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Biomedical subjects

H P Thomas

Publications and source records attributed to H P Thomas.

13 recordsLinked to original sources
PubMed2004

[Prevention of disability in the elderly].

While in younger age groups prevention of acute diseases is the primary goal of therapeutic intervention, in the elderly the up-rise of disabilities due to chronic conditions must be focused. Underestimated risk factors like cognitive decline, depression, falls and lack of social contacts are highly correlated with disability. A comprehensive functional diagnostic is therefore important in order to identify risk factors and to develop preventive strategies. The geriatric assessment plays a major role in this concept. Preventive home visits have become an effective intervention model. On the other side, specific tools for nursing home residents are lacking. We highlight the epidemiological context and the dimension of disability of a population in which preventive models for the elderly can play a major role. Than, we point out models that put their emphasis on preventive strategies for frail elderly persons.

Aged↗
PubMed2002

[Primary and secondary prevention in dyslipidemia in the elderly].

Cardiovascular disease (CVD) is the leading cause of mortality and a major cause of disability in advanced age. The relationship between coronary heart disease (CHD) and dyslipoproteinaemia is well known. The fact, however, that atherosclerosis is a systemic disease leads also to the consideration that patients suffering from cerebrovascular and peripheral arterial disease should benefit similarly from lipid lowering therapy as do patients with CHD. There is already growing evidence that the incidence of stroke may be markedly decreased by statin therapy. Though overall, the clinical significance of hypercholesterolaemia seems to decrease with increasing age, patients at age 65 to 75 tend to benefit even more than younger patients when elevated LDL-cholesterol is treated effectively. It should be noticed that prevention or postponement of cardiovascular events may also prevent premature functional limitations and disability in old age. Hence, it is suggested to screen elderly people with CVD for dyslipoproteinaemia and to treat elevated cholesterol levels by means of life style changes, nutritional therapy, and drug therapy. Treatment regimes should be considered depending upon complete risk stratification and geriatric assessment. Chronological age alone cannot be an argument to withhold a proven effective therapy from a growing segment of the population at risk.

Aged↗
PubMed2001

[Classical cardiovascular risk factors: predictive value and treatment of the elderly. The rocky road to evidence-based medicine].

Coronary heart disease and cerebrovascular disease are still the most common causes of death in Western countries. A number of risk factors have been identified in young and middle-aged adults, such as dyslipidemia, hypertension and diabetes. Their prevalence and importance, however, are less clear in the elderly. In terms of dyslipedemia it is questionable whether hypercholesterolemia is a definite risk factor. On the other hand, mortality can be reduced by lowering LDL cholesterol, but the benefit in the oldest old is not yet known. Systolic blood pressure rises with age and is discussed controversely as a potential risk factor in the elderly. Some large trials could show a clear relationship between high blood pressure while others did not see any association. Similar to the treatment of hypercholesterolemia, antihypertensive drugs showed beneficial effects in elderly people until the age of 80. But the treatment of the oldest old cannot be recommended in general. Diabetes and impaired glucose tolerance are some of the most common diseases in elderly people. They are considered to be an important risk factor until the age of 75. Their role in the oldest old is still under debate. Until now, we do not know anything about possible treatment effects because of the lack of controlled trials. Elderly people seem to have a risk profile different from younger people; especially in extreme ages the predictive role of classical risk factors is unclear. On the other hand, drug treatment could reduce mortality and morbidity in patients with hypercholesterolemia or hypertension. There are no studies which investigated the effects of blood glucose control in the elderly. The collection of sufficient data is a geriatric challange in order to decide whether treatment is useful or not.

Aged↗
PubMed2000

DALI LDL-apheresis: anticoagulation with r-hirudin in a patient with heparin-induced thrombocytopenia (HIT II).

A 50-year old male patient with familial hypercholesterolemia and hyperlipoproteinemia (a), who underwent low density lipoprotein-apheresis treatment developed heparin-induced thrombocytopenia type II (HIT II). Because heparin is contraindicated in patients with HIT, an alternative LDL-apheresis system and modified anticoagulation regimen was necessary. Treatment was changed to a new system called DALI (direct adsorption of lipids). After confirmation of the diagnosis HIT II, DALI LDL-apheresis was carried out with recombinant-hirudin (lepirudin) and citrate in order to prevent hypercoagulability. Efficient LDL-apheresis therapy with minimum therapeutic blood levels of lepirudin (1.4 mg/dl) was achieved with an initial intravenous bolus of 0.114 mg/kg of lepirudin followed by continuous lepirudin infusion of 0.350 mg/h. Thrombin-antithrombin III complex production was well controlled and other hemostatic markers showed no abnormalities. LDL-cholesterol and lipoprotein(a) concentrations were effectively reduced. R-hirudin offers a novel anticoagulation strategy and is, at present, the only alternative for patients with HIT II requiring LDL-apheresis on a regular basis.

Antithrombins↗
PubMed1999

[Which lipid parameters are atherogenic? Pathological lipid values and their therapeutic consequences].

In cross-sectional investigations, disturbances in lipid metabolism are found in about 40-50% of the population. A particularly close correlation is found between cardiovascular mortality and elevated LDL cholesterol. But disordered triglyceride metabolism and increased concentrations of lipoprotein(a) are also considered major factors that further the atherosclerosis process. A knowledge of the underlying mechanisms and the possibilities for influencing lipid metabolic disorders provide the basis for rational treatment. Unfortunately, disorders in lipid metabolism often continue to go undetected until the so-called endpoints (infarction, stroke) have occurred.

Arteriosclerosis↗