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Background —Angiotensin (Ang) II, a major regulatory factor for left ventricular mass, is generated from Ang I by ACE. ACE levels are associated with an insertion/deletion (I/D) polymorphism in the ACE gene. The ACE polymorphism should result in varied Ang II concentrations and hence affect left ventricular mass. We therefore investigated whether ACE genotype is a predictor of heart weight. Methods and Results —From 693 consecutive patients autopsied between 1994 and 1998 in our hospital, patients with valvular disease, myocardial infarction, or cardiomyopathy were excluded. The remaining 443 autopsy patients were the subjects of our study. The heart weight at autopsy was corrected for body surface area. Genomic DNA was purified from the kidney, and ACE genotype was determined by polymerase chain reaction. Heart weight in the DD genotype (249.9±49.9 g/m 2 ) was significantly higher than that in the ID (230.0±51.2 g/m 2 ; P 2 ; P r =0.145, P r =0.147, P =0.0019). Multiple regression analysis showed that a history of hypertension ( P P =0.0001), and DD genotype ( P =0.0154) were independent predictors of heart weight. Conclusions —ACE genotype predicts cardiac mass; however, it was less effective than epigenetic factors such as hypertension or age.

Gastric cancer in the elderly was evaluated with regard to age-related pathomorphological changes. Resected gastric cancer was studied with regard to location, stage, morphology and histology in male young old (65-74 years old) which were 25 cases and 31 lesions, respectively male middle old (75-84 years old); 104 cases and 120 lesions, male very old (85 years-); 96 cases and 110 lesions, female young old; 22 cases and 31 lesions, female middle old; 91 cases and 106 lesions, female very old; 51 cases and 55 lesions. Multiple gastric cancers were more frequent in female older group. In early cancer the frequency of elevated type increased significantly and that of depressed type decreased in very old group. In advanced cancer Borrmann I type was not so common in very old group. Histologically the frequency of signet ring cell cancer decreased and of tubular adenocarcinoma and of papillary adenocarcinoma increased significantly in female very old group. Hepatic metastasis increased significantly in male very old group. Lymph node metastasis and peritoneal metastasis did not show any change in age-related frequency.

The relation of aging to the length of the spinal cord and to the cross-sectional area at the levels of C6 and L3 of the spinal cord was studied in 140 autopsy cases who between the age of 47 to 105 without spinal cord lesions. In addition the effect of being bed-ridden on the spinal cord was studied in 11 of 140 cases. As pathological controls, we referred to 40 autopsy cases with compression change of the cervical cord. The length of the spinal cord had no correlation with aging but had a significant positive correlation with the height of the subject. A significant decrease in the cross-sectional area of the spinal cord was observed after the age of 80, in particular at C6. However, the extent of the decrease was not as serious as that of pathological control cases. Decrease of cross-sectional area was associated with that of white matter area. In addition, effect of being bed-ridden on the spinal cord was reflected in a significant decrease of the grey matter of the lumbar cord.

Two autopsy cases of aortitis syndrome (Takayasu's aortitis) in the elderly are presented. Case 1 was an 81-year-old woman in whom hypertension was observed at age 37, and difference of right and left arm blood pressure was pointed out at age 65. She was referred to the authors' hospital at age 72. Chest X-ray and computed tomography of the thorax indicated atypical coarctation and diffuse calcification of the aorta. Case 2 was a 69-year-old woman in whom hypertension was pointed out at age 49, and blood pressure in the arms was found to differ from that in the legs at age 63. Chest X-ray and computed tomography showed diffuse calcification and marked narrowing of the descending aorta. Pathological examination revealed marked calcification in the thickened adventitia of the aorta with mild atherosclerotic change. Irregular fibrotic changes of the adventitia and degeneration of elastic fibers of the media of the aorta were noted in both cases, and were consistent with Takayasu's aortitis. This disorder is common in young women and only a small number of elderly cases are reported although its incidence is increasing. Diffuse calcification of the aorta with an absence of inflammatory signs, which is frequent in older patients, were observed in both case. Systemic hypertension is the most important risk factor with coarctation of the aorta in Takayasu's aortitis. Bypass surgery is recommended in young patients, however in elderly patients, it is generally avoided, in favor of medical control of hypertension.

A Japanese man who died at age 85 had been followed since the age of 59, when he first presented. He had hypertension of 162/102 mmHg and a loud systolic murmur on his first visit. He had had an active daily life without any medication for the next 10 years. At the age of 72 he complained of mild chest discomfort on exercise. Although electrocardiography showed no abnormalities, echocardiogram showed calcified bicuspid aortic valve with mild stenosis. At the age of 81 the dyspnea and chest oppression were exacerbated, associated with marked ST depression on exercise electrocardiogram and restriction of aortic valve opening on echocardiograms. In the following years a gradual increase in QRS voltage and ST depression with T wave inversion were recorded on resting electrocardiograms and sharp increases in both left ventricular end-diastolic diameter and flow velocity at the aortic root were observed on echocardiograms. At the age of 85 he died of intractable heart failure with massive pleural effusion. Autopsy revealed marked hypertrophy and moderate dilatation of the heart (weight: 580 g). The bicuspid aortic valve had anterior-posterior cusps with a raphe on the anterior cusp. The mobility of the cusps was almost lost because of severe calcification and thickening. Severe stenosis was found near the orifice of the right coronary artery, but there were no significant ischemic myocardial lesions.

It has been assumed that amyotrophic lateral sclerosis (ALS) involves precocious senility as one of its pathogenetic aspects. The authors studied 55 autopsied cases of ALS in relation to age at death, ranging from 42 to 86. The materials consisted of 8 cases in the fifth decade, 8 in the sixth, 20 in the seventh, 12 in the eighth, and 7 in the ninth. The total duration of illness ranged from 6 months to 14 years. The most distinct relationship was observed in the anterior horn lesion of the cervical enlargement which became less severe with advancing age, irrespective of the length of illness. Fifth decade cases showed marked atrophy with severe neuronal loss and fibrillary gliosis in the anterior horn, while those in the ninth decade showed slight changes which were similar to age-matched controls. On the other hand, pyramidal tract degeneration did not show any correlation to age at death or to length of illness. Pyramidal tract degeneration was found in all younger age group cases, being always severe. In the older age groups, however, the degeneration varied extremely in degree from case to case. Some cases showed severe degeneration comparable with that in the younger age groups, while the others had no findings suggesting degeneration. In addition, cases on artificial respirators had a longer duration of illness, and more marked degeneration in the anterior horn, irrespective of age. Our study did not reveal that senile changes including senile plaques and neurofibrillary tangles were more marked in ALS cases. No clinicopathological correlation with dementia was recognized.(ABSTRACT TRUNCATED AT 250 WORDS)