scholarly journals Geriatric approach to the treatment of senile patients with colorectal cancer

2022 ◽  
pp. 72-79
Author(s):  
V. M. Nekoval ◽  
S. K. Efetov ◽  
P. V. Tsarkov

Introduction. The lack of consensus guidelines for the treatment of colorectal cancer (CRC) in senile patients, the high incidence of early postoperative complications after radical surgery caused the search for the most optimal approach to the management of this category of patients.The aim is to introduce a geriatric approach to the treatment of colorectal cancer in senile patients, reduce the incidence of Clavien–Dindo grade 4 early postoperative complications.Materials and methods. 190 senile patients who underwent radical surgery with D3 lymphadenectomy with stage II and III colorectal cancer were enrolled in the study. They were divided into two groups: the control group included 100 patients who underwent standard treatment, the study group included 90 patients, to whom the geriatric approach with a comprehensive geriatric assessment (CGA) and subsequent pre-rehabilitation was applied. A comparative intergroup analysis was performed on the basis of obtained data.Results. The study group differed from the control group in higher polymorbidity and high operational and anesthetic risk (p <0.001). Implementation of geriatric pre-rehabilitation with due account for CGA results and correction of polymorbidity improved chances of providing surgical care using laparoscopic and robotic technologies. The frequency of intraoperative blood transfusion and prolonged mechanical ventilation in the study group was reduced (p <0.001 and p = 0.009, respectively). Predictors that increase the chances of developing acute postoperative myocardial infarction were identified. They included the patient’s male gender (p = 0.004), redo surgery after development of early postoperative complications (p = 0.043), prolonged mechanical ventilation (p = 0.052), increased length of stay in the intensive care unit (p = 0.011), and comorbidity (p = 0.022). The introduction of the geriatric approach made it possible to reduce the risk of postoperative myocardial infarction by 17.86 times (p = 0.007).Conclusion. The geriatric approach to the senile patients with colorectal cancer makes it possible to expand the indications for radical treatment in severe polymorbidity and senile asthenia, as well as to reduce the incidence of early postoperative complications.

2021 ◽  
Vol 24 (6) ◽  
pp. E935-E939
Author(s):  
Mohamed Fawzy Abdel-Aleem ◽  
Ibrahim Ahmed Elsedeeq ◽  
Gamal Hamid Ahmed ◽  
Tarek El- Tawil ◽  
Amal Rizk ◽  
...  

Background: The strength of association between preoperative natriuretic peptide levels and adverse outcomes after cardiac surgery recently has been studied in different research, but results still are diversely variable. Methods: Sixty-five consecutive patients undergoing elective off-pump coronary artery bypass grafting prospectively were recruited. Preoperative levels of NTproBNP were measured in venous blood samples collected before induction of anesthesia. Results: The average age was 57.62 ± 7.21. Of the patients, 86.15% were male. Euro-scoreII averaged 1.76 ± 0.34. The mean preoperative NTproBNP levels were 312.41 ± 329.93 pg/mL. Only two patients died (3%). Three patients required prolonged mechanical ventilation (4.6%). Four patients (6%) suffered from new onset postoperative AF. Five patients (7.6%) had low cardiac output, of which three needed IABP, and four patients (6%) had postoperative myocardial infarction. The mean ICU stay was 3.37 ± 0.84 days, and the mean hospital stay was 6.38 ± 1.3 days. There were no significant differences in preoperative NTproBNP levels in patients who had or didn’t have any of the postoperative complications or in-hospital mortality (P > .05). Conclusion: Our study showed no significant correlation between preoperative NTproBNP levels and postoperative low cardiac output, atrial fibrillation, postoperative myocardial infarction, length of ICU stay, prolonged mechanical ventilation, length of hospital stay as well as in-hospital mortality following elective off-pump CABG. Therefore, more prospective specific studies are needed to delineate the role of preoperative natriuretic peptides as significant predictors of poor outcomes after CABG surgery.


Author(s):  
Tupitsyn V.V. ◽  
Bataev Kh.M. ◽  
Men’shikova A.N. ◽  
Godina Z.N.

Relevance. Information about the cardiovascular diseases risk factors (CVD RF) for in men with chronic lung inflam-matory pathology (CLID) is contradictory and requires clarification. Aim. To evaluate the peculiarities of CVD RF in men under 60 years of age with CLID in myocardial infarction (MI) to improve prevention. Material and methods. The study included men aged 19-60 years old with type I myocardial infarction. Patients are divided into two age-comparable groups: I - the study group, with CLID - 142 patients; II - control, without it - 424 patients. A comparative analysis of the frequency of observation of the main and additional cardiovascular risk fac-tors in groups was performed. Results. In patients of the study group, more often than in the control group we observed: hereditary burden of is-chemic heart disease (40.8 and 31.6%, respectively; p = 0.0461) and arterial hypertension (54.2 and 44.6%; p = 0.0461), frequent colds (24.6 and 12.0%; p = 0.0003), a history of extrasystoles (19.7 and 12.7%; p = 0.04); chronic foci of infections of internal organs (75.4 and 29.5%; p˂0.0001), non-ulcer lesions of the digestive system (26.1 and 14.6%; p = 0.007), smoking (95.1 and 66.3%; p˂0.0001), MI in winter (40.8 and 25.9%; p = 0.006). Less commonly were observed: oral cavity infections (9.2 and 23.6%; p˂0.0001); hypodynamia (74.5 and 82.5%; p = 0.0358), over-weight (44.4 and 55.2%; p = 0.0136), a subjective relationship between the worsening of the course of coronary heart disease and the season of the year (43.7 and 55.2%; p = 0.0173) and MI - in the autumn (14.1 and 21.9%; p = 0.006) period. Conclusions. The structure of CVD RF in men under 60 years of age with CLID with MI is characterized by the pre-dominance of smoking, non-ulcer pathology of the digestive system, frequent pro-student diseases, meteorological dependence, a history of cardiac arrhythmias and foci of internal organ infections. It is advisable to use the listed factors when planning preventive measures in such patients.


2021 ◽  
Vol 7 (6) ◽  
pp. 6395-6401
Author(s):  
XueQin Li ◽  
XiuYing Chen

Background VAP is a common complication of ventilator maintenance therapy. The occurrence of VAP is related to many factors such as long duration of breathing, invasive operation, pollution of respiratory tubes and instruments, and low immunity of patients. The prevention of VAP in critically ill patients I the primary problem for clinical medical staff. Avoiding exogenous bacteria invading the respiratory tract and endogenous bacterial infection is the main method. Objective To investigate the value of optimized cluster nursing intervention combined with targeted nursing measures in reducing the incidence of ventilator-associated pneumonia (VAP) in patients with mechanical ventilation in intensive care unit (ICU). Methods 200 patients with mechanical ventilation in ICU of our institute from January 2017 to June 2020 were selected and randomly divided into study group and control group, with 100 cases in each group. The study group was treated with cluster nursing intervention combined with targeted nursing measures optimized by muItL criteria decision analysis method, and the control group was treated with targeted nursing measures. The incidence of VAP, the detection rate of pathogenic bacteria in sputum specimens and the effect of nursing execution were compared between the two groups. 200 patients were divided into VAP group and non-VAP group according to whether VAP occurred. Multivariate Logistic regression model analysis was used to explore the risk factors of VAP in AECOPD patients. Results A total of 4 strains were detected in the study group and 18 strains were detected in the control group. The detection rate of pathogenic bacteria in the study group was higher than that in the control group (y2=10.010, P=0.002<0.05). The incidence of VAP in the study group was 4.00% lower than 17.00% in the control group, and the difference was statistically significant (P<0.05). Compared with VAP group and non-VAP group, the proportion of patients with serum albumin<30g/L, diabetes mellitus rate, APACHE II score>15 points, tracheotomy rate and mechanical ventilation time≥5 days in VAP group were significantly higher than those in non-VAP group, which had statistical significance (P<0.05). The results of logistic regression model snowed that serum albumin ≥30g/L and optimized cluster nursing could effectively reduce the risk of VAP in ICU patients with mechanical ventilation (P<0.05). The risk of VAP in ICU patients with mechanical ventilation was increased by the combination of diabetes rate. APACHE II score≥15 points, tracheotomy and mechanical ventilation time ≥ 5 days (P<0.05). Conclusion The risk of VAP in ICU patients with mechanical ventilation is high, and the optimized cluster nursing intervention combined with targeted nursing measures can effectively reduce the incidence of VAP.


Author(s):  
Gordienko A.V. ◽  
Epifanov S.Yu. ◽  
Sotnikov A.V.

Relevance. Recurrent myocardial infarction and early postinfarction angina negatively affects on the prognosis of myocardial infarction. Aim. To evaluate myocardial infarction clinical features in men under 60 years old with recurrent myocardial infarction and early postinfarction angina to improve prevention and outcomes. Material and methods. The study included men aged 19-60 years old with type I myocardial infarction. Patients are divided into two age-comparable groups: I - the study group, with recurrent myocardial infarction - 79 patients; II - control, without it - 432 patients. A comparative assessment of the myocardial infarction clinical features frequency in selected groups were performed. Results. The studied groups did not differ in the frequency of the main variants of the myocardial infarction course. In patients of the study group more often than in the control group, a complicated course of the disease was observed (88.2 and 50.2%, respectively; p < 0.0001), deaths (13.6 and 3.4%; p < 0.0001). Complications in the study group were dominated by arrhythmias (47.3 and 33.7%; p = 0.007), cardiogenic shock (13.6 and 6.1%; p = 0.006), myocardial ruptures (3.6 and 0.5% ; p = 0.004), thromboembolism (15.5 and 2.2%; p <0.0001), urinary dysfunction (7.3 and 2.5%; p = 0.01), Dressler's syndrome (4.5 and 1.1%; p = 0.009) and mental disorders (16.4 and 5.6%; p < 0.0001). Conclusions. Nonanginal forms of the disease in the study group were observed in 17% of cases. The complications of the disease for group I are characterized by cardiac arrhythmias and conduction disorders, thromboembolism, myocardial ruptures, cardiogenic shock, extracardiac complications of myocardial infarction. The study group has a worse prognosis, which requires early diagnosis, revascularization, the use of auxiliary mechanical devices, and careful implementation of standardized treatment algorithms.


2011 ◽  
Vol 1 (2) ◽  
pp. 59-63
Author(s):  
Tabish Hussain ◽  
Li Yu Shu ◽  
A Seid Adji ◽  
Tumenjavkhlan Sosorburam

Objective: Cardiac failure is a global burden among cardiovascular diseases, and major cause of morbidity and mortality especially among elderly age group. Angiotensin Converting Enzyme(ACE) inhibitors, remained the choice of treatment as they inhibit the renin angiotensin aldosterone system along with reduction in levels of pro-inflammatory cytokines, both of them are key factors in progression and complications of heart failure. The aim of this study was to rule out the effect of aging and efficacy of ACE inhibitor, Captopril, among Chinese cardiovascular patients with acute myocardial infarction (MI) during the hospitalization phase of therapy. Material & Methods: Randomized control trial at hospital of Tongji Medical College Wuhan, China over a period of more than 1 year from April 2009 till July 2010 recruiting patients in two stages. A total of 260 patients with mean age 65±8 years were recruited. All suffered from first time myocardial infarction and arrived in Cardiac emergency within 72 hours of the event. The participants were then randomly divided in study and control groups which were then further classified in sub-groups depending upon their age. Study group received ACE inhibitor Captopril in addition to standardized therapy while control group just received the conventional therapy for the event. Statistical analyses were done to formulate the corre-lation between multi-variables. Results: Participants were divided in Study group (N=150) (A and C, Young and Old) and the control group (N=110) (B and D, Young and Old). Survival rate was better among elderly on captopril in comparison to younger ones during the hospitalization. The Systolic blood pressure among study group was significantly lower than control group (132.9±16.3mmHg/84.7 ±9.1mmHg vs. 147.1±17.4mmHg/85.1 ±10.9mmHg, P<0.05).Patient’s survival was statistically significant with respect to age (P<0.001). Conclusion: Treatment with Captopril is definitely associated with improved short as well as long term cardiac prognosis and markedly. Captopril therapy is associated with improved long term prognosis and reduced cardiac mortality during the hospitalization phase of the therapy and recovery period. But the most significant finding is that the increased survival after taking Captopril was higher in elderly patients than in younger patients. ACE inhibitors like Captopril in proper dosage play a real vital beneficial role among elderly patients as compared to the younger ones, but still there is need to recruit a large cohort in different ethnic groups with different genetic makeup. Key Words: Myocardial infarction (MI); Ace-inhibitor; Aging DOI: 10.3126/ajms.v1i2.2947Asian Journal of Medical Sciences 1 (2010) 59-63


Author(s):  
Gordienko A.V. ◽  
Golikov A.V. ◽  
Tassybayev B.B. ◽  
Reiza V.A.

Relevance. The role of hemodynamic changes in myocardial infarction complicated by acute kidney injury is interpreted in different ways. Aim. To evaluate the heart chambers and structures peculiarities in men under 60 years old with myocardial infarction complicated by acute kidney injury to improve prevention and outcomes. Material and methods. The study included men 19-60 years old with type I myocardial infarction. The patients were divided into two age-comparable groups: I - study group, with acute kidney injury - 25 patients; II - control, without it - 366 patients. A comparative assessment of the heart chambers and structures parameters in the first 48 hours (1) and at the end of the third week of the disease (2), their dynamics, also acute kidney injury development risk analysis (ANOVA) were performed. Results. The study group differed from the control group in smaller sizes of the left atrium2 (38.1±6.0 and 42.0±5.4 (mm), respectively; p=0.01), a higher frequency of the middle anterior (100 and 15.6%; p=0.02) and antero-septal (100 and 17.7; p=0.04) segments akinesia and the absence (0 and 81.5%; p=0.04) of tricuspid regurgitation. In the study group, there was a smaller increase in the ventricles size than in the control group (left: 0.6 and 1.7%, respectively; right: 15.3 and 33.6%) and a greater decrease in the atria size, compared in the control group (left: -1.8 and -25.3%; right: -25.3 and -0.1%) (p<0.0001). The risk markers of the acute kidney injury developing were the dimensions of the left atrium1˂34 mm, interventricular septum≥12.0 mm, end systolic1≥4.23 and diastolic1≥5.3 of the left ventricle, right ventricle1˂2.6; of the right atrium1≥4.7 (cm), the mass of the left ventricle1≥328.8 g. Conclusions. Men under 60 years old with acute kidney injury in myocardial infarction are characterized by lesions of the middle anterior and antero-septal segments, the absence of tricuspid regurgitation, and a smaller left atrium in the subacute period of the disease. The above of the heart chambers dimensions values should be used in the high-risk groups for the acute kidney injury development formation, as well as for prognostic modeling.


Author(s):  
Golikov A.V. ◽  
Epifanov S.Yu. ◽  
Reiza V.A.

Relevance. Dyslipidemia is considered one of the main risk factors for the development of recurrent myocardial infarction and early postinfarction angina. Aim. To evaluate the features of lipid metabolism in acute and subacute myocardial infarction in men under 60 years old with recurrent episodes of ischemia (recurrent myocardial infarction and/or early postinfarction angina) to search for new approaches to improve prevention measures. Material and methods. The study included men aged 19-60 years old with type I myocardial infarction. Patients are divided into two age-comparable groups: I - the study group, with recurrent myocardial infarction - 68 patients; II - control, without it - 427 patients. A comparative assessment of lipid metabolism parameters and their dynamics in selected groups were performed. Results. The study group differed in higher levels of total serum cholesterol (6.17±1.78 mmol/l) from the control group (5.56±1.28 mmol/l; p=0.02) at the end of the third week of disease, its dynamics during the observation period (I: 9.1%; p<0.0001; II: -1.8%; p<0.0001) and the dynamics of the atherogenic coefficient (I: -4.7.1; p=0.02; II: 6.3%; p<0.0001). In both groups, the group showed an increase in lipoproteins of low (I: 33.1; p=0.02; II: 45.5%; p<0.0001) and very low density (I: 275.8; p=0,0004; II: 233.4%; p<0.0001), atherogenic indices, decrease: triglycerides (I: -31.8%; p=0.02; II: -1.7%; p<0.0001) and high-density lipoproteins (I: -0.6%; p=0.02; II: -6.1%; p<0.0001). Conclusions. The group with recurrent ischemia is characterized by more pronounced hypercholesterolemia at the end of the subacute period of myocardial infarction in comparison with the control group due to an increase in the concentrations of atherogenic lipid metabolism fractions. The dynamics of indices and the coefficient of atherogenicity during this period is multidirectional, which requires additional study.


2018 ◽  
Vol 5 (2) ◽  
pp. 50-61 ◽  
Author(s):  
M. V. Kruchinina ◽  
V. N. Kruchinin ◽  
Ya. I. Prudnikova ◽  
A. A. Gromov ◽  
M. V. Shashkov ◽  
...  

The objectiveis to measure the level of fatty acids in erythrocyte membranes and serum of patients with colorectal cancer.Materials and methods.The study group included 100 patients with diagnosed colorectal cancer (57 men and 43 women). The control group included 24 reasonably healthy people (14 men and 10 women) matched for age and sex, without malignant cancers or manifested pathology of the internal organs.Results.Decreased levels of saturated, monounsaturated fatty acids and increased levels of polyunsaturated fatty acids (PUFAs) in erythrocyte membranes and serum (p <0.0001–0.05) were observed. The levels of omega-3 PUFAs in colorectal cancer exceeded the levels in healthy individuals both in erythrocyte membranes and in serum; for omega-6 PUFAs only a trend was observed. At the same time, the ratio of omega-6/omega-3 PUFAs in colorectal cancer was lower than in control (p <0.0001–0.002). The state of erythrocyte membranes more significantly and for more parameters characterized differences between the groups than serum. The most discriminating parameters between patients with colorectal cancer and healthy individuals both in erythrocyte membranes and serum were the levels of C20:2;11,14 (eicosadienoic), C20:3;8,11,14 (dihomo-γ-linolenic), C20:4;5,8,11,14 (eicosatetraenoic, arachidonic), C22:5;7,10,13,16,19 (docosapentaenoic), and C22:6;4,7,10,13,16,19 (docosahexaenoic) PUFAs.


2017 ◽  
Vol 1 (3) ◽  
Author(s):  
Yongbo Wang

Objective: To investigate the effects of radiofrequency ablation assisted partial hepatectomy in the treatment of primary liver cancer. Methods: A total of 60 patients with primary liver cancer treated in our hospital from March 2013 to October 2015 were selected as study subjects and were divided into the control group and the study group by the random number table method, 30 cases in each group. The control group were treated with partial hepatectomy. On the basis, the study group were treated with radiofrequency ablation. The operation associated indexes (operation time, the average wound bleeding volume, postoperative length of hospital stay), preoperative and postoperative liver function indexes [alanine aminotransferase (ALT), total bilirubin (TBIL), aspartate aminotransferase (AST)], the incidence of complications and recurrence rates in the two groups were observed. Results: The operation time and postoperative length of hospital stay of the study group were significantly shorter than those of the control group, and the average bleeding volume was significantly less than that of the control group (P < 0.05). There was no significant difference in ALT, TBiL and AST between the two groups before operation(P>0.05). After operation, ALT, TBiL and AST in the two groups were significantly lower than those before operation, and the changes in the study group were greater than those in the control group (P < 0.05). The incidence of postoperative complications and the recurrence rate in 1 year after operation were significantly  lower than those in the control group (P < 0.05). Conclusion: Radiofrequency ablation has obvious positive effect in patients with primary liver cancer undergoing partial hepatectomy. It has advantages of little bleeding, short rehabilitation time, protecting liver function, few postoperative complications and low recurrence rate.


2018 ◽  
Vol 5 (5) ◽  
pp. 1172 ◽  
Author(s):  
Hariprasad S. ◽  
Basavaraj M.

Background: Myocardial Infarction (MI) is the term given for a state of myocardial necrosis which is secondary to an acute interruption of the coronary blood supply. Severity is dependent on level of occlusion, length of time of occlusion and presence or absence of collateral circulation. Myocardial infarction is now considered part of a spectrum referred to as acute coronary syndrome. It is a spectrum of acute myocardial ischemia that also includes unstable angina (STEMI) and non-ST segment elevation myocardial infarction (NSTEMI). The changes in serum electrolytes were studied in this study with a special focus on sodium and potassium serum levels in patients suffering from AMI. Hence, the aim of the study was to examine the changes in serum electrolytes among AMI patients and then comparison was done with the healthy persons.Methods: The study comprised of 80 subjects, which were divided equally into study group and control group. The study group comprised cases of confirmed diagnosis of recent onset of AMI. Clinical data was collected using interviewing questionnaires. The blood samples of both groups were analysed for serum electrolytes (Na+, K+, Cl-, Ca+ and Mg+) with the help of ion sensitive electrode analyser along with quality control sera.Results: There was statistically significant decrease in sodium and potassium levels in AMI patients. It was found that there was decrease in sodium serum levels in AMI patients suffering with hypertension. Potassium levels were increased in AMI patients suffering from Diabetes Mellitus and Hypertension, which was found to be statistically significant.Conclusions: Hyponatremia and hypokalemia are indicators of acute myocardial infarction. Serum sodium and potassium levels are prognostic indicators, i.e., rise in sodium levels after initial fall was indicative of clinical improvement. Therefore, estimation of sodium and potassium level in acute MI patients can help assess their prognosis.


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