We analyzed a total of 468 cases, all inmates of the Yokufukai Home for the Aged who had undergone a 50-gram oral glucose tolerance test (OGTT) from January 1980 to December 1981 and who were followed up to the end of March 1994. All cases were divided into different normal, borderline and diabetic categories according to glucose tolerance. 1) Normal cases accounted for 39.6% of males and 39.2% of females, 50% and 52.5% were borderline cases in males and female and these were 10.4% and 8.3% diabetic cases, respectively. 2) The overall survival rate of females was significantly higher than that of males groups (p<0.05). 3) There was no significant difference in survival rate of males and females in the normal and impaired glucose tolerance groups (border and diabetic). Conclusion. Mildly impaired glucose tolerance could be considered as part of the normal aging process.
In Japan, elderly patients who develop myasthenia gravis (MG) are increasing in number. However, there are few clinical reports concerning this issue. We evaluated the clinical manifestations, inducing or exacerbating factors, complications, treatments and prognosis of systemic MG in 11 patients older than 60 years of age. Bulbar symptoms were more frequent in these patients compared with younger MG patients, and 6 out of 11 cases (54.5%) were mistakenly diagnosed as cerebrovascular disorders. Among inducing or exacerbating factors of MG were psychological problems inherently involved with the aged, physical factors, and inappropriate termination or rejection of medication. Increase in the level of anti-Ach-R antibodies was recognized in 10 out of 11 cases (90.9%). A high percentage of the patients had thymoma (36.4%) and thyroid diseases (45.5%): 3 with Hashimoto's thyroiditis (27.3%), 1 with thyroid ophthalmopathy associated with hyperthyroidism, and 1 with simple goiter. Others were accompanied by ischemic heart disease, prostatic hypertrophy or stomach cancer. We treated these patients with corticosteroids, immunoglobulin, radiation for thymoma, or thymectomy in addition to administration of anticholinesterase agents. Prognostically, we found that duration of illness before death was shorter in those with onset later than 70 years of age. Seven out of 11 (63.6%) patients died of either aspiration pneumonia (4 cases), complications of thymectomy, congestive pulmonary edema or stomach cancer. There were no deaths associated with myasthenic crisis.
To investigate the relationship between atherosclerosis in the cerebral and coronary arteries, we examined the prevalence of asymptomatic atheromatous cerebrovascular lesions in patients with acute myocardial infarction (AMI). The subjects consisted of 33 consecutive AMI patients with angiographically proven coronary artery stenosis/occlusion (s) who had no history of ischemic strokes, and 33age/sex matched controls without a history of coronary heart diseases or/and cerebrovascular diseases. Asymptomatic cerebrovascular lesions were evaluated by magnetic resonance angiography (MRA) with a 3-dimensional time-of-flight method within 2 months after the AMI onset. The evaluated arteries on MRA included the carotid bifurcation and the intracranial arteries (intracranial portion of the internal carotid artery, horizontal portion of the middle cerebral artery, and the basilar artery). Asymptomatic cerebrovascular stenotic lesions (more than 25% stenosis) on MRA were found in 8 AMI patients (24.2%) at the carotid artery bifurcation and 5 (15.2%) in the intracranial arteries, compared to 1 (3.0%) and 3 (9.1%) respectively in control subjects. The lesions in the carotid bifurcation were significantly frequent in the AMI patients (p<0.05), while those in the intracranial arteries did not differ between the two groups. The AMI patients with the intracranial artery lesions were significantly older than those without such lesions (p<0.05). The data obtained indicates that the coexistence of asymptomatic atheromatous cerebrovascular diseases, especially the lesions in the carotid bifurcation, should be considered in treating patients with AMI. The older AMI patients, who may have not only extracranial lesions but also intracranial lesions, should be treated more carefully.
A 79-year-old bedridden female in whom bilateral small renal calculi were pointed nine months previously, presented with a high fever and non-specific abdominal symptoms. A diagnosis of bilateral renal and ureteral stones causing hydronephroureters with severe infection was made. She was referred to the urology department and treated with extracorporeal shock wave lithotripsy (ESWL). Persistent urinary tract infection caused by urease-producing bacteria, often seen in the bedridden elderly contributes to form infection-induced renal calculi. Such calculi are sometimes found in bilateral kidneys, can grow rapidly, and can often form with few, if any, symptoms. ESWL has been established as noninvasive treatment of choice for the great majority of upper urinary tract stones. All types of stones, including renal staghorn calculi, can be treated by ESWL with endourological support. Recurrence of stones after treatment is expected in approximately 40% of cases. In order to prevent recurrence, the stone should be removed totally and the patients must be observed carefully to keep the urinary tract totally free of infection.