bluuebunny/crossref_metadata_2025 huggingface dataset:
The Use of Urokinase in Acute Myocardial Infarction: Report of Two Cases†
Authors: Mazel M. S. , Parsa F. , Riera R.
Published: April 2015

In the course of a study (now including 53 patients) on the effectiveness of urokinase in the treatment of acute coronary occlusion, coronary angiography was performed in 2 patients before and after the use of this drug. In both instances the angiograms demonstrated obstruction in the coronary‐artery branches, with additional narrowing and some collateral circulation. After urokinase therapy, blood flow was restored in the areas previously obstructed. These 2 case reports are presented because they demonstrate this favorable change in coronary blood flow in association with this particular form of therapy. It is hoped that the completed urokinase study may add some information concerning the effect of thrombolysis in the management of myocardial infarction.
Possible Organic Factors in the Prevention of Emotional Problems of the Aged
Authors: Kent Edward A.
Published: April 2015

This presentation attempts a new approach to the understanding of both normal and abnormal behavior in older persons who are ready for retirement. The suggested orientation is based upon the concept of an organic cerebral basis for the neurophysiologic disturbances which result in emotional problems. A unified concept of human behavior allows for early establishment of mature brain patterns and the disruption of these patterns by disuse atrophy in later life. This provides a clue to the development of better measures for the prevention and treatment of emotional problems in the aged — problems which now come under the classification of chronic brain syndrome or senile brain disease.
Thyroid‐Adrenocortical Relationships in the Safe Treatment of Arthritis, Allergy, and Skin Disorders with Prednisone
Authors: Barnes Broda O.
Published: April 2015

Although the anti‐inflammatory action of cortisone or its derivatives is efficacious in arthritis or certain allergic and skin diseases, the standard use of such compounds is limited to short‐term administration because of induced disturbances in mineral and glucose metabolism. Another side effect of cortisone is suppression of thyroid hormone secretion. The author has found that when thyroid therapy is prescribed for patients with arthritis (300 to date), certain skin diseases or selected allergic disorders, the addition of prednisone in a small dosage of 5–10 mg daily will produce further improvement for at least a five‐year period, without side effects. The thyroid and adrenocortical hormones apparently are synergistic in the treatment of arthritis and allergy.
Urinary Steroids in the Measurement of Aging and of Atherosclerosis†
Authors: Marmorston Jessie , Griffith George C. , Geller Paul J. , Fishman Eugene L. , Welsch Federico , Weiner John M.
Published: April 2015

Several studies conducted by the authors' group have shown that urinary steroid measurements are a valuable aid in differentiating the normal aging process, the pronounced aging associated with increased risk to coronary heart disease, and the deviations associated with myocardial infarction. Data are presented on 428 men in the age range of 30–70 years. The study design most effective in elucidating aging and disease patterns involves selection of subjects from a wide age range. Data on persons identified as clinically normal can be used to describe physiologic aging. Once this is determined, data on persons with disease can be used to identify abnormalities of aging associated with the clinical conditions studied. This approach offers a potential method for differentiating between aging effects and disease effects. The foregoing findings led to the development of an Index of Aging in males, based on combined serum lipid and urinary steroid values. This Index may be a means of differentiating between normal aging and the deviations seen in atherosclerosis and myocardial infarction. Current studies are directed toward extending these observations.
Pelvic Distress in the Aged Patient
Authors: Paulson George W.
Published: April 2015

Unexplained pelvic distress or pain was observed in the 4 patients of this report (3 women and 1 man), and also in 6 other patients during a 10‐year period of neurologic practice. In each of the 4 reported cases, the discomfort was interpreted as sexual. It is suggested that this may be a valid entity and that, as with trigeminal neuralgia and postherpetic neuralgia, it is truly limited to aged patients. The mechanism, incidence and significance are unknown.
A Follow‐Up Longitudinal Study of Selected Physiologic Functions in Former Physical Education Students–After Forty Years
Authors: Asmussen Erling , Fruensgaard Karen , Nørgaard Steen
Published: April 2015

Reported is the continuation of follow‐up investigations of certain physiologic functions in former physical education students. The first follow‐up study was conducted about 30 years after the initial measurements. The present follow‐up study concerned a re‐investigation of the same group (23 men and 11 women), 10 years later, i.e., about 40 years after the first examination. Resting values for heart rate, blood pressure and metabolism were determined, as well as values for lung volume, hand‐grip strength, and reaction time. During moderately hard exercise, measurements were made of oxygen uptake, ventilatory equivalents, and heart rate. By extrapolation of these heart‐rate determinations to “maximal heart rate,” the maximal oxygen uptake was estimated and expressed as L × min−1 and as ml × kg−1 × min−1. The data show a general deterioration in practically all the physiologic functions studied, most pronounced during the last 10 years of the 40‐year period.
Psychopharmacologic Investigations in Elderly Volunteers: Effect of Diazepam in Males†
Authors: Salzman Carl , Shader Richard I. , Harmatz Jerold , Robertson Linda
Published: April 2015

Forty male volunteers over the age of 60 took either a daily dose of diazepam (12 mg) or placebo for a two‐week period. Differential responses to these compounds partially depended upon age and the initial symptom level. Diazepam produced sedative side effects, a modest antidepressant effect, and a reduction in memory. Placebo had an antianxiety effect in the relatively older subjects, and was associated with decreased fatigue, improved memory and improved motor function. Considerable variability was observed in both drug and placebo responses among the elderly. A self‐rating depression scale (D30R) was useful for assessing changes in affective states and in discriminating between the effects of active drug and placebo.
What Is A Geriatrician?
Authors: Poe William D.
Published: April 2015

A geriatrician is something more than a physician who simply cares for old people. The geriatrician should, above all, be well grounded in internal medicine, have a genuine fondness for the elderly and their problems, and be experienced in neurology, psychiatry and rehabilitation medicine. A possible additional role is that of organizer and coordinator of health services for old people.
Screening and Supportive Techniques for Home Dialysis in the Treatment of Renal Failure*
Authors: KOLODNER LOUIS , McCUAN ELOISE , LEVENSON JULIA
Published: April 2015

ABSTRACT: Patients with end‐stage renal disease are being kept alive by dialysis treatment which may be provided either in an institution or in the patient's home. However, medical advancements have outstripped the ability of the treatment team to insure the quality of life for these long‐term patients. Although the predominant pattern of care continues to be the hospital‐ or institution‐based unit, an attempt is being made by both patients and physicians to make home dialysis a more viable alternative. There are two major barriers to the large‐scale effectiveness of treatment by home dialysis: 1) lack of criteria for the selection of candidates, and 2) lack of a continuing supportive service system. Home care requires a total understanding of the psychosocial functioning of the patient and the family.
Old‐Age Emotions
Authors: DÉANES ZSUZSANNA
Published: April 2015

ABSTRACT: One hundred old people (age range 60–94 years) were studied with respect to the state of their emotions. The chief factors leading to emotional sterility were loneliness, retirement and decline in sensory and locomotory functions. Among the 100 subjects, 60 were optimists and 40 were pessimists; most of the pessimists were lonely people. Suggestions are made for combating emotional “emptiness” before it leads to catastrophic mental impairment.
Geriatric Psycho‐Social History Outline
Authors: VELARDO CHRISTOPHER C.
Published: April 2015

ABSTRACT: The details of a Geriatric Psycho‐Social History Outline for use with the institutional aged are presented. All health care facilities cequire background information on the patient at the time of admission, but with long‐term facilities a more comprehensive psycho‐social history is needed. The Outline provides a basis for obtaining information in five categories: 1) identification (detailed, observational and attitudinal); 2) referral source; 3) background; 4) family constellation or environmental factors; and 5) finances. Its comprehensiveness requires more than one preadmission interview. It is aimed at reducing morbidity and mortality rates following admission to long‐term facilities. If the aged person becomes somewhat familiar with the institution before admission, he is less susceptible to accelerated physiologic and psycho‐social deterioration and death. Because of constant growth in the field of gerontology, new and improved instruments must be devised to help carry the load. The Geriatric Psycho‐Social History Outline is for use as a guide to those who require such information if they are to function at maximum efficiency.
Doxorubicin (Adriamycin) Therapy of Uterine Sarcoma without Surgery in an Elderly Patient
Authors: ADDUCCI JOSEPH E.
Published: April 2015

ABSTRACT: A case is presented of primary endolymphatic stromal sarcoma of the uterus in a debilitated elderly patient. Surgical intervention was contraindicated. Radium therapy was unsuccessful. A 4‐month course of treatment with doxorubicin (Adriamycin) resulted in disappearance of the tumor. The patient is living 19 months after the beginning of Adriamycin therapy.
Reactivation of Tuberculosis: A Problem of Aging
Authors: DUBROW EDWARD L.
Published: April 2015

ABSTRACT: Six examples demonstrate the reactivation of pulmonary tuberculosis in elderly patients. In 3 cases the tuberculosis became reactivated 25, 47 and 51 years respectively after the initial diagnosis. In aged patients with pulmonary symptoms and abnormal x‐ray findings, the presence of reactivated tuberculosis should always be considered. Sometimes steroid or x‐ray therapy for other disease may be the reactivating factor.
Use of the Holter Electrocardiographic Monitor in the Diagnosis of Transient Ischemic Attacks*
Authors: LEVIN EUGENE B.
Published: April 2015

ABSTRACT: The diagnosis of transient ischemic attacks usually is based on an accurate history and physical examination (with the finding of carotid bruits), a complete neurologic examination, a brain scan, an encephalogram and an angiogram. Recently the Holter technique for continuous 24‐hour electrocardiographic monitoring has been used as a diagnostic aid in these problem cases. Severe bradycardia, sick sinus syndrome, tachy‐brady syndrome, recurrent tachycardia and heart block have been found to be the cause of the central‐nervous‐system symptoms in aged atherosclerotic patients. Correction with anti‐arrhythmia drugs and pacemakers, with or without carotid endarterectomy, has been highly successful. Data are presented on 204 patients tested by Holter monitoring over a 2.5‐year period in a small community hospital; 6 cases are illustrated in detail. The Holter monitor is a valuable tool in evaluating the patients with cerebrovascular insufficiency.
Massive Postoperative Hemorrhage from Hepatic Artery Erosion
Authors: CASE THOMAS C.
Published: April 2015

ABSTRACT: A 66‐year‐old male patient who had undergone repeated operations for peptic ulcer disease involving the right upper abdominal quadrant, developed cholecystitis with calculous obstruction of the common bile duct. The gallbladder was removed. Later, an operation was performed for removal of a residual stone from the common duct. At this time an anomalous arterial structure was noted about the duct. Hemorrhage occurred ten days postoperatively, and the anomalous hepatic artery was found to be eroded. The bleeding was controlled. During the succeeding two weeks there were four episodes of bleeding (involving erosion of the hepatic artery and adjacent tissues), three of which were controlled. The fourth episode ended in the death of the patient from exsanguination secondary to bleeding from stress ulcers in the gastric remnant. At no time did the laboratory data unequivocally indicate an abnormality of blood coagulation. Erosion of the anomalous cystic artery apparently precipitated the fatal chain of events.
Age Distribution of Patients with Parkinsonism*
Authors: HOEHN MARGARET M.
Published: April 2015

ABSTRACT: The modal age at onset of the parkinsonian syndrome during the past thirty years is less than a decade higher than it was in the late 19th and early 20th centuries, suggesting that the same disease entity is affecting parkinsonian patients now as then. The evidence points to the existence of two distinct clinical entities: 1) parkinsonism secondary to encephalitis lethargica, which had its greatest influence on the epidemiology of parkinsonism between 1920 and 1945; and 2) classic parkinsonism, which has undergone little change in the past hundred years.
Friendship Manor: A Community Geriatrics Model
Authors: POE WILLIAM D. , RICE H. LAWRENCE
Published: April 2015

ABSTRACT: Models for the delivery of medical services are attracting much attention lately. It appears that geriatrics will become more important in the future. These facts have led to a narrative about the development of a system of medical care for a retirement community in Roanoke, Virginia.
Importance of Aortic Dilatation in the Genesis of the Innocent Systolic Ejection Murmur of the Aged
Authors: VITTAL S. BAI , LUISADA A. A. , RAO D. B.
Published: April 2015

ABSTRACT: Aortic systolic murmurs and aortic dilatation were studied in a randomized sample of 100 hospital patients over the age of 60. Clinical, phonocardiography, radiologic and carotid‐pulse data provided the basis for graphic characterization of the murmurs. Senile aortic dilatation was common (66 patients). In a high percentage (39 patients), dilatation of the ascending aorta (and sometimes of the arch) was associated with an aortic systolic murmur. The “innocent” type was always associated with aortic dilatation. This “innocent murmur of the aged,” even though caused by structural alterations, should be considered in the same light as the “innocent murmur of children,” as it is not associated with dynamic embarrassment of the circulation.
Hypochondriasis Associated with Organic Brain Syndrome: A New Approach to Therapy
Authors: WALSH ARTHUR C.
Published: April 2015

ABSTRACT: Symptoms of hypochondriasis in patients with organic brain disease usually disappear during the course of an anticoagulant‐psychotherapy regimen for the treatment of dementia.
Daily Vitamin C Consumption and Fatigability
Authors: CHERASKIN E. , RINGSDORF W. M. , MEDFORD F. H.
Published: April 2015

ABSTRACT: The increased prevalence of fatigue in persons with a low intake of vitamin C is mentioned only briefly in the literature. An analysis of the authors' data on vitamin C intake and fatigability in 411 dentists and their wives revealed a negative relationship. The mean number of fatigue symptoms among the low users of vitamin C was double that among the relatively high users of vitamin C. The mean difference was statistically significant.
Comparison of Two Systems for Stroke Rehabilitation in a General Hospital
Authors: McCANN B. CAIRBRE , CULBERTSON RICHARD A.
Published: April 2015

ABSTRACT: This study was designed to compare the effectiveness of stroke rehabilitation therapy in a specialized Stroke Unit with that provided on the medical service of a general hospital (Rhode Island Hospital). The 8‐bed Stroke Unit is staffed by a multidisciplinary team, and a weekly conference is held for evaluation and planning. On the basis of data obtained from the hospital records, two groups of patients were studied: 224 who were treated in the Stroke Unit, and 110 who were evaluated and approved for admission to the Unit but were not accommodated. A rigid “first come, first served” policy for admission to the Unit was observed. Hypothesis testing was performed with reference to the patient's medical condition, socioeconomic status, demographic characteristics, and difficulties during hospital stay to determine whether the groups were comparable. A patient was considered to have improved if his condition decreased in severity between the time of admission to therapy and the time of discharge. Severity was rated as: mild (level one), moderate (level two), severe (level three), and profound (level four).

No significant difference in rehabilitation results was found between the two treatment systems at severity levels two (moderate) and four (profound). However, the Stroke Unit attained significantly better results with level‐three patients (severe stroke). This group received more sessions of physical therapy and remained in the hospital longer than did the level‐three patients treated on the general medical service. Physicians referred patients selectively to the Stroke Unit, although the Unit had no policy of screening patients for admission, and this may have had some influence on the achievement of better results with level‐three patients. Level‐four patients did not do well in either setting.
Section I. The Interpretation and Use of Newer Diagnostic Studies
Authors: Mayne John G.
Published: April 2015

The diagnosis and the treatment of rheumatic diseases in older people pose special problems. Degenerative joint disease, almost universally present in the elderly, may not be the basis for the newly developing rheumatic symptoms. Systemic inflammatory disease may be confused with malignancy or it may be an initial manifestation of malignancy. Some drugs used to control central‐nervous‐system or cardiovascular disease may produce painful rheumatic syndromes. Results of laboratory tests used in the diagnosis of rheumatic diseases may be altered by other nonrheumatic disorders in older people. Papers in this symposium will explore these concepts in greater detail.
Back Pain: Osteoarthritis†
Authors: Bandilla Klaus K.
Published: April 2015

Back pain is one of the chief complaints of the elderly. It may be either a chronic deep skeletal muscular pain or an acute circumscribed pain arising from nerve‐root irritation. The main causes of back pain in older people are: 1) degenerative changes (spondylosis, osteoarthritis, ankylosing hyperostosis); 2) malignancy (multiple myeloma, metastases from carcinoma or lymphoma); and 3) metabolic disorders (osteoporosis, osteomalacia, chondrocalcinosis, Paget's disease). Mechanisms and variations are discussed in detail.
Total Joint Replacement: Lower Extremities†
Authors: Fitzgerald Robert H.
Published: April 2015

In experience with total joint replacement in the lower extremity, to date, total hip arthroplasty has been the most successful. Total arthroplasty operations as applied to the knee and ankle are giving promising results. These methods offer new avenues for relief of pain and deformity and stabilization of arthritic joints in the lower extremity.
Mission of the National Institute on Aging†
Authors: Butler Robert N.
Published: April 2015

The National Institute on Aging (NIA), the newest of the eleven National Institutes of Health, is dedicated to improving the quality of life of the old in America through biomedical, social, and behavioral research. Aging is viewed as more than just decline and deterioration; it is also a process of continued development and accumulated knowledge. The NIA will encourage innovative research, but will not support the delivery of health services, as that is the domain of other agencies. In areas of overlap, such as diseases common to the old, the NIA will collaborate with other Institutes. A good target area for collaboration is senile dementia. Other areas of interest to the NIA are: encouraging the incorporation of geriatric medicine as a subspecialty, developing retirement test patterns, and investigating drug‐drug and drug‐age interactions, personality and social processes, and immunocompetence.
The Biology of Aging: 1976, An Overview†
Authors: Wallace Daniel J.
Published: April 2015

This article is a comprehensive overview of the biology of aging. The largely unproductive history of research on aging is presented, to lay the groundwork for a discussion of why such research is performed and what aging levels and human models are employed. The anatomic, biochemical, physiologic and behavioral measures used in such studies are delineated. Some of the most promising theories of aging (genetic, autoimmune, viral, free radical) are discussed, as are factors that could prolong the lifespan if optimally employed. Philosophic considerations are emphasized.
Histochemical and Ultrastructural Changes in Senile Human Skeletal Muscle
Authors: Tomonaga Masanori
Published: April 2015

Eighty biopsy specimens of muscles from 79 elderly patients (chiefly in the 60–90 age group) were examined by histochemical and electron microscopic methods. Neuropathic change and type‐II fiber atrophy of various grades were prominent findings in the muscles from patients of advanced age. Nemaline rod formation, “ragged red” change and an increase of sarcolemmal nuclei were also common. Several electron microscopic features of the muscle fiber corresponded to those reported for various neuromuscular diseases. Various factors associated with the aging process apparently act on the motor neurons and cause the neuropathic and myopathic changes seen in the muscles of the aged.
A Device for Expressing the Serum Insulin‐Glucose Relationship in Diabetes, Hyper‐ or Hypothyroidism, and Chronic Hepatitis
Authors: Yamada Takashi , Ohtake Masao , Kotani Masanobu
Published: April 2015

When the serum insulin values during a 50‐gm oral glucose tolerance test were expressed as the function of glucose concentrations, a good linear relationship was found in normal subjects and in patients with diabetes, hyperthyroidism, hypothyroidism or chronic hepatitis. The insulin index calculated from the line representing this relationship was less than 100 in all 19 diabetic patients and most of the 13 hyperthyroid patients with oxyhyperglycemia, whereas it was more than 100 in the 14 normal subjects, the 4 hypothyroid patients, and the 8 patients with oxyhyperglycemia due to chronic hepatitis. The insulin index decreased with increasing maximal blood glucose concentration during the glucose tolerance test in diabetic patients. Furthermore, improvement in the insulin index was correlated with the effectiveness of sulfonylurea drugs in the diabetic group.
The Renal Lesion Associated with Total Lipodystrophy
Authors: Saito Ikuo , Saruta Takao , Iyori Shigeru , Sakaguchi Hiroshi
Published: April 2015

This report concerns a 41‐year‐old man with total lipodystrophy associated with a specific renal disorder. He had massive proteinuria, mild azotemia and a normal level of serum complement in addition to the generalized loss of subcutaneous fatty tissue. Results of a 50‐gm glucose tolerance test indicated a high fasting insulin level with an exaggerated response to glucose. Hypoglycemic responses to exogenous insulin were reduced. Renal biopsy revealed changes consistent with glomerular lipidosis. This case is unique in that the renal lesion was not the Kimmelstiel‐Wilson pathologic change attributable to abnormal glucose metabolism.
Serum Enzyme Alterations in Hypothyroidism before and After Treatment
Authors: Gaede Jane T.
Published: April 2015

Recognition of a pattern of elevations in commonly measured serum enzymes [creatine phosphokinase (CPK), lactic dehydrogenase (LDH), and glutamate oxalacetate transaminase (SGOT)] can facilitate the diagnosis of hypothyroidism, especially when muscle weakness is a symptom. Elevated levels of serum cholesterol, total protein, and albumin further contribute to a chemical profile of hypothyroidism, which can be observed in a routine chemistry screening test such as that obtained with the SMA 12/60 AutoAnalyzer. An illustrative case concerns a 50‐year‐old man who presented with angina pectoris and leg weakness. Subsequently he was found to have severe hypothyroidism. Special attention is given to the serum enzyme values which initially were elevated and fell to normal levels during thyroid replacement therapy. Isoenzyme fractionation of LDH and CPK indicated skeletal muscle as the source of the elevated enzyme activity. The literature on enzyme abnormalities in hypothyroidism is reviewed, with special reference to hypothyroid myopathy.
On‐Site Geropsychiatric Services to Guests of Residential Homes
Authors: Sherr Virginia T. , Goffi Maria Teresa
Published: April 2015

During a 7.5‐year liaison between a 152‐bed residential (multi‐level care) home for the aged and a psychiatrist‐social worker team, 58 of the 339 residents were referred to the team. With increasing expertise of the staff of the home and with early psychosocial intervention, the need for psychiatric hospitalization dropped virtually to zero. Of the 23 persons currently referred, 65 percent are recovering well with psychiatric‐social‐nursing support and psychotropic drugs; another 26 percent are achieving significant behavioral improvement without change in their chronic mental confusion. The average time required of the psychiatrist proved to be four hours monthly; telephone consultations averaged two hours monthly. About half an hour per week was spent in conference between the psychiatrist and social worker, to allow achievement of mutual goals. Appropriate one‐site psychiatric‐social therapy permitted continuity of care and usually prevented threatened disruption of the residents' lives. Thus the modest investment of time by the psychiatrist and social worker improved the level of life satisfaction, not only for the patients but for the Home.
Intra‐Hospital Transfer: Effects on Chronically Ill Psychogeriatric Patients
Authors: Raasoch John , Willmuth Ragon , Thomson Laurence , Hyde Robert
Published: April 2015

Since the Vermont State Hospital was approaching a major transition period, it was decided to study systematically the effects of intra‐unit and inter‐unit transfer on its psychogeriatric patients. Ten patients were assessed by means of four standardized measures in the intra‐unit study, specifically investigating the effects of integrating wards previously devoted either to chronic or to acute psychiatric illness. Twenty‐five patients from a specialized geriatric unit were evaluated, by separate investigators, with respect to changes occurring as a result of their transfer to regional mixed units. The critical incident log, the problem classification form, and the clinical global impression showed some changes, for which there were several possible explanations. None of the changes was as dramatic as predicted by staff members holding divergent views prior to the study. The optimists predicted a “blossoming” of the psychogeriatric patients in the mixed, regional units, whereas the pessimists prophesied dire consequences. The group of patients studied was not completely homogeneous with respect to the effect of transfer. Clinical assessment after transfer could be relied on to detect improvement in some of these psychogeriatric patients and deterioration in others. Some understanding of the complexity of the multifactor determinants of change developed along with increased cooperation among the investigators and the nursing staff. A middle ground of mutual respect for fresh ideas and an appreciation for years of experience was reached.
Treatment Approaches with the Psychiatric Elderly†
Authors: Goga John A. , Hambacher William O.
Published: April 2015

In reviewing the literature on treatment approaches with the psychiatric elderly, a large number of studies were found which espouse comprehensive rehabilitation programs that usually require supplementation of existing personnel and expansion of facilities. Although some agencies and institutions are fortunate in securing the needed funds for such program implementation, most others face the reality of limited personnel and funding cutbacks. This paper briefly reviews modalities which do not demand additional expenditures for specialized facilities in the treatment of chronically ill geropsychiatric patients.
Central Neurotransmitter Substances and Aging: A Review
Authors: Samorajski T.
Published: April 2015

Available evidence suggests that age is an important determinant of the levels of neurotransmitters and their associated enzymes and metabolites in some regions of the brain. Alterations at the synaptic level, or selective cell death in the brain, or both, may be implicated in progressive loss of function, behavioral changes and the onset of age‐related diseases. Stimulation of hypothalamic neuroendocrine transducer cells by agents that alter neurotransmitter metabolism might provide some measure of control of the process of aging.
True Aneurysm of the Radial Artery: Report of a Case with Long‐Term Follow‐Up
Authors: Lee Bok Y. , Kim Kang Kiel , Madden John L.
Published: April 2015

Reports on aneurysm of the arteries of the wrist and hand are relatively rare. Presented here is a case of true aneurysm of the radial artery in a 41‐year‐old man. The patient had an enlarging painful swelling on the volar aspect of the left wrist, of six months’ duration. Under local anesthesia, a transverse incision over the wrist crease revealed an arterial aneurysm. The aneurysm was excised, followed by end‐to‐end anastomosis. The patient recovered uneventfully and was discharged nine days after the operation. A follow‐up arteriogram, five years later, showed a patent radial artery with good blood flow. This is an excellent example of a successful reconstructive surgical procedure involving a small artery.
Stable Chronic Disease: A Behavioral Model
Authors: Byl Nancy Nies , Clever Linda Hawes
Published: April 2015

A three‐year study was undertaken in the general medical clinic of a private community hospital, to assess the health behavior, health status, and profile of function of a group of 84 older patients with stable chronic disease. A working definition of stable chronic disease was developed and tested. It was shown that these patients used a disproportionate amount of health care services. Half of the group was treated by a nurse practitioner/physician team and half by a house officer/preceptor team. Patients in both groups behaved similarly. These patients: 1) made frequent demands for outpatient services but did not need more than average hospital care; 2) tended to have problems of socio‐economic indigency; 3) were likely to have hypertension, obesity, arthritis, and functional disease; 4) were chiefly women; 5) required special visits 9 percent of the time, usually for exacerbations of illness or intercurrent health problems; 6) made greater demands if they had functional complaints as a primary or secondary health problem; and 7) viewed their health more positively and functioned at a higher level if they were over 65 years of age. It was also found that the nurse practitioner, working in consultation with a physician, was able to provide high‐quality health care.
Evaluating the Quality of Nursing Home Care
Authors: Howard John B. , Strong Kenneth E.
Published: April 2015

Evaluation of the quality of care that a nursing home patient receives is difficult and requires physician participation as well as the participation of specially trained nursing personnel. A form of limited medical audit is suggested to aid in such evaluation. In the proprietary nursing home studied by the authors, the quality of care was not being effectively assessed by the survey process then employed. In addition to other factors, emphasis is now placed on the avoidance of additional costs or extra paper work in the process of determining the quality of care.
Relation of Long‐Term Electronic Cardiac Pacing to Mental Status and Adaptation in the Institutional Aged
Authors: Rodstein Manuel , Zarit Steven , Savitsky Elias , Goldfeder Madelon
Published: April 2015

The long‐term effects of cardiac pacemakers on the mental status and adjustment of an aged population were investigated. In an institution for the aged, 25 residents (average age, 85) in whom pacemakers had been implanted for an average of 53 months were compared to 18 residents of the same age and sex who had a slow heart rate. A semistructured interview was given to determine mental status, affective condition, perceived health, and other concerns. Cardiac status was rated for all subjects according to the criteria of the New York Heart Association. By the measures of adjustment and mental status, no differences were found between pacemaker patients and those with a slow heart rate. Cardiac status was somewhat poorer in the pacemaker group. When comparison was made between the pacemaker patients with uncompromised or only slightly compromised cardiac status and subjects with a slow heart rate and similar cardiac status, no significant differences were found in the foregoing measures. These findings suggest that although there may be changes in functioning in the acute phase following implantation of a pacemaker, there are no long‐term effects on adjustment in subjects of advanced age. Adaptation in an institution for the aged may be more related to personality factors than to specific health problems.
Testing As a Component of Continuing Education Programs: Evaluation of Conference Presentations by This Method
Authors: Mitchell Merlin M. , Mayne John G. , Wellman William E.
Published: April 2015

As a means of evaluating the effect of each presentation at a national medical conference and of the meeting as a whole, the scheduled lecturers were asked to supply the testers with several questions that summarized the most important points of their talks. Audience participants at the meeting were given tests drawn from these questions — one test before the beginning of the meeting, and another at the end. The results were compared for the answers to each lecturer's 3‐question group, and for the complete tests. All scores were better at the end than at the beginning of each lecture. A follow‐up survey of the attitudes of participants showed a positive reaction to the use of such testing at future meetings.
Tardive Dyskinesia in Psychogeriatric Patients: A Five‐Year Follow‐Up
Authors: Mehta D. , Mehta S. , Mathew P.
Published: April 2015

The neurologic side effects of antipsychotic drugs in the treatment of major psychiatric disorders are causing great concern. The status of tardive dyskinesia in 13 elderly psychiatric patients at the 5‐year follow‐up point, is reported. In 11 of the 13, tardive dyskinesia persisted. Among these 11 patients, the severity was reduced in 2, increased in 2, and unchanged in 7. Only in 2 of the total 13 subjects had the tardive dyskinesia disappeared. However, both of these patients were receiving neuroleptic drugs and had parkinsonism, a syndrome that might have masked the dyskinesia. Recommendations are made for prophylaxis and for good clinical judgment in the use of antipsychotic drugs.
Malignancy in Rheumatic Disease: Interrelationships
Authors: Sheon Robert P. , Kirsner Allan B. , Tangsintanapas Penput , Samad Fasin , Garg Mohan L. , Finkel Robert I.
Published: April 2015

Patients with inflammatory arthritis and malignancy comprise two distinct populations. One group represents the chance occurrence of malignancy and rheumatic disease. These patients have symmetric polyarthritis, chiefly classic rheumatoid arthritis, and react positively to the rheumatoid factor test. There is no temporal relationship between tumor onset and rheumatic disease onset. In the second group, there may be a causal relationship between the malignancy and the rheumatic disease. These patients have asymmetric rather than symmetric arthritis and test results are negative for rheumatoid factor. There is a close temporal relationship between the onset of the tumor and the onset of the rheumatic disease. The mortality rate is significantly higher than in patients with symmetric polyarthritis. In 80 percent of women with asymmetric arthritis and malignancy, the tumor is mammary carcinoma. This indicates the advisability of a careful breast examination in this group of women.
Intraocular Lens Implantation: Faster, More Complete Rehabilitation of the Cataract Patient†
Authors: Hirschman Henry
Published: April 2015

Cataract, the leading cause of blindness in the United States, chiefly affects the elderly. Surgical therapy in the 1920's is contrasted with that in the 1970's. Visual corrections with spectacles, contact lenses, and intraocular lenses are discussed. Intraocular lens implantation, when performed by specially trained surgeons, offers cataract patients prompt and complete visual rehabilitation.
Pathology of Centenarians. I. The Cardiovascular System and Lungs
Authors: Ishii Toshiharu , Sternby Nils H.
Published: April 2015

The cardiovascular and lung lesions in 23 centenarians (7 males and 16 females) were examined pathologically. The heart showed varied degrees of hypertrophy, and myocardial fibrosis was present in 15 of the 23 patients. Coronary arteriosclerosis was noted coincidentally. In addition to these findings, amyloid deposition was seen in the hearts of 8 patients. Generalized atherosclerosis of the arterial tree was severe to moderate in all cases. Bronchopneumonia was present in 15 of the 23 patients, and fresh or old thromboembolism in 8. There was a tendency toward emphysema and chronic bronchitis in the structure of the lung. The frequent occurrence of myocardial fibrosis and bronchopneumonia was characteristic in the series. It was significant that cardiac amyloid deposition was noted in these cases.
Huntington's Disease: Improvement with an Anticoagulant‐Psychotherapy Regimen
Authors: Walsh Arthur C. , Melaney Catherine
Published: April 2015

A 45‐year old woman with Huntington's disease (HD) was followed for three years while under an anticoagulant‐psychotherapy regimen. The chorea disappeared and the patient improved rather than deteriorating as predicted. All psychotropic drugs were discontinued. This case of reversal of the disease may help to confirm the hypothesis that HD is probably due to circulatory insufficiency in the substantia nigra.
Sinus Bradycardia in the Aged
Authors: FRIEDMAN GEORGE
Published: April 2015

In the aged, sinus bradycardia represents the sinus‐node‐dysfunction component of diffuse conduction system disease associated with coronary and cerebral arteriosclerosis. Findings are presented on 15 patients whose ages ranged from 69 to 93 years at the time of admission to a home for the aged. They remained under observation (with electrocardiographic data) for from less than 1 year up to 18 years. The findings illustrate the evolution of conduction system abnormalities, including sinus node dysfunction, occurring either as an initial or an interval event. These abnormalities represent positive indications for pacemaker insertion in the aged.
Depression in the Elderly. II. Possible Drug Etiologies; Differential Diagnostic Criteria*
Authors: SALZMAN CARL , SHADER RICHARD I.
Published: April 2015

Drugs for the treatment of various medical or psychiatric disorders may sometimes cause or exacerbate depression in the elderly. Drug interactions due to polypharmacy (a common method of prescribing for aged patients) may also play a role in the genesis of depression. The roles of specific drugs and of drug interactions are reviewed. Criteria for the diagnosis of depression in the elderly, as well as differential diagnostic guidelines, are presented and constructive suggestions offered.
Pharmacy Services in a Federal Extended Care Facility, as Provided by a Pharmacy Student
Authors: III WILLIAM L. GLENN , PATRY ROLAND A. , KROEGER RUTH
Published: April 2015

The objective of this study was to identify the role of the pharmacy student in providing health care to a Federal Nursing Home Care Unit. Under the supervision of a graduate pharmacy resident, the student was responsible for monitoring compliance in drug therapy, providing consultation services, and developing several research projects. A detailed study of allergy documentation in 78 patients showed that 25.6 percent of their records indicated drug allergies, but upon further investigation only 5.1 percent could be confirmed. Fourteen (41 percent) of the 34 reported allergy‐producing substances had been administered again after the initial allergic incident, without ensuing difficulties. Evaluation of the self‐medication program indicated that 71.4 percent of 14 study patients could not easily open their child‐proof medicine containers. A change to “tight” containers enhanced the patients' ability to open them. However, no significant conclusions could be drawn regarding improvement in the patients' compliance with prescription directions. Pharmacy students can be a valuable resource in improving documentation, testing drug prescription compliance, and participating in the general care of patients in long‐term facilities.
Clinical Utility of a Rapid Diagnostic Test Series for Elderly Psychiatric Outpatients
Authors: MURKOFSKY CHARLES , CONTE HOPE R. , PLUTCHIK ROBERT , KARASU TOKSOZ B.
Published: April 2015

Psychiatric evaluation of the elderly is especially difficult for several reasons, e.g., the presence of organic impairment, the effects of multiple drug therapy, and the tendency to confuse the normal concomitants of aging with neurotic symptoms. The authors have developed and evaluated a brief series of self‐report assessment tests (GRDB) designed to assist the psychiatrist in the process of diagnosis. Coefficients of the internal consistency of the seven scales are presented. A comparison was made between 28 psychiatric patients attending a geriatric clinic and 48 well‐functioning elderly persons matched for age and sex, and living in the same community. Results showed that the geriatric outpatients functioned at a lower level of adaptation than did the control group, on all seven scales—depression, daily living skills, social interaction, cognitive skills, number of illnesses, number of life problems, and the use of drugs and alcohol. These findings provide a measure of discriminant validity. The advantages of this brief assessment instrument are discussed.
Unusual Abdominal Complications of a Suicidal Overdose of Analgesic and Psychotropic Drugs in an Elderly Patient
Authors: MEHTA D. , MEHTA S. , MATHEW P.
Published: April 2015

A suicidal 67‐year‐old woman with manic‐depressive psychosis took an overdose of aspirin, amitriptyline and diazepam. The initial effects were pyrexia, tachycardia, hyperpnea, metabolic acidosis, electrocardiographic changes, hypo‐prothrombinemia, gastritis, and pancreatitis. Four to six weeks later, she was examined because of persistent abdominal pain with nausea, anorexia, anemia, and possibly a malabsorption syndrome. An exploratory laparotomy was performed. The surgeon found several adhesions, a small intestinal volvulus, and a nodular pancreas. This suggested previous perforation of the small bowel from enteritis, causing a “blind‐loop” syndrome. The involved section of the small bowel was resected. With appropriate treatment, the patient is well three months after operation.
Are the Aged a Minority Group?*
Authors: PALMORE ERDMAN
Published: April 2015

The aged resemble minority groups in three ways, i.e., they suffer from prejudice, discrimination, and deprivation. On the other hand, they are not born into their age group, and they have little sense of group identity or political unity. The most descriptive term would seem to be “quasi‐minority group.” However, the aged are becoming less and less like minority groups as society seems to be moving toward an “age‐irrelevant” era.
Relationship of Age and Biomedical Risk Factors to Progression of Coronary Artery Disease*
Authors: Abrahams Joel Peter , Nash David T. , Gensini Goffredo G. , Arno Thomas
Published: April 2015

The relationship between age, biomedical risk factors and the progression of occlusive disease of the coronary arteries was studied in 176 patients (age range, 27–66 years) who had undergone at least two cine angiograms. The biomedical risk factors of interest were serum concentrations of cholesterol and triglycerides, smoking, hypertension, diabetes mellitus, family history of coronary disease, electrocardiographic abnormalities, obesity, and age. The findings did not reveal any significant differences in mean lipid levels between patients showing progression of disease and those who did not. However, the distribution of serum cholesterol values indicated more hypercholesterolemic patients among the disease‐progression group, and more patients with ideal cholesterol levels among the no‐progression group. The other biomedical variables did not appear to be related to the progression of coronary disease. Among the older patients, hypercholesterolemia and diabetes mellitus were related to disease progression. Among the younger patients, smoking was related to progression.
Geriatric Rigidity and Its Psychotherapeutic Implications
Authors: Brink T. L.
Published: April 2015

The elderly tend to be more rigid than younger adults in their attitudes and personalities, and such rigidity is correlated with poor adjustment. However, the rigidity is not the cause of the poor adjustment; rather, it is an attempted solution. One of the patterns of rigidity is an outgrowth of the lifestyle of pessimism, suspicion, self‐reliance, self‐discipline, determination, and endurance. Two case studies are presented illustrating how rigidity can channel thoughts and prevent the brooding which works itself into depression or anxiety, while simultaneously reinforcing self‐help behavior. Geriatric psychotherapy should be problem‐centered and should not launch a frontal assault on rigidity or attempt to reconstruct the patient's personality. Behavioral modification, authority, and motivation slogans can be used in conjunction with the rigidity to improve the patient's coping ability.
Disengagement versus Engagement — A Need for Greater Expectations
Authors: Bell Joanne Zysk
Published: April 2015

An attempt is made to clarify some existing perspectives of successful aging. The environmental milieu of the aged is laden with potent and pervasive implications about successful adaptation. Considerable exploration is required to facilitate a realistic focus upon various theoretical contributions already presented. The influence of stresses and adaptive energy depletions preceding the senescent state is discussed in an effort to facilitate knowledgeable assimilation of the potential impact of the socioeconomic milieu upon the aged. It is the author's contention that the elderly person, upon retirement, presents an adaptive energy reserve highly personalized in its ability to accommodate to change, and especially dependent upon the nature, number and intensity of environmental stressors to adapt, successfully or unsuccessfully, to senescence. Various environmental stressors are identified (e.g., changes in social opportunities and expectations which create new needs and constrict the realm of emotional and vocational influence, thus reducing opportunities and diminishing self‐esteem). Heavy emphasis is placed upon role theory, interaction ritual, and transactional analysis. These concepts are extended to the institutional setting–an environment which serves only to magnify mechanisms occurring diffusely throughout the social system while adding its own unique dimension to the stressors confronting the elderly.