyphosis. Our results showed that kyphoscoliosis in the elderly resulted in under-or overstimation of an average of 1.2-3.9% when the arm span was used instead of the body height to obtain the predicted value of vital capacity. Furthermore, there was no significant correlation among the following paremeters: the severity of kyphosis, body height or arm span and age. The arm span showed a good correlation with the body height. From these observations, it was concluded that instead of the body height the arm span could be used for calculating the predicted value on lung function tests as a more convenient methods in bed-ridden patients.
The relationship between the ectopic calcification of abdominal aorta and the de-calcification of the bone in 137 elderly patients was investigated by quantitative computed tomography. We calculated the index (CAI) of the calcification volume to the aorta volume in the lower abdominal aorta, and simultaneously estimated the bone mineral content (BMC) of the vertebral body using a calibration phantom. The CAI increased and the BMC decreased progressively in proportion to aging. There was a significant negative correlation between the CAI and the MBC in females in the eighth and ninth decades (eighth decade: n=37, r=-0.400; p<0.01, ninth decade: n=37, r=-0.334; p<0.05). These results suggested that in elderly females, abdominal aortic calcification is closely related to de-calcification from the vertebral body.
This clinical study of watershed infarct was carried out in two hospitals for elderly patietns. The purpose of this study was an investigation of the clinical specificity of this type of infarct as compared with other types of infarcts. The most important point was to determine which patients with this type of infarct usually become demented. The items of investigation were brain CT findings, measurements of the width of the ventricles and the extent of sylvian fissures from CT images, blood pressure, past history of hypertension, diabetes mellitus, alcohol use and smoking, blood analysis of total cholesterol, HDL-cholesterol, hematocrit, hemoglobin A1 and uric acid and the incidence of patients in whom dementia had improved from the previous state. From CT findings, we classified all patients with brain infarcts into 4 groups; 173 patients with central infarcts, 56 patients with watershed infarcts, 20 patients with subcortical lesions of the Binswanger type and 11 patietns with occlusion of main brain arteries. Among all investigated patients, there were 56 non-demented and 162 demented (74.3%) patients. Among the patients with watershed infarcts, there were 10 non-demented and 45 (81.8%) demented patients. In the group of demented patients with watershed infarcts, females were four times as many as males. Demented patients with watershed infarcts in the right hemisphere were twice as frequent as those with infarcts in the left hemisphere, while the number of non-demented patients with this type of infarct in right hemisphere was the same as that in the left hemisphere. In the case of demented patients with watershed infarcts in the bilateral frontal lobes, their mean value on the GBS scale was very high (90.2). We could not confirm any differences in risk factors of the findings of blood analyses between watershed infarcts and other types of infarcts. The incidence of improvement by 5 points or more on Hasegawa's rating scale for dementia was lower in patients with watershed infarcts than in those with other types of infarcts. There was no relation between the degree of dementia and the degree of ventricle dilatation in patients with watershed infarcts. Although the incidence of dementia was not significantly higher in patients with watershed infarcts than in patients with other types of infarcts, watershed infarcts in the bilateral frontal lobes produced severe dementia, and generally the incidence of improvement in demented patients with watershed infarcts was lower than that in those with other types of infarcts. Thus the watershed infarct is a clinically important cerebral lesion in elderly people and demented patietns.
To study the age-relatd changes of the sinus node function and the variations of influence of autonomic nervous system, pharmacologic total autonomic blockade (TAB) was conducted in 35 patietns with symptomatic sinus bradycardia (21 men and 14 women, 50±21 years, mean±SD). Twenty-one patients [Group I, consisting of 14 patients younger than 60 years (group IY) nd 7 patients 60 years or older (grop IE)] had a normal intrinsic heart rate (IHRo), and 14 patients had an abnormal IHRo [Group II, consisting of 8 patietns younger than 60 years (group IIY) and 5 patients 60 years or older (group IIE)]. The basic cycle length was significantly longer in group II than in group I, suggesting that intrinsic sinus node function was more seriously deteriorated in group II in spite of the compensatory effect of autonomic regulation. In group II it was characteristic that the cycle length (CL) after atropine sulfate administration was longer than the CL of the predicted intrinsic heart rate (IHRp). Otherwise, some group II patients might be regarded as normal by atropine sulfate administration alone. Parasympathetic tone showed a negative correlation with age, and it was most enhanced in group IIY, suggesting that parasympathetic negative chronotropy was stronger in this group. In the course of propranolol administration, prolongation of CL was significantly larger in group IIE than in group IIY, but there was no age-related difference in group I. In group II, beta-adrenergic blockade with propranolol administration showed that sympathetic positive chronotropy was a critical compensatory factor around the upper limit of the CL of IHRp. In conclusion, aging plays an important role for heart rate alteration during TAB, which depends upon the pathogenesis of the sick sinus syndrome.
An 84-year-old woman was admitted to Tokyo Metropolitan Tama Geriatric Hospital because of knee pain, anemia and hyperglobulinemia. On physical examination, evidence of arthritis was observed in the both knees. Nodular temporal arteries were palpable with hypertrophy and weak pulsation. The urine was normal except that the sediment contained 20-30 withe blood cells per high power view. Laboratory data showed raised erythrocyte sedimentation rate of 150mm per hour, elevation of β and γ globulin and mild anemia. Although the levels of serum IgG, IgA were markedly increased, there was no monoclonal component on immunoelectrophoresis. Lightmicroscopy examination of an aspirated specimen of bone marrow showed slight hypocellularity and mild plasmacytosis. However, atypical plasma cells were not observed. Radiographs of the knee showed narrowing of the joint space and calcification of articular cartilage and meniscus. Biopsy of the left temporal artery revealed typical findings of giant cell arteritis. The administration of prednisolone resulted in rapid normalization of laboratory findings. But her arthraligia, which had been relieved by analgesics after admission, was worsened if she took prednisolone without analgesic. Therefore, analgesics were given again with prednisolone for the control of the arthralgia.