摘要:

Two types of follicular change in the thyroid are described. The first represents an involutional change in which colloid cysts (macrofollicles) are often found. The second represents a hyperplastic‐dysplastic (microfollicular) lesion. Two types of change in calcitonin (C) cells are also described, one of which may represent an involutional process, although this is not certain. The second is a hyperplastic (micronodular) lesion, but without evidence of dysplasia. An infiltration of lymphocytes is also commonly encountered.Only about 15% of cases after age 60 are free of the follicular and lymphoid lesions. Both the macro‐ and microfollicular lesions show a statistically significant increase with age, as do the lymphoid lesion and its derivative Hashimoto's thyroiditis. C cell micronodules also appear to increase with age, but there are too few such cases for a reliable statistical analysis.An analysis of combinations of the follicular and lymphoid lesions show a particularly frequent association of the microfollicular and lymphoid lesions. Evidence is presented suggesting that many microfollicular lesions may represent clones of mutated cells, and that the lymphocytes may be targeted to these microfollicles. Lymphocytes were rarely found in association with C cell micronodules.Within individual thyroids there is considerable variation in the proportion of each lesion when combinations are present. Thus with advancing age there is. an increasing heterogeneity of thyroid structure that may confound attempts to correlate structural and physiological changes with age. J Am Geriatr Soc 35:843–854

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1987.tb02337.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

This study utilizing immunocytochemical techniques consists of two segments, 1) an analysis of the changes with age in the hormone content of normal, involuting, macro‐and microfollicles, as well as calcitonin (C) cells, and 2) an analysis of the components of the lesion characteristic of lymphocytic thyroiditis.Involuting and macro‐ (cystic) follicles show a decline in hormone content with age, while microfollicles show a variable pattern with some showing a high and others a low content, as well as some showing an absence of hormone. There also appears to be an increase with age in hormone‐containing C cell micronodules, but we were unable to demonstrate a decline in hormone content of individual C cells.Studies on the in vivo binding of immunoglobulins, as an indicator of thyroid antibody binding, showed an increase with age in IgG and IgM binding to follicular epithelium. Much stronger reactions were observed in the epithelium of microfollicles than in that of involuting or macrofollicles. There were also examples of presumptive in vivo antibody binding by C cell micronodules.We were unable to demonstrate an imbalance of helper/suppressor T cell ratio in the thyroiditis lesion, but did find that some lymphocytes contain thyroid hormones, suggesting that the latter may act as cytokines and assist in the perpetuation of the lesion. The epithelial expression of human lymphocyte antigens (HLA) was strong in microfollicles and weak or absent in involuting or macrofollicles in sections with lymphocytic thyroiditis. It was also strong in the epithelium of a microfollicular adenoma without a lymphocytic infiltrate while weak or absent in the epithelium of adjacent normal follicles.These observations have led to the proposal that the lesion of lymphocytic thyroiditis may be initiated by an age‐associated proliferation of “not self” dysplastic microfollicles which express the HLA surface antigen, and that the early lymphocytic infiltrate is targeted against these microfollicles in the form of an antibody mediated cytotoxic reaction. J Am Geriatr Soc 35:8

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1987.tb02338.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

Alcoholism in the elderly is often underidentified because of the differences in the presentation and symptom patterns compared to younger individuals. One way to address this problem is through routine use of screening instruments, but up to this time, none of the instruments used to identify alcoholism in younger populations have been shown to be valid in the elderly. We studied the validity of the Michigan Alcoholism Screening Test, scored both with weighted (MAST) and unit scoring (UMAST), and two short versions: the Brief MAST (BMAST) and Short MAST (SMAST) in 52 hospitalized elderly male alcoholics and 33 nonalcoholic controls. The MAST and UMAST showed excellent sensitivity and specificity, while the SMAST was less specific, and the BMAST less sensitive and less specific. Factor structure of the two brief versions was similar to that found in younger alcoholics, suggesting that symptom constellation is not necessarily different in the elderly. We recommend the use of the MAST or UMAST for screening for alcoholism in the elderly. J Am Geriatr Soc 35:864–869, 19

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1987.tb02339.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

Pap smear screening is an accepted method of detecting cervical dysplasia or malignancy, and use of this test has been shown to reduce the incidence of invasive squamous cervical cancer in young and middle aged women. Conflicting recommendations exist concerning the screening of women over the age of 65, and little information is available concerning the results of screening in this population. Elderly women are routinely omitted from screening, as it is generally believed that they usually refuse testing. This paper reports a study attempting to evaluate the feasibility of screening in women over the age of 64 attending a large urban outpatient geriatric clinic. It demonstrates that pap smear screening is acceptable to this population, particularly if performed by the usual primary care provider. It also confirms previous reports that women in this age group have had very little screening in the past, and that screening uncovers a large number of abnormalities. Of note is the high rate of false positive smears in this population. J Am Geriatr Soc 35: 870–875, 19

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1987.tb02340.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1987.tb02341.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1987.tb02342.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1987.tb02343.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1987.tb02344.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1987.tb02346.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1987.tb02348.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY