bluuebunny/crossref_metadata_2025 huggingface dataset:
ORAL METASTASIS FROM HYPERNEPHROMA*
Authors: Carmen Benjamin V. Del , Korbitz Bernard C.
Published: April 2015

Abstract

A case of hypernephroma (renal‐cell carcinoma) with oral metastasis is presented. The patient was a 77‐year‐old man who returned to his physician with a painful mass on his tongue three weeks after a left nephrectomy. He was subsequently referred to the authors with a tentative diagnosis of squamous‐cell carcinoma of the tongue. The mass could have been mistaken for another primary tumor but biopsy revealed metastatic hypernephroma. The reporting of cases such as this may help the clinician in the diagnosis of unusual metastatic lesions.
MANAGEMENT OF INFECTIONS AND INFESTATIONS IN THE ELDERLY*
Authors: Seneca Harry
Published: April 2015

Abstract

This survey includes discussion on: 1) the physiological and pathological characteristics of the elderly, particularly regarding their reactions to infections; 2) how the required specificity of antimicrobial therapy is achieved in cases of infection; 3) how antimicrobial therapy has affected mortality rates; 4) adverse drug reactions in the aged, 5) general principles of chemotherapy, and 6) the limitations of use for prophylaxis. The guiding principle for the therapeutic use of antibiotics and antibacterials is that the drug should be specific, i.e., chosen on the basis of its effect on the pathogens in susceptibility tests. A close watch should be kept for adverse effects.
IRREVERSIBLE BRAIN DAMAGE AND RELATED PROBLEMS: PRONOUNCEMENT OF DEATH
Authors: Ivan L. P.
Published: April 2015

Abstract

Irreversible brain damage in respirator‐treated coma patients is discussed from both the theoretical and practical points of view. In relation to postmortem organ transplantation, certain problems arise: 1) the conflicting interests between donor and recipient teams, 2) what constitutes the best possible care of the patient, 3) the criteria for the diagnosis of irreversible brain damage, 4) explaining the situation to the relatives, and 5) the pronouncement of death. The author proposes some helpful criteria that involve the “time of death by consultation” followed by the phase of “postmortem maintenance of organs.”
PERITONITIS IN GERIATRIC PATIENTS
Authors: Chaitin Horace , Wienick Leopold
Published: April 2015

Abstract

The diagnosis and management of peritonitis are becoming more and more important because of the great increase in our geriatric population. The mortality rate is particularly high among the aged. A series of 600 cases during a three‐year period is reported. The differential diagnosis involves numerous other diseases which may predominate in various age groups. It is essential to establish the cause of the peritonitis since the type of therapy depends upon the correct diagnosis. In cases of appendicitis, gall‐bladder disease, perforated peptic ulcer and mesenteric thrombosis, immediate operation is the treatment of choice. Conservative therapy gives the best results in pancreatitis or diverticulitis.
RECENT ADVANCES IN NEUROSURGICAL TREATMENT FOR THE ELDERLY*
Authors: Stellar Stanley , Cooper Irving S.
Published: April 2015

Abstract

The future looks bright for continued advances, not only in neurosurgery but in general surgery and its subspecialties, in the light of recent new techniques involving cryosurgery and the laser. This progress has particular application to the diseases common to middle‐aged and elderly persons. The authors' studies are outlined. There are good prospects for the better treatment of neoplasms (pending discovery of how to prevent them), and also the extension of the knowledge attained to other knotty therapeutic problems. In addition, there are the advantages of new drug treatment such as l‐dopa for Parkinson's disease, or perhaps hyperbaric oxygenation for certain brain disorders.
SERUM FOLATE AND VITAMIN‐B12 LEVELS IN THE ELDERLY
Authors: MEINDOK H. , DVORSKY R.
Published: April 2015

Abstract:

The serum levels of folic acid and vitamin B12 were estimated in 3 groups of subjects: Group 1 consisted of 59 elderly patients screened from 152 consecutive hospital admissions from homes for the aged and from a geriatric center; Group 2 consisted of 51 geriatric patients admitted to the hospital from their own homes; and Group 3 (controls) consisted of 100 younger healthy subjects who were not in the hospital. Medication with drugs known to interfere with the biologic assay of these vitamins was the chief reason for eliminating all but 59 of the 152 patients tested originally for Group 1.

Very low levels of serum folate (less than 3 mμg/ml) were found in 24 per cent of the Group 1 geriatric patients, in 7.8 per cent of the Group 2 geriatric patients, and 5 per cent of the younger controls. Two of the geriatric patients had anemia due to folate deficiency and responded to oral administration of folic acid. The high incidence of unusually low serum folate levels was attributed to widespread folic‐acid deficiency resulting from poor nutritional intake and related to organic disease, especially neurologic disability; apparently it bore no relationship to the chronologic age of the patients. The significantly higher level of serum vitamin B12 found in the geriatric group possibly was due to the increasing use of vitamin B12 (orally or parenterally) in the treatment of elderly patients during the last fourteen years.
PLASMA PROTEIN ELECTROPHORETIC PATTERN AND BLOOD VISCOSITY IN ARTERIOSCLEROTIC HEART DISEASE
Authors: MRAZEK SVATOPLUK A.
Published: April 2015

Abstract: During a three‐year follow‐up period a comparison was made of the plasma protein electrophoretic pattern and plasma and whole blood viscosity in 56 long‐term geriatric patients with arteriosclerotic heart disease (ASHD) and 20 “control” patients admitted after a recent attack of acute myocardial infarction (M. I.). The electrophoretic protein patterns were similar in both groups, with an increase in the height of the fibrogen peak and a decrease in the beta lipoprotein fraction. Whole blood viscosity usually was normal in the ASHD cases. In the cases of recent M. I., whole blood viscosity was normal or decreased in the patients treated with anticoagulants, and normal or increased in those who received no anticoagulant therapy.

The electrophoretic data support the hypothesis of a lowered reserve of cholesterol‐binding protein in ASHD, resulting in cholesterol lability and an increased tendency toward deposition. Increased viscosity of the blood can contribute to mechanical failure of the heart, especially if damaged by M. I.

The apparent increased incidence of ASHD in geriatric patients in this era of improved health care and updated diagnostic procedures is due to multiple factors which may not necessarily be present in each case. Some of these factors are discussed in relation to the data presented.
APPENDECTOMY IN ASSOCIATION WITH RIGHT INGUINAL HERNIORRHAPHY: REPORT OF A CASE
Authors: WEINSTEIN EUGENE C.
Published: April 2015

Abstract: This report describes the performance of an appendectomy during routine right inguinal herniorrhaphy. A brief review of the more recent literature on appendectomy as part of inguinal herniorrhaphy is presented along with the reasons why the prophylactic use of antibiotics does not seem warranted.
SUSTAINED‐RELEASE TRANQUILIZER THERAPY IN HOSPITALIZED GERIATRIC PATIENTS
Authors: CHESROW EUGENE J. , KAPLITZ SHERMAN E.
Published: April 2015

Abstract: Thirty hospitalized male geriatric patients with a variety of organic disorders causing moderate to severe anxiety‐tension states were treated with a sustained‐release form of meprobamate in a three‐week, placebo‐controlled, double‐blind study. Meprobamate in this form (800 mg per day in two doses) was significantly superior (clinically and statistically) to placebo for all factors tested—chiefly anxiety, tension, and insomnia—and the overall response. There were no significant side effects. Early in the study 10 patients (at the end of the study uncoded as 7 in the placebo group and 3 in the drug group) complained of lack of symptom relief, so the medication was changed to labelled sustained‐release meprobamate (Meprospan) without breaking the code. Marked improvement then occurred in 4 of this group.

The important reduction in frequency of administration and the prolonged effectiveness of the drug were also great advantages in giving the hospital staff members more time for intensive care of the patients.
THE FUNCTIONAL ASSESSMENT OF ELDERLY PEOPLE
Authors: Lawton M. Powell
Published: April 2015

Abstract

The author discusses various techniques for assessing the functioning of elderly people in the areas of physical health, physical self‐care, instrumental activities of daily living, mental and psychiatric status, social roles and activities, attitudes, morale, and life satisfaction. Though these tests of geriatric function are not yet perfected, the practitioner will find them a valuable aid in diagnosis, and thus in the selection of proper treatment for his aged patients.
PREDICTIVE MEDICINE. IV. THE GRADATION CONCEPT
Authors: Cheraskin E. , Ringsdorf W. M.
Published: April 2015

Abstract

In the traditional philosophy of medicine, a diagnosis usually is made only when a set number and constellation of signs and symptoms prevail. Hence, when there is a long and tortuous incubation period, clinically and biochemically, the disease may remain either undiagnosed or labelled as an ill‐defined psychologic syndrome. Sensitivity to clinical and biochemical changes is an integral part of predictive medicine.
PULVINECTOMY: A PRELIMINARY REPORT*
Authors: Cooper I. S. , Waltz J. M. , Amin I. , Fujita S.
Published: April 2015

Abstract

Based on the results of cryopulvinectomy in 6 totally incapacitated patients with advanced neurologic disease, it would seem that the pulvinar (a thalamic nucleus of which the function was formerly unknown) contributes to motor control, muscle length, and posture.
MECHANISM AND MANAGEMENT OF ANEMIA IN MALIGNANT DISEASE*
Authors: Korbitz Bernard C.
Published: April 2015

Abstract

The more common causes of anemia in malignant disease are discussed. Of 78 patients requiring transfusions on the Oncology Service of the University of Wisconsin Medical Center during the period December 1968–May 1969, records were available on 65. Gross blood loss was the most common cause of the anemia (44 cases); next was suppression of the bone marrow by chemotherapy (27 cases) or radiation therapy (8 cases); tumor spread to bone marrow (18 cases); infection (15 cases); uremia (5 cases); and poor nutrition (5 cases). Directions are given for evaluation of the patient.

The search for the cause of the anemia should be intensive, for only in this way can the proper diagnosis be made and the appropriate treatment recommended.
COMPENSATION ILLNESS AS A RETIREMENT CHANNEL
Authors: Brodsky Carroll M.
Published: April 2015

Abstract

This report concerns three categories of employees who are retired from work early because of a disability for which they can claim compensation: 1) the “worn out” worker with no special plans, 2) the man who has a hobby which he intends to pursue actively, and 3) the man who wants to engage in a different occupation after retirement. Extensive tests reveal no physical basis for the disability and treatment does not alter its course. Both patient and physician are involved in the transition from occupational function to subjective non‐function. Unless the situation is recognized, rehabilitation workers and vocational counselors are led to futile activity.

Most of these patients are happy in retirement. However, the fulfillment of their desires is very costly to society in time, money and frustration. It would seem to make social and economic sense to retrain certain motivated persons into new occupations before they become disabled in this manner. This applies particularly to persons in occupations that require great physical stamina and agility—occupations in which the workers wear out early.
GYNECOLOGICAL SURVEY OF HOSPITALIZED ELDERLY WOMEN
Authors: Glik I. , Soferman N.
Published: April 2015

Abstract

A survey of 235 elderly women (age range, 60–80+) admitted to the Obstetrics and Gynecology Department of a Municipal Governmental Hospital in Tel Aviv, Israel, revealed the following reasons for admission: postmenopausal bleeding in 117 women (50 per cent), genital prolapse in 78 women (33 per cent), and genital tumors in 40 women (17 per cent).

In 48 cases, curettage and biopsy showed that bleeding was due to local proliferative changes (polyps) or diffuse changes (polyposis and hyperplasia); in 46 cases bleeding was due to atrophic degenerative changes; and in 15 cases of carcinoma of the endometrium, it was related to estrogenic stimulation. In the majority of these cases, bleeding appeared between eleven and twenty years after the menopause.

Among the benign genital tumors, there were 4 cases of fibroid uterus, and 12 cases of ovarian tumor (5 functional cystic, 5 proliferative cystic, 1 endocrine thecoma type, and 1 fibroma). Three cases of malignant tumor of the ovary were all of the cystadenocarcinoma type. The patients with benign or malignant ovarian tumors complained of acute or chronic abdominal pain and postmenopausal bleeding. The other malignant tumors were: carcinoma of the cervix (3 cases), carcinoma of the vulva (2 cases), and carcinoma of the salpinx (1 case).

Genital prolapse was the second leading cause of surgical intervention. In most cases the patient's age was no contraindication for surgery, and the postoperative course was no different than in younger women, when appropriate precautions were taken.
MEDICAL CARE IN THE EXTENDED CARE FACILITY*
Authors: MILLER MICHAEL B.
Published: April 2015

Abstract:

Seven case reports are used to illustrate various aspects of quality care for the ill aged in an extended care facility or a nursing home. The majority of these patients require maximal nursing care for activities of daily living. Quality medical care implies the physician's capacity to design a therapeutic program involving the coordinated efforts of a total rehabilitation approach on the part of the available multidisciplinary professional team. If the concept of custodial care were made obsolete and only skilled care provided for all patients, quality medical care would ensue.
PEYRONIE'S DISEASE
Authors: Feder Bernard H.
Published: April 2015

Peyronie's disease, a penile deformity of the mature male, is distressing but not necessarily permanent. The initial inflammatory infiltrate does not always progress to irreversible fibrosis. Although spontaneous resolution sometimes occurs, resolution can be hastened and rendered more likely by anti‐inflammatory measures such as cortisone and small‐dose irradiation. Pain may have some significance. The deformity on erection tends to persist when treatment is delayed until pain has developed. The pain itself will often disappear. Fifty‐six patients were given small‐dose irradiation. Forty‐six determinate cases were available for definitive evaluation. Deformity persisted in only 4 of 10 (40 per cent) who were treated before pain had developed. Of the 36 who were treated after the development of pain, the deformity persisted in 24 (67 per cent). The pain failed to respond in only 7 of the 36 (19 per cent). Objective evaluation is difficult. Aggressive intervention may do more harm than good. Properly administered, small‐dose irradiation is an innocuous form of treatment which may prove helpful.
SODIUM BUTABARBITAL (BUTISOL SODIUM) AS AN HYPNOTIC AGENT FOR AGED PSYCHIATRIC PATIENTS WITH SLEEP DISORDERS*
Authors: Stotsky B. A. , Cole Jonathan O. , Tang Yun Teh , Gahm Irvin G.
Published: April 2015

Abstract

In a triple‐blind, crossover, fixed‐dosage study, sodium butabarbital (Butisol Sodium) was tested as an aid to sleep for 53 hospitalized aged psychiatric patients with sleep disorders. After one week of placebo therapy to detect “placebo reactors,” the additional three‐week schedule (oral administration) consisted of the following sequences: (a) placebo, Butisol 50 mg, Butisol 100 mg; (b) Butisol 50 mg, Butisol 100 mg, placebo; (c) Butisol 100 mg, placebo, Butisol 50 mg. Observations were made at the first two half hours after administration of medication at 8 p.m. and hourly thereafter until 6 a.m., for onset of sleep, duration of sleep, number of times awake, duration of waking period, quality of sleep, and mental state on awakening. Three tests were used for evaluating the patients: CGI, NOSIE and TES.

Sodium butabarbital (Butisol Sodium) in moderate dosage (50 mg) was an effective hypnotic agent for the majority of the patients and also appeared to be conducive to behavioral improvement in the daytime as reported by both nurses and psychiatrists. There was no advantage to using the 100‐mg dosage as an hypnotic, and some disadvantage with respect to daytime behavior. Patients slept better and longer during the drug periods than during the placebo periods. There were no more side effects during the drug periods than during the placebo periods, nor were more detrimental effects evident upon awakening. Clearly sodium butabarbital is useful as an hypnotic for aged psychiatric patients.
SENESCENCE: IDENTICAL RATES OF WATER LOSS IN VARIOUS SPECIES*
Authors: Calloway N. O.
Published: April 2015

Abstract

Water is lost constantly from animals throughout life, and the rate of loss is the same for all species. Thus the body of any animal at 2 years after conception shows the same percentage of water as the body of any other animal at 2 years after conception. When the rate of loss is graphed from empiric data, the following equation can be derived: W = W1A–k, where W is the percentage of water at any time, W1 is the percentage of water at unit time, A is age, and −k is a rate‐constant. The behavior of body water content with time in animals is described by the constant, —0.043. It is, therefore, an important rate‐constant in aging.
INSTITUTIONS FOR THE AGED—THERAPEUTIC COMMUNITIES?*
Authors: Grauer H.
Published: April 2015

Abstract

Certain modifications in technique and a restriction of therapeutic aims are necessary when the concept of milieu therapy is applied in geriatric settings. The main task is to help the aged residents accept dependency on others with a minimum of fear, anger and antisocial behaviour. In this way, undue depression, paranoia, and marked regression are prevented. The environment (milieu) should be one in which each patient functions at his own optimal level with some degree of choice and self‐determination. If approached in this manner, the “therapeutic community” can be a useful treatment modality in geriatric settings.
A CRITICAL APPRAISAL OF MILIEU THERAPY IN A GERIATRIC DAY HOSPITAL*
Authors: Goldstein S.
Published: April 2015

Abstract

The author outlines his experiences with milieu therapy in the establishment of a therapeutic community in a geriatric day hospital. Both the benefits and the difficulties are discussed. The findings eventually led to an “agonizing re‐appraisal” of methods, in order to avoid filling the day hospital with chronically ill and excessively dependent (but complaining) patients rather than with those who have acute disorders and need more immediate rehabilitation. Despite setbacks, the effort to create an optimal therapeutic milieu seems well worth while.
MOTOR MANIFESTATIONS IN MOLIMINA CRURUM NOCTURNA (INCLUDING “RESTLESS LEGS”)
Authors: Brenning Runar
Published: April 2015

Abstract

The author discusses the various motor manifestations of molimina crurum nocturna (MCN), with particular reference to nocturnal leg cramps and “restless legs.” He gives reasons why most nocturnal leg cramps can be classified as a symptom of MCN from a pathogenetic point of view, even if central‐nervous‐system impulses and preparation for muscular contraction are involved. Data are presented to show the efficacy of an enantaldehyde‐furaldehyde combination, among other drugs.
ADJUSTMENT OF PATIENTS AFTER HIP SURGERY*
Authors: Kupfer David J. , Detre Thomas P. , Swigar Mary E. , Southwick Wayne O.
Published: April 2015

Abstract

The relationship between intellectual functioning and postoperative adaptation was investigated in 25 geriatric patients who required surgery for hip fracture. One year after operation, two groups were formed on the basis of responses to a structured interview questionnaire. The two groups were: A) 10 well‐adjusted patients, and B) 10 poorly‐adjusted patients. The poorly‐adjusted patients with decreased general and psychosocial functioning showed impairments with respect to remote memory, simple calculation, and abstract thinking. They also had more cardiovascular disease in comparison to the well‐adjusted group.

Three alternative interpretations of the data are discussed: 1) the impairment in intellectual and social functioning in group B may have represented postoperative deterioration and thus caused the poor adjustment; 2) subtle signs of intellectual impairment may have escaped detection before surgery in group B; and 3) the baseline intellectual functioning of group A may have been higher preoperatively and consequently the better adjustment may have reflected the same trend post‐operatively.

An interview form (KDS™—10) is presented which can facilitate testing both before surgery and at various intervals during the follow‐up period.
COMMUNICATIVE NEEDS OF THE GERIATRIC POPULATION
Authors: Weiss Curtis E.
Published: April 2015

Abstract

Some of the communicative needs of geriatric patients are discussed. Perhaps the best way to demonstrate the importance of communication among the geriatric population is to place ourselves in that eventual situation. How shall we spend our later years? How satisfying will those years be if they are marred by difficulty in communication? By conducting scientific research and by providing remedial speech, language and hearing therapy for the aged, the answers to these questions might prove to be less traumatizing. By beginning now to work with our elderly citizens, speech clinicians can add “life” to the lives of the aged, and just possibly to their own lives.
ENTAMOEBA HISTOLYTICA ASSOCIATED WITH CHRONIC GLOMERULONEPHRITIS: CASE REPORT
Authors: Margolis Jack , Arganaras Eduardo , Margolis Robert
Published: April 2015

Abstract

A case is presented of amebiasis associated with chronic glomerulonephritis in an elderly man. At autopsy, trophozoites (Entamoeba histolytica) were found in the kidneys, bladder, prostrate, colon and lungs. Whether the association of amebiasis and chronic glomerulonephritis was a cause‐and‐effect relationship or simply a fortuitous occurrence could not be determined.
AN ERGOT PREPARATION (HYDERGINE) IN THE TREATMENT OF CEREBROVASCULAR DISORDERS IN THE GERIATRIC PATIENT: DOUBLE‐BLIND STUDY
Authors: Ditch Morris , Kelly Francis J. , Resnick Oscar
Published: April 2015

Abstract

In a controlled double blind study, 40 geriatric patients with cerebrovascular disorders were treated with sublingual tablets of Hydergine or placebo for twelve weeks. The inventory of symptoms (32 items) included an array which portrayed their physical status, behavioral traits, and intellectual impairments. Final appraisals based on re‐evaluations at three‐week intervals during treatment showed that, compared to the placebo, Hydergine produced greater improvements in 19 of the 30 items rated. The most impressive results ascribable to Hydergine pertained to cognition and intellectual function. No untoward effects from this drug were observed during the course of this study. A probable mode of action of this ergot preparation is also discussed.
A GERONTOLOGICAL SHELTERED WORKSHOP: THE AGED PERSON'S ATTITUDES ABOUT MONEY*
Authors: REINGOLD JACOB , WOLK ROBERT , SCHWARTZ SHIRLEY
Published: April 2015

Abstract: This study concerns 59 residents of an Old Age Home who participated, for pay, in the sheltered workshop program. Observations were made with regard to their earning capacity, how they spent their money, and what attitudes they had toward it.

The aged can, and want to, earn money. For them, it may have many meanings, e. g., comfort, a more satisfying way of life, or restoration of self‐esteem. Work may act therapeutically as a compensation for lack of love, appreciation and dignity. In attempting to be more sensitive to the needs of the aged, we should not overlook their need for personal money. Work for pay is an important factor in solving the overall problem.
AN INNOVATIVE PROGRAM FOR A PRIVATE PSYCHOGERIATRIC DAY CENTER
Authors: BERGER MILTON M. , BERGER LYNNE FLEXNER
Published: April 2015

Abstract: An initial report is presented concerning the establishment of a new type of “partial hospitalization unit” in an urban area to bridge the increasingly large, alarming and unmet gap between the services provided by state psychiatric hospitals and the essentially nonpsychiatric services provided by senior citizens centers for elderly men and women.

The authors describe the need for day centers specifically designed and staffed in a fashion which can offer: 1) the therapeutic resources for a flexible, individually prescribed program to meet the emotional, psychic and social needs of each person referred to the Center, and 2) an active program of re‐education and remotivation while cooperating with the patient's regimen for physical rehabilitation.
Relationship of Lipids to Glucose Tolerance and Insulin Response in the Aged*
Authors: WOLDOW ASHER , SHAPIRO BERNARD , COHEN JACOB J. , KOLLMAN GEORGE
Published: April 2015

The relation between lipid and carbohydrate metabolism was studied in 97 patients (average age, 82) by means of the glucose tolerance curve, blood insulin curve, and blood lipid pattern. A significant percentage of abnormal lipid values (including cholesterol and triglycerides) was found, whether or not the glucose tolerance curve was normal or abnormal. The blood insulin response to a 75–gm glucose load showed a correlation with lipid levels whereas the glucose tolerance curve alone did not. In patients with a high insulin response curve there was a greater incidence of abnormal lipid values than in patients with normal or low insulin response curves. The glucose‐insulin (G/I) ratio was an even better predictor of the lipid pattern. Low G/I ratios were more frequently associated with elevated lipid levels, regardless of the absolute glucose and insulin values.
Management of Complicated Biliary‐Tract Disease in Geriatric Patients*
Authors: GRODSINSKY C. , BRUSH B. E. , PONKA J. L.
Published: April 2015

The surgical complications of biliary‐tract disease are discussed in relation to a study comprising 18 cases of cholecystoduodenal fistula, 6 cases of gallstone ileus, and representative cases of gallstones, pancreatitis and suppurative cholangitis. The average age of the patients was 67 years. The findings led to the following conclusions: 1) age is an important factor in the increased risk in these complicated cases, but with careful management, surgery can be successful; 2) acute cholecystitis usually can be treated conservatively in aged patients, but all too often the patients ignore the recommendation for an elective operation and are later admitted to the hospital with complications that demand emergency surgery; 3) this sequence of events applies particularly to patients with biliary calculi, who should undergo an elective operation before more serious complications develop. Had our patients been operated on earlier, the surgical risk would have been minimal and the complications would have been prevented.
Gait Disorders in the Aged*
Authors: STEINBERG FRANZ U.
Published: April 2015

Since disorders of gait may eventually deprive the aged person of his independence, they should be detected early and treated before the disability becomes irreversible. In the healthy aged, changes in gait may be caused by loss of joint mobility and a decline in the precision of neuromuscular control. More serious gait disorders are caused by neurological or musculoskeletal disorders. Difficulty in walking may be the first manifestation of a stroke, parkinsonism, or a combined system disease. Other disorders such as the small‐step senile gait or apraxia of gait are directly related to the aging process. Lesions of the low back or the lower extremities are common causes of gait disturbances. Often overlooked is a deficiency in the low‐back and hip extensor mechanism. In the early phases, this condition is at least partially correctable by suitable physical therapy.
A Program for Review of Community Nursing‐Home Utilization*
Authors: PICKARD KARL
Published: April 2015

A Utilization Review Program in operation since January 1, 1971, has used a uniform method for studying over 5,000 patients in 35 nursing homes in the City of New York. New criteria for evaluating the need for long‐term care of these patients were accepted by the various sponsoring agencies. These criteria permit practical interpretation of the codes established for this purpose, and can serve as a blueprint for more such community programs as differentiated from programs associated with only a single institution. The new criteria should lead to tightening of the admission of patients who do not belong in nursing homes, and expedite the transfer of patients who no longer need long‐term care in these homes. The program was established for two main purposes: 1) to lower the costs for the sponsoring agencies, and 2) to improve the quality of medical care. To date there has been some progress in quality control, but no significant lowering of costs, apparently because of lack of health‐related facilities.

The findings may help to stimulate the establishment of proper health‐related facilities geared to the problems of the custodial care of patients who need restorative health measures. Such a program within such health‐related facilities would take care of physical, psychological and social rehabilitation. The institutional patients would be taught how to participate in this program, and elderly persons in the community could also take part. Thus the facility could become a true geriatric center.
Anticoagulant Therapy for Senile Dementia*
Authors: RATNER JACK , ROSENBERG GILBERT , KRAL VOJTECH A. , ENGELSMANN FRANK
Published: April 2015

A double‐blind, one‐year study was made of the effectiveness of anticoagulant therapy in senile and/or arteriosclerotic dementia. Seven such hospital patients (average age, 83.4 years) were treated with warfarin (sample oral dosage, 2.5 mg daily, monitored according to the prothrombin time). Seven other such patients (average age, 86.4 years) served as controls, and were given placebo tablets. All 14 subjects were assessed with respect to 25 variables reflecting cognitive functions and mental changes, before treatment, and at six and twelve months after starting treatment. The results were evaluated statistically. In the anticoagulant group the t‐tests showed no significant differences for the means in 24 of 25 variables during the one‐year treatment period. The control patients showed no significant changes in the psychological variables after six months; however, after one year, they showed significant deterioration in 4 variables and a trend toward deterioration in most of the others.

Thus the anticoagulant group appeared to deteriorate less than the control group. Only further studies will elucidate the possible influence of undertaking therapy in patients who already may have been too deteriorated to benefit from it significantly.
Conservative Surgery for Pancreatic Cancer in Geriatric Patients*
Authors: FICARRA BERNARD J.
Published: April 2015

A plea is made for a conservative approach to the surgical treatment of adenocarcinoma of the head of the pancreas in geriatric patients. A radical extensive extirpative operation carries a prohibitively high rate of morbidity and mortality. A conservative by‐pass procedure often enables the patient to live a few more years in relative physical comfort and social enjoyment. Experience with 12 geriatric patients is cited.
Common and Uncommon Neurological Manifestations as Presenting Symptoms of Vitamin‐B12 Deficiency
Authors: ABRAMSKY ODED
Published: April 2015

Data on 3 elderly patients with neurological manifestations of vitamin‐B12 deficiency, without anemia, are presented. In one case the appearance of peripheral neuropathy preceded the onset of speech disturbances and mental changes and the onset of the common syndrome of subacute combined degeneration of the spinal cord. In the other 2 patients, lateral sclerosis in one case and pseudotabes in the other case were the presenting features. Several months after the beginning of cyanocobalamin therapy, the patients were almost cured.

Early diagnosis of vitamin‐B12 deficiency is important in cases of myelopathy, encephalopathy or peripheral neuropathy without hematological changes, because the neurological damage may become completely irreversible if treatment is delayed by failure in early diagnosis.
Hyperkalemia and Coma Associated with Renal Tubular Acidosis in an Old Patient with Refractory Edema Due to the Nephrotic Syndrome: Furosemide‐Bicarbonate Therapy
Authors: SZENDE L. , RADÓ J. P. , TAKÓ J. , DÉVÉNYI I.
Published: April 2015

In a 70‐year‐old man, renal tubular acidosis and hyperkalemia occurred together with the nephrotic syndrome and stable chronic renal failure associated with diuretic‐refractory edema. Apparently an extreme medullary hyaline sclerosis accompanying nephroarteriosclerosis was the anatomical basis of the insufficiency of distal potassium and hydrogen‐ion secretion. The patient was refractory even to excessive doses of exogenous aldosterone. Therefore the edema was attributed exclusively to an increase of proximal tubular sodium reabsorption. The renal tubular acidosis was predominantly of the distal type, but the high daily bicarbonate requirement indicated also the presence of a proximal component. Hyperkalemia presumably was caused by the lack of aldosterone effect, but excessive proximal tubular sodium reabsorption also may have played a part. With or without the influence of diuretics, a definite correlation could be demonstrated between the osmolal clearance and the potassium clearance.

The decrease of hyperkalemia caused by furosemide, ethacrynic acid and hydrochlorothiazide was attributed to an enhanced sodium‐for‐potassium exchange in the distal tubules due to the increased sodium load induced by these drugs. The “refractory edema” could be drained off by high doses of furosemide (1600 mg a day) even in the presence of progressive impairment of renal function. By the intravenous infusion of high doses of furosemide and bicarbonate, the acidotic and hyperkalemic coma of this patient with “refractory edema” was successfully combatted several times.
Geriatric Hematology
Authors: EARNEY WILLIAM W. , EARNEY ADAM JOHN
Published: April 2015

A comprehensive hematologic study was made on 400 geriatric subjects (200 males and 200 females) in a nursing home. All the subjects were ambulatory and were considered to represent a relatively “normal” group for the 70–80 and 81–94 age brackets. The purpose was to determine whether geriatric blood values are comparable to standard adult blood values, and whether sex, or age groups beyond 70 had any effect.

The results indicated that geriatric hematologic values have a broader range (for both the high and low levels) than that of standard adult values. Also, there are quantitative differences in the mean values between geriatric men and women. There were no consistent indications that age beyond 70 affected the mean values for the geriatric group. No significant morphologic changes in the blood cells were observed.
Arteriosclerotic Changes of the Cerebral Vessels Simulating Intracranial Neoplastic Lesions
Authors: HERISHANU Y. , LAVY S. , HERMAN A.
Published: April 2015

This report concerns 3 elderly patients with a progressive hemispheric neurological syndrome in whom the electroencephalographic, brain‐scan, and angiographic findings were indicative of an intracranial neoplastic lesion. For further clarification, air studies were performed and severe generalized brain atrophy was demonstrated. The diagnostic pitfalls raised by angiographic findings which, in arteriosclerotic patients, sometimes may mimic a neoplastic lesion are stressed. The role of air studies in the final diagnosis is discussed.
Chronic Subdural Hematoma in the Elderly: A Challenge in Diagnosis and Treatment
Authors: RASKIND ROBERT , GLOVER M. BENJAMIN , WEISS S. R.
Published: April 2015

This report concerns 52 elderly patients with chronic subdural hematoma. Difficulties in diagnosis are enhanced in this age group because many of the elderly cannot give a coherent history and often manifest signs of changes in the central nervous system due to concomitant vascular and other degenerative diseases. Even in aged persons, chronic subdural hematoma is curable by surgical methods. In this series 39 patients were restored to normal function, and 9 to the previous level of function; 3 were lost to follow‐up; and only 1 was worse after surgery; there were no deaths. Poor results are almost always attributable to delay in diagnosis. Hence the importance of paying great attention to diagnostic procedures, and prompt treatment.
The Psychology of Death in Geriatrics
Authors: WEST NORMAN D.
Published: April 2015

The psychological problems related to the geriatric patient who is nearing death can well be related to geriatric patients in general. The following psychological factors chiefly influence the attitudes of elderly patients toward impending death: 1) mental impairment, 2) the feeling that death represents an end to physical suffering, 3) an end to loneliness, 4) an end to physical inadequacy, 5) the belief that it represents a chance to be reunited with loved ones, and 6) denial of the imminence of of death. Even if death does not intervene immediately, the physician can be of significant help in providing dignity and serenity to the elderly person during his last days.
Relevance of the Inter‐Society Commission for Heart Disease Resources to the Aging Population*
Authors: FREDRICKSON DONALD T.
Published: April 2015

The Inter‐Society Commission for Heart Disease Resources (ICHD) is an organization composed of 150 distinguished practitioners of cardiovascular medicine. In 30 reports it has identified the essential resources required for optimal cardiovascular care. This includes detailed specifications for cardiac surgical problems including catheterization‐angiocardiographic laboratories, coronary care units, pulmonary care units, instrumentation safety programs for hospitals, and many other diagnostic and treatment services. In addition, the Commission suggests ways in which a community's hospitals can be interrelated into a stratified system so that taken together the combination of resources provides the best possible cardiovascular care available under existing conditions. These statements will be of value to medical planners in all parts of the country as a guide for evaluating existing services and developing new programs.
An Accounting of An Iconoclast*
Authors: BARACH ALVAN L.
Published: April 2015

The author discusses some highlights in his learning experiences throughout life, as exemplified in the poetry of Milton (the character of Satan), the poetry of Goethe (the character of Faust), and particularly the teachings of Sigmund Freud.
Understanding Our Client, The Geriatric Patient*
Authors: HULICKA IRENE M.
Published: April 2015

The problems of geriatric patients in institutions are discussed. Their basic needs can be classified as physiological, safety and security, affiliation, esteem and self‐actualization. Factors in institutional life which militate against the fulfillment of these needs are depersonalization, biologization, dependency, authoritarianism, staff convenience and staff insensitivity. Recommendations are made for attempts to overcome these negative factors.
Tuberculin Skin Testing in a Chronically Sick Aged Population
Authors: NOVICK ANDREW , NOVICK ISAAC , POTOKER STEVEN , ROSENBERG GILBERT
Published: April 2015

Two hundred and thirty‐seven chronically sick aged patients were skin tested with Tuberculin PPD, Intermediate Test Strength. Healthy younger staff members constituted a control group. The percentage of negative reactors among the patients appeared to be directly related to the severity of their chronic illness, as represented by the various ward categories. The percentage of negative reactors among the patients who subsequently showed a positive reaction to Tuberculin PPD, Second Test Strength, was directly related to the state of health of the patients. In sick old persons, a negative reaction to Tuberculin PPD, Intermediate Test Strength, should be followed by testing with Second Test Strength before it can be confirmed that the person is a negative reactor. The significance of a negative reaction to even very large doses of Tuberculin PPD should be viewed in the context of the overall clinical picture when dealing with a chronically sick aged patient.
Acute Abdominal Symptoms Due to Torsion of an Ovarian Cystadenoma in a Centenarian
Authors: BALAS P. , BALAROUTSOS C. , CHRYSOSPATHIS P.
Published: April 2015

ABSTRACT: A case is reported of torsion of an ovarian cystadenoma in a 101‐year‐old woman. The tumor was removed surgically. The noteworthy features of the case were the rarity of this complication in such an aged woman, the presence of clinical and radiological signs that made the correct diagnosis possible before operation, and the remarkable tolerance to surgery displayed by the centenarian patient.
Arterial Oxygen Tension in Relation to Age in Hospital Subjects
Authors: NEUFELD OSCAR , SMITH JOSEF R. , GOLDMAN S. L.
Published: April 2015

One hundred and seventy‐seven hospital patients whose ages ranged from 20 to 80 years were studied to determine whether or not there are any changes in arterial oxygen tension (during the breathing of room air) in relation to age. The findings indicated that there is an inverse correlation between age and arterial oxygen tension. This may be of great clinical significance since anoxemia has a pronounced effect on the central nervous system, the cardiopulmonary system, and many aspects of the preoperative and postoperative status of surgical patients. The present concept that normal arterial oxygen tension is 100 mm Hg, regardless of age, may have to be altered.
Use of an Ergot Preparation (Hydergine) in the Convalescent Phase of Stroke
Authors: BOCHNER F. , EADIE M. J. , TYRER J. H.
Published: April 2015

Hydergine (1 mg three times daily) or placebo was administered orally to geriatric patients who were convalescing from stroke. Twenty‐one patients were studied in a 12‐week double‐blind trial, and 15 in a 12‐week double‐blind cross‐over study. Regular assessments were made of symptomatology, physical, mental and psychological status and recovery from paralysis. Statistical analyses of the results of both studies showed that there was no significant difference between the effects of Hydergine and of placebo. The possible relationship between cerebral function, cerebral arteriosclerosis and cerebral blood flow is discussed.
Transcutaneous Measurement of Arterial Wall Properties As a Potential Method of Estimating Aging*
Authors: MOZERSKY DAVID J. , SUMNER DAVID S. , HOKANSON D. E. , STRANDNESS D. E.
Published: April 2015

The visco‐elastic properties of arterial walls vary with the structural alterations which occur secondary to aging. An ultrasonic echo‐tracking device developed in this laboratory was used for noninvasive estimation of these properties. Femoral artery compliance (% Δ V/V) and pressure strain elastic modulus (Ep) were estimated in 36 normal subjects (68 vessels). The subjects were divided into three groups according to age: <35, 35–60, >60. The femoral arterial diameter and changes in diameter with each pulse beat were measured transcutaneously with the echo‐tracking device. Brachial arterial blood pressure was obtained by means of a cuff and stethoscope. The results showed a progressive increase in Ep and a complementary decrease in % Δ V/V with increasing age. Ep varied from 2.64 dynes/cm2 ± 0.26 SEM in the young group to 6.28 dynes/cm2 ± 1.03 SEM in the old group. % Δ V/V varied from 6.0% ± 0.5 SEM in the young group to 3.3% ± 10.5 SEM in the old group. Statistical comparisons of Ep showed significant differences between the groups, indicating that arterial stiffness increases with age. % Δ V/V was significantly lower in the old group than in the young. Variation within groups increased markedly with advancing age, and values for Ep and % Δ V/V overlapped in all groups.
Hypoferremia in Acute Myocardial Infarction
Authors: SYRKIS I. , MACHTEY I.
Published: April 2015

During the period 1960–1970, serum iron was estimated in 327 patients with acute myocardial infarction and compared with the levels of serum glutamic oxalacetic transaminase (SGOT) in the same subjects. Most of these patients had marked hypoferremia which was already evident by the second day after the infarction and lasted until the end of the first week after onset of the disease. The hypoferremia was much more pronounced than the elevation in SGOT and lasted longer. It is suggested that the drop in serum iron concentration can be used as an additional test in the diagnosis of acute myocardial infarction.
Clinical and Physiological Effects of Stimulation of the Paleocerebellum in Humans
Authors: COOPER I. S. , CRIGHEL E. , AMIN I.
Published: April 2015

Chronically implanted electrodes allowed the repeated stimulation, with different rates and intensities and for variable durations, of the paleocerebellum in 4 patients with intractable muscular hypertonia and also in a patient with epilepsy resistant to antiepileptic drugs. Chronic stimulation of the anterior cerebellum at high rates (100–200 cycles per second) inhibited muscular hypertonus. Chronic stimulation at 10 cycles per second in the patient with epilepsy inhibited the seizures.
Age‐Related Insulin Patterns in Normal Glucose Tolerance*
Authors: NOLAN SEAN , STEPHAN THORSTEN , CHAE SOO , VIDALON CARLOS , GEGICK CHARLES , KHURANA RAMESH C. , DANOWSKI T. S.
Published: April 2015

In 707 non‐obese female adults with unimpaired glucose tolerance, the fasting blood glucose levels of those in the fourth, fifth and sixth decades of life exceeded the levels found in those of the third decade (20–29 years), but there was no evidence of a progressive increase in successive age decades. The slightly greater fasting glycemia in the later age decades was accompanied by higher increments in blood glucose in the first half hour of the glucose tolerance test. These higher levels of glucose during the fasting state and in the first half hour after oral administration of glucose were not associated with increments in serum insulin greater than those recorded for the third age decade. This age‐related increase in fasting and post‐glucose blood sugar levels without an increase in serum insulin could result from the age‐related increase in the thickness of capillary basement membranes. The higher levels of glucose could then serve to restore glucose transport and cell glucose metabolites to normal without evoking a rise in serum insulin.

In 479 obese women with unimpaired glucose tolerance, there was no evidence of the age‐related increase in fasting blood glucose nor the slightly exaggerated hyperglycemia found early in the test in non‐obese subjects with normal glucose tolerance. The relative fasting hyperinsulinemia and the increased insulin responses to induced hyperglycemia known to characterize obese persons were present in all age decades but the hyperinsulinemia was less marked in subjects older than 30. In these obese subjects with unimpaired glucose tolerance, there was no evidence of any delay in the insulin response to the induced hyperglycemia.