In 1994, Scinto et al. reported hypersensitivity in the pupil-dilation response to topical application of a cholinergic antagonist, tropicamide, in patients with Alzheimer-type dementia. Similar tests on Japanese subjects showed significant differences in pupil response between subjects with Alzheimer-type dementia (under age 70 years) and age-matched controls. The present study included 24 patients with early-onset Alzheimer-type dementia, 29 patients with late-onset Alzheimer-type dementia, 15 healthy controls (all spouse of patients with Alzheimer-type dementia), 9 patients with vascular dementia and 5 patients with Down's syndrome. After adapting to semi-darkness (10lux), a solution of tropicamide (Midrin-P, Santen Co, Ltd) was instilled into the right eye. Pupil diameters were measured every 5 to 10min, and the maximum pupil diameter for each eye was used in the data analysis. The solution was diluted until the tropicamide concentration reached 0.01%. Pupil diameters were measured, and differences between baseline and maximum pupil diamter were computed. Among 18 patients with early-onset Alzheimer-type dementia (mean age 63.9 years) the pupils dilated by 1.12± 0.52mm (mean±SD) as compared with 0.20±0.75mm in 7 age-matched controls (mean age 57.8 years); this difference was significant (T-test, p<0.05). Correlations between the degrees of pupillary dilation and the scores on the revised version of Hasegawa's Dementia Scale were not significant. These data suggest that in subjects under 70 years of age, the diagnostic methods described by Scinto et al. can be used to distinguish those with Alzheimer-type dementia from those without dementia, but those methods may not be effective in subjects over 70 years of age.
We used ultrasonography to evaluate atherosclerotic lesions in the common carotid arteries of 147 inpatients (82 men, 65 women; mean age, 72.2 years). We sought to determine the relation between these lesions and various risk factors for atherosclerosis, as well as the utility of ultrasonography in quantitative evaluation of atherosclerotic disease. A 7.5MHz transducer was used and atherosclerotic lesions were evaluated on the basis of the thickness of their intimal-medial complex, which we term wall thickness. The relations between these measurements and age, sex, blood pressure, smoking history, lipid metabolism, diabetes mellitus, and atherosclerotic disease were studied. Wall thickness of the common carotid arteries correlated with age (men: r=0.45; women: r=0.38), Brinkman Index (r=0.25), systolic blood pressure (r=0.44), diastolic pressure (r=0.18), and high-density lipoprotein cholesterol (HDL-C, r=-0.23). Multiple regression analysis with these risk factotrs as explantory variables showed that age, Brinkman Index, systolic blood pressure, HDL-C, and diabetes mellitus contributed significantly to increased wall thickness. Wall thickness was significantly greater in patients with atherosclerotic disease such as cerebral infarction and ischemic heart diseases. These findings indicate that appropriate treatment for multiple atherosclerotic risk factors may be necessarily in the elderly.
The diet in Japan has improved, but calcium intake has not increased for the past ten years, and it remains insufficient. To prevent osteoporosis, instruction in nutrition is directed at increasing calcium intake. We studied the effect of measuring bone mineral density on calcium intake in people receiving nutrition education. Intake of other nutrients was also measured. The subjects were 87 healthy women living in an agricultural region (Yamanashi Prefecture). They were members of a group formed to improve the diet of people in their area. For three days in October 1992 and in August 1994 food-weight records were obtained. A total of 76 of the 87 women chose to have their bone mineral density measured. The measurements before the first nutrition assessment in 1992. The intake of almost all nutrients tended to be greater in 1994 than in 1992. Calcium intake exceeded the minimum daily requirement (600mg). Calcium intake increased between 1992 and 1994 only in the subjects whose bone mineral density had been measured. Calcium intake decreased in the other subjects. Therefore, nutrition education programs aimed at preventing osteoporosis may be more effective if bone mineral density is measured. In addition, an appropriate balance of other nutrients can be maintained as the intake of calcium is increased.
We measured the platelet distribution width, the mean platelet volume, the volume percentage of platelets, and the platelet-to-large-cell ratio in 15 elderly patients with disseminated intravascular coagulation (DIC). Peripheral venous blood mixed with ehtylenediaminetetraacetic acid was analyzed with a Sysmex E-4000 analyzer. The underlying diseases were sepsis, pneumonia, pyelonephritis, and other inflammatory diseases. The mean duration of survival from the onset of DIC was 16.9±23.9 days. The distribution of red cell sizes before the onset of DIC did not differ significantly from that in patients without DIC, but fragmentation of erythrocytes on blood films was more common in the early stage of DIC (p<0.01). Before the onset of DIC, the two groups did not differ significantly in the frequency of giant platelets on blood smears. At the onset of DIC, the platelet distribution width, the mean platelet volume, and the platelet-to-large-cell ratio were significantly higher than in patients without DIC. The concentration of glutamicoxaloacetic transaminase and those of other serum enzymes did not change significantly, but the serum creatinine concentration and the blood urea nitrogen level increased as the platelet-to-large-cell ratio increased. No significant relation was evident between the levels of serum C-reactive protein andcreatinine, between the platelet-to-large-cell ratio and the mean volume of red blood cells, or between the platelet-to-large-cell ratio and the distribution of red cell sizes. These data suggest that studies of platelets are more useful in the diagnosis of DIC at early stages of impaired organ function than are other indicators of inflammation such as the level of C-reactive protein.
33 patients with acute cerebral stroke (21 men and 12 women, averaged age 69.9±11.2 years) were examined dor fluctuations in the level of serum Lp (a) 3, 7, 14, and 28 days after the onset of symptoms. The Lp (a) level was higher (p<0.05, p<0.001) on days 7 and 14 than on the day of onset. Higher values were associated with poorer outcomes and with larger abnormal densities on brain CT scans. In 33 of these patients, the apo (a) phenotype was determined. Diluted serum was electrophoresed with SDS-containing gel as a carrier, then transcribed on a nitrocellulose membrance, stained by Western blotting and then sensitizing-stained. The results were evaluated by the method of Utermann et al. Outcome was significantly poorer in patients with a double-band apo (a) phenotype than in those with a single-band (p<0.05). Those with a double-band had significantly higher mean value of Lp (a), except on the day of onset, than did those with a single-band. Patients with large degrees of electrophoresis had significantly higher values of Lp (a) than did those with small degrees. These Beta suggest that serial measurement of Lp (a) can be of some value in predicting the outcome in patients with cerebral stroke. Determination of apo (a) phenotype may also be useful in the prevention and prognosis of cerebral stroke, especially when it is caused by cerebral infarction.
A 74-year-old woman was admitted to the hospital because of constipation and marked abdominal distension. She had become to be bedridden after cerebral infarction 10 years previously, and was tabescent due to vomiting. A left hemicolectomy and colostomy were performed because conservative therapy seemed to be ineffective. The postoperative course was good and her nutritional status improved.
A 71-year-old woman complained of gingival bleeding and epistaxis, and was given a diagnosis of idiopathic thrombocytopenic purpura. She was successfully treated with orally administered prednisolone and azathioprine. She experienced a relapse when she was 77 years old, and immunosuppressive therapy was not effective. Platelet transfusion was performed. She died because of massive gastrointestinal bleeding. An infarct was found in the left anterior part of the myocardium at autopsy. Disseminated intravascular coagulation was not detected on pathological investigation. Abnormal platelet aggregation may be important in the pathogenesis of thrombotic disease in thrombocytopenia.