Nippon Ronen Igakkai Zasshi. Japanese Journal of Geriatrics
Print ISSN : 0300-9173
Volume 39 , Issue 4
Showing 1-22 articles out of 22 articles from the selected issue
  • Kozo Matsubayashi
    2002 Volume 39 Issue 4 Pages 355-363
    Published: July 25, 2002
    Released: November 24, 2009
    JOURNALS FREE ACCESS
    Download PDF (3180K)
  • Hidenao Fukuyama
    2002 Volume 39 Issue 4 Pages 364-370
    Published: July 25, 2002
    Released: November 24, 2009
    JOURNALS FREE ACCESS
    Recent advances in the technology of non-invasive neuroimaging techniques, include X-ray CT, magnetic resonance imaging, positron CT, etc. The trend of neuroimaging is from the diagnosis of the brain structural change to the functional localization of the brain function with accurate topographical data. Brain activation studies disclosed the responsible regions in the brain for various kinds of paradigms, including motor, sensory, cognitive functions. Another aspect of brain imaging shows the pathophysiological changes of the neurological disorders, such as Alzheimer's disease by abnormal CBF or metabolism changes. It is very important to note that the neurotransmitter receptor imaging is now available for various kinds of transmitters. We recently developed a new tracer for nicotinic type acetylcholine receptor, which might be involved in the pathophysiology of Alzheimer's disease and its treatment. In the near future, we will be able to visualize the proteins in the brain such as amyloid protein, which will make us to diagnose Alzheimer's patients accurately, and with respect to neuroscience research, not only neuronal functional localizations but also relationship between them will become important to disclose the functional aspects of the brain.
    Download PDF (3226K)
  • Jun Nakura
    2002 Volume 39 Issue 4 Pages 372-374
    Published: July 25, 2002
    Released: November 24, 2009
    JOURNALS FREE ACCESS
  • Yukio Tanizawa
    2002 Volume 39 Issue 4 Pages 375-377
    Published: July 25, 2002
    Released: November 24, 2009
    JOURNALS FREE ACCESS
    Download PDF (1006K)
  • Tomohiro Katsuya, Jitsuo Higaki, Toshio Ogihara
    2002 Volume 39 Issue 4 Pages 378-380
    Published: July 25, 2002
    Released: November 24, 2009
    JOURNALS FREE ACCESS
  • Norihiro Yamada
    2002 Volume 39 Issue 4 Pages 381-385
    Published: July 25, 2002
    Released: November 24, 2009
    JOURNALS FREE ACCESS
    Download PDF (546K)
  • Hiroki Kurihara
    2002 Volume 39 Issue 4 Pages 386-388
    Published: July 25, 2002
    Released: November 24, 2009
    JOURNALS FREE ACCESS
    Download PDF (990K)
  • Tomomi Fujisawa, Hiroshi Ikegami, Toshio Ogihara
    2002 Volume 39 Issue 4 Pages 390-392
    Published: July 25, 2002
    Released: November 24, 2009
    JOURNALS FREE ACCESS
    There is considerable heterogeneity in elderly patients with diabetes mellitus. It is of clinical importance to assess such heterogeneous features in each elderly patient, because this would lead to a better setting of target glucose level in the management of diabetes. In the present study, diabetic subjects were clinically investigated from three different aspects; past, current and future.
    First, the “past” aspect represents how long and how high the hyperglycemia the patient has had. Our cross-sectional investigation showed a broad range of duration of diabetes as well as of degree of hyperglycemia, and as a consequence, diabetic complications were diverse. Second, the “current” aspect implies the degree of insulin deficiency and its resistance. According to our observation, elderly patients had diverse degrees of impaired insulin secretion, together with age-related resistance to insulin. Third, “future” aspect refers to the expected length of life, which largely depends on the current age. The complication status (not limited to diabetic complications), however, also affects clinical course and death rates, indicating diversity of life expectancies due to complications besides current age.
    Thus, the present analysis showed that elderly individuals with diabetes mellitus exhibit a remarkable heterogeneity. The present study also indicated the clinical merit of assessment with the three aspects; past, current and future, in assessing clinical diversity of elder patients with diabetes.
    Download PDF (549K)
  • Reiko Kotani, Masao Nagata, Koichi Yokono
    2002 Volume 39 Issue 4 Pages 393-395
    Published: July 25, 2002
    Released: November 24, 2009
    JOURNALS FREE ACCESS
    Download PDF (341K)
  • Atsushi Araki, Yukari Murotani, Yukitoshi Aoyagi
    2002 Volume 39 Issue 4 Pages 396-399
    Published: July 25, 2002
    Released: November 24, 2009
    JOURNALS FREE ACCESS
    Because of diversities of physical, mental, and psychological functions as well as clinical and social backgrounds, comprehensive geriatric assessment (CGA) is of great importance in treating elderly diabetic patients. We addressed three issues as to functions important for the CGA.
    First, we assessed several domains of cognitive function in 213 elderly diabetic patients. Attention and visual memory in diabetic patients without vascular disease were impaired compared with non-diabetic controls after adjusting for age and sex using analysis of covariance. Multivariate analysis revealed that age, hyperglycemia, and the presence of cerebral infarction were independent determinants for the impairment of attention in the diabetic patients. The results suggest that glucose control is important for the maintenance of cognitive function in elderly diabetic patients. Secondly, we assessed positive well-being as a measure of psychological function using a PGC morale scale in 197 elderly diabetic patients without cerebrovascular disease at baseline and examined whether the low well-being affect the development of cerebrovascular disease in a 3-year longitudinal study. The results indicate that low well-being was an independent risk factor for cerebrovascular disease after adjusting conventional risk factors in elderly diabetic patients. Thirdly, as a physical function, we assessed 5-m walking speed for both usual and maximum walking in 64 diabetic patients. The walking speed decreased with age and correlated significantly with the knee extension power and functional reach. The result suggests that muscle-strength exercise and balance training as well as endurance exercises are necessary to improve age-related decreases in walking speed and for effective exercise in elderly patients. From a gerontological point of view, new strategies of elderly diabetes treatment including muscle strength exercise and psychological approaches should be established to improve physical, mental, psychological, and social functions as assessed by the CGA.
    Download PDF (1126K)
  • Masayoshi Hashimoto
    2002 Volume 39 Issue 4 Pages 400-403
    Published: July 25, 2002
    Released: November 24, 2009
    JOURNALS FREE ACCESS
    Evidence has accumulated that impairment of vascular endothelial function is the initial step in the development of atherosclerosis. One important finding is the impairment of the release of the endothelium-dependent relaxing factor, which is now thought to be nitric oxide or its related substances, from endothelial cells. Flow-mediated dilatation (FMD) induced by reactive hyperemia has been know to be endothelium dependent, and this can be detected during reactive hyperemia by high-resolution ultrasound in superficial arteries. Several coronary risk factors such as hypercholesterolemia, smoking and hyperhomocysteinemia have been reported to be significantly related with decreased FMD. A non-invasive technique using B-mode ultrasonography can visualize and assess the lumen and vessel wall of the carotid artery. We analyzed Intima-media thickness (IMT) of the right common carotid artery using this method. IMT thickening consists of both an intimal atherosclerotic process and medial hypertrophy. Since IMT is increased in subjects with familial hypercholesterolemia and shows a progressive reduction with cholesterol-lowering treatment, IMT seems to be significantly related to the early phase of atherosclerosis. Ankle brachial pressure index and pulse wave velocity have been clinically applied to evaluate atherosclerosis. These methods are also introduced in this symposium.
    Download PDF (498K)
  • Toshio Hayashi
    2002 Volume 39 Issue 4 Pages 404-408
    Published: July 25, 2002
    Released: November 24, 2009
    JOURNALS FREE ACCESS
    To maintain the good quality of life in elderly, it is important to diagnose and asymptomatic advanced or prone to rupture atherosclerosis by using non-invasive techniques and it is also important to treat and prevent the progression of atherosclerotic disease. Comprehensive geriatric assessment is useful for maintain the good quality of life as well as evaluation of activity of daily life. Treadmill exercise test which protocol was arranged for Japanese elderly revealed high incidences of coronary ischemia susceptible patients in elderly diabetic patients. Concomitant measurement of blood pressure of lower extremities is also useful for early diagnosis of arteriosclerosis oblieterence. Vascular endocrinological examination such as brain natriutretic peptide is expectable for early diagnosis of latent impairment of cardiac function. Evaluation of endothelial function by measuring flow mediated dilatation and evaluation of narrowing carotid artery by using ultrasound echocardiograph is useful. These examinations are expectable for future treatment of elderly patients.
    Download PDF (1174K)
  • Motoo Kikuchi, Toshiaki Inagaki, Nagao Shinagawa, Ryuzo Ueda
    2002 Volume 39 Issue 4 Pages 409-413
    Published: July 25, 2002
    Released: November 24, 2009
    JOURNALS FREE ACCESS
    The clinical significance of a slight increase of serum soluble interleukin-2 receptor (sIL2R) concentration in the stable elderly was investigated. Thirty-five residents of nursing homes with physical impairment as a sequel to cerebral infarctions, without any inflammatory condition, anodyne or immunological treatment, were divided into two groups: 24 without overt or suspected malignancy (NC) and 11 with a history of malignancy (CA). Serological screening with measurement of sIL2 R concentrations was performed and numbers of lymphocytes with CD4, CD8 markers were determined. The NC group was divided into controls (n=15, sIL2R<=883U/mL) and subjects demonstrating elevation (n=9, NH), as in a previous study. Differences were found in serum concentrations of albumin, blood urea nitrogen, total cholesterol concentration, Pettigrew's prognostic nutritional index (PNI), as well as the ADL score, but not age or sex between NH and controls. Factor analysis in NC revealed serum creatinine and blood urea nitrogen concentrations to correlate positively, and serum albumin, total cholesterol concentrations, ADL score, PNI to correlate negatively to sIL2R. Differences were found in sIL2R, albumin, total protein, total cholesterol, β-lipoprotein, PNI between CA and controls, but correlations were not found in CA. Survival rate of controls over twenty-four months was better than that of NH, but not of CA. Our results suggest that a slight increase of concentration of sIL2R is related to subclinical systemic deterioration, especially with regard to nutrition, with a plausible connection to prognosis of the stable elderly without malignancy.
    Download PDF (732K)
  • Shinji Teramoto
    2002 Volume 39 Issue 4 Pages 414-418
    Published: July 25, 2002
    Released: November 24, 2009
    JOURNALS FREE ACCESS
    We tested the effects of the sustained release of theophylline on the physiologic function of the respiratory system in elderly patients with chronic obstructive pulmonary disease (COPD). We measured the pulmonary function, static respiratory pressures, and ventilation during exercise, before and after the administration of sustained release of theophylline, Unifil, in 12 male COPD patients (mean age 82.1±0.6 years old). Forced expiratory volume in one second was increased by the administraiton of 400mg of Unifil, but not by 200mg of Unifil, whereas the ratio of residual volume to total lung capacity was decreased by the administration of 400mg Unifil. Maximum inspiratory pressure was significantly increased after the administration of 400mg of Unifil. Dyspnea sensation during exercise assessed by the Borg scale was reduced by the administration of 400mg of Unifil. These results indicate that the treatment with the greater dosage administration of Unifil is effective to improve the physiological function of the respiratory system in elderly patients with COPD, and it may be the treatment of choice for elderly COPD patients.
    Download PDF (795K)
  • Kyoko Kin, Toshihiko Iwamoto, Masaru Takasaki
    2002 Volume 39 Issue 4 Pages 419-426
    Published: July 25, 2002
    Released: November 24, 2009
    JOURNALS FREE ACCESS
    This study was conducted to clarify the relationship between the outcome of various diseases in elderly patients and platelet function. The outcome in 347 consecutive patients aged 60 or older, who were treated without antiplatelet drugs on registration, was retrospectively studied after platelet aggregability tests. The mean age was 77.5 years (161men and 186 women). The grading curve (GC) type, as an index of platelet aggregability, was determined spectrophotometrically with an aggregometer and adenosine-5'-diphosphate as an agonist. They were classified into three groups according to GC type: Group I with a GC type of -2 or -1 (n=40), group II with a GC type of 0 or +1 (n=208), and group III with a GC type of +2 or +3 (n=99). The mean follow-up period was 3.9 years. There were 3 deaths in group I, 33 in group II, and 30 in group III. Mean annual mortality rate was 2.1% in group I, 4.0%in group II, and 7.5% in group III. Among causes of death, vascular events was seen in 15 patients of group III, although the most common cause of death was pneumonia in the three groups. The annual mortality rates due to vascular events were 0.7% in group I, 0.6% in group II, and 4.2% in group III, indicating a significantly higher mortality rate in group III. Antiplatelet therapy was performed in approximately 15% of each group during their clinical course, and, when they were excluded for survival analyses, annual mortality rate was also higher in group III than in groups I and II. Cox proportional hazards models for vascular death yielded a hazard ratio of 2.3 and 2.2 in the increased GC type and diabetes, respectively. These findings indicated that elderly patients with accelerated aggregability had higher mortality rates due to vascular events. Therefore, accelerated aggregability in the elderly suggested not only the progress of arteriosclerosis, but indications of antiplatelet therapy to prevent vascular events.
    Download PDF (1114K)
  • Eiichi Sudo, Shiho Tanuma, Etsuko Sudo, Yoshihiko Takahashi, Akira Yos ...
    2002 Volume 39 Issue 4 Pages 427-432
    Published: July 25, 2002
    Released: November 24, 2009
    JOURNALS FREE ACCESS
    It has been suggested that videofluorography (VF) is useful in the diagnosis of aspiration. The aim of this study was to investigate the usefulness of the water swallowing test and VF in swallowing rehabilitation in patients with cerebrovascular disease. Fifteen patients (mean age 72.9±2.3 years) were examined. The swallowing abnormality was assessed by the water swallowing test and VF. Patients with abnormal swallowing function on the water swallowing test (Group A, n=4) showed aspiration and silent aspiration into the trachea on VF. However, patients suspected of dysphagia on the water swallowing test (Group B, n=11) could swallow, demonstrating the disappearance of silent aspiration, with pooling of barium in the piriform sinus on VF. All patients in Group A could not ingest any food by mouth and received percutaneous endoscopic gastrostomy or intermittent oro-esophageal tube feeding. The swallowing function in Group B improved after swallowing rehabilitation. All patients in Group B could ingest food by mouth. These findings suggest that the water swallowing test is useful for quantitative assessment of swallowing disorder and for deciding on therapy of swallowing function.
    Download PDF (894K)
  • Motoo Kikuchi, Toshiaki Inagaki, Ryuzo Ueda
    2002 Volume 39 Issue 4 Pages 433-438
    Published: July 25, 2002
    Released: November 24, 2009
    JOURNALS FREE ACCESS
    Multiple myelomas often occur in elderly people with complications due to aging. A 54-year-old man was first admitted with cerebral infarction, and multiple myeloma (IgG kappa, stage IIIA) occurred in November 1989 that was followed by partial remission after chemotherapy. The karyotype of the bone marrow cells was 46, XY, and no p53 gene mutations were detected by polymerase chain reaction and single-strand conformation polymorphism analysis. Chemotherapy (melphalan 10 mg, vindesine 3mg, ranimustine 150mg, prednisolone 60mg for 4 days) was performed in February 1999 because of aggravation of the myeloma. After daily subcutaneous injection of 50μg of nartograstim for six days to treat neutropenia, soft tissues around the right eye were swelled gradually without redness, accompanied by elevation of the serum creative-kinase concentration. The swelling disappeared, and the enzyme level normalized after discontinuation of nartograstim. In July, on the sixth day of daily subcutaneous injection of 75μg of filgrastim after the same chemotherapy, similar swelling of the soft tissues around the left eye became evident, and again this proved reversible. In July 2000, 40mg of dexamethasone was infused, and after 5-day subcutaneous-injection of 75μg of filgrastim daily, the right subclavicular soft tissue became swollen. He died of myocardial infarction, and autopsy revealed infiltration of myeloma cells into the right subclavicular muscle and bone marrow packed with myeloma cells. This case suggests that myeloma cells can proliferate and infiltrate into soft tissues on exposure to granulocyte-colony stimulating factors.
    Download PDF (2810K)
  • Eiichi Sudo, Shiho Tanuma, Nami Haraguchi, Chikara Kobayashi, Yoshihik ...
    2002 Volume 39 Issue 4 Pages 439-443
    Published: July 25, 2002
    Released: November 24, 2009
    JOURNALS FREE ACCESS
    We report a 75-year-old woman with chronic obstructive pulmonary disease (COPD) suffering from cough, sputum, high-grade fever and dyspnea on effort. Her chest radiograph revealed an infiltrative shadow in the right lower lung field and her laboratory data showed marked inflammatory changes. Her arterial blood gas analysis showed marked hypoxemia and hypercapnia. After her laboratory data and general condition improved, we performed pulmonary rehabilitation for the patient for about 6 weeks. The program consisted of pursed lip breathing, diaphragmatic breathing, muscle stretch gymnastics, and walking. The 6-minute walking test distance increased from 170m to 280m. The minimum SpO2 during the 6-minute walking test increased from 88% to 91%. (O23L/m) After discharge, she continued to receive home care from a visiting nurse specialized in respiratory medicine and 24 hour-monitoring of O2-compliance at home. She has not experienced acute exacerbation or re-hospitalization for 1 year. We conclude that home care service is effective to maintain stable conditions such as state of breathing, SpO2, vital signs, and activities of daily living for elderly COPD outpatients.
    Download PDF (1436K)
  • Satoshi Yokoyama, Terunao Ashida, Takao Sugiyama, Aya Ebihara, Jun Fuj ...
    2002 Volume 39 Issue 4 Pages 444-447
    Published: July 25, 2002
    Released: November 24, 2009
    JOURNALS FREE ACCESS
    A Japanese man who died at age 85 had been followed since the age of 59, when he first presented. He had hypertension of 162/102mmHg and a loud systolic murmur on his first visit. He had had an active daily life without any medication for the next 10 years. At the age of 72 he complained of mild chest discomfort on exercise. Although electrocardiography showed no abnormalities, echocardiogram showed calcified bicuspid aortic valve with mild stenosis. At the age of 81 the dyspnea and chest oppression were exacerbated, associated with marked ST depression on exercise electrocardiogram and restriction of aortic valve opening on echocardiograms. In the following years a gradual increase in QRS voltage and ST depression with T wave inversion were recorded on resting electrocardiograms and sharp increases in both left ventricular end- diastolic diameter and flow velocity at the aortic root were observed on echocardiograms. At the age of 85 he died of intractable heart failure with massive pleural effusion. Autopsy revealed marked hypertrophy and moderate dilatation of the heart (weight: 580g). The bicuspid aortic valve had anterior-posterior cusps with a raphe on the anterior cusp. The mobility of the cusps was almost lost because of severe calcification and thickening. Severe stenosis was found near the orifice of the right coronary artery, but there were no significant ischemic myocardial lesions.
    Download PDF (1808K)
  • Jiro Kanie, Chizuko Kaganu, Takayuki Yamamoto, Hiroyuki Akatsu, Yusuke ...
    2002 Volume 39 Issue 4 Pages 448-451
    Published: July 25, 2002
    Released: November 24, 2009
    JOURNALS FREE ACCESS
    An 85-year-old woman was receiving enteral feeding via percutaneous endoscopic gastrostomy (PEG). The patient exhibited symptoms of gastro-esophageal reflux, leakage of nutrient from the PEG insertion point, vomiting, pyrexia, dyspnea when given nutrients and recurrent pneumonia. We therefore gave a half-solid nutrient, which was made by a mixture of agar powder and conventional liquid nutrient Immediately after starting the half-solid nutrient feeding via PEG, the patients no longer exhibited the above symptoms apart from mild pyrexia, which also vanished two weeks later. This case suggested that simply changing the fluidity of nutrients can contribute to a reduction of complications expected to occur in patients on PEG tube feeding.
    Download PDF (1500K)
  • [in Japanese]
    2002 Volume 39 Issue 4 Pages 452-460
    Published: July 25, 2002
    Released: November 24, 2009
    JOURNALS FREE ACCESS
    Download PDF (1433K)
  • 2002 Volume 39 Issue 4 Pages 461-475
    Published: July 25, 2002
    Released: November 24, 2009
    JOURNALS FREE ACCESS
    Download PDF (2825K)
feedback
Top