The influence of thyroid function on the circadian rhythm of heart rate was assessed using 24 hour electrocardiographic recordings in 196 elderly euthyroid subjects (78.4±8.1 years; male 60, 76.1±9.1 years; female 136, 79.4±7.4 years). Serum free T3, free T4 and TSH levels were measured by radioimmunoassay. To determine if heart rate fluctuates rhythmically with a circadian period, mean hourly heart rates in 24 hour electrocardiographic recordings were used to fit cosine curves by the statistical technique of least squares, and the parameters of the rhythm -the mesor, amplitude, acrophase, maximal and minimal hourly heart rates- were estimated. To investigate the factors influencing the diurnal variation of heart rate, we applied multiple regression analysis. The cosine curves were fitted with a P value of 0.01 or less in all subjects. The mesor, maximal and minimal hourly heart rates were inversely proportional to serum TSH concentrations in males. Neither amplitude nor acrophase had relation to the thyroid function in males. The mesor, maximal and minimal hourly heart rates were directly proportional to serum-free T4 concentrations and inversely proportional to serum TSH concentrations in females. The increase in the acrophase correlated with the increase in serum-free T4 levels, and the acrophase increased in proportion to serum-free T3 levels in fameles.
Serum lipid levels and the roentgenograms of the Achilles' tendon were examined in ten patients with Werner's syndrome. Seven of these ten patients showed serum total chloesterol levels of more than 250mg/dl and six of the seven patients had thickened Achilles' tendons of more than 9mm. Significant positive correlation was found between serum levels of total cholesterol and the thickness of the Achilles' tendon in these ten patients, suggesting that substance (s) precipitated in the thickened tendon may have been derived from serum cholesterol. Moreover, some relatives suffered from hypercholesterolemia in three of the six patients with thickened Achilles' tendons, suggesting that at least these three patients may also suffer from familial hypercholesterolemia (FH). Because of this surprisingly high frequency of concurrence of Werner's syndrome and FH (three to six out of ten patients), it is possible that an abnormal lipid metabolism similar to FH may be due to some intrinsic abnormality of patients with Werner's syndrome.
The records of 1280 patients autopsied at the Yokufukai Geriatric Hospital from October 1, 1973 to August 31, 1987 were reviewed and 75 patients with untreated lung cancer, aged 70 or older, were selected. The mean age and standard deviation was 82.1±5.4 years. Male consisted of 34 subjects and 41 were female of. Histological study revealed 42 cases of adenocarcinoma, 19 cases of squamous cell carcinoma, 7 cases of small cell carcinoma, 2 cases of large cell carcinoma, 1 case of carcinoid and 4 cases of the other types. The mean survival period of 44 untreated patients diagnosed as lung cancer during life was 21.1±24.1 months. The mean survival periods for 24 patients with adenocarcinoma and 11 patients with squamous cell carcinoma were 24.0±29.3 and 12.9±11.7 months, respectively. There was no statistically significant difference in the mean survival period of adenocarcinoma and squamous cell carcinoma. 9% of 44 untreated lung cancers survived for at least 5 years, although the survival rate was slightly lower than that generally reported in the literature. On the basis of staging of TNM classification at the autopsy, the mean survival period from the diagnosis for 13 patients with stage 1 and 27 patients with stage 4 were 27.5±33.3 and 18.5±19.7 months, respectively. The incidence of brain metastasis in 75 cases was 14.7%. In this study, adenocarcinoma was more predominant in the elderly (56.0%). An inverse relationship of age to stage was partially observed.
Elderly patients (more than 60 years old, n=45) with leukemia who presented from 1976 to June 1987 were studied. Twenty-two were classified as the typical type and 23 were the atypical type (hypoplastic n=10, low percentage n=13) from the bone marrow findings at the time of diagnosis. among these 45 patients 102 infections, 48 of which occurred in patients with typical type leukemia, 31 infections occurred in hypoplastic leukemia and 23 in low percentage leukemia. Respiratory infections were the most common, regardless of the type of leukemia. The following pathogens, the majority of them were gram negative bacteria, were isolated before the administration of antimicrobial agents. Thirty infections were caused by multiple pathogens (typical 14, hypoplastic 10, low percentage 6). Of those 40% were caused by gram negative pathogens, 30% were due to both gram negative and positive pathogens. The causes of death in 37 patients included bleeding (n=150) and infections (n=13). Typical leukemia (n=8) was the most common among patients who died of infection.
Thirteen patients with lung cancer and 62 agematched control subjects were investigated in this study (68.5±2.7 y.o. and 70.5±1.1 y.o. respectively). The peripheral blood natural killer (NK) cell activity of patients with lung cancer and control subjectus was 59.3±4.4% and 69.3±1.8%, respectively. The NK cell activity in these patients was singnificantly lower than the NK activity of control subjects (p<0.05). The Interleukin-2 (IL-2) productivity of stimulated peripheral lymphocytes from patients with lung cancer was 4.96±0.99 unit, and from control subjects was 12.31±1.51 unit. When compared with control subjects, the IL-2 productivity in the patients with lung cancer was significantly lower (p<0.05). There were no differences in values of OKT series or OKT4/OKT8 ratio between these patients and control subjects. Ten of the 13 patients received schizophyllan intramuscularly once a week (40mg/week). The NK cell activity was significantly increased on the second day after the second injection of schizophllan, but there was no change in IL-2 productivity. We conclude that the peripheral blood NK cell activity and IL-2 productivity of patients with lung cancer was decreased. The antitumor polysaccharide, schizophllan, temporarily raised the NK cell activity of these patients.
It is important to know the magnitude of serum-protein binding of drug dynamics in vivo. The authors investigated the effects of a variety of serum free fatty acids in elderly subjects. Serum albumin levels and ceftezole (CTZ)-protein binding in elderly subjects were lower than in younger subjects. No significant difference was noted between the two groups in regard to total free fatty acid (T-FFA) level. However, compared with younger subjects, palmitolic and oleic acid were higher and myristic and linoleic acid were lower in elderly subjects, suggesting that free fatty acid (FFA) undergoes qualitative changes due to ageing. In elderly subjects CTZ-binding correlated negatively with T-FFA, oleic acid and linoleic acid, but positively with stearic acid. Oleic acid decreased CTZ-potein binding. This decrease was higher than that due to decreased albumin levels in elderly subjects with albumin levels less than 4.0g/dl. These findings indicated that reduced protein binding in elderly subjects is due to decreased serum albumin and changes in FFA constitution with ageing. Therefore it was suggested that drug-albumin binding may change due to the competitive action of albumin sites, and albumin-drug binding capacity. Since drug-protein binding capacity seriously affect metabolism, excretion, efficacy and side effects due to the presence of free drugs, these aspects require further investigation in elderly subjects.
Long-term follow-up of the amplitude of firillatory waves (f waves) on the standard electrocardiograms (10.6±3.3yr, up to 20yrs) was performed in 45 patients with chronic stable atrial fibrillation (24 men and 21 women, average age 60.2±11.5yrs). The patients were divided into three groups on the basis of the underlying heart disease. Seventeen patients with mitral stenosis were classified as the MS group, 11 with hypertensive heart disease, old myocardial infarction, and aortic insufficiency as the HD group, and 17 without apparent heart diseases as the no heart disease (NHD) group. The f wave amplitude was measured at lead V1 according to the technique employed by Peter. The initial f wave amplitudes of the MS group (0.24±0.12mV, mean±SD) and of the HD group (0.19±0.08mV) were significantly larger thant hat of the NHD group (0.13±0.08mV, p<0.05). The f wave amplitudes were significantly decreased during the observation period in each group, and the terminal f wave amplitudes (expressed as the percent of the initial f wave amplitude) were 61±34% in MS group, 59±26% in the HD group and 67±34% in the NHD group. In the NHD group, there was no significant difference in the terminal f wave amplitude between the cases with (n=10) and without (n=7) maintenance dose of digitalis. These results showed the apparent reduction of the f wave amplitude with perpetuation of this arrhythmia, and suggested that maintenance doses of digitalis had little effect on this process.
Thirty five elderly patients with acute non-lymphocytic leukemia were studied to examine the effects of antileukemic chemotherapy according to age group. Complete remissions were obtained in 5 of 10 patients (50%) age 60 to 69 years, in 5 of 14 (36%) age 70 to 79 years, but in 0 of 9 patients over 80 years. Three patients died before chemotherapy. The median survivals of these groups were 337, 90 and 76 days, respectively. The median survival of the patients in whom complete remissions were achieved, was 700 days.
Utilizing data from seven independent double-blind controlled trials for cerebrovascular diseases (CVD) in chronic stages, a study was performed to describe the short-term prognosis of congnitive impairment with CVD patients and to identify correlating factors. 943 patients out of 2, 818 with CVD (cerebral infarction, cerebral hemorrhage and brain arteriosclerosis) were selected. The subjects had more than moderate intellectual deterioration, i.e., less than 21.5 points on Hasegawa's dementia scale (HDS) at the baseline of the trials. The improvement rate was estimated at 11% (102/943) with more than a 10 point change on HDS in 8 weeks and 34% (322/943) with more than a 5 point change. Long duration of illness, old age, severe initial global severity rating and severe initial cognitive impairment were correlated significantly with aggravation of cognitive impairment. However, sex, type of CVD, complication and rehabilitation were not markedly related with aggravation. In addition, it appeared clear that there was a tendency of improving cognitive impairment on patients with severe subjective symptoms (vertigo, headache, dull headache, feeling of congestion), anxiety, irritability in consequence of the covariance analysis of adjusting for duration of illness, age, global severity and initial cognitive impairment. On the other hand, incontinence, impairment of activities of daily living (excretion), motor weakness and low total protein correlated significantly with aggravation. These findings might be explained on the basis of changes in stages from reversible to irreversible with cognitive impairment, the contribution of aging and the influence of peripheral symptoms.
A retrospective study of refractory pneumonia (n=54), who were randomly selected from total of 657 cases of pneumonia in the elderly, was performed. These were divided into the following two grups in terms of complications. The group with multiple organ failure (MOF group; n=30), complicated by multiple organ failure during their clinical course of refractory pneumonia, was compared with refractory pneumonia without multiple organ failure (non-MOF group; n=24). Among 57% of cases of the MOF group, respiratory failure developed prior to MOF and among 37% of the cases respiratory failure occured simultaneously with MOF. The respiratory failure in the MOF group was closely related to coagulopathy. Histopathological studies of the MOF group revealed remarkable congestion and edema. From these observations, respiratory management is considered the most important to avoid concomitant multiple organ failure.
To characterize the left ventricular (LV) systolic and diastolic function in elderly hypertensives, mechano-and echocardiography was performed in 27 elderly patients more than 65 years of age (20 hypertensives and 7 normotensives) and 46 middle-aged patients (34 hypertensives and 12 normotensives). In normotensives, a positive correlation was found to exist between age and blood pressure, LV wall thickness, II-RF interval and the A/E ratio, whereas the correlation of age to systolic parameters such as ET/PEP and EF was absent. This suggests that the LV diastolic function was impaired progressively by aging with preservation of the LV systolic function. In elderly hypertensives, LV systolic function was deteriorated and the A/E ratio increased as diastolic blood pressure became elevated. The A/E ratio also increased in this group as compared with that in middle-aged hypertensives, although the difference was not statistically significant. Unlike those in middle-aged hypertensives, the indices of LV function except the elevated blood pressure and the increased cardio-thoracic ratio were not significantly different between hypertensive and normotensive elderly patients. This might be because of the wide range of normal values in elderly persons due to the various degrees of atherosclerotic changes and other pathophysiologic factors, which might have masked obvious characteristics of hypertension in elderly hypertensives.