摘要:

ABSTRACTOf 166 surgical patients for whom the diagnosis of primary hyperparathyroidism was established over a 20‐year period, about one‐third were over 60 years of age. For an additional 9 patients, no operation was advised, usually because of other life‐endangering disease and the presence of only a mild degree of hypercalcemia without complications. In recent years, nearly 50 per cent of the patients did not have renal calculi or osteitis fibrosa cystica; this was unrelated to age. Most of the patients with management problems were seen since 1965. Age alone was not a dominant factor in relation to serious complications from hypercalcemia, the presence of other critical disease increasing the risk of operation, or the development of major postoperative complications. The only death from primary hyperparathyroidism occurred in a 74‐year‐old patient who refused re‐operation and died from an acute hypercalcemic crisis. A liberal, but selective, policy of surgical treatment is justified for primary hyperparathyroidism in the elderly. Patients for whom the diagnosis of primary hyperparathyroidism is established may be separated into three groups: those for whom early operation is indicated, those for whom operation should be delayed to permit recovery from other life‐endangering acute disease, and those for whom operation is unjustified because of minimal uncomplicated hypercalcemia and other serious disease greatly limiting life expectancy. These categories encompass all age groups and are not restricted to the elderly. All patients require periodic

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1975.tb00424.x

年代:1975

数据来源: WILEY

摘要:

ABSTRACTIn a study of senile degenerative lesions—including Alzheimer's neurofibrillary changes, senile plaques and amyloid angiopathy—the hippocampal area of the brain was examined by thioflavine T fluorescence microscopy in 146 consecutive autopsy patients over the age of 49. The incidence and quantity of neurofibrillary changes and senile plaques rose with age, and an approximate positive correlation in quantity was noted among the three kinds of degenerative change. The quantity of neurofibrillary lesions and senile plaques was significantly different between the demented and non‐demented patients, but not between the severely and less severely demented patients. The cause of dementia was studied retrospectively, based on the extent of morphologic changes in the brain, thus classifying dementia into three types: degenerative, vascular, and mixed. Clinically, the mixed type resembled the vascular type with regard to major neurologic signs, and there was some similarity to the degenerative type with regard to mental fea

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1975.tb00425.x

年代:1975

数据来源: WILEY

摘要:

ABSTRACTStarting in childhood, blood lipid levels rise progressively with each ten‐year period until age 70, when cholesterol and triglyceride levels begin to stabilize and then decline. By age 80 there is a precipitous drop to approximately the values noted in persons of the 20–30 age group. Data on 195 residents of a geriatric center are included. Despite the lower average lipid levels, 30 per cent of the elderly show some lipid abnormality. There is a definite increase in the risk of death from coronary artery disease in hyperlipidemic persons as compared to those who are normolipidemic, even during the eighth and ninth age decades. Hyperlipidemia appears to be a significant risk in the elderly, as in persons of any age, and should be treated accordin

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1975.tb00426.x

年代:1975

数据来源: WILEY

摘要:

ABSTRACTThe hemangiopericytoma is an invasive tumor of vascular origin. No matter how benign the course and how circumscribed the mass, it must be considered a lesion with high malignant potential. In the case reported here, a hemangiopericytoma of the pancreas with metastasis to the liver was associated with microangiopathic hemolytic anemia in a 78‐year old woman. The anemia may have been present before the onset of metastasis. If so, it could have been a major factor in the breakdown of host response and could have initiated the malignant dissemination. Under these circumstances it could be an indicator of metastasis in patients with previously diagnosed tumors. However, there are many cases of metastatic malignancy associated with this anemia in which the opposite situation holds. The anemia is usually of extracorpuscular origin. Apparently intravascular coagulation caused by injury from tumor‐cell aggregates in small vessels induces erythrocyte fragmentation on fibrin strands. A vicious cycle of cell fragmentation, vascular injury and fibrin strand formation completes the course. Analysis of the findings should be based upon more than a strictly pathologic approach; it should also be related to the new discoveries in cancer resea

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1975.tb00427.x

年代:1975

数据来源: WILEY

摘要:

ABSTRACTIn the course of a study (now including 53 patients) on the effectiveness of urokinase in the treatment of acute coronary occlusion, coronary angiography was performed in 2 patients before and after the use of this drug. In both instances the angiograms demonstrated obstruction in the coronary‐artery branches, with additional narrowing and some collateral circulation. After urokinase therapy, blood flow was restored in the areas previously obstructed. These 2 case reports are presented because they demonstrate this favorable change in coronary blood flow in association with this particular form of therapy. It is hoped that the completed urokinase study may add some information concerning the effect of thrombolysis in the management of myocardial infarctio

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1975.tb00428.x

年代:1975

数据来源: WILEY

摘要:

ABSTRACTTrigeminal neuralgia can be excruciatingly painful. For aged patients, among whom trigeminal neuralgia most commonly occurs, medical therapy may often afford relief of pain. However, since this disorder is likely to become worse with increasing age, medical therapy eventually may fail because of increasing drug requirements and intolerable side effects. Major forms of surgical treatment requiring craniotomy may afford longstanding relief but are associated with significant side effects in 3–5 per cent of cases. For these reasons the authors began to test a new surgical approach, i.e., stereotaxic percutaneous electrocoagulation of the trigeminal nerve. More than 300 patients have been treated by this technique in the past five years. Successive radiofrequency lesions allow the production of a graded sensory deficit sufficient to relieve pain while preserving touch and motor function in the face. Unnecessary suffering from the severe pain of trigeminal neuralgia need not occur because of age or a debilitated condition which might ordinarily preclude surgical treatment. More than 100 patients over 65 years of age (4 of them older than 90) have been treated. Of this group, 93 per cent reported good to excellent results. Seven per cent have had some recurrent pain during the follow‐up period; however, recoagulation has been required in only 5 per cent of these patients. Recoagulation may be readily performed in any patient who shows evidence of fading of the sensory deficit. The electrocoagulation technique and the results in elderly patients are discus

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1975.tb00429.x

年代:1975

数据来源: WILEY

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1975.tb00434.x

年代:1975

数据来源: WILEY

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1975.tb00435.x

年代:1975

数据来源: WILEY