Diagnosis In Elderly Patients Research Articles

WITHDRAWN: Ulcerative Colitis in Elderly People: An Emerging Issue

Ulcerative colitis (UC) is a common cause of chronic gastrointestinal disease in the developed world, which has a bimodal age distribution, with 10-30% of the affected population older than 60 years. Elderly patients with UC will be seen more frequently with the aging of the population and increasing incidence of UC. The management of UC in the elderly population is more complex due to comorbidities and polypharmacy. This review article provides a brief up-to-date comprehensive summary of the epidemiology, diagnosis, and management of UC, with a focus on the special caring for elderly patients. Clinical challenges in the diagnosis of elderly patients with UC and the adverse effects or benefits of treatment options have been described.

Limited Prognostic Value of Pretreatment Neutrophil-to-Lymphocyte Ratios in Elderly Patients with Multiple Myeloma.

Recent studies reported neutrophil to lymphocyte ratio (NLR) as a predictor of overall survival (OS) in multiple myeloma (MM). However, the role of NLR at diagnosis in elderly patients with MM has been less explored. Therefore, we aimed to investigate the relationships between NLR and prognosis in elderly patients with MM. We retrospectively analyzed the data for 76 newly diagnosed elderly MM patients between January 1, 2007 and September 31, 2015. Seventy-six age- and gender-matched healthy controls were also included in the study. NLR was significantly higher in MM patients than the control group (2.9 ± 2.29 vs. 1.88 ± 0.54, respectively; p < 0.0001). Patients with a NLR < 2 at diagnosis had slightly better OS when compared to those with a NLR ≥ 2 (41 and 36 months, respectively), but the differences were not statistically significant. The elevated NLR did not predict response to initial therapy. Patients were regrouped into the bortezomib group and the non-bortezomib group. In the bortezomib group, notably the OS was borderline significantly longer in the patients with NLR < 2 when compared to those with NLR ≥ 2 (48 months vs. 25 months, p = 0.041). In the multivariate analysis, ISS III stage and high lactate dehydrogenase levels were significantly associated with OS. We found NLR had no effect on prognosis in newly diagnosed elderly MM patients. Further studies focused on this subject are warranted.

Polymyalgia Rheumatica: A Challenging Diagnosis in Elderly Patients - Case Reports

Polymyalgia Rheumatica: A Challenging Diagnosis in Elderly Patients - Case Reports

Changes in survival of primary central nervous system lymphoma based on a review of national databases over 40 years.

2040 Background: There has been significant improvement in treatment outcomes of Primary Central Nervous System Lymphoma (PCNSL) at specialized centers over past decades, and it is unclear if these changes have translated to benefits in the general population. In this study, we utilized national databases to examine survival trends over time. Methods: Incidence rates were obtained from the Central Brain Tumor Registry of the United States (CBTRUS, 2000 – 2013) and 18 Surveillance, Epidemiology and End Results (SEER, 1973 – 2013) registries. Data for survival analysis was obtained from SEER and analyzed using SEER*STAT. To focus on non-HIV-associated PCNSL, patients with “other infectious and parasitic diseases including HIV” as cause of death and follow up were excluded. CBTRUS identified 19,027 patients over 13 years and SEER 6,765 over 40 years. Results: The annual incidence of PCNSL in 2013 was 0.4 per 100,000 population (CBTRUS/SEER). Incidence increased from 0.1 per 100,000 in the 1970s to 0.4 per 100,000 in the 1980s, correlating with an increase in the diagnosis of elderly patients, ≥70 (1973:0.2 vs 2013:2.1 – SEER). Incidence rates differed greatly between young and elderly patients (20-29: 0.08 vs 70-79: 4.32 – CBTRUS). The median overall survival (mOS) of all patients is 17 months (m) with no survival benefit based on sex. Survival doubled from 12.5 m in the 1970s to 26 m in the 2010s. There was a significant difference in survival based on age: &lt; 50: 83 m vs 50-69: 25 m vs ≥70: 6 m (p-value &lt; 0.0001). In patients &lt; 50, mOS increased from 35.5 m in the 1970s to 134 m in the 2000s (mOS not achieved in 2010s). In patients 50-69, mOS increased from 8 m in the 1970s to 35 m in the 2010s. However, mOS in the elderly population, ≥70, has not changed in the last 40 years (6 m in the 1970s vs 7 m in the 2010s, p-value = 0.1). Conclusions: PCNSL is a disease that more frequently affects the elderly. Although overall survival has increased over the past 4 decades, reflecting current literature in PCNSL, survival in the elderly has not changed since the 1970s. Identification of this vulnerable patient population highlights the need for clinical trials targeting the elderly in hopes of improving treatment strategies and ultimately outcomes.

Primary cardiac diffuse B cell lymphoma presenting with right heart failure: a case report and review of literature

Primary cardiac lymphoma (PCL) is one of the rarest tumours of the heart, which is typical of non-Hodgkin’s type and involves only the heart and pericardium. It accounts for 1.3% of all cardiac tumours, and diffuse B cell lymphomas are more frequent type of PCL. A 52-year-old male was admitted to our department with features of right sided heart failure, and 2D echocardiography and colour Doppler study revealed right atrial myxoma. The patient underwent surgery on cardiopulmonary bypass. Intraoperatively, there was a large, lobulated, firm mass of size 5 cm × 4 cm × 3 cm arising from the lateral wall of the right atrium involving the roof and extending up to the superior vena cava. Histopathology study confirmed the diagnosis of diffuse B cell lymphoma. The patient was treated with chemotherapy post-operatively. PCL, although a rare variety of cardiac tumour, must be considered as a differential diagnosis in elderly patients presenting with cardiac failure. Therefore, proper evaluation is mandatory and timely management is required in such cases.

Pneumonia diagnosis in elderly patient with a bivalve shell lodged in the mid-esophagus.

Pneumonia diagnosis in elderly patient with a bivalve shell lodged in the mid-esophagus.

Parotid oncocytoma: diagnostic vs surgical dilemma

Oncocytomas are rare benign tumors of salivary gland origin, most often seen involving the parotid gland. They should be considered as a possible diagnosis in elderly patients with slow growing, nontender and mobile parotid swelling. We report here a middle aged female with left parotid swelling that was misdiagnosed on fine needle aspiration cytology and confirmed with histopathology report. Rarity of the disease with frequent cytologic overlaps and interpreter’s inexperience account for the majority of aspiration cytology pitfalls. Therefore, aspiration cytology alone may be misguiding at times, leading to surgical over-correction and further potential complications. The ever-changing trends of mucoepidermoid carcinoma (pre-operative, fine needle aspiration cytology), pleomorphic adenoma (intraoperative) and oncocytoma (post-operative, histopathology) have created diagnostic dilemma, confusion and challenged the surgical rationale. In cases with discrepancy between clinical, cytological and pathological reports, diagnostic as well as surgical dilemma exists wherein a thorough diagnostic re-assessment and a proper surgical revision is warranted.

PECULIARITIES OF THE CEREBRAL GLUCOSE METABOLISM IN PATIENTS WITH VASCULAR DEMENTIA (POSITRON EMISSION TOMOGRAPHY STUDY)

Vascular dementia is quite common diagnosis in elderly patients (5–10% of all dementia cases). Despite that, where is no reliable neuroimaging diagnostic marker like patterns of cerebral glucose metabolism changes in positron emission tomography (PET) in Alzheimer’s disease and some other types of dementia. The purpose of this research was to study cerebral glucose metabolism peculiarities with PET and to compare findings with metabolic changes in normal aging. Two groups of subjects were examined: patients suffered from vascular dementia and age-matching control group without cognitive and neurological disorders. Cerebral glucose hypometabolism in vascular dementia was heterogeneous and differed in different patients. Besides that, comparison with the control group demonstrated larger volume of hypometabolism and statistically significant decrease of cerebral metabolism in parietal, frontal and cingular cortex.

Gastrocolic omental cyst in an adult: Case presentation and review of literature

Abstract Background Mesenteric lymphangioma are rare tumours. They usually present early on in life, if congenital, or soon after trauma. The usual sites of presentation of lymphangiomas are in the neck, and axillae. In the abdomen they are more common in the mesentery, primarily of the ileum, or retroperitoneal. Objective A rare case is presented of a mesenteric lymphangioma. Clinical case It involves an elderly African-American male, many years after trauma, and characterised with early satiety, causing weight loss, but without gastric outlet obstruction or vomiting. Its diagnosis, management and review of literature are presented. Conclusions Mesenteric cysts are rare tumours that should be included as differential diagnosis in elderly patients with a history of previous abdominal trauma.

Risk by indication for pancreaticoduodenectomy in patients 80 years and older: a study from the American College of Surgeons National Surgical Quality Improvement Program

BackgroundExpected mortality after elective pancreaticoduodenectomy (PD) in contemporary series is less than 5% in elderly patients; however, to our knowledge, mortality rate has not been correlated with indication for PD. We hypothesized that perioperative risk following PD would correlate with diagnostic indication in older patients. MethodsThe American College of Surgeons NSQIP database was reviewed to identify patients (<80 and ≥80 years) who underwent PD from January 1, 2005, through December 31, 2012. High- and low-risk diagnoses were determined by using 30-day, major-morbidity data. Univariate and multivariable analyses were used to compare outcomes. ResultsPancreatic cancer and chronic pancreatitis were found to be low-risk diagnoses in elderly patients, whereas bile duct and ampullary neoplasm, duodenal neoplasm, and neuroendocrine tumors were high-risk diagnoses. The risk of 30-day mortality for older patients (≥80 y) undergoing PD was 6.1% for those with high-risk diagnoses vs 4.5% for those with low-risk diagnoses (P = .27). On multivariable analysis (controlling for confounders), a high-risk diagnosis was shown to be an independent predictor of prolonged length of stay, superficial surgical-site infection (SSI), and organ-space SSI. There was no increased risk of complications in patients ≥80 years with low-risk diagnoses. ConclusionIn patients 80 or older undergoing PD, perioperative risk varies by diagnostic indication. Patients should receive preoperative counseling about their risk.

Calcium Pyrophosphate Dihydrate Crystal Deposition Disease Simulating Osteoarthrosis of the Knee: A Case Report

ObjectiveThe purpose of this case report is to describe a case where calcium pyrophosphate dehydrate crystal deposition disease (CPPD) simulated osteoarthritis of the knee. Clinical FeaturesA 78-year-old woman had a 2-week history of severe right knee pain accompanied by mild swelling. The onset was sudden and did not involve a history of trauma or previous injury to the right knee. Inspection and palpation revealed pain along the medial joint line and marked difficulty ambulating. Results of Lachman’s test, anterior drawer test, and posterior sag sign were negative upon orthopedic assessment. Diagnostic imaging was performed and showed degenerative changes with diffuse calcification of the fibrocartilage and hyaline articular cartilage within the knee joint and the medial collateral ligament consistent with the appearance of CPPD crystal deposition. Intervention and OutcomeLow-level laser therapy was performed to the affected medial joint line of the knee, and knee stabilization exercises were given. Lower Extremity Function Scale changed from 34% to 60% after 4 weeks of care. ConclusionAlthough knee osteoarthritis is much more common than knee CPPD, it is important to consider both diagnoses in elderly patients who present with unilateral knee pain. Diagnosis should be based on clinical presentation, history, and radiographic or histological means to ensure accuracy and proper diagnosis.

Fraction of exhaled nitric oxide measurements in the diagnoses of asthma in elderly patients.

ObjectiveTo assess the value of fraction of exhaled nitric oxide (FeNO) measurements in the diagnosis of asthma in elderly patients.MethodsThe clinical symptoms of 202 elderly patients were assessed with the asthma module of the International Study of Asthma and Allergies in Childhood test, which had been modified for the elderly patients, and the diagnostic routine for chronic obstructive pulmonary disease (COPD), which was based on the Global initiative for chronic Obstructive Lung Disease criteria. Of the 202 patients assessed, 43 were subjected to pulmonary function evaluations (spirometry) and FeNO measurements.ResultsOf the 202 elderly patients, 34 had asthma (23 definite and eleven probable), 20 met COPD criteria, 13 presented with an overlap of asthma and COPD, and 135 did not fit the criteria for obstructive pulmonary disease. Among the 43 elderly patients who were subjected to FeNO measurements, ten showed altered results (23.2%) and 33 had normal results (76.7%). The average value of FeNO in patients with definite and probable asthma undergoing this procedure was 29.2 parts per billion whereas that in nonasthmatic patients was 17.5 parts per billion (P=0.0002).ConclusionWe show a clear relationship between FeNO levels and asthma symptoms and previous asthma diagnoses in elderly patients.

Rare Isolated Necrosis of the Cecum: Case Report

In this study, we aimed to investigate the properties of events of isolated cecal necrosis related with diverticulum, the difficulties of diagnosis and the risk factors. In physical examination of a male patient presented to the emergency department of Tepecik Training and Research Hospital with right lower quadrant abdominal pain, the findings were evaluated as acute abdomen. The patient had chronic renal failure, chronic low blood pressure, ischemic heart failure, acromegaly and diabetes mellitus, and he was operated urgently. Isolated cecal necrosis was observed peroperatively. Right hemicolectomy and ileocolic anastomosis was performed as a surgical procedure. He was followed up in the intensive care unit postoperatively with active fluid - electrolyte resuscitation and appropriate antibiotherapy. The patient with various comorbidities died fifteen day after surgery. Isolated cecum necrosis should be considered in the differential diagnosis of elderly patients and patients with comorbid disease presenting with acute abdomen. Physical examination findings of right lower quadrant abdominal pain could be misdiagnosed as acute appendicitis.

How to select elderly colorectal cancer patients for surgery: a pilot study in an Italian academic medical center.

ObjectiveCancer is one of the most common diagnoses in elderly patients. Of all types of abdominal cancer, colorectal cancer (CRC) is undoubtedly the most frequent. Median age at diagnosis is approximately 70 years old worldwide. Due to the multiple comorbidities affecting elderly people, frailty evaluation is very important in order to avoid over- or under-treatment. This pilot study was designed to investigate the variables capable of predicting the long-term risk of mortality and living situation after surgery for CRC.MethodsPatients with 70 years old and older undergoing elective surgery for CRC were prospectively enrolled in the study. The patients were preoperatively screened using 11 internationally-validated-frailty-assessment tests. The endpoints of the study were long-term mortality and living situation. The data were analyzed using univariate Cox proportional-hazard regression analysis to verify the predictive value of score indices in order to identify possible risk factors.ResultsForty-six patients were studied. The median follow-up time after surgery was 4.6 years (range, 2.9-5.7 years) and no patients were lost to follow-up. The overall mortality rate was 39%. Four of the patients who survived (4/28, 14%) lost their functional autonomy. The preoperative impaired Timed Up and Go (TUG), Eastern Cooperative Group Performance Status (ECOG PS), Instrumental Activities of Daily Living (IADLs), Vulnerable Elders Survey (VES-13) scoring systems were significantly associated with increased long term mortality risk.ConclusionSimplified frailty-assessing tools should be routinely used in elderly cancer patients before treatment in order to stratify patient risk. The TUG, ECOG-PS, IADLs and VES-13 scoring systems are potentially able to predict long-term mortality and disability. Additional studies will be needed to confirm the preliminary data in order to improve management strategies for oncogeriatric surgical patients.

Is the Electroencephalogram Power Spectrum Valuable for Diagnosis of the Elderly with Cognitive Impairment?

To study the changes of electroencephalogram (EEG) power spectrum in the elderly with mild cognitive dysfunction in resting and working memory task states. In this study, 40 patients with mild Alzheimer's disease (AD group), 40 patients with mild cognitive impairment (MCI group), and 40 normal controls (NC group) were enrolled. Their EEGs were recorded in resting and working memory task states. The EEG power spectrum, including δ, θ, α1, α2, β1, and β2, were analyzed from 10 channels: right and left frontal (F3, F4), central (C3, C4), parietal (P3, P4), temporal (T3, T4), and occipital (O1, O2). In the resting state, the δ and θ powers from some regions in the AD group were higher than those in the NC group and the MCI group ( p < 0.05). The δ powers from some regions in the MCI group were higher than those in the NC group ( p < 0.05). During the working memory task, the δ, θ, and α1 powers from some regions in the MCI and AD groups were higher than those in the NC group ( p < 0.05). The slow EGG waves and increased δ and θ power spectrum from some regions in patients with mild AD and MCI could be found during the resting state. The increased δ, θ, and α1 powers from some regions in AD and MCI patients were obvious in the working memory task. It can thus be postulated that the EEG power spectrum may have a certain value in the diagnosis of elderly patients with mild cognitive dysfunction.

Multimorbidity Patterns in Elderly Primary Health Care Patients in a South Mediterranean European Region: A Cluster Analysis

ObjectiveThe purpose of this study was to identify clusters of diagnoses in elderly patients with multimorbidity, attended in primary care.DesignCross-sectional study.Setting251 primary care centres in Catalonia, Spain.ParticipantsIndividuals older than 64 years registered with participating practices.Main outcome measuresMultimorbidity, defined as the coexistence of 2 or more ICD-10 disease categories in the electronic health record. Using hierarchical cluster analysis, multimorbidity clusters were identified by sex and age group (65–79 and ≥80 years).Results322,328 patients with multimorbidity were included in the analysis (mean age, 75.4 years [Standard deviation, SD: 7.4], 57.4% women; mean of 7.9 diagnoses [SD: 3.9]). For both men and women, the first cluster in both age groups included the same two diagnoses: Hypertensive diseases and Metabolic disorders. The second cluster contained three diagnoses of the musculoskeletal system in the 65- to 79-year-old group, and five diseases coincided in the ≥80 age group: varicose veins of the lower limbs, senile cataract, dorsalgia, functional intestinal disorders and shoulder lesions. The greatest overlap (54.5%) between the three most common diagnoses was observed in women aged 65–79 years.ConclusionThis cluster analysis of elderly primary care patients with multimorbidity, revealed a single cluster of circulatory-metabolic diseases that were the most prevalent in both age groups and sex, and a cluster of second-most prevalent diagnoses that included musculoskeletal diseases. Clusters unknown to date have been identified. The clusters identified should be considered when developing clinical guidance for this population.

Rising trend of proximal femoral nail in therapy of Extracapsular Hip Fractures

Spontaneous spinal epidural hematoma (SSEH) is a rare entity.SSEH is an accumulation of blood in the vertebral epidural space in the absence of trauma or iatrogenic procedure like lumbar puncture.The incidence of SSEH has been estimated at 0.1 patients per 100,000 individuals and represents less than 1% of spinal space-occupying lesions .Here we are presenting case of a 65year old female hypertensive on treatment with controlled blood pressure, who presented with sudden onset paraplegia and weakness of muscles of hand, associated with urinary and bowel incontinence that started 6 hours before presenting to Emergency Room .Patient was subjected to MRI spine that revealed a collection in spinal epidural space ,hypointense in T1W images and hyperintense in T2W images, extending from C6-C7 to T1-T2 suggestive of acute / subacute epidural hematoma (fig 1).In our case all possible causes of an epidural haematoma were ruled out by relevant investigations.Patient was subjected to surgical evacuation of hematoma after 48 hours of presentation.Perioperative and Postoperative period was uneventfull . Sensations over involved areas improved. Motor weakness also improved from Grade III to Grade IV+ in bilateral lower limbs and from Grade II to Grade IV in small muscles of hand and triceps, however Patient persisited with urinary incontinence.CONCLUSION: When a patient receiving anticoagulant therapy complains of sudden and unexplained neck or back pain, we should suspect the possibility of SSEH. For early diagnosis, immediate MRI is essential .In addition, we should consider SSEH as one of the important differential diagnoses in elderly patients who have developed acute myelopathy.

Acute Mesenteric Ischemia Is a More Common Cause than Expected of Acute Abdomen in the Elderly

BackgroundThe incidence of acute mesenteric ischemia (AMI) increases exponentially with age. The significance of AMI as a differential diagnosis in elderly patients with acute abdomen may be underestimated. MethodsConsecutive patients hospitalized for AMI between 2009 and 2013 were retrospectively identified in a well-defined population. Acute appendicitis, ruptured abdominal aortic aneurysm, acute pancreatitis, and acute cholecystitis were used as reference diagnoses, and the age-specific incidence rates were calculated. In addition, long-term mortality risk was assessed for AMI survivors. ResultsThe in-hospital incidence rates of AMI, acute obstructive mesenteric ischemia, and non-obstructive mesenteric ischemia were 7.3, 4.5, and 2.0/100,000/year, respectively. AMI was more common than ruptured abdominal aortic aneurysm, and the age-specific incidence of AMI was higher than the incidence of acute appendicitis in patients over age 75 years with acute abdomen. During the follow-up, the age-adjusted risk of death was 1.8 times higher in AMI survivors than in survivors of acute cholecystitis. ConclusionAMI may be a more common cause of acute abdomen in elderly patients than is generally thought, emphasizing the importance of performing urgent computed tomography with contrast enhancement preferably in arterial and venous phases in these patients.

An Interesting and Potentially Dangerous Medication Error Caught on Admission

associated with CAA should be considered in the differential diagnosis for elderly patients with rapidly declining dementia. Timely histological diagnosis and aggressive treatment are critical to a successful recovery. In the case of our patient, a comprehensive care plan included medical management along with therapies in the skilled care nursing facility. Author Disclosures: Financial support for the poster will be requested from the East Carolina University, Brody School of Medicine.

Association between finger tapping, attention, memory, and cognitive diagnosis in elderly patients.

This study examined the association between spontaneous finger tapping and cognitive function, with a detailed analysis of the two main phases of finger tapping, the touch-phase and the off-phase. 170 elderly patients (83 men, 87 women; M age = 82.1 yr., SD = 6.2) underwent cognitive assessment including the Mini-Mental State Examination, a forward digit span test, and 15 sec. of finger tapping. Results indicated a significant increase in the length and variability of the finger-touch phase among participants with mild cognitive impairment or dementia compared to participants with no cognitive impairment, suggesting a relationship between finger tapping and attention, short-term memory, and cognitive diagnosis. Pattern classification analyses on the finger tapping parameters indicated a specificity of 0.91 and sensitivity of 0.52 for ruling out cognitive impairment.