bluuebunny/crossref_metadata_2025 huggingface dataset:
Rehabilitation of the Geriatric Amputee*
Authors: STEINBERG FRANZ U. , GARCIA WILSON J. , ROETTGER RICHARD F. , SHELTON DOROTHY J.
Published: April 2015

ABSTRACT: During a five‐year period, 90 patients who had undergone lower‐extremity amputations when aged 60 or older were treated at the Amputee Clinic of the Jewish Hospital of St. Louis. Seventeen of the 90 were not fitted with prostheses because of various medical contraindications. Thirteen of the remaining 73 patients who were fitted with prostheses had died by the time of follow‐up, and 23 others could not be located. Of the 37 known survivors, 23 wore their prosthesis for more than six hours daily and used it as their main mode of locomotion; 14 used it only occasionally or not at all.

Sex and age at the time of amputation were of little value in predicting the success of prosthetic rehabilitation. Patients with below‐knee amputations fared much better than those with above‐knee amputations. Contraindications to fitting an aged amputee with a prosthesis are mental deterioration, congestive heart failure, severe angina pectoris, and advanced chronic obstructive pulmonary disease. Neurologic disorders such as parkinsonism or stroke with a significant neurologic residual are additional contraindications. Patients who have ulcerations or infections of the remaining extremity or who have severe contractures of the stump usually cannot be fitted with a prosthesis. The ability to use axillary crutches is not a realistic prerequisite for supplying an aged amputee with a prosthesis. A patient who has walked before the amputation and who afterward can walk with a walker, usually will be able to use an artificial limb. Amputees who cannot be expected to use a prosthesis can still be rehabilitated to an independent wheelchair existence.
Application of a New Technique (Closing Volume) for the Early Detection of Obstructive Lung Disease in the Elderly*
Authors: DEVINS GEORGE S. , GUNN WILLIAM S.
Published: April 2015

ABSTRACT: A new noninvasive technique (closing volume) for measuring early obstruction of the airways was studied in 47 geriatric patients, and pulmonary function was found to be abnormal in 39 (84 per cent). In 31 (66 per cent) of the 47 patients the conventional spirometric FEF25–75 method also indicated obstructive airway disease, but in an additional 8 (17 per cent) the closing volume technique indicated small airway obstruction undetectable by other tests. The closing volume method is more sensitive than previous methods and should be used as a routine part of pulmonary function screening. Obstruction of the small airways is more common in the elderly than is realized, and this technique would provide a means for early detection.
Hemophilus Influenzae Infectious Arthritis in an Adult: Cephalothin Therapy: Review of Previous Cases
Authors: DEE THOMAS H. , TUCKER ELIZABETH , RYTEL MICHAEL W.
Published: April 2015

ABSTRACT: A case of Hemophilus influenzae arthritis in a penicillin‐sensitive female adult was successfully treated with large dosages of cephalothin intravenously. Upon admission to the hospital the patient gave a history of an upper respiratory‐tract infection; her temperature was 104° F. Her right shoulder was hot and painful; aspiration produced about 12 ml of grossly purulent fluid. The sputum contained an abundance of pus cells and many Gram‐positive cocci. Improvement started within forty‐eight hours after starting cephalothin therapy, and the patient was afebrile after the fourteenth day. Cultures of the sputum, blood and joint fluid grew H. influenzae, found to be sensitive to several antibiotic drugs including cephalothin. There were no radiographic changes nor any demonstrable loss of function. A review of the 9 previously reported cases in adults is also presented.
Massive Thrombosis of the Coronary Sinus As an Unusual Complication of Transvenous Pacemaker Insertion in a Patient with Persistent Left, and No Right Superior Vena Cava
Authors: CHAITHIRAPHAN SUPHACHAI , GOLDBERG EMANUEL , WOLFF WILLIAM , JOOTAR PAYONK , GROSSMAN WILL
Published: April 2015

ABSTRACT: Persistent left superior vena cava associated with lack of a right superior vena cava constitutes a rare anomalous pathway of venous return to the heart; drainage is usually into the coronary sinus. The patients often are asymptomatic and the anomaly is detected only accidentally during catheterization of the right heart. The patient reported here (an 85‐year‐old man) had the foregoing abnormal form of venous return, which presented great difficulty when insertion of a transvenous pacemaker was attempted. Subsequently the patient died from bronchopneumonia, and postmortem examination revealed massive thrombosis of the coronary sinus. This may be the first report of such a complication of intravenous pacemaker implantation. Complete occlusion of the coronary sinus in this situation may prevent venous return from the upper part of the body. The literature is reviewed and recommendations are made for alternative management of this unusual problem.
Medical Planners and the Geriatric Imperative
Authors: Poe William D.
Published: April 2015

The health needs of old people demand a change in the attitudes of physicians and social planners. There is a great gap between complicated models for health care and the delivery of that care to the ill elderly. Physicians should have better training in geriatrics in better and more coordinated facilities. Home health services are important. However, it is essential to avoid false starts and to adhere to sound principles. This is the job of the planners rather than the prophets; it is the geriatric imperative.
Visual Hallucinations and Delirium During Treatment with Amantadine (Symmetrel)
Authors: Postma J. U. , Van Tilburg W.
Published: April 2015

In 13 elderly patients, 12 of whom had Parkinson's disease, visual hallucinations and delirium developed as a side effect of amantadine hydrochloride (Symmetrel) therapy. The symptoms promptly disappeared when amantadine was discontinued. Thereafter, each parkinsonian patient was treated satisfactorily with levo‐dopa. Treatment with a combination of amantadine and an anticholinergic agent increases the likelihood of delirium because of the hazard of retention of urine. Although amantadine is effective in the treatment of Parkinson's disease in the elderly, the incidence of delirium as a complication seems higher in this age group.
Some Differences Between Elderly People Who Use Community Resources and Those Who Do Not
Authors: Rosenzweig Norman
Published: April 2015

This study initially involved 120 subjects in four groups of 30 members each. It was designed to compare institutional aged persons (Jewish Home for the Aged, or JHAs) with ambulatory persons who used community resources (Jewish Community Center, JCCs). Controls were selected from a stratified sample in a community‐wide study of the Detroit Jewish population; half of the control subjects lived alone (LAs) and half lived with their families (LWFs); none of them used community resources. All 120 subjects were at least 60 years old. The female:male ratio was 71:49. They were asked to fill in a 442‐item questionnaire which yielded data about personal and family background, current status, attitudes, interests and self‐evaluation. The 30 JHAs were significantly older than the 30 JCCs, but otherwise there were few differences. Therefore the focus of the study was shifted to a comparison of the 30 JCCs, who used community facilities, with the 30 LAs and the 30 LWFs, who did not.

The JCCs were not well educated and were of low economic status. They obtained social gratification through group activities. They had many acquaintances but few close friends whose loss could be a threat. As a group, they seemed content. The LA and LWF groups were better educated, more successful financially, and more likely to derive personal satisfaction from their work. They formed closer family attachments and were more object‐oriented, so they were more vulnerable to loss of home and family. Setting high value on individual capacities, they were more likely to be threatened by illness. Any attempt to extend a helping hand to elderly citizens who do not avail themselves of community resources will have to take into account the prevalence of these distinctly different life styles.
A Survey of the Prescribing and Administration of Drugs in a Long‐Term Care Institution for the Elderly
Authors: Ingman Stanley R. , Lawson Ian R. , Pierpaoli Paul G. , Blake Paula
Published: April 2015

The prescription and administration of drugs (especially of the neuroactive class) was observed in 131 patients in an extended care facility. The average number of neuroactive drugs prescribed (2.1) was distinctly different from the average number administered (1.3) because of the large number of pro re nata (prn) prescriptions. More neuroactive substances were prescribed for patients with superior mentation and minimal physical disability; the difference between low and high groups was 1.7 (mentation) and 2.8 (physical status). The most common neuroactive drugs prescribed were: 1) analgesics, 2) major tranquilizers, and 3) hypnotics. Questionable prescribing practices were demonstrated by the fact that 30 patients had prescriptions for 38 “not‐recommended” drugs; 23 of these prescriptions were for propoxyphene compound. After requiring physicians to rewrite drug orders every thirty days, a survey made ten months later showed that there was a decline (0.8) in the number of drugs prescribed per patient and a slight increase (0.45) in the number of drugs administered.

Professional drug surveillance is crucial for improving the therapeutic process. At least two modifications of current prescribing practices are recommended: 1) a record should always be made of the precise condition(s) under which a drug prescribed “prn” is to be administered; and 2) a strong effort should be made to reduce the total number of drug prescriptions. The results of this survey suggest that certain procedural matters necessitating change are not in themselves the most substantive factors in improvement. Present “third party” review mechanisms likely will not ameliorate the current situation. It will be necessary to implement complex organizational changes in most extended care facilities.
Patent Ductus Arteriosus in Old Age
Authors: Syrkis I. , Machtey I. , Sagiv M.
Published: April 2015

An unusual case of patient ductus arteriosus (PDA) in a 78‐year‐old man is presented. The patient was known to have PDA since the age of 30, but it had remained well compensated until shortly before death. He had undergone some difficult operations successfully, and had no specific pulmonary complaints. Death at age 78 was caused by arteriosclerotic heart disease following myocardial infarction. Autopsy revealed a smooth patent ductus arteriosus with no perforation. The survival of a PDA patient to such advanced age is a comparatively rare occurrence.
Triiodothyronine Turnover in Hospitalized Psychogeriatric Patients†
Authors: Hontela S.
Published: April 2015

In a group of 12 hospitalized psychogeriatric patients, the fractional triiodothyronine (T3) turnover rate was significantly higher than in healthy control subjects of the same age, whereas the thyroxine (T4) turnover rate and other aspects of pituitary‐thyroid function were virtually similar in both groups. Despite the presence of manifestations of sympathetic overactivity or hypermetabolism, the patients did not have true hyperthyroidism, as verified by the laboratory findings and the results of antithyroid treatment. The increased T3 turnover in aged hospitalized patients with brain disorders may be a compensatory mechanism which develops under these particular circumstances in order to maintain neurohormonal homeostasis. An alternate possibility is that the increased T3 turnover is secondary to hyperkinesis.
Psychopharmacologic Investigations in Healthy Elderly Volunteers: Effects of Pipradrol‐Vitamin (Alertonic) Elixir and Placebo in Relation to Research Design†
Authors: Shader Richard I. , Harmatz Jerold S. , Kochansky Gerald E. , Cole Jonathan O.
Published: April 2015

Ninety‐nine healthy elderly volunteers were tested to assess the effects of: 1) a pipradrol‐vitamin (Alertonic) elixir, 2) a placebo, and 3) no treatment, during a one‐week period. The assessment measures were the Minnesota Multiphasic Personality Inventory Depression Scale, the Zung Depression Scale, Profile of Mood States, and the WAIS Digit Span. Alertonic had no significant effects on mood, memory or appetite, and the placebo effect was rarely greater than 50 per cent. There were no significant side effects. The findings demonstrate a valid method for studying psychotropic agents in the elderly.
Radical Mastectomy in the Aged Female†
Authors: Cortese Armand F. , Cornell George N.
Published: April 2015

Of 142 female patients over age 75 at The New York Hospital‐Cornell Medical Center, 58 underwent radical mastectomy and 40 simple mastectomy for primary breast cancer. After five years, 49 per cent of the radical mastectomy group were cancer‐free compared with 35 per cent of the simple mastectomy group. The gross five‐year survival rates were 50 per cent and 47 per cent respectively. In the radical mastectomy group, when the axillary nodes did not show cancer at the time of operation, there have been no known recurrences and 70 per cent of the patients have survived at least five years. There was no surgical mortality. These findings support the view that until more controlled data are available, radical mastectomy is still the preferred therapy for primary breast cancer.
Psychopharmacologic Investigations in Healthy Elderly Volunteers: MMPI Depression Scale†
Authors: Harmatz Jerold S. , Shader Richard I.
Published: April 2015

The Depression Scale of the Minnesota Multiphasic Personality Inventory (MMPI) was used as a screening test for healthy volunteers in a psychopharmacologic research study. Data were collected on 43 men and 46 women under age 35 versus 33 men and 43 women over age 65 (plus a subsequent group of 40 men over age 65), and comparisons were made with more extensive data from the Mayo Clinic. The evidence indicates that elderly subjects differ strikingly from young subjects in their responses to items in the MMPI self‐ratings of depression. Revised information on normative responses is needed. At present there are too many problems of interpretation when the Depression Scale items are applied to the elderly.
Autopsy Data and Their Total Evaluation†
Authors: Cherry W. H. , Forbes W. F.
Published: April 2015

The role of the autopsy is discussed in the study of the etiology of the current major causes of death (cardiovascular and neoplastic diseases) in developed countries. Evidence is accumulating for the importance of environmental factors in the etiology of these diseases. The study of regional differences in occurrence is described as a method of identifying specific factors. Maps are shown of mortality rates for all causes of death in Ontario counties for males aged 65–74 and 95+ during 1964–68. Some of the difficulties in obtaining data in this form, and in their analysis, are indicated. Regional mortality patterns can be interpreted by the use of associations with available regional socioeconomic measures, or by the use of regional data on trace‐metal levels in autopsy samples of human lung, rib, vertebra, kidney and liver. The methodology and the difficulties involved in the determination of trace‐metal levels in these tissues are discussed, as is the possible relevance of these levels to the study of degenerative diseases. All these considerations emphasize the valuable contributions of autopsy studies.
Collagenase in the Treatment of Dermal and Decubitus Ulcers
Authors: Rao D. B. , Sane P. G. , Georgiev E. L.
Published: April 2015

The current management of decubitus ulcers, factors in wound healing and the role of enzymes in treatment are discussed. The therapeutic benefits of collagenase (Santyl) ointment in 21 patients are described, supplemented by serial color photographs. Statistical evidence is provided for the conclusion that collagenase ointment is an excellent adjunct to therapy.
Surgical Mortality in the Elderly
Authors: Santos Antonio L. , Gelperin Abraham
Published: April 2015

Surgical mortality rates were reviewed for the four‐year period 1970–1973, in a series of 2,186 operations. The majority of these operations were performed in patients aged 70 or older; of these, 116 were performed in patients of the 90+ age group. Predictably, the surgical mortality in the older groups was higher than in the younger groups. However, the overall mortality for patients aged 70 or older was 4.9 per cent as compared with 8 to 21 per cent for series reported in the literature. Gastrointestinal, biliary, and chest procedures carried a much higher mortality than did the other major categories. Minor surgical operations in the elderly should be approached with caution since they may be associated with a significant mortality rate. Nevertheless, elderly patients should not be denied surgical intervention, major or minor, on the basis of age alone when the operation can make their remaining years more comfortable.
Behavioral Disorders in the Elderly
Authors: Sadowski Adam , Weinsaft Paul
Published: April 2015

Based on the study of 40 patients in a unit of a large geriatric center, as well as on long overall experience, the problems of aged men and women with various emotional disorders are discussed. Case abstracts are presented to illustrate chronic organic brain syndrome, delirium, hallucinatory behavior, paranoid ideation, depression, and reactions triggered by physical illness. The geriatrician should be fully aware of all the interlocking factors in the patient's adjustment to his condition. Only in this way can the geriatrician and staff choose the best relevant therapy.
Metastatic Hemangiopericytoma Associated with Microangiopathic Hemolytic Anemia: Review and Report of a Case
Authors: Kupers Edward C. , Friedman Nathan B. , Lee Stephen , Wolfstein Ralph S.
Published: April 2015

The hemangiopericytoma is an invasive tumor of vascular origin. No matter how benign the course and how circumscribed the mass, it must be considered a lesion with high malignant potential. In the case reported here, a hemangiopericytoma of the pancreas with metastasis to the liver was associated with microangiopathic hemolytic anemia in a 78‐year old woman. The anemia may have been present before the onset of metastasis. If so, it could have been a major factor in the breakdown of host response and could have initiated the malignant dissemination. Under these circumstances it could be an indicator of metastasis in patients with previously diagnosed tumors. However, there are many cases of metastatic malignancy associated with this anemia in which the opposite situation holds. The anemia is usually of extracorpuscular origin. Apparently intravascular coagulation caused by injury from tumor‐cell aggregates in small vessels induces erythrocyte fragmentation on fibrin strands. A vicious cycle of cell fragmentation, vascular injury and fibrin strand formation completes the course. Analysis of the findings should be based upon more than a strictly pathologic approach; it should also be related to the new discoveries in cancer research.
Membranous Nephropathy: An Overview
Authors: Salomon Mardoqueo I. , Hsu Konrad , Tchertkoff Victor
Published: April 2015

Membranous nephropathy (MN) accounts for about 20 percent of cases of the nephrotic syndrome. The importance of renal biopsy in establishing the diagnosis is emphasized. In the great majority of MN patients, no etiologic factor can be discerned. In a significant minority, MN appears to be a manifestation of sarcoidosis, diabetes, lupus, syphilis, malaria, or toxicity from heavy metals or drugs. In some cases the “cause” is neoplasia (including lymphoma) or a viral infection. Massive proteinuria, hypoproteinemia and edema are the principal manifestations of MN, finally resulting in renal failure. Treatment consists chiefly of diet and diuretic drugs. In the more pronounced cases, corticosteroids may have a favorable effect and in very resistant cases, cyclophosphamide is indicated. Judicious use of these modalities if often associated with the diminution or disappearance of the clinical signs of MN.
Craniopharyngioma in the Elderly Patient: Case Report
Authors: Schonder A. A.
Published: April 2015

A case is presented of craniopharyngioma in a 78‐year‐old woman. The symptoms and signs, except for those in the visual fields, were nonspecific. A review of the literature shows that this case history is representative of craniopharyngioma in the older adult. The findings in this elderly patient are contrasted with the signs and symptoms of craniopharyngioma in children.
A Geriatric Functional Rating Scale to Determine the Need for Institutional Care
Authors: Grauer H. , Birnbom F.
Published: April 2015

This study was carried out to validate a rating scale which could serve as a guide in determining the need for institutional care. The scale assesses the subject's physical and mental disability, balanced against his ability to function and the support available from relatives and community resources. Cut‐off points were tested by the use of an 18‐month follow‐up interval. Initially, 130 aged men and women from three different settings were rated. At the time of follow‐up eighteen months later, 83 per cent of the subjects who had obtained an initial score indicative of their inability to function in the community were either dead or in an institution. In contrast, 90 per cent of those who obtained an initial score indicating that they were able to continue in the community, were not in an institution at the time of follow‐up. The rating scale can be used not only to help decide the need for institutional care, but also to help determine the most suitable setting for the patient if placement is necessary.
Transitional‐Cell Cloacogenic Carcinoma of the Anal Canal: Case Report
Authors: Case Thomas C. , Gillooley John F.
Published: April 2015

A case is presented of transitional‐cell cloacogenic carcinoma of the anal canal in a 66‐year‐old woman. Eight years previously she had received radiation therapy for early carcinoma of the uterine cervix, but there was no evidence of recurrence. The rectal carcinoma was therefore regarded as a second primary malignant tumor. This point in differential diagnosis was considered important because of its bearing on the plan of treatment. After abdominoperineal resection of the tumor, the prognosis seemed favorable.
Amyloid in the Aged Heart: Frequency and Clinical Significance
Authors: Wright John R. , Calkins Evan
Published: April 2015

Cardiac amyloid accumulation is a common autopsy finding in elderly persons, the frequency increasing with each advancing age decade. In most cases the deposits are microscopic, confined to the atrial subendocardium, and of dubious significance. In a few cases, however, there is much more extensive cardiac involvement, with infiltration of the ventricular musculature and intracardiac conduction system. In the authors’ recent autopsy study of 100 patients over 60 years of age, 10 had diffuse cardiac amyloidosis with biventricular involvement. Microscopically, the amyloid deposits often resembled foci of interstitial fibrosis. Significant cardiac enlargement (weight > 380 gm) was present in only 2 of these patients, and in only one of them were the clinical signs and symptoms clearly attributable to the amyloid infiltration. It was difficult to assess the possible contribution of ventricular amyloid to congestive failure since most of the patients also had coronary arteriosclerosis.

In the aged, clinically significant cardiac amyloidosis associated with cardiac enlargement appears to be part of a disease spectrum more commonly characterized by focal, clinically insignificant cardiac amyloid deposits. Yet several features suggest that senile cardiac amyloidosis may differ from the clinically significant cardiac amyloidosis occasionally seen in younger patients.
Drug Therapy for Cardiovascular Disease in the Aged
Authors: Kennedy Robert D.
Published: April 2015

Cardiovascular diseases and their treatment in the aged are discussed under the headings of ischemic heart disease, hypertension, cardiac failure (with special reference to the use of diuretics and digoxin), infective carditis and thyroid disorders. Advanced age modifies the approach to treatment; the choice of drugs and the dosage must be adjusted accordingly. Possible drug interactions should also be considered. A rehabilitation program is of great benefit for many elderly cardiac patients. It should be planned individually and involve psychologic and environmental factors as well as medical therapy. After successful treatment of the acute episode, even the aged patient can undertake rewarding activities in his remaining lifetime.
Psychosomatic Rehabilitation of Elderly Persons
Authors: Hutterer Ilona , Dénes Zsuzsanna
Published: April 2015

The psychosomatic rehabilitation of the elderly is an important task from both social and economic viewpoints. For psychic rehabilitation, moderate activity and the playing of games (such as chess, dominoes or cards) are recommended. Based on experiences with a group of 50 persons of the 70–90 age group, bridge playing is an especially desirable form of recreation. For somatic rehabilitation, physical exercise is a valuable aid, based on experiences with 338 partially disabled patients of the 51–81+ age group.
A Psychogeriatric Assessment Program. III. Clinical and Experimental Psychologic Aspects*
Authors: KLINGNER A. , KACHANOFF R. , DASTOOR D. P. , WORENKLEIN A. , CHARLTON S. , GUTBRODT E. , MÜLLER H. F.
Published: April 2015

ABSTRACT: Variables stemming from standard psychologic tests, psychophysiologic tests, and operant conditioning procedures were employed in assessing the status of 80 psychogeriatric patients with either organic brain syndromes or functional psychoses. Differences were observed in the responses between the two groups. In general, the performance of the patients with organic brain syndromes was more deviant than that of the patients with functional psychoses, and the performance of the hospitalized geriatric patients (regardless of diagnosis) was worse than that of the normal control groups.
Incidence of Murmurs in the Aging Heart
Authors: PEREZ G. L. , JACOB M. , BHAT P. K. , RAO D. B. , LUISADA A. A.
Published: April 2015

ABSTRACT: One hundred patients aged 60 or older were studied clinically after excluding those with cardiac enlargement, definite valvular lesions or electrocardiographic (ECG) evidence of left ventricular hypertrophy. In 30 of the 100 patients a significant systolic murmur was heard on auscultation. Phonocardiograms (PCGs), mitral echograms and pulse tracings were obtained in 28 of these 30 patients (2 had died meanwhile), and the ECGs and chest roentgenograms were reviewed. In 23 PCG patients there was an early or midsystolic murmur, best recorded at the base of the heart and often transmitted to the apex. Mitral valve echograms and carotid and jugular pulse tracings were normal in all cases. Chest roentgenograms revealed aortic enlargement in 83 percent of the 23 patients. In the elderly with no evidence of organic heart disease, a basal systolic murmur is probably an aortic flow phenomenon caused by either moderate aortic dilatation or minimal fibrotic fusion of one or more commissures of the aortic valve.
Cyclandelate in the Treatment of Cerebral Arteriosclerosis*
Authors: HALL PETER
Published: April 2015

ABSTRACT: Twenty‐one patients with cerebral arteriosclerosis were treated for twelve months with placebo or cyclandelate (Cyclospasmol), 400 mg four times daily, in a double‐blind study with medication cross‐over after six months. The group included 8 men and 13 women, with a mean age of 69 years. Each patient showed at least 5 of 9 signs or symptoms adopted as “inclusion criteria” for the study. Concomitant psychotropic or other drug therapy was standardized or matched during the trial, and periodic assessments were made of the patients' behavioral, physical, neurologic and psychiatric status. No serious side effects were observed. There was no significant difference between the cyclandelate and placebo phases in measurements of physical state. Changes on the gross behavior scales were insufficient for analysis. Tests of memory, control of manual dexterity and comprehension of everyday situations showed statistically significant improvement during the cyclandelate phase. In contrast to placebo, no measurable intellectual decline occurred during cyclandelate therapy.
Clinical Implications of Left Ventricular Function in Patients with Acute Myocardial Infarction
Authors: PRAKASH RAVI , ARONOW WILBERT S.
Published: April 2015

ABSTRACT: Correlation of left ventricular filling pressure (55 patients) with the left ventricular stroke work index (61 patients) provided a rapid means of objectively determining ventricular performance after myocardial infarction. Pressure was monitored by means of the Swan‐Ganz balloon‐tipped catheter and thermal indicators were used for measuring cardiac output. A hemodynamic grouping of these myocardial infarction patients on the basis of the stroke work index showed close correlation with morbidity and mortality and provided a more accurate prognostic indicator than did the commonly used clinical predictors. Serial assessment of ventricular function further aided in defining the prognosis when it was not clear on admission. Thus, the levels of normal or abnormal ventricular function and the effect of therapeutic measures can be rapidly evaluated by determining the pressures and flows in patients with acute myocardial infarction.
Tolmetin Sodium, a New Anti‐Arthritis Drug: Double‐Blind and Long‐Term Studies
Authors: CORDREY LEE J.
Published: April 2015

ABSTRACT: The effectiveness of tolmetin sodium in the treatment of rheumatoid arthritis was evaluated by: 1) a 12‐week, double‐blind study with a dosage range of 800–1600 mg daily; and 2) an open 2‐year study with a dosage range of 400–2400 mg daily. The double‐blind study involved 14 patients (7 tolmetin sodium, 7 placebo), and the long‐term study involved 24 patients. At frequent intervals, evaluations were made of joint pain, swelling, stiffness and inflammation; grip strength; walking time; and subjective well‐being. Various laboratory tests were also performed. In the double‐blind study, tolmetin sodium proved superior to placebo and produced moderate improvement. In the long‐term study, 5 patients improved markedly, 14 moderately, and 3 minimally. Severe side effects were notably absent. Some mild side effects occurred but they were transient and did not interfere with therapy. Tolmetin sodium seems effective and safe in the management of rheumatoid arthritis.
A Complex Case of Sarcoidosis Fever
Authors: FRIEDMAN GEORGE
Published: April 2015

ABSTRACT: Febrile episodes in a male patient with coronary artery disease and arteriovenous malformation of the spinal cord had been attributed to urinary‐tract infections and pulmonary atelectasis. The autopsy findings, however, indicated that the fever may have been related to sarcoidosis which had not been detected pre mortem.
Femorotibial Bypass in the Elderly for Revascularization of the Severely Ischemic Lower Extremity*
Authors: REICHLE FREDERICK A. , RAO NARASIMHA , TYSON R. ROBERT , SHUMAN CHARLES
Published: April 2015

ABSTRACT: In the elderly, revascularization of a severely ischemic lower extremity with occlusion of both femoral and popliteal arteries often can be achieved by surgical construction of a distal bypass to the tibial or peroneal arteries. An aggressive diagnostic and therapeutic approach is necessary, in an attempt to prevent recourse to primary amputation. Femoroperoneal or femorotibial bypass can be performed safely and is recommended in elderly patients with advanced ischemia of a lower extremity with absolute indications for surgical intervention, e.g., gangrene, gangrenous ulceration or rest pain. A significant number of limbs can be salvaged by this method. Although the mortality rate in the older age groups is predictably higher, the overall rate for this operation compares favorably with that for primary amputation.
An Ergot Alkaloid Preparation (Hydergine) in the Treatment of Dementia: Critical Review of the Clinical Literature
Authors: HUGHES JOHN R. , WILLIAMS JAMES G. , CURRIER ROBERT D.
Published: April 2015

ABSTRACT: A critical review is presented of 12 clinical trials with Hydergine (a hydrogenated ergot alkaloid preparation) in the treatment of dementia. Qualitative and quantitative comparisons of improvement in symptoms showed that Hydergine consistently produced statistically significant (p ≤ 0.05) improvement in 13 symptoms associated with dementia. However, because of the small magnitude of the improvement and the absence of indications of long‐term benefit, Hydergine would seem to be of minor value in dementia therapy. Further research with better methodology and design might lead to a different conclusion.
Behavioral Change in the Chronicity Pattern of Dementia in the Institutional Geriatric Resident*
Authors: KATZ MELVYN M.
Published: April 2015

ABSTRACT: To determine whether behavioral change as a result of environmental stimulation can be reported in individualized terms for the aged with organic brain syndrome or senile dementia, a program of multimodal group interactive therapy was started in an extended care facility. During a 1.5‐year period, the study included 108 residents, whose average age was 84 years. The technique used was a combination of modified Reality Orientation, Remotivation, Activity and Milieu therapies. Thirteen groups residing in different wings of the facility were treated for 55 sessions by 11 activity specialists and 2 elderly volunteers under the supervision of the consulting clinical psychologist. Data were collected on emerging behavioral changes with respect to awareness, attention, verbalized ideation, voice quality, speech quantity, sociability, self‐care, quality of affect, energy level, expressed somatic concern and physical movement. Of the initial 108 residents, 80 had chronic brain syndrome of varying severity or senile dementia. During treatment, 35 of these 80 residents (44 percent) were improved, 17 (20 percent) were unchanged, 14 (18 percent) became worse, and 14 (18 percent) remained unrated. The results warrant a redefinition of the psychotherapeutic approach. It should include factors other than the severity and chronicity of disease in determining the prognosis for behavioral change in geriatric institutional residents.
Observations on the Natural History of Atherogenesis
Authors: ELKELES ARTHUR
Published: April 2015

ABSTRACT: Longstanding scoliosis of the lumbar spine with convexity to the left leads to severe atherosclerosis in the adjacent segment of the abdominal aorta. By contrast, the lateral wall of the ascending aorta, which is free to pulsate, usually is not affected even in very old persons. This relative immunity, however, is not maintained in cases of syphilitic mesaortitis; damage to the elastic tissues of the media leads to atherosclerosis. Man is the only mammal known to be highly susceptible to severe atherosclerosis. The concept is advanced that the erect posture of man, which leads to the physiologic anterior curvature of the lumbar spine, predisposes to atheroma formation in the abdominal aorta, particularly in women. Evidence for the osteoporosis‐atherosclerosis concept is presented. Sustained muscular activity starting early in life can delay osteoporosis and atherosclerosis. A possible mechanism for the onset and gradual progression of physiologic osteoporosis is suggested. The concept of atherogenesis advanced here is based on observations which suggest a correlation of aging processes in the mesenchymal tissues. These aging processes, in conjunction with mechanical factors partly caused by the erect posture, may account for the unique susceptibility of man to severe atherosclerosis.
Initial Adjustment to a Long‐Term Care Institution: Medical and Behavioral Aspects
Authors: RODSTEIN MANUEL , SAVITSKY ELIAS , STARKMAN ROSALIND
Published: April 2015

ABSTRACT: One hundred elderly persons consecutively admitted to the Jewish Home and Hospital for Aged were studied during the first month after admission. Medical changes (chiefly cardiovascular) and behavioral changes were analyzed independently and then correlated. Four subgroups were found: 1) smooth adjustment and no significant medical changes (33 subjects); 2) smooth adjustment with significant medical changes (17 subjects); 3) severe adjustment problems but no significant medical changes (31 subjects); and 4) severe adjustment problems with significant medical changes (19 subjects). The aged persons most likely to have initial adjustment difficulties usually had poor capacity for interpersonal relationships, were socially isolated, were either single or divorced, had a dependent personality, had severe chronic brain syndrome, had a negative or ambivalent attitude toward admission, and often had been referred for psychiatric evaluation before admission. Major patterns of reaction were anxiety, aggressiveness and depression. Significant medical changes were more likely to develop in those with previous poor health who manifested an advanced state of confusion and depressive trends. Depression was related to concomitant medical changes rather than to the previous health status; it exacerbated the reaction to medical illness, which resulted in a decline in the level of functioning. In 58 per cent of the 50 patients with initial adjustment difficulties, a satisfactory level of adaptation was reached during the first six months after admission.
Nocturnal Neurosis of the Elderly: Failure of Agencies to Cope with the Problem
Authors: COHEN CARL I.
Published: April 2015

ABSTRACT: About half of the elderly seen in medical consultations in several midtown Manhattan facilities have “nocturnal neurosis.” This syndrome is characterized by a mixed neurosis with a pronounced nocturnal increase in the severity of symptoms, occurring in recently isolated persons. Apparently, failure of the neighborhood social network to function during the evening hours largely accounts for the problem. Few centers provide nighttime activities. A proliferation of evening programs might significantly reduce the prevalence of nocturnal neurosis in the elderly.
Polymyalgia Rheumatica
Authors: McCABE EDWARD S.
Published: April 2015

ABSTRACT: Polymyalgia rheumatica should be considered when a syndrome of constitutional symptoms, especially weight loss, low‐grade fever, weakness, wasting proximal muscles, fatigue, malaise and depression, is seen in the elderly. Giant‐cell arteritis plays a part later in the course. Thus the need for biopsy of a long segment of the temporal artery to help in determining diagnosis and therapy. An elevated erythrocyte sedimentation rate (ESR) is an important clue. The usual high value is about 80 mm/hour; if it is over 100 mm/hour, giant‐cell arteritis should be suspected. Salicylates, indomethacin, phenylbutazone and hydroxychloroquine produce some clinical improvement but do not lower the high ESR; moreover, the patients are prone to experience relapses. Prednisone, however, not only produces clinical improvement but lowers the high ESR. Potassium p‐aminobenzoate may be useful in maintaining the remission.
The Medical Director in an Extended Care Facility
Authors: FONROSE HAROLD A.
Published: April 2015

ABSTRACT: The growth of the aged population has increased the need for Extended Care Facilities. The role of the Medical Director in these institutions is extremely important in developing the needed programs and in formulating policies to insure that medical care is maintained at a high‐quality level.
Autoimmune Disease: The Consequence of Deficient T‐Cell Function?*
Authors: KAY MARGUERITE M. B.
Published: April 2015

ABSTRACT: The age‐related decrease in T‐lymphocyte function is discussed in relation to the onset of autoimmune disease. It is postulated that the decrease in T‐cell “immune surveillance” permits: a) the ingress of viruses whose enzymes modify host glycoproteins and render them immunogenic, and b) the replication of viruses incorporated into the genome of cells during infections in early life. The existence of immunodeficiencies too subtle to be detected by our present laboratory methods is postulated and discussed in relation to diseases observed in geriatric patients. It would seem that the prevention of some geriatric diseases should begin in the pediatrician's office.
The Right (?) to Know*
Authors: LYGHT CHARLES E.
Published: April 2015

ABSTRACT: No author whose paper has been rejected has need to feel chastened, sad, or dejected; but neither should he, since his text ran lame, seek others with whom to share the blame. Folks who review and persons who edit scarcely deserve a minus credit; their thoughtful counsel perhaps can assist in bringing changes otherwise missed. A willingly swallowed sound suggestion seldom results in indigestion. The aim to improve is certainly twice as vital as knowing who gave the advice. Instead of requiring identity, a far better plan, it seems to me, is for all concerned now to agree that no one need shoot the referee!
Pharmacokinetic Approach to Drug Dosing in the Aged
Authors: RITSCHEL W. A.
Published: April 2015

ABSTRACT: Data in the literature show that there is a constant ratio of total body fluid to lean cell mass with increasing age (1.15 for males and 1.31 for females). Since the drug receptors usually are found in the tissues, and since cell mass and total body fluid apparently decrease at a constant rate, it would seem that the volume of distribution of drugs decreases proportionally with increasing age. Kidney function, as measured by the glomerular filtration rate and transport maximum, apparently decreases with increasing age according to zero‐order kinetics. Based on these data, correction factors were established for the change in volume of distribution and renal functions with increasing age. Equations were derived for calculating the loading dose and maintenance dosage of drugs in multiple‐dose therapy in females and males. Equations are presented for drugs following the minimal inhibitory concentration (MIC) pattern and the log dose‐response pattern, respectively. The MIC pattern is recommended in the use of bacteriostatic drugs, for which it is essential to maintain during the entire course of therapy a minimum inhibitory concentration. The log dose‐response pattern is recommended for bactericidal and antiarrhythmia drugs, for which it is essential to obtain an average therapeutic steady‐state concentration. Based on this pharmacokinetic approach, it would seem that elderly patients, during multiple‐dose therapy, are exposed to dose sizes that are too large if no correction is made.
A Mobile, Mental‐Hospital‐Based Team for Geropsychiatric Service in the Community
Authors: SHERR VIRGINIA T. , ESKRIDGE O. CARL , LEWIS SANDY
Published: April 2015

ABSTRACT: At Norristown State Hospital a mobile Team of workers was organized to give personalized and preventive psychiatric, medical and social attention to distressed elderly people within the communities served by this large psychiatric institution. The Team's mobility permitted flexible approaches to problem‐solving at the person's own home or other place of residence. Over its 8.5 years of existence the Team evaluated 1,438 elderly persons and acted in a consultant capacity to 77 nursing or retirement homes. Most of these clients were treated successfully within the community; only 222 required admission to the parent hospital during that time. Those treated in their own homes usually were able to maintain or improve the quality of their lives. The timely psychiatric, medical and social help often uncovered physical and social factors that previously had been overlooked.
Postmortem Study of a Case of Werner's Syndrome
Authors: TOKUNAGA MASAYUKI , MORI SHIGERU , SATO KOZO , NAKAMURA KATSUHIRO , WAKAMATSU EIKICHI
Published: April 2015

ABSTRACT: The postmortem study of a classic case of Werner's syndrome is presented. The subject was a Japanese man who died at the age of 39. Major findings included general microsplanchnia, extreme atrophy of the testes and skin, calcified aortic atherosclerosis, an increase of basophils in the pituitary, aspiration pneumonia, chronic pyelonephritis and a meningioma in the occipital area of the brain. Histologically, no osteoporosis was evident in the lumbar spine and iliac bone. The findings suggest that in Werner's syndrome the dominant pathologic factor may be found in connective tissue other than bone.
Tachyarrhythmias in Old Age
Authors: VAIDYA P. N. , BHOSLEY P. N. , RAO D. B. , LUISADA A. A.
Published: April 2015

ABSTRACT: The electrocardiograms of 1,171 patients above the age of 65 in a predominantly geriatric institution were reviewed to determine the incidence of tachyarrhythmias. Data on the overall incidence and the individual types of arrhythmias are presented. Atrial fibrillation was the most common arrhythmia observed, followed by atrial flutter and supraventricular tachycardia. Atrial fibrillation often was associated with other evidence of myocardial damage. The significance of sinus bradycardia and grade I A‐V block in the pathogenesis of atrial fibrillation and the significance of the tachyarrhythmias are discussed.
Elderly Applicants to Long‐Term Care Institutions. L Their Characteristics, Health Problems and State of Mind*
Authors: KRAUS A. S. , SPASOFF R. A. , BEATTIE E. J. , HOLDEN D. E. W. , LAWSON J. S. , RODENBURG M. , WOODCOCK G. M.
Published: April 2015

ABSTRACT: As part of a study of long‐term institutional care of the elderly, this report presents a comparison of the characteristics, health problems, and state of mind of 193 elderly applicants for such care (Group A) with those of 141 elderly persons living independently in the community (Group I). Group A members were older, living with a spouse less often, and had low incomes. They showed much more cerebrovascular disease, incontinence, recent loss of independence in the activities of daily living, dementia, recent hospitalization, loneliness, and depression. They had had much less recent involvement in social and recreational activities, although most had not been socially isolated. They had received more extensive help from relatives and friends, and it seemed unlikely that additional help from these sources would keep many more of these elderly persons out of institutions. Community agencies and services had been used by a relatively low proportion of Group A, and hardly at all by Group I.
Estrogen‐Androgen Levels in Aging Men and Women: Therapeutic Considerations*
Authors: GREENBLATT ROBERT B. , OETTINGER MOSHE , BOHLER CLORINDA S.‐S.
Published: April 2015

ABSTRACT: The influence of aging on serum levels of gonadotropins (FSH and LH), testosterone and estradiol was studied in the following groups: 4 normal men (ages 30 to 50), 38 men with symptoms of the male climacteric (ages 51 to 84), 25 men with relative impotence (ages 31 to 50), 10 normal women (ages 24 to 31), and 6 menopausal women (ages 58 to 76). FSH and LH levels began to rise in men in their 40's, and the increase became more conspicuous in the later age decades. The degree of elevation was nowhere comparable to that observed in the aging women. In the male, the serum testosterone levels showed a progressive decrease from the fifth age decade onward, whereas in the female there was an increase after the menopause. Estradiol levels showed no significant change in the aged male, but they were somewhat higher than in the aged female. Exceptions to the low‐testosterone and low‐gonadotropin relationship were observed in individual cases and might be explained by relatively high estradiol values. Proper replacement therapy by means of estrogens for the postmenopausal female and androgens for the aging male is often of great benefit, physically and emotionally.