bluuebunny/crossref_metadata_2025_split huggingface dataset:
Management of Complicated Biliary‐Tract Disease in Geriatric Patients*
Authors: GRODSINSKY C. , BRUSH B. E. , PONKA J. L. 
Published: April 2015

ABSTRACT: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

ABSTRACT: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

ABSTRACT: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

ABSTRACT: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

ABSTRACT: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

ABSTRACT: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

ABSTRACT: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

ABSTRACT: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

ABSTRACT: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

ABSTRACT: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

ABSTRACT: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

ABSTRACT: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.
Understanding Our Client, The Geriatric Patient*
Authors: HULICKA IRENE M. 
Published: April 2015

ABSTRACT: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

ABSTRACT: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.
Arterial Oxygen Tension in Relation to Age in Hospital Subjects
Authors: NEUFELD OSCAR , SMITH JOSEF R. , GOLDMAN S. L. 
Published: April 2015

ABSTRACT: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

ABSTRACT: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

ABSTRACT: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

ABSTRACT: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

ABSTRACT: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

ABSTRACT: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.
Pseudo‐Senility: Acute and Reversible Organic Brain Syndromes*
Authors: LIBOW LESLIE S. 
Published: April 2015

ABSTRACT:The cerebral blood flow in healthy elderly men is not notably different from that in 20‐year‐old control subjects. Only in the presence of a significant degree of arteriosclerosis is there a decrease in cerebral blood flow. Eventually there is a decrease in cerebral metabolic function associated with a decline in mentation. To explain much of the early mental change in many elderly persons, the environment must be assessed. In an 11‐year NIMH study of more than 600 variables, 2 factors proved to be accurate predictors of survival and mortality in the healthy elderly: (a) a new health indicator, viz, the organization of the subject's daily behavior; and (b) the presence or absence of chronic cigarette smoking. Behavior patterns of today's elderly are discussed.Pseudosenility, i.e., acute and potentially reversible mental change, is common in the elderly and may often be overlooked or misdiagnosed. Some causes are: medications, metabolic imbalance, depression, malnutrition, malignancy, hepatic disease, diminished cardiac output, cerebrovascular syndromes, febrile conditions, and chronic lung disease. Chronic, possibly reversible, mental syndromes include the depressions, dementias, deficiency states, and alcoholic encephalopathies. The treatment is outlined.
Why More of the Aged with Auditory Deficits Do Not Wear Hearing Aids
Authors: WEISS CURTIS E. 
Published: April 2015

ABSTRACT:The information in this article regarding aural rehabilitation was obtained directly and indirectly from aged persons with impaired hearing, from their families, and from nurses and assistants in several nursing homes and extended care facilities. Although many elderly persons with auditory deficits have had successful experiences with hearing aids, many others have not. The possible reasons are discussed, as are ways of overcoming prevalent negative attitudes by study of the psychosocial aspects and the careful assessment of individual patients by qualified personnel.
Cardiovascular Adaptation to Twelve Minutes of Mild Daily Exercise in Middle‐Aged Sedentary Men*
Authors: TERJUNG R. L. , BALDWIN K. M. , COOKSEY J. , SAMSON B. , SUTTER R. A. 
Published: April 2015

ABSTRACT:A group of sedentary middle‐aged men (N=15) completed a 6‐week exercise program that involved two 6‐minute daily exercise bouts of running‐in‐place. Total body weight, skinfold thickness and serum triglyceride levels were not altered by this mild exercise program. However, increases in the subjects' work capacity and decreases in systolic blood pressure and heart rate for a given work load were observed. The results of measuring systolic time intervals by a noninvasive technique suggested that myocardial contractility at rest had increased after the 6‐week period. These results indicate that a beneficial adaptation of cardiovascular function can occur in sedentary middle‐aged men in response to a mild form of activity that can be accomplished with a minimum of time, inconvenience and facilities. In addition, the use of noninvasive techniques in measuring systolic time intervals appears to be a useful means of evaluating changes in cardiovascular function induced by exercise training.