In order to evaluate the reliability and validity of a self-completed questionnaire (QUIK), devised to measured QOL, we examined the QUIK scores of elderly who visited the Kumamoto Health Administrative Center for a medical check-up in March 1994. The QUIK questionnaire, which is a close-ended and disease non-specific questionnaire, covered four domains such as physical functioning, emotional adjustment, interpersonal relationships, and attitudes toward life, interacting reciprocally. The mean and standard deviation on QUIK were much better in terms of total score (5.1±5.4), for each domain score in comparison with the patient group, and even in comparison with the non-patient group. The distribution of total scores on QUIK were as follows: excellent 15%, good 35%, fair 36%, poor 11%, very poor 2% and grossly impaired 0% according to a six-tiered rating scale. The internal consistency in terms of total score was α=0.86. Very close correlation were seen among score, each domain score and satisfaction, being healthy and present state of feeling. If the cut-off points of total score were set between 9 and 10, the sensitivity were 0.65, specificity was 0.65 for the age index, sensitivity 1.00, validity 0.29 for the satisfaction index, while, sensitivity was 0.85 and validity 0.48, for the feeling index. There was a very close reciprocal correlation among the four domains, except for the relation between physical functioning and interpersonsal relationship using multiple regression analysis. Further, significant correlations were obtained between the score in each domain and the score based on subtracting each domain score from the total score.
We performed a clinical evaluation in 41 patients with urosepsis at Tokyo Metropolitan Geriatric Hospital from July 1992 through March 1993. The most common organism isolated from the patients was Escherichia coli (46.3%), followed by Pseudomonas aeruginosa (9.8%), Methicillin-resistant staphylococcus aureus (7.3%), and mycetes (7.3%). The most frequent underlying disease was cerebrovascular disease (34.1%) and malignancies were observed 29.2% of all cases. Twenty-six patients (63.4%) had indwelling urethral catheters. Indwelling catheters were suspected to be related to the onset of urosepsis in 16 cases. Total mortality of urosepsis was 4.9% (2/41) in this study. We speculate that the main cause of urosepsis is a long-term use of urethral catheterization, especially in elderly patients with severe complications who are vulnerable to infections. It is important to assess and correct the conditions of dysuria of individual patients before placing indwelling urethral catheters.
Geriatric Intermediate Care Facilities (GICF) have been established to help the hospitalized elderly return home. Users of the GICF are elderly persons who do not need hospitalization, but are mentally or physically impaired. To determine what factors influence users' destinations upon discharge from GICF, we analyzed various characteristics such as age, sex, place of residence before admission, length of stay, intellectual impairment, ability to perform activities of daily living (ADL) among users (N=389) in a GICF in Chiba City. Multiple logistic regression analyses revealed that, compared with the users who were hospitalized, users who were male, admitted for home, stayed for long periods, and had a high ability to perform ADL were more likely to return home. The analyses also revealed that, compared with the users who were institutionalized, users who came from home, stayed for short periods, and had a high ability to perform ADL were more likely to return home. Evaluating a user's physical, mental, and socioeconomical conditions at an early stage of admission to a GICF may allow us to predict whether the user can be successfully discharged to his or her home or will have to remain at the GICF for an extended period.
We ascertained 56 related cases with early onset familial Alzheimer's disease (EOFAD; mean age of onset <65 years) and 10 related cases with late onset familial Alzheimer's disease (LOFAD; mean age of onset ≥65 years) through a questionnaire administered to neuro-psychiatric and medical school hospitals in Japan and through a review of cases in Japanese literature. Mean age of onset and death (±S.D.) of EOFAD were 43.4±8.6 years (n=94) and 51.1±10.5 years (n=85), respectively. Distributions of the age-onset were relatively constant within a family but significantly different between families. Our result may suggest that clinical differences between families represent genetic heterogeneity at the molecular level. Six out of 32 related cases of with EOFAD showed the 717 Val→Ile mutation of β/A4 amyloid precursor protein (APP) gene. This result suggests that the frequency of this mutation in Japanese population is higher than in Caucasian and allelic the existenced heterogeniety, in Japanese EOFAD.
An 80-year-old woman was admitted to our hospital because of chest oppression and general malaise. On admission, auscultation of the heart revealed friction rub, so-called water-wheel like murmur. Chest X-ray film and computed tomography showed cardiomegaly and free air in the pericardium. Electrocardiogram showed low voltage with ST elevation in II, III, aVF and V1-V4. These findings suggested that the patient had pneumopericardium with pericarditis. Wenchebach type A-V block and atrial bradycardia appeared. Thus, the ventricular pacing was performed. However, patient died of multipe organ failure. The postmortempericardiography showed the gastro-pericardial fistula with hiatus hernia.
A 77-year-old man was diagnosed to have diabetes. He was hospitalized for appetite loss, weight loss (6kg/3 months) and right femoral pain. An abnormal shadow was noted on chest X-P. On admission, he was alert and there were no abnormal physical findings except limitation in the range of motion in the right lower extremity. His femoral pain was treated by a non-steroid anti-inframmatory drug (NSAID). Right femoral bone biopsy revealed angiosarcoma and staining for factor VIII, with negative staining for epithelial membrane antigen on enzyme assay. Therefore, he received systemic administration of recombinant interleukin-2 (rIL-2). rIL-2 was administered intravenously twice daily at a dose of 40×104JRU. The total dosage of rIL-2 amounted to 1200×104 JRU, but renal failure deteriorated and he died on the 50th hospital day of his second admission. Combination of rIL-2 and NSAID may cause progression of nephropathy.