scholarly journals Preoperative risk evaluation in patients over 75 years candidates to non-cardiac and cardiac surgery

2017 ◽  
Vol 87 (2) ◽  
Author(s):  
Alessandro Boccanelli ◽  
Pompilio Faggiano

<p>In the 24<sup>th</sup> and 25<sup>th</sup>of June 2016, 80 national experts were invited to Rome from The Italian Society of Geriatric Cardiology and the Italian Association of Cardiovascular Prevention and Rehabilitation to revise the current knowledge on the perioperative risk in the elderly. Cardiologists, geriatricians, heart and general surgeons and anesthesiologists discussed the topic with the objective of reaching a consensus and to launch observational research and registries in the field of perioperative risk evaluation in the elderly. The introduction of objective measures of frailty on top of traditional cardiac evaluation in the different surgical contexts could allow for a more precise definition of “surgical risk”, appropriate perioperative management and postoperative outcome.</p>

2020 ◽  
Vol 6 (3) ◽  
Author(s):  
Stefano Cavallero ◽  
Ligia J. Dominguez ◽  
Laura Vernuccio ◽  
Mario Barbagallo

Although presbyphagia is a clinically relevant problem among elderly population, possibly leading to dysphagia in old age, it remains a still underestimated health condition. The present review analyzes swallowing related anatomical and functional changes during aging, both in healthy people and in those affected by dysphagia. First of all, dysphagia in old people must not be confused with presbyphagia. To distinguish these two different conditions, a correct definition of both should be considered. Subsequently, a comprehensive evaluation including instrumental analysis should be carried out. The aim of this narrative review is to analyze the current knowledge of this clinical condition and to provide the state of art to clinicians. A systematic PubMed research on dysphagia in the elderly was conducted and most relevant and most recent references were manually screened and selected. The aim of a correct diagnosis is to enable the choice of a correct intervention in order to prevent and treat complications of dysphagia, such as ab ingestis pneumonia and malnutrition. Moreover, the assessment, diagnosis and therapy of dysphagia/ presbyphagia should include the intervention of different specialists.


2020 ◽  
Vol 25 (3) ◽  
pp. 162-173 ◽  
Author(s):  
Sascha Zuber ◽  
Matthias Kliegel

Abstract. Prospective Memory (PM; i.e., the ability to remember to perform planned tasks) represents a key proxy of healthy aging, as it relates to older adults’ everyday functioning, autonomy, and personal well-being. The current review illustrates how PM performance develops across the lifespan and how multiple cognitive and non-cognitive factors influence this trajectory. Further, a new, integrative framework is presented, detailing how those processes interplay in retrieving and executing delayed intentions. Specifically, while most previous models have focused on memory processes, the present model focuses on the role of executive functioning in PM and its development across the lifespan. Finally, a practical outlook is presented, suggesting how the current knowledge can be applied in geriatrics and geropsychology to promote healthy aging by maintaining prospective abilities in the elderly.


2020 ◽  
Vol 20 ◽  
Author(s):  
Md. Sahab Uddin ◽  
Sharifa Hasana ◽  
Md. Farhad Hossain ◽  
Md. Siddiqul Islam ◽  
Tapan Behl ◽  
...  

: Alzheimer’s disease (AD) is the most common form of dementia in the elderly and this complex disorder is associated with environmental as well as genetic components. Early-onset AD (EOAD) and late-onset AD (LOAD, more common) are major identified types of AD. The genetics of EOAD is extensively understood with three genes variants such as APP, PSEN1, and PSEN2 leading to disease. On the other hand, some common alleles including APOE are effectively associated with LOAD identified but the genetics of LOAD is not clear to date. It has been accounted that about 5% to 10% of EOAD patients can be explained through mutations in the three familiar genes of EOAD. The APOE ε4 allele augmented the severity of EOAD risk in carriers, and APOE ε4 allele was considered as a hallmark of EOAD. A great number of EOAD patients, who are not genetically explained, indicate that it is not possible to identify disease- triggering genes yet. Although several genes have been identified through using the technology of next-generation sequencing in EOAD families including SORL1, TYROBP, and NOTCH3. A number of TYROBP variants were identified through exome sequencing in EOAD patients and these TYROBP variants may increase the pathogenesis of EOAD. The existence of ε4 allele is responsible for increasing the severity of EOAD. However, several ε4 allele carriers live into their 90s that propose the presence of other LOAD genetic as well as environmental risk factors that are not identified yet. It is urgent to find out missing genetics of EOAD and LOAD etiology to discover new potential genetics facets which will assist to understand the pathological mechanism of AD. These investigations should contribute to developing a new therapeutic candidate for alleviating, reversing and preventing AD. This article based on current knowledge represents the overview of the susceptible genes of EOAD, and LOAD. Next, we represent the probable molecular mechanism which might elucidate the genetic etiology of AD and highlight the role of massively parallel sequencing technologies for novel gene discoveries.


2013 ◽  
Vol 103 (6) ◽  
pp. 538-544 ◽  
Author(s):  
Glenna M. Malcolm ◽  
Gretchen A. Kuldau ◽  
Beth K. Gugino ◽  
María del Mar Jiménez-Gasco

Much of the current knowledge on population biology and ecology of soilborne fungal pathogens has been derived from research based on populations recovered from plants displaying disease symptoms or soil associated with symptomatic plants. Many soilborne fungal pathogens are known to cause disease on a large number of crop plants, including a variety of important agronomical, horticultural, ornamental, and forest plants species. For instance, the fungus Verticillium dahliae causes disease on >400 host plants. From a phytopathological perspective, plants on which disease symptoms have not been yet observed are considered to be nonhosts for V. dahliae. This term may be misleading because it does not provide information regarding the nature of the plant–fungus association; that is, a nonhost plant may harbor the fungus as an endophyte. Yet, there are numerous instances in the literature where V. dahliae has been isolated from asymptomatic plants; thus, these plants should be considered hosts. In this article, we synthesize scattered research that indicates that V. dahliae, aside from being a successful and significant vascular plant pathogen, may have a cryptic biology on numerous asymptomatic plants as an endophyte. Thus, we suggest here that these endophytic associations among V. dahliae and asymptomatic plants are not unusual relationships in nature. We propose to embrace the broader ecology of many fungi by differentiating between “symptomatic hosts” as those plants in which the infection and colonization by a fungus results in disease, and “asymptomatic hosts” as those plants that harbor the fungus endophytically and are different than true nonhosts that should be used for plant species that do not interact with the given fungus. In fact, if we broaden our definition of “host plant” to include asymptomatic plants that harbor the fungus as an endophyte, it is likely that the host ranges for some soilborne fungal pathogens are much larger than previously envisioned. By ignoring the potential for soilborne fungal pathogens to display endophytic relationships, we leave gaps in our knowledge about the population biology and ecology, persistence, and spread of these fungi in agroecosystems.


2021 ◽  
Author(s):  
José M. Pascual ◽  
Ruth Prieto

Classifying CPs within the overly vague, uninformative category “suprasellar” prevents gaining any true insight regarding the risks associated with the surgical procedure employed. Routine MRI obtained with conventional T1- and T2-weighted sequences along the midsagittal and coronal trans-infundibular planes allow an accurate and reliable preoperative definition of CP topography. CPs developing primarily within the infundibulum and/or tuberal region of the hypothalamus, as well as those wholly located within the 3V, should be distinguished preoperatively from those lesions originally expanding beneath the 3V floor (3VF), the true suprasellar tumors. Among adult patients, about 40% of CPs correspond to infundibulo-tuberal tumors expanding primarily within the 3VF, above an intact pituitary gland and stalk. This subgroup of CPs shows strong adherences to the surrounding hypothalamus, as they are embedded within a wide band of reactive gliotic tissue, usually infiltrated by microscopic finger-like solid cords of tumor tissue. In elderly patients, a significant proportion of CPs correspond to papillary tumors developing above an intact 3VF, usually showing small pedicle-like or sessile-like attachments to the infundibulum. With the current diagnostic MRI workup routinely employed for CPs, it is possible, for the majority of lesions, to preoperatively differentiate these topographical variants and predict the type of CP-hypothalamus relationship that will be found during surgery.


2021 ◽  
Vol 14 (3) ◽  
pp. 233
Author(s):  
Piera Federico ◽  
Emilio Francesco Giunta ◽  
Annalisa Pappalardo ◽  
Andrea Tufo ◽  
Gianpaolo Marte ◽  
...  

Hepatocellular carcinoma (HCC) is the primary tumour of the liver with the greatest incidence, particularly in the elderly. Additionally, improvements in the treatments for chronic liver diseases have increased the number of elderly patients who might be affected by HCC. Little evidence exists regarding HCC in old patients, and the elderly are still underrepresented and undertreated in clinical trials. In fact, this population represents a complex subgroup of patients who are hard to manage, especially due to the presence of multiple comorbidities. Therefore, the choice of treatment is mainly decided by the physician in the clinical practice, who often tend not to treat elderly patients in order to avoid the possibility of adverse events, which may alter their unstable equilibrium. In this context, the clarification of the optimal treatment strategy for elderly patients affected by HCC has become an urgent necessity. The aim of this review is to provide an overview of the available data regarding the treatment of HCC in elderly patients, starting from the definition of “elderly” and the geriatric assessment and scales. We explain the possible treatment choices according to the Barcelona Clinic Liver Cancer (BCLC) scale and their feasibility in the elderly population.


2017 ◽  
Vol 87 (2) ◽  
Author(s):  
Alessandra Pratesi ◽  
Francesco Orso ◽  
Camilla Ghiara ◽  
Aldo Lo Forte ◽  
Anna Chiara Baroncini ◽  
...  

<p>At present, the majority of cardiac surgery interventions have been performed in the elderly with successful short-term mortality and morbidity, however significant difficulties must to be underlined about our capacity to predict long-term outcomes such as disability, worsening quality of life and loss of functional capacity.<br />The reason probably resides on inability to capture preoperative frailty phenotype with current cardiac surgery risk scores and consequently we are unable to outline the postoperative trajectory of an important patients’ centered outcome such as disability free survival. In this perspective, more than one geriatric statements have stressed the systematic underuse of patient reported outcomes in cardiovascular trials even after taking account of their relevance to older feel and wishes. Thus, in the next future is mandatory for geriatric cardiology community closes this gap of evidences through planning of trials in which patients’ centered outcomes are considered as primary goals of therapies as well as cardiovascular ones.</p>


2017 ◽  
Vol 8 (1-IT) ◽  
Author(s):  
Mario Tanga ◽  
Giacomo Gelati ◽  
Marco Casazza

6Contemporary science and culture show more and more extended and meaningful signs about the increasing explaining power of evolutionary paradigm. This power overcomes the field of the history of living species. We consider “On the Origin of Species” of 1859 by Charles Darwin as the establishment of this paradigm, but this original and fruitful idea has received the several and different contributions from near and (seemingly) far scientific fields. This process happened according distinguishable waves and leaded the evolutionary theory very far from its starting point, making it something wider and different. The current knowledge of this theory involves many kinds of scholars: biologists, zoologists, botanists, development biologists, genetics/genomics scholars and also scholars of many other disciplines, as statistics, mathematics, ecology, environmental sciences, physics, chemistry, linguistics, sociology, neuro-sciences, epidemiology, informatics, immunology. During the end of XX Century, the study of complexity, of self-organization and of emerging properties has been a decisive factor to extend evolution until beyond the boundaries of Biology. These phenomena, or properties, or features, that are shown by “living” and “not-living” systems (so called basing ourselves on traditional definitions), have deeply modified even the “properly” biologic evolution itself and besides this has demonstrated that, mutatis mutandis, evolutionary processes or phenomena happen also out of biologic dominion, referring “biologic” to “wet-ware world”. This is to say the class of evolutionary phenomena is more widely and more inclusively extended than our opinion. We can mean this as a revolution (according to Kuhn’s definition) that imposes us to restructure the definition of evolution itself and even to redraw the boundaries and the map of Biology itself. Aiming to establish a name of this field of study we propose “PanEvolutionary Theory” (PanEvo Theory). No doubt Prigogine offered an important contribution to this area. The thinking and the work of Enzo Tiezzi can be placed seen in the same perspective. Disregarding direct connections and contacts with the Nobel Prize Prigogine, however the studies of Enzo Tiezzi are neither a fully unexpected work nor a theory lacking of important potentialities: it is not a strange or eccentric academic exercise. Except the close contact and the dense exchanges with Prigogine, we collocate Enzo Tiezzi in the same context of Gregory Chaitin, of Rachel Carson, of John Harte and Robert H. Socolow, of James Paul Wesley, of Sertorio, of Oort and Peixoto, just to cite the most strictly related. Our Academy had the privilege and the honor of having Enzo Tiezzi in its ranks. We think that merits and developments of the thinking of this scholar have to produce important and lasting fruits in the future.


2013 ◽  
pp. 12-19
Author(s):  
Patrizia Zoboli ◽  
Giuseppe Chesi ◽  
Fabrizio Boni ◽  
Federica Maselli ◽  
Lisa Zambianchi

BACKGROUND Internal medicine specialists are often asked to evaluate a patient before surgery. Perioperative risk evaluation for elderly patients is important, because complications increase with age. The increasing age of the general population increases the probabilities of surgery in the older patients. The manifestation of a surgical problem, is more likely to be severe and complicated in the elderly patients. In fact, emergency surgery treatment occurs more frequently in the elderly (e.g., it is much more common to see intestinal obstruction complicating colorectal cancer in the elderly compared with a younger population). Old age is an independent factor for long hospital stay after surgery. The role of the preoperative medical consultant is to identify and evaluate a patient’s current medical status and provide a clinical risk profile, in order to decide whether further tests are indicated prior to surgery, and to optimise the patient’s medical condition in the attempt of reducing the risk of complications. The medical consultant must know which medical condition could eventually influence the surgery, achieve a good contact and communication between the medical and surgical team, in order to obtain the best management planning. AIM OF THE STUDY This paper focuses on the rational use of antibiotic prophylaxis and on the treatment of the complications of post-surgery infections (e.g., pulmonary complication, peritonitis, intra-abdominal infection). Specific aspects of pre-operative risk evaluation and peri and post-operative management are discussed. CONCLUSIONS The internal medicin specialist in collaboration with the surgical team is necessary in the peri and post-surgery management.


1994 ◽  
Vol 39 (5) ◽  
pp. 253-257 ◽  
Author(s):  
Kenneth Rockwood ◽  
Karen Stadnyk

We reviewed the findings of the Canadian Study of Health and Aging in the context of studies published between January 1986 and June 1993 that documented dementia and Alzheimer's disease prevalence. Studies were identified using a MEDLINE literature search. Additional references were selected from the bibliography of identified articles. Most reports of all types of dementia prevalence are within a narrow range for each of the age groups 65+, 75+ and 85+ years. By contrast, two recent reports on the prevalence of Alzheimer's disease have reported much higher estimates (10.3% and 15.3%) in the elderly (65+ years). A variety of threats to both validity and generalizability of the estimates are present in all studies. In community studies which employed clinical interviews most subjects were only mildly affected; the natural history of impairment of this group requires further study if the consequences of these findings are to be understood. There is important variability in the definition of the functional consequences of cognitive impairment in the elderly which affects both the diagnosis and staging of dementia.


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