INVESTIGATION OF PITUITARY-ADRENOCORTICAL FUNCTION IN THE ELDERLY DURING STANDARDIZED OPERATIONS AND POSTOPERATIVE INTRAVENOUS METYRAPONE TEST ASSESSED BY PLASMA CORTISOL, PLASMA COMPOUND S AND EOSINOPHIL CELL DETERMINATIONS

1971 ◽  
Vol 67 (3) ◽  
pp. 495-507 ◽  
Author(s):  
H. Kaalund Jensen ◽  
M. Blichert-Toft
Keyword(s):  
Cell Count ◽  
Plasma Cortisol ◽  
Surgical Stress ◽  
The Elderly ◽  
Adrenocortical Function ◽  
Elderly Subjects ◽  
Postoperative Phase ◽  
Age Difference ◽  
Adrenal System ◽  
Eosinophil Cell

ABSTRACT Twenty elderly subjects with an average age of 73.0 years (range 66–82) underwent standardized surgery (laparotomies). Thirteen younger subjects with an average age of 45.4 years (range 23–58) served as controls. Changes in plasma cortisol, plasma compound S and eosinophil cell count were checked throughout the first 24 hours after surgery. A maximum increase in the plasma cortisol concentration exceeding the spontaneous initial value by 150 and 110 per cent respectively was observed, in the young and elderly subjects. An insignificant rise only was seen in the plasma compound S concentration. The eosinophil cell count fell to less than 50 n/μl. The variations in the three parameters, observed in the geriatric group, indicate a less marked response to surgical stress although no evidence was found for the existence of any significant age difference. Between the fourth and eighth postoperative day, an intravenous metyrapone test was carried out in 13 elderly and 10 young subjects. The changes in the concentration of plasma cortisol and plasma compound S and in the eosinophil cell count were recorded. When exposed to an apparently identical stimulation of the feedback system during the postoperative phase, the elderly patients showed a much greater response than that seen in the younger patients. The possibility that the pituitary-adrenal system in the elderly develops a higher sensitivity following repeated exposures to stress, is discussed. Exhaustion of the pituitary-adrenal system during the postoperative phase was not demonstrated in the elderly.

Cognitive Changes after Surgery in the Elderly: Does Minimally Invasive Surgery Influence the Incidence of Postoperative Cognitive Changes Compared to Open Colon Surgery?

2014 ◽  
Vol 39 (3-4) ◽  
pp. 125-131 ◽  
Author(s):  
Christopher B. Tan ◽  
Jackson Ng ◽  
Rajkumar Jeganathan ◽  
Fernando Kawai ◽  
Cynthia X. Pan ◽  
...  
Keyword(s):  
Pilot Study ◽  
Laparoscopic Group ◽  
The Elderly ◽  
Colon Surgery ◽  
Open Group ◽  
Elderly Subjects ◽  
Age Difference ◽  
Care Hospital ◽  
Cognitive Changes ◽  
Open Versus

Background: Postoperative delirium in the elderly is a growing concern. Data regarding significant differences in postoperative cognitive dysfunction (POCD) in elderly persons undergoing laparoscopic versus open colon resection are not well established. Objectives: The goal of this study was to compare the incidence of POCD in laparoscopic versus open colon surgery in an elderly population. Design and Setting: A prospective nonrandomized pilot study was conducted at an urban tertiary care hospital. Participants: The study included patients aged 65 years and above, without documented dementia who underwent elective colon surgery. Measurements: We collected demographic and clinical data, including age, sex, polypharmacy, and comorbidities. The subjects underwent pre- and postoperative Cambridge Neuropsychological Test Automated Battery (CANTAB) testing. Worsening individual scores from the Paired Associated Learning (PAL) and Spatial Working Memory (SWM) portions of CANTAB determined the presence of POCD. Inflammatory cytokine (i.e., IL-6) levels were measured pre- and postoperatively. Results: We enrolled 44 subjects (26 laparoscopic and 18 open surgery). The two groups did not differ significantly in age, sex, polypharmacy, and comorbidities. The average incidence of POCD was 47%. PAL scores worsened in 12/23 (52%) in the laparoscopic group and in 7/15 (47%) in the open group. These group differences lacked statistical significance (p = 0.75). SWM scores worsened in 14/25 (56%) in the laparoscopic group and in 6/18 (33%) in the open group, which was also not statistically significant (p = 0.12). No age difference occurred between the ‘worsened scores' group and ‘stable scores' group, and older age was not associated with POCD. IL-6 levels were higher in the open versus the laparoscopic group (p < 0.0001). Conclusion: In this pilot study, the average incidence of POCD was not statistically different between elderly subjects undergoing open versus laparoscopic surgery. Age did not influence the occurrence of POCD. Although inflammatory markers were significantly higher in the open group, consistent with a higher degree of stress response, this group did not have higher rates of delirium. This association is worth to be investigated in a larger sample. © 2014 S. Karger AG, Basel

FREE 17-HYDROXYCORTICOSTEROID LEVEL AND EOSINOPHIL CELL COUNT DURING CORTICOTROPHIN TESTS

1964 ◽  
Vol 47 (2) ◽  
pp. 209-222 ◽  
Author(s):  
Herman Hortling ◽  
Aimo Pekkarinen ◽  
Eva Puupponen
Keyword(s):  
Cell Count ◽  
Adrenal Cortex ◽  
Inverse Correlation ◽  
Allergic Diseases ◽  
Adrenocortical Function ◽  
Normal Range ◽  
Intravenous Infusions ◽  
Eosinophil Cell

ABSTRACT The effect of intravenous infusions for 5 hours of 20–25 IU corticotrophin on the free 17-OHCS content in the plasma and on the number of the eosinophil cells in the blood was studied in patients with normal adrenocortical function and in patients with allergic diseases receiving 40–60 mg cortisol daily in a dose which suppresses the function of the adrenal cortex, as well as in hypophysectomized and adrenalectomized patients. When the maximal content of free 17-OHCS during the corticotrophin infusion was above 25–30 μg/100 ml an inverse correlation with the number of eosinophils was found. When, however, the free 17-OHCS level reached in the plasma was in the normal range (< 25 μg/100 ml) or very low no correlation was found between the free 17-OHCS content in the plasma and the percentage changes in the number of eosinophils in the blood. In general the responses in the content of free 17-OHCS in the plasma and also in the number of the eosinophil cells in the blood, to intravenous corticotrophin administration is a good indicator of the adrenocortical function.

SERUM CORTICOTROPHIN, PLASMA CORTISOL AND URINARY EXCRETION OF 17-KETOGENIC STEROIDS IN THE ELDERLY (AGE GROUP: 66–94 YEARS)

1971 ◽  
Vol 66 (1) ◽  
pp. 25-34 ◽  
Author(s):  
H. Kaalund Jensen ◽  
M. Blichert-Toft
Keyword(s):  
Urinary Excretion ◽  
Plasma Cortisol ◽  
The Elderly ◽  
Cortisol Concentration ◽  
Elderly Subjects ◽  
Age Group ◽  
Circadian Variations ◽  
Elderly Age ◽  
Antibody Technique ◽  
Double Isotope

ABSTRACT The serum corticotrophin concentrations was determined in 28 elderly subjects (70–94 years) by the radioimmunochemical double-antibody-technique. In 5 elderly subjects, the corticotrophin concentration was studied throughout the 24-hour period. The plasma cortisol concentration was determined by means of a double-isotope-derivative technique in 69 elderly subjects (66–94 years). In 10 elderly and 8 younger subjects the concentration was checked throughout the 24-hour period. The urinary excretion of 17-ketogenic steroids was determined in a total of 80 elderly subjects (66–94 years). For comparison corticotrophin and cortisol measurements in young volunteers assayed by identical methods were used and partly carried out in cooperation with other investigators. At 8 a. m. the average corticotrophin concentration was 101.8 ± 55.0 (sd) pg/ml of serum and the average cortisol concentration was 15.0 ± 4.60 (sd) μg/100 ml of plasma. No significant age or sex variation could be detected. With regard to both hormones, the circadian variations were marked with parallel changes in the concentrations of corticotrophin and cortisol. The highest concentration was measured in the morning and the lowest in the evening. The urinary excretion of 17-ketogenic steroids showed a tendency to decrease with increasing age. The regression equation for females was ȳx = −0.07x + 11.42, for males ȳx = −0.22x + 26.59.

Ageing and the sensitivity of the adrenal gland to physiological doses of ACTH in man

1990 ◽  
Vol 126 (3) ◽  
pp. 507-513 ◽  
Author(s):  
N. A. Roberts ◽  
R. N. Barton ◽  
M. A. Horan
Keyword(s):  
Plasma Cortisol ◽  
Response Curve ◽  
Elderly Women ◽  
The Elderly ◽  
Cortisol Concentration ◽  
Elderly Subjects ◽  
Elderly Men ◽  
Plasma Acth ◽  
Acth Secretion ◽  
Cortisol Responses

ABSTRACT Healthy men and women aged 19–38 or 67–83, in whom endogenous ACTH secretion was suppressed with dexamethasone, were given successive injections of 60 ng, 150 ng and 250 μg ACTH(1–24) at hourly intervals, and blood samples for measurement of plasma cortisol were taken every 10 min. The response to each injection was taken as the increase in cortisol concentration 20 min later, when there was a peak with the lower doses, with allowance for disappearance of cortisol produced after the previous injection. On average, the responses to 60 and 150 ng ACTH were about 0·4 and 0·7 respectively of the response to 250 μg. There were no consistent effects of age or sex on any index of adrenocortical sensitivity or responsiveness, but some groups showed isolated differences from both their age- and sex-matched counterparts: the response to 60 ng ACTH was low in young men, maximal responsiveness was low in elderly men and the slope of the dose–response curve was high in elderly women. In most of the elderly subjects, plasma ACTH was determined separately under normal conditions. It was negatively correlated with the cortisol responses to 60 and 150 ng ACTH, suggesting that differences in adrenal sensitivity between subjects contribute to the variability of plasma ACTH. Journal of Endocrinology (1990) 126, 507–513

scholarly journals Extra Virgin Olive Oil Prevents the Age-Related Shifts of the Distribution of HDL Subclasses and Improves Their Functionality

Nutrients ◽  
2021 ◽  
Vol 13 (7) ◽  
pp. 2235
Author(s):  
Alyann Otrante ◽  
Amal Trigui ◽  
Roua Walha ◽  
Hicham Berrougui ◽  
Tamas Fulop ◽  
...  
Keyword(s):  
Olive Oil ◽  
Virgin Olive Oil ◽  
Density Lipoprotein ◽  
Extra Virgin Olive Oil ◽  
The Elderly ◽  
High Density ◽  
Lipoprotein Cholesterol ◽  
Elderly Subjects ◽  
Age Related ◽  
Young Subjects

High-density lipoproteins (HDL) maintain cholesterol homeostasis through the role they play in regulating reverse cholesterol transport (RCT), a process by which excess cholesterol is transported back to the liver for elimination. However, RCT can be altered in the presence of cardiovascular risk factors, such as aging, which contributes to the increase in the incidence of cardiovascular diseases (CVD). The present study was aimed at investigating the effect of extra virgin olive oil (EVOO) intake on the cholesterol efflux capacity (CEC) of HDL, and to elucidate on the mechanisms by which EVOO intake improves the anti-atherogenic activity of HDL. A total of 84 healthy women and men were enrolled and were distributed, according to age, into two groups: 27 young (31.81 ± 6.79 years) and 57 elderly (70.72 ± 5.6 years) subjects. The subjects in both groups were given 25 mL/d of extra virgin olive oil (EVOO) for 12 weeks. CEC was measured using J774 macrophages radiolabeled with tritiated cholesterol ((3H) cholesterol). HDL subclass distributions were analyzed using the Quantimetrix Lipoprint® system. The HDL from the elderly subjects exhibited a lower level of CEC, at 11.12% (p < 0.0001), than the HDL from the young subjects. The CEC of the elderly subjects returned to normal levels following 12 weeks of EVOO intake. An analysis of the distribution of HDL subclasses showed that HDL from the elderly subjects were composed of lower levels of large HDL (L-HDL) (p < 0.03) and higher levels of small HDL (S-HDL) (p < 0.002) compared to HDL from the young subjects. A multiple linear regression analysis revealed a positive correlation between CEC and L-HDL levels (r = 0.35 and p < 0.001) as well as an inverse correlation between CEC and S-HDL levels (r = −0.27 and p < 0.01). This correlation remained significant even when several variables, including age, sex, and BMI as well as low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and glucose levels (β = 0.28, p < 0.002, and β = 0.24, p = 0.01) were accounted for. Consuming EVOO for 12 weeks modulated the age-related difference in the distribution of HDL subclasses by reducing the level of S-HDL and increasing the level of intermediate-HDL/large-HDL (I-HDL/L-HDL) in the elderly subjects. The age-related alteration of the CEC of HDL was due, in part, to an alteration in the distribution of HDL subclasses. A diet enriched in EVOO improved the functionality of HDL through an increase in I-HDL/L-HDL and a decrease in S-HDL.

scholarly journals POS1288 TUBERCULOUS SPONDYLODISCITIS IN ELDERLY: EPIDEMIOLOGY, CLINICAL, FEATURES, TREATMENT AND OUTCOMES

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 926.1-926
Author(s):  
M. Mrabet ◽  
S. Boussaid ◽  
S. Jemmali ◽  
H. Sahli ◽  
H. Ajlani ◽  
...  
Keyword(s):  
Clinical Features ◽  
The Elderly ◽  
Lumbar Pain ◽  
Elderly Subjects ◽  
Normocytic Anemia ◽  
Imaging Features ◽  
X Rays ◽  
Significant Difference ◽  
Young Subjects ◽  
Tuberculous Spondylodiscitis

Background:Tuberculosis is still endemic all over the world. The incidence of tuberculous spondylodiscitis (TS) is steadily increasing. Clinical features and outcomes of this affection are various and depending on various parameters, including age.Objectives:Our objective was to explore the differences in presentation and the results of further investigations and the prognosis of TS between young and elderly subjects.Methods:We conduct a retrospective and descriptive study in a single rheumatology department. Data were collected from files of patients hospitalized in the past 20 years (2000-2020) who have been diagnosed with TS. We carried out a comparative study concerning the clinical biological, imaging features and outcomes between young subjects and subjects aged over 65 years.Results:Fifty-two cases of TS were collected (37F/15M). The mean age of the population was 55.21 years ± 17.79 [19-91]. Thirty-three patients (69.2%) were classified as young versus 16 elderly patients (30.8%), with female predominance in both groups (69.4% and 75% respectively, p = 0.57). Young subjects was more frequently vaccinated (88.9%) by Bacillus Calmette–Guérin (BCG) (p < 0.001). A delayed diagnosis was noted in both groups (p = 0.24). Lumbar spine involvement was the most common (57.7%). In the two age ranges, the onset of the disease was progressive (p = 0.22), characterized by segmental spine stiffness (p = 0.57) and lumbar pain with general signs (p = 0.27), such as: impaired general condition, fever, night sweats and weight loss. Biological inflammatory syndrome and normochrome normocytic anemia were encountered in both cases (p = 0.08 and p = 0.2, respectively). Standard X-rays and Computed tomography were more performed in young subjects (94.4% and 69.4%, respectively; p < 0.001), unlike magnetic resonance imaging which was more common in elderly subjects but with no statistically significant difference (p = 0.22). Disc pinch, erosion of vertebral plateaus and vertebral collapse were the major signs (82.7%, 65.4% and 67.3%, respectively). Clinical, biological and imaging arguments contributed to positive diagnosis in both groups (p = 0.24). Common medical treatment was anti-tuberculosis: Isoniazid (H), Rifampicin (R), Pyrazinamide (Z), Ethambutol (E) and physical treatment such as immobilization witch was more common in the eldery (56.3%, p = 0.16). The evolution of the disease was characterized by a clear improvement of young subjects during the second week of treatment (p < 0.001). A more frequent clinical improvement in older subjects was during the fourth week but with no statistically significant difference (p = 0.13). The occurrence of immediate complications was more frequent in the elderly (p = 0.23) with a predominance for drug complications (56.3%) such as: hepatic cytolysis (12.5%), hyperuricemia (18.8%) and major intolerance to anti-tuberculosis (18.8%).Conclusion:TS is a frequent condition that needs to be treated rapidly. the clinical presentation of TS in the elderly is less noisy which leads to more frequent complications and mortality.Disclosure of Interests:None declared

Decreased Neutrophil Cyclic AMP Response to Isoprenaline Stimulation in the Elderly

1983 ◽  
Vol 65 (2) ◽  
pp. 155-157 ◽  
Author(s):  
T. G. Cotter ◽  
K. O'Malley
Keyword(s):  
Monoclonal Antibodies ◽  
Cyclic Amp ◽  
The Elderly ◽  
Population Heterogeneity ◽  
Elderly Subjects ◽  
Age Related ◽  
Significant Difference ◽  
Young Subjects ◽  
Drug Free

1. Neutrophils from drug-free elderly subjects produced approximately 50% less cyclic AMP in response to isoprenaline than did neutrophils from young subjects. A significant difference in basal cyclic AMP levels was also evident (elderly 2.8 ± 0.37; young 4.9 ± 0.36 pmol of cAMP/107 cells; P < 0.05). 2. With a range of anti-neutrophil monoclonal antibodies no evidence of age-related neutrophil population heterogeneity was found. 3. These findings indicate that the age-related decline in β-adrenoceptor responsiveness is not due to changes in the neutrophil population. 4. The present results support the hypothesis that there is a generalized decline in β-adrenoceptor-mediated responsiveness in the elderly.

Cold-induced Increases in Erythrocyte Count, Plasma Cholesterol and Plasma Fibrinogen of Elderly People without a Comparable Rise in Protein C or Factor X

1994 ◽  
Vol 86 (1) ◽  
pp. 43-48 ◽  
Author(s):  
Penelope J. Neild ◽  
Denise Syndercombe-Court ◽  
W. R. Keatinge ◽  
G. C. Donaldson ◽  
M. Mattock ◽  
...  
Keyword(s):  
Elderly People ◽  
Plasma Volume ◽  
Arterial Thrombosis ◽  
Protein C ◽  
Plasma Cholesterol ◽  
The Elderly ◽  
Erythrocyte Count ◽  
Elderly Subjects ◽  
Factor X ◽  
Young Subjects

1. Six elderly (66-71 years) and six young (20-23 years) subjects (half of each group women) were cooled for 2 h in moving air at 18°C to investigate possible causes of increased mortality from arterial thrombosis among elderly people in cold weather. Compared with thermoneutral control experiments, skin temperature (trunk) fell from 35.5 to 29.5°C, with little change in core temperature. 2. Erythrocyte count rose in the cold from 4.29 to 4.69 × 1012/l, without a change in mean corpuscular volume, indicating a 14% or 438 ml decline in plasma volume; increased excretion of water, Na+ and K+ accounted for loss of only 179 ml of extracellular water. 3. Plasma cholesterol and fibrinogen concentrations rose in the elderly subjects from 4.9 mmol/l and 2.97 g/l (control) to 5.45 mmol/l and 3.39 g/l in the cold, and in the young subjects from 3.33 mmol/l and 1.84 g/l (control) to 3.77 mmol/l and 2.07 g/l in the cold. Increases were significant for the elderly subjects, the young subjects and the group as a whole, except for cholesterol in the young subjects, and all were close to those expected from the fall in plasma volume. 4. Plasma levels of Protein C and factor X did not increase significantly in the cold in the elderly subjects, young subjects, or the group as a whole. 5. The results suggest that loss of plasma fluid in the cold concentrates major risk factors for arterial thrombosis, while small molecules, including protective Protein C, redistribute to interstitial fluid.

scholarly journals Human Nonmercaptalbumin Is a New Biomarker of Motor Function

2021 ◽  
Vol 10 (11) ◽  
pp. 2464
Author(s):  
Sadayuki Ito ◽  
Hiroaki Nakashima ◽  
Kei Ando ◽  
Kazuyoshi Kobayashi ◽  
Masaaki Machino ◽  
...  
Keyword(s):  
Oxidative Stress ◽  
Logistic Regression ◽  
Regression Analysis ◽  
Grip Strength ◽  
Motor Function ◽  
Walking Speed ◽  
The Elderly ◽  
Elderly Subjects ◽  
Locomotive Syndrome ◽  
Reduced Mobility

The ratio of human nonmercaptalbumin (HNA) and reduced albumin (HMA) may be a new marker for oxidative stress. Locomotive syndrome (LS) is reduced mobility due to impairment of locomotive organs. We investigated whether the HNA/HMA ratio could be a new biomarker of LS. This study included 306 subjects (mean age 64.24 ± 10.4 years) who underwent LS tests, grip strength, walking speed, and tests for HNA and HMA. Oxidative stress was measured by the ratio of HMA (f(HMA) = (HMA/(HMA + HNA) × 100)), and the subjects were divided into normal (N group; f[HMA] ≥ 70%) and low (L group; f[HMA] < 70%) groups. There were 124 non-elderly (<65 years) and 182 elderly subjects (≥65 years). There were no significant differences in LS, grip strength, and walking speed between the L and N groups in the non-elderly subjects. However, significant differences were found in the elderly subjects. In logistic regression analysis, there was an association between f(HMA) and the LS severity at older ages. LS in the elderly is associated with a decline in HMA and, thus, an increase in oxidative stress. Thus, f(HMA) is a new biomarker of LS.

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