ERCP和PTC介入治疗肝移植术后胆道并发症的作用比较

目的比较ERCP和PTC介入治疗肝移植术后胆道并发症的作用和疗效。方法回顾性分析2004年8月至2006年8月44例接受介入治疗的肝移植术后胆道并发症患者临床资料，比较ERCP和PTC介入治疗在肝移植术后胆道并发症中的疗效和并发症。结果首选ERCP介入治疗31例，3例操作失败（9．6％）；PTC介入治疗16例，均操作成功。胆道吻合口狭窄和非胆道吻合口狭窄ERCP和PTC介入治疗的治愈率分别为73．3％、77．7％和23．1％、14．3％，差异无统计学意义（P〉0．05）。两种介入治疗术后并发症的发生率差异无统计学意义（P〉0．05）。结论ERCP和PTC介入治疗肝移植术后胆道并发症的疗效和并发症的发生率相当，可以将PTC介入技术作为治疗肝移植术后胆道并发症的首选措施。     

多学科协作诊治模式下老年结直肠癌患者应用新辅助化疗联合手术治疗的临床效果

目的探讨在多学科协作（multi—disciplinary team，MDT）诊治模式下，新辅助化疗联合手术的综合治疗策略在老年人群中应用的安全性和临床差异性。方法回顾性研究2007年6月～12月期间就诊于四川大学华西医院肛肠外科专业组的结直肠癌患者的资料，分析比较老年组（≥60岁）和非老年组（〈60岁）之间应用综合治疗策略的临床疗效差异。结果在术前指标中，老年组患者合并心血管系统、内分泌系统以及其他系统疾病的构成比均明显高于非老年组（P〈0．05），其中老年组术前患有高血压和糖尿病患者的构成比均明显高于非老年组（P〈0．05），其余术前指标差异无统计学意义（P〉0．05）。各项术中指标的差异在2组间均无统计学意义（P〉0．05）。而在术后指标中，老年组术后并发症发生率高于非老年组（P〈0．05），老年组患者术后拔除胃管、尿管和引流管的时间和非老年组之间的差异无统计学意义（P〉0．05）；同时老年组患者术后进食时间、经肛门排气／排便时间以及下床活动时间与非老年组比较，差异也无统计学意义（P〉0．05）。在化疗相关并发症方面，2组间差异也无统计学意义（P〉0．05）。结论尽管老年患者可能术前基础情况更差、治疗难度更大，但新辅助化疗联合手术的综合治疗策略并不会导致老年组患者手术治疗的延误，而且手术干预过程中的术式选择也并不会受到影响，术后近期治疗效果满意。因此在老年群体中应用该策略是具有一定临床效果和安全性的。     

老年肾移植的临床特点(附75例报告)

目的：探讨老年患者肾移植的临床特点。方法：回顾性分析了75例老年患者肾移植的临床资料，以同期行肾移植的160例非老年成人患者为对照组。结果：老年组围手术期的并发症发生率（50．7％）和死亡率（4．0％）均显著高于对照组（20.0％和0，P〈0．01）。老年组急性排斥反应发生率为4．0％，显著低于对照组（12．5％，P〈0．05）。老年组1年人存活率为90.6％，显著低于对照组（98．1％，P〈0．05）；1年肾存活率为90．6％，低于对照组（96．3％）但无统计学差异（P〉0．05）。结论：老年患者行肾移植术可以取得良好效果，但围手术期的并发症发生率较高。老年受者术后急性排斥反应发生率低，应使用低剂量的免疫抑制剂。     

完全腹腔镜根治性右半结肠切除术在老年结肠癌患者应用中的前瞻性研究

[摘要] 目的 探讨老年结肠癌患者行完全腹腔镜根治性右半结肠切除术的安全性、可行性。方法 前瞻性选择2017年2月-2018年11月我院收治的80例老年右半结肠癌患者,按照随机数字表法分成两组,实验组患者采用完全腹腔镜根治性右半结肠切除术,对照组患者采用腹腔镜辅助根治性右半结肠切除术。比较两组患者的基线情况、术前ASA分级、术前肿瘤分期(TNM)、手术指标、术后指标、术后并发症等。结果 两组患者间年龄、性别、体质指数、术前合并症、ASA分级、TNM分期,差异均无统计学意义(P>0.05)。两组患者间手术时间、术中出血量、术后淋巴结数、标本长度、住院时间,差异均无统计学意义(P>0.05)。实验组、对照组术后切口长度分别为(4.2±0.8 vs 5.9±0.7cm),差异有明显统计学意义(P<0.00)。实验组术后肠功能恢复时间、首次流质饮食时间均早于对照组（2.5±1.4 vs 3.2±1.3d）、（2.6±1.4 vs 3.2±1.4d）,差异均有统计学意义(P<0.05)。实验组、对照组术后并发症的发生率分别为(12.5% vs 15.0%),差异无统计学意义(P>0.05)。结论 老年结肠癌患者行完全腹腔镜根治性右半结肠切除术是安全、可行的,并可获得更好的术后恢复。     

152例老年肾脏病肾活检术的临床意义

目的探讨实时超声引导下自动活检枪经皮肾穿刺活检术在老年肾脏病中的临床意义及风险评估。方法回顾性分析152例老年肾脏病患者行肾自动活检术的成功率及并发症,并与同期2219例非老年组肾脏病患者进行比较。结果152例老年肾脏病患者肾活检均取得肾组织,其中取材不良6例（3．95％）,取材合格27例（17．76％）,取材良好119例（78．29％）,与非老年患者比较,无统计学差异（P〉0．05）;152例老年患者中21例出现轻度并发症（13．82％）,其中肉眼血尿7例,肾周血肿14例,无出现严重并发症,并发症发生率与非老年组无统计学差异（P〉0．05）;老年组通过。肾活检后修改诊断36例,诊断修正率为23．68％;根据病理结果修正治疗方案47例,治疗修正率为30．92％。结论超声引导自动肾活检术在老年肾脏病患者中应用成功率高且安全;肾活检病理诊断对老年肾脏疾病的诊治有重要价值,值得进一步推广应用。     

经皮经肝穿刺胆囊引流术对不同ASA分级急性胆囊炎患者行腹腔镜胆囊切除术的影响

目的探讨经皮经肝穿刺胆囊引流术（PTGBD）对不同美国麻醉师协会（ASA）分级的急性胆囊炎患者行腹腔镜胆囊切除术的影响。方法回顾性分析2010年3月—2014年12月在咸阳市中心医院住院治疗的324例接受腹腔镜胆囊切除术的急性胆囊炎患者的临床资料,根据腹腔镜胆囊切除术前有无PTGBD治疗史,将研究对象分为2组,其中单纯行腹腔镜胆囊切除术的184例患者为对照组,PTGBD＋择期腹腔镜胆囊切除术的140例患者为实验组,观察两组的中转开腹率、总住院天数、胆囊切除术后平均住院天数、术后并发症发生率和术后腹腔引流情况等。并比较不同ASA分级下两组患者临床资料的差异。计量资料以均数±标准差（面±s）表示,组间比较使用t检验。计数资料采用频数（百分比）表示,组间比较使用,检验。结果实验组术中中转开腹率为23．6％（33／140）,对照组为20．7％（38／184）;实验组术后平均住院天数为（7．3±3．3）d,对照组为（6．8±2．3）d。实验组术后并发症发生率为2．8％（4／140）,对照组为0．5％（1／184）;实验组腹腔引流率为80．0％（112／140）,对照组为73．9％（136／184）;两组患者的术中中转开腹率、术后平均住院天数、术后并发症发生率和腹腔引流率相比差异均无统计学意义（P〉0．05）。实验组患者总住院天数为（17．6±4．4）d、对照组患者为（10．6±3．0）d,两组相比差异具有统计学意义（P〈0．001）;根据ASA分级进行亚组分析,ASA-Ⅰ级的两组患者在体温、C反应蛋白及总住院天数方面,实验组患者显著高于对照组患者,差异有统计学意义（P〈0．05）。ASA—Ⅱ级的两组患者在年龄、白细胞计数,C反应蛋白及总住院天数方面,实验组患者明显高于对照组患者,差异有统计学意义（P〈0．05）。对于ASA-Ⅲ级患者,实验组中转开腹率为28．3％（13／46）,对照组为32．1％（9／28）;实验组术后平均住院天数为（10．8±3．7）d,对照组为（11．2±4．8）d;实验组总住院天数为（19．7±7．2）d,对照组为（16．8±8．6）d,两组ASA-Ⅲ级患者相比差异均无统计学意义（P〉0．05）。结论PTGBD对不同ASA分级的急性胆囊炎患者行腹腔镜胆囊切除术的影响不同。PTGBD后择期行腹腔镜胆囊切除术是一种安全、有效的把急诊胆囊手术变成择期胆囊手术的方法,值得广泛运用。     

PTCD在老年恶性梗阻性黄疸ERCP操作失败患者中的疗效观察

[摘 要] 目的 探讨老年恶性梗阻性黄疸（MOJ）患者ERCP操作失败后行PTCD补救治疗的临床疗效。方法 选取53例ERCP操作失败后行PTCD治疗的老年MOJ患者作为研究组,并选取同期46例首选PTCD治疗的老年MOJ患者作为对照组,回顾性分析两组治疗前后临床症状和肝功能变化情况,手术成功率,术后并发症发生率及病死率等。结果 研究组ERCP操作失败的主要原因为肿瘤致胆管严重狭窄,导丝无法通过,占67.9%;失败后行PTCD补救治疗,手术成功率为94.3%,与对照组比较无统计学差异（ χ 2 =0.135,P=0.714）;并发症发生率为30.0%,虽略高于对照组（24.4%）,但差异并无统计学意义（ χ 2 =0.368,P=0.544）。由于肿瘤侵犯较重,研究组胆道支架置入成功率明显低于对照组（35.8% vs 69.6%, χ 2 =11.208,P=0.001）,但术后2周,研究组临床症状及肝功能各项指标均较术前明显改善（P＜0.01）。两组减黄效果相当,均无死亡病例。结论 老年MOJ患者 ERCP操作失败后行PTCD补救治疗,其手术成功率、并发症发生率及病死率均与首选PTCD治疗无差异,临床疗效显著,值得临床参考。     

不同年龄段直肠癌患者临床病理学特征的研究

目的探讨直肠癌患者年龄与临床病理学特征的关系。方法对161例直肠癌患者的临床资料进行了回顾性分析。其中小于40岁者21例（青年组）,40-60岁者62例（中年组）,大于60岁者78例（老年组）。结果不同年龄组患者入院时的主要临床表现和肿瘤发生部位的差异无统计学意义（P〉0．05）。误诊率以青年组最高．为38．1％（8／21）,显著高于中年组（9．7％,6／62）和老年组（2．6％,2／78）,差异有统计学意义（P〈0．01）。年龄与直肠癌分化程度及TNM分期均呈负相关．随着年龄的增加．低分化和Ⅳ期直肠癌所占比例呈明显下降趋势。结论老年和青年直肠癌患者某些临床病理学特征存在明显差异．青年直肠癌患者肿瘤分化程度较老年患者为低．肿瘤分期较晚。     

青年与老年直肠癌临床对比分析

目的探讨青年与老年直肠癌的临床、病理及预后差异。方法中国医学科学院肿瘤医院自1990年1月至2000年1月收治40岁以下直肠癌患者138例（青年组），65岁以上者163例（老年组），对这组患者的病例资料进行生存分析和预后的多因素分析。结果青年组Ⅲ期直肠癌患者比例（53．6％，74／138）明显高于老年组（34.3％，55／163）；P=0．001；青年组中黏液腺癌和低分化腺癌患者比例（28．2％，39／138）也高于老年组（10．4％，17／163）P〈0．001。青年组和老年组5年生存率分别为50．4％和64．1％．两组比较差异有统计学意义（P〈0．05）；而按照TNM分期进一步分析显示．同期别两组的生存率差异均无统计学意义（P〉0．05）。多因素分析结果显示，肿瘤T分期（P=-0．001）和淋巴结转移（P〈0．05）是影响两组患者预后的独立因素。结论与老年直肠癌相比，青年直肠癌患者的病期较晚、肿瘤分化程度较低，影响其预后；但相同病期者生存率相似。早期诊疗是提高直肠癌总体生存率的关键。     

ERCP联合LC治疗老年胆囊结石合并胆总管结石86例

[摘 要] 目的 探讨内镜下十二指肠乳头括约肌切开术/内镜下乳头球状气囊扩张术（EST/EPBD）联合腹腔镜胆囊切除术（LC）治疗老年（>60岁）胆囊结石合并胆总管结石的临床疗效。方法 回顾性分析上海市同仁医院2012年1月至2017年4月间普外科收治的ERCP（EST/EPBD）取石后择期行LC手术的86例老年胆囊结石合并胆总管结石患者（EST/EPBD+LC组）与同期42例LC+LCBDE患者（LC+LCBDE组）的临床资料。结果 EST/EPBD+LC组84例成功施行EST/EPBD取石,其中82例成功施行LC,成功率95.3%（82/84）;LC+LCBDE组39 例完成手术,成功率92.9%（39/42）,两组差异无统计学意义（P > 0.05）。EST/EPBD+LC 组与LC+LCBDE组总并发症发生率差异无统计学意义[13（15.1%） vs 9（21.4%）,P > 0.05],但是胆瘘[0 vs5（11.9%）],手术时间[（81.78±25.6）min vs（ 131.25±35.6）min],住院时间[（7.98±2.73）d vs（ 11.02±3.13）d],EST/EPBD+LC组优于LC+LCBDE组,差异有统计学意义（P < 0.05）。术后胰腺炎[9（10.5%） vs1（2.4%）,住院费用（[ 5.19±0.85）万元 vs（ 3.58±0.62）万元]方面,LC+LCBDE组优于EST/EPBD+LC组（P <0.05）。结论 ERCP（EST/EPBD）取石后联合LC治疗老年胆囊结石合并胆总管结石安全可行,具有胆瘘发生率低、手术时间短、住院时间短等优点,但住院费用较高,且术后胰腺炎发生率较高。     

Surgical treatment of advanced colorectal cancer in the elderly

The aim of the study was to compare the short and long-term outcomes of older and younger colorectal cancer patients with advanced disease resected with a curative intent. Six hundred and ninety-two patients were analysed. Four hundred and seventy-nine patients were younger than 70 years (Group 1), and 213 were 70 years of age or above (Group 2). The overall perioperative mortality rate in the younger group was 0.8% (n = 7), as against 1.4% (n = 3) in the elderly group (p = NS). The morbidity rates were 35% and 42%, respectively (p = NS). At univariate analysis, the elderly patients had a worse overall survival compared to the younger group, when only patients undergoing postoperative chemo-radiotherapy were considered (54% vs 67% overall survival at 5 years; p = 0.03). Using logistic regression analysis, tumour stage (p < 0.0001) and radicality of surgery (p < 0.0001) correlated significantly with overall survival rates in the elderly. Colorectal surgery for malignancy can be performed safely in the elderly with acceptable morbidity and mortality rates and long-term survival.     

Laparoscopic fundoplication in elderly patients with gastroesophageal reflux disease

HYPOTHESIS: It is unclear if age should be considered a factor in the choice of treatment for gastroesophageal reflux disease (GERD) and if fundoplication in elderly patients is as safe and effective as it is in younger patients. We hypothesized that the outcome of laparoscopic antireflux operations in patients younger than 65 years is similar to that of patients 65 years and older. DESIGN: Retrospective review of findings from a prospectively acquired database. SETTING: University-based tertiary care center. PATIENTS: Three hundred four consecutive patients underwent laparoscopic fundoplication for GERD. Two hundred forty-one patients were younger than 65 years (group A; median age, 46 years), and 63 patients were 65 years or older (group B; median age, 69 years). MAIN OUTCOME MEASURES: Presence, duration, and severity of GERD symptoms; presence of a hiatal hernia or esophageal stricture; duration of operation; incidence of complications; and length of hospital stay. RESULTS: Elderly patients more often had regurgitation and respiratory symptoms in addition to heartburn. Hiatal hernias were more common among elderly patients (77% vs 51%). The duration of the operation was similar for the 2 groups. The incidence of intraoperative and postoperative complications was low and similar in the 2 groups. The median hospital stay was 24 hours for each group. Heartburn resolved in approximately 90% of patients in each group. CONCLUSIONS: Elderly patients more often had hiatal hernias and respiratory symptoms. Laparoscopic antireflux surgery was as safe in elderly patients as it was in younger patients, and clinical outcomes were as good.     

超高龄胆胰壶腹周围疾病行治疗性内镜逆行胰胆管造影的临床特征分析

目的探讨超高龄胆胰壶腹周围病变行内镜逆行胰胆管造影（ERCP）治疗的可行性及患者的临床特征。 方法回顾性分析2014年5月至2018年5月川北医学院附属医院收治的307例行ERCP治疗的患者临床资料。根据患者年龄分为超高龄组（≥80岁）和非超高龄组（<80岁），探讨两组患者的临床特征。 结果92例超高龄组患者年龄（85.29±7.32）岁，215例非超高龄组患者年龄（57.81±14.26）岁。超高龄组患者原发病以壶腹部癌为主（P<0.01），ASA Ⅲ、Ⅳ级患者以及合并高血压、冠心病、糖尿病、慢性阻塞性肺疾病、十二指肠乳头旁憩室的比例明显高于非超高龄组（P<0.05）。超高龄组支架植入指征为胆管恶性狭窄以及采取支架植入或更换的患者比例明显更高（P=0.023、<0.001），而胆总管结石内镜取石比例更低（P=0.005），术后出血的发生率明显升高（P=0.021）。单因素分析显示原发疾病为壶腹部癌（P=0.044），合并十二指肠乳头旁憩室（P<0.001）、高血压（P=0.022）及冠心病（P=0.012），内镜下乳头括约肌切开术进行十二指肠乳头处理（P=0.012）为ERCP术后出血的危险因素。 结论超高龄胆胰壶腹周围病变患者恶性疾病患病率高、合并疾病多，但并非治疗性ERCP术的绝对禁忌证，临床需防范术后出血的风险。     

Esophagectomy for carcinoma: impact of age on clinical results and survival

Advances in perioperative management have allowed more and more elderly patients to undergo major surgery with postoperative morbidity and mortality rates similar to those of younger individuals. The aim of this study was to evaluate the impact of age on the clinical outcome and long-term survival of patients with oesophageal cancer undergoing oesophagectomy. Eight hundred and seventy-five patients with oesophageal carcinoma were divided into two groups: A (n = 393) aged > or = 65 years, and B (n = 482) aged < 65 years. One hundred and forty-nine (38%) patients in group A underwent surgery compared to 263 (55%) in group B (P < 0.01). Postoperative mortality and the prevalence of anastomotic leak and respiratory complications were similar in both groups. There was, however, a higher prevalence of cardiovascular complications in group A (13% versus 3%, P < 0.01). Five-year survival was about 35% in both groups. In conclusion, advanced age should not be considered a contra-indication to oesophagectomy for carcinoma, since the long-term survival of elderly patients undergoing resection is similar to that of younger ones.     

Outcomes of ostomy procedures in patients aged 70 years and older

HYPOTHESIS: Patients aged 70 years and older undergo proportionately more emergency and permanent fecal ostomy procedures than younger patients. Older patients have comparable short-term outcomes in morbidity and mortality, with adverse outcomes dependent on comorbid conditions and timing of the procedure rather than age alone. Older patients should be treated similarly to younger patients in terms of subsequent ostomy takedown, if an acceptable operative risk. DESIGN: A retrospective review of our facility's experience with fecal ostomies between 1992 and 2002 was performed to determine the effect of advanced age on surgical outcome measures. SETTING: A tertiary managed care medical center. PATIENTS: Three hundred eighty-three consecutive patients who underwent new fecal ostomy procedures between October 1, 1992, and October 1, 2002. One hundred three patients were aged 70 years or older (mean age, 76.4 years), and 280 patients were younger than 70 years (mean age, 49.6 years). There were 220 elective procedures and 163 emergency procedures. Outcome was analyzed between the 2 age groups. MAIN OUTCOME MEASURES: Indications for ostomy, type of ostomy, preoperative comorbidity, postoperative morbidity and mortality, length of intensive care unit and hospital stay, and subsequent ostomy takedown success. RESULTS: Three hundred eighty-three new fecal ostomies were created. The diagnosis leading to creation of the ostomy was more often malignancy in older patients (74.8%) compared with younger patients (45.0%). Both age groups underwent a similar proportion of emergency procedures (older vs younger patients, 43.7% vs 42.1%; P=.07), but more older patients were left with permanent stomas (59.2% vs 41.1%, P=.002). Older patients also had more preoperative comorbidities (P=.001), higher American Society of Anesthesiologists scores (P=.001), longer hospital stays (P=.04), and more postoperative complications. Thirty-day mortality was 6.8% in the older group vs 0.4% in the younger group (P=.001). Fewer older patients were eligible for ostomy reversal (41.1% vs 59.2%), and a smaller proportion of eligible older patients actually underwent the reversal procedure (78.7% vs 95.2%). The complication rate associated with ostomy reversal was not significantly different in the 2 age groups (P=.002). CONCLUSIONS: Patients aged 70 and older undergo proportionately more permanent fecal ostomy procedures than younger patients, with longer hospital stays, more postoperative complications, and higher mortality rates. However, surgical outcome measures in older patients following ostomy procedures remain within acceptable standards. Furthermore, older patients tolerate ostomy reversal with minimal morbidity and should not be denied consideration based on age alone if an eligible candidate.     

Trauma in nonagenarians and centenarians: review of 137 consecutive patients

The purpose of this study was to examine the hospital course and outcomes of elderly trauma patients. We accomplished a retrospective review of all consecutive trauma patients admitted to a level II trauma center from January 2000 to April 2002. Gender, Injury Severity Score (ISS), length of stay (LOS), operative procedure, morbidity, and mortality of patients > or = 90 years of age were compared with younger patients. Of 2645 trauma admissions, 137 patients (5%) were > or = 90 years (range, 90 to 108 years; mean, 93.1 years); 5 patients were > or = 100 years. One hundred eleven (81%) patients were female; 26 (19%) male. Average ISS for patients > or = 90 was 8.75 and was 7.78 for younger patients. One hundred sixteen elderly patients (85%) had ISS < 15. Falls were the most common mechanism of injury (93%), usually ground-level falls (64%). Two hundred ninety-two injuries included 133 fractures and 102 soft tissue injuries. Thirty-four elderly patients (25%) and 733 younger patients (29%) required surgery. Complications developed in 8 per cent of older and 6 per cent of younger patients. Hospital LOS averaged 4.36 days for older and 3.51 days for younger patients. Six older (4.4%) and 63 younger (2.5%) patients died. ISS scores and LOS were slightly higher in elderly patients, but morbidity and mortality were comparable in both groups.     

Management of chronic pancreatitis in the pediatric patient: endoscopic retrograde cholangiopancreatography vs operative therapy

Purpose

The management of chronic pancreatitis (CP) in children is challenging. We compare endoscopic retrograde cholangiopancreatography (ERCP) to operative therapy (OR).

Methods

The study involved review of patients younger than 18 years with CP who underwent ERCP or OR from 1973 to 2007. Follow-up was complete in 95% of patients (median, 6 years; range, 1-23 years).

Results

We identified 37 children with CP; 25 (68%) were managed by OR with 20 of these previously failing ERCP. Twelve (32%) were managed by ERCP alone. Mean follow-up was longer in the OR group (5.1 vs 2.1 years; P = .02). Patients with idiopathic pancreatitis (58% vs 13%; P = .04) and patients with a later onset of pancreatitis (12.0 vs 7.4 years; P = .002) were more likely to be managed with ERCP alone. The patients who underwent OR had a lower rate of recurrent pancreatitis (39% vs 75%; P < .0001), although this did not correlate to fewer hospitalizations or less narcotic use compared to ERCP alone. When patients who failed ERCP and progressed to OR were included in the ERCP alone group, ERCP was worse in recurrence (90% vs 39%; P < .0001) and rate of hospitalization (55% vs 33%; P = .04) compared to OR.

Conclusion

Patients with CP managed by OR have a lower rate of recurrent pancreatitis and hospitalization compared to ERCP.     

Endoscopic retrograde cholangiopancreatography in children: A surgeon's perspective

PURPOSE: The aim of this study was to review the indications, success rate, and complications of endoscopic retrograde cholangiopancreatography (ERCP) in the pediatric age group. METHODS: From 1990 to 1999, 21 ERCP procedures were attempted in 20 patients. They consisted of 8 boys and 12 girls whose age ranged from 4 to 17 years (mean, 11.3 years). Fourteen were performed under deep sedation (mean age, 12.8 years), and 7 were done under general anesthesia (mean age, 7.6 years). All ERCP procedures were performed by experienced adult endoscopists. RESULTS: The indication for ERCP was biliary in 15 patients. Eleven had suspected choledocholithiasis by either ultrasound scan, intraoperative cholangiogram or magnetic resonance imaging (MRI). In 6 cases, the ERCP was done for pancreatic pathology. In 11 patients, the ERCP was diagnostic only, and in 10 a therapeutic procedure was done. The overall success rate was 90.5%. Post-ERCP complications consisted of 6 episodes of pancreatitis (28.5%), 4 of which followed a therapeutic procedure, and 1 episode of bleeding. Pancreatitis resolved 2 to 6 days post-ERCP. The patients underwent follow-up between 2 and 56 months after the ERCP (mean, 11 months). CONCLUSIONS: The authors conclude that even in experienced hands, ERCP in the pediatric population has a much higher complication rate than in adults (33.3%). We recommend that very specific indications be met before subjecting a pediatric patient to an endoscopic retrograde cholangiopancreatography.     

Effect of age in the Bypass Angioplasty Revascularization Investigation (BARI) randomized trial

BACKGROUND: The influence of age on the relative success of either percutaneous transluminal coronary angioplasty (PTCA) or coronary artery bypass grafting (CABG) in patients requiring myocardial revascularization continues to be controversial. METHODS: In the Bypass Angioplasty Revascularization Investigation (BARI) trial, 1,829 patients with symptomatic multivessel coronary artery disease requiring revascularization were randomly assigned to undergo either CABG or PTCA. RESULTS: Seven hundred nine patients (39%) were 65 to 80 years old at baseline; the other 1,120 were younger than 65 years. The in-hospital 30-day mortality rate for PTCA and CABG in the younger patients was 0.7% and 1.1%, respectively, and that for patients 65 years or older was 1.7% and 1.7%, respectively. In older compared with younger patients, stroke was more common after CABG (1.7% versus 0.2%, p = 0.015) and heart failure or pulmonary edema was more common after PTCA (4.0 versus 1.3%, p = 0.011). In both age groups, CABG resulted in greater relief of angina and fewer repeat procedures. The 5-year survival rate in patients younger than 65 years was 91.5% for CABG and 89.5% for PTCA. In patients 65 years or older, the 5-year survival rate was 85.7% for CABG and 81.4% for PTCA. Cardiac mortality at 5 years was greater in patients assigned to the PTCA group than in those assigned to the CABG group. However, no significant treatment differences were noted in cardiac mortality when only nondiabetic patients were examined. CONCLUSIONS: Within the context of the Bypass Angioplasty Revascularization Investigation trial, older patients with multivessel coronary disease do well with either PTCA or CABG. Compared with younger patients, older patients had less recurrent angina and were less likely to undergo repeat procedures, particularly among those assigned to undergo CABG. Cardiac mortality was greater in patients 65 years or older assigned to undergo PTCA; however, this difference was not noted when treated diabetic patients were excluded from analysis.     

Surgical treatment for elderly breast cancer patients over the age of 70

Because elderly breast cancer patients differ in various biological characteristics from younger patients, it is important to clarify the clinical characteristics and treatment results of elderly patients with this disease. A total of 332 breast cancer cases (327 patients) who received surgery were divided into three groups, consisting of a premenopause group younger than 50 years of age (group A, N = 144), a postmenopause group younger than 70 years of age (group B, N = 140), and elderly cases 70 years of age or older (group C, N = 48). A positive node involvement was seen in about 40% of all cases, but the lymph node positivity of group C was significantly lower than that of group A or B. The postoperative 5-year survival rates of groups A, B, and C were 88.9%, 87.5%, and 89.4% at all stages, and 90.2%, 86.2%, and 91.4% at stages I and II, respectively. Only in group C did survival rates show no significant difference between node status. We conclude that both radical and cosmetic surgical treatments performed in elderly breast cancer patients aged 70 years or older are as effective as in younger breast cancer patients.