bluuebunny/crossref_metadata_2025 huggingface dataset:
CANCER OF THE BREAST WITH METASTASIS TO THE FALLOPIAN TUBE
Authors: Case Thomas C.
Published: April 2015

Abstract

A 36‐year‐old woman had two successive primary cancers of the breast (left, right) removed surgically. At the time of the second mastectomy a bilateral salpingo‐oophorectomy also was performed. Unexpectedly, a breast cancer metastasis was found in the right Fallopian tube; infiltrating cancer was also present in the left ovary.

Although reports in the literature increasingly indicate that the length of survival after breast cancer is not dependent upon the more radical forms of treatment, the history of the case described here brings up the question of whether or not contralateral mastectomy and bilateral salpingo‐oophorectomy at the time of the first breast operation would help to prevent the development of a second primary breast cancer.
LARGE VILLOUS ADENOMA OF THE RECTUM ASSOCIATED WITH ELECTROLYTE IMBALANCE
Authors: Case Thomas C.
Published: April 2015

Abstract

A case is presented of a large rectal villous adenoma of eighteen months' duration associated with marked fluid and electrolyte imbalance, in a 65‐year‐old man. At operation, the bowel was found to be so extensively involved that an abdominoperineal resection with colostomy had to be performed.

Abdominoperineal resection is the procedure of choice in dealing with extensive lesions of this character. Without complete removal of the tumor, the patient may fail to recover and secondary operations may not be successful.
CHANGES IN THE CORTICAL THICKNESS OF THE CLAVICLE ACCORDING TO AGE
Authors: FUJITA TAKUO , ORIMO HAJIME , OHATA MASAHIRO , YOSHIKAWA MASAKI
Published: April 2015

Abstract: Micrometer measurements in the chest roentgenograms of 197 males and 168 females whose ages ranged from 10 to 80 years, showed that the relative cortical thickness of the clavicles decreased with advancing age. When the linear regression slopes of decrease for the clavicles, metacarpals and femur were compared, the steepest slope was for the clavicles, especially in females.

The use of clavicular cortical thickness as a criterion might offer a practical method of assessing skeletal age from routine posterior‐anterior chest x‐ray films.
EXOCRINE PANCREATIC FUNCTIONS IN THE AGED
Authors: FIKRY M. ESSAM
Published: April 2015

Abstract: Twenty‐three elderly males in Egypt, whose ages ranged from 60 to 72 years, underwent a study of their exocrine pancreatic functions by means of the intravenous secretin test.

The results showed a reduction of the volume of pancreatic secretions (mean, 55.2 ml) to one third of the normal mean for adults, and a selective reduction in enzyme activity. Amylase and trypsin activities (554 units and 1/102 dilution respectively) were decreased to two thirds of the normal values. Lipase activity was normal (mean, 1.1 unit per ml).

This reduced volume and enzyme production might be attributed to three factors acting singly or in combination: 1) the aging process itself, 2) the frequency of chronic fibrosing pancreatitis in the aged, favoured by the high incidence of gall stones, and 3) impairment of the vascular supply to the pancreas.

Therapeutic supplementation of pancreatic enzymes is recommended, to prevent these clinical or latent deficiencies which may have a great bearing on the health of the aged.
ANTICOAGULANT THERAPY AS A POTENTIALLY EFFECTIVE METHOD FOR THE PREVENTION OF PRESENILE DEMENTIA: TWO CASE REPORTS
Authors: WALSH ARTHUR C.
Published: April 2015

Abstract: The hypothesis is proposed that presenile dementia results from arterial insufficiency of the brain consequent to a thrombotic process in the arteries supplying the brain. In accord with this hypothesis is the observation that in 9 patients, long‐term anticoagulant therapy appeared to prevent the expected progression of the dementia. Two illustrative case histories are given in detail. It is suggested that further therapeutic trials are warranted. It is also suggested that a thorough investigation of both the intracranial and extracranial arterial blood supply to the brain in patients with presenile dementia might yield useful information as to the etiology.
HEALTH MAINTENANCE IN OLDER ADULTS
Authors: HRACHOVEC JOSEF P.
Published: April 2015

Abstract: Since the period of great progress against epidemic and acute diseases, a host of major chronic diseases afflicting older adults have emerged as the key health problems of our time. Concomitantly there arises the need for deeper knowledge of the causes, dimensions and subtleties of age decline in the individual's reserve capacities and resistance to disease, and the need for better understanding of the relationship of chronic diseases to environmental factors as an integral part of our search for basic measures toward health maintenance and disease prevention in older adults. The age decline in reserve capacities and in resistance to disease can either be slowed down by preventive measures and even reversed to some extent by physical exercise, or it can be further aggravated by excessive demands beyond their declining limits.

The relationship of chronic diseases to environmental factors is illustrated by the effects of nutrition on the life span, on atherosclerosis and on other diseases. The relationship of obesity, diabetes and coronary heart disease to one another, to the increased ingestion of fat or sugar, to gorging, and to long‐spaced, heavy meal‐eating habits is discussed.

In view of the sum total of environmental influences, a lifetime application of basic measures for health maintenance and disease prevention is stressed. Unfortunately, much too often a compromise with health is becoming an accepted pattern, possibly because of an increasing willingness to consider health not as a pure and incontestable human good, but as a generally desirable element, in active competition with other human needs such as economic gain or just plain pleasurable living.
ISSUES IN PLANNING FOR GERIATRIC SERVICES*
Authors: LEVEY SAMUEL , STOTSKY BERNARD A.
Published: April 2015

Abstract: An intensive analysis is needed of the roles not only of the general hospital and of the extended care facility, but also of the skilled nursing home, the intermediate care facility and noninstitutional alternatives in providing necessary services to the aged. At present, training programs are not geared to develop a significant cadre of professionals with the idealism, enthusiasm and absence of ambivalence to move the field rapidly toward reasonable programs and measures.

Rate‐setting practices in geriatric services have often led to the perpetuation of apathy and incompetence, and programs have suffered accordingly. Currently, with Medicaid, the problem is more serious because experience with Medicaid suggests that even with massive intervention by subsidies from the Federal government, patterns of care of the elderly alter little, although there is an associated large shift in the price structure, including costs and charges for such care. Controls for monitoring the quality of care have been limited, especially in extended care facilities and in nursing homes and related institutions. Unless well‐defined steps are introduced, the relationship between costs and quality of care at all levels will be subject to further variability. A critical problem is the snail‐like momentum in the creation of alternate services which could provide competition for existing methods and services. Again, the problems of manpower and incentives come to the fore. Neither exists in the abundance required to create even a modest impact on the present system.
A SAMPLING OF ATTITUDES TOWARD AGING
Authors: ZAMPELLA A. D.
Published: April 2015

Abstract: A questionnaire survey was made of 48 patients concerning their attitudes toward old age and retirement. The patients were in either a nursing home or a group medical practice in the Greater New York area; their ages ranged from 56 to 90 years. The factors investigated were: choice of retirement area, retirement attitudes, employment, recreation, religion, marriage, relationships with neighbors, family living arrangements, illness and incapacitation, Medicare, the past, the future, and death. The findings led to certain conclusions which may be helpful as guidelines in the care of the aged and in early essential planning for retirement.

In this study, the elderly person who was endowed with a feeling of mature, self‐earned independence and physical well‐being, who enjoyed adequate income and housing and was happily married, retained his self‐esteem and integrity. He was less likely to become a burden on his family, friends or community, or to regress into illness that required early admission to an institution. His morale was high, even with a multiplicity of physical disorders. He retained the strong desire to maintain the identity of his personality within the mainstream of community and family life. On the other hand, undue identification with the aged and the process of aging, especially when complicated by unfortunate developments such as social, economic, emotional, personal and physical losses, evoked lifelong personality defenses in the elderly, even toward death with its increasing proximity.

The best approach to care of the elderly would seem to lie in preventive medicine, i.e., averting illness by a program of health care throughout the years. This program would stress natural processes, minimizing the pathological while maintaining the physiological.
AMYLOIDOSIS: AGE OF OCCURRENCE AND RATE OF PROGRESSION: EXPERIMENTAL STUDY IN THE WHITE PEKIN DUCK*
Authors: RIGDON R. H. , MACK JOHN
Published: April 2015

Abstract: Primary amyloidosis is reported as occurring more often in older animals and man. This study concerned 52 white Pekin ducks from which hepatic biopsy specimens were obtained at various ages. It was found that hepatic amyloidosis occurred more frequently in older ducks, but it did occur in young white Pekins. The age at onset of hepatic amyloidosis varied. The rapidity of development also varied, as indicated by liver biopsies and by the weight of the liver.

Since primary amyloidosis in man may be genetically influenced, it is important to know when amyloid first appears in the tissues, and the rate of progression.
STUDIES OF THE BLADDER DEFENSE MECHANISM. II. POSTOPERATIVE CYSTITIS IN THE ELDERLY
Authors: Drach George W. , Cox Clair E.
Published: April 2015

Abstract

Chronic postoperative cystitis in the elderly patient is a difficult problem, and is especially annoying if all obvious anatomic abnormalities have been corrected. This study of 20 such patients who underwent bladder surgery indicates that several local resistance factors may be related to this continued urinary infection. In elderly postoperative patients with chronic cystitis the bladder defense mechanisms have reached such a state of imbalance that they cannot cope with the invading organisms either by the mechanism of voiding or by vesical‐wall defense factors. The relative importance of the various cellular and serologic local defense mechanisms in resisting bacteria in bladder urine and the bladder mucus layer, mucosa or submucosa is not known.

There is no apparent quantitative histologic defect in the local bladder cellular response of the elderly patient. Therefore, a decreased quality of response is implied. In addition, trauma created by indwelling catheterization or by surgery destroys the anatomic integrity of the bladder wall and may thereby encourage the development of deep‐seated infection by permitting tissue invasion. Foci of tissue infestation by E. coli were demonstrated in 1 of 2 patients in whom it was possible to make such a study. These foci are not subject to the normal voiding defense mechanism and the antibacterial factors within the bladder or urine; they can be eliminated only by inflammatory cells, antibodies, or antibacterial agents capable of attaining bactericidal tissue levels.

Two axioms were confirmed by this study: 1) any period of preoperative indwelling catheterization should be as brief as possible, and 2) specific antimicrobial therapy should be planned preoperatively so that surgery takes place at a time when the urine and tissues are sterile; this sterility should be maintained until all foreign bodies, such as catheters, are removed from the urinary tract.
DETERMINING THE FACTORS THAT AFFECT REHABILITATION*
Authors: Cain Leila S.
Published: April 2015

Abstract

A study was made to determine whether progress in physical therapy and psychological status are related to the following factors: diagnosis, sex, age, average number of treatments per week, length of hospital stay, and aphasia. Two eight‐week cross sections of data on patients with hemiplegia, paraplegia, quadriplegia, bilateral leg amputation, and hip fracture were analyzed statistically. The first cross section involved 123 patients (age range, 17 to 89) and the second cross section, 88 patients (age range, 17 to 90).

Factors related to progress in physical therapy were: the average number of treatments (improved patients received more), length of hospital stay (longer for the improved patients), psychological status (better in the improved patients), and possibly age (improved patients were younger). Younger patients also had a better psychological status, and patients having a better psychological status received more treatments and had been in the hospital longer. Aphasic patients had a poorer psychological status than did those without aphasia.
GERIATRIC PSYCHIATRY AND SOCIAL GERONTOLOGY*
Authors: Stangle Esther K.
Published: April 2015

Abstract

Geriatric psychiatry and social gerontology are defined. These two disciplines are comparatively new, making for wide differences of opinion owing to the great lack of fundamental data. There are also semantic problems, either related or unrelated to habit‐bound perceptions and interpretations.

A case report demonstrates how, under the psychiatrist's guidance, the author assisted in the social rehabilitation of a 75‐year‐old woman. Both milieu‐ and socio‐therapy were used to help this woman move from an unsuitable large home, where she was isolated, into a retirement residence which was safer, more healthful physically and mentally, and more conducive to continuing social self‐realization.

The author's work with groups is discussed. Mental stimulation and group discussion appear to help the older adult modernize his behavior and broaden his viewpoints, thus increasing his opportunities for continuing self‐development.
THE Q‐II INTERVAL. III. A STUDY OF THE SECOND HEART SOUND IN OLD AGE*
Authors: Slodki Sheldon J. , Hussain Ahmed T. , Luisada Aldo A.
Published: April 2015

Abstract

A study of the intervals between the onset of QRS and the aortic (IIA and pulmonic (IIP) components of the second heart sound was made in 16 subjects between 70 and 92 years of age. A group tendency toward prolongation of both Q‐IIA and Q‐IIP was found. The relatively greater prolongation of left over right ventricular systole or vice versa gave rise to reverse‐type splitting (25 per cent) or a single second sound (38 per cent) respectively; normal splitting was found in 37 per cent of the cases.

The various possible causes of prolongation of these intervals are discussed. As neither diastolic hypertension nor severe ischemic heart disease was present in the group with reverse splitting, this manifestation would seem to be the result of the process of aging. Prolongation of the pre‐ejection period was an important contributory factor in some cases.

On the basis of these findings, new formulas were developed for prediction of Q‐IIA and Q‐IIP which would be applicable to elderly persons.
VASCULAR PROFILE SCREENING TESTS: A NEW APPROACH TO THE DETECTION OF VASCULAR DISEASE
Authors: Allison Robert D.
Published: April 2015

Abstract

By means of a four‐electrode plethysmograph, blood pulse volume changes were determined over the head, neck torso and extremities in healthy subjects and in patients with vascular disease in these areas. The amplitudes of the recorded pulses, plotted bilaterally from the central line of a body silhouette, provided an outline or profile of the vascular supply. In healthy subjects the characteristic outline was symmetrical, but in patients with vascular disease it was asymmetrical in the specific areas involved.

Such qualitative identification of vascular abnormalities according to recognized patterns decreases the time required to evaluate numerical data, and indicates the vascular areas in which there should be more quantitative assessment. This screening procedure is useful for the detection of early vascular disease and, when combined with quantitative evaluation, for a guide in the therapeutic management of older patients with established vascular disease.
OBESITY IN ARTHRITIS: RELATED FACTORS: DIETARY THERAPY
Authors: Traut Eugene F. , Thrift Chester B.
Published: April 2015

Abstract

The prevalence of obesity was compared in an arthritis clinic (699 patients) and a general medical clinic (1,026 patients). Obesity was no more common in the patients from the arthritis clinic. Among the 699 cases of arthritis there were 558 cases of degenerative (osteo‐) arthritis (D. A.) and 114 cases of rheumatoid arthritis (R. A.). Data on these forms of the disease in relation to obesity are presented with regard to sex, ethnic group, constitutional habitus, age, severity of arthritis, location of the affected joints, body weight, and the times of onset of the obesity and the arthritis.

Of all the obese arthritic patients, 30 per cent had gained an average of 30 pounds before the onset of arthritis; 60 per cent had gained from 40 to 80 pounds; and 10 per cent had gained from 80 to 100 pounds. Damage to the weight‐bearing joints was related more to the percentage gain than to the absolute gain in body weight. The joints of patients with a pre‐arthritis weight of 120 pounds exhibited more damage from a body‐weight increment of 50 pounds than did the joints of patients with a pre‐arthritis weight of 180 pounds. Thirty‐seven per cent of the D. A. patients were obese before manifesting arthritis. Obesity followed arthritis in only 12 per cent of the D. A. group compared with 35 per cent of the R. A. group.

Difficulties in the dietary control of obesity in these free‐clinic arthritic patients are discussed. The weight‐reducing program became more effective after limiting eligibility for return visits to patients who lost a specified number of pounds.
MENTAL AND FUNCTIONAL STATUS IN THE ELDERLY: RELATIONSHIP TO BLOOD GAS AND pH LEVELS
Authors: Landau Samuel , Ravindranath Somalinga S. , Goldberg Emanuel
Published: April 2015

Abstract

One hundred and five patients (age range, 47–93 years) in a New York City nursing home were studied to estimate the extent to which physical dysfunction and disorientation could be attributed to pulmonary insufficiency. Arterial blood gases (oxygen and carbon dioxide) and pH were determined on all subjects. Venous and arterial blood gases were compared and found to be variable over a wide range. Only a small percentage of the patients had respiratory insufficiency as defined on the basis of blood gas levels, and their distribution appeared to be random with regard to mental and physical function. Respiratory insufficiency was not a significant cause of disorientation and physical dysfunction in this nursing‐home group. Hyperpnea and respiratory alkalosis were present in all patients. Severe hypocarbia and alkalosis appeared to affect the prognosis unfavorably.
INFLUENCE OF CERTAIN DRUGS ON CATARACT FORMATION*
Authors: Abraham Samuel V. , Teller Jerome J.
Published: April 2015

Abstract

A study was made of 636 eyes (336 treated with miotics and 300 untreated) in two age groups of patients: (a) 40–64 years, and (b) 65–88 years. The results definitely indicated the greater frequency of cataracts in the older patients, and the greater rapidity of lens changes in those treated with the stronger miotics.

There seems to be no characteristic change in the lens that can be attributed to any specific toxin or drug. Early lens changes usually involve the younger lens fibers. Lens changes depend upon the age of the subject, the severity and duration of the injurious factor, the length of time elapsing since the “insult,” and the general state of health.
VARIABLES IN HOST RESISTANCE PERTAINING TO SEPTICEMIA. I. BLOOD GLUCOSE LEVEL
Authors: Robson Martin C. , Heggers John P.
Published: April 2015

Abstract

Many factors are important in host resistance to infection, but the mechanisms have not been elucidated. This study of 267 cases of septicemia concerns one factor of host resistance—the blood glucose level. It appears to affect Gram‐negative organisms differently from Gram‐positive organisms. The average concentration of blood glucose in the patients with Gram‐negative septicemia was significantly lower than in the patients with Gram‐positive septicemia, regardless of the presence or absence of diabetes mellitus. It is suggested that this relationship, as gleaned from our retrospective clinical study, be investigated further as a possible means of elucidating and monitoring over‐all host resistance to infection.
INTRAGASTRIC COLOR PHOTOGRAPHY IN THE DIAGNOSIS OF GASTRIC CANCER
Authors: Nelson Robert S.
Published: April 2015

Abstract

Intragastric color photography has been performed routinely for approximately ten years at the M.D. Anderson Hospital and Tumor Institute by the use of 1) directed photography, with the intra‐ or extragastric camera attached to a gastroscope, and 2) blind photography, with only the intragastric camera in the inflated stomach. The value of the blind photography method in the early diagnosis of gastric cancer is now being assessed. Direct photography is firmly established as a method for recording the gross features of neoplastic lesions, for evaluation of equivocal findings, and for the training of endoscopists. The ability to take color pictures of the interior of the stomach may in time improve the diagnosis and treatment of gastric cancer.
THE HOSPITAL RECORD AS A TOOL FOR ASSESSMENT OF PHYSICIAN POSTGRADUATE EDUCATIONAL NEEDS IN THE CARDIOVASCULAR FIELD*
Authors: Taubenhaus Leon J.
Published: April 2015

Abstract

A tool for the assessment of physician practices was developed by means of hospital record review for two cardiovascular syndromes—acute myocardial infarction and congestive heart failure. The application of this method to a review of the records of three community hospitals identified deficiencies in medical practice and indicated that such review could be useful in the design as well as in the evaluation of postgraduate education.
SOME TERMINAL ASPECTS OF DISEASE IN OLD AGE: A CLINICAL STUDY OF 300 PATIENTS
Authors: Howell Trevor H.
Published: April 2015

Abstract

The terminal stages of life were observed in 300 patients whose ages ranged between 65 and 104 years. The clinical syndromes found to be associated with the final deterioration were classified into four groups: 1) ischaemia in 31 per cent; 2) toxaemia in 15 per cent; 3) unexpected complications in 25 per cent; and 4) incomplete or unsatisfactory diagnosis in 29 per cent.

In geriatrics the direction and speed of the patient's course are more important than the patient's exact position at any given time.
POTENTIALITIES FOR RESEARCH ON MECHANISMS OF AGING
Authors: Hrachovec Josef P.
Published: April 2015

Abstract

The interesting findings of many studies on aging are outlined. These indicate the importance of large‐scale research on the biology of senescence as an integral part of health maintenance and disease prevention. The Research on Aging Act (Bill 870), now before the Senate Committee on Labor and Public Welfare, deserves active evidence of the support of all physicians, since on its passage will depend many programs for the improvement of health in the later years of life.
PROLAPSUS UTERI CAUSING HYDRONEPHROSIS
Authors: Mueller‐Heubach Eberhard
Published: April 2015

Abstract

This report concerns the findings in 3 fatal cases of third‐degree prolapse of the uterus with pronounced hydronephrosis. The cause of the urinary obstruction in patients with prolapsus uteri seems to be compression of the ureters by the plexus of thickened uterine vessels which are stretched abnormally by the prolapsed cervix. This compression usually occurs at the point where the ureters and the blood vessels lie athwart one another in the base of the broad ligament.

Early correction of uterine prolapse is advocated because, even in longstanding cases, it may result in regression of the ureteral dilatation and thus prevent pyelonephrosis or uremia.
THE AGED OFFENDER: A REVIEW OF THE LITERATURE AND TWO CURRENT STUDIES FROM THE NEW YORK STATE DIVISION OF PAROLE
Authors: Hays David S. , Wisotsky Morris
Published: April 2015

Abstract

A review of the literature on criminality among the aged discloses a paucity of research in this important area. The few studies reported have focused on offenses associated with the psychological or psychopathological aspects of aging. Since there are scarcely any data on older men with a history of chronic delinquency, the present study was designed to meet this deficiency. It involved an investigation of offenders chronologically aged beyond 60 years, but whose crimes were committed in various periods of their lives, some even in childhood or adolescence.

The sample consisted of 36 males drawn at random from the population of aged parolees in the New York State Division of Parole. Data were chiefly obtained by means of a social‐data form developed by the writers and completed by the parole officers of the aged parolees. This form elicited information about personal identifying data, family history, criminal background and present life adjustment. A psychiatric examination also was made in half the cases. The findings led to the following conclusions: These aged parolees do not appear to be especially influenced by any religious, ethnic or familial factors. As a group they are relatively active, self‐supporting, and fairly well adjusted to their work and parole. Pathological disturbances are not as common or as severe as in Hay's study of elderly offenders drawn from a Mental Hygiene Unit population. The basic loneliness of aged offenders was strongly confirmed in regard to marital status (most had no spouse) and living arrangements. A subsidiary study of men who had committed less than three offenses showed a tendency to better mental health and a greater likelihood of marriage and employment as compared with men who had committed more than three offenses.
PRINCIPLES, RULES OF THUMB, OR WAYS OF LOOKING AT JOBS WITH LONG‐TERM PATIENTS*
Authors: Thompson Prescott W.
Published: April 2015

Abstract

Homes and other institutions for the aged should be places for living, not just dying. The characteristics of such a facility include stress on the individual identity of each patient, provision for individual preferences, no deprivations unless strictly necessary, and encouragement of patients in fulfilling their aspirations. The staff members should have a deep understanding of their patients. Psychiatrically trained nurses and social workers are a great asset. The psychiatrist as a consultant to the administration is a valuable additional to the staff. The job of caring for geriatric long‐term patients can be a challenge to provide ways for helping them to accomplish the tasks of the later years, so that their lives may have meaning until the very end.
LARGE CARCINOID TUMOR OF THE TRANSVERSE COLON
Authors: Case Thomas C.
Published: April 2015

Abstract

A case is reported of an unusually large (8 cm × 6 cm) carcinoid tumor of the transverse colon. The patient had marked anemia but no severe symptoms of obstruction although the bowel lumen proved to be almost completely occluded. Since the pathologist found no evidence of malignancy in the tumor nor of metastasis in the fourteen lymph nodes examined, surgical removal may prove to be curative.
CORTICAL BONE MINERAL DENSITY VERSUS CORTICAL THICKNESS IN THE DIAGNOSIS OF OSTEOPOROSIS: A ROENTGENOLOGIC‐DENSITOMETRIC STUDY*
Authors: MEEMA H. E. , MEEMA SYLVIA
Published: April 2015

Abstract: Cortical bone mineral density (porosity) values were compared to minimum combined cortical thickness values (for the radius) in normal and in osteoporotic men and women. The normal group consisted of 211 men and 301 women whose ages ranged from 21 to 91 years. The abnormal groups included: (a) 27 men and 35 women with osteoporosis (vertebral compression) whose ages ranged from 31 to 85 years, and (b) 10 women with hyperparathyroidism or osteomalacia whose average age was 53 years.

Both cortical bone mineral density and cortical thickness decreased significantly with aging, but there were many individual variations.

The type of cortical bone loss differed somewhat between the sexes, especially in the early stages of its development when porosity was relatively more marked in men whereas thinning prevailed in women. Thus early bone loss in most men and in some women cannot be diagnosed by the simple measurement of cortical thickness; more elaborate methods of bone mineral analysis are required. However, in the oldest age groups the degree of cortical thinning frequently paralleled that of porosity, and in women cortical thinning tended to be predominant. Therefore, cortical thickness measurements usually are adequate for the diagnosis of pronounced osteoporosis.

The average values for mineral density of cortical bone in normal young adults were similar to the values for ash weight per volume of cortical bone reported by other investigators. Since this ash content appears to be relatively constant in different mammals and in different bones of the same individual, the in vivo roentgenologic‐densitometric method of determining bone mineral density can be used to show deviations from normal such as occur in a significant proportion of cases of metabolic bone disease.
SYMPOSIUM ON OSTEOPOROSIS—SUMMATION AND EMPHASIS*
Authors: WHEDON G. DONALD
Published: April 2015

Abstract: The data in the preceding papers in this Symposium on Osteoporosis are summarized briefly. Each study has made an excellent contribution to our knowledge of bone physiology and pathology. The increasing interest in such research ensures a gradual improvement in our ability to prevent or treat the common, often serious disease, osteoporosis.
A GERIATRIC GYNECOLOGICAL SURVEY
Authors: TURKEL WITOLD V. , STONE MARTIN L. , NAPP E. EDWARD
Published: April 2015

Abstract: Findings of a geriatric gynecological survey at Bird S. Coler Hospital, New York, reflect the increased life expectancy of American females and thus the greater number of geriatric gynecological problems. This hospital cares for 750–800 female patients (average age, 71.5 years) who are admitted chiefly for chronic disabling disorders. The two phases of their gynecological care are: 1) routine screening examination, and 2) consultative services. Details are described. Candidates for surgery first must receive a medical clearance and a gynecological examination. Of the patients screened, 3.5 per cent were medically cleared for surgery; in these cases, surgery was successful in 57 per cent.

The present survey of 775 patients, as compared with a survey made ten years previously showed: 1) the incidence of senile vulvitis had decreased from 95.8 to 1.6 per cent, of atrophic vaginitis from 98.5 to 20.8 per cent, and of cystocele from 17 per cent to less than 1 per cent; and 2) the incidence of uterine fibroids, adnexal masses, uterine prolapse, rectocele and post‐hysterectomy conditions had remained relatively unchanged. In the present series, Papanicolaou tests showed a high percentage of normal cytology in the vaginal smears. In a significant percentage of patients who had received digitalis (but no estrogen) for more than a year, the vaginal smear showed an estrogenic effect as compared with the controls.
EXAMINATION OF GERIATRIC PATIENTS FOR CARPAL TUNNEL SYNDROME: RESULTS OF SURGICAL THERAPY
Authors: STERN FRANCIS H.
Published: April 2015

Abstract: The carpal tunnel syndrome may be found in elderly patients who work at jobs entailing repetitive use of the hands. In a series of 13 such patients, after failure of corticosteroid therapy, surgical therapy (transection of the anterior carpal ligament) produced complete relief of symptoms in 8 cases, 75 per cent relief in 2 cases, 50 per cent relief in 1 case, and no relief in 2 cases.

The occupational cause of carpal tunnel syndrome is frequently overlooked in favor of sometimes hasty diagnoses of cervical disease.
MENTAL PATIENTS IN NURSING HOMES. II. INTELLECTUAL IMPAIRMENT AND PHYSICAL ILLNESS*
Authors: STOTSKY BERNARD A. , DOMINICK JOAN R.
Published: April 2015

Abstract: Among geriatric patients transferred from mental hospitals to nursing homes, disorientation is common. Visual or aural impairment and short attention span are contributing factors. Suggestions are given for aiding the patients in this respect. Staff members should be on the alert to detect whether or not a physical illness or a drug‐induced change underlies an emotional disturbance in patients who are unable to communicate satisfactorily. Examples are given. Lack of information on the patient from the transferring hospital handicaps the nursing home in treatment. A sample record, containing the type of information required, is presented.
CHRONIC SUBDURAL HAEMATOMA IN THE AGED
Authors: LAVY S. , HERISHIANU Y.
Published: April 2015

Abstract: Fifteen elderly patients with chronic subdural haematoma were studied by various clinical and laboratory methods, including lumbar puncture, roentgenography, electroencephalography, echo‐encephalography, air studies and exploratory craniotomy. A history of head injury was obtained in only 6 of the 15 cases.

Two mechanisms seem to account for the neurological picture: 1) disturbed cerebral arterial circulation owing to direct pressure of the haematoma on the main artery of the hemisphere, and 2) progressive cerebral edema owing to impaired venous return. Since the condition of the patient may vary, the signs and symptoms may be confused with those of transient cerebral ischemic attacks. With early diagnosis and treatment of chronic subdural haematoma in the elderly, the prognosis is excellent.
A PHILOSOPHY FOR GERIATRIC RESEARCH
Authors: LOOMER HARRY P.
Published: April 2015

Abstract: The Menorah Geriatric Guidance Clinic was started eleven years ago in affiliation with the Menorah Home and Hospital for the Aged. An outline is given of its philosophy regarding investigaton of the “inner space of older man.” This is a prologue to a forthcoming comprehensive report on the performance of the clinic, the definition of prognostic factors in diagnosis and treatment, and plans for improving services.
THE CENTENARIANS: SOME FINDINGS AND CONCEPTS REGARDING THE AGED
Authors: LERNER JOSEPH
Published: April 2015

Abstract: There is no simple solution to the problems of the aged in our culture. Since the aged differ in their needs, the current generalizations fail to achieve adequate solutions.

Our study concerned 267 centenarians under Social Security in the United States. Among them were a judge and a former slave who still enjoyed life beyond age 100. However, for the great majority of these very old people, their longevity had little value or meaning. Most of them had no feeling of participation in their environment, either because of psychological factors or organic factors (or both). These centenarians as a group had withdrawn from life and were simply existing. In general, the picture of old age as a highly rewarding or golden period of life for “senior citizens” is not confirmed by these findings.
THE ERYTHROCYTE SEDIMENTATION RATE AND OTHER BLOOD TESTS IN TERMINAL CANCER
Authors: Mead John , Larson Daniel L.
Published: April 2015

Abstract

400 cases of advanced metastatic disease were reviewed; in 100, the patient had either a normal erythrocyte sedimentation rate (61 cases) or a normal level of lactic acid dehydrogenase (39 cases). In these 100 selected cases the values for serum total protein, alkaline phosphatase, calcium and phosphorus were usually normal. Two‐thirds of the patients had anemia.

Thus our present screening tests—erythrocyte sedimentation rate and lactic acid dehydrogenase activity—for the presence of occult or advanced metastatic disease are often inadequate.
RELIABILITY AND VALIDITY OF A SCALE FOR ASSESSING THE FUNCTIONING OF GERIATRIC PATIENTS
Authors: Plutchik R. , Conte H. , Lieberman M. , Bakur M. , Grossman J. , Lehrman N.
Published: April 2015

Abstract

A simple, objective rating scale for geriatric patients was developed and used to evaluate a sample of 207 patients at Bronx State Hospital. Evaluations were made mainly by ward attendants. Interjudge reliability based on independent assessments was +.87. Female patients were significantly older than male patients; however, there was no difference between males and females with regard to their impairment scores. Geriatric patients had significantly higher impairment scores than non‐geriatric patients. Clinical ratings by psychiatrists of the average level of ward functioning correlated closely with the mean rating scores. The scale appears to be a highly reliable and relatively valid measuring instrument for assessing the status of geriatric patients.
CHANGING PERSPECTIVES AND CROSS CURRENTS IN NURSING HOME CARE, 1968–1969*
Authors: MILLER MICHAEL B.
Published: April 2015

Abstract:

Objective evidence is cited of substantial progress in nursing home legislation, care of the patients, new construction, and a healthier attitude on the part of society for the continued care of the chronically ill aged. However, these are countered by many cross currents at all levels in the medico‐social revolution of medical care.

Although there is much progress, the uncertainty of the future in all areas of our society provides little room for complacency. Creative ideas are abundant, but stability remains elusive.
THE ROLE OF THE STATE HOSPITAL IN THE CARE OF THE ELDERLY*
Authors: KOBRYNSKI BORYS , MILLER ALAN D.
Published: April 2015

Abstract:

Advances in psychiatry and new attitudes of society toward the mentally ill have been instrumental in the transformation of the mental hospital from an asylum for deviants into an active therapeutic center for mental illnesses. Also a new approach has crystallized towards the geriatric group who until recently were placed indiscriminantly in mental hospitals.

In New York State mental hospitals the new selective admission policy for elderly patients showed in nine months more than a 30 per cent reduction of geriatric admissions and a significantly decreased mortality rate in the geriatric group. The use of newer therapeutic techniques has shown good promise and has changed the outlook for geriatric patients who previously received custodial care only. The release of elderly patients who improved to the extent of being able to live outside the hospital has been rather slow because of shortages in facilities and services in the communities. The Department of Mental Hygiene gives high priority to the funding of community programs for the elderly which will serve as alternatives more desirable than placement in a mental hospital. It is expected that when these programs are fully implemented the release of elderly patients from mental hospitals will be accelerated.
INCIDENCE OF SILENT POSTOPERATIVE PULMONARY EMBOLI IN GERIATRIC PATIENTS
Authors: STERNLIEB CHERYL M.
Published: April 2015

Abstract:

In an attempt to ascertain the incidence of post‐operative pulmonary emboli (including early small emboli) in the elderly, 50 surgical patients (age range, 21–91) were studied both preoperatively and postoperatively by means of the following: lung scintiscanning (four views), electrocardiograms, chest roentgenograms, and determinations of serum glutamic oxalacetic transaminase (SGOT), lactic dehydrogenase (LDH), and bilirubin. These tests were performed twice postoperatively at one‐week and two‐week intervals.

In 4 cases the postoperative lung scan findings were compatible with recent pulmonary emboli, although the patients were asymptomatic. There was no consistent correlation with serum enzyme elevations, nor with the sex of the patient, type of operation, type of anesthesia, or diabetic status. All 4 patients with indications of postoperative emboli were over 40 years of age, and 3 of them had undergone their operations in the lithotomy position. The overall incidence of positive findings with postoperative lung scanning was 8 per cent, but in patients over 40 years of age it was 10 per cent.

In view of the significant incidence of postoperative pulmonary emboli and the possible age correlation, further study is needed to ascertain the feasibility of prophylactic postoperative anticoagulation therapy in elderly patients.
PHASING OUT MEDICARE: CHANGING DEFINITIONS OF SKILLED NURSING CARE AND CUSTODIAL CARE*
Authors: Miller Michael B.
Published: April 2015

Abstract

Increasingly restrictive definitions of skilled nursing care versus custodial (or non‐covered) care by the Social Security Administration with respect to the Medicare program are now being implemented by fiscal intermediaries. If continued, the constructive intentions of Congress in behalf of the ill aged will be effectively frustrated and, in the name of economy, the national health care program for the aged will soon disappear.

The new synthetic definitions require evaluation and reappraisal in clinical terms if the welfare of the ill aged is to be served.
THE PROBLEM OF DEATH AND DYING IN THE GERIATRIC PATIENT*
Authors: Wolff Kurt
Published: April 2015

Abstract

The attitude of geriatric patients toward aging and death was studied in: (a) 90 psychiatric patients classified according to six personality types, and (b) 340 psychiatric patients (chronic brain syndrome or schizophrenic reaction) who were in contact with reality and could express their ideas coherently. The attitudes of these patients toward death ranged from lack of any special concern (in the passive‐dependent and schizoid personalities) to a great fear (in the other four personality groups). In 85 per cent of the 340 patients in the second study, the problems of death and dying played an important role in their emotions; moreover, 92 per cent were uncertain about their goals and values in life.

The psychiatrist has the task of helping to change the image of aging not only in the elderly but in our society. Old people need assistance in identifying or changing their life values. More important to the patient than “life hereafter” is his belief that he has not lived and is not now living in vain. This perception of self‐esteem engenders a feeling of serenity. The psychiatrist's therapeutic goal should be to convey hope, re‐establish confidence, and thus counteract the fear of death.
PENTAZOCINE INTRAMUSCULARLY FOR CONTROL OF POSTOPERATIVE PAIN IN ORTHOPEDIC PATIENTS
Authors: Befeler David , Giattini Joseph F.
Published: April 2015

Abstract

The analgesic efficacy and the safety of parenteral pentazocine therapy were evaluated in 210 postoperative orthopedic patients (106 males and 104 females) whose ages ranged from 14 to 91 years. At intervals of three to four hours, pentazocine was injected intramuscularly in doses ranging from 15 to 60 mg. In 41 cases the dosage schedule was variable. After omission of these cases, the observations on pain relief in relation to dosage were evaluated in 169 patients. The 15–20 mg group of 13 patients was too small a sample to serve as a basis for drawing conclusions. Thus the evaluation was based on the effects of a consistent dosage of 30, 45, 50 or 60 mg administered intramuscularly every three to four hours in 156 patients. Of these, 89 per cent reported excellent or good analgesia. The most commonly used dosage was 30 mg; with this, 91 per cent of 128 patients had excellent or good relief of pain. The drug was particularly effective in the elderly. The usual duration of therapy was one week.

Adverse reactions directly related to pentazocine occurred in 4 per cent of the 210 patients, but necessitated discontinuation of the drug in only 1 per cent. These untoward effects were usually mild and transient. Not one of the 45 patients in the 70–91 age group had an adverse reaction.

It is concluded that pentazocine administered intramuscularly is a well tolerated and effective analgesic for relieving postoperative pain in orthopedic patients.
ADDISON'S DISEASE DUE TO RETICULUM‐CELL SARCOMA APPARENTLY CONFINED TO THE ADRENALS
Authors: Sparagana Mario
Published: April 2015

Abstract

A 71‐year‐old diabetic white male was admitted with weakness, weight loss, fever, gastrointestinal symptoms, and postural hypotension. At first he was treated with digitalis and diuretics for congestive heart failure. However, he became worse and increasing signs of adrenal insufficiency appeared although there was no hyperpigmentation. Urinary steroid values before and after administration of ACTH, and the responses to fluorohydrocortisone and cortisone acetate supported the diagnosis of Addison's disease. After initial improvement, myocardial infarction, vasomotor collapse and pneumonia intervened. Despite increased dosages of steroids and the administration of antibiotics, oxygen and vasopressors, the patient died. At necropsy, the adrenals were found to be completely replaced by reticulum‐cell sarcoma. The tumor had invaded the upper pole of both kidneys, but no tumor tissue was found in the lymph nodes or in any other location. Presumably the tumor arose within the adrenals.
THE INTENSIVE CARE UNIT OF CONEY ISLAND HOSPITAL: ANALYSIS OF RESULTS IN A TWELVE‐MONTH PERIOD*
Authors: Bohensky Frederick B.
Published: April 2015

Abstract

737 patients were admitted to the intensive care unit of Coney Island Hospital during a twelve‐month period, at the rate of about 60 per month. The data are analyzed regarding sex, age, race, duration of illness, monthly admission rate, condition of the patient on admission, working diagnoses, length of hospital stay, effectiveness of treatment, final disposition, mortality rate, hour of death, and number of consultations. Of the 737 patients admitted, 269 died (130 of them being classified for the purposes of this study as D.O.A. because they were in the unit for less than twelve hours before death). For the remaining 468 patients, records of disposition were available on only 453; of these, 444 were transferred to the wards after improvement, and 9 were discharged. Contrary to the general impression, the number of deaths was no greater during the 11:00 p.m.–7:00 a.m. shift than at other times. For the patients receiving treatment in this intensive care unit, the mortality rate was 18.7 per cent—which seems quite low in view of the severity of the diseases, the poor prognosis, and the relatively advanced age of the patient (average age, 66 years).

The medical intensive care unit, though handicapped by the scarcity of qualified physicians and nurses, is an important element in good hospital care. Every effort should be made to improve and enhance such facilities.
THE PHENACETIN ENIGMA
Authors: Pribe Walter A.
Published: April 2015

Abstract

The unregulated sale of phenacetin‐containing anodynes frequently has led to abuse of this drug by consumers. The demonstration of renal papillary necrosis in persons who habitually use excessive amounts (3.5 kg or more as the cumulative lifetime dose) has been corroborated in extensive animal studies. It is not known whether phenacetin itself or one of its metabolites causes the damage. The mechanism of damage is probably inhibition of cellular enzymes and direct anoxia induced by interference with hemoglobin metabolism. The clinical diagnosis is difficult, but is aided by alertness for a history of phenacetin ingestion, even in the remote past. Further study can be expected to demonstrate an association between phenacetin ingestion and several renal disease processes of obscure etiology.