In order to evaluate the quantitative and qualitative changes of elatin in different arteries, biochemical properties were measured; that is, elastin content, isodesmosine (ID) as cross-links content, free thiol content (free SH/total SH), hydrophobic properties and coexisting fibronectin (FN) content in elastin fraction from different arteries, correlation coefficients of these properties and these their effect with aging were also calculated. The results from different arteries in regard to changes in elastin can be summarized as follows: 1. The basilar artery in the quantitative changes of elatin. There was no correlation of these parameters in the basial artery from the other arteries. 2. The content of ID in the coronary artery was lower than that of the other arteries. The level of ID was negatively associated with aging, FN, elastin and free SH. On the other hand, the level of free SH was positively associated with aging, cholesterol and FN. 3. The contents of free SH, hydrohobicity and FN in elastin from the arch to the thoracic artery were lower than that of the other arteries. Hydrohobicity was negatively correlated with ID, and FN was positively correlated with cholesterol. 4. In the abdominal artery, FN content was higher than that of other arteries. There was a correlation between FN and free SH. However, free SH was inversely associated with elastin, ID and hydrohobicity.
The results of bacteria isolated from the urine of inactive elderly patients with urinary incontinence in 1982, 87, 93 and 95 were compared and the chronological changes of urinary bacteria were analyzed. The following results were obtained: (1) The most common bacteria isolated from the patients in 1995 were D-group Enterococcus, followed by Providencia rettgeri, E. coli, Pseudomonas aeruginosa and Proteus mirabilis. It is thought that the main cause of the more frequent isolation of Enterococcus is an abuse of cephems and fecal contamination. (2) The most common bacteriaisolated from the patients who were managed with an indwelling urethral catheter were Proteus and Providencia species, and their incidence tended to decrease from 1982 to 1995. (3) Infection with Pseudomonas species tended to increase, as did that Staphylococcus species, especially Methicillin-resistant Staphylococcus aureus and then decreased. Based on these findings, it is important to assess and treat dysuria before inserting an indwelling urethral catheter, and to selet an antibacterial agent that is effective in elderly patients with urinary incontinence and limited activity.
The relationship between carotid atherosclerosis and plasma endothelin-1 (ET-1) concentration was studied in senile patients with essential hypertension. A total of 212 patients (83M, 129F; mean age, 63 years) with essential hypertension (WHO stage I-II), and 109 age-matched control subjects (mean age, 61 years) were enrolled in the study. The maximum thicknesses of the intima-media complex (IMTmax) in the right common carotid artery (CCA) and the right internal carotid artery (ICA) was measured by B-mode ultrasonography, and ET-1 was measured by enzyme immunoassay. ET-1 levels were significantly higher in the hypertensive patients than in the control subjects. In middle-aged patients (35-64 years old), IMTmax values of the ICA in patients with high ET-1 concentrations (ET-≥1.71pg/ml) were significantly higher than in patients with normal ET-1 concentrations (ET-1<1.71pg/ml). However, the IMTmax of the CCA did not show a similar correlation. In senile patients (65-83 years old), both the CCA and ICA IMTmax values were significantly higher in patients with high ET-1 concentrations than in those with normal ET-1 concentrations. These results indicate that high ET-1 levels in middle-aged patients with essential hypertension may play a role in the progression of ICA atherosclerosis. High ET-1 levels in senile patients with essential hypertension may cause progression of atherosclerosis in both the ICA and CCA.
A 71-year-old man who had ischemic heart disease with poor left ventricular function and ventricular tachycardia was admitted to hospital for evaluation. Cardiac catheterization was performed on August 19, 1996, and right coronary arteriography revealed total occlusion at segment 3. Left coronary arteriography revealed total occlusion at segment 6, and a lesion at segment 13 was 75% occluded. Partial collateral flow from the right ventricular branch to the left anterior descending artery was demonstrated, and the left ventricular ejection fraction was 24%. Recurrent ventricular tachycardia followed by pre-syncope occurred from August 23, 1996, and the patient underwent emergency coronary artery bypass surgery to the left anterior descending artery and circumflex artery using saphenous vein grafts. Ventricular tachycardia followed by pre-syncope occurred frequently after the bypass surgery, and antiarrhythmic agents (Vaughan Williams classification Ia and Ib groups) were ineffective. He received amiodarone (100mg/day after a loading dose of 200mg/day for 2 weeks) from September 6, 1996. His symptoms of arrhythmia decreased, and side effects have not been observed. Low-dose amiodarone was effective in this case of ischemic heart disease with left ventricular dysfunction and sustained ventricular tachycardia.
A 77-year-old woman with severe valvular heart disease and chronic renal failure was admitted to hospital for control of her heart condition and to improve her ability to perform activities of daily living. In the past 2 years, she had been admitted to hospital four times due to severe congestive heart failure, and she was bedridden because of muscle weakness. A multidisciplinary approach was taken. A cardiologist reassessed her medications and determined an exercise level in co-operation with a physical therapist. After 40 days of rehabilitation, the patient was able to walk 200m without the help of a cane. With an increase in the exercise level, her cardiothoracic ratio increased from 68 to 74%. The furosemid was then increased from 40 to 60mg per day and 20mg of denopamine was added, which resulted in a decrease of the cardiothoracic ratio to 66%. Dietary assessment revealed her usual salt intake was more than 10g per day, and the dietitian advised the patient that her daily salt intake should be lower than 7g and water intake less than 800ml per day. Consultations with social-service personnel made revealed problems in her family and living environment, and she was advised of available social services. For good compliance, the patient had her medication explained by a pharmacist. Assessment of activities of her daily living and intensive education about congestive heart failure were performed by the nurse in charge. After discharge, a nurse team visited her home every two weks and watched for signs of heart failure. This comprehensive intervention prevented an exacerbation of heart failure and readmission for nine months.