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 54,520 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A prospective study was carried out on 288 general surgical patients aged 65 years and over. Over 40% of patients suffered no post-operative complication. The commonest post-operative problem was respiratory, with 17% of patients having simple atelectasis, 12% acute bronchitis and 10% pneumonia. Six per cent of patients developed post-operative heart failure and/or myocardial infarction. Delirium was noted post-operatively in 7% of patients, and new focal neurological signs in 1%. The post-operative hospital fatality rate was 5% (4% when deaths due to carcinomatosis were excluded). Nine patients out of ten spent less than a month in hospital. The relation of post-operative morbidity and mortality to seven factors was examined: type of surgery, urgency of surgery, urgency of admission, age, number of pre-operative medical diagnoses, American Society of Anesthetists' grade, and pre-operative mobility level. It appears that pre-operative medical fitness rather than chronological age is the main determinant of post-operative outcome in the elderly surgical patient.
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PMID:A prospective study of elderly general surgical patients: II. Post-operative complications. 260 40

The Xe-133 ventilation pattern in congestive heart failure (CHF) was assessed using 24 inpatient ventilation/perfusion studies performed to rule out pulmonary embolism. Patients with histories of CHF, myocardial infarction (MI), and cardiomyopathy were included in the study. Frank pulmonary edema, pulmonary embolism, and other known lung diseases such as chronic obstructive lung disease, tumor, and pneumonia were excluded. Fifteen of the 24 patients had abnormal ventilation scans. Twelve of the 15 showed bilateral basal Xe-133 retention on washout; the remaining 3 showed diffuse, posterior regional retention. On perfusion scans, 14 of the 15 abnormal ventilation patients showed evidence of CHF such as inverted perfusion gradient, enlarged cardiac silhouette, or patchy perfusion, and all of them had a history of CHF or cardiac disease. Nine of the 24 patients had normal ventilation scans, including normal washout patterns. Seven of the nine had normal perfusion (p less than 0.01). Four of the nine normal ventilation patients had a history of cardiac disease or CHF but no recent acute MI. Bilateral basal regional Xe-133 retention, coupled with perfusion scan evidence of CHF such as inverted perfusion gradient, enlarged cardiac silhouette, and patchy perfusion pattern, appears to be a sensitive and characteristic ventilation/perfusion finding in mild or subclinical CHF.
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PMID:Bilateral basal Xe-133 retention and ventilation/perfusion patterns in mild and subclinical congestive heart failure. 260 44

The authors studied 30 cases of aortic dissection performed from January 1978 to December 1987. Dissection was classified as type A (intimal tear beginning in the ascending aorta or arch) and type B (intimal tear beginning in the descending aorta). Type A predominated (66.7%). Type B dissection was most frequent in patients older than 60. Precordial pain was the main symptom in type A cases, whereas 62.5% of type B cases showed no precordial pain. Most frequent findings in type A patients were hypotension (45.5%), murmur of aortic regurgitation (40.0%), and dyspnea (40.0%), whereas in type B patients, most frequent findings were hypertension (28.6%), and pulse deficit (42.9%). The major differential diagnosis for type A was myocardial infarction (43.8%), and for type B, peripheral artery failure (25.0%) and acute pneumonia (25.0%). 24 patients (80.0%) had hemorrhage. Hemorrhage into the pericardial sac occurred in 68.8% of type A patients, and 50.0% of type B patients had retroperitoneal hemorrhage. Systemic hypertension, atherosclerosis, medial cystic necrosis and endocrine disorders were considered predisposing factors for both type of dissection. A case of dissection after aortic valve replacement associated with ascending aorta tubular graft replacement was observed in this series. In type A patients, average survival was 6.3 days, and in type B, 11.1 days. The major cause of death was hemorrhage (70.0%).
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PMID:[The dissecting aorta: clinical analysis and anatomo-pathologic correlations in 30 cases]. 263 76

A follow-up of 92 patients with diabetes mellitus, who were hospitalized at the Department of Pediatrics, University of Bergen, during the years 1950-63, was conducted in June 1986. The mean age of the 76 living patients was 38 years, and the mean duration of diabetes 30 years. Sixteen patients had died. According to the death certificates the causes of death were as follows: Myocardial infarction, uremia, pneumonia, diabetes not further specified, suicide, sudden death not further specified, ketoacidosis, accident to the head, and convulsions (epilepsy). The 39 patients living in the county of Hordaland (including Bergen) were invited to a clinical examination. Twenty-nine patients (mean age 37 years, mean duration of diabetes 29 years) accepted. In eleven, the disease had influenced the choice of occupation. Twelve experienced professional difficulties due to diabetes, and thirteen had major complaints due to the disease. Three used antianginal drugs, and a further three were receiving antihypertensive treatment. Four women had hypothyreosis. Twelve had proteinuria or pathologic microalbuminuria. Only two of 27 patients examined by means of fluorescein-angiography showed no retinopathy. Evidence of cardiovascular autonomic neuropathy was observed in ten patients. Since only three patients had used fast-acting insulin regularly during the last ten years, it should be possible to give patients with type 1 diabetes better treatment in the future.
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PMID:[Prognosis of diabetes mellitus type 1. A follow-up study]. 273 38

Two cases of manifesting carriers of Duchenne muscular dystrophy (DMD) were described. Case 1. The 41 year-old woman presented gait disturbance at the age of 40. She had two sons. The first son died of pneumonia soon after birth. The second son developed DMD and died of heart failure when he was 17 years old. Neurological examination revealed mild muscle weakness in neck flexors, gluteus maximus (left side dominance) and hamstrings (right side dominance) as well as bilateral calf pseudohypertrophy. Electromyography showed myopathic changes and serum creatine kinase (CK) was elevated (1941IU/l). The karyotype was 46XX. Computed tomography (CT) of skeletal muscles showed that the following muscles were partly replaced by fatty tissue: bilateral paravertebral muscles, left gluteus maximus, left quadriceps femoris, right adductor magnus, long head of right biceps femoris, bilateral peroneus longus and medial head of left gastrocnemius. Histological examination of left quadriceps femoris revealed only minimal change of focal endomysial proliferation and fiber size variation, demonstrating no necrotic fiber or no abnormalities in fiber type. Case 2. The 42 year-old woman was admitted to the hospital complaining of dyspnea and palpitation. The disease was initially diagnosed as myocardial infarction based on cardiomegaly, ECG abnormality (Q in aVL, V5,6., ST depression and negative T in V5,6, ST elevation in I, aVL) and elevated serum CK. However, the diagnosis was rejected due to the lack of subsequent changes in ECG and the continued elevation of serum CK even after her complaints had disappeared.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Asymmetrical patchy muscle involvement in manifesting carriers of Duchenne muscular dystrophy--computed tomographical and histological study]. 274 85

Surgical therapy with mapping-guided subendocardial resection was used in 30 patients with drug-refractory ventricular tachycardia. Results of preoperative, intraoperative and postoperative electrophysiologic evaluation and long-term clinical follow-up are reported. Left ventricular aneurysm was located in the inferior wall in 8 patients and in the anterior wall in 22. Left ventricular mapping was performed in 15 patients preoperatively and in all 30 patients intraoperatively. Subendocardial resection was supplemented with cryoablation in 26 patients and with laser photocoagulation in 4. Coronary bypass surgery was performed in 27 patients. The surgical mortality rate was 10%; the three deaths were due to cardiogenic shock, pneumonia and sepsis, respectively. At postoperative electrophysiologic study, ventricular tachycardia was inducible in 8 (30%) of 27 patients. Previously ineffective antiarrhythmic drugs were effective in preventing the induction of ventricular tachycardia in four of these eight patients. Two of the remaining four patients received an automatic implantable cardioverterdefibrillator; the other two were treated with amiodarone. At a mean follow-up period of 18 +/- 17 months (range 1 to 52), there has been one sudden death and one nonfatal recurrence of ventricular tachycardia in the 18 patients without inducible arrhythmias postoperatively. Among the eight patients with inducible ventricular tachycardia after subendocardial resection, there has been one nonfatal ventricular tachycardia recurrence. Thus, among the 27 patients surviving surgery, 17 (63%) were cured with surgery alone, and another 7 (26%) had their ventricular tachycardia controlled with drugs (n = 5) or the defibrillator (n = 2). Inability to completely map the tachycardia, a clinical history of cardiac arrest requiring resuscitation and the presence of myocardial infarction within 2 months predicted postoperative arrhythmia inducibility and recurrence.
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PMID:Surgical therapy for drug-refractory ventricular tachycardia: results with mapping-guided subendocardial resection. 278 95

The length of hospital stay after coronary surgery was studied in 4,683 patients undergoing cardiac catheterization followed by coronary surgery at Emory University Hospital or Crawford Long Hospital between the years 1981 and 1986. Length of stay after coronary surgery had a median and modal value of 7 days. There was, however, a long statistical tail of patients with a prolonged length of stay extending out to more than 180 days. Prolonged length of stay (greater than 10 days) could be correlated with preprocedural variables such as age, elective versus emergency status, angina class, ejection fraction, and gender. Length of stay increased from a mean of 6.9 +/- 1.4 days under the age of 40 years to 10.9 +/- 12.1 days over the age of 70 years (p less than 0.0001). Length of stay was correlated with the periprocedural variables of wound infection, neurologic event, arrhythmias, pneumonia, postoperative myocardial infarction, mortality, and pericarditis. Length of stay increased from 8.8 +/- 9.6 days without a neurologic event to 21.1 +/- 17.9 days with a neurologic event (p less than 0.0001). Similarly, without a wound infection, the average stay was 8.7 +/- 8.9 days; with a wound infection, the average stay was 32.2 +/- 25.8 days (p less than 0.0001). The correlates of prolonged stay were tested in another population comprising 781 patients undergoing cardiac catheterization followed by coronary artery bypass grafting in 1987. The predictors of prolonged stay in the 1987 population were wound infection, pneumonia, arrhythmias, age, neurologic events, postoperative infarction, and ejection fraction. Thus, length of hospital stay after coronary surgery may be predicted by multiple preprocedural and periprocedural variables.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Determinants of prolonged length of hospital stay after coronary bypass surgery. 278 9

Forty-one patients with rheumatoid arthritis (RA) were treated with a weekly low-dose of methotrexate for a mean period of 32 months (range, 5-81 months) and were given a mean total dose of 954 mg (range, 145-2000 mg). Eighty-three percent of the patients improved. Of these 39% (16 patients) had a complete clinical remission and 17% (7 patients) showed marked improvement, 27% (11 patients) showed moderate improvement and 17% (7 patients) were unchanged. Patients responding to methotrexate therapy maintained the improvement as long as the therapy continued, unless severe infections occurred. Seven patients withdrew during the study including two, who died of myocardial infarction. Methotrexate was withdrawn because of adverse drug reactions in two patients, fear of toxicity in two and for administrative reasons in one patient. Adverse reactions developed in 25 patients (61%). In all but two cases these reactions were mild and reversible. Pancytopenia, a major side effect, was present in two patients: in one patient in association with pneumonia and in the other patient associated with an acute infectious enteritis (after three years treatment in the first and six years in the second patient); both recovered when methotrexate was discontinued. Age, sex, duration of treatment did not remarkably influence the outcome of therapy or the occurrence of adverse reactions.
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PMID:Low-dose methotrexate treatment of rheumatoid arthritis; long-term observation of efficacy and safety. 280 7

One hundred and eleven patients over 65 years of age underwent a major abdominal surgery between March 1986 and February 1987. The cardiorespiratory (CR) complications found were: cardiovascular (CV) failure 36%, post-operative myocardial infarction 5%, respiratory (R) failure 24%, pneumonia 11%. The overall mortality rate was 36%. The factors related with CV failure were: age over 75 years, ischemic cardiopathy, Goldman 3 and over, ASA III and over, cardiac failure, transoperatory hypotension and over 4 hours duration surgery. The ones related with myocardial infarction were: age over 75 years, Goldman 3 and over, ASA III and over, over 4 hours duration surgery and vital capacity (VC) less than 60%. For pneumonia the only related factor was VC less than 60%. For mortality, the factors found were Goldman 3 and over, ASA III and over and VC less than 60%. The mortality rate in patients without CR failure was 9%, with CV failure 35% (p less than 0.01), with R failure 33% and CR failure 90% (p less than 0.001).
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PMID:[Cardio-respiratory complications after major abdominal surgery in elderly patients. Risk factors and prognosis]. 281 95

The Swedish trial in old patients with hypertension (STOP-Hypertension) is a multicentre, randomized, double-blind study of beta-blockers/diuretics versus placebo in old hypertensives. Primary end-points are stroke and myocardial infarction (fatal and non-fatal) as well as other cardiovascular mortality. To evaluate the logistics of STOP-Hypertension, a pilot study was carried out. All patients aged 70-84 years in 31 centres were consecutively registered in a log-book. Altogether 4668 patients were screened: 41.5% had previously been treated for hypertension and 13.5% had blood pressures greater than or equal to 180/105 mmHg. Thus, 55% were 'hypertensive'. In all, 465 patients (18% of the 'hypertensive' patients) started a 3-month washout period (previously treated, n = 396) or a 4-week run-in period (previously untreated, n = 69) period. The most frequent reasons for not starting the run-in/washout were other indications for treatment with beta-blockers/diuretics (13%), unwillingness to participate (8%) or isolated systolic hypertension (4%). The pilot study was evaluated after 1 year: 89 patients (1.9%) had been randomized, 66 patients (1.4%) were still in the run-in/washout period and the majority of the remaining patients were not randomized because they had not reached the inclusion blood pressure (greater than or equal to 180 mmHg systolic and/or greater than or equal to 105 mmHg diastolic) following withdrawal of their antihypertensive medication. During the run-in/washout period there were few serious clinical events: one case of myocardial infarction, three patients had strokes (two fatal), 10 developed congestive heart failure, three tachyarrhythmia and two pneumonia (one fatal).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:STOP-Hypertension--preliminary communication from the pilot study of the Swedish Trial in Old Patients with Hypertension. 289 71


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