Effective Treatment For Elderly Patients Research Articles

Long term analysis of recurrences in patients treated by multimodality approach for local treatment of early rectal cancer—Liverpool’s Experience

18539 Background: Local treatment of early rectal cancer with curative intent is highly controversial. Three years ago, we reported our results in 100 patients treated by multimodality approach. We have updated our results and analyse the pattern of recurrences in155 patients treated up to 2005 Methods: From Jan 1992 to Jan 2005, local treatment was offered to 155 patients with low rectal carcinoma. The majority of patients were elderly with the mean age of 76 years( range 33–101). There were 87 males and 68 females. 109 had surgery; TEM (79 patients) and TAR(30 patients). Forty six patients had radical radiotherapy alone.Locally treated patients were followed up regularly with DRE and sigmoidoscopy. CT and MRI scans were done at 0,12 and 24 months. Results: Local recurrence only occured in 13 patients (8.3%). Four patients had local and distant recurrence (2.5%). Overall local recurrence occured in 17 patients (10.8 %). Salvage surgery was carried out in 11 patients(10 APER and 1 local excision). Two had retreatment with Papillon. A total of 13 patients had salvage treatments (76.5%). At median follow-up of 40 months (range 12–168) only 72.7% of patients were still alive. Five patients (3.2%) developed distant metastases only and one had nodal recurrence. Cancer specific survival was 96% and colostomy free survival was 93%. Conclusions: Local treatment of early rectal cancer is a complex issue that needs to be address and discuss. As ageing populationis likely to increased in the next decade demands on local treatment will increase. It is important to balance the benefits of radical surgery in terms of lower local recurrence against increase mortality and morbidity from such procedures especially in elderly patients, versus slightly higher local recurrences and much lower mortality and morbidity from conservative treatments such as TEM and Papillon contact radical radiotherapy. Our study has shown that local treatment is safe and effective treatment for elderly patients with medical co morbidity. In our experience, salvage surgery can be offered for recurrences in the majority of patients but long term close follow-up is necessary. A careful case selection and multimodality treatment is essential for successful out come. No significant financial relationships to disclose.

Gentle yet effective treatment for elderly patients with refractory or relapsing multiple myeloma

Fourteen patients, aged 65–85 years, with refractory (11) or relapsing (3) multiple myeloma were treated with a “protracted-sequential” protocol comprising vincristine 1–2 mg or vindesine 3 mg/M2 (max. 5 mg) IVI over 4 hr on D1, prednisolone 40–50 mg PO D1–14, and melphalan 2–4 mg PO or cyclophosphamide 50–100 mg PO D15–28; cycles were repeated at 4–6 weekly intervals. Treatment was continued for 12 months if the response was optimal or indefinitely if the response was suboptimal. Five patients responded optimally; their survival from the commencement of this protocol ranged from 30 to 120 months. The other nine patients achieved a partial response, their survival ranging from 4+ to 79 months. The treatment is simple, nontoxic, and as convenient as the “classic combination” of melphalan and prednisolone. Am. J. Hematol. 65:81–82, 2000. © 2000 Wiley-Liss, Inc.

2-Chlorodeoxyadenosine (Cladribine) in the Treatment of Elderly Patients with B-Cell Chronic Lymphocytic Leukemia

The aim of our study was to determine the efficacy and toxicity of 2-chlorodeoxyadenosine (2-CdA) in 2-hour infusions in the treatment of elderly patients with B-cell chronic lymphocytic leukemia (B-CLL). Forty three patients aged 70 years and older received 1 to 6 courses of 2-CdA (median 3) in a dose of 0.12 mg/kg daily for 5 consecutive days. Thirty three of them were untreated and 10 had relapsed or refractory to disease after prior therapy with chlorambucil, COP and CHOP. Complete response (CR) was achieved in 13 (30.2%) and partial response (PR) in 17 (39.6%) patients, giving an overall response rate of 69.8%. The difference in overall response rate between both groups were not statistically significant (69.8% and 50%, respectively). The most frequent side effects of 2-CdA treatment were thrombocytopenia observed in 18 (41.9%) and infections in 7 (16.3%) patients. Drug related neutropenia was observed in 6 (13.9%) and allergic dermatitis in 2 patients. Six (13.9%) patients died, one because of drug related thrombocytopenia resulting in a central nervous system hemorrhage, two because of pneumonia and two of cardiovascular complications. In conclusion, our results suggest that 2-CdA is also effective treatment for elderly patients with CLL. The drug toxicity is acceptable and seems to be similar for that observed in younger patients.

Permanent cardiac pacing in elderly patients with recurrent falls, dizziness and syncope, and a hypersensitive cardioinhibitory reflex.

The study was designed to assess the outcome of treatment with permanent dual-chamber pacing of elderly patients with falls, dizziness and syncope associated with the demonstration of a hypersensitive cardioinhibitory...

Lisinopril. A review of its pharmacology and clinical efficacy in elderly patients.

Lisinopril, the lysine analogue of enalaprilat, is a long-acting angiotensin converting enzyme (ACE) inhibitor which is administered once daily by mouth. The efficacy of lisinopril in reducing blood pressure is well established in younger populations, and many trials now show it to be effective in lowering blood pressure in elderly patients with hypertension. In comparative and non-comparative clinical trials, 68.2 to 89.1% of elderly patients responded (diastolic pressure < or = 90 mm Hg) to > or = 8 weeks' lisinopril treatment. Age-related differences in antihypertensive efficacy do not appear to be clinically significant, and dosages effective in elderly patients tend to range from 2.5 to 40 mg/day. Dosages usually need to be lower in patients with significant renal impairment. In congestive heart failure, lisinopril 2.5 to 20 mg/day increases exercise duration, improves left ventricular ejection fraction and has no significant effect on ventricular ectopic beats. It is similar in efficacy to enalapril and digoxin and similar or superior to captopril on most end-points. Data from the GISSI-3 post-myocardial infarction trial show that lisinopril reduced mortality and left ventricular dysfunction when given for 42 days starting within 24 hours of the onset of infarction symptoms. Results at 6 weeks and 6 months were similar in elderly and younger patients. Elderly patients, however, among other subgroups, exhibited a strong reduction in risk of low ejection fraction after treatment (-25.5%). Economic studies suggest that lisinopril is cost saving compared with other ACE inhibitors in some markets. When given according to the GISSI-3 protocol, lisinopril appears to be one of the less expensive of the successful ACE inhibitor regimens for acute myocardial infarction. In other trials, patients with diabetic nephropathy and hypertension improved or did not deteriorate during lisinopril treatment. Blood pressure was controlled and reductions or trends towards reductions in albuminuria were observed. These reductions were similar to those in diltiazem, nifedipine and verapamil recipients, and greater than those in patients receiving atenolol. Lisinopril appears to reduce mortality in diabetic patients after myocardial infarction and may also improve neuropathy associated with diabetes. Lisinopril is well tolerated and the profile of adverse events seen is typical of ACE inhibitors as a class. There is a tendency for more elderly than younger patients to discontinue treatment, but this trend is not clearly related to the incidence of adverse events in these age groups. Drug interactions occur with few other agents and are usually clinically significant only between lisinopril and either diuretics or lithium. Lisinopril is, thus, an effective treatment for elderly patients with hypertension, congestive heart failure and acute myocardial infarction and has shown promising benefits in patients with diabetic nephropathy.

Percutaneous Transluminal Coronary Angioplasty in Elderly Patients

Fifty-six patients aged 75 years and older underwent percutaneous transluminal coronary angioplasty (PTCA) at our institution from 1984 to 1991. The average age was 76.7 +/- 1.5 years, and 84% of the patients were males. Single-vessel disease occurred in 21 patients, double-vessel disease in 16, and three-vessel disease in 19 patients. The mean left ventricular ejection fraction was 57 +/- 5%, and 8 patients had an ejection fraction of < 40%. The anginal functional class was I in 1 patient, II in 3, III in 6, and IV in 46 patients. Single-vessel PTCA was attempted in 43 patients, two-vessel PTCA in 8, and three-vessel PTCA in 5 patients. Revascularization was complete in 35% of the patients, incomplete in 57, and no revascularization was obtained in 8% of the patients. Ninety-one percent of the patients had a successful procedure. In 5 patients there was severe dissection, 1 patient died, 1 patient had an acute myocardial infarction, and 1 patient had emergency bypass surgery. Long-term follow-up (6-96 months, mean 21 +/- 4) in the 51 successfully treated patients revealed late cardiac death in 1 patient, repeated PTCA for restenosis in 9, and coronary bypass surgery in 2 patients. Twenty-two patients were asymptomatic, 12 had improved symptoms, and 5 remained symptomatic. PTCA appears to be a safe and effective treatment in elderly patients with one- and two-vessel disease, with excellent long-term results. Age is not a contraindication to PTCA. The results in elderly patients with three-vessel disease are less encouraging.

Which elderly depressives will respond to ECT?

AbstractRecent research has confirmed that ECT is an effective treatment for elderly patients with severe depressive illnesses, but not without some hazard in its administration. The currently available prognostic indicators for ECT have been developed in adults under 65 years old. In this study, the Newcastle ECT prediction scale, the presence of delusions and a scale developed in an elderly population are used to predict response to ECT in a group of 30 elderly depressives. Only the latter is shown to predict responses to ECT. The significance of these findings is discussed.

The use of electroconvulsive therapy in old age psychiatry

AbstractAll patients receiving electroconvulsive therapy (ECT) under the care of the Old Age Psychiatry service at the University Hospital of South Manchester between 1976 and 1982 were studied. Data on 193 courses were collected. Eighty per cent of patients were well or considerably improved at discharge. When relapses occurred they usually responded well to antidepressant treatment and did not indicate a poor outcome in the long term. The results confirm that ECT is a safe and effective treatment for elderly patients with severe depressive illnesses, despite the fact that many of them suffer from concurrent physical problems and that some have evidence of intellectual impairment.