In Japan, there are 21 million older people above 65 years, and about 8% of them are frail elderly. Geriatrics is to study the frail elderly as to why they become frail elderly, and to treat patients properly or the remaining 92% older people not to become frail elderly. In order to promote health of the older people, geriatricians have to take deep insights for cares as well as medical treatments. With such a will, we find the way to prevent diseases in the older people. In this review, we describe medical treatments and cares for promoting successful aging.
Tourniquets are used in extremity surgery and provide a relatively bloodless field, thereby minimizing blood loss and helping identify the vital structures. However, they may cause an ischemia-reperfusion injury with potentially harmful local and systemic consequences. Many therapeutic effects such as diuretic, natriuretic, hypotensive, anti-rheumatic, anti-prostatic, and in-vitro anti-oxidant effects of the Urtica dioica (UD) have been determined. In the present study, we aimed to investigate the potential role of UD plant for prevention of oxidative stress in muscle tissues generated by tourniquet application in rats. Wistar rats were used in this study. The UD extract or 1.15% KCl aqueous solution, in which UD leaf samples were homogenized, was given to each group of eight rats once a day for 5 days through an intraesophageal canule. No treatment was applied to untreated group. Tourniquets were applied to the left posterior limb of rats for 1 or 2 h followed by a reperfusion period of 1 h. After the ischemia and reperfusion, the rats were killed with a high dose of anesthetic drug, and malonyldialdehyde (MDA) levels were measured in their tibialis anterior muscles. Basal MDA levels were obtained from tibialis anterior muscles of 8 control rats, which were not exposed to ischemia. MDA levels were lower in the UD-treated rats than those in untreated and KCl-treated rats after either 1 or 2 h of ischemia and 1 h reperfusion. These results indicate that UD has a potential antioxidant effect on ischemic muscle tissues.
Staphylococcus epidermidis is one of the most common causes of postoperative infectious endophthalmitis, which is a serious complication of ocular surgery and penetrating trauma. Moxifloxacin is a newly developed fluoroquinolone with a potent antimicrobial activity. Corticosteroids are used in endophthalmitis to suppress devastating intraocular inflammatory response. This study was designed to assess the efficacy of intravitreal moxifloxacin alone and in combination with intravitreal dexamethasone. To the best of our knowledge, there is no published report demonstrating the effect of intravitreal moxifloxacin on bacterial endophthalmitis. One eye of each rabbit (n = 24) was infected by inoculation of 105 colony-forming units (CFU) of S. epidermidis into the vitreus cavity. Rabbits received intravitreal injection of moxifloxacin (50 μg) or a combination of moxifloxacin (50 μg) and dexamethasone (400 μg). No treatment was given to control group. Clinical and histopathological examination scores and microbiological analysis of vitreus aspirates were compared. In the treatment groups, the clinical and histopathological scores and mean CFU were significantly lower than those in the control group (p < 0.05) but showed no significant difference between the treatment groups. These results suggest that intravitreal injection of moxifloxacin is effective against S. epidermidis in this experimental rabbit model. Moxifloxacin may be a promising agent in the treatment of bacterial endophthalmitis.
The number of elderly subjects requiring care is rapidly increasing, however, their health status has not been well studied. The purposes of this study were to describe the health characteristics of the elderly at home who were using long-term care insurance, and to clarify factors that influence dependence for activities of daily living (ADL). The subjects were 194 elderly people living at home, who were approved for care. The items surveyed were the demographic characteristics, care level (or level of dependence for ADL), Barthel index, grip strength, thigh muscle volume, cognitive impairment using the mini-mental state examination (MMSE), depressed mood using the geriatric depression scale (GDS-15), and serum albumin and hemoglobin levels. The grip strength (p = 0.0001), thigh muscle volume (p = 0.0030), MMSE score (p = < 0.0001) and serum albumin level (p = < 0.0001) decreased, while the GDS-15 score (p = 0.0142) increased with deteriorating care levels. The proportion of subjects not requiring assistance for the items “bathing” and “stair-climbing” in the Barthel index was markedly low in the subjects belonging to the relatively low (mild) care levels. The logistic regression analysis showed that factors associated with dependence for “bathing” and “stair-climbing” were the use of day-services, male sex, decline of grip strength, and a high GDS-15 score. In conclusion, it is important to strengthen the muscles of the upper half of the body, and to correct depressed moods for maintaining levels of ADL in the elderly requiring care at home.
To assess the outcome of burn patients with neuropsychiatric disorders, we performed a 7-year retrospective review of burn patients admitted to the National Defense Medical College. Seventy-seven skin burn patients over 10 years of age were included in this study and divided into two groups, neuropsychiatry and control groups. The neuropsychiatry group consisted of self-inflicted burn patients (n = 21) and burn patients with a neurological disorder (n = 18), who could not move away from burning source due to neurological problems. The control subjects (n = 38) had been healthy before burn. No significant differences in the age, gender or causes of burn were observed between the two groups. Notably, total burned surface area, area of full-thickness burn, and mortality are greater in the neuropsychiatry group than those in the control. However, after matching the patients for the severity of burn injuries, the above parameters show no significant differences between the two groups. Therefore, the outcome of the burned patients depends on the patients' will and ability to move away from the burning source. Whenever we treat severe burn patients, we should assess their neuropsychiatric conditions.
Cadmium (Cd) is a toxic element ubiquitous in the environment, and general populations have been exposed to this element primarily via foods. Thus, the critical level of non-occupational Cd exposure to cause any health effects among general populations is of public health as well as toxicological concern. The objectives of the present study were to examine the quantitative relationship between cadmium (Cd-U) and β2-microglobulin in urine (β2-MG-U) as a marker of exposure to Cd and as a marker of renal tubular dysfunction, respectively, and to identify a threshold Cd-U, if present, in causing a substantial increase in β2-MG-U. Thus, paired data on geometric mean (GM) Cd-Ucr (i.e., Cd-U as corrected for creatinine [cr] concentration) and GM β2-MG-Ucr (β2-MG-Uas corrected for cr) of residents in polluted as well as nonpolluted areas in Japan were retrieved in international and domestic sources. In practice, 245 cases of the data pairs were obtained in 51 articles published since 1975. Statistical analysis on ordinary scales disclosed that β2-MG-Ucr increased markedly when Cd-Ucr exceeded a certain level. The relation between the two parameters after double-logarithmic conversion was in a shape of the letter J or a stick for ice hockey. Analysis for Cd-Ucr at the flexion point gave Cd-Ucr of 4 (on double logarithmic scales) or 7 μg / g cr (on ordinary scales). Cd-Ucr levels that correspond to a β2-MG-Ucr of 1,000 μg / g cr were estimated to be 8-9 μg / g cr, by ordinary and logarithmic assumption as well as by the 3rd degree regression analysis. Thus, it is concluded that there is a threshold Cd-Ucr level that leads to a substantial increase in β2-MG-Ucr, and that the threshold level is greater than 4 μg / g cr.
Pepsinogen, the precursors of pepsin, is classified into two subtypes: pepsinogen I (PG I) and pepsinogen II (PG II). Patients with impaired renal function are associated with elevated concentrations of serum pepsinogen. Contradictory results have been reported about the effect of dialysis on the serum pepsinogen levels, as the previous studies were conducted only in a particular period of dialysis. We therefore investigated the effect of continuous ambulatory peritoneal dialysis (CAPD) or hemodialysis on serum pepsinogen levels in patients with chronic renal failure (CRF) before and after dialysis treatment. Thirty-four patients with CRF were enrolled in this study and were treated by CAPD (n = 22) or hemodialysis (n = 12). As a control group, subjects with normal renal function were included (n = 20). Serum PG I and PG II levels were measured in control subjects and CRF patients before dialysis treatment and after three-month dialysis treatment. Before dialysis treatment, serum PG I levels were significantly higher in CRF patients than control subjects. In patients treated by CAPD, the serum PG I levels were significantly decreased but its levels were still higher than the values of the control subjects, whereas PG I levels remained unchanged in patients treated by hemodialysis. There were no differences in serum PG II levels between control subjects and CRF patients before or after dialysis treatment. Thus, CAPD is more effective than hemodialysis in the clearance of PG I.
Although the evaluation and treatment of patients with peripheral nerve injuries has evolved and improved over the years, there are still some arguments on the methods and results of surgery. We reviewed retrospectively the clinical, electrophysiological and surgical characteristics of peripheral nerve lesions for 1,636 nerves in 1,565 patients who had been managed in our department in a 10-year period. The most common cause of injuries was gunshot wound in 56.3% of all patients, followed by sharp lacerations (20.6%), fractures (10.6%) and tractions (5.1%). Among 1,636 cases of nerve injuries, the most frequently wounded nerve was median nerve (32.3%), followed by ulnar (24.1%), radial (12.1%), sciatic (10.7%) and peroneal nerves (7.7%), and brachial plexus (7.7%). Simple decompression was the most preferred technique for nerve repair in 27.8%. The electrophysiological improvement was observed in 66.8%, as assessed by electromyography. Clinical improvement was found in 58.4%, as judged by muscle strength grading. If the nerve is compressed or contused, but remains intact, the improvement is satisfactory after surgery. The type of injury, its time of occurrence, initial deficit, and degree of recovery expected are important issues in establishing the treatment plan, which may range from skilled observation to extensive surgical intervention.
Osteoporosis has been defined as a metabolic bone disease characterized by a loss of bone mineral density (BMD) greater than 2.5 standard deviations below young adult peak bone mass or the presence of fracture. By considering that some factors related to female reproductive system might influence the ultimate risk of osteoporosis, we aimed to investigate if a relationship exists between the present BMD of postmenopausal women with their past and present reproductive characteristics. The present study focused on how BMD could be affected by the following factors in postmenopausal women, such as age at menarche, age at first pregnancy, the number of pregnancies and total breast-feeding time. We reviewed detailed demographic history of 303 postmenopausal women. According to the results of the present study, a negative correlation was found between the number of parities and BMD. The BMD values decreased as the number of pregnancies increased. When the BMD values for lumbar vertebrae 2 and Ward's triangle were investigated, it was observed that a significant difference exists between the women with no child birth and those with more than five parities. There was a significant relationship between age at first pregnancy and BMD values at the lumbar vertebrae 2 and Ward's triangle. Women who had five or more abortions were found to have significantly lower spine BMD values compared to women who had no abortions or women who had one or two abortions. These findings indicate that the increased risk of osteoporosis is associated with the increased number of pregnancies and abortions and higher age at first pregnancy.
Nearly 80% of patients with temporal lobe epilepsy have some types of lesion identified by conventional 1.5 tesla (T) magnetic resonance imaging (MRI). We performed high-field 3 T MRI in a 5-year-old patient with recurrent complex partial seizures who was diagnosed as having right temporal lobe epilepsy based on the results of single photon emission computed tomography and ictal video-electroencephalogram monitoring, because 1.5 T MRI failed to detect any abnormalities in the suspected region. High-field 3 T MRI revealed a small high-intensity lesion on fast spin-echo short inversion time inversion-recovery images of the hippocampus, possibly responsible for the seizures. This is the first report detecting a hippocampal lesion by 3 T MRI, which could not be found by conventional 1.5 T MRI.
Hydatid disease is a parasitic disease caused by Ecinococcus granulosus characterised by cyst formation in various organs. The infestation mostly involves the liver. Hydatid cysts of the liver can rupture either spontaneously or due to trauma. Incidence of rupture is about 3-17% of all cases with hydatid disease. Unless treated surgically, rupture can result in death. Here, we present a case of hydatid cyst ruptured after a severe cough episode and disseminated first to the subcapsular area, then to the peritoneal space. Probably due to a decrease in parenchymal pressure in the liver after decompressive effect of rupture, the patient felt an improvement in abdominal pain, refused operation, and left the hospital on his own responsibility. This unfortunate relief resulted in a delay of 55 hours in management. The leakage of liquid materials into peritoneal space resulted in a severe inflammatory reaction and eventually death of the patient. The patient died of a late peritonitis rather than anaphylaxis, which is the most common reason for death in such patients. As a conclusion, physicians should be aware of a temporary relief in abdominal pain after cyst rupture that may cause a delay in management and in turn loss of patient due to peritonitis.