Outcomes of first-line endoscopic management for patients with sigmoid volvulus

Background

Sigmoid volvulus is a common cause of colonic obstruction in old and frail patients. Its standard management includes the endoscopic detorsion of the colonic loop, followed by an elective sigmoidectomy to prevent recurrence. However, these patients are often poor candidates for surgery.

Use of complementary and alternative medicine by older patients with arthritis: a population‐based study

Objective

To determine the prevalence of complementary and alternative medicine (CAM) use and to identify factors associated with its use in older patients with arthritis.

Methods

A population‐based telephone survey of 480 elderly patients with arthritis was conducted to determine demographics, comorbidities, health status, arthritis symptoms, and the use of CAM and traditional providers and treatments for arthritis.

Results

CAM provider use was reported by 28% of respondents, and 66% reported using one or more CAM treatments. Factors independently related to CAM provider use (P < 0.05) included podiatrist or orthotist use, physician visits for arthritis, and fair or poor self‐reported health. For CAM treatments, independent associations were found with physical or occupational therapist use, physician visits for arthritis, chronic obstructive pulmonary disease, and alcohol abstinence. Rural residence, age, income, education, and health insurance type were unrelated to CAM use.

Conclusion

Many older patients with arthritis reported seeing CAM providers, and most used CAM treatments. The use of CAM for arthritis was most common among those with poorer self‐assessed health and higher use of traditional health care resources.

     

Long-term efficacy and safety of radiofrequency ablation in elderly patients with atrioventricular nodal re-entrant tachycardia.

AIMS: The purpose of this study was to evaluate the efficacy, risks, safety, and follow-up of radiofrequency (RF) catheter ablation of atrioventricular nodal re-entrant tachycardia (AVRNT) in patients (pts) > or = 75 years old (n=42) (GpI) compared with pts younger than 75 years (n=234) (GpII). METHODS AND RESULTS: The study population consisted of 276 consecutive pts (39.5% men/60.5% women), from 15 to 98-year-old (average 56+/-17 years) with AVRNT referred for RF ablation (RFA) from October 1997 to January 2004. Combined anatomical and electrogram approaches were used to guide RFA. The cumulative risk of AVRNT recurrence was analysed by the Kaplan-Meier method and log-rank test. The average follow-up was 34+/-18 months. GpI (80+/-4 years) differed significantly from GpII (51+/-14 years) regarding: heart rate tachycardia (160+/-20 vs. 180+/-30 bpm; P=0.0001), the slow pathway antegrade refractory period (370+/-70 vs. 340+/-60 ms; P=0.01), the fast pathway antegrade refractory period (360+/-60 vs. 330+/-60 ms; P=0.003), retrograde refractory period (360+/-60 vs. 330+/-60 ms; P=0.0007), left ventricular ejection fraction (60+/-12 vs. 65+/-7%; P=0.0009), and ischaemic ECG signs during tachycardia (76.2% vs. 61%; P=0.09). RFA was successfully obtained in 275/276 (99.6%), 42/42 in GpI (100%), and 233/234 (99.6%) in GpII. Five complications occurred (1.8%): major complications in two pts (0.7%) and minor complications in three pts (1.1%). Major complications were deep venous thrombosis with pulmonary embolus (n=1) and pericardial effusion (n=1), minor complications were groin haematoma (n=3). One complication was observed in GpI (groin haematoma) (2.4%) and four in GpII (deep venous thrombosis with pulmonary embolus in one, groin haematoma in two, and pericardial effusion in one) (1.7%). The number of recurrences was not statistically different between the two groups (0 vs. 3.4%; P=0.5) with a respective average follow-up of 28+/-18 and 35+/-18 months, respectively. CONCLUSION: Catheter ablation of AVRNT in elderly and very elderly pts appears to be a reasonable approach regarding feasibility and effectiveness without increasing the risk of AV block.     

福州市老年公寓人群分类初探

目的 为发展多种模式的老年公寓提供参考依据。方法 对福州市5区4所老年公寓的112名老年人进行分类调查。结果 依据老人的文化程度、职业、收入和家庭成员等因素，福州市老年公寓可分为福利型、康复型和开放型。结论 根据各类型老年人特点，应努力纠正现存老年公寓缺陷，完善养老制度，发展多种模式的老年公寓，满足不同层次老年人的需求。     

老年人早期非小细胞肺癌的放射治疗：附45例分析

本文报道老年人早期非小细胞肺癌45例,年龄60～89岁。肿瘤最大直径1～3cm。手术+放疗20例,单纯手术15例,单纯放疗10例,5年生存率分别为57.1％、66.6％、42.8％。早期肺癌首选手术,根据病情选择性开展术前或术后放疗能减少复发,提高切除率,改善生存质量。对高龄不宜或拒绝手术者,肿瘤高位侵犯主支气管,气管隆突或术后复发的患者,应进行根治性放射治疗。