Nippon Ronen Igakkai Zasshi. Japanese Journal of Geriatrics
Print ISSN : 0300-9173
Volume 39 , Issue 1
Showing 1-23 articles out of 23 articles from the selected issue
  • Katsuya Inoue
    2002 Volume 39 Issue 1 Pages 1-7
    Published: January 25, 2002
    Released: November 24, 2009
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  • Tosifusa Toda
    2002 Volume 39 Issue 1 Pages 8-13
    Published: 2002
    Released: November 24, 2009
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  • Yuzo Okamoto
    2002 Volume 39 Issue 1 Pages 15-17
    Published: January 25, 2002
    Released: November 24, 2009
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  • Masahiro Sasaki, Junichi Yamaguchi
    2002 Volume 39 Issue 1 Pages 18-19
    Published: January 25, 2002
    Released: November 24, 2009
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  • Nobuyoshi Hirose, Masato Tani, Kenji Toba, Mitsuo Oni, Koichi Shin, Yo ...
    2002 Volume 39 Issue 1 Pages 20-21
    Published: January 25, 2002
    Released: November 24, 2009
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  • Kiyoto Okumiya, Kozo Matsubayashi, Yukari Morita, Masanori Nishinaga, ...
    2002 Volume 39 Issue 1 Pages 22-24
    Published: January 25, 2002
    Released: November 24, 2009
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  • Ayumi Kono
    2002 Volume 39 Issue 1 Pages 25-27
    Published: January 25, 2002
    Released: November 24, 2009
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  • Ryutaro Takahashi, Noboru Yamaguchi, Syuji Kawai, Yoshimori Minemawari ...
    2002 Volume 39 Issue 1 Pages 28-34
    Published: January 25, 2002
    Released: November 24, 2009
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  • Masayasu Inoue
    2002 Volume 39 Issue 1 Pages 36-38
    Published: January 25, 2002
    Released: November 24, 2009
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  • Keisuke Fukuo
    2002 Volume 39 Issue 1 Pages 39-41
    Published: January 25, 2002
    Released: November 24, 2009
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  • Yasufumi Sato
    2002 Volume 39 Issue 1 Pages 42-43
    Published: January 25, 2002
    Released: November 24, 2009
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  • Hideyuki Okano
    2002 Volume 39 Issue 1 Pages 44-47
    Published: January 25, 2002
    Released: November 24, 2009
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  • Yuji Hiraki
    2002 Volume 39 Issue 1 Pages 48-50
    Published: January 25, 2002
    Released: November 24, 2009
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  • Hideyuki Ichikawa, Shiro Hayashi
    2002 Volume 39 Issue 1 Pages 51-56
    Published: January 25, 2002
    Released: November 24, 2009
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    It has been commonly accepted that age itself is never an absolute contraindication for surgical treatment. Some many problems could be solved through surgical intervention, we studied perioperative status, postoperative morbidity and mortality, and short-and-long-term outcomes after abdominal surgery in a series of patients 90 year old or older, operated at a provincial General Hospital. Seven patients were treated using elective surgical procedures, while 6 had emergency surgery. The incidence of postoperative morbidity was fairly high after both elective and emergency operations. Major complications occurred in one patient who died on the 20th postoperative day, due to multiple organ failure. One case of hospital death occurred when a patient died on the 240th day after a gastrectomy. There was long-term survival of over five years occurred among the patients in the study who had reviewed elective operations for malignant lesions. No definite relation was revealed between the risk score and post-operative morbidity or mortality. No evident change in performance status was found even aged patient who underwent abdominal surgical procedures.
    These results indicate the need for more meticulous consideration, including more precise decisions regarding the indication for surgical intervention, and more intensive perioperative management, in order to secure more favorable therapeutic outcomes and quality of life for high-risk patients over 90 year of age.
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  • Hisashi Ohmori, Takuzo Hano, Shuhei Ito, Ichiro Nishio
    2002 Volume 39 Issue 1 Pages 57-61
    Published: January 25, 2002
    Released: November 24, 2009
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    In order to evaluate the characteristics of initial therapy for elderly hypertensive patients in Wakayama prefecture, a case-card survey was performed in February 1997. The investigation consisted of blood pressure when starting therapy, initial physical examination and laboratory tests, and the initial drug therapy, and s effects 3 months later. The initial physical examination and laboratory tests were the diagnostic procedures for determining the presence of target organ damage, they included electrocardiogram (ECG), chest X-rays, echocardiogram (UCG), funduscopy and urinalysis.
    Data of 7, 647 cases from 156 facilities were obtained. These cases were divided into 2 groups, a non-elderly group (under 65 years, 3, 396 cases) and an elderly group (65 years or over, 4, 012 cases).
    The blood pressure at the start of pharmacological treatment was 174.9±17.4/93.7±11.0mmHg (mean±SD) in the elderly group, and 170.6±17.8/98.6±11.2mmHg in the non-elderly group. Systolic blood pressure in the elderly group was higher than in that the non-elderly group and diastolic blood pressure was lower in the elderly group than that in the non-elderly group. Cases of ECG (98.3% vs 71.3%; the non-elderly group vs the elderly group), chest X-ray (86.5% vs 65.2%), UCG (27.1% vs 23.7%), urinary test (96.0% vs 69.3%), examination of ophthalmic fundi (27.0% vs 24.3%), were much lower in the elderly group than in the non-elderly group. The rate of positive findings of left ventricular hypertrophy by EGG criteria (24.8% vs 20.3%), cardiomegaly by chest X-p (35.3% vs 26.6%), proteinuria by urinary test (14.8% vs 12.9%) was lower in the elderly than non-elderly.
    Details of drug use in non-elderly vs elderly were as follows; calcium antagonists (47.3% vs 51.9%), angiotensin converting enzyme inhibitor (ACE-I) (14.2% vs 12.2%), diuretics (6.3% vs 10.2%), β-blockers (11.2% vs 4.7%), α-blockers (1.4% vs 1.3%), others (1.5% vs 2.4%), multiple (13.7% vs 12.5%), undefined (4.2% vs 4.7%). Sufficient hypotensive effects were obtained in 61.5% of the non-elderly, and 68.5% of the elderly.
    Initial physical examination to assess target organ damage was lower in the elderly than the non-elderly. It was thought necessary to be corrected. The incidence of main antihypertensive drugs in the elderly were Ca antagonists, ACE-I and diuretics. Treatment trends met the Japanese guideline on treatment of hypertension in the elderly.
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  • Shinichi Saito, Kiyoshi Nakatsuka, Takami Miki, Hiroshi Naka, Kayoko K ...
    2002 Volume 39 Issue 1 Pages 62-68
    Published: January 25, 2002
    Released: November 24, 2009
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    Oral administration of active vitamin D3 can reduce the loss of bone mass and the incidence of fractures in patients with osteoporosis in Japan. We conducted a prospective study to confirm the effects of 1α(OH)D3 (Alfacalcidol, Alfarol Chugai Tokyo) on bone and calcium metabolism in elderly women with osteoporosis. Enrolled in the present study were 16 elderly osteoporosis women aged 72.6±4.5 years to whom 1μg of 1α(OH)D3 was administered daily. Fasting blood and urine were obtained at baseline, 1 week, 4 weeks, 12 weeks and 24 weeks after the treatment. Monitored parameters were vitamin D metabolites, intact-PTH, bone alkaline phosphatase (BAP), osteocalcin (OC), deoxypyridinoline (DPD) and pyridiuium crosslinked type I collagen telopeptides (CTx). Serum 1α, 25(OH)2D and PTH levels were significantly increased (p<0.01) and decreased (p<0.05), respectively at 1 week after commencing administration. There was a significant decrease of DPD (p<0.05) at 12 weeks after commencing administration compared to the baseline levels.
    Serum levels of BAP and OC were found elevated at 1 week, and decreased at 12 weeks. In conclusion, the present study clinically confirmed that 1α(OH)D3 stimulates bone formation in vitro. Long-term administration of 1α(OH)D3 indirectly suppressed bone resorption through the suppression of parathyroid function in the elderly.
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  • Tomoko Shirota, Akiko Oishi, Akiko Shinohara, Kazuhiro Uchida, Yutaka ...
    2002 Volume 39 Issue 1 Pages 69-74
    Published: January 25, 2002
    Released: November 24, 2009
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    The purpose of this study was to investigate the changes in nutritional status and nutrient intake among 387 elderly residents (≥60y.o.) of Hisayama Town. A dietary survey was carried out at baseline in 1988 and repeated at the end of the follow-up period in 1998.
    During the 10-year follow-up period, mean values of body height and weight, and body mass index significantly decreased in both sexes. Likewise, blood hemoglobin and serum total cholesterol levels significantly decreased, while serum albumin and HDL-cholesterol levels significantly increased.
    Among dietary factors, mean energy intake significantly decreased due mainly to a decrease in the amount of carbohydrate intake, but no significant changes in the amount of protein and fat intakes were observed. The percentages of the Recommended Dietary Allowance for all nutrients eaten except for iron changed at the levels above 100%. The percentage of energy derived from carbohydrate significantly decreased, while those from protein and fat significantly increased.
    In conclusion, among community-dwelling healthy elderly people, mean energy intake significantly decreased due to a decrease in the amount of carbohydrate intake, and the fat intake relatively increased, with advancing age, but the blood lipid profile remained unchanged.
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  • Hiroyuki Umegaki, Hideki Nomura, Akira Nakamura, Fujiko Ando, Hiroshi ...
    2002 Volume 39 Issue 1 Pages 75-82
    Published: January 25, 2002
    Released: November 24, 2009
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    To determine the factors related to the destination on discharge from the geriatric ward of Nagoya University Hospital, we analyzed the relationship between the scores of comprehensive geriatric assessment at admission and the destination in patients who had dwelled in home. The scores of basic activity of daily living (Barthel index), instrumental activity of daily living (Lowton scale), and cognitive function (Mini-Mental State Examination) were significantly lower in the patients who moved to institutions than those in the patients who returned home. The proportion of disabilities in all items, except eating, in the Barthel index, and all items but washing in the Lowton scale were signuficantly higher in patients who moved to institutions than in patients who returned home. Space orientation, calculation, and drawing in the Mini-Mental State Examination were related to the destination. In items for social life communication and group behavior were related to the destination. In multiple logistic regression models, it was suggested that activity of daily living, specifically independence of excretion, and ability in communication were significantly related to the destination on discharge.
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  • Toshihiro Miyamura, Sumio Iijima, Zentaro Yamagata
    2002 Volume 39 Issue 1 Pages 83-87
    Published: January 25, 2002
    Released: November 24, 2009
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    An exact diagnosis of osteoarthritis is very important to prevent deterioration of ADL (activities of daily living) of the elderly. However, it is very difficult to diagnose the stage of osteoarthritis, and only a few indices for structural quantification of osteoarthritis have been reported. The purpose of this research is to investigate a new index for the bone structure in osteoarthritis.
    We examined right knees of 41 women aged from 34 to 85 years. Directivity index (DI) is a new index of bone structure calculated by directivity of the power spectrum from radiographs of tibial bone using fast Fourier transform (FFT). DI was obtained by subtracting the integral power value at 0 and 90 degree directions on the x-y plane of the two-dimensional power spectrum of tibial bone from the integral power value at a direction of 45 degrees.
    A significant relationship between the state of the knee joint by X-ray inspection and DI was indicated by evaluation of the correlation coefficient. However, no significant relationship was found between the state of the knee joint by X-ray inspection and the first moment of the Fourier power spectrum or the fractal dimension.
    There is a possibility that DI can estimate slight deformation of bone structure in osteoarthritis. In the future, we will apply DI to the prevention of osteoarthritis and a deterioration of ADL in the elderly.
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  • Sayaka Kikuchi, Yutaka Hayashi, Seiji Fujioka, Hitoshi Kukita, Naoto O ...
    2002 Volume 39 Issue 1 Pages 88-93
    Published: January 25, 2002
    Released: November 24, 2009
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    A 68-year-old woman with idiopathic thrombocytopenic purpura (ITP) was admitted to our hospital with acute myocardial infarction on 7 February 1999. She had been treated since 1991 for mitral stenosis and regurgitation, atrial fibrillation due to mitralism, diabetes mellitus, hypertension, hyperlipidemia. Chest radiograph on admission showed cardiomegaly with congestion and cardiothoracic ratio was 63%. The platelet count on admission was 22, 000/μl, but she did not have petechia or purpura. Urgent coronary angiography revealed total occlusion in segment 7, and 13 and 75% stenosis in segment 4PD, 9 and 10. Subsequently, direct percutaneous transluminal coronary angioplasty (PTCA) was performed in segment 7. Dissection occurred during the intervention, and a coronary stent was implanted. we started heparin infusion and medication with ticlopidine hydrochloride as post-stenting therapy after the intervention, and there was no bleeding tendency.
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  • Aya Ebihara, Terunao Ashida, Takao Sugiyama, Shigeru Okuno, Jun Fujii, ...
    2002 Volume 39 Issue 1 Pages 94-96
    Published: January 25, 2002
    Released: November 24, 2009
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    The patient was 47 years old on his first visit in 1969 and has been treated at our outpatient clinic until now, at the age of 79. The initial blood pressure was 164/98mmHg without abnormalities on electrocardiogram or urinalysis. He was followed-up for 8 years with non-pharmacologic treatment, which was eventually changed to antihypertensive drug treatment. At the age of 71 he was admitted because blood pressure increased to 210/110mmHg, with marked fluctuation. At admission bilateral ocular (right<left) and carotid bruits (right<left) were detected. At the age of 75 he had cerebellar infarction with reversible neuro-logic deficits. At the age of 76 he was again adimitted because the labile hypertension was difficult to control. Cerebral angiography which was performedto clarify the relationship between labile hypertension and cerebral ischemia revealed significant bilateral stenosis at the portion of the cavernous sinus inthe internal carotid arteries. The stenosis was more remarkable on the left side than the right side. Based on the angiographic findings we considered the ocular bruits to be not a murmur of augmentation flow but a stenotic murmur.
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  • Hisanori Morimoto, Hidetoshi Hashida, Toshio Honda, Yasushi Aibara
    2002 Volume 39 Issue 1 Pages 97-100
    Published: January 25, 2002
    Released: November 24, 2009
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    An 83-year-old man was given a diagnosis of left parotid cancer in our hospital in November 1997. He refused to undergo a surgical procedure because of his advanced age. Therefore chemotherapy and radiotherapy were used. Chemotherapy with CAP (Cyclophosphamide, Adriacin, and CDDP) was conducted on 6 occasions between December 1997 to July 2000. Prednisolone (15mg) was administered daily from July 15, 2000. The patient started suffering from diarrhea on August 2, 2000. As the patient also began to suffer high grade fevers and stomachaches, he was admitted on a diagnosis of acute enterocolitis. He had bloody stool on August 11. On emergency colonoscopy, an ulceration with bleeding was located in the lower rectum. The biopsy specimen revealed intranuclear inclusion bodies and positively staining cells for monoclonal antibody to cytomegalovirus through the immunohistochemical technique, and it was diagnosed as cytomegalovirus enterocolitis. He was treated with ganciclovir. One month later, his clinical symptoms had improved.
    Cytomegalovirus enterocolitis is an opportunistic infection, so immunocompromised hosts (such as cancer patients, patients using immunosuppressants, old people) have a greater probability of contracting cytomegalovirus infection. A ganciclovir is an effective treatment. A cytomegalovirus enterocolitis should considered in the differential diagnosis of enterocolitis, when alimentary symptoms like diarrhea or bloody stool are found in immunocompromised hosts.
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  • 2002 Volume 39 Issue 1 Pages 101-123
    Published: January 25, 2002
    Released: November 24, 2009
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