We recently reported that diffuse aspiration bronchiolitis (DAB) was detected in 1% of autopsied lungs of aged cases of pneumonia. We hypothesized whether repeated HCl micro-aspiration (RHMA) is involved in DAB and established an animal model by administering HCl intratracheally to rats every two days for 2 weeks. Saline was given to control animals in the same fashion. Then, we performed bronchio-alveolar lavage (BAL) or excised lungs for histologic examination. There was no difference in BAL cell counts, TNFα-production, elastase-like activity or albumin levels between the HCl and control groups. Histologically, DAB-like findings were observed in the HCl-treated animals. These data suggest that RHMA might be involved in DAB, while neither TNFα-production nor elastase-like activity may play a significant role in inducing DAB.
The prognostic factors influencing survival after operations for gastric cancer in the elderly were evaluated by Cox's proportional hazards model analysis. Data were obtained from 511 operations over a 10-year period, in patients with a mean age of 75.6±7.9 years. The significant prognostic factors of survival out of 47 examined risk factors were, in order of standardized coefficient values, (1) stage of cancer, (2) %IBW, (3) peritoneal dissemination (P-factor), (4) multiple non-gastric cancers, (5) postoperative hepatic injury and (6) postoperative cardiac complication. No other factors, including preoperative associated diseases and postoperative pulmonary complication (the major risk factor of operative death), were significant risk factors of survival. We conclude that by giving special postoperative attention to prevent hepatic injury and cardiac complication, the length of survival of elderly patients with gastric cancer will improve.
To screen for risk of embolism, we investigated the association between the presence of left atrial (LA) thrombus by transesophageal echocardiography (TEE) and blood coagulation tests, including thrombin-anti-thrombin III complex (TAT), plasminogen activator inhibitor 1 (PAI-1), plasmin-α2-plasmin inhibitor complex (PIC), D-dimer, tissue plasminogen activator (tPA), free tPA, tPA·PAI-1 complex, prothrombin fragment 1+2 and fibrin degradation product E (FDP-E) in 40 patients with atrial fibrillation (Af) (13 males, 27 females, mean age 76±8yrs). Blood coagulation tests were performed in 21 control subjects with sinus rhythm (12 males, 9 females, mean age 75±4yrs). LA thrombi were detected in the appendage of 8 patients and in the atrium of 6 patients. Severe atherosclerotic plaque with thrombi in the thoracic aorta were detected in 6 patients without LA thrombi. FDP-E, D-dimer and PIC increased significantly in patients with LA thrombi or aortic plaque in comparison with controls with sinus rhythm. In patients with Af, 25 of them (group A) has more than 4 abnormal coagulation values out of 9 tests and 15 of them (group B) had abnormalities in less than 3 tests. LA thrombi or aortic plaque were detected in 18 patients in group A and 2 patients in group B (72% vs 13%, p<0.01). In 4 of 6 patients with large LA thrombi, the thrombi were resolved after administration of warfarin. Before administration of warfarin, tPA, PA-1 and tPA·PA-1 complex levels were higher in the two patients whose thrombi did not resolve. Thus, the combination of blood coagulation tests and TEE may be useful in early screening for risk of embolism in aged patients with Af and in predicting the effect of warfarin therapy on LA thrombi.
One hundred and three ambulatory and healthy elderly (age; 73.8±7.3 years) took part in a one year prospective study of falling. All the subjects underwent a baseline examination consisting of an interview, physical and mental examination, laboratory tests and identification of all drugs being taken. Additionally, spontaneous postural sway while standing still was measured using a computerized postutography system. Thereafter, we carried out bimonthly check-ups to obtain information about falls. During the study period, the subjects sustained 54 falls and 14 subjects fell twice or more. Multiple logistic regression analysis of selected medical and demographic variables indicated that the most influential variables regarding those who fell twice or more were a history of falling, not living alone and poor tandem gait. Although a history of falling contributed to the value of spontaneous sway while standing still, the value did not attain a statistical significance for predicting falling.
The relation of aging to the length of the spinal cord and to the cross-sectional area at the levels of C6 and L3 of the spinal cord was studied in 140 autopsy cases who between the age of 47 to 105 without spinal cord lesions. In addition the effect of being bed-ridden on the spinal cord was studied in 11 of 140 cases. As pathological controls, we referred to 40 autopsy cases with compression change of the cervical cord. The length of the spinal cord had no correlation with aging but had a significant positive correlation with the height of the subject. A significant decrease in the cross-sectional area of the spinal cord was observed after the age of 80, in particular at C6. However, the extent of the decrease was not as serious as that of pathological control cases. Decrease of cross-sectional area was associated with that of white matter area. In addition, effect of being bed-ridden on the spinal cord was reflected in a significant decrease of the grey matter of the lumbar cord.
A case of therapy-related acute non-lymphocytic leukemia (t-ANLL) in a 70-year-old female patient is reported. An operation for lung cancer was performed in February 1991, and she was treated with etoposide (VP-16), a topoisomerase II inhibitor. Nineteen months after the start of chemotherapy, she complained of palpitations, and anemia and thrombocytopenia developed. The myelogram revealed 41.2% leukemic cells, and a diagnosis of t-ANLL induced by VP-16 was made. The karyotype of bone marrow cells showed 46, XX, t(7; 11) (p13; p15), 16p+. She obtained complete remission (CR) by treatment with low dose cytosine arabinoside (Ara-C) and cytarabine ocfosfate (SPAC). Karyotype with t-ANLL induced by alkylate agents frequently shows unbalanced abnormalities. The difference of cytogenetic findings suggest the difference of mechanisms. Detailed chromosomal analysis make clear the oncogenesis of t-ANLL. It is reported that the prognosis of patients with t-ANLL treated by conventional chemotherapy is poor. Considering that elderly cases of acute leukemia have a lower probability of achieving CR than non-elderly cases, because of complications and side effects of chemotherapy such as bone marrow supression, treatment with low dose Ara-C and SPAC is thought to be indicated in elderly patients with t-ANLL.
A 78-year-old female was admitted to our hospital with acute abdomen (abdominal pain and bloody stool). Abdominal examination revealed mild rebound tenderness on the right side. The laboratory data revealed severe inflammation (WBC: 33100/μl, CRP: 35.5mg/dl). Panperitonitis was suspected because of diffuse and severe abdominal pain and rebound tenderness on the next day. X-ray examination by gastrografin showed mucosal irregularity and tubular narrowing of the tubular narrowing of the ascending colon which indicated ischemic colitis, and an emergency operation was performed. Histological examination of the pathologic specimens revealed fibrinoid necrosis and destruction of the internal lamina in small and medium-size arteries. We report a case diagnosed as ischemic colitis due to polyarteritis nodosa by the findings of its pathologic specimens.