bluuebunny/crossref_metadata_2025 huggingface dataset:
Autosensitization Cell Membrane Diseases: A Unifying Concept of Autoimmune Diseases, Collagen Diseases, Neuromyopathies and Cancer
Authors: MAKARI JACK GEORGE
Published: April 2015

ABSTRACT: It is proposed that the term “autosensitization cell membrane (ACM) diseases” be applied to a conglomerate of disorders in which there apparently is a state of autosensitization to common glycolipid plasma membrane (GPM) antigens. Except for cancer, all the other ACM diseases may be the result of this autosensitization to GPM antigens. These disorders are subdivided on the basis of the cell source of GPM, whether from erythrocytes as in autoimmune haemolytic anaemia, from endothelial cells as in collagen diseases, from epithelial cells as in organ‐specific immune diseases, or from nerve cells as in neuromyopathies. In cancer, two types of autosensitization occur. The first is autosensitization to GPM originating from damaged normal cells adjoining cancer cells. The second is autosensitization to cancer‐specific tumour polysaccharide substance (TPS) antigens originating in the cancer cells themselves. Evidence for this hypothesis is presented.
Psychiatric Hospitalization for Senile Dementia
Authors: WELLS DONN A. , LIEBOWITZ SUSAN W.
Published: April 2015

ABSTRACT: More than three‐fourths of all demented patients seen in one psychiatric ward of a university hospital during a two‐year period were discharged within thirty days. Almost half of the group were able to return home from the hospital, and less than one‐third were committed to a state hospital. These results support the view that admission to the psychiatric ward of a general hospital for medical‐psychiatric assessment of dementia can be worth while. However, further investigation is needed to determine how well the short‐term rehabilitation function of the ward serves to ease the transition of these patients from one setting to another.
The Therapy of Independent Living for the Elderly
Authors: KALSON LEON
Published: April 2015

ABSTRACT: A description is given of the Riverview Apartment facility for the relatively healthy aged, which is operated in association with the Jewish Home and Hospital for Aged in Pittsburgh. In the apartments there is a deliberate program to foster independent living, based on such factors as: 1) a tenant‐landlord relationship, 2) maintenance of contact with the family physician, 3) the serving of an evening meal to ensure good nutrition and to observe the general health of the tenants, and 4) provision of recreational programs that encourage self‐generation of activities. Independent apartment housing contributes a great deal to the status of the elderly. Without it, many old people would be forced to live in institutions or elsewhere under dependency conditions that accelerate deterioration.
The Mental Hygiene of Aging: Present‐Day View*
Authors: BRACELAND FRANCIS J.
Published: April 2015

ABSTRACT: This period of rapid change in our society engenders much psychological stress for the elderly. Ways for maintaining mental health in old age are discussed. A fundamental factor in modern management is the recognition that the emotional problems of the aged are the same as those in younger persons; there is no specific pattern after age 65. The preventive aspects of psychiatry should be increasingly stressed.
Cardiac Pacing — The State of the Art*
Authors: CHENG TSUNG O.
Published: April 2015

ABSTRACT: The best method for cardiac pacing is transvenous. The percutaneous transfemoral approach has gained increasing popularity, especially when the objective is to obtain a His‐bundle recording. Although most of the clinical experience on cardiac pacing in the past decade has been with ventricular pacemakers, atrial pacing is becoming an increasingly important clinical tool. Among its many diagnostic, prognostic and therapeutic applications are: stress test for angina, diagnosis of the Wolff‐Parkinson‐White syndrome, recognition of bilateral bundle‐branch block, differentiation between mitral valvular obstruction and left ventricular dysfunction in rheumatic heart disease, selection of the pacing site in the sick sinus syndrome, and safe termination of supraventricular tachycardias in overdigitalized patients. The extensive use of cardiac pacemakers has also resulted in a new spectrum of auscultatory phenomena. Their occurrence depends upon the mode and site of pacing, the nature of the supraventricular rhythm, and the production of extra sounds and murmurs by the pacing catheters. An understanding of these phenomena is useful for proper clinical evaluation of pacemaker function as well as the underlying cardiac dysrhythmias.
A Self‐Insured Free Policy for Geriatric Mental Health
Authors: FRIEDMAN JACOB H. , STRACHAN JOYCE
Published: April 2015

ABSTRACT: The authors interviewed 100 psychogeriatric patients whom they knew well, and obtained their responses to 6 questions concerning what the patient would like to be doing in one year, five years, and ten years versus what he would expect to be doing in one year, five years, and ten years. These 100 cases were subdivided into: Group I, 22 patients who had psychiatric functional illnesses (no organic brain syndromes); Group II, 39 patients who had recovered from their functional illness; and Group III, 39 patients who responded both when ill and when recovered. As a control, 100 geriatric persons who had never been mentally ill were similarly interviewed (Group IV). Except for a negligible number of optimistic replies, chiefly in Group IV, the responses were consistently pessimistic. Apparently the elderly person can develop a “no expectations” mental attitude that protects against frustration and disappointment. This amounts to a premium‐free insurance policy for mental health and may be a reason why the incidence or prevalence of functional mental illness is no greater in the elderly than in the young.
Welfare Emotions and Family Therapy in Geriatrics
Authors: GRAUER H. , BETTS D. , BIRNBOM F.
Published: April 2015

This article is a description of a two‐phase approach to family therapy in a geriatric setting. Phase 1 involves separation of the hostile family members. This is easily accomplished, often by placing the patient in a Day Hospital, but does not lead to rehabilitation. Phase 2 involves the working‐through of family conflicts, and is much more difficult to accomplish. However, it can be successful if “welfare emotions” exist in the family, based on a good marriage, work record and retirement adaptation. The resulting rehabilitation and discharge is a valuable experience in geriatrics. Thus permanent or premature admission to an institution often can be avoided.
Diverticulitis in the Elderly
Authors: KRATZER GUY L. , ONSANIT TAWACHAI
Published: April 2015

The surgical records of 53 patients (average age, 64) with diverticulitis were reviewed. Complications (e.g., hemorrhage, peritonitis, abscess, fistula) had occurred in 30 cases. X‐ray examination in 46 patients showed that the sigmoid was involved in 71 per cent. Among the 50 surviving patients, only 3 had not definitely improved after operation. The treatment of the disease and its various complications is described. The most common errors are: 1) mistaking diverticulitis for appendicitis or a gynecologic disorder, and 2) delay in the diagnosis of perforation.
Ileo‐Colic Intussusception with Villous Tumors in a 93‐Year‐Old Woman
Authors: CASE THOMAS C.
Published: April 2015

In a 93‐year‐old woman, two colonic villous adenomas (one malignant, one benign) were found at operation; the cecal tumor had caused ileo‐cecal intussusception. Postoperative recovery was uneventful until the twelfth day, when sudden hemorrhage from the gastrointestinal tract resulted in circulatory collapse and death. Reasons are given for considering early elective surgery in these cases.
Methyldopa‐Hydrochlorothiazide Therapy in Hypertensive Geriatric Patients
Authors: CORMAN L. ANDRÉ , SKVERSKY NORMAN J.
Published: April 2015

A combination of methyldopa and hydrochlorothiazide effected a significant reduction of blood pressure in 22 hypertensive geriatric patients. A significant drop in hemoglobin concentration was observed in 5 patients during treatment. The drug was discontinued in 4 of these patients and the hemoglobin concentration rose but did not return to the pretreatment level. Methyldopa‐hydrochlorothiazide was continued in the fifth patient, and there was a similar slight increase after two additional months of treatment. In all patients the Coombs' test gave negative results throughout the study.
The Antiquity of Age‐Associated Bone Demineralization in Man
Authors: PERZIGIAN ANTHONY J.
Published: April 2015

Adult males and females in contemporary populations undergo age‐associated demineralization of the skeleton (osteoporosis). Males lose less bone mineral than females, partly because of the slower rate and later age at onset of the loss in males. This study demonstrates that age‐associated demineralization also characterizes prehistoric populations. Demineralization in a prehistoric, hunting‐and‐gathering skeletal population was studied cross‐sectionally. The bone mineral content of radii from skeletons (5‐year age groups from 20 years to 60+) was measured by means of a photon absorptiometry technique. Males not only lost less cortical and trabecular bone than did females but began demineralization at a later age. These sexual differences also apply to modern populations.

The apparent universality of osteoporotic demineralization in both time and space attests to a basic genetic unity within our species. Medical science has met with only limited success in combatting the osteoporosis which so often results in collapsed vertebrae and fractured femora in the geriatric population. Bone loss with age has a strong genetic basis and therefore will not easily be arrested or even slowed by the nutritional and hormonal therapy that is employed today.
Treatment Patterns in Psychiatry: Relationships to Symptom Features and Aging
Authors: FRACCHIA JOHN , SHEPPARD CHARLES , MERLIS SIDNEY
Published: April 2015

Examination of the therapeutic regimens used in treating 89 long‐term hospitalized male psychiatric patients in two groups (age 60 or older, and age 59 or younger) indicated that fewer psychotropic drugs were used in the older group (N = 45) even though both groups presented the same symptom picture, qualitatively and quantitatively, in interview and self‐report situations. This tendency to prefer a non‐drug treatment regimen in the older group did not appear to be due to the presence of a greater incidence of somatic illness, as both groups showed an equal frequency of concurrent physical illness. The data are interpreted as indicating that older patients are treated differently because they are perceived differently by the staff, most likely as a result of energy depletion and the diminished ability to act out their symptoms, associated with increasing age.
Fellowships in Geriatric Medicine
Authors: RAO DODDA B.
Published: April 2015

While the ailing aged population is increasing, the citadels of medical teaching and training continue to accord low priority to the dire need for education in the care and clinical management of the elderly. The pace of care and the mounting costs of general hospitals make it imperative for chronic disease hospitals to cope with the many complex problems. It is fitting, therefore, to foster suitable programs in Geriatric Medicine. A brief outline is presented of a Fellowship training program in Geriatric Medicine in the setting of a chronic disease hospital. Since local problems will require local solutions, modifications of these programs are inevitable.
Starting a Geriatric Day Care Center within a State Hospital
Authors: WILSON JOAN W.
Published: April 2015

The establishment of a Geriatric Day Care Center at Trenton Psychiatric Hospital is described under the headings of physical environment, the program, staffing, and inter‐staff relationships. The purpose of the Center is to provide more comprehensive and effective services for the elderly. The social reinforcement, physical care and psychiatric aspects of the program are geared toward the acquisition of new skills and the relearning of old ones, to create a strong self‐image for the patient in dealing with the problems of old age and retirement.
Does Procaine Hydrochloride Therapy in Aging Patients Affect the Serum Cholesterol Level?
Authors: ROBERTS CHARLES DeWITT , ROBERTS EDNA N.
Published: April 2015

In 1960 Smigel et al., in trying to assess Asian's claims for the value of procaine therapy, reported on the effect of procaine in 50 geriatric patients (of whom 21 were controls). A decrease in the serum cholesterol level was observed in 23 of the 29 procaine patients, although no special importance was attached to this fact. The present writers subjected these cholesterol data to statistical analysis and believe that they may be statistically significant. Further study seems merited.
Effects of an Oral Glucose Load on Serum Immunoreactive Insulin, Free Fatty Acid, Growth Hormone and Blood Sugar Levels in Young and Elderly Subjects*
Authors: SANDBERG HERSCHEL , YOSHIMINE NOBORU , MAEDA SHUZO , SYMONS DIANE , ZAVODNICK JACQUELINE
Published: April 2015

In 29 healthy young adults and 22 ambulatory elderly subjects, a study was made of the effects of an oral glucose load on the levels of serum immunoreactive insulin (IRI), free fatty acids (FFA), growth hormone (HGH) and blood glucose. In the elderly, the pre‐load blood glucose and serum IRI levels were higher than in the younger group, reached the peak more gradually, and took longer to return to the baseline values. There was no significant difference in the serum FFA levels between the two groups until 3 hours after the glucose load, at which time the FFA values had returned to the fasting level in the young subjects but remained depressed in the elderly subjects. Serum HGH fasting levels in the elderly males were significantly higher than in the younger males and remained so at 1–2 hours after the glucose load. For the females, the numbers were too small and the intragroup variability too great to permit drawing conclusions. The total findings lend support to Dilman's hypothesis of a genetically programmed elevation of the hypothalamic threshold to feedback suppression, with age.
The Role of the Physician in the Nursing Home: Past, Present and Future*
Authors: GLADUE J. RAYMOND
Published: April 2015

Predictions are made about the role of the nursing‐home physician in the future system of medical care for the aged. The character of the chronic disease and nursing home facilities of the future is based on three factors: 1) the attitude of society toward the care of the aged. 2) the trends in financing the costs, and 3) the medical needs of the aged. Experience calls for the establishment of two kinds of chronic disease facility: 1) the chronic disease and rehabilitation center, and 2) the skilled nursing care facility (long‐term). Ninety‐five per cent of the aged are still in the community and functioning. These aged need practitioners who will help them to continue functioning in the community and who, if transfer is necessary, will know the appropriate chronic disease facility and will continue the doctor‐patient relationship in the new setting. Such geriatric practitioners and those in the same regional medical community will become the medical care team that provides comprehensive, continuing, community‐based care for our aged.
Some Clinical and Biochemical Variables in Patients with Chronic Brain Syndrome
Authors: HATTANGADI S. B. , GRAD B. , BECKETT M. E. , CSANK J. Z.
Published: April 2015

Several clinical and biochemical variables were studied in 28 patients with arteriosclerotic brain disease (ABD) or senile dementia (SD) residing in the psychogeriatric service of a veterans' hospital with extended care facilities. The results did not provide any means of distinguishing between ABD and SD. Of special interest were: 1) the lack of any reliable difference in the serum cholesterol levels between the two groups of patients, and 2) the failure to find focal neurologic signs on clinical examination in both groups. Comparison of the patients with chronic brain syndrome (CBS) and normal elderly subjects indicated that the CBS patients weighed less, had higher preprandial blood glucose levels and lower levels of serum albumin and alpha‐1, alpha‐2 and beta globulin. Electroencephalographic abnormalities were much more common among the CBS group. No significant differences between our patients and normal elderly subjects were found with respect to blood pressure, serum cholesterol, creatinine, sodium, potassium, chloride, phosphorus, CO2combining power, osmolarity, total serum proteins, total serum globulin, gamma globulin, and the frequency of abnormalities in the electrocardiogram and in the intracranial and intrathoracic blood vessels.
The Problem‐Oriented Medical Record in Long‐Term Institutional Care
Authors: CRAWFORD GLENN B.
Published: April 2015

A problem‐oriented medical record is a useful aid in the management of the long‐term patient. The record consists of a data base, a list of problems, an initial treatment plan, and progress notes. Periodic review and use of this record system clarify the goals and thus improve the results obtained in treating the long‐term patient.
A Look into the Future of Geriatric Medicine*
Authors: WRIGHT IRVING S.
Published: April 2015

The present and future needs of geriatric medicine are outlined, including a greatly increased need for personnel in various categories. Reasons for the present inadequacy may be traced to the negative attitudes of medical and nursing school faculties, and the lack of communication between various groups who care for the elderly. The Council on Long‐Term Care of Geriatric Patients of the American Geriatrics Society plans to attack these problems in several ways, e.g., better guidelines, interdisciplinary symposia and training programs. Also, emphasis is placed upon present methods for preventing premature disability in association with the aging process, and the need for basic research to reach a much deeper understanding of aging. A great new movement is underway. Physicians and social scientists should meet the challenge.
Is There an Anemia Responsive to Pantothenic Acid?*
Authors: McCURDY PAUL R.
Published: April 2015

Upon admission to the hospital, a 53‐year‐old black woman showed anorexia, weight loss, lethargy, incontinence and hypochromic anemia with increased storage of iron in the bone marrow. After an unsuccessful trial of pyridoxine, all symptoms and signs improved dramatically following administration of pantothenic acid. (At the time of admission, chest x‐ray findings were such that INH‐streptomycin therapy was started.) She was discharged 6.5 months after entry. For several years thereafter she received no vitamin therapy, and a similar clinical picture again developed. There was a clinical, but probably not a hematologic, response to a multiple‐vitamin preparation containing large amounts of pantothenic acid. At this time and later, the course was complicated by cancer of the cervix, from which the patient died.
Lingual‐Facial‐Buccal Movements in the Elderly. II. Pathogenesis and Relationship to Senile Chorea
Authors: WEINER WILLIAM J. , KLAWANS HAROLD L.
Published: April 2015

On the basis of clinical similarities, pathologic implications and the response to pharmacologic agents, it would seem that spontaneous lingual‐facial‐buccal dyskinesia of the elderly and senile chorea represent the early versus the final manifestations of the same degenerative process within the striatum.
Simple Technic for Transverse Colostomy
Authors: CASE THOMAS C.
Published: April 2015

A simple technic for transverse colostomy is described. The procedure affords a secure method of fixation of the exteriorized colonic loop and also avoids possible herniation through the incision.
The Problem of Fecal Impaction in the Aged
Authors: YOUNG RICHARD W.
Published: April 2015

In a hospital for the aged it is important for the physicians and nurses to be on the alert to detect cases of fecal impaction, a condition which can be easily overlooked if reliance is placed only on the patient's answers to questions. The possible complications of fecal impaction can be serious; those observed in a 700‐bed geriatric hospital are listed.
Growth Hormone Levels in Chemical Diabetes
Authors: STEPHAN T. , KHURANA R. C. , NOLAN S. , CHAE S. , GEGICK C. G. , VIDALON C. , DANOWSKI T. S.
Published: April 2015

ABSTRACT: Chemical diabetes is an incompletely defined form of glucose intolerance which is more common in the later decades of life. Long‐term observations indicate that in half of the patients with persistent chemical diabetes, overt diabetes mellitus develops in the course of one decade of aging. Other studies have established that chemical diabetes is characterized by hyperinsulinemia which may be preceded by an initial lag in the insulin responses to oral administration of glucose. As a group, persons with chemical diabetes manifest higher serum triglyceride levels, a greater frequency of electrocardiographic abnormalities, and increased proteinuria.

The data presented describe growth hormone patterns in chemical diabetes. The findings indicate that the lower serum growth hormone levels of obese adults of all age decades are also evident during glucose tolerance tests indicative of mild or moderate chemical diabetes. However, more severe degrees of glucose intolerance and chemical diabetes in obese persons are characterized by further decreases in growth hormone indices beyond those characteristic of obesity alone.
Diabetic Osteopathy: Report of a Relentlessly Progressive Case, with Clinico‐Pathologic Correlations
Authors: SHAGAN BERNARD P. , FRIEDMAN SANDOR A. , ALLESANDRI RAUL
Published: April 2015

A case is presented of diabetic neuropathy with progressive, persistent destruction of the skeletal structure of one foot despite immobilization. Pathologic examination revealed only bland necrosis of the bone and cartilage. The pathogenesis of diabetic osteopathy requires further clarification.
Fractures in the Aged, with Special Reference to the Femur
Authors: ZISSERMAN LOUIS
Published: April 2015

ABSTRACT: A survey was made of the records on 492 patients who had died in a Home for the Aged during the 1964–1971 period. It was found that fractures occurred most frequently in patients between the ages of 75 and 85, especially among the women. The commonest fractures were located in the proximal end of the femur, the ribs and the vertebrae. Fractures often were multiple at these bone sites, but usually not in combination with each other in the same patient. Fracture of the femur was three times as likely to occur in women as in men. Multiple fractures of the femur (at different times) occurred in 18 women, but not in the men; in 17 women both femurs were involved. There was an increase in pulmonary deaths among the fracture group. Of the 107 patients who had femur fractures, 32.4 per cent died within six months after repair of the fracture. This figure represents the immediate and delayed postoperative mortality. Forty patients were classified as an “accident‐prone” group because their charts showed more than 20 incidents of trauma. However, in this group, there were only 5 femur fractures versus an “expected” (random) incidence of 6–7 fractures. Thus there was no basis for claiming that fractures of the femur were closely correlated with trauma.
The Aging Skin*
Authors: RAPAPORT MARVIN
Published: April 2015

ABSTRACT: This article is a brief outline of some characteristics of the aging skin. The importance of correct diagnosis is illustrated by a case history involving scabies versus a nervous disorder. The role of prolonged exposure to sunlight in the development of skin tumors is discussed.
The Exercise Profile
Authors: CHERASKIN E. , RINGSDORF W. M. , MICHAEL D. W. , HICKS B. S.
Published: April 2015

ABSTRACT: Dietary intake and physical activity were assessed in approximately 700 members of the health professions. It was found that although the diets of both exercisers and nonexercisers contained about the same number of calories, there was a great difference in the proportions of nutrients involved in these calories. For the exercisers, the intake of every vitamin, mineral and amino acid studied exceeded that for the nonexercisers, and many of the differences were statistically significant. Since these nutrients are classified as resistance agents because they decrease the likelihood of disease, the dietary pattern adopted by these exercisers should be encouraged. The nonexercisers consumed more refined carbohydrates than did the exercisers; the difference was highly significant statistically. Since refined carbohydrates are classified as susceptibility agents because they enhance the possibility of disease, the dietary pattern adopted by these nonexercisers is to be avoided.

Diet and exercise, either independently or together, affect emotional health. A poor nutrient intake and lack of exercise are susceptibility factors which diminish mental health, whereas a good nutrient intake and exercise are resistance factors which promote mental health.
Possible Geriatic Telepathy
Authors: SCHWARZ BERTHOLD ERIC
Published: April 2015

ABSTRACT: Although largely unrecognized, geriatric telepathy may be a more common and widespread form of communication than has been supposed. In later life, when impairment of hearing and sight, social isolation and loneliness, increased dependency, brain syndromes or other illnesses are so prevalent, patients may be unusually sensitive to telepathy. Several examples are presented of possible paranormal exchanges in older persons, and also data from the life of Joseph Dunninger and from psychiatric practice. Telepathy occurring at times of intense unconscious emotional significance may serve to bridge gaps in interpersonal relationships and thereby diminish anxiety and improve psychophysiological homeostasis. The interplay between telepathy and related psi phenomena that interacts with the vicissitudes of aging is an interesting field for further exploration.
A Note on the Use of Anticoagulant Therapy in Chronic Brain Syndrome
Authors: LUKAS EMMA R. , HAMBACHER WILLIAM O. , FALLICA ANTHONY J.
Published: April 2015

ABSTRACT: A “single‐blind” study on the use of anticoagulant therapy in 8 geriatric patients with chronic brain syndrome indicated that the subjects performed significantly less well on the Graham‐Kendall test (for organic abnormalities) both immediately after, and three months after cessation of a 4‐month course of treatment. Scores from the Mental Status Questionnaire indicated a significant improvement in psychological functioning after treatment. However, the apparent contradiction in these results could be attributed to differences in the maintenance of positive effects engendered by the initial high levels of motivation. Our findings plus those of Walsh and Rosenberg suggest that a carefully controlled study involving more patients and more varied measuring techniques would add useful information to the understanding of chronic brain syndrome.
Management of Emotional Disturbances in Geriatric Patients
Authors: MAURER ALBERT S.
Published: April 2015

ABSTRACT: The flexibility and continuity of care provided by the hospital, outpatient, nursing and rehabilitative facilities of a comprehensive health‐care complex (e.g., Hopedale) can serve the needs of the aged patient ideally. However, a program of total health care must be oriented to the particular medical, psychologic and socio‐environmental problems of aging. Behavioral disturbances in the geriatric patient often are associated with disrupted social patterns, organic illness, and feelings of inadequacy and uselessness. Therefore emotional disorders should be a primary consideration. If neglected, they may hinder or prevent effective health care. The objective must be to identify all sources of disturbance to the patient, to eliminate adverse stimuli, to reassure the patient by providing emotional support and understanding, and to institute the required medical, rehabilitative and nursing care. A 12‐day trial of thioridazine in the treatment of 27 patients is described; the drug was found to be a valuable asset in the management of senile anxiety, agitation, depression and related behavioral disturbances. By means of a systematic program, emotional disorders in the elderly can be promptly recognized and treated. Thus, health care will be enhanced and many geriatric patients can be restored to a practical level of functioning.
Diabetes Insipidus As a Complication of Pneumococcal Meningitis
Authors: ABRAMSKY O. , SOFFER D. , MARKS E. S.
Published: April 2015

ABSTRACT: In a 68‐year‐old man, transient diabetes insipidus developed as a complication of pneumoccocal meningitis. This complication is very rare. The pathophysiology is discussed and a mechanism is proposed to explain the phenomenon.
Primary Lymphosarcoma of the Breast in a 75‐year‐Old Woman: Case Report
Authors: CASE THOMAS C.
Published: April 2015

ABSTRACT: A case is presented of primary lymphosarcoma of the right breast in a 75‐year‐old woman. Am extended simple mastectomy was performed as the therapy of choice. In view of the patient's advanced age and the lack of evidence for metastasis from this primary lesion, possibly a five‐year survival may be expected.
Age‐Related Changes in Growth Hormone in Non‐Diabetic Women
Authors: VIDALON C. , KHURANA R. C. , CHAE S. , GEGICK C. G. , STEPHAN T. , NOLAN S. , DANOWSKI T. S.
Published: April 2015

ABSTRACT: In non‐obese women with unimpaired glucose tolerance (1,185 oral glucose tolerance tests) the serum level of growth hormone (GH) in the fifth and sixth age decades was below that in the third and fourth decades. Although obesity was associated with serum GH levels below those characteristic of non‐obese women, there was no evidence of a further age‐related decrease of the type observed in the non‐obese subjects. The lower serum GH level in women of the later age decades may well be related to the menopause with its decrease in the serum level of estrogen. Since there is no further age‐related decline in GH in obesity, it would appear that in obese premenopausal females, estrogen does not exert its usual GH‐enhancing effects.
New Models in Geriatrics and Long‐Term Care*
Authors: REICHEL WILLIAM
Published: April 2015

ABSTRACT: Two important problems in broadening the educational opportunities in geratrics are: 1) the lack of university attention to the field of geriatrics and long‐term care, and 2) the negative attitude of physicians toward the comprehensive care of the elderly. New models in geriatrics and long‐term care include the proposal for a medical director of long‐term care facilities, nurse practitioners in geriatrics, geriatric evaluation specialists, and organized staffs of attending physicians at nursing homes. Educational programs at the community level should have high priority in the plan finally adopted.
Denial of Parental Illness and Maintenance of Familial Homeostasis*
Authors: MILLER MICHAEL B. , BERNSTEIN HERBERT , SHARKEY HAROLD
Published: April 2015

ABSTRACT: The aging family re‐enacts the pattern of family behavior during the illness of a parent just as, in the youth of the family, they were trained by the parent. The aid sought by the family from the professional worker is not that of counselling, but of corroboration and continuation of existing family values. The premature death wish of the family for the ill aged parent is a reflection of similar feelings within the family prior to the parental illness and impending death. The crisis of parental illness does not substantially alter family patterns of behavior. However, family maladaptive processes, including the denial and distortion of reality regarding the parental illness, constitute a defense mechanism. This defense presumably is for the preservation of a long‐standing pattern of family homeostasis, whether normative or pathologic.
Postsplenectomy Thrombocythemia: An Unmasked Myeloproliferative Disorder
Authors: JAMSHIDI KHOSROW , ANSARI AZAM , GARCIA MARIO C. , SWAIM WILLIAM E.
Published: April 2015

ABSTRACT: Persistent postsplenectomy thrombocythemia should be differentiated from transient postsplenectomy thrombocytosis, as the former leads to hemorrhagic and thrombotic complications. The authors reviewed 29 cases of “postsplenectomy thrombocythemia” collected from the literature (1933–1970) and added 2 of their own. The data on these 31 cases indicate that the disease should be diagnosed and treated as primary thrombocythemia, present in masked form before splenectomy.
Some Notes on Disorganized Joints
Authors: Howell Trevor H.
Published: April 2015

Disorganized joints seem to have become more common in recent years among patients in geriatric units. Most of the affected patients have either chronic rheumatoid arthritis or osteoarthrosis. Descriptions are given of subluxated shoulders, perforated elbows, wandering hips, and disorganized knees.
Treatment Patterns in Psychiatry: Clinical and Personality Features of Elderly Hospitalized Patients during Milieu, Single‐Drug and Multiple‐Drug Programs
Authors: FRACCHIA JOHN , SHEPPARD CHARLES , MERLIS SIDNEY
Published: April 2015

Psychologic tests and psychiatric ratings for 90 elderly long‐term psychiatric patients showed that those who were treated psychopharmacologically (one or more psychotropic drugs) had personality profiles indicative of less control of impulses and less anxiety binding than did those who received milieu (no‐drug) therapy. Since the three groups of elderly patients tested (no‐drug, one‐drug, multiple‐drugs) did not differ significantly from one another on all measures of intellectual functioning, emotional characteristics and individual psychiatric symptoms, it appears that treatment modes may be mediated more on the basis of reactive personality features than on the basis of clinical differences in basic pathology. Thus, although the patients treated with a single drug or multiple drugs did not manifest different symptom profiles qualitatively or quantitatively, when compared to patients who received no drugs they made their symptoms more apparent to the staff.
Calcium Metabolism in Elderly Epileptic Patients during Anticonvulsant Therapy
Authors: RAY ASWINI K. , RAO DODDA B.
Published: April 2015

Because several investigators have observed hypocalcemia and rickets or osteomalacia in epileptic children and adults who receive anticonvulsant drugs, the authors studied 36 elderly epileptic patients who were being treated with 100 mg of diphenylhydantoin and 30 mg of phenobarbital three times daily for periods ranging from six weeks to ten years. In none of the 36 patients did hypocalcemia develop. Serum phosphorus levels remained within normal limits, but alkaline phosphatase activity was slightly increased in 42 per cent of the cases. It is concluded that hypocalcemia and osteomalacia, if they do develop, are extremely rare in elderly epileptic patients who receive anticonvulsant therapy for short or long periods. In more than 90 per cent of such elderly patients a primary cause for the seizure disorder is obvious, and in more than two‐thirds of them the cause is cerebrovascular disease.
Purposeful Activity Increased on a Geriatric Ward through Programmed Recreation*
Authors: QUILITCH H. ROBERT
Published: April 2015

Of 43 residents in a hospital geriatric ward for regressed and disabled persons, only 3 were found to engage in some purposeful daily activity; the rest were relatively inactive. Under a regimen of programmed activities (e.g., bingo games) for one hour each afternoon, the daily average number of residents engaged in purposeful behavior rose to 13, but dropped to 3 again when the daily activities were discontinued. The program generated considerable staff enthusiasm and increased the likelihood of the use of similar activity programs on other hospital wards.
Primary and Secondary Renal Failure in a Total Community (Tecumseh, Michigan): Preponderance in the Elderly and Possible Antecedent Factors*
Authors: PERLMAN LAWRENCE V. , KENNEDY BRIAN W. , HAYNER NORMAN S.
Published: April 2015

ABSTRACT: In 14 (8 men and 6 women) of the 8,641 original examinees in the Tecumseh Study, renal failure (RF) was found to have developed during an eight‐year period. The proportion rose significantly with age. At the initial examination (one to eight years before the onset of RF), no subject subsequently uremic had a history of acute glomerulonephritis or chronic renal disease nor was frankly azotemic, although in 4 there was a suggestion of early disease. Six of the 12 subjects (50 per cent) over age 45 who later became uremic gave a history compatible with urinary‐tract infection (UTI), compared with 380 (22 per cent) of the remaining 1,746 examinees in this age range. Conversely, in 6 of 386 persons (1.6 per cent) with a history of UTI, renal failure developed, in contrast to 6 of 1,372 persons (0.4 per cent) without such a history. Common disorders noted at the initial examination one to eight years before RF were congestive heart failure (9 cases), loss of hearing (7 cases), coronary heart disease (5 cases), hyperuricosemia (5 cases), and hyperglycemia (5 cases). This study shows that most persons in whom renal failure develops are elderly and have pre‐existing vascular disease; in about a quarter of them, the findings at the time of the initial examination indicate early renal disease. Although these data point to a relationship between UTI and RF in some cases, in most patients with a history of UTI, renal failure does not develop.
Heat Production and Senescence
Authors: CALLOWAY N. O.
Published: April 2015

The decline in animal heat production begins near conception and is continuous throughout life. The rate of decline varies with each species of homeothermic animal. The fixed minimum of heat production reached near senescent death is independent of the species and appears to be a constant value of approximately 20 calories per kilogram per day. The identical equation with different constants describes this behavior for various homeothermic species.
Long‐Term Oral Administration of Probucol [4, 4‘‐(Isopropylidenedithio) bis (2, 6‐di‐t‐Butylphenol)] (DH‐581) in the Management of Hypercholesterolemia*
Authors: HARRIS ROBERT S. , GILMORE HUGH R. , BRICKER LEE A. , KIEM IRIS M. , RUBIN EDWARD
Published: April 2015

Fifty patients who received a new hypocholesterolemic agent, probucol, in a dosage of 0.5 gm twice daily, were studied for one year. Mean pretreatment serum cholesterol and triglyceride values were 329 mg/100 ml and 360 mg/100 ml respectively. Baseline lipoprotein electrophoreses showed 17 Fredrickson phenotypic patterns of type 2, 6 of type 3, 10 of type 4, 3 of type 5, and 14 non‐definitive patterns. After twelve months of treatment with probucol, the mean serum cholesterol level was 263 mg/100 ml (a minus 20 per cent change) and the mean triglyceride level was 293 mg/100 ml (a minus 19 per cent change) for all patients. The median baseline cholesterol level was 311 mg/100 ml and the median cholesterol value during twelve months of therapy was 252 mg/100 ml, a reduction of 19 per cent. The median baseline triglyceride level was 174 mg/100 ml and the median triglyceride value during twelve months of therapy was 147 mg/100 ml, a reduction of 16 per cent. Significant changes were noted in the serum lipoprotein patterns; the majority of type 2 and type 3 changed to the non‐definitive pattern, but the majority of type 4 and type 5 remained unchanged. Seven patients had xanthelasmas, but all these lesions decreased in size and 3 lesions disappeared during probucol therapy. Side effects were minimal. About a third of the patients had mild transient flatulence or slight transient eosinophilia. There was no effect on prothrombin time.

Probucol appears to be a safe and effective hypolipidemic agent. It can also induce changes in serum lipoprotein patterns and markedly reduce the size of xanthelasmas.
Adequate Hospital Care for the Aged*
Authors: DORSEY FREDERICK G.
Published: April 2015

Adequate hospital care for the aged is dependent upon an understanding of the part it plays in comprehensive health care. The older patient and his physician must expect help and benefit. The difference in hospital care for the aged versus the middle‐aged is mostly a matter of degree. For example, elementary nursing care to prevent contractures, atrophy of muscles, and deterioration of body functions is more important for the aged. Standards for the care of heart disease and stroke have been established recently and will contribute greatly to the understanding of adequate care for the aged.
Diagnostic Tests, Drugs, and the Geriatric Patient
Authors: MEANS BERRY J. , LAMY PETER P.
Published: April 2015

ABSTRACT: The physiologic changes that occur with aging have a direct bearing on the use of diagnostic agents. In the elderly, the choice and dosage of these agents must be adjusted to the altered physiologic state of the patient. Examples discussed are the tuberculin test, the phentolamine test for pheochromocytoma, contrast media for angiocardiography or excretory urography, the barium‐enema examination, the sulfobromophthalein test for liver function, and the oral glucose tolerance test.
Can Nursing‐Home Care Be Cost‐Effective?*
Authors: KANE ROBERT L. , JORGENSEN LOU ANN , PEPPER GINETTE
Published: April 2015

ABSTRACT: In an effort to find alternatives to the current abandonment of the nursing‐home patient, a project was started for the purpose of testing the cost effectiveness of other forms of primary care, i.e., care delivered by the nurse practitioner and the social worker. The goal of the three‐year demonstration project is to measure the effectiveness of different combinations of these services in improving the patients' level of functioning and behavior. Preliminary one‐year results are presented regarding changes in drug regimens, record keeping, and the care provided by nursing‐home staffs.
Importance of the Initial Evaluation Conference in a Hospital‐Based Comprehensive Care Program*
Authors: BEACHAM E. G.
Published: April 2015

ABSTRACT: An outline is given of the development of a Chronic Disease unit as part of a Hospital‐Based Comprehensive Care Program in Baltimore City Hospitals. Special attention is paid to the Initial Evaluation Conference (I.E.C.) since this early thorough assessment of the patient by various disciplines provides essential information when the patient later may become a candidate for discharge from the hospital. Despite necessary modifications from the original plan, the I.E.C. remains a vital part of the program for long‐term hospital care of the elderly.
Experimental and Clinical Aspects of Transplantation of Entire Hyaline Cartilage Surfaces*
Authors: WILEY A. M. , KOSINKA E.
Published: April 2015

ABSTRACT: Experiments were conducted on the storage of hyaline cartilage, and on the results of cartilage allografts implanted in dogs over a two‐year period. Rejection phenomena were minimal as long as joint function was resumed early and adverse mechanical factors were controlled. Parallel experiments on dogs confirmed the potential of hyaline cartilage for repair with a smooth fibrotic membrane. It proved impossible to preserve viable hyaline cartilage grafts for longer than a week. Articular surface transplantation was performed in a small group of patients. Results have been sufficiently encouraging to conclude that human articular surface allografts may still have a place in the management of certain disorders in which artificial joint replacement may not be feasible.
Alcoholic Brain Damage: Anticoagulant Therapy
Authors: WALSH ARTHUR C. , LUKAS EMMA
Published: April 2015

ABSTRACT: Anticoagulant (Dicumarol) therapy was given for five to six weeks to 15 hospital patients with organic brain damage secondary to alcoholism. The results were excellent in 5, good in 7 and poor in 3 cases; 8 of the patients could be discharged home.
Genitourinary‐Tract Problems of the Aged Male*
Authors: BASSO ALESSANDRO
Published: April 2015

ABSTRACT: The author reviews the literature on benign prostatic hypertrophy and adenocarcinoma of the prostate and summarizes the current concepts on the etiology and treatment of these diseases. Special reference is made to hormonal relationships.
Sex in the Aged
Authors: DE NICOLA PIETRO , PERUZZA MARINO
Published: April 2015

ABSTRACT: Sexual activity and habits in the aged are analyzed on the basis of the pertinent literature and also personal observations on 85 subjects (53 males and 32 females) whose ages ranged from 62 to 81 years. The importance of diseases and of environmental, social and psychologic factors is discussed in connection with the impairment of sexual activity in old people. Sexual activity in the aged is not exceptional and may give serenity to aging. Medical, social and psychologic prophylactic counselling should be applied as early as possible by geriatricians in collaboration with sexologists.
The Day Hospital: An Alternative to Institutional Care*
Authors: LORENZE EDWARD J. , HAMILL CHARLOTTE M. , OLIVER ROBERT C.
Published: April 2015

Objectives and admission criteria are discussed as they pertain to day hospitals for patients with physical disability or chronic illness as distinct from patients with primary psychiatric illness. The day hospital, as part of a general hospital complex, provides health care and supportive services during the day for accepted patients, who return home at night. The new Day Hospital of the Burke Rehabilitation Center is described in these terms and also with special reference to their research program for obtaining extensive data on admission criteria, cost of service, and the resulting benefits.
The Second Heart Sound in Left Anterior Hemiblock
Authors: PISUTHA‐ARNOND PORNCHAI , FEIGEN LARRY , RAO DODDA B. , LUISADA ALDO A.
Published: April 2015

ABSTRACT: The second heart sound was studied in 43 old people in order to ascertain whether left anterior hemiblock (LAHB) caused any change in the sequence of and the interval between the components of this sound. The second sound in LAHB was compared with that in subjects with a normal electrocardiogram, and the second sound in right bundle‐branch block (RBBB) plus LAHB was compared with that in uncomplicated RBBB. Despite a slight trend toward a narrower degree of splitting (later A component) in LAHB, the difference did not prove statistically significant. Thus LAHB seems to cause no dynamic changes affecting the second heart sound.
Electrocardiographic Changes during Intravenous Glucose Loading in the Aged
Authors: TIMAFFY MIKLÓS
Published: April 2015

ABSTRACT: The relationship between glucose tolerance values and electrocardiographic (ECG) deviations was studied in 50 subjects (25 men and 25 women, average age 73.4 years). The loading consisted of 24 gm of glucose in 60 ml of solution, given intravenously to the fasting patient. ECG records and blood determinations were obtained before the injection and 5 minutes afterward; then blood sugar was determined at 10‐minute intervals up to 60 minutes; at 60 minutes an ECG was also recorded. For a control, similar examinations had been carried out previously in 20 of the 50 subjects, the injection consisting of 60 ml of physiologic saline instead of glucose. The various deviations occurring in the ECG included depression of the ST segment, a U wave, premature beats and partial A‐V block. None of these changes had been observed after injection of physiologic saline. A possible mechanism may have been an insulin‐induced change of potassium metabolism. In view of the fact that a relatively small excess of sugar can affect myocardial metabolism, it is essential that the subject undergo the standard fasting procedure when observations are being made. On the basis of the ECG findings it is important that the dietary intake of sugar be low, particularly in persons approaching middle age.