bluuebunny/crossref_metadata_2025 huggingface dataset:
TRACHEOSTOMY IN ACUTE RESPIRATORY FAILURE: EFFECTS ASSESSED BY ARTERIAL BLOOD GASES
Authors: Neufeld Oscar , Anagnost Basil D. , Navarre J. Robert , Dziad P. , Osten Taylor A. , Klever Thomas G. , Bakondy Thomas T.
Published: April 2015

Abstract

The effects of tracheostomy in 27 patients with severe respiratory difficulty are described in terms of arterial blood gas values and clinical observations. Postoperatively, mouth breathing was compared with tracheostomy breathing.

Obstruction of the lower respiratory tract from accumulated secretions leads to hypoventilation, ineffective coughing, carbon dioxide retention, anoxia and coma. In such cases, tracheostomy may be life‐saving because it provides a reliable pathway: a) for suctioning the secretions (which may be unusually abundant in emphysema with bronchitis), and b) for the administration of artificial respiration.

An important factor in the outcome of tracheostomy is meticulous postoperative care. Attention to such things as proper tube alignment and proper suctioning techniques goes a long way toward preventing possible mucosal damage and infection. Tracheostomy provides therapeutic relief even to patients who are gravely ill (narcosis, coma) with emphysema and bronchitis.
A RESPIRATORY CARE PROGRAM FOR THE ELDERLY
Authors: Kiss George T.
Published: April 2015

Abstract

There is great need for respiratory care programs in medical institutions for the elderly, for both diagnostic and therapeutic purposes. Such a program in St. Joseph's Manor, Trumbull, Connecticut is described and some statistics are given for the first eleven months of operation. Detection of tuberculosis was much improved. The benefits were outstanding in the management of intercurrent respiratory difficulties.
THE EXTENDED CARE FACILITY—A COMMENTARY ON DEFINITIONS*
Authors: Miller Michael B.
Published: April 2015

Abstract

Discussions are presented of definitions for custodial care, the nursing home, the extended care facility, the nursing care institution, and personal care and sheltered care institutions.

If the hospital is to become the “locus of total health organization” in any community, as recommended by the American Hospital Association, the continued fragmentation of services in long‐term care—justified on the basis of a variety of appellations—will frustrate the development of high‐quality care for the chronically ill aged. The hospital must be involved centripetally and centrifugally in all medical problems of the community concerning health and disease. If the medical needs of the populace are to be served, the hospital must educate the community in affairs related to health, train professionals involved in health care, set criteria for the performance and delivery of high‐quality medical services, and serve as a liaison between governmental agencies and the public.

The ill aged, wherever housed, need diagnostic, medical, nursing and psychiatric services. The instability and complexities of their medical, psychiatric and social problems require all the talent and resources of the nonsurgical hospital for effective long‐term management. The multiplicity of new terminologies will not obviate the obligation of the hospital to broaden its perspectives and create a progressive care program for the chronically ill, who are afflicted with all gradations of disability. To fulfill this obligation, the hospital can build, acquire, merge, form partnerships, or affiliate with existing extended care facilities, public or private. If this generation is to be proud of its accomplishments in health care, then, by definition, any institution in which ill people are housed should have the status of a hospital.
COMING OF AGE: A CHALLENGE FOR GERIATRIC NURSING*
Authors: Davis Barbara Allen
Published: April 2015

Abstract

The author reviews the historical evolution of geriatric nursing in this country from its earliest beginnings to the present, with a focus on the work being done in this area by the Geriatric Division on Nursing Practice of the American Nurses' Association—the professional organization of registered nurses. A discussion of trends in geriatric nursing and of changes in geriatric nursing practice is included. A plea is made for more cooperation between doctors and nurses in plans to improve the care of the aged.
BREAST METASTASES TO PELVIS, RESEMBLING RECTAL CARCINOMA WITH BLUMER SHELF
Authors: Case Thomas C.
Published: April 2015

Abstract

A case of multiple malignant metastases is reported. The original carcinoma was in the left breast, with metastasis to the ovary and later to the pelvis. The pelvic metastatic process with the associated proliferative changes could have been confused with primary carcinoma of the rectum. There was a discharge from both the rectum and the vagina, and the Blumer shelf of proliferative tissue threatened colonic obstruction. Radical surgery was contraindicated because of the far advanced pelvic malignancy.
SOMATIC ILLNESS—PREVENTION AND REHABILITATION*
Authors: Geltner Luzer
Published: April 2015

Abstract

Somatic illnesses of the elderly are discussed from the standpoints of prevention and rehabilitation.

The Periodic Health Examination (P.H.E.) after age 40 should play a prime role. This form of prevention merges into treatment, maintenance care and rehabilitation. Purely laboratory screening without expert medical interpretation has many pitfalls and is a dehumanizing process. P.H.E. and maintenance care should be undertaken by the general practitioners. Examples in Edinburgh and The Netherlands are cited.

It is recommended that Age Guidance Clinics be established. These would be patterned somewhat after Child Welfare Clinics, but adapted to the needs of patients of advanced age. They would require much larger staffs of specially trained nurses.

The first important step on the long road to successful rehabilitation is the total evaluation of the patient's physical, mental and social assets. A simple assessment of the physical deficiencies cannot serve as an adequate foundation for successful total restoration. Physico‐medical rehabilitation has added a great deal to acceptable methods of treatment for elderly people. Definite criteria and limitations must be recognized, however, and the programme should be employed with common sense and realism.
EFFECT OF EXERCISE ON OVERWEIGHT MIDDLE‐AGED MALES*
Authors: Oscai Lawrence B. , Williams Ben T.
Published: April 2015

Abstract

An exercise program (running) significantly reduced body weight in 5 previously sedentary, overweight males whose ages ranged between 35 and 46 years. (Five control males remained sedentary.) With exercise, body weight decreased an average of 4.5 kg (from 88.1 to 83.6 kg). The weight reduction was primarily the result of loss of body fat; the fat‐free weight did not change significantly. Each subject participated in 47 training sessions during a 16‐week period. The heart rate, measured by palpation at ten‐minute intervals throughout each training session, ranged between 155 and 170 beats per minute.

It appears that exercise is effective in reducing body weight and can reverse the trend towards increased adiposity in middle age and thereafter.
SENILE TIBIAL NODULES
Authors: Young Alex W.
Published: April 2015

Abstract

In a series of 462 geriatric patients, 22 had senile tibial nodules. The incidence, clinical appearance and diagnosis are discussed. The nodules are split‐pea sized, palpable but rarely visible lesions found in the tibial fat in older geriatric women. Although the pathogenesis cannot be firmly established, they may be related to underlying progressive vascular disease.
SERUM PROTEINS, PROTEIN‐BOUND IODINE AND TRIIODOTHYRONINE UPTAKE IN THE ELDERLY
Authors: MEINDOK H. , FRANKS W. M.
Published: April 2015

Abstract: Values (means and standard deviations) for serum total protein, albumin, electrophoretic protein fractions, protein‐bound iodine and triiodothyronine uptake were determined in 45 men and 55 women whose ages ranged between 60 and 102 years. Groups of healthy younger people were used as controls.

In the elderly, the serum total protein and albumin levels were lower and the alpha‐2 globulin level was higher than in the younger persons.

The elderly persons in the study group were residents of a home for the aged, and had varying degrees of minor degenerative illnesses. It is extremely difficult to find an old person for study who is completely free of disease.

It is suggested that changes in the serum protein in the elderly result from degenerative and undetected pathological processes, and that chronological age by itself is probably unimportant. Our values would seem to be more useful in clinical geriatric practice than previously published values on small groups of completely disease‐free old persons or those with crippling disability.
FUNCTIONAL ASSESSMENT OF THE SUSPECTED MENTALLY ILL AGED*
Authors: Gaitz Charles M.
Published: April 2015

Abstract

A study of 100 consecutive admissions of elderly persons to a county psychiatric screening ward revealed that functional assessment of such persons is a highly complex procedure. Our experience confirmed the belief that such patients have a combination of social, medical and psychological problems; evaluation requires the services of persons qualified in several disciplines. In this instance, a multidisciplinary team examined each patient, consensually agreed on a treatment plan, and then used existing community resources to implement the program. This report describes some of the methodological and philosophical aspects of screening procedures, and some of the pitfalls encountered unless a comprehensive examination is performed.

The team consisted of a psychiatrist, internist, social worker, nurse and psychologist. Each discipline obtained information in a more or less traditional manner. The “art” of assessment begins with the understanding of the interrelatedness of specific functions. Adequate assessment of a patient required an exchange of information among the team members; no single discipline could rely completely on its findings. A comprehensive treatment plan could evolve only after the data were integrated. In making judgments about patients, an examiner must not overlook the limitations of partial examinations and the intrusion of personal values and other subtleties.
PROLONGATION OF LIFE: ROLE OF FREE RADICAL REACTIONS IN AGING
Authors: Harman Denham
Published: April 2015

Abstract

The mean life span has plateaued in the developed countries at around 70 years. Future substantial increases in the mean life span are apt to be due to inhibition of the process(es) involved in aging. One potentially practical means of inhibiting the rate of human aging is based on the hypothesis that free radical reactions play a significant role in the degradation of biological systems. Experiments based on this hypothesis have been encouraging. For example, several inhibitors of free radical reactions have been found to increase the mean life span of mice when added to the daily diet; 2‐mercaptoethylamine and butylated hydroxytoluene were the most effective. Likewise, decreasing the amount and degree of unsaturation of the dietary fat of female C3H mice resulted in a decrease in the mortality rate. The probable role of free radical reactions in the pathogenesis of four age‐associated diseases—cancer, atherosclerosis, hypertension and amyloidosis—is discussed.

It is suggested that the addition of one or more inhibitors of free radical reactions to nutritionally adequate and acceptable natural diets selected to minimize the intake of substances that might participate in random endogenous free radical reactions, may increase the average life span of man by five or more years, with accompanying increases in the years of useful, healthy life.
CARCINOID TUMORS AND THE CARCINOID SYNDROME
Authors: Kazi Majid‐Uddin , Grover Victor
Published: April 2015

Abstract

Data are presented on 10 cases of carcinoid tumor; 8 of the tumors were in the gastrointestinal tract and 2 in the lung. Two cases were associated with carcinoid syndrome (flushing attacks, diarrhea, bronchospasm); in one of these with marked symptoms, the 24‐hour excretion of 5 hydroxy indole acetic acid reached 107 mg.

On the basis of these findings and those reported in some pertinent literature, it would seem that the carcinoid syndrome does not develop unless carcinoid products (including excessive amounts of serotonin) are discharged into the systemic circulation. These products are secreted in abnormally high proportions over normal pathways, and thus reduce the normal formation of other substances necessary for health. The question of whether all carcinoid tumors originate in the gut is still unresolved.
THE CYBERNETIC THEORY OF AGING
Authors: Still Joseph W.
Published: April 2015

Abstract

An outline is given of the basic facts that the cybernetic theory of aging attempts to harmonize. An experiment is cited which adds substantially to support of the theory. The theory is described and its relation to Bjorksten's crosslinkage theory indicated. Ten significant questions for further study and an outline of the possible basic causes of aging are presented. The potential role of preventive endocrinology is stressed. A plea is made for more support for research on aging.
NON‐FATAL CLOSTRIDIUM PERFRINGENS BACTEREMIA*
Authors: Ellner Paul D. , O'Donnell Edward D.
Published: April 2015

Abstract

Sixteen cases of bacteremia due to Clostridium perfringens are documented. None of these patients had hemolytic phenomena or shock, and all survived the bacteremic episode; 9 of them were more than 50 years old (mean age, 64). A review of these 16 cases and the 34 in the literature indicates that invasion of the blood by Clostridium perfringens may take two clinical forms: 1) a septicemia with intravascular hemolysis, shock and a high mortality rate; and 2) a benign bacteremia without hemolysis. Of the 50 reported cases of the benign bacteremic form, 68 per cent occurred in patients past the age of 50 (mean age, 64), and the recovery rate was 90 per cent.
ANESTHESIA FACTORS AFFECTING SURGICAL MORBIDITY AND MORTALITY IN THE ELDERLY MALE
Authors: Stevens Kenneth M. , Aldrete J. Antonio
Published: April 2015

Abstract

This study concerns the relationship of anesthesia and related factors to surgical morbidity and mortality in 178 males over the age of 70 who underwent 204 operations. Of the 110 complications during anesthesia, arterial hypotension was the most common. Postoperatively there were 139 complications, and 16 deaths. The influences of age, pre‐anesthetic risk, type and duration of surgery, type of anesthesia, and the occurrence of hypotension during surgery are discussed in relation to the postoperative course.

Adequate preoperative preparation of elderly patients is extremely important. This includes complete examination, replacement of any blood volume deficits, and possibly prophylactic digitalization.

Epidural block anesthesia resulted in higher operative and postoperative morbidity and mortality. Hypotension during anesthesia was more common when halothane was the main anesthetic. Postoperative morbidity and mortality were higher in patients anesthetized by a combination of nitrous oxide, muscle relaxants and intravenously administered sedation.
SEGMENTAL ULCERATIVE COLITIS IN THE AGED: REPORT OF TWO CASES
Authors: Case Thomas C.
Published: April 2015

Abstract

Two cases of segmental ulcerative colitis in the aged are presented. Barium‐enema x‐ray examinations were useful in locating the lesions but not in identifying the exact nature of the disease. Early surgery is indicated in most cases in order to prevent complications, and especially to detect malignant lesions.
AN IMMUNIZATION PROGRAM FOR DOMICILIARIES (CHRONIC DISEASE FACILITIES)*
Authors: Fisher Seymour
Published: April 2015

Abstract

A program of immunization should be mandatory at all domiciliaries. This would concern chiefly elderly people. The program should include immunization against diphtheria, influenza, poliomyelitis, smallpox and tetanus. Immunization against typhoid or typhoid‐paratyphoid fevers and rabies should be left to the discretion of the individual station. A suggested schedule is presented. Although the intradermal route for immunization is highly recommended, the method used should be that which the staff finds most satisfactory.

Immunization is not without danger. The label on the vial of immunizing agent always should be read carefully and the instructions followed. Means for combating local or anaphylactic reactions should always be readily available.
THE CONCEPT OF BIOLOGIC HALF‐LIFE IN RELATION TO SENESCENCE
Authors: Calloway N. O.
Published: April 2015

Abstract

The half‐life of the biologic processes of aging can be calculated accurately. Since the processes change more rapidly in early life, the half‐life (time required for half the process) occurs very early, even before the individual is born. Data on the change in tissue water percentage and in the basal metabolic rate are illustrative.

The half‐life is of great interest to both the gerontologist and the internist since it indicates the paramount importance of the inherent initial material in the individual. The obstetrician and the pediatrician have tremendous responsibilities to see that the individual is well maintained in early life so that he may retain the great biologically competitive thrust with which he is born, because by the time of birth he has already aged half or more than he will ever age.
THE PSYCHIATRIST AND THE POLYGRAPH
Authors: Lerner Joseph
Published: April 2015

Abstract

The polygraph technique, a professional method for detecting deception, has wide application in medical and legal circles and in the evaluation of employees and applicants for jobs. In the specific environment of the polygraph interview, some emotional problems may come to the surface. In this way, the technique also may be of psychotherapeutic value.

Although no one can hold a brief for the infallibility or complete innocuousness of the procedure, its constructive aspects merit recognition in balance with all other considerations. As a part of the broad process of evaluation, the polygraph can make a significant contribution. As with other ancillary procedures, it deserves a place in the field of medical and psychological evaluation.
RESPIRATORY DEPRESSION IN THE COMA OF MYXEDEMA: TREATMENT WITH ETHAMIVAN INTRAVENOUSLY*
Authors: Schneider P. J.
Published: April 2015

Abstract

A case of myxedema coma is presented. The patient had severe hypothyroidism, marked hypercapnia, hypothermia, and fluid and electrolyte abnormalities. He was treated with l‐triiodothyronine intravenously, ethamivan intravenously, and intermittent positive‐pressure breathing (oxygen and air). Recovery from the coma apparently was attributable to the effect of ethamivan on the respiratory depression; whenever ethamivan was omitted the stuporous state returned.

Supportive respiratory measures are an integral part of treatment in the coma of myxedema, and further investigation of the effect of analeptic agents such as ethamivan is justified.
THE AGEING CELL: AGEING AND DEATH AS ASPECTS OF GROWTH AND DEVELOPMENT; NATURAL PHENOMENA CONTROLLED BY GENETIC FACTORS
Authors: Fikry M. Essam
Published: April 2015

Abstract

Development of an organism from a fertilised egg, entails growth and differentiation in structure and function, classic genetics and molecular biology.

Ageing and death are forms of differentiation. Development and growth, differentiation and ageing, proceed according to a definite predestined programme in the nucleus. The nucleus contains DNA molecules (genes), in which information is coded governing all biochemical cellular activities which are catalysed by enzymes formed according to a messenger RNA. The nucleus contains a mechanism of repression and derepression of genes which regulates the production and suppression of enzymes, and therefore the type of growth, differentiation, ageing and death.

Ageing and death, as aspects of differentiation are inherited characters controlled by DNA molecules (genes). They can be affected, as are other inherited characters, by external factors which have an impact on the DNA molecules.
REHABILITATION OF GERIATRIC AMPUTEES
Authors: Cheek Richard C. , Britt Louis G.
Published: April 2015

Abstract

The study group comprised 60 indigent patients (average age, 70) in a public hospital who had undergone amputations of the lower extremity, chiefly because of gangrene. These patients sought aid only in the last stages of disease, and meanwhile they neglected personal hygiene. There were 10 deaths. The most common contraindications for the use of a prosthesis were chronic brain syndrome (dementia) and muscle weakness or contractures. Of the 60 patients, 22 were considered to be candidates for prostheses, and 5 of these were lost to follow‐up. Thus only 17 potential candidates underwent preprosthetic training, for maximal ability. Eight of the 17 ultimately, because of contraindications, had to be content with crutches or a wheelchair. In the other 9 cases, however, prostheses were successful.

Recommendations regarding the management of such patients in a large public hospital include: 1) continuity of management by having the amputee under the supervision of the same physician(s) throughout his course; 2) a series of lectures for the house staff on the rehabilitation of amputees; and 3) a definite protocol for the immediate fitting of a prosthesis in suitable cases.
NEW GERIATRIC ADMISSION POLICY IN A STATE MENTAL HOSPITAL*
Authors: Friedman Jacob H. , Lehrman Nathaniel S.
Published: April 2015

Abstract

State hospitals are still being used as a dumping ground (the End of the Road) for geriatric patients who present serious nursing problems. The Geriatric Service at Bronx State Hospital, affiliated with the Albert Einstein College of Medicine, underwent a marked metamorphosis from the traditional custodial service to a community‐oriented unit with emphasis on treatment. This was accomplished only when the admission criteria were changed.

The community can be educated to accept such a modern admission policy for geriatric patients in a state hospital by: 1) having definite criteria for admission; 2) explaining to the referring agency the reasons why patients may or may not be suitable for admission; 3) answering all complaints of public officials who intervene for their constituents; 4) advising the family what procedure should be followed to have the patient admitted to an old age home or nursing facility, or for obtaining a homemaker; 5) providing an out‐patient department (preferably to include a day hospital) for those patients who are not sufficiently ill to be admitted to the state hospital for 24‐hour maintenance; 6) providing a speaker to explain especially to hospital staffs the criteria for admission; and 7) providing a mobile psychiatric team to visit the patient in his home, hospital, nursing home or old age home, and also to consult with the family physician.
PANCREATIC EXOCRINE INSUFFICIENCY: DIAGNOSIS AND MEDICAL MANAGEMENT*
Authors: Brown James W.
Published: April 2015

Abstract

Pancreatic exocrine insufficiency is discussed from the viewpoints of physiology, etiology, signs and symptoms, laboratory findings, and treatment. Characteristic manifestations are those of malabsorption, with steatorrhea. The pancreatic secretin test is still the most valuable laboratory tool, though quantitative determination of fecal chymotrypsin may ultimately prove to be more advantageous. Pancrelipase or various other combinations of digestive enzymes often provide effective therapy.
DIPHENYLHYDANTOIN (DILANTIN) NEUROTOXICITY—A DECEPTIVE SYNDROME
Authors: Ang Manuel K. , Guiang Rudolfo , Berger A. R.
Published: April 2015

Abstract

Two patients are reported in whom diphenylhydantoin (Dilantin) neurotoxicity developed as a result of inadvertent overdosage. The clinical features indicative of such toxicity are emphasized. Prompt recognition of the condition can forestall permanent sequelae and spare the patient unnecessary or hazardous diagnostic procedures.
DREAM RECALL IN THE NORMAL AGED*
Authors: Kahn Edwin , Fisher Charles , Lieberman Lois
Published: April 2015

Abstract

Recall from REM‐period awakenings was studied in the elderly. Twenty‐seven subjects (age range, 66 to 87 years) each slept one or two nights at the laboratory. From 166 REM awakenings there were 92 (55.4 per cent) instances of recall of dream content. This 55.4 per cent recall was significantly lower than the 87 per cent we previously found for the young adult. There was a tendency for women to have more frequent recall than men. REM dreams in the elderly were not manifestly concerned with loss or frustration. A small, nonsignificant positive correlation was found between the amount of recall and verbal intelligence.
MASKED RHEUMATIC MYOCARDITIS IN AN ELDERLY MALE
Authors: Margolis Jack , Weiss Morris
Published: April 2015

Abstract

A case is described in which active rheumatic myocarditis was found at autopsy in a 77‐year‐old man. Although he had been admitted many times to the V.A. Hospital during a period of about fourteen years, at no time did the history, physical examination, roentgenograms, electrocardiograms and laboratory determinations arouse any suspicion of the presence of rheumatic heart disease.
CHANGES IN SKELETAL MASS AND FRAGILITY WITH CASTRATION IN THE RAT: A MODEL OF OSTEOPOROSIS*
Authors: SAVILLE PAUL D.
Published: April 2015

Abstract: Skeletal calcium content was measured in 99 normal and 65 castrated male and female rats. The breaking load in compression of the femur and humerus was measured and the femur‐breaking stress calculated. Weight of muscle on the hindlimbs, and the volume and density of the femur were determined.

Normal female rats have a greater skeletal calcium content than males, and stronger long bones relative to body weight. This is because bone volume is greater in females compared to males at the same body weight. Castrated males and females have a similar skeletal calcium content; this is less than normal for females but more than normal for males and is due to differences in bone volume between the sexes. When bone calcium is considered as a function of bone volume, it is similar in the two sexes among smaller animals, although among larger animals the males have more mineral. Castration reduces the calcium content—when considered as a function of bone volume—about equally in the two sexes.
RETIREMENT AND HEALTH*
Authors: RYSER CAROL , SHELDON ALAN
Published: April 2015

Abstract: Objective and subjective data on physical health were obtained as part of a large study on the effects of retirement. The objective data included such items as hospital admissions, visits to the physician, and the presence of some commonly experienced symptoms; the subjective data pertained to such factors as perception of, and satisfaction with health status, and the occurrence of limitations or changes. In a sample of 500 retired persons (both sexes, 60–70 age group), self‐perception of health indicated that they were in good, or even improved, health after retirement. Correlations of physical health status with demographic, behavioral and psychological variables led to the conclusion that persons who are privileged socio‐economically are also privileged physically and psychologically in the post‐retirement phase of their lives. Attitudes toward the process of retirement are also significantly correlated with physical health. Evidence in the literature largely confirms these findings.
FRACTURES OF THE NECK OF THE FEMUR IN THE AGED: REVIEW OF 224 CONSECUTIVE CASES
Authors: NADEN D. , DENBESTEN L.
Published: April 2015

Abstract: A review is presented of the end‐results in the treatment of 224 patients with fracture of the neck of the femur, at the University of Iowa Hospital. Of the 224 patients, 115 were aged 80 or older.

The incidence of fracture non‐union was no higher among the older patients.

One fourth of the patients died in the first year after fracture; of those surviving, one fourth never walked again.

There was a high correlation of adequate reduction and fixation of the fracture with final healing and a return to the pre‐fracture ambulatory state.
THE DELAYED EFFECT OF ACTH ADMINISTRATION ON THE PLASMA CORTICOID LEVEL OF NORMAL ELDERLY PERSONS AND PATIENTS WITH CHRONIC BRAIN SYNDROME*
Authors: GRAD B. , KRAL V. A. , BERENSON J. , KAPPOS W. J.
Published: April 2015

Abstract: ACTH (40 I.U.) was injected intramuscularly into 30 normal elderly subjects (N), 30 patients with senile psychosis (S), and 30 patients with psychosis due to arteriosclerosis (CAS). The ages of the subjects ranged between 64 and 97 years, the mean ages of the N, S and CAS groups being 74, 79 and 77 years respectively. Blood samples were drawn immediately before the injection and at eight and ten hours afterwards. The plasma cortisol and corticosterone (PC) concentrations were determined by the method of Murphy et al.

The time curves for the three groups differed significantly. The PC values were highest in the S patients and lowest in the N subjects at eight and ten hours. Differences between the S and CAS patients were statistically significant, as were the differences between the CAS patients and the N subjects. There was no reliable difference in PC levels between men and women. The PC values in eight and ten hours were significantly higher than those at the zero hour; in addition, the eight‐hour value was significantly higher than the ten‐hour one. However, the sex × time and the disease × sex × time interactions were not significant.

The results of these studies provide at least one explanation of why patients with senile or arteriosclerotic brain syndrome are more reactive to stress than are normal aged subjects—their adrenal cortices are more reactive.
EFFECT OF PENTYLENETETRAZOL (METRAZOL) ON BLOOD CHOLESTEROL CONCENTRATION IN MAN*
Authors: BESSMAN ALICE N. , CHANDRASEKAR SUBRAMANIAM
Published: April 2015

Abstract: The effect of pentylenetetrazol (Metrazol) on serum cholesterol concentration was studied in 29 patients with initial cholesterol levels of 200 mg per 100 ml or higher. In addition, placebo was administered to 10 suitably matched controls. The dosage of pentylenetetrazol was 200 mg four times daily.

In the patients to whom the drug was continuously administered for four weeks, there was a statistically significant fall in the concentration of serum cholesterol at the end of two weeks, but a return to the initial high level at the end of four weeks. In the patients to whom the drug was intermittently administered (for two two‐week periods with a one‐week interval), there was a significant decrease in the concentration of serum cholesterol at the end of each two‐week period. In all cases there were no deleterious effects. The maximal hypocholesterolemic effect of pentylenetetrazol was at the end of two weeks, but this lowering effect disappeared when drug administration was continued.

The study shows marked individual variations in the cholesterol‐lowering response of patients to pentylenetetrazol. Thus, with respect to the continuing search for such drugs, it would seem that no one drug will be effective in lowering blood cholesterol concentration in all patients. The type of hypercholesterolemia and the type of response to drug administration will each play its role.
MENTAL PATIENTS IN NURSING HOMES. I. SOCIAL DEPRIVATION AND REGRESSION*
Authors: STOTSKY BERNARD A. , DOMINICK JOAN R.
Published: April 2015

Abstract: A one‐year controlled study was made of 16 nursing homes containing 1,400 patients, 141 of whom were former patients of the Boston State Hospital. The purpose was to determine the effect of therapeutic activities in these settings. The design of the study is described.

Institutional deprivation may be physical, intellectual or spiritual. Deprivation in nursing homes was found to be particularly related to: 1) lack of stimulation, 2) lack of adequate walking space inside and outside the homes, 3) lack of recreational and occupational therapy, 4) lack of space for group socialization and activities, 5) lack of a common dining room, so that patients have to eat off trays in their rooms, 6) absence of volunteer workers from the community, 7) separation of patients on different floors, and 8) minimal socialization between male and female patients. Case reports exemplifying deprivation reactions and regressive behavior (a warning signal of possible organic changes) are presented.

Proposed programs for overcoming these problems include: 1) in‐service training of staff, 2) better communication between the state hospital and the nursing home, 3) intervention for emergencies or recurring problems, 4) the establishment of recreational and occupational therapy, and 5) the recruitment of volunteers to visit, conduct group games, and arrange extramural activities.
ELECTROCARDIOGRAPHIC VARIANTS IN THE GERIATRIC PATIENT
Authors: HARRISON WILLIAM V.
Published: April 2015

Abstract: Electrocardiographic patterns change with aging, and with several other factors (some transient) that do not indicate disease. It is mandatory that an interpreter of electrocardiograms be aware of these factors. Otherwise, he may be responsible for creating a “cardiac cripple” with all the attendant emotional and familial disturbances which sometimes can be catastrophic. Such a case is presented, as are others from the literature.

In conclusion, the author states: “Let us not take from the relatively healthy old person his sense of cardiac security. Let us not label him as a cardiac patient. Let us leave him to live out his years in confidence that his heart, though as old as his years, may carry him to the end of his allotted span.”
PSYCHOSOCIAL ASPECTS OF CHRONIC DISABILITY
Authors: HANDY IMENA A.
Published: April 2015

Abstract: The prominence of chronic disabling diseases in present‐day medical practice calls for an increase in social service work to help manage the associated psychosocial problems. The four stages of the social worker's in‐hospital treatment for these patients are: 1) encouraging the patient to discuss his problems, 2) stimulating some understanding of how he may overcome these problems, 3) putting this perception into action, and 4) integrating the gains made by the patient. Work with the patient's family is inevitably involved. This kind of planning results increasingly in enabling mental hospitals to carry out their primary purpose of active treatment for the mentally ill and freeing them from the additional responsibilities of domiciliary and hospital care for chronic disease; permitting the chronically disabled to return to their own communities among familiar people and surroundings; and sometimes even accomplishing complete resocialization with return to a full and independent life. The alternative is an isolated, meaningless, dependent institutional life. Two illustrative case histories are presented.
GENERALIZED SHARP ACTIVITY IN THE ELECTROENCEPHALOGRAM OF MIDDLE‐AGED AND ELDERLY PSYCHIATRIC PATIENTS*
Authors: MÜLLER H. F.
Published: April 2015

Abstract: A survey of the electroencephalograms (EEGs) of 510 psychiatric subjects aged 50 or older revealed 41 cases of unusual spontaneous or photically evoked sharp and spiky activity.

The EEGs of elderly patients often show generalized sharp activity, usually more intense than in younger subjects. This activity may be an aspect of various types of background rhythm, or it may be partly independent of them. Clinically, these patients tend to manifest psychomotor agitation and other symptoms indicating physical and mental overactivity. At least in patients whose EEGs show intense sharp activity, there can be little doubt about this EEG‐clinical relationship. It appears, therefore, that we are dealing with electrical phenomena which indicate forebrain hyperexcitability and which are associated with a hyperactive state in other parts of the organism.
COLONIC DIVERTICULOSIS IN THE AGED
Authors: BROWN JAMES W.
Published: April 2015

Abstract: Colonic diverticulosis, a common disorder in the elderly, may have life‐threatening complications, e.g., diverticulitis, hemorrhage or obstruction. Important causative factors in diverticulosis are high intraluminal pressure and weakness of the colonic muscular wall. A high‐residue rather than a low‐residue diet may be preferable in treatment and prevention. Psyllium‐seed hydrophilic mucilloid bulking agents are useful in therapy. Anticholinergic medication may be used if the patient has symptoms or fluoroscopy shows colonic spasm. Morphine, which induces high intracolonic pressure, should never be used. Surgery is rarely indicated if there are no complications.
COLOUR SENSITIVITY IN OLD AGE
Authors: DALDERUP L. M. , FRIEDRICHS M. L. C.
Published: April 2015

Abstract: In two homes for the aged, 136 elderly residents underwent the Stilling test for colour sensitivity. A comparison group was composed of 33 much younger persons.

Colour sensitivity decreases with age, without definite preponderance of red‐green over blue‐yellow disturbances, or vice versa. The loss of colour sensitivity occurs at slightly incongruent rates in the right and left eye.
FLURAZEPAM VERSUS AMOBARBITAL AS A SEDATIVE‐HYPNOTIC FOR GERIATRIC PATIENTS: DOUBLE‐BLIND STUDY
Authors: FISHER SEYMOUR , GAL PAUL
Published: April 2015

Abstract: Twenty‐seven patients were given, orally, 15 mg of flurazepam (Dalmane) daily for fourteen days and then 50 mg of sodium amobarbital (Amytal sodium) daily for another fourteen days—or else these drugs in reverse order—according to a double‐blind cross‐over design. The patients were men who resided in a Veterans Administration domiliciary. Their average age was 66.5 years.

Favorable subjective and objective reports were given concerning the effect of these drugs on sleep, and no adverse reactions or side effects were observed. Physical and psychological tests for assessment of both immediate and cumulative effects did not show any significant differences between the effects of the two drugs. Further studies of flurazepam are indicated.
EFFECTS OF ROUTINE VITAMIN SUPPLEMENTATION IN THE AGED
Authors: HECHT ALAN
Published: April 2015

Abstract: A study was made in a nursing home of the effects of multivitamin therapy on appetite and weight (during periods varying from sixty to one hundred and ten days) in 59 patients (18 males and 41 females), of whom 55 were over 65 years of age. None of them manifested symptoms of vitamin deficiency.

Approximately half of the patients responded with an increase in weight, and approximately half with an increase in appetite. An increase in appetite was more common in cases of appetite deficiency. When there was an improvement in appetite (and help for feeding was available), a gain in weight usually occurred. When there was no increase in appetite, there was little gain in weight unless the appetite was good before vitamin administration. Attention to feeding procedures apparently was a factor in producing some of the weight gain.

There is no reliable method for predicting the outcome of multivitamin therapy when the indications for such treatment are not specific deficiency states.
GERIATRIC INFECTIOUS MONONUCLEOSIS: REPORT OF A CASE WITH EPSTEIN‐BARR VIRUS ANTIBODIES
Authors: GOLDEN RICHARD L.
Published: April 2015

Abstract: A diagnosis of infectious mononucleosis in a 52‐year‐old woman was confirmed by hematologic and serologic studies. Epstein‐Barr (EB) virus antibodies were present in her serum. The incidence of this disease in older people may be much higher than previously suspected. Heterophile tests should be performed in those patients manifesting significant lymphocytosis. The determination of EB virus antibody provides an additional means of diagnosis.
Clinically Unrecognized, Silent Renal‐Cell Carcinoma in Elderly Cancer Patients
Authors: Hajdu Steven I. , Berg John W. , Foote Frank W.
Published: April 2015

Abstract

Forty clinically unrecognized, silent renal‐cell carcinomas, found at autopsy in 8,921 cancer patients, are reported. A clinicopathologic study led to the following conclusions: Clinically unrecognized, silent renal‐cell carcinoma is predominantly a disease of elderly men. Renal‐cell carcinomas may range from small and clinically asymptomatic to large and clinically symptomatic, but the size of the carcinoma is not a reliable criterion of potential aggressiveness. In elderly cancer patients with unusual symptoms, every attempt should be made to rule out a possible additional primary renal neoplasm before attributing the new symptoms to the known cancer.
A SURVEY OF 100 APHASIC MEDICARE PATIENTS IN A SPEECH PATHOLOGY PROGRAM*
Authors: Sarno Martha Taylor
Published: April 2015

Abstract

100 aphasic Medicare (over age 65) patients were studied with respect to age and sex, duration and severity of symptoms, and length of speech therapy. These patients were referred to a speech pathology service in a rehabilitation center. In general, Medicare aphasic patients are older, more severely impaired, and seek services earlier in comparison to previously reported populations of aphasic patients. There is need for studying alternative methods of management for the severely aphasic group.
SUICIDE AND AGING*
Authors: RESNIK H. L. P. , CANTOR JOEL M.
Published: April 2015

Abstract:

Suicide is among the ten leading causes of death, but in addition many suicides may be concealed among accidental and natural deaths. The aged comprise 9 per cent of the population, yet they commit 25 per cent of the reported suicides.

Suicide occurs in white males over age 65 at a rate nearly four times the national average, and in white females over 65 at a rate twice the national average.

New techniques of intervention, case finding, and follow‐up are necessary with the aged, since they communicate their suicidal intention less frequently and are more often successful.

All professionals should be alert to the possibility that older persons with a serious physical illness which could lead to death may avoid the fear and anxiety about prolonged dying, by committing suicide. Older persons also may want to die because they have accepted both real and imagined communications from a rejecting society.
WHAT WIVES SAY ABOUT NURSING HOMES
Authors: GREENWALD SHAYNA , LINN MARGARET W.
Published: April 2015

Abstract:

99 wives of patients transferred from a general medical VA Hospital to 25 nursing homes in an urban area submitted usable answers to a questionnaire asking them to comment on their experiences with the program for nursing home care. Data were first analysed by content analysis, and wives were grouped according to whether they praised (16.2%), criticized (47.4%), or did not comment (36.4%) on the homes. Comments reflecting praise were usually short and nonspecific. Criticisms were lengthy and could be grouped by categories concerning service, food, visits of a physician, medication and supplies. A series of statistical procedures were employed to determine if the wife's response was related to the husband's characteristics at the time he left the hospital or to the quality of the homes. Results indicated that wives' comments were not related to husbands' characteristics; whereas, statistical significance was found for wives' comments and the quality of nursing homes.
SOME FUNCTIONAL RELATIONSHIPS IN GERIATRIC PSYCHIATRY*
Authors: MÜLLER H. F.
Published: April 2015

Abstract:

Based upon electroencephalographic, clinical and experimental findings in the field of geriatric psychiatry, this article presents a group of working hypotheses which may lead to: 1) a better understanding of some EEG phenomena in terms of the overall clinical picture (and vice versa); and 2) more specific questions for further study. A diagram is presented which summarizes the more important points. This approach is prompted by the marked difference between the types of geriatric EEG, and also certain EEG‐clinical correlations—phenomena which make this field particularly interesting for the investigation of psychophysiological relationships.
POST‐OBSTRUCTIVE DIURESIS: A REVIEW*
Authors: Narins Robert G.
Published: April 2015

Abstract

The clinical syndrome and pathophysiologic mechanisms underlying the development of post‐obstructive diuresis are reviewed. The means by which the kidney normally regulates sodium and water balance are first presented as background for this review.
PARKINSONISM, L‐DOPA AND MENTAL DEPRESSION
Authors: Cherington Michael
Published: April 2015

Abstract

Twelve patients with classical idiopathic Parkinson's disease were treated with L‐dopa. All 12 experienced improvement in motor status. In 6, however, marked depressive symptoms developed after several months of treatment. Although the study involved only 12 patients, it reveals a disturbing aspect of the treatment of parkinsonism with l‐dopa. The occurrence of mental depression deprives the patient of the happier existence that increased mobility should offer. There is also the increased danger of suicide; the 2 patients who attempted it were the only ones with a previous history of depression. More studies must be made to determine to what degree mental depression may limit the use of L‐dopa.
READINESS FOR PSYCHIATRIC HOSPITAL RELEASE IN RELATION TO LEVELS OF SOCIAL EFFICIENCY AND PSYCHOPATHOLOGY
Authors: Handy Imena A.
Published: April 2015

Abstract

The social learning model in contrast to the medical model deserves more trials in preparing schizophrenic patients for release from mental hospitals. Observations by the three disciplines (physicians, psychologists and social workers) on 465 male schizophrenic patients in a Veterans Administration hospital indicated that release readiness was correlated more closely with the degree of social efficiency than with the degree of psychopathology. Thus, in addition to the various treatments used to reduce symptoms, there is great need for resocialization programs.
MEDICAL DIFFERENCES BETWEEN THE YOUNG AND THE AGED*
Authors: Cole Warren H.
Published: April 2015

Abstract

Although the medical profession is slowly realizing that many disorders in the aged must be treated differently than in the young, there is still no proper appreciation of these age differences. Too often, when a patient reaches life‐expectancy age, the physician relaxes his medical attention. It is assumed that the patient will die soon, although the actuarial statistics may show that he has many more years of life. Accordingly, therapy should be more intensive in order to attain the maximal life span.

Elderly people will tolerate many major operations (e.g., herniorrhaphy or thyroidectomy) as well as young people. However, when it comes to serious major operations (e.g., radical neck dissection or radical excision of the rectum for carcinoma), the mortality rate for the aged may be four to eight times higher than for young patients.

Elderly patients tolerate emergency major operations and complications very poorly. The chronologic age is not the chief factor in the mortality rate; more important are the operative complications. Therefore, preoperatively, every effort should be made to identify and treat diseases that might cause complications postoperatively. After operation a close watch must be kept for complications so that they may be treated promptly and effectively.

Operative technic must be meticulous, with no excessive trauma and with particular attention to hemostasis and wound closure. The operation should be completed in the shortest possible time consistent with safety.

A summary of 6 reports in the medical literature shows an operative mortality rate for major operations of 2.6 per cent in patients under 60, compared to 7.2 per cent for patients over 60. The mortality rate for emergency operations is much higher than for elective operations—18.5 per cent versus 6.5 per cent, respectively. A summary of 4 reports shows that cardiac complications were the greatest single cause of postoperative mortality (21.6 per cent), with pneumonia and atelectasis a close second. Despite precautions such as bandaging the extremities and early ambulation, pulmonary embolism accounted for 9.4 per cent of the deaths. [Though inoperable carcinoma caused more deaths (22.2 per cent of the entire group) than any of the other diseases, it is classified as a multiple cause.]

Since the mortality rate for major operations in both aged and young patients is still significant, there is great need for more accuracy in determining operability.