Letter to the Editor: Craniopharyngiomas in the elderly: the crucial influence of tumor topography on surgical risk assessment

2021 ◽  
Author(s):  
José M. Pascual ◽  
Ruth Prieto
Keyword(s):  
Risk Assessment ◽  
Elderly Patients ◽  
Tumor Tissue ◽  
Significant Proportion ◽  
Wide Band ◽  
The Elderly ◽  
Surgical Risk ◽  
Definition Of ◽  
Weighted Sequences ◽  
Tumor Topography

Classifying CPs within the overly vague, uninformative category “suprasellar” prevents gaining any true insight regarding the risks associated with the surgical procedure employed. Routine MRI obtained with conventional T1- and T2-weighted sequences along the midsagittal and coronal trans-infundibular planes allow an accurate and reliable preoperative definition of CP topography. CPs developing primarily within the infundibulum and/or tuberal region of the hypothalamus, as well as those wholly located within the 3V, should be distinguished preoperatively from those lesions originally expanding beneath the 3V floor (3VF), the true suprasellar tumors. Among adult patients, about 40% of CPs correspond to infundibulo-tuberal tumors expanding primarily within the 3VF, above an intact pituitary gland and stalk. This subgroup of CPs shows strong adherences to the surrounding hypothalamus, as they are embedded within a wide band of reactive gliotic tissue, usually infiltrated by microscopic finger-like solid cords of tumor tissue. In elderly patients, a significant proportion of CPs correspond to papillary tumors developing above an intact 3VF, usually showing small pedicle-like or sessile-like attachments to the infundibulum. With the current diagnostic MRI workup routinely employed for CPs, it is possible, for the majority of lesions, to preoperatively differentiate these topographical variants and predict the type of CP-hypothalamus relationship that will be found during surgery.

scholarly journals How to Treat Hepatocellular Carcinoma in Elderly Patients

2021 ◽  
Vol 14 (3) ◽  
pp. 233
Author(s):  
Piera Federico ◽  
Emilio Francesco Giunta ◽  
Annalisa Pappalardo ◽  
Andrea Tufo ◽  
Gianpaolo Marte ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Elderly Patients ◽  
Elderly Population ◽  
Primary Tumour ◽  
The Elderly ◽  
Chronic Liver Diseases ◽  
Old Patients ◽  
Choice Of Treatment ◽  
Definition Of ◽  
Optimal Treatment Strategy

Hepatocellular carcinoma (HCC) is the primary tumour of the liver with the greatest incidence, particularly in the elderly. Additionally, improvements in the treatments for chronic liver diseases have increased the number of elderly patients who might be affected by HCC. Little evidence exists regarding HCC in old patients, and the elderly are still underrepresented and undertreated in clinical trials. In fact, this population represents a complex subgroup of patients who are hard to manage, especially due to the presence of multiple comorbidities. Therefore, the choice of treatment is mainly decided by the physician in the clinical practice, who often tend not to treat elderly patients in order to avoid the possibility of adverse events, which may alter their unstable equilibrium. In this context, the clarification of the optimal treatment strategy for elderly patients affected by HCC has become an urgent necessity. The aim of this review is to provide an overview of the available data regarding the treatment of HCC in elderly patients, starting from the definition of “elderly” and the geriatric assessment and scales. We explain the possible treatment choices according to the Barcelona Clinic Liver Cancer (BCLC) scale and their feasibility in the elderly population.

scholarly journals COT-16 INDICATION OF SYSTEMIC THERAPY FOR ELDER PATIENTS WITH BRAIN TUMORS: A SYSTEMATIC REVIEW AND PERSPECTIVE

2019 ◽  
Vol 1 (Supplement_2) ◽  
pp. ii43-ii43
Author(s):  
Yoko Nakasu ◽  
Koichi Mitsuya ◽  
Satoshi Nakasu ◽  
Kazuhiko Nozaki
Keyword(s):  
Elderly Patients ◽  
Systemic Therapy ◽  
Brain Tumours ◽  
Performance Status ◽  
The Elderly ◽  
Assessment Tools ◽  
Geriatric Population ◽  
Pubmed Database ◽  
Group 2 ◽  
Definition Of

Abstract BACKGROUND Little is known about indications and outcome prediction of systemic therapy for elderly patients with brain tumours. Clinical conditions of individuals are heterogenous from healthy to frail or diseased,moreover,are often reversible. METHOD We retrieved the literature of brain tumour,systemic therapy,chemotherapy,immunotherapy,in randomized controlled trials (RCTs) and reviews on PubMed database from 2008 to 2018. RESULTS 1) Definition of elderly by age in years: Depending on each protocol,the definition is arbitrary. Patients older than 60 or 70 years are usually in the elderly group. 2) Systemic evaluation: Performance status (PS) and visceral function are not sufficient to assess elderly patients. Assessment tools specifically developed for the geriatric population are recommended to evaluate individual patients. 3) Effects and toxicity of systemic therapy: Only a few RCT showed no inferiority of outcome in patients older than 60 or 65 years. There are only few evidences about the senile fragility of blood-brain barrier or distribution of drugs in the elderly brain. Molecular subtyping of brain tumours might predict the effects and toxicities of therapies for elderly patients. CONCLUSION Feasibility of modern systemic therapies are not well studied for elderly patients with brain tumours. Clinical condition varies in individual elderly patients. We need prospective studies of systemic therapy in elderly patients based on an eligibility with not only chronologic age but comprehensive geriatric assessments.

scholarly journals Application of POSSUM and P-POSSUM in Surgical Risk Assessment of Elderly Patients Undergoing Hepatobiliary and Pancreatic Surgery

2020 ◽  
Vol Volume 15 ◽  
pp. 1121-1128
Author(s):  
Zhi-Wei Hu ◽  
Rui-Qiang Xin ◽  
Yi-Jun Xia ◽  
Guang-Peng Jia ◽  
Xiao-Xu Chen ◽  
...  
Keyword(s):  
Risk Assessment ◽  
Elderly Patients ◽  
Pancreatic Surgery ◽  
Surgical Risk ◽  
Hepatobiliary And Pancreatic Surgery ◽  
P Application

The Use of Frailty as a Surgical Risk Assessment Tool in Elderly Patients

2014 ◽  
Vol 3 (1) ◽  
pp. 1-7 ◽  
Author(s):  
Louis M. Revenig ◽  
Kenneth Ogan ◽  
Thomas J. Guzzo ◽  
Daniel J. Canter
Keyword(s):  
Risk Assessment ◽  
Elderly Patients ◽  
Assessment Tool ◽  
Risk Assessment Tool ◽  
Surgical Risk

scholarly journals 315 Cardiac surgery in the elderly: the underestimate role of frailty in the decision making

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Pasquale Campana ◽  
Maddalena Conte ◽  
Maria Emiliana Palaia ◽  
Laura Petraglia ◽  
Adele Ferro ◽  
...  
Keyword(s):  
Decision Making ◽  
Cardiac Surgery ◽  
Nutritional Status ◽  
Elderly Patients ◽  
Frailty Index ◽  
The Elderly ◽  
Risk Scores ◽  
Surgical Risk ◽  
The Impact

Abstract Aims Elders represent the most common population with indication to cardiac surgery, also presenting the highest mortality/disability after interventions. Both for valve and coronary artery surgery the estimation of the surgical risk, including the frailty assessment, is recommended to guide the decision making. However, frailty results not exhaustively assessed by the commonly used surgical risk scores such as EuroSCORE I-II and score of the Society of Thoracic Surgeons and is mostly used the Kat’s Index (included in the latest European guidelines). This study aims at establishing the feasibility and the value of a Comprehensive Geriatric Assessment (CGA) in elderly undergoing cardiac surgery. Methods From June 2021we consecutively enrolled 50 elderly patients undergoing cardiac surgery (age > 65 years old). All patients underwent CGA with an expert geriatrician and the demographic, biometrics, clinical and echocardiographic data were collected. We evaluated frailty and disability (Kats index, Barthel Index and Frailty Index FI), cognitive status (Montreal Cognitive Assessment MOCA, Mini Mental State Examination MMSE and Geriatric Depression Scale), physical status (Tinetti test, Short Performance Physical Battery SPPB, Physical Activity Scale for the Elderly PASE and 6-min Walking test), delirium condition, sarcopenia and nutritional status (Mini-Nutritional Assessment MNA). A clinical, echocardiographic, and geriatric 3-month follow-up is planned. In particular, we are evaluating the impact of frailty, assessed by CGA, on peri-surgical outcome and the potential additive value of a CGA on the commonly used surgical risk-scores and Kat’s Index. Furthermore, we are assessing the impact of cardiac surgery of frail elderly at GCA. Results The CGA was feasible in all patients and lasted 1 h/patient. In our baseline data, only 23% of the enrolled patients resulted ‘frail’ according to Kat’s Index. However, in the remaining 77% of the study population, the CGA have identified 30% of patients with increased frailty index and 30% with disability, assessed by Barthel Index and physical function indexes (PASE and SPPB). In these patient, frailty and disability were associated to impaired nutritional status, assessed at MNA. Furthermore, 40% of the patients of this group resulted sarcopenic at the hand grip test. The cognitive valuation has shown a cognitive impairment in the 20% of patients at the MMSE and the 70 % at the MOCA. Of note, the 40% of the patients resulted to suffer of depression, not diagnosed before the GCA. At mid-November 2021 the follow-up will be completed. Conclusions The preliminary results of the presents study suggest that in patients undergoing cardiac surgery frailty is currently underdiagnosed. The follow-up analysis will establish if a CGA has an additive value on common surgical risk estimators. This study has a potential impact on the risk stratification of elderly patients undergoing invasive procedures and defines the need of a geriatrician in the heart team.

Abstract TMP105: High Utilization Of CAS Procedures Among The Elderly In The Post Crest Era

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Mahmoud Rayes ◽  
Pratik Bhattacharya ◽  
Rahul Damani ◽  
Seemant Chaturvedi
Keyword(s):  
High Risk ◽  
Elderly Patients ◽  
Medical Center ◽  
Significant Proportion ◽  
The Elderly ◽  
Carotid Revascularization ◽  
Choice Of Procedure ◽  
Asymptomatic Patients ◽  
Risk Criterion ◽  
Specific Symptoms

Background: An important interaction of age with outcome was revealed in Carotid Revascularization Endarterectomy Versus Stenting Trial (CREST) where elderly patients ≥70 years had worse outcomes with Carotid stenting (CAS) than with Endarterectomy (CEA). Our hypothesis was that following the CREST study, the proportion of CAS procedures in the elderly would decrease. Methods: We performed a retrospective review of carotid revascularization procedures between June 2009 and April 2012 at a large volume urban medical center. Demographics, indications, surgical high-risk criteria and outcomes of in-hospital stroke/death/MI were collected. Data analysis was performed in subjects over 70 years. Time trends were examined in the post-CREST period. Results: A total of 701 procedures (CEA 36%, CAS 64%) were performed during the study period, of which 360 (51.4%) were in patients ≥70 years (CEA 33%, CAS 67%). A significant proportion (22.1%) was in those ≥80 years. The choice of procedure did not change following CREST. The majority of CAS procedures in elderly (90.8%) were performed by cardiologists. Asymptomatic patients (47.3%) and patients with non-specific symptoms (18.7%) comprised a large proportion of this subgroup. A third of elderly patients with asymptomatic and nonspecific symptoms did not have any surgical high-risk criterion. The proportion of elderly patients receiving CAS for non-specific symptoms increased progressively over time post CREST (27.9% in the most recent months). A similar rise in non-specific indications was noted in the subgroup of patient ≥80 years receiving CAS. About half of this subgroup did not have any surgical high-risk criterion. Conclusion: Two years after CREST results, CAS continues to be performed among the elderly, often for non-specific symptoms or in asymptomatic patients. The lack of a decrease in CAS procedures in the elderly raises questions about whether evidence-based carotid revascularization occurs in the real world.

Impact of Age and Comorbidity in Myelodysplastic Syndromes

2008 ◽  
Vol 6 (9) ◽  
pp. 927-934 ◽  
Author(s):  
Reinhard Stauder ◽  
Thomas Nösslinger ◽  
Michael Pfeilstöcker ◽  
Wolfgang R. Sperr ◽  
Friedrich Wimazal ◽  
...  
Keyword(s):  
Risk Assessment ◽  
Elderly Patients ◽  
Myelodysplastic Syndromes ◽  
Intensive Therapy ◽  
Functional Decline ◽  
Surrogate Marker ◽  
Scoring Systems ◽  
The Elderly ◽  
Western World ◽  
Comorbidity Scores

Myelodysplastic syndromes (MDS) represent a heterogeneous group of myeloid neoplasms that are preferentially diagnosed in the elderly. With the increase in older patients with MDS in the Western world and the availability of more therapeutic options, new strategies and algorithms for optimal management and treatment of these patients must be developed. Although age is recognized as an important adverse variable affecting survival, most scoring systems have not included age in score risk calculations. Comorbidity is of particular importance and a frequent covariable in elderly patients with MDS. However, although comorbidity scores have been established and used for risk assessment in younger high-risk patients scheduled to undergo intensive therapy, these scores are only just being applied to elderly patients, with relevant results. Advanced age should not exclude a patient with MDS from appropriate treatment, and age alone should not be considered a surrogate marker for functional decline or comorbidities. This article discusses the need to improve scoring systems, individualized risk-assessment, and treatment algorithms for elderly patients with MDS by including age and comorbidities.

scholarly journals The Perioperative Nursing of Treating the Elderly Patients of Femoral Intertrochanteric Fracture with PFNA

2015 ◽  
Vol 4 (1) ◽  
pp. 1
Author(s):  
Ying Zhang
Keyword(s):  
Elderly Patient ◽  
Elderly Patients ◽  
Intertrochanteric Fracture ◽  
Perioperative Period ◽  
The Elderly ◽  
Good Recovery ◽  
Surgical Risk ◽  
Perioperative Nursing ◽  
Femoral Intertrochanteric Fracture ◽  
Pull Through

<p><strong>Objective:</strong> Summarize the perioperative nursing of the elderly patient of femoral intertrochanteric fracture. <strong>Method: </strong>Retrospectively analyze the preoperative preparations as well as the postoperative nursing of treating the 75 elderly patients of femoral intertrochanteric fracture with PFNA. <strong>Results: </strong>Those 75 patients all pull through perioperative period and their functions are in good recovery. <strong>Conclusion:</strong> The elderly patient of femoral intertrochanteric fracture has much surgical risk together with many complications during perioperative period. Adopting effective comprehensive nursing can improve the treatment effect of the operation, and can also reduce the complications. </p>

scholarly journals Risk assessment and prediction of severe or critical illness of COVID-19 in the elderly

2020 ◽  
Author(s):  
Xiao-Yu Zhang ◽  
Lin Zhang ◽  
Yang Zhao ◽  
Wei-Xia Li ◽  
Hai-Bing Wu ◽  
...  
Keyword(s):  
Risk Assessment ◽  
Regression Analysis ◽  
Critical Illness ◽  
Elderly Patients ◽  
Risk Prediction ◽  
The Elderly ◽  
Cd4 Cells ◽  
Multivariable Regression Analysis ◽  
Multivariable Regression ◽  
D Dimer

Background: This study aims to investigate the clinical characteristics and risk prediction of severe or critical events of COVID-19 in the elderly patients in China. Methods: The clinical data of COVID-19 in the elderly patients admitted to the Shanghai Public Health Clinical Center during the period of January 20, 2020 to March 16, 2020 were collected. A retrospective cohort study design was conducted to screen out independent factors through Cox univariable regression analysis and multivariable regression analysis, and the efficacy of risk prediction of severe or critical illness was examined through the receiver operating characteristic (ROC) curve. Results: A total of 110 elderly patients with COVID-19 were enrolled. 52 (47.3%) were males and 21 (19.1%) had severe or critical illness. Multivariable regression analysis showed that CD4 cells and D-dimer were independent risk factors. D-dimer, CD4 cells, and D-dimer/CD cells ratios with cut off values of 0.65 (mg/L), 268 (cell/ul) and 431 were in the prediction of severe or critical illness of the elderly COVID-19. The AUC value of D-dimer, CD4 cells, CD4 cells/D-dimer ratio, the tandem group and the parallel group were 0.703, 0.804, 0.794, 0.812 and 0.694, respectively. Conclusions: D-dimer, CD4 cells and their combination have risk assessment value in predicting severe or critical illness of COVID-19 in the elderly.

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