RESUMEN
AIMS AND BACKGROUND: Helicobacter pylori is known to be the pathogenic agent of atrophic gastritis and above all ulcer disease. It is also thought to play a role, together with other factors, in the development of stomach cancer and is currently the focus of numerous studies. In industrialised countries, infection is relatively commonplace in children, whereas its incidence rises more steeply in patients aged over 35, reaching a mean prevalence of 50% in over 60 year olds. METHODS: During 1997 the authors carried out an epidemiological study to assay levels of anti-Helicobacter pylori (IgG anti-Hp) in a sample of 91 aged patients hospitalised in the S. Margherita Geriatric Hospital in Pavia. The patients had been admitted to hospital for various pathologies and the study also took into account gastric pathologies which usually, particularly in neoplastic forms, prefers the third and fourth ages. The assay for antibodies was performed using mouse monoclonal antibody, specific for Helicobacter pylori, absorbed on a polyester pad. A total of 5 ml of blood were collected from each patient. The blood samples were all centrifuged and the serum frozen at -20 degrees C until the tests were performed. RESULTS: In this study, 46 of the 91 patients tested were positive for anti-Helicobacter pylori antibodies, 35 were negative and 10 borderline. CONCLUSIONS: The high level of positive results found in these patients is in line with the findings reported by other authors.
Asunto(s)
Infecciones por Helicobacter/epidemiología , Helicobacter pylori/inmunología , Anciano , Animales , Anticuerpos Antibacterianos/análisis , Anticuerpos Monoclonales , Ensayo de Inmunoadsorción Enzimática , Infecciones por Helicobacter/diagnóstico , Humanos , Inmunoglobulina G/análisis , Ratones , Persona de Mediana EdadRESUMEN
After reviewing the literature on this subject, the authors examine the quality of life of geriatric patients after biliary tract surgery secondary to biliary tract carcinoma or non-neoplastic pathologies. From an analysis of the results the authors conclude that surgery is useful not only in non-neoplastic forms, but also in the event of carcinoma given that it is possible to improve the quality of life of these patients.
Asunto(s)
Enfermedades de las Vías Biliares/cirugía , Calidad de Vida , Anciano , Enfermedades de las Vías Biliares/mortalidad , Procedimientos Quirúrgicos del Sistema Biliar/estadística & datos numéricos , Femenino , Humanos , Estado de Ejecución de Karnofsky , Masculino , Periodo Posoperatorio , Resultado del TratamientoRESUMEN
INTRODUCTION AND METHODS: After reviewing the literature on the subject, the authors analysed the patients suffering from intestinal infarction selected from those examined between 1-1-1985 and 31-12-1995. It was found that out of 11,500 patients only 9 (0.07%) suffered from this pathology. RESULTS: The authors found that geriatrics (between 65 and 74 years old) were most commonly affected by this pathology, with a majority of females (55.35%) and that the most frequently associated pathologies were cardiopathies. Medical treatment and surgery were used (depending on the results of the various tests). Of these patients only 3 (33.32%) were treated medically, whereas the remainder underwent surgery using different techniques in each case. Excision of the thrombus was performed in 22.23% with the partial resection of the intestine in 44.45%. The quality of life in operated patients was reasonably satisfactory. Those undergoing excision of the thrombus enjoyed 100% wellbeing compared to only 25% of those undergoing partial intestinal resection. Those receiving medical treatment all died. The most frequent complications were short intestine (11.11%) and wound infection with possible dehiscence. CONCLUSIONS: The authors conclude by highlighting the gravity of the pathology from a diagnostic and therapeutic point of view and by underlining that the quality of life in general of operated patients was good in 33.34% of those living, with Karnofsky's Index of 100 in 22.23%.
Asunto(s)
Infarto/diagnóstico , Intestinos/irrigación sanguínea , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Infarto/complicaciones , Infarto/mortalidad , Infarto/terapia , Italia/epidemiología , Estado de Ejecución de Karnofsky , Masculino , Calidad de VidaRESUMEN
After reviewing the literature on the subject, the authors examine all the cases of aortic aneurysm referred to their attention. From the tests performed, they note that males are most often affected and the age group with the highest incidence is the seventh decade of life, in particular between 60-66 years old. After having observed a pulsing abdominal mass leading to a suspected diagnosis, the radiological methods recommended by the authors include echotomography or CT, or if required, magnetic resonance. Arteriography is less convincing than the previous tests for diagnostic purposes because, as well as providing a false image of the vessel lumen (owing to the overlay of stratified thrombi it can show a virtually normal lumen), it may cause a risk of embolism. The surgeon therefore prefers an intraoperative finding in the case of subrenal aneurysm. In conclusion, faced with a diagnosis of aneurysm of the abdominal aorta, in the majority of cases, having prepared the patient, it is necessary to perform aorto-bisiliac or bifemoral graft surgery depending on aneurysm size as soon as possible in order to avoid the fissuration or even the rupture of the aneurysm.
Asunto(s)
Aneurisma de la Aorta Abdominal/cirugía , Anciano , Aneurisma de la Aorta Abdominal/diagnóstico , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
After reviewing the literature on this subject, the authors examine the results of a five-year follow-up in all patients undergoing lung cancer surgery. The results obtained showed that old-age patients (third age) are more numerous than geriatric (fourth age) patients, and males are more frequently affected than females. The most frequent localisation in the series examined was the upper right lobe and the majority of these patients underwent lobectomy, the form of surgery that produced the best results (30.3% alive and well with a Karnofski index as high as 90 in some cases). The authors conclude that when the patient's conditions allow, surgery is advisable in lung cancer in an attempt to improve the patient's quality of life.
Asunto(s)
Anciano , Neoplasias Pulmonares/cirugía , Calidad de Vida , Factores de Edad , Femenino , Estudios de Seguimiento , Humanos , Masculino , Neumonectomía , Factores Sexuales , Factores de TiempoRESUMEN
After a brief review of the literature on this topic, the authors examine the Quality of Life in patients undergoing surgery for neoplasia of the pancreas. They found that radical pancreatic surgery for cancer in elderly patients produced better results than hepatic surgery, even if the death rate was again very high (45.95%). It is very important to underline that the patient's general conditions are very important in this form of surgery. They provide the basis for selecting derivative, endoscopic or percutaneous surgery, with the possible application of an endoprosthesis so as to treat jaundice and improve the patient's Quality of Life.
Asunto(s)
Páncreas/cirugía , Calidad de Vida , Anciano , Anciano de 80 o más Años , Peso Corporal , Femenino , Humanos , Estado de Ejecución de Karnofsky , MasculinoRESUMEN
After having examined the literature on the subject, the authors examined 23 cases of lymphoma selected from those admitted to hospital over the past 10 years: 44.78% were Hodgkin and 65.22% non-Hodgkin. They examined the localisation, which was gastric in all cases, associated pathologies and treatment, which was total gastrectomy in 56.52%. Moreover, the authors also considered the quality of life of patients undergoing total gastrectomy which was found to be good in 23.07%, a percentage which is higher than that expressed for other types of surgery (gastric resection) or medical treatment (chemotherapy). In conclusion, the authors affirm that total gastrectomy is worth performing in these patients, even if the percentage of deaths is higher than for gastric resection, given that te quality of life is better in total gastrectomy.
Asunto(s)
Gastrectomía/métodos , Enfermedad de Hodgkin/cirugía , Linfoma no Hodgkin/cirugía , Neoplasias Gástricas/cirugía , Anciano , Anciano de 80 o más Años , Femenino , Humanos , MasculinoRESUMEN
Following a review of the literature on this topic, the authors examine the quality of life in elderly patients who have undergone hepatic resection due to carcinoma in the past 5 years. An analysis of the results obtained showed that there was 20% wellbeing in right hepatectomized patients, only 14.29% in left hepatectomized and bisegmentectomized patients, and 11.11% in patients who had undergone the excision of metastases. In conclusion, the authors affirm that even if the number of deaths in relatively high it is always worth operating in an attempt to improve the patient's quality of life.
Asunto(s)
Anciano , Neoplasias Hepáticas/cirugía , Calidad de Vida , Femenino , Estudios de Seguimiento , Hepatectomía , Humanos , Hígado/cirugía , Neoplasias Hepáticas/mortalidad , Neoplasias Hepáticas/secundario , Masculino , Factores de TiempoRESUMEN
Following a careful examination of the literature on the subject, the authors examine the follow-up records of all patients operated over the past 10 years for non-neoplastic and neoplastic esophageal pathologies. From the results it emerged that all those operated for non-neoplastic pathologies were still living and their quality of life was good with a very high proportion of patients presenting a score of 100 for Karnofsky's index. With regard to neoplastic forms, on the other hand, many patients had died (approximately 50%), but the majority of those living, who had undergone gastro-esophageal resection and consequent esophago-gastrostomy with thoracization of the stomach, were well with a Karnofsky score of 100. The authors explain these results by taking into account the general conditions (biological age) of patients and conclude that surgery is advisable in both non-neoplastic and neoplastic forms, given that it is important to try to improve the quality of life even in the latter.
Asunto(s)
Anciano , Enfermedades del Esófago/cirugía , Calidad de Vida , Neoplasias Esofágicas/cirugía , Femenino , Estudios de Seguimiento , Gastrostomía , Humanos , Yeyunostomía , Estado de Ejecución de Karnofsky , MasculinoRESUMEN
Having reviewed the literature on this topic, the authors examined the "quality of life" of elderly patients undergoing surgery for gastric carcinoma over the past 5 years. From the results obtained it was seen that the most frequent operation was total gastrectomy (51.1%), followed by gastric resection (48.9%); it was therefore possible to assert that living patients were all well, with a score of 100 on Karnofsky's scale (22.40%), despite the high percentage of deaths during the period examined. The authors therefore concluded that, given that the "quality of life" of those undergoing surgery was satisfactory, it is worthwhile operating whenever possible to give geriatric patients the possibility of leading a normal life.
Asunto(s)
Carcinoma/cirugía , Calidad de Vida , Neoplasias Gástricas/cirugía , Distribución por Edad , Anciano , Carcinoma/epidemiología , Femenino , Estudios de Seguimiento , Gastrectomía/estadística & datos numéricos , Humanos , Estado de Ejecución de Karnofsky , Masculino , Distribución por Sexo , Neoplasias Gástricas/epidemiologíaRESUMEN
After reviewing the literature on this topic the authors studied all patients admitted to the Institute of Surgical Pathology I at the University of Pavia for breast cancer between 1-1-1974. An analysis of the findings revealed that: (a) Out of 993 patients with breast cancer, 204 (20.54%) belonged to the geriatric age group (> 65 years old) and of the latter 135 (66.17%) belonged to the 3rd age group and 69 (33.82%) belonged to the 4th age group (> 75 years old). (b) In the 3rd age group 25 (18.51%) were benign tumours and 110 (81.48%) were malignant, whereas in the 4th age group 4 (5.79%) were benign and 65 (94.20%) were malignant. (c) Familial patterns were also examined and were found to be positive in 47 (23.03%) cases in the 3rd age group and in 30 (14.71%) in the 4th age group. (d) In the physiological anamnesis it is interesting to note that there was 1 menarche before 12 (0.9%) in the 3rd age group; delayed menopause (after 50) in 66 cases (60%) in the 3 rd age group and in 29 cases (44.61%) in the 4 th age group. (e) In the pathological anamnesis of the patients in question it was observed that the most frequent site of previous tumours was the breast (72 cases, equivalent to 10.9% in the 3rd age group; 9 cases, 13.8% in the 4th age group). (f) In the next pathological anamnesis and at EOL it was observed that the tumours was most often found in the supero-external quadrant, in the right breast in the 3rd age group (66 cases, 48.89%) and in the left one in the 4th age group (42 cases, 60.87%). (g) Test included breast cancer scan, mammography, aspirated needle and biopsy where required. (h) Surgery in the form of Halsted's mastectomy was the preferred therapy and as early as possible. Some Authors use conservative therapy. (i) Histological tests were performed in all patients and revealed that the most frequent malignant tumour was ductal carcinoma. (j) Postoperative complications took the form of wound suppuration. (k) Only one tumour (carcinoma) was observed in male patient aged 83 years old, without metastasis. From the above findings it can be concluded that the most evident risk factor for breast cancer is the influence of the estrogen hormone.
Asunto(s)
Neoplasias de la Mama/epidemiología , Factores de Edad , Anciano , Anciano de 80 o más Años , Neoplasias de la Mama/patología , Neoplasias de la Mama/cirugía , Femenino , Humanos , Italia/epidemiología , Metástasis Linfática , Masculino , Mastectomía/estadística & datos numéricos , Complicaciones Posoperatorias/epidemiologíaRESUMEN
Following a brief review of the literature on this topic, the paper analyses a series of geriatric undergoing surgery for cancer of the large intestine and controlled during follow-up over the past years. From the results obtained, the authors assessed the quality of life of these patients according to Masera and Esposito's classification, as a state of well-being, intermediate or illness: it was found that 78.7% were in a state of well-being, 10.3% were unchanged, 12.1% were in a state of illness, and only 6.9% had died. The authors therefore concluded that the quality of life in the majority of elderly patients undergoing surgery is good, thus encouraging surgeons to intervene.
Asunto(s)
Colon/cirugía , Calidad de Vida , Anciano , Colectomía/estadística & datos numéricos , Neoplasias del Colon/epidemiología , Neoplasias del Colon/mortalidad , Neoplasias del Colon/cirugía , Femenino , Estudios de Seguimiento , Humanos , Masculino , Complicaciones Posoperatorias/epidemiologíaRESUMEN
Following a review of the literature on this topic, the authors examine all patients with thyroid pathologies who were admitted to the 1st Institute of Surgical Pathology of the University of Pavia between 1-1-1974 and 31-12-1990. Only patients aged over 65 were included in the study and were subdivided into two groups, namely those aged between 65-74 (3rd age) and those over 75 (4th age). Particular attention was focused on the type of pathology (benign or malignant), other pathologies associated to the basic pathology, the type of operation performed and, in the case of malignant diseases, the histological type of tumour and any metastasis. The results of this series were then compared to those reported elsewhere. The Authors conclude that thyroid pathologies in geriatric patients are very important since, given that at this age the gland is becoming atrophic, the onset of disease often occurs before the age of 65 and symptoms in these patients are imprecise. In view of the good results obtained, it is always worth operating in order to give the patient a reasonable life expectancy, especially in those cases with collateral disorders (compression) caused by the thyroid mass.
Asunto(s)
Enfermedades de la Tiroides/cirugía , Adenocarcinoma/cirugía , Factores de Edad , Anciano , Carcinoma/cirugía , Carcinoma Papilar/cirugía , Femenino , Humanos , Masculino , Neoplasias de la Tiroides/cirugía , TiroidectomíaRESUMEN
After reviewing the literature on this topic, the authors examine all patients admitted to the Institute of Surgical Pathology in Pavia with a diagnosis of intestinal occlusion from 1-1-1974 to 31-12-1990. Of these, only those aged over 65 were included in the study and were in turn subdivided into 3rd and 4th age groups. The etiopathogenesis of this disorder is also discussed, stressing that it may be non-neoplastic (Group I) or neoplastic (Group II). The treatment used is also examined (surgical in the majority of cases) together with postoperative complications occurring in these patients. From the results obtained it is concluded that the method used in the pre-, intra- and postoperative stages provided satisfactory results, also in relation to the postoperative mortality rate which relatively low compared to other published reports.
Asunto(s)
Obstrucción Intestinal/diagnóstico , Anciano , Urgencias Médicas , Femenino , Humanos , Neoplasias Intestinales/complicaciones , Neoplasias Intestinales/epidemiología , Obstrucción Intestinal/epidemiología , Obstrucción Intestinal/etiología , Obstrucción Intestinal/cirugía , Intestinos/cirugía , Italia/epidemiología , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/epidemiologíaRESUMEN
Acute pathologies of the biliary tract in geriatric patients were examined in this study taking into account the major causes, treatment used and results obtained. All patients aged over 65 who had been hospitalised during the past 17 years for acute pathologies of the biliary tract (564 cases, equivalent to 34.2% of all in-patients suffering from acute biliary pathologies) were included in the study. These patients were then subdivided into 3rd and 4th age groups (65-74 and < 75 years respectively). The results obtained in the 3rd age group (267 patients, 60%) showed the greatest number of cases of inflammatory lithiasic disease of the cholecystus (61.2%) and VBP (17.7%), whereas 45 patients, equivalent to 49.5%, presented tumours with jaundice. Out of a total of 179 cases in patients in the 4th age group, equivalent to 39.3%, 119 (66.5%) were suffering from lithiasic cholecystitis and 16 (8.9%) from calcolosis of the VBP with jaundice. Cancer of the pancreas head was diagnosed in 27 patients (58.7%), whereas 9 (19.6%) had obstruent cancer of the biliary tract. The Authors conclude that both the preoperative preparation, the choice of operation and postoperative treatment give satisfactory results with a very low early mortality (0.8% in non-tumour cases and 6.9% in tumour cases).
Asunto(s)
Enfermedades de las Vías Biliares , Enfermedad Aguda , Anciano , Enfermedades de las Vías Biliares/complicaciones , Enfermedades de las Vías Biliares/diagnóstico , Enfermedades de las Vías Biliares/etiología , Enfermedades de las Vías Biliares/terapia , Neoplasias del Sistema Biliar , Femenino , Humanos , Masculino , Complicaciones PosoperatoriasRESUMEN
Following a review of the literature on the topic, the Authors examined all patients admitted to the Institute of Surgical Pathology 1st at the University of Pavia between 1-1-1974 and 31-12-1988 for hiatus hernia, paying special attention to those aged over 65. From an analysis of the results, it was possible to evaluate the influence of collateral pathologies and age-dependent biological changes on the basic disease and the outcome of the operation in elderly patients. In conclusion, this pathology, although not strictly confined to old age, affects a large number of elderly patients, particularly females. It rarely causes acute attacks and it is therefore possible to time the operation to coincide with the patient's best conditions. This is the reason for the excellent results achieved, whereas complications are not related to chronological age but above all to the biological age of the patient.
Asunto(s)
Hernia Hiatal/cirugía , Anciano , Hernia Hiatal/complicaciones , Hernia Hiatal/diagnóstico , Hernia Hiatal/epidemiología , Humanos , Italia/epidemiología , Persona de Mediana Edad , Complicaciones Posoperatorias/epidemiologíaRESUMEN
After examining the various diagnostic methods used for gastric cancer, the paper analyses all geriatric patients affected by this disease and hospitalised in the Institute of Pathological Surgery at the University of Pavia between 1/1/1974 and 31/12/1986. The results obtained confirmed that: the subjective symptoms of the elderly patient affected by gastric cancer differ in a large number of cases from those in adults; in some cases, in fact, the disease is silent for long periods of time, whereas it is only slight in others; tests performed revealed neoplasia and possible metastases. In conclusion, although the symptomatology in elderly patients is not clear, some symptoms (weight loss, anemia, etc.) may give the doctor cause for concern. Diagnosis may be made using a variety of tests, ranging from the more commonplace (X-ray of the digestive tract, echography, gastroscopy with biopsy, etc.) to the most recent techniques (immunoscintigraphy).
Asunto(s)
Neoplasias Gástricas/diagnóstico , Anciano , Diagnóstico Diferencial , Femenino , Fundus Gástrico , Humanos , Masculino , Métodos , Persona de Mediana Edad , Antro Pilórico , Neoplasias Gástricas/epidemiologíaRESUMEN
Following a review of the literature on the topic, the authors examined all patients admitted to the Institute of Surgical Pathology 1st at the University of Pavia between 1-1-1974 and 31-12-1988 affected by hernias of the abdominal wall or surgical laparoceles, paying special attention to those patients aged over 65. Attention was focused on concomitant diseases, the acuteness of the basic pathology and possible recurrence. From the results obtained it was concluded that the associated pathology and the acute state of the basic diseases condition the successful outcome of the operation more than age itself. For this reason, it is important that patients affected by these pathologies are operated as soon as possible in order to carry out an elective operation which reduces postoperative complications and reduces the risk of recurrence.
Asunto(s)
Hernia Ventral/epidemiología , Enfermedad Aguda , Factores de Edad , Anciano , Hernia Ventral/complicaciones , Hernia Ventral/terapia , Humanos , Italia/epidemiología , Persona de Mediana Edad , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/terapia , Recurrencia , Factores SexualesRESUMEN
After a review of the literature on the subject, all IIIrd and IVth age patients admitted for acute abdomen to the Department of Surgical Pathology I of the University of Pavia between 1-1-1974 and 31-12-1988 were studied. The various pathologies encountered in acute abdomen are considered on the basis of the results obtained, stress being laid on the clinical and diagnostic problems observed in these patients in relation to those of adult age. It is concluded that the study method used in the elderly gave good results with a mortality rate lower than that encountered in other studies on the subject.
Asunto(s)
Abdomen Agudo/epidemiología , Abdomen Agudo/etiología , Abdomen Agudo/mortalidad , Abdomen Agudo/cirugía , Anciano , Femenino , Humanos , Italia/epidemiología , Masculino , Persona de Mediana EdadRESUMEN
After a review of the literature a study was conducted into oesophageal cancers among elderly patients in Pavia University's Institute of Surgical Pathology in 1974-1985. The results led to the following conclusions: this disease occurs most often among the elderly especially those in their sixties; symptoms (dysphagia, weight loss, regurgitation with epigastric and retrosternal pain are initially unclear which makes early diagnosis difficult; most cases require surgery. It is concluded that the appropriate tests should be performed at the first warning signs and that, once the condition is diagnosed, the elderly patient should be prepared for surgery which should be as radical as possible.