Sixteen elderly patients (age≥60 years, elderly group) with mitral stenosis and 20 young patients (age≤59 years, young group) underwent percutaneous transvenous mitral commissurotomy (PTMC) by the single balloon technique. Pulmonary arterial and mean left atrial pressures, mitral valvular pressure gradient and left atrial dimension were significantly decrease in both groups after PTMC. Mitral valve areas by Gorlin formula were significantly increased from 1.14±0.40 to 1.78±0.66cm2 in the elderly group and from 1.25±0.50 to 2.04±0.81cm2 in the young group after PTMC. Thirteen elderly and 19 young patients became in NYHA class I or II after PTMC, and three elderly patients with early gastric cancer had the lower risk of the gastrectomies by preoperative PTMC. But, two elderly patients remained in NYHA class III or IV due to increased mitral regurgitation and late tamponade, and one elderly patient died by heart failure after PTMC. PTMC has the advantages of shorter hospitalization and lower invasion for the patients compaired with surgery, therefore PTMC is an effective treatment in both elderly and young groups. Elderly patients with severe mitral stenosis have higher risk of PTMC and are needed discreet strategy.
In order to clarify the influence of social activities on the feeling of well-being or depression in the elderly, we studied these relationships in 2 groups with different activities. Group I consisted of 26 subjects (mean age, 77.2 years) living in a retirement house and exposed to relatively few social stimuli. Group II consisted of 47 subjects (mean age, 75.6 years) who were living in their own homes and were confirmed to be socially active. The Morale Scale and the Zung Self-Rating Depression Scale (SDS) were used to evaluate feelings of well-being or depression. The morale scale in group I was significantly lower than in group II. In particular, there was a significant difference in the factor related to aging. The SDS score of group I was significantly higher than that of group II. The depressive state incidence was significantly higher in group I than in group II in all subjects. There was a highly significant correlation between the morale scale score and the SDS score. These results indicate that group I is less satisfied and more depressed than group II. We conclude that social environmental factors are extremely important for the quality of life of elderly people.
The author assessed the physiological aging parameters of 38 apparently healthy subjects who were over 80 years old 1989, who were not on medication, and who had consulted with the Keio Health Counseling Center over 10 years. All subjects had no history of overt vascular disease ande/or malignancy in 1989. In 17 of 38 subjects, physical, hematological and blood chemical parameters when they were in their 70s were analyzed. Many parameters were unchanged and remained within normal limits for ordinary adults. Cataract, atherosclerotic change of optic fundi and diagonal ear lobe creases were seen in all subjects during the study period. Concerning standard deviations, those of forced expiratory volume in one second/predicted vital capacity and pure tone average (acoustic ability) decreased with age, unlike those of other parameters. Furthermore, multiple regression analysis, revealed that serum albumin decreased but pure tone average, Scheie's atherosclerotic score, senile cataract, HDL-cholesterol blood urea nitrogen and forced expiratory volume in one second/predicted vital capacity increased with age. This study was not cohort study with selected subjects but shows very slight change of almost any parameter irrespective of age and abnormality can suggest the existence of disease.
Early duodenal cancer has been detected with increasing frequency of endoscopy and the advent of an aging society. Aged patients, however, are often inoperable because of complications due to various underlying diseases. The authors report a case of early duodenal cancer curatively operated by endoscopic polypectomy and refer to related cases in the literature.
The authors report two cases of hepatic encephalopathy with chronic hepatic failure. Case 1 was a 78-year-old woman with liver cirrhosis, admitted because of general fatigue and loss of appetite. Her electroencephalogram showed frequent slow waves in the θ range with intermittent triphasic waves T1-weighted MR images showed increased signal intensity in the globus pallidus and the putamen. Case 2 was a 71-year-old woman with chronic hepatitis, admitted because of depression. Her electroencephalogram showed frequent slow wave activities in the θ-δ range with intermittent triphasic waves. Her serum ammonia level was 84μg/dl (normal 12-54μg/dl). T1-weighted MR images showed increased signal intensity in the globus pallidus, the putamen and the hypothalamus. On the basis of these findings, both patients were diagnosed as having hepatic encephalopathy, although disturbance of consciousness was not obvious. The observed MR image abnormalities might be due to the metabolic and pathological changes of chronic hepatic failure. Such MRI findings may be useful for the diagnosis of hepatic encephalopathy.
The case is a 83-year-old woman who came to our hospital with melena and epigastralgia as chief complaints, presenting pre-shock state with high serum amylase value. ERP revealed diffuse dilatation of pancreatic duct and cyst of the accessory pancreatic duct. Endoscopy showed hemorrhage of the accessory papilla. A diagnosis of chronic pancreatitis and hemosuccus pancreaticus was made. Becuse of the patient's advanced age, conservative treatment (total parenchymal nutrition, transfusion, hemostatics, etc.) were prescribed. The patient succumbed due to heart failure 15 months later. This case of gastrointestinal bleeding from a pancreatic pseudocyst due to neighboring arterial rupture is discussed with reference to some related literature.
A 66-year-old woman visited a local hospital complaining of left brachial tumor in June 1988. She was diagnosed as having non-Hodgkin's lymphoma (diffuse medium-sized type) by biopsy of the tumor. No other lesions were detected at any site. The disease was classified as stage IA and radiotherapy was carried out resulting in complete remission (CR). Because a tumor was observed at the same site again she was admitted to our hospital. Under a diagnosis of recurrence, she received 2 courses of COP-BLAM therapy, and achieved CR. Subsequently she was treated with chemotherapy as an outpatient. As another tumor developed at the same site in June 1992, the patient was readmitted. The re-evaluation of clinical stage revealed no other lesions. Under a diagnosis of second recurrence, still in stage I, she underwent both chemotherapy (IMV-triple P therapy) and radiotherapy, and CR was achieved again. She is now being treated as an outpatient. Malignant lymphoma originating from soft tissue, particularly the skeletal muscle, is rare. The present case was considered to be rare because the tumor was a non-Hodgkin's lymphoma originating from the left brachial soft tissue, in which the tumor recurred twice at the same site.