Tatsuji Niimi

[Comprehensive functional assessment of the elderly in institutions, particularly in terms of social life].

The purpose of this study was to clarify aspects of social life in a comprehensive functional assessment of 160 elderly subjects, over 60 years of age, in institutions for the elderly. Five items were assessed: economic conditions, marital status, family conditions, family relationships and group behavior. The institutions were of 4 types: a geriatric hospital, a special nursing home for the aged, a home for the elderly and a home with moderate fees. The assessment of social life demonstrated significant correlation between the revised version of Hasegawas Dementia Scale, activity of daily living and physical conditions. Inter-institution comparisons revealed significant differences in terms of economic conditions for the home for the elderly, family conditions for the home with moderate fees, and family relationships and group behavior for the geriatric hospital. Total grades across the 5 items were significantly lower for the geriatric hospital cases. This assessment proved useful to illuminate aspects of social life of the elderly in institutions.

HCV antibody status in elderly Japanese

Abstract The incidence of HCV positivity and its relation to surgical and disease history was studied in elderly Japanese. The subjects included 230 individuals (97 men and 133 women) aged 60 to 102 years (mean: 79.2 years), and anti-HCV positivity was found in 42 cases (18.3%). More than 10% of the subjects in each age decade were anti-HCV positive, with the highest rate seen in the 60–69-year-old group (31.0%). No age-related differences in anti-HCV titer were observed. Twenty-eight of 32 subjects examined were HCV-RNA positive and analysis of HCV-RNA status revealed that most anti-HCV-positive subjects had a persistent HCV infection. About 60% of the anti-HCV-positive subjects had undergone surgery, supporting the conclusion that horizontal transmission via surgery or blood transfusion was an important route of HCV transmission. Liver dysfunction was noted in 33.3% of the anti-HCV-positive subjects, always in association with the presence of HCV RNA. Liver cirrhosis was diagnosed for two subjects, but no liver cancers were detected. One of two autopsied cases, a 91-year-old female who had undergone surgery 20 years before, showed characteristic features of chronic persistent hepatitis in spite of normal liver function tests before death. Our findings suggest that not only long-term monitoring for liver cirrhosis and liver cancer but also attention to the infection risk of transmission to others is needed in the care of elderly anti-HCV-positive individuals.

A case of an aged patient suspected of craniopharyngioma with a chief symptom of eunuchoidism accompanied with panhypopituitarism

A 78-year-old man with developmental disturbance of the genital organs and eunuchoidism was reported. He also had a high pitched voice, thickness of the lower lip and kyphosis of the thorax. He seemed to be fretful, but his intelligence was normal. Neurological tests revealed bilateral hemianopsia and decreased tendon reflexes. A plain skull radiograph clearly showed an egg shaped calcified mass extending upward from the sella turcica which resembled a ballooning shape. Brain CTs showed a high density round mass which expanded the sella turcica and raised the floor of the third ventricle. The inner part of the tumor showed irregular high density. T1-weighted MR imaging revealed an iso signal intensity, and T2 showed low signal intensity in the mass. These findings strongly supported the diagnosis of calcificated craniopharyngioma. Endocrinological study showed panhypopituitarism caused by the tumor compressing the pituitary gland and the hypothalamus. The main reasons why there were no apparent symptoms of hypopituitarism were because the receptors were up-regulated and secondarily because the thyroid and the adrenal cortical functions decreased while struggling to maintain balance with each other. There was also a possibility that these symptoms might have been masked by normal aging. Benign monoclonal hypergammopathy was also indicated, although we could not find a clear correlation between this finding and others.

[Clinical and pathological study of cerebrovascular disease in the 60-101 age group].

The purpose of this study is to clarify the clinical and pathological characteristics of cerebrovascular disease in nonagenarians and centenarians. In all autopsied cases from 1981 to 1986 (60-101 years old, 138 men and 157 women), cerebrovascular disease was observed in 32 cases (90-101 years old, 8 men and 24 women) and 174 cases (60-89 years old, 95 men and 79 women) in our hospital. The incidence of cerebrovascular disease was 58.3%, 68.8%, 75.1% and 64%, pathologically, in their sixties (60s), seventies (70s), eighties (80s) and over nineties (90s) respectively. In those who had cerebrovascular disease, cerebral infarctions were found in 79.9% of the cases of the under-90 group and 81.2% of cases of the over-90 group. In both groups, infarction was mainly found in over 2 regions, in the putamen, caudate, thalamus and in the white matter and cortex of the frontal lobe. In the over-90 group, the medium-sized infarctions decreased and small-sized infarctions increased. Cerebral hemorrhages were found in 16.1% of cases in the under-90 group and 12.6% of cases in the over-90 group. In the over-90 group, large-sized hemorrhages were found in 75%, and the incidence of hemorrhages was 50%, 50% in the lentiform nucleus and the subcortex respectively. The frequency of mental symptoms, frontal signs and oral dyskinesia in the over-90 group was significantly higher than in the under-90 group. The onset of cerebrovascular attacks was unknown in 43.8% cases.(ABSTRACT TRUNCATED AT 250 WORDS)

The relation between ECG findings and lesions of acute and old myocardial infarction in autopsy cases

Sixty-four elderly autopsy cases with acute myocardial infarction (AMI) were investigated in Nagoya Koseiin Geriatric Hospital. First AMI was observed in 35 cases, and recurrent AMI in 29. The primary causes of death were cardiac rupture and congestive heart failure in the first AMI and the recurrent AMI, respectively. The most frequent ECG findings before AMI were ischemic ST-T-change (57%) and Q-QS abnormality (41%) on the first and recurrent AMI, respectively. The ECG findings were normal in 6 (21%) of 29 recurrent MI cases. There was a tendency towards Q-QS abnormality in large size old MI, but not in small size MI. In 29 cases with recurrent AMI, the positional relationship between the old MI and the AMI was classified into 3 groups of different area, same area, and different and same area according to the Maccarie classification. The frequency in our cases was similar in the 3 groups. Ten cases with different area were further classified into 3 groups, i.e. opposite, adjacent, and opposite and adjacent. Opposite cases consisted of 4 (40%) cases, while opposite and adjacent consisted of 6 (60%). It is suggested that the recurrent AMI is more likely to be fatal when AMI occurs opposite to a previous lesion rather than adjacent to an old lesion.