bluuebunny/crossref_metadata_2025_split huggingface dataset:
Surgical Procedures Involving Cardiopulmonary Bypass in Patients Aged 70 or Older†
Authors: Berman Neil D. , David Tirone E. , Lipton Irving H. , Lenkei Susan C. 
Published: April 2015

ABSTRACTCardiac surgery was performed in 27 patients whose ages ranged from 70 to 78 years (mean, 72). In 17 of these patients, the operation was coronary artery bypass grafting without other procedures. There were 3 operative deaths (17.6 percent) but no late deaths during a mean follow‐up period of 14 months, and all the 14 surviving patients were improved symptomatically. In the other 10 of the 27 patients, the operation was valve replacement. There was no operative mortality among the 6 aortic valve patients and 1 operative death among the 4 mitral valve patients; the corresponding late deaths were 2 and 1, respectively, during a mean follow‐up period of 41.3 months. Improvements in operative management and improved criteria for the selection of patients should afford benefits and risks for elderly cardiac patients similar to those for younger cardiac patients.
Group Rehabilitation for the Vascular‐Disease Amputee
Authors: Kerstein Morris D. 
Published: April 2015

ABSTRACTGroup therapy for lower‐extremity, vascular‐disease amputees was successful in the return of these patients to their normal milieu. Thirty men (mean age, 63 years) were studied during a one‐year period. The group meetings progressed from a phase of directed therapy to one of nondirected therapy. This group of hospitalized amputees was chosen specifically because of its social, economic and medical identity. After a self‐identified adequate period of therapy, all patients returned to their former places in society.
Permanent Gastrostomy As a Solution to Some Nutritional Problems in the Elderly†
Authors: Pomerantz Marc A. , Salomon Jacob , Dunn Robert 
Published: April 2015

ABSTRACTThe number of elderly patients living in institutions is increasing. Many of them are unable to maintain an adequate nutritional status because of: 1) neurologic deficits that preclude normal swallowing; 2) obstruction of the upper gastrointestinal tract; or 3) a systemic disease that has produced profound anorexia. This report presents the data on 106 permanent‐feeding gastrostomies, performed with low morbidity and low mortality. Use of a gastrointestinal anastomotic stapling device greatly facilitated the operation. The permanent gastrostomy offers an effective means of providing adequate nutrition for elderly patients who otherwise cannot maintain the necessary nutritional status.
Proteinuria and Renal Function During Antihypertensive Treatment for Essential Hypertension
Authors: Yamada Takashi , Ishihara Masaki , Ichikawa Kazuo , Hiramatsu Kunihide 
Published: April 2015

ABSTRACTIn an attempt to determine the effects of antihypertensive treatment on proteinuria and renal function, these factors were studied in 155 patients with essential hypertension, before and during antihypertensive therapy. Slight renal impairment tended to increase with the progress of hypertension, as evidenced by a slight but significant increase in the levels of blood urea nitrogen (BUN) and serum creatinine, and by a progressive decrease in creatinine clearance. A decrease in proteinuria appeared as early as one month after initiation of treatment and continued for at least two years during treatment. Apparently the proteinuria was caused by increased glomerular pressure and by vascular damage in the glomerular vessels. In 7 patients, normalization of blood pressure resulted in an elevation of BUN and creatinine concentrations, although initial renal function did not differ significantly from that in other groups who did not show such derangement during treatment. Thus, a reduction of proteinuria seems to be a good criterion for predicting beneficial results from antihypertensive treatment.
Diagnosing Mental Illness in the Elderly
Authors: Gaitz Charles M. 
Published: April 2015

ABSTRACTDiagnosing mental illness in the elderly is difficult because changes in physical and psychologic functioning may mimic psychiatric disorders. The reverse is also true. Although chronologic age is not related directly to predisposition to mental illness, the stresses experienced by elderly persons as a result of declining health and loss of social status may result in mental disorders. Accurate diagnosis, which takes all these factors into account, is particularly important for the rational treatment of elderly patients.
Subdural Hematoma: A Clinical Approach
Authors: Rosin Arnold J. , Dijk Y. M. Van 
Published: April 2015

ABSTRACTSubdural hematoma (SDH) in the elderly often occurs following a relatively mild fall. Compared to the old person's high risk of falling, SDH is relatively uncommon and the diagnosis may be elusive. Five cases are presented, two in detail. In one, despite the acute onset within hours and manifestations of an ipsilateral neurologic deficit, operative removal of the SDH gave excellent results. The second patient represented a dementia assessment problem prior to admission to an institution. Inpatient observation eventually revealed a deteriorating neurologic state and led to the correct diagnosis of SDH. The patient returned home, fully recovered, two weeks after the appropriate surgical procedure. The pathogenesis of SDH is discussed. Clinical suspicion of its presence should prompt the performance of an echoencephalogram and a computerized axial tomogram of the brain.
Diagonal Ear Lobe Crease and Coronary Risk Factors
Authors: Shoenfeld Y. , Mor R. , Weinberger A. , Avidor I. , Pinkhas J. 
Published: April 2015

ABSTRACTThe prevalence of ear lobe crease (ELC) was determined in 421 patients with myocardial infarction (MI) and in 421 controls. A higher prevalence (p < 0.05) of ELC was found in MI patients (77 percent) in comparison to controls (40 percent), regardless of age. In addition, a higher prevalence was found in patients in whom MI was combined with diabetic retinopathy or hypertension, and in Ashkenazi Jews compared to non‐Ashkenazi Jews. Ear lobe biopsies in 12 subjects revealed tears of the elastic fibers in all subjects with ELC, and prearteriole wall thickening in subjects with MI and/or ELC, but not in the 2 subjects with neither MI nor ELC. The early appearance of ELC may imply the existence of coronary heart disease with or without coronary risk factors.
Utilization Review Committee As a Peer Review Mechanism
Authors: Pattee James J. 
Published: April 2015

ABSTRACTThe appropriate utilization and the quality of care in long‐term care facilities should be documented and monitored. This is best accomplished at the local level by physicians and other professionals serving on Utilization Review Committees. Paper compliance to regulation of state or federal agencies is a poor substitute for active involvement of the professionals at the local level.
Paraphrenia: Paranoid States of Late Life. II. American Research
Authors: Bridge T. Peter , Wyatt Richard Jed 
Published: April 2015

ABSTRACTIn Part I of this study, a review of the European literature on paraphrenia demonstrated that the disorder affects a significant number of older persons and is probably part of the schizophrenic spectrum. Part II presents the current research evidence and issues concerning paraphrenia, a disorder commonly misdiagnosed or overlooked in the United States. Recommendations are made for a rigorous investigation of this group of patients that American psychiatry has not studied adequately. Comparisons of paraphrenic and schizophrenic patients undoubtedly will provide new insights into both the process of schizophrenia and the process of aging.
Multiple Monitored Electroconvulsive Therapy in the Elderly†
Authors: Yesavage Jerome A. , Berens Eric S. 
Published: April 2015

ABSTRACTTwenty patients aged 45 or older with the diagnosis of endogenous depression were evaluated in terms of safety and efficacy in their response to multiple monitored electroconvulsive therapy (MMECT) versus single electroconvulsive therapy (SECT). The MMECT group (10 patients) when compared retrospectively with the control SECT group (10 patients) showed a similar record for safety and efficacy. However, the MMECT group required shorter overall duration of treatment, fewer sessions of general anesthesia, and lower dosages of anesthetic agents. The chief benefit of MMECT probably is in the reduction of the time the patient is at risk for suicide.
Reliability of Palpation of Pedal Pulses As Ascertained by the Kappa Statistic
Authors: Lawson Ian R. , Ingman Stanley R. , Masih Younus , Freeman Barbara 
Published: April 2015

ABSTRACTAn improved statistic (weighted Kappa) was tested for reviewing the reliability of the palpation of pedal pulses by three observers. Significant improvement was noted after training. Reliability also persisted with respect to a reduced form of the conventional ordinal grading system. The findings indicated that problems of usefulness or reliability may arise when more than five distinctions are made in describing the pulses or when the data are completely reduced to only a dichotomous (present‐absent) system.
Reference Values for Blood Findings in Relatively Fit Elderly Persons
Authors: Jernigan James A. , Gudat John C. , Blake Jerome L. , Bowen Laura , Lezotte Dennis C. 
Published: April 2015

ABSTRACTIn a retirement community group of 73 relatively fit elderly white persons, a cross‐sectional study of 53 different blood tests was conducted. The five test categories for blood values were hematology, chemistry, thyroid function, protein electrophoresis, and immunology. Fifteen percent of the blood findings were outside the range accepted as normal by the examining laboratories. Most of the subjects showed between 5 and 10 “abnormal” values within the five test categories. Since the findings were fairly predictable in view of the patho‐anatomic changes that accompany aging, and since the manifestations of disease were at most subclinical, only minor alterations in individual management were needed. Subsequent appropriate clinical re‐evaluation of these subjects during a six‐month follow‐up revealed no striking changes. It would appear that the ranges of “normal” reference values may need to be expanded. Although cross‐sectional laboratory studies are useful, longitudinal studies seem essential if clinicians are to attain a more valid perspective.
A Geriatric Evaluation Service: Follow‐Up Survey
Authors: Hughes Elizabeth M. , Lindsey Ada M. 
Published: April 2015

ABSTRACTA survey was conducted to determine the community resources used by the urban elderly when long‐term care in a mental hospital was deemed inappropriate by a Geriatric Evaluation Team. The follow‐up study of 112 elderly subjects showed that there are alternatives to institutionalization for the majority of elderly persons referred to a geriatric evaluation and screening service. The natural support system (family members) proved to be of significant value, and more than half of the subjects had daily contact with some other person. Available community services, however, were used infrequently.
Ultrasonic Doppler Measurement of Systolic Pressure in the Quantitative Evaluation of Chronic Arterial Occlusions
Authors: Martin M. , Gorgla S. 
Published: April 2015

ABSTRACTThis study deals with a method of performing ultrasonic Doppler measurements in patients with chronic arterial occlusions. Ankle systolic pressures distal to occlusions (as diagnosed by angiography) were sampled and the mean values calculated. Standard deviations of the method were validated. The ultrasonic Doppler method for measurement of systolic pressure is a valuable new tool for assessing peripheral arterial occlusions. Especially in geriatric patients, with their high rate of vascular problems and the lingering danger of heel necrosis in the course of longstanding immobility, this method supplies the attending physician with quantitative data as a basis for diagnosis, prophylaxis, and treatment.
Noninvasive Evaluation of Peripheral Arterial Disease in the Geriatric Patient
Authors: Lee Bok Y. , Thoden William R. , Trainor Frieda S. , Kavner David 
Published: April 2015

ABSTRACTA progressive increase in the incidence of peripheral arterial occlusive disease is being observed in today's steadily aging population. In recent years, a number of simple noninvasive vascular techniques have become available for the diagnosis of peripheral arterial occlusive disease. These techniques provide the physician with physiologic information about the patient's peripheral circulation which permits discrimination between complaints compatible with the aging process and those indicative of an underlying disease state. This article reviews the noninvasive vascular diagnostic techniques that the authors found useful in evaluating the geriatric patient. These include oculoplethysmography, Doppler ultrasound, photoplethysmography, arterial impedance plethysmography, and electromagnetic flowmetry.
Reduced Aldosterone Secretory Response to Acute ACTH Stimulation in Sodium‐Restricted Elderly Subjects
Authors: Morimoto Shinpei , Takeda Ryoyu , Uchida Kenzo , Miyamori Isamu , Miyamoto Masaji , Mimou Naonori , Kigoshi Toshikazu 
Published: April 2015

ABSTRACTThe plasma aldosterone (PA) response to ACTH stimulation (5 μg/kg, im) under conditions of varied sodium intake was studied in 10 young (20–35 yr), 9 middle‐aged (41–56 yr) and 11 elderly (66–73 yr) normotensive subjects. No differences in serum sodium, serum potassium, plasma Cortisol and urinary sodium excretion were observed among the three groups during both a 130 mEq (normal) intake and a 25 mEq (low) sodium intake for three days. Basal plasma renin activity (PRA) and PA levels were lower in the elderly than in the young or middle‐aged groups. These age‐related decreases were slight with a normal sodium intake and pronounced with a low sodium intake. ACTH administration induced increases in PA in the three groups. However, the maximal net increment of PA above the baseline level after ACTH did not differ among the three groups with a normal sodium intake, but was lower in the elderly than in the young or middle‐aged groups with a low sodium intake. The ACTH‐induced maximal percentage increment of PA did not differ among the three groups during both the normal and the low sodium intakes. A significant positive correlation was found between the maximal net increment of PA and either the basal PRA or PA level in the combined group of young, middle‐aged and elderly subjects. Thus, aging causes a reduced aldosterone secretory response to ACTH, in parallel with decreases in basal PRA and PA levels, under conditions of low sodium intake.
Family Abuse of the Elderly
Authors: Steuer Joanne , Austin Elizabeth 
Published: April 2015

ABSTRACTIn 12 cases of family abuse of disabled elderly persons, the majority of the abused were women. Caretakers included spouses, children, siblings or other relatives. Abuse was both physical and verbal/psychologic. Neglect, the most common form of physical abuse, sometimes resulted in decubitus ulcers and vermin infestation. Misuse of medical therapy and nutrition were other areas of physical abuse. Psychologic abuse included derogation, infantilization, and threats of institutionalization, abandonment, and homicide. Possible causes of abuse included alcoholism in the caretaker, financial concerns, and long‐term family conflicts. Various recommendations are made for the management of abusive families.
Social Issues in Geriatric Psychiatry
Authors: Goldstein Stanley E. 
Published: April 2015

ABSTRACTIn the past decade significant advances have been made in caring for the emotional problems of the elderly. The evolution of the multidisciplinary team and easier access to health care play important roles. Of seminal importance is the emergence of the psychogeriatrician and the establishment of psychogeriatric units. Treatment of the elderly should extend beyond the confines of the hospital to include families, community agencies and community resources.
When Is the Physician “Playing God”?
Authors: Zimring Joseph G. 
Published: April 2015

ABSTRACTIn the author's opinion, the medical profession is committed to the preservation and prolongation of life through use of all ordinary remedies, but is not obliged ethically or morally to apply extraordinary measures when there is no realistic hope of recovery. In addition to the proper medical therapy, the care given during the dying phase of life by the physician includes the responsibility of deciding whether the geriatric patient should be allowed to die in a dignified manner. The question of who should bear this responsibility is discussed.
Health and Medical Care for the Elderly and Aged Population: The State of the Evidence†
Authors: Bloom Bernard S. , Soper Keith A. 
Published: April 2015

ABSTRACTEmerging statistics emphasize the special needs of the elderly for health and medical care services. A variety of services are being recommended to meet these needs, but few of them have been subjected to rigorous study for determining efficacy, effectiveness or cost. Examination of about 1,000 studies of health and medical services for the elderly published between 1967 and 1978 revealed only 7 that met predetermined criteria for well‐designed and executed investigations. The varied needs of the elderly are finally being recognized, and undoubtedly pressure will be increased for meeting these needs. In this era of finite monetary resources and budgetary restraints, we need better data upon which to base the selection of medical care services for the aged. Resources needed to provide care of known benefit should not be diverted to provide care of unknown benefit.
Serum Cortisol Response to Acute Myocardial Infarction in the Aged
Authors: Adair Richard , Kasahara Masayuki 
Published: April 2015

ABSTRACTThe adrenocortical response to acute myocardial infarction in aged patients was studied by measuring serum cortisol concentration (radioimmunoassay) at the time of hospital admission. The mean serum cortisol level in 9 patients over 80 years old was similar to that in 5 patients less than 60 years old. In all patients who died, or in whom shock developed, the serum cortisol concentration was significantly elevated.
Prosopo‐Affective Agnosia and Computerized Tomography Findings in Patients with Cerebral Disorders
Authors: Kurucz Janos , Soni Anant , Feldmar Gabriel , Slade Walter R. 
Published: April 2015

ABSTRACTThirty‐nine male patients (median age 61, range 19–92) from a neurologic ward were examined by a test for prosopo‐affective agnosia (PAA), i.e., impairment in the recognition of facial affect (emotions) with no impairment in the recognition of facial features (PA, prosopo‐agnosia). The scores for patients without hemispheric damage were close to those of normal subjects; the scores for patients with right or left hemispheric disease were lower; and the worst performers were patients with diffuse bilateral disease. The relative independence of PAA from PA was re‐affirmed. The neurologic findings on 21 patients were confirmed by computerized tomography (CT). On the PAA test, patients with negative CT results had scores close to those of normal subjects; patients with right or left hemispheric disease had lower scores; and the worst performers were patients with diffuse cortical atrophy. All patients who scored 87.5 percent or lower showed positive results with the CT scan, indicating that the PAA test may have some value in predicting positive CT findings. A significant deterioration in the ability to recognize facial affect was evident in the group of 15 patients aged 65 or older.
Thyroid Hormone Metabolism in Patients with Liver Cirrhosis, as Judged by Urinary Excretion of Triiodothyronine
Authors: Aizawa Toru , Yamada Takashi , Tawata Masato , Shimizu Takuo , Furuta Seiichi , Kiyosawa Kendo , Yakata Minoru 
Published: April 2015

ABSTRACTThis study included 35 patients with liver cirrhosis, 23 patients with hyperthyroidism, 12 with hypothyroidism, and 3 with other endocrine disorders. In the various endocrine disorders an appreciable amount of triiodothyronine (T3) was excreted into the urine but the daily excretion was fairly constant in each patient. Urinary excretion of T3 was negligible or depressed in hypothyroidism, but increased with a rise in the serum level of T3. Serum and urinary T3 decreased in liver cirrhosis, but the serum thyroxine (T4) level was within the normal range. When the cirrhosis patients were divided into 3 groups according to the urinary excretion of T3, a decrease of urinary T3 was associated with a decrease in the serum levels of T3 and free T3. An increase of serum thyroid‐stimulating hormone (TSH) either before or after injection of thyrotropin‐releasing hormone (TRH) was inversely correlated with a decrease of serum and urinary T3. The decrease of serum and urinary T3 was correlated with the magnitude of liver damage as judged by indocyanine green retention and a decreased urinary excretion of cyclic adenosine 3',5'‐monophosphate. In vitro experiments indicated that rat liver, as compared to the kidney, heart and skeletal muscle, strongly converts T4 to T3, but this activity is greatly reduced by liver damage induced by ligation of the bile duct. It is suggested that patients with liver cirrhosis are, to some extent, in a state resembling subclinical hypothyroidism because of inability of the liver to metabolize a sufficient amount of T3 from T4.
Geriatric Paranoia: Case Report Illustrating Behavioral Management
Authors: Brink T. L. 
Published: April 2015

ABSTRACTParanoid thinking is a defense mechanism against feelings of inferiority and humiliation. Paranoid behavior serves as a means of getting attention, sympathy and help. A case study of an 81‐year‐old woman illustrates the nature of geriatric paranoia and the roles of interpersonal relationships, rigid personality, depression, and the impairment of sensory and memory functions. The problem proved to be the effects on the family and neighbors of the patient's verbally expressed paranoid delusions. Treatment consisted of reducing the frequency of these paranoid complaints by means of reality therapy and verbal non‐reinforcement.
Peripheral Neuropathy in the Elderly: A Clinical and Electrophysiologic Study
Authors: Huang C. Y. , Med M 
Published: April 2015

ABSTRACTFifty‐nine elderly patients with clinical and neurophysiologic evidence of peripheral neuropathy were reviewed. Diabetes, alcoholism and malignancy were the important etiologic factors, but other causes of acquired neuropathy such as drugs, autoimmune disease, and acute or chronic demyelinating neuropathy continue to warrant attention. Postural hypotension associated with neuropathy occurred in three patients with diabetes and one patient with lymphoma. Prognosis for the neuropathies did not seem to be adversely affected by age.
Shoulder‐Hand Syndrome: Importance of Early Diagnosis and Treatment
Authors: Chu Dong S. , Petrillo Claudio , Davis Sanders W. , Eichberg Rodolfo 
Published: April 2015

ABSTRACTIf the shoulder‐hand syndrome is left without special care, it may lead to severe painful disabilities of the upper extremity. Early recognition of the clinical signs and symptoms and aggressive total care are essential for successful treatment and for the prevention of severe flexion contractures of the hand and shoulder, especially in patients whose symptoms have developed after a cerebrovascular accident. An outline is given of the treatment modalities (corticosteroids, physiotherapy and mechanical devices) used at the Institute for Rehabilitation Medicine (NYU) for obtaining maximum function of the involved upper extremity.