摘要:

ABSTRACTThe United States Senator from Maryland, as speaker at the Awards luncheon of the American Geriatrics Society (Washington meeting), presented his views on priorities in various health programs for the elderly, and asked for the Society's cooperation in making some of the difficult decisions that lie ahead. An important item is cost‐effectiveness. These decisions will affect every discipline involved in geriatrics, and have an important bearing upon the quality of life for the elderly. A better understanding is needed of the interaction between aging and disease, and the use of preventive measure

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1979.tb01672.x

年代:1979

数据来源: WILEY

摘要:

ABSTRACTA prospective study begun in 1976 to determine the incidence of endometrial cancer in postmenopausal women was undertaken because of the adverse publicity alleging an increased risk of endometrial cancer in women receiving estrogen therapy. A retrospective study for the year 1975 was added. During 8,170 patient‐years in the 3‐year 1975–1977 period, 14 endometrial malignancies were diagnosed, for an annual incidence of 1.7 per 1,000 women. During the 3,792 patient‐years of observation of estrogen‐progestogen users, the incidence of endometrial cancer was 0.5:1,000. The incidence of this carcinoma among estrogen users (8 cases during 2,088 patient‐years) was 3.8:1,000. The difference between these two groups was statistically significant (p<0.01). One adenocarcinoma was detected in a patient who used estrogen vaginal cream for 7 months, for an incidence of 1.7:1,000 during 573 patient‐years of observation. In the untreated women, during 1,515 patient‐years, there were 3 endometrial cancers, for an incidence of 2.0:1,000. There was no significant difference between the untreated group and the estrogen users, and only a trend (p<0.21) between the estrogen‐progestogen users and the untreated women. Synthetic progestogens were used to treat 199 women with endometrial hyperplasia (a precancerous lesion) for 3–6 months. The hyperplastic endometrium reverted to normal endometrium in 96.5 percent. The authors believe that all postmenopausal women with an intact uterus should be given the Progestogen Challenge Test, and the progestogen continued each month as long as bleeding follows. Such methods should be highly effective in preventing most endometrial ca

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1979.tb01673.x

年代:1979

数据来源: WILEY

摘要:

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

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1979.tb01674.x

年代:1979

数据来源: WILEY

摘要:

ABSTRACTEndocrine and renal functions were studied in 149 patients with essential hypertension by measuring plasma electrolytes, renin activity, creatinine and aldosterone, as well as the urinary excretion of creatinine and sodium chloride, before and during treatment for hypertension. Half of the patients responded to trichlormethiazide (thiazide‐responsive group) but the other half did not (thiazide‐unresponsive group). Systolic and diastolic blood pressures increased progressively with age in the thiazide‐unresponsive group, but were lower and did not progress with age in the thiazide‐responsive group. There was no consistent difference in plasma renin activity between the thiazide‐responsive and the thiazide‐unresponsive groups. The fluctuation of plasma renin activity in response to an excess of sodium chloride or to thiazide treatment was reduced progressively with age. Creatinine clearance decreased and the blood urea nitrogen level increased with age. The age‐related decrease of plasma renin activity is discussed in the light of the age‐related impairment in the ability of the kidney to excrete s

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1979.tb01675.x

年代:1979

数据来源: WILEY

摘要:

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 operat

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1979.tb01676.x

年代:1979

数据来源: WILEY

摘要:

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 pat

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1979.tb01677.x

年代:1979

数据来源: WILEY

摘要:

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 t

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1979.tb01678.x

年代:1979

数据来源: WILEY

摘要:

ABSTRACTThere is a paucity of studies on the characteristics of elderly patients who are admitted for treatment of acute disorders, even though their utilization of hospitals is high. This study involved 828 older persons admitted to a general hospital during a period of six months, for the treatment of acute illness. The typical patient appeared to be a woman in her 70's who entered the medical department because of a cardiovascular or a gastrointestinal disturbance, stayed no longer than 10 days, and returned home to live with her spouse. Though such a person apparently needed minimal assistance in readjusting successfully to the community, there were some exceptions, especially among those who had been living alone or with persons other than a spouse. There was minimal utilization of professional services that might help to assure an optimal post‐hospital readjustmen

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1979.tb01679.x

年代:1979

数据来源: WILEY

摘要:

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 su

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1979.tb01680.x

年代:1979

数据来源: WILEY

摘要:

ABSTRACTThis study included 40 patients over 60 years of age with echocardiographic findings of mitral valve prolapse (MVP). Most of these patients were unaware of any cardiac disorder until the time of echocardiography. In the majority, the clinical manifestations were benign, and the duration of symptoms variable. Congestive heart failure (CHF) was noted in 10 patients (25 percent) who were unaware of having any cardiac disorders until the onset of their symptoms. In 5 patients (4 with CHF and 1 with endocarditis), surgical replacement of the prolapsed mitral valve was necessary. Endocarditis was present in 4 patients (10 percent), none of whom had been instructed in the prophylactic use of antibiotics. The physician's awareness of mitral valve prolapse in the elderly patient is important, since the disorder may not be as benign in aged patients as in younger ones, and life‐threatening complications may occu

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1979.tb01681.x

年代:1979

数据来源: WILEY