Bacase of pre-thrombotic state frequently present in the elderly, sepsis easily progresses to pre-DIC and DIC, sometimes with a fatal outcome. We assesed 31 elderly patients who developed pre-DIC and DIC due to severe infection. They were divided into two groups, early death group: 14 elderly patients with poor prognosis died within 14 days, and long survival group: 17 patients with good prognosis lived 15 days or more. Controls consisted of 31 elderly thrombotic disease cases and 25 healthy elderly cases. The DIC score was significantly higher in the early death group than in the long survival group, and there was a correlation between DIC score and survival. Moreover, many of the early death group were long-termed bed-ridden patients, serum BUN and Cre levels were significantly increased in the early death group compared to the long survival group. While plasma TAT, PIC and D-dimer levels were increased in thrombotic disease group compared to the healthy control group, TAT and D-dimer were also increased in the pre-DIC and DIC state than in the thrombotic state. In the early death group, D-dimer was higher than in the long survival group. We suggest that early diagnosis by molecular marker is important in the DIC stage, and a high D-dimer level may be a poor prognostic factor.
A community based study named Kahoku Longitudinal Aging Study (KLAS) was conducted since 1990 for the purpose of evaluating the comprehensive geriatric functional assessment (CGA) and preventing a decline in CGA in the community-dwelling elderly population. It was carreid out in a Japanese rural town, in which 32% of the population was over 65 years of age. This study included a questionaire about activity of daily living (ADL), information-related physical function, mental (cognitive and affective) and social functional domains. In addition to subjective informative instruments, varioius types of objective assessment such as quantitative neuro-behavioral function tests and medical examinations were performed. Subjects were all the eligible elderly aged over 65 years in the community. Although the ratio of subjects who were independent in ADL decreased with advancing age in both 1991 and 1993, the ratio of the independent elderly in ADL became significant higher (74%) in 1993 than in 1991 (71%). Scores on 2 kinds of neurobehavioral function tests in the 159 subjects aged over 75 years who attended the examination every year showed a significant and slight decrease during two years. However, some test indices significantly improved during the 2 years. These results suggested that age-related dependency in ADL and some kind of neurobehavioral functions might be prevented, in part, by health promoting education and improvement of life style.
A comparative community-based study of physical activity in the elderly was carried out between two Japanese rural towns, Kahoku and Yaku. This study included a questionnaire about activity of daily living (ADL) and information-related functions in relation to lifestyle. Subjects were all the eligible elderly aged ove 65 years of each community (1618 and 704 subjects in Kahoku and Yaku respectively). The ratio of the eligible elderly aged over 65 years were 32% in Kahoku and 2% in Yaku. The response rates were 91% in kahoku and 51% in Yaku. Common findings in both towns were as below; 1) scores in ADL decreased with advancing age, 2) information-related functions were simlar in each town, and between genders, 3) marital condition among males was similar in both towns, 4) ADL scores were higher in the financially rich group than in the poor one, 5) ADL scores were higher in female subjects whose husbands were alive than in widows, 6) ADL scores were higher in subjects who walked every day than those who did not, 7) ADL scores were lower in subjects who took medicine every day than those who did not, however, this finding did not apply to antihypertensive drugs, 8) ADL scores were higher in subjects who drank in beverages than in those who never imbibed. The different results between Kahoku and Yaku were supposed to be due to differences in lifestyle. Of particular note is that the ratio of the aged who were independent in ADL was similar in each town, though the ratio of the eligible population over 65 years old was higher in Kahoku than in Yaku. In conclusion, advancing age per se does not necessarily result in the increase of the elderly who are dependent, and geriatric functions especially ADL can be influenced by daily lifestyle.
A comparative community-based study of blood pressure (BP) variability in the elderly was carried out in the Japanese rural towns of Kahoku and Yaku. The prevalence of hypertension, orthostatic hypotension and use of antihypertensive drugs, effects of postute on BP and the “white coat” effect in BP were examined in each town. There was no difference in the prevalence of hypertension between in the two towns. Orthostatic increase in BP and pulse rate was more common in elderly females than in elderly males in both towns, inicating that standing itself was a load for subjects and activated sympathetic nervous tone in the female elderly. The prevalence of orthostatic hypotension was 8.5% and 12% in Kahoku and Yaku respectively, and the “white coat” effect on BP was demonstrated in the elderly in each town. In conclusion, we should take orthostatic change and the “white coat” effect into consideration in the evaluation of BP among the elderly.
A comparative community-based study of serum lipids and other blood chemistry data in the elderly was carried out in two Japanese rural towns, Kahoku and Yaku. We studied the following blood chemistry factors; total proteins (TP), albumin (Alb), blood glucose (glucose), urea nitrogen (BUN), uric acid (UA), total cholesterol (T-Cho), high density lipoprotein (HDL-C) and lipoprotein (a) (Lp(a)). Subjects were the 312 eligible elderly aged over 75 years in Kahoku, and 172 similar elderly in Yaku. There were no significant differences in TP, Alb, glucose, BUN and UA of the elderly in the two areas. Mean HDL-C level was significantly lower and mean Lp(a) concentration was significantly higher in the elderly in Kahoku than in Yaku, Mean value of T-Cho did not differ significantly between the elderly in the two areas, however, the ratio of subjects whose T-Cho concentrations were over 220mg/dl was significantly higher in Kahoku than in Yaku. These data suggested that the risk of atherosclerosis from the standpoint of view of serum lipids was higher in the elderly in Kahoku than in those in Yaku. Epidemiological data of Kochi and Kagoshima prefecture indicated that the mortality ratio from ischemic heart disease was higher in Kahoku than in Yaku, although that from cerebral infarction was lower in Kahoku than in Yaku. Comparative study of laboratory data in various districts is useful to investigate the relationship between lifestyle and diseases.
A comparative study of nurobehavioral functions in the elderly was carried out between two Japanese rural towns, Kahoku and in Yaku. To evaluate of neurobehavioral functions, we used 1) Mini Mental State Examination (MMS), 2) Hasegawa Dementia Scale Revised (HDSR), 3) Kohs block design test, 4) Visuospatial cognitive performance score (VCPS), 5) Button Score (Button-S), 6) Up & Go test, and 7) Functional reach (FR). A questionnaire about ADL, information-related function and lifestyle was also done. Subjects consisted of all the eligible 332 elderly aged over 75 in Kahoku and 194 elderly aged over 75 in Yaku. In Kahoku, each function test had a significant correlation with age. However, in Yaku, the Up & Go, FR, MMS and HDSR results showed no significant correlation with age. Scores in cognitive function tests such as MMS, VCPS, and the Kohs test were better in kahoku than in Yaku, although scores in behavioral function tests such as FR were better in Yaku than in Kahoku. MMS, HDSR and Kohs tests significantly correlated with information-related function while Button-S, Up Go and FR tests had signficant correlation one with ADL in both areas. Scores on function tests were better in the living-alone group and the group who had a daily work than in other groups in Kahoku. However, differences in scores in function tests between these two types of groups failed to reach a level of significance in Yaku. These data suggested that the difference in life-style influenced neurobehavioral functions in the eldery.
A comparative community-based study of quality of life (QOL) in the elderly was carried out between two Japanese rural towns, Kahoku and Yaku. QOL, which included the subjective sense of health, appetite, sleep at night, mood, memory, family relationships, friendship, economic condition, life satisfaction and happiness was assessed using a visual analogue scale (VAS) as well a Geriatric depression Scale (GDS), a variety of neurobehavioral function tests, and a questionnaire about activity of daily living (ADL). Subjects were all the eligible elderly aged over 75 years in both communities. Inter-rater reproducibility in VSA was more reliable than that in GDS. Life satisfaction and a subjective sense of happiness highly correlated with mood, family relationships, friendship and economic condition. GDS and VAS significantly correlated with family relationships, active participation in a group and economic condition, howevre, they did not correlated with age. The subjective sense of happiness correlated with ADL and steadiness of walk as assessed by neurobehavioral function tests. Living style correlated with VAS in the male elderly, but not femle. Each score in VAS for family relationships, friendship, economic condition, life satisfaction and subjective sense of happiness was significantly higher in the elderly in Yaku than in Kohoku. The diseases which elderly people wanted to avoid were dimentia cancer, stroke, and cardiovascular disease in that order. In conclusion, QOL in the elderly population was influenced by disease, neurobehavioral functions, especially walking function, gender difference, lifestyle as well as cultural environment.
Urinary collagen crosslinks, lysyl pyridinoline (LP) and hydroxy lysyl pyridinoline (HL), have been shown to be specific parameters of bone degradation, while serum osteocalcin, referred to as bone Gla-protein (BGP), has been used as a sensitive marker of bone formation. The current cross-sectional study was designed to compare between pyridinoline contents in initial fasting urine and serum BGP in postmenopausal women aged 50-90 years. Both LP and HL increased by around 20% and BGP increased by nearly 30% in a latger stage of menopause, indicating the possibility that bone turnover did not decline with age as far as could be assessed by these chemical markers. It was of interest that significant correlations of pyridinoline to BGP in the 50s and 60s (r=0.52-0.60, p<0.05) became insignificant after age 70. Although there is a limitation to these biochemical markers, the present data indicate that the coupling mechanism between bone resorption and formation may become inefficient with aging in postmenopausal women.
An 81-year-old woman was hospitalised because of pneumonia in December 1989. In February 1991, an iliac bone biopsy was performed on the suspicion of disturbed bone metabolism due to chronic renal failure. Since she developed anemia due to continuous bleeding from the surgical wounds, saccharated iron oxide was administered beginning in March. Hypophosphatemia was noted 23 days after the beginning of administration. Due to the possibility of osteomalacia, active vitamin D was given but the hypophosphatemia persisted. Following an EDTA-2 Na load test performed to evaluate the reabsorption of phosphorus in the renal tubules, it was considered that the patient had a functional disorder of the parathyroid glands and that reabsorption of phosphorus was interrupted in the renal tubules. Furthermore, abnormal distributions of phosphorus seemed to occur in the same areas where sucrose was metabolized and iron was stored. Therefore, it was considered that these abnormalities induced hypophosphatemia following the intravenous administration of saccharated iron oxide. In addition to these actions, the possibility remained that phosphate absorption was inhibited in the small intestine by calcium lactate.
A 59-year-old male patient with general paresis was hospitalized because of personality changes and memory disturbances without any neurological deficits. His Mini Mental State score was 11, and his total IQ on the WAIS-R was 56. TPHA titers in serum and the CSF were over 40960x and 640x respectively. Both the white blood cell count as well as total protein were found to be increased in the CSF and FTA-ABS in the CSF was positive. The patient was treated with penicillin, one million units per day intramuscularly for 14 days, and four million units per day intravenously for 10 days. The abnormal findings in the CSF, his unstable mood and agitation improved, as well as his scores on the Mini Mental State (17) and total IQ (74), and the patient was able to once again function socially. This case emphasizes the importance of early diagnosis and treatment of general paresis.
Chemotherapy and radiotherapy were performed on patients over 70 years of age with malignant lymphoma of the thyroid gland and complete remission (CR) was achieved in three patients who are reported here. Case 1: An 87-year-old woman who had been treated for Hashimoto's disease for 10 years as an outpatient was diagnosed as having a diffuse-small cell, B-cell type lymphoma by an aspiration biopsy of the tumor in the left thyroid. COP-BLAM chemotherapy followed by radiotherapy achieved CR. Case 2: A 71-year-old woman was referred to our department because of a right cervical tumor. A biopsy of the tumor revealed a diffuse medium-sized, B-cell type lymphoma. She also has been proved to have hypothyroidism. She entered CR after COP-BLAM chemotherapy combined with a radiotherapy. Case 3: A 76-year-old male patients with Hashimoto's disease who had been treated for 12 years at another outpatient clinic, presented with a right cervical tumor. Aspiration biopsy of the tumor yielded a diagnosis of B-cell lymphoma. COP-BLAM chemotherapy combined with radiotherapy achieved a CR. All three patients entered CR after chemotherapy combined with radiotherapy. Moreover, the microsome test and thyroid test also became negative after the combined modality therapy. In the future, there will probably be increases in the incidence of malignant lymphoma of the thyroid gland, due to the aging of society, and it will be necessary to establish methods of diagnosis and treatment for this disease.