Since the number of centenarians is increasing rapidly in recent years, the establishment of normal ranges in red blood cell (RBC) parameters for healthy centenarians is necessary for diagnostic criteria of anemia. The subjects were 129 centenarians consisting of 27 men (17; healthy, 69; low ADL) and 102 women (33; healthy, 69; low ADL) after excluding centenarians with diseases affecting RBC parameters. The t test was used for statistical evaluation. The mean RBC count for healthy centenarian men was 403±54.7×104/μl; hemoglobin (Hb) level, 12.4±1.3g/dl; hematocrit (Hct), 38.2± 3.9%; MVC, 95.3±5.3fl; MCH, 31.4±2.2pg; and MCHC, 32.1±1.1%. Comparable results for healthy centenarian women were as follows: 375±43.9×104/μl, 11.6±1.2g/dl, 36.3±3.6%, 97.1±5.3fl, 31.0±2.3pg, and 32.0±1.3%, respectively. The mean Hb for healthy centenarian women was significantly lower than that for healthy centenarian men. The mean RBC, Hb and hematocrit values for low ADL-centenarian men were lower than the comparable values for healthy centenarian men. Conversely, the mean MCV value for low ADL-centenarian men was higher than that for healthy centenarian men. There was no difference in any RBC parameter between healthy centenarian women and low ADL-centenarian women. In addition, there was no difference in any RBC parameter between centenarian women living in their own homes and those living in old-aged homes. This study demonstrated the normal ranges of RBC parameters for healthy centenarians, and lower RBC, Hb, and Hct values for low ADL-centenarian men.
We compared the short and long term outcome between an elderly group (E; aged 70 year more, 17 cases) and a younger group (Y; less than 70 years, 95 cases). Reperfusion rates were similar in both groups (E; 70.6% vs Y; 67.3%). Reocclusion rates at predischarge CAG were similar in both groups (E; 70.6% vs Y; 67.3%). Reocclusion rates at predischarge CAG were similar in both groups (E; 7.2% vs Y; 6.8%). Hospital cardiac deaths in E were higher than Y (E; 5.9% vs Y; 4.2%). Intestinal bleeding in E was more frequent than in Y (E; 5.9% vs Y; 3.2%). We concluded that thrombolytic therapy for acute myocardial infarction in elderly patients was useful, however bleeding complication in elderly patients were higher than in younger patients.
To explore factors associated with longevity, we studied geographic distribution of centenarians in Japan, based on 1990 the population census. We calculated the proportion of centenarians from ratio of number of centenarian to that of population aged 65 years or older. Centenarians in Japan consisted of number 4, 152 persons. By prefecture, Tokyo had the most centenarians (383), followed by Okinawa (193) and Fukuoka (151) prefectures. Fukui had the least (24), followed by Akita (26) and Ishikawa (29) prefectures. The proportion of centenarians in Japan was 21.6 (per 100, 000 populations) in 1990. By prefecture, the highest proportion lived in Okinawa (133.8), whereas the fewest were found in Akita (8.9). The relationship between geographic distribution of centenarians and environmental factors and nutritional factors were analyzed. Correlation coefficients between proportion of centenarians and mean temperature, high quality of welfare work and of medical services, and having much leisure time were positively significant. As for nutritional factor, correlation coefficients between proportion of centenarians and protein (% of energy) was positively significant, while intake of total energy was negatively significant.
Utilization of percutaneous transluminal coronary angioploasty (PTCA) has dramatically expanded even in the management of elderly patients with coronary artery disease. However, restenosis after successful PTCA remains the major problem limiting the long-term efficacy of the procedure. Reported restenosis rates vary from 25 to 43%. In order to determine the relationship of restenosis to coronary risk factors in the elderly, we analyzed the data in 87 patients who had undergone PTCA and angiography before and 3 to 6 months after PTCA. Of these, 29 patients were 65 years of age or older (elderly group) and 58 were less than 65 years of age (younger group). Restenosis, defined as a luminal narrowing of greater than 50% at follow-up time, was found in 20 of the elderly group (69.0%), and in 26 (44.8%) of younger group (p<0.0001). Total cholesterol, LDL cholesterol, apolipoprotein B (apo B), and the ratio of apoB/apoA1 in the elderly group were significantly lower than those in the younger group. HDL cholesterol levels were lower than 40mg/dl in both groups (not significant). Each group was subdivided into two types; restenosis type and non-restenosis type. There were no significant differences in serum lipid, apolipoprotein, and lipoprotein(a) levels between the 2 subtypes in each group. The degree of coronary atherosclerosis calculated by Gensini's method, the number of damaged coronary vessels, diabetes mellitus, hypertension, and smoking did not appear to affect the rate of restenosis in either group. This study indicated that age is an important risk factor for coronary restenosis. Age should be considered in the indication of PTCA, even though the initial successful rate of PTCA is high in the elderly, and careful follow-up is necessary.
The purpose of this retrospective study was to elucidate 1) which subgroups are prone to have ischemic cerebrovascular disease (CVD) among patients with atrial fibrillation (Af), 2) vulnerable period of CVD after the diagnosis of chronic Af and 3) the clinical efficacy of antiplatelet therapy in chronic nonvalvular Af patients. During 9 years, a total of 479 patients included 124 cases with paroxysmal Af, 30 cases with paroxysmal Af initially which later changed to chronic Af and 325 cases with chronic Af were enrolled. Among these 355 cases with chronic Af, 57 cases had valvular heart disease (VHD). The results were as follows: 1) The high risk subgroups (incidence rate/100 person-years is more than 6) were chronic Af with VHD or hypertension. The low risk subgroups (less than 2) were paroxysmal Af under 60 years of age, chronic Af with mitral valve prolapse syndrome or with hyperthyroidism. 2) There was no vulnerable period for occurrence of CVD during 9 years' follow-up from the onset of Af. 3) No significant difference in the incidence of CVD was seen in the groups with antiplatelet therapy and without.
Atherosclerotic plaque with central depression (depressed lesion) was firstly proposed in our previous report as one of the morphological features of regressed lesions, which was characterized by the presence of isolated, well defined lesions with a centrally depressed area and smooth surface. They were obviously different from atherosclerotic plaques with ulceration (ulcerated plaques) in elderly autopsy cases. In this study, 30 ulcerated plaques obtained from specimens of the elderly aortas were histologically and immunohistochemically investigated to clarify the morphogenesis of the depressed lesion and its correlation to the ulcerated plaque. These depressed lesions were divided into 4 groups according to their derivation; (a) fused lesion of multiple fibrous plaques, (b) regressing lesion of plaques, (c) healed ulcerated plaques, and (d) mixed type of these lesions. Regeneration of endothelial cell was noted in the peripheral zone of ulcerated plaques, and collagen type IV was also increased in the stroma of these ulcerated plaques. These were healed ulcerated plaques. The ulcerated plaques with complete restoration of endothelial cells on the ulcerated surface may become atherosclerotic plaques with central depression. These lesions are one of the histological features of regression in advanced atherosclerosis.
Diffusion-weighted magnetic resonance imaging (DWI) was carried out on a patient with Binswanger's disease suffering from acute cerebral infarction. Though an acute infarcted lesion was demonstrated as a high signal area on the T2-weighted image, it was impossible to determine whether it was acute or chronic because of extensive deep white matter lesions (periventricular hyperintensity and white matter hyperintensity lesions). However, only the acute infarcted lesion was detected on DWI which showed it as a high signal area, suggesting reduced molecular diffusion of water. The apparent diffusion coefficient (ADC), a physiological parameter that characterizes the self-diffusion on water in tissue, was lower in the acute lesion and higher in the chronic lesion. DWI can differentiate acute from chronic infarcts, which is not possible by conventional CT and MRI.
A 76-year-old female was referred to our hospital for examination of milky pleural effusion. We diagnosed her illness as chylothorax because of the high concentration of triglyceride in the effusion. There was neither obstruction nor damage of the thoracic duct. Systemic evaluation disclosed an abdominal mass in the umbilical region. Fasting with intravenous hyperalimentation followed by pleurodesis with minocycline successfully eliminated the effusion. On the other hand, the abdominal mass was diagnosed as mesenteric panniculitis by open biopsy. Since she also had chylous ascites, the tumor could have obstructed the intestinal lymphatics. Chylothorax was probably caused by damage to collateral lymph circulation.