Primary glomerular diseases in the elderly Glomerulonephritis in the elderly

Recent studies have pointed out that the incidence of primary glomerular diseases is similar in the elderly and in younger populations. However the clinical characteristics of the different subtypes may be different in the advanced age. Minimal change nephropathy responds favorably to corticosteroids and/or cyclophosphamide, but many untreated or non-responder patients progress to end-stage renal disease or die from nephrotic complications. Focal and segmental glomerulosclerosis also has a severe prognosis in older patients but some 50% of patients may attain remission of the nephrotic syndrome with a prolonged corticosteroid treatment. The responders tend to maintain normal renal function over time. Membranoproliferative glomerulonephritis and IgA nephritis have a severe prognosis and do not respond to treatment. The clinical presentation and the outcome of membranous nephropathy are similar in the elderly and in younger adults. Corticosteroids are of little benefit while a 6-month treatment with chlorambucil and methylprednisolone may obtain remission of the nephrotic syndrome in about 2/3 of older patients. Crescentic glomerulonephritis has an ominous prognosis in older patients but some patients may improve if treatment with methylprednisolone pulses is started early. Acute postinfectious glomerulonephritis is often associated with renal failure in older patients. The prognosis may be severe.     

Infection control in the Netherlands

A survey was made by the Dutch association of infection control practitioners (VHIG) concerning the organization of infection control in Dutch hospitals and the activities of its members. The results are reported and compared with recent American studies. A comparison is made between a group of infection control technicians (ICTs) who were not nurses and a group of nurses (ICNs), working in infection control. Although the ICT has significantly more daily contacts with the hospital microbiologist and is more often secretary to the infection control committee and the ICN visits the outpatient department significantly more often, the other activities in their practice are essentially the same. From this study we conclude that either an ICT or an ICN can adequately function as an infection control practitioner in the Netherlands.     

Infection in the myelodysplastic syndromes

PURPOSE: To determine the incidence, characteristics, and outcome of infection in patients with myelodysplastic syndromes (MDS) and risk factors that may lead to infection. PATIENTS AND METHODS: We reviewed infections that occurred in 86 consecutive patients with MDS who received care from 1968 to 1986 at a university-affiliated Veterans Affairs Medical Center. Time lines charting the course of each patient with MDS were created and included infections, MDS subgroup at the time of presentation and at the time of each infection, peripheral neutrophil counts, and therapies for MDS. RESULTS: Infections occurred at a rate of nearly one per patient year of observation. Infection rates were associated with MDS subgroup as follows: refractory anemia with or without ringed sideroblasts (RA +/- RS) less than refractory anemia with excess blasts (RAEB) less than RAEB in transformation (RAEB-T). The group of RA +/- RS patients who had erythroid abnormalities but minimal or no dyspoiesis of other cell lines had the lowest rate of infections. Infection rates were higher in patients with less than or equal to 1,000 neutrophils/microL blood than in patients with greater than 1,000 neutrophils/microL blood for each classifiable MDS subgroup. Neutrophil concentration and MDS subgroup were independent risk factors for infection in patients with MDS. Bacterial pneumonias and skin abscesses were the most common infections. Infection was the most common cause of death during MDS, accounting for 64% of deaths, and was more common than transformation to acute leukemia as a cause of death. CONCLUSION: Infection is a common, life-threatening problem in patients with MDS. Neutropenia and MDS subgroup are each risk factors for infection. Clinicians should aggressively evaluate patients with fever and MDS for infection, especially pneumonia and skin infections.     

Microcirculation in the elderly

Studies on microcirculation in the elderly include observations in the small vessels of the bulbar conjunctiva and of the nailbed with respect to a classification of the findings according to a number of semeiologic criteria (diameter and shape alterations, terminal capillary network, intravascular red cell aggregation). In vascular diseases of the elderly there are typical alterations of the capillaroscopic findings in the bulbar conjunctiva and in the nailbed, particularly in cases of arteriosclerosis, arterial hypertension, diabetic microangiopathy, heart failure, ischemic myocardiopathies. During the treatment with some vasoactive drugs (nicotinic acid and its derivatives, buflomedil, CPD-choline) there are marked modifications of the small conjunctival vessels, with evident dilatations, appearance of collaterals, increased homogeneity of the blood flow, better evidence of the capillary network and reduction of intravascular red cell aggregation.     

Cancer in the elderly

A considerable knowledge has been collected in the last 20 years through retrospective and prospective trials on the medical management of cancer in older patients. Today a better approach to prevention and treatment of chemotherapy-related complications in older patients is provided by specific guide-lines.In this review, a synthetic information on the medical treatment specifically required by patients with age associated conditions for the most common tumor types (breast, non-small-cell lung prostate, colrectal cancer, and aggressive non-Hodgkin's lymphoma) is presented.     

Diabetes in the elderly

The association of diabetes and cardiovascular disease is a major health concern in the elderly population. Patients 65 years of age or older with diabetes have a greater risk of ischemic heart disease and cardiovascular mortality than nondiabetic patients of the same age. In addition, although there has been an overall reduction in cardiovascular disease morbidity and mortality in the United States over the past 50 years, the burden of cardiovascular disease attributable to diabetes mellitus has actually increased over this time. In addition to traditional risk factors (eg, hypertension, dyslipidemia), the effect of nonclassical cardiovascular risk factors, such as exogenous and endogenous insulin, metabolic syndrome, impaired fasting glucose, chronic kidney disease, advanced glycation end products, and adipokines, in elder patients with diabetes is currently being evaluated. This article addresses current evidence related to cardiovascular risk in elderly patients with diabetes.     

Brachytherapy in the elderly

A rapidly and constantly increasing aged population in the western countries poses a wide range of specific problems to oncologists. A different way to face medical issues should be sought for older patients with cancer, looking at the characteristics that are peculiar to the elderly from different points of view. Brachytherapy is an effective form of radiotherapy which, for its specific characteristics, may be a valid alternative to more complex modalities of treatment, thus allowing a better sparing of normal tissues and structures yet achieving a similar tumor control rate. This paper reviews the literature on the subject of cancer treatment in the elderly, focusing on radiotherapy and brachytherapy, to evaluate the current attitude toward this problem in the medical community and to see if it is possible to identify a patient population that will benefit from this technique.     

老年人癫癎

既往对老年人癫的特殊性和重要性认识不足,常把这一特殊群体放在总的成年人群中进行研究。然而流行病学研究已显示老年人癫的发病率和患病率均明显高于65岁以下的成年人群,并且随年龄的增长发病率在不断增加。随着社会进步,人的寿命也在延长,老年人的比例在增加,因此老年人患病     

Pharmacokinetics in the elderly

The rapidly increasing proportion of persons over 65 years old is well known and is associated with a challenge for health care professionnels vis à vis the use of modern drug therapy, and a higher risk of adverse drug reactions. These reactions are often related to inappropriate therapy based on an incomplete knowledge of changes in drug handling in the elderly. Multiple disease, concomitant therapy, environmental conditions, social behaviour, compliance, changes in physiology with advancing age can all alter pharmacokinetics and pharmacodynamics of drugs. Age can modify drug absorption, metabolism, distribution and elimination. The changes associated with aging in drug interaction and the role of underlying clinical status are discussed. The pharmacokinetics of some drugs in the elderly are described. Careful attention to concomitant drug therapy for multiple disease is needed before prescribing for elderly patients.