bluuebunny/crossref_metadata_2025 huggingface dataset:
THE CYBERNOSES OF THE AGED—THE FAILURE OF SELF‐REGULATING MECHANISMS
Authors: Meerloo Joost A. M.
Published: April 2015

Abstract

Symptoms observed in the aged are analyzed according to the cybernetic model. The concept of cybernosis encompasses all changes in macro‐ and microstructures, with their interactions and servomechanisms. Regression is the return to a genetic older self‐regulating model. There are psychic as well as somatic regressions, immunological as well as psychic defense mechanisms, and physical as well as social adaptations. According to the cybernetic model, neuroses and psychoses constitute failures in a hierarchy of structural systems and adaptational responses. The cybernosis concept is valuable when it leads to new insights, especially when it augments our forms of observation and research. Evidence of breakdowns in regulatory mechanisms in the aged may be observed in the areas of thermo‐regulation, diadic rhythm, psychosomatic security systems, symbiosis, and adaptive regressions, often enhanced by changing social attitudes toward the aged.

Study of the cybernoses of the aged may be expected to give the therapist as much useful information as does study of the genesis of infantile defense mechanisms. Research on both aspects of‐life (breakdown as well as build‐up) will lead to a greater understanding of man.
PULMONARY EMBOLISM: MODERN CONCEPTS AND DIAGNOSTIC TECHNIQUES
Authors: Riccitelli M. L.
Published: April 2015

Abstract

The subject of pulmonary embolism is assuming ever‐increasing importance, not only medically but legally. More than ever, the physician should have basic knowledge of the pathophysiology. This article outlines the modern concepts of the mechanisms involved and the etiologic factors. Pulmonary embolism is often difficult to diagnose. A thorough history and physical examination are fundamental, but there are several good diagnostic aids in the field of radiography, angiography, thermography, lung scanning, ultrasonic procedures, and enzyme and pulmonary function tests. Modern medical treatment is outlined—including preventive therapy, the treatment of shock, and the use of anticoagulants and thrombolytic agents. Surgical techniques include some ingenious new methods. However, the best results are obtained when surgical skill is combined with good judgment in the proper selection of cases.
JOHN S.—WIDOWER
Authors: Freeman Joseph T.
Published: April 2015

Abstract

A surgeon writing in 1895 described a surgical procedure that enabled “John S., aged 66, widower” to regain his ability to sustain erections. The article was entitled “Old Age a Myth”—a conclusion that was not justified on the basis of the data presented. The indexer for Index Medicus seemed to realize this and added the explanatory phrase “[in sexual matters].” All too often, even today, re‐potentiation is equated with rejuvenation.
RETIREMENT*
Authors: Sherman E. David
Published: April 2015

Abstract

This review outlines the problems associated with retirement and some of the vital factors in their solution. A study of the psychological aspects indicates that often psychiatric illness is diagnosed in elderly persons when the real issue is low morale. Retirement is discussed under the headings of timing, type (compulsory or voluntary), programs, mental health, self‐employment, retirement occupations, preventive medicine, and medico‐social aspects.

Society must strive to attain a goal in which each older worker approaching the stage of retirement is afforded the opportunity to choose between an economically secure and purposeful role in retirement, or a similar role in employment if he is able and willing to work. This objective can be achieved only when there is a flexible program for retirement with adequate pension plans, both public and private, and a pre‐retirement program which assists older workers to prepare adequately for constructive roles in retirement.
CHOLECYSTOSTOMY: UTILITY IN GERIATRIC PATIENTS*
Authors: Ficarra Bernard J.
Published: April 2015

Abstract

Although cholecystectomy is the procedure of choice for cholelithiasis with stone impacted in the cystic duct, there are occasions in the management of this disease in geriatric patients when cholecystostomy with removal of the impacted stone is preferable. The surgeon must be guided in his decision by the physical status of the elderly patient, the anesthesia tolerance, and the findings at the time of starting the operation. When in doubt, perform a cholecystostomy. The gallbladder can always be removed at a later date if necessary. Though it may be more impressive to remove the gallbladder, simple drainage with removal of the stone may be life‐saving.
AMINO ACID METABOLISM IN OSTEOPOROSIS
Authors: OHATA MASAHIRO , FUJITA TAKUO , ORIMO HAJIME , YOSHIKAWA MASAKI
Published: April 2015

Abstract:

To evaluate amino acid metabolism in osteoporosis, the effects of oral loading with an amino acid mixture were studied in 11 aged patients with advanced osteoporosis, 5 aged patients with mild osteoporosis, and 7 healthy aged subjects (controls). The osteoporotic patients were free of other major diseases. In all three groups the physical examination, blood chemical determinations, urinalysis and fluoroscopy of the upper gastrointestinal tract gave normal findings; in particular, no liver or kidney disease was indicated by the results of function tests. A diagnosis of vertebral osteoporosis was made when the ratio of vertebral to disc density in the lateral tomogram of the lumbar spine was 1.0 or higher; in the normal subjects, the ratio was always less than 1.0. The presence of compression fracture(s) was considered to indicate severe osteoporosis, whereas the absence of such fractures graded the disease as mild.

Gaschromatographic analysis of the serum for certain free amino acids was made on the blood specimens drawn immediately before, and at one, two, three and four hours after oral ingestion of the test amino acid mixture. The serum valine level for the severely osteoporotic group was significantly higher at one hour (215 + 21 μg/ml versus 151 + 9 for the controls) and at four hours (178 + 16 μg/ml versus 139 + 8.7 for the controls) after ingestion of the mixture. The peak height of the serum valine level was also significantly higher in the severely osteoporotic patients (263 + 25 μg/ml) than in the controls (192 + 5.5 μg/ml). In the mildly osteoporotic patients the values were intermediate. For leucine and phenylalanine, the tolerance curves for the osteoporotic patients were similar to those for the controls. The findings are consistent with the hypothesis that possibly there is a deficiency or defect of valine transaminase in osteoporosis.
OPHTHALMODYNAMOGRAPHY IN GERIATRIC PATIENTS
Authors: RAO D. B. , CORY C. C.
Published: April 2015

Abstract:

Interest in the extracerebral circulation, particularly in the elderly, has led to new methods of estimating blood pressure in the carotid arteries. The method described here involves use of the ophthalmodynamograph, which simultaneously monitors orbital blood pressure and brachial artery blood pressure.

The study was made on 66 patients in a geriatric day hospital. The 53 females (average age, 76) and 13 males (average age, 70) had multiple disease. The five most common diagnoses were cerebrovascular accident with hemiplegia (18 cases), osteoarthritis (10 cases), cerebral arteriosclerosis (9 cases), ischaemic heart disease with congestive failure (9 cases), and parkinsonism (6 cases). In 120 eyes, the orbital diastolic pressure varied from 50 mm to 135 mm Hg, being between 80 and 100 mm in 50 per cent and below 80 mm in 27 per cent. The orbital diastolic pressure often was greater than the brachial; in 10 cases the difference was greater than 20 mm. When the diastolic pressures in the two eyes were compared, 9 cases showed a difference greater than 10 mm and 24 cases a difference greater than 6 mm.

Problems exist regarding the interpretation of certain waveform changes in the tracings. However, the apparatus is reliable, safe, and easier to use than most available techniques for studying blood flow in this region.
SPLIT‐COURSE COBALT60 IRRADIATION FOR TREATMENT OF ADVANCED CARCINOMA OF THE LUNG
Authors: WILKIE LOUIS J.
Published: April 2015

Abstract:

A survey was made of the cases of lung carcinoma referred to the Radiology Department for cobalt60 therapy during the first five years after installation of the cobalt unit at Creighton Memorial St. Joseph's Hospital in Omaha. After elimination of 27 cases in which there had been other conjunctive therapy such as surgery, chemotherapy or x‐ray irradiation, there were 85 cases for study. Two cases were lost to follow‐up, so the data pertain to 83 patients (mean age 60, range 30–78).

The complete planned course of cobalt60 irradiation delivered a total dose of 4,000–5,000 r during six to eight weeks, with half the dose given in the first two weeks, followed by a two‐week rest period. Only 39 of the patients were able to complete the planned course of 4,000–5,000 r. The mean length of survival for all the patients was fourteen and a half months after starting therapy. Two patients are still living at seventy‐five and seventy months, and 1 at thirty months. The overall survival rate was 4 per cent, but for the group receiving the full course of therapy it was 7.5 per cent. About three quarters of the 83 patients obtained moderate to marked relief of symptoms.

These results are similar to several reported in the literature, and serve to emphasize the benefits of cobalt teletherapy in otherwise incurable cancers of the lung.
MENISCAL TEARS OF THE KNEE IN THE ELDERLY
Authors: GARDNER RICHARD C.
Published: April 2015

Abstract:

Tears of the knee meniscus are contrasted in the young versus the elderly. The diagnosis may prove difficult in the elderly, as often there is no definite history of trauma. Characteristic signs and symptoms and methods for examination are outlined. Early menisectomy may prevent erosion of the cartilage and degenerative changes in the joint.
THE PHARMACEUTICAL INDUSTRY; AN EASY TARGET
Authors: COHN RONALD E.
Published: April 2015

Abstract: A physician makes some observations on his two‐year experience in clinical investigation with an ethical pharmaceutical company. Despite criticism, some of which is entirely unjustified, the pharmaceutical industry continues to contribute greatly to medical therapy.
LACTOBACILLUS OVERGROWTH DIET AS AN ADD IN CONTROLLING ESCHERICHIA COLI SEPTICEMIA AND ENDOTOXEMIA IN CANCER PATIENTS: A CASE REPORT*
Authors: ELLIS STEPHEN , SPRATT JOHN S.
Published: April 2015

Abstract: Adult patients, particularly the elderly, those afflicted with major illness, these undergoing major surgical procedures and those receiving antibiotic drugs are subject to extensive alterations of the normal intestinal flora. These alterations predispose to a massive overgrowth of the intestinal flora by beta Escherichia coli with resultant septicemia and endotoxemia. Pediatricians have managed this problem since before the days of antibiotics by creating a competitive overgrowth of nonpathogenic bacteria through feeding cultures of lactobacilli and nutritious culture media of lactose‐containing milks. A case is reported wherein this pediatric approach was used in a postsurgical patient to inhibit the progressive deterioration arising from beta Escherichia coli overgrowth not arrested by antibiotics. (The treatment of Gram‐negative septicemia and/or shock is outlined.) The prophylactic use of a lactobacillus overgrowth diet in elderly patients who risk the development of Escherichia coli overgrowth should be tried more often.
AGGRESSIVE MANAGEMENT OF RHEUMATOID ARTHRITIS IN THE ELDERLY
Authors: NASTRO LAWRENCE J.
Published: April 2015

Abstract: Usually the elderly patient with rheumatoid arthritis manifests the residual of several years of active disease. Eleven cases are cited to illustrate that effective treatment must be tailored to the current stage of the disease. Acute rheumatoid arthritis is not common in the elderly. When it develops, salicylates and complete bed rest in a hospital remain the therapeutic anchors. If symptoms do not subside in from two to three weeks, indomethacin, gold therapy and corticosteroids may be tried. In most cases, distinct improvement occurs with this regimen. Chronic deforming rheumatoid arthritis is a different story, however. It is extremely difficult to treat effectively.

In both the acute and the chronic form of rheumatoid arthritis, an active rehabilitation program is the key to the prevention of functional deterioration and to the maintenance of the patient as a fairly self‐sufficient person.
VITAMIN‐C DEFICIENCY IN THE ELDERLY AND ITS MANIFESTATIONS
Authors: MITRA M. L.
Published: April 2015

Abstract: In a 64‐bed geriatric unit, 4 cases of vitamin‐C deficiency were found. The patients manifested anaemia (chiefly normocytic), multiple bruises and intense tibial tenderness; the results of Hess's capillary fragility test were positive. The diagnosis was confirmed by the urinary ascorbic‐acid saturation test. One of the patients also had folic‐acid deficiency. The relation between the two conditions is discussed. All the signs of vitamin‐C deficiency cleared up quickly during treatment with ascorbic acid, although the urinary test indicated that it took three weeks for the saturation point to be reached.

These results emphasize the importance of a full clinical examination for elderly patients. Vitamin‐C deficiency, if unrecognized, can defeat efforts at rehabilitation because the intense tibial pain (preventing ambulation) and the weakness due to anaemia usually keep the patient bedfast.
LONG‐TERM CARE FOR THE ELDERLY: OPTIMUMS, OPTIONS AND OPPORTUNITIES
Authors: Brody Elaine M.
Published: April 2015

Abstract

The medical profession has participated in many scientific breakthroughs which have prolonged the life‐span of millions of people. The physician, in the daily practice of his art, continues to prolong individual lives. Whether he will or no, the modern doctor therefore finds that he has a continuing responsibility to deal with the social consequences of those historic and current acts. When his patient is elderly and impaired, and when institutional placement must be considered, the doctor has a view from the bridge. His professional and human judgments indicate the optimum solution. The current realities dictate the options. He can look towards the general community and press for the development of services to make possible his prescription of continued community living for the patient and he can look towards the institutional community for what is necessary in care and programs to make the lives he has prolonged worth living. That is the opportunity.
PREDICTIVE MEDICINE. III. AN ECOLOGIC APPROACH
Authors: Cheraskin E. , Ringsdorf W. M.
Published: April 2015

Abstract

This article deals with some aspects of host resistance and susceptibility that can be modified by adding or withdrawing certain factors. Any practical program of predictive medicine must involve consideration of the internal milieu and how it may be altered by these factors.
A NOVEL GAIT OF PSYCHOGENIC ORIGIN
Authors: Baltzan David M.
Published: April 2015

Abstract

A novel gait in a 78‐year‐old woman is described. Though tentative diagnoses gave priority to an organic degenerative process, careful observation led to the diagnosis of a psychomotor aberration. (The patient claimed that the disorder was drug‐induced.) After starting a program of concentration on self‐control in association with imipramine, chlordiazepoxide and a regulated diabetic regimen, the patient recovered completely. The case illustrates how psychogenic counterparts can mimic organic cerebral deficits.
NEW PATHOLOGIC ASPECTS OF PRIMARY CARCINOMA OF THE PROSTATIC URETHRA
Authors: Milstoc M.
Published: April 2015

Abstract

Two cases of an extremely rare tumor, the primary transitional‐cell carcinoma of the male prostatic urethra, are presented. The diagnostic problems of the 2 cases are emphasized in relation to a special group of elderly long‐term patients in a hospital for chronic diseases. In addition, one of the patients had two primary carcinomas and mixed widespread metastases. It is the first such case.

This report of the 2 cases and the discussion of their pathologic aspects may help in the diagnosis of other primary urethral tumors in an early stage.
LARGE LEIOMYOSARCOMA OF THE STOMACH CARDIA TREATED BY GASTRIC‐REMNANT INTERPOSITION
Authors: Case Thomas C.
Published: April 2015

Abstract

A case is presented of a large invasive leiomyosarcoma of the stomach cardia, with metastases to the spleen. Operation consisted of removal of the tumor, most of the stomach, and the adherent spleen. Continuity of the gastrointestinal tract was established by gastric‐remnant interposition, thus avoiding total gastrectomy. Instead of the usual Roux‐Y procedure, a loop of jejunum was used in order to insure a good blood supply at the esophagojejunal anastomosis.
NEW HORIZONS IN OUR KNOWLEDGE OF DIABETES MELLITUS*
Authors: Levine Rachmiel
Published: April 2015

A summary is given of the latest advances in our knowledge of the fundamental processes in diabetes, including the nature of insulin and the regulation of its production, the role of glucagon in diabetes, and the problem of the associated vascular disorders. Intensified research is needed in the areas of more specific criteria for diagnosis, etiology and pathogenesis, and the precise mode of insulin action at the molecular level; also, the basis for the acceleration of arteriosclerosis in diabetes, and the possible relationship between microangiopathy and the abnormal nutritional metabolism. Successful implantation of functioning human islet tissue is another goal.
DEGOS' DISEASE ASSOCIATED WITH A “SPONTANEOUS CURE” OF DIABETES
Authors: Salomon Mardoqueo I. , Mandel Edward H. , Gallo Gloria
Published: April 2015

A case is presented of a 50‐year‐old woman with Degos' disease (malignant atrophic papulosis) of 2.5 years' duration. Almost simultaneously with the onset of Degos' disease, the diabetes mellitus which had been present for 13 years began to fade and vanished entirely within a few months. This occurred although the patient was receiving corticosteroid therapy which proved indispensable for control of the severe Degos' disease. A renal biopsy revealed normal renal tissue despite the long duration of the diabetes.
UTILIZATION OF IN‐PATIENT SERVICES BY THE ELDERLY
Authors: Berkman Barbara , Rehr Helen , Siegel Doris , Pomrinse David , Paneth Janice
Published: April 2015

The authors present descriptive data on the 5,312 patients aged 65 or older, admitted in 1967 to the medical and surgical in‐patient services of the Mount Sinai Medical Center in New York City. These patients accounted for 24 per cent of the total number of adults admitted. The services admitting most of the elderly were General Medicine, General Surgery, Urology, Ophthalmology and Neurology. These patients had a longer average stay in the hospital than the national average for hospitalized elderly; almost 20 per cent of them stayed thirty‐one days or longer. Over four‐fifths of the elderly were admitted to Private and Semi‐Private Pavilion accommodations, and the remainder entered the teaching services of the Semi‐Private Division. The Division patients had longer lengths of stay, on the average, than patients in the Pavilions. The patients referred to Social Service were chiefly from the General Medical, Neurological, and Orthopedic services. The most significant factor determining who was referred to Social Service was extended “length of stay.” Over half of the elderly receiving social services were patients whose hospital stays were thirty‐one days or longer.

It is anticipated that the elderly will become a larger proportion of the sick, requiring more medical care and hospitalization. They will continue to use more bed‐days than any other group of patients. It is recommended that health‐care institutions become more consciously aware of the elderly and their impact on hospital resources, and that the hospital stay be regarded as one phase in a continuum of care.
PREDICTIVE MEDICINE. IX. DIET
Authors: Cheraskin E. , Ringsdorf W. M.
Published: April 2015

A unique feature in a predictive medicine program is the role of diet in the prediction of classical disease. Examples are given of the relationships between diet and the clinical state, the electrocardiographic P1 wave, and the biochemical state. Countless dietary interrelationships are based on the link‐ages between nutritional substances, metabolic reactions, and hormones.
PREDICTIVE MEDICINE. X. PHYSICAL ACTIVITY
Authors: Cheraskin E. , Ringsdorf W. M.
Published: April 2015

Physical activity is a factor in preventing disease. Examples are given of the relationships to age, clinical and biochemical states, electrocardiographic signs, and the consumption of coffee/tea, alcohol, tobacco, and vitamin supplements. Physical activity is a cardinal feature of any predictive medicine program.
TOPICAL 5‐FLUOROURACIL: VARIABILITY OF EFFECTIVE DOSAGE AND DURATION OF REACTION
Authors: Sykes Marguerite P. , Salem Philip , Joffe Bernard
Published: April 2015

Topical 5‐fluorouracil (ointment) is an effective, inexpensive and safe remedy for solar and actinic keratoses. This form of therapy also seems to be indicated for patients with multiple and recurrent epitheliomas that have not responded well to surgery and/or x‐ray therapy. It is important to keep in mind the occasional variability in the effective dosage and the rare occurrence of a prolonged disfiguring reaction to treatment.
SERUM LACTIC DEHYDROGENASE ISOENZYMES IN DIABETES AND CHLORPROPAMIDE THERAPY
Authors: Haunz E. A. , Cornatzer W. E. , Luper Miltza , Baldwin Jerry J.
Published: April 2015

Serum LDH isoenzyme fractions were evaluated in non‐diabetic control subjects, diet‐controlled diabetic patients and diabetic patients receiving chlorpropamide (Diabinese) in addition to diet. Statistically significant elevations of fraction I were observed in both the diet‐controlled and the chlorpropamide diet‐controlled diabetic groups when compared with the normal controls. Fraction III, however, showed a statistically significant decrease in activity in the two diabetic groups when compared with the normal controls. No significant changes were observed in the other fractions. The findings indicate that the diabetic state per se may elicit an increase in fraction I with a decrease in fraction III, and that chlorpropamide therapy has no effect on the relative concentrations of the various serum LDH isoenzymes. This evidence confirms a previous observation from this laboratory that liver function remains unaltered during chlorpropamide therapy and that the mild abnormalities reported here are in all likelihood peculiar to the diabetic state itself.
BRIEF MAXIMAL ISOMETRIC EXERCISE IN HYPERTENSION
Authors: Kiveloff Broino , Huber Olive
Published: April 2015

Brief, maximal isometric exercise of six seconds' duration, repeated three times daily for five to eight weeks may be associated with lowering of the blood pressure in hypertensive patients. In 8 subjects with hypertension there was a decrease of 16–42 mm Hg in systolic pressure and 2–24 mm in diastolic pressure. In 5 subjects receiving a constant dosage of hypotensive drugs, there was a decrease of 4–28 mm in systolic pressure and 2–14 mm in diastolic pressure. In 2 subjects previously treated with hypotensive drugs in whom isometric exercise was substituted for the drugs, normal blood pressure was maintained for eleven months.
IMPROVEMENT IN CLAUDICATION AFTER INSERTION OF A CARDIAC PACEMAKER
Authors: Terplan Martin
Published: April 2015

Despite severe arterial insufficiency (with claudication) in both lower extremities, insertion of a cardiac pacemaker improved the distal circulation in a 76‐year‐old man with atrioventricular dissociation. This result suggests that when the cardiac condition requires insertion of a pacemaker, this procedure should antedate any arterial reconstruction in cases of severe peripheral vascular disease.
THE AMBIENT AIR, THE GOOD OF IT AND THE BAD OF IT: THE DEVELOPMENT OF THERAPEUTIC GASES AND AIR POLLUTION*
Authors: Barach Alvan L.
Published: April 2015

Abstract

The author outlines the history of the isolation of therapeutic gases from the ambient air, and also the industrial introduction of gases that pollute the air and menace the health of man. Both geriatric and middle‐aged patients with respiratory and cardiac disease have experienced exacerbation of symptoms and even death as a result of high concentrations of air pollutants.

Methods have been developed (e.g., alkaline sprays and air‐filtering units) for combatting emergency periods of air pollution in the home and hospital. Every physician should keep up to date in this regard. Thus unnecessary illness and death may be prevented while communities work out good over‐all programs on the basis of valid information.
PHYSICIANS AND LONG‐TERM CARE FACILITIES
Authors: Freeman Joseph T.
Published: April 2015

Abstract

The author discusses dilemmas confronting the physician in view of the rapidly expanding over‐65 population—particularly the matter of post‐hospital care. The older person usually has three options on leaving the general hospital: (a) return home to the family, (b) enter an extended care facility before returning home, or (c) enter a nursing home. Five important questions to be considered are: 1) the objectives of post‐hospital care of the aged; 2) where such services shall be rendered; 3) who shall render them; 4) who shall pay for them; and 5) the possibility of deterring the rate of senescence in the aging population. Seven proposals are made for improving the present post‐hospital program.
PREDICTIVE MEDICINE. VIII. FAMILIAL VERSUS GENETIC FACTORS
Authors: Cheraskin E. , Ringsdorf W. M.
Published: April 2015

Abstract

Though genetic factors influence health and disease, they are involved less often than supposed. Environmental factors possibly may be an “overlay” in genetic problems. There is reasonable evidence that the environment plays a role in diet, enzymes, the biochemical state, and the clinical picture. Supportive data are presented showing statistically significantly correlations in married couples (who seldom are genetically linked).

More emphasis should be placed on environmental factors in predictive medicine programs. Although it may be difficult to alter the environment, it is not as difficult as trying to alter the genetic state.
TREATMENT OF DIABETIC NEUROPATHY WITH CLOFIBRATE
Authors: Berenyi Magdalena R. , Straus Bernard , Miglietta Osvaldo E.
Published: April 2015

Abstract

Since angiopathy is an important factor in the pathogenesis of diabetic peripheral neuropathy, any drug which modifies lipid deposition in the peripheral vessels is of value in therapy. Therefore a double‐blind study was made of the lipid‐lowering agent, clofibrate (ethyl chlorophenoxyisobutyrate). Clofibrate (2 gm daily) was given to 9 patients with diabetie neuropathy, and a placebo to 6 such patients, during a 12‐month period. The diagnosis of neuropathy was confirmed by electromyography.

Seven of the 9 clofibrate patients improved clinically during the medication period, as judged by the disappearance of pain, paresthesia and numbness, by an increase in muscle strength, and by a return of deep tendon reflexes. Only 1 of the 6 placebo patients showed clinical improvement. Moreover, in 3 of the placebo group, peripheral vascular complications developed which resulted in gangrene and leg amputation. In none of the clofibrate patients did vascular complications develop during the same period. No untoward side effects were noted.

The concentration of serum lipids (cholesterol, total lipids, phospholipids and triglycerides) did not change significantly in either group. Changes of conduction velocity in the motor and sensory nerves were not significant in the clofibrate group, whereas there was a tendency toward deterioration in the placebo group.

The clinical improvement observed and the lack of major side effects with the dosage used warrant further study of clofibrate in the management of diabetic neuropathy.
MYELOID METAPLASIA IN A CASE OF ESTROGEN‐TREATED POLYCYTHEMIA VERA: ASSOCIATION WITH MYOCARDIAL INFARCTION
Authors: Wirth Lothar
Published: April 2015

Abstract

A 61‐year‐old man with myocardial infarction and myeloid metaplasia had had myocardial infarction and polycythemia vera eleven years earlier. Estrogen therapy had controlled the polycythemia but had not prevented myeloid metaplasia.
PREDICTIVE MEDICINE. V. LINEAR VERSUS CURVILINEAR FUNCTIONS
Authors: Cheraskin E. , Ringsdorf W. M.
Published: April 2015

Abstract

In predictive medicine it is essential to regard the relationship between biochemical and clinical patterns as a curvilinear (parabolic) function involving a trichotomous system rather than the traditional dichotomous system. The parabolic pattern is a function of age and also of the range of values chosen to describe “normo‐,” “hypo‐” and “hyper‐” for the biochemical measurement in question.
PREDICTIVE MEDICINE. VI. PHYSIOLOGIC VERSUS NORMAL VALUES
Authors: Cheraskin E. , Ringsdorf W. M.
Published: April 2015

Abstract

A technique is outlined for the establishment of physiologic ranges of blood glucose and serum cholesterol. Standards for health should be based upon observations in subjects who are relatively free of signs and symptoms. The results may call for reappraisal of some accepted physiologic values.
PRIMARY MEDICAL CARE—ITS PROVISION CAN BE MADE COMPETITIVELY ATTRACTIVE TO PHYSICIANS
Authors: Garrison Glen E.
Published: April 2015

Abstract

The greatest deficiency in health care in the United States is the inadequate supply of family‐oriented or front‐line medical care. In order to improve the attractiveness of front‐line medical practice, physicians who publicly make their major commitment to it should be assured access to appropriate facilities and to the services of an adequate volume and variety of assistants provided at public expense, as is now done for medical subspecialists. Family medicine programs should be established in medical schools to provide the greatly needed education and research in front‐line health care.

In the future the methods of financing health care should include mechanisms to provide special incentives to attract professional health‐care workers to dedicate their careers to solving the most serious deficiencies that may develop.
DEVELOPMENT OF A SCALE (GIES) FOR ASSESSMENT OF COGNITIVE AND PERCEPTUAL FUNCTIONING IN GERIATRIC PATIENTS
Authors: Plutchik Robert , Conte Hope , Lieberman Morris
Published: April 2015

Abstract

This study was concerned with the development of a brief, structured, testing procedure for evaluating the cognitive and perceptual functioning of geriatric patients. When male patients were compared with female patients, the males performed significantly better than the females. Older geriatric patients did more poorly on the test than did younger patients. For both males and females, the major decrease in cognitive functioning occurred between the decades of the 60's and the 70's. The test significantly discriminated between patients who showed relatively good social and physical functioning and those who showed relatively poor functioning when these areas were independently assessed. Analyses showed that most of the items significantly discriminated between a high‐scoring group and a low‐scoring group. Split‐half reliability of the test was +.93. The test appears to be a promising technique for assessing geriatric patients before and after various forms of therapy.
PROFESSIONAL WORKERS' ATTITUDES TOWARD THE AGED
Authors: Wolk Robert L. , Wolk Rochelle B.
Published: April 2015

Abstract

Answers to a questionnaire by 220 respondents were classified according to occupation (social service workers, psychologists, nurses), age of the respondents, and whether or not they were working with old people. The responses showed a greater number of positive attitudes toward the aged from the professional groups who chose to work with them—44 of the 220 respondents. Within this group, the older workers manifested still more positive attitudes than did the younger workers. Among those who did not choose to work with the aged, there was no difference regarding negative stereotypes between the younger and older respondents. Nurses were the most positive in their attitudes; significantly, their work involves physical contact rather than verbal communication.

Neither young nor older professional workers view the aged appropriately, although the younger ones are somewhat less negative in their attitudes. Older workers, threatened by their own advancing age, tend to overcompensate for their negative attitudes, especially in regard to intellectual functioning. In general, positive experiences create positive attitudes, and negative experiences negative attitudes.
BOOK REVIEW
Authors: Wright Irving S.
Published: April 2015

The Management of Geriatric Cardiovascular Disease, Raymond Harris, M.D., F.A.C.C., J. B. Lippincott Co., Philadelphia, 306 pgs., illustrated, 1970
AGING IN HIROSHIMA AND NAGASAKI ATOMIC BOMB SURVIVORS: ACCUMULATION OF CARDIAC LIPOFUSCIN
Authors: Anderson Robert E. , Yamamoto Tsutomu , Oshida Kenzo , Thorslund Todd
Published: April 2015

Abstract

This report concerns the amount of age‐dependent lipofuscin in the myocardium (left ventricle) as found at autopsy in a group of 54 persons who had been exposed proximally (1,400 meters from the hypocenter) to the Hiroshima and Nagasaki atomic bombs of 1945. The subjects were matched by sex and age‐decade of death with a similar number of subjects who were in neither city at the time of the explosions. The results failed to demonstrate an accelerated accumulation of pigment in the proximally exposed group. Although the difference was not statistically significant, the majority of the exposed group appeared to accumulate lipofuscin more slowly than did the nonexposed group. The possible implications are discussed.
MALE NURSING HOME PATIENTS: RELOCATION AND MORTALITY*
Authors: Ogren Evelyn H. , Linn Margaret W.
Published: April 2015

Abstract

The effect of transfer from one nursing home to another was studied in 82 male veterans over a four‐year period. Group T comprised 41 patients who were transferred from the initial nursing home to one or more other homes; Group NT (controls) comprised 41 patients who were not transferred from the initial nursing home. Disability and illness were assessed by specific rating scales, and the 32 nursing homes were evaluated by three social workers. There were no significant differences between the two groups of patients, although the NT group seemed more disorganized at the end of the study period. For the transferred group there was no increase in the mortality rate. Apparently the most important factor in good adjustment to a nursing home is the understanding of the patient's needs for assistance and service.
THE ORAL GLUCOSE TOLERANCE TEST IN ADULTS OF VARIOUS AGES
Authors: Tubbs Harry A. , Tubbs Joan E.
Published: April 2015

Abstract

If glucose intolerance or early maturity‐onset diabetes are to be detected, all adults, even if there is no family history of diabetes, should be tested. A study was made of 489 ambulatory, relatively “healthy” adult patients. They were screened for the detection of diabetes and decreased glucose tolerance, and 300 standard three‐hour oral glucose tolerance tests (OGTTs) were also performed. Urinary glucose determinations were made concomitantly.

Details of the analytical procedures are given. Standardized dietary preparation is stressed. Formulae for converting whole‐blood glucose values to plasma values are presented. The Wilkerson diagnostic criteria seem the most appropriate for general use.

From 5 to 15 per cent of the adults with normal OGTT values had significant glucosuria. The percentage incidences of glucose intolerance and of diabetes increased with age. Patients with 4‐plus glucosuria (quantitatively, at least 2 per cent) should be considered diabetic until proved otherwise, even though the glucose tolerance curve may be normal, since the height of the curve may be related to the low renal threshold. Adults with a significant degree of glucose intolerance need treatment, whether the intolerance be due to diabetes mellitus, or secondary to some other primary disease, or caused by certain therapeutic measures (e.g., surgery, drugs).
PROGERIA AND WERNER'S SYNDROME AS MODELS FOR THE STUDY OF NORMAL HUMAN AGING*
Authors: REICHEL WILLIAM , GARCIA‐BUNUEL RAFAEL , DILALLO JOSEPH
Published: April 2015

Abstract: Progeria and perhaps Werner's syndrome represent important models for the study of normal human aging. A case of progeria is presented. If a connective‐tissue disorder is the basis of progeria, this could account for the resemblance to human aging changes in skin, blood vessels and myocardium. An alternate hypothesis is that progeria is not merely a connective‐tissue disorder that resembles normal aging, but is aging prematurely expressed. A disorder in the normal genetic regulatory mechanism that controls the onset of aging could cause a progeric condition with the associated connective‐tissue changes and other aging changes prematurely seen. It is vital to determine which of these two mechanisms is the cause of this disease. Such an understanding may provide great insights into the normal biological mechanisms of development and aging.
EXTENDED CARE
Authors: LORENZE EDWARD J.
Published: April 2015

Abstract: This article presents some of the background experience and models which led to the development of the concept of Extended Care in Medicare legislation. This legislation is a landmark because, for the first time, sound financial support has been given in the area of after‐care of the general‐hospital patient. The aims of Extended Care as visualized under Medicare are excellent in themselves. However, problems arise in administration of the programs (e. g., in defining skilled nursing care) and in developing methods by which quality service can be given.

The area of health legislation that must be considered in the immediate future involves financial support and implementation of rehabilitation services beyond those provided by Extended Care at present. In addition, there should be programs for those who remain chronically ill and require institutional custodial care. Such patients are in a relatively stable condition after their allotted period in Extended Care with its rehabilitation services, but they have not improved enough to return home; at present, they are not eligible for future services under Extended Care. These are examples of major areas in which there is great need for improvement.
LITHIUM IN PSYCHIATRIC THERAPY
Authors: LERNER JOSEPH , SCHLOSSBERG ELIAS
Published: April 2015

Abstract: In a study of the use of lithium carbonate, 70 patients in a psychiatric hospital were treated. Of these, 43 were in the manic phase of manic‐depressive psychosis and 27 had other psychiatric disorders (chiefly schizophrenic). Of the 43 manic patients, 3 did not improve with lithium therapy, 20 improved, and 20 improved markedly. Of the 27 patients with other psychiatric disorders, 19 did not improve, 3 improved, and 5 improved markedly. Side effects were minimal. Lithium carbonate is effective treatment for patients in the manic phase of manic‐depressive psychosis, a disorder which causes a disproportionate amount of difficulty in psychiatric hospitals.
THERAPEUTIC VALUE OF ARTS AND CRAFTS IN A GERIATRIC HOSPITAL
Authors: FINKELSTEIN MILDRED , ROSENBERG G. , GRAUER H.
Published: April 2015

Abstract: The therapeutic value of arts and crafts in dealing with the chronically ill in a geriatric hospital is discussed. In the Arts and Crafts Department at Maimonides Hospital and Home for the Aged in Montreal, approximately 65 patients are offered a full range of activities and are provided with both physical and mental stimulus. Through such activities which cater to the needs of the elderly, a measure of self‐esteem, independence, productivity and socialization can be restored.
Glucose Tolerance in Various Age Groups of the Elderly
Authors: HEIKINHEIMO RAUNO
Published: April 2015

Fasting blood glucose concentrations and the values obtained two hours after administration of 50 gm of glucose were examined in 1500 patients admitted to the department for chronic diseases in a hospital in Finland. In females of the higher age groups, fasting blood glucose was more frequently over 100 mg per 100 ml than it was in age groups under 60. In males, no such phenomenon was observed. Two hours after the administration of glucose all the older age groups showed high blood glucose values much more often than did the younger age groups. In males, no additional tendency to increase with age was observed in the age brackets beyond 60–64 years. In females, on the contrary, elevated values became continuously more common as age increased. Diagnostic information obtained by the glucose tolerance test appears to be questionable in the case of elderly patients. Doubt is also thrown on the justifiability of the prediabetes concept by the very high frequency of diabetic‐type glucose tolerance curves in the oldest age groups.
The Biologic Clock: The Mitochondria?
Authors: HARMAN DENHAM
Published: April 2015

The author suggests that the maximal life span of a given mammalian species is largely an expression of genetic control over the rate of oxygen utilization. The latter determines the rate of accumulation of mitochondrial damage produced by free radical reactions, the rate increasing with the rate of oxygen consumption, which ultimately causes death.
Enzymatic Lysis in Vitro of Hyalin Deposits in Human Kidney
Authors: BJORKSTEN JOHAN , BLOODWORTH J. M. B. , BUETOW RALPH
Published: April 2015

Vascular hyalin was readily dissolved in vitro from sections of the formalin‐preserved, paraffin‐embedded kidney of a hypertensive patient, by means of an enzyme (BJ‐B‐66) isolated from Bac. cereus. The enzyme attacked other hyalins and tissue components as well. The enzyme is active at body temperature and pH, and appears substantially nontoxic to rats and hamsters.
Physical Diagnosis of Coronary Artery Disease and Its Sequelae*
Authors: CHENG TSUNG O.
Published: April 2015

Physical examination tends to be regarded negatively in the diagnosis of coronary artery disease (CAD). A resurgence of current interest in the physical diagnosis of CAD and its sequelae results from the availability of surgical techniques for their treatment and is made possible by a systemic clinical‐physiological‐angiographical correlative approach. An accentuated first sound (S1) in association with presystolic and diastolic gallops in the absence of congestive heart failure is highly suggestive of papillary muscle dysfunction (PMD) and/or ventricular aneurysm (VA), two of the most common sequelae of CAD. When S1 in VA is not accentuated, mural thrombosis should be suspected. The murmurs of PMD are much more common in CAD than generally believed and can be either ejection‐type, early systolic, midsystolic, pansystolic, or late systolic. A late systolic murmur (LSM) in CAD represents a mild form of PMD and may be distinguished from the murmur of the “auscultatory‐electrocardiographic” syndrome by its responses to amyl nitrite and the squatting position. Murmurs of PMD can be differentiated from other mitral regurgitant murmurs by their changing configurations, post‐extrasystolic diminution and inspiratory accentuation. Paradoxical splitting of the second sound in CAD is more an auscultatory illusion than an actual reversal of the sequence of closure of the aortic and pulmonic valves. Diastolic murmurs in CAD may be due to either VA or segmental coronary artery stenosis. It is concluded that physical examination gives valuable clues to the existence of CAD or its sequelae and to the functional status of the underlying myocardium. It constitutes the single most useful non‐invasive tool available to every physician.
To Remain Alive with Dignity: A Neurosurgical Viewpoint
Authors: RASKIND ROBERT , GLOVER M. B.
Published: April 2015

There is a tendency among some physicians to overlook the therapeutic possibilities in a patient with a past history of malignancy or incurable disease which ostensibly is the cause of the patient's present distress. This practice is often based upon the belief that the available treatment is too risky, dangerous, severely mutilating, or hopeless. Such an attitude stems from failure to obtain a well‐documented diagnosis and prognosis predicated on the many safe and relatively inexpensive procedures (surgical and nonsurgical) currently available to the physician. A group of case histories is presented in which one or more physicians rejected further investigation because no therapy was deemed justifiable. The diagnosis in each case was later found to be in error, as determined by additional clinical studies or postmortem examination.

In many cases of neurosurgical dysfunction, life may be prolonged — with dignity — by: 1) determining the accuracy of the original diagnosis, 2) confirming clinical impressions by one or more objective findings, 3) the liberal use of consultations, and 4) the continuing review of current modes of therapy.
Sociopsychological Obstacles to L‐Dopa Therapy That May Limit Effectiveness in Parkinsonism
Authors: HYMAN MARTIN D.
Published: April 2015

Chronic illness produces changes in patients' self‐conceptions and social relationships which may impair their level of functioning. L‐dopa therapy is particularly relevant to patients ill for some time with a disease believed by themselves and their associates to be chronic. In parkinsonian patients, therefore, the effect of L‐dopa on their level of functioning, as distinct from their symptoms, is likely to be inhibited by some of the social and psychological concomitants of chronic illness. The literature on these concomitants and on recovery from chronic illness indicates that functional recovery will be impeded if: 1) the patient considers himself to be impaired, devalued and stigmatized, and 2) his social environment is characterized by extreme social isolation or cohesion, a pessimistic prognosis on the part of others, or an illness‐induced family restructuring which the relatives are loath to reverse.
Rating Scales for Psychotropic Drug Research with Geriatric Patients. I. Behavior Ratings*
Authors: SALZMAN CARL , SHADER RICHARD I. , KOCHANSKY GERALD E. , CRONIN DENISE M.
Published: April 2015

Rating scales for the assessment of behavior in geriatric patients are reviewed in two categories: 1) specific, and 2) nonspecific for geriatric populations. The advantages of each are discussed. The choice must be left to the rater's judgment in view of his investigative requirements.
An Ergot Alkaloid Preparation (Hydergine) in Geriatric Therapy
Authors: ROUBICEK J. , GEIGER CH. , ABT K.
Published: April 2015

Clinical and electroencephalographic studies of an ergot alkaloid preparation (Hydergine) were made in nonpsychotic geriatric patients. In Study I (acute and subacute), 4 persons (average age, 68.5 years) were given 0.6 mg of Hydergine by injection daily for fifteen days. Apart from slight changes in affectivity and decreases in diastolic blood pressure, no significant effects were observed. In Study II (chronic), 22 pairs of patients (average age, 78.7 years) matched in sex, age and previous occupation received by mouth 4.5 mg of Hydergine or placebo daily for three months, according to a randomization schedule under double‐blind conditions. A series of psychological and psychopathological tests were conducted. Of 21 clinical and psychological variables, 13 showed a significant improvement with Hydergine, and 2 with placebo. Statistically significant improvements with Hydergine were noted for affectivity, psychomotor activity, and for global estimation of 18 items in a behavioural and psychological rating scale. The difference between the group with improved EEGs and the non‐improved group was significantly more favourable with Hydergine than with placebo (P < 0.001). The positive type of EEG changes and the geriatric EEG in general are discussed.