Background: Calcified aortic valve disease is increasing with explosively in the elderly. Elevated serum lipoprotein (a) (Lp(a)) plays an important role in the pathogenesis of atherosclerosis. Thus, we investigated the relationship between aortic valve sclerosis and serum Lp (a) levels in elderly patients. Methods: Echocardiography was performed in 97 subjects (77±7years, 48 males and 49 females), Lp(a), fasting plasma glucose, and blood pressure were measured at the time of the study. Aortic valve sclerosis was assessed using echocardiography. Results: Aortic valve sclerosis was observed in 63 patients (sclerosis group; 24 males and 39 females) and not in 34 subjects (non-sclerosis group; 24 males and 10 females). Univariable analysis revealed that age, Lp (a) level, and the number of females were higher in the sclerosis group than in the non-sclerosis group (age; 78±7 vs 74±7years, p=0.0090, Lp(a); 34±29vs 20±12mg/dl, p=0.0095, female; 39vs10, p=0.0041). Blood pressure, total cholesterol, HDL-cholesterol, LDL-cholesterol, triglyceride, and fasting blood glucose did not seem to affect aortic valve sclerosis. In all of 9 patients with serum Lp(a)greater than60mg/dl aortic valve sclerosis was present In discriminative analysis, gender (female) (λ=0.9038, p=0.0020) and Lp(a) (λ=0.8316, p=0.0053) were related to aortic valve sclerosis. Conclusion: Elevated serum Lp (a) was observed in elderly patients with aortic valve sclerosis.
138 patients with Wolf-Parkinson-White (WPW) syndrome (n=96), atrioventricular nodal reentrant tachycardia (AVNRT: n=27) and the other supraventricular tachycardia (n=15), were divided into two groups, a control group (less than 65 years old; n=108) and an elderly group (more than 66 years old; n=30). We then estimated the success rate and safety of radiofrequency ablation for supraventricular tachycardia in elderly patients. For WPW syndrome, there were 76 (97%) successes and 9 (13%) recurrences in the control group (n=78). In the elderly group of WPW patients, the number of successes was 18 (100%) and the number of recurrences one (63%). In 27 patients with AVNRT, the number of successes was 26 (96%) and there were no recurrences. In 15 patients with some other supraventricular tachycardia, there were 11 patients (73%) successes and one recurrence (11%). Major complications consisted of cardiac tamponade in 2 patients, dissecting aneurysm in one patient and cerebral embolism in one patients. All major complications occurred in patients with WPW nyndrome. The cause of the complications, except the cerebral embolism was manipulation of the electrical or ablation catheter. Three of four patients with major complications belonged to the control group. It is possible that radiofrequency catheter ablation for supraventricular tachycardia in elderly patients is safe and highly effective. However, it is still invasive therapy. Ablation of a left accessory pathway by the transaortic valve approach especially needs meticulous care.
The Short Form 36 Health Survey (SF-36) is a questionnaire that is widelyused to measure health-related quality of life. Because selfadministered questionnaires may not be appropriate for seriously ill or elderly people, we administered the SF-36 to institutionalized elderly people by face-to-face interviews, and tested its reliability and validity. We also compared the SF 36 scores of those subjects with the scores of community-dwelling elderly people. We studied 117 people aged 65 or over who were living in residential facilities on Sado island and 62 randomly sampled elderly people who were living in the community. The SF-36 scores of the institutionalized subjects had acceptable ceiling and floor effects, and their internal consistency, concurrent validity, and construct validity were high. The only exceptions were the scores on the “vitality” subscale. Adjusted mean scores on four subscales were higher among the institutionalized subjects than among those living in the community: role limitation due to physical condition, role limitation due to emotional condition, social functioning, and bodily pain. The two groups did not differ with regard to scores on the “mental health” scale, the “vitality” scale, or the “general health perception” scale. We conclude that the SF-36 can be useful for measuring health-related quality of life among institutionalized elderly people, if it is administered in face-to-face interviews.
The N400 of event-related potentials (ERPs) was recorded in 17 healthy young subjects (mean age 24.4years), 14 healthy old subjects (healthy control subjects, mean age 62.7years), and 21 patients with nondemented Parkinson's disease (PD, mean age, 63.8years) as they listened to words or nonwords. Some words were repeated immediately after the initial presentation (2sec), while others were repeated after 5 intervening words (12sec) or after 2 to 4 minutes. The subjects were required to respond to occasional nonwords. Rey's auditory verbal learning test (AVLT) was also performed. The mean N400 amplitude was smaller in patients with PD than in either healthy group, but there was no difference between the two healthy groups. In the young subjects, N400 was attenuated for repeated words, and the attenuation was more pronounced for immediate than for delayed repetitions. N400 attenuation in the old subjects was more markedly reduced as the interval between the 1st and 2nd presentation increased than in the young subjects. In PD patients, attenuation was noted only for immediate repetition. Free recall by the old subjects was impaired relative to the young subjects throughout the AVLT trials, and was even more impaired in patients with PD. In addition, the number of free recalls increased less with the number of trials in patients with PD than in the old subjects. These results may indicate that episodic memory declines with advancing age, and declines even more in patients with PD. In addition, the ability to transform information from short-term memory to long-term memory appear to be impaired in patients with PD.
We report two cases of Churg-Strauss syndrome with impaired prognosis. Case 1: A 58-year-old woman started to complain of progressive dysesthesia and muscle weakness of the lower extremities on February 6, 1992 and was admitted to our hospital eight days later. The eosinophil count was 1, 170/μl and chest X-ray on admission revealed bilateral diffuse interstitial shadows. Necrosis of muscle fibers and significant infiltration of eosinophils into vessel walls were histopathologically demonstrated. Case 2: A 69-year-old woman was admitted to our hospital with productive cough and back pain. An expiratory wheeze was audible in all lung fields and bronchial asthma was diagnosed. Laboratory findings showed eosinophilia (8, 550/μl), an IgE level of 16, 266IU/ml and no positive data for allergic bronchopulmonary aspergillosis. A biopsy of subcutaneous nodules in the lower extremity revealed significant edema of vessel walls and infiltration of eosinophils and lymphocytes. Churg-Strauss syndrome was diagnosed in both cases, and corticosteroid therapy was successful in alleviating eosinophilia. However, symptoms of vasculitis in case 1, including mononeuritis multiplex, did not improve, and cardiomyopathy in case 2 progressively worsened. Particulary in elderly patients, it is very important to make an early diagnosis and to initiate therapy that does not disturb quality of life, even for diseases generally regarded as having a good or fair prognosis.
A 73-year-old women was admitted to the geriatric ward of the University of Tokyo Hospital with anemia, osteepeina, and renal dysfunction. Although symptoms typical of multiple myeloma such as punched-out lesions and hyperproteinemia were not found, protein electrophoresis revealed that λtype Bence-Jones protein was excreted in urine. Multiple myeloma was diagnosed. Furthermore, renal dysfunction was accompanied renal tubular acidosis type II (proximal type). Renal dysfunction in patient with multiple myeloma in usually caused by so-called myeloma casts in the distal tubules, but renal tubular acidosis type II is rarely observed. It is possible that injury of the proximal renal tubular eithelium by Bence-Jones protein resulted in renal tubular acidosis type II in this patient.