scholarly journals Cholecystoduodenal Stenting: An Option in Complicated Acute Calculous Cholecystitis in the Elderly Comorbid Patient

2018 ◽  
Vol 2018 ◽  
pp. 1-6
Author(s):  
Brady Chapman Bonner ◽  
Nicholas I. Brown ◽  
Varghese Pynadath Joseph ◽  
Manju Dashini Chandrasegaram
Keyword(s):  
The Elderly ◽  
Gallbladder Drainage ◽  
Acute Calculous Cholecystitis ◽  
Intravenous Antibiotics ◽  
Invasive Techniques ◽  
Calculous Cholecystitis ◽  
Term Management ◽  
Severe Cardiac Disease

We describe the course of an 84-year-old lady with acute calculous cholecystitis. She was unable to have a cholecystectomy due to multiple comorbidities including morbid obesity, type 2 diabetes, Guillain–Barrè syndrome, chronic sacral pressure ulcer, and severe cardiac disease. Conservative treatment with intravenous antibiotics was initially successful; however, she subsequently re-presented with an empyema of the gallbladder. She was readmitted for further intravenous antibiotics and underwent percutaneous gallbladder drainage. The patient did not want a permanent catheter for drainage, nor the prospect of repeat drainage procedures in the future for recurrent cholecystitis. Following a discussion of the rationale and risks involved with other minimally invasive techniques, she underwent cholecystoduodenal stent placement following disimpaction and removal of cystic duct stones. The procedure restored antegrade gallbladder drainage, and at 18 months she remains symptom-free from her gallbladder. Long-term management of recurrent cholecystitis in elderly comorbid patients commonly includes permanent cholecystostomy or repeated percutaneous gallbladder drainage, both of which can be poorly tolerated. Permanent cholecystoduodenal stenting is a reasonable alternative in carefully considered patients in whom the benefits outweigh the risks. We describe our experience with cholecystoduodenal stenting and discuss some of the concerns and considerations with this technique.

scholarly journals Diabetes type 2 diabetes in the elderly – solved and unsolved questions

2016 ◽  
Vol 19 (4) ◽  
pp. 322-330
Author(s):  
Tat'jana Vladimirovna Saprina ◽  
Nailja Maratovna Fajzulina
Keyword(s):  
Quality Of Life ◽  
Diabetes Mellitus Type 2 ◽  
Diabetes Type 2 ◽  
The Elderly ◽  
Diabetes Type ◽  
Elderly Persons ◽  
Basic Information

The number of elderly persons with diabetes mellitus type 2 is expected to progressively increase. Management of this category of patients should be individualised and include the adequate correction of hyperglycaemia, prevention of long-term complications, prevention of hypoglycaemia, reduction of cardiovascular mortality and preservation of quality of life. This article summarises basic information on the pathophysiology of carbohydrate metabolism, peculiarities of the course of diabetes and use of antidiabetic drugs in the elderly. Special attention is paid to reviewing the goals of glycaemic control and proposed clinical guidelines.

scholarly journals Anterior hypopituitarism secondary to biopsy-proven IgG4-related hypophysitis in a young man

2019 ◽  
Vol 2019 ◽  
Author(s):  
H Joshi ◽  
M Hikmat ◽  
A P Devadass ◽  
S O Oyibo ◽  
S V Sagi
Keyword(s):  
Clinical Manifestations ◽  
Pituitary Hormone ◽  
List Type ◽  
Igg4 Related Disease ◽  
Anterior Pituitary Hormone ◽  
Immune Mediated ◽  
Learning Points ◽  
Term Management

Summary IgG4-related disease (IgG4-RD) is an immune-mediated fibro-inflammatory condition which can affect various organs including the pituitary gland. The true annual incidence of this condition remains widely unknown. In addition, it is unclear whether IgG4 antibodies are causative or the end result of a trigger. With no specific biomarkers available, the diagnosis of IgG4-related hypophysitis remains a challenge. Additionally, there is a wide differential diagnosis. We report a case of biopsy-proven IgG4-related hypophysitis in a young man with type 2 diabetes mellitus. Learning points: IgG4-related hypophysitis is part of a spectrum of IgG4-related diseases. Clinical manifestations result from anterior pituitary hormone deficiencies with or without diabetes insipidus, which can be temporary or permanent. A combination of clinical, radiological, serological and histological evidence with careful interpretation is required to make the diagnosis. Tissue biopsy remains the gold standard investigation. Disease monitoring and long-term management of this condition is a challenge as relapses occur frequently.

Health Risks Associated with Meat Consumption: A Review of Epidemiological Studies

2015 ◽  
Vol 85 (1-2) ◽  
pp. 70-78 ◽  
Author(s):  
Evelyne Battaglia Richi ◽  
Beatrice Baumer ◽  
Beatrice Conrad ◽  
Roger Darioli ◽  
Alexandra Schmid ◽  
...  
Keyword(s):  
Total Mortality ◽  
The Elderly ◽  
Epidemiological Studies ◽  
Red Meat ◽  
Processed Meat ◽  
Increased Risk ◽  
Meta Analyses ◽  
Protein Supply

Abstract. Recent evidence from large prospective US and European cohort studies and from meta-analyses of epidemiological studies indicates that the long-term consumption of increasing amounts of red meat and particularly of processed meat is associated with an increased risk of total mortality, cardiovascular disease, colorectal cancer and type 2 diabetes, in both men and women. The association persists after inclusion of known confounding factors, such as age, race, BMI, history, smoking, blood pressure, lipids, physical activity and multiple nutritional parameters in multivariate analysis. The association has not always been noted with red meat, and it has been absent with white meat. There is evidence of several mechanisms for the observed adverse effects that might be involved, however, their individual role is not defined at present. It is concluded that recommendations for the consumption of unprocessed red meat and particularly of processed red meat should be more restrictive than existing recommendations. Restrictive recommendations should not be applied to subjects above about 70 years of age, as the studies quoted herein did not examine this age group, and the inclusion of sufficient protein supply (e. g. in the form of meat) is particularly important in the elderly.

scholarly journals Long-term management of type 2 diabetes with glucagon-like peptide-1 receptor agonists

2017 ◽  
Vol Volume 10 ◽  
pp. 79-87 ◽  
Author(s):  
Hamish Courtney ◽  
Rahul Nayar ◽  
Chinnadorai Rajeswaran ◽  
Ravi Jandhyala
Keyword(s):  
Type 2 Diabetes ◽  
Receptor Agonists ◽  
Glucagon Like Peptide ◽  
Glucagon Like Peptide 1 ◽  
Term Management

scholarly journals Long-Term Immunogenicity and Safety of a Conventional Influenza Vaccine in Patients with Type 2 Diabetes

2015 ◽  
Vol 22 (11) ◽  
pp. 1160-1165 ◽  
Author(s):  
Yu Bin Seo ◽  
Ji Hyeon Baek ◽  
Jacob Lee ◽  
Joon Young Song ◽  
Jin Soo Lee ◽  
...  
Keyword(s):  
Influenza Vaccine ◽  
Standard Dose ◽  
The Elderly ◽  
Diabetic Group ◽  
Controlled Study ◽  
Diabetic Patients ◽  
Seroprotection Rate ◽  
Diabetes Status

ABSTRACTNo previous studies have assessed the persistence of immune responses in individuals with diabetes. We conducted this study to evaluate the long-term immunogenicity and safety of an influenza vaccine in type 2 diabetic subjects compared with nondiabetic controls. A randomized and controlled study was conducted at two university hospitals during the 2012-2013 influenza season. The study vaccine was a standard-dose trivalent subunit inactivated intramuscular vaccine. Serum hemagglutination-inhibiting (HI) antibodies were measured at the time of vaccination and 1 month and 6 months after vaccination. Local and systemic reactions were recorded for 7 days. A total of 105 diabetic patients and 108 controls were included in the analysis. One month after vaccination, both the diabetic and nondiabetic groups satisfied all of the criteria of the Committee for Medical Products for Human Use (CHMP), and the immunogenicity profiles were statistically similar between the two groups. Although the vaccine was well tolerated, and all adverse reactions were mild to moderate, there was a tendency toward a reduced incidence of local reactions in the diabetic group. All values in the long-term immunogenicity profiles were statistically similar between the two groups, except for the seroprotection rate for the A/H1N1 influenza virus strain, which was significantly lower in the elderly diabetic group than that in the elderly nondiabetic group. However, in multivariate analysis, long-term immunogenicity was associated with age and prevaccination titer, regardless of diabetes status. (This study has been registered at CRIS [https://cris.nih.go.kr/cris/en/] under registration no. KCT0001423.)

scholarly journals Evaluation of results of laparoscopic cholecystectomy after cholecystostomy for acute calculous cholecystitis

2020 ◽  
Vol 10 (2) ◽  
Author(s):  
Tuấn Ngọc Nguyễn ◽  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Conversion Rate ◽  
Cross Sectional Study ◽  
High Rate ◽  
Cross Sectional ◽  
Female Ratio ◽  
Gallbladder Drainage ◽  
Acute Calculous Cholecystitis ◽  
Percutaneous Transhepatic Gallbladder Drainage ◽  
Calculous Cholecystitis

Tóm tắt Đặt vấn đề: Xác định tỷ lệ phẫu thuật nội soi (PTNS) thành công và một số yếu tố liên quan của PTNS cắt túi mật (TM) sau dẫn lưu túi mật (DLTM) qua da xuyên gan hoặc DLTM qua da trong viêm túi mật cấp (VTMC) do sỏi. Phương pháp nghiên cứu: Nghiên cứu cắt ngang người bệnh (NB) được PTNS cắt TM sau DLTM do VTMC do sỏi tại Bệnh viện Trưng Vương từ tháng 01/2013 đến tháng 6/2019. Kết quả: 72 NB được DLTM, 35 nam, 37 nữ, tỉ lệ nam/nữ 0,94. Tuổi trung bình là 57,8 ± 14,3. DLTM thành công 100%. Tỉ lệ chuyển mổ mở của PTNS cắt TM sau DLTM là 1,4 % (1 NB). Kết luận: DLTM trong VTMC do sỏi là kỹ thuật dễ thực hiện, an toàn, tỉ lệ thành công cao (100%), không có tai biến, và biến chứng nghiêm trọng. PTNS cắt TM sau DLTM thành công cao (98,6%), tỉ lệ chuyển mổ mở thấp, tai biến, biến chứng không đáng kể. DLTM là phương pháp điều trị tạm thời hiệu quả để chuẩn bị cho PTNS cắt TM sau đó. Abstract Introduction: Identification of successful rate of laparoscopic cholecystectomy (LC) and analysis of factors related to results of LC for post-percutaneous transhepatic gallbladder drainage or percutaneous gallbladder drainage (PTGBD) in acute calculous cholecystitis (ACC). Materials and Methods: Cross-sectional study. The patients with cholecystostomy due to ACC underwent LC at Trung Vuong hospital from January 2013 to June 2019 enrolled. Results: 72 patients had PTGBD including 35 male and 37 female, male/ female ratio was 0.94. The mean age was 57.8 ± 14.3 years old. The success rate of PTGBD was 100%. The LC has performed successfully for PTGBD and conversion rate to open surgery was 1,4% (1 patient). Conclusion: PTGBD for ACC is a feasilble and safe technique, high rate of success (100%) without any serious accidents and complications. LC after PTGBD has conducted successfully at high rate (98,6%), very low conversion rate and minimal complications. PTGBD is an effective temporary management for preparation of subsequent laparoscopic cholecystectomy Keywords: Cholecystitis, Percutaneous Transhepatic Gallbladder Drainage.

The long-term effect of community-based health management on the elderly with type 2 diabetes by the Markov modeling

2014 ◽  
Vol 59 (2) ◽  
pp. 353-359 ◽  
Author(s):  
Jianqian Chao ◽  
Mengmeng Zong ◽  
Hui Xu ◽  
Qing Yu ◽  
Lili Jiang ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Health Management ◽  
The Elderly ◽  
Term Effect ◽  
Markov Modeling ◽  
Community Based ◽  
Long Term Effect

scholarly journals Long-term results of surgical treatment of calculous cholecystitis with the use of mini-access

2014 ◽  
Vol 21 (1) ◽  
pp. 67-69
Author(s):  
R. A. Sopiya ◽  
A. A. Popov ◽  
A. J. Korobov ◽  
E. R. Sopiya
Keyword(s):  
Surgical Treatment ◽  
Clinical Laboratory ◽  
Long Term Results ◽  
Acute Calculous Cholecystitis ◽  
Sf 36 ◽  
Instrumental Methods ◽  
Calculous Cholecystitis

The paper presents the follow-up results of the mini-access surgery for chronic calculous cholecystitis (72 patients) and for calculous cholecystitis (133 patients) performed 3-6 years ago. The long-term results were estimated on two international questionnaires of quality of life (SF-36, GSRS), and on the data of clinical, laboratory and instrumental methods of investigation. All patients operated on for chronic calculous cholecystitis had good long-term results. 99.3 % of the patients with acute calculous cholecystitis had good and satisfactory results of surgical treatment. Only 1 (0.7 %) patient had an unfavourable result, because of choledocholithiasis, identified 2 years after surgery.

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