Enterococcus avium splenic abscess: a rare bird.
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Abscess↗
Biomedical subjects
T A Farnsworth
Publications and source records attributed to T A Farnsworth.
Hypokalaemic, hyperchloraemic metabolic acidosis requiring ventilation.
A 16-year-old patient required intermittent positive pressure ventilation for hypokalaemic muscle weakness resulting from metabolic complications of combined colonic bladder augmentation and incomplete voiding via a prosthetic sphincter. Catheter re-establishment of urinary flow and electrolyte replacement produced dramatic metabolic and clinical improvement allowing the return of adequate spontaneous respiration.
Acidosis↗
Primary cerebral malignant melanoma: an unusual cause of dyspraxia.
Primary intracranial melanomas are rare and occur mainly in young adults. Originating from leptomeningeal melanoblasts and extending into the parenchyma, the tumours closely resemble meningiomas, from which they are radiologically difficult to distinguish despite progress in neuroimaging. Definitive diagnosis is usually made on histopathological examination, though confirmed only after post-mortem examination in some cases. Prolonged disease-free periods, and in rare cases long-term survival, are possible following successful total surgical excision. This case presented with typical clinical features but, at 79 years old, an unusual age.
Aged↗
Late tension pneumocephalus following frontal craniotomy.
Tension pneumocephalus is an uncommon but life-threatening complication of craniotomy which requires urgent diagnosis and treatment. It most often occurs perioperatively following subsequent anaesthesia using nitrous oxide. All previously reported postoperative cases followed posterior fossa or upper spinal cord surgery. Only two cases associated with frontal craniotomy have been reported since 1972, both occurring intraoperatively.
Aged↗
Subjective perception of additional support requirements of elderly patients discharged from accident and emergency departments.
Fifty per cent of elderly patients discharged from accident and emergency (A&E) departments experience functional deterioration and increased dependence; 5.6% require readmission within 14 days. Discharge is often to inadequate community support. Functional assessment by A&E department staff may identify patients at greatest risk. The predictive ability of 25 patients aged 75 years or over to identify their additional support requirements following discharge from the A&E department was evaluated retrospectively using interview questionnaires 10-20 days after discharge. A total of 23 patients, of mean age 79.3 years, were interviewed. Six patients expressed concern both about coping at home and about needing extra support; four of the nine patients who recruited additional help were in this group (P = 0.239; n.s.). There was no correlation between additional support needed and patients living alone (P = 0.302; n.s.), dependent relative (P = 0.325; n.s.) or existing domiciliary support (P = 0.197; n.s.). All patients were satisfied with their management, and of the six who expressed concern about being able to cope at home, none informed A&E staff. Patients' perception is an unreliable indicator of their need for additional help and their ability to manage at home after discharge from A&E departments. Additional support requirements appear to be unrelated to domestic circumstances.
Aftercare↗
Treatment of elderly hypertensives: some questions remain unanswered.
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Aged↗
Diagnostic dilemmas in acutely ill elderly people.
The atypical and non-specific clinical presentations of disease in elderly people may produce diagnostic confusion. Laboratory investigations can be especially important in achieving the correct diagnoses in the older age group. Accurate interpretation of laboratory data from elderly patients necessarily requires a knowledge of the effects of ageing on the biochemical and haematological parameters of healthy individuals, so that involutional changes are not misinterpreted as representative of disease and, conversely, significant deviations from normal values are not attributed to the ageing process. In addition, the laboratory data on elderly subjects may be further complicated by specific effects of illness in the aged. Co-existent pathology or multiple drug therapy, which are most common in old people, also cause changes which should be recognised by laboratory and clinical staff alike.
Acute Disease↗
The effect of postprandial hypotension on rehabilitation of the frail elderly with cerebrovascular disease.
A total of 15 elderly patients recovering from stroke were included in a random, observer-blind, crossover trial to investigate the effects of postprandial cardiovascular changes. Exercise capability, sitting and erect blood pressure and heart rate were recorded pre- and postprandially; a control group received water only. Exercise capability decreased significantly (P < 0.05) in the control group, but not in the test group. Systolic and diastolic blood pressures in the erect position post-exercise were significantly (P < 0.05) reduced in the test group 15 min after eating; in the control group there was no significant change. A significant (P < 0.05) increase in heart rate in the erect position was seen postprandially in the test group after exercise, but not in the control group. All other changes recorded did not reach statistical significance. No reduction in exercise capability occurred in patients exhibiting postprandial hypotension after food, as simultaneous increases in heart rate probably resulted in output being maintained.
Aged↗
Varying thrombolytic administration rates in elderly patients with acute myocardial infarction.
Receipt of thrombolytic therapy in patients aged 75 or over with proven acute myocardial infarction admitted initially to either the coronary care unit (CCU) or a geriatric medical ward (GMW) was studied retrospectively in a hospital administering thrombolysis only in the CCU. Mean age and age distribution of patients admitted to each unit initially showed no significant difference. Of 50 patients admitted directly to the CCU, 28 (56%) received thrombolysis, compared with 13 of 50 (26%) GMW admissions (P < 0.02). Of 37 GMW admissions, 14 (38%) failed to receive thrombolysis without documented contraindication compared with 2 of 22 (9%) CCU admissions (P < 0.05). Aspirin was administered in 39 (78%) CCU and 31 (62%) GMW admissions (P < 0.05). Non-administration of aspirin without apparent contraindication occurred in 3 of 11 (27%) compared with 8 of 19 (42%) GMW admissions (NS). Elderly patients thus failed to receive thrombolytic therapy as a result of initial admission to a unit unable to administer this treatment.
Age Factors↗