The subject of aged people and stress was discussed from both clinical and basic points of view, mainly by introducing our reserach results, beginning with our immunoneuroendocrine studies on aging and stress. Stress stimulates the secretion of two adrenal hormones, cortisol and dehydroepiandrosterone-sulfate (DHEA-S). Both hormones are metabolized and excreted from the kidney, respectively converting to 17-OHCS and 17-KS-S in the urine. We have found that the two adrenal steroids reflect the physiology and pathophysiology of stress and aging, thereby suggesting that the simultaneous analysis of these parameters could be utilized as new biological markers for stress and aging. It was speculated that a disturbed balance between cortisol and DHEA-S would result in various aging- and stress-related disorders. Furthermore, clinical problems in aged people with stress-related diseases such as psychosomatic diseases, neurosis and depression were illustrated by some interesting cases. In particular, much data about peptic ulcer disease in the aged, a typical psychosomatic disease, were presented. In addition, clinical characteristics of old people with irritable bowel syndrome, aerophagia, neurogenic abdominal distention and depression were described. Data of our research to determine why pancreatic cancer is accompanied with depression so frequently were also presented. Finally, it was emphasized that a holistic approach, paying to sufficient attention to psychosomatic aspects, is very important for the management of stress diseases in the aged.

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The usefulness of hemoglobin A_1c and fructosamine for screening of glucose intolerance were compared in 383 semi-urban residents ranging from 35 to 88 years of age. Both the sensitivity and specificity of the indices for screening of those with 110mg/dl and over of fasting blood glucose were examined. The results showed that hemoglobin A_1c was better than fructosamine for screening for glucose intolerance.

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From the viewpoint of prevention of cerebrovascular disease, we examined the relationship between irritable persons (CMI, Q-180 possitive) and the levels of serum triglyceride (TG), total cholesterol (T-chol), HDL-cholesterol among farmers, part-time farmers and nonfarmers among 1075 inhabitants, consisting of 306 males with a mean age of 54, and 76 females with a mean age of 49, in a rural area with a high frequency of apoplex. Since the levels of serum TG, T-chol, HDL-chol in male farmers showed the same pattern as that of female part-time farmers, it seemed that the female farmers were working as heavily as the male farmers. Irritable male farmers showed a higher level of TG and lower level of HDL-chol than other personalities. However, irritable female farmers showed significantly lower levels of TG or higher level of HDL-chol than that of other personalities. Obesity measured by BMI of irritable persons showed the same level among occupations in male farmers. Also there was no difference in BMI levels of irritable persons among female part-time farmers and non-farmers. Irritable male farmers showed higher levels of TG and lower levels of HDL-chol than non-farmers and showed the same level of T-chol. The levels of these parameters in non-farmers showed the same levels as in the rural inhabitants. The levels of TG and HDL-chol of irritable male farmers were higher and that of T-chol was lower than those of irritable nonfarmers. Irritable female part-time farmers and nonfarmers showed lower levels of TG and HDL-chol than those of the other personalities. Irritable female part-time farmers showed lower levels of TG and T-chol than irritable female non-farmers, but there was no difference in the HDL-chol level between the two groups. Thus, it seemed that irritability affected habits of food intake and sexual differences of fat metabolim. There was a close relationship between serum lipid levels and irritability as demonstrated by the multiple regression method. Mass survey to screen for irritability by CMI and to advise on life style seems to be one means to prevent cerebrovascular disease.

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The purpose of this study was to assess possible correlations between paraplegia in flexion and dementia in elderly patients in our special nursing home and geriatric hospital. At the time of our study, 10.5% of all our patients were suffering from paraplegia in flexion, with the ratio increasing with advancing age. Disorders of the nervous system, and in particular disorders caused by cerebrovascular disease were found at a high rate of frequency among the paraplegia in flexion patients, in whom the incidence of dementia was 97.8%. In most cases, the degree of dementia was severe, the types and respective percentages being as follows: vascular type 37.8%, Alzheimer's type 24.4%, mixed type 22.2% and others 15.6%. Many of these patients demonstrated pseudobulbar palsy, frontal sign, Babinski's sign, and typical reflexes of spinal automatism. We think that paraplegia in flexion is probably caused by reflexes of spinal automatism and extensive cerebral lesions.

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A total of 32 previously untreated patients aged 65 years or older with non-Hodgkin's lymphoma (NHL) were treated with VEPA (vincristine, cyclophosphamide, prednisolone and doxorubicin) or ML-Y1 (doxorubicin, cyclophosphamide, vincristine, methotrexate, bleomycin, procarbazizin and prednisolone). The median age of the patients was 70 years (range 65-77), 19 males and 13 females. The outcome of 16 patients with VEPA and 16 patients with ML-Y1 was retrospectively evaluated. There were no significant differences in response or survival between VEPA and ML-Y1, complete remission rates were 37.5% vs. 31.3% and duration of 50% survival were 20 months and 13 months, respectively. Major side effects of both regimens were myelosuppression, hair loss, nausea, vomiting and peripheral neuropathy. There was no increased toxicity in ML-Y1 but this regimen seemed like VEPA, to be insufficient for NHL in elderly patients. A new intensive regimen should be designed to treat NHL in the elderly patients.

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The patient, a 69-year-old woman, was admitted to Osaka City University Hospital on July 25, 1992, for severe hypercalcemia. Laboratory data on admission revealed severe hypercalcemia of 14.9mg/dl and renal dysfunction with serum creatinine of 2.9mg/dl. As reflected by increased urinary excretions of pyridinoline and deoxypyridinoline and suppressed serum levels of parathyroid hormone (PTH) and 1, 25-dihydroxyvitamin D, increased bone resorption seemed to be a main factor for the development of hypercalcemia. The development of hyprcalcemia seemed to be acute because of (i) her severe symptoms caused by hypercalcemia and (ii) impaired renal function which improved after normalization of serum calcium. Following combination therapy of saline infusion and furosemide, there was a gradual decrease and later normalization of serum calcium together with serum creatinine. Even 8 months after discontinuation of the therapy for hypercalcemia, the serum calcium level has remained within the normal range. Measurement of serum factors which have hypercalcemic effects such as PTH, parathyroid hormone-related peptide and cytokines (interleukin-1α, interleukin-1β, interleukin-2, interleukin-6 and tumor necrosis factor-α) were all within the normal range. In summary, hypercalcemia in this patient was regarded as a kind of disequilibrium hypercalcemia due to a combination of increased bone resorption and decreased renal capacity to excrete calcium. Furthermore, since it was temporary and has not recurred despite no treatment, her hypercalcemia developed due to imbalance in calcium regulation but not due to any organic disease.

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