scholarly journals Magnetic resonance–guided laser interstitial thermal therapy for brain tumors in geriatric patients

2020 ◽  
Vol 49 (4) ◽  
pp. E12
Author(s):  
Elizabeth E. Ginalis ◽  
Shabbar F. Danish
Keyword(s):  
Brain Tumors ◽  
Neurological Symptom ◽  
Geriatric Patients ◽  
Age Groups ◽  
Postoperative Mortality ◽  
Thermal Therapy ◽  
Intracranial Tumors ◽  
Laser Interstitial Thermal Therapy ◽  
Group 2 ◽  
Group 1

OBJECTIVEThere is a paucity of studies assessing the use of MR-guided laser interstitial thermal therapy (LITT), specifically in the elderly population. The aim of this study was to evaluate the safety of LITT for brain tumors in geriatric patients.METHODSGeriatric patients (≥ 65 years of age) treated with LITT for intracranial tumors at a single institution between January 2011 and November 2019 were retrospectively identified. The authors grouped patients into two distinct age cohorts: 65–74 years (group 1) and 75 years or older (group 2). Baseline characteristics, operative parameters, postoperative course, and morbidity were recorded for each patient.RESULTSFifty-five geriatric patients underwent 64 distinct LITT procedures for brain tumors. The majority of lesions (40 [62.5%]) treated were recurrent brain metastases or radiation necrosis. The median modified frailty index was 0.1 (low frailty; range 0–0.4) for patients in group 1 and 0.2 (intermediate frailty; range 0–0.4) for patients in group 2 (p > 0.05). The median hospital length of stay (LOS) was 1 day (IQR 1–2 days); there was no significant difference in LOS between the age groups. The hospital stay was significantly longer in patients who presented with a neurological symptom and in those who experienced a postoperative complication. The majority of patients (43 [68.3%] of 63 cases) were fit for discharge to their preoperative accommodation following LITT. The rate of discharge to home was not significantly different between the age groups. Those discharged to rehabilitation facilities were more likely to have presented with a neurological symptom. Nine patients (14.1% of cases) were found to have acute neurological complications following LITT, with nearly all patients showing complete or partial recovery at follow-up. The 30-day postoperative mortality rate was 1.6% (1 case). The complication and 30-day postoperative mortality rates were not significantly different between the two age groups.CONCLUSIONSLITT can be considered a minimally invasive and safe neurosurgical procedure for the treatment of intracranial tumors in geriatric patients. Careful preoperative preparation and postoperative care is essential as LITT is not without risk. Appropriate patient selection for cranial surgery is essential, because neurosurgeons are treating an increasing number of elderly patients, but advanced age alone should not exclude patients from LITT without considering frailty and comorbidities.

scholarly journals NCOG-65. MR-GUIDED LASER INTERSTITIAL THERMAL THERAPY FOR BRAIN TUMORS IN GERIATRIC PATIENTS

2020 ◽  
Vol 22 (Supplement_2) ◽  
pp. ii144-ii144
Author(s):  
Elizabeth Ginalis ◽  
Shabbar Danish
Keyword(s):  
Mortality Rate ◽  
Neurological Symptom ◽  
Geriatric Patients ◽  
Age Groups ◽  
Postoperative Mortality ◽  
Thermal Therapy ◽  
Partial Recovery ◽  
Intracranial Tumors ◽  
Laser Interstitial Thermal Therapy ◽  
Significant Difference

Abstract INTRODUCTION There is a paucity of studies assessing the use of magnetic resonance-guided laser interstitial thermal therapy (LITT) in the elderly population. METHODS Geriatric patients (≥65 years) treated with LITT for intracranial tumors at a single institution from January 2011 to November 2019 were retrospectively identified. We grouped patients into two cohorts: 65-74 years (group 1) and 75 years or older (group 2). Baseline characteristics, operative parameters, postoperative course, and morbidity were recorded. RESULTS There were 55 patients who underwent 64 distinct LITT procedures. The majority of tumors (62.5%) treated were recurrent brain metastasis/radiation necrosis. The median hospital length of stay was 1 day, with no significant difference between age groups. Hospital stay was significantly longer in patients who presented with a neurological symptom and in those who experienced a postoperative complication. The majority of patients (68.3%) were discharged to their preoperative accommodation. Rate of discharge to home was not significantly different between age groups. Those discharged to rehabilitation facilities were more likely to have presented with a neurological symptom. Nine patients (14.1%) were found to have acute neurological complications, with nearly all patients showing complete or partial recovery at follow-up. The 30-day postoperative mortality rate was 1.6% (n = 1). The complication and 30-day postoperative mortality rate were not significantly different between age groups. CONCLUSIONS LITT can be considered as a minimally invasive and safe neurosurgical procedure for treatment of intracranial tumors in geriatric patients. Careful preoperative preparation and postoperative care is essential as LITT is not without risk. Appropriate patient selection for cranial surgery is essential as neurosurgeons treat an increasing number of elderly patients, but advanced age alone should not exclude patients from LITT.

CLINICAL AND LABORATORY PECULIARITIES OF WHOOPING COUGH IN CHILDREN OF DIFFERENT AGE GROUPS

2020 ◽  
Vol 99 (6) ◽  
pp. 98-104
Author(s):  
I.V. Babachenko ◽  
◽  
Y.V. Nesterova ◽  
N.V. Skripchenko ◽  
◽  
...  
Keyword(s):  
Whooping Cough ◽  
Severe Disease ◽  
Respiratory Rhythm ◽  
Age Groups ◽  
Low Frequency ◽  
Pertussis Infection ◽  
Group 2 ◽  
Sick Children ◽  
Hematological Changes ◽  
Group 1

Objective of the research: to present the clinical and laboratory peculiarities of modern whooping cough in hospitalized children of different ages. Materials and methods: сlinical and laboratory characteristics of whooping cough were analyzed in 88 hospitalized sick children aged 1 month to 18 years in groups of children: group 1 – children under 1 year old; group 2 – children 1–6 years old; group 3 – children 7–17 years old. DNA of causative agents of pertussis infection was isolated by PCR in nasopharyngeal swabs using a commercial kit AmpliSens®Bordetella multi-FL (Moscow). Results: children of group 1 in 90% (n=43) of cases were not vaccinated against whooping cough, severe forms were recorded in 17% (n=8) of children of the 1st year of life, and in 15% (n=7) – due to respiratory rhythm disturbances. The diagnosis was confirmed by PCR in 94% (n=45) of children, leukocytosis with lymphocytosis was detected in 81,5% (n=101). Along with hematological changes typical for whooping cough, 79% (n=38) of patients in the first year of life had thrombocytosis (>400×109/l), which was most pronounced in severe disease course 511,5 [425; 568,5]×109/l vs 421 [347; 505,5]×109/l; p<0,05, which has no tendency to decrease throughout the entire observation period and correlates with the level of leukocytes (rs=0,69; p<0,001). Patients over 7 years old in 88% (n=21) of cases were vaccinated against whooping cough, but 79% (n=27) hemograms had no characteristic changes, which, along with a low frequency of confirmation of the diagnosis by PCR 22% (n=4), made it difficult to diagnose whooping cough. Conclusion: children over 7 years of age may not have characteristic hematological changes and PCR diagnostics are insufficiently effective, which contributes to the spread of whooping cough in family foci.

Optimal Propofol Plasma Concentration during Upper Gastrointestinal Endoscopy in Young, Middle-aged, and Elderly Patients

2000 ◽  
Vol 93 (3) ◽  
pp. 662-669 ◽  
Author(s):  
Tomiei Kazama ◽  
Ken Takeuchi ◽  
Kazuyuki Ikeda ◽  
Takehiko Ikeda ◽  
Mutsuhito Kikura ◽  
...  
Keyword(s):  
Plasma Concentrations ◽  
Age Groups ◽  
Young Patients ◽  
Upper Gastrointestinal Endoscopy ◽  
Hemodynamic Responses ◽  
Verbal Command ◽  
Group 3 ◽  
Group 2 ◽  
Somatic Response ◽  
Group 1

Background Suitable propofol plasma concentrations during gastroscopy have not been determined for suppressing somatic and hemodynamic responses in different age groups. Methods Propofol sedation at target plasma concentrations from 0.5 to 4.0 microgram/ml were performed randomly in three groups of patients (23 per group) who were undergoing elective outpatient gastroscopy: ages 17-49 yr (group 1), 50-69 yr (group 2), and 70-89 yr (group 3). Plasma propofol concentration in which 50% of patients do not respond to these different stimuli were determined by logistic regression: verbal command (Cp50ls), somatic response to gastroscopy (Cp50endo), and gag response to gastroscopy (Cp50gag). Hemodynamic responses were also investigated in the different age groups. Results Cp50ls concentrations were 2.23 microgram/ml (group 1), 1.75 microgram/ml (group 2), and 1.40 microgram/ml (group 3). The Cp50endo values in groups 1 and 2 were 2.87 and 2.34 microgram/ml, respectively, which were significantly higher than their respective Cp50ls values. Cp50endo value in group 3 was 1.64 microgram/ml, which was close to its Cp50ls value. Because of a high degree of interpatient variability, Cp50gag could not be defined. Systolic blood pressure response decreased with increasing propofol concentrations. Conclusions The authors determined the propofol concentration necessary for gastroscopy and showed that increasing age reduces it. Propofol concentration that suppresses somatic response induces loss of consciousness in almost all young patients.

scholarly journals SURGICAL MODALITIES FOR SIGMOID COLON CANCER COMPLICATED BY DECOMPENSATED OBSTRUCTION

2020 ◽  
Vol 19 (3) ◽  
pp. 80-91
Author(s):  
S. N. Schaeva ◽  
E. V. Gordeeva ◽  
E. A. Kazantseva
Keyword(s):  
Colon Cancer ◽  
Lymph Nodes ◽  
Sigmoid Colon ◽  
Surgical Procedures ◽  
Postoperative Mortality ◽  
Sigmoid Colon Cancer ◽  
Second Stage ◽  
Resection Status ◽  
Group 2 ◽  
Group 1

AIM: to evaluate the early and long-term results of emergency two-stage surgical procedures in patients with sigmoid colon cancer complicated by decompensated bowel obstruction.PATIENTS AND METHODS: the cohort study included 112 patients with sigmoid colon cancer complicated by bowel obstruction that underwent emergency two-stage surgical procedures in general surgical and coloproctological units in 2011-2017. The group 1 (n=60) included patients who, at the first stage, underwent Hartmann’s procedure, at the second stage – stoma reversal. The group 2 (n=52) included patients with a loop colostomy at the first stage and radical elective surgery as a second stage. The comparative analysis between the groups was carried out according to the following criteria: the type of surgery, the type of intestinal stoma, the rate and type of postoperative complications, postoperative mortality, resection status (R0/R1), the number of removed lymph nodes, the rate of adjuvant polychemotherapy (PChT).RESULTS: postoperative mortality in the group 1 was 3.33% (n=2) and occurred after the first main stage (Hartmann’s procedure), there were no deaths in group 2 (p=0.28). The procedures in group 2 fully met the criteria of oncological radicalism based on the number of lymph nodes examined and resection status (p<0.0001 and p<0.0001, respectively). Three-year overall survival at stage IIB in group 1 was 44.4% vs 75.2% in group 2 (p<0.0001); with IIIB in the 1st group – 60.3% vs 68.2% in group 2 (p=0.034); at IIIС in the 1st group – 35.7% vs 60.7% in the 2nd group (p=0.009). The 3-year disease – free survival at stage IIB in the 1st group was 41.7% vs 68.8% in the 2nd group (p<0.0001); with IIIB in the 1st group – 53.6% vs 64.5% in group 2 (p=0.036); at IIIС in the 1st group – 33.2% vs 60.8% in the 2nd group (p=0.023).CONCLUSION: for sigmoid colon cancer complicated by decompensated obstruction, in general hospitals the stage treatment with the colostomy at the first stage is preferable.

scholarly journals THE DYNAMICS OF BLOOD PRESSURE OF DIFFERENT AGE PATIENTS GROUPS WITH HYPERTENSION AND DIABETES TYPE II AFTER CORRECTION OF CAROTID STENOSIS

2019 ◽  
Vol 72 (5) ◽  
pp. 1007-1011
Author(s):  
Igor I. Kobza ◽  
Oksana Z. Didenko ◽  
Ostap G. Yavorskyi ◽  
Тaras I. Kobza
Keyword(s):  
Blood Pressure ◽  
Carotid Stenosis ◽  
Blood Pressure Monitoring ◽  
Age Groups ◽  
Diabetes Type ◽  
Type Ii ◽  
Diabetes Type Ii ◽  
Group 2 ◽  
Two Age Groups ◽  
Group 1

Introduction: hypertension and diabetes remain the main risk factors for stroke, which leads to premature disability and mortality. The aim: To study the dynamics of blood pressure (BP) in patients of different age groups with hypertension and diabetes type II before and after carotid endarterectomy. Materials and methods: 90 patients with hypertension and diabetes type II were selected for CE. Patients are divided into two age groups: up to 65 years (group 1) and after 65 years (group 2). We assessed the dynamics of ambulatory blood pressure monitoring (ABPM). The examination was carried out 2 days before and 6 months after surgery. CE was conducted under local anaesthesia. Results: Before operation in patients in group 2, there was a significantly higher level of average systolic BP per 24 hours (p <0.02), per day (p <0.01), per night (p <0.01) and diastolic BP per night (p <0,01). At the preoperative stage, there was a significant increase in the parameters of the variability of BP, but the increase in the variability of BP with age was not fixed. After surgery, patients with Group 1 observed a more significant positive dynamics of ABPM indices than patients in Group 2. In two age groups, the percentage of patients with an insufficient reduction of BP at night was prevalent. Conclusions: Surgical treatment of carotid stenosis is associated with a steady decrease in BP in the distant period after CE. Significant regression of BP is characteristic for patients of the younger age group.

scholarly journals National Surveillance of Injury in Children and Adolescents in the Republic of Korea: 2011–2017

2020 ◽  
Vol 17 (23) ◽  
pp. 9132
Author(s):  
Soo Hyun Park ◽  
Ji Young Min ◽  
Won Cul Cha ◽  
Ik Joon Jo ◽  
Taerim Kim
Keyword(s):  
Brain Injuries ◽  
Pediatric Population ◽  
Age Groups ◽  
Prevention Strategies ◽  
Group 4 ◽  
Group 3 ◽  
The Republic ◽  
Group 2 ◽  
Prevention Potential ◽  
Group 1

Understanding age-specific injury patterns allows the continued improvement of prevention strategies. This is a retrospective study analyzing the Korea Emergency Department-Based Injury In-depth Surveillance data, including those aged ≤19 years old between January 2011 and December 2017. In this study, we focused on changes in the modes of injury and severity, and prevention potential by dividing the patients into four age groups: group 1 (0–4 years), group 2 (5–9 years), group 3 (10–14 years), and group 4 (15–19 years). The most common mode of injury in younger age groups 1 and 2 was a fall or slip. Most injuries in older age groups 3 and 4 were unintentional and intentional collisions combined. Traumatic brain injuries (2.1%), intensive care unit admissions (1.8%), and overall death (0.4%) were the highest in group 4. The proportions of severe and critical injury (EMR-ISS ≥ 25) were 7.5% in group 4, 3.2% in group 3, 2.5% in group 1, and 1% in group 2. This study presents a comprehensive trend of injuries in the pediatric population in South Korea. Our results suggest the importance of designing specific injury-prevention strategies for targeted groups, circumstances, and situations.

scholarly journals Interaction Between Age and Change in Velocity During a Baseball Training Program

2020 ◽  
Vol 8 (6) ◽  
pp. 232596712092793
Author(s):  
Christopher Antonacci ◽  
Thomas R. Atlee ◽  
Peter N. Chalmers ◽  
Christopher Hadley ◽  
Meghan E. Bishop ◽  
...  
Keyword(s):  
Training Program ◽  
Age Groups ◽  
Maximum Velocity ◽  
Age Group ◽  
Significant Difference ◽  
Group 3 ◽  
Baseball Pitchers ◽  
Group 2 ◽  
The Relationship ◽  
Group 1

Background: Pitching velocity is one of the most important metrics used to evaluate a baseball pitcher’s effectiveness. The relationship between age and pitching velocity after a lighter ball baseball training program has not been determined. Purpose/Hypothesis: The purpose of this study was to examine the relationship between age and pitching velocity after a lighter ball baseball training program. We hypothesized that pitching velocity would significantly increase in all adolescent age groups after a lighter baseball training program, without a significant difference in magnitude of increase based on age. Study Design: Cohort study; Level of evidence, 2. Methods: Baseball pitchers aged 10 to 17 years who completed a 15-week training program focused on pitching mechanics and velocity improvement were included in this study. Pitchers were split into 3 groups based on age (group 1, 10-12 years; group 2, 13-14 years; group 3, 15-17 years), and each group trained independently. Pitch velocity was assessed at 4 time points (sessions 3, 10, 17, and 25). Mean, maximum, and mean change in pitch velocity between sessions were compared by age group. Results: A total of 32 male baseball pitchers were included in the analysis. Mean/maximum velocity increased in all 3 age groups: 3.4/4.8 mph in group 1, 5.3/5.5 mph in group 2, and 5.3/5.2 mph in group 3. While mean percentage change in pitch velocity increased in all 3 age groups (group 1, 6.5%; group 2, 8.3%; group 3, 7.6%), the magnitude of change was not significantly different among age groups. Program session number had a significant effect on mean and maximum velocity, with higher mean and maximum velocity seen at later sessions in the training program ( P = .018). There was no interaction between age and program session within either mean or maximum velocity ( P = .316 and .572, respectively). Conclusion: Age had no significant effect on the magnitude of increase in maximum or mean baseball pitch velocity during a velocity and mechanics training program in adolescent males.

scholarly journals Estimation of radiographic angles and distances in coronal part of mandibular molars: A study of panoramic radiographs using EMAGO software

2014 ◽  
Vol 08 (01) ◽  
pp. 090-094 ◽  
Author(s):  
Ioannis N. Tsatsoulis ◽  
Christos G. Filippatos ◽  
Spyros G. Floratos ◽  
Evangelos G. Kontakiotis
Keyword(s):  
Age Groups ◽  
Pulp Chamber ◽  
Panoramic Radiographs ◽  
Dimensional Changes ◽  
Mandibular Molars ◽  
Group 5 ◽  
Group 2 ◽  
Dentin Formation ◽  
Chamber Floor ◽  
Group 1

ABSTRACT Objective: This study was designed to investigate radiographically the effects of age and external irritating stimuli on the morphology and thickness of the pulp chamber ceiling and floor in mandibular molars. Materials and Methods: A total of 234 panoramic radiographs were recruited and 494 mandibular molars were examined in this study. The sample was divided into six age groups: Group 1, <20 years; Group 2, 20-29 years; Group 3, 30-39 years; Group 4, 40-49 years; Group 5, 50-59 years and Group 6, >60 years. Each group was subdivided into two subgroups with regard to the tooth condition (intact or non-intact teeth). Four distances, two angles and two ratios were measured, in order to estimate the dimensions of the pulp chamber and the thickness of the pulp chamber ceiling and floor. Results: The thickness of the pulp chamber ceiling and floor increased significantly from Group 1 to 6. The pulp chamber floor angle presented progressive sharpness from Group 1 to 6 whereas the pulp chamber ceiling angle presented progressive bluntness from Group 1 to 5 and sharpness from Group 5 to 6. Significant differences were identified in the thickness of the pulp chamber ceiling, the thickness of the pulp chamber floor and the ceiling-floor distance between intact and non-intact teeth. Conclusion: Based on those results, there are differences in the location of secondary dentin formation between the two pulp chamber walls. Age is related to diminished pulp chamber size. The increase rate of the pulp chamber ceiling thickness is similar to that of the pulp chamber floor thickness. Furthermore, external irritating stimuli have an effect on the pulp chamber dimensional changes.

Iliac Fascia Compartment Block and Analgesic Consumption in Patients Operated on for Hip Fracture

2017 ◽  
Vol 19 (5) ◽  
pp. 0-0 ◽  
Author(s):  
Mateusz Klukowski ◽  
Rafał Kowalczyk ◽  
Grzegorz Górniewski ◽  
Paweł Łęgosz ◽  
Marek Janiak ◽  
...  
Keyword(s):  
Proximal Femur ◽  
Medical Records ◽  
Ultrasound Guidance ◽  
Postoperative Mortality ◽  
Early Mobilization ◽  
Femur Fractures ◽  
Study Results ◽  
Group 2 ◽  
Fascia Iliaca Compartment Block ◽  
Group 1

Background. Fractures of the proximal femur in elderly patients are a challenge for orthopedics, anesthe­sio­logy and geriatrics. Early mobilization reduces postoperative mortality among these patients. Effective anal­gesia is necessary to achieve this goal. Material and methods. A retrospective analysis of perioperative medical records of 78. patients undergoing surgical treatment of proximal femur fractures was performed. Group 1 (n=35)consisted of patients who were treated with pharmacologic analgesia only (systemic analgesics) and Group 2 (n=43) involved patients who re­ceived a preoperative fascia iliaca compartment block (FICB) and pharmacologic analgesia. FICB was per­formed under ultrasound guidance, and systemic analgesics were administered according to a standardized pro­to­col. Demographics, anesthesia and operation data as well as the dosage of analgesics used on postoperative day 0 were collected for the study. Results. Patients with antecedent iliac fascia blockade required fewer analgesic interventions (3 vs. 11, p <0.0001) and showed significantly less need for analgesics than non-block patients. No complications were observed after performing FICB. Conclusion. The iliac fascia compartment block produces effective postoperative analgesia and reduces postoperative opioid consumption.

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