Dpression in the elderly is characterized by agitated depression, chronic course, high risk of suicide, and masked depression-like states in which somatic symptoms are predominant. In the treatment of the elderly with depression, nontricyclic antidepressants are beneficial because of their few side effects. In addition to pharmacotherapy, psychotherapy is indispensable. Psychotherapy should be given frequently even though the time of each interview may be limited. The therapeutic efforts should be directed to coordinate the relationships among family members and advise the patients to take some role in their society, because distorted relationships among family members and the loss of roles are closely related to the development of dpression.
We clinico-statistically studied 8 patients (0.77%) with tuberculous peritonitis (3 cases) and tuberculous endometritis (5 cases) aged 50 or older who visited our gynecological clinic for 6 years from July, 1986 to June, 1992 in Tokyo Metropolitan Tama Geriatric Hospital. The mean age was 72 years with a range of 52 to 82 years. Five cases with tuberculous endometritis were diagnosed based on the findings of endometrial cytology and bacteriology, and the incidence was 0.93% of 535 cases in which the uterine cavity could be examined. Three cases with tuberculous peritonitis were strongly suspected by the ascitic findings (cytology and adenosine deaminase level), and culture of ascitic fluid for acid-fast bacilli was positive in 2 of the three cases. Another case with negative culture was diangosed based on the marked improvement of clinical findings and symptoms during chemotherapy for tuberculosis. No cases were complicated by active lung tuberculosis. All cases had a family and/ or past history of pulmonary tuberculosis. The PPD skin test was positive in 7 of the 8 cases. In all cases, the clinical laboratory data and symptoms were markedly improved by chemotherapy for tuberculosis. Endometrial cytology and transvaginal ultrasonography were very effective methods for the diagnosis of tuberculous endometritis and peritonitis associated with ascites.
Clinical characteristics of aging in congenital atrial septal defect (ASD) without significant right-to-left shunt (>10%), were examined especially focusing on atrial arrhythmias such as atrial fibrillation (Af) and atrial premature contraction (PAC) in serial 48 patients, aged 42.6±2.3, ranging 16-67 years, Af was found in 12 (25%) out of 48 patients. Comparing patients with Af and those without Af, the average age (52.8±2.6 vs 38.6±2.8 years, p<0.05), functional class of New York Heart Association (2.0±0.2 vs 1.6±0.1, p<0.05) and left atrial dimension (41.4±1.1 vs 34.7±1.2mm, p< 0.01) were significantly higher in the patients with Af than those without Af. Hemodynamic variables, i. e., mean right or left atrial pressure, Pp/Ps, Qp/Qs, left-to-right shunt, electrocardiographic R/S ratio in the lead V1 and tricuspid regurgitation had no relation either with aging or Af. Furthermore, daily PAC counts on Holter electrocardiograms significantly correlated with the age of the patients (r=0.642, p<0.05). These results suggest that the incidence of Af in congenital ASD is significantly related with aging/duration of ASD, but not with hemodynamic variables.
This paper describes ultrasonically-guided infusion of minocycline hydrochloride solution (MINO infusion therapy) in benign nonparasitic cysts of the liver. MINO infusion therapy was performed in 7 large hepatic cysts and successful results were obtained in 6 lesions. The infusion procedure in the initial 4 hepatic cysts a 7 Fr catheter was placed into the cyst and MINO solition was left in the cyst according to the procedure of ethanol infusion theray. In the most recent 2 cases the cyst was punctured with a 21G needle, washed with physiologic saline and then infused MIND solution without placement of an indwelling drainage tube. This modified procedure is simple and safe and also yields a good therapeutic result. MINO infusion therapy for benign hepatic cyst is very useful and the modified procedure can be performed safely in elderly patients and in patients with several complications.
The incidence of cerebrovascular event during a period of 3 years in the geriatric society in Japan was examined along with the alternating pattern of cerebrovascular accidents in relation to aging and seasonal factors. The population of Tsuwano town was approximately 7000. The percentage of aged people over 65-year-old reached 23.1% in the 1990 national census. All cerebrovascular accident patients in our hospital and two outpatients clinic in this city were registered during the period from April, 1990 to March, 1993. The number of patients in the period was 95 cases, of which 19 were classified as transient ischemic attack (TIA), 30 as cerebral thrombosis, 16 as cerebral embolism, 10 as cerebral hemorrhage, 7 as subarachnoid hemorrhage, and 13 as unclassified cerebral infarction. The frequency of each type except TIA was 39.5 cerebral thrombosis, 21.1% cerebral embolism, 13.2% cerebral hemorrhage, and 9.2% subarachnoid hemorrhage. In all cases, hypertension was observed in 62.1%. and past history of cerebrovascular accident was observed in 29.5%. The cerebral embolism group was older than the other groups and one-half of this group had atrial fibrillation. Peak incidence differed by type of illness, TIA and cerebral embolism occurred uniformly throughout the year, but subarachnoid hemorrhage and cerebral thrombosis in the spring. The relationship of cerebrovascular accident to crisis, especially potentiation by cerebral thrombosis was evaluated in light of climatic factors.
A 81-year-old man who had been healthy without any history of abnormal bleeding, developed ecchymosis and hematuria in November, 1992 and was hospitalized in December, 1992. On admission, he developed widespread ecchymosis in his trunk and extremities, and subsequently ecchymosis of his cheek and neck, and also oral and pharyngeal hematoma. The laboratory data were as follows: whole blood clotting time, >20 minutes; activated partial thromboplastin time (APTT), 108.6 seconds; Factor VIII activity, 4%. The level of Factor VIII inhibitor was high, 65.0 Bethesda Unit/ml. This inhibitor was a IgG type immunoglobulin, which had both κ and λ light chain. His serological and blood biochemical data of the blood were normal, and tests for autoantibodies were negative. The patient was treated with plasma exchange therapy, Prednisolone (PSL), Cyclophosphamide and Factor VIII concentrate. The hemorrhagic symptoms were improved, the inhibitor dispappeared and the activity of Factor VIII returned to normal after one month. Follow-up was continued in the outpatient clinic for 5 months. After the dose of PSL was decreased, he developed bloodysputum and hematuria, and was readmitted in August, 1994. Factor VIII activity was 21% and the titer of Factor VIII inhibitor was 3.0BU/ml. The hemorrhagic symptoms disappeared soon after increasing the dose of PSL, and the Factor VIII activity was normalized and the inhibitor could not be detected. These treatments appeared to offer effective control on severe hemorrhage in a patient with Factor VIII inhibitor.