Hana Matějovská Kubešová

Radical surgery for pancreatic malignancy in the elderly.

Background: Improving life expectancy is associated with increasing incidence of pancreatic cancer. We reviewed morbidity and mortality in patients aged 65 years and older undergoing curative intent surgery in two centers in the Czech Republic. Methods: Data were retrieved by retrospective analysis of the medical records over the period 2000–2007. In total, 60 patients were included. The mean age was 71 years (median 70 years; range 65–85 years). Most patients (43, 72%) underwent hemipancreatoduodenectomy, combined in 4 with portomesenterial vessel resection. Twelve patients (20%) had distal pancreatectomy and 5 patients (8%) total pancreatectomy. Results: Overall morbidity was 28%. Only 10 patients (18%) developed serious surgical complications in terms of pancreatic leak (5, 8%), biliary leak (2, 3%), and intra-abdominal inflammatory collection (4, 7%). Four patients (6.6%) died within 30 days. The 1-year survival was 62.8%. Conclusion: We can conclude that age per se is not a contraindication to surgery. Patient’s overall general condition, co-existing co-morbidities, and ability to get over with any potential complications are more important.

Bone Marrow as Multidimensional Orbit Oscillator after Autologous Bone Marrow Transplantation

The local renin‐angiotensin system (RAS) in bone marrow is probably involved in the control of hematopoiesis. Earlier observations suggest the relationship between the frequency of sodium and potassium concentration changes in urine and bone marrow recovery after chemotherapy. The purpose of this study was to prove the relationship between sodium and potassium excretion changes in urine and granulocyte counts in peripheral blood after autologous bone marrow and peripheral blood stem cell transplantation.

Metabolic Syndrome in Older Patients

This paper presents an overview of the definitions of metabolic syndrome and the criteria used to determine this diagnosis. It discusses the pathological-physiological aspects of the syndrome´s individual components – insulin resistance and type 2 diabetes mellitus, hypertension, atherogenic hyperlipidemia, as well as the mutual relationship between hyperuricemia and metabolic syndrome. The paper also includes the authors´ original results- a study of the incidence of metabolic syndrome among community dwelling seniors. In South Moravia, 147 seniors were examined in cooperation with general practitioners and the Geriatrics Outpatient Clinic of the Department of Internal Medicine, Geriatrics and General Practice, Medical Faculty of Masaryk University and Faculty Hospital Brno. The criteria of metabolic syndrome diagnosis as per the International Diabetes Federation definition were met by 23 clients i.e. 15.7% of the sample studied. A considerable section of the sample, though, met three of the criteria- 18 clients, 12.1%. It was determined that the incidence of metabolic syndrome did not correlate significantly with age - r = - 0.10, p>0.05 - i.e. there was rather a trend towards lower incidence with advancing age. The incidence of metabolic syndrome appeared to have a significantly negative correlation with cognitive performance tested by Mini Mental State Examination - r= -0.44 and self-sufficiency tested by ADL (activities of daily living) - r=-0.44. Conclusions: Metabolic syndrome occurs in approx. 20-40% of older patients depending on the clinical criteria applied. The incidence of metabolic syndrome in the older population has a significantly negative effect on cognitive functions and the self-sufficiency of older patients as well as on the incidence of depression.

Pulmonary Embolism in the Elderly - Significance and Particularities

The chapter aims at presenting a practically orientated survey of major problems of a clinical picture and therapeutic pitfalls in pulmonary embolism (PE) affected patients from the point of view of a geriatrician. Growing number of PE people of advanced age and considerably small awareness of this fact in wider medical public makes this chapter highly significant. Pulmonary embolism (PE) in the elderly represents immediate threat of life. Especially in old age clinical signs of PE are non-specific and could be both underdiagnosed and overdiagnosed. The high occurrence of PE (particularly its silent form) is of crucial importance in the elderly mortality. Our recommendations would like to emphasize the need of no underestimation of this fact and to carry out preventive measures in all age groups (including “oldest old” and frail persons. Thrombembolism is the most common cause of death, and a major cause of morbidity, in later life. Like cardiac and arterial thrombembolism, the incidence of venous thrombembolism increases exponentially with age. Since the inpatient mortality in general hospitals is about 10%, it is estimated that about 1% of patients admitted to the hospital die of PE. However, for every patient who dies of PE in a surgical ward, three die in nonsurgical wards. In the great majority of patients dying of PE, previous venous thrombembolism was not diagnosed or treated. DVT (deep venous thrombosis) is often nonocclusive and hence clinically silent prior to embolization; while nonfatal PE occurring prior to the fatal one may not be recognized clinically, especially in older patients who frequently have cardiorespiratory symptoms, such as a heart failure or chronic obstructive airways disease. Prophylaxis against PE is of paramount importance because venous thromboembolism is difficult to detect and poses an excessive medical and economic burden. Mechanical and pharmacologic measures often succeed in preventing this complication. The hypothesis that the combination of immobility and coagulation activation predisposes to DVT formation is supported by the prophylactic efficacy of both mechanical measures which increase leg vein blood flow, and antithrombotic drugs especially anticoagulants. We would like to emphasize the need of permanent thinking of the possibility of PE in elderly persons with present risk factors and also the requirement of correctly assessed diagnoses and the start of therapeutic procedures as soon as possible.