Nippon Ronen Igakkai Zasshi. Japanese Journal of Geriatrics
Print ISSN : 0300-9173
Volume 28 , Issue 2
Showing 1-18 articles out of 18 articles from the selected issue
  • Mitsunori Morimatsu
    1991 Volume 28 Issue 2 Pages 123-128
    Published: March 30, 1991
    Released: November 24, 2009
    JOURNALS FREE ACCESS
    The 159 patients with Parkinson's disease with onset after the age of 50 (mean: 62.3 years) were studied with reference to diagnosis and treatment. The results were as follows: 1. Other than the characteristic features, the symptoms at onset were depression (6% of the patients), lumbago (4%), hemiplegia-like (4%) and dizziness (3%), causing misdiagnoses in some of the patients. Among 159 patients studied, the severity most frequent was Yahr stage 3 (63%) at first examination, indicating the necessity of earlier diagnosis. 2. Magnetic resonance imaging (MRI) of the substantia nigra and striatum was investigated using a 1.5 Tesla field and T2-weighted images, which gave no specific results concerning diagnosis and severity. However, it was useful in differential diagnosis between this disease and parkinsonism caused by multiple system atrophy and cerebrovascular diseases. 3. With 123I-IMP SPECT, decrease in blood flow in the frontal and temporal lobes correlated with the severity (Yahr stage) of the disease. Regarding cognitive functions the scores of Hasegawa's Dementia Scale and Mini-Mental State showed a highly significant correlation with the amount of blood flow in frontal and parietal lobes, suggesting that dementia might be caused by dysfunction of these lobes. 4. In 98 patients treated with levodopa mixed with dopa-economizers for more than a year, the maximum improvement was small in severely disabled patients of Yahr stage 5 and 4 because none improved to stage 3A or below (3A is an arbitrary criterion meaning mild involvement in stage 3 with 3B meaning more severe cases). When the patients under levodopa therapy for more than three years (mean: 74 months) were classified into two groups consisting of those receiving a high dose (600mg or more per day) and those receiving a lower dose (500mg or less per day), greater deterioration was eventually seen in the higher dose group, in addition to higher frequency of wearing-off and on-off phenomena, the latter being observed only in this group. It is therefore reasonable to say that although the administration of a higher dose of levodopa may bring more improvement temporarily, it is probablly hazardous over the long term. However, levodopa should be used for patients in any stage under poor control with drugs other than levodopa, and when levodopa is given the dose should be less than 600mg a day, with a combination with bromocriptine and other drugs if necessary. Rehabilitation including physical therapy should be combined with drug therapy.
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  • T. Yamada
    1991 Volume 28 Issue 2 Pages 129-134
    Published: March 30, 1991
    Released: November 24, 2009
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  • Y. Akanuma
    1991 Volume 28 Issue 2 Pages 135-139
    Published: March 30, 1991
    Released: November 24, 2009
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  • T. Matsuda
    1991 Volume 28 Issue 2 Pages 140-144
    Published: March 30, 1991
    Released: November 24, 2009
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  • Toshiaki Inagaki, Yoshio Hashizume, Kazuya Nokura, Toshiyuki Yamamoto, ...
    1991 Volume 28 Issue 2 Pages 145-151
    Published: March 30, 1991
    Released: November 24, 2009
    JOURNALS FREE ACCESS
    The purpose of this study is to clarify the clinical and pathological characteristics of cerebrovascular disease in nonagenarians and centenarians. In all autopsied cases from 1981 to 1986 (60-101 years old, 138 men and 157 women), cerebrovascular disease was observed in 32 cases (90-101 years old, 8 men and 24 women) and 174 cases (60∼89 years old, 95 men and 79 women) in our hospital. The incidence of cerebrovascular disease was 58.3%, 68.8%, 75.1% and 64%, pathologically, in their sixties (60's), seventies (70's), eighties (80's) and over nineties (90's) respectively. In those who had cerebrovascular disease, cerebral infarctions were found in 79.9% of the cases of the under-90 group and 81.2% of cases of the over-90 group. In both groups, infarction was mainly found in over 2 regions, in the putamen, caudate, thalamus and in the white matter and cortex of the frontal lobe. In the over-90 group, the medium-sized infarctions decreased and small-sized infarctions increased. Cerebral hemorrhages were found in 16.1% of cases in the under-90 group and 12.6% of cases in the over-90 group. In the over-90 group, large-sized hemorrhages were found in 75%, and the incidence of hemorrhages was 50%, 50% in the lentiform nucleus and the subcortex respectively. The frequency of mental symptoms, frontal signs and oral dyskinesia in the over-90 group was significantly higher than in the under-90 group. The onset of cerebrovascular attacks was unknown in 43.8% cases. All of these cases were patients with infarctions. The frequency of hypertension in those patients with cerebrovascular disease was significantly higher than in those without it. In conclusion, in the over-90 group, multiple and small-sized infarctions were found, representing cerebrovascular attacks which had not been diagnosed. However hypertension might reasonably be considered a contributing factor to the occurrence of cerebrovascular disease.
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  • Hiroshi Takaki, Iwao Sato, Izuru Masuda, Katsuro Shimomura
    1991 Volume 28 Issue 2 Pages 152-159
    Published: March 30, 1991
    Released: November 24, 2009
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    Exercise-induced angina (EA) is an important menifestation of myocardial ischemia in stress testing. However, whether or not the presence of EA indicates a greater severity and worse prognosis of coronary artery disease is uncertain. It is well known that the elderly have a greater prevalence of silent myocardial infarction. This suggests that the incidence and significance of EA in elderly patients may differ from those in the younger patients. Therefore, we, at first, studied the age-related change in the incidence of EA by reviewing 983 consecutive treadmill tests. Furthermore, to evaluate the age-related change of the clinical and prognostic significance of EA, exercise tests, angiographic findings and 29 months follow-up data were assessed in 142 patients without prior myocardial infarction who underwent treadmill test and coronary angiography (CAG) for the investigation of coronary artery disease. The rate of positive test results among 983 treadmill tests exceeded 30% only in patients 60 years old or older. Accordingly, we divided the patients into two different age groups: middle-aged patients (≤59yr, M-patients) and elderly patients (≥60yr, O-patients). Among 983 treadmill tests, O-patients had a higher rate of positive results (presence of EA or positive ECG criteria) than M-patients (36 vs. 24%, p<0.001). However, incidence of EA was similar in the 2 groups (17 vs. 14%). Among 142 CAG patients, there were no differences in rate of positive test results (72 vs. 69%), incidence of EA (53 vs. 59%), average number of diseased vessels (1.5±1.1 vs. 1.3±1.1) between the O-patients and M-patients. In M-patients with EA exercised shorter than patients without EA (6.3±2.1 vs. 8.6±3.0min., p<0.001) with a greater ST index (-1.8±1.5 vs. -0.3±2.2, p<0.001) and ST/HR slope (15.3±11.7 vs. 8.1±8.8μV/bpm, p<0.05) and had higher severity of diseased vessels (1.7±1.0 vs. 0.9±1.0 p<0.01). Moreover, higher incidences of subsequent revascularization (67 vs. 21%, p<0.001) and remaining anginal symptoms (33 vs. 14%, p<00.05) were also observed in patients with EA than patients without EA. By contrast, in O-patients, none of these differences were observed between patients with and without EA. Cardiac death occurred in 3 patients with EA (1 in M-patients, 2 in O-patients). Subsequent myocardial infarction occurred in 4 patients with EA (1 in M-patients, 3 in O-patients) and in 1 without EA in O-patients. Thus, clinical and prognostic significance of anginal pain during exercise testing varies in accordance with aging. Even when angina is not induced by treadmill test in patients without myocardial infarction, elderly patients could not be expected to show clinical and prognostic significance as good as that observed in middle-aged patients without exercise-induced angina.
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  • Haruo Hanyu, Hisayuki Arai, Hideyo Katsunuma, Ryuichi Fujita, Chiyuki ...
    1991 Volume 28 Issue 2 Pages 160-165
    Published: March 30, 1991
    Released: November 24, 2009
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    A neuroradiological study of crossed cerebellar atrophy (CCA) was performed using X-ray CT in 103 patients suffering from unilateral supratentorial cerebrovascular diseases. CCA was demonstrated in 9 (8.7%) of 103 patients. No difference between the occurrence of CCA in cerebral hemorrhage and that in cerebral infarction was found. CCA was seen in the chronic stage of cerebrovascular disease more than 3 years since stroke occurrence, and was found to be present more frequently and to a greater extent 7 years later. No correlation between the site of bleeding and the occurrence of CCA was found. Trans-synaptic degeneration of the corticopontocerebellar tract was considered in CCA following putaminal and combined hemorrhage involving an internal capsule lesion. However, in thalamic hemorrhage, retrograde degeneration within the cerebellorubrothalamic tract was presumed. CCA following cerebral infarction was seen in patients with massive lesions in the territory of the middle cerebral artery. Multivariate analysis showed that lesions of the parietal and frontal lobes appeared to greatly contribute to the development of CCA. As the degeneration and atrophy in the thalamus on the side of the lesion appeared early and frequently, it was suggested that retrograde degeneration of the cerebellorubrothalamic tract participated, in addition to anterograde corticopontocerebellar tract degeneration, in CCA following middle cerebral artery infarction. It is likely that CCA is caused by both transsynaptic degeneration of the corticopontocerebellar tract and the cerebellorubrothalamic tract.
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  • Toshiji Iwasaka, Noritaka Tarumi, Yasuo Takayama, Yumie Matsui, K. Hay ...
    1991 Volume 28 Issue 2 Pages 166-171
    Published: March 30, 1991
    Released: November 24, 2009
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    To evaluate the difference in the frequency of complication of mitral valve prolapse (MVP) according to sex in subjects aged 60 years and older, 543 patients (218 men and 325 women) who were diagnosed as having MVP by echocardiography at the Lahey Clinic Medical Center were studied. Three hundred and fourty eight patients had no complication of MVP (male vs female=129:219). Infective endocarditis occured in 20 patients (male vs female=13:7). Rupture of chordae tendineae occured spontaneously in 29 patients (male vs female=20:9) and were associated with infective endocarditis in 8 other patients (male vs femaled=6:2). Eighteen patients required mitral valve surgery for severe mitral regurgitation. The frequencies of these complications were higher in males than those in females. Cerebral ischemic events were encountered in 54 patients. There was no significant difference in the frequency between male and female. In conclusion, MVP in elderly men might be at for cardiac complication.
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  • Masayoshi Sakakibara, Manabu Kamegai, Fumihiko Miyake, Masahiro Muraya ...
    1991 Volume 28 Issue 2 Pages 172-181
    Published: March 30, 1991
    Released: November 24, 2009
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    In chronic case of myocardial infarction (OMI), alternation of a daily total energy consumption (DTEC) between in OMI and in the pre-infarction stage was investigated. The limiting factors of DTEC, including functional classification according to New York Heart Association (NYHA) subset, Forrester's hemodynamic subset (FS) in the stage of acute myocardial infarction (AMI), numbers of significant coronary arterial stenosis (NCAG), cardiac function at rest in OMI, for example; cardiac index (CI), pulmonary capillary wedge pressure (PCW), left ventricle end-diastolic pressure (EDP) and exercise tolerance in OMI, were considered. Subjects, consisting of 191 OMI cases, were classified into the younger group <59 years old (79 males and 10 females) and the older group >60 years old (102 males and 23 females). Daily physical activity was examined by questionnaries from these patients and DTEC was calculated based on daily physical activity. Results in the younger group and older group were investigated separately. Reduction of DTEC after myocardial infarction was recognized in all ages and both sexes. however, reduction of DTEC in the older group was less than in the younger group, especially in males. Concerning the limiting factors of the older group, exercise tolerance in OMI was related to reduction of DTEC. NYHA category, FS in the AMI stage, NCAG, CI, PCW and EDP had no significant relation to DTEC. In addition, the effects of social limiting factors, for instance retirement, and mental limiting factors were considered to be important.
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  • Kozo Matsubayashi, Akiko Kawamoto, Shigeaki Kimura, Katsusuke Takeuchi ...
    1991 Volume 28 Issue 2 Pages 182-187
    Published: March 30, 1991
    Released: November 24, 2009
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    The validity of a newly developed computer-aided “Visuospatial Cognitive-Performance Test” (VCP-Test) was examined in two populations, 68 normal elderly volunteers (mean age, 69.5% years) and 25 patients with dementia (mean age, 68.2 years). None of the cases in the two groups had either motor impairment or ataxia. The VCP-Test was a kind of vigilance task in which a subject is required to tap the key corresponding to the local change-over of the image on the computer display as quickly as possible. After 40 trials, consecutive data of performance efficiency were automatically displayed on the LCD display and printed out. A significant negative correlation between the VCP-Test and age in normal elderly population was recognized. Moreover, the relationship between the VCP-Test and the Hasegawa Dementia Scale (HDS), and the Mini-Mental State (MMS) was also significant in patients with dementia. In conclusion, the VCP-Test was considered to be useful for geriatric neurobehavioral functional assessment and for the detection of dementia.
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  • Kizuku Kuramoto, Seigo Ueda, Satoru Matsushita, Yasuko Suzuki, Yoshihi ...
    1991 Volume 28 Issue 2 Pages 188-193
    Published: March 30, 1991
    Released: November 24, 2009
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    The effect of serum cholesterol on aortic, cerebral, coronary and femoral atherosclerosis as well as on the incidence of cerebral and myocardial infarctions were analyzed in 3, 236 consecutive autopsies in the elderly. Serum cholesterol levels declined over the age of 80 in both genders. The cholesterol levels of females were significantly higher than that of males in each age group from the sixties through the nineties. The increase in serum cholesterol was correlated with the progression of coronary atherosclorosis in both genders, but not with cerebral or femoral atherosclerosis. Slight progression of aortic atherosclerosis was observed when serum cholesterol was over 160mg/dl. Cholesterol induced progression of coronary atherosclerosis was found in cases with hypertension, but not in the normotensive group. In accordance with the progression of coronary atherosclerosis, the incidence of myocardial infarction increased with an elevation of serum cholesterol levels, and this relationship between myocardial infarction and cholesterol levels was found only in patients with hypertension. No correlation was found between the incidence of cerebral infarction and serum cholesterol levels. It was concluded that hypercholesterolemia in the elderly is a risk factor of myocardial infarction in cases with hypertension, but is not a risk factor of cerebral infarction.
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  • Shigeki Akabane
    1991 Volume 28 Issue 2 Pages 194-199
    Published: March 30, 1991
    Released: November 24, 2009
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    In order to evaluate atherosclerotic changes in diabetes mellitus (DM), pulse wave velocity (PWV), forearm blood flow (FBF: by venous occlusion straingauge plethysmography), forearm vascular resistance (VR: mean arterial pressure/FBF) and radial artery blood velocity (RABV: by ultrasonic Doppler) were determined noninvasively in healthy controls (n=15) as well as age-matched diabetic patients with (DMHT, n=11) or without hypertension (DMNT, n=21). Both in controls and diabetic subjects, PWV demonstrated a significant positive correlation with age. Diabetics tended to show higher, although not significantly higher, PWV in comparison with controls. In controls, but not in diabetics, FBF and VR respectively demonstrated a significant negative and positive relationship with age. Diabetics younger than 50 years had a lower FBF and a higher VR in comparison with age-matched controls. In the DMHT group, FBF was significantly attenuated. There was no difference in RABV between controls and diabetic group. PWV did not correlate with FBF or VR. However, FBF did show a significant negative correlation with VR. RABV negatively correlated with FBF in diabetics, indicating that FBF may reflect distensibility in forearm arteries and veins. These results suggest that FBF may be a better arteriosclerotic index for resistance vessels and DM or hypertension may accerelate arteriosclerotic changes.
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  • Hideki Mori, Shinji Seto, Yasuhiko Oku, Kunitake Hashiba, Shizuka Ochi ...
    1991 Volume 28 Issue 2 Pages 200-204
    Published: March 30, 1991
    Released: November 24, 2009
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    The relationship between arteriosclerosis and osteoporosis (OP) was assessed in 20 elderly women. The aortic pulse wave velocity (PWV) was used as the index of arteriosclerosis and bone mineral content (BM) of the vertebral body, which was measured by quantitative computed tomography, was used as an index of OP. PWV and BM showed a significant correlation with aging (PWV and age: r=0.466, p<0.05, BM and age: r=-0.487, p<0.05). In the group in which the serum alkaline phosphatase (ALP) was higher than 180IU/l (n=11), there was a significant inverse correlation between PWV and BM (r=-0.728, p<0.02). On the other hand, there was no correlation between PWV and BM in the group in which ALP was lower than 180IU/l (n=9). These results suggest that in cases with OP and high levels of ALP, calcium (Ca) seems to be released from the bone system and transferred to the wall of the aorta. The mechanism and pathogenesis of this Ca transference is unknown and should be investigated.
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  • Akira Deguchi, Kouzou Kawamura, Hideo Wada, Seiko Murashima, Katsumi D ...
    1991 Volume 28 Issue 2 Pages 205-209
    Published: March 30, 1991
    Released: November 24, 2009
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    Plasma levels of thrombomodulin (TM), fibrinogen, antithrombin III (ATIII) and thrombin ATIII complex (TAT) were studied in healthy young subjects (group A), healthy elderly subjects (group B) and patients with chronic nonembolic cerebral infarction (group C). The level of TM in group B tended to be higher than that in group A. Levels of TM, fibrinogen and TAT in group C suggested the presence of a hypercoagulable state. When group C was further divided into those with and without diabetes mellitus (DM), the TM level in the former tended to be higher than that in the latter. Furthermore, among the patients with DM, those with diabetic retinopathy showed significantly higher levels of TM than those without retinopathy. Thus, high TM levels indicate the presence of endothelial injury. In groups B and C, TM correlated positively with fibrinogen, and negatively with ATIII, which also indicates that a high TM level is related to a hypercoagulable state. In conclusion, the TM level is considered to be a potential marker of the presence of endothelial injury.
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  • Atsushi Mizuuchi
    1991 Volume 28 Issue 2 Pages 210-216
    Published: March 30, 1991
    Released: November 24, 2009
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    To elucidate morphological change of alveoli in compensatory lung growth, left pneumonecotmy was performed on male 4 weeks-old rats (Fischer-344) and light microscopic morphometry, scanning electron microscopic study and histochemistry using anti-bromodeoxyuridine were made. The wet lung weight and lung volume of the residual lungs in the pneumonectomized rats reached the same as those of sham operated rats at one and two weeks after the operation, respectively. From the data concerning the mean linear intercept in the cardiac lobe of the pneumonectomized rats, alveoli of two different sizes were observed, suggesting that the compensatory lung growth in the alveoli may take two steps or at least two different sizes of alveoli may exist mixed together. The data of histochemistry suggest that in pneumonectomized rats the alveoli beneath the pleura (less than 2mm) included an increased number of S phase cells compared with those of deeper areas. From these morphological changes in the lungs of the pneumonectomized rats it is possible to suggest a hypothesis that stretch stimulation is the first trigger in compensatory lung growth.
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  • Yoh-ichi Kaku
    1991 Volume 28 Issue 2 Pages 217-225
    Published: March 30, 1991
    Released: November 24, 2009
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    A potent, new muscarinic cholinergic antagonist, L-[N-methyl-3H] quinuclidinyl benzilate methyl chloride ([3H-]-NM-QNB) was used to detect functional changes of muscarinic acetylcholine receptors (mAChR) on human lymphocytes in relation to age.
    Using techniques developed for the study of mAChR in brain homogenate, direct binding to whole live lymphocytes was shown for [3H]-NM-QNB. We examined Group of healthy adult females (41-66 years old, N=34) and patients with“probable”Alzheimer's disease (55-75 years old, N=11).
    It was shown that mAChR on lymphocytes were divided into two subtypes; high affinity (Ms) and low affinity types (Mw) for a ligand, [3H]-NM-QNB. For the healthy controls (age range 41∼66 years old, N=31), a negative correlation (r=-0.172) was found between Kd (Ms) and age. Also the negative correlation between Bmax (Ms) and age was shown to be weak (r=-0.164).
    The regression equations are:
    Y=-11.9X+1306.4(Kd(Ms); N=31)
    Y=-80.6X+8296.1(Bmax(Ms); N=31)
    where, X and Y designate the age of individuals and Kd (or Bmax), respectively. Hence, for patients with Alzheimer's disease, no significant changes with age in Kd (Ms) or Bmax (Ms) were obtained. Furthermore, correlations between the stage of clinical dementia of patients and Kd (Ms), and between the staging and Bmax (Ms) were shown to be strong (p<0.05). Significant change (p<0.05) in Bmax (Ms) was recognized in lymphocytes from patients with Alzheimer's disease (N=11), compared with age-matched controls (N=20).
    There results suggest that the binding properties of [3H]-NM-QNB to mAChR on lymphocytes may be useful in the study of changes associated with aging, and also in the evaluation of the clinical dementia rating of Alzheimer's disease.
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  • Toshiaki Inagaki, Yoshio Hashizume, Kazuya Nokura, Toshiyuki Yamamoto, ...
    1991 Volume 28 Issue 2 Pages 226-231
    Published: March 30, 1991
    Released: November 24, 2009
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    An autopsy case of progressive supranuclear palsy (PSP) associated with central pontine myelinolysis (CPM) is reported. A 73-year-old male patient suffered from gait disturbance for about 5 years. The clinical features were characterized by gradual development of supranuclear ophthalmoplegia, tremor, bradykinesia, rigidity, neck dystonia, dementia and pseudobulbar palsy at the advanced stage of his illness. Treatment with levodopa did not improve his neurological signs and symptoms. PSP or multiple system atrophy was considered as a clinical diagnosis of the patient. He died of pneumonia, acute pancreatitis and liver dysfunction in November 1985. The main neuropathological findings were neuronal loss and gliosis with neurofibrillary tangles of globose type in the globus pallidus, subthalamic nucleus, substantia nigra and dendate nucleus, and at the base of the pons, bilateral and symmetrical demyelination was found. In addition, myelin staining revealed circumscribed pallor in the cerebral white matter. The histologic diagnosis was PSP associated with CPM. An association of PSP with CPM is rare in the elderly and possible etiologic factors of both diseases were discussed.
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  • 1991 Volume 28 Issue 2 Pages 232-269
    Published: March 30, 1991
    Released: November 24, 2009
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