Nippon Ronen Igakkai Zasshi. Japanese Journal of Geriatrics
Print ISSN : 0300-9173
Volume 41 , Issue 1
Showing 1-27 articles out of 27 articles from the selected issue
  • Fukashi Udaka, Masaya Oda, Masakuni Kameyama
    2004 Volume 41 Issue 1 Pages 1-7
    Published: January 25, 2004
    Released: March 02, 2011
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  • Masaya Igarashi
    2004 Volume 41 Issue 1 Pages 8-15
    Published: January 25, 2004
    Released: March 02, 2011
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  • Keiichi Nakagawa, Tetsu Iwase, Tadashi Murakami, Yuichiro Saito, Kayok ...
    2004 Volume 41 Issue 1 Pages 16-22
    Published: January 25, 2004
    Released: March 02, 2011
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  • Takeshi Tabira
    2004 Volume 41 Issue 1 Pages 23-25
    Published: January 25, 2004
    Released: March 02, 2011
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  • Kazuaki Shimamoto
    2004 Volume 41 Issue 1 Pages 26-28
    Published: January 25, 2004
    Released: March 02, 2011
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  • Michitaka Naito
    2004 Volume 41 Issue 1 Pages 29-32
    Published: January 25, 2004
    Released: March 02, 2011
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  • Eiki Ishii
    2004 Volume 41 Issue 1 Pages 33-34
    Published: January 25, 2004
    Released: March 02, 2011
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  • Kiyomi Yamane
    2004 Volume 41 Issue 1 Pages 35-38
    Published: January 25, 2004
    Released: March 02, 2011
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    Patients in the Department of Neurology undergoing treatment for disorders such as cerebrovascular disease, dementia, metabolic disease, neuromuscular disease and intractable disease, are included as subjects requiring terminal care.
    Intractable diseases ware defined by the Ministry of Health and Welfare (Ministry of Health, Welfare and Labor) in 1972 as being of unknown etiology, untreatable, chronically progressive and sometimes worsened by the care provided when nursing these patients.
    Intractable diseases in the Department of Neurology rank with those seen in other departments. Amyotrophic lateral sclerosis is the most difficult to treat due to the lack of effective drugs. On the other hand, Parkinson disease is the most treatable among intractable diseases in the Department of Neurology with the appearance of several new effective drugs. TRH (thyrotropin releasing hormone) is effective for ataxic gait in some patients with spinocerebellar degeneration.
    In the terminal care of intractable diseases in the Department of Neurology, common problems such as disturbances of swallowing, respiration and speaking develop in almost all patients and measures must be taken to treat these disturbances. Artificial respiration must be considered for respiratory distress. Artificial feeding by intubation must be considered for swallowing disturbance. All kinds of communication aids must be considered for speaking difficulties.
    The medical and nursing care team needs to manage these problems with consideration of the quality of life of the patients and their families as well as the complication of the diseases.
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  • Kenichi Nakahara
    2004 Volume 41 Issue 1 Pages 39-41
    Published: January 25, 2004
    Released: March 02, 2011
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    In an era of global aging, the care for the aged is one of the major societal concern. The comprehensive geriatric assessment (CGA) has proved to be a rational innovation to take care of the aged with impaired mental function and/or low activity of daily living. On the other hand, the reasonable attitude and philosophy for providing care for patients in terminal state is not settled. For example, there are least agreements on the terminal period, desirable place of death, living will of dementia patient, futile or under-therapy, and life support at death. In cancer patients, these problems have been practically resolved. Because there are many similarities between the management of elderly patients with CGA and that of patients with terminal state, CGA should be applied for all patients in terminal state with diseases besides malignancy. From the questionnaire to care-provider and general population, various opinions and many differences were observed between these two groups. Briefly, the opinions of care-provider were more reserved than that of general population. However, more than 70% of both groups were unanimous in that the present terminal care should be reformed. Otherwise, considering the diverse opinions for the terminal for the aged, serious discussions and suitable studies on terminal care are required for fulfilling rest of life and peaceful death of aged people.
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  • Hirofumi Sakurai
    2004 Volume 41 Issue 1 Pages 42-44
    Published: January 25, 2004
    Released: March 02, 2011
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  • Kazumasa Uemura
    2004 Volume 41 Issue 1 Pages 45-47
    Published: January 25, 2004
    Released: March 02, 2011
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  • Satoshi Murasawa
    2004 Volume 41 Issue 1 Pages 48-50
    Published: January 25, 2004
    Released: March 02, 2011
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  • Yoshiaki Taniyama, Naruya Tomita, Seiji Endoh, Yasufumi Kaneda, Toshio ...
    2004 Volume 41 Issue 1 Pages 51-54
    Published: January 25, 2004
    Released: March 02, 2011
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    Cardiovascular diseases are the leading causes of mortality and morbidity in developed countries. Most conventional therapy is inefficient and tends to treat the symptoms rather than the underlying causes of the disorder. Gene therapy based on ultrasound with microbubbles offers a novel approach for the prevention and treatment of cardiovascular diseases. The major development of gene transfer has importantly contributed to intense investigation of the potential of gene therapy in cardiovascular medicine. The amazing advances in molecular biology have provided a dramatic improvement of the technology that is necessary to transfer target genes into somatic cells. Gene transfer methods have been surprisingly improved. In fact, some of them (retroviral vectors, adenoviral vectors or liposome based vectors, etc) have been used in clinical trials already. However, some severe side effects were reported in clinical gene therapy using such viral vector, so people wish for safe and efficient clinical gene therapy.
    Transfection with ultrasound and microbubbles has been reported as a new powerful tool in a new class for gene therapy.
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  • Masaki Honda
    2004 Volume 41 Issue 1 Pages 55-57
    Published: January 25, 2004
    Released: March 02, 2011
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  • Shinichi Yoshimura, Noboru Sakai
    2004 Volume 41 Issue 1 Pages 58-60
    Published: January 25, 2004
    Released: March 02, 2011
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    Although neurogenesis is observed in the human adult brain, its regulation and role are unknown. Among lots of factors promoting neurogenesis, we focused on fibroblast growth factor-2 (FGF-2), because it is known to be an important factor for neural stem cell culture. In our study, neurogenesis was upregulated in the dentate gyrus (DG) following cerebral ischemia and kainic acid-induced seizure in wild type animals, but it was reduced in FGF-2-- mice. When FGF-2 was overexpressed using gene transfer technique with herpes virus vector, neurogenesis was upregulated, and, furthermore, degenerative changes of the hippocampus after traumatic brain injury were also reduced. These results suggested that FGF-2 is a critical factor to regulate neurogenesis in the DG after brain injury. Administration of growth factors after brain injury may provide a strategy for repair of the brain following neuronal injury and other CNS disorders.
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  • Fujiko Ando
    2004 Volume 41 Issue 1 Pages 61-64
    Published: January 25, 2004
    Released: March 02, 2011
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    Preventive medicine is supposed to be important for reducing bed-ridden (‘netakiri’, in Japanese) or frail elderly people. Previous studies showed that only about 30% of the bed-ridden elderly had decreased their ADL levels directly due to diseases, such as cerebrovascular disease or hip fracture. One of the other important causes of ‘Netakiri’ is disused syndrome. A few weeks after staying in bed, not only muscle power but also bone mineral density and intellectual interest often decrease in the elderly. Rehabilitation in daily life is expected to prevent disused syndrome. House-bound (‘tojikomori’, in Japanese) is supposed to be another cause of reduction of ADL. There are miscellaneous causes of tojikomori. Aging is one of the most important factors, but cannot be modified. Physical, mental, social or environmental factors are also important. Participation in social activity, improvement of intellectual interest and habitual physical excise, as well as prevention of diseases, is expected to be useful for preventing ‘tojikomori’ and ‘netakiri’ in the elderly.
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  • Naoki Fujimoto
    2004 Volume 41 Issue 1 Pages 65-67
    Published: January 25, 2004
    Released: March 02, 2011
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  • Masuo Morimoto
    2004 Volume 41 Issue 1 Pages 68-71
    Published: January 25, 2004
    Released: March 02, 2011
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  • Tokiko Yamada
    2004 Volume 41 Issue 1 Pages 72-76
    Published: January 25, 2004
    Released: March 02, 2011
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  • Toshihiko Ihi, Kenshi Kumamoto
    2004 Volume 41 Issue 1 Pages 77-81
    Published: January 25, 2004
    Released: March 02, 2011
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    The purpose of this report is to elucidate the characteristics of elderly patients with tuberculosis (TB), based on 235 patients hospitalized in our institution from January 1999 to October 2001. The mean age of all patients was 60.8 years old and the male-to-female ratio was 2.1:1. The clinical features were compared between 121 patients aged 65 years old or more (elderly group) and 114 patients younger than 65 years old (non-elderly group). The time lag between onset of the symptoms and the first visit to a doctor was 19 days in the elderly and 49 days in the non-elderly (P<0.01). Previous therapy, extrapulmonary TB, and underlying diseases were significantly frequent in the elderly (P<0.05). Cavitation on chest X-ray film was found in 23% of the elderly and in 40% of the non-elderly (P<0.01). The frequency of positive smear was similar in the two groups. Peripheral blood lymphocyte count, serum total protein, albumin and total cholesterol were lower in the elderly who died during admission than in the living elderly (P<0.01). There was no significant difference in mortality due to TB between the two groups, although deaths due to non-tuberculous diseases were more frequent in the elderly. Pneumonia and other infectious diseases accounted for 50% of deaths in the elderly. Nutrition and infection other than TB should be taken into consideration in treating elderly patients with TB.
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  • Takehiko Ohura, Hiromi Sanada, Yoshio Mino
    2004 Volume 41 Issue 1 Pages 82-91
    Published: January 25, 2004
    Released: March 02, 2011
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    In recent years, the concept of cost-effectiveness, including medical delivery and health service fee systems, has become widespread in Japanese health care. In the field of pressure ulcer management, the recent introduction of penalty subtraction in the care fee system emphasizes the need for prevention and cost-effective care of pressure ulcer.
    Previous cost-effectiveness research on pressure ulcer management tended to focus only on “hardware” costs such as those for pharmaceuticals and medical supplies, while neglecting other cost aspects, particularly those involving the cost of labor. Thus, cost-effectiveness in pressure ulcer care has not yet been fully established.
    To provide true cost effectiveness data, a comparative prospective study was initiated in patients with stage II and III pressure ulcers. Considering the potential impact of the pressure reduction mattress on clinical outcome, in particular, the same type of pressure reduction mattresses are utilized in all the cases in the study. The cost analysis method used was Activity-Based Costing, which measures material and labor cost aspects on a daily basis. A reduction in the Pressure Sore Status Tool (PSST) score was used to measure clinical effectiveness. Patients were divided into three groups based on the treatment method and on the use of a consistent algorithm of wound care:
    1. MC/A group, modern dressings with a treatment algorithm (control cohort).
    2. TC/A group, traditional care (ointment and gauze) with a treatment algorithm.
    3. TC/NA group, traditional care (ointment and gauze) without a treatment algorithm.
    The results revealed that MC/A is more cost-effective than both TC/A and TC/NA. This suggests that appropriate utilization of modern dressing materials and a pressure ulcer care algorithm would contribute to reducing health care costs, improved clinical results, and, ultimately, greater cost-effectiveness.
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  • Ryuichi Kawamoto, Osamu Yoshida, Takaaki Doi
    2004 Volume 41 Issue 1 Pages 92-98
    Published: January 25, 2004
    Released: March 02, 2011
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    We conducted a comprehensive evaluation of the mental health of community-dwelling elderly people, and encompassed the physiological, psychological, social and environmental aspects of their lives. The study used a questionnaire similar to the one used by Matsubayashi et al in their study in Kahoku-cho. The Japanese version of General Health Questionnaire 12 (GHQ-12) was used to evaluate mental health. Responses were received from 2, 799 (81.5%) of 3, 432 Numura-cho residents. After eliminating inadequate responses, 1, 298 (37.8%) (586 men and 712 women) were analyzed. By setting mental health disorder, defined as a value of GHQ-12 exceeding 4.0, as the target variable, logistic regression analysis was conducted using the background factors as explanatory variables. Information related function (odds ratio: 0.45; 95% CI: 0.30-0.66), living with others (0.36, 0.14-0.94), presence of spouse (2.52, 1.14-5.59), economic condition (0.45, 0.22-0.91), family relationship (0.17, 0.05-0.52), work & sports (0.31, 0.14-0.67) and emotional support (0.67, 0.48-0.95) were found to be explanatory variables for mental health in the young elderly; as were activities of daily living (0.52, 0.35-0.79), Information related function (0.56, 0.35-0.90) and emotional support (0.37, 0.24-0.58) in the old elderly; as were activities of daily living (0.37, 0.19-0.70) and economic condition (0.32, 0.11-0.95) in the very old. For amelioration of the mental health of elderly persons living in the community, attempts should be made to improve the background factors clarified by the present study by efficiently utilizing health, medical and welfare services.
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  • Yoshihisa Hirakawa, Yuichiro Masuda, Takaya Kimata, Kazumasa Uemura, M ...
    2004 Volume 41 Issue 1 Pages 99-104
    Published: January 25, 2004
    Released: March 02, 2011
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    A byproduct of the aging of the population has been a dramatic rise in patients with dementia. The aim of the present study is to clarify the use of aggressive and palliative treatments, artificial nutrition and sedation in long-term care hospitals in Japan. We assessed 123 deaths in people aged 65 and older who died in two long-term care hospitals in and around Nagoya from January 2001 to December 2002. All deceased were divided into two groups according to their diagnosis of dementia. Data on the particular characteristics of the deceased, diagnosis of dementia, aggressive treatments (including CPR, intubation, mechanical ventilation, the use of systemic antibiotics and blood transfusion), palliative treatments (including oxygen, narcotic and nonnarcotic pain medication) artificial nutrition (including hyperalimentation and tube feeding) and sedation during the last six months of their lives were collected from medical charts. The prevalence of aggressive and palliative interventions did not vary significantly with the diagnosis of dementia except for the use of vasopressors. Artificial nutrition was prevalent and few patients received sedatives in either group. Patients with and without dementia received similar treatments in the end-stage. A greater understanding of the course of dementia is needed to further discussions on the terminal care of people with dementia. A national consensus on how to treat end-stage demented patients is also needed.
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  • Tsutomu Yamada, Sumihisa Sueyoshi, Sumie Ohni, Toshinori Oinuma, Masak ...
    2004 Volume 41 Issue 1 Pages 105-111
    Published: January 25, 2004
    Released: March 02, 2011
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    Peroxisome proliferator-activated receptors (PPARs) play an important role in vascular events during progression of atherosclerosis, associated with lipid metabolism, inflammatory response and others. To clarify relationships between the expression of PPARs subtypes and regression, we studied mRNA expression of PPARs subtypes with reverse transcriptase polymerase chain reaction (RT-PCR) and immunohistochemistry, especially in centrally depressed atherosclerotic plaques (depressed plaque) in the aortas of elderly patients, and proposed morphological feature of atherosclerotic regression. Samples were separated from the depressed plaque, atheromatous plaque, and diffuse intimal thickening (DIT) in the aortas of elderly patients at autopsy and they were analyzed for RT-PCR. The depressed plaques obtained were divided into two parts: depressed area and surrounding elevated area. Total RNA was prepared, using the TRIzol Reagent, and was reverse transcribed using random hexamer primers and Thermoscript kit for RT-PCR. Immunohistochemical analysis was processed for mouse anti-PPARγ antibody, detected by the ABC method. 1) Decreased foam cells were found in the depressed area than in the surrounding elevated area of the depressed plaque. These foam cells were immunohistochemically positive for HAM56 and strong reactivities for PPARγ were found in the nuclei of macrophage-derived foam cells. PPARγ was also detected in the nuclei of endothelial cells and smooth muscle cells. 2) Expressions of PPARα and PPARγ were found in the depressed plaques with RT-PCR. These expressions were found both in the depressed area and the surrounding elevated area without significant differences. 3) PPARγ mRNA expression both in the depressed area and the surrounding elevated area, was greater than in DIT, and was less than in the atheromatous plaque. 4) Expression of PPARγ mRNA was intense and increased in the surrounding elevated area than in the depressed area. 5) A significant increase of PPARγ expression was found in the atheromatous plaque than in the DIT. 6) There was no significant difference of PPARα mRNA expression between the depressed area and the surrounding elevated area. The depressed plaque has been considered to be a morphological characteristic of regression in recent studies. Expression of mRNA for PPARs was detected in the depressed plaque as well as the atheromatous plaque, furthermore, there were different expressions and intensity of PPARs between the depressed area and the surrounding elevated area of the depressed plaque. These findings suggest that the expression of PPARs may be involved not only in the progression of atherosclerosis but also in regression.
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  • Akiyoshi Ogimoto, Mareomi Hamada, Yuji Shigematsu, Yuji Hara, Hideyuki ...
    2004 Volume 41 Issue 1 Pages 112-116
    Published: January 25, 2004
    Released: March 02, 2011
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    We report a rare and unique case of possible extrapulmonary tuberculosis in an 83-year-old man who had cardiac tamponade and paroxysmal atrial flutter. The patient was admitted to our hospital because of syncope. The cardiac tamponade and paroxysmal atrial flutter were treated by pericardiocentesis and drainage of bloody pericardial fluid. Mycobacterium tuberculosis was not detected in diagnostic specimens, nor was any evidence of malignancy found. The remarkable elevation of adenosine deaminase and the predominance of lymphocytes in the pericardial fluid, considering the past history of tuberculosis, led to a diagnosis of extrapulmonary tuberculosis. After receiving standard antituberculous therapy by ethambutol, isoniazid, and rifampicin, the patient recovered and has remained well up to the present day. Thirty-six months have passed since his recovery without the recurrence of cardiac tamponade or any other cardiac events.
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  • Hidetoshi Hashida, Yoshihisa Hanayama, Toshio Honda, Yasushi Aibara
    2004 Volume 41 Issue 1 Pages 117-120
    Published: January 25, 2004
    Released: March 02, 2011
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    An 84-year-old woman began to have low fever below 38°C with slight lassitude from June 19, 2002. Despite oral administration of Clarithromycin for 3 days, the fever did not subside and the lassitude increased, so she was admitted to our department. While inflammatory findings were noticed, the cause was not identified by blood and imaging examinations (thoracoabdominal CT, etc.). Although her tuberculin reaction was positive, symptoms indicative of pulmonary tuberculosis were absent. Administration of Cefotiam and Imipenem Cilastatin sodium was ineffective. Pyometra was diagnosed. After drainage, the uterine cavity was washed every day. On the basis of culture of fluid retained a few colonies of Gram-negative bacteria were isolated, but were not identified, Cefpirome was administered, whereupon the fever subsided gradually, but mild inflammatory findings remained. Even after discharge on July 24, the retention increased, so drainage and washing were done repeatedly. However, mild inflammatory findings persisted. She began to have a fever from September 17 and was readmitted. After admission, administration of Flomoxef sodium was started, but no improvement was seen. A small amount of hydrothorax appeared on the left. Thoracocentesis yielded a bloody, slightly turbid exudative. Acid-fast staining and Mycobacterium tuberculosis specific PCR of pleural effusion were negative, but adenosindeaminase was 87.4U/l. Therefore, a diagnosis of tuberculous pleurisy was made. DNA/PCR of tubercle bacilli in the fluid retained in the uterus was positive, and re-retention was prevented by administration of anti-tuberculosis drugs. These findings suggest a strong possibility of tubercle bacillus having been the causative bacteria. Particularly in the case of the elderly, it appears important that pyometra be included in differential diagnosis as the cause of fever even without gynecological symptoms and that tubercle bacillus be considered the causative bacterium.
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  • 2004 Volume 41 Issue 1 Pages 121-128
    Published: January 25, 2004
    Released: March 02, 2011
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