Nippon Ronen Igakkai Zasshi. Japanese Journal of Geriatrics
Print ISSN : 0300-9173
Volume 40 , Issue 2
Showing 1-19 articles out of 19 articles from the selected issue
  • Takao Suzuki
    2003 Volume 40 Issue 2 Pages 85-94
    Published: March 25, 2003
    Released: March 02, 2011
    JOURNALS FREE ACCESS
    Download PDF (1872K)
  • Hiroshi Shibata, Hidehiro Sugisawa, Shuichiro Watanabe
    2003 Volume 40 Issue 2 Pages 95-100
    Published: March 25, 2003
    Released: March 02, 2011
    JOURNALS FREE ACCESS
  • Mikiro Mori
    2003 Volume 40 Issue 2 Pages 101-108
    Published: March 25, 2003
    Released: March 02, 2011
    JOURNALS FREE ACCESS
    Visual sensastion results initially from light-induced isomerization of 11-cis-retinal in rhodopsin and cone pigments of photoreceptor cells. This transformation triggers cascades of events, i. e., activation of transducin and cGMP photodiesterase, decrease of cGMP, closure of cGMP-gated channels, and generation of active potential. Activated rhodopsin is then inactivated and uncouples all-trans-retinal, which is metabolized to all-trans-retinol and transferred to the retinal pigment epithelium, where it is re-isomerzed to form 11-cis-retinal. The 11-cis-retinal returns to the photoreceptor outer segments and regenerates rhodopsin. Many of the players in these two pathways are also essential for survival and maintenance of photoreceptors. Mutations in their genes cause retinitis pigmentosa and macular dystrophies. This article aims to summarize current understanding of the molecular mechanisms underlying these reactions and their relevance to pathophysiology of the retinal diseases.
    Download PDF (5568K)
  • Yusuke Tanigawara
    2003 Volume 40 Issue 2 Pages 109-119
    Published: March 25, 2003
    Released: February 24, 2011
    JOURNALS FREE ACCESS
    Download PDF (1857K)
  • Ryoichi Yoshida, Yoshinori Ito, Midori Hatta, Eiichi Otomo
    2003 Volume 40 Issue 2 Pages 120-123
    Published: March 25, 2003
    Released: February 24, 2011
    JOURNALS FREE ACCESS
    Download PDF (798K)
  • Toshihiko Iwamoto
    2003 Volume 40 Issue 2 Pages 124-126
    Published: March 25, 2003
    Released: February 24, 2011
    JOURNALS FREE ACCESS
    Download PDF (480K)
  • Yasuo Katayama, Kazuhiro Usuda, Yasuhiro Nishiyama, Kenichiro Katsura
    2003 Volume 40 Issue 2 Pages 127-129
    Published: March 25, 2003
    Released: February 24, 2011
    JOURNALS FREE ACCESS
    The frequency of post-stroke depression (PSD) was evaluated in an ischemic stroke cohort four weeks after onset, and the relationship between self-rating depression scale (SDS)/and infarct size, number and location of the ischemic brain lesions was also studied.
    The effects of a newly developed antidepressant SSRI (selective serotonin reuptake inhibitor), fluvoxamine maleate, on PSD and cerebral blood flow (CBF) was investigated in other ischemic stroke patients.
    The frequency of patients who had more than 40 on SDS score was 46% (18/39), and that of patients who had more than 50 was 13% (5/39). There were no differences in SDS score in infarct size, number and location of ischemic brain lesions, however there were significant differences in the lesion side. The score of the patients who had lesions in the left hemi-sphere was significantly higher than that of those who had them in the right.
    Administration of fluvoxamine maleate for four weeks improved the score on the Hamilton rating scale for depression (HAM-D) from 16.6±4.7 (n=5) to 8.4±4.3 (n=5), however it did not influence the mean cortical CBF.
    This study shows that the patients frequently had depression after ischemic stroke, and that left side lesion had a significant relationship with PSD. Therefore it is important that psychiatric examination of post-stroke patients is conducted. This study also shows that a newly developed antidepressant, fluvoxamine maleate, was effective for PSD.
    Download PDF (427K)
  • Ichiro Fujishima
    2003 Volume 40 Issue 2 Pages 130-134
    Published: March 25, 2003
    Released: February 24, 2011
    JOURNALS FREE ACCESS
    Dysphagia is a commmon comlication after stroke, being reproted in 30-50% in acute stage patients. It is also critical that dysphagia may occure 3 to 5 days after onset because of brain edema, so clinicians must be careful to treat stroke patients with close observation. Especially elderly patients with dysphagia have a high risk of aspiration peumonia, which might be life threatening condition for them. Dysphagia generally recovers spontaneously and frequency of the chronic stage cases is thought to be less 6%.
    The 30ml water swallow test is used to screen dysphagia. If cough or some symptom of aspiration such as wet voice or breathing difficulties are seen, dysphagia is strongly suspected. Oral care is essential and diet modification and rehabilitation techiques are applied. Fiberoptic evaluation or fluoroscopic examination is recommended for severe dysphagia. The treatment plan should be established according to the pathological conditions. The goal of dysphagia management is to prevent aspiration pneumonia, dehaydration and malnutition. If swallowing difficulties continue, alternative nutrition, PEG or intermittent tube feeding, could be helpfull. Multidisciplinary team approach should be adopted for dysphagia management.
    Download PDF (655K)
  • Masaru Yanai
    2003 Volume 40 Issue 2 Pages 135-137
    Published: March 25, 2003
    Released: February 24, 2011
    JOURNALS FREE ACCESS
  • Hiroshi Shibata
    2003 Volume 40 Issue 2 Pages 138-141
    Published: March 25, 2003
    Released: February 24, 2011
    JOURNALS FREE ACCESS
    Download PDF (509K)
  • Akiko Aoki, Yoshiyuki Kuroiwa, Yoshiaki Ishigatsubo
    2003 Volume 40 Issue 2 Pages 142-146
    Published: March 25, 2003
    Released: February 24, 2011
    JOURNALS FREE ACCESS
    Objective: To evaluate the influence of the age at disease onset on the clinical symptoms, laboratory findings, treatment, and complications of microscopic polyangiitis (MPA).
    Patients: From 1999 to 2001, we encountered 4 MPA patients with disease onset at age 65 or older (average 77.3, all were female: the elderly group). For comparison, 4 MPA patients with disease onset a 64 years or younger (average 44.7, two were male: the non-elderly group) were used.
    Results: There was no statistically significant difference in clinical features between the two groups. All patients in the elderly group were referred to our hospital, because of fever of unknown origin or suspicion of connective tissue disease. The elderly group had a longer duration from the first admission to the start of treatment. Renal biopsies were done in all of the non-elderly group and one of the elderly group. The diagnosis of the other 3 patients of the elderly group was based on muscle or nerve biopsy, showing necrotizing vasculitis. At the time of diagnosis, antibodies to myeloperoidase (MPO-ANCA) were positive in 7 of 8 patients (87.5%). 2 patients of the non-elderly group were died of heart failure and hepatic failure by cyclophosphamide (CYC). The other 6 patients achieved substantial improvement.
    Conclusions: Muscle or nerve biopsy helped clinical management of elderly patients when renal biopsies could not be done. IVCY was relatively safe and effective treatment for MPA in elderly as well as non-elderly patients.
    Download PDF (2386K)
  • Masakazu Washio, Yumiko Arai, Hisako Izumi, Mitsuru Mori
    2003 Volume 40 Issue 2 Pages 147-155
    Published: March 25, 2003
    Released: February 24, 2011
    JOURNALS FREE ACCESS
    The present study was conducted to investigate the factors related to the feeling of psychological stress, called heavy burden, in caregivers who took care of frail elderly persons 1 year after the introduction of the public long-term care insurance system (i. e., kaigo hoken) in the northern part of Fukuoka Prefecture, Kyushu, Japan. Forty-seven caregivers answered a self-administered questionnaire involving the Japanese version of the Zarit Caregiver Burden Interview (ZBI) and thus described their own caregiving situation. Compared to caregivers with a light burden, heavily burdened caregivers were less likely to have time to go out without their frail elderly, but tended to spend a longer time with them in providing for their physical care. Compared with less burdened caregivers, heavily burdened caregivers tended to be concerned with what others thought or said and more likely to use a short-stay service (i. e., temporary nursing home assistance).
    More social services should be provided to let caregivers have their own time without caring for their patients. In addition, local governments and caremanagers should help caregivers to understand the benefits of services available for the elderly and their caregivers.
    Download PDF (1333K)
  • Koichi Kawanishi, Hiroaki Miyashita
    2003 Volume 40 Issue 2 Pages 156-159
    Published: March 25, 2003
    Released: February 24, 2011
    JOURNALS FREE ACCESS
    A 94-year-old man had with vascular dementia, visual disturbance, hearing difficulty and speech and motor disturbance. He had a history of diabetes mellitus over 50 years. He developed brittle type diabetes. On administration of mixed type insulin (30: 70, 12-18 units in the morning and 6-8 units in the evening), his blood glucose concentrations fluctuated from almost zero to 500-600mg/dl. After change to short acting regular insulin (4-5 units) before each meal and intermediate type insulin (2 units) before sleeping time, extreme hyperglycemia was not observed, but the brittleness with frequent hypoglycemia persisted. The hypoglycemic symptoms were absent at the time of striking hypoglycemia: it was thought that the patient was condition unaware of hypoglycemia. The cause of the brittle diabetes in the extremely elderly was thought to be depletion of endocrine insulin secretion due to marked β-cell reduction and/or β-cell exhaustion secondary to long term duration of diabetes. Daily detailed observation is required to care for such mentally deteriorated patient with brittle diabetes.
    Download PDF (625K)
  • Toshie Ogasawara, Kiyotaka Kawauchi, Masako Yasuyama, Shin-ichiro Ohka ...
    2003 Volume 40 Issue 2 Pages 160-166
    Published: March 25, 2003
    Released: February 24, 2011
    JOURNALS FREE ACCESS
    A 66-year-old man was admitted to our hospital for fever on January 19, 1998. He began showing periodic high fever in June 1997 and an increased serum LDH in August 1997. His history included surgery for esophageal cancer in 1993. On admission, the patient's body temperature was 38.5°C. Physical examination was negative for lymphadenopathy, hepatosplenomegaly, and skin rash. Peripheral blood revealed a hemoglobin level of 8.6g/dl and a platelet count of 7.9×104l. Bone marrow examination showed hypocellularity with marked histiocytic hemophagocytosis. The various bacterial cultures were negative. Serum LDH was elevated to 1, 606IU/l, and ferritin was greater than 3, 000ng/ml. Antinuclear antibodies were negative. No significant elevation of viral antibody titers including that to Epstein-Barr virus was found. Hemophagocytic syndrome (HPS) was diagnosed, but no underlying diseases was identified. The patient's condition was complicated by interstitial pneumonia and pleural effusion. γ-globulin and pulse methylprednisolone both proved ineffective for the HPS; however, complete remission was achieved with cyclic intravenous administration of etoposide (VP-16, 150mg/day). Interestingly, the interstitial pneumonia resolved promptly with etoposide therapy. The patient relapsed, in July 2001, exhibitting high fever, cytopenia, and marrow hemophagocytosis. His condition was ameliorated by administration of etoposide.
    This was a rare case of chronic and recurrent HPS of unknown etiology accompanied by interstitial pneumonia. Etoposide should be considered as a primary therapy for HPS and its comlications in cases such as our patients.
    Download PDF (3174K)
  • Hidetaka Ota, Kohtarou Azuma, Toshiyuki Horiuchi, Hirohito Kazama, Ats ...
    2003 Volume 40 Issue 2 Pages 167-171
    Published: March 25, 2003
    Released: February 24, 2011
    JOURNALS FREE ACCESS
    A 93 year-old woman was admitted due to anorexia and unconsciousness. Biochemical examination of serum showed hypercalcemia (corrected Ca; 16.6mg/dl). The level of intact parathyroid hormone (i-PTH) was suppressed, whereas parathyroid hormone-related peptide (PTHrp) was to 5.0pM (normal range: below 0.6pM). IL-6 and renal cAMP were also elevated. We started to ameliorate hypercalcemia by saline infusion, furosemide and calcitonin. However, hypercalcemia was not improved and the patient died of DIC and renal failure. Autopsy revealed primary lesion of NHL (diffuse large B cell type) to be in the stomach with infiltration of lymphoma into the liver, pancreas, spleen, adrenal glands, jejunum, and lumbar vertebrae. The results of immunohistochemical examination demonstrated the expression of PTHrP in lymphoma cells. PTHrP was also found in lymphoma cells of the spleen by the RT-PCR technique. These findings indicated that hypercalcemia was caused by overexpression of PTHrP from lymphoma cells.
    Download PDF (4704K)
  • Etsuko Shiono, Terunao Ashida, Kazuro Sugishita, Takao Sugiyama, Jun F ...
    2003 Volume 40 Issue 2 Pages 172-175
    Published: March 25, 2003
    Released: February 24, 2011
    JOURNALS FREE ACCESS
    A 75-year-old man had a 26-year history of hypertension and an 18-year history of effort angina pectoris. He suffered acute myocardial infarction at age 61. According to serial echocardiography, the initially hypokinetic segment of the left ventricular apex was transformed to an apical aneurysm over the course of 10 years (at age 71). Ten months later, a transient ischemic attack occurred, despite the administration of aspirin. At age 72, echocardiography revealed a hyperechoic lesion that was suspected to be a thrombus within the aneurysmal cavity. Cerebral infarction (right occipital lobe) occurred 13 years after myocardial infarction, at age 73. After warfarin therapy for 3 months, the thrombus-like echo in the left ventricular aneurysm disappeared.
    Download PDF (4868K)
  • Akira Miyata, Soichirou Fujii, Takeshi Kikuchi, Masayoshi Kibata
    2003 Volume 40 Issue 2 Pages 176-181
    Published: March 25, 2003
    Released: February 24, 2011
    JOURNALS FREE ACCESS
    A 75-year-old man was admitted because of right knee joint pain in December 1999. He had suffered from acute myelocytic leukemia (AML; M0) in November 1994 and achieved the first complete remission (CR) then. His AML relapsed in August 1996, but fortunately he achieved a second CR. Radiographical bone examination revealed osteolytic lesions in his right knee and bone scintigraphy showed uptake in the right knee and the middle part of the left femur. MRI also revealed a low attenuation signal in the left femur. He had no abnormal findings in peripheral blood or bone marrow. Histological examination of the biopsied bone tissue showed a diffuse proliferation of round cells with medium-sized or large nuclei. These cells were histochemstrically negative for myeloperoxidase and naphtol-ASD-chloroacetate esterase, and were also negative for lysozyme, cytokeratin 7, 9, 20, EMA, CEA, CD3, CD79a on immunohistochemistry, but were positive for CD43, CD56. In immunophenotypic analysis of these cells by flow cytometry, CD7, CD13, CD33, CD41, CD56 were revealed to be strongly positive. On the basis of these findings we diagnosed these tumors as granulocytic sarcomas (GS), extramedullary recurrence of AML M7. Although radiation (36Gy) to these tumors brought a temporary relief of the pain, he died of systemic relapse of AML in February 2001. When presented CD7+ AML M0 had been diagnosed, but GS cells were also positive for CD56 and CD41. Although CD56 had not been examined initially, he might have been had myeloid/NK cell precursor acute leukemia and CD41 might be acquired later in the course of the disease. It is known that AML M0, M7 and myeloid/NK cell precursor acute leukemia have poor prognoses, nevertheless he survived for 6 years. It may be that intensive and repeated chemotherapy for AML can obtain excellent outcome in the elderly cases in good systemic condition and with favourable prognostic factors.
    Download PDF (4998K)
  • 2003 Volume 40 Issue 2 Pages 182-187
    Published: March 25, 2003
    Released: February 24, 2011
    JOURNALS FREE ACCESS
    Download PDF (1236K)
  • 2003 Volume 40 Issue 2 Pages 188-195
    Published: March 25, 2003
    Released: February 24, 2011
    JOURNALS FREE ACCESS
    Download PDF (1601K)
feedback
Top