A retrospective comparison study of patients old and young with non-Hodgkin's lymphoma]

One hundred patients with diffuse non-Hodgkin's lymphoma were treated with combination chemotherapy including adriamycin. Seventy-one patients were under age 70 and 29 were 70 years or older. The clinical characteristics of the two groups were similar, except that the patients showed elevated serum BUN were in the elderly group. The complete remission rate in the elderly patients (66%) was slightly lower than that in the younger patients (75%) (p = NS). The average length of survival in the elderly patients was significantly shorter than in the younger patients (p less than 0.05) (projected 5-year survival: 28 +/- 11% vs 52 +/- 7%). The duration of remission for all patients in the elderly patients did not differ from that in the younger patients (projected 2-year survival: 40 +/- 10% vs 45 +/- 6%). Death during the induction chemotherapy from causes other than lymphoma occurred in 14% of patients over 70-year-old and in one percent of younger patients. At relapse, the response rate was significantly lower in the elderly patients than in the younger patients (CR+PR: 28% vs 78%, p = 0.03). To prevent toxic death in remission induction therapy, drug dose elderly patients should be attenuated according to their general conditions and performance status.     

Percutaneous transluminal coronary angioplasty in patients over the age of 70 years

Percutaneous transluminal coronary angioplasty was successfully performed in 207 of 242 patients over the age of 70 years. Multivessel disease was present in 71 per cent of patients; 93.0 per cent of patients had good left ventricular ejection fractions (greater than or equal to 35 per cent). Angioplasty was successful in 348 of 385 lesions dilated (90 per cent), with the desired degree of revascularization achieved in 90 per cent of patients with the dilatation of one or two lesions. The complications encountered included five Q wave infarctions (2.1 per cent), seven angioplasty-related deaths (2.9 per cent), and three emergency bypass surgeries (1.2 per cent). The cumulative probability of survival was 92 +/- 3 per cent at 63 months, and at a mean of 2.9 years 66 per cent of patients were angina-free. These data indicate that selected symptomatic coronary disease patients over the age of 70 years unsatisfactorily managed with medication have been successfully managed with coronary angioplasty. The results of coronary angioplasty compare favorably to those of coronary artery bypass surgery.     

Poisoning in the elderly

A prospective evaluation of poison exposure calls, in reference to persons greater than or equal to 60 years of age, was performed at the Maryland Poison Center during a six-month period in 1981. Each call was examined with respect to location of exposure, caller, circumstance, treatment location, and final outcome. The study group consisted of 237 persons, of whom 66 per cent were women. The majority of callers were not medical personnel, and the most common location for exposure was the home. Most exposures occurred by the oral route and were the result of an accident (83.1 per cent) as opposed to suicide (14.8 per cent) or drug abuse (1.7 per cent), which are more frequent in younger adults. Although only 27.4 per cent of the study population received treatment in an emergency room or required hospital admission, the probability of admission for the elderly person seen in the emergency room was significantly greater than that for younger adults and the children. Of the four fatalities that occurred, three were classified as suicides and one as an accident.     

The care of elderly patients by elderly physicians

To examine the content of care that elderly patients receive from physicians greater than or equal to 65 years of age, data from the 1981 National Ambulatory Medical Care Survey were analyzed. Compared to physicians aged 35 to 54 years, elderly physicians devoted a larger proportion of their practices to the care of elderly patients. In caring for these patients, elderly physicians spent more time per visit than did younger physicians and were more likely to conduct general examinations and provide counseling. In contrast, elderly physicians were less likely to perform mental status or vision examinations. Elderly physicians were also less likely to provide telephone follow-up for those patients greater than or equal to 75 years of age and more likely to discharge patients greater than or equal to 65 years of age without any specific follow-up planned. These data suggest that the content of care for elderly patients may differ substantially depending upon the physician's age.     

Age-related sleep-wake disorders at a sleep disorder center

The specific sleep disorders of 97 patients 61-81 years old were compared with those of 264 middle-aged (41-60 years old) and 202 young (20-40 years old) patients. Sleep disorder diagnoses were made according to the Diagnostic Classification of the Association of Sleep Disorders Centers based on evaluations consisting of mental and physical examinations and all-night sleep recordings. Most young and middle-aged patients complained of excessive daytime sleepiness; the elderly complained of insomnia as often as excessive daytime sleepiness. The evaluations revealed objective findings in 93 per cent of the elderly, but only 77 per cent of younger patients. Nocturnal myoclonus or restless leg syndrome was the diagnosed cause of 23 per cent of elderly patients' sleep-wake problems, but only 11 per cent of middle-aged and 4 per cent of young patients had this problem. Respiratory disorders of sleep were found in 27 per cent of elderly, 35 per cent of middle-aged, and 20 per cent of young patients. Elderly patients (6 per cent) had psychiatric disorders diagnosed as the causes for their problems less frequently than did younger patients (22 per cent).     

Elderly patients are at greater risk of cytopenia during antiviral therapy for hepatitis C.

The results of antiviral therapy for hepatitis C virus (HCV) have improved recently with the use of pegylated interferon (PEG-IFN)/ribavirin (RBV) combination therapy. At this point, most patients with chronic HCV remain untreated. Thus, it is anticipated that therapy will be more appealing and prescribed more broadly than in the past, including in patients considered marginal. AIM: To examine the effects of PEG-IFN-based antiviral therapy in elderly patients with chronic HCV. METHODS: The charts of patients treated with chronic HCV were reviewed. Patients were defined as elderly if they were 60 years of age or older. The control group consisted of patients younger than 60 years of age who were matched to the treated elderly patients based on sex, treating physician, prescribed treatment and intended prescribed treatment duration. The data recorded included end of treatment response, sustained virological response (SVR), adverse events, dose modification and withdrawal of therapy. RESULTS: Thirty of 147 (20.4%) elderly patients attending a hepatitis C clinic were treated. The average age of the elderly patients was 65+/-4 years. Forty-three per cent were men and 57% were women. Ten per cent received IFN monotherapy, 70% received a combination of IFN/RBV therapy and 20% received a combination of PEG-IFN/RBV therapy. The overall response rates in the elderly patients compared with the younger patients was 46.7% versus 65.8% (P=0.11) for end of treatment response and 33.3% versus 51.2% (P=0.13) for SVR. The rate of dose modification was 50% in the elderly patients compared with 29% in the control group (P=0.08). Therapy was discontinued in 53% of the elderly compared with 34% of younger patients (P=0.17). The younger patients reported more side effects than elderly patients; although, there were more laboratory abnormalities (anemia, thrombocytopenia and neutropenia) in the elderly patients during therapy than in the younger group (0.93 per patient versus 0.49 per patient, P=0.01). CONCLUSION: Elderly patients with chronic HCV can be treated successfully. However, they are more at risk to develop cytopenias while on treatment. In such patients, the close monitoring of blood counts is necessary. Larger studies are needed to confirm these findings and to determine whether SVR differs in this population.     

Long-term clinical outcome of coronary artery stenting in elderly patients

BACKGROUND: The elderly constitute a rapidly expanding segment of our population and cardiovascular disease becomes more prevalent with increasing age. Existing data have shown that percutaneous coronary interventions in the elderly are associated with an increase risk of in-hospital complications compared to younger patients. In the present study we retrospectively assessed the long-term clinical outcome of coronary artery stenting in an elderly population and compared them with the cohort of younger patients. METHODS: The study population included 402 consecutive patients with coronary artery disease who underwent coronary artery stenting; of these 69 were elderly (age > 70 years, group I) and 333 were younger (age 相似文献   

Survival of elderly men with congestive heart failure.

Congestive heart failure (CHF) is the most common discharge diagnosis for elderly patients. The survival of elderly (age greater than or equal to 75 years) patients with CHF has not recently been reported, especially with reference to left ventricular ejection fraction (LVEF). A patient database was searched for the diagnosis of CHF and then screened for age greater than or equal to 75, Framingham Criteria for CHF and an LVEF evaluation. Ninety-four men fitted all criteria, including a minimum potential follow-up of 3 years. Life-table analysis was employed to compare their survival experience to an expected survival based on a sex- and age-equivalent subset of the 1980 Census data. Causes of death were determined from autopsy, medical records or death certificates. Mean age at onset of CHF was 82.5. Forty-three per cent had an LVEF greater than or equal to 0.45. There was no difference in the prevalence of potential aetiologies between those with LVEF greater than or equal to 0.45 versus LVEF less than 0.45. Life-table analysis revealed that CHF patients had a worse survival than controls for the first 5 years after diagnosis, attributable primarily to a high first-year mortality (28%) for the CHF group. There was no difference in survival between the LVEF greater than or equal to 0.45 and LVEF less than 0.45 groups.     

Prevalence and incidence of insulin-treated diabetes mellitus in adults in Canterbury, New Zealand.

A population-based diabetes register showed a prevalence of insulin-treated diabetes mellitus (n = 1148) in Canterbury, New Zealand, of 3.3 per 1000 population at 1 January 1984. Median age was 52 years, with equal sex distribution. Eleven percent were aged 0-19 years. Prevalence was highest in those aged 50 years or more, reaching 7.6 per 1000 in the 70-79 years age group. Only 28% of cases presented with diabetes under 20 years of age. Of those diagnosed in adulthood, only 17% did not commence insulin therapy as their permanent treatment modality within 12 months post-diagnosis. Incidence of new insulin-requiring diabetic cases between 1981 and 1986 (excluding persons commencing insulin more than 12 months after diagnosis) was 12.8 per 100,000 per year. There were two incidence peaks, one in adolescence (16.9 per 100,000), the other in the older age group. Rates in the elderly peaked at 25.9 per 100,000 for males aged 60-69 years, and at 19.5 per 100,000 for females aged 70 or more years. Only 83 of the 268 new cases starting insulin within this period were 0-19 years of age. Based on prevalence surveys of diabetes mellitus in Canterbury, New Zealand, it was determined that 14.3% of all known adult diabetic people were insulin-treated.     

Results of percutaneous transluminal coronary angioplasty in patients greater than or equal to 65 years of age (from the 1985 to 1986 National Heart, Lung, and Blood Institute's Coronary Angioplasty Registry)

The 1985 to 1986 National Heart, Lung, and Blood Institute Percutaneous Transluminal Coronary Angioplasty (PTCA) Registry series of 1,801 initial procedures included 486 patients age greater than or equal to 65 years (elderly). In comparison to younger patients, a greater proportion of elderly patients were women and had unstable angina. Elderly patients had more history of hypertension and more history of congestive heart failure. Although the elderly had more extensive vessel disease, the numbers of lesions and vessels attempted with PTCA were similar in the older and younger cohorts. Angiographic success rates were similar for all age groups. Although complication rates in the catheterization laboratory did not differ, patients greater than or equal to 65 years were much more likely to require emergency coronary artery bypass graft surgery (CABG) (5.4 vs 2.8%, p less than 0.05) or elective CABG (3.9 vs 1.6%, p less than 0.01). The in-hospital death rate was considerably higher among the elderly (3.1 vs 0.2%, p less than 0.01). At 2-year follow-up, symptomatic status and cumulative rates of myocardial infarction, CABG and repeat PTCA were similar for elderly and younger patients. The death rate after 2 years was higher among elderly patients (8.8% of patients greater than or equal to 65 years vs 2.9% of patients less than 65 years, p less than 0.01). When the relative risk of death for the elderly was adjusted for factors more prevalent among those greater than or equal to 65 years (history of congestive heart failure, multivessel disease, unstable angina, history of hypertension and female gender), the relative risk remained significant but was substantially reduced (from 3.3 to 2.4).     

Diagnosis of acute pulmonary embolism in the elderly

The diagnostic features of acute pulmonary embolism among 72 patients greater than or equal to 70 years old were evaluated and compared with characteristics of pulmonary embolism among 144 patients 40 to 69 years and 44 patients less than 40 years old. Syndromes characterized by either 1) pleuritic pain or hemoptysis, 2) isolated dyspnea, or 3) circulatory collapse were observed with comparable frequency among patients greater than or equal to 70 years old and younger patients. One of these presenting syndromes occurred in 64 (89%) of the 72 patients greater than or equal to 70 years old. Those who did not show these syndromes were identified on the basis of unexpected radiographic abnormalities, which may have been accompanied by tachypnea or a history of thrombophlebitis. Among the 72 patients greater than or equal to 70 years with pulmonary embolism, dyspnea or tachypnea (respirations greater than or equal to 20/min) occurred in 66 (92%), dyspnea or tachypnea or pleuritic pain in 68 (94%) and dyspnea or tachypnea or radiographic evidence of atelectasis or a parenchymal abnormality in 72 (100%). Complications of angiography were evaluated among patients with and without pulmonary embolism. Major complications of pulmonary angiography among patients greater than or equal to 70 years old (2 [1%] of 200) were not more frequent than among younger patients (6 [1.1%] of 562) (p = NS). However, renal failure (major or minor) was more frequent in patients greater than or equal to 70 years old than in younger patients (6 [3%] of 200 versus 4 [0.7%] of 562) (p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)     

Ischaemic heart disease and prodromes of sudden cardiac death. Is it possible to identify high risk groups for sudden cardiac death?

A study was carried out to determine the incidence of sudden cardiac death in a well defined population in relation to prodromes, medical history, and previous medical consultations before sudden cardiac death. In Frederiksborg county, Denmark (population 332 000), of 1309 consecutive deaths in a six month period, 166 were due to sudden cardiac death; among men aged 50-69, 22% of all deaths were due to sudden cardiac death. The incidence per 1000 population per year by age group (less than 50, 50-69, greater than or equal to 70 years) was 0.19, 3.6, 11.4 in men and 0.12, 1.0, and 6.4 in women. The increasing incidence with age was significant. Ischaemic heart disease or hypertension had been recorded in 75% (124/166) of patients. Prodromes were reported in 54% (38/71) of patients with angina, and in 26% (25/95) without. Nineteen per cent (32/166) had neither prodromes nor overt heart disease. Forty six per cent of patients with known ischaemic heart disease and 24% without had consulted a doctor less than four weeks before death. Eight per cent had had a myocardial infarction within a year of death.     

Ischaemic heart disease and prodromes of sudden cardiac death. Is it possible to identify high risk groups for sudden cardiac death?

A study was carried out to determine the incidence of sudden cardiac death in a well defined population in relation to prodromes, medical history, and previous medical consultations before sudden cardiac death. In Frederiksborg county, Denmark (population 332 000), of 1309 consecutive deaths in a six month period, 166 were due to sudden cardiac death; among men aged 50-69, 22% of all deaths were due to sudden cardiac death. The incidence per 1000 population per year by age group (less than 50, 50-69, greater than or equal to 70 years) was 0.19, 3.6, 11.4 in men and 0.12, 1.0, and 6.4 in women. The increasing incidence with age was significant. Ischaemic heart disease or hypertension had been recorded in 75% (124/166) of patients. Prodromes were reported in 54% (38/71) of patients with angina, and in 26% (25/95) without. Nineteen per cent (32/166) had neither prodromes nor overt heart disease. Forty six per cent of patients with known ischaemic heart disease and 24% without had consulted a doctor less than four weeks before death. Eight per cent had had a myocardial infarction within a year of death.     

Invasive disease due to Streptococcus pneumoniae in an area with a high rate of relative penicillin resistance

During 1984 we conducted a population-based survey of culture-confirmed invasive disease due to Streptococcus pneumoniae among persons who lived in the Oklahoma City, Oklahoma, metropolitan area (population, 846,000) through the 20 clinical laboratories in the area. There were 139 residents identified with invasive pneumococcal disease (11 with meningitis and 128 with other bacteremic infections), for an infection rate of 16.4 per 100,000 population (meningitis, 1.3 cases per 100,000; other bacteremias, 15.1 cases per 100,000). Cases peaked in January-May and December (75% of cases). Rates were highest among infants less than 12 months old (97 cases per 100,000) and persons greater than or equal to 80 years old (87 cases per 100,000). Seventeen (12.2%) of the pneumococcal isolates were relatively penicillin resistant. These isolates were most prevalent among elderly persons greater than or equal to 70 years old (six [17.6%] of 34) and young children 0-4 years old (7 [15.9%] of 44) compared with persons 5-69 years old (four [6.6%] of 61).     

Ventricular ectopy during prolonged ambulatory electrocardiographic monitoring in elderly hypertensive subjects

To examine whether ventricular ectopy in hypertensive older people is associated with age, the hypertensive process, or treatment, a 24-hour ambulatory electrocardiogram recording was obtained in 94 noninstitutionalized subjects aged 60-90 years with isolated hypertension and 136 noninstitutionalized normotensive subjects aged 60-82 years. A significantly higher prevalence of frequent ventricular ectopic beats (VEB greater than 100 per recording) was found in hypertensive and normotensive groups age greater than or equal to 70 years compared to age 60-69 years (44% vs 15%, P less than .01, and 28% vs 9%, P less than 01, respectively). Complex ventricular ectopy was found to be significantly increased only in the hypertensive group greater than or equal to 70 years compared to 60-69 years (53% vs 28%, P less than .05). No significant difference for any type of ventricular ectopy was found between treated and untreated hypertensive subjects. Analysis of variance of frequent ventricular ectopy showed a significant effect of age (P less than .001) but not of hypertension. Multivariate regression analysis with frequent ventricular ectopy as the dependent variable confirmed this relationship. For complex ventricular ectopy, analysis of variance showed a significant effect of hypertension (P less than .001) and age (P less than .05). Multivariate regression analysis confirmed that complex ventricular ectopy was significantly associated with hypertension (P less than .01) and age (P less than .05). In elderly subjects aging alone is associated with increased frequency of ventricular ectopy, whereas complex ventricular ectopy is more significantly related to the hypertensive process than to age.     

Prevalence of complement fixing antibody to Mycoplasma pneumoniae in Thai children.

The prevalence of antibodies to Mycoplasma pneumoniae was determined in normal Thai children by means of complement fixation. There were 445 children (243 boys and 202 girls) of different ages, ranging from newborn to 15 years. The lowest frequency of complement-fixing antibody was found in children age 1-3 months, and highest in children age 6-10 years which corresponds to the age distribution of symptomatic M. pneumoniae infection. The lowest and highest titers measured were less than 1:8 and 1:512 respectively. The prevalence of complement fixing antibody of titers more than or equal to 1:8, 1:32, 1:64 and 1:128 were 61.3, 31.7, 25.4 and 10.3 per cent of total children, respectively. Among children less than one month old, the frequency of complement fixing antibody of titers greater than or equal to 1:32 was 12.2 per cent and decreased to 1.3 per cent among children from the age 1-3 months. This decrease probably represented the disappearance of maternal antibody over this period. An increase in both the frequency and the geometric mean titer was seen thereafter. The peak frequency of high titers (greater than or equal to 1:32), 81.1 per cent, occurred in children 6-10 year of age. Paired sera were obtained from 72 children with high titers of greater than or equal to 1:64, 9.7 per cent had four fold changes of titer which indicated recent infection.(ABSTRACT TRUNCATED AT 250 WORDS)     

Primary cardiovascular events and serum lipid levels in elderly Japanese with hypercholesterolemia undergoing 6-year simvastatin treatment: a subanalysis of the Japan lipid intervention trial

OBJECTIVES: To determine the relationship between serum lipid levels and the incidence of coronary events in older Japanese hypercholesterolemic patients without prior coronary heart disease (CHD). DESIGN: Post hoc subanalysis of the results in the Japan Lipid Intervention Trial. SETTING: A large-scale cohort observational study conducted throughout Japan. PARTICIPANTS: Men aged 35 to 70 and postmenopausal women younger than 70 with serum total cholesterol (TC) level of 220 mg/dL or greater treated for 6 years with low-dose simvastatin (52,421 total patients). After exclusion of 5,127 patients because of prior CHD and 4,934 patients because of incomplete data, 42,360 patients were divided into an older (9,860 patients, aged 65-70, mean age 67.1) and younger (32,500 patients, younger than 65, mean age 54.9) group and analyzed. MEASUREMENTS: Fasting serum lipid levels were measured every 6 months. Major coronary events, including fatal or nonfatal myocardial infarction, and sudden cardiac death as the primary endpoint and other cardiovascular diseases, including onset of angina pectoris, cerebrovascular events, and any causes of death, as the secondary endpoints were monitored. RESULTS: Simvastatin treatment in older patients was as safe and effective as in younger patients. Incident rates of major coronary events were 1.30 per 1,000 patient-years in the older group and 0.80 per 1,000 patient-years in the younger group. The incidence of a major coronary event was correlated to serum TC and low-density lipoprotein cholesterol (LDL-C) levels in both groups. The absolute risk of major coronary events in the older group was higher than in the younger group at any level of LDL-C, whereas the relative risk increased by 1.7% with an elevation of each 1 mg/dL LDL-C level in both groups. In the older group, the risk of major coronary events also increased as triglyceride level increased, whereas the risk decreased as high-density lipoprotein cholesterol level increased above 60 md/dL. CONCLUSION: The LDL-C level-dependent increase of relative risk of CHD was similar in elderly and younger patients, whereas the absolute risk at any LDL-C level in elderly patients was higher than in younger patients.     

Exercise conditioning in the elderly coronary patient

We compared conditioning effects of a supervised exercise program in 100 elderly and younger patients with a recent coronary event. Twenty-one patients were greater than or equal to 62 years of age (mean, 65 years) and 79 were less than or equal to 61 years of age (mean, 48.7 years). While the elderly patients attained a lower peak exercise intensity on entry and on completion of the exercise protocol, they obtained a similar relative training benefit as the younger patients. Peak exercise intensity increased 68% in each group and submaximal (five METS) heart rate-blood pressure product decreased 27% in the older patients and 26% in the younger patients. Rate of entry into our program was substantially lower in the elderly patient group, 19% v 57% in younger patients (P less than 0.001) despite a similar inhospital recruiting effort. Thus, although elderly coronary patients obtain similar training benefits as younger patients, they are less likely to participate in a program designed to decrease cardiac disability.     

Successful change of treatment strategy in elderly patients with primary central nervous system lymphoma by de-escalating induction and introducing temozolomide maintenance: results from a phase II study by The Nordic Lymphoma Group

The Nordic Lymphoma Group has conducted a phase ll trial in newly diagnosed primary central nervous system lymphoma patients applying an age-adjusted multi-agent immunochemotherapy regimen, which in elderly patients included temozolomide maintenance treatment. Patients aged 18–75 years were eligible. Thirty-nine patients aged 18–65 years and 27 patients aged 66–75 years were enrolled. The median age of the two age groups was 55 and 70 years, respectively. The overall response rate was 73.8% for the entire cohort: 69.9% in the younger and 80.8% in the elderly subgroup. With a median follow up of 22 months, the 2-year overall survival probability was 60.7% in patients aged 65 years or under and 55.6% in patients aged over 65 years (P=0.40). The estimated progression-free survival at two years was 33.1% (95%CI: 19.1%–47.9%) in patients aged under 65 years and 44.4% (95%CI: 25.6%–61.8%) in the elderly subgroup (P=0.74). Median duration of response was ten months in the younger subgroup, and not reached in the elderly patient subgroup (P=0.33). Four patients aged 64–75 years (6%) died from treatment-related complications. Survival in the two age groups was similar despite a de-escalation of induction treatment in patients aged over 65 years. Duration of response in elderly patients receiving maintenance temozolomide was longer than in the younger age subgroup. While toxicity during induction is still of concern, especially in the elderly patients, we conclude from these data that de-escalation of induction therapy in elderly primary central nervous system lymphoma patients followed by maintenance treatment seems to be a promising treatment strategy. (clinicaltrials.gov identifier:01458730)     

Patient age and results of balloon aortic valvuloplasty: the Mansfield Scientific Registry experience. The Mansfield Scientific Aortic Valvuloplasty Registry Investigators

Patients enrolled in the Mansfield Scientific Aortic Valvuloplasty Registry were followed up a mean of 7 months after balloon aortic valvuloplasty. Results were compared for patients less than 70, 70 to 79 and greater than or equal to 80 years of age at time of valvuloplasty. As assessed by aortic valve area indexed to body surface area, stenosis was more severe in the older patients and the incidence of congestive heart failure was also greater in those aged greater than or equal to 80 years. The results of valvuloplasty were comparable in all three age groups, and indexed final valve area was not significantly different among the groups. In-hospital mortality ranged from 4.2% to 9.4%, but this and other complications were not significantly different among the groups. Total 7 month mortality was 23%. As performed in this registry study, balloon aortic valvuloplasty produced similar results in older and younger patients, despite initially more severe disease in the older patients.