Nippon Ronen Igakkai Zasshi. Japanese Journal of Geriatrics
Print ISSN : 0300-9173
Volume 37 , Issue 4
Showing 1-16 articles out of 16 articles from the selected issue
  • Kanjiro Masuda
    2000 Volume 37 Issue 4 Pages 261-264
    Published: April 25, 2000
    Released: November 24, 2009
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  • Satoshi Inoue
    2000 Volume 37 Issue 4 Pages 265-270
    Published: April 25, 2000
    Released: November 24, 2009
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  • Toshio Hayashi, Hisanori Horiuchi
    2000 Volume 37 Issue 4 Pages 271
    Published: April 25, 2000
    Released: November 24, 2009
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  • Tamotsu Imai, Makoto Sakai
    2000 Volume 37 Issue 4 Pages 272-277
    Published: April 25, 2000
    Released: November 24, 2009
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  • Masaharu Ishihara, Hikaru Sato, Takuji Kawagoe, Yuji Shimatani, Satosh ...
    2000 Volume 37 Issue 4 Pages 278-282
    Published: April 25, 2000
    Released: November 24, 2009
    JOURNALS FREE ACCESS
    Although it has been well demonstrated that TIMI grade 3 flow is associated with improved survival after acute myocardial infarction in non-elderly patients, its implication in elderly patients has not been clarified. To assess this issue, 1, 115 patients with acute myocardial infarction who underwent coronary angiography within 24 hours after the onset of chest pain were studied: there were 131 elderly patients (age≥75 years) and 984 non-elderly patients (age<75 years). Follow-up was achieved for 1, 092 patients (98%). Elderly patients were associated with more female, Killip class≥2, 3 vessel disease and non-smokers. Although modality of reperfusion therapy was not different, final TIMI flow grade was less frequently obtained in elderly patients (53% vs 65%, p=0.005). Elderly patients were associated with higher in-hospital mortality (25 % vs 9%, p<0.001) and lower 10 years cardiac death free rate (p<0.001). Cox proportional hazards model showed that final TIMI flow grade 3 was an independent predictor of 10 years cardiac death free in elderly patients (odds ratio (OR)=0.39, 95% confidence interval (CI)=0.20-0.74, p=0.004) as well as non-elderly patients (OR=0.41, 95% CI=0.29-0.58, p<0.001). In conclusion, our data suggest that final TIMI grade 3 flow is an important determinant to improve short- and long-term survival after acute myocardial infarction in elderly patients as well as in non-elderly patients.
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  • Kazuya Kawai, Naohisa Hamashige, Shoichi Kubokawa, Shuichi Seki, Hirom ...
    2000 Volume 37 Issue 4 Pages 283-287
    Published: April 25, 2000
    Released: November 24, 2009
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    The efficacy of reperfusion treatment has been established in patients with acute myocardial infarction (AMI), however, its role is still controversial in the elderly patients. Data from Kochi Acute Myocardial Infarction Registry, consisting of 1, 248 cases, showed that, compared to younger patients, elderly patients had greater ratio of women, painless infarction, delayed presentation, worse Killip classes, lower reperfusion procedure and higher mortality. To clarify the early management of AMI in the elderly, we analyzed the clinical data of 1, 160 cases, according to age subgroup (317 advanced elderly, aged 75-84; 438 elderly, aged 65-74; 405 middle-aged, aged 45-64) and according to the period (term I, 1990-92; term II, 1993-95; term III, 1996-98).
    Results: 1) The advanced elderly received less reperfusion treatment (37% vs. 65%) and showed higher mortality (21% vs. 8%), compared to middle-aged patients. 2) In advanced elderly patients, mortality was reduced (term I, 27%; term II, 20%; term III, 19%), according to increasing application of reperfusion treatment (term I, 22%; term II, 45%; term III, 40 %). 3) Inoadvanced elderly patients with reperfusion treatment, thrombolysis resulted in a higher mortality (17% vs. 7%) compared to direct angioplasty, probably due to increased incidence of cardiac rupture and pump failure in this age group.
    Conclusions: Reperfusion treatment improves mortality of AMI even in elderly patients. To minimize complications, direct angioplasty may be better for elderly patients.
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  • Takeshi Tamura, Yoshihisa Nakagawa, Takeshi Kimura, Hideyuki Nosaka, M ...
    2000 Volume 37 Issue 4 Pages 288-291
    Published: April 25, 2000
    Released: November 24, 2009
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  • Masafumi Kuzuya
    2000 Volume 37 Issue 4 Pages 292-297
    Published: April 25, 2000
    Released: November 24, 2009
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  • Hiroaki Oguro, Kazunori Okada, Shuhei Yamaguchi, Shotai Kobayashi
    2000 Volume 37 Issue 4 Pages 298-303
    Published: April 25, 2000
    Released: November 24, 2009
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    Methods; To investigate the influence of silent ischemic brain lesions (silent brain infarction (SBI) and periventricular hyperintensity (PVH)) on cognitive function and brain atrophy, we studied MRI and cognitive tests in 27 healthy elderly people (above 65 years old) for 6 years.
    We examined Okabe's Scale for verbal intelligence, Koh's Block Design Test for performance intelligence and Zung's Self-rating Depression Scale (SDS).
    On MRI, lesions with high intensity on T2-weighted image and low intensity on T1-weighted image, and which were larger than 3mm were diagnosed as SBI. The PVH was classified into 5 grades (0-4), and we divided the subjects into the PVH 0-1 group and the PVH 2-4 group.
    We evaluated brain atrophy using the ventricular area index (VAI) (the ratio of ventricular area to intracranial area at the level of lateral ventricle) on MRI by NIH image 1.55 (Macintosh).
    Results; The SBI group and the PVH 2-4 group showed significant decline in Okabe's Score, and Koh's IQ, increase in SDS and VAI during six years.
    On the other hand, the non-SBI and the PVH0-1 group showed a decline only in Okabe's score, and an increase in VAI. The rate of change in VAI was significantly higher in the subjects with SBI than those without it.
    However, there was no significant difference in the VAI change rate between the PVH 2-4 group and the PVH 0-1 group.
    Conclusion; Silent ischemic brain lesions such as SBI and PVH may have significant influence on decline of cognitive functions and progression of brain atrophy even in healthy elderly people.
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  • Kiyoshi Wakugami, Hidefumi Suenaga, Aritomo Egashira, Toshihiro Taira, ...
    2000 Volume 37 Issue 4 Pages 304-308
    Published: April 25, 2000
    Released: November 24, 2009
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    Copper deficiency (normal serum copper level: 78-136μg/dl) has been reported in patients with long-term enteral nutrition, caused by a copper deficit in enteral nutrition. Occasionally, this leads to anemia and leukopenia. We used Hersheys' pure cocoa that is rich in copper (content 3.8mg/cocoa 100g) for copper deficiency. A total of 86 (40 men and 46 women, mean age 69 years) patients on enteral nutrition were studied. The primary diseases were cerebral vascular disease in 71 patients, neurological disease in 5 and others in 10. Those who showed serum copper levels of 20μg/dl or less (N=8) were given 30-45g of cocoa (copper content 1.14-1.71mg) per day for about 40 days. Among them, two patients could not continue because of vomiting and diarrhea and were excluded from this study. Mean serum copper levels increased from 8.7±6.2 to 99.0±25.4μg/dl (N=6). Those who showed serum copper levels 20-77mg/dl (N=31) were given 10g of cocoa (copper content 0.38mg) per day for about 40 days. When mean serum copper levels increased from 50.5±19.3 to 89.0±12.9μg/dl with cocoa administration, anemia and neutropenia caused by copper deficiency showed a tendency to improve. After completing the study period, cocoa was reduced to 5g (copper content 0.19mg) per day in 23 patients. The mean serum copper levels increased from 90.7±10.4 to 100.6±17.1μg/dl for about 100 days. Recently, the amount of daily copper requirement for adults has been reported to be 1.28-2.5mg per day. We showed that 10g of cocoa (0.6mg total copper: 0.38mg in cocoa and 0.22mg in other nutrients) is sufficient to treat copper deficiency, and 5g of cocoa (0.37mg total copper: 0.19mg in cocoa and 0.18mg in other nutrients) is enough to maintain the normal level of serum copper in patients with long-term enteral nutrition.
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  • Kouki Watanabe, Takashi Tsuruoka, Kazuya Kawai, Tsutomu Ishizu, Jun Su ...
    2000 Volume 37 Issue 4 Pages 309-316
    Published: April 25, 2000
    Released: November 24, 2009
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    There are many reports on the efficacy of Ca-antagonists for treatment of elderly essential hypertension. In particular, many studies have noted the beneficial effects of antihypertensive therapy on the quality of life (QOL). Nevertheless, there are no reports on antihypertensive therapy regarding the relationship between brain blood flow (BBF) and QOL. Therefore, we examined the efficacy of nitrendipine, a Ca-antagonist, on the brain blood flow and QOL, and its side effects in elderly essential hypertensive patients.
    The subjects were 17 (males: 4, females: 13) patients with untreated hypertension of WHO stage I or II, aged 70 years or older. The mean dose of nitrendipine was 9.4±0.4mg daily. Before and 6 months after treatment, we examined blood pressure (BP), heart rate (HR), echocardiography (left ventricular mass index [LVMI], % fractional shortening [% FS]), plasma noradrenaline (Nad), plasma renin activity (PRA), BBF using the IMP-ARG method with BBF scintigraphy, and QOL was examined with a questionnaire. Two patients were excluded from this study because 1 had no decrease in BP, and another was moved to a different hospital. BP significantly decreased from 178/93 to 137/77mmHg, but HR was not changed after treatment. BBF significantly increased from 37.0±4.9 to 41.0±4.9ml/dl/min, but% FS, Nad, and PRA did not significantly change. The degree of QOL was improved by 4.2±1.2 points and there was a significant positive correlation between the changes of BBF and of QOL (r=0.66, p=0.04). However, moderate pharmacotherapy for BP seems to be necessary because there were 2 patients whose BBF decreased accompanied by excessive drop in BP after treatment.
    In conclusion, it is possible to safely use nitrendipine for elderly essential hypertensive patients. Nitrendipine has beneficial effects on BBF, and it was suggested that the increase of BBF is one of the most important factors in improvement of QOL.
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  • Daisuke Ohta, Katsuaki Yoshida, Sueharu Tsutsui
    2000 Volume 37 Issue 4 Pages 317-321
    Published: April 25, 2000
    Released: November 24, 2009
    JOURNALS FREE ACCESS
    We investigated the aged demented inpatients who had repeated aspiration in our hospital during a period of 21 months from July 1997. Subjects are 60 patients aged from 65 to 94. We investigated the clinical background of the subjects, dividing them into the group with pneumonia and the group without pneumonia, and compared their type of dementia, grade of dementia, underlying diseases, laboratory data, diet, and outcome. We further compared the effect of mucoid diet for pneumonia. The most comon underlying diseases were hypertension, cerebrovascular disease, diseases of the digestive system, and malignant tumor.
    There was no statistically significant difference in the outcome of the two groups. Within the subjects, death due to pneumonia was statistically significantly less in patients who had a mucoid diet. These findings suggested that a mucoid diet is useful for the protection against death caused by aspiration pneumonia.
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  • Michiko Mori
    2000 Volume 37 Issue 4 Pages 322-333
    Published: April 25, 2000
    Released: November 24, 2009
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    To of improve the patient's quality of life while maintaining them in good conditions, it is important not to bring them to an irreversible conditions as a result of activities of daily living (ADL). To achieve this, establishment of the end point of ADL load is necessary.
    Questionnaires on judgement criteria for bed rest filled out by 218 doctors, who were cardiologists, neurologists, pulmonary specialists, gastroenterologists, nephralogists or hematologists, was surveyed.
    In the high risk disease patients I studied the worsening of the condition resulted in organ insufficiency, basd on which the appearance of end point was retrospectively established.
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  • Yoshinari Isaka, Hideki Etani, Satoshi Furukawa, Etsuko Nakanishi, You ...
    2000 Volume 37 Issue 4 Pages 334-339
    Published: April 25, 2000
    Released: November 24, 2009
    JOURNALS FREE ACCESS
    Little is known about the risk factors for progression of silent cerebral infarction (SCI). We evaluated the 5-year change in high signal intensity on T2-weighted MR images of the brain in 50 asymptomatic patients with SCI. SCI progression was evaluated by the sum of the high intensity score (HIS) and the number of new lesions found on reexamination.
    Progression of SCI was seen in 19 patients (38%) on the 5-year follow-up examination. The baseline HIS in the whole brain was 8.02±6.93 and the follow-up HIS was 8.7±7.16 (p<0.001). SCI progression was frequently seen in the corona radiata (p<0.02 or <0.05) or posterior periventricular white matter (p<0.05). Patients with poor control of hypertension (>160/95mmHg) have a higher prevalence of SCI progression (9/12 (75%) vs. 10/38 (26.3%); OR=8.4, p<0.005) than the patients with effective control of BP (≤160/95mmHg). The progression group showed a significantly higher baseline-HIS in the whole brain than the nonprogressing group (9.7±5.6 vs. 7±7.5; p<0.05). Neither age percentages of alcohol drinkers, male sex, current smokers, hypertensives, hyperuricemia, hypercholesterolemia, diabetes, obesity, left ventricular hypertrophy, ischemic heart disease, nor differences in the controls of diabetes and hypercholesterolemia during the study were different between the progressing and the nonprogressing groups.
    Our data showed that poor control of high blood pressure and the degree of T2 high intensity in the baseline were strong predictors of SCI progression.
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  • Tadao Takahashi, Yasunori Hino, Tokuji Hirashima, Kojiro Kuroiwa, Haji ...
    2000 Volume 37 Issue 4 Pages 340-343
    Published: April 25, 2000
    Released: November 24, 2009
    JOURNALS FREE ACCESS
    The risk factors of anastomotic leak in the elderly following operations for gastric cancer were evaluated by multiple logistic model analysis. Data were taken from 705 operations over a 14-year period. The mean age of patients was 75.8±7.6 years. The significant risk factors for anastomotic leak were amounts of intra-operative bleeding and male gender. No other factors were significant, including age, preoperative associated diseases, preoperative nutritional states and postoperative complications, some of which were, however, significant factors by univariate analyses. We conclude that we should make every endeavor to lower the amount of intra-operative bleeding in order to prevent postoperative anastomotic leaks in the elderly, especially in male patients.
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  • Sadao Takahashi, Koji Oida, Isamu Miyamori
    2000 Volume 37 Issue 4 Pages 344-348
    Published: April 25, 2000
    Released: November 24, 2009
    JOURNALS FREE ACCESS
    A 75-years-old woman with poorly controlled type 2 diabetes mellitus, who was being treated by insulin therapy (Penfil N) was given troglitazon (400mg/day)-insulin combination therapy. Insulin therapy was stopped after several hypoglycemic attacks. Her blood sugar level improved within three months even recieving only troglitazone. Her high serum insulin level (453μU/ml) was due to insulin antibody induced by insulin therapy. Cessation of troglitazone showed deterioration of glycemic control and gain of body weight. Examinations of insulin secretion and resistance indicated that the cessation of troglitazone induced insulin resistance. Resumption of troglitazone did not improve her blood glucose level again. Her serum insulin level had decreased due to discontinution of insulin therapy. Insulin resistance by insulin antibody might be one of the main reasons of her notable troglitazone reactivity. The relationship between troglitazone reactivity and insulin antibody should be elucidated in many cases in the future.
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