scholarly journals Evaluating Treatment Patterns of Gastrointestinal Stromal Tumors in the Elderly and Predicting Outcomes by a Validated Model: A Population-based Study

2020 ◽  
Author(s):  
Si Zhao ◽  
Hanlong Zhu ◽  
Xiuhua Zhang
Keyword(s):  
Elderly Patients ◽  
Gastrointestinal Stromal Tumors ◽  
Age Groups ◽  
Treatment Decision ◽  
Staging System ◽  
The Elderly ◽  
Population Based ◽  
Tnm Staging ◽  
Stromal Tumors ◽  
Improved Model

Abstract Background: Data on the management and outcome of gastrointestinal stromal tumors (GISTs) in elderlypatients are scant due to their poor representation in clinical trials. Methods:In total, 1379 elderly patients (≥65 years) histologically confirmed GIST between2010 and 2016 were enrolled from the Surveillance, Epidemiology, and End Results (SEER) database.Results: As a result,surgery alone was the predominant treatment used in both age groups. Patients aged ≥75 years who underwent surgery alone had a median survival of 69 months, chemotherapy alone 51 months, surgery plus chemotherapy 60 months, and no therapy 51 months. While among patients aged 65-74 years, the median OS was not reached (NR), 49, 83, and NR, separately. Besides, C-indexes for the OS nomogram in the training set and validation set were0.771 and 0.761, respectively. Of importance, the predictive model displayed a comparable result to the 8th American Joint Committee on Cancer TNM staging system (p＜0.05), demonstrating improved model discrimination. Conclusions: For elderly patients with GISTs, surgery alone or surgery plus chemotherapy seemed feasible and effective, conferring potential survival benefits even in very elderly patients. Moreover, this simple-to-use nomogram may assist clinicians in treatment decision-making and effectively predict 3- and 5-year survival.

ACUTE KIDNEY INJURY IN ELDERLY PATIENTS

2019 ◽  
Vol 72 (8) ◽  
pp. 1466-1472
Author(s):  
Grażyna Kobus ◽  
Jolanta Małyszko ◽  
Hanna Bachórzewska-Gajewska
Keyword(s):  
Acute Kidney Injury ◽  
Renal Failure ◽  
Acute Renal Failure ◽  
Elderly Patients ◽  
Older Patients ◽  
Age Groups ◽  
Kidney Injury ◽  
The Elderly ◽  
Younger Patients ◽  
Common Cause

Introduction: In the elderly, impairment of kidney function occurs. Renal diseases overlap with anatomic and functional changes related to age-related involutionary processes. Mortality among patients with acute renal injury is approximately 50%, despite advances in treatment and diagnosis of AKI. The aim: To assess the incidence of acute kidney injury in elderly patients and to analyze the causes of acute renal failure depending on age. Materials and methods: A retrospective analysis included medical documentation of patients hospitalized in the Nephrology Clinic during the 6-month period. During this period 452 patients were hospitalized in the clinic. A group of 77 patients with acute renal failure as a reason for hospitalization was included in the study. Results: The prerenal form was the most common cause of AKI in both age groups. In both age groups, the most common cause was dehydration; in the group of patients up to 65 years of age, dehydration was 29.17%; in the group of people over 65 years - 43.39%. Renal replacement therapy in patients with AKI was used in 14.29% of patients. In the group of patients up to 65 years of age hemodialysis was 16.67% and above 65 years of age. -13.21% of patients. The average creatinine level in the group of younger patients at admission was 5.16 ± 3.71 mg / dl, in the group of older patients 3.14 ± 1.63 mg / dl. The size of glomerular filtration GFR in the group of younger patients at admission was 21.14 ± 19.54 ml / min, in the group of older patients 23.34 ± 13.33 ml / min. Conclusions: The main cause of acute kidney injury regardless of the age group was dehydration. Due to the high percentage of AKI in the elderly, this group requires more preventive action, not only in the hospital but also at home.

Gastrointestinal stromal tumors (GISTs) at uncommon locations: A large population based analysis

2015 ◽  
Vol 111 (6) ◽  
pp. 696-701 ◽  
Author(s):  
Moshim Kukar ◽  
Aditi Kapil ◽  
Wesley Papenfuss ◽  
Adrienne Groman ◽  
Stephen R. Grobmyer ◽  
...  
Keyword(s):  
Gastrointestinal Stromal Tumors ◽  
Large Population ◽  
Population Based ◽  
Stromal Tumors

Cochlear implantation in elderly patients: stability of outcome over time

2016 ◽  
Vol 130 (8) ◽  
pp. 706-711 ◽  
Author(s):  
O Hilly ◽  
E Hwang ◽  
L Smith ◽  
D Shipp ◽  
J M Nedzelski ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Cochlear Implantation ◽  
Short Form ◽  
Age Groups ◽  
The Elderly ◽  
Long Term Results ◽  
Profound Hearing Loss ◽  
Younger Patients ◽  
Over Time

AbstractBackground:Cochlear implantation is the standard of care for treating severe to profound hearing loss in all age groups. There is limited data on long-term results in elderly implantees and the effect of ageing on outcomes. This study compared the stability of cochlear implantation outcome in elderly and younger patients.Methods:A retrospective chart review of cochlear implant patients with a minimum follow up of five years was conducted.Results:The study included 87 patients with a mean follow up of 6.8 years. Of these, 22 patients were older than 70 years at the time of implantation. Hearing in Noise Test scores at one year after implantation were worse in the elderly: 85.3 (aged under 61 years), 80.5 (61–70 years) and 73.6 (aged over 70 years;p= 0.039). The respective scores at the last follow up were 84.8, 85.1 and 76.5 (p= 0.054). Most patients had a stable outcome during follow up. Of the elderly patients, 13.6 per cent improved and none had a reduction in score of more than 20 per cent. Similar to younger patients, elderly patients had improved Short Form 36 Health Survey scores during follow up.Conclusion:Cochlear implantation improves both audiometric outcome and quality of life in elderly patients. These benefits are stable over time.

Optimizing Antiepileptic Drug Therapy in the Elderly

2005 ◽  
Vol 39 (11) ◽  
pp. 1852-1860 ◽  
Author(s):  
William R Garnett
Keyword(s):  
Drug Therapy ◽  
Elderly Patients ◽  
Antiepileptic Drug ◽  
Age Groups ◽  
The Elderly ◽  
Complex Partial Seizures ◽  
Medline Search ◽  
Age Related ◽  
Epilepsy In The Elderly ◽  
Clonic Seizures

OBJECTIVE To review and evaluate the medical literature concerning antiepileptic drug (AED) therapy in elderly patients. DATA SOURCES A MEDLINE search (1982–December 2004) was conducted. Bibliographies of the articles identified were also reviewed, and an Internet search engine was used to identify additional pertinent references. STUDY SELECTION AND DATA EXTRACTION Clinical studies and reviews were evaluated, and relevant information was included. DATA SYNTHESIS The elderly have the highest incidence of seizures among all age groups. Complex partial seizures are the most common, followed by primary generalized tonic–clonic seizures. An accurate diagnosis may prove difficult because of a low suspicion of epilepsy in the elderly and other diseases that may mimic seizures. Most AEDs are approved for treatment of elderly patients who have partial and tonic–clonic seizures. However, a number of age-related variables should be addressed when selecting an appropriate AED. Age-dependent differences in pharmacokinetics and pharmacodynamics of AEDs must be taken into account. Drug–drug interactions must be considered since elderly people often take multiple medications. The ultimate factor that often determines AED selection is tolerability. CONCLUSIONS Numerous factors must be considered in treating elderly patients for seizures, but maximizing the ability of patients to tolerate drug therapy is often the basis for AED selection. Special consideration should be made along several lines, including elderly patients’ cognitive functioning and their tendency to respond to lower AED concentrations.

scholarly journals Achalasia in the Elderly: Diagnostic Approach and a Proposed Treatment Algorithm Based on a Comprehensive Literature Review

2021 ◽  
Vol 10 (23) ◽  
pp. 5565
Author(s):  
Amir Mari ◽  
Wisam Sbeit ◽  
Wisam Abboud ◽  
Halim Awadie ◽  
Tawfik Khoury
Keyword(s):  
Elderly Patients ◽  
Botulinum Toxin Injection ◽  
Treatment Algorithm ◽  
Balloon Dilation ◽  
Treatment Decision ◽  
The Elderly ◽  
Laparoscopic Heller Myotomy ◽  
Therapeutic Options ◽  
Management Algorithm ◽  
Elder Patients

Achalasia is not uncommonly diagnosed in elderly patients and its incidence and prevalence are growing in this population. However, a scarcity of studies has assessed the typical pathophysiological and clinical features of the disease as well as the effectiveness and safety of the various therapeutic options in elderly populations. Botulinum toxin injection has been used for achalasia treatment since 1994 and is traditionally considered the preferred treatment for fragile elder patients. However, recently more evidence has become available regarding the safety and effectiveness of pneumatic balloon dilation (BD), laparoscopic Heller myotomy (LHM) and per-oral endoscopic myotomy (POEM) in elderly patients with achalasia. In the current review we present the current literature on this topic with a focus on the clinical presentation of achalasia in the elderly and manometric features thereof, as well as summarize the effectiveness and safety of the various therapeutic options. Furthermore, we propose a practical management algorithm as a means to guide the treatment of future cases. We recommend that a conservative/BTI approach should be adopted in the fragile unfit patient. In the elderly fit patient, the treatment decision should be based on the achalasia type, patient preference and the available expertise, similar to the approach adopted for the non-elderly population.

Incidence of Skull Fractures in Olmsted County, Minnesota

Neurosurgery ◽  
1984 ◽  
Vol 15 (3) ◽  
pp. 318-324 ◽  
Author(s):  
Evan Lloyd Nelson ◽  
Joseph L. Melton ◽  
John F. Annegers ◽  
Edward R. Laws ◽  
Kenneth P. Offord
Keyword(s):  
Rural Areas ◽  
Motor Vehicle ◽  
Skull Fracture ◽  
Age Groups ◽  
The Elderly ◽  
Population Based ◽  
Incidence Rates ◽  
Skull Fractures ◽  
Olmsted County ◽  
Type Motor

Abstract Between 1935 and 1974, 3598 episodes of head trauma among Olmsted County, Minnesota, residents resulted in 1097 skull fractures. Of these, 53% were simple, 16% were depressed, 12% were compound, and 19% were basilar. The age- and sex-adjusted incidence of skull fractures was 44.3 per 100,000 person-years overall, was somewhat greater in the urban than in the rural areas of Olmsted County, and was relatively stable for the final 30 years of the study. Age-specific incidence rates were highest for the very young, and simple linear fractures were the predominant type of skull fracture in this age group and among the elderly. The male:female ratio of incidence rates varied from 2.1:1 to 4.5:1 depending on fracture type. Motor vehicle accidents accounted for 38% of the skull fractures and were a particularly important cause among young males. Falls accounted for 37% of the skull fractures and were the major cause of fractures in the elderly and pediatric age groups. The results of this population-based study may be helpful in formulating recommendations for the evaluation and management of head-injured patients.

Long-term Survival among Patients with Gastrointestinal Stromal Tumors Diagnosed after Another Malignancy: A SEER Population-Based Study

2020 ◽  
Author(s):  
Chaoyong Shen ◽  
Chengshi Wang ◽  
Tao He ◽  
Zhaolun Cai ◽  
Xiaonan Yin ◽  
...  
Keyword(s):  
Gastrointestinal Stromal Tumors ◽  
Population Based ◽  
Clinicopathological Characteristics ◽  
Second Primary ◽  
Primary Malignancy ◽  
Clinicopathologic Characteristics ◽  
Term Survival ◽  
Stromal Tumors ◽  
Group A

Abstract BACKGROUND: To explore overall survival (OS) and GISTs-specific survival (GSS) among cancer survivors developing a second primary gastrointestinal stromal tumors (GISTs). METHODS: We conducted a cohort study, where patients with GISTs after another malignancy (AM-GISTs, n=851) and those with only GISTs (GISTs-1, n=7660) were identified from the Surveillance, Epidemiology, End Results registries (1988-2016). Clinicopathologic characteristics and survival were compared between the two groups. RESULTS: The most commonly diagnosed first primary malignancy was prostate cancer (27.7%), followed by breast cancer (16.2%). OS among AM-GISTs was significantly inferior to that of GISTs-1: 10-year OS was 40.3% vs. 50.0%, (p<0.001); A contrary finding was observed for GSS (10-year GSS: 68.9% vs. 61.8%, p=0.002). In the AM-GISTs group, a total of 338 patients died, of which 26.0% died of their initial cancer and 40.8% died of GISTs. Independent of demographics and clinicopathological characteristics, mortality from GISTs among AM-GISTs patients was decreased compared with their GISTs-1 counterparts (HR, 0.71; 95% CI, 0.59-0.84; p<0.001); whereas OS was inferior among AM-GISTs (HR, 1.11; 95% CI, 0.99-1.25; p=0.085). CONCLUSIONS: AM-GISTs patients have decreased risk of dying from GISTs compared with GIST-1. Although another malignancy history does not seemingly affect OS for GISTs patients, clinical treatment of such patients should be cautious.

Worldwide Experiences with Assisted Peritoneal Dialysis

2017 ◽  
Vol 37 (5) ◽  
pp. 503-508 ◽  
Author(s):  
Anna Giuliani ◽  
Akash Nayak Karopadi ◽  
Mario Prieto-Velasco ◽  
Sabrina Milan Manani ◽  
Carlo Crepaldi ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Elderly Patients ◽  
Elderly Population ◽  
Age Groups ◽  
The Elderly ◽  
Clinical Results ◽  
Social Barriers ◽  
Stage Renal Disease ◽  
End Stage ◽  
Assisted Peritoneal Dialysis

End-stage renal disease (ESRD) is common in the elderly population, and renal replacement therapy (RRT) is often required. However, in this particular subgroup of patients, the choice between hemodialysis (HD) and peritoneal dialysis (PD) is often not an easy decision to make. Published literature has adequately demonstrated that PD prevalence is significantly less than HD across all patient age groups despite several advantages. We also know that elderly patients are less likely to complete a PD assessment, due to both medical and social barriers. Additionally, elderly patients are often reluctant to go ahead with PD despite being eligible PD candidates, mainly due to the fear of performing self-therapy. Recently, many new assisted PD (asPD) programs have cropped up in several countries. The main aim of these programs is to overcome barriers to PD and to promote PD utilization among elderly and non-self-sufficient patients. Although asPD has proven to be associated with good clinical results, there still remain concerns about its greater use. In this review, we will first describe an ideal asPD model and then enumerate examples of strategies and outcomes associated with successful asPD programs worldwide.

scholarly journals Establishment and Verification of Synchronous Metastatic Nomogram for Gastrointestinal Stromal Tumors (GISTs): A Population-Based Analysis

2020 ◽  
Vol 2020 ◽  
pp. 1-7 ◽  
Author(s):  
Yuqiang Li ◽  
Guangfeng Zhang ◽  
Xiangping Song ◽  
Lilan Zhao ◽  
Cenap Güngör ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Gastrointestinal Stromal Tumors ◽  
Logistic Regression Model ◽  
Validation Cohort ◽  
Tumor Location ◽  
Population Based ◽  
Brier Score ◽  
Validation Group ◽  
Synchronous Metastasis ◽  
Stromal Tumors

Aim. Assess the risk of synchronous metastasis and establish a nomogram in patients with GISTs. Methods. Surveillance, Epidemiology and End Results database (2004-2014) was accessed. With the logistic regression model as the basis, a nomogram was constructed. Results. 7,256 target patients were contained in our study. The nomogram discrimination for mGIST prediction revealed that tumor size contributed most to synchronous metastasis, followed by lymph nodes, extension, pathologic grade, tumor location, and mitotic count. C-index values of predictions were 0.821 (95% CI, 0.805-0.836) and 0.815 (95% CI, 0.800-0.831), and Brier score were 0.109 and 0.112 in training and validation group, respectively. The value of area under the ROCs were 0.813 (p<0.001) in the primary cohort and 0.819 (p<0.001) in the validation cohort. Through the calibration curves (as seen in the figures), nomogram prediction proved to have excellent agreement with actual metastatic diseases. Conclusion. A new nomogram was created that can evaluate synchronous metastatic diseases in patients with GISTs.

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