This paper introduces a “dual structure model” that explains the population history of the Japanese population including the Okinawa islanders (Ryukyus) and Ainu under a single hypothesis. The model assumes that the first occupants of the Japanese Archipelago came from somewhere in Southeast Asia in the Upper Palaeolithic age and gave rise to the people in the Neolithic Jomon age, or Jomonese; then the second wave of migration from North Asia took place in and after the Aeneolithic Yayoi age; and the populations of both lineages gradually mixed with each other. The “dual structure model” also assumes that the population intermixture is still continuing and the dual structure of the Japanese population is maintained even today. Thus, several regional differences such as those between eastern and western Japan in physical as well as cultural characteristics can be explained by the rates of intermixture that vary from region to region. In general, this model agrees well not only with physical and cultural evidence but also with non-human evidence revealed by man's symbiotic animals such as Japanese dogs and mice. At the same time, the model provides a reasonable way of explanation in regard to affinities and relationships among the Japanese main islanders, Ryukyus and Ainu.
Comparative studies of the differences in elderly patients with and without cardiovascular disorders were made in regard to complications occurring during and after operation. The subjects included 38 patients (6 men and 32 women) aged 70 to 99 years (mean: 84 years) at Nagoya City Kouseiin Geriatric Hospital who had orthopedic surgery under general anesthesia, between March 1990 and October 1992. Diseases identified in these subjects were sequelae of cerebrovascular disease (38 subjects), heart disease (22 subjects), hypertension (9 subjects), senile dementia (6 subjects), Parkinson's disease (5 subjects), malignant disease (3 subjects) and diabetes mellitus (2 subjects). They were initially divided into 2 groups according to ultrasonic cardiography: a normal group comprising 20 patients without cardiovascular abnormalities, and a disorder group comprising 18 patients with reduction of left ventricule function, left ventricular hypertrophy and/or valvular disease (more than moderate). All subjects were examined with regard to age, weight, the nutrition index proposed by Onodera, activity of daily living (ADL), cardiac output, left ventricular ejection fraction, serum level of BUN and albumin etc. Moreover, the disorder group subjects were divided into 2 groups according to the presence or absence of heart failure occurring after surgery. In addition to the above-mentioned, we also studied the duration of surgery and anesthesia, and water balance during and after surgery. Results showed that the ADL and nutrition index in the disorder group were lower compared to the normal group. Although incidence of complications during surgery was not significantly different between the normal group and the disorder group, postoperative complications were higher in the disorder group and almost complications were heart failure. Our study also indicated that patients who suffered heart failure after operation did not have significantly lower cardiac function, but they had mild anemia, longer duration of anesthesia and excessive postoperative water balance. In summary, to prevent postoperative complications in patients with cardiovascular disorder, it is important to correct anemia before surgery and to conduct deliberate management of water balance during and after surgery.
The purpose of this study was to clarify aspects of social life in a comprehensive functional assessment of 160 elderly subjects, over 60 years of age, in institutions for the elderly. Five items were assessed: economic conditions, marrital status, family conditions, family relationships and group behavior. The institutions were of 4 types: a geriatric hospital, a special nursing home for the aged, a home for the elderly and a home with moderate fees. The assessment of social life demonstrated significant correlation between the revised version of Hasegawa's Dementia Scale, activity of daily living and physical conditions. Inter-institution comparisons revealed significant differences in terms of economic conditions for the home for the elderly, family conditions for the home with moderate fees, and family relationships and group behavior for the geriatric hospital. Total grades across the 5 items were significantly lower for the geriatric hospital cases. This assessment proved useful to illuminate aspects of social life of the elderly in institutions.
We examined neutrophil functions in seven elderly patients with non-Hodgkin's lymphoma before and during treatment with granulocyte colony-stimulating factor (G-CSF) at the neutropenic stage after combination chemotherapy. Subcutaneous injection of 75μg/d of G-CSF produced by E. coli was started when the neutrophil count decreased less than 1, 500/μl, and continued until the neutrophil count increased to about 10, 000/μl. The phagocytic activity of neutrophils from the elderly on day 3 of G-CSF treatment was markedly enhanced; 1, 129.9±403ps/100PMNs, which was 185.7 ±31.4% (p<0.001) as compared with that before G-CSF treatment. The neutrophil alkaline phosphatase (NAP) activity was also enhanced on day 3; 398.3±48 score, which was 135.2±5.1% (p<0.001) as compared with that before G-CSF treatment. Two patients developed interstitial pneumonitis during or shortly after the treatment with G-CSF. Interstitial pneumonitis suddenly developed when their neutrophil count was increased, and the phagocytic activity and NAP activity recovered. The phagocytic activity of neutrophils from them was enhanced to 1, 090±26ps/100PMNs and 772ps/100PMNs during the treatment with G-CSF, as compared with that before G-CSF treatment of 644±29ps/100PMNs and 465±69ps/100PMNs, respectively. The NAP activity was also enhanced to 372 from 264. One patient suffered from transient pulmonary dysfunction during the treatment with G-CSF. His neutrophil count was more than 13, 000/μl, and the phagocytic activity enhanced to 949±105ps/100PMNs. Dyspnea with suppressed PaO2 recovered reversibly after cessation of G-CSF. Pulmonary function should be carefully assessed in the elderly.
The potential capability of a new dual energy (DE) quantitative computed tomography (QCT) method, 4-equation 4-unknown method (DEQCT4E-4U), was evaluated for estimation of bone mineral density (BMD) as well as bone mineral content/cm width (BMC) in trabecular bone of lumbar vertebrae. Cortical BMD and BMC were also estimated by the single energy QCT method (SEQCT 80kVp) and the age-related change of cortical BMD and the cortical BMC/trabecular BMC ratio was also studied. The result indicated that the estimation of the BMD combining analysis of BMC in trabecular bone obtained by the present method provides further knowledge concerning vertebral trabecular bone mineral status. The profiles of the age-related changes of the cortical BMD and cortical BMC/trabecular BMC ratio in females were markedly different from those in males. These results indicated that our method combining analysis of BMC (BMD) of cortical bone and trabecular bone was also found to provide valuable information to evaluate the vertebral bone mineral status.
Acute cholangitis due to impacted bile duct stone is sometimes fatal and require prompt bile duct decompression. Particularly, AOSC (acute obstructive suppurative cholangitis) is the most serious form of bacterial cholangitis and its prognosis is ususally very poor when treated conservatively. We have been treated impacted bile duct stones by decompressing the duct endoscopically. Here, we report the characteristics of our elderly patients with impacted bile duct stones who received urgent decompression treatment mainly by endoscopic techniques. In the endoscopical traetment group, the number of patients with AOSC was 5 out of 46 AC (acute cholangitis) patients (11%) under 69 years old, 14 out of 52 (27%) from 70 to 79 years old, and 12 out of 28 (43%) over 80 years old. Obviously, the severity of acute cholangitis (ratio of AOSC to AC) was higher in the elderly. This tendency was similar to the patients who received urgent transhepatic decompression treatment, although they were small in number. In all the patients treated, 7 were classified into the most serious AOSC category with Reynolds'sign, and notably 6 out of 7 were over 70 years old. More strikingly, 5 of 7 patients were over 80, and their mortality rate was indeed high. Thus, in the elderly, bacterial cholangitis by impacted bile stones was a very serious condition. Especially, the outcome of AOSC over 80 years old with Reynolds' sign was very poor, in spite of emergency endoscopic treatment.
Angiodysplasia is one cause of chronic gastrointestinal tract bleeding that can not be difficult to detect. In particular, angiodysplasia in the small intestine is very rare and has seldom been reported. An 80-year-old man complained of hematochezia and was admitted to other hospital on October 1991. However, no bleeding sites in the gastrointestinal tract could be revealed by radiographic and endoscopic examinations. After 8 months, he was admitted to our hospital with the same symptom on June 1992. He suffered hemorrhagic shock due to continuous bleeding. Hypotension and anemia progressed in spite of immediate blood transfusion. Emergency angiography revealed extravasation from a peripheral branch of the jejunal artery, in addition tortuous and dilated ileal arteries. Embolization was performed with the catheter inserted superselectively into the nearest arcade of the segmental branch of the vasa recta. After embolization, no complications were occurred. He was discharged and is being followed up as an outpatient.
A 71-year-old male had suffered from cough with purulent sputum. He was admitted to our hospital because of worsening of his symptoms. The chest X-ray film showed diffuse nodular shadows and emphysematous changes in both lung fields. Transbronchial lung biopsy demonstrated findings compatible with diffuse panbronchiolitis (DPB). Bronchoscopy showed the tracheal lumen was sagittaly narrowed and membranous portion was protruded into the lumen. The trachea completely collapsed when coughing. His disease was diagnosed as saber-sheath type tracheomalacia (Johnson III). Tracheomalacia was reported to be observed in 0.9% of patients examined by bronchoscopy. The dominant type of tracheomalacia is crescent type, and saber-sheath type is rare. Chronic airway inflammation with DPB might have exacerbated the tracheomalacia in this case.
We studied two cases of the elderly with acute exacerbation of interstitial pneumonia to elucidate a prognostic role of super oxide generation in peripheral whole blood. The first case was a 70-year-old man, who presented with acute exacerbation of interstitial pneumonia and was hospitalized. Following steroid-pulse therapy, CRP, ESR, blood-gas and his physical condition improved, resulting in successful discharge. In this case, super oxide generation standardized by the number of neutrophils (K) decreased to less than 1.0 in association with the improvement of physical condition. The second case was a 92-year-old woman in whom acute exacerbation of interstitial pneumonia was diagnosed. While the pulse therapy, CRP, LDH and blood-gas temporarily improved, K was continuously greater than 1.0 and the physical condition worsened, resulting in her death. These cases suggest that the measurement of super oxide generation in peripheral whole blood may play a useful role in assessing the prognosis of the elderly with acute exacerbation of interstitial pneumonia.
An 87-year-old woman, who had been suffering from hypothyroidism and had been treated as an outpatient at our department since 1982, noticed left cervical swelling toward the end of November 1992. Because ultrasonic examination revealed a mass in her thyroid gland, she was admitted for a closer examination and additional treatment. Biopsy of thyroid gland revealed non-Hodgkin's lymphoma (NHL; the diffuse small cell type, B-cell origin). A part from the swelling of thyroid gland and the left cervial lymph node, performance of various examinations did not detected any other NHL lesions. Therefore, it was classified as stage II NHL according to the Ann Arbor classification. Laboratory data on admission were as follows; WBC 4, 400/μl, Hb 13.6g/dl, platelet count 10.1×104/μl, GOT 51 IU/l, GPT 31 IU/l, TSH 1.17, free-T4 1.03, free-T3 2.04, and microsome test 1, 600x. Those data indicated marked hypothyroidism. In addition, stage IIa and IIc gastric cancers were detected by the examination with gastric endoscopy performed for stage classification. Both were adenocarcinomas. Because polyps were found in her sigmoid colon with colonoscopy, polypectomy was performed. The polyps were diagnose histologically as moderately differentiated adenocarcinoma. On July 20, COP-BLAM therapy was started (CPM 600mg div, VCR 1.2mg iv, ADR 30mg iv on day 1, PDN 40mg p.o and PCZ 100mg p.o. on days 1-10, BLM 7.5mg div on day 14). Subsequently, the left cervical lymph node swelling disappeard, and shrinkage of the mass in the thyroid gland was observed. During the second cycle of the chemotherapy, which was started on Feburary 15, she complained dyspnea on February 25 and she was found to have heart failure and fungal pneumonia, which was successfully treated by administration of oxygen, diuretics, and antifungal agents. Consequently, because the continuation of strong chemotherapy was considered impossible, she was treated with sustained oral administration of VP-16 (25mg/body) and entered into complete remission (CR), She was discharged on April 10 and is now receiving a continued maintenance therapy with a small dose of VP-16 on an outpatient basis. We reported a case of primary NHL of the thyroid, which was detected during the course of Hashimoto's disease and associated with the simultaneous occurrence of gastric cancer and colon cancer, and with chemotherapy.
A 85-year-old woman consulted our hospital with general fatigue, palpitation and chest discomfort changing with different postures. Her electrocardiogram showed sinus tachycardia, atrial premature beats and left atrial overload. 53% cardiothoracic ratio, slightly protruding third arch of the cardiac silhoutte and dilated pulmonary artery were seen on the chest X-ray. Two dimensional echocardiography revealed a mass in the left atrium although the quality of echocardiography was suboptimal due to her thoracic deformity. There was no uptake of T1-201 or Ga-67 by the mass. The four-chamber view of Tc-99m ECG-gated SPECT radionuclide angiocardiography showed a filling defect in the left atrium. The T1 weighted magnetic resonance imaging revealed a left atrial mass with relatively low signal intensity. After intravenous injection of Gadolinium-DTPA the signal intensity of the mass increased singnificantly and the contrast of the mass was improved. The size of the mass was 4×4×3cm with a stalk connecting to the interatrial septum. These findings were compatible with left atrial myxoma. Gadolinium-DTPA magnetic resonance imaging is useful in diagnosing left atrial myxoma because it provides information on the size, anatomical location, relationship with other cardiovascular structures and even the characteristics of the mass.