Osteoporosis treatment aims to prevent fractures and maintain the QOL of the elderly. However, persons at high risk of future fracture cannot be effectively identified on the basis of bone density (BMD) alone, although BMD is used as an diagnostic criterion. Therefore, the WHO recommended that absolute risk for fracture (10-year probability of fracture) for each individual be evaluated and used as an index for intervention threshold. The 10-year probability of fracture is calculated based on age, sex, BMD at the femoral neck (body mass index if BMD is not available), history of previous fractures, parental hip fracture history, smoking, steroid use, rheumatoid arthritis, secondary osteoporosis and alcohol consumption. The WHO has just announced the development of a calculation tool (FRAX: WHO Fracture Risk Assessment Tool) in February this year. Fractures could be prevented more effectively if, based on each country's medical circumstances, an absolute risk value for fracture to determine when to start medical treatment is established and persons at high risk of fracture are identified and treated accordingly.
Aim: The Ubiquitin (Ub)-proteasome system maintains cellular homeostasis through proteolysis, and Ub appears in the damaged cells of many organs. Nonspecific interstitial pneumonia (NSIP)in elderly patients was studied to clarify the relationship between Ub-positive cells, cellular damage, and resistance to therapy. Methods: Specimens of surgical lung biopsy with the NSIP pattern (NSIP/P) from 13 patients (mean age, 68 years old) were examined histologically and immunohistochemically. Pneumocytes examined under high-power microscopy were counted for eosinophilic inclusion bodies and Ub-positive cells. NSIP/P was histologically evaluated and cases were scored for erosion and intraluminal granulation tissue subtypes (polypoid, mural, or occluded) as lung injury markers. NSIP/P was subdivided into cellular NSIP and fibrosing NSIP according to the proportions of interstitial inflammation and fibrosis. Results: 1) Six of 13 patients with NSIP/P had Ub-positive cells (Ub+ group), and all inclusions identified by light-microscope were positive for Ub. A greater number of Ub+ pneumocytes were found compared with the inclusions by light-microscope, and Ub immunostaining was useful for the detection of the inclusions. 2) Granulation tissue scores in the Ub+ group were significantly greater than in the Ub- group (p<0.05); there was no difference in granulation tissue subtypes between the groups. 3) Granulation tissue scores in fibrosing NSIP/P (including each subtype) were significantly greater than in cellular NSIP/P. 4) After a follow-up period, there was no correlation between Ub+ group and NSIP therapy resistance or between the granulation tissue subtypes and therapy resistance. Conclusion: Some elderly patients with NSIP had inclusions, and these inclusions were Ub+. Pneumocyte injury might occur via the Ub-proteasome system pathway in elderly patients with NSIP/P, although there was no correlation between Ub+ pneumocytes and therapy resistance.
Purpose: This study assessed the effects of an unsupervised exercise training program at home on exercise function and health related quality of life (HRQOL) in patients with chronic obstructive pulmonary disease (COPD). Methods: Forty-two patients with COPD (age 72.9±7.7 years; all males) were assigned to the exercise group (n=32) or the no-exercise group (n=10). The exercise group received a video recording of respiratory exercises to help them perform this program at home for six months. The no-exercise group did not receive any exercise program. The outcome measures were forced expiratory volume in one second (FEV1), vital capacity (VC), MRC dyspnea scale, 6 min walking distance (6MWD), shuttle walking distance (SWD), Borg scale and chronic respiratory disease questionnaire (CRQ) which includes four domains: dyspnea, fatigue, emotional function, and mastery. Results: Patients completing this study consisted of: 19 patients in the exercise group, and 7 patients in the no-exercise group. Seventeen of the patients in the exercise group performed respiratory exercises every day for six months. We did not find any significant change in pulmonary function and dyspnea in either group. Significant improvements were achieved in 6MWD, SWD, CRQ (Dyspnea, Mastery) in the exercise group only. Conclusion: Our study suggested that unsupervised exercise training program at home consisting of respiratory exercise improved of exercise tolerance and HRQOL in patients with COPD.
Aim: It has become important for elderly to live better rather than to live longer. There have been many reports about quality of life (QOL) of the elderly, but we have no knowledge about the relation between the QOL and the cognitive function. We investigated the relationship between the QOL and the cognitive function among community-dwelling elderly. Methods: A total of 12,059 community-dwelling elderly were invited to join a cognitive screening study by telephone (TICS-J) combined with a mailed QOL questionnaire. Among them, 1,920 subjects (age 71.87±5.50 (mean±SD) years old, duration of education 11.08±2.61 years) who completed both TICS-J and QOL questionnaire were actually measured. TICS-J was administered by the previously reported method, and the QOL questionnaire was developed based on the component of QOL proposed by Lawton, and consisted of 6 subscales (daily activity, satisfaction with health, satisfaction with human support, satisfaction with economic state, symptoms of depression, and positive mental attitude). Correlations were analyzed among the scores of TICS-J, age, duration of education, and scores on each QOL subscale. Multiple linear regression analysis was conducted after QOL subscale scores, adjusting for gender, age, and duration of education, were entered as dependent variables. Results: Four out of 6 subscales scores of QOL showed significant differences between men and women. All QOL subscale scores showed significant differences between the two groups in the TICS-J scores. Partial correlations were seen among TICS-J scores and each QOL subscale score. Multiple linear regression analysis revealed significant influence of cognitive function by TICS-J on QOL subscales scores. Conclusions: Cognitive function was considered to have more influence on QOL scores than gender or age. TICS-J and the QOL questionnaire in this study were useful to evaluate the outcome of welfare in community-dwelling elderly.
Aim: This study aimed to clarify whether age-related changes affect the short-term postoperative improvement of physical functions and abilities in compressive cervical myelopathy by comparing elderly and non-elderly cervical myelopathy. Methods: A total of 56 patients with cervical myelopathy who were candidates for surgery (63.1±11.5 years; 40 men, 16 women) were investigated. Written consent to participate in this study was obtained from all participants. The following items were assessed before and/or a month postoperatively; six basic characteristics (Hattori's classification, symptom duration, comorbidity, Pavlof ratio, dynamic instability of cervical spine and cervical intramedullary high intensity change); one motor and one sensory function in the lower and upper extremities, respectively; two walking abilities; one manual dexterity. After division into the elderly group (≥65 years) and non-elderly group (65 years>). basic characteristics, physical functions and abilities were compared between the two groups. Results: The elderly group consisted of 27 participants (72.7±5.2 years; 16 men, 11 women) and the non-elderly group consisted of 29 participants (54.1±8.1 years; 24 men, 5 women). In the 6 preoperative characteristics, the rate of having comorbidity in the elderly group (63.0%) was significantly greater than the non-elderly group (27.6%). Most comobidities were orthopedic disorders. Preoperative motor function in the lower extremity in the elderly group was significantly inferior to the non-elderly group, whereas the improvement rate based on preoperative finding at a month postoperatively was equal to the non-elderly group. Preoperative walking abilities were significantly inferior to the non-elderly group, although their improvement rates were equal to or significantly greater than the non-elderly group. Moreover, preoperative upper extremity motor function and manual dexterity in the elderly group were equal to those in the non-elderly group, and their improvement rates were also equal. Conclusions: Preoperative motor function in the lower extremity and walking abilities in elderly cases of compressive cervical myelopathy were significantly inferior to non-elderly cases of cervical myelopathy, although their improvement rates based on preoperation at one month postoperatively were equal to or significantly greater than non-elderly cases of cervical myelopathy; therefore age-related change is not a directly negative factor for short-term postoperative improvement.
The differential diagnosis between polymyalgia rheumatica and elderly-onset rheumatoid arthritis is difficult because these diseases share similar clinical findings, especially at onset. We report a case of elderly-onset rheumatoid arthritis that was distinguished from polymyalgia rheumatica with malignancy. A 77-year-old woman was admitted to our hospital because of pain and bilateral stiffness in her shoulders and her hips. Tests for rheumatoid factor and anti-cyclic citrullinated peptide antibody were negative. Bone erosions and joint space narrowing were not detected radiographically, and polymyalgia rheumatica was suspected. Her arthralgia disappeared with a few days after treatment with prednisolone (10 mg per day) was started, and ESR and CRP were normalized. Computed tomographic scanning of the chest showed a nodular lesion in the right lower lobe, and biopsy revealed lung cancer. Positron-emission tomography with 18F-fluorodeoxyglucose (FDG) performed before lung surgery showed increased uptake of FDG in the bilateral shoulder joints and wrist joints. Enhanced MRI showed synovitis and bone erosions in the right acromioclavicular joint and bilateral carpal bones and also radiographically bone erosions were seen in the carpometacarpal joint of the right thumb. Therefore, a diagnosis of elderly-onset rheumatoid arthritis was made. In patients with polymyalgia rheumatica, the detection of rheumatoid synovitis should be routinely evaluated.
We report the case of a primary gastrointestinal stromal tumor (GIST) found in the greater omentum of an extremely elderly woman. A 99-year-old woman with a history of heart failure and renal failure presented with dyspnea and disturbance of consciousness. A tumor located between the stomach and spleen had been detected by abdominal computed tomography three years previously. After admission, she received oxygen supplementation and diuretics. However she died of heart failure and disseminated intravascular coagulation on the 31st day of hospitalization. Autopsy was performed on the same day. A large mass measuring 12.5×7.0×7.5 cm was revealed, originating from the greater omentum. Histopathologically, it was composed of spindle cells with the nuclei showing a focal palisading pattern, however there were no mitoses. Immunohistochemically, the tumor was positive for c-kit. The tumor was diagnosed as a primary GIST of the greater omentum.
A 79-year-old woman was suffered from rapidly progressive paresthesia of lower limbs and gait disturbance. After one month, she showed flaccid paraplegia and hyperreflexia in the lower limbs with positive Babinski signs. Anti-HTLV-1 antibody titer was elevated in the serum, but negative in the cerebrospinal fluid (CSF). CSF examination showed mild pleocytosis, elevated protein, and normal glucose content. Adult T cell lymphoma (ATL)-like cells were seen in the CSF. MRI showed no abnormal intensity in the spinal cord and brain. Two months later, she showed rapid worsening of the paraplegia and she became unable to stand. A tentative diagnosis of rapidly progressive HTLV-1 associated myelopathy (HAM) was given, but intravenous methylprednisolone was ineffective. Six months later, she developed pneumonia, and abundant ATL cells were seen in the peripheral blood, suggesting a diagnosis of ATL. Direct infiltration of ATL cells to central nervous system was therefore suggested to have caused neurological abnormalities in this case. One may consider central nervous system leukemia when rapidly progressive HAM-like symptoms and signs are recognized, especially without positive anti-HTLV-1 antibody in the CSF.