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Biomedical subjects

H J Keating

Publications and source records attributed to H J Keating.

18 recordsLinked to original sources
PubMed1992

Major surgery in nursing home patients: procedures, morbidity, and mortality in the frailest of the frail elderly.

OBJECTIVE: To determine the surgical procedures being done on long-term care (level 2) nursing home residents and the resultant in-hospital morbidity and mortality. DESIGN: A retrospective chart review of inpatient medical records from two hospitals, identified by computerized search of medical records and/or referral by directors of nursing of area nursing homes. SETTING: Patients originated in skilled-care nursing homes in New Castle County, Delaware, USA. Surgery was performed in the area's two major hospitals, one a 1000-bed regional referral and teaching hospital, and the other a 300-bed community hospital. PATIENTS: Residents of skilled-care nursing homes (level 2) who underwent major surgery between January 1979 and December 1989. MEASUREMENTS AND MAIN RESULTS: Eighty procedures were performed in 74 patients. Many different types of procedures were done. After primary repair of hip fracture the most common procedures were non-orthopedic extremity and abdominal surgeries. Three deaths occurred (mortality 3.8%), and all were in patients undergoing emergency surgery who were classified above American Society of Anesthesiology Class 3. Serious complications occurred in 43% of the procedures and were most commonly cardiopulmonary and psychiatric, including profound depression in four. Antibiotic-associated colitis occurred in three patients and required a second surgical procedure in one. Fewer adverse outcomes were seen in patients undergoing elective surgical procedures with spinal or local anesthesia than in patients receiving general anesthesia. CONCLUSIONS: Although retrospective and limited to inpatient data, in-hospital surgical mortality in this very frail population was low, comparable to series in unselected geriatric populations. However, major complications were very common. Primary hip surgery repair may have been too frequently done. A multi-institution, prospective trial would be useful to assess functional outcome of surgery in this population.

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PubMed1990

Perioperative responsibilities of the physician/geriatrician.

The number of elderly patients undergoing surgery is increasing. A model that identifies sources of perioperative risk to the elderly patient is presented and discussed. We suggest that the perioperative responsibility of the physician/geriatrician lies in a self-conscious examination of these sources of risk in order to maximize the likelihood of a beneficial outcome.

Age Factors↗
PubMed1990

Alternatives to major surgery in the high-risk elderly.

The frail elderly patent with surgical disease presents a unique challenge to the geriatrician. Coexisting medical disease and increasing surgical risk coupled with a perceived reduction in benefit based on limited functional capacity or life span often make the frail elderly unable or unwilling to undergo major surgery. The many recent advances in medical therapy outlined in this review offer alternatives to major surgery in this population.

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PubMed1987

Preoperative considerations in the geriatric patient.

Because of the "graying" of the population, the increasing availability of surgeons, and the improvement of surgical techniques and intensive care, more and more surgery will be done on geriatric patients. Sometimes, however, surgery will not be considered in a geriatric patient because of mistaken underestimation of life expectancy. The medical consultant is charged with confirming that surgery represents the consequence of the patient's informed decision, a task that is usually time consuming and often difficult. The medical consultant next identifies patient-related and procedure-related factors that affect surgical morbidity and mortality. General physiologic declines in all organ systems are characteristic of aging, but the most important ones affecting surgical risk are those of cardiovascular, pulmonary, immunologic, and central nervous systems. These systems must be assessed by an orderly preoperative evaluation that aims to optimize the patient's status and anticipate and minimize postoperative complication.

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PubMed1975

Influence of Concanavalin A, wheat germ agglutinin, and soybean agglutinin on the fusion of myoblasts in vitro.

Although muscle cell fusion was shown to be an energy-requiring process, release of myoblasts from an EGTA fusion block could be accomplished with Earle's balanced salt solution (containing 1.8 mM Ca++) free of glucose or any other energy-produced metabolite. The effect of concanavalin A, abrin, and the lectins from wheat germ, soybean, and Lens culinaris on myoblast fusion was examined with synchronized myoblast cultures upon release from fusion block. At a concentration of 15 mug/ml, these lectins were found to inhibit the fusion process to the extent of 62%, 41%, 32%, 8%, and 19%, respectively. Concanavalin A inhibition could be prevented by alpha-methyl-D-mannoside. The inhibitory effect of all the lectins except abrin could be reversed by changing to the normal, serum-containing medium. The number of binding sites was 3.4 X 10(7), 6.1 X 10(7), and 1.7 X 10(6), respectively. Although myoblasts were found to have about twice as many binding sites for wheat germ agglutinin as for concanavalin A, concanavalin A was determined to be twice as effective as wheat germ agglutinin as an inhibitor of myoblast fusion. These findngs raise the possibility that specific cell surface glycoproteins may be an important factor in this process.

Abrin↗