Chronic obstructive pulmonary disease (COPD) is a disease involving either or both of chronic bronchitis and emphysema. In the elderly, bronchial asthma is usually called chronic asthma because of sustained asthma attachs and resistance to therapy. Although the absolute value of IgE is low in the asthma in the elderly, IgE values correlated to the symptoms of asthma in the elderly. Therefore, asthma in the elderly is supposed to be primarily caused by allergic reactions. Airway epithelium products histamine methyl-transferase (HMT) and cholinesterase. Allergic reactions and/or virus infection in the airway epithelium reduce productions of these enzymes, which exacerbate bronchoconstriction. Steroid hormons increase these engymes and relieve bronchoconstriction. Silent aspiration may exacerbate asthma attack in the night and recurrent cough and sputum in COPD. Macrolide antibiotics relieve chronic infections in the elderly. Plural constriction against bullae using thoracoscopy reduce dyspnea drematically in emphysema.
The purpose of this study is to evaluate chemical and pathological changes of the lung and to elucidate the role of TNFα and elastase in acute lung injury induced by HCl or lipopolysaccharide (LPS). Anesthetized rats were injected with pH 1.4 0.7ml/kg body weight of HCl and 0.5mg/kg body weight (BW) of LPS (E. coli) into the lung. Acute tracheal injury model (Mendelson Syndrome) were made. Control animals received only saline. Animals were sacrificed 1, 6, or 12 hours after the HCl or LPS or HCl and LPS injection, bronchoalveolar-lavage (BAL) was performed in the same way in control and experimental groups. The other animals which were treated as well were excised by histology. There was neither increase in TNF α-production nor increase in neutrophils resulting from HCl injection only. Elastase-like activity was not detected in animals treated only with HCl. However, 1 hour after LPS injection, the production of TNF α (37.0±8.0Units/ml) was significantly greater than that of the control group (12.1±4.2Units/ml) in BALF. Six hours after HCl and LPS injection, the concentration of elastase-like activity (0.023±0.002nM) was significantly greater than that of the LPS group (0.011±0.001nM). Only patches of intraalveolar hemorrhage and elevation of fibrin was observed in the HCl injected rats at 1 hour after injection. Six hours after LPS injection, the alveolar spaces were filled with large amounts of neutrophils. These findings suggest that TNF α and elastase play a significant role in HCl and LPS-induced acute lung injury.
Cohort studies were made regarding 1, 300 elderly was born before 1918, who were living in a city of Osaka Prefecture in 1979 and were confirmed not to be demented: the fourth survey made in the 13th year thereafter, 1992, showed the following results: 1. The prevalence of senile dementia of Alzheimer's type (SDAT) increased with age, but that of cerebrovascular dementia (VD) did not. 2. The prevalence of female SDAT was remarkably higher with age. 3. The incidence of senile dementia was 0.92%. 4. The results of multi-variate analysis showed the onset of VD and SDAT to be deeply connected with age, blood pressure, the degree of drinking, salt intake and age, inactive ADL, blood pressure respectively
Autopsy cases reported in “Annual of the Pathological Autopsy Cases (Vol. 29, 1986-Vol. 33, 1990)” were analyzed to elucidate the percentage incidences of correct clinical diagnosis concerning cerebrovascular diseases and myocardial infarction. In 19, 402 cases (aged 30 years and over), cerebral infarction, cerebral hemorrhage, subarachnoid hemorrhage and myocardial infarction were reported as major pathologic changes. The percentage of the correct clinical diagnosis was 88.4% of 2, 858 cases with subarachnoid hemorrhage, 84.7% of 3, 051 cases with cerebral hemorrhage and 80.3% of 3, 602 cases with cerebral infarction. The clinical diagnosis was correct in 66.6% of 9, 891 cases with myocardial infarction. The difference between incidence of cerebrovascular disease and myocardial infarction was statistically significant (p<.001). In women with subarachnoid hemorrhage, correct clinical diagnosis was made in 90.6% and the more than 85.5% in men (p<.0001). Among the older patients (aged 60 years and over) with cerebral infarction, 81.5% were diagnosed correctly while that in the middle-aged (aged 30-59 years) was 70.7% (p<.0001). The autopsy cases from general hospitals showed a somewhat higher percentage concerning cerebral infarction and cerebral hemorrhage than those from university hospitals (p<.05). From 1986 to 1990, the ratio of accurate clinical diagnosis concerning cerebrovascular diseases was maintained as high as in 1986. The ratio for myocardial infarction decreased from 70.7% in 1986 to 63.1% in 1990. It was concluded that much efforts are needed to establish correct clinical diagnoses of myocardial infarction in Japan.
We studied the characteristic features of gastric ulcers in 50 elderly cases (over 60 years old) concerning 2 points. Initially, we compared the clinical features of the elderly patients with those of the non-elderly (under 60 years old) patients. Secondly, we compared the endoscopic appearance of the atrophic border of elderly patients with that of elderly persons without gastric ulcer, using the Takemoto and Kimura's classification of endoscopic atrophic borders. The results were that elderly patients with gastric ulcer had few symptoms. The symptoms associated with bleeding, however, were recognized. Many of them had some complications. There was no difference in the healing rate at 8 weeks from the beginning of the treatment by histamine H2-receptor blocker (H2 blocker) between the elderly and non-elderly with gastric ulcer. Concerning the endoscopic atrophic border of the elderly persons without ulcers, the number of the open type cases was significantly greater than that of the closed type. On the contrary, in elderly persons with gastric ulcer, the number of the closed type was significantly greater than that of the open type, especially the number of C-2 type was the greatest. The healing rate of the elderly with closed type border was higher than that of elderly cases with open type border in 4 and 8 weeks from the beginning of the treatment.
The event-related potential (ERP), somatosensory evoked potential (SEP) and visual evoked potential (VEP) were studied in 15 patients with Alzheimer's disease (AD), 16 patients with Parkinson's disease with dementia (PD), 7 patients with Binswanger's disease (BD) and 15 normal controls. ERP was recorded during auditory discriminative tasks. SEP evoked by median nerve stimulation was recorded from the second cervical vertebra and contralateral primary somatosensory cortex with a midfrontal reference. VEP was recorded during pattern reversal stimulation. All three groups with dementia showed significant prolongation of the N200 and P300 latencies of ERP compared with the normal controls. In addition, patients with AD showed significant prolongation of the P200 latency. There was a significant correlation between the P300 latency of ERP and MMSE scores in AD patients. Patients with AD and PD showed significant prolongation of the interpeak latency between N13 and P40 (N13-P40) and N20-P40 of SEP compared with the normal controls. Patients with BD showed significant prolongation of the N13-N20, N13-N33, N13-P40 and N20-P40. These results suggest that there is impairment of the ascending somatosensory pathway in patients with dementia. Patients with PD showed significant prolongation of the P100 latency of VEP compared with normal controls. There was a significant correlation between the N200 latency of ERP and the P100 latency of VEP in PD patients. The VEP results suggest that dysfunction in the central visual system plays a role in abnormal pattern VEP in PD. In conclusion, the present results show that these three dementing diseases have different electrophysiological features, which may be related to the underlying pathogenic mechanisms. Additionally, the measurement of multimodal evoked potentials may be helpful in the differential diagnosis of patients with dementia.