老年急性非静脉曲张性上消化道出血临床特点分析

目的总结分析急性非静脉曲张性上消化道出血≥75岁老年患者的临床特点,以便进一步了解该类患者的特殊性,为更好的临床诊治提供参考。方法回顾性分析165例于2006～2007年收住消化内科的非静脉曲张性上消化道出血患者的临床病历资料,其中老年组（≥75岁）96例,非老年组（〈60岁）59例,详细记录其临床表现、实验室检查、内镜下表现及伴随的其他系统疾病,并进行对比和分类分析。结果老年组与非老年组急性非静脉曲张性上消化道出血的首要原因均为溃疡病,老年组胃溃疡发病率（20.8%）高于非老年组（8.5%）（P〈0.05）,而非老年组十二指肠球部溃疡（57.6%）及复合性溃疡（15.3%）发病率高于老年组（39.6%及5.2%）（P〈0.05）,老年组急性糜烂出血性胃炎发病率（13.5%）明显高于非老年组（3.4%）（P〈0.05）,老年组有上腹痛和（或）上腹部压痛者（49%）低于非老年组（66.1%）（P〈0.05）。与非老年组比较,老年组伴随的其他系统疾病明显增高（P〈0.01）;应用阿司匹林/非甾体类抗炎药（NSAIDs）明显增多（P〈0.01）;血尿素氮数值明显增高（P〈0.01）;住院时间明显延长（P〈0.05）。2组幽门螺杆菌感染情况比较无显著性差异（P〉0.05）。结论≥75岁老年患者非静脉曲张性上消化道出血病情较非老年组重,住院时间长,治疗也较为复杂。对于老年组急诊内镜下诊治可以明确诊断,并可同时进行镜下止血治疗。     

塞拉利昂弗里敦地区老年埃博拉病毒病患者临床特点研究

目的研究塞拉利昂弗里敦地区老年埃博拉病毒病(Ebola virus disease,EVD)患者的临床特点。方法选取我国解放军援塞医疗队2014年10月—2015年3月收治的老年(60岁)EVD确诊患者21例(老年组)进行回顾性分析,研究其临床特点。选取同期收治的非老年EVD患者235例(非老年组)作为对照。结果老年组病毒载量与非老年组差异无统计学意义。老年组主要临床表现依次为发热、乏力、纳差、腹痛、头痛、咳嗽、关节痛、恶心呕吐、腹泻、肌肉痛、胸痛和结膜炎。老年组腹痛(85.7%)和精神错乱(23.8%)的发生率均高于非老年组[64.3%(P=0.047)和8.9%(P=0.047)],关节痛(61.9%)的发生率低于非老年组(83.0%)(P=0.018)。老年组病死率(33.3%)与非老年组(39.1%)差异无统计学意义,老年组入院后至死亡的平均死亡时间[(3.0±1.4)d]与非老年组[(2.3±1.7)d]差异亦无统计学意义。结论老年EVD患者临床表现及预后与非老年EVD患者类似,但仍具有其自身特点,这对诊断和治疗具有重要的指导意义。     

Problems and therapeutic strategy for emergency operation of the abdomen in the aged

AIM: To study the problems and therapeutic strategies for emergency abdominal operations in elderly patients by comparing aged and non-aged who underwent an emergency operations for abdominal diseases. MATERIALS AND METHODS: The patients were divided into two groups: those 70 years old or more (85 cases, elderly) and those under 70 years old (228 cases, non-elderly). The type of disease, preoperative complications, postoperative course and outcome of main diseases such as ileus and perforation peritonitis were investigated. RESULTS: Regarding emergency diseases in the aged group, ileus, peritonitis and acute appendicitis were frequently found, in that order, and accounted for 79% of the cases. Incarceration of hernia was more frequently found than in the non-elderly group. On the contrary, acute appendicitis was more frequently found in the non-elderly group. Preoperative complications were found in 46 cases (54%), and were most prevalent in hypertension, cardiac diseases, and diabetes mellitus in this order. In the non-elderly group, preoperative complications were found in 59 cases (26%). Postoperative complications were found in 52 cases (61%) in the elderly group and in 21 (9%) in the non-elderly group. Respiratory complications were found most frequently, and were seen in 32% of the elderly cases. Respiratory complications were significantly more frequent in the elderly group than in the non-elderly group. Death following the operation was found in 9% in the aged group which was mostly due to ileus and peritonitis. CONCLUSION: With regard to the acute abdominal diseases in the elderly patients, both diagnosis and indications of surgery for ileus and peritonitis should be adequately done. Preparation for postoperative respiratory complications and cardiovascular diseases might help to save lives of the elderly.     

上海地区老年溃疡性结肠炎患者临床特点的初步探讨

目的 探讨上海地区老年溃疡性结肠炎(UC)患者与非老年患者临床特点之间的差异,为提高对老年UC患者的诊治水平提供经验.方法 回顾性分析上海交通大学医学院附属瑞金医院1998年至2009年214例UC患者的临床资料及内镜学资料,通过自设量表建立数据库,以发病年龄≥60岁作为分组标准,分为老年组28例和非老年组186例.计数资料组间比较采用卡方检验,计量资料采用t检验、方差分析或非参数检验,采用Logistic回归分析进行危险因素分析.结果 上海地区UC发病年龄高峰为40～49岁,老年患者占13.08%.两组患者在主要临床表现、合并症、临床评分、内镜评分方面差异无统计学意义.老年患者在活动期外周血血小板计数增高者(75%)较非老年组(29%)为多(F=4.4,P=0.043),但增高幅度不如非老年患者明显(Z=-2.6,P=0.008).老年患者结肠病变范围较局限,以累及脾曲以下者多见(F=5.8,P=0.012).中重度老年患者采用糖皮质激素治疗者(28.6%)较非老年患者(55.7%)少见(F=7.7,P=0.007).两组死亡率分别为20.83%和2.94%.老年患者因UC死亡率显著增高(F=12.8,P=0.008).结论 老年UC患者与非老年患者相比,在实验室检查、结肠累及范围、治疗用药、预后等方面均体现出一定差异.

Abstract：

Objective To investigate the clinical characteristics between elderly and non-elderly patients with ulcerative colitis (UC) in Shanghai, so as to improve the diagnosis and management of the disease. Methods The clinical and endoscopic data from 214 patients with UC,who were admitted to Shanghai Ruijin Hospital between 1998 and 2009,were retrospectively analyzed. The database was established and according to onset age,the patients were divided into elderly group (n= 28, ≥60 years of age) and non-elderly group (n = 128, ＜60 years of age), The comparisons between two groups were performed using Chi square test for non-quantitative variables, and student's t test and nonparametric tests for quantitative variables. Logistic regression was used to analyze the risk factor.Results Onset peak of UC was found in patients ranged from 40 to 49 years of age, and elderly patients were accounted for 13.08 % in Shanghai. There was no significant difference between two groups with respect to clinical manifestation, complications, Truelove and Witts criteria index, or endoscopic score. In active phase, elevated peripheral platelet counts were seen in more elderly patients than those in non-elderly patients (75% vs 29%, F= 4. 4, P= 0. 043). However, high level of peripheral platelet was found in non-elderly patients (Z= -2.6, P=0. 008). Endoscopic examination revealed that the colonic lesion in elderly patients was limited and was more common in left-sided colon and protosigmoid (F=5. 8, P = 0. 012). More non-elderly patients were treated with steroid in comparison to elderly patients with mild or severe UC (28. 6% vs 55.7%, F=7.7,P=0. 007). In addition, the high mortality was found in elderly patients when compared with non-elderly patients (20.8 % vs 2.84%, F= 12. 8, P = 0. 008). Conclusion The differences existed between elderly and non-elderly UC patients with respect to clinical manifestation, lab investigation, involved extent of colon, medication and prognosis.     

Hepatocellular carcinoma in extremely elderly patients： An analysis of clinical characteristics, prognosis- and patient survival

AIM:To identify the clinical and prognostic features ofpatients with hepatocellular carcinoma (HCC) aged 80years or more.METHODS:A total of 1310 patients with HCC wereincluded in this study.Ninety-one patients aged 80 yearsor more at the time of diagnosis of HCC were defined asthe extremely elderly group.Two hundred and thirty-fourpatients aged≥50 years but less than 60 years wereregarded as the non-elderly group.RESULTS:The sex ratio (male to female) wassignificantly lower in the extremely elderly group (0.90:1)than in the non-elderly group (3.9:1,P<0.001).The positive rate for HBsAg was significantly lower in theextremely elderly group and the proportion of patientsnegative for HBsAg and HCVAb obviously increased inthe extremely elderly group (P<0.001).There wereno significant differences in the following parameters:diameter and number of tumors,Child-Pugh grading,tumor staging,presence of portal thrombosis or ascites,and positive rate for HCVAb.Extremely elderly patientsdid not often receive surgical treatment (P<0.001) andthey were more likely to receive conservative treatment(P<0.01).There were no significant differences insurvival curves based on the Kaplan-Meier methods incomparison with the overall patients between the twogroups.However,the survival curves were significantlyworse in the extremely elderly patients with stage Ⅰ/Ⅱ,stage Ⅰ/Ⅱ and Child-Pugh grade A cirrhosis in comparisonwith the non-elderly group.The causes of death did notdiffer among the patients,and most cases died of liver-related diseases even in the extremely elderly patients.CONCLUSION:In the patients with good liver functionsand good performance status,aggressive treatment forHCC might improve the survival rate,even in extremelyelderly patients.     

老年男性冠心病患者冠状动脉造影结果的分析

目的探讨老年男性冠心病与中青年男性冠心病患者不同的临床表现及其与冠状动脉造影结果的关系。方法选自我院782例以冠心病诊断进行冠状动脉造影的男性患者,其中老年男性374例(老年组);中青年男性408例(中青年组)。根据临床表现2组分别分为自发性心绞痛患者、劳累性心绞痛患者、急性心肌梗死患者、陈旧性心肌梗死患者、疑诊冠心病患者。分析老年组与中青年组之间的不同构成,以及各组之间冠状动脉造影阳性率的比较。结果老年组患者中劳累性心绞痛的比例明显高于中青年组,两组患急性心肌梗死和陈旧性心肌梗死的比例相近,中青年组患者疑诊冠心病的比例明显高于老年组。老年组冠状动脉造影阳性率明显高于中青年组。结论老年组患者冠状动脉存在固定性狭窄的比例明显高于中青年组患者,应当针对这一特点进行相应的治疗。     

Muscle diseases in elders: a 10-year retrospective study

BACKGROUND: Muscle complaints are frequent among older adults, but histological data in this setting are scarce. Our objective was to detect the major categories of muscle diseases in the elderly population based on histological study. METHODS: We reviewed all muscle biopsies performed in our hospital on patients older than the age of 65 during a 10-year period (1988-1997). As a control group, we included the next patient younger than 65 who underwent muscle biopsy after each elderly patient. We recorded demographic, clinical, and histological data of the patients, as well as the final diagnosis. Concordance between pre- and postbiopsy diagnosis was also analyzed. RESULTS: We included 239 muscle biopsies corresponding to elderly patients and 239 to controls. Compared with the control group, elderly patients more frequently exhibited type II fiber atrophy and were diagnosed with a specific myopathy. The latter was achieved in 86 cases (36%), idiopathic inflammatory myopathies and vasculitis being the most frequent diagnoses. Interestingly, in about one quarter of the elderly patients in whom a definite diagnosis of muscle disease was achieved, this diagnosis had not been clinically suspected prior to muscle biopsy. Overall, in 60 out of 239 elderly patients (25%), a specific therapeutic regimen could be instituted on the basis of the muscle biopsy results. CONCLUSIONS: Muscle diseases are not rare in elderly patients. Therefore, muscle biopsy constitutes a safe and useful tool for diagnosis because, if not performed, some potentially treatable diseases may be undiagnosed or misdiagnosed.     

涎液化糖链抗原-6在老年特发性肺纤维化诊治中的应用

目的探讨涎液化糖链抗原-6（kerbs von den lungen-6, KL-6）在老年特发性肺纤维化（idiopathic pulmonary fibrosis, IPF）诊断和治疗中的评估价值。 方法选取2018年7月至2019年11月牡丹江医学院附属红旗医院收治的普通型间质性肺炎型IPF患者68例，其中老年患者36例（老年IPF组）、非老年患者32例（非老年IPF组），另择同期老年健康体检者32例（老年健康组）作为对照。采用酶联免疫吸附试验测定血清KL-6表达水平，记录所有IPF患者的肺功能指标，并对其普通型间质性肺炎病变程度进行评估。比较各组血清KL-6的表达水平及肺部高分辨率CT（HRCT）评分，分析KL-6与肺功能指标和肺部HRCT评分的相关性。多组间的比较采用方差分析（进一步两两比较采用LSD-t检验）或秩和检验，计数资料的比较采用χ²检验；相关关系采用Pearson相关分析或Spearman秩相关分析。 结果3组患者KL-6表达水平的差异有统计学意义（F=63.425，P<0.05），其中老年IPF组明显高于非老年IPF组和老年健康组（P<0.01）。ROC曲线显示，KL-6诊断老年IPF的临界值为516.21 U/ml，此时敏感度和特异度最高，分别为94.4%和87.5%。无论是老年IPF组还是非老年IPF组，急性加重患者血清KL-6表达水平均明显高于稳定患者（t=2.843、2.215，P<0.05或0.01）；老年IPF组中急性加重患者血清KL-6表达水平均明显高于非老年IPF组（t=2.657，P<0.05）。相关分析显示，无论是68例IPF患者还是老年IPF组患者，其KL-6水平与HRCT评分均呈正相关（r=0.748、0.699，P<0.01）。老年IPF患者血清KL-6表达水平与部分限制性通气功能和弥散功能指标呈负相关（r=-0.515、-0.393、-0.384，P<0.05）。 结论血清KL-6对诊断IPF有一定临床意义，尤其对于老年患者具有较高的诊断敏感度及特异度，且与疾病严重程度及治疗效果呈现一定相关性。     

老年人戊型肝炎临床特征分析

目的探讨老年人戊型肝炎(HE)的临床特征。方法回顾性分析59例老年HE患者(老年组)和46例非老年HE患者(非老年组)的临床资料,比较老年组与非老年组之间的差异。结果老年组重型肝炎的发生率明显高于非老年组(P<0.05)。老年组白蛋白(ALB)水平明显低于非老年组(P<0.01),总胆红素(TBIL)水平、凝血酶原时间(PT)明显高于非老年组(P<0.05)。老年组合并症的发生率明显高于非老年组(P<0.01)。老年组住院时间较非老年组明显延长(P<0.01)。结论老年人HE多见,肝功能损害重,病程长,病死率高。     

Renal Biopsy Findings in Acute Renal Failure in the Cohort of Patients in the Spanish Registry of Glomerulonephritis

Background and objectives: Renal biopsy in acute renal failure of unknown origin provides irreplaceable information for diagnosis, treatment, and prognosis. This study analyzed the frequency and clinicopathologic correlations of renal native biopsied acute renal failure in Spain during the period 1994 through 2006.Design, setting, participants, & measurements: Acute renal failure was defined as a rapid deterioration of glomerular filtration rate, with or without oligoanuria or rapidly progressive renal insufficiency, including acute-on-chronic renal failure. Patients who were younger than 15 yr were considered children, those between 15 and 65 yr adults, and those >65 elderly.Results: Between 1994 and 2006, data on 14,190 native renal biopsies were collected from 112 renal units in Spain. Of these, 16.1% (2281 biopsies) were diagnosed with acute renal failure. The prevalence of the main clinical syndromes was different in the three age groups: Biopsy-confirmed acute renal failure in children was 5.7%, in adults was 12.5%, and in elderly increased significantly to 32.9%. The prevalence of biopsy-confirmed acute renal failure according to cause was as follows: Vasculitis, 23.3%; acute tubulointerstitial nephritis, 11.3%; and crescentic glomerulonephritis types 1 and 2, 10.1%. The prevalence of the different causes differed significantly according to age group.Conclusions: The Spanish Registry of Glomerulonephritis provides useful information about renal histopathology in biopsy-confirmed acute renal failure. The prevalence of vasculitis and crescentic glomerulonephritis is high, especially in elderly patients. These data obtained from a national large registry highlight the value of renal biopsy in undetermined acute renal failure.The study of the epidemiology of biopsy-confirmed renal disease provides useful information about the prevalence of renal disease and its clinical manifestations. Although there are several renal biopsy registries around the world, most describe the distribution of histopathologic findings, and very few analyze in detail the main clinical pictures that indicate renal biopsy, yet knowledge of the epidemiology of renal syndromes is of paramount importance in clinical nephrology.The Spanish Registry of Glomerulonephritis has recorded individual patient data for all renal biopsies performed since 1994 (1,2). This information enables us to study the epidemiology of renal syndromes and histopathologic data. Renal biopsy in acute renal failure (ARF) of unknown origin provides irreplaceable information for diagnosis, treatment, and prognosis. In this report, we analyze the frequency and clinicopathologic correlations of renal native biopsied ARF in Spain during the period 1994 through 2006.     

老年急性胰腺炎患者临床特点分析(附185例报道)

[目的]分析老年急性胰腺炎患者的临床特点及有效的临床诊治措施。[方法]对本院近10年内收治的185例老年急性胰腺炎患者(老年组)的临床资料进行回顾性分析,并与同期192例非老年急性胰腺炎患者(非老年组)的资料进行对比分析。[结果]老年组发生急性胰腺炎的病因主要是胆道疾病,其次是血脂异常及饮酒;与非老年组相比,老年组重症胰腺炎发生率较高(P0.05),且全身并发症休克、感染、多器官功能障碍较多(P0.05);老年组发生急性胰腺炎病死率为9.7%,非老年组病死率为2.1%,2组比较差异有统计学意义(P0.01)。[结论]急性胰腺炎是老年患者的常见疾病,也是致死率较高的疾病;临床给予早期诊断治疗,可以有效地改善老年患者的预后。     

纤维支气管镜在老年人呼吸系统急症中的应用（附36例临床分析）

目的探讨纤维支气管镜（纤支镜）在老年人呼吸系统急症诊治中的作用。方法使用ＯｌｙｍｐｕｓＢＦ－Ｂ３Ｒ纤支镜对老年呼吸系统急症患者在床边实施纤支镜诊治，以３０分钟内达到急症纤支镜应用目的为有效进行统计分析，并与同期非老年患者进行对照。结果在紧急吸痰排除气道梗阻或窒息，抢救窒息性大咯血，急查呼吸困难、肺不张或大咯血原因，紧急经鼻置入气管插管等情况下，老年组４２例次中，３５例次有效，有效率８３．３％；非老年组８４例次中，７５例次有效，有效率８９．３％。两组比较差异无显著性（Ｐ值＞０．０５）。结论纤支镜在老年人呼吸系统急症中可发挥积极、有效的诊治作用     

Predictive factors for mortality in elderly Japanese patients with severe microscopic polyangiitis: A retrospective single-center study

Purpose: To determine mortality and its predictive factors in elderly Japanese patients with severe microscopic polyangiitis (MPA).

Method: This retrospective single-center study determined the mortality of 52 patients with MPA who were admitted to our geriatric medical center from 2002 to 2014. The variables at baseline, including patient demographics, clinical characteristics, and treatment, were analyzed for their association with mortality.

Result: Mean age at onset of MPA was 73.2 years, and the one-year survival rate was 65.9%. Relapse was observed in 32.7%. Among variables at diagnosis, age, cardiomyopathy, central nervous system (CNS) involvement, alveolar hemorrhage, disease severity, the 1996 Five-Factor Score (FFS), and the 2009 FFS were associated with mortality in univariate analysis. Cardiomyopathy, CNS involvement, age?>65 years, disease severity, Birmingham Vasculitis Activity Score, the 1996 FFS, and the 2009 FFS were associated with relapse-free survival in univariate analysis.

Conclusion: We investigated mortality and relapse-free survival and their predictive factors in elderly Japanese patients with severe MPA. Age, disease severity, the 1996 FFS, and the 2009 FFS at diagnosis were prognostic factors for both mortality and relapse-free survival.     

Clinical analysis of community-acquired pneumonia requiring hospitalization in a community hospital--comparison of elderly and non-elderly patients

A comparative study of 890 patients with community-acquired pneumonia requiring hospitalization in a community hospital was performed. The patients were divided into an elderly patient group and a non-elderly patient group. The elderly patients with community-acquired pneumonia exhibited frequent atypical symptoms such as dyspnea, consciousness disturbance and complication of shock, and also were frequently in a poor nutritional condition. The causative microorganism was isolated in 40.8% of the elderly patients and in 44.0% of the non-elderly patients. Polymicrobial agents were detected frequently in the elderly patients. Streptococcus pneumoniae (19.4%), MSSA (16.8%), Klebsiella pneumoniae (15.1%) and Haemophilus influenzae (15.0%) were frequently isolated from the sputum of the elderly patients, while Mycoplasma pneumoniae (25.2%), H. influenzae (15.0%), S. pneumoniae (12.2%) and MSSA (10.2%) were frequently isolated from that of the non-elderly patients. Regarding treatment with antibiotics, therapy with a single antibiotic therapy, such as cephem or carbapenem was carried out for the elderly patients, while new quinolone or tetracycline was administered to the non-elderly patients. Although the treatment with antibiotics was adequate according to the guidelines of the American Thoracic Society, the prognosis was poor; i.e.) in the elderly patients an efficacy rate of 74.3% and a mortality rate of 9.5%. In the non-elderly patients, the prognosis was good; i.e.) an efficacy rate of 88.0% and a mortality rate of 1.7%. These results suggest that the most important factors affecting the prognosis were the general condition of elderly patients and delay in an adequate diagnosis and treatment because of atypical clinical findings.     

老年心房颤动患者射频消融治疗的临床特征及疗效

目的:了解接受射频消融治疗的老年心房颤动患者的临床特征及疗效。方法:本研究入选2010年6月至2011年6月,在我院接受导管消融治疗的668例心房颤动患者,按年龄分为:老年心房颤动组(≥60岁,308例)和非老年心房颤动组(<60岁,360例)。消融终点包括:完成所有预设的消融径线;全部肺静脉均达电隔离;阴性诱发结果。随访成功的定义为:未服用抗心律失常药物及无任何房性心律失常发作至少3个月以上。结果:①老年心房颤动患者的临床特征:女性心房颤动患者、合并高血压比例患者和CHADS2评分≥2的患者所占的比例,显著高于非老年心房颤动组(P<0.001);②导管消融过程及安全性,首次手术成功率和严重并发症,差异无统计学意义(P>0.05);③术后随访:随访时间为术后6～12个月。非老年组和老年组的心房颤动再次消融患者比例和总消融成功率,差异无统计学意义(P>0.05)。结论:尽管老年心房颤动患者临床合并症较多,但导管消融成功率及术后合并症与非老年心房颤动患者无差异。因此导管射频消融对于老年心房颤动患者也是安全有效的治疗方法。     

老年人反流性食管炎1119例分析

目的 探讨老年人反流性食管炎（RE）的临床和内镜特点。方法 将2067例RE分为老年组（1119例）和非老年组（948例），并对其临床和内镜资料进行对比分析。结果 老年组和非老年组RE检出率分别为8．9％和4．3％（P〈0．01）；呕血或／和黑便的发生率分别为14．6％和6．9％（P〈0．05）；其他临床表现两组相似。老年组内镜下分级为Ⅰ级62．4％、Ⅱ级24．7％、Ⅲ级11．6％和Ⅳ级1．3％，非老年组分别为74．5％、21．1％、4．1％和0．3％，两组构成趋势一致，但老年组Ⅲ级＋Ⅳ级所占的比率显著高于非老年组，分别为13．0％和4．4％（P〈0．01）；老年组伴发食管裂孔疝和残胃者分别为32．4％和9．8％，非老年组分别为11．9％和4．2％（均为P〈0．05）；老年组合并的Barrett食管伴异型增生者占33．8％（24／71）、癌变者占4．2％（3／71），非老年组分别为11．8％（9／76）和0％（均为P〈0．05）。结论 RE是老年人常见病，检出率是非老年人的2倍；老年人RE伴发食管裂孔疝和残胃者较多，内镜下病变较重，伴出血者较多；老年人RE合并的Barrett食管更易发生异型增生和癌变。     

Less frequent body weight gain in elderly type 2 diabetic patients treated with glimepiride

Background:   The purpose of the present paper was to study the effect of a new sulfonylurea, glimepiride, which has an extra-pancreatic action that improves insulin resistance, on glycemic control and body weight gain in elderly patients with type 2 diabetes mellitus (DM).
Methods:   Thirty-seven type 2 diabetic patients being treated with either gliclazide or glibenclamide were switched to glimepiride for 6 months and clinical parameters were compared between elderly (≥ 65 years old, n  = 9) and non-elderly (< 65 years old, n  = 28) patients.
Results:   There was no significant difference between the two groups in baseline characteristics, or in changes in fasting plasma glucose (FPG) and HbA1c. For body weight change, however, none of the elderly patients (0/9) exhibited an increase, but 9 of 28 (32%) non-elderly subjects showed body weight gain ( P  < 0.05).
Conclusions:   Body weight gain with glimepiride treatment is less frequent in elderly patients with type 2 DM than in non-elderly patients with the disease. These data together with the recent increase in obese elderly patients with diabetes suggest that glimepiride is recommended for treatment of type 2 diabetes in this age group.     

Clinical characteristics of elderly patients with tuberculosis

The purpose of this report is to elucidate the characteristics of elderly patients with tuberculosis (TB), based on 235 patients hospitalized in our institution from January 1999 to October 2001. The mean age of all patients was 60.8 years old and the male-to-female ratio was 2.1:1. The clinical features were compared between 121 patients aged 65 years old or more (elderly group) and 114 patients younger than 65 years old (non-elderly group). The time lag between onset of the symptoms and the first visit to a doctor was 19 days in the elderly and 49 days in the non-elderly (P < 0.01). Previous therapy, extrapulmonary TB, and underlying diseases were significantly frequent in the elderly (P < 0.05). Cavitation on chest X-ray film was found in 23% of the elderly and in 40% of the non-elderly (P < 0.01). The frequency of positive smear was similar in the two groups. Peripheral blood lymphocyte count, serum total protein, albumin and total cholesterol were lower in the elderly who died during admission than in the living elderly (P < 0.01). There was no significant difference in mortality due to TB between the two groups, although deaths due to non-tuberculous diseases were more frequent in the elderly. Pneumonia and other infectious diseases accounted for 50% of deaths in the elderly. Nutrition and infection other than TB should be taken into consideration in treating elderly patients with TB.     

Impact of aging on the clinical outcomes of Japanese patients with coronary artery disease after percutaneous coronary intervention

Japan has become an aging society, resulting in an increased prevalence of coronary artery disease. However, clinical outcomes of elderly Japanese patients after percutaneous coronary intervention (PCI) remain unclear. Of the 15,227 patients in the Shinken Database, a single-hospital-based cohort of new patients, 1,214 patients who underwent PCI, was evaluated to determine the differences in clinical outcomes between the elderly (≥75 years) (n = 260) and the non-elderly (<75 years) (n = 954) patients. A major adverse cardiac event (MACE) was defined as a composite end point, including all-cause death, myocardial infarction (MI), and target lesion revascularization. Male gender and obesity were less common, and the estimated glomerular filtration rate (eGFR) was significantly lower in the elderly than in the non-elderly. Left ventricular ejection fraction (LVEF) was comparable between these groups. Left main trunk disease and multivessel disease were more common in the elderly than in the non-elderly group. Occurrence of MACE was frequent, and the incidences of all-cause death, cardiac death, and the admission rate for heart failure were significantly higher in the elderly patients. Multivariate analysis showed that prior MI, low eGFR, and poor LVEF were independent predictors for all-cause death in the elderly patients. Elderly patients had worse clinical outcomes than the non-elderly patients. Low eGFR and LVEF were independent predictors of all-cause death after PCI, suggesting that left ventricular dysfunction and renal dysfunction might synergistically contribute to the adverse clinical outcomes of the elderly patients undergoing PCI.     

老年重症急性胰腺炎25例临床分析

目的总结老年人重症急性胰腺炎（severe acute pancreatitis,SAP）的临床诊治特点,以提高对老年人重症急性胰腺炎的认识。方法回顾性分析近5年来收治25例老年（60～84岁）SAP患者的例临床资料,并与同期30例非老年人（22—59岁）对照组SAP患者资料进行对比研究。结果老年SAP患者以胆石症为主要病因,多伴其他慢性疾病,老年患者各种临床症状发生率均低于对照组（P〈0．05）;老年组APACHEⅡ（24、48h）和Ranson评分高于对照组（P〈0．05）;老年患者的局部并发症和多器官功能障碍（衰竭）发生率明显高于对照组（P〈0．05）;病死率和死亡原因与对照组无明显差异。结论我国老年SAP病因以胆源性为主,临床症状无特异性,伴发疾病多,并发症和多器官功能障碍（衰竭）发生率较高。老年人急性胰腺炎仍以内科非手术综合治疗为主。