bluuebunny/crossref_metadata_2025 huggingface dataset:
HYPERKALEMIC CHANGES DURING SPIRONOLACTONE THERAPY FOR CIRRHOSIS AND ASCITES, WITH SPECIAL REFERENCE TO HYPERKALEMIC INTERMITTENT PARALYSIS
Authors: Radó János P. , Marosi Judit , Szende László , Takó József
Published: April 2015

Abstract

The frequency and clinical significance of the hyperkalemia associated with spironolactone therapy was studied by analyzing 755 serum potassium values obtained on 29 patients with cirrhosis and ascites. The patients were classified as follows: 1) control group treated intermittently with combinations of conventional diuretics; and 2) spironolactone groups—(A) patients treated with spironolactone alone, and (B and C) nonazotemic and slightly azotemic patients, respectively, treated with spironolactone plus diuretics.

Hyperkalemia was indicated in 3.3 per cent of 302 control serum potassium determinations, and in 48 per cent of 325 determinations made during spironolactone treatment. The increase in serum potassium concentration was more marked in the slightly azotemic group, although the initial levels were no higher than in the other groups of patients. Hyperkalemic intermittent paralysis associated with spironolactone therapy occurred in 5 patients. Studies of the urinary excretory patterns suggested a distal as well as a proximal tubular site of action of spironolactone. The significance of the tubular levels of spironolactone action in the development of hyperkalemia is discussed.
BACTERIAL L‐FORMS FROM URINARY‐TRACT INFECTIONS IN A VETERANS HOSPITAL POPULATION*
Authors: Conner James F. , Coleman Sylvia E. , Davis John L. , McGaughey Fay S.
Published: April 2015

Abstract

In a study of 115 patients with chronic and acute urinary‐tract infections, 26 (23 per cent) were found to have bacterial L‐forms in the urine which could be cultured in a special hypertonic medium. The most common genera of bacteria producing these forms were Proteus, Pseudomonas and Escherichia‐Aerobacter. Most of the patients had cystitis, pyelonephritis or a general diagnosis of “urinary‐tract infection.” In a case of acute exacerbation of chronic pyelonephritis, the L‐form of Proteus mirabilis appeared after eradication of the parent form with chloramphenicol. The L‐form was sensitive to erythromycin even though the parent form was not, and after therapy with this antibiotic the L‐form did not reappear for a ten‐month period of study.

L‐forms occur frequently enough in the urine to warrant culturing for these forms specifically and considering the possible significance of L‐forms in relation to the type of urinary‐tract infection and the type of antibiotic therapy used.
DRIP INFUSION PYELOGRAPHY: A STUDY OF 300 CASES IN A GERIATRIC POPULATION
Authors: Arcomano Joseph P. , Kraft Ernest
Published: April 2015

Abstract

The urinary tract was studied by means of drip infusion pyelography (large volume of contrast material and fluid administered rapidly) in 300 male geriatric patients.

Results were better and reactions were fewer and less severe than with conventional pyelographic techniques. The necessity for retrograde pyelographic examination, with its attendant morbidity, was significantly reduced. Drip infusion pyelography is recommended as the procedure of choice for evaluating the urinary tract in elderly patients.
DIAGNOSTIC PROGRESS IN LUNG CANCER: HISTORICAL PERSPECTIVE
Authors: Rosenblatt Milton B. , Lisa James R.
Published: April 2015

Abstract

This article is a comprehensive review (including 72 references) of progress in the previously difficult diagnosis of lung cancer, from the early 19th century to the present time. The observations are grouped according to physical signs, sputum examination, x‐ray examination, bronchoscopy, thoracic surgery, ancillary procedures, and accuracy in diagnosis.

The “epidemic” rise in lung‐cancer mortality since 1930 may well be the result of newly acquired diagnostic facilities.
SUCCESSFUL SURGERY FOR CARCINOMA OF THE SIGMOID IN A 92‐YEAR‐OLD MAN: CASE REPORT
Authors: Case Thomas C.
Published: April 2015

Abstract

A case is presented of carcinoma of the sigmoid in a 92‐year‐old man. The tumor, which almost completely occluded the lumen of the bowel, was removed surgically and a two‐layer, end‐to‐end anastomosis performed. No metastases were evident. Recovery was good and the patient is well at present—more than a year later. This is an example of good prognosis for control of cancer in a very old patient who was able to withstand a major surgical procedure.
CARCINOMA OF THE PANCREAS IN ASSOCIATION WITH CHRONIC PANCREATITIS
Authors: Weinstein Eugene C.
Published: April 2015

Abstract

A well‐documented case of carcinoma of the pancreas in association with chronic pancreatitis is presented. It is hoped that other physicians with similar experiences will accurately report their cases so that an intelligent decision can be reached as to whether pancreatic carcinoma is one of the many sequelae to chronic pancreatitis.
SURGICAL CONSIDERATIONS IN THE TREATMENT OF CEREBROVASCULAR INSUFFICIENCY IN THE GERIATRIC PATIENT*
Authors: Diethrich Edward B. , McCutchen John J. , Liddicoat John E. , De Bakey Michael E.
Published: April 2015

Abstract

Extensive experience (more than 3,000 cases) with the operative treatment of cerebrovascular insufficiency has led to the recognition of definite patterns of extracranial arterial occlusive disease and the development of several concepts basic to the preoperative, operative and postoperative managment of these patients. Four case histories are presented, with detailed illustrations.

Although in the geriatric patient there is a high incidence of associated arterial lesions (e.g., aneurysm of the abdominal aorta and peripheral arterial occlusive disease) and of disorders of other organ systems (particularly the heart, lungs and kidneys), careful management of these cases has resulted in a low operative mortality and a high rate of long‐term relief of symptoms.
TREATMENT OF GERIATRIC PEPTIC ULCER WITH CHYMOTRYPSIN AND AN ANTIBIOTIC
Authors: Coblentz Alexander
Published: April 2015

Abstract

In man, the healing of a benign, non‐endocrine peptic ulcer of the stomach or duodenum is basically a process of regeneration dependent upon freedom from exposure to the digestive enzymes, unneutralized acid and infection. Under these conditions the peptic ulcer heals within ten days.

Our method involved the use of chymotrypsin—an enzyme inhibitor of gastric hydrochloric acid, the substrate for conversion of pepsinogen to pepsin—together with an antibiotic. Healing was obtained in 92 per cent of roentgenologically proven peptic ulcers in 146 geriatric patients, within ten days after starting treatment.

Evaluation of most methods of peptic ulcer therapy is open to criticism because of lack of controls. In this study each patient served as his own control, since during a nine‐year period, other methods of treatment had failed.
THE END OF THE ROAD? (CASE REPORT)
Authors: Friedman Jacob H.
Published: April 2015

Abstract

A case report is presented to illustrate the importance of a geriatric service and a proper therapeutic program in a State mental hospital. Such therapy can play a significant role in achieving maximal personal satisfaction, comfort and self‐esteem for many geriatric patients, with eventual resolution of severe emotional problems.
SEPTIC ARTHRITIS CAUSED BY HEMOPHILUS INFLUENZAE IN AN ADULT: CASE REPORT
Authors: Lefkovits Aaron M. , Noonan Jimmy R.
Published: April 2015

Abstract

In a 63‐year‐old Negro male, septic arthritis developed in the right knee (already the site of advanced degenerative changes) after an upper respiratory infection. The causative organism was identified as Hemophilus influenzae only after the fluid aspirated from the knee was inoculated into chocolate‐agar under CO2, four days after admission to the hospital. Re‐accumulated fluid was aspirated repeatedly from the joint. Antibiotics were administered intra‐articularly, intravenously and later orally. The patient also was treated symptomatically and with physiotherapy. He recovered satisfactorily to the point of being able to walk with crutches, and left the hospital eight weeks after admission.
CHANGING CONCEPTS IN THE TREATMENT OF URINARY INFECTIONS
Authors: Lampe William T.
Published: April 2015

Abstract

The present treatment of urinary‐tract infections is unsatisfactory because of the high rate of relapse. Attempts to prevent relapses should include careful study of the urinary tract (with as little instrumentation as possible) to determine the presence or absence of urinary obstruction—a prime cause of infection. The urine should be examined by cultural techniques for detecting significant bacteriuria. This should be repeated at the end of two weeks of therapy and at one month, three months, six months and a year thereafter.

The most important clinical aspect of treatment is long‐term follow‐up, checked by means of urine cultures. There is good evidence that long‐term treatment for one or two years with sulfamethoxazole or nitrofurantoin in combination with methenamine mandelate will reduce the recurrence rate of urinary‐tract infections; drug toxicity is low. The recommended short‐term (ten to fourteen days) course of treatment for initial infections is inadequate for the recurrent type. Recurrent urinary‐tract infections require long‐term treament in association with careful urine‐culture examinations at periodic intervals for one to two years.
ARTHROPATHY OF THE WRIST IN A PATIENT WITH DIABETIC NEURITIS
Authors: Berenyi Magdalena R. , Siegel Martin W. , Schwarz Gerhart S.
Published: April 2015

Abstract

A case of upper‐extremity destructive hypertrophic arthritis in a 64‐year‐old patient with diabetic neuropathy is presented. No previous report of such a lesion involving the upper extremity could be found.

As an increasing number of well controlled diabetic patients attain a longer life span, the incidence of diabetic neuropathy will rise, as will the incidence of associated arthropathies.
AN INTEGRATED THEORY OF AGING
Authors: Carpenter Donald G. , Loynd James A.
Published: April 2015

Abstract

An integrated theory of aging is proposed which consists of an interrelated grouping of other current theories. Each of these has had some success in explaining various separate phenomena of aging, but none has provided an explanation of all the phenomena associated with aging and death. The theories considered are: 1) cross‐linkage, 2) free‐radical, 3) collagen, 4) waste‐product, 5) rate‐of‐living, 6) stress, 7) diffusion, 8) mutation, 9) immunologic, and 10) cybernetic. The cybernetic theory is used as the framework within which the other theories serve as functional blocks, the key functional block being the cross‐linkage theory. Within the cybernetic framework, the various theories are aligned in two modes—the non‐genetic, and the genetic. The non‐genetic mode governs the organism's level of molecular efficiency, whereas the genetic mode governs the minimal level of molecular efficiency required for survival of the organism.

The integrated theory of aging appears to answer satisfactorily the objections to the individual theories, and to offer a basis for fairly accurate theoretical prediction of the experimentally observed mortality curve.
SOCIAL REHABILITATION OF THE AGED: SOME NEGLECTED ASPECTS*
Authors: Lawton M. Powell
Published: April 2015

Abstract

The first section of this article on some neglected aspects of social rehabilitation of the aged concerns the philosophy of rehabilitation. A general principle is that the probability of improvement is highest when the goal for the old person is set successively at only the next step higher than the current level of functioning. The personnel of the institution should be kept aware of the success of their efforts in attaining these realistic goals.

The ensuing sections of the article contain recommendations for certain fresh approaches to various problems regarding application of the old person to a home for the aged, the waiting period, and the crucial entry period. Since change of residence constitutes an acute stress for many old people, appropriate psychological and social attention is very important and may set the course for the success of rehabilitation. Private space, social space and furnishings in the institution are discussed. The importance of the staff is dealt with from the viewpoints of the social role, the helping role, and the personal distance between employee and resident. The goal of rehabilitation in the institution extends even to death in an attempt to add dignity and self‐respect in the final phase of life.
OBSTACLES TO GOOD MEDICAL EDUCATION IN PRIVATE COMMUNITY HOSPITALS—THE PROBLEM OF CONTINUING MEDICAL EDUCATION
Authors: WERCH S. C.
Published: April 2015

Abstract: This paper offers an analysis and evaluation of obstacles to the continuing medical education of physician‐practitioners associated with private community hospitals, as delineated in a study of the use of the educational keys (publications, lectures, exhibits, chart audits, consultation, house‐staff teaching, and research). It is concluded that obstacles may result from lack of understanding of the professional interests and needs of the physician‐practitioner and the improper and unskillful employment of educationl keys; and that these obstacles affect his continuing medical education according to the following groups: 1) those that affect the physician when he participates indirectly, 2) those that affect him when he participates directly, and 3) those that affect his motivation to participate. Recommendations are offered for the alleviation or removal of these barriers.
THE CROSSLINKAGE THEORY OF AGING
Authors: BJORKSTEN JOHAN
Published: April 2015

Abstract: For many decades the theory and practice of cross‐linking (bonding that ties two or more large molecules together side to side) have been developed in industry, but only since the 1940's has the theory been considered in the field of medicine as a primary reaction underlying age‐dependent changes.

Crosslinking is damaging to the tissues and involves loss of elasticity, reduced swelling capacity, increased resistance to hydrolases and probably enzymes generally, and thus an increase in molecular weight and a tendency toward embrittlement. There is a growing amount of direct evidence and much indirect evidence for postulating the relationship between crosslinking and aging.

Crosslinking agents present in the living organism include aldehydes, lipid oxidation products, sulfur, alkylating agents, quinones, free radicals induced by ionizing radiation, antibodies, polybasic acids, polyhalo derivatives and polyvalent metals. The latter four types of compound are slow‐acting but can also accumulate in the body to form a frozen metabolic pool. Sufficient amounts of all these potential crosslinking materials are present in the body to make the changes of aging unavoidable.
GERIATRIC OPHTHALMOLOGY: MAINTAINING READING ABILITY IN THE ELDERLY
Authors: DAVIDSON M.
Published: April 2015

Abstract: Attention is called to the great importance in a total rehabilitation program of promoting the maintenance of reading ability among the elderly. This is a powerful tool for opening channels of communication across space and time. It counteracts the tendency of the elderly toward isolation, withdrawal and mental deterioration. The primary goal is the achievement of life‐long learning, a value that cannot be measured in dollars and cents.

Manpower at present is quite inadequate for taking care of the total needs of our growing population, one‐tenth of which (the aged) consumes half of our available medical resources. This is particularly true in the field of eye care. Our limited goals involve less than 1 million of the aged, after eliminating the poorly motivated and those with poor ophthalmological prognoses.

A brief outline is given of the progress made in providing better visual aids for persons with partial sight, and in the development of promising research.

There is also urgent need for research on dyslexia in the aged and the potentiality of bibliotherapy in an attack on the problem.
SOCIAL DYSFUNCTION AMONG PSYCHIATRIC AND NON‐PSYCHIATRIC OUTPATIENTS*
Authors: Goodman Spencer P. , Schulthorpe William B. , Evje Margaret , Slater Phillip , Linn Margaret W.
Published: April 2015

Abstract

There has been a need for a quantitative measure of social functioning in older subjects, in addition to the intuitive appraisal made possible by social work orientation. Our purpose was to determine, through the use of a newly developed scale, the dimensions and degrees of social dysfunction in schizophrenic and medical outpatients in a VA hospital. Three teams of two social workers interviewed 80 male subjects. One worker used the scale and another made only a global judgment or adjustment. Multivariate computer analysis showed that the ratings for emotional withdrawal, adaptive rigidity, lack of participation in the community, goallessness, and low self‐concept discriminated the two groups at beyond the .01 level. Total scores on the 21‐item scale correlated at r = .89 with the global judgments of adjustment made by social workers not using the scale.

These results indicate validity for the scale, which measures dysfunction in personal, interpersonal, and performance areas. The findings also suggest that the scale—easily administered by social work practitioners—will lend itself to continuing research such as profiling samples of aging populations, or for teaching or diagnosis.
RESPONSE OF ISCHEMIC HEART DISEASE TO CHONDROITIN SULFATE‐A*
Authors: Morrison Lester M.
Published: April 2015

Abstract

One hundred and twenty patients with demonstrable ischemic heart disease (IHD) or coronary heart disease (CHD)—suggested designation, ischemic coronary disease (ICD)—were divided into two groups of 60 patients each and observed for a study period of two and a half years. Treatment was randomly assigned, and comparisons were made on the basis of clinical evaluation and mortality and morbidity rates. Sixty patients were treated with the acid mucopolysaccharide, chondroitin sulfate‐A (CSA), in addition to regular medicinal and dietary regimens. Sixty comparable patients serving as controls were not given CSA, but otherwise were treated under similar dietary and medicinal regimens. CSA was given orally in tablet form; the initial dosage of 10 gm daily was reduced to 1.5 gm daily, and was well tolerated by all patients. No abnormal laboratory or clinical findings and no toxicity or side effects from CSA were noted.

At the end of the 2.5‐year observation period, 21 of the 60 ICD patients in the control group had experienced acute cardiac episodes or myocardial ischemia; of these, 4 were fatal. The 17 survivors were hospitalized—7 with myocardial infarction, 7 with acute myocardial ischemia or coronary insufficiency, and 3 with non‐critical or transient myocardial ischemia. In the matched CSA‐treated group of 60 ICD patients, there were 5 deaths. Autopsies were conducted in all cases. One patient with myocardial ischemia died from a myocardial infarction. A second patient who died from myocardial infarction had persistent hypertension which often was difficult to control. A third patient, who had chronic atrial fibrillation and flutter, died from coronary insufficiency and cardiac congestive failure following a massive cerebrovascular hemorrhage. Two other patients died from non‐cardiac causes—one from a malignant cerebral astrocytoma, and the other from a skull injury which induced ventricular fibrillation. The surviving 55 patients of this group have not required treatment or hospital admission for acute cardiac symptoms or recurrent cardiac illness.

The ratio of 21:3 for coronary episodes in the CSA group versus the non‐CSA group warrants further studies with caid mucopolysaccharides such as CSA and CSC. This would involve statistically designed and controlled studies on large groups of patients and possibly on sections of the normal adult population. These data could be invaluable in determining the feasibility of the therapeutic use of acid mucopolysaccharides for the prevention and treatment of ischemic coronary disease.
BRONCHOPNEUMONIA IN TERMINALLY ILL PATIENTS
Authors: Mrazek Svatopluk A.
Published: April 2015

Abstract

Bronchopneumonia was found in one third of all autopsies at the VA hospital in Fayetteville, N.C. In about two thirds of the bronchopneumonia cases there was evidence of aspiration. The risk of bronchopneumonia is increased with old age, white race, length of hospital stay, and the presence of debilitating disease. This is particularly true in cases of cerebral arteriosclerosis, especially when associated with dysphagia. Aspiration due to dysphagia is a predominant cause of bronchopneumonia in these patients. The beginning of bronchopneumonia is usually insidious, the symptoms few, and the course often rapid. Meticulous preventive measures are more important than reliance upon diagnostic procedures and therapy.
THE GERIATRIC PROFILE INDEX: A SYSTEM FOR IDENTIFYING, MANAGING, AND PLANNING FOR GERIATRIC PATIENTS IN STATE HOSPITALS
Authors: Albers Dale A. , Howard Glen W. , Pasewark Richard W.
Published: April 2015

Abstract

The Geriatric Profile Index (GPI) is a procedure for identifying at any given time the number and characteristics of the inpatient geriatric population of a state hospital, as an aid in fiscal and program planning that will maintain quality standards of care.

The results of nearly three years' experience in Wyoming State Hospital can be summarized as follows: 1) The quick identification of the number and functional characteristics of the geriatric patients in the hospital prevents these patients from becoming lost among the general hospital population. 2) The GPI is a valuable aid in planning for the geriatric patient and his return to the community. Moreover, it provides a fairly consistent baseline with which to allocate and redeploy the hospital staff for the purpose of strengthening existing hospital programs and establishing new ones such as direct‐care services, physical therapy, geriatric social services, social remotivation, and community placement. Since its introduction, 30 per cent of our geriatric inpatient population have been returned to the community. 3) The GPI brings professional roles into sharper focus and delineates professional responsibility more clearly. It enhances communication between staff members at all levels because it lessens the use of professional jargon by providing a clear and concise nontechnical summary of the patient's situation, thereby minimizing the communication impediments often found in large organizations. It has antedated, and thus placed the hospital in early compliance with the Utilization and Review requirements of Medicare, Title XVIII. Its predictive quality has facilitated the development of new programs addressed to the needs of the elderly patient (Title XIX). It has also tended to refine staff thinking, in that it makes practitioners defend their diagnostic positions and clarify their concepts of practice.
OPEN‐HEART SURGERY IN PATIENTS OVER SIXTY YEARS OF AGE*
Authors: Bowles L. Thompson , Hallman Grady L. , Cooley Denton A.
Published: April 2015

Abstract

During an eight‐year period 54 patients over 60 years of age underwent open‐heart operations. All these patients were in the New York Heart Association's classifications III or IV.

The most common lesions requiring operation were ventricular aneurysm and aortic stenosis. The over‐all hospital mortality rate was 20 per cent. Five patients died after discharge from the hospital, mainly because of ischemic heart disease. Advanced coronary artery disease also was a factor in 4 of the 11 hospital deaths.

The mortality rate in elderly patients compares favorably with that in younger patients having similar lesions.

It is concluded that advanced age should not be a deterrent to surgical therapy for patients with heart disease if the operation otherwise is indicated.
NUTRITIONAL ASPECTS OF OSTEOPOROSIS*
Authors: LUTWAK LEO
Published: April 2015

Abstract: Osteoporosis is discussed from the viewpoints of pathophysiology and therapy. Particular attention is paid to the role of dietary calcium, and the influence of vitamin D, fat, phosphate and fluoride on the metabolism of calcium. Although increased calcium intake usually leads to increased absorption and retention of calcium, there are exceptions, and after prolonged periods of high calcium intake there may be less and less retention of calcium. With our present lack of knowledge about osteoporosis, prevention is more attainable than cure. Nevertheless, the treatment of osteoporosis should include adequate physical activity and adequate intake of calcium (at least 1 gram daily), protein, vitamin D, and (for females) estrogen.
QUANTITATIVE RADIOGRAPHIC SURVEY TECHNIQUE FOR DETECTION OF BONE LOSS*
Authors: ALBANESE ANTHONY A. , EDELSON A. HERBERT , LORENZE EDWARD J. , WEIN EVELYN H.
Published: April 2015

Abstract: Bone loss in adults is a problem of epidemiology, geography, biochemical individuality and nutritional history. In recent times, the problem has been further complicated by the extensive use of corticosteroids for the clinical management of arthritic diseases. Prolonged exposure to these substances is definitely associated with the onset of severe disabling osteoporosis.

Our preliminary radiographic data on 369 males and 666 females indicate that subnormal bone density in terms of finger phalanx 5–2 measurements is more prevalent in “healthy normal” subjects than heretofore realized. The procedure described here for the early detection of subclinical osteoporosis appears to be a useful aid in determination of the etiologic factors and assessment of the beneficial effects of various therapeutic modalities. As a logical continuation of this study, a questionnaire has been designed to relate change in phalanx 5‐2 bone density to such data as vital statistics, medical history, medication, fluoride exposure and dietary habits of each participant in the study. A survey of the present and future radiographic and associated biochemical data in this frame of reference should prove helpful in the determination of optimal measures for the prophylaxis and management of osteoporosis.
PERIPHERAL VASCULAR DISEASE EN THE AGED: MODERN CONCEPTS AND DIAGNOSTIC TECHNIQUES
Authors: RICCITELLI M. L.
Published: April 2015

Abstract: One of the most important problems in the management of elderly patients is the maintenance of adequate peripheral blood flow. The most common among the degenerative, vasospastic and inflammatory disorders interfering with the peripheral circulation is arteriosclerosis, a disease of obscure etiology and unsatisfactory therapy.

Accurate assessment of the peripheral circulatory reserve is mandatory for making earlier and more accurate diagnoses, and before drawing final conclusions about specific therapy. A complete detailed history, with information from all sources, is essential. Intermittent claudication is one of the earliest symptoms of chronic occlusive peripheral arterial disease.

Current techniques are discussed for the estimation of blood flow, for testing the dilatation capacity of blood vessels, and for detecting the site of arterial block. Included are oscillometry, plethysmography and claudication tests, in addition to clinical assessment. More sophisticated techniques used by research workers are thermography, conjunctival and nailbed biomicroscopy, disulfine blue clearance, and xenon133 scintiscanning.
TRIFLUPROMAZINE VERSUS PENTYLENETETRAZOL‐NICOTINIC ACID FOR TREATMENT OF CHRONIC BRAIN DISEASE ON A GENERAL‐HOSPITAL PSYCHIATRIC SERVICE
Authors: DANTO BRUCE L.
Published: April 2015

Abstract: A comparison was made of the effects of triflupromazine (Vesprin) and pentylenetetrazol‐nicotinic acid (Nico‐Metrazol) in 118 patients with cerebral arteriosclerosis or senile brain disease. For two weeks, 63 of the patients received Nico‐Metrazol and 55 received Vesprin in relatively low dosages. The study was conducted on the psychiatric wards of a general hospital, where patients await discharge placement after fifteen days' stay.

Evaluations were made according to rating scales for behavioral factors and side effects. For the 118 patients, over 90 per cent of the ratings for both drugs indicated no change, and less than 5 per cent indicated improvement. Side effects, when noted, were insignificant. Most patients still had to be discharged to state mental hospitals. These findings confirm the observations of others that a change is not observed earlier than four to six weeks.

Behavioral ratings under the necessarily short‐term periods of treatment and fashions in drugs do not provide effectual information. It would seem that better therapeutic agents are needed for the immediate treatment of aged persons with chronic brain disease who are admitted to the psychiatric wards of general hospitals because of the acute onset of unmanageable behavior.
OCCULT HYDROCEPHALUS IN THE ELDERLY
Authors: Chandrasekaran Subramaniam , Reynolds Robert E.
Published: April 2015

Abstract

Four cases of low‐pressure hydrocephalus were identified in the Chronic Disease Hospital of the Baltimore City Hospitals. The patients were men whose ages ranged from 50 to 62. Much optimisn is expressed in the literature about the treatment of low‐pressure hydrocephalus. The results of treatment in our 4 cases were not satisfactory; only 1 case benefitted from the shunting operations. Moreover, there is considerable risk inherent in the various diagnostic procedures.
MANAGEMENT OF CHRONIC BRAIN SYNDROME SECONDARY TO CEREBRAL ARTERIOSCLEROSIS, WITH SPECIAL REFERENCE TO PAPAVERINE HYDROCHLORIDE
Authors: Stern Francis H.
Published: April 2015

Abstract

The vasodilator drug, papaverine hydrochloride (sustained‐release form) was used in a double‐blind crossover study of 30 geriatric patients with symptoms of chronic brain syndrome secondary to cerebral arteriosclerosis. At a dosage level of 300 mg twice daily in sustained‐release form, papaverine hydrochloride was more effective than placebo in relieving 13 of the 15 target symptoms characterizing the syndrome. Side effects were numerous but mild, and did not interrupt the study. Drowsiness, constipation and vertigo accounted for 80 per cent of the side effects noted with the active drug, whereas 81.5 per cent of the side effects noted with placebo were nausea, vertigo, headache and flatulence. The drug had no significant effect on the weight of the patient.

Papaverine hydrochloride proved to be a valuable adjunct in the subjective relief of symptoms of chronic brain syndrome secondary to cerebral arteriosclerosis.
OBSTACLES IN COORDINATING SERVICES FOR THE CARE OF THE PSYCHIATRICALLY ILL AGED*
Authors: GAITZ CHARLES M. , HACKER SALLY
Published: April 2015

Abstract:

A coordinated program for comprehensive care is a good approach to the management of the psychiatrically ill aged. Nevertheless, the patients, their families, community professionals, and the organizational patterns of many facilities and agencies offer a variety of obstacles to comprehensive care. These obstacles are discussed under the headings: 1) attributes of the patients, 2) patient‐family interactions, 3) attributes of professional caregivers, 4) adequacy of community resources and organization, 5) multidisciplinary interactions, and 6) attributes of the case coordinator. These categories are not mutually exclusive, nor do they exhaust the full range of the problems. Such a classification, however, helps to determine some of the major difficulties encountered by coordinators in implementing programs for comprehensive care.
TREATMENT OF ANGINA PECTORIS WITH DIPYRIDAMOLE: A DOUBLE‐BLIND STUDY
Authors: IGLOE MAX C.
Published: April 2015

Abstract:

In a double‐blind study, 48 patients (age range, 47 to 75) with angina pectoris received either dipyridamole (Persantine) (200 mg daily) or placebo for an average of five months. Nitroglycerin was taken sublingually as required for relief of acute attacks. Previous use of long‐acting nitrates had produced no significant improvement.

Of the 26 patients receiving dipyridamole, 21 (81 per cent) showed an overall satisfactory clinical response (marked or moderate improvement) compared to 2 (9 per cent) of the 22 receiving placebo. The difference between the two treatments was statistically significant. Evaluation of objective criteria also showed the superiority of dipyridamole. The mean improvement for drug group vs. placebo group was as follows: decrease in anginal attacks, 48/24 per cent; decrease in need for nitroglycerin, 50/18 per cent; and increase in walking distance, 84/36 per cent. In terms of subjective evaluation of anginal pain, 69 per cent of the drug group improved compared to 18 per cent of the placebo group.

Two patients had reactions while taking the drug. Transient blurred vision was noted by one patient, but it did not interfere with continuation of dipyridamole. Nausea and insomnia in another patient (not in the final study group) caused cessation of therapy. No reactions were reported among the placebo patients.

From the results of this controlled study it is concluded that dipyridamole, a non‐nitrate coronary vasodilator, is a relatively safe and effective agent for the long‐term treatment of patients with angina pectoris.
POLYMYOSITIS ASSOCIATED WITH CARCINOMA OF THE PROSTATE
Authors: MACHTEY I.
Published: April 2015

Abstract:

The case is presented of a man who, at the age of 63, began to complain of joint pain. The clinical picture of polymyositis gradually developed, and three years after the onset of the joint pain a carcinoma of the prostate was diagnosed. The rheumatic complaints improved during treatment with indomethacin and estrogen. Early in the disease a repeatedly abnormal x‐ray finding in the duodenum raised the possibility of a carcinoma of the pancreas. At the height of this symptomatology, the patient twice exhibited neurological signs, diagnosed as a small stroke; an abnormal EEG was found immediately following the second attack and one year later.

This report adds a new case to the few in which polymyositis is associated with carcinoma of the prostate.
CRANIOPHARYNGIOMA IN AGED PATIENTS
Authors: HERISHANU Y.
Published: April 2015

Abstract:

At Hadassah University Hospital, Jerusalem, in the last fifteen years there have been 4 cases of craniopharyngioma in patients more than 50 years of age. The clinical picture was characterised by organic mental signs and the absence of suprasellar calcification on regular x‐ray examination. Ocular impairment was present in 3 of the 4 cases. In all 4 patients the tumor was located behind the optic chiasm, indicating that perhaps craniopharyngioma in aged patients is a different tumor from craniopharyngioma in young patients in whom it shows several specific characteristics. Air‐contrast studies of the brain ventricles were the preoperative diagnostic method of choice. Confirmation of the diagnosis was made at operation in 3 patients, and at necropsy in the fourth.
THE PANCREATIC BETA‐CELL RESPONSE TO INTRAVENOUS ADMINISTRATION OF GLUCOSE IN ELDERLY SUBJECTS*
Authors: Barbagallo‐Sangiorgi G. , Laudicina E. , Bompiani G. D. , Durante F.
Published: April 2015

Abstract

A study was made of the serum insulin level after the intravenous administration of glucose (0.33 gm/ kg) in two groups of normal subjects—18 in the 60–85 age bracket, and 16 in the 23–45 age bracket. All had a normal coefficient of glucose utilization and a normal blood glucose curve after intravenous administration of glucose. Serum insulin was assayed by the radio‐immunological method, with use of an ion exchange resin. Blood samples were drawn at 2, 5, 10, 30, 45 and 60 minutes after the end of the glucose infusion.

In the elderly subjects the maximal value was reached only after 5 minutes and the mean value was 39± 9 µU/ml (range, 27–50), whereas in the younger subjects the serum insulin level rose immediately, reaching a maximal value 2 minutes after glucose infusion, the mean value being 54 ± 10 µU/ml (range, 42–66). Thus the response of the pancreatic beta‐cells to functional stimulation in the elderly subjects was slower and weaker than in the younger ones, although there was no decrease in glucose tolerance. There were no differences with respect to the peripheral utilization of insulin.
SULFAMETER IN CLINICAL MEDICINE
Authors: Seneca Harry
Published: April 2015

Abstract

Sulfameter (sulfamethoxydiazine, Sulla) is a safe long‐acting sulfonamide of low toxicity. It can maintain blood and urinary sulfonamide levels, with 5 per cent acetylation in the blood and 20–30 per cent acetylation in the urine. The dosage is 500 mg three times daily for the first day, followed by a maintenance dosage of 500 mg daily for two weeks.

Good clinical and bacteriological results have been reported from both Europe and the United States in the treatment of respiratory infections, urinary‐tract infections, ear, nose and throat infections, and skin infections including pustular acne vulgaris. Sulfamethoxydiazine also can be used as a suppressive drug for as long as nine months in the management of chronic urinary‐tract infections, with no adverse side effects.
MOFETTE THERAPY AND CO2 WATERBATHS FOR ARTERIOSCLEROSIS OBLITERANS
Authors: Hadnagy CS. , Balogh L. , Krepsz I. , Benedek G. , Brassai Z. , Csorba L. , Andras E.
Published: April 2015

Abstract

Although for centuries balneotherapy has been popular in Europe, it has not attained wide acceptance in the United States. This article is an interesting sidelight on a specific means of inducing therapeutic vasodilatation. In Covasna, Rumania, post‐volcanic CO2 gas emanations are used in the form of mofette therapy (twice daily) and CO2 waterbaths (about once daily) for the treatment of rheumatic diseases.

This study concerns 40 male geriatric patients with arteriosclerosis obliterans, whose symptoms improved markedly during treatment. In each, the state of the circulation in the big toe of an affected foot was evaluated by means of radioactivity measurements after injection of I131—both before and after therapy. The results indicated that the arterial blood supply to the feet was definitely enhanced after CO2 therapy, thus promoting the formation of collateral circulation.
ENVIRONMENT, ITS LANGUAGE AND THE AGING
Authors: Weinberg Jack
Published: April 2015

Abstract

Aging should be viewed as a slowly emerging developmental phase in the life span of the individual. It involves a dual process: 1) primary aging, which may be considered the normal progression of biological matter towards eventual death, and 2) secondary aging, which is pathological and is a result of environmental deficiencies and stresses imposed upon the organism.

People, regardless of age, relate to their environment only to the degree in which it contains information relevant to them. Environment has a language containing messages that constantly convey information to us. We perceive and decode these messages through our sensory apparatus. Our sensory, organs envelop each of us with personal spatial boundaries within which messages may be perceived, and which may differ in dimension and scope for each organ. With aging, our sensory organs undergo changes which limit their capacity to perceive and decode the messages received. In addition there is the psychological dynamism of the exclusion of stimuli, which is a defensive maneuver of our problem‐solving self, our ego, when our reservoir of psychic energy is at a low ebb. Yet, culturally we do everything possible to minimize the amount of information carried by these modalities.

Both the aging process and the environment have their particular languages. Improving the communication between them can prevent or reduce the state of reciprocal withdrawal, which is all too common among the aged and enhances the feeling of alienation and despair. A great deal can be done to enrich the environmental information and thus augment the messages carried to the aging organism.
OXYGEN INHALATION IN OBLITERATIVE ARTERIAL DISEASE, INCLUDING ITS USE IN SENILITY
Authors: Barach Alvan L.
Published: April 2015

Abstract

In elderly persons with excellent mental and physical health there may be only a 7 per cent decrease in cerebral blood flow with aging, whereas in patients with cerebral arteriosclerosis and organic brain disease there is demonstrable hypoxia of the brain tissue with a 20–25 per cent decrease in cerebral blood flow. As suggested by Kety et al., lack of oxygen seems to be the primary disturbance, rather than inability of the aging brain cells to absorb and metabolize oxygen. An adequate environmental oxygen supply to the brain is an important factor in the maintenance of unimpaired function of the higher faculties in man.

This article outlines the historical development of our knowledge of ischemic hypoxia as a physiological background for the therapeutic use of hyperbaric oxygen in cerebral arteriosclerosis and senility. Data also are included on the intermittent inhalation of high concentrations of oxygen at atmospheric pressure, over prolonged periods. With either type of oxygen therapy there have been reports of improvements in patients with obliterative disease of the cerebral, coronary and peripheral circulation, especially with regard to the acute manifestations.

Additional studies are required to confirm the value of such oxygen therapy in cerebral arteriosclerosis, particularly as it often appears to be effective in acute coronary arteriosclerosis. This admittedly speculative concept seems worthy of investigation.
SPECULATIONS ON VASCULAR CHANGES WITH AGE
Authors: Goldman Ralph
Published: April 2015

Abstract

Several extracardiac age changes may affect cardiovascular efficiency. Extracellular fluid and blood volume are relatively increased with age. The loss of aortic elasticity results in a rise in systolic pressure when work produces increases in cardiac output. The vascular rigidity further consumes energy by loss of the propulsive effect of elastic recoil. Finally, peripheral resistance increases due to arteriolar constriction; this appears to be under reversible physiologic control. The sum of these normal changes contributes to the functional decrement of aging; it is more universal and more important than atherosclerosis, yet has commanded inadequate attention.
IMPLANTABLE TRANSVENOUS CARDIAC PACEMAKERS: INDICATIONS, COMPLICATIONS AND MANAGEMENT*
Authors: Goldman B. S. , Black L. L. , Lipton I. H.
Published: April 2015

Abstract

Permanent transvenous pacing of the heart for control of both rate and rhythm has achieved widespread acceptance in the treatment of heart block. It is now performed in adults of any age group, and there are no special contraindications. Data are presented on the results of 122 transvenous pacemaker implantations from one to three years after operation. The average age of the patients was 68, and 38 of them were over 75 years old. Episodic sinus arrest or asystole in patients with otherwise adequate cardiac rates can be detected by continuous electrocardiographic monitoring and treated by implantation of demand‐type pacemakers. Asynchronous units now are used only in very elderly patients with stable complete heart block.

Displacement of the catheter has been the major problem; if recurrent, it is managed by direct epicardial insertion of the pacemaker leads through an extrapleural approach to the heart. The longevity of the power‐pack components and the battery still falls short of the manufacturers' claims. This emphasizes the need for establishment of pacemaker clinics so that sudden failure of pacemakers can be prevented.
SERUM CHOLESTEROL AND CHOLESTEROL‐ESTERIFYING ACTIVITY IN ATHEROSCLEROSIS*
Authors: GHERONDACHE CONSTANTIN N. , BLINSTRUB CHESTER A.
Published: April 2015

Abstract: In a group of 240 elderly subjects (149 women and 91 men, age range 65 to 95) drawn at random from a population of 650 geriatric patients, the women showed a higher incidence of coronary artery disease and a lower incidence of cerebral atherosclerosis than the men.

In the atherosclerotic patients there was a higher concentration of total serum cholesterol (213.4 ± 3.5 S.E. mg/100 ml) and a lower level of cholesterol‐esterifying activity (27.7 ± 0.8 S.E.) than in the healthy elderly subjects (180.8 ± 6.9 S.E. mg/100 ml, P < .001; and 46.8 ± 1.1 S.E., P < .001 respectively). These differences were more significant in women than in men. In general, the mean serum cholesterol level was higher in the women with atherosclerotic manifestations than in the men (223.4 ± 5.7 S.E. mg/100 ml versus 200.9 ± 2.8 S.E. mg/100 ml in the coronary artery disease group; and 220.0 ± 6.2 S.E. mg/100 ml versus 196.8 ± 7.9 S.E. mg/100 ml in the cerebral atherosclerosis group). These sex differences may be related to the hormonal changes that occur in women at the age of the menopause.

The cholesterol‐esterifying activity of serum was significantly higher in the healthy group (46.8 ± 1.1 S.E.) than in the group with coronary artery disease (30.3 ± 1.2 S.E., P < .001) or in the group with cerebral atherosclerosis (25.5 ± 1.0 S.E., P <.001).
SELF‐ADMINISTRATION OF MEDICATIONS BY PATIENTS IN HOSPITALS OR EXTENDED CARE FACILITIES
Authors: LIBOW L. S. , MEHL B.
Published: April 2015

Abstract: Patients in hospitals and extended care facilities usually are given their medications by a nurse until the very moment of discharge. Then they are expected to adhere accurately to often difficult schedules which may include taking several drug preparations of confusing sizes, shapes and colors.

A group of 20 elderly long‐term hospital patients were studied for their abilities regarding self‐administration of medications. They demonstrated surprising accuracy. In the two‐week study, only 5 of the 20 patients made errors; and in a total of 588 opportunities, only 14 errors occurred.

Self‐administration, in properly selected cases, appears to offer a chance to “teach” patients and to tailor the medication schedules realistically to their limitations. The results of our small pilot study indicate that, through appropriate application of this policy, we may expect a freeing of nursing time for other services, a decrease in hospital costs, and a reduction of post‐hospital morbidity through increased accuracy of drug administration. Several other facets of this policy are under study, e.g., how well patients will perform during longer periods; the methods for checking reliability of the patient; the roles of nurse, pharmacist and physician; and the hospital legal aspects.
GERIATRIC HERPES ZOSTER*
Authors: Rogers R. S. , Tindall John P.
Published: April 2015

Abstract

A retrospective study was made of the 243 geriatric patients with herpes zoster and post‐zoster complications referred to Duke University Medical Center during the years 1939 through 1968. The factors of age, race, sex, distribution, laterality, duration, severity, complications, and associated disorders were evaluated. There was an absolute increase in the frequency of trigeminal nerve involvement among geriatric zoster patients compared with zoster patients of all ages. The commonly‐held belief that the duration is longer and the disease more severe in geriatric patients was confirmed. The incidence of complications also was significantly increased in the 243 geriatric zoster patients.

Suggestions concerning the management of both uncomplicated and complicated cases of herpes zoster are made. The use of large systemic dosages of corticosteroids is discussed in terms of the benefits versus the risks.