Nippon Ronen Igakkai Zasshi. Japanese Journal of Geriatrics
Print ISSN : 0300-9173
Volume 37 , Issue 8
Showing 1-15 articles out of 15 articles from the selected issue
  • Naoki Fujimoto
    2000 Volume 37 Issue 8 Pages 575-583
    Published: August 25, 2000
    Released: November 24, 2009
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  • Kou Imachi
    2000 Volume 37 Issue 8 Pages 584-590
    Published: August 25, 2000
    Released: November 24, 2009
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  • Masao Yoshizumi, Hiroshi Ikegami
    2000 Volume 37 Issue 8 Pages 591
    Published: August 25, 2000
    Released: November 24, 2009
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  • Noriaki Kume
    2000 Volume 37 Issue 8 Pages 592-595
    Published: August 25, 2000
    Released: November 24, 2009
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  • Shigeki Higashiyama
    2000 Volume 37 Issue 8 Pages 596-599
    Published: August 25, 2000
    Released: November 24, 2009
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  • Zenji Makita
    2000 Volume 37 Issue 8 Pages 600-602
    Published: August 25, 2000
    Released: November 24, 2009
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  • Hitoshi Takagi
    2000 Volume 37 Issue 8 Pages 603-606
    Published: August 25, 2000
    Released: November 24, 2009
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  • Yasufumi Sato
    2000 Volume 37 Issue 8 Pages 607-610
    Published: August 25, 2000
    Released: November 24, 2009
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  • Kazushi Shinozaki, Masato Inazu, Kiyotaka Yanagawa, Hiroshi Takeda, Te ...
    2000 Volume 37 Issue 8 Pages 611-612
    Published: August 25, 2000
    Released: November 24, 2009
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  • Toshiro Nakazawa, Masahiko Yano, Kanta Suzuki, Shinichi Takei, Isao Ko ...
    2000 Volume 37 Issue 8 Pages 613-618
    Published: August 25, 2000
    Released: November 24, 2009
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    From September 1995 through May 1999, percutaneous endoscopic gastrostomy (PEG) was performed in 47 elderly patients, aged 65 to 93 (average 78.9). Several treatments were additionally performed to prevent serious complications in these cases, and their usefulness and problems were investigated.
    Gastropexy was performed to prevent peritonitis in cases of self-removal of tubes in the acute stage. Intraoperative fluoroscopy was used prevent perforation of the intestines. However, re-insertion of the endoscopic, which was necessary with the push method, was omitted to reduce the burden on the patients. In patients with tube troubles in the chronic stage such as the buried bumper syndrome or self-removal, the existing fistula was preserved and the gastrostomy was reconstructed using a narrow polyvinyl chloride tube and a flexible guide wire to prevent peritonitis by erroneous insertion of the tube.
    In terms of results, gastropexy was useful to prevent peritonitis in one patient with early self-removal of the tube. Data to evaluate the usefulness of fluoroscopy in preventing perforation of the intestine were insufficient, so more patients need to be studied in the future. Even when confirmation of the location of the internal bumper by endoscopy was omitted, there was no case of poor traction of the bumper, so this procedure seems unnecessary. Review of tube troubles, in the chronic stage revealed no case of peritonitis caused by erroneous insertion of tubes or erroneous injection of nutrients with our reconstruction methods, and complete reconstruction of the gastrostomy with preservation of the existing fistula appeared to be possible. However those additional treatments require extension of the operation time and rise in cost with increased use of medical instruments, so the indications should be carefully considered.
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  • Shuuichi Fukaya, Toshihiko Iwamoto, Kyoko Kin, Masaru Takasaki
    2000 Volume 37 Issue 8 Pages 619-626
    Published: August 25, 2000
    Released: November 24, 2009
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    To clarify the factors influencing platelet function in elderly patients with chronic thrombotic disease, platelet aggregability was studied in 839 blood samples from 497 patients with a variety of diseases. Clinical stage (thrombotic disease), vascular risk factors, and data concerning any administration of antiplatelet drugs were assessed, as well as brain computerized tomographic and carotid ultrasonographic findings. Platelet aggregability was determined spectrophotometrically with an aggregometer (PAM-8T) and adenosine-5'-diphosphate as an agonist to determine new parameters: the grading curve (GC) type, and platelet aggregability threshold index (PATI). Multiple regression analysis showed that the antiplatelet therapy greatly influenced the GC type. Platelet aggregability, which accelerated with aging, was strongly suppressed by ticlopidine. Furthermore, excluding samples with antiplatelet therapy, statistical analysis showed that platelet aggregability was accelerated in women, and in patients with bilateral or complicated carotid lesions, although these patients were significantly older than the others. These findings suggested that accelerated aggregability in the elderly substantially reflected the progress of arteriosclerosis with age. Moreover, the findings indicated that the determination of GC type and PATI were useful in monitoring elderly patients recieving antiplatelet therapy, especially with ticlopidine.
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  • Hiroshi Fujimaki, Yutaka Kasuya, Shiro Koga, Shino Kagami, Tokuji Hira ...
    2000 Volume 37 Issue 8 Pages 627-632
    Published: August 25, 2000
    Released: November 24, 2009
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    A significant number of elderly patients who begin dialysis are not able to return home even after attaining stable dialysis. The aim of the present study is to clarify the factors preventing returning home.
    Patients aged over 60 years who had newly started dialysis (103 cases) were studied. These were 58 men and 45 women. The age was 73±7years (mean±standard deviation).In each patient, the cause of renal failure (non-diabetes/diabetes), nutritional state, complications, ambulation, cognitive function, urgency of the initiation into dialysis therapy, occurrence of access failure, presence or absence of the partner, presence or absence of members of the younger generation living in the same house, and the outcome (returning home or prolonged hospitalization) were surveyed.
    Of the 103 patients, 80 could return home, and 23 could not. First, we investigated the influence of the differences in each factor on the outcome. The subjects were divided into two groups by two categories in each factor. The numbers of patients who could not return home was calculated respectively.
    Comparisons were carried out by the χ2 test. Statistically significant factors were ambulation (p<0.0001), cognitive function (p<0.0001), and cause of renal failure (p:0.049).
    Multivariant logistic regression analysis was also performed using back-ground factors as explanatory variables and the outcome as a dependent variable. The factors presented by the nominal scale were converted to dummy variables.
    Statistically significant factors were ambulation (p<0.0001), cognitive function (p:0.001), and presence or absence of a partner (p:0.012).
    Inability to walk, impaired cognitive function, and absence of a partner were the factors preventing returning home.
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  • Yoshio Miyajima, Yukihiko Maehata, Hiroshi Matsuda, Ichiro Fukumoto, T ...
    2000 Volume 37 Issue 8 Pages 633-638
    Published: August 25, 2000
    Released: November 24, 2009
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    Our clinical experience indicates that decubitus ulcers with tissue loss/necrosis extending beyond the subcutaneous fat in aged patients are liable to become refractory and that most of these patients experience a cold feeling/cyanosis in the lower extremities. In order to determine the relationship between the severity of the decubitus ulcers and the hemodynamics in the lower extremities, we conducted a blood flow test using the ultrasonic Doppler method on the lower extremities in patients. Sixty-eight inpatients (38 men, 30 women, with an average age of 80.5±7.6 years old) were selected. B-mode tomographs were obtained with an ultrasonic diagnostic apparatus. The power Doppler method was used to measure blood flow rate, vascular lumen diameter, and intravascular blood flow at the dorsalis pedis artery, posterior tibial artery, peroneal artery furcation, and femoral artery. The subjects were divided into three groups: patients without decubitus ulcers; patients with mild to moderate decubitus ulcers of IAET Classification grade I-III; and patients with severe decubitus ulcers (IAET Classification grade IV), and the measurements were compared among the groups. The results revealed a tendency for the vascular lumen to become narrowed and intravascular blood flow to be reduced at all sites as decubitus ulcers increased in severity and showed the hemodynamics in the lower extremities to be particularly poor in the severe group. We measured the hemodynamics in the lower extremity with the ultrasonic Doppler method from the viewpoint of decubitus ulcer prevention and found differences in blood flow in the lower extremities according to the severity of decubitus ulcers. A reduction in blood flow in the lower extremities is considered to indirectly indicate a susceptibility to decubitus ulcers and to serve as a sign of its exacerbation. We consequently considered the test to be useful and concluded that deterioration of hemodynamics due to the progress of arteriosclerosis is one of the causes of decubitus ulcer exacerbation.
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  • Kazuhiro Kurihara, Yuriko Nakada, Chiko Kokawa, Kyoei Morozumi, Noriak ...
    2000 Volume 37 Issue 8 Pages 639-643
    Published: August 25, 2000
    Released: November 24, 2009
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    An 86-year old woman rapidly developed serious jaundice (T-Bil 18.3mg/dl, D-Bil 12.3mg/dl). Her jaundice was exacerbated by eating, and improved by fasting. Abdominal CT showed a giant diverticulum in the second part of the duodenum and dilation of the proximal common bile duct. Endoscopic findings confirmed juxtapapillary duodenal diverticulum in contact with the distal common bile duct. MRCP revealed extrinsic compression of the distal common bile duct by the diverticulum. Lemmel's syndrome was diagnosed. Jaundice did not recur after surgery. We speculated that in this case the diverticulum filled by duodenal contents easily compressed the distal common bile duct after eating.
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  • 2000 Volume 37 Issue 8 Pages 644-658
    Published: August 25, 2000
    Released: November 24, 2009
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