bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Vaginal Flora after Natural or Surgical Menopause
Authors: Blum Martin , Elian Inge 
Published: April 2015

ABSTRACTA study was made of the cervical and upper vaginal flora in menopausal women, in an attempt to determine whether such women are predisposed to infections when undergoing gynecologic operations. The series comprised 72 women (age range, 44–80 years) classified as follows: a) 35 with a natural menopause, b) 18 with a surgical menopause induced by abdominal panhysterectomy, and c) 19 postmenopausal women after vaginal hysterectomy performed for genital prolapse. The vaginal flora of these menopausal women consisted predominantly of Gram‐positive bacteria which, together with the Gram‐negative bacteria, conformed to the normal pattern of microorganisms in the vagina. Such bacteria also are found in women of child‐bearing age, but occasionally they can be pathogenic. Despite the inherent biohormonal changes of the menopause, expressed especially by the low estrogen level, 26.4 percent of the cultures in our study were sterile, even after major vaginal operations. Thus, the pattern of the vaginal flora, even though occasionally pathogenic, should not be a contraindication to gynecologic surgical procedures in postmenopausal women. Even when vaginal cultures show the presence of these bacteria, it does not seem necessary to use prophylactic antibiotic and hormonal therapy routinely. Rather, it should be given selectively, depending upon the local state of the tissues and upon the postoperative course.
Occult Progressive Renal Damage in the Elderly Male Due to Benign Prostatic Hypertrophy
Authors: Mukamel E. , Nissenkorn I. , Boner G. , Servadio C. 
Published: April 2015

ABSTRACTA review of the case histories of 345 patients who underwent prostatectomy showed that 1.7 percent (6 patients) had “occult and progressive renal damage” secondary to prostatic hypertrophy. All these men were over the age of 60 and the disturbances in micturition were so mild that the patients were unaware of, or chose to ignore them. The presenting symptoms were nonspecific and included generalized weakness, anorexia, nausea, constipation, and weight loss. Investigation revealed imparied renal function of varying degrees. Prostatectomy was associated with a dramatic improvement in all 6 patients. Physicians should be aware of the clinical entity of occult and progressive renal damage secondary to obstruction of the bladder outlet, especially in the elderly male. Uremia can develop with minimal urinary symptoms. Elderly men often suppress or deny their symptoms because of the fear of operation.
“Spontaneous” Atheroembolic Disease As a Cause of Renal Failure in the Elderly*
Authors: Varanasi Umamaheswara R. , Moorthy A. Vishnu , Beirne Gregory J. 
Published: April 2015

ABSTRACTAn 86‐year‐old man with previous normal renal function was hospitalized because of renal insufficiency. He had a long history of atherosclerotic heart disease, mild hypertension and pulmonary embolism, requiring anticoagulant therapy. In view of the normal‐sized kidneys and absence of casts in the urinary sediment, a diagnosis of atheroembolic renal disease was made. The patient's renal function deteriorated, but he refused hemodialysis. Death occurred within a few weeks. At autopsy, severe aortic atherosclerosis was observed and atheroembolic renal disease was confirmed as the cause of renal failure. Occasionally, renal failure can be the sole manifestation of spontaneous atheroembolic disease. This possibility should be considered if the physician is called upon to establish the diagnosis when renal insufficiency develops in atherosclerotic patients.
Contributions of the Long‐Term Care Facility to the Medical Care of the Aged
Authors: Rodstein Manuel 
Published: April 2015

ABSTRACTCare of the aged in the United States by advanced long‐term care institutions has resulted in many important contributions to our knowledge of the aging process and disease over the past four decades. These institutions are characterized by well organized medical staffs, with full‐time medical directors who also serve as chiefs of the Medical Department and as stimulators and coordinators of research and teaching. These institutions provide comprehensive management, with laboratory, x‐ray and necropsy capabilities and multiple levels of care. Many serve as teaching centers and have affiliations with medical schools and university hospitals for house staff and postgraduate medical training. Several contributions to the medical literature on aging are described, among them being the earliest published in this country concerning pneumonia, cancer, arcus senilis, atypical and silent myocardial infarction, digitalis therapy, subacute bacterial endocarditis, calcific aortic stenosis and congenital heart disease. Fundamental papers have been published on a system of functional classification, attitudes toward death and dying, evaluation of mental status, the diagnosis and care of chronic brain syndrome, psychologic evaluation, the diagnosis and care of many ophthalmologic disorders, and the causes, incidence and prevention of accidents among the aged. The long‐term care institution, under proper circumstances, is an excellent site for good medical care, and significant contributions to research and teaching.
The Life Satisfaction Index‐Form A as Applied to Older Adults: Technical Note on Scoring Patterns
Authors: Ray Robert O. 
Published: April 2015

ABSTRACTThe value of standardized scales for determining life satisfaction among older adults is being questioned, but use of the scales continues. The Life Satisfaction Index‐Form A (LSIA) in its many variations continues to be among the most widely used scales for this purpose. In a comparison of two scoring methods (36‐point vs. 18‐point) for the LSIA, the lack of a significant difference indicated that a 36‐point scale is not necessary. Caution in the use and interpretation of the variances between the two scoring methods is suggested.
Pneumonia and Psychotropic Drug Use in Elderly Psychiatric Patients
Authors: Craig Thomas J. , Bracken Joan 
Published: April 2015

ABSTRACTA study of the use of psychotropic drugs among 30 elderly psychiatric patients with pneumonia (15 of whom died), in comparison to the general elderly population of the hospital, revealed a negative association between the use of psychotropic agents and the development of pneumonia. The factors of age, sex, pre‐existing illness, and organism virulence/patient resistance were all associated with death from pneumonia. However, the present findings do not support the hypothesis that psychotropic drugs are implicated in pneumonia deaths among elderly psychiatric patients.
Human Neurologic Function and the Aging Process†
Authors: Potvin A. R , Syndulko K. , Tourtellotte W. W. , Lemmon J. A. , Potvin J. H. 
Published: April 2015

ABSTRACTSixty‐one normal men whose ages ranged from 20 to 80 years were evaluated on two occasions by means of a comprehensive series of 128 instrumented tests of neurologic function. The tests measured cognition, vision, strength, steadiness, reactions, speed, coordination, fatigue, gait, station, sensations, and tasks of daily living. The reliability of each test measure was determined, and any measure found unreliable (r ≤ 0.41) was not further analyzed. Significant age‐related linear decreases were found for almost all neurologic functions. The declines over the age span varied from less than 10 percent to more than 90 percent for different functions. For the upper extremities, the largest declines (> 50 percent) were in hand‐force steadiness, speed of hand‐arm movements, and vibration sense; for the lower extremities, the largest declines were in one‐legged balance with eyes closed and in vibration sense. For 13 of 14 tests in which significant dominant body‐side effects were found, larger losses in function with aging were observed on the dominant body side. Upon re‐testing 7–10 days later, the subjects improved their scores by more than 5 percent on only 17 tests, 9 of which concerned the activities of daily living. No significant differential learning effects were found across age groups. The results point to the importance of developing a data bank on age‐based neurologic function so that therapeutic effects can be evaluated in terms of age‐ and sex‐matched normal functioning.
Evaluating Patients’ Warfarin Requirements
Authors: Jones Brian R. , Baran Andrij , Reidenberg Marcus M. 
Published: April 2015

ABSTRACTSeventy consecutive patients receiving warfarin as an anticoagulant were evaluated for the relationship between the response to the loading dose of warfarin and the response to the maintenance dose. No patients were excluded because of complicating diseases or the concurrent use of other drugs. There was a moderate correlation (r = 0.54, p < 0.01) between response to the loading dose and response to the maintenance dose. Thus, a relatively weak response to a loading dose of warfarin can be used to predict a need for a relatively large maintenance dose in unselected patients requiring anticoagulant therapy. Age seems to be a relatively weak determinant of warfarin sensitivity. Other factors such as the genetic control mechanism, concurrent drug therapy, and complicating diseases apparently are more important determinants.
Posthemiplegic Shoulder‐Hand Syndrome, with Special Reference to Related Cerebral Localization
Authors: Eto Fumio , Yoshikawa Masaki , Ueda Satoshi , Hirai Shunsaku 
Published: April 2015

ABSTRACTSeven autopsy cases of shoulder‐hand syndrome following hemiplegia were studied with regard to cerebral localization. One of them showed an isolated brain lesion in the premotor area due to a metastasis from malignant melanoma. Four other cases with cerebral infarction and one with glioblastoma multiforme showed massive brain lesions involving the frontal and parietal lobe cortex in the area supplied by the middle cerebral artery. The seventh case showed a hemorrhagic cerebral lesion in the lentiform nucleus. The most common overlap area in 6 of the 7 cases was located in the premotor region including the anterior part of the motor region. The shoulder‐hand syndrome following hemiplegia always develops on the side contralateral to the brain lesion which might cause a unilateral longstanding autonomic dysfunction. As corroborated in a review of the relevant literature, a lesion in the premotor area appears chiefly responsible for the primary mechanism of the shoulder‐hand syndrome in post‐stroke hemiplegia.
Oral versus Intramuscular Vitamin Supplementation for Hypovitaminosis in the Elderly
Authors: Baker Herman , Frank Oscar , Jaslow Seymour P. 
Published: April 2015

ABSTRACTThiamin, folate, biotin, riboflavin, nicotinates, pantothenate, carotenes, and vitamins B6, B12, A, E and C were measured in the blood of 228 elderly ambulatory residents of a nursing home. Their mean age was 87 years (range, 60–102). None had undergone major surgical procedures; their diet was good, and each had received at least one multivitamin pill every day for 3 to 5 months before the study. A comparison group of 204 healthy volunteers, aged 20–50, was also studied. Of the 228 elderly subjects, 88 (39 percent) showed vitamin deficits despite oral vitamin supplementation. Single and multiple deficits of vitamin B6, nicotinate, vitamin B12, folate, and thiamin were found. Three months after a single intramuscular injection of multivitamins (with no other vitamin supplementation), these deficits were no longer detectable in the blood of 89–100 percent of the vitamin‐deficient elderly. Intramuscular rather than oral vitamin supplementation is a more effective method for maintaining adequate blood levels of vitamins in the elderly; the intramuscular route apparently promotes saturation of tissue stores with enough vitamins to meet the needs, and thus obviates problems of vitamin malabsorption possibly due to drug interference or small‐bowel atrophy.
The Diagnosis of Depression in the Elderly†
Authors: Blazer Dan 
Published: April 2015

ABSTRACTThe reported prevalence of depressive symptomatology among the elderly ranges from 5 to 65 percent in hospital and community populations. Depression is considered the most common emotional disorder of advanced age. One of the chief diagnostic problems has been the lack of differentiation between disorders manifested by dysphoric or depressive symptoms. Recent work on operational criteris, as exemplified in the Third Edition of the American Psychiatric Association's Diagnostic and Statistical Manual (DSM‐III) provides a basis from which the diagnosis of depression can be made and subgroups of elderly depressed subjects can be delineated. A community survey involving a stratified random sample of 997 persons aged 65 or older living in Durham County was completed in 1972. An 18‐item subscale eliciting depressive symptomatology was abstracted from the survey questionnaire and submitted to factor analysis, tests of reliability, and association with clinical diagnosis. The instrument proved to be a useful means of identifying persons with depressive symptomatology, as outlined in DSM‐III. It also can be used for epidemiologic studies of depression in the elderly.
Bartter's Syndrome in a 74‐Year‐Old Woman: Response to Anti‐Inflammatory Agents
Authors: Gordon Michael , Pollard Alan 
Published: April 2015

ABSTRACTThe occurrence of Bartter's syndrome is described in a 74‐year‐old woman with a fractured hip. She showed hypokalemia and elevated levels of plasma renin and aldosterone. Only with difficulty did large doses of potassium supplementation raise the serum potassium level. After discontinuation of the exogenous potassium, there was a good response to treatment with antiinflammatory agents such as indomethacin and aspirin.
Aging and Mastication: Changes in Performance and in the Swallowing Threshold with Natural Dentition†
Authors: Feldman Roy S. , Kapur Krishan K. , Alman John E. , Chauncey Howard H. 
Published: April 2015

ABSTRACTFew comprehensive studies of oral function have been conducted on adult populations. A “Longitudinal and Cross‐Sectional Study of Oral Health in Healthy Veterans” was activated at the VA Outpatient Clinic in Boston in 1969; it included general oral and dental examinations as well as tests of masticatory performance and the swallowing threshold. The current investigation involved 863 subjects from the “Dental Study” who had either their natural teeth or a fixed replacement for missing teeth. Masticatory performance as measured by the subject's ability to reduce a test portion of cut carrot by a mandatory number of chewing strokes remained constant for persons with complete or partially compromised natural dentition. Swallowing threshold performance as measured by the particle size acceptable for swallowing remained constant for persons with complete dentition. Tooth loss significantly decreased the swallowing threshold performance and increased the particle size which the subject was willing to swallow. Older subjects increased the number of chewing strokes and the time required for this test, an observation not related to performance as measured by final particle size. Only with compromised dentition, however, did this increased effort result in increased performance. The results of this study indicate the persistence of masticatory performance (fixed number of strokes per second) with age, and also indicate an age‐related and dentition‐related increase in the effort expended by the subject to prepare the test food for swallowing.
Anemia in Institutionalized Elderly Patients†
Authors: Kalchthaler Thomas , Tan M. Eunice Rigor 
Published: April 2015

ABSTRACTIn a one‐year period (1976–1977), 161 residents of a long‐term facility were evaluated. There were 44 men and 117 women. According to criteria established by the World Health Organization, 64 residents (40 percent) were anemic. The incidence was greater for women than for men. The peak incidence occurred in the 71–80 age group for women, and in the 90+ age group for men. Iron deficiency secondary to surgical procedures, gastrointestinal bleeding or anticoagulant therapy was the most common cause of correctable anemia. Of the 64 anemic patients, 42 percent responded to therapy. Anemia among the elderly in institutions is often reversible, unlike the anemia of chronic disease. Evaluation should include a careful history and physical examination plus readily available laboratory findings. Invasive procedures are rarely indicated.
High‐Density Lipoproteins and Peripheral Vascular Disease in Octo‐ and Nonagenarians
Authors: Schneider J. 
Published: April 2015

ABSTRACTIn a medical service for ambulant patients, 180 unselected octo‐ and nonagenarians were studied. They showed high‐density lipoprotein (HDL) values similar to those reported for younger age groups. In 81 patients, a combination of various noninvasive angiologic techniques was used in addition to the history and physical examination. The frequencies of the clinical signs of peripheral arterial disease, and of stenoses and occlusions in the lower‐limb vessels, differed significantly between three HDL‐cholesterol subgroups, being highest in the group with the lowest HDL values.
Direct Skin Microscopy as an Aid in the Early Diagnosis of Precancer and Cancer of the Skin in the Elderly
Authors: Goldman Leon 
Published: April 2015

ABSTRACTAs part of the routine physical examination of the elderly, the skin, especially on the commonly exposed areas of the face, neck, hands and forearms, should be examined for early signs of precancer and cancer. Various lesions are described. The early signs of precancerous actinic keratoses usually are missed without a special examination which includes the use of magnifiers or the new skin microscope. This microscope is a long focal‐lens stereobinocular instrument that can scan large areas of skin for the early detection of precancer and cancer. As part of the routine examination of elderly patients, it is a valuable aid in the practice of preventive geriatric medicine.
Erythrocyte Sedimentation Rate: The Normal Range in the Elderly
Authors: Sharland D. E. 
Published: April 2015

ABSTRACTA study was made of the erythrocyte sedimentation rate (ESR) in 258 normal nonhospitalized elderly subjects (189 women and 69 men). Their ages ranged from 70 to 89 years. Those who had been followed for at least one year showed a mean ESR of 13 mm/hr, with a range of 3–65 mm. A subgroup of 55 (47 women and 6 men) who had been followed for periods of 3 to 11 years showed a mean ESR of 14 mm/hr, with a range of 3–69 mm. The findings indicate that an ESR above the accepted normal range may be consistent with continued good health in the elderly. Thus the ESR determination may be of very limited diagnostic value in this age group.
An Overview of Neuropsychiatric Disturbances in the Elderly
Authors: Shraberg David 
Published: April 2015

ABSTRACTIn no other period of life than old age do neurophysiologic alterations seem to affect behavior and cognition so significantly. Consequently, the relationship between neurology and psychiatry remains substantial when attempts are made to understand and deal with the many problems of aging. This study concerns improvement in the organization of such an approach to the neurologic and psychiatric problems of the elderly and to various interdisciplinary factors. Special consideration is given to changes in the central nervous system with aging, and to the differential diagnosis of dementia and pseudodementia.
Crystal‐Associated Arthropathies: What's New in Old Joints†
Authors: Pritzker Kenneth P. H. 
Published: April 2015

ABSTRACTDegenerative arthritis in the aged includes two major disease categories—osteoarthritis and the crystal‐associated arthropathies. The crystals chiefly involved are monosodium urate (gout) and calcium pyrophosphate dihydrate (CPPD), although several others (e.g., cholesterol, brushite and apatite) have been implicated. This report illustrates how the newer diagnostic techniques such as polarized‐light microscopy, analytical electron microscopy and x‐ray microdiffraction have augmented knowledge concerning diseases associated with articular crystal deposition. For example, diffraction techniques are required for accurate identification of the apatite crystals found in synovial fluid effusions and in the matrix vesicles of degenerate cartilage. According to ultrastructural studies, monosodium urate crystals found in tophi, joint surfaces and effusions show a distinct morphology. Present in inactive joints, the crystal surfaces are bare; in acute gout, the crystals are covered with mucin, confirming the observation that protein binding to crystals is necessary for inflammation to proceed. CPPD disease is by far the most common crystal‐associated arthropathy affecting the aged. The incidence of CPPD deposits in articular tissues increases with age but, in contrast to gout, affects both men and women. The pathogenesis of CPPD disease is a mystery, but factors under investigation include matrix abnormalities, ionic imbalances, and enzyme disorders.
Nosocomial Urinary‐Tract Infections in a Skilled Nursing Facility†
Authors: Sherman Fredrick T. , Tucci Victor , Libow Leslie S. , Isenberg Henry D. 
Published: April 2015

ABSTRACTFifty‐five documented infections reported from an admission unit of a large skilled nursing facility (SNF) during a five‐month period were analyzed. Of these, 45 (82 percent) were urinary‐tract infections (UTIs), chiefly asymptomatic bacteriuria. Sixty‐three percent of the UTIs were acquired in the SNF, and the remainder were acquired during the preceding stay in a general hospital. Statistically, Proteus species infections were more common among the SNF‐acquired UTIs, whereas Pseudomonas aeruginosa infections were the most common among the hospital‐acquired UTIs. The following recommendations are made: 1) for previously hospitalized elderly patients in whom urinary‐tract sepsis develops soon after admission to an SNF, treatment should start with an antibiotic active against Pseudomonas aeruginosa while the results of cultures are pending; 2) symptomatic lower urinary‐tract infections caused by SNF‐acquired Proteus species should be treated with nalidixic acid or trimethoprim**‐sulfamethoxazole; 3) the term “nosocomial infection” should be broadened to include infections acquired in long‐term care institutions; and 4) infection surveillance should be started in selected long‐term care institutions for the elderly as part of an expanded National Nosocomial Infections Survey.
Urinary Catecholamine Response to Glucagon in Young and Elderly Patients with Essential Hypertension†
Authors: Mandai Takashi , Ogihara Toshio , Hata Takeshi , Okada Yoshiaki , Ogasahara Saburo , Mikami Hiroshi , Nakamaru Mitsuaki , Kumahara Yuichi 
Published: April 2015

ABSTRACTThe role of the sympathetic nervous system (SNS) in essential hypertension was evaluated by examining the response of urinary catecholamines to the intramuscular injection of glucagon in both young and elderly normal subjects (total 16) and in both young and elderly patients with essential hypertension (total 16). Urine was collected for 2 hours before glucagon injection and for 2 and 4 hours after injection, for determination of adrenaline and noradrenaline. The increments of urinary adrenaline and noradrenaline after glucagon injection were significantly higher in young hypertensive than in young normotensive subjects or in normotensive and hypertensive elderly subjects. The observation that the reactivity of the SNS is increased in young patients with essential hypertension lends support to the hypothesis that the SNS is more important in the maintenance of hypertension in the young than in the elderly.