We performed screening for osteoporosis for the early detection of a decrease in the bone mineral density. The subjects consisted of 852 inhabitants (308 males and 544 females) aged 40 years or more in Nansei (population, 12, 107) in Mie Prefecture. Interviews, measurement of height and body weight, blood examination, and determination of the bone mineral density by the MD method were performed. In addition, a questionnaire on diet was carried out. The bone mineral density was decreaed in 76 subjects (8.9%), of whom females were the majority. Height and body weight were significantly lower in the group with decreased bone mineral density than in the group with normal bone mineral density. The serum calcium (Ca), alkaline phosphatase (ALP), and inorganic phosphorus (P) levels were similar in the two groups. Concerning the family profile, the percentage of subjects living alone was significantly higher (p<0.05) in the group with decreased bone mineral density (13.5%) than in the group with normal bone mineral density (3.6%). Screening for osteoporosis is still in the trial stage and involves various problems that require further studies. As subjects for screening, females before, during, and immediately after menopause are important.
A series of 46 autopsied adult cases of sudden and unexpected natural death were investigated. In this study, sudden and unexpected death was defined as any death occurring with 24 hours of onset of symptoms in a person with or without probable cause of death suggested by medical history. The cases included 31 males and 15 females aged 26 to 85 years (mean 66.6 years). Age distribution peaked in seventies. The lesions causing sudden and unexpected death according to the most frequent organ systems were, diseases of the heart (acute myocardial infarction with or without old infarct, 20; old myocardial infarction without acute infarction, 2; dilated cardiomyopathy, 2; sarcoidosis, 1; amyloidosis, 2; and valvular disease, 2), the aorta (ruptured aneurysm, 6; dissecting aneurysm, 2), the respiratory tract (pulmonary embolism, 7; pulmonary hypertension, 1), the alimentary tract (intestinal obstruction, 1), and other diseases (cause unknown, 1). The cardiovascular lesions were found in 78.2% of cases autopsied. The sudden and unexpected death caused by acute myocardial infarction was found in 47.8%, and acute myocardial infarction seemed to play a major role in cardiac sudden death in these series. The respiratory lesions were found in 17.4%. Four of seven cases with pulmonary embolism died in two weeks after surgical operation. The most common underlying disease was post-operative condition.
To examine the correlation between neuropsychological and cerebral blood flow changes in Alzheimer-type dementia (AD), we studied 17 patients with AD longitudinally (intervals ranging from 12 to 40 months). AD patients were divided into a slowly-progressive group (S, 10 patients) and a rapidly-progressive group (R, 7 patients) on the basis of progression rates of symptoms. The perfusion ratio (%) (PR), defined as the activity density in regions of interest normalized to the mean activity density in unaffected regions (cerebellum, primary visual and sensory-motor cortex), was used as a measure of relative regional crebral blood flow by SPECT. Hasegawa's dementia score (HDS) in both the first and last studies significantly correlated with PR of the temporoparietal lobe, but not PR of the frontal lobe. The PR of the frontal lobe in the first study was significantly decreased in R-group patients compared to S-group patients. However, there was no diference in PR of the temporoparietal lobe between the S and R groups. Though the change in PR (PR (last study-first study)/duration) in the frontal lobe was significantly less in R-group than in S-group patients, there was no difference in the change in PR in the temporoparietal lobe. These results suggest that the degree of intellectual impairment is related to the function of the temporoparietal lobe, that progression is related to function of the frontal lobe, and that frontal hypoperfusion on SPECT may predict relatively rapid intellectual deterioration.
To elucidate the influence of aging upon the improvement of symptoms and cardiac size associated with surgical repair of atrial septal defect, clinical symptoms, cardiothoracic ratio and hemodynamic variables in older patients (group A; age at operation ≥50 years old, n=11) were compared with those in younger patients (group B; age at operation <50 years old, n=8). There were no differences in hemodynamic variables, i.e., peak systolic pulmonary pressure, pulmonary to systolic flow ratio (Qp/Qs), pulmonary to systolic vascular resistance ratio (Rp/Rs) and left to right shunt ratio between the two groups. Symptomatic benefits occurred in all patients, although 3 patients in group A who had atrial fibrillation preoperatively still displayed symptoms such as exertional dyspnea. The postoperative (after 3 months) cardiothracic ratio improved in all patients except for 3 patients in group A who were operated at over 60 years of age. Although there was no significant difference in preoperative cardiothoracic ratio between the two groups, the postoperative cardiothoracic ratio in group B was significantly smaller than that in group A. These results indicate that operative closure of atrial septal defect is recommended for all patients aged 50 years old or older, but early improvement of symptoms and cardiomegaly in older patients is lower than that in younger patients.
One hundred and six elderly patients with chronic stroke who were admitted to Seiai Rehabilitation Hospital were studied regarding urinary incontinence. The average age of the subjects was 74±8 years old, ranging from 60 to 94 years. Seventy three of the 106 patients (69%) had urinary incontinence which was found in 72% of brain infarction, 61% of brain hemorrhage and 67% of subarachnoid hemorrhage. The prevalence of urinary incontinence in cases of brain stem, thalamic, and putaminal hemorrhage was 80%, 67% and 46%, while that in cases of cortical infarction and infarct of perforating arteries was 84% and 68%, respectively. The rate of urinary incontinence was significantly higher in those aged 75 years or over (p<0.05), those with poor activities of daily living (ADL, p<0.005), or with dementia (p<0.001). Dementia was a complicating factor more frequently in aged patients (p<0.05) and in those with poor ADL (p<0.001), although no correlation was seen between age and ADL (p=0.08). These results indicated the high prevalance of urinary incontinence in elderly inpatients with chronic stroke, which is significantly related to impairment of mental and physical activities.
The aim of this study was to clarify whether the control state of fasting blood surgar can influence the occurrence of diabetic microangiopathy and macroangiopathy even in elderly patients with diabetes mellitus. In Kochi Prefecture 18 internal physicians participated in evaluating clinical courses of 898 patients, consisting of 466 males and 432 females, for an average of 69 months. Elderly cases aged 65 years or more old (group 1) consisted of patients who were aged 71.8±5.2 years old (M±SD). The average age of 481 adult cases under 65 years of age (group II) was 54.4±8.4 years old. Between the good and poor control groups, there was no difference in terms of blood pressure, body mass index (BMI) and serum lipids. Arteriosclerotic diseases such as myocardial infarction, cerebral infarction and arteriosclerosis obliterans appeared about as frequently in both the good and the poor control groups, while microangiopathies such as retinopathy, nephropathy and neuropathy were significantly more frequent in the poor control group compared to the good control group. The same tendency concerning these complications was seen in group II. Concerning treatment, diet treatment without drug treatment was significantly more frequent in the good control group compared to the poor control group, while hypoglycemic agents and subcutaneous insulin injection were used more often in the poor control group, the more severe state of diabetes mellitus in the latter group. Concerning the main reasons for good control, successful diet treatment was cited most often, followed by regular intake of medications. On the other hand disturbed diet treatment was the most frequent reason for poor control, indicating the strategic importance of diet treatment. Arteriosclerotic diseases were found more often in group I than group II, while the frequency of microangiopathies was similar. Concerning sexes, male patients tended to suffer more often from arteriosclerotic diseases than female patients, but the frequency of microangiopathy was similar. From the above findings it was concluded that poor control of fasting blood sugar level was related to microangiopathies in both non-elderly adult and elderly patients.
We measured lumbar bone mineral density (L2-4 MBMD) in the postmenopausal elderly diabetic women and made comparisons with age-matched controls in terms of the age, body mass index (BMI) and %BMD of age-matched. In addition we evaluated the correlation between BMD and menarche age, menopause age, HbA1c, serum calcium, serum phosphate, serum alkalinephosphatase (S-Alp) and the ratio of urine calcium to urine creatinine (UCa/Cr). Moreover we divided non-insulin dependent diabetic patients (NIDDM) into two groups; the high BMD group and the low BMD group. Serum Alp and the ratio of UCa/Cr were compared in these two groups. The relationships between regimen of therapy and BMD were also analyzed in female NIDDM. There were no significant differences of BMD and background factors between controls and NIDDM. The ratio of UCa/Cr in the high BMD group were significantly less than that in low BMD group (p<0.05). BMD in NIDDM with retinopathy was lower, but not significantly, than that in NIDDM without retinopathy. The methods of therepy for NIDDM such as diet alone, an oral hypoglycemic agent and insulin did not influence BMD in elderly postmenopausal diabetics. These results indicated that BMD in elderly postmenopausal diabetics are dependent on UCa/Cr and retinopathy.
We report a case of sleep apnea syndrome (SAS) with nocturnal pulmonary hypertension (NPH) in a 71-year-old man suffering from dyspnea during sleep. Severe snoring at night and daytime sleepiness were noticed before admissiion by his wife. Nocturnal oxygen desaturation (NOD) was documented with a pulse oximeter and severe sleep apnea syndrome was diagnosed on the basis of results of respiratory inductive plethysmography, an apnea index (AI)>20, minimum SpO2 56%. NPH was diagnosed by Swan-Ganz catheter. The levels of NPH were severe. Elevation of systolic pulmonary arterial pressure (PAP) above 40mmHg was observed 137 episodes at night. Both NPH and NOD were improved by 1L/min of nasal oxygen therapy. A number of episodes of systolic PAP above 40mmHg with oxygen therapy was 55 episodes. Peak mean PAP was 36mmHg in room air vs 33mmHg in oxygen therapy. Minimum SpO2 with oxygen therapy was improved to 69%. Total time of SpO2<90% at night was 153 minutes in room air vs 37 minutes in oxygen therapy. In this case, NPH and NOD due to severe SAS were remarkably improved by oxygen therapy.