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1.
Comparative outcomes of vascular access in patients older than 70 years with end-stage renal disease
Deokbi Hwang Sujin Park Hyung-Kee Kim Seung Huh 《Journal of vascular surgery》2019,69(4):1196-1206.e5
Objective
The advantage of arteriovenous fistulas (AVFs) in older patients requiring dialysis is controversial. We reviewed our vascular access experience in patients ≥70 years of age (older group) compared with younger patients.Methods
We analyzed consecutive patients who underwent access surgery between 2013 and 2016. Primary success (PS) and primary patency (PP) data were analyzed between the older and younger groups before and after propensity score matching of the patients' characteristics and access composition. PS was defined as the achievement of access function that was amenable to two sessions of successful cannulation without early occlusion or maturation failure requiring revision. PP was defined as the time with uninterrupted patency without intervention.Results
A total of 594 consecutive accesses were created among 563 patients, of whom 119 were allocated into each group after propensity score matching. In the whole cohort, 193 accesses (32.5%) were performed in older patients. AVFs were performed in 130 (67.4%) older patients and 293 (73.1%) younger patients. Regarding AVFs, the PS rate (83.6% in the older group vs 94.3% in the younger group; P = .001) and the overall PP at 6 and 12 months (73.1% and 57.1%, respectively, in the older group vs 86.7% and 77.7%, respectively, in the younger group; P = .009) were lower in the older group than in the younger group. However, no differences were found in the PS and PP rates for arteriovenous grafts between groups. Regarding the AVF location, the PS rate for forearm AVFs was significantly lower in the older group than in the younger group (76% vs 93%; P < .001); however, the PS rate of the upper arm was not different between the groups (94% vs 97%; P = .425). In the patients with PS, the PP rate of AVFs was similar between the two groups. In the older group with forearm AVFs, the median diameter of the radial artery was larger in the patients with PS than in the patients without PS (2.20 mm with PS vs 2.00 mm without PS; P = .008). The propensity score matching results demonstrated similar trends for the whole cohort, with lower PS (P = .042) and PP rates (P = .023) for AVF in the older group.Conclusions
The outcomes after AVF were poorer in the older group than in the younger group, which was primarily due to unsatisfactory outcomes in patients with forearm AVFs. Thus, stricter criteria, especially regarding the radial artery diameter, should be applied for forearm AVFs in older patients, and additional research is necessary to delineate the risk factors for primary failure. 相似文献2.
Abstract Chorea is a rare complication of polycythaemia vera. Polycythaemic chorea occurs predominantly in females and usually in generalised
form. We present a 66-year-old woman with acute onset hemichorea-ballism with no vascular pathology in the basal ganglia region.
A clear relationship was observed between the onset of chorea and worsening of haematological parameters in the patient. After
repeated phlebotomies the patient's clinical status was improved. Polycythaemic chorea must be considered, especially in the
elderly, as early diagnosis leads to effective treatment and prevention of complications. 相似文献
3.
Effect of impact exercise on bone mineral density in elderly women with low BMD: a population-based randomized controlled 30-month intervention 总被引:4,自引:3,他引:1
Raija Korpelainen Sirkka Keinänen-Kiukaanniemi Jorma Heikkinen Kalervo Väänänen Juha Korpelainen 《Osteoporosis international》2006,17(1):109-118
Evidence of the effect of exercise on bone loss comes mainly from studies in voluntary postmenopausal women, and no population-based, long-term interventions have been performed. The purpose of this population-based, randomized, controlled trial was to determine the effect of long-term impact exercise on bone mass at various skeletal sites in elderly women with low bone mineral density (BMD) at the radius and hip. Participants ( n =160) were randomly assigned to 30 months either of supervised and home-based impact exercise training or of no intervention. The primary outcome measures were femoral neck, trochanter and total hip BMD, and the secondary outcomes were bone density measures at the radius and calcaneum. Outcomes were assessed at baseline, 12 months and 30 months using blinded operators. The analyses were performed on an intention-to-treat analysis. Mean femoral neck and trochanter BMD decreased in the control group [–1.1%, 95% confidence interval (CI) –0.1% to –2.1% and –1.6%, 95% CI –0.4% to –2.7%], while no change occurred in the exercise group. Mean trochanter BMC decreased more in the control group (–7.7%, 95% CI –9.7% to –5.6% vs. –2.9%, 95% CI –5.3 to –0.9). There were six falls that resulted in fractures in the exercise group and 16 in the control group during the 30-month intervention ( P =0.019). A significant bone loss occurred in both groups at the radius and calcaneum. In multivariate analysis, weight gain was associated with increased BMD and BMC at all femur sites both in the exercise group and in the pooled groups. In conclusion, impact exercise had no effect on BMD, while there was a positive effect on BMC at the trochanter. Exercise may prevent fall-related fractures in elderly women with low bone mass.There was no conflict of interest. 相似文献
4.
Michael Dietrich Christoph Meier Daniela Zeller Patrick Grueninger Roger Berbig Andreas Platz 《European journal of trauma and emergency surgery》2007,33(5):512-519
Abstract
Background: Primary shoulder hemiarthroplasty is an established treatment modality for complex fractures of the proximal humerus. Long-term
functional outcome is often disappointing. However, little is known about social implications particularly in the elderly.
Methods: A single-institution case series of consecutive geriatric patients (age > 70 years) treated with shoulder hemiarthroplasty
for complex fractures of the proximal humerus between 1994 and 1997 was analysed. Postoperative morbidity, long-term function,
radiological outcome and social implications were evaluated.
Results: Seventy-seven patients fulfilled the study criteria. Median age at the time of operation was 80 years (range 70–93 years).
Systemic and local postoperative complications were observed in 8% including 2 patients (3%) with revision surgery. Postoperative
mortality was 1%. Forty-eight patients (62%) were available for follow-up (median 49 months, range 25–80 months), 22 (29%)
died from causes unrelated to hemiarthroplasty before follow-up and 7 patients (9%) did not attend follow-up examination.
Median Constant-Murley score was 41 points (range 17–77 points). Long-term results concerning pain were satisfying. The Oxford
shoulder score ranged from 14 to 40 (median 30). Forty-one patients (85%) still lived in their original environment and managed
their daily life independently despite poor shoulder function. Four patients (8%) lived in a retirement home and 3 (6%) in
a nursery home. Eighty percent of our patients were still able to use public transportation, do the daily shopping and wash
their whole body by themselves.
Conclusion: Most patients managed their daily life independently despite poor shoulder function. 相似文献
5.
探讨老年人微小病变性(MC)特发性肾病综合征(PNS)的临床特征及预后。方法 观察成人MC性PNS118例,其中老年患者18例,占15.2%。结果 发现老年患者NS的临床表现与成年组相似;但血尿发病率较低,22%比38%;高血压和肾功能不全的发病率明显增高,38.9%比16%和33.3%比19%(P<0.01)。老年组对激素治疗的敏感性略差;但NS复发率明显减少,11.1%比43%。结论 尽管NS的复发和对激素依赖使治疗有一定困难,但激素、细胞毒性药物和环孢素A对于消除蛋白尿,延缓肾功能不全是有助的。 相似文献
6.
高龄初产妊高征孕妇过氧化反应的研究 总被引:3,自引:0,他引:3
目的:探讨高龄初产妊高征孕妇体内过氧化反应。方法:测定正常初产妇、妊高征孕妇妊娠晚期母血过氧化脂质(LPO)、超氧化物歧化酶(DOD)的含量。结果:1.高龄初产妇母血LPO较非高龄初产妇明显升高,SOD明显下降,P<0.05。孕妇年龄与母血LPO呈明显正相关,与SOD呈明显负相关,P均<0.05。2.妊高征孕妇LPO较正常孕妇显著增高,SOD显著下降,P<0.05,并随病情加重LPO水平升高、SOD水平下降更为显著,P<0.05。3.高龄初产妊高征孕妇母血LPO含量较非高龄初产妊高征孕妇明显增高,P<0.05,而SOD则无显著变化,P>0.05。4.妊高征孕妇胎儿宫内生长发育迟缓(IUGR)发生率较正常孕妇显著升高,P<0.025,各组脐血清LPO、SOD含量无显著差异,P<0.05。结论:高龄初产妊高征孕妇体内过氧化作用明显增强,LPO水平的升高可能为高龄初产妇妊高征发生率及IUGR发生率增加的原因之一。 相似文献
7.
8.
9.
Background: There is a growing interest in the use of local anaesthesia for inguinal hernia repair. It certainly seems to
be an acceptable alternative for the elderly. Supporting intravenous sedation, however, still requires monitoring, anaesthetic
personnel and some preparations for the patient. Therefore we set up a feasibility study of hernia repair under local anaesthesia
without intravenous sedation or monitoring in elderly patients. Method: A total of 62 patients (aged 65 years or more) with
unilateral inguinal hernia received a Mesh Plug Repair. Prospectively collected data included procedure-related complications
and information on pain and quality of life as measured by Short Form 36. Results: No procedure-related complications were
noted. Comparing the preoperative scores, the SF-36 on day 14 (n=61) did not differ significantly. After a median follow-up of ten months (n=54), significantly higher scores were found for scales of physical and emotional role and pain (all p<0.05). Twenty-two patients reported some form of pain (40.7%). 94.4% of the patients would recommend the procedure when asked.
Conclusion: The results of this study indicated that Mesh Plug Repair performed under unmonitored local anaesthesia with no
intravenous sedation is a feasible alternative for elderly patients. It has advantages for the medical organization without
disadvantages for the patient. 相似文献
10.
目的 了解社区老年人支气管哮喘的患病情况 ,为哮喘防治奠定基础。 方法 采用整群抽样 ,对南海市桂城社区 2 481名 60岁以上老年人进行哮喘的流行病学调查。 结果 确诊老年人哮喘 98例 ,患病率为 3 .95 % (男4.91%、女 2 .92 % ) ,男性高于女性 (P <0 .0 5 ) ;工业区老年人哮喘的患病率高于文化区 (患病率分别为 5 .12 %、3 .2 6% ,P<0 .0 5 ) ;有遗传家族史者 45例 ,占 45 .92 % ;78%的患者发病年龄 >14岁 ;诱发因素前 3位分别是上呼吸道感染、气候变化和刺激性气体 ;合并COPD2 5例 ,占 2 5 .5 1%。 结论 老年人哮喘是不容忽视的疾病 ,需加强对社区哮喘的管理和教育。 相似文献