[Isolated systolic hypertension in the elderly]. / L'ipertensione sistolica isolata dell'anziano.

Isolated systolic hypertension is the most common type of hypertension in the elderly. A number of trials have widely shown that it is an independent risk factor for cardiovascular morbidity and mortality. This review focuses the prevalence of isolated systolic hypertension, its pathophysiology, diagnosis and treatment. The optimal treatment strategy is to maximize reduction in systolic blood pressure and to minimize reduction in diastolic blood pressure. All classes of antihypertensive agents can be used, but calcium antagonists, ACE-inhibitors and, more recently, the angiotensin II antagonists appear to be more successful in improving large artery stiffness and therefore are especially useful in treating isolated systolic hypertension in the elderly. A careful evaluation and treatment has to be made in particular in those patients with more risk factors, in order to choose the most appropriate drug and to avoid dangerous drug-drug interactions where polypharmacy occurs.

[Possibly ranitidine-induced autoimmune hepatitis]. / Verosimile epatite autoimmune da ranitidina.

Approved for clinical use in peptic ulcer in 1983, ranitidine competitively inhibits the interaction of histamine with H2 receptors. The incidence of adverse reactions has been low and generally minor. After reviewing the literature on hepatitis associated with ranitidine use, we report the case of a young woman, affected by multiple sclerosis, who developed severe liver injury associated with the intake of this drug. This case meets the principal criteria necessary to establish a causal relationship between the administration of a drug and the verification of an adverse reaction. The singularity of our case with respect to others reported in the literature arises from the demonstration of an anatomo-pathological picture suggestive of toxic or idiosyncratic hepatitis after the initial administration that, at rechallenge, evolved into a histologic picture of autoimmune hepatitis. We believe that physicians should be aware of the potential hepatotoxicity of ranitidine.

Do men and women follow different trajectories to reach extreme longevity? Italian Multicenter Study on Centenarians (IMUSCE).

Gender accounts for important differences in the incidence and prevalence of a variety of age-related diseases. Considering people of far advanced age, demographic data document a clear-cut prevalence of females compared to males, suggesting that sex-specific mortality rates follow different trajectories during aging. In the present investigation, we report data from a nationwide study on Italian centenarians (a total of 1162 subjects), and from two studies on centenarians living in two distinct zones of Italy, i.e., the island of Sardinia (a total of 222 subjects) and the Mantova province (Northern Italy) (a total of 43 subjects). The female/male ratio was about 2:1 in Sardinia, 4:1 in the whole of Italy, and about 7:1 in the Mantova province. Thus, a complex interaction of environmental, historical and genetic factors, differently characterizing the various parts of Italy, likely plays an important role in determining the gender-specific probability of achieving longevity. Gender differences in the health status of centenarians are also reported, and an innovative score method to classify long-lived people in different health categories, according to clinical and functional parameters, is proposed. Our data indicate that not only is this selected group of people, as a whole, highly heterogeneous, but also that a marked gender difference exists, since male centenarians are less heterogeneous and more healthy than female centenarians. Immunological factors regarding the age-related increase in pro-inflammatory status, and the frequency of HLA ancestral haplotypes also show gender differences that likely contribute to the different strategies that men and women seem to follow to achieve longevity. Concerning the different impact of genetic factors on the probability of reaching the extreme limits of the human life-span, emerging evidence (regarding mtDNA haplogroups, Thyrosine Hydroxilase, and IL-6 genes) suggests that female longevity is less dependent on genetics than male longevity, and that female centenarians likely exploited a healthier life-style and more favorable environmental conditions, owing to gender-specific cultural and anthropological characteristics of the Italian society in the last 100 years.

Mitochondrial DNA inherited variants are associated with successful aging and longevity in humans.

Mitochondrial DNA (mtDNA) is characterized by high variability, maternal inheritance, and absence of recombination. Studies of human populations have revealed ancestral associated polymorphisms whose combination defines groups of mtDNA types (haplogroups) that are currently used to reconstruct human evolution lineages. We used such inherited mtDNA markers to compare mtDNA population pools between a sample of individuals selected for successful aging and longevity (212 subjects older than 100 years and in good clinical condition) and a sample of 275 younger individuals (median age 38 years) carefully matched as to sex and geographic origin (northern and southern Italy). All nine haplogroups that are typical of Europeans were found in both samples, but male centenarians emerged in northern Italy as a particular sample: 1) mtDNA haplogroup frequency distribution was different between centenarians and younger individuals (P=0.017 by permutation tests); and 2) the frequency of the J haplogroup was notably higher in centenarians than in younger individuals (P=0.0052 by Fisher exact test). Since haplogroups are defined on the basis of inherited variants, these data show that mtDNA inherited variability could play a role in successful aging and longevity.

Intimal-medial thickness of the common carotid arteries and lower limbs atherosclerosis in the elderly.

BACKGROUND: In the present study, the authors consider the possible association between intimal-media thickness of the common carotid arteries and lower limb atherosclerosis, in a group of elderly patients; the authors also consider the presence of cardiovascular risk factors. METHODS: B-mode ultrasound measurement of the intimal-media thickness of the common carotid arteries was performed on 80 subjects. Lower limbs atherosclerosis was defined as the presence of intermittens claudicatio and/or ankle-arm index < 0.9. Baseline clinic examination and blood tests were performed in all subjects to consider the presence of cardiovascular risk factors. Linear regression analysis was used to assess the linear relationship between intimal-media thickness of the common carotid arteries and lower limb atherosclerosis. RESULTS: Linear regression analysis showed a statistical association between increased values of intimal-media thickness of the common carotid arteries and lower limb atherosclerosis. Sixty-four (80%) subjects presented one or more associated cardiovascular risk factors. CONCLUSIONS: The results of the the present study confirm that intimal-media thickness of the common carotid arteries is a marker for the identification of generalized atherosclerosis and may be useful for the identification of subjects, even at early stages, at risk of cardiovascular diseases.

Antidepressant drugs in the elderly.

1. In this article some of the most important and tolerated drugs in the elderly are reviewed. 2. Tricyclic antidepressants have to be used carefully because of their important side effects. Nortriptyline and desipramine appear to be the best tolerated tricyclics in old people. 3. Second generation antidepressants are preferred for the elderly and those patients with heart disease as they have milder side effects and are less toxic in overdose. 4. MAO inhibitors are useful drugs in resistant forms of depression in which the above mentioned drugs have no efficacy and the last generation drugs (reversible MAO inhibitors), such as moclobemide, seem to be very successful. 5. Lithium is sometimes used especially to prevent recurrence of depression, even if its use is limited in old patients due to its side effects. 6. Psychotherapy is often used as an adjunct to pharmacotherapy, while electroconvulsant therapy is used only in the elderly patients with severe depression, high risk of suicide, or drug-resistant forms.

Gene/longevity association studies at four autosomal loci (REN, THO, PARP, SOD2).

The possibility that four loci (REN, THO, PARP, SOD2) are associated with longevity was explored by comparing the genotypic pools of subjects older than 100 years with those of younger subjects matched for sex and geographic area (northern and southern Italy). The markers (all located within the respective gene) were HUMREN4; HUMTHO1; HUMPARP (gt)845nt; SOD2(C/T)401nt. In order to reduce the number of genotypes, multiallelic polymorphisms were recoded as diallelic according to allele size and frequency patterns (small: S, and large: L, alleles). A significant loss of LL homozygous genotypes was found at the THO locus in male but not in female centenarians with respect to matched controls. On the other hand no significant difference was found between case/control genotypic frequencies at REN, PARP, SOD2 loci. The latter loci therefore do not affect inter-individual variability in life expectancy (at least in terms of qualitative variants associated with the tested markers). However, the data is consistent with an association between the THO locus and longevity.

[Stenosis of the internal carotid arteries and cardiovascular risk factors in a group of patients aged 65 years and over]. / Stenosi delle arterie carotidi interne e fattori di rischio cardiovascolari in un gruppo di pazienti ultrasessantacinquenni.

BACKGROUND: In the present study, the degree of stenosis of internal carotid arteries and the presence of cardiovascular risk factors are examined. METHODS: Two hundred patients underwent high resolution B-mode echotomography of the carotid arteries; furthermore, the presence of associated cardiovascular risk factors was considered. RESULTS: Small stenosis (< 16%) were reported in 113 (56.5%) patients; moderate stenosis (16-49%) were reported in 58 (29%) patients; severe stenosis (50-79%) were reported in 19 (9.5%) patients; subocclusive stenosis (80-99%) were reported in 2 (1%) patients; occlusions were reported in 8 (4%) patients. One hundred and fifty patients (75%) presented one or more associated cardiovascular risk factors. Hypertension was present in 122 (61%) patients; hypercholesterolemia in 43 (21.5%) patients; diabetes mellitus in 41 (20.5%) patients; 26 (13%) patients were smokers. CONCLUSIONS: According to other studies, stenosis < 50% were the most frequent (85.5%) in the subjects examined. Stenosis > or = 50% were more frequent in males than females. Hypertension was the most frequent associated cardiovascular risk factor; therefore the degree of stenosis increased with the increasing number of cardiovascular risk factors.

[Prevalence and features of peptic ulcers in the elderly: a retrospective study on a not hospitalized population aged 65 or over]. / Caratteristiche e prevalenza dell'ulcera peptica nell'anziano: studio endoscopico retrospettivo su una coorte di pazienti ultrasessantacinquenni non istituzionalizzati.

BACKGROUND: The prevalence of peptic ulcer increases with aging. Data relative to peptic ulcer in the elderly are around 5.2% to 9.9%. The aim of the present study was to evaluate the prevalence and the features of peptic ulcer in a non hospitalized population aged 65 or over. METHODS: We performed, for the first time, EGDS on 706 patients with symptoms related to the superior gastroenteric tract. We considered the following risk factors: familiarity for peptic disease, habits, eventual use of FANS, infection of Hp. RESULTS: Our data show that peptic ulcer increases with aging and with physiopathological age-related changes. 114 (16.1%) patients were affected by DU; 84 (11.9%) patients were affected by GU Symptoms thereafter were not clear: epigastralgy was present in 46.4% of patients affected by GU; pyrosis, belchings, swellings, epigastric headness were present in 37.7% of patients with DU. Several times PU may arise with some complications: melena was present in 14.9% of patients with DU vs 11.9% of patients with GU, hematemesis was present in 1.7% of patients with DU vs 5.9% of patients with G.U. The most important risk factor was the infection of Hp, at was present in 71.9% patients with GU and 81.6% patients with DU FANS assumption, often with high dose, was present in 30.9% of patients with GU and 18.4% of patients with DU.

[Polydistrectual atherosclerosis in the elderly. Ischemic cardiopathy and obliterative peripheral arteriopathy of the lower limbs]. / Aterosclerosi polidistrettuale nell'anziano. Cardiopatia ischemica e arteriopatie obliteranti periferiche degli arti inferiori.

BACKGROUND: Numerous epidemiological studies have recently drawn attention to the polydistrict nature of atherosclerotic disease. In particular, it has been made clear the frequent association between coronary heart disease and peripheral arterial disease of the lower limbs. We have therefore evaluated the frequency of peripheral arterial disease in a consecutive unselected series of patients affected by coronary heart disease, over 65 and under 65. We have besides evaluated the frequency of some factors of risk for atherosclerotic disease on the subjects affected by coronary heart disease alone and in those with associated peripheral arterial disease. METHODS: We have studied 502 patients (280 males and 222 females) with coronary heart disease admitted to the II Division of General Medicine of Pugliese-Ciaccio Hospital of Catanzaro. Of the 502 patients examined, 367 (72.7%) over 65 and 137 (27.3%) under 65. Factors of risk considered were familiarity, cigarette smoking, diabetes mellitus, dyslipidosis, arterial hypertension. RESULTS AND CONCLUSIONS: Peripheral arterial disease was present in 37% of the subjects examined. In the elderly group there was a frequency of 87.6%, while in subjects under 65 the frequency was 12.4%. Symptoms of claudicatio were present in 100% of the subjects under 65 and 58.6% of the elderly subjects. Risk factors that apply with greater frequency were diabetes mellitus, arterial hypertension and smoking. The results of our study show the importance of searching for stenosis even if asymptomatic in patients with coronary heart disease, above all if elderly.

DNA multiallelic systems reveal gene/longevity associations not detected by diallelic systems. The APOB locus.

To identify possible genetic factors affecting human longevity we compared allele pools at two candidate loci for longevity between a sample of 143 centenarians (S) and a control sample of 158 individuals (C). The candidate loci were APOB and TPO, which code for apolipoprotein B and thyroid peroxidase, respectively. Both restriction fragment length (RFL) (XbaI2488 and EcoRI4154) and variable number of tandem repeat (VNTR) (3'APOB-VNTR) polymorphisms were analysed at the APOB locus; the TPO-VNTR polymorphism (intron 10) was analysed at the TPO locus. The main result of the investigation was that there is an association between the APOB locus and longevity that is revealed only when multiallelic polymorphisms are considered. In particular: (i) the frequency of 3'APOB-VNTR alleles with fewer than 35 repeats is significantly lower in cases than in controls; (ii) the linkage disequilibrium between the XbaI-RFLP and the EcoRI-RFLP is significantly different from 0 in cases but not in controls; (iii) the EcoRI-RFLP and XbaI-RFLP allele frequencies do not discriminate between cases and controls. The differences observed between case and control allele pools are specific to the APOB locus, since no significant difference was observed at the TPO locus.

Concurrence of benign edematous polysynovitis in the elderly (RS3PE syndrome) and endometrial adenocarcinoma.

RS3PE Syndrome is an inflammatory disease which affects mainly males and responds, rapidly, to low dose steroids. We describe the concurrence of RS3PE, poorly responsive to low dose steroids, and endometrial adenocarcinoma. In this patient, clinical and laboratory signs of RS3PE disappeared after total hysterectomy. Patients with RS3PE, poorly responsive to low dose steroids, need an accurate clinical and laboratory evaluation before considering the disease as idiopathic.

[Cerebral hypoperfusion symptoms in elderly subjects with hyperkinetic and/or hypokinetic arrhythmia. Study of institutionalized and non- institutionalized patients]. / Sintomatologia da ipoperfusione cerebrale nei soggetti anziani portatori di aritmie ipercinetiche e/o ipocinetiche. Indagine su pazienti istituzionalizzati e non.

BACKGROUND: We evaluated the symptomatology caused by cerebral hypoperfusion in a group of over-65 year old hospitalized and non-patients, with hyperkinetic and hypokinetic arrhythmias. METHODS: 2441 clinical records of hospitalized and ambulatory patients at the unit of Cardiology, "Pugliese-Ciaccio" Hospital of Catanzaro between January 1st 1991 and March 31st 1995 were examined. The clinical records of those patients who had showed anamnestic episodes of syncope, lipothymia and dizziness were selected. The selected sample was made of 36 hospitalized patients and 36 ambulatory patients. The Holter-ECGs of these patients were examined. RESULTS: Six episodes of syncope (16.7%) were found in the hospitalized patients and 4 in the ambulatory patients (11.1%). Ten (27.8%) and 8 (22.2%) episodes of lipothymia, were found in the hospitalized and ambulatory patients respectively. Dizziness was found in 20 (55.5%) hospitalized and in 24 (66.6%) ambulatory patients. In all the patients the symptoms appeared during the recording and were linked to hyperkinetic arrhythmias in 22 (61.1%) hospitalized patients and in 25 (69.4%) ambulatory patients and to hypokinetic arrhythmias in 14 (39.9%) and 11 (30.5%) hospitalized and ambulatory patients. CONCLUSIONS: The present study pointed out that patients with hyperkinetic arrhythmias (both hospitalized and ambulatory) show symptoms of cerebral hypoperfusion more frequently than those with hyperkinetic arrhythmias.

[Sexuality of elderly women]. / La sessualità delle donne anziane.

Physiological aging in older women it is not necessarily the cause of a change in their sexual attitudes. The organic changes, during concomitant illness, is often known to be the cause of sexual dysfunction, when present. Psychosocial factors are also very important in determining sexual dysfunction. Successful management of sexual dysfunction in older women is totally dependent on clinical history, physical examination of genitalia, personal interview. A multidisciplinary team approach is required for otimal management of sexual problems in elderly women.

Nail-fold capillaroscopy in the study of microcirculation in elderly hypertensive patients.

Hypertension represents one of the most important atherosclerotic risk factors, since it causes vascular damage both to macro- and microcirculation. Capillaroscopy is very useful to examine "in vivo" the small vessels of nail-fold and conjunctival layer of the bulb which are the most suitable areas for a morphological study of microcirculation. Capillaroscopy gives remarkable information from a clinical and diagnostic point of view, both in the diseases involving microcirculation (connective tissue disorders, diabetes) and in the evaluation of microvascular impairments in systemic diseases such as arterial hypertension. Aim of the present study was at evaluating capillaroscopic characteristics in a consecutive and non-selected series of elderly hypertensive patients and comparing the results to those observed on fundus oculi. Our study revealed the decrease of the number of capillary loops which appear thin and lengthened, in the hypertensive persons, as compared to the control group. Dilated and tortuous capillaries, arteriovenous sludge and "flea bite" juxtacapillary microhemorrhages were found more frequently in the patients with isolated systolic hypertension; they are linked to the atherosclerotic nature of that disease.