Nippon Ronen Igakkai Zasshi. Japanese Journal of Geriatrics
Print ISSN : 0300-9173
Volume 27 , Issue 6
Showing 1-15 articles out of 15 articles from the selected issue
  • Masayoshi Namiki
    1990 Volume 27 Issue 6 Pages 675-679
    Published: November 30, 1990
    Released: November 24, 2009
    JOURNALS FREE ACCESS
    Hematemesis and hematochezia (melena) in elderly patients are serious symptoms which should be carefully handled since they can lead to death without suitable treatment. In elderly patients the advance of arteriosclerotic changes throughout the body decreases blood flow and function in various organs. When these arteriosclerotic changes become prominent in the gastric vascular structure, bleeding from gastric ulcers tends to easily occur and it can be difficult to stop. A large amount of bleeding can cause irreversible shock due to the decreased cardiopulmonary function, and diminished hepatorenal capacity would also be a decisive factor in determining the outcome of the state of shock. Once hemorrhage happens, it is of great importance to properly evaluate the general conditions of the patient and to perform adequate measures with special emphasis on the pathophysiological characteristics of elderly patients. In recent years the causes of bleeding in the gastrointestinal (GI) tract have changed, and various new medical methods to control hemorrhage, such as endoscopic sclerotherapy, have been developed and widely applied in elderly patients. The present lecture describes clinical aspects, including these up-to-date topics, which are closely based on daily practics. During the past 6 years (from 1984 through 1989) we have experienced in our and affiliated hospitals, 1, 611 patients who developed hematemesis or/and hematochezia, out of which 554 patients were aged more than 65. The pathogenesis, treatment and outcome of these patients were analyzed in detail. With regard to the cause of hematemesis in elderly patients, gastric ulcer ranked top (47%). Duodenal ulcers, which used to be very rare 20 years ago, have recently increased in number. Since acute gastric mucosal lesions (AGML) also cause hematemesis, it should be noted especially in elderly patients that the regular intake of various drugs for other diseases could induce AGML, leading to GI bleeding. In addition, hemorrhage from ruptured esophageal or/and gastric varices and from Dieulafoy ulcers, which have recently gained attention, can occasionally be fatal and should be thus very carefully managed. Colon cancer, ischemic colitis and drug-induced colitis are among the relatively frequent causes of hematochezia in elderly patients. Due attention should also be paid to bleeding from colon polyps. To control hemorrhage in the GI tract, various endoscopic treatments have been performed in recent years. In particular, endoscopic therapy frequently indicated in elderly patients with a severe underlying disorder(s) or in poor general conditions. Even today the outcome of GI bleeding in elderly patients is not completely satisfactory even if a variety of measures are applied. Therefore, more precise evaluation and more suitable management is necessary in the treatment of elderly patients.
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  • Shinji Teramoto, Takahide Nagase, Yoshinosuke Fukuchi, Kiyoshi Ishida, ...
    1990 Volume 27 Issue 6 Pages 680-686
    Published: November 30, 1990
    Released: November 24, 2009
    JOURNALS FREE ACCESS
    Fifteen patients aged over 65 years of age with advanced non-smll-cel lung cancer (mean age=70.7, stage IIIb:IV=4:11) were treated with combination chemotherapy consisting of Cisplatin (50 or 80mg/m2) and a vinca-alkaloid (Vindesine 3mg/m2 or Etoposide 80mg/m2). The effectiveness and side effects of this cisplatin therapy in different combinations of vinca-alkaloid regimens (Vindesine vs Etoposide) were examined. The mean dose of Cisplatin in the Etoposide combination group (75.2mg/m2) was significantly higher than that in the Vindesine combination group (54.3mg/m2) (p<0.01). A notable reductionin the tumor size was observed in 25% of the Etoposide group, only. The 6-month survival rate and one-year survival rate were respectively 85.7%, 57.1% in the Vindesine+Cisplatin group, and 87.5%, 50% in the Etoposide+Cisplatin group. The common side effects were nausea, vomiting, anorexia, and alopecia. These symptoms were either alleviated by antiemetic drugs or followed by spontaneous recovery. Leucopenia, anemia and thrombocytopenia were found in both groups, and there was no difference in the time course of myelosuppression between the two groups. The extent of nephrotoxicity was assessed by creatinine clearance rate. Its decrease in the Vindesine group (60.1→38.9ml/min) was higher than that in the Etoposide group (64.9→48.9ml/min), while there was no significant change in BUN, serum creatinin and urine NAG between the two groups. There were no cases in which chemotherapy schedules had to be interrupted due to myelosuppression and nephrotoxicity. These results suggest that advanced non-small-cell lung cancer in the aged can be safely treated with 50-80mg/m2 Cisplatin combination therapy, and that Cisplatin+Etoposide therapy is more effective than Cisplatin+Vindesine therapy in the aged.
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  • Hironosuke Sakamoto, Kouji Imataka, Shigeto Naitoh, Hiroshi Nishimura, ...
    1990 Volume 27 Issue 6 Pages 687-692
    Published: November 30, 1990
    Released: November 24, 2009
    JOURNALS FREE ACCESS
    Atrial fibrillation is one of the arrhythmias that increase with increasing age. In this study we compared transition intervals from sinus rhythm to permanent atrial fibrillation and the time course of the f wave amplitude immediately after the transition between 32 younger (<65 years) and 44 elderly patients (≥65 years) in whom transition from sinus rhythm to permanent atrial fibrillation was confirmed on serial ECG recordings. Each group was classified into three categories according their underlying diseases; hypertensive heart disease, valvular disease, and lone atrial fibrillation. In patients with hypertensive heart disease or lone atrial fibrillation, there was no significant difference in the transition intervals between the younger and the elderly groups. In both groups the transition intervals were significantly (p<0.05) longer in patients with lone atrial fibrillation than those in patients with hypertensive heart disease (44.6 vs. 12.5 months in younger and 26.8 vs. 12.9 months in elderly). A significant positive correlation (r=0.58, p<0.01) was observed between the final P wave and the initial f wave amplitude on establishment of permanent atrial fibrillation in all patients. In the younger group, the initial f wave amplitude of patients with valvular disease (0.27±0.04 mV, mean±SE) was significantly larger than those of patients with hypertensive heart disease (0.15±0.03mV, p<0.05) and of patients with lone atrial fibrillation (0.16±0.01mV, p<0.05).The f wave amplitude of valvular disease was significantly decreased after 1 year (0.22±0.03mV, p<0.05). Even after 3 years it was signifiantly (p<0.05) larger than that of patients with two other diseases, which showed no changes during the observation period. On the other hand, in the elderly group, the initial f wave amplitudes were 0.16±0.03mV in patients with hypertensive heart disease, 0.18±0.01mV in patients with valvular disease, and 0.15±0.01mV in patients with lone atrial fibrillation. There was no significant difference in the initial f wave amplitude among all 3 diseases and no significant changes in f wave amplitude during the observation period.
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  • Naoakira Niino, Setsu Iijima, Tamaki Mizoguchi, Fumio Eto, Hajime Orim ...
    1990 Volume 27 Issue 6 Pages 693-698
    Published: November 30, 1990
    Released: November 24, 2009
    JOURNALS FREE ACCESS
    A case-control study was conducted on 31 patients with clinically diagnosed Alzheimer type dementia, and 32 hospital and 373 community controls. Information was obtained from the next-of-kin for all subjects concerning life histories, health practice, eating habits, life events, family histories and past medical events. After adjusting for the effects of other factors, “intake of sweets” was significantly associated with dementia of the Alzheimer type. Those who had restricted intake of sweets were less common in the case group than in two control groups. Other factors examined in this study did not reach statistical significance.
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  • Hiroshi Jokaji, Hidesaku Asakura, Masanori Saito, Chika Uotani, Ichiro ...
    1990 Volume 27 Issue 6 Pages 699-705
    Published: November 30, 1990
    Released: November 24, 2009
    JOURNALS FREE ACCESS
    Parameters of fibrinolysis, including plasminogen, α2 plasmin-inhibitor (α2 PI), tissue-type plasminogen activator (t-PA) and plasminogen activator inhibitor-1 (PAI-1) antigens, and fibrinogen were assayed in 53 patients (28 women and 27 men; mean age: 64 years, age range: 32∼87 years) with non-insulin-dependent diabetes mellitus (NIDDM). The control group was similarly aged (mean age: 60.4 years, age range: 38∼81). The levels of t-PA and t-PA/PAI-1 ratio of the diabetic group (mean±SD; 9.8±4.3ng/ml, 0.94±0.47, respectively) were significantly higher than that of the control group (5.5±2.5ng/ml, 0.51±0.23, respectively). The increased levels of t-PA antigen and t-PA/PAI-1 ratio in diabetics mean that free t-PA has been released. However, there was no significant difference in the level of PAI-1 between the diabetic group (12.9±6.4ng/ml) and the control group (12.1±5.6ng/ml). Levels of fibrinogen, plasminogen and α2 PI in plasma were not different in the two groups. Duration of the disease, levels of glycosylated hemoglobin, differences in treatment and presense of diabetic nephropathy or retinopathy did not affect the fibrinolytic parameters. The levels of fibrinogen was higher in those with nephropathy than in the diabetics without nephropathy and retinopathy (p<0.05). There were no significant differences in the levels of t-PA, t-PA/PAI-1 ratio and PAI-1 between younger (less than 65 years) and older (65 years or more) subjects, in either the control or diabetic groups. From these results, it is concluded that fibrinolytic activity in patients with type II diabetes mellitus is enhanced, although the mechanism has not been elucidated.
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  • Takahide Nagase, Yoshinosuke Fukuchi, Sinji Teramoto, Eiichi Sudo, Chu ...
    1990 Volume 27 Issue 6 Pages 706-710
    Published: November 30, 1990
    Released: November 24, 2009
    JOURNALS FREE ACCESS
    To elucidate the effects of aging on ventilation in nocturnal disturbed breathing (NDB), we investigated 16 subjects aged 65 years or over with system developed by the authors using a respiratory inductive plethysmography connected to a personal computer. The subjects underwent 10 hours of continuous monitoring of lung volume and SaO2. Significant desaturation (SDS, greater than 4% drop in SaO2 from baseline value) and desaturation index [DI, ΣSDS(%)×duration(hr)]were calculated using the same program. The subjects with SDS below 50 were assigned to group A (n=9, mean age=79.7, male:female=8:1) and the remaining subjects with SDS over 50 (n=7, mean age=74.7, male: female=3:4) to group B. There was no significant difference in ventilatory parameters between group A and B. We then compared the male group (n=11, mean age=77.8) with the female group (n=5, mean age=76.8). The number of SDS in the female group (101.4±34.7) was significantly greater than that of the male group (33.4±8.3*, p<0.02), while minute ventilation of the female group (5.25±0.31l/min) was significantly smaller than that of the male group (8.86±1.36*l/min, p<0.05). DI was found to significantly correlate with the SaO2 nadir and the number of apnea and SDS. There was no significant relationship between SDS and ventilatory parameters in this study. NDB among elderly female may be of more importance than has been reported.
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  • Tadahiro Sato, Makoto Kodaira, Takashi Inamatsu, Kouichiro Ootubo, Tos ...
    1990 Volume 27 Issue 6 Pages 711-717
    Published: November 30, 1990
    Released: November 24, 2009
    JOURNALS FREE ACCESS
    From 1972 to 1989, 20 cases of tuberculous peritonitis were seen in Tokyo Metropolitan Geriatric Hospital. In 13 patients the diagnosis of tuberculous peritonitis was made only at autopsy, which in 7 patients was made during life. Of all 20 cases the mean age was 78 years, with a range of 63 to 96 years. There were no differences in mean ages between autopsied patients and clinically diagnosed patients. There were 11 male and 9 female patients. In autopsied patients 6 were male and 7 were female. Of the clinically diagnoded patients 5 were male and 2 were female. Seven of 13 patients who were diagnosed at autopsy had liver diseases, for example liver fibrosis, liver cirrhosis, hepatocellular cartinoma or chronic hepatitis. In 4 of 7 patients who were diagnosed during life, ileus was also present and their diagnosis of tuberculous peritonitis was made at operation. Only 6 patients had tuberculin test with intermediate strength PPD. There were no positive reactions. In patients who were diagnosed during life, abdominal swelling, anorexia, abdominal pain and fever, the most common clinical manifestations, were seen in 100%, 75%, 50% and 86%, respectively. In contrast, they were seen in 33%, 57%, 0% and 62%, respectively, in autopsied patients. The volume of ascitic fluid varied from zero to 3000cc. Total white-cell count in the peripheral blood was within or lower than the normal range in 85% of all 20 cases. The lymphcyte count in the peripheral blood was decreased in 95% of all 20 cases. There were no characteristic features in the serum biochemical analysis. In conclusion, it is very difficult to make the diagnosis of tuberculous peritonitis based on the clinical manifestations in elderly patients.
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  • Masahiro Tada, Seiji Shimizu, Keiichi Kawai
    1990 Volume 27 Issue 6 Pages 718-723
    Published: November 30, 1990
    Released: November 24, 2009
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    Analysis of 14 cases of stercoral ulcer showed that they tended to occur in patients over 70 years of age and associated diseases included heart failure under hemodialysis, cerebral hamorrhage, and postoperative states requiring bet rest for long duration. Constipation is always preceded the occurence of the disease, and the initial symptoms was generally massive hematochezia of sudden onset. Massive blood transfusion was often required, however, heater probe hemostasis was effective. The most common site of involvement was the rectum, and the shape of ulcer was irregular or round. Measurement of the mucosal blood flow in the rectum revealed that blood perfusion was markedly reduced immediately after the occurence, and that it recoverd with healing of ulcer. Ischemia was considered to participate in the pathogenesis of the disease.
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  • Teruhiko Kachi, Itsuro Sobue
    1990 Volume 27 Issue 6 Pages 724-727
    Published: November 30, 1990
    Released: November 24, 2009
    JOURNALS FREE ACCESS
    The corticomotoneuronal pathway in the aged was studied using the technique of percutaneous electrical stimulation of the brain and the spinal cord. Central motor conduction time (CMCT) from the cerebral motor cortex to the cervical segment of the spinal cord (C-CMCT) was measured in 26 intact volunteers (20∼85 years old) by substracting the latency to onset of EMG activity of the thenar muscle after cervical stimulation from the latency to onset of EMG activity of the same muscle after cortical stimulation. The latencies to onset of action potential of the anterior tibial muscle after cortical stimulation and the onset of action potential of the same muscle after lumbar stimulation were also measured in 11 volunteers (aged 46∼67 years), and the difference between the two latencies was evaluated as the central motor conduction time from the cortex to the lumbar segment of the spinal cord (L-CMCT). Mean C-CMCT was 5.1 ms. and mean L-CMCT was 12.8 ms. Neither was related to the patient's height or age. There was no difference in either C-CMCT or L-CMCT between males and females. The results suggested that the conduction of the pyramidal tract is not affected by age, and this must be recognised when motor functions in the aged are studied.
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  • Masayuki Matsumoto, Hiroshi Sekimoto, Yoshikazu Goriya, Mikio Matsumot ...
    1990 Volume 27 Issue 6 Pages 728-735
    Published: November 30, 1990
    Released: November 24, 2009
    JOURNALS FREE ACCESS
    The prevalence and degree of mitral annular calcification (MAC) in elderly cases of hypertrophic cardiomyopathy with asymmetric septal hypertrophy (ASHCM) were studied in comparison with healthy elderly and chronic hypertensive elderly with concentric left ventricular hypertrophy (HT+LVH) by echocardiography. In seven elderly patients with ASHCM (mean age 77.3±8.1 years) severe MAC was observed in all cases (1 male and 6 females) and systolic anterior motion of the mitral valve (SAM) was present in 3 cases, incomplete in 2 and absent in 2 cases. Of 57 healthy elderly with a mean age of 78.8±8.8 years, 8 subjects (1 male and 7 females, 14%) showed MAC. The prevalence of MAC was 0% in the sixties, 14% in the seventies, 16% in the eighties and 29% in the nineties. MAC was severe in four subjects above eighty years old. In 3 cases with HT+LVH with a mean age of 72.3±4.7 years no MAC was observed and SAM was present in one, partially observed in one and absent in one case, respectively. Serum calcium (Ca) and phosphorus (P), reported to be related with the formation of MAC, and fasting blood sugar level (FBS) were evaluated. In healthy elderly with MAC, serum Ca was 8.78±0.46mg/dl, P 3.55±0.37mg/dl and FBS 97.75±29.01mg/dl. These values were 9.32±0.57mg/dl, 3.06±0.83mg/dl and 77.09±21.18mg/dl in healthy elderly without MAC and 8.64±0.49mg/dl, 3.61±0.39mg/dl and 92.75±13.84mg/dl in ASHCM and 8.63±0.25mg/dl, 3.13±0.35mg/dl and 93.00±4.58mg/dl in cases with HT+LVH. No statistically significant difference was ovserved among these groups for these values. In the present study, a high prevalence of MAC complicating to ASHCM was seen, but no relation was found between MAC formation and serum Ca levels. The chronic mechanical stress to the mitral valve apparatus due to the disproportionate contraction of the left ventricle because of ASH and due to elevated left ventricular pressure in the presence of LV outflow obstruction seemed to have been strongly involved in the formation of MAC in ASHCM.
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  • Masayoshi Sakakibara, Tatsuya Iwasaki, Manabu Kamegai, Kazuhiko Tanabe ...
    1990 Volume 27 Issue 6 Pages 736-742
    Published: November 30, 1990
    Released: November 24, 2009
    JOURNALS FREE ACCESS
    Coronary angiographic (CAG) findings, exercise tolerance and daily physical activity were studied with reference to aging in 314 cases of the chronic myocardial infarction and in 199 cases of angina pectoris. Exercise tolerance was evaluated by a symptom-limited treadmill test and the daily physical activity by the functional classification of the New York Heart Association (NYHA) based on questionnaires filled out by the patients. Although the single to multivessel disease ratio decreased with age, there was no significant trend in diffuse or segmental character of stenosis with age. In addition, More than 80% of patients showed good exercise tolerance of more than stage II in Bruce's protocol. However, there was a general trend towards decrease in exercise tolerance with age. Furthermore approximately 80% of patients showed a good daily activity. However, the NYHA (I+II) to NYHA (III+IV+cardiac death) ratio was lower in patients aged 60 or more compared to those under age 60. Patients aged 60 or more with single vessel disease had lower daily physical activity compared to the under 60 age group, although this did not seem to be related to any physical limitation. Therefore, social and occupational aspects as well as the clinical severity of ischemic heart disease should be considered in the treatment of elderly cases.
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  • Masafumi Nakayama, Yoshinori Kyomasu, Yasuko Suzuki, Yasuoki Mashima, ...
    1990 Volume 27 Issue 6 Pages 743-748
    Published: November 30, 1990
    Released: November 24, 2009
    JOURNALS FREE ACCESS
    Cine flow MRI was performed on a 1.5 Tesla system to observe signal intensity of blood flow within the ascending aorta in the elderly who had no aortic stenosis and to determine frequency of the flow signal void. Coronal and sagittal imaging planes of the ascending aorta were obtained in 27 aged patients with no known cardiac diseases (14 men and 13 women, mean age of 76) and 7 young volunteers (7 men, mean age of 24), utilizing ECG-gating, GRASS (gradient-recalled acquisition in steady state), and a flow compensation sequence. The young volunteers presented little or no signal void within the ascending aorta. In 26 (96%) of the 27 aged patients, on the other hand, signal void was demonstrated in the blood flow distal to the aortic valve during systole. The maximum length of the signal void that was measured at 318-632msec after the R wave of ECG ranged from 33 to 97mm. Conventional and Doppler echocardiography was used to evaluate motion and morphology of the aortic valve in 19 of the 27 aged patients. Eighteen of these 19 subjects had aortic signal void on cine MRI. Echocardiography showed sclerotic changes of the aortic valve (i.e., increased echogenicity of the cusps and/or commissure fusion) in 10 (53%) of the 19 subjects. The mean maximum length of the signal void in the 10 patients with aortic valve sclerosis was significantly greater than that in the 9 patients with echocardiographically normal valve (68 vs. 45mm, p<0.01). These results suggest that signal void of blood flow in the ascending aorta, which is recognized as one of the characteristic findings in patients with aortic stenosis, is not a specific feature for this disease but rather a common one in the elderly particularly those with sclerotic changes of the aortic valve. However, the length of the signal void may distinguish between nonstenotic and stenotic aortic valves.
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  • H Zheng, C Kurashima, Y Hayashi, Y Esaki, K Hirokawa
    1990 Volume 27 Issue 6 Pages 749-755
    Published: November 30, 1990
    Released: November 24, 2009
    JOURNALS FREE ACCESS
    Immunologic and immunohistologic analyses were performed on lymphocytic infiltration in periportal areas of the liver obtained from 105 autopsy cases over 60 years of age and 63 cases under 60 years of age, all cases showing no symptoms of overt liver diseases. Lymphocytic infiltration in the periportal areas began to be found in the livers of young autopsy cases in the 4th decade, with an incidence of more than 60%. The incidence reached 100% in cases of 6th decade and over, accompanied by increased severity. The infiltrating lymphocytes consisted mainly of T cells, (approximately 85%), regardless of sex, age and underlying diseases. In terms of T cell subsets composing the infiltrating lymphocytes, there were 3 types; A: CD4+ cells>CD8+ cells. B: CD4+ cells=CD8+ cells. C: CD4+ cells>CD8+ cells. Type A was seen in 60/105 cases (57%), type B in 10/105 (9%) and type C in 35/105 (34%). The presence of cases with predominant CD8+ cells appeared to be characteristic of lymphocytic infiltration lesions in the liver, and was different from lesions in other organs. It was suggested that lesion of lymphocytic infiltration in the periportal areas of the liver might be of an autoimmune nature, gradually advancing with age.
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  • K. Toda, H. Tachibana, B. Okuda, M. Sugita
    1990 Volume 27 Issue 6 Pages 756-757
    Published: November 30, 1990
    Released: November 24, 2009
    JOURNALS FREE ACCESS
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  • 1990 Volume 27 Issue 6 Pages 758-804
    Published: November 30, 1990
    Released: November 24, 2009
    JOURNALS FREE ACCESS
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