Impact of frailty on elderly patients with infective endocarditis

Abstract Introduction Frailty studies focused on patients with infective endocarditis (IE) are scarce and its potential impact on patient outcomes is not well known. The aim of this study is to describe the clinical profile and prognosis of elderly patients with IE, comparing patients who met the frailty criteria versus those who did not. Methods A total of 121 cases of confirmed IE were consecutively collected in three tertiary hospitals between 2017 and 2019. The patients were classified into two groups: Group I (n=49), patients with IE who met the Frail criteria for frailty, and Group II (n=72), those patients without frailty by this scale. Results The median age of our cohort was 77 years (69–82), and 62.8% were men. Frail patients were older than those in Group II, as shown in Table 1. Regarding comorbidity, chronic anemia (40.8% vs 25%; p<0.060) was more common in Group I, as well as rheumatic manifestations at admission (12.2% vs 1.4%; p=0.014). The most frequently isolated microorganisms were S. aureus (n=25), coagulase negative staphylococci (n=25), viridans group streptococci (n=14), and enterococci (n=14). Enterococci (16.3% vs 8.3%, p=0.177) and non-viridans streptococci (10.2% vs 2.8%); p=0.086) were more frequent in frail patients. Vegetation (79.6% vs 80.6%; p=0.896) and periannular complications (24.5% vs 29.2%; p=0.571) were similar in both groups. No significant differences were found regarding the location of the infection. The incidence of in-hospital complications was similar between both groups. Frail patients underwent surgery less frequently than those in Group II, and had higher predicted mortality on surgical risk scale scores. However, the percentage of patients who met the surgical criteria and were considered inoperable was similar (33.3% vs 26.2%; p=0.415). In-hospital mortality was similar in both groups. When analyzing in-hospital mortality according to the therapeutic strategy in Group I, a mortality of 34.5% was observed in frail patients with conservative medical treatment, compared to 47.1% in those patients who underwent surgery in the same group. One third of our patients received outpatient antibiotic treatment, being significantly more frequent in Group I (39.6% vs 29.0%; p=0.232). Conclusions The elderly patients with IE and frailty criteria were older and more frequently had rheumatic symptoms at admission. Enterococci and non-viridans streptococci were isolated more frequently than in non-frailty patients. Surgery was less performed among frail patients, who had a higher predicted surgical risk. Although complications and in-hospital mortality were similar between both groups, in the group of frail patients, those with conservative management showed lower mortality compared to surgery. FUNDunding Acknowledgement Type of funding sources: None.

Download Full-text

Contemporary epidemiology and outcomes in recurrent infective endocarditis

Heart ◽

10.1136/heartjnl-2019-315433 ◽

2019 ◽

Vol 106 (8) ◽

pp. 596-602 ◽

Cited By ~ 3

Author(s):

Afonso B Freitas-Ferraz ◽

Gabriela Tirado-Conte ◽

Isidre Vilacosta ◽

Carmen Olmos ◽

Carmen Sáez ◽

...

Keyword(s):

Infective Endocarditis ◽

Hospital Mortality ◽

Prosthetic Valve ◽

Late Complication ◽

Tertiary Care ◽

First Episode ◽

Native Valve ◽

Fourfold Increase ◽

Group I ◽

Group Ii

ObjectiveRecurrent infective endocarditis (IE) is a major complication of patients surviving a first episode of IE. This study sought to analyse the current state of recurrent IE in a large contemporary cohort.Methods1335 consecutive episodes of IE were recruited prospectively in three tertiary care centres in Spain between 1996 and 2015. Episodes were categorised into group I (n=1227), first-IE episode and group II (n=108), recurrent IE (8.1%). After excluding six patients, due to lack of relevant data, group II was subdivided into IIa (n=87), reinfection (different microorganism), and IIb (n=15), relapse (same microorganism within 6 months of the initial episode).ResultsThe cumulative burden and incidence of recurrence was slightly lower in the second decade of the study (2006–2015) (7.17 vs 4.10 events/100 survivors and 7.51% vs 3.82, respectively). Patients with reinfections, compared with group I, were significantly younger, had a higher frequency of HIV infection, were more commonly intravenous drug users (IVDU) and prosthetic valve carriers, had less embolic complications and cardiac surgery, with similar in-hospital mortality. IVDU was found to be an independent predictor of reinfection (HR 3.92, 95% CI 1.86 to 8.28).In the relapse IE group, prosthetic valve endocarditis (PVE) and periannular complications were more common. Among patients treated medically, those with PVE had a higher relapse incidence (4.82% vs 0.43% in native valve IE, p=0.018). Staphylococcus aureus and PVE were independent predictors of relapse (HR 3.14, 95% CI 1.11 to 8.86 and 3.19, 95% CI 1.13 to 9.00, respectively) and in-hospital-mortality was similar to group I. Three-year all-cause mortality was similar in recurrent episodes compared with single episodes.ConclusionRecurrent IE remains a frequent late complication. IVDU was associated with a fourfold increase in the risk of reinfection. PVE treated medically and infections caused by S. aureus increased the risk of relapse. In-hospital and long-term mortality was comparable among groups.

Download Full-text

Levobupivacaine in spinal anesthesia for primary knee and hip arthroplasty

N.N. Priorov Journal of Traumatology and Orthopedics ◽

10.17816/vto202027131-35 ◽

2020 ◽

Vol 27 (1) ◽

pp. 31-35

Author(s):

K. Yu. Ukolov ◽

V. L. Ayzenberg ◽

M. V. Kapirina ◽

M. E. Mikitina

Keyword(s):

Elderly Patients ◽

Spinal Anesthesia ◽

Knee Arthroplasty ◽

Hip Arthroplasty ◽

Postoperative Nausea And Vomiting ◽

Anaesthetic Agents ◽

Group I ◽

Primary Knee Arthroplasty ◽

Group Ii ◽

Knee And Hip Arthroplasty

Introduction. Spinal anesthesia is widely used in major orthopedic. Primary hip and knee arthroplasty are major surgical procedures associated with significant potential morbidity in elderly patients. This increases requirement to surgical and anesthetic procedures. Some studies provide evidence that levobupivacaine when used as an alternative to bupivacaine in spinal anesthesia is less cardiotoxic and neurotoxic. Aim: To compare the efficacy and safety of these two spinal anaesthetic agents in elderly patients undergoing primary hip or knee replacement. Patients and methods. The study included 90 patients performed arthroplasty with spinal anesthesia. I group patients received spinal anesthesia bupivacaine 0,5%, II group patients received intrathecal levobupicavaine 0.5%. Group I (n=60), 22 (37%) underwent primary hip arthroplasty, and 38 (63%) patients that underwent primary knee arthroplasty with mean age (65,4 + 6,5). Group II (n=30), 18 (60%) patients that underwent primary total hip arthroplasty and 12 (40%) patients that underwent primary knee arthroplasty with mean age (65,5 + 8,1). Anesthesia algorithm did not differ for both groups. Results. Vital parameters and adverse effects in relation to spinal anesthesia were observed. Decrease of heart rate was more significant in group II. Blood pressure parameters were comparable to both groups though, 10% of Group I patients received infusion of norepinephrine for treatment of hypotension. The two groups were comparable with glucose and lactate variations as well as the duration of analgesia and postoperative nausea and vomiting. No postoperative delirium was noted in both groups. Conclusion. Spinal anesthesia with levobupivacaine is more safe for elderly patients undergoing knee and hip arthroplasty.

Download Full-text

Abstract 2301: Frail Elderly Patients at Increased Risk for Mortality and Prolonged Institutional Care After Cardiac Surgery

Circulation ◽

10.1161/circ.118.suppl_18.s_702 ◽

2008 ◽

Vol 118 (suppl_18) ◽

Author(s):

Dana H Lee ◽

Billie Jean Martin ◽

Alexandra M Yip ◽

Karen J Buth ◽

Gregory M Hirsch

Keyword(s):

Renal Failure ◽

Cardiac Surgery ◽

Elderly Patients ◽

Hospital Mortality ◽

Frail Elderly ◽

Independent Predictor ◽

Institutional Care ◽

Biological Age ◽

Younger Patients ◽

Frail Patients

Patients referred for cardiac surgery are increasingly older, but chronological age does not always capture biological age. This study assessed frailty, as a functional parameter of biological age, as a predictor of mortality or prolonged institutional care. Functional measures of frailty and clinical preoperative data were collected for all cardiac surgery patients at a single center (2004 –2007). Based on the Katz Index of Activities of Daily Living, frailty was defined as any impairment in feeding, bathing, dressing, transferring, toileting, continence, or ambulation, or dementia. The impact of frailty on in-hospital mortality or institutional discharge (other hospital or nursing facility) was assessed with multivariate logistic regression. The interaction of frailty and age was examined, with non-frail patients age<70 as the referent group. Results: Of 3096 patients, 133 (4.3%) were frail. Frail patients were older, more likely to be female, have COPD, CHF, EF<40%, recent MI, pre-operative renal failure, cerebrovascular disease, greater acuity, and more complex operations (p<0.05). Frail patients experienced higher rates of mortality, sepsis, delirium, post-operative renal failure, and transfusion (p<0.001). A greater proportion of frail patients than non-frail patients (49% vs. 9%) were discharged to a setting other than home. In the risk-adjusted models, frailty was an independent predictor of mortality (OR 1.8, 95% CI 1.0 –3.2) or institutional discharge (OR 6.4, 95% CI 4.1–9.9). Furthermore, frail elderly (age≥70) patients had greater risk of institutional discharge (OR 22.7, CI 12.4 – 41.7) than frail younger patients (OR 6.5, CI 3.4 –12.5) or non-frail elderly patients (OR 3.5, CI 2.6 – 4.6). Similarly, frail elderly patients had greater risk of mortality (OR 4.0, CI 1.9 – 8.1) than frail younger patients (OR 1.9, CI 0.8 – 4.7) or non-frail elderly patients (OR 2.4, CI 1.7–3.5). Frailty was an independent predictor of in-hospital mortality and prolonged institutional care. Frailty combined with older age further discriminated those at highest risk. Special consideration should be given to the management of frail elderly patients who have surgical cardiac disease.

Download Full-text

Impact of Age on Short- and Long-Term Outcomes after Pancreatoduodenectomy for Periampullary Neoplasms

Gastroenterology Research and Practice ◽

10.1155/2020/1793051 ◽

2020 ◽

Vol 2020 ◽

pp. 1-6 ◽

Cited By ~ 1

Author(s):

Mario Gruppo ◽

Francesca Tolin ◽

Boris Franzato ◽

Pierluigi Pilati ◽

Ylenia Camilla Spolverato ◽

...

Keyword(s):

Overall Survival ◽

Elderly Patients ◽

Adjuvant Treatment ◽

Long Term Outcomes ◽

Group I ◽

Periampullary Neoplasms ◽

Short And Long Term ◽

Group Ii ◽

The Impact

Background. Although mortality and morbidity of pancreatoduodenectomy (PD) have improved significantly over the past years, the impact of age for patients undergoing PD is still debated. This study is aimed at analyzing short- and long-term outcomes of PD in elderly patients. Methods. 124 consecutive patients who have undergone PD for pancreas neoplasms in our center between 2012 and 2017 were analyzed. Patients were divided into two groups: group I (<75 years) and group II (≥75 years). Demographic features and intraoperative and clinical-pathological data were collected. Primary endpoints were perioperative morbidity and mortality; complications were classified according to the Clavien-Dindo Score. Secondary endpoints included feasibility of adjuvant treatment and overall survival rates. Results. A total of 106 patients were included in this study. There were 73 (68.9%) patients in group I and 33 (31.1%) in group II. Perioperative deceases were 4 (3.6%), and postoperative pancreatic fistulas were 34 (32.1%). Significant difference between two groups was demonstrated for the ASA Score (p=0.004), Karnofsky Score (p=0.025), preoperative jaundice (p=0.004), and pulmonary complications (p=0.034). No significance was shown for diabetes, radicality of resection, stage of disease, operative time, length of stay, postoperative complications according to the Clavien-Dindo Score, postoperative mortality, pancreatic fistula, and reoperation rates. 69.9% of the patients in group I underwent adjuvant treatment vs. 39.4% of the older ones (p=0.012). Mean overall survival was 28.5 months in group I vs. 22 months in group II (p=0.909). Conclusion. PD can be performed safely in elderly patients. Advanced age should not be an absolute contraindication for PD, even if greater frailty should be considered. The outcome of elderly patients who have undergone PD is similar to that of younger patients, even though adjuvant treatment administration is significantly lower, demonstrating that surgery remains the main therapeutic option.

Download Full-text

1048. Beta-Hemolytic Streptococcal Infective Endocarditis: Characteristics and Outcomes From a Large, Multi-National Cohort

Open Forum Infectious Diseases ◽

10.1093/ofid/ofy210.885 ◽

2018 ◽

Vol 5 (suppl_1) ◽

pp. S313-S313

Author(s):

Nuria Fernandez-Hidalgo ◽

Amal Gharamti ◽

María Luisa Aznar ◽

Vivian H Chu ◽

Hussein Rizk ◽

...

Keyword(s):

Infective Endocarditis ◽

Hospital Mortality ◽

High Rate ◽

National Database ◽

Case Report Form ◽

Viridans Streptococci ◽

Cardiac Device ◽

Data Set ◽

Standard Case ◽

National Cohort

Abstract Background β-Hemolytic streptococci (BHS) are an uncommon cause of infective endocarditis (IE). The aim of this study was to describe the clinical features and outcomes of patients with β-hemolytic streptococcal infective endocarditis in a large multi-national cohort, and compare them to patients with oral Viridans IE, a more common cause of IE. Methods The International Collaboration on Endocarditis Prospective Cohort Study (ICE-PCS) is a large multi-national database that recruited patients with IE prospectively using a standardized data set. Sixty-four sites in 28 countries reported patients prospectively using a standard case report form (CRF) developed by ICE collaborators. Patients with BHS IE were compared with patients with IE due to Oral Viridans Streptococci (OVS). Results Among 1336 cases of streptococcal IE, 823 (62%) were caused by OVS and 147 (11%) by BHS. The majority of patients in both groups belonged to the male gender and had similar median age. Among the predisposing conditions, congenital heart disease and native valve predisposition were more commonly associated with OVS IE than with BHS IE (P < 0.005). The presence of endocavitary cardiac device is associated more with BHS IE than with OVS IE (P = 0.026). BHS were more likely to be penicillin-susceptible than OVS (P = 0.001). Clinically, patients with BHS IE are more likely to present acutely (P < 0.005) and with fever (P = 0.024). BHS IE is more likely to be complicated by stroke (P < 0.005) and other systemic embolism (P < 0.005). The overall in-hospital mortality of BHS IE was significantly higher than that of OVS IE (P = 0.001). The independent factors associated with in-hospital mortality for β-hemolytic streptococcal IE were age, per 1-year increment (OR 1.044; CI 1.014–1.075; P = 0.004) and prosthetic valve IE (OR 3.029; CI 1.171–7.837; P = 0.022). The complications associated with a higher in-hospital mortality were CHF (OR 2.513; CI 1.074–5.879; P = 0.034), especially CHF NYHA III or IV (OR 4.136; CI 1.707–10.025; P = 0.002), and stroke (OR 3.198; CI 1.343–7.619; P = 0.009). Conclusion Our findings suggest that BHS IE is an aggressive disease characterized by an acute presentation. It is associated with a significant rate of complications and a high rate of in-hospital mortality. This underlines the importance of early surgery to prevent the progression of disease. Disclosures All authors: No reported disclosures.

Download Full-text

Risk Factors for Hospital Mortality in Acute ST-Segment Elevation Coronary Syndrome Complicated by Cardiogenic Shock

The Russian Archives of Internal Medicine ◽

10.20514/2226-6704-2021-11-4-264-270 ◽

2021 ◽

Vol 11 (4) ◽

pp. 264-270

Author(s):

O. V. Arsenicheva

Keyword(s):

Risk Factors ◽

Hospital Mortality ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Ventricular Ejection Fraction ◽

St Segment Elevation ◽

Coronary Syndrome ◽

Group I ◽

Group Ii

The aim. To study the risk factors for hospital mortality in patients with acute coronary syndrome with ST-segment elevation (STEACS) complicated by cardiogenic shock (CS).Materials and methods. A total of 104 patients with STEACS complicated by CS were studied. The follow-up group (group I) included 58 (55,8%) patients who died in hospital (mean age 71,8±7,31 years), the comparison group (group II) – 46 patients, who have been treated and discharged (mean age 59,5±6,18 years). All patients underwent general clinical studies, the level of troponins, lipids, glucose, creatinine in plasma was determined, electrocardiography and echocardiography were performed. Coronary angiography and percutaneous coronary intervention (PCI) were urgently performed. The method of binary logistic regression with the determination of the odds ratio and its 95% confidence interval for each reliable variable was used to identify risk factors for hospital mortality.Results. In group I patients with CS, compared with group II, patients over the age of 70 (32 (55,2%) vs 10 (22,7%), р=0,0004), with concomitant chronic kidney disease (32 (55,2%) vs 9 (19,6%), p=0,0002), postinfarction cardiosclerosis (30 (51,7%) vs 9 (19,6%), р=0,001) and chronic heart failure of III-IV functional class (32 (55,1%) vs 11 (23,9%), p=0,001) were significantly more often observed. Baseline levels of plasma leukocytes, troponin and creatinine were significantly higher in deceased patients with CS. Left ventricular ejection fraction below 40% was observed more often in the follow-up group than in the comparison group (46 (79,3%) vs 27 (58,7%), p=0,022). In group I, compared with group II, there was a higher incidence of three-vessel coronary lesions (36 (75%) vs 12 (26,1%), p=0,0001) and chronic coronary artery occlusion unrelated to STEACS (25 (52,1%) vs 12 (26,1%), р=0,009). The same trend was observed when assessing the average number of stenoses and occlusions of the coronary arteries. PCI was performed in 43 (74,1%) of the deceased and 43 (93,5%) of the surviving STEACS patients with CS (p=0,009). The follow-up group had a higher rate of unsuccessful PCI (30,2%) vs 3 (7%), р=0,001) and performed later than 6 hours after the onset of an angina attack (28 (65,1%) vs 6 (14%), р=0,0001).Summary. Hospital mortality in patients with STEMI complicated by CS was associated with the presence left ventricular ejection fraction less than 40%, three-vessel coronary lesion and performing PCI later than 6 hours from the beginning of the pain attack.

Download Full-text

In-Hospital Outcomes of Acute ST Elevation Myocardial Infarction in Patients with Acute Kidney Injury

Cardiovascular Journal ◽

10.3329/cardio.v11i1.38244 ◽

2018 ◽

Vol 11 (1) ◽

pp. 59-66

Author(s):

Md Mosharul Haque ◽

M Atahar Ali ◽

Mustafizul Aziz ◽

Mohammad Ullah ◽

Mohammad Anowar Hossain ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Kidney Injury ◽

Mortality Rate ◽

Serum Creatinine ◽

Hospital Mortality ◽

Independent Predictor ◽

Kidney Injury ◽

Group I ◽

St Elevation ◽

Group Ii

Background: Acute kidney injury (AKI) is a risk factor for long-term adverse outcomes, including acute myocardial infarction and death. The objective of this study was to find out in-hospital outcomes in patients with acute ST elevation myocardial infarction with acute kidney injury.Methods: A total 190 patients were included in this study and were equally divided into two groups, Group-I (with AKI) and Group-II (without AKI), according to absolute changes of serum creatinine level. AKI was defined as absolute changes in serum creatinine (SCr. at 48 hours’ minus admission SCr) and categorized as mild AKI (increase of 0.3 to <0.5 mg/d), moderate AKI (increase of 0.5 to <1.0 mg/dl), and severe AKI (increase of e”1.0 mg/dl) using Acute Kidney Injury Network (AKIN) criteria.Results: Overall in-hospital mortality rate was 14.7% in Group-I (mortality rate for those with mild, moderate, and severe AKI were 7%, 13.3%, and 31.8%) compared with 5.3% in Group-II. Regarding inhospital morbidities, significant arrhythmia (29.5%) was the most common complication followed by acute heart failure (18.9%), cardiogenic shock (12.6%), and mechanical complications (4.2%) which were more in Group-I compared to patients with Group-II. After adjustment of other risk variables, the multivariate logistic regression analysis revealed AKI remained an independent predictor of in-hospital mortality with adjusted odds ratios (OR) was 4.991 (95% confidence interval, 1.873-13.301).Conclusions: AKI is an independent predictor of in-hospital mortality and morbidity. It emphasizes the importance of efforts to identify risk factors and to prevent AKI during in-hospital management of acute STEMI patients.Cardiovasc. j. 2018; 11(1): 59-66

Download Full-text

Incidence and risk factors of recurrent pain in acute aortic dissection and in-hospital mortality

VASA ◽

10.1024/0301-1526/a000704 ◽

2018 ◽

Vol 47 (4) ◽

pp. 301-310

Author(s):

Dilixiati Siti ◽

Asiya Abudesimu ◽

Xiaojie Ma ◽

Lei Yang ◽

Xiang Ma ◽

...

Keyword(s):

Risk Factors ◽

Aortic Dissection ◽

Hospital Mortality ◽

Acute Aortic Dissection ◽

Emergency Operation ◽

Type A ◽

Type B ◽

Recurrent Pain ◽

Group I ◽

Group Ii

Abstract. Background: We investigated the prevalence of recurrent pain and its relationship with in-hospital mortality in acute aortic dissection (AAD). Patients and methods: Between 2011 and 2016, 234 AAD patients were selected. Recurrent pain was defined as a mean of VAS > 3, within 48 hours following hospital admission or before emergency operation. Patients with and without recurrent pain were divided into group I and group II, respectively into type A AAD and type B AAD patients. Our primary outcome was in-hospital mortality. Results: The incidence of recurrent pain was 24.4 % in AAD patients. Incidence of recurrent pain was higher in type A AAD patients than type B AAD patients (48.9 vs. 9.6 %). Overall in-hospital mortality was 25.6 %. Type A AAD had a higher in-hospital mortality than type B AAD patients (47.7 vs. 12.3 %). Group I had significantly higher in-hospital mortality than group II (type A: 79.1 vs. 17.8 %; type B: 57.1 vs. 7.6 %, all P < 0.001), as was the case with medical managed patients (type A: 72.1 vs. 13.3 %; type B: 35.7 vs. 2.3 %, all P < 0.001). Logistic regression analysis showed that use of one drug alone and waist pain were predictive factors for recurrent pain in type A AAD and type A AAD patients, respectively (OR 3.686, 95 % CI: 1.103~12.316, P = 0.034 and OR 14.010, 95 % CI: 2.481~79.103, P = 0.003). Recurrent pains were the risk factors (type A: OR 11.096, 95 % CI: 3.057~40.280, P < 0.001; type B: OR 14.412, 95 % CI: 3.662~56.723, P < 0.001), while invasive interventions were protective (type A: OR 0.133, 95 % CI: 0.035~0.507, P < 0.001; type B: OR 0.334, 95 % CI: 0.120~0.929, P = 0.036) for in-hospital mortality in AAD patients. Conclusions: Approximately one-fourth of AAD patients presented with recurrent pains, which might increase in-hospital mortality. Thus, interventional strategies at early stages are important.

Download Full-text

Electrolyte disturbances in elderly patients with severe diarrhea due to cholera.

Journal of the American Society of Nephrology ◽

10.1681/asn.v651463 ◽

1995 ◽

Vol 6 (5) ◽

pp. 1463-1467

Author(s):

J Cieza ◽

Y Sovero ◽

L Estremadoyro ◽

F Dumler

Keyword(s):

Elderly Patients ◽

Normal Saline ◽

Extracellular Fluid ◽

Anion Gap ◽

Severe Diarrhea ◽

Electrolyte Disturbances ◽

Group I ◽

Intravenous Hydration ◽

Group Ii ◽

Time Of Admission

The purpose of this clinical study was to evaluate prospectively electrolyte disturbances in elderly patients with severe diarrhea due to cholera. A total of 20 adult (Group I; < 60 yr) and 22 elderly (Group II; > or = 60 yr) patients were studied. In all patients, extracellular fluid (ECF) volume reexpansion was achieved with normal saline at 50 mL/kg per hour. Once a diuresis of 40 mL/h was achieved, intravenous therapy was discontinued and patients' ECF volumes were reexpanded orally with a polyelectrolyte solution. Blood and urine samples were obtained on admission, at the time when adequate diuresis ensued, and after 12 h of oral ECF volume reexpansion. On admission, both groups had severe ECF volume contraction but only mild increases in osmolality (308 +/- 12 and 310 +/- 13 mosmol/kg for Groups I and II respectively; P = NS). Acidemia (pH) was equally severe in both (Group I: 7.13 +/- 0.11; Group II: 7.11 +/- 0.09; P = NS), and the anion gap was comparably increased in both groups (30 +/- 8 and 26 +/- 7 mmol/L for Groups I and II, respectively; P = NS). None of the patients was hypokalemic at the time of admission (Group I: 4.3 +/- 0.5 mmol/L; Group II: 4.5 +/- 0.5 mmol/L; P = NS). Adequate diuresis was achieved at 2.0 +/- 0.7 h in both groups. At the end of the rapid ECF volume reexpansion phase, the anion gap normalized in both groups (Group I: 15.6 +/- 3.7 mmol/L; Group II: 14.4 +/- 2.8 mmol/L; P = NS), and serum potassium concentrations remained normal (Group I: 4.4 +/- 0.4 mmol/L; Group II: 4.1 +/- 0.4 mmol/L; P = NS). We conclude that use of aggressive intravenous hydration with normal saline followed by oral ECF volume reexpansion allows prompt correction of electrolyte abnormalities in adult and elderly patients with severe diarrhea as a result of cholera.

Download Full-text

Postoperative radiotherapy of the cervical carcinoma in elderly patients: Over 60 years

Acta chirurgica iugoslavica ◽

10.2298/aci0703153p ◽

2007 ◽

Vol 54 (3) ◽

pp. 153-158 ◽

Cited By ~ 1

Author(s):

V. Plesinac-Karapandzic ◽

S. Zoranovic ◽

S. Plesinac ◽

Z. Milosevic ◽

D.M. Masulovic

Keyword(s):

Elderly Patients ◽

Cervical Carcinoma ◽

Radiation Effects ◽

Postoperative Radiotherapy ◽

External Beam ◽

External Beam Irradiation ◽

Group I ◽

Group Ii ◽

Brachy Therapy

The purpose of the study was to analyze survival and late radiation effects according to performed surgery and radiation therapy in elderly patients. Between 1996-1997. year 44 patients with cervical carcinoma older then 60 years were treated with postoperative radiotherapy. Radiotherapy included external beam irradiation with TD 36-45 Gy in 18-22 fractions and endocavitar brachy-therapy with TD 28-35Gy in 4-5 fractions. We analyzed two groups of patients group I 29/44 (65,9%) had radical operation by Werthaim-Meigs vs group II 15/44 (34,1%) patients had standard operation. Median follow-up was 48 months. Survival for all patients was 70,43%. Late postirradiation effects in the gastrointestinal tract were 40,9% and in urinary tract 25% - in both groups. A larger percent of late postirradiation sequeles were on GIT in group I vs group II (44,8% vs 33,3%) and on UR tract also (31,03% vs 13,3%). The doses of external beam irradation were equalize in both groups, while brachytherapy regime 4xTD7,5Gy was more represent in group I. Late side effects and complications after postoperative radiotherapy are acceptable, but it is necessary to carry out randomized trials with different dose regime in brachytherapy.

Download Full-text