To determine the risk factors for sudden deaths in hospitalized patients, 209 patients (103 men and 106 women, age 76.7±12.6 years old, mean±S.D.) who died in 1996 were divided into two groups and their records were analyzed. One group, the sudden death group (SD), consisted of 16 patients who had stayed in the hospital for 2 weeks or more before the onset of symptoms that led to death within 24 hours. Those who died more than 24 hours after symptoms began were placed into the non-sudden death group (NSD). Fourteen patients who died within 2 weeks of admission were not analyzed in this study. Comparing the data of the two groups led to the following findings. First, the major causes of death in the SD group were exacerbation of chronic cardiac failure (5 cases), acute cardiac failure (2 cases), exacerbation of chronic respiratory failure (2 cases) and acute respiratory failure (2 cases). Second, patients in the SD group were significantly older than those in the NSD group, and had significantly more prescriptions for digitalis. Third, patients in the SD group had higher levels of hemoglobin and hematocrit, lower levels of BUN and a higher cardiothracic ratio. Fourth, patients in the SD group had a higher incidence of ST abnormalities and T wave abnormalities in their electrocardiograms. Brugada syndrome or long QT syndrome were not seen in either group. Taken together, these findings suggest that aged patients with cardiac failure and myocardial ischemia may be at higher risk of sudden death.
The present report describes the relationship between the glucose tolerance and hypertension surveyed in a ten-year longitudinal epidemiological study in two rural communities in Hokkaido, Japan. The 1972 subjects (928 men and 1044 women, aged 40-64, mean 51.1±7.0 years) were randomly selected in 1977 and 1978, underwent a 50-g oral glucose tolerance test (GTT) at the first year. The prevalences of borderline hypertension (BHT) and of hypertension (HT) were highest in those with diabetes mellitus (DM), followed by those with borderline diabetes (BDM) and those normal glucose tolerance (NGT). Systolic and diastolic blood pressure were significantly and positively correlated with plasma glucose levels during fasting (FPG), 60min, after GTT (60G), and 120min. after GTT (120G), and were ordered as follows: NGT<BDM<DM. The FPG, 60G and 120G plasma glucose levels were all significantly higher in BHT and HT than in NT. The prevalences of the progression to hypertension from non-hypertension over the ten-year follow-up period were ordered as follows: NGT<BDM<DM. Glucose levels in progression group were higher than those in non-progression group. Multiple logistic regression analysis indicated that age, glucose intolerance, systolic blood pressure, and obesity index were significant predictors of the progression to hypertension. These results indicate that impaired glucose tolerance may be associated with hypertension, and might play a role in the development of hypertension.
The prevalence of glucose intolerance was surveyed in 8, 063 people over 30 years old from the general population of Japan. The data used in the analysis were from the Fourth National Circulatory Disorders Basic Survey, which was conducted in 1990. Survey items included history of diabetes mellitus, body mass index (BMI) and daily life activity. Blood and urine were also examined, and the blood glucose levels, presence or absence of sugar in urine, and levels of glycohemoglobin (HbA1c) were determined. Glucose intolerance was identified from the blood glucose level, HbA1c level and history of diabetes mellitus. The frequency of glucose intolerance was 8.6% in all subjects (11.9% in men and 6.3% in women). The frequency was higher in older people: 1.7 times higher in men over 65 years old and 2.5 times higher in women over 65 years old. Among people over 40 years old, glucose intolerance was significantly more prevalent in men than in women. It was also significantly more prevalent in men living in big cities than in men living in rural areas. Among obese male subjects and men with a low level of activity in daily life, the frequency of glucose intolerance was higher than in normal male subjects. The level of activity in daily life tended to be lower for people living in big cities than for those in rural areas. The results suggest that the prevalence of glucose intolerance depends on the environment in which people live. The results also indicate that raising the level of activities in daily life might help prevent diabetes mellitus.
We evaluated the circadian variation and exercise stress response patterns of blood pressure (BP) in elderly patients with essential hypertension. Ambulatory BP monitoring for 48 hours every 30 minutes, and treadmill exercise test using a Bruce protocol at PM 3 to 5 were performed in 49 untreated patients with hypertension. Mean daytime (awake), and night-time (sleeping) systolic BP (SBP) and diastolic BP (DBP) values were analyzed by reviewing the patients' diaries, and the nocturnal reduction rate (NRR) of SBP and DBP were calculated according to the following formula. NRR (%)=[(daytime mean-nighttime mean)/daytime mean]×100. The patients were divided into two groups according to the presence (dipper, n=25) or absence (non-dipper, n=24) of a reduction in both SBP and DBP during the night by an average of more than 10% of the daytime BP. Mean values of SBP and DBP measured over 48 hours in the dipper and non-dipper groups were similar. Responses of SBP to dynamic exercise at 2 to 5 minutes in the non-dipper group were significantly smaller than those in the dipper group (p<0.05). Non-dipper patients with hypertension responded to dynamic exercise stress with smaller increases in SBP than did those in the dipper group. The differences in BP responses to exercise may affect the circadian blood pressure profile in dipper and non-dipper elderly patients with essential hypertension.
To evaluate factors that influence of atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) levels in elderly people, we measured those levels in 54 men and 148 women (84.4±0.5 years old), and looked for associations of ANP and BNP with clinical factors and echocardiographic variables [left ventricular mass index and atrial to-early peak transmitral velocity ratio (A/E)]. ANP and BNP levels were 1.6 and 6.5 times higher than average. Sex was not a significant factor. We also looked for a link between cardiac rhythms and levels of ANP and BNP. Patients with atrial fibrillation had significantly higher levels of ANP and BNP than did patients with sinus rhythm. ANP and BNP levels were abnormally high in patients with left ventricular hypertrophy (LVH). We could measured A/E in 161 of 202 subjects; 154 of 157 subjects with normal LV systolic function had A/E>1 which indicates abnormally low in LV diastolic function. Moreover, abnormally high LV diastolic stress might have been present, because 124 of 202 subjects had aortic regurgitation. We divided the patients into two groups; those 65 to 75 years old, and those over 75 years old. The older patients had significantly higher levels of ANP and BNP even without LVH and without a difference in renal function. Furthermore, the older patients had significantly higher levels of BNP even without LVH, with normal renal function, with sinus rhythm, with normal LV systolic function, and in NYHA ClassIorII. These data indicate that ANP and BNP levels in people with senility may be associated with the cardiac rhythm and with abnormally low renal function, myocardial hypertrophy, abnormally high cardiac volume, and abnormally low diastolic function.
A 71-year-old woman was admitted to our hospital because of severe hypertriglyceridemia. The patient had a 26-year history of non-insulin-dependent diabetes mellitus and hyperlipidemia (T-chol 300mg/dl, TG 300mg/dl). She was treated with sulfonylurea and clofibrate. Seven years before admission, she had undergone a radical mastectomy for cancer of the left breast. After the operation, she had received tamoxifen and fluorouracil. One month before admission, she had marked hypertriglyceridemia (triglyceride 2, 106mg/dl). After discontinuation of tamoxifen and fluorouracil, her serum triglyceride level decreased to 372mg/dl; when tamoxifen was given again, it increased to 581mg/dl, and her hepatic triglyceride lipase activity decreased from 0.228 to 0.164μmol FFA/ml/min. Apolipoprotein E phenotype was wild type E3/3. The concentration of sex-hormone-binding globulin increased from 110 to 130nmol/l. These changes associated with tamoxifen treatment were similar to those seen after administration of estrogen. Tamoxifen, an anti-estrogen, has been used as adjuvant therapy in cases of estrogen-receptor-positive breast cancer. Tamoxifen has some weak estrogenic activity. The tamoxifen-induced hypertriglyceridemia seen in this case was an effect of its estrogenic action.
We report two cases of intestinal perforation caused by accidental swallowing of Press-Through Packages (PTP). The first case occurred in a 90-year-old woman with moderate dementia. She was admitted to our hospital because of abdominal pain and intestinal obstruction. She showed symptoms and sign of peritonitis and underwent abdominal surgery. The postoperative diagnosis was diffuse peritonitis due to a perforated rectal ulcer caused by the sharp corners of an accidentally swallowed PTP. The second case occurred in an 82-year-old woman with recurrent symptoms and signs of intestinal obstruction. She underwent abdominal surgery and the operation revealed an ileal perforation due to penetration by the sharp edge of a PTP. Both patients were discharged in good condition. PTPs are rapidly becoming popular as packaging for tablets and capsules. However, reports of accidental swallowing of PTPs have recently been increasing. In most cases, the PTPs were found in the esophagus and removed endoscopically. Progression of accidentally swallowed PTPs to the intestines is rare. However, when this occurrs, the patient's condition becomes more serious. We propose that drugs should not be dispended in PTPs but rather handed to the patients, especially to elderly patients, or when impossible, the corners of PTPs should be rounded.