Thymoma with pericardial tamponade.

Thymomas are tumors of the anterior mediastinum. They are most often seen in adults aged 45 to 50 years. These tumors are routinely asymptomatic for prolonged periods of time. The most common presentation is discovery on routine chest x-ray. We therefore present a case report of an elderly woman who presented with symptoms of dyspnea caused by a malignant thymoma. To our knowledge, symptomatic pericardial tamponade due to a thymoma with a massive pericardial effusion has not been described previously.

Angiographic evidence of right coronary bridging.

Systolic constriction of the left anterior descending coronary artery is a well-recognized angiographic and autopsy finding. The etiology of this phenomenon is an intramural course of the coronary artery. Even though there has been autopsy evidence of an intramural course of the right coronary artery, this rare finding has not been associated with systolic constriction, "bridging" on coronary angiography. There is evidence that strenuous exercise can induce ischemia in an intramural left coronary artery. We therefore present a case report of angiographic evidence of systolic constriction of the right coronary artery.

Isolated rupture of the right ventricle in a patient with acute inferior wall MI.

A case of isolated rupture of the right ventricle secondary to acute MI, presented as cardiac tamponade, is reported. The patient underwent successful emergency surgery for closure of the right ventricular rupture without aortocoronary bypass.

Exercise capacity in the elderly.

One of the primary manifestations of ageing is a reduced ability to respond to physiologic challenges. With aging, the ability to perform exercise and physical work declines and is reflected in the reduction in maximal oxygen consumption. Although this decline is influenced to some degree by the state of health and age, it seems that maintenance of regular physical activity significantly counteracts the loss of aerobic capacity. In healthy old age, the cardiovascular system is able to compensate for certain age-associated declines in cardiac function. A program of endurance training, even when begun in old age, can restore more youthful levels of physical fitness and results in tangible improvements in certain resting, submaximal and maximal indicators of exercise capacity. With comprehensive preexercise clinical screening, physical training can be conducted safely with minimal musculoskeletal problems in the aged. The long-term effects of exercise on morbidity, mortality and psychologic function in old age are unknown.

Lipidemia--a multigeneration predictability study.

This study involved a 1st generation of 194 aged residents at the Philadelphia Geriatric Center plus 2nd and 3rd generations of 357 and 306 offspring, respectively. Serum cholesterol levels (including type of abnormality) and triglyceride levels were determined. The results suggest that hyperlipidemia at all ages is related to a familial genetic problem. The data on each generation, starting even with the 80-year-old parents, could be used to predict lipid abnormalities in each succeeding generations. However, when comparing the 1st generation with the 3rd generation, predictability was lacking, probably because of the inclusion of two sets of spouses and many enviromental factors that altered the situation. In the 2nd generation, 40 per cent of the subjects had an elevated lipid level compared to 30 per cent in the 1st and 3rd generations. The higher concentrations in the 2nd generation probably reflected increased risk factors such as improper diets, smoking, hypertension, obesity and stress at that age level. Hyperlipidemia in the aged apparently is not just a metabolic degenerative abnormality. It should be treated, as in younger people. Data on risk factors such as a high blood lipid level may help not only the aged, but succeeding generations.

Hyperlipidemia and its significance in the aged population.

Starting in childhood, blood lipid levels rise progressively with each ten-year period until age 70, when cholesterol and triglyceride levels begin to stabilize and then decline. By age 80 there is a precipitous drop to approximately the values noted in persons of the 20-30 age group. Data on 195 residents of a geriatric center are included. Despite the lower average lipid levels, 30 per cent of the elderly show some lipid abnormality. There is a definite increase in the risk of death from coronary artery disease in hyperlipidemic persons as compared to those who are normolipidemic, even during the eighth and ninth age decades. Hyperlipidemia appears to be a significant risk in the elderly, as in persons of any age, and should be treated accordingly.