摘要:

ABSTRACTThe marked decline in the autopsy rate is a serious matter that is not receiving enough attention in the present medical system. Before 1940, a high rate of postmortem examinations was a mark of distinction for a hospital and the findings contributed greatly to our knowledge of disease. This should continue. In geriatrics, a valuable goal is the differentiation of pathologic processes from the process of aging. One outstanding factor in the neglect of the autopsy is the cost to the hospital or other institution; moreover, the cost is not reimbursable by third‐party insurance payers. The Pathology Resource Center is proposed as a solution for the problem. Regional autopsy centers could serve the surrounding institutions with greater competence and economy. Medicine should no longer be restricted regarding the valuable contributions to knowledge provided by autopsy finding

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1975.tb00373.x

年代:1975

数据来源: WILEY

摘要:

ABSTRACTIn the past forty years the autopsy rate in many large institutions has fallen drastically to a level of only 20–25 per cent. The large number of diagnostic errors revealed in autopsy records is in itself a cogent reason for a return to higher standards. The inhibitory effect of high cost would be modified by the use of central regional pathology services and by reimbursement from third‐party insurance carriers. The end‐result would be a higher quality of medical care for all patients, not excepting those in the geriatric age

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1975.tb00374.x

年代:1975

数据来源: WILEY

摘要:

ABSTRACTThe role of the autopsy is discussed in the study of the etiology of the current major causes of death (cardiovascular and neoplastic diseases) in developed countries. Evidence is accumulating for the importance of environmental factors in the etiology of these diseases. The study of regional differences in occurrence is described as a method of identifying specific factors. Maps are shown of mortality rates for all causes of death in Ontario counties for males aged 65–74 and 95+ during 1964–68. Some of the difficulties in obtaining data in this form, and in their analysis, are indicated. Regional mortality patterns can be interpreted by the use of associations with available regional socioeconomic measures, or by the use of regional data on trace‐metal levels in autopsy samples of human lung, rib, vertebra, kidney and liver. The methodology and the difficulties involved in the determination of trace‐metal levels in these tissues are discussed, as is the possible relevance of these levels to the study of degenerative diseases. All these considerations emphasize the valuable contributions of autopsy

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1975.tb00375.x

年代:1975

数据来源: WILEY

摘要:

ABSTRACTThe current management of decubitus ulcers, factors in wound healing and the role of enzymes in treatment are discussed. The therapeutic benefits of collagenase (Santyl) ointment in 21 patients are described, supplemented by serial color photographs. Statistical evidence is provided for the conclusion that collagenase ointment is an excellent adjunct to therapy.

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1975.tb00376.x

年代:1975

数据来源: WILEY

摘要:

ABSTRACTThis long‐term study of the natural history of glucose tolerance in the aged is now in its eleventh year. Of 411 nondiabetic persons screened on admission to the Jewish Home for the Aged (J.H.A.) since 1968, 15 per cent had abnormally elevated levels of postglucose blood sugar (PGBS) as compared with 25 per cent in the period 1964–1968. Fewer positive reactors were discovered with annual screenings and with the glucose tolerance test (GTT). Although the proportion of positive reactors and of diabetic‐type GTT curves was higher in subjects over age 80 than under age 80, there were 82 residents screened annually for five to nine years who retained normal glucose tolerance despite advancing age. The relatively lower rate of deterioration of glucose tolerance in the second period was attributable to: 1) the younger age of residents admitted since 1968, and 2) the diabetes‐oriented diet plus emphasis on exercise and prevention of obesity. The reactive hypoglycemia found in 6 per cent of the residents was asymptomatic, whereas iatrogenic hypoglycemia was usually symptomatic and often severe. This led to a deliberate policy of undertreatment. Dietotherapy induced a lasting remission in about 60 per cent of newly diagnosed cases of diabetes, often to the point of normal glucose tolerance. Early diagnosis of chemical diabetes, by postponing or obviating the need for antidiabetic therapy, reduced the incidence of iatrogenic hypoglycemia. Diabetes‐oriented measures are recommended for the aged in general, and for residents of homes for the aged in p

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1975.tb00377.x

年代:1975

数据来源: WILEY

摘要:

ABSTRACTTwenty‐eight geriatric residents of a nursing home participated in a double‐blind study to compare the 12‐hour therapeutic effectiveness of a single intramuscular injection (1.0 mg) of haloperidol with that of placebo for the relief of vomiting and nausea due to gastrointestinal disorders. Significantly fewer episodes of vomiting occurred in the haloperidol group than in the placebo group. Nausea also was less frequent in the haloperidol group. After four hours, symptoms recurred much more often in the placebo group. Global evaluations showed that a significantly greater number of haloperidol patients inproved markedly than did those given placebo. There were no clincially significant changes in vital signs throughout the study in the haloperidol group. In 1 placebo patient the pulse rate was significantly increased; otherwise no adverse reactions were reported for this group. Thus, in a nursing‐home population of geriatric patients who experienced vomiting and nausea due to gastrointestinal disorders, haloperidol administered parenterally proved to be a safe and highly effective antiemeti

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1975.tb00378.x

年代:1975

数据来源: WILEY

摘要:

ABSTRACTSurgical mortality rates were reviewed for the four‐year period 1970–1973, in a series of 2,186 operations. The majority of these operations were performed in patients aged 70 or older; of these, 116 were performed in patients of the 90+ age group. Predictably, the surgical mortality in the older groups was higher than in the younger groups. However, the overall mortality for patients aged 70 or older was 4.9 per cent as compared with 8 to 21 per cent for series reported in the literature. Gastrointestinal, biliary, and chest procedures carried a much higher mortality than did the other major categories. Minor surgical operations in the elderly should be approached with caution since they may be associated with a significant mortality rate. Nevertheless, elderly patients should not be denied surgical intervention, major or minor, on the basis of age alone when the operation can make their remaining years more comforta

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1975.tb00379.x

年代:1975

数据来源: WILEY

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1975.tb00380.x

年代:1975

数据来源: WILEY

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1975.tb00381.x

年代:1975

数据来源: WILEY