bluuebunny/crossref_metadata_2025 huggingface dataset:
PROBLEMS IN ACUTE PANCREATITIS
Authors: KalliomÄKi J. L. , Antila L. E.
Published: April 2015

Abstract

The overall mortality in a series of 132 hospitalized patients (43 men and 89 women) with acute pancreatitis was 28 per cent; for patients younger than 60 it was 9.1 per cent, and for those older than 60 it was 41.6 per cent. The typical case with a fatal ending was represented by the aged patient with several diseases, especially heart disease, for whom pancreatitis was a catastrophic stress. Fifty‐one per cent of the deaths occurred during the first twenty‐four hours after the hospital admission. In one‐third of the cases, the pain differed from the usual pain of pancreatic disease; in 18 per cent it simulated pain from cardiac infarction; and in 9 per cent there was no pain. The gall bladder was definitely pathological in 48 per cent of the patients; 18 per cent had undergone subtotal gastrectomy for gastric ulcers; 4.5 per cent had active ulcers; and 9 per cent had diabetes. Palpation findings were negative in 13 per cent. Half of the serum transaminase (SGOT) values and nearly half of the alkaline phosphatase values were elevated. In 38 per cent of the cases, icterus was present in some phase of the disease. Nasogastric intubation was used for treatment in 13.6 per cent of the cases, and enzyme inhibition by trypsinkallikrein inactivator was attempted in about 30 per cent. For mild pancreatitis, several therapeutic methods give beneficial results. However, necrotic pancreatitis with a violent course usually leads rapidly to death, despite treatment.
CARDIAC DIAGNOSIS AND DECISION‐MAKING IN A HOSPITAL EMERGENCY ROOM
Authors: Desser Kenneth B. , Goldberg Emanuel
Published: April 2015

Abstract

The emergency room records of 140 patients with cardiac complaints were reviewed. The average age was 60 years. Chest pain was the most common symptom and a majority of patients with this complaint expressed fear of an acute coronary episode. Of 41 cases admitted with the initial diagnosis of myocardial infarction, only 21 had that diagnosis at the end of two weeks. Of 91 patients sent home from the emergency room, 83 were alive and well at the end of six weeks. A single patient died of acute myocardial infarction ten days after leaving the emergency room. No patient was averse to admission, and in 10 instances patients came to the emergency room equipped with personal items indicating anticipation of admission. Such studies are feasible and may elucidate further the role of the emergency room in the early care of the “coronary suspect.”
SYMPTOMATIC ATHEROSCLEROSIS: PREVENTION OR MODIFICATION BY TREATMENT WITH DESICCATED THYROID*
Authors: Wren James C.
Published: April 2015

Abstract

To determine the possible effects of thyroid therapy on the course of atherosclerosis, 347 patients (173 males and 174 females) were selected for a five‐year study. The atherosclerosis was symptomatic in 132 patients (mean age, 64.5 years), and asymptomatic in 215 (mean age, 54.7). The asymptomatic patients were considered high risks, however, because of the presence of one or more of the following: nonspecific ECG abnormality, arterial hypertension, diabetes, or hypercholesterolemia. Of the total group, approximately 9 per cent (31 of 347) were hypothyroid by laboratory tests; the remainder were euthyroid.

All patients were treated with desiccated thyroid in physiological dosage. Substantial clinical improvement was measurable in a significant number of patients in both groups. The mean serum level of total cholesterol was reduced by 22.2 per cent. A more favorable ECG pattern was observed in 14 per cent. Cardiovascular morbidity was less than predicted. Eleven deaths (mean age of patients, 75) occurred during the study; in 10 of these cases there had been one or more symptomatic episodes of atherosclerosis before treatment. The mortality rate was 58 per cent of the expected rate for a matching population as drawn from New Jersey Life Tables, and 44 per cent of the expected rate as drawn from U. S. Life Tables. Thyroid therapy deserves a more extensive trial as a possible means of modifying or preventing the effects of atherosclerosis.
AGE AND THE KINETICS OF RESPONSE TO SUGARS AND INSULIN*
Authors: CALLOWAY N. O. , KUJAK RICHARD
Published: April 2015

Abstract:

The utilization of glucose, glucose + insulin, insulin, fructose, galactose and ribose (after intravenous injection) was studied in healthy subjects—6 of each age group (approximately 20, 40 and 80 years) in each of the 6 phases of the study.

We confirmed that glucose is not used as well by the elderly as by the young. When glucose and insulin were given together, however, there was little variance with age. When insulin was given alone, there was no age difference regarding the rates of fall in the blood sugar level, but in the older subjects there was a slight slowing of the rate of recovery from the hypoglycemia. Fructose metabolism showed a slight variation with age; the older persons were not able to utilize fructose as rapidly as the younger persons. The same situation applied to galactose. Ribose utilization, however, was not affected by the age of the subject.
REPORT ON THE UNIVERSITY OF MICHIGAN TWENTY‐THIRD CONFERENCE ON AGING*
Authors: ROSS C. HOWARD
Published: April 2015

Abstract:

The 23rd Annual Conference on Aging, held at the University of Michigan, Ann Arbor, August 12–14, 1970, is reviewed. A general theme was developed for the role of the elderly in the 1970 decade. Plans were presented for the White House Conference in 1971. Social Security, Medicare, and Medicaid—past, present and future—were expounded. Historical tributes were paid to social legislation and its architects. The subject of Health and Security for the Aged pervaded all sessions and workshops. Nationally recognized leaders provided the inspired faculty.
FAMILY CARE AS A USEFUL ALTERNATIVE TO THE LONG‐TERM HOSPITAL CONFINEMENT OF GEROPSYCHIATRIC PATIENTS
Authors: RISDORFER EMMERICH N. , PRIMANIS GEORGE , DOZORETZ LOUIS
Published: April 2015

Abstract:

The present philosophy in the treatment of mental patients tends to bring the problem back to the community. In such a rehabilitative program, the Binghamton State Hospital is using supervised family‐care homes as a successful alternative to the long‐term hospital confinement of homeless geropsy‐chiatric patients.

Within the administration of Binghamton State Hospital, there are 60 family‐care homes for 390 patients, of whom about one third are over 65 years of age. In some homes there are mixed populations with respect to both age and sex. In October 1969 there were 77 geriatric females and 36 geriatric males under family care. The average age was 69 for the females and 71 for the males. The average length of hospital stay before placement in family care was nine years and ten months. The average duration of residence in a family‐care home up to October 1969 was four years and four months. The homes are selected by the State Hospital Administration and are supervised by various teams of the unitized Broome County Unit. A team consists of a physician, a social worker, nurses, attendants, an occupational therapist and a recreational therapist. It instructs the family‐care “mother” and the patient about the various methods for resocialization, takes care of medical and psychiatric supervision, and makes arrangements for eventual working activities.

Placement in a family‐care home has three practical results: 1) elderly psychiatric patients are returned to the community without being under the stress of having to manage their own daily problems; 2) in the hospital there is better utilization of the beds for patients who require residential treatment programs; and 3) family care is more economical for the hospital and, consequently, for society.
ARETAEUS ON DISEASE IN OLD AGE
Authors: Howell Trevor H.
Published: April 2015

Aretaeus the Cappadocian was one of the great physicians of antiquity. Excerpts are quoted from his descriptions of various acute and chronic diseases, especially in relation to old age. Two of his aphorisms are particularly pertinent: 1) “One must be fertile in expedients and not be satisfied to apply his mind entirely to the writings of others.” 2) “It is impossible to make all the sick well … but the physician can secure respite from pain, intervals in disease, and can render disease latent.”
PREDICTORS OF SURVIVAL IN GERIATRIC MENTAL ILLNESS DURING THE ELEVEN YEARS AFTER INITIAL HOSPITAL ADMISSION*
Authors: Epstein Leon J. , Robinson Betsy C. , Simon Alexander
Published: April 2015

In 1959, a study was made of 534 patients aged 60 or older admitted to the psychiatric observation ward of the San Francisco General Hospital. In a two‐year follow‐up period it was found that orientation, performance on the Wechsler Adult Intelligence Scale, and ability for physical and social self‐maintenance were favorable prognostic signs.

In 1970, data were available on 463 of the original sample, and unavailable on 71 (not included in this report). The proportion of survivors (which had been 67 per cent at one year) decreased steadily to 6 per cent at eleven years. The variables that were related to prognosis two years after admission continued to be the only significant predictors of survival; no new factors were established. The same trend was observed in a non‐hospital community sample of subjects. However, mortality was far greater in the hospital sample.
IMPORTANCE OF EARLY SURGERY IN BILIARY‐TRACT DISEASE
Authors: Case Thomas C.
Published: April 2015

Three case reports are presented on patients (ages, 71, 90 and 91) with long‐standing biliary disease who were successfully treated by surgery. However, the hazards and complications described might have been avoided if surgery had been undertaken earlier in life when the patients were in better physical condition to withstand the stress.
SPEECH REHABILITATION FOR THE GERIATRIC PATIENT
Authors: Buckman Gerald F.
Published: April 2015

More attention should be paid to communication disorders in the geriatric population. Appropriate areas of referral to speech and hearing pathologists include aphasia and apraxia (so common after stroke), various dysarthrias (e.g., in parkinsonism), the requirements for esophageal artificial speech after laryngectomy, and presbycusis. Interdisciplinary cooperation will lead to complete rehabilitation services for all patients.
PREDICTIVE MEDICINE. XI. PROGNOSTIC LEVELS
Authors: Cheraskin E. , Ringsdorf W. M.
Published: April 2015

With a lamelleted sphere as a model, an analysis of the periphery of the human subject (symptoms and signs) is useful in providing a measure of the extent of disease. However, in itself, it has little utility in a predictive medicine program. In present multiple‐testing methods, correlation of the biochemical state with the symptoms and signs is the basis for making a diagnosis of classical disease. However, the predictive potential is limited. A predictive medicine program, to fulfill its true purpose, must view the total sphere in all its layers.
IMPROVED SURVIVAL OF BURNED AGED PATIENTS TREATED WITH 0.5% SILVER NITRATE
Authors: Hartford C. E. , Ziffren S. E.
Published: April 2015

Abstract

A review is presented of the data on aged patients with thermal burns involving more than 10 per cent of the body surface, treated at the University of Iowa Hospitals during the five‐year period 1965–1969. Thirty‐two patients, 60 years of age or older, were treated exclusively with 0.5% silver nitrate solution as the topical antibacterial agent. The result was a statistically significant lowering of the mortality rate to 10 per cent among the patients with burns involving less than 30 per cent of the body surface.
AGE‐DEPENDENT BONE LOSS AFTER GASTRECTOMY
Authors: Fujita Takuo , Okuyama Yamaji , Handa Noboru , Orimo Hajime , Ohata Masahiro , Yoshikawa Masaki , Akiyama Hiroshi , Kogure Takashi
Published: April 2015

Abstract

Clavicular cortical thickness measured in postero‐anterior chest roentgenograms was decreased in 53 patients after gastrectomy as compared with 447 males and 277 females in apparent health and 122 males and 109 females with peptic ulcer not surgically treated. This decline in clavicular cortical thickness became more pronounced as years elapsed after gastrectomy. Gastrectomy appeared to have accelerated the age‐dependent bone loss, possibly through interfering with calcium absorption and other nutritional intake.
THE GERIATRIC PATIENT: AGE‐DEPENDENT PHYSIOLOGIC AND PATHOLOGIC CHANGES
Authors: Lamy Peter P. , Kitler Mary Ellen
Published: April 2015

Abstract

Age‐dependent physiologic and pathologic changes are discussed under the categories of the soft tissues, the cardiovascular, digestive, respiratory, skeletal and nervous systems, the genito‐urinary tract, the senses, speech, hearing, visual function, and the nutritional state.
FOOT PROBLEMS IN THE ELDERLY PATIENT
Authors: Hsu John D.
Published: April 2015

Abstract

A study was made of the foot problems of 426 elderly patients in the Foot Clinic of Baltimore City Hospitals. The disorders causing foot pain and disability were: circulatory (31 per cent), structural (21 per cent), nail and skin problems (36 per cent), neurogenic (8 per cent), and miscellaneous (4 per cent). Illustrative cases are discussed.

The health of the feet is an important factor in the maintenance of the elderly patient's mobility and independence. Early recognition of foot lesions is essential in achieving this goal. In the early stages, simple therapeutic measures (foot hygiene and wearing proper shoes) often provide great relief and prevent further deterioration.
FEMORAL ARTERY COMPRESSION (THE ADDUCTOR‐CANAL SYNDROME): SURGICAL TREATMENT
Authors: Pratt Gerald H.
Published: April 2015

Abstract

Muscular compression is an important precipitating factor in adductor‐canal occlusion of the femoral artery. The choice of surgical procedure depends upon the condition of the “run‐off” and collateral circulation. To the previous technic (preliminary sympathectomy, then a by‐pass or an endarterectomy plus a patch graft) the author had added periarterial sympathectomy and complete division of the adductor‐canal fascia and muscles, to relieve compression. Of more than 100 patients so treated, two‐thirds were over 65 years old. The good results make this an operation of choice compared to the “close up and do nothing procedure” in patients with impaired “run‐off” circulation.
THE CORONARY CARE UNIT AND MORTALITY FROM MYOCARDIAL INFARCTION: A CONTINUED EVALUATION
Authors: Fagin I. Donald , Anandiah K. M.
Published: April 2015

Abstract

To evaluate the influence of a coronary care unit (CCU) on mortality from myocardial infarction, a retrospective analysis of the data on 977 patients who had 1,014 episodes of infarction is presented. Comparisons of data for the year before establishment of the CCU with the data for the first year and the third year of CCU operation did not reveal any significant improvement in over‐all hospital mortality figures. However, the mortality rate in CCU patients was lower than in non‐CCU patients, and salvage after cardiac resuscitation was much higher in the CCU. Arrythmias were recognized more frequently and congestive failure was recognized earlier in the CCU.
GEROGENIC FRACTIONS IN THE TRITIATED RAT
Authors: Bjorksten Johan , Acharya P. V. N. , Ashman Stephen , Wetlaufer Donald B.
Published: April 2015

Abstract

A rat that had received tritiated acetate perinatally was killed at the age of 609 days, and was found to have retained substantial quantities of tritium in all organs examined. This study was focussed on the liver, which—after a succession of extractions with a series of various solvents followed by catalytic hydrolysis at body temperature—yielded a residue that was‐insoluble in a wide range of common solubilizing media. Treatment with hot mineral acid partially dissolved this residue and electrophoretic fractionation further led to 4 fractions of which a single fraction contained most of the tritium in the insoluble residue.

Our analyses showed that the insoluble residue contained a variety of common amino acids and a considerable amount of phosphorus. The solubilized fractions derived from the insoluble residue all contained substantial concentrations of pentose, deoxypentose, and phosphorus. They showed ultraviolet absorption spectra qualitatively similar to those of nucleic acids. From their chromatographic behavior on crosslinked dextran columns, all 4 solubilized fractions showed molecular weights greater than 5000. In addition, these fractions showed substantially greater resistance to hydrolytic degradation than do authentic RNA and DNA. Taken together, this is interpreted as evidence that the gerogenic insoluble residue is composed of a highly crosslinked network of at least RNA, DNA and protein, which is stabilized by covalent crosslinkages of unusual stability. Formation of these crosslinked structures could easily interfere with the function of certain critical molecules of RNA, DNA or other polymers, leading to impaired cell function and death.
RADIOLOGICAL OSTEOPOROSIS: CORRELATION WITH DIETARY AND BIOCHEMICAL FINDINGS
Authors: RESHEF A. , SCHWARTZ A. , BEN‐MENACHEM Y. , MENCZEL J. , GUGGENHEIM K.
Published: April 2015

Abstract: Roentgenograms of the lumbar spine, left femur and left hand were obtained on 1451 adults who did not have bone disease or malignant disease. Osteoporosis was visually evaluated on the basis of radiological density and the number of collapsed vertebrae. The height and the antero‐posterior length of the 3rd lumbar vertebra, and the total and medullary diameters of the femur and the 2nd metacarpus were measured. In females, vertebral height decreased with age and the degree of osteoporosis. The ratio of vertebral mid‐height to anteroposterior length decreased in females with age and in both sexes with increasing severity of osteoporosis. The ratio of mid‐height to anterior vertebral height was independent of age, sex and the presence of osteoporosis. In tubular bones, the medullary‐canal width increased with age and the severity of osteoporosis, particularly in females. This finding was more pronounced in the metacarpus than in the femur.

In 291 of these subjects the dietary intake of calcium and protein was estimated and the urinary excretion of nitrogen, calcium, phosphorus and hydroxyproline examined and related to creatinine excretion. Low dietary intakes of calcium in males, and of protein in both males and females, were significantly correlated with the severity of osteoporosis. However, since the consumption of these nutrients decreased with age, and since osteoporosis was more common and more severe in the old people than in the young, it would seem that the correlation of protein and calcium consumption with osteoporosis was age‐dependent. Urinary excretion of calcium, phosphorus and nitrogen in both sexes, and of hydroxyproline in males, was not correlated with osteoporosis.
ACETYLSALICYLIC ACID AND ARTERIOSCLEROTIC THROMBOEMBOLIC DISEASES IN THE AGED
Authors: HEIKINHEIMO RAUNO , JÄRVINEN KAUKO
Published: April 2015

Abstract: This is a study of morbidity and mortality among 430 aged people treated in a Finnish municipal home during a one‐year period. Of the 430 persons, 209 were given 1 gm of acetylsalicylic acid (ASA) daily, and the 221 “controls” were given placebo. Of the 209 patients in the ASA group, 70 were hospitalized (morbidity), and 36 died (mortality). For the placebo group of 221 patients, the corresponding figures for morbidity and mortality were 73 and 29. Even when the hospital patients were classified according to the diagnosis, no significant difference was observed for either morbidity or mortality between the two groups. In this series of aged people, ASA seemed to have no prophylactic effect regarding arteriosclerotic‐thromboembolic disease.
PREDICTIVE MEDICINE. II. EXPERIMENTAL MODELS
Authors: CHERASKIN E. , RINGSDORF W. M.
Published: April 2015

Abstract: Attempts to predict disease susceptibility have led to the development of proneness profiles. The diagnostic factors include age, sex, weight, blood pressure, blood biochemical values, and dietary habits.

Persons with one chronic disorder sooner or later have other chronic ailments. Thus there must be common denominators in seemingly different patterns of proneness. This is illustrated by the well established coronary proneness profile and by the less well developed cancer profile. What is urgently needed is a proneness profile designed to anticipate the syndrome of sickness.

There is a very ancient belief that health is a simple state to be obtained by observing a few simple positive and negative rules … But it follows from the complexity of the body that health cannot be a simple state … Because there are literally thousands of ways of being ill, to be well one has to be well in thousands of ways at once.

Sir Russell Brain
An L‐Dopa Paradox: Bipolar Behavioral Alterations
Authors: RIKLAN MANUEL
Published: April 2015

Paradoxical behavioral alterations may occur during L‐dopa therapy in parkinsonian patients, particularly those of the geriatric age group. For example, there have been many reports of alleviation of depression with L‐dopa, but induction of depression has also been observed. With respect to cognition and perception, there have been many reports of disorientation and paranoid ideation from the toxic effects of L‐dopa, but increased alertness and improved intelligence have also been observed. The basic alteration appears to be a non‐modality specific increase in physiological and behavioral activation. This, in turn, may lead to opposite kinds of specific (e.g., directional) changes in emotional, cognitive and perceptual functions, depending in part upon the baseline status of the patient. A concept designated as directed‐activation is proposed as a partial hypothesis.
Massive Edema Induced by Thioridazine (Mellaril): An Unusual Complication
Authors: MARGOLIS JACK
Published: April 2015

A case of massive edema apparently due to thioridazine (Mellaril) therapy is reported for the first time. On three occasions the 39‐year‐old male patient showed a marked weight gain and edema while taking thioridazine, but prompt diuresis and marked weight loss when the drug was discontinued.
Accident—or Apparent Accident*
Authors: WEHRMACHER WILLIAM H.
Published: April 2015

Disturbed cardiac rhythm often leads to sudden incapacitation and an apparent accident under perilous circumstances. Rhythm disturbances occur more frequently among older people, who may lack many ordinary protections against accidents because of failing eyesight and hearing, an impaired sense of smell, forgetfulness, a slow reaction time, weakness, or painful and damaged joints. Such persons may be deprived by a momentary cardiac disturbance of the ability to respond quickly. Thus they may release control of a motor car so that it careens across a busy highway, or they may fall from a height or into moving machinery from a precarious footing. If the cardiac disturbance can be detected early enough, the potential accident victim can be withdrawn from peril; however, if the cardiac disturbance can be prevented, the old person may retain the personal ability to deal with hazards. Six illustrative cases, with electrocardiograms, are presented.
The Limitations of Reflex Heating Therapy in the Elderly
Authors: ANDREWS G. R. , OFNER F.
Published: April 2015

An investigation was carried out to determine the cutaneous vascular response of 10 elderly men under conditions of reflex heating. It was found, in 38 of 40 observations, that heat (infra‐red irradiation) applied to the trunk resulted in a constriction of the skin vessels of the lower extremities in lieu of the expected vasodilatation. This paradoxical reaction is attributed to the possibly defective thermoregulatory mechanism in elderly arteriosclerotic patients. It is concluded that reflex heating, even when applied with necessary precautions, is an unreliable therapeutic method for the aged.
Interrelations of the Aging Process and Accidents*
Authors: RODSTEIN MANUEL
Published: April 2015

With the twelfth chapter of Ecclesiastes as a background, the author draws analogies to life for the aged. The various aspects discussed include intellectual function, memory, orientation, tremor, acrophobia, gait, hypo‐hyperkinesia, muscle weakness, homeostasis, orthostatic hypotension, visual and auditory acuity, osteoporosis and fractures. Deficiencies involving these factors make the aged person particularly prone to accidental injury. The more optimistic side of the picture is represented by the many people who remain mobile and active in old age.
Reflux Esophagitis in the Elderly, with Special Reference to Antacid Therapy*
Authors: McHARDY GORDON , BALART LOUIS
Published: April 2015

The incidence of hiatal hernia increases with aging. When esophagitis occurs in the susceptible esophageal mucosa, it is probably the result of degenerative changes in the supporting tissues (collagen‐elastin) and a diminution in cellular replication. The authors' concepts of the etiology of reflux esophagitis are described. Severe complications are not uncommon. In most patients, there is a good response to postural, dietary and antacid therapy, not only during the initial episode but during recurrence and in complicated cases. No surgical procedure has general acceptance. In the elderly patient, morbidity and mortality are of such significance that the benefits must be measured carefully against the disadvantages. Most operations are designed to correct a hiatal hernia and to enhance sphincteric competency. The complication, esophagitis, is a medical problem unless a concomitant disorder refractory to medical management requires operative intervention. The presence of hiatal hernia usually is a coincidence. The authors have found an antacid combination (Gaviscon) to be an effective factor in the medical treatment of reflux esophagitis.
Horizontal (Cleavage) Tears of the Knee‐joint Menisci in the Elderly
Authors: CHAND KISHAN
Published: April 2015

At autopsy, extensive knee arthrotomies were performed on 11 Scottish males (average age 77) and 11 females (average age 75) who had died from various medical disorders and had no history of complaints referable to the knees. The aim was to study the incidence of horizontal (cleavage) tears of the menisci in the general population. In the males, there was a high incidence of cleavage tears of the medial meniscus (in 14 of 22 knees) whereas the lateral menisci were usually normal (in 21 of 22 knees). In the females, there was a low incidence of both medial (in 6 of 22 knees) and lateral meniscal tears (in 2 of 22 knees). Cleavage tears of the medial meniscus in geriatric males may be part of the aging process, and this should be kept in mind if surgery is contemplated for reasons other than severe symptoms.
Effects of Sex Steroids on Lipid Levels*
Authors: BORENSTEIN RICHARD , STAHL NORMAN L. , GREENBLATT ROBERT B.
Published: April 2015

ABSTRACT: In this preliminary study, pellets of pure (naturally occurring) estradiol and/or testosterone were implanted in 44 women and pellets of pure testosterone were implanted in 9 men, at six‐month intervals. The effects on serum lipid levels were determined. There was no evidence that either estradiol or testosterone influenced the blood cholesterol level in women. This is not in agreement with the findings of several other investigators who used synthetic estrogens. Also, there was no significant change in the blood levels of lipoprotein, cholesterol or triglyceride after administration of large doses of testosterone to men.
Comparison of the Hypnotic Effectiveness of Secobarbital, Pentobarbital, Methyprylon and Ethchlorvynol
Authors: PATTISON JOSEPH H. , ALLEN RICHARD P.
Published: April 2015

ABSTRACT: A double‐blind placebo‐controlled study was made of the hypnotic effects of secobarbital (100 mg), pentobarbital (100 mg), methyprylon (Noludar) (300 mg), and ethchlorvynol (Placidyl) (500 mg) in 50 patients in a chronic disease hospital. The criteria included sleep onset and sleep duration (in half‐hour units). Pentobarbital, methyprylon, and secobarbital were clearly superior to placebo, and pentobarbital was consistently the best. Methyprylon seemed slightly better than secobarbital. In elderly or chronically ill patients for whom administration of barbiturates is considered too risky, methyprylon is an alternative effective hypnotic for simple insomnia.
Chlorpromazine in Geriatric Psychiatry
Authors: BIRKETT DAVID PETER , BOLTUCH BRUCE
Published: April 2015

ABSTRACT: Fifty patients in the psycho‐geriatric unit of a county hospital were divided randomly into two groups; 30 were treated with chlorpromazine for six weeks, and 20 constituted the controls. The morning blood pressure (with the patient in the standing position) was used to monitor chlorpromazine dosage; the highest dosage reached was 200 mg daily (5 cases), but in 11 cases the dosage could be only 50 mg daily. Improvement was assessed by means of Rating Scales (NOSIE and BPRS) and Global Assessment. Chloral hydrate and phenobarbital were prescribed as needed during the trial.

No significant differences were found between the groups on the basis of the rating scales or global assessment. Nonsignificant trends favored the chlorpromazine group. (Two patients in the original control group had to be dropped from the study because chlorpromazine therapy was necessary to control violent agitated behavior.) Side effects observed more commonly in the chlorpromazine group were tremor, weight gain, and nasal congestion. Drowsiness, fatigue, unsteadiness, falling, constipation, and abnormal facial movements were no more common in the chlorpromazine group than in the control group.
Comparative Mortality for Various Surgical Operations in Older versus Younger Age Groups*
Authors: ZIFFREN SIDNEY E. , HARTFORD CHARLES E.
Published: April 2015

ABSTRACT: The mortality rates associated with various surgical operations are compared in patients of the following four age groups: younger than 60, 60–69, 70–79, and 80 or older. The reasons for higher mortality in association with specific operations in aged patients are discussed.
Etiology and Treatment of Pancreatic Disease: Modern Concepts
Authors: RICCITELLI M. L.
Published: April 2015

Although pancreatic disease may occur at any age, it is more prevalent in the elderly. Pancreopathy usually can be diagnosed by properly performed enzyme and function studies. However, because of its protean manifestations, the presence of pancreatic disease is often missed even after exploratory laparotomy and histologic examination. Prompt diagnosis can be life‐saving, especially in patients with acute abdominal symptoms. This requires diagnostic skill and a basic knowledge of the physiologic and pathologic mechanisms. Chronic pancreatitis follows a precise pattern of events, depending upon many complex underlying mechanisms. Early recognition can interrupt or delay its evolution. This article concerns various etiologic concepts, modern diagnostic methods (including enzyme and function studies, radiography, angiography, pancreatography), and medical and surgical treatment, with emphasis on the use of digestive enzymes.
Disseminated Leiomyosarcomatosis: Case Report
Authors: CASE THOMAS C. , GIANNELLI STANLEY , CONKLIN EDWARD F. , CAMER STEPHEN
Published: April 2015

A case of generalized leiomyosarcoma in a 60‐year‐old woman is presented. Apparently the lesion originated in the right lung prior to 1967, since the gastrointestinal and genitourinary tracts and the pelvic organs remain normal. The disease recurred five years after the first operation, necessitating further surgical therapy for removal of the variously situated tumors. The pathology report stated: metastatic leiomyosarcoma. Because of the slow growth of the lesions, the prognosis is favorable.
Three Primary Malignancies Occurring within Fourteen Months in the Same Patient
Authors: KORBITZ BERNARD C.
Published: April 2015

A 72‐year‐old woman was treated 1) for papillary cystadenocarcinoma of the ovary, by surgery and radiotherapy, 2) for carcinoma of the right breast, by surgery and radiotherapy, and 3) for terminal acute granulocytic leukemia by blood transfusions. All three of these malignancies occurred within a fourteen‐month period and the patient died about sixteen months after the diagnosis of ovarian carcinoma. The co‐existence of carcinoma of the ovary and breast in the same patient, and the possible etiologic relationship of the radiotherapy to the development of acute leukemia are discussed.
Planning for the Later Years*
Authors: FISHBEIN MORRIS
Published: April 2015

Planning for old age is a procedure contingent upon unforeseen changes. However, the risks can be minimized if planning is started earlier in life when the person is in full possession of his senses, rather than later when his wisdom may be impaired by cerebral deterioration. The government has launched vast programs of medical and social care, but much remains to be done. Employment after age 65 is a difficult problem. Yet employment, or at least productive mental activity, is essential for mental health. Maintenance of mental health is all‐important in decreasing the need for institutional care of the elderly and preserving a satisfying independent environment.
Mental Disturbances in Old Age
Authors: RUDD T. N.
Published: April 2015

The best approach to the care of mentally disturbed geriatric patients involves complete investigation of each case upon hospital admission so that physical factors will not be overlooked when making the diagnosis. The potential for cure should not be underestimated. Proper physical and psychologic conditions of environment and the post‐discharge strengthening of direct home support through day‐center services to relieve family strain, have a pronounced beneficial influence.
On the Genesis of Atherosclerosis*
Authors: BARNES BRODA O.
Published: April 2015

Although atherosclerosis has been known for over 3000 years, it came into prominence in the 20th century apparently because a reduction in deaths from infections permitted a population susceptible to atherosclerosis to reach adult life. Atherosclerosis is accompanied by an early deposit of abnormal quantities of mucopolysaccharides in the tissues. In hypothyroid children, the tissue content of mucopolysaccharides is increased, but is restored to normal by thyroid therapy. A factor in the increased death rate from atherosclerosis seems to be the survival of hypothyroid children from infectious diseases; they thus become potential candidates for premature death from atherosclerotic disease. Thyroid therapy can be a prophylactic agent against premature deaths from heart attacks, hypertension, and diabetes.
A Surgeon Reviews a Half Century of Progress in the Treatment of Coronary Heart Disease
Authors: MAZEL M. S.
Published: April 2015

Great progress has been made during the past fifty years in the treatment of coronary heart disease. No longer are the untimely deaths attributed to stomach disorders or acute indigestion. Electrocardiography has contributed greatly to our knowledge. The coronary angiogram is rapidly becoming one of the most important diagnostic procedures. Underlying causes of coronary heart disease include heredity, the rich American diet, smoking, and such associated disorders as diabetes and hypertension. Patients with hyperlipemia, hypercholesterolemia or hypertriglyceridemia are particularly prone to coronary disease. Early fibrinolytic therapy before the occluding thrombus can become organized in gradually replacing anticoagulant therapy. For surgical treatment, the saphenous‐vein bypass graft is the procedure of choice in selected cases. In this operation the occlusion is bypassed and the heart receives the blood supply needed for survival. The morbidity and mortality from coronary heart disease will be greatly reduced if fibrinolytic agents are used early enough in an acute heart attack before the occlusion damages the heart muscle beyond repair. Afterward, when it can be performed safely, the saphenous‐vein bypass operation should be used in conjunction with one of the simple revascularization procedures to give the patient maximal protection from future attacks.
Problems of Nutrition in the Aged*
Authors: RAO DODDA B.
Published: April 2015

The importance of nutrition for life and health is paramount, especially in the aged, who are so vulnerable to malnutrition. Important factors leading to improper nutrition in the aged, the relation of these factors to health, the problems of assessment of malnutrition in the aged, and the prevailing public and professional attitudes toward the whole question are discussed. Malnutrition and disease are a great strain on health services, so it is better to practice prevention by adhering to the principles of sound nutrition. Recommendations are made regarding the qualifications of an “ideal” food for the aged, and the planning of successful diets. Eating should not be a chore or a dietary experiment; rather, it should be a genuine pleasure, particularly in old age when so many other pleasures can be enjoyed no longer.
Identification of Mild Hypertension and Some Risk Factors That Influence Prognosis
Authors: ROBINSON S. K.
Published: April 2015

Mild hypertension is identified as a state in which the blood pressure (BP) is elevated, but there are no cardiac symptoms, no heart, brain, kidney or metabolic diseases, and no abnormalities in the optic fundi. Two grades of BP are suggested for the identification of mild hypertension, since the level of blood pressure influences the prognosis: in Grade 1 the BP ranges from 140/90 to 180/110 mm Hg, and in Grade 2 from 180/110 to 220/120 mm Hg. The yearly mortality rates over a ten‐year period were 0.3 and 1.3 per cent for patients with Grades 1 and 2 hypertension, i.e., of the same order as the mortality rate for the general population. Over a twenty‐year period the mortality rate was higher for patients with Grade 2 hypertension. In the Grade 1 group, the clinical status underwent only minimal changes during the first ten years; in the Grade 2 group, adverse changes in clinical status began to appear after five years. Breathlessness or anginal pain indicated a bad prognosis in both sexes. Presistent headache increased the risk of stroke, especially in females. Proper classification of mild hypertension can lessen the load in clinics, reduce expenses for drugs, and lessen the risk for the patient.
Papaverine — Hepatotoxic or Not?*
Authors: DRIEMEN PEARL M.
Published: April 2015

ABSTRACT: Papaverine hydrochloride (Pavabid) has been recommended in geriatric practice for increasing cerebral blood flow and improving mental functioning. However, reports of hepatotoxicity as indicated by physical signs and symptoms and elevated levels of serum alkaline phosphatase, serum glutamic oxalacetic transaminase and serum glutamic pyruvic transaminase led to this study. Thirty patients (age range, 52 to 88 years) with a primary diagnosis of organic brain syndrome were studied. Each was treated with papaverine. The foregoing tests were performed before medication and after two, four, six and eight weeks of therapy. Papaverine was discontinued in 53 per cent of the cases by the end of the sixth week because of abnormal results with the liver function tests, yet none of the patients had nausea, vomiting, jaundice or dark urine. The physiological meaning of these findings is open to more than one interpretation; hence no explanation is offered. However, the question of whether or not papaverine is truly hepatotoxic must be considered.
Behavioral Effects of Drug Therapy on Psychogeriatric Inpatients. I. Chlorpromazine and Thioridazine
Authors: ALTMAN HAROLD , MEHTA DINESH , EVENSON RICHARD C. , SLETTEN IVAN W.
Published: April 2015

ABSTRACT: Psychogeriatric inpatients were treated for six weeks (after a six‐week clearance period) with one of three medication regimens involving chlorpromazine and thioridazine, to study the behavioral effects. (Total N = 132.) Although the treatments started simultaneously and proceeded concurrently, each treatment assignment was made at random and independently of the other two. The treatments were: 1) chlorpromazine vs. thioridazine, studied “double‐blind”; 2) a single bedtime dose of drug vs. fractional doses throughout the day; and 3) different total daily dosages (30, 60, 90 or 120 mg). Patients were rated on the MIBS, a new inpatient behavior form that utilizes 11 factored scales plus ratings of drug side effects. Schizophrenic and non‐schizophrenic subgroups were evaluated, as well as the total sample. Results were negative for treatments No. 1 and No. 2, but total dosage was significantly correlated with factor scale changes. The pattern of changes was different for the two diagnostic subgroups. The findings on side effects indicated that raters were confounding side effects and therapeutic effects.
The Goethean Culture of Experience—Aging without Abdication
Authors: Barach Alvan L.
Published: April 2015

The exuberance of the younger generation, based on new personal freedoms and a fresh idealism in human relations, ignited a potentially rewarding path for the adult community to follow. However, the youthful revolt could not be sustained by the substitution of emotional activism for thought, and acute self‐interest for former declarations of concern for fellow human beings.

Aging is an unprovoked attack on one organ after the other. Yet, our defects may constitute perpetual victories as we declare a new fidelity to whatever powers and passions remain. The creative reader will be fortified in his grasp of the Goethean culture of experience as he communes with the Prometheans who wrote in defense of personal liberty. The aim of this essay is to reveal an unpredictable turn of events in which the brief spark contributed by the younger generation illuminated a vista of a better way of life for older people, a vista of personal freedom which requires only a fresh documentation from an already available humanistic background. Our western tradition of literature and the other liberal arts may be used to define a culture of enhanced experience, without being curbed by the ultra‐cautious counseling and antiquated restraints which society had imposed upon older people.
The Age‐Prevalence of Cardiovascular Abnormalities in Relation to the Aging of Special‐Sense Function
Authors: WEBSTER IAN W.
Published: April 2015

ABSTRACT: The application of standardized multi‐test data to the study of aging is explored through age‐prevalence patterns and two theoretical models. In 1350 subjects, the age‐prevalence of raised blood pressure, abnormal electrocardiograms, hypertriglyceridemia, hypercholesterolemia, and 2‐hour hyperglycemia, as indicators of cardiovascular disease, were studied in relation to decreases in hearing and vision, as indicators of sensory neural impairment. The age‐dependent changes in special‐sense function occurred independently of cardiovascular abnormalities. Thus a way is indicated whereby a pathologic state may be distinguished from the aging process.
Plasma‐Cell Mastitis: Case Report
Authors: CASE THOMAS C. , GILLOOLEY JOHN , MADRAZO ALPHONSO A. , ORTIZ VICTOR N.
Published: April 2015

ABSTRACT: A case is presented of plasma‐cell mastitis that clinically appeared to be scirrhous carcinoma. The 10‐year history of a mass in the breast was significant in the differential diagnosis. Diagnosis by frozen section can be accurate only if a representative portion of the tissue is examined. Mastectomy is indicated only if the mass proves to be carcinoma.
Evolution of the Medical Director Concept*
Authors: GLADUE J. RAYMOND
Published: April 2015

ABSTRACT: To illustrate the evolution of the Medical Director concept, phases I, II and III of “The Maryland Story” are presented. The Medical Director should be an integral part of the nursing home staff if the quality of care is to be upgraded. The public, the government, nursing homes and the medical profession should recognize this need. The role of the Medical Director should be clearly defined so that there will be no overlapping with the primary responsibility of the Administrator. Organized medicine and regulatory agencies should develop training programs for Medical Directors, to help nursing homes become a significant part of our health care system. There is great need for specialists in geriatrics.
Laboratory Screening in the Evaluation and Placement of Geriatric Patients
Authors: STEEL KNIGHT , WILLIAMS T. FRANKLIN , FAIRBANK MATTHEW , KNOX KEN
Published: April 2015

ABSTRACT: Two hundred geriatric patients were seen in a clinic for evaluation and placement. Laboratory screening consisted of an SMA‐12 series of blood chemical tests, a hemogram, urinalysis, electrocardiogram, and chest roentgenogram. A striking number of abnormalities were uncovered, including several that might be of great significance in therapy.
Postmenopausal Bleeding*
Authors: GAMBRELL R. DON
Published: April 2015

ABSTRACT: During a two‐year period, 363 women with postmenopausal bleeding were studied. Included were women in whom the menses had been absent for one or more years and women treated with exogenous estrogens for at least one year. Endometrial tissue obtained by curettage was found to be hyperplastic (sometimes malignant) in a third of the cases, atrophic in a third, and proliferative in a third. Mechanisms of bleeding and sources of endogenous estrogens in postmenopausal women are discussed, as is the subject of steroidogenesis in patients unusually susceptible to endometrial carcinoma. In women with obesity, diabetes, or liver disease there is either an increased production rate of Δ4‐androstenedione or increased conversion of this hormone to estrone. The management of postmenopausal bleeding is discussed. The role of progesterone in preventing hyperplastic changes in the endometrium is emphasized. It is recommended that, during the climacteric, women receiving estrogen therapy and even those who are not, should be given progestogen for several cycles to see if withdrawal bleeding can be induced. If such bleeding does not occur, then progestogen therapy should be discontinued.
Psychiatric Problems of the Aged*
Authors: SCHMIDT CHESTER W.
Published: April 2015

ABSTRACT: Depression is the most important of the various psychiatric illnesses (including organic brain syndromes, schizophrenia, neuroses and personality disorders) that may develop in old age. The symptoms and the relationship to suicide are discussed. Therapeutic efforts (chemotherapy, electroshock, psychotherapy) may be directly affected by the physician's attitude. Drugs for the treatment of depression include the tricyclic antidepressants, MAO inhibitors, amphetamines, phenothiazines, minor tranquilizers (chlordiazepoxide, diazepam) and lithium. Contraindications and the dangers of misuse are emphasized. Electroshock is indicated for suicidal or medically endangered patients or for those who do not respond to chemotherapy. The psychiatric skills of the family practitioner are very important in helping the patient to adjust to the crises of old age and in preventing mental illness.
Perspectives for Psychopharmacologic Research in Gerontology*
Authors: JEFFREY DWIGHT W.
Published: April 2015

A contribution to gerontologic research is offered by the study of aging as a series of alterations in the efficiency of body processes in response to the administration of drugs. Geriatric pharmacology involves the use of drugs for: 1) preventive therapy and rejuvenation, 2) the treatment of disease, and 3) ascertaining the pathologic and physiologic status of the patient. Only rarely do gerontologic studies entail the manipulation of particular factors in order to reveal their effects in altering the aging process (which should be the dependent variable). Aging offers a fascinating panorama of phenomena for research. Scientists from other fields could well be persuaded put their knowledge and skills to work in this field.