Biomedical subjects
Publications and source records attributed to Ronald E Vlietstra.
The recent decline in autopsy rates has many causes and has been the subject of vigorous debate amongst clinicians, pathologists, and investigators. For cardiologists, the lack of direct information on the vessel wall may impede the ability to develop and interpret new imaging methods and to understand the effects of the newest interventions.
Radiation-induced skin burns can be produced by high doses of fluoroscopic X rays. Though uncommon, such injuries can cause considerable distress to the patient and they can lead to deep ulcers requiring skin grafts. Factors that increase the chance of a burn can be readily identified and in nearly all instances they can be avoided or minimized. We discuss these issues and use case illustrations to point out how burns can be avoided.
The investigation of atrial fibrillation should be tailored to match the needs of the patient. Those needs may differ between younger and older patients. While many different investigations might be used, the emphasis in this review will be on what must be done. It should be remembered that rigid protocols cannot be presented, however, because many of these important issues have not been subjected to critical scrutiny in elderly cohorts.
Half of all pacemakers implanted in the United States are for patients aged 75 years and older. The expectations and needs of an older group are different from patients who are younger, yet it is only recently that different pacing mode benefits for elderly persons have been tested in clinical trials. Some of the results have been surprising and suggest new algorithms for management. Other issues are still on the threshold of investigation. These include pacing for heart failure in elderly patients and pacing combined with cardioverter-defibrillator implantation.