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Biomedical subjects

G L Bhan

Publications and source records attributed to G L Bhan.

9 recordsLinked to original sources
PubMed1997

Acute upper gastrointestinal hemorrhage in older people: a prospective study in two neighboring districts.

OBJECTIVE: To study the distribution of mucosal lesions and outcomes in older people with acute upper gastrointestinal hemorrhage (UGIH). DESIGN: Prospective case study. SETTING: Two neighboring district hospitals with similar admission policies. SUBJECTS: Consecutive patients aged 75 years or older admitted with hematemesis and/or melena during the study period. OUTCOME MEASURES: Length of hospital stay, mortality, surgical intervention, and transfusion requirements. RESULTS: A total of 109 patients were entered into the study. Of these, 106 (97%) underwent gastroscopy, and bleeding sites were identified in 98%. Upper gut malignancies were identified in eight patients, ulcerative esophagitis in 32, benign gastric ulcers in 24, and duodenal ulcers in 23 patients. Forty-seven percent had severe anemia on admission (Hb < 10 g/dL). Thirty-eight patients were referred for surgery, and eight were operated on, with one postoperative death. Six other patients died, five of whom had malignancies. The overall mortality of 6% reduced to 2% if those with malignancy were excluded. The 92 patients discharged had a median hospital stay of 15 days (range 2-30). CONCLUSIONS: Older people with acute UGIH have advanced upper gut pathology with preponderance of esophageal lesions. Classical symptoms seem lacking, but mortality can be decreased despite adverse comorbid factors. Lower thresholds for endoscopy are advocated in older adults, and comparative studies of UGIH symptoms with younger patients are required.

Acute Disease↗
PubMed1990

A study to assess the efficacy of chemoprophylaxis in the prevention of endoscopy-related bacteraemia in patients aged 60 and over.

Five hundred and fifteen patients aged 60 and over (mean age 74.7; 278 men and 237 women) underwent routine endoscopic procedures (gastroscopy, bronchoscopy and cystoscopy). Alternate patients were given antibiotics before the procedure, as currently recommended, and blood was taken for culture from all patients within five minutes of completion of the procedure. Of 74 patients who underwent bronchoscopy, only one culture, from one of 37 controls was positive. Of 262 who underwent gastroscopy, cultures were negative in the 130 who received antibiotics but positive in 13 of the 132 controls (9.8 per cent p less than 0.001). Cystoscopy was performed in 179; one culture was positive in the 88 given antibiotics (1.1 per cent) compared to 25 in the 91 controls (27.5 per cent; p less than 0.001). Bacteraemia rates appear to be low following bronchoscopy (less than 5 per cent) but higher with gastroscopy (10 per cent) and cystoscopy (28 per cent). Chemoprophylaxis was effective in reducing these rates in this patient group.

Aged↗
PubMed1987

Treatment of elderly hypertensives with beta-blocker/thiazide combination.

The aim of the study was to determine the efficacy and tolerability of a low dose beta-blocker and diuretic combination in elderly hypertensives. In a prospective, double blind, placebo-controlled cross over study 30 patients with blood pressure higher than 160/90 mmHg and a mean age of 71.5 years were treated with a combination of sotalol hydrochloride 80 mg and hydrochlorothiazide 12.5 mg. With this regimen a significant drop in systolic and diastolic blood pressure (patient in sitting position) was obtained when compared with placebo (p less than 0.05). No significant side effects were noted because high-risk patients were excluded and the beta-blocker was used in low dose combination with thiazide diuretic for synergistic action. We conclude that a combination of beta-blocker and diuretic is an effective and safe therapy in carefully selected elderly patients with mild to moderate hypertension.

Age Factors↗
PubMed1987

Renal failure in the elderly.

A pilot study recording the incidence, management and outcome of renal failure in elderly patients presenting to three geriatric units in a six-month period is described. A total of 4001 patients were admitted during this time and 273 patients were considered to have renal failure at presentation (criteria, plasma urea level greater than or equal to 17 mmol/l and/or creatinine level greater than or equal to 160 mumol/l). In 151 patients (55 per cent) the cause was pre-renal and this form of renal failure had a good prognosis; over 60 per cent recovered and increasing age did not affect prognosis adversely. Ninety-six patients (35 per cent) had intrinsic renal disease which was commoner in younger patients and had a mortality rate of 48 per cent. In the majority of patients renal failure was mild, only 24 per cent having a urea level greater than 31 mmol/land/or creatinine level greater than 400 mumol/l.

Acute Kidney Injury↗
PubMed1983

Cardiopulmonary resuscitation of old people.

In a prospective study, cardiopulmonary resuscitation was attempted in 52 elderly patients (mean age 75.6 yr, range 64-91). Of 14 who were resuscitated initially, 5 died in the first week. Of the 9 still alive at one month (mean age 75.3, range 65-85), none seemed to have adverse effects, in terms of mental status or physical dependence, from the episode of cardiac arrest and resuscitation; 7 had left hospital. The nature of the cardiac dysrhythmia is a strong predictor of outcome. Age, sex, and time of arrest are not.

Aged↗