Aortic stenosis(AS)is one of the most common types of valvular heart disease in older adults,with age being significantly associated with the development of AS.The transcatheter aortic valve replacement(TAVR)procedure...Aortic stenosis(AS)is one of the most common types of valvular heart disease in older adults,with age being significantly associated with the development of AS.The transcatheter aortic valve replacement(TAVR)procedure,since it was first performed in 2002,has emerged as a preferred treatment option for patients who are at intermediate to high surgical risk due to advanced age or medical comorbidities.Older adults with severe AS may present with acute decompensated heart failure leading to cardiogenic shock(CS).Among patients 65 years and older with AS presenting for TAVR,4.1%were reportedly in acute CS.Regardless of etiology,mortality from CS itself is high(30%−50%)and increases with advancing age.TAVR for these patients could provide a definite treatment for both AS and CS.There is still limited evidence regarding the safety and efficacy of TAVR in this population,but recent studies are promising,with successful procedural results and a good recovery rate after the procedure.However,particularly for older adults,there are other factors that clinicians should consider during pre-and post-procedural status,such as patient’s goals,frailty,polypharmacy,dementia,or delirium.In this article,we reviewed current studies regarding TAVR for older adults with AS and CS,the reason for comprehensive geriatric assessment,and the introduction of appropriate geriatric assessment tools based on the Age-Friendly 4Ms framework that cardiologists can adopt in real-world practice.展开更多
AIM:To determine the utility of computed tomography(CT) scanning in localizing colon tumors.METHODS:At a single tertiary care teaching hospital,a retrospective chart review was conducted on patients who underwent surg...AIM:To determine the utility of computed tomography(CT) scanning in localizing colon tumors.METHODS:At a single tertiary care teaching hospital,a retrospective chart review was conducted on patients who underwent surgery for colon malignancies between January 2004 and May 2006.One hundred and four charts containing all of the following data were reviewed:preop erative colonoscopy report,preoperative CT report,surgical operative report,tumor pathology report.The colon was divided into five segments from the cecum to the sigmoid and the location of the lesions was categorized into one of these areas.The tumor location was considered "erroneous" if its location determined during surgery differed from the location determined by colonoscopy or CT.RESULTS:Over all,tumor location was accurately determined via colonoscopy in 83/104 cases(79.8%) and erroneously in 21/104(20.2%) of cases.CT scan accurately localized colon tumors in 52/104(50.0%) of cases,incorrectly localized tumors in 18/104(17.3%) of cases,and did not detect known tumors in 34/104(32.7%) of cases.Of the 21 tumors erroneously located by colonoscopy,11(52.4%) were accurately localized by CT scan.The average tumor size for all patients in this study was 5.72(+/-3.11) cm.The average size of tumors properly located by colonoscopy and CT was 5.39(+/-3.34) cm and 6.79(+/-3.48) cm,respectively.The average size of the tumors not detected by CT was 3.98(+/-1.75) cm.CONCLUSION:CT scanning may be used in concert with colonoscopy to help localize colon tumors.展开更多
文摘Aortic stenosis(AS)is one of the most common types of valvular heart disease in older adults,with age being significantly associated with the development of AS.The transcatheter aortic valve replacement(TAVR)procedure,since it was first performed in 2002,has emerged as a preferred treatment option for patients who are at intermediate to high surgical risk due to advanced age or medical comorbidities.Older adults with severe AS may present with acute decompensated heart failure leading to cardiogenic shock(CS).Among patients 65 years and older with AS presenting for TAVR,4.1%were reportedly in acute CS.Regardless of etiology,mortality from CS itself is high(30%−50%)and increases with advancing age.TAVR for these patients could provide a definite treatment for both AS and CS.There is still limited evidence regarding the safety and efficacy of TAVR in this population,but recent studies are promising,with successful procedural results and a good recovery rate after the procedure.However,particularly for older adults,there are other factors that clinicians should consider during pre-and post-procedural status,such as patient’s goals,frailty,polypharmacy,dementia,or delirium.In this article,we reviewed current studies regarding TAVR for older adults with AS and CS,the reason for comprehensive geriatric assessment,and the introduction of appropriate geriatric assessment tools based on the Age-Friendly 4Ms framework that cardiologists can adopt in real-world practice.
文摘AIM:To determine the utility of computed tomography(CT) scanning in localizing colon tumors.METHODS:At a single tertiary care teaching hospital,a retrospective chart review was conducted on patients who underwent surgery for colon malignancies between January 2004 and May 2006.One hundred and four charts containing all of the following data were reviewed:preop erative colonoscopy report,preoperative CT report,surgical operative report,tumor pathology report.The colon was divided into five segments from the cecum to the sigmoid and the location of the lesions was categorized into one of these areas.The tumor location was considered "erroneous" if its location determined during surgery differed from the location determined by colonoscopy or CT.RESULTS:Over all,tumor location was accurately determined via colonoscopy in 83/104 cases(79.8%) and erroneously in 21/104(20.2%) of cases.CT scan accurately localized colon tumors in 52/104(50.0%) of cases,incorrectly localized tumors in 18/104(17.3%) of cases,and did not detect known tumors in 34/104(32.7%) of cases.Of the 21 tumors erroneously located by colonoscopy,11(52.4%) were accurately localized by CT scan.The average tumor size for all patients in this study was 5.72(+/-3.11) cm.The average size of tumors properly located by colonoscopy and CT was 5.39(+/-3.34) cm and 6.79(+/-3.48) cm,respectively.The average size of the tumors not detected by CT was 3.98(+/-1.75) cm.CONCLUSION:CT scanning may be used in concert with colonoscopy to help localize colon tumors.
