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Purpose: To prospectively evaluate the safety and effectiveness of magnetic resonance (MR) imaging-guided galvanotherapy in prostate cancer., Materials and Methods: This prospective study was approved and authorized by the institutional review board, and patients gave informed consent. Forty-four men (mean age, 63.1 years) with histologically proved prostate cancer were treated with galvanotherapy. After transgluteal puncture of the prostate with local anesthesia, two MR imaging-compatible electrodes were positioned under MR imaging guidance in the periphery of the right and left lobes of the prostate so that they had direct tumor contact. The patients were treated three times in 1-week intervals, and direct current was applied to the localized cancer in the prostate gland with a total charge of 350 coulombs. Follow-up with laboratory testing (prostate-specific antigen [PSA] levels) and endorectal MR imaging with tumor volume measurement was performed 3, 6, and 12 months after the procedure. The Friedman test was used to compare tumor volumes and PSA levels across the four time points., Results: All patients tolerated MR imaging-guided galvanotherapy well without any major side effects or complications. Six patients had some reversible difficulty with urination, and five reported temporary unilateral leg paresthesia. Tumor volume as determined with MR imaging decreased from a pretherapeutic median of 1.90 to 1.12 cm(3), which corresponded to a significant (P < .01) reduction of 41%. One patient (2%) had complete remission and 18 (41%) had partial remission at follow-up 12 months after therapy. Twenty-three patients (52%) were classified as having stable disease. Two patients (5%) had progressive disease. Median PSA levels decreased in the 12-month control period from 7.05 to 2.4 ng/mL (66%, P < .01)., Conclusion: MR imaging-guided galvanotherapy is a safe procedure and can result in local control of prostatic carcinoma, with a concomitant reduction in the PSA level., Supplemental Material: http://radiology.rsnajnls.org/cgi/content/full/245/2/895/DC1.

Interest in the provision of medical care to the elderly in Canada has been minimal but is growing. Contrary to the negative attitudes that used to prevail, the medical problems of the aged are intellectually challenging and rewarding, and also will respond to appropriate action. Perceptive diagnosis and evaluation of the person and family, skillful treatment and management, a multidisciplinary team approach and careful follow-up planning and support are required. These principles and skills can be taught, and health science faculties are beginning to accept their responsibility to do so.

The purpose of this study was to examine the incidence of accidental hypothermia in people 65 years and older who were residing at home or were seen in emergency rooms of the four Hamilton hospitals between January 1 and March 31, 1980. For the purpose of this study, accidental hypothermia was defined as a rectal temperature or a core body temperature below 35°C. Persons with temperatures below 35.5°C were considered "at risk" of becoming hypothermic. Special low reading thermometers were supplied to professionals taking part in this study. No cases at risk of, or having, hypothermia were found at home. Nine people were found to be at risk and seven were found to be hypothermic in the emergency room group. None of these manifested the classical signs of hypothermia.

Confusional states in the elderly are not uncommon and demand a high level of diagnostic and therapeutic skills in the physician. An immediate requirement is to provide protection and care while the cause is being elucidated. Tranquilizing medication is useful but the dosage must be both sufficient for the patient to gain control and monitored to prevent overdosage. Confusion may be due to disorder in various body systems with effects on the brain, or to a primary brain disorder. Careful evaluation of general health and also of cognitive, affective and social factors is necessary to clarify diagnosis and management.

Placement of the elderly involves the person, family, treating professionals and those professionals who will provide future care. It must be based on accurate assessment of the person's abilities, interests and care needs. It requires knowledge of possible community support services and residential care facilities. The person must recognize, accept and adjust to the care needs and as far as possible, be allowed the final decision on placement. This requires that he or she be fully informed and given time to consider. There is often competition for resources; a system is needed to ensure identification of the optimal resource for each individual, equitable access to resources according to a recognized priority rating, and a certainty that every person will find a place appropriate to his need.

The Assessment and Placement Service (APS) of the Hamilton-Wentworth District Health Council assists health professionals in identifying the needs of persons with chronic disabling diseases, and in finding appropriate resources or programs. More than 80 percent of the 9,300 persons referred between September 1971 and December 1975 were over the age of 64. Although most referrals were local, some came as far away as British Columbia and Florida for persons wishing placement locally. Of the 2,005 persons referred and placed in 1975, 1,063 came from acute disease hospitals, 201 from other institutions, 628 from the community within this District, and the remainder from elsewhere. There were 1,187 women, of whom 89.5 per cent were over the age of 64, and 811 men, of whom 65.8 per cent were over that age. In the opinion of their physicians, only 20 percent of all persons referred had normal memory, and only 13 percent had normal judgment. In the 64+ age group, 71.1 percent of the women were widows, and 25.9 percent of the men were widowers. One-third of those referred were living alone, and one-fourth with a spouse only. For placement, 453 patients went to private residences or boarding homes, often with the support of community services, and the remainder went to various institutions according to identified needs. Follow-up contact one month later showed conditions to be satisfactory in most instances. Deficiencies in the health care system were identified and reported to the Health Council.

The prescribing of psychoactive drugs for 1431 chronically ill elderly patients being assessed for long-term institutional or community care was surveyed. Psychoactive drugs had been prescribed for about one quarter of the patients; benzodiazepines were the most frequently prescribed group. Judging from the extensive prescribing of flurazepam and chloral hydrate, commonly used hypnotics, the main reason psychoactive drugs were prescribed was to provide night-time sedation. Antidepressants and drugs promoted as useful in improving cognitive function were infrequently prescribed. Commendable prescribing practices included the infrequent use of "cerebral vasodilators" and barbiturates. Questionable prescribing practices included the infrequent use of tricyclic antidepressants in severely depressed patients and the use of tranquilizers in patients described by their attending physician as markedly or extremely withdrawn.

Factors contributing to improper use of medication were examined in 40 patients aged 65 years or more who were in a home care program. They reported taking an average of 3.8 prescription medications and 1.2 nonprescription medications each. Pill counts showed that they were actually taking 57% of the prescribed medications; compliance decreased with the number of medications concurrently prescribed. Poor labelling instructions, difficulty opening childproof containers and misunderstanding of verbal instructions contributed to this problem. The patients tended to rely more on physicians than on pharmacists or visiting nurses for advice problems with medication.

Twenty-eight cancer patients in whom pain was a problem were interviewed over a seven week period. At the end of the period, 11 patients were still suffering the same amount of pain (moderate to severe pain as measured by the Distress Score Method of Marks and Sacher). The reasons for this include medication, the patients' attitude to drugs, mental confusion and other psychosocial problems. We propose that most of the problems would be solved by individualizing therapy and giving drugs regularly in adequate dosage.

A survey of 60 randomly selected pharmacists explored their relationship with elderly patients, including their information storage systems, dispensing practices and the major problems they encounter with these patients. Nearly all the pharmacists kept a medication profile for each elderly patient, and one third used a computer, which facilitated recording of additional information. However, few recorded the age of the patient. Many pharmacists counselled their elderly patients on the correct use of medications, but few provided counselling on the use of nonprescription drugs. Most of the pharmacists reported using techniques to improve compliance among elderly patients. More than 80% of the pharmacists reported apparently inappropriate prescribing by physicians at least occasionally.

The results of a questionnaire completed by the superintendents of five of the six major mental hospitals in the Province of Quebec concerning patients aged 60 and over showed that this group made up one-fifth to two-fifths of the total populations. The proportion of the population that was over age 60 when admitted varied from just under one-third to almost three-quarters. The ratio of those who died or were discharged at age 60 or more to the total elderly population varied greatly among institutions.Between 67% and 91% of the elderly were capable of ambulation and self-care with minimal help, and from 13.5% to 53% were considered mentally capable of living in a private home or residential home.Diagnostic types varied, among hospitals, from 28% to 65% functional, 13% to 32% organic and 4% to 33% senile psychoses.Experience with preventive and treatment programs elsewhere is discussed.