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M G Impallomeni

Publications and source records attributed to M G Impallomeni.

6 recordsLinked to original sources

Warfarin-associated thoracic aortic dissection in an elderly woman.

BACKGROUND: The risk/benefit ratio of warfarin therapy changes in the over 75s, when haemorrhagic side-effects become more common. These may not always be reported in the literature. CASE REPORT: A woman of 80 years, on long-term warfarin therapy presented with an acute dissecting thoracic aortic aneurysm; on investigation the only precipitating factor found was an international normalised ratio of 4.8. This patient, who also had an abdominal aortic aneurysm, survived, on discontinuation of her anticoagulant therapy. CONCLUSIONS: We describe a previously unreported complication of warfarin therapy in a patient over 75 years of age, to add to the cautions in prescribing this drug in patients of this age group.

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Plasma lactoferrin as a marker of infection in elderly individuals.

To assess lactoferrin as a marker of infection, plasma lactoferrin (LF) levels were determined in elderly in patients with infection and compared with age- and sex-matched healthy and hospital controls and young healthy blood donors. The median LF level in infection (800 ng/mL) was significantly higher than in healthy elderly living in old people's home (300 ng/mL) or elderly hospital controls (298 ng/mL) (p less than 0.01 in each case). Plasma LF correlated significantly with elastase alpha-1-proteinase inhibitor complex (EPIC) (Rs = 0.8, p less than 0.01) and C-reactive protein (CRP) (Rs = 0.45, p less than 0.02), but not with erythrocyte sedimentation rate (ESR) or white blood cell counts. We conclude that plasma LF, like CRP and EPIC, is a marker of infection in elderly individuals.

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Incidence of pulmonary embolism in elderly patients newly admitted to an acute geriatric unit: a prospective study.

To study the incidence of pulmonary embolism (PE) in elderly patients newly admitted to an acute geriatric unit, the authors carried out ventilation perfusion scans on 33 patients, 25 women and 8 men, mean age 79 years, consecutively admitted to the geriatric wards. The first scan was done within 5 days of admission and repeated between days 10 and 20. Where possible, patients with a positive second scan had a repeat scan at 2-3 months. Six (18%) patients were found to have a high probability of PE, 4 (12%) at the time of admission and two (6%) after admission. Three patients (9%) were considered to suffer from chronic pulmonary artery disease. Mortality was 5 for the whole group (15%) and 1 of 6 (17%) with a high probability of PE; this patient was suffering from carcinomatosis. The only patient who was anticoagulated suffered serious side effects. In no patient was PE clinically suspected. The authors conclude that PE is common in sick elderly patients newly admitted to acute geriatric wards, that rehabilitation with mobilization may precipitate new PE, and that nonanticoagulated PE does not seem to appreciably shorten the prognosis for life. Treatment with anticoagulants may be more dangerous than not treating PE in this older age group.

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Unusual presentation of myxoedema coma in the elderly.

Seven patients were found to be suffering from myxoedema coma over a two-year period in this geriatric department. The majority presented with unusual clinical features. Generalized convulsions were particularly common, occuring in five patients. Four patients were previously diagnosed as suffering from myxoedema, but thyroxine therapy had been discontinued. These findings would suggest that this condition is not unusual in the elderly; but it could easily be missed on account of its atypical presentation.

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