bluuebunny/crossref_metadata_2025 huggingface dataset:
Some Aspects of Pulmonary Tuberculosis in Older Patients
Authors: ROGERS W. F.
Published: April 2015

This article is a review of pulmonary tuberculosis in older patients. Incidence, detection, clinical peculiarities and difficulties in implementing therapy are discussed. Special problems are involved in the management of pulmonary tuberculosis in the elderly, many of whom are treated at home. The administration of streptomycin combined with isoniazid in one injection offers some advantages in therapy.
Patterns of Aging in Physically and Mentally Ill Patients
Authors: MRAZEK SVATOPLUK A.
Published: April 2015

Fifty‐one male patients who had been in a Veterans Administration neuropsychiatric hospital for an average of almost thirteen years underwent clinical and laboratory examinations to determine the degree of change in their condition since the last admission. The average age was 63 years (range, 29–88). No consistent abnormalities were noted in blood viscosity, serum calcium or serum cholesterol. Although urinary 17‐ketosteroid excretion was not related to age, it was related (low excretion) to osteoporosis. Plasma protein electrophoresis showed no relation between total lipoproteins and age. However, 12 of the 17 alpha1 decreases and 17 of the 27 alpha2 increases were in patients over 63. Chronic brain syndrome (chiefly associated with cerebral arteriosclerosis) became the predominant diagnosis after age 63.
Folie à Deux in the Aged: Review and Case Report of Role Reversal
Authors: McNIEL JESSE N. , VERWOERDT ADRIAN , PEAK DANIEL
Published: April 2015

The English literature on folie à deux in patients over 65 is reviewed, and a case in two sisters who reversed dominant and submissive roles in old age is presented. The common concept of folie à deux as an imposed entity should be de‐emphasized in favor of the concept that the preservation of a critical close relationship is the primary etiological factor in most unitary delusion systems of long duration. Apparently the syndrome is similar in both old and young, but folie‐à‐deux relationships in the elderly seem to have a particularly strong interdependent and psychotic character, with a high ratio of folie simultanée. This weak ego state should be kept in mind when planning treatment.
Hemodialysis and Renal Transplantation in Patients of the 50–80 Age Group*
Authors: BAILEY GEORGE L. , MOCELIN ALTAIR J. , GRIFFITHS HARRY J. L. , ZSCHAECK DIETRICH , GHANTOUS WALID N. , HAMPERS CONSTANTINE L. , MERRILL JOHN P. , WILSON RICHARD E.
Published: April 2015

Hemodialysis, renal homotransplantation, or both were employed at the Peter Bent Brigham Hospital as treatment modalities for renal failure in 100 patients of the 50–80 age group. Complicating nonrenal disorders were common. Despite the infirmities of advanced age, rehabilitation was achieved in 68 per cent, and the cumulative mortality was only 31 per cent. The success of this program establishes the fact that age alone should no longer be a barrier to the use of these forms of therapy.
Basis for Choice of Simple Procedure for Carcinoma of the Breast
Authors: CASE THOMAS C.
Published: April 2015

A surgeon who has had over thirty years' experience with the “extended simple mastectomy” for carcinoma of the breast gives reasons for his choice of this procedure rather than radical mastectomy. In his view, this procedure does the most good for the greatest number of breast cancer patients.
Aortic Resections in Retrospect*
Authors: TAHERI SYDE A.
Published: April 2015

ABSTRACT: Publication, more than twenty years ago, of the first report on resection with graft replacement for abdominal aortic aneurysm opened the field of aneurysmectomy for treatment of this highly lethal lesion. A review is presented of advances in abdominal aortic resection since that time. The mortality rate is constantly decreasing, the indications for the procedure are increasing, and the life expectancy of patients treated by elective aneurysmectomy is about double that of those not treated surgically.

The mortality from ruptured aneurysm is still too high, and further efforts are needed. The consistent early diagnosis and treatment of all aneurysms is the key to the prevention of rupture.
Close Correlation Between Extent of Cardiac Fibrosis and Alterations in Myocardial Electrolyte Content*
Authors: LEHR DAVID , KRUKOWSKI MARILYN , FILLISTI JEANETTE , KAPLAN JANET
Published: April 2015

ABSTRACT: A chemical method for the objective and fairly accurate measurement of the degree of experimental myocardial necrosis is described. The method is based on significant differences in the electrolyte composition of healthy myocardium and connective tissue, which permit estimation of the extent of myocardial fibrosis according to the degree of deviation of the myocardial electrolytes from the norm. The applicability of the method was demonstrated in studies of standardized myocardial fibrosis induced in the rat by three adrenergic amines (epinephrine, phenylephrine and isoproterenol), in which the extent of scarring observed with the naked eye and under the light microscope showed good correlation with the degree of persistent ionic shifts in the fibrotic myocardium.

This simple method of estimating the degree of myocardial fibrosis by chemical means may aid in animal experimental investigations of the prevention and repair of myocardial injury. It may thus contribute to the development of therapeutic regimens for the prevention and treatment of human heart disease.
Gastric Irradiation for Complicated Peptic Ulcer in Geriatric Patients*
Authors: ANSELM KLAUS , SCHUMAN BERNARD M.
Published: April 2015

ABSTRACT: Thirty‐six elderly patients with complicated peptic ulcer were treated by gastric irradiation (2000 roentgens directed at the fundus). In 30 of the 36 cases there was a significant improvement in symptoms. A marked decrease of hydrochloric acid secretion was observed in the 15 tested before and after therapy.

Gastric irradiation offers a safe means of treatment for complicated peptic ulcer in patients who, because of advanced age or associated disease, are poor surgical risks.
Cerebral Complications of Ulcerated Atheromata at the Carotid Bifurcation*
Authors: DAINKO EDWARD A.
Published: April 2015

ABSTRACT: In 9 of 36 carotid endarterectomies performed for relief of cerebral ischemia, ulcerated atheromata were found at the carotid bifurcation; in the other 27 cases the chief feature was stenosis. Three representative cases are presented, including descriptions of how the carotid lesions were studied angiographically before operation. The significance of these lesions is stressed. If carotid ulceration is present, it is recommended that patients with cerebral ischemic symptoms undergo carotid endarterectomy regardless of the degree of stenosis. This aggressive surgical approach should reduce the incidence of strokes due to emboli from carotid atheromata.
Simple Percutaneous Transfemoral Venous Method of Cardiac Pacing
Authors: CHENG TSUNG O.
Published: April 2015

ABSTRACT: Percutaneous transfemoral venous cardiac pacing was employed consecutively in 150 patients. The results are compared with those of pacing by other venous routes. It is concluded that percutaneous transfemoral venous pacing is a simple, practical, expeditious and safe procedure. Provided fluoroscopic facilities are available, it is the method of choice for temporary cardiac pacing, whether employed as an elective procedure or an emergency measure.
Auditory Changes in the Aged: A Follow‐Up Study*
Authors: EISDORFER CARL , WILKIE FRANCES
Published: April 2015

ABSTRACT: Auditory thresholds for pure‐tones and spondee words were examined in 92 community volunteers seen in a seven‐year follow‐up study. Hearing levels for speech material did not change as much with increasing age as did hearing for pure‐tones. Analysis by age, sex, and race showed that blacks had superior hearing to whites, particularly men, but in general the rate of loss over time was about the same. From about age 74, men of both races had better hearing than women at the frequencies generally considered important for speech reception, but the sex differences were not reflected in their hearing for speech material. As expected, women had better hearing than men at the high tones; however, when race was considered, the hearing patterns for black men resembled those of women. During the seven‐year period, the pattern of hearing decrement was different for men and women.
The Prevention of Blindness in the Aged*
Authors: KORNZWEIG ABRAHAM L.
Published: April 2015

ABSTRACT: The main causes of blindness in the aged (cataract, macular disorders, glaucoma, diabetic retinopathy, vascular diseases, accidents) and the available methods of treatment and prevention are discussed. Six additional recommendations are presented for the prevention and treatment of blindness: 1) an overall high‐priority program for diabetic retinopathy; 2) inclusion of an eye examination by an ophthalmologist as part of the medical check‐up in homes for the aged and nursing homes; 3) establishment of a center for the study of diseases of the macula; 4) increased support for research on fundamental eye diseases such as cataract, glaucoma and vascular diseases; 5) screening programs to discover those aged patients who have eye diseases for which treatment is available to prevent blindness; and 6) establishment of an educational center to disseminate knowledge of eye diseases that can be prevented.
An Ergot Alkaloid Preparation (Hydergine) Versus Placebo for Treatment of Symptoms of Cerebrovascular Insufficiency: Double‐Blind Study
Authors: JENNINGS W. G.
Published: April 2015

ABSTRACT: Fifty geriatric patients with symptoms of cerebrovascular insufficiency took part in a double‐blind study; 24 were treated with Hydergine, an ergot alkaloid preparation, in a dosage of two 0.5‐mg tablets three times daily for twelve weeks; and 26 were treated with placebo. Compared to the placebo group, the Hydergine group improved significantly with respect to cognitive and intellectual capacity, attitude and mood, and physical complaints. Improvement was manifested particularly by relief of such symptoms as confusion, depression, uncooperativeness, fatigue, anorexia, and dizziness. The Hydergine patients also became mentally more alert and had greater initiative.
Revascularization of Severely Ischemic Lower Extremities in the Elderly by Femorotibial Bypass*
Authors: REICHLE FREDERICK A. , TYSON R. ROBERT
Published: April 2015

ABSTRACT: In 79 of 89 patients operated on for severely ischemic lower extremities, the procedure used was femorotibial or femoroperoneal bypass. Two thirds of the patients were over 60 years of age. In some cases the follow‐up period was as long as eight and a half years. A functional bypass was achieved as often in the older groups (67–77 per cent) as in the younger group (74 per cent). The rate of limb salvage was lower in the older groups, but it was still a significant 57–65 per cent versus 74 per cent in patients younger than 60. Femorotibial bypass in lieu of primary amputation is recommended for elderly patients with such absolute indications for surgery as gangrene, gangrenous ulceration, or rest pain.
Modern Health Care Delivery for the Aged: A Program in Total Health Maintenance*
Authors: ROSEN HERBERT J.
Published: April 2015

ABSTRACT: A comprehensive program for geriatric health care is outlined. The complexity of the clinical picture should be recognized as a basis for providing proper management. Special attention should be given to the clinical history and the physical and laboratory examinations in geriatric patients. The results of holistic treatment often are highly rewarding and can do much to modify the persistent false image of old age.
Carcinoma of the Prostate with Bilateral Breast Metastases
Authors: SEIPEL WAYNE D. , MALAMENT MAXWELL
Published: April 2015

ABSTRACT: An unusual case is presented of carcinoma of the prostate metastasizing to both breasts (verified by biopsy). This is the sixth such case to be reported. The relationship of breast tumors to estrogen therapy is discussed. The estrogen therapy given for treatment of prostatic carcinoma apparently does not influence the occurrence of metastases to the breast.
Some Aspects of Chronic Renal Failure
Authors: SALOMON MARDOQUEO I.
Published: April 2015

The clinical manifestations of chronic renal failure are manifold and may masquerade as either “functional” or organic symptoms unrelated to the kidney. The main complications are metabolic, cardiovascular, gastroenterologic and neurologic. The etiology and pathogenesis of chronic renal insufficiency are surveyed and general outlines of treatment are discussed.
In Support of the Natural Sociological Environment for the Elderly
Authors: ZAMPELLA A. D.
Published: April 2015

By emphasizing the natural aspects of the aging process and providing residence for the elderly in a homelike and cheerful environment consistent with their physical limitations, the need for early institutional confinement usually can be averted. The result is happier and more independent old people who retain dignity, self‐respect and, as long as possible, self‐sufficiency. Elderly persons need a sense of mature independence, self‐earned security in congenial surroundings, personal use of treasured possessions, full release from family responsibilities, freedom to live without regimentation or classification as aged or senile, and the assurance that medical and other facilities are readily available in a friendly atmosphere for pleasantly prolonged living.
A Nursing‐Home Care Unit: Extended Care Service
Authors: KURASIK STEVE
Published: April 2015

A new Nursing‐Home Care Unit, opened at the Miami Veterans Administration Hospital in September 1970, is described. The aim is to take the best possible care of the residents in all aspects of their lives during the process of rehabilitation. The Unit could be regarded as a model for nursing homes everywhere.
Splenomegaly Secondary to Malaria In Utero?
Authors: CASE THOMAS C.
Published: April 2015

A case of splenomegaly probably secondary to malaria in utero is presented. The patient was a 50‐year‐old male who was admitted to the hospital because of longstanding abdominal pain and swelling. Otherwise he had had no serious illnesses and no symptoms of malaria. Splenectomy was performed because of the hazard of injury to the organ in the patient's occupation as a laborer handling heavy machinery.
Kaposi's Sarcoma
Authors: GLATT O. S.
Published: April 2015

A review of Kaposi's sarcoma and 2 case abstracts are presented. There are many conflicting theories about the pathogenesis of this multiple hemorrhagic sarcomatosis of the skin and internal organs. Clinically, in the adult, it may run a relatively benign course, though subject to recurrences. The differential diagnosis is important, as several other diseases resemble it. In cases in which bleeding of an internal organ is the only presenting symptom, a history of a forgotten healed skin lesion may be an important clue. X‐ray therapy is the most effective treatment.
Delayed Appearance of Metastases from Carcinoma of the Breast
Authors: PIWOZ SEYMOUR
Published: April 2015

Two patients with breast carcinoma treated by radical mastectomy survived for periods of thirty and thirty‐four years respectively before metastases were found in the clavicle and chest wall. Other cases of long delayed metastases are cited.
Recognition, Relevance and Deactivation of Gerontophobia: Theoretical Essay
Authors: BUNZEL JOSEPH H.
Published: April 2015

Gerontophobia, or irrational dislike of the elderly, is a psychopathological defense mechanism on a mass basis. There are medical, legal and social varieties. Three therapeutic possibilities are: 1) mass education, 2) insight therapy, and 3) intra‐group mobilization.
Oxygen Inhalation in the Control of Psychogeriatric Symptoms in Patients with Long‐Term Illness
Authors: FRAIBERG PAUL L.
Published: April 2015

Daily hypobaric (low pressure) oxygen inhalation was given to 59 behaviorally disturbed geriatric patients at a nursing center. They were either disruptive in behavior or withdrawn, and all had a serious chronic or terminal illness, as evidenced by a mortality rate of 8 per cent during the two‐month study period. The scores for changes in psychogeriatric and behavioral manifestations showed that 28 of these oxygen‐treated patients (47.5 per cent) achieved ratings of “excellent” or “good,” i.e., they became more alert, less confused, less hostile, more cooperative, more sociable and much more interested in the world around them. There were no untoward results. Hypobaric oxygen therapy is a simple and relatively effective aid in the control of behaviorally disturbed elderly patients.
Gold Leaf in the Treatment of Leg Ulcers
Authors: RISBROOK ARTHUR T. , GOODFRIEND STANLEY S. , REITER JULIA M.
Published: April 2015

Upon admission to a nursing home, a 79‐year‐old woman with peripheral arteriosclerosis had a large (10 times 17.5 cm) raw painful ulcer of the left leg. She had had the ulcer for five years and, ten months before admission, had undergone an aorto‐femoral bypass with sympathectomy. Gold leaf therapy was started but was discontinued after two years for a trial of other methods. These were unsuccessful. After another two‐year course of gold leaf therapy, the ulcer was healed. The length of time that elapsed before healing emphasizes the need for perseverance.
Biochemical Observations during a Trial of Inosiplex in Senile Dementia*
Authors: MARCH JAMES , FIELD JACK , SHANLEY JOSETTE , TURNER WILLIAM J.
Published: April 2015

Inosiplex (Isoprinosine), a complex containing hypoxanthine riboside, was administered to 7 men with senile dementia; in 6 it was given for six to nine months, and in 1 for three months. During the first six months, neither further regression nor clinical improvement was noted, although 5 patients gained weight. Originally the study had included 9 patients, but 1 was dropped at one month because of certain diagnostic features and 1 was dropped at one month because the serum uric acid level had risen to 11.3 mg/100 ml. Among the remaining 7 patients, the serum uric acid level in 1 case rose to 10.2 mg/100 ml at six months, but in the other 6 the uric acid values had returned to normal at six months after an earlier slight rise. The urinary excretion of hypoxanthine, xanthine, guanine and uric acid accounted for about 60 per cent of ingested hypoxanthine at one month and 40 per cent at three to seven months. The biochemical data are discussed in relation to some current approaches to the treatment of senile dementia. Inosiplex may prove to have a significant anabolic effect.
Gastrointestinal Hemorrhage in Geriatric Patients*
Authors: GRODSINSKY CARLOS , BRUSH BROCK E.
Published: April 2015

ABSTRACT: Gastrointestinal hemorrhage in the elderly is described under the headings: 1) a single episode of hematemesis, melena or rectal bleeding, 2) active persistent bleeding, 3) slow persistent bleeding, and 4) periodic bleeding. Illustrative cases are presented. Although the signs and symptoms are sometimes misleading, a careful history and examination will suggest the diagnosis in 70 per cent of cases. However, sometimes it is very difficult to locate the bleeding point preoperatively. Endoscopy, radiography and angiography are valuable aids. Initially, it is important to learn whether the hemorrhage comes from the upper or the lower gastrointestinal tract, as the selective diagnostic and surgical procedures differ. In all cases the effective management of major gastrointestinal hemorrhage requires rapid identification of the source of bleeding.
Stature and Aging*
Authors: KALLIOMÄKI J. L. , SILTAVUORI L. , VIRTAMA P.
Published: April 2015

ABSTRACT: The study series consisted of 100 women and 100 men over the age of 45 who remembered their heights at the age of 20. Ninety women and 36 men also recalled their weights at age 20. The combined cortical thickness and the cortical index of both clavicles were measured, as well as the height and weight. The reduction of height for the 45–59 age group in women was 1.8 cm, and in men 1.1 cm; for the 60–69 age group in women it was 2.7 cm, and in men 1.7 cm; and for the 70+ age group in women it was 2.8 cm, and in men 2.0 cm. The difference between women and men was significant in the two younger age groups. There was a significant increase in the weight of women in the age groups 45–59 and 60–69 compared with their weight at the age of 20. No significant difference was found for the men. The reduction of stature was considered to be the result of loss of intervertebral tissue and pronounced curvatures of the spine (characteristic of old women gaining weight) rather than osteoporosis.
Lorazepam versus Glutethimide as a Sleep‐Inducing Agent for the Geriatric Patient
Authors: BANEN DAVID M. , RESNICK OSGAR
Published: April 2015

ABSTRACT: The safety of lorazepam was compared with that of a standard drug, glutethimide, in 50 chronically ill geriatric patients. Repeated physical examinations, laboratory determinations and other tests indicated that any organic disease in these patients had become stabilized before the study and was not affected by the test drugs. Early morning drowsiness, dizziness and lethargy were noted with each drug during the first and second weeks. More patients in the glutethimide series discontinued therapy because of side effects than in the lorazepam series. Dosage reduction to 1 mg nightly was necessary in many of those treated with lorazepam. Lorazepam is useful for aiding elderly patients to sleep. The initial dosage should be 1 mg nightly. If necessary, this dosage usually can be increased with safety to 2 mg nightly.
Profile for Long‐Term Survival after Myocardial Infarction
Authors: BERMAN BERNARD H. , LEON DONALD F.
Published: April 2015

Thirty‐nine patients who survived a myocardial infarction were studied afterward for periods ranging from ten to twenty years. The data indicate that for such long‐term survival the following factors are significant: onset of myocardial infarction in the early 50's; a strong genetic background for longevity; normal blood pressure, weight, heart size, and lung fields; and avoidance of smoking. Secondary factors are the avoidance of problem drinking habits, and assuming an occupation that does not involve sustained heavy labor.
Community Liaison with a Mental Hospital
Authors: GOLDSTEIN S. E. , ROGERS Mrs. J.
Published: April 2015

A report is given on a one‐year trial of obtaining discharge of suitable geriatric patients from a Brockville mental hospital to nursing homes or homes for the aged in Ottawa, Canada. Reasons for rejection or acceptance of transfer are discussed. Barriers of prejudice, lack of staff liaison, and lack of supervised non‐nursing facilities in Ottawa had to be overcome before the program could be effective. Family relationships are stressed. Persistent education regarding the new approach was a large factor in success, as was the principle of reversible exchange of patients between the institutions involved. Hospital beds are needed for the rapid short‐term treatment of acutely ill patients. Therefore it is important to confirm that no patients are admitted to, or remain in mental hospitals unnecessarily.
Comparison of Thioridazine and Diazepam in the Control of Nonpsychotic Symptoms Associated with Senility: Double‐Blind Study
Authors: KIRVEN L. E. , MONTERO E. F.
Published: April 2015

The effects of thioridazine (average dosage 38.9 mg daily) and of diazepam (average dosage 9.0 mg daily) were studied by the double‐blind method for four weeks in 56 hospitalized geriatric patients who had behavioral symptoms associated with senility. Clinical assessment was made by the psychiatrists' modified Hamilton Anxiety Scale for specific psychiatric symptoms and by the Nurses' Observation Scale for Inpatient Behavior, with a global rating for each. On the Hamilton Scale, the thioridazine patients improved more than the diazepam patients with regard to anxiety, tension, fears, behavior at interviews, overall mental illness and global change, whereas the diazepam patients improved more with regard to insomnia, intellect, depressed mood and agitation. The NOSIE ratings favored thioridazine. The only side effects observed were drowsiness during the first week in 2 thioridazine patients receiving 60 mg daily and in 4 diazepam patients receiving 18 mg daily; one of the diazepam patients also had slurred speech for the first week. The conclusion is that in the relatively low dosage employed in this series, thioridazine will improve behavioral symptoms in senile patients without the added stress of oversedation or other side effects.
Colovesical Fistula*
Authors: STEIER MICHAEL E. , MITTY WILLIAM F. , NEALON THOMAS F.
Published: April 2015

Twenty‐four geriatric patients with colovesical fistula were admitted to St. Vincent's Hospital, New York, between January 1961 and December 1970. A review of these cases showed that only 42 per cent were correctly diagnosed upon admission. Diverticulitis was the leading etiologic factor, and in most cases the fistula was located between the sigmoid and the bladder. The most valuable diagnostic procedures were cystoscopy and barium‐enema x‐ray examination. Pneumaturia (present in 75 per cent of the cases) and fecaluria were significant physical findings, as was abdominal pain. A three‐stage operation — preliminary colostomy, then colonic resection and fistulectomy, and finally closure of the colostomy — is the safest surgical procedure.
Antiviral Drugs in Jakob‐Creutzfeldt Disease
Authors: HERISHANU Y.
Published: April 2015

ABSTRACT: A 61‐year‐old patient had a rapidly progressive neurological syndrome consisting of aphasia, dysgraphia, dyslexia, right‐left disorientation, slight motor lateralizing signs, tremor and myoclonic jerks. The electroencephalogram showed the bursts of spikes and slow waves (1 per second) characteristic of Jakob‐Creutzfeldt disease (spastic pseudosclerosis). A Nevin‐Jones variant of the disease was diagnosed. Amantadine and idoxuridine were given without any positive effect. The patient died in a state of septicemia. A review of experience with antiviral drugs in slow virus neurological infections is presented.
Enhancement of Brain L‐Dopa Concentration with α‐Chymotrypsin
Authors: SENECA HARRY , HENDERSON EDWARD
Published: April 2015

ABSTRACT: α‐Chymotrypsin (5 mg per kg per dose) plus L‐dopa (250 mg per kg per dose) was administered orally to 15 mice in a series of 5 feedings during a 26‐hour period. There was a 2.35‐fold increase in the brain concentration of L‐dopa compared with the increase in 5 mice given L‐dopa alone. It is suggested that oral administration of α‐chymotrypsin in combination with L‐dopa might be of clinical value in the management of Parkinson's disease.
Serum Folate Levels During Anticonvulsant Therapy with Diphenylhydantoin
Authors: HAGHSHENASS M. , RAO DODDA B.
Published: April 2015

ABSTRACT: In chronic disease hospitals, diphenylhydantoin (DPH) is widely used as an anticonvulsant drug. During prolonged treatment with DPH, low serum folate levels and occasionally megaloblastic anemia may develop. This study involved the evaluation of serum folate, iron, total iron‐binding capacity and the hemogram in 27 patients with seizure disorders who were treated with DPH (100 mg three times daily), and 25 patients who served as controls. The dietary intakes of iron, folic acid and vitamin C were adequate, but the serum folate level was extremely low in most of the DPH patients, particularly those aged 60 or older. No macrocytosis was observed during the three‐month study period.
Pre‐ and Postoperative Management of Elderly Surgical Patients*
Authors: GLENN FRANK
Published: April 2015

ABSTRACT: Can the aging process be altered to prevent the pathologic changes that impair function? The matter should be put in proper perspective. This involves biologic and other forms of research as well as the therapeutic application of current knowledge.

About 40 per cent of elderly patients under general hospital care are admitted for surgical treatment. In 1973, the total is expected to reach 2.5 million. Morbidity and mortality associated with surgery are highest among the elderly. However, with the use of new procedures and stress on the factors involved in proper pre‐ and postoperative care, the risk has been greatly reduced. Age‐over‐65 is no longer a contraindication to surgery. The matter of careful evaluation and treatment is discussed under the following categories: status of the patient, status of the various organs and systems (including the effect of trauma), elective versus emergency operations, and the prognosis, especially in relation to such disorders as biliary‐tract disease, cardiovascular disease, cancer, and degenerative hip disease. Preoperative assessment must be thorough and complete. If the situation is not an emergency, there should be a period of corrective nutrition, activity, supportive medication, and instruction of the patient regarding what he may expect. For selective surgical procedures, the response to those measures determines the type of anesthetic and the extent and nature of the operation. The stress of the surgical procedure should never exceed the patient's tolerance. The immediate postoperative care (recovery room) is extremely important. The objective is to prevent complications. The experience of the surgeon, the cooperation of all involved, and meticulous attention to detail are required in the surgical care of the elderly.
Complications of Peptic Ulcer Disease in Geriatric Patients*
Authors: GRODSINSKY C. , NIBLER J. G. , BRUSH B. E.
Published: April 2015

ABSTRACT: Many patients with the complications of peptic ulcer disease are in the geriatric age group. This is partly the result of the overall increase in this segment of the population in recent years, and partly the result of delay in the referral of younger patients with intractable forms of the disease. Hemorrhage is the most common life‐threatening manifestation of peptic ulcer in the geriatric patient. Prompt evaluation by esophagogastroscopy and barium x‐ray examination is of paramount importance in proper management. Perforation of peptic ulcer is less common in the elderly. When diagnosed, it requires immediate surgical treatment. Pyloric obstruction should be suspected in a patient with chronic nutritional depletion, superimposed acute dehydration, electrolyte imbalance and even shock. Nasogastric decompression of the dilated stomach and re‐establishment of fluid and electrolyte balances should be attended to before carrying out definitive surgical treatment.

Geriatric patients tolerate major surgery relatively well, but only if special attention is given to associated medical and metabolic abnormalities. Chronic obstructive lung disease with diminished pulmonary reserve is among the most common of these associated disorders. The prevention of serious pulmonary complications demands aggressive management both before and after operation for peptic ulcer. Diminished cardiovascular reserve must be taken into account if postoperative congestive heart failure or pulmonary edema is to be prevented. The presence of renal disease also should be evaluated as a factor in postoperative complications.
Sudden Unexpected Death in the Elderly
Authors: BENDKOWSKI B.
Published: April 2015

ABSTRACT: This report deals with sudden unexpected deaths among 900 geriatric patients seen in a general practice of 3,050 patients in a residential area not far from London. During the year 1972, 18 of the 41 deaths among the 900 elderly patients were sudden and unexpected. Records also were obtained from the Coroner's Office dealing with 385 sudden deaths among elderly patients in this area. Cardiovascular diseases accounted for the largest number of sudden deaths, bronchopulmonary diseases second, and cerebrovascular accidents third. Multiple injuries and suicides are serious and preventable causes of death. The clinical, social and medico‐legal aspects of sudden unexpected deaths are discussed.
Feeding the Elderly Heart
Authors: Kupers Edward C.
Published: April 2015

Treatment of the elderly cardiac patient should not be limited to the heart alone. Many other factors demand attention, e.g., psychic stress (depression), nutritional deficits and physiologic imbalances. Dietary guidelines are presented, including special references to carbohydrates, proteins, fats, vitamins and minerals. A nutritional program for the aged cardiac patient should be carried out on an individual basis to allow for appropriate modifications. Mass nutritional programs for the elderly may not be suitable for the specific cardiac patient with his various problems.
An Ergot Alkaloid Preparation (Hydergine) in the Treatment of Presenile Brain Atrophy (Alzheimer's Disease): Case Report
Authors: Burian Ernst
Published: April 2015

An ergot alkaloid preparation, Hydergine, when used therapeutically for arteriosclerotic brain disease and after cerebrovascular accidents usually has a beneficial effect. Thus Hydergine was used on the Intermediate Care Service of a Veterans Administration hospital to treat 21 such patients. The dosage of Hydergine was two 0.5‐mg tablets sublingually three times daily for ninety days. A good response was obtained in 62 per cent. Because of this encouraging result, 4 patients with presenile brain atrophy (Alzheimer's disease) were treated similarly. Of these 4 patients, 2 improved and 2 did not. One of the 2 who improved was a 62‐year‐old man who had become a total nursing‐care problem. Alzheimer's disease was confirmed by brain biopsy. His response to Hydergine was so dramatic that his case is reported here. The improvement and the absence of side effects justify further trials of Hydergine in presenile brain atrophy.
Brief Extensive Isometric Exercise in the Treatment of Intermittent Claudication
Authors: Kiveloff Broino
Published: April 2015

In 7 cases of intermittent claudication due to peripheral vascular disease, pain was relieved and walking ability improved after brief extensive isometric exercise. This form of exercise may be useful in the prevention of intermittent claudication.
Sudden Death in an Elderly Population from Aspiration of Food
Authors: Gelperin Abraham
Published: April 2015

During the year 1973, sudden death from food aspiration was identified in 3 patients of a geriatric hospital population. The correct diagnosis was made only at autopsy. As is usual under these circumstances, the clinical diagnosis had been myocardial infarction. This article emphasizes the importance of recognizing the possibility of food aspiration in these cases, as immediate bronchial aspiration or tracheostomy is the only life‐saving procedure.
Peritoneoscopy in Geriatric Patients*
Authors: ANSELM KLAUS , GLUCKMANN ROBERTO M.
Published: April 2015

The results of peritoneoscopy in 119 patients of advanced age are described. The procedure permits thorough inspection of the entire abdominal cavity and, in association with guided biopsy, leads to early diagnosis in patients with suspected carcinoma, ill defined chronic liver disease or ascites of undetermined etiology. The relative lack of serious complications makes this procedure feasible in patients of all ages.
“High Risk” Factors and Atherosclerotic Cardiovascular Diseases in the Aged
Authors: VAVRIK M.
Published: April 2015

The association between the so‐called “high risk” factors — hypercholesterolemia, hypertension, diabetes — and atherosclerotic cardiovascular diseases (ACVD) was studied in 509 subjects over 60 years of age. The correlation between these factors (especially their cumulation) and the prevalence of clinically evident ACVD was statistically significant. Nevertheless, in comparison to the high prevalence of atherosclerosis in these groups of elderly subjects, the prevalence of cumulation of two or even three of these atherogenic factors was relatively so low that their atherogenic importance appeared questionable. This fact may be of great importance in the strategy for prevention of myocardial infarction and cerebrovascular accidents in these age groups.
Functioning of the Elderly Patient in Relation to the Physician's Diagnosis of Chronic Brain Syndrome*
Authors: CARMICHAEL JOAN , LINN MARGARET W.
Published: April 2015

Physicians may respond to the age of the patient rather than to the degree of impairment in making a diagnosis of chronic brain syndrome (CBS), A study of 800 male veterans placed in nursing homes during a seven‐year period included demographic data, ward staff rating and physicians' assessments of impairment. In 159 patients the diagnosis was CBS, and in 80 this diagnosis was the primary one. A comparison was made with 159 patients (drawn at random) who did not have CBS. The CBS group showed greater impairment of the vascular, renal and nervous systems. Analysis of intergroup differences was performed with controls for age, since the CBS group was significantly older. Confusion and uncooperativeness as rated by ward nurses still ranked highest as discriminators. The findings suggest that diagnosis was supported by the behavioral and impairment data rather than by the age of the patient. Age alone was not a basis for predicting confused behavior. Rather than label the CBS patient as an “old crock,” we should learn to understand him as an individual with a valid diagnosis of real impairment.
Continuous Cyclic Hormonal Therapy*
Authors: RHOADES FRANCIS P.
Published: April 2015

A two‐year study of estrogen replacement therapy was conducted on 1,200 postmenopausal women. Computerized data concerning the effect on 20 common symptoms showed 95 per cent relief during an appropriate regimen of estrogen‐progesterone therapy. The improvement in the ability to enjoy life counteracted any reluctance to undergo hormone‐induced withdrawal bleeding in the women with an intact uterus. There was no laboratory or clinical evidence that the treatment caused cancer. The benefits of continuous cyclic hormone therapy for estrogen‐deficient women far outweigh the possible dangers.
Modern Concepts of Senile Macular Degeneration*
Authors: KORNZWEIG ABRAHAM L.
Published: April 2015

ABSTRACT: The macula lutea of the retina in the human eye is the area of clearest central vision. However, it is the area most vulnerable to hereditary and degenerative disorders. It is also susceptible to certain metabolic, general and infectious diseases. The modern theories regarding such vulnerability are discussed under the headings of anatomy, development, genetic factors, pathology and physiology. Since disorders of the macula are a common cause of loss of vision in the elderly, it is hoped that this presentation will help internists and generalists toward a better understanding of this disabling disease of the eye.
Psychiatric Assessment of the Aged: A Differential Model for Diagnosis
Authors: VARNER ROY V. , CALVERT W. R.
Published: April 2015

ABSTRACT: A 4‐category differential model was developed for the simultaneous psychiatric and total‐problem assessment of elderly persons referred to a geropsychiatric mental health center. The working structure and comprehensiveness of the services are described. The four diagnostic categories and the accompanying medical and socio‐economic problems represented a broad spectrum ranging from obvious mental illness which began earlier in life, to a relatively “normal” mental state associated with a temporary mild affective disorder arising from the stresses of growing old. Appropriate treatment can be surprisingly effective. This diagnostic model can be used successfully by many types of workers in the field of geriatric mental health services. It is compatible with official psychiatric nomenclature and with the use of theoretical conceptual models.
Acute Intestinal Obstruction from Trichobezoar in the Sigmoid Colon: Case Report
Authors: CASE THOMAS C.
Published: April 2015

ABSTRACT: A case is presented of intestinal obstruction from a trichobezoar in the sigmoid colon. The radiographic evidence of an obstructive, though unidentified, lesion in the sigmoid made surgical intervention mandatory. The sigmoidal site was unusual, as most trichobezoars are found in the stomach. For this reason, the diagnosis was not suspected preoperatively.
Presenile Dementia: Further Experience with an Anticoagulant‐Psychotherapy Regimen*
Authors: WALSH ARTHUR C. , WALSH BERNICE H.
Published: April 2015

ABSTRACT: The principles of an anticoagulant‐psychotherapy regimen for presenile dementia are discussed. Short histories are given of 10 patients (including one with Huntington's chorea as well as dementia) who responded well to this treatment. It is important to keep the blood prothrombin time at 2.0–2.5 times the control time. The earlier treatment is started, the better the result. Even in cases in which there is no significant improvement, the prevention of further deterioration is of great value. If properly controlled, this regimen is relatively safe and can maintain or improve the quality of life for dementia patients.
Scleredema and Diabetes Mellitus
Authors: MARGOLIS JACK , BROADRICK BROADWAY
Published: April 2015

ABSTRACT: A case of the uncommon association of scleredema and diabetes mellitus is presented. Such patients usually are obese, and the scleredema quite extensive and longlasting. The difference between this entity and scleredema adultorum is discussed. Attempts at treatment during a two‐week period were unsuccessful.
Physiologic Factors Affecting Defecatory Sensation: Relation to Aging
Authors: NEWMAN HERBERT F. , FREEMAN JOHN
Published: April 2015

ABSTRACT: A study was made of the defecatory sensation in 130 patients with normal rectums. By means of a specially designed balloon inserted into the rectum, determinations were made of intrarectal pressure, rectal diameter and rectal tension. The desire to defecate was correlated with the levels of these measurements. There was a progressive rise with age in the threshold for these factors. Rectal sensitivity to distention was lower in the constipated patients than in those who were not constipated.
An Assessment of Aging Based on Screening Data
Authors: WEBSTER IAN W. , LOGIE ALEXANDER R.
Published: April 2015

ABSTRACT: A method for quantitating biologic age is described. Biologic age was calculated by this method from 7 different measurements made in subjects who were objectively and subjectively well. The 29 “well” subjects were selected by a computer program on the basis of the medical questionnaire, chest roentgenogram, urinalysis and electrocardiogram, from 705 “apparently well” females who attended a mutiple screening centre. These subjects had a lower calculated biologic age compared with the reference population. The model could be of value in assessing the aging rate and comparing the effect of social and environmental factors on aging in different population groups.
Some Principles of Medication in Geriatrics*
Authors: FREEMAN JOSEPH T.
Published: April 2015

In geriatrics, inappropriate and incorrect use of drugs is reflected in a higher percentage of untoward effects. Most reactions are identified readily but some are lost in the induced disturbances of physiologic balance that occur more readily in the aged. Improper dosage, injudicious methods of administration, and lack of awareness of drug interactions are common and are associated with failure to quantitate the reactive capacities of aging body resources. The paucity of didactic instruction and the difficulty which aged patients encounter in observing a medical regimen add to the problems of therapy. The fact that aging alters drug effects and that drug effects alter senescent functions emphasizes the need to be familiar with the roster of confirmed pharmacologic data. Observance of such regulations would improve treatment of the individual patient. Medication schedules must be in line with recognized levels of normality in senescence. These precautions will reduce the chances of initiating primary or sequential mishaps when drugs are administered to the elderly who are more susceptible to side effects and less likely to be responsive to reparative measures.
Advanced Occlusive Arterial Disease (Gangrene) in the Aged, and Decision‐Making for Amputation*
Authors: MILLER MICHAEL B.
Published: April 2015

In aged patients with advanced occlusive arterial disease, organic brain syndrome, other serious disorders (especially diabetes), and spreading gangrene of a lower limb, the decision for amputation may be crucial for the patient's life. For the brain‐damaged patient, decision‐making is influenced by the sometimes conflicting attitudes of the patient's family, the attending physician, and the nursing‐home staff. Four illustrative cases are presented. The presence of gangrene posed overwhelming nursing problems. In the population of patients described, the decision for surgery was based less on objective medical criteria and more on the subjective attitudes of the physician and the families. The physician seemed to be influenced by the wishes of the family and by his attitude toward the aged in general. Serious consideration should be given to the correction of distorted ethical values in the treatment of the mentally ill aged.
The Search for Early Indicators of Social Service Need among Elderly Hospital Patients*
Authors: BERKMAN BARBARA , REHR HELEN
Published: April 2015

ABSTRACT: A study was made of the possible usefulness of certain sociodemo‐graphic characteristics as early indicators of the need for referral of elderly hospital patients to Social Service. The study population covered the 5,312 elderly patients accommodated in the private, semiprivate and teaching wards of the hospital's medical and surgical services during the year 1967. Of these patients, 520 were referred to Social Service. The data on 6 items (age, sex, marital status, religion, color, and medical service location) routinely recorded on each admission sheet were collected to determine whether they would prove predictive of the need for referral to Social Service; if so, they would constitute an inexpensive automated screening device for this purpose. At present, most elderly patients who need the services of social workers are referred only late in the course of hospitalization. Incidental to the original plan of study was the collection of data on the length of hospital stay. The 6 “admission” variables were found to be of no value as early predictors, but the ancillary variable (length of stay) proved to be importantly related to the overall need for Social Service. However, since the data on this variable can be obtained only at the time of discharge, they cannot be used as a screening device for early identification of the need. Further studies may reveal a means of early prediction of the length of hospital stay.
New Lifestyle for the Aged in a Long‐Term Hospital*
Authors: FINKELSTEIN MILDRED , ROSENBERG GILBERT
Published: April 2015

ABSTRACT: The aged patient in an institution can be helped to develop a new lifestyle. A structured atelier workshop is described. A key factor in success is to raise the patient's standard of work so that he can perform as an artisan and sell products of professional quality, thereby earning money. The patient benefits by the tangible recognition that he is a part of the working force. This knowledge makes it easier for the patient to accept the institution as his community.