There are a few reports that associate several loci of the human luekocyte antigen (HLA) with longevity, such as DR1 which is significantly frequent in the very old, especially in Okinawa centenarians. In cntrast DR9 is decreased. This report investigates 87 healthy Okinawan centenarians and 148 healthy Okinawan controls examined since 1987 with HLA phenotyping and family history questionnaires. The mean age in centenarians was 101.6 years, and that of controls was 66.4. We inquired the age and the cause of death of the parents of the subjects. Subjects whose parent's deaths were by suicide, homicide, accident, war or due to war trauma, were excluded and only those resulting from illness or natural causes were included. The relation between age of death of parents and DR types were studied. Compared to controls, DR1 was significantly increased in the centenarians (p=0.036, RR 4.239), and DR8 was decreased (p=0.012, RR=0.412). When the mean age of death of parents for each DR group and that of total was determined, the mean death age of those with DR9 was significantly lower than the mean of the total (p<0.05). More over, when the frequency rate of the DR types were compared with the parents' death age, that of DR9 decreased as the age of death increased. It is suggested that some loci of HLA-DR relate to longevity and some genetic protection against immunerelated diseases contributes to long-lived lineage.
A 71-year-old female presented with a 10-year history of slowly progressive gait disturbance and dorsolumbar pain. Motion of he neck and trunk was severely restricted. She showed decreased sensation of vibration and position in the upper and lower limbs and had Romberg's sign. Hyperesthesia of touch sensation was distributed in a stocking pattern. She showed hyporeflexia and pathological reflexes in lower limbs. Her gait was ataxic and spastic. Laboratory examination of blood and urine revealed no remarkable findings. Radiographic examination revealed ligamentous calcification and ossification along the anterolateral aspect of the vertebral column at several levels, and there was ossification of hte ligament and tendon attachment to the bone at extraspinal sites. The radiographic features were characteristic of diffuse idiopathic skeletal hyperostosis (DISH). Computed tomograpy at lower thoracic and lumbar vertebral portions showed compression of the spinal cord by ossification of the flavatum ligament. The conduction velocity of tibial nerves and sural nerves were delayed, and the mechanism of the occurrence of peripheral nerve lesions in this patient could be explained by extrinsic compression by heterotopic calcification or some metabolic factor due to DISH.
We report a rare case of Basedow's disease associated with high output heart failure and angina pectoris over the age of 80 years. An 85-year-old woman was admitted with palpitation, finger tremor, hyperidrosis and weight loss. Basedow's disease was diagnosed by physical (diffuse goiter) and laboratory (free T3 19.4pg/ml, free T4>8.0ng/dl, TSH<0.1μU/ml, TRAb positive, 123I uptake high) findings and was treated with methimazole. Chest oppression and dyspnea on exertion with negative T wave, cardiomegaly and pulmonary congestion appeared after methimazole. Cardiac catheterization showed a high cardiac output (CI 5.01/min/m2, PCW 26mmHg, PA 57/26mmHg, RA 15mmHg) and a significant coronary stenosis (LAD (9) 99%). High output heart failure and angina pectoris responded to treatment. They subsequently worsened, because she stopped taking methimazole for a month and serum levels of thyroid hormones increased again. After retreatment with methimazole, serum levels of thyroid hormones decreased to within normal limits, and high output heart failure and angina pectoris also improved.
A 77-year-old woman with hypertension was admitted to our hospital because of exertional dyspnea end peripheral edema. Chest X-ray showed cardiomegaly, pulmonary congestion and right pleural effusion. Hypertensive heart failure was diagnosed and treated, and right pleural effusion disappeared in 2 weeks. Abnormalities on laboratory data, i.e. anemia and increased ESR et al. continued after the improvement of heart failure. Serum IgG was elevated (2570mg/dl), while IgA and IgM were decreased. Immunoelectrophoresis indicated the presence of monoclonal IgG-λ in the serum. Bone marrow puncture revealed an increase in atypical plasma cells (38.4%). Multiple myeloma was diagnosed from these findings and treated with melphalan and prednisolone. But increases in atypical plasma cells (43.2%) and serum IgG (2573mg/dl) continued. During treatment, right pleural effusion increased again. Thoracocentesis showed bloody effusion with numerous atypical plasma cells, and the presence of monoclonal IgG-λ was indicated by immunoelectrophoresis. The patient died of renal and heart failure 2 months after the onset of malignant pleural effusion. Cytological examination and immunoelectrophoresis are necessary for pleural effusion in multiple myeloma.
Gerontology is a new field including various disciplines such as medicine, engineering science, social science etc, and is sometimes called as “longevity science”. Because of the wide area of the field, it is important to show the scope of the science and the development of its thesaurus contributes to this end. We developed a relevant thesaurus based on the research funded by Longevity Science Promotion Organization, and using the thesaurus, we also developed a database and retrieval system of the gerontology research. This system can be accessed on the Internet.