The cardiopulmonary complications associated with gastroscopy could be reduced by giving little or no prior sedation. The ability to tolerate the procedure with and without sedation was compared in 62 elderly patients by recording responses to a questionnaire designed to evaluate the patient's own assessment of the examination. A similar percentage of sedated and unsedated patients described the procedure as mildly unpleasant (63% vs 57%; chi 2 = 0.500; p > 0.10). The majority (73%) of unsedated patients did not want to be sedated for future examinations because of the inconvenience of the recovery period. Elderly patients should therefore be given the choice of undergoing the procedure without sedation. Full counselling and explanation of the procedure are however even more important to allay anxiety and apprehension if the procedure is undertaken without sedation.

Age Factors↗

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Diagnostic approaches to parotid swellings.

Although the mainstay assessment of parotid swellings remains clinical examination, cytology, computed tomography and magnetic resonance imaging may give valuable preoperative information on both the likely histology and the location of the individual swelling. This is important for therapeutic and prognostic reasons.

Diagnostic Imaging↗

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Subcutaneous alveolar soft-part sarcoma mimicking metastatic hypernephroma.

Alveolar soft-part sarcoma represents a rare tumor of the subcutaneous and soft tissues that may present to the dermatologist. It may mimic both other primary tumours and other metastatic tumours. This mimicry has not been emphasised in the previous literature.

Adult↗

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Compression sonography in patients with low probability of pulmonary emboli on lung scans.

Explore the source record for details and available documents.

Humans↗

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Caring for the elderly: problems and priorities.

In view of the projected massive increase in the number of the very aged, all health-care agencies, professionals and the government must develop an acceptable strategy of care. With a positive attitude towards aging based on facts and knowledge, the burden of such a demographic change can be minimized. Perhaps a dedicated government department or even a separate ministry may be useful.

Aged↗

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Low-dose amiodarone in severe chronic heart failure.

Sudden cardiac death is a common cause of mortality in patients with congestive heart failure. Asymptomatic ventricular arrhythmia has been attributed as the cause for increased overall mortality in such patients. We conducted a prospective randomised single-blind placebo-controlled trial with low-dose amiodarone to assess its efficacy in reducing mortality in severe congestive heart failure and its effect on exercise tolerance, left ventricular systolic function and ventricular ectopic activity. Patients were randomised to receive amiodarone (n = 36) 400 mg/day orally for one month followed by a maintenance dose of 200 mg/day, or to a standard treatment (n = 40) according to intention-to-treat principle. There were 10 cardiac deaths in the amiodarone-treated group and 16 in the control group. Significant improvement was noted in exercise time in the treadmill test (modified Bruce Protocol) among patients in the amiodarone-treated group while no such statistical difference was detectable in the placebo group. Side-effects in the amiodarone group included asymptomatic rise in hepatic enzymes (three-fold) in 6 percent and proarrhythmia in 3 percent of patients. Nausea was reported in one patient and rash in one. Though low-dose amiodarone proved to be an effective antiarrhythmic agent, it failed to live up to the expectation of improving sudden cardiac death in patients with severe chronic heart failure and asymptomatic ventricular ectopy.

Amiodarone↗

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Follow-up results of balloon angioplasty for native coarctation of aorta.

Balloon angioplasty of native discrete (< 1 cm) coarctation of thoracic aorta was performed in 29 patients [aged 13 to 31 years (mean 21.5 +/- 5.8 years), 22 males and 7 females], from March 1993 to December 1995. The patients were followed up for two years. After angioplasty, peak systolic arterial pressure (PSAP) decreased from 173.5 +/- 18.1 mm Hg to 122.5 +/- 9.9 mm Hg (p < 0.001), peak systolic pressure gradient (PSG) decreased by 90.9 percent from 86.2 +/- 15.77 to 7.77 +/- 3.8 mm Hg (p < 0.001) and the coarcted segment diameter increased about three times from 3.7 +/- 1.6 to 10.9 +/- 3.3 mm (p < 0.001). PSG decreased to < 10 mm Hg in 27 patients (93%) whereas in the other two patients PSG was 17 and 13 mm Hg. Restenosis appeared in 2 patients (6.8%); aneurysm in one patient (3.4%) which remained static even after 1.3 years of follow-up; mild dissection in 3 patients (10.3%); temporary femoral artery occlusion in 2 (6.8%) patients who recovered with heparin injection. Though hypertension disappeared after balloon dilatation in all patients, it reappeared in 3 patients (10.3%) within 7 days and in 10 patients (34.5%) within 6 months. In conclusion, balloon angioplasty of CoA is a good alternative to surgical correction.

Adolescent↗

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Elderly patients' satisfaction with hospital care.

OBJECTIVES: The aim of this study was to assess patient satisfaction with the geriatric services of a district general hospital and to examine whether there was a difference in satisfaction between patients in hospital and those who had been recently discharged. METHODS: A structured and validated patient satisfaction questionnaire was administered before discharge to hospitalised patients with a mental test score of 8 or more. It was also administered to a group of patients in the community who had been discharged from hospital not more than 72 hours earlier. The questionnaire was designed to assess seven separate areas, and contained 51 statements with which patients were asked to agree or disagree. Statistical analysis was by the Mann-Whitney U test and p < 0.05 was taken as significant. A total of 134 elderly patients (> 72 years) were surveyed over a four-month period. RESULTS: Satisfaction with the hospital geriatric service was high in both groups of patients. However, patient satisfaction differed between the two groups in three areas: interpersonal aspects; access, availability and convenience of the health services; and financial aspects.

Aged↗