bluuebunny/crossref_metadata_2025 huggingface dataset:
ENDOTOXIC SHOCK AND HYPERPYREXIA IN UROLOGICAL PRACTICE
Authors: Seneca Harry
Published: April 2015

Abstract

During the six‐month period, February—August 1966, 400 cystoscopies and 228 urological operations were performed on ward and semiprivate patients on the Urological Service of Columbia‐Presbyterian Medical Center. Postoperative complications occurred in 63 cases:

There were 12 suspected cases of endotoxic shock, in only 5 of which was bacteremia proved to be present.

There were 51 cases of pyrexia with a temperature of more than 102° F.

Most of these complications were caused by urea‐splitting bacteria.

If a urea‐splitting bacterium is present in the urine, instrumentation and/or operation should be deferred if possible until a specific bactericidal can be given. In emergency situations, two specific antibacterials should be available for the control of possible endotoxic shock.

Attempts at prevention of postoperative endotoxic shock by means of prophylactic antibacterial therapy have been disappointing.

In view of the fact that anabolic, relatively nonandrogenic steroids increase the resistance of animals to experimental infection with Aerobacter aerogenes and Streptococcus hemolyticus, and neutralize the effect on A. aerogenes endotoxin (lipopolysaccharide), it is suggested that these steroids be used to supplement the present treatment of bacteremia or bacterial endotoxic shock.
A STUDY OF THE FATIGUE‐INDUCED INCREASE IN SKELETAL MUSCLE VOLTAGE IN TWO AGE GROUPS
Authors: Carlson Karl E. , Smyth Kenneth D.
Published: April 2015

Abstract

The voltage gain in human muscle under conditions of prolonged isometric contraction was measured in 24 subjects—12 “young normal” subjects whose ages ranged from 26 to 53 years, and 12 “normal over‐65” subjects whose ages ranged from 66 to 78 years.

In terms of rate of voltage increase and initial voltage, there was little or no difference between the two age groups. The mean percentage increase in voltage for the older group was about half that for the younger group. However, this was interpreted on the basis of about a 50 per cent reduction in contraction time for the older group.

Skeletal muscle fatigue when the biceps brachii muscles were subjected to prolonged isometric contraction developed in the over‐65 group in about the same manner (electrically) as in the young group. The only significant difference was the ability of the younger subjects to sustain the contraction about twice as long as did the older subjects.
METHAQUALONE—A SEDATIVE OR MILD TRANQUILIZER FOR GERIATRIC PATIENTS
Authors: Cromwell Henry A.
Published: April 2015

Abstract

An investigation of the sedative‐tranquilizing effects of methaqualone (Quaalude) by the double‐blind, placebo‐controlled crossover method was started on 50 patients (38 females and 12 males) with the anxiety‐tension syndrome, whose average age was 79 years; 35 patients completed the study.

From analysis of the clinical data it is concluded that methaqualone is effective as a sedative or mild tranquilizer in geriatric patients. The subjective responses indicated that it improved the general condition of 30 of the 35 patients. There was a statistically significant difference between the number of patients who improved with methaqualone and the number who improved with placebo.

Side effects were few and occurred about equally during the placebo and the methaqualone treatment periods.

As a secondary observation—3 of 5 women who were taking nonsteroidal anti‐inflammatory drugs for osteoarthritis volunteered the information that the pain was less during methaqualone therapy.
ENVIRONMENTAL FACTORS IN BLOOD GLUCOSE REGULATION
Authors: Cheraskin E. , Ringsdorf W. M. , Setyaadmadja A. T. S. H. , Barrett R. A. , Sibley G. T. , Reid R. W.
Published: April 2015

Abstract

To investigate the influence of environment on the level of blood glucose, 639 adult subjects were studied, in three groups. One‐third consisted of married women; one‐third consisted of their husbands; and one‐third consisted of unrelated females (randomly drawn) age‐paired to the wives. Blood glucose concentration was measured by the Dextrostix method.

In the two male‐female comparisons the blood glucose levels were alike only in the husband‐wife group, and in this group the correlation became more marked with advancing age. Since the husbands and their wives presumably lived under similar conditions, this may constitute evidence for the role of environment in the regulation of blood glucose, without in any way minimizing the role of genetic factors.
MANAGEMENT OF UREMIA IN OLDER PATIENTS: HEMODIALYSIS AND RENAL TRANSPLANTATION*
Authors: Figueroa Julio E.
Published: April 2015

Abstract

Sixteen uremic patients aged 50 or older were treated at the Ochsner Medical Center by hemodialysis, renal transplantation, or both, during a 30‐month period. Nine had acute uremia, and 7 chronic uremia. Renal function was restored in 2 of the 9 patients with acute uremia, but only 1 survived. The most common causes of unsuccessful results were respiratory failure due to aspiration pneumonitis and death due to complicating diseases, usually arteriosclerosis. Of the 7 patients with chronic uremia, 5 survived; 2 of these have reduced renal function but the other 3 have been completely rehabilitated by hemodialysis (at home) or renal transplantation.

As a result of our experience, we advocate that hemodialysis be used in all patients with acute renal failure, regardless of age, and that hemodialysis and renal transplantation be considered in all patients with chronic renal failure, regardless of age, as long as complicating diseases do not preclude long‐term survival.
ADULT PREVENTIVE MEDICINE: THE FOURTH PHASE IN THE EVOLUTION OF MEDICINE*
Authors: STILL JOSEPH W.
Published: April 2015

Abstract: Adult preventive medicine is the presently emerging phase of scientifically based medicine. This article: 1) traces the necessity for the development of adult preventive medicine because of many social mutations that have taken place in this century, and 2) outlines its theoretical foundations, involving such matters as health education and adult preventive medicine programs (medical weight control, anti‐smoking, preventive endocrinology, health education in human physiology and how to cope with stress, potential and motivational analysis, and predictive physico‐chemical programs).

The role of the physician will change from that of a supervisor of detection‐treatment medicine to that of an advisor and consultant in adult preventive medicine. Computerized pre‐disease diagnosis and health education (including knowledge concerning the use and abuse of stress) will be emphasized, to improve upon the present history‐and‐physical‐examination method.

The total program will require a tremendous increase in professionals trained to manage its various aspects.
FOLLOW‐UP STUDY ON PATIENTS DISCHARGED FROM A CHRONIC DISEASE HOSPITAL TO DOMICILIARY CARE DURING 1965 AND 1966
Authors: WILSON MURIEL
Published: April 2015

Abstract: Follow‐studies were conducted on unselected groups of patients discharged from a chronic disease hospital to private homes or to domiciliary facilities. Most of these patients were between the ages of 70 and 72. Reports are presented on 105 patients discharged in 1965 to such facilities—at the end of one year from the time of discharge, at the end of one and a half years, and at the end of two years. Additional data are presented regarding the main diagnosis and length of hospital stay in relation to results after one year in 75 patients discharged during the first eight months of 1966.

The 1965 data indicate that 45 per cent of those discharged were still functioning adequately at the end of one year, 39 per cent after one and a half years, and 32 per cent after two years, with an additional percentage (18 per cent at one year, 15 per cent at one and a half years and 17 per cent at two years) showing minor or gross deterioration but still able to be maintained outside of a hospital.

In view of the advanced age, the multiplicity of diseases and the average life expectancy of these aged patients, the results represent a reasonable degree of success in the rehabilitation of long‐term patients, and also tend to refute a common belief that the chronically ill geriatric patient will inevitably deteriorate rapidly after discharge from the hospital.

The numbers of patients are too small for drawing definite conclusions, but may indicate areas worthy of further study.
CHRONIC SUBDURAL HEMATOMA IN THE ELDERLY: A CURABLE LESION
Authors: RASKIND ROBERT , METCALF J. S. , WEISS S. R. , DORIA ALBERTO
Published: April 2015

Abstract: Thirty‐nine elderly patients were treated surgically for chronic subdural hematoma. Of the 34 who survived the postoperative period, 30 were restored to their pre‐illness states of activity and function; the remaining 4 had paraplegia or hemiparesis.

Chronic subdural hematoma in patients past 60 years of age presents many difficulties in diagnosis. However, clues often may be elicited by careful inquiry into the history, thorough physical examination, echo‐encephalography, plain roentgenograms of the skull, and analysis of the cerebrospinal fluid. Subdural hematoma must be seriously considered in any person older than 60 with a history of recent personality changes, rapidly progressing senility, headaches, or neurological deficits, whether or not there has been any known trauma to the head.

It is important to recognize that the lesion is often curable. The better results in our series were obtained in those cases in which diagnosis and surgical intervention were carried out early in the course of the illness.
STEREOTACTIC THALAMOTOMY IN THE TREATMENT OF EXTRAPYRAMIDAL DISORDERS: CRITERIA FOR SELECTION OF PARKINSONIAN PATIENTS
Authors: PERLMUTTER IRWIN , FAIRMAN DAVID
Published: April 2015

Abstract: Stereotactic thalamotomy has been performed to date on 370 patients with extrapyramidal disorders; 287 of these patients had Parkinson's disease.

The proper selection of candidates for this operation, among elderly persons just as among younger ones, is essential for success. The criteria for selection of parkinsonian patients are listed, as are the contraindications for the operation in this disease.

When properly selected elderly parkinsonian patients undergo accurately performed stereotactic thalamotomy, good results (complete or marked relief of tremor and/or rigidity) can be expected in about 75 per cent of the cases. Two representative case reports are included.
CONCENTRIC HYALIN INTRANEURONAL INCLUSIONS OF LEWY TYPE IN THE BRAINS OF ELDERLY PERSONS (50 INCIDENTAL CASES): RELATIONSHIP TO PARKINSONISM
Authors: Forno L. S.
Published: April 2015

Abstract

The significance of the intracytoplasmic hyalin neuronal inclusions first described by Lewy over fifty years ago is discussed on the basis of an analysis of 50 autopsy cases in which Lewy bodies were an incidental finding. Lewy bodies were not found in any person younger than 62 in this series. The distribution of the inclusions was similar to that in 21 cases of idiopathic parkinsonism, and in half the cases there was similar although less severe, nerve‐cell loss in the substantia nigra. Twenty‐two per cent of the incidental cases eventually proved to have had some mild clinical symptomatology that might indicate parkinsonism.

It is suggested that Lewy bodies are related to a specific abnormality of nerve‐cell metabolism, affecting the neuromelanin‐containing nerve cells in particular, and related to idiopathic parkinsonism rather than to age alone. Incidental cases may represent mild, early and preclinical cases of parkinsonism.
PROVISION OF REHABILITATION IN NURSING HOMES*
Authors: Stone Lana B.
Published: April 2015

Abstract

Interviews were conducted with the administrators of 118 nursing homes in Minnesota. Data were collected regarding: 1) characteristics of the nursing home, 2) economic characteristics, 3) characteristics of the patients, and 4) characteristics of the administrators. Information also was collected on: 1) medical rehabilitation services, 2) psycho‐social rehabilitation services, 3) volunteer services, and 4) activity programs. Indices were developed and the data subjected to statistical analysis.

Results of the study indicate that nursing homes differ in the kinds of rehabilitation services and programs provided to their elderly patients. Different nursing homes emphasize different aspects of rehabilitation. Moreover, although nursing homes differ as to kinds of rehabilitation services and programs provided, few nursing homes serve a homogeneous population, similar in terms of rehabilitation potential and rehabilitation needs. Patients with high potential are housed in nursing homes providing few, if any, medical rehabilitation services, and persons who might especially benefit from programs of nonmedical rehabilitation dwell in facilities placing little emphasis upon their psychological and social needs.

An obvious conclusion is that nursing‐home patients should be classified according to rehabilitation potential and rehabilitation needs and matched with nursing homes which can best fulfill the requirements. Although both potential and needs for rehabilitation may be medically assessed, there are few criteria by which to classify nursing homes according to rehabilitation services offered. This study represents a first attempt to discover those characteristics of nursing homes which provide various kinds of rehabilitation services and programs for their aged residents.
FAMILIAL FACTORS IN PSYCHIC ADJUSTMENT
Authors: Cheraskin E. , Ringsdorf W. M.
Published: April 2015

Abstract

To investigate the influence of environment upon the psychic (emotional) state, 150 adult subjects were studied, in three groups. One‐third consisted of married women; one‐third consisted of their husbands; and one‐third consisted of unrelated females (randomly drawn) age‐paired to the wives. Psychic state was determined by a simple self‐administered controlled association test (Cornell Word Form‐2).

In the two male‐female comparisons, the psychic responses were related only in the husband‐wife group, and in this group the correlation increased with advancing age. Since the husbands and their wives presumably lived under similar conditions, this may constitute evidence for the role of environment in the psychic state, without in any way minimizing other causative factors.
HORMONES AND CHOLESTEROL ESTER METABOLISM
Authors: Schweppe John S. , Jungmann Richard A.
Published: April 2015

Abstract

A study was made of the effects of testosterone, estradiol, ACTH, insulin, epinephrine and l‐thyroxine on a microsomal preparation of female rat liver esterifying enzyme and cholesterol plus palmitic, oleic and linoleic acids. In the doses used, these hormones modified the rate of ester synthesis. Further experiments showed that low doses of androgen or estrogen had a stimulating effect whereas high doses had an inhibitory effect.

On the basis of our findings and a review of the literature, it is concluded that the concentration of cholesterol or its esters in the plasma at any given time is determined by the net rate: 1) of absorption, 2) synthesis, 3) transport and lipoprotein binding, and 4) fecal excretion and partial re‐absorption following oxidative degradation of cholesterol to bile acids.

The turnover rate of free cholesterol is far more rapid than that of the ester. Also, the degree of unsaturation of the ester influences the rate of turnover. Mono‐unsaturated esters have the highest turnover rate. Lipoprotein binding in the very‐low‐density fraction is dependent upon diet; the more dense lipoproteins (> 1.061–1.21) are thought to be partially under genetic control.

Hormones act at three levels: 1) biosynthesis, 2) compartmentalization and transport (binding), and 3) excretion. The first two mechanisms may be involved with androgens, estrogens and insulin.

The atherosclerotic process involves many physicochemical factors. Diet and hormones modify the ester fraction. They also change the endogenous synthesis of cholesterol from acetate or mevalonate. Apparently the composition of the ester plays an important role in the deposition of cholesterol and its esters in sites of predilection.
HYPEROSMOLAR STATES IN THE CHRONICALLY ILL
Authors: Berenyi Magdalena R. , Straus Bernard
Published: April 2015

Abstract

Three chronically ill patients with hyperosmolar states of different origin were studied. The discussion involves hyperglycemic nonketotic coma, coma due to tube feeding of high‐protein nutrients, and hyperosmolality following diuretic administration and an inadequate intake of fluids. The hypertonic dehydration of these patients was caused by a deficit of water and an excess of solutes. Common to all 3 cases were urinary‐tract infections with probable pyelonephritis.

The loss of concentrating power in the pyelonephritic kidney results in a reduction of the ability to conserve body water. In older patients, there is an increase in the obligatory water loss via the urine because tubular function in the aging arteriosclerotic kidney is diminished. Other important factors in the pathogenesis of hyperosmolar states are fever, infection, inability to respond to thirst, impairment of glucose tolerance, and the frequent use of diuretics. The essential elements of management are early recognition and prompt correction with hypotonic solutions.
DEPRESSION AND SUICIDE IN THE GERIATRIC PATIENT
Authors: Wolff Kurt
Published: April 2015

Abstract

A survey was made of 200 elderly male patients in a VA hospital; 100 (Group A) had depression of the psychoneurotic or psychosomatic type with no evidence of suicidal potential, and 100 (Group B) had a psychotic depressive reaction with suicidal tendencies. The behavioral features of each group are described.

In Group A the symptoms of depression were related to “loss” (of physical health, of independence, of social status, of a spouse or close relative) or “failure.” These patients were of the passive‐dependent type. In Group B, the symptoms of depression were related to compulsivity (work, ambition, perfection). These patients “introjected” their hostile feelings. Eighty per cent had suicidal tendencies.

It is very important to differentiate these types of depression because the proper treatment, and the fairly good prognosis, are based upon understanding the psychodynamics.
SULFATE‐CONTAINING GASTRIC MUCUS COMPONENTS AND PEPTIC ULCER: A POSSIBLE RELATIONSHIP
Authors: Familiar R. G.
Published: April 2015

Abstract

Ulcer‐producing agents or procedures may act by interfering with the production of sulfate‐containing components of the gastric mucus. The rate‐limiting step in the production of sulfate‐containing mucus components may be the stimulated formation of phosphoadenosine phosphosulfate by vitamin A.

Research is required to establish, or deny, a link between ulcerogenic agents and this sulfate activation reaction.
MANAGEMENT OF THE HEMIPLEGIC PATIENT
Authors: Kurasik Steve , Sutton Bruce B.
Published: April 2015

Abstract

In the past hemiplegic patients often have been considered hopeless cripples and relegated to some chronic disease institutions or nursing homes, there to vegetate for their remaining years. Our experience indicates that regardless of the extent of disability, the hemiplegic patient always can be helped to some degree by a dynamic program of rehabilitation.

Presented briefly are discussions on the care and treatment of hemiplegic patients during the acute phase, the management of residual defects, and the objectives of a rehabilitation program. It is essential to learn the natural history of hemiplegia in order to suggest the proper treatment for the proper patient at the proper time. The goals of rehabilitation must be realistic. Evaluation should include long‐range planning and establishment of the therapeutic limitations. The patient's functioning and adjustment to his handicap depend greatly upon the family's attitudes toward him and his disability. With proper management of the disability, the hemiplegic patient can look forward with hope to years of useful life.
THE CHRONICALLY ILL AGED, FAMILY CONFLICT, AND FAMILY MEDICINE
Authors: Miller Michael B.
Published: April 2015

Abstract

The study of the chronically ill aged provides special opportunities to observe patient‐family interactions on exposure to the stress occasioned by the long‐term illness of a parent. The author and his associates have observed 9 patient‐family reactive patterns, 4 of which are inappropriate or paradoxical, and 5 of which are appropriate. The inappropriate patterns predominate among the more severely handicapped patients. Such observations contribute to the study of comprehensive care. The medical focus should be expanded to include the family in the treatment unit. An adequate nomenclature for “family diagnosis” is yet to be developed.

The medical profession's traditional strong orientation towards the patient and his disease, almost to the exclusion of understanding the impact of the patient's illness on the immediate and remote social environment (and vice versa) impedes the development of comprehensive care. The diversity of socio‐cultural, religious, economic and other factors affecting patient‐family interactions and the practice of medicine is of such magnitude that the medical profession must learn to work in symbiotic association with its sister social sciences—sociology, psychology, anthropology, psychiatry and theology. Treatment of the patient as a whole person includes the study and management of the family as an entity and as part of the treatment unit that involves community health engrafted on the prevailing society or culture.
THE EDENTULOUS PATIENT. II. XEROSTOMIA AND THE BLOOD SUGAR LEVEL
Authors: Cheraskin E. , Ringsdorf W. M.
Published: April 2015

Abstract

Sixty‐seven edentulous patients with complete dentures were studied during 153 visits. Xerostomia was reported during 37 of the 153 visits, but usually it was mild and intermittent; it was constant in only 5 cases, and never severe. The blood sugar data indicated hypoglycemia during 6 per cent of the visits and hyperglycemia during 16 per cent; 3 out of 4 values were normal. In relation to xerostomia, statistical analysis showed that the blood sugar level was higher in patients with dry mouth.
THE SIGNIFICANCE OF STATURE AS A CLINICAL MEASUREMENT OF AGEING
Authors: DEQUEKER JAN V. , BAEYENS JEAN P. , CLAESSENS JAN
Published: April 2015

Abstract: A study was made of 140 women (age range, 30 to 94 years) selected at random in a large psychiatric hospital, to determine changes in stature after maturity and the correlation of such age‐associated changes with various body measurements. It was found that:

1. There is a statistically significant decrease in stature with age.

2. The ratio of body length to armspan is a convenient method for assessing the amount of height loss with age.

3. The rate of decrease in stature is about 1.3 cm per age decade.

4. Loss of stature with age is best correlated with osteoporosis (metacarpal index) but is also correlated, less significantly, with skinfold thickness on the dorsum of the hands.

5. Loss of stature with age is not importantly correlated with osteoarthrosis, as determined by changes in joints of the hand.
RECURRENT GASTROJEJUNOCOLIC FISTULA TREATED BY ILEOSIGMOIDOSTOMY
Authors: CASE THOMAS C.
Published: April 2015

Abstract: A twenty‐year history of a ease of recurrent peptic ulcer with recurrent gastrojejunocolic fistula is presented. The sequence of surgical events was: (a) closure of a perforated duodenal ulcer in 1948; (b) gastric resection for ulcer and obstruction in 1950; (c) gastric re‐resection for gastrojejunocolic fistula in 1963; (d) gastric re‐resection for a similar lesion in July 1967; and (e) ileosigmoidostomy for a similar lesion in September 1967. Pancreatic adenoma was suspected but not identified. The compromise operation (ileosigmoidostomy) in 1967 has proved effective to date (one year later).
INITIAL REACTIONS TO NURSING HOME PLACEMENT
Authors: LINN MARGARET W. , GUREL LEE
Published: April 2015

Abstract: Two hundred and thirty‐eight male patients transferred from a Veterans Administration hospital (general‐medical) to nursing homes were studied prior to placement and one week thereafter. Ratings of the patients by hospital nurses and nursing home nurses, according to a disability scale, indicated no significant changes in the level of disability by the end of the first week. This applied not only to the whole group of patients but to two subgroups—those with favorable, and those with unfavorable attitudes toward nursing homes. Other criteria, such as death in the nursing home or re‐admission to the hospital, also indicated stability in the condition of the patients. It would seem that negative reactions are measurable only at some time later than one week after placement. On the basis of these findings, it is recommended that rehabilitative or supportive efforts be offered early in nursing home placement.
MENTAL PATIENTS IN NURSEVG HOMES. III. OWNERS, ADMINISTRATORS, AND NURSES*
Authors: STOTSKY BERNARD A. , DOMINICK JOAN R.
Published: April 2015

Abstract: The nursing supervisor is the key staff member in a nursing home, though subject to control by the administrator and owner. The three general types of nursing supervisor are: 1) permissive, 2) dominant, controlling, and 3) staff‐centered. Under a permissive supervisor, the pervasive indecision leads to an indifferent staff and anxious patients. Under the dominant supervisor, the home is a model of efficiency and neatness but the loss of self‐esteem and interest leads to a high turnover of staff and disregard of patients' emotional needs. Under the staff‐centered supervisor, control and responsibility are shared with the staff. Patients are allowed some self‐expression and are treated with understanding. Yet, this supervisor maintains mastery of the home. What happens to a home when the nursing supervisor leaves without immediate replacement? The deterioration is described. The attitude of student nurses who visit nursing homes as part of their training is often greatly changed in the direction of a better understanding of the problems of geriatric nursing.
MENTAL PATIENTS IN NURSING HOMES. IV. ETHNIC INFLUENCES*
Authors: DOMINICK JOAN R. , STOTSKY BERNARD A.
Published: April 2015

Abstract: This study was an attempt to determine the unique features of various ethnic groups which affect social relationships in nursing homes. Detailed examples are given of what was observed in the following geriatric groups during visits to nursing homes: Chinese, Armenian, Roman Catholic (one home predominantly Italian, and one run by the Little Sisters of the Poor), Jewish (one efficiently managed, and one less well managed, chiefly for the foreign‐born), predominantly Negro (entire staff and more than half the patients), and Protestant (Puritan type and Currier and Ives type); in addition, an example is given of people who had grown old and were cared for in their own communities by neighbors and relatives. Some of these situations were much better than others, though overall, it was evident that loneliness, aimlessness and monotony tend to dominate the lives of most aged people in institutions. However, those who are strongly bound by ethnic, cultural and religious ties do not feel isolated, abandoned and hopeless.
MENTAL HEALTH CONSULTATION AND EDUCATION IN NURSING HOMES*
Authors: FRANKEL FRED H. , CLARK ELEANOR
Published: April 2015

Abstract: As part of an attempt by a teaching hospital to improve care of the patients in a selected group of 12 nursing homes in a metropolitan area, mental health consultation and education was offered to 4 of the 12 facilities for periods varying from a year to three years. The method involved fortnightly discussions with groups consisting of administrative and supervising nursing personnel. The shortcomings of this necessarily cautious and exploratory approach, and the need to include elementary instruction in any program for nursing‐home personnel are discussed. A model program which calls for a serious commitment of time and effort by the participating nursing‐home facilities is outlined.

There is no short‐cut to good care of the patient. Mental health principles cannot be taught by brief superficial contact with nursing‐home facilities, and nothing short of commitment and effort on the part of all concerned will make any lasting impact in this growing area that is crucially inadequate. Legislation to ensure minimal standards (already on the books in the form of Medicare and Medicaid) will require for implementation the efforts of the public health and welfare authorities, the medical profession, and the public. Realistic reimbursement of the facilities for their services, and training grants to enable them to meet the costs of in‐service training are an essential part of any plan.
IMPACT OF MEDICARE UPON A PRIVATE PRACTICE OF OPHTHALMOLOGY*
Authors: SPEARMAN M. P. S.
Published: April 2015

Abstract: Under Medicare, the author has performed 112 elective cataract operations in elderly patients, which for the most part would have been financially prohibitive without such coverage. Medicare has been of distinct, unqualified benefit to these patients. It is not the sovereign remedy for all the ills of the aged, but on the other hand it has not corrupted or demeaned these people, nor shattered the American way of life. After a preliminary chaotic period in 1966, the billing and collecting machinery has become smooth and efficient, and payment is prompt. There is a high degree of satisfaction on the part of the patients.
SUPPRESSION OF BACTERIURIA BY METHENAMINE MANDELATE IN AGED HOSPITAL PATIENTS WITH CHRONIC DISEASE
Authors: BOHENSKY FREDERICK B.
Published: April 2015

Abstract: Therapeutic success in the treatment of urinary‐tract infections in aged patients is admittedly unpredictable because of the high frequency of anatomical urinary‐tract abnormalities and degenerative vascular disease. This preliminary study involved 90 aged patients in a chronic disease hospital. Before the study began, 65 of the 90 patients had bacteriuria; during approximately four weeks of methenamine mandelate therapy, the bacteriuria cleared in 72 per cent. Initially, 25 of the 90 patients did not have bacteriuria, but in 13 of the 25, bacteriuria was present by the end of the treatment period. The medication was well accepted by the patients, and no significant adverse reactions were observed.

The data indicate that the prophylactic or therapeutic use of methenamine mandelate to suppress bacteriuria does not involve any medical risk. If the causes of urinary‐tract obstruction are removed, this medication may control bacteriuria even in geriatric patients with severe and debilitating diseases.
THE DIAGNOSTIC SIGNIFICANCE OF INTESTINAL GAS
Authors: GROSBERG SAUL J.
Published: April 2015

Abstract: Excessive intestinal gas poses a significant problem in gastroenterology, not to be either exaggerated or underestimated. The symptoms may be severe enough to mask such diseases as peptic ulcer, cholelithiasis, angina pectoris, and emphysema. The pseudo‐anginal magenblase syndrome is caused by entrapped gas. Although the physiology and pathology of intestinal gas is fairly well understood, the treatment is an exercise in frustration. Certain effective dietary and medicinal measures are suggested.
PROCAINE AMIDE‐INDUCED LEUKOPENIA
Authors: KWAN VICENTE W.
Published: April 2015

Abstract: A case of leukopenia secondary to procaine amide therapy in a 70‐year‐old woman is reported. Although either leukopenia or agranulocytosis is rare in patients taking this drug (widely used in the treatment of ventricular arrhythmias), periodic blood counts should be made to preclude the development of agranulocytosis, which can be fatal.
EFFECTS OF PIPRADROL HYDROCHLORIDE ON GERIATRIC PATIENTS
Authors: TUREK IBRAHIM , KURLAND ALBERT A. , OTA KAY Y. , HANLON THOMAS E.
Published: April 2015

Abstract: Sixty‐eight geriatric patients with chronic brain syndrome residing in a state psychiatric hospital were studied in three groups to determine the effects of pipradrol hydrochloride (2 mg daily), placebo, and pipradrol hydrochloride (5 mg daily). The higher dosage of pipradrol was associated with improvement in ward behavior (psychological tests) at the three‐week point of the six‐week course of treatment. Placebo and the lower dosage of pipradrol were similar in their effects upon behavior; neither produced any significant change in the measures examined. No side effects were observed in any of the treatment groups. Differences in the reactivity of the nonpsychotic versus the psychotic patients were also investigated. The higher dosage of pipradrol appeared to increase positive ward behavior on the part of the nonpsychotic patients and to reduce negative ward behavior on the part of the psychotic patients.
Age and Calcium Metabolism in Relation to Cardiovascular Changes Induced by Renal Injury with Sodium Sulfaacetylthiazole
Authors: Okano Kazutoshi , Fujita Takuo , Orimo Hajime , Yoshikawa Masaki
Published: April 2015

Abstract

Obstructive nephropathy caused by a single intraperitoneal injection of sodium sulfaacetylthiazole (SAT) in a dosage of 0.5 gm/kg body weight induced interstitial myocarditis and medial calcification with medionecrosis of the aorta in 4‐month‐old rats but not in immature 1‐month‐old rats. The calcium content of the aorta, heart and kidneys and the 24‐hour uptake of 45Ca by the aorta, heart and kidneys were significantly increased. The histological changes, the increased calcium content of the heart and aorta, and the increased uptake of 45Ca were prevented by prior parathyroidectomy. Intraosseous 45Ca two weeks after administration for the purpose of labelling the stable bone fraction, was markedly decreased by injection of SAT in rats above the age of 4 months with intact parathyroids but not in immature rats and in parathyroidectomized adult animals. Such mobilization of 45Ca in the stable bone fraction was probably promoted through the increased secretion of parathyroid hormone secondary to SAT‐induced acute renal failure.
A SURVEY OF RESIDENTS IN FIVE NURSING AND REST HOMES IN CUMBERLAND COUNTY, NORTH CAROLINA
Authors: Gregory Robert J.
Published: April 2015

Abstract

A survey was conducted to study the characteristics of 169 residents in 5 nursing or rest homes in Cumberland County, North Carolina. The survey preceded an intensive drive by the Local Council on Older Adults to stimulate numerous programs to involve these residents in more activities and contacts with other people. The baseline data are reported in terms of results obtained from interviews with varying numbers of the residents concerning basic demographic information and the administration of three simple assessment measures—Social Competency Inventory (90 subjects), Mental Status examination (102 subjects) and Activities of Daily Living (89 subjects).

The data preclude drawing firm conclusions. However, the tests did discriminate between various ability levels, in relation to future attempts to evaluate the impact of treatment programs on groups. The age groups of the residents ranged from “under 45” to “85 and over” but most were concentrated in the 45–84 category. It would seem that the younger residents were those who were not functioning well mentally, whereas the older residents were those who had adequate mental ability but could not function physically or socially. Plans are to repeat the survey and note the impact of the programs of the Council on Older Adults.
THE CHEMOPSYCHOTHERAPEUTICS OF GERIATRIC SEDATION
Authors: DAWSON‐BUTTERWORTH KEITH
Published: April 2015

Abstract:

This article indicates some of the social, emotional, organic factors involved in disturbing the balance of the geriatric psychological equilibrium and outlines the need for an appropriate rationale of treatment with modern tranquillisers and sedatives. Both the problem of individual variation to treatment and the need for delineation of contributory organic factors are emphasised. Some features of senile psychoses, delirium, and depression are considered. Reference is made to the principles of sedation and tranquillisation and a number of the more widely used agents are reviewed. Some of the more notable side effects are briefly outlined.

Several clinical group studies involving the use of sedatives and tranquillisers were made on 143 patients from a general‐hospital geriatric unit and 41 geriatric patients from a psychiatric hospital. The presence of mental illness in geriatric patients was not associated with long‐term need for nocturnal sedatives but did tend to increase the duration of hospitalisation and reduce the chances of rehabilitation. It was found possible to manage all types of patients in the geriatric range without barbiturates, which are contraindicated. The need for a more flexible approach to medication in the psychiatric geriatric population is indicated. Some of the currently available chemopsychotherapeutic agents, although useful, are of only limited value in aiding the more disturbed patients.
SPEECH CHANGES IN PARKINSONISM DURING L‐DOPA THERAPY: PRELIMINARY FINDINGS
Authors: RIGRODSKY SEYMOUR , MORRISON ELEANOR B.
Published: April 2015

Abstract:

In the few reported studies on the effects of drug therapy on the speech symptoms of patients with Parkinson's disease, the conclusion generally has been that medication does not improve speech. Recent studies on the drug, L‐dopa, indicate that large doses reduce the severity of physical signs and symptoms. In this investigation, the speech of 21 parkinsonian patients was evaluated under various conditions of L‐dopa therapy. Although statistical significance was obtained for only one aspect (the time factor) of speech in favor of improvement during maximal dosage (4–8 gm daily), there appeared to be a trend in the direction of improved speech during L‐dopa therapy. These findings are not nearly as dramatic as the improvement in physical symptoms observed in the same patients. However, the speech changes all occurred within less than one month; greater changes might have been observed had the patients been followed for a longer period with maximal dosage.
THE RELATIONSHIP OF REPORTED CARDIOVASCULAR FINDINGS TO HEIGHT OF THE T1‐WAVE IN THE ELECTROCARDIOGRAM
Authors: CHERASKIN E. , RINGSDORF W. M.
Published: April 2015

Abstract:

The literature is replete with evidence to show that, with advancing age, distinct changes occur in the electrocardiogram. One of the most obvious is the progressive decrease in the height of the T1‐wave. Because this change is so common, possibly it is part of the aging process.

A study of 164 presumably healthy subjects revealed: 1) a statistically significant low negative correlation between age and the height of T1 (r = −0.181, P < 0.05); 2) a low but statistically significant positive relationship (r = +0.197, P < 0.05) between age and reported cardiovascular complaints; 3) an even higher (r = +0.326, P < 0.01) statistically significant positive correlation of age and cardiovascular findings in subjects with relatively low T1 waves; and 4) no significant correlation (r = +0.009, P > 0.05) between age and cardiovascular reported findings in subjects with relatively high (1.6–4.0 mm) T1 waves.

Thus, within the limits of this study, reported cardiovascular findings increase with aging only in subjects whose electrocardiograms show relatively low T1 waves.
RHABDOMYOSARCOMA OF THE HEART (CASE REPORT)
Authors: MARGOLIS JACK , ARGANARAS EDUARDO
Published: April 2015

Abstract:

A case of the rare tumor, rhabdomyosarcoma of the left atrium of the heart, is presented. The patient was a 63‐year‐old man whose chief complaint was weakness and shortness of breath, believed to be due to chronic pulmonary emphysema with fibrosis (confirmed at autopsy). He was recovering from an attack of congestive heart failure with pneumonitis (after therapy, the heart size was normal and the lungs were clear), when he died suddenly. The cardiac tumor was unsuspected until it was revealed at autopsy.

This diagnosis should be kept in mind, particularly in cases with symptoms resembling those of mitral stenosis. The reporting of such cases may help in the diagnosis of other primary cardiac tumors early enough for corrective surgery.
THE CONCEPT OF PSEUDONEUROTIC SCHIZOPHRENIA AND THE ROLE OF PSYCHIATRY IN MODERN SOCIETY
Authors: LERNER JOSEPH
Published: April 2015

Abstract:

Pseudoneurotic schizophrenia has been used as a diagnostic classification for about twenty years. A review of thousands of reports fails to indicate that such a diagnosis has effectively differentiated it from other categories. The term has added to the confusion of both psychiatrists and nonpsychiatrists who are responsible for the use of psychiatric reports in the various processes of adjudication. The modern psychiatrist, participating with labor and industry in the management of psychiatric aspects of personal adjustment, will find no advantage in using the diagnosis “pseudoneurotic schizophrenia.”
EMPHYSEMA
Authors: Rosenblatt Milton B.
Published: April 2015

Abstract

This review of the medical literature on emphysema before and during the nineteenth century clearly demonstrates that the disease was highly prevalent before modern times. The alleged increase in the prevalence of emphysema during recent decades—on the basis of official death certifications—is a statistical illusion.
AN ISOLATED CASE OF MUMPS IN A GERIATRIC POPULATION
Authors: Glick Daniel
Published: April 2015

Abstract

This article concerns an isolated case of mumps in an 88‐year‐old woman in a geriatric‐centre hospital. The disease was preceded by what appeared to be acute pancreatitis, and was complicated by a secondary infection of the parotid. Viral studies confirmed the diagnosis. Also, mumps soon developed in 2 nursing aides who were attending the patient.
ACUTE MYOCARDIAL INFARCTION IN THE AGED: PROGNOSIS AND MANAGEMENT*
Authors: Harris Raymond , Piracha Abdul Rashid
Published: April 2015

Abstract

A study was made of 196 patients (120 men and 76 women) with acute myocardial infarction. The mean age was 65 years, with a range of 31 to 104 years. Of the 196 patients, 69 (35.2 per cent) died. The mortality rate increased particularly after age 70, for each sex. The incidences of associated heart failure and shock also increased with age. The data indicate that: 1) the elderly patient with acute myocardial infarction is a poor risk, 2) statistics on the mortality rate should include the age of the patient, and 3) advanced age, congestive heart failure, shock, and cardiac arrhythmias are prime factors in the prognosis.

The requirements for reducing the mortality rate include early and accurate diagnosis of acute myocardial infarction, and more intensive treatment before the onset of irreversible changes. The way in which the symptoms of acute myocardial infarction differ in the aged are outlined, as are the principles of treatment and specific recommendations.
SURVIVAL IN OLD AGE: PHYSICAL, PSYCHOLOGICAL AND SOCIAL CORRELATES OF LONGEVITY*
Authors: I'FEIFFER ERIC
Published: April 2015

Abstract:

This study involved a sub‐group of a panel of community volunteers—37 long‐lived persons (20 men, 17 women) and 37 short‐lived persons (20 men, 17 women). The findings suggest that group characteristics of long‐term survivors differ sharply from those of short‐term survivors in old age. Moreover, it seems that there is no single factor which contributes to longevity; rather, there is a constellation of biological, psychological, and social factors amounting to what may be best described as elite ***status. Persons with high intelligence, sound financial status, well‐maintained health, and intact marriages may be expected to live significantly longer than their less intelligent and poorer brothers and sisters whose health is also declining and whose marriages are no longer intact. Many of the factors identified here as contributing to longevity are not readily subject to individual, social, or political manipulation, with the possible exception of financial factors.

It is hoped that investigations in other parts of the country and with differing populations of elderly people can determine if the hypotheses put forward here apply to elderly persons generally. It would also be interesting to know if these factors are similarly important in influencing survival at other stages of the life cycle. Infant mortality in this country certainly seems to be related to some of the factors examined in this study.
PATHOGENIC BACTERIA AND THEIR SENSITIVITY PATTERNS IN A HOSPITAL POPULATION OF GERIATRIC PATIENTS WITH CHRONIC DISEASE
Authors: LI KOIBONG , MILLER CELIA
Published: April 2015

Abstract:

In a hospital population of geriatric patients with chronic disease, 1,584 patients were tested and the pathogens most commonly involved in their infections were identified. The antibiograms of these bacteria (in vitro) were established. The leading pathogens were Proteus mirabilis, Pseudomonas aeruginosa, Providence group (Proteus inconstans), Escherichia coli, Staphylococcus aureus, and Streptococcus fecalis, in descending order of frequency. Of significance was the emergence of the Providence group (Proteus inconstans), and its high degree of resistance to most antibiotics tested. It is conceivable that the Providence group might become a major pathogen in the future, because its resistance to antibiotics favors its survival. A new, more effective drug is desired for this group.
FIVE‐YEAR FOLLOW‐UP OF GERIATRIC CHRONICALLY ILL MENTAL PATIENTS IN FOSTER HOME CARE
Authors: WATT NORMAN F.
Published: April 2015

Abstract:

A follow‐up study of 12 geriatric chronically ill mental patients placed in foster homes as the result of an intensive ward rehabilitation program revealed that 8 (67 per cent) of these men remained out of the hospital at the end of five years. Six had been discharged from the hospital and 2 remained on trial visit status in foster homes. All but 1 of the 8 men were still in foster homes at the time of follow‐up. Neither age, the severity of psychiatric disability nor the length of previous hospitalization was a deterrent to success in home care, as long as the patient was not extremely irritable or aggressive. Indeed, the older men in this study remained out of the hospital significantly longer than did the younger ones. Eight of the 12 patients required transfer to a new foster home, re‐admission to the hospital, or new placement after rehospitalization—which shows the importance in such a program of having continuous supervision by a persistent social work staff.

The number and proportion of geriatric chronically ill patients who reside in our mental hospitals have risen dramatically during the last few decades and will almost certainly continue to increase. By the usual channels of release from the hospital, this group of patients has the poorest prospects of all to remain out of the hospital. Foster home care is a humane and economical alternative for many of these patients. Our findings indicate that if patients are carefully selected, prepared and supervised after placement, the chances of long‐term success in foster home care can be impressively good.
CONTROL OF CIGARETTE HABIT BY PSYCHOLOGICAL AVERSIVE CONDITIONING: CLINICAL EVALUATION IN 53 SMOKERS
Authors: OCHSNER ALTON , DAMRAU FREDERIC
Published: April 2015

Abstract: In a group of 53 smokers, the aversive conditioning method of controlling the cigarette habit by means of an educational pamphlet containing corresponding daily references to the evils of tobacco proved highly successful in a three‐week test period. Results were rated as excellent in 34 cases (64 per cent), good in 11 cases (21 per cent), fair in 5 cases (9 per cent), and poor in 3 cases (6 per cent). Twenty participants (38 per cent) stopped smoking entirely and 9 others (17 per cent) reduced their cigarette consumption to one or less per day. Forty‐five participants (85 per cent) smoked less than half as much as before. Many smokers who reduced their cigarette consumption substantially during the test period gradually tapered it off to complete abstinence.