Middle-aged Person Research Articles

Modified rotational acetabular osteotomy (RAO) for advanced osteoarthritis of the hip joint in the middle-aged person First report

Classical methods for pelvic osteotomy, such as those of Salter, Pemberton, Chiari, and Wagner, have been developed for reconstruction of the subluxed hip joint in children and young adults. Regarding pelvic osteotomy involving a middle-aged patient, however, there are not as many operation methods to consider, and it is difficult to choose the most suitable technique for alleviating advanced osteoarthritis. Based on current practice, total hip replacement (THR) seems the accepted method, though it presents problems such as loosening, sinking, and infections; because of these factors physicians hesitate to recommend THR surgery, particularly if the patient is otherwise healthy and appears to have many good years ahead of him. As an alternative, we have been developing and improving the acetabular osteotomy, based on Tagawa's rotational acetabular osteotomy (RAO) and Wagner's acetabular osteotomy (type II). In this paper we present the results of a modified RAO operation performed on 50 middle-aged patients with an average age of 42 years and 2 months (31-61). The average follow-up was 3 years and 3 months (1-9 years). In 82% of patients the result was satisfactory (41 of 50 cases). A similar osteotomy technique has been used by Eppright and Wagner. We feel that our method achieves a more favorable result for an older patient with severe osteoarthritis, since both the surgery and the follow-up rehabilitation are more comprehensive. A modified acetabular osteotomy should not be regarded as merely an alternative to total hip replacement, but as the preferred choice for hip-joint reconstruction.

Familial Support of the Elderly in a Rural Mennonite Community

AbstractWith an increasing number of persons entering old age and having longer life expectancies, there has been a consequent alteration of family dynamics, such that middle aged individuals frequently provide support to their older parents. At the same time, the middle aged person is often in the midst of raising his or her own children, attending to personal aspirations, and enacting the role of spouse.This study investigated support from middle aged offspring to elderly parents in a rural Mennonite community. Information on the expectation for and consequences of support to parents was gathered from pastors and middle aged family members in two Mennonite conferences, as well as from a Lutheran sample with a similar historical background.Pastoral interviews showed no differences in doctrinal beliefs regarding familial care of parents, although the institutional church responses varied. Middle aged offspring in the Lutheran congregation reported less involvement in religious practice than did members of either Mennonite congregation. Burden of caring for elderly parents felt by middle aged people showed no statistically significant differences between congregations; however, greater reported religiosity was associated with lesser burden.

Parental survival, an independent predictor of longevity in middle-aged persons.

In a 25-year follow-up of 2370 middle-aged civil servants and spouses of civil servants, the authors studied the effect of the number of parents (none, one, or both) which a middle-aged person still has alive on this person's survival. Among men, no relationship was found with the number of parents alive after 15 years of follow-up and a weak gradient was found after 25 years. Among women, there was a clear gradient of mortality according to the number of parents alive, both after 15 and after 25 years. In a logistic regression analysis of mortality, after 25 years, the age-adjusted effect of having both parents alive relative to none was significant in men and women (for men: odds ratio = 0.63, 95% confidence interval = 0.42-0.97; for women: odds ratio = 0.36, 95% confidence interval = 0.19-0.69). These estimates did not change materially upon inclusion of other determinants for chronic disease and death into the model (smoking, blood pressure, serum cholesterol, and body mass index). The authors concluded that the parental effect was independent of these risk factors.

Perceptions of Development

A group of 144 college students expressed attitudes about the competencies of self, average peer, average middle-aged person, and average old-aged person for abstract thinking, everyday problem solving, and moral reasoning. An additional three groups of 48 college students role played one area of competence by completing Cattell's Culture-Fair Test, the Means-Ends Problem Solving Test, or the Defining Issues Test for each of the four target groups. The aim of this study was to assess the agreement between the two methods. The attitudinal results reflect that general self and middle-age ratings are significantly higher than peer and old-age ratings, except for moral reasoning where the old-age ratings are highest. The role-playing results for abstract thinking and moral reasoning indicate a perceived decline between college age and old age. The disagreements between the attitudinal and role-playing results indicate that there are substantial limitations on the equivalence of the two methods.

Experience with atypical mycobacterial infection in the deep structures of the hand

Two new cases of atypical mycobacterium infections of the deep structures are reported. With two reported previously by the authors and a review of 24 others recorded by others, the symptoms and signs are reviewed. Typically it occurs in the middle-aged person, some of whom give a history of a puncture wound within 6 weeks of onset of symptoms. Synovium in the finger is involved commonly and a carpal tunnel syndrome may be the result of involvement of the bursae. Fever does not occur and no systemic signs are present. Biopsy and cultures are essential for diagnosis, but a presumptive diagnosis indicates that, after synovectomy, treatment should be started with antituberculous drugs, isoniazid with ethambutol, Rifampin, or both and continued for 18 to 24 months, unless in vitro sensitivity tests indicate a change of medication. The usual organisms are M. kansasii, M. marinum, M. intracellulare, and M. avium.

Non-Hodgkin’s Lymphoma in Colon

The incidence of Non-Hodgkin's lymphoma has steadily risen and while other cancers have increased 25%, NHL has increased >80%. In the majority of NHL patients, the disease arises in lymph nodes, but primary extranodal disease accounts for 30% of new lymphoma patients and often present as localized disease. We report a rare and interesting case of intermediate grade diffuse Non-Hodgkin's lymphoma in colon. A 30year old man presented to our department with the complaints of mild epigastric pain, occasional loose stools and, abdominal swelling for 3 months along with significant weight loss for the last 2 months. On examination, he appeared cachectic with only 33 kg, an intra-abdominal mass was palpable in the epigastrium rt side from the midline measuring 3cmx5cm, hard in consistency but does not move with respiration which was consisted with abdominal lymph node. USG guided FNAC of right upper abdominal mass revealed: Non-Hodgkin's lymphoma. Biopsy report of tissue from colon revealed diffuse non- Hodgkin's lymphoma, intermediate grade. To our knowledge, very few cases are reported so far with similar presentations and finally diagnosed with non-hodgkin's lymphoma of colon. Thus, in our clinical practice, if a middle aged person present with wt. loss, chronic diarrhoea, and abdominal swelling, we should also suspect this might be a case of Non-Hodgkin's lymphoma of colon as an extranodal presentation. DOI = 10.3329/jom.v8i2.1413 J MEDICINE 2007; 8 : 74-75

Werner's Syndrome Progeria of the Adult

THE Introduction THE SIGHT OF a young or middle aged person of very short stature with a wizened face, completely grey hair, and thick glasses suggesting previous cataract surgery is most certainly uncommon. In 1904 Otto Werner 1 described four patients with these progeric features and since then approximately 115 more persons with similar striking features have been recognized, thus justifying the eponym syndrome. The spectrum of adult progeria is extensive (Table) with signs first becoming evident between 15 and 30 years of age. The short stature and striking facial changes are constant, 2 uniting the small congregation of people with Werner's syndrome with a common mien. Scalp hair turns grey or is lost and the eyebrows become sparse. The subcutaneous fat overlying bony prominences and cartilage is poorly developed so that the epidermis tightly encases the ears, nose, malar ridges, and the forehead. Fine radial lines form around

THE CAF'E CORONARY. SUDDEN DEATHS IN RESTAURANTS.

A MIDDLE-AGED or elderly person, at a fashionable restaurant, is partaking of filet mignon, or perhaps broiled lobster or prime rib of beef. At the same time, he is conversing with companions at dinner. Suddenly, he ceases to eat and talk. The dinner companions are perplexed but not alarmed for there is no indication of distress. Then, the person suddenly collapses at the table. Attempts at resuscitation are made by the maitre d'hotel, waiters, and friends. In some instances, a physician may be present who also attempts to aid the stricken person. The ambulance arrives and the person is rushed to the nearest hospital emergency room where he is dead on arrival. The emergency room physician, or the family doctor, attributes death to natural causes and probably to coronary artery disease. The above is the characteristic story of death from asphyxiation due to occlusion of the airway by food. The

INFECTION IN THE OLDER PATIENT

In older people afflicted with one of several types of infectious diseases, the morbid process may exhibit patterns which differ considerably from those in the young or middle aged person. As practitioners of medicine, we are called upon to treat more and more older people. It behooves us, therefore, to understand the nature of these altered disease patterns and to utilize this knowledge in practice. It is appreciated generally that the body's defense mechanism against an infectious agent is inflammation. The pathogenesis of the inflammatory reaction is a complex of vasohumoral alterations, which produce a local response to combat the invading organism and systemic changes to support the combat. In older people, the dynamics of inflammation are obtunded, with diagnostic signs and symptoms so unlike the disease as seen in younger individuals that the diagnosis is difficult and may be made late. A number of examples of these altered morbid

Treatment of checkrein shoulder by use of manipulation and cortisone.

• Checkrein is distinguished from other types of shoulder by a history, in a middleaged person, of disuse that may or may not have followed an initiating event, by slow return of joint mobility limited to the lower ranges with a painful check to the upper ranges of motion, by resistance to ordinary treatment, by findings of limited passive abduction and rotation, by x-ray findings of demineralization from disuse with calcification deposits in 20%, and by a palpable and audible release of resistance during manipulation under anesthesia. Of 44 checkrein shoulders so manipulated, 33 promptly regained a normal range of motion if the postmanipulation pain was suppressed by orally given cortisone, parenterally given corticotropin, and/or locally injected hydrocortisone acetate and hyaluronidase. In 11 cases, improvement was achieved but some pain or limitation remained. Six cases of frozen that did not satisfy the above diagnostic criteria were not improved. Since manipulation has in one of these resulted in fracture of the anatomic neck of the humerus, it must be done with care.

THE PRESERVATION OF THE NUTRITIVE VALUE OF FOODS IN PROCESSING

The prodigious increase in the consumption of succulent vegetables and fruits makes an interesting statistical study. A century ago most of the people of the United States regarded tomatoes as poisonous, and when children ate them inadvertently medication to counteract their toxin was not unusual. In 1918 Hess 1 recommended tomato juice as an antiscorbutic for 3 month old infants, and in later publications he stated that infants can tolerate twice as much tomato juice as orange juice. Today tomato juice is the leader in volume of an array of ever available fruit juices. Many a middle aged person who takes for breakfast a glass of orange juice comprising two or three normal size fruits can well remember when one such fruit in his Christmas stocking was his annual quota. Samuel Pepys once drank a whole glass of orange juice and was surprised that he did not become ill. Less

Common duct obstruction

Common duct obstruction

PRIMARY JUGULAR BULB THROMBOSIS IN AN ADULT

Primary jugular bulb thrombosis is not an infrequent occurrence in infants and children. Since McKernon¹first called attention to this condition, a little more than a quarter of a century ago, a number of cases have been described. In adults primary jugular bulb thrombosis is extremely rare, relatively few cases having been reported. In the instances cited the age range was well within the third decade of life. The patients of Potts,²Ginsberg,³and Maybaum and Goldman⁴were all under 21 years of age. The patient of Wieder and Bates⁵was 26 years old. Fraser's⁶patient was a 41 year old woman and her case, except for the one presented here, is the only example, to my knowledge, of primary bulb thrombosis in a middle aged person. <h3>REPORT OF A CASE</h3> <i>History.</i>—P. W., a white man, aged 46, had pain in the left

The Croonian Lecture. On the irritability of nerves

Its object is principally to investigate the opinion hitherto entertained, that the nerves may be considered as chords that have no power of contraction within themselves, but only serve as a medium by means of which the influence of the brain may be communicated to the muscles, and the impressions made upon the different parts of the body may be conveyed to the brain. After pointing out the extreme difficulty of such an inquiry, owing to the few opportunities that offer for investigating the real state of the nerves in the living body, Mr. Home intimates that he resolved to avail himself of every opportunity that might offer of any operation in surgery performed upon nerves, either in a healthy state, or under the influence of disease, in order to elucidate this intricate point, without neglecting certain experiments he thought he could devise upon animal bodies, before they are wholly deprived of life. The first case, which explains some circumstances respecting the actions of the nerves when under the influence of disease, was that of a middle-aged person, who, having hurt his thumb by a fall, experienced long after an occasional swelling and convulsions in that part, attended with spasms, which at times extended in the direct course of the trunks of the radial nerve up to the head, the patient being at times afflicted with absolute insensibility. In order to put a stop to the progress of tips irritation, which seemed to constitute the disease, it was proposed to divide the nerve as it passes from under the annular ligament of the wrist. This operation was accordingly performed, but not altogether with the desired success, owing probably to the wound not healing by the first intention.