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AIM We assessed health-related quality of life (HRQOL) of community-dwelling older people who practiced Tai Chi in a cross-sectional study using the MOS 36-item short-form health survey (SF-36, Japanese version). METHODS SF-36 and another questionnaire about age, sex, experience with Tai Chi, were distributed to 903 people who were above 65 years old and belonged to the Japan Health Tai Chi Association. Of these, 804 people responded (89.04%). From the SF-36, we used the sub-scores for physical functioning (PF), physical role (PR), bodily pain (BP), general health (GH), vitality (VT), social functioning (SF), role emotional (RE), and mental health (MH). These sub-scores were compared with those obtained from age-matched national standards for groups 60 to 69 years old and 70 to 80 years old respectively (n=1.040). RESULTS The 60- to 69-year-old subjects had significantly higher PF (p

Over the past 10 years (1992-2002) the physical activity of healthy elderly (over 65) has been more youthful by 7.5 years in men and 10 years in women. Functional independence in elderly diabetic patients (over 65) has been more youthful by 15 years. pathological examination revealed that the cerebral arteries have been more youthful by 20 years in men and 10 years in women during the past 14 years (1986-2000). Based on these data, the current definition of elderly (65 year over) should be changed to those over 75 years. Changing the social system (retirement, pension, medical care etc.) to harmonize with the coming aging society is a matter of great urgency.

Hypercholesterolemia reduces production of nitric oxide (NO), a potent inhibitor of platelet aggregation, in endothelial cells. Recently platelet has been found to have NO synthase. Hypercholesterolemia may influence platelet NO production. We investigated NO-dependent inhibition of platelet aggregation in elderly hypercholesterolemic patients with total cholesterol (Tchol) of 240 mg/dl or more (n = 21). In elderly controls with Tchol less than 240 mg/dl (n = 61), L-arginine (5-50 mM) inhibited ADP-induced platelet aggregation in a dose-dependent manner (42.4% inhibition at 50 mM). However, L-arginine did not inhibit platelet aggregation in elderly hypercholesterolemic patients. L-arginine increased cyclic GMP production in elderly controls, but not in hypercholesterolemic patients (p < 0.02). Hypercholesterolemic patients showed increased platelet aggregation compared with elderly controls(p = 0.018). L-nitro-arginine methyl ester 12.5-50 uM increased platelet aggregation in both groups. Superoxide dismutase improved L-arginine inhibition of platelet aggregation in elderly hypercholesterolemic patients (p = 0.02). LDL cholesterol of 160 mg/dl or more was an independent predictor for loss of L-arginine inhibition of platelet aggregation (relative risk 3.9, p = 0.0098). This result suggests that hypercholesterolemia causes decreased NO-dependent inhibition of platelet aggregation due to reduced NO utilization. NO-dependent platelet aggregation may be a powerful tool for detection of vascular injury.

More than 100,000 people suffer from functional urinary incontinence in Japan. To improve the quality of life of these people, we tested a device for monitoring micturition by means of a thin-layer membrane sensor in a diaper. The device was tested in elderly inpatients, and associated changes in the wordload of the nursing staff were also recorded. The device was beneficial because the precise micturition time was easily obtained and thus the daily pattern of micturition became obvious. With the use of this device, the time during which the patients wore wet diapers was shorter than with the conventional system of scheduled changes. However, the increase in the frequency of diaper changed doubled the workload of the nursing staff. In conclusion, improving the quality of life with regard to urinary incontinence entails an increase in the workload of the nursing staff; efficient distribution of that work may require some staff members to devote all their time to changing diapers.

To help plan for the future of undergraduate education in geriatric medicine in Japan, we reviewed the literature concerning undergraduate teaching of geriatric medicine in western countries. Undergraduate teaching in geriatric medicine in the UK is well developed: 22 of 25 universities have a full department of geriatric medicine. Training in geriatric medicine is mandatory in almost all universities. In contrast, geriatric medicine is an elective in most universities in the US. There is a shortage of geriatric medicine faculty in the US, which is similar to the situation in Japan. Clinical and basic research in geriatric medicine and gerontology should be encouraged to attract persons into this field.

A 76-year-old woman was admitted to our hospital because of productive cough, fever and anorexia in January 1995. She had suffered from bronchial asthma for 25 years. From 1983, exacerbation of PIE was recorded three times, on which occasions prednisolone and antibiotics were quite effective. On admission, marked leukocytosis (28,000/microliters) and eosinophilia (18,000/microliters) were found. However, plasma IgE level was normal, and specific antigen for eosinophilia was not detected by RAST or the skin allergic reaction test. Chest X-ray film and CT scan revealed extensive bilateral pulmonary infiltration. Increase in eosinophils (33%) was demonstrated in bronchoalveolar lavage. Furthermore, biopsy specimen of the affected lung revealed diffuse infiltration of eosinophils into alveolar septa. On the basis of these findings, the patient was diagnosed as chronic eosinophilic pneumonia (PIE syndrome). Hyponatremia (117 mEq/l) was persistent after the hydration with normal saline. Plasma ADH was not suppressed (2.29 pg/ml) in spite of hypoosmolality of plasma. Laboratory examination showed that renal, adrenal and thyroid function as well as plasma renin activity were normal. Taking these findings together, she was diagnosed as having SIADH. Treatment with prednisolone improved not only the PIE syndrome but also SIADH.

We studied two cases of the elderly with acute exacerbation of interstitial pneumonia to elucidate a prognostic role of super oxide generation in peripheral whole blood. The first case was a 70-year-old man, who presented with acute exacerbation of interstitial pneumonia and was hospitalized. Following steroid-pulse therapy, CRP, ESR, blood-gas and his physical condition improved, resulting in successful discharge. In this case, super oxide generation standardized by the number of neutrophils (K) decreased to less than 1.0 in association with the improvement of physical condition. The second case was a 92-year-old woman in whom acute exacerbation of interstitial pneumonia was diagnosed. While the pulse therapy, CRP, LDH and blood-gas temporarily improved, K was continuously greater than 1.0 and the physical condition worsened, resulting in her death. These cases suggest that the measurement of super oxide generation in peripheral whole blood may play a useful role in assessing the prognosis of the elderly with acute exacerbation of interstitial pneumonia.

Since behavioral disturbance among patients with dementia is a great burden for their caregivers, quantification of behavioral disturbance is essential in determining disease severity and assessing the impact of the disease on caregivers. However, the method of its quantification for objective assessment is not established yet. We studied the reliability and validity of a Japanese version of the Dementia Behavior Disturbance Scale (DBD Scale) which was originally developed by Baumgarten et al. We also studied the relationship between DBD scores and the degree of burden felt by caregivers. Our subjects consisted of 27 cases with dementia (mean age 77.7 years), and 17 cases of patients with neurological disorders without dementia (76.8 years), and 10 institutionalized patients with dementia (82.3 years). The test-retest reliability, internal consistency, and inter-rater reliability were very good; the coefficient of correlation between DBD scores at the two interviews was 0.96, the coefficient of internal consistency was 0.95, and the intraclass correlation coefficient was 0.71 +/- 0.10. DBD scores correlated significantly with SPMSQ errors and caregivers' burden; r = 0.54 and 0.53, respectively. Our results indicate that the DBD Scale is highly reliable, and may be useful for objective assessment of behavioral disturbance and caregivers' burden.

A 73-year-old male was admitted to Tokyo University Hospital due to cardiac arrest secondary to ventricular arrhythmias. Although the patient survived after cardiopulmonary resuscitation, he needed mechanical ventilation. When we tried to wean the patient from mechanical ventilation, we found that he suffered from frequent sleep apneas of over 40 times/hour. To evaluate the severity and frequency of the apneas, we performed polysomnographic study on the patient under assist ventilation. The polysomnographic study revealed that frequency of apneas was very high but the magnitude of desaturation was not so severe during the night. Since we confirmed the lowest SaO2 in this patients was over 90% during day and night, we tried to wean from the patient from the ventilator again and succeeded. The clinical application and usefulness of nocturnal ventilatory monitoring for patients with mechanical ventilation was discussed.

The authors investigated the concentrations of multiple neurochemicals (6 kinds of catecholaminergic and 5 kinds of indolaminergic substances) in the lumbar cerebrospinal fluid (CSF) of patients with and without senile dementia (13 Alzheimer type (AD), 7 vascular type (VD), 11 Parkinson's disease (PD) and 9 non-demented controls (C)) by means of a neurochemical analyzing system (Neurochem, ESA). By means of the enzyme-linked immunosorbent assay (ELISA), we also determined the concentration of alpha 1-antichymotrypsin (ACT) in the CSF, which may be a possible diagnostic biochemical marker of the senile dementia of Alzheimer type. ACT in CSF was significantly higher in the AD group. It correlated negatively with Hasegawa's dementia scale (HDS) significantly. It also correlated negatively with the concentration of HVA significantly and showed tendency to correlate with the concentrations of dopamine and the ratio of kynurenine and tryptophan (KYN/TRP). Each dementia group showed characteristic concentration patterns of neurochemicals (DA, HVA, MHPG/NE, KYN/TRP, and 5-HIAA/5-HT). Our approach may provide a new quantitative method to diagnose geriatric neuropsychological diseases as well as senile dementia.

This study was conducted to examine the nocturnal ventilatory parameters and gas exchange in the elderly with nocturnal disturbed breathing. In order to facilitate analysis of ventilatory parameters with minimum manpower, we developed an unattended continuous nocturnal monitoring system for ventilation and arterial oxygen saturation. Using this system, nocturnal ventilatory parameters and gas exchange were investigated in our geriatric ward. We investigated 30 elderly subjects aged between 65 and 94 (mean age 77.8 +/- 6.5 years, male; female = 15:15). The subjects were free of severe cardiovascular and cerebrovascular disorders, and underwent 10 hours of continuous monitoring of ventilation and arterial oxygen saturation (SaO2). Number of significant desaturation (SDS; desaturation greater than 4% in SaO2 from the baseline value) and desaturation index (DI; sigma SDS(%) x duration (hour)) were calculated using the same system. The number of apnea episodes significantly correlated with DI and the number of SDS. DI also significantly correlated with lowest SaO2, while the number of SDS and the number of apneas were not found to be correlated with lowest SaO2. The number of SDS and the number of apnea episodes did not correlated with lowest SaO2. From the view point of gas exchange during the night, newly introduced DI is more comprehensive parameter when compared with the number of apneas or SDS. Subjects with a DI of over 0.5 were assigned to the group A (n = 8, mean age = 77.8) and the remaining subjects were assigned to group B (n = 22, mean age = 77.8). We compared the group A with the group B regarding nocturnal ventilatory parameters and SaO2.(ABSTRACT TRUNCATED AT 250 WORDS)

To evaluate the efficacy of the single dose chemoprophylaxis of recurrent urinary tract infection (UTI) in the elderly, 20 female inpatients (mean age 81.4) who had one or more culture documented UTIs in the past 12 months were studied. They were randomly assigned to be treated for 6 months either with chemoprophylaxis (200 mg of norfloxacin) or conventional therapy (without any antimicrobials except when overt UTI occurred). After a 4 months of washout period, the protocols were exchanged with each other and next 6 months of trial was carried out. All cases were followed at least 4 months after the discontinuance of the chemoprophylaxis. The difference of efficacy between the two modalities was evaluated by periodical examinations of urine cultures, urinalysis and inflammatory markers. During chemo-prophylaxis, the frequency of the symptomatic UTI (bacteriuria greater than 10(4)/ml, pyuria greater than 5/HPF, CRP greater than +) was 0.267/patient.year which was significantly lower than during conventional therapy (2.97/patient.year, p less than 0.01). This prophylactic effect remained 4 months after the discontinuance of the drug. On the other hand, bacteriuria was persistent in more than half of patients with chemoprophylaxis. Minimal inhibitory concentration of norfloxacin for separated bacteria revealed that the resistant species steeply increased from 4 to 6 months after the beginning of chemoprophylaxia. These species disappeared 4 months after the drug was discontinued. Optimal durations of chemoprophylaxis and drug-holidays were discussed.

Fifteen patients aged over 65 years of age with advanced non-small-cl lung cancer (mean age = 70.7, stage IIIb: IV = 4:11) were treated with combination chemotherapy consisting of Cisplatin (50 or 80 mg/m2) and a vinca-alkaloid (Vindesine 3 mg/m2 or Etoposide 80 mg/m2). The effectiveness and side effects of this cisplatin therapy in different combinations of vinca-alkaloid regimens (Vindesine vs Etoposide) were examined. The mean dose of Cisplatin in the Etoposide combination group (75.2 mg/m2) was significantly higher than that in the Vindesine combination group (54.3 mg/m2) (p less than 0.01). A notable reduction the tumor size was observed in 25% of the Etoposide group, only. The 6-month survival rate and one-year survival rate were respectively 85.7%, 57.1% in the Vindesine + Cisplatin group, and 87.5%, 50% in the Etoposide + Cisplatin group. The common side effects were nausea, vomiting, anorexia, and alopecia. These symptoms were either alleviated by antiemetic drugs or followed by spontaneous recovery. Leucopenia, anemia and thrombocytopenia were found in both groups, and there was no difference in the time course of myelosuppression between the two groups. The extent of nephrotoxicity was assessed by creatinine clearance rate. Its decrease in the Vindesine group (60.1----38.9 ml/min) was higher than that in the Etoposide group (64.9----48.9 ml/min), while there was no significant change in BUN, serum creatinine and urine NAG between the two groups. There were no cases in which chemotherapy schedules had to be interrupted due to myelosuppression and nephrotoxicity.(ABSTRACT TRUNCATED AT 250 WORDS)

94-year-old male patient, with orthostatic hypotension, possibly due to impairment of vasoconstriction and parasympathetic nervous system dysfunction was reported. This patient experienced faintness and lower muscle weakness on standing. The blood pressure was 180/90 mmHg in a supine position, while it significantly decreased to 100/58 mmHg in an upright position. There was no evidence indicating the presence of organic brain diseases, cardiovascular diseases, and endocrine diseases, plasma catecholamine, renin, aldosterone, and vasopressin levels at rest were within normal range. Thus, the cause of orthostatic hypotension of this patient was unknown. His systolic blood pressure decreased by 70 mmHg, and his diastolic blood pressure also decreased by 25 mmHg in response to a 70 degrees head-up tilting test (170/71-100/46 mmHg). Plasma vasopressin level significantly increased in response to this test (0.62-67.2 pg/ml). Plasma catecholamine levels also increased (Adr 0.01-0.10 ng/ml, Ndr 0.05-0.22 ng/ml). Other autonomic nervous system examinations revealed normal responses to mental arithmetic test, hyperventilation test, cold pressure test, and adrenalin test. However, the results of the carotid occlusion test, acetylcholine test, atropine test, phenylephrine test were considered to be abnormal. From these findings, we concluded that the functions of sympathetic nervous system were almost intact, while the parasympathetic functions were impared in this case. The orthostatic hypotension of the patient as effectively treated with fludrocortisone. This report suggests that impairment of vasoconstriction and parasympathetic neurodysfunction might be involved in the development of orthostatic hypotension in the elderly.

In order to evaluate the degree of accuracy of measurement of total body bone mineral content (TBBMC) by dual photon absorptiometry (DPA), the TBBMC in four healthy male volunteers were measured serially for 3 to 12 months. In three to six determinations of TBBMC in various stage of radiation source (153-Gd), the coefficients of variation in four subjects were 1.59, 0.74, 1.25 and 1.27%. Thus, the mean CV was 1.22 +/- 0.35% (mean +/- SD). This indicates that the measurement of TBBMC using DPA is an accurate tool for long-term follow up of bone mineral content and up to 1.6% change of TBBMC might be considered to be a significant change in TBBMC. No apparent drift of TBBMC associated with source decay was noticed in the present study. Subsequently, fifteen females with osteoporosis were studied to evaluate the efficacy of certain therapeutic modes. The patients were divided into two groups. Group 1 (n = 10) given 10 to 40 U of elcatonin (eel calcitonin derivative) intramuscularly every week for 3 to 6 months. Group 2 (n = 5) were treated with 0.5 mu/day of oral 1-alpha-OHD3 for 3 to 6 months. The TBBMC of these fifteen patients were followed by DPA (Lunar DP-4). Seven patients out of ten treated with elcatonin (70%) showed significant (up to 1.6% change in TBBMC compared with baseline) increase in TBBMC after 3 to 6 months treatment. The mean percentage change in TBBMC in group 1 was 101.9 +/- 2.7% (mean +/- SD) when the initial TBBMC was taken as 100%.(ABSTRACT TRUNCATED AT 250 WORDS)

健常者, 代謝性骨疾患につきビタミンK依存性カルシウム結合蛋白質 (osteocalcin) の血中濃度を radioimmunoassay により測定し以下の成績を得た.1) 30～69歳までの健常者では血中オステオカルシン濃度に年齢差・性差は認められなかった. 30～39歳: 男子(n=18) M±SE 10.42±0.57ng/ml, 女子(n=10) M±SE 9.32±1.09ng/ml, 40～49歳: 男子(n=47)M±SE 9.57±0.35ng/ml, 女子(n=16) M±SE 10.00±0.83ng/ml, 50～59歳: 男子(n=33)M±SE 9.25±0.38ng/ml, 女子(n=14)M±SE 9.65±0.48ng/ml, 60～69歳: 男子(n=10)M±SE 9.77±0.97ng/ml, 女子(n=9)M±SE 10.10±0.68ng/ml, 以上30-69歳: total (n=157) のM±SEは9.68±0.20ng/mlであった.2) 血中オステオカルシン濃度は甲状腺機能亢進症, 慢性腎不全では健常者に比し有意の上昇を示し, 老人性骨粗鬆症では有意の低下を示した. 甲状腺機能亢進症 (n=39) のM±SE:17.29±1.56ng/ml(p

急性期を除く虚血性心疾患および脳血栓症を伴う動脈硬化症患者のうちの37例の耐糖能異常を示さない動脈硬化群 (AS群, 平均年齢68.4歳, HbA1: 平均±標準誤差, 7.1±0.1%), 29例の糖尿病群 (DM群, 平均年齢67.6歳, HbA1:10.2±0.4%) および健常群18例 (NC群, 平均年齢40.3歳, HbA1:6.9±0.3%) の3群を対象として, 血小板凝集能, β-トロンボグロブリン (β-TG), 血漿脂質, リポ蛋白, アポ蛋白, アンチトロンビンIII (AT-III), 線溶活性を測定し, 比較検討した. 血小板凝集能は比濁法を用いてADP, コラーゲン, アドレナリン, アラキドン酸による in vitro の血小板凝集能を, また Wu-Hoak 法による in vivo の血小板凝集能 (循環血小板凝集) をそれぞれ検討した. 血漿・血小板のβ-TGは radioimmunoassay 法により, アポ蛋白は一元免疫拡散法により測定し, 血漿AT-IIIは生理活性を, また線溶はユーグロビン溶解時間を測定した. その結果, ADP, コラーゲン, アドレナリン, アラキドン酸による血小板凝集能はいずれもAS群で最も亢進する傾向を示し, 次いでDM群, NC群の順に高かった. 循環血小板凝集ではNC群に比較してAS群, DM群で亢進傾向が示された. 血漿β-TGはDM群で最も高く, 次いでAS群, NC群の順であった. 血小板中β-TGもNC群, AS群に比較してDM群において増加傾向が認められた. 血漿脂質はNC群に比べてAS群, DM群で高値を示し, Apo A-I, A-IIは健常者で高値を示し, 3群のうちDM群で最も低い値を示し, またApo BはNC群に比べてAS群, DM群で高値を示した. 線溶活性はDM群で低下した. 従って, 糖尿病の macroangiopathy と非糖尿病のそれとの間の差異に血漿・血小板β-TG, 血漿脂質, アポ蛋白, 線溶の関与の方が in vitro の血小板凝集能の関与に比べて大きいと考えられた.