Postural Fall in Blood Pressure in the Elderly in Relation to Drug Treatment and Other Lifestyle Factors

In a study of 843 independent-living men and women aged between60 and 87 in Perth, Western Australia, stepwise multiple regression,after correction for initial levels of systolic blood pressure,showed that postural fall in systolic blood pressure was positivelyrelated to alcohol intake of more than 20 ml/day, the use ofsleeping tablets and higher levels of anxiety on the Spielbergerstate-trait scale, and negatively related to body mass index.Postural fall in blood pressure was not significantly relatedto treatment for hypertension, age, sex, patterns of usual physicalactivity, tea or coffee drinking, or the diagnosis of diabetesmellitus. This analysis is the first to examine the relationshipbetween lifestyle factors and the magnitude of the fall in systolicblood pressure on standing after adjustment for the associationbetween the change in a variable and its initial level. Ouranalysis suggests the need for further study of the possiblerole of lifestyle factors such as the use of sleeping tabletsand alcohol in postural hypotension in the elderly.     

ORGAN SPARING SURGERY FOR MALIGNANT GERM CELL TUMOR OF THE TESTIS

PURPOSE: We evaluate the indication, technique and long-term outcome of organ preserving tumor resection rather than standard orchiectomy in 73 patients with bilateral testicular germ cell tumors or tumors of a solitary testicle. MATERIALS AND METHODS: Tumor resection was performed in 73 patients with 52 and 17 metachronous and synchronous bilateral testicular germ cell tumors, respectively, and 4 testicular germ cell tumors of a solitary testicle. Histology of the enucleated germ cell tumor revealed seminoma in 42 (57.5%) patients, embryonal carcinoma in 14 (19.2%), mature teratoma in 11 (15.1%), and mixed and combined germ cell tumors in 6 (8.2%). Mean tumor diameter was 15 mm. (range 5 to 30). Associated testicular intraepithelial neoplasia was diagnosed in 82% of patients who underwent local radiation with 18 Gy. RESULTS: After a median followup of 91 months (range 3 to 191) 72 (98.6%) patients had no evidence of disease and 1 died of systemic tumor progression. No local relapse occurred in 46 patients with associated testicular intraepithelial neoplasia treated with local radiation. However, local recurrence did develop in 4 patients after 3, 6, 12 and 165 months without radiation but all survived after undergoing inguinal orchiectomy. Testosterone levels were normal in 62 (84.9%) patients, hypogonadism developed in 7 (9.6%) and preoperative levels remained low in 4 (5.5%). Of the 10 patients who postponed local radiation for paternity reasons 5 had successfully fathered a child after organ sparing surgery. CONCLUSIONS: After a long-term followup of greater than 7 years organ sparing surgery represents a viable therapeutic approach to bilateral testicular germ cell tumor with an excellent postoperative outcome. Tumor enucleation might be considered a standard approach if the guidelines are respected, including cold ischemia, organ confined tumor less than 20 mm., multiple biopsies of the tumor bed, adjuvant local irradiation postoperatively to avoid local recurrence, close followup and high compliance.