Journal of the American Geriatrics Society
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This study concerns the relationship between age and injury in 1,297 patients with recent burns who were admitted variously to 73 hospitals. Older patients showed a significantly higher proportion of severe injuries than did middle-aged and younger groups. Even after adjusting for the severity of injury, the morbidity and mortality were higher in the over-65 group. ⋯ Surgical treatment such as debridement and grafting was used no more frequently in older patients than in younger ones, even though the greater severity of the burns would normally be expected to require more operations. The fact that older patients had more complications could have influenced physicians in their surgical decisions. Also, the attitude that the elderly are less able to tolerate surgical procedures may have played a role in the use of less aggressive treatment in relation to the severity of the burn.
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A classic case of progeria (Hutchinson-Gilford syndrome) in a 9-year-old Japanese boy is presented. The characteristic clinical features in this patient were similar to those reported in the literature. The total amount of acid glycosaminoglycans excreted in the urine was within the normal range, but there was an increase in hyaluronic acid excretion. The hyaluronuria was a novel finding in progeria, providing a common linkage with the hyaluronuria found in Werner's syndrome.
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This follow-up survey of physicians' attitudes and practices reveals a changing approach toward the care of terminal patients. It shows that: 1) communication with dying patients is becoming more open, 2) support for the omission of life-prolonging treatments is increasing, and 3) opposition to the use of death-hastening measures remains strong. It indicates that the physician's experience with terminal patients and the setting of his practice influence his attitude towards these patients and the approach to treatment.
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The electrocardiograms of 1,171 patients above the age of 65 in a predominantly geriatric institution were reviewed to determine the incidence of tachyarrhythmias. Data on the overall incidence and the individual types of arrhythmias are presented. ⋯ Atrial fibrillation often was associated with other evidence of myocardial damage. The significance of sinus bradycardia and grade I A-V block in the pathogenesis of atrial fibrillation and the significance of the tachyarrhythmias are discussed.
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Chronic non-rheumatic pain in the aged should be viewed in the context of physiologic and clinical alterations due to aging which may create diagnostic problems. In the elderly, the abnormality of the clinical presentation and the patient's failure to remember the time and the nature of the precipitating incident may be extremely misleading. Many clinical features may also be altered by the aging process itself. ⋯ The prescription of combination preparations may involve use of a drug that is beneficial for one disorder but harmful for another. Aged persons display a marked tendency toward abnormal reactions to the usual drug regimens. A wise combination of treatment by medical means (including drugs), physiotherapy, and sometimes surgical procedures, usually is effective for the relief of this type of chronic pain.