The effects of ageing on nocturnal blood pressure (BP) and the circadian rhythm of BP were studied. Ambulatory BP and heart rate (HR) were monitored at 30-minute intervals for 24 hours, in 326 normotensive volunteers aged 15-83. The following groups were monitored: young: <40yrs, n=177; middle: 40yrs≤∼<60 years, n=100; old: 60yrs≤, n=49 Firstly, the ratio of nocturnal fall (RONF) of BP (or HR) was calculated as follows: [(average day time BP (or HR)-average night time BR (or HR)]/averaged whole day BP (or HR)×100. Then we calculated 2 measurements: 1. The dipper (RONF of BP (or HR)≥10% 2. The non-dipper. (RONF of BP (or HR)<10%). A cosine fitting technique using the least-squares method was employed to find the circadian rhythm of BP and HR. The results of the study showed that the incidence of the non-dipper on systolic BP (SBP) was higher for old subjects than for young subjects. In addition, the nocturnal BP and HR were higher for old subjects than for young subjects. The circadian amplitude of HR was lower in old subjects. The circadian midline estimating statistic of rhythm (MESOR) or SBP increased with age. The circadian acrophase of BP and HR increased with age. Conclusion: non-dippers of BP and HR were observed in any age groups. The frequency of BP and HR non-dipper was greater for old subjects than young subjects. This result may suggest the clinical significance of nocturnal BP and HR for the evaluation of hypertensive subjects.
A clinicopathological study of senile dementia of Alzheimer's type (SDAT) accompanied by the white matter lesions of Binswanger's type was carried out. Fifty-seven patients, who were diagnosed as suffering from SDAT based on clinical and pathological criteria, were classified into two groups based on the white matter lesions of Binswanger's type. Namely, group 1 consisted of the SDAT patients without any subcortical or white matter lesions (30 cases); group 2 consisted of those with white matter lesions of Binswanger's type (11 cases). The other 9 cases included those with vascular lesions and 4 with some of the same pathological changes found in Parkinson's disease. Clinically, group 2 patients showed subcortical symptoms such as urinary incontinence, Parkinsonian gait, being accompanied by hypertension and arrythmias. Periventricular lucency (CT) were common in group 2. Macroscopically, both groups showed moderately to severe atrophy, and the width of the corpus callosum of group 2 was narrower than that of group 1. There was no difference in cerebral arteriosclerosis between the groups. In microscopic findings, patients in group 2 showed diffuse distribution of cortical changes such as senile plaques as well as Alzheimer's senile plaques as well as Alzheimer's neurofibrillary tangles while those in group 1 showed various types of diffuse or local distribution. Arteriolosclerosis of the white matter were found in both groups. There was no difference in aortic atherosclerosis and/or heart disease. The complication of white matter lesions of Binswanger's type was not a rare finding in SDAT.
To estimate normal ranges of blood urea nitrogen (BUN) and serum creatinine (Cr) levels in the aged, we measured BUN and Cr levels in 332 cases of apparenthealthy elderly subjects (male, 152; female, 180) aged 70 years or more. We measured the variables also in 315 cases of sex-matched young control subjects (male, 139; female, 176). This study was a part of the Kahoku Longitudinal Aging Study (KLAS) that aims to reveal the comprehensive functions in the aged. We calculated the mean and the standard deviation (SD) in each group, and excluded subjects with values beyond twice the SD-line. We defined the normal range as range within the single SD-line of the remainder. The estimated normal range of BUN was 14-23mg/dl both in male and female elderly subjects, and that of Cr was 0.9-1.3mg/dl in male and was 0.7-1.1mg/dl in female. The mean BUN level in the elderly subjects was significantly higher than that in the control young subjects. The mean Cr level in the elderly subjects was slightly higher than that in the control subjects. Significant positive correlation was found between BUN levels and age in male elderly subjects. Although Cr levels did not correlate with age in elderly subjects, Cr levels divided by body surface area significantly correlated with age. We concluded that the normal range of BUN and Cr levels differed between young and elderly subjects, and that the decline in renal function correlated with age after the seventh decade.
Clinical records of 128 non-selected patients with esophageal cancer treated by radiation were reviewed to investigate reasons why treatment had to be discontinued, relationship between age and survival, and factors influencing prognosis. Radiation therapy was completed in 77 patients but was discontinued in 27 patients. Preoperative radiation was attempted in 24 patients. An overall median survival of 128 patients was 6.4 months, with 8.5 and 3.3 percent surviving 3 and 5 years. Median survivals of incomplete RT, completed Rt and RT+Surgery were 1.3, 7.7 and 11.3 months. By Kaplan-Meier analysis significant difference was observed in survival rate between incomplete RT and the other two groups, but not between RT and RT+ surgery. T1 tumor cases with incomplete RT were characterized by a higher C-Score (higher incidence of comorbidity and complications), lower albumin concentration and poor performance status. Median survivals of 60 years, 70 and 80 were 12, 5.4 and 6.2 months, respectively. Performance status and C-score were significantly different between the 60yr and 80yr groups. Survival rates were also apparently affected by the size of the primary tumor and metastasis. Thus important factors influencing prognosis were performance status, albumin concentration, and comorbidity and complications, in addition to stage of tumor itself. Although performance status and albumin concentration were considered directly related to tumor stage, old age may have an adverse effect on these factors through increase of comorbidity and complication. The data may be useful for decision making for treatment of esophageal cancer of the aged.
A 91-year-old woman had decreased systemic blood pressure accompanied by dyspnea and general fatigue after resection of a face tumor (Merkel cell carcinoma). Dopamine was administered to elevate systemic blood pressure, but it did not sufficiently restore the hemodynamic status. Left ventricular apical aneurysm was observed on echocardiogram. Furthermore, SAM (systolic anterior movement of the mitral valve) was observed on M-mode echocardiogram and a pressure gradient of 34.6mmHg in the midventricular position was confirmed by continuous wave Doppler using the Bernoulli equation. After volume overload and discontinuation of dopamine, SAM completely disappeared and midventricular pressure gradient markedly decreased. Her general condition improved. Because of the narrowed outflow tract, hypercontractile state induced by β adrenergic stimulation seemed to be one of the important factors for the genesis of SAM and pressure gradient.