OPERATIONS UPON THE AGED

From the point of view of the surgeon, as repeatedly emphasized in the surgical literature, the mortality rate for operations upon old persons is only slightly higher for elective surgical operations than for the same operations on younger persons when proper preoperative and postoperative precautions are taken. However, the mortality rate for emergency operations is much higher in old persons than in younger ones. Many surgeons believe, therefore, that disease for which operation is otherwise indicated should be treated surgically irrespective of the age of the patient per se.The authors'' experience with operations upon old persons at the San Francisco Hospital accords with these conclusions.     

Self-destructive behaviour in the Hungarian population

In Hungary today the mortality rate of middle aged (55-64 years old) men is higher than it was in the 1930s. Within these statistics there are considerable socioeconomic differences, the mortality rate of lower secondary or lower educated middle aged men is 1.45 times higher than among those with higher education. About 40% of these socioeconomic mortality differences can be explained by higher prevalence of risk behaviour in lower socioeconomic groups. According to the results of our national representative survey conducted in the Hungarian population with 12640 persons in 1995, the prevalence of smoking was 45.5% among men and 26.6% among women. In the populaton younger than 45 years old the prevalence of smoking among men was 47.9%, among women 31.9%. Among men there is a clear socioeconomic gradient in smoking, in the number of daily cigarettes, the quantity of spirit consumption in one occasion, among women this socioeconomic gradient is not so obvious. The effectiveness of health promotion programmes depends on effective management of the motivational, psychological determinants of risk behaviour.     

Mutual stereotypes of younger and older adults and their relation with self-concept and self-esteem

In this study younger and older persons were compared with regard to their stereotypes about both age groups, their self-concept and self-esteem. We examined the relation between age and stereotypes about younger and older adults, the relation between stereotypes about one's own age group and self-concepts, and the relation between self-concepts and self-esteem. Stereotypes and self-concepts were measured on two dimensions, warmth and competence. Twenty-eight younger adults (16-25 years) and 26 older adults (65-85 years) participated in this study. Both age groups perceived younger persons as more competent than older persons and older persons as more warm than younger persons. Older persons rate themselves higher than their in-group on competence and warmth. Younger respondents did the same, but on warmth only. A rating of the own person as more competent than the stereotype of their own age group, is related to self-esteem for older persons. Distancing oneself from negative stereotypes about one's own age group is an important key in maintaining high levels of self-esteem, but only in old age.     

Selection of operation in patients with bleeding esophageal varices.

The results of surgical treatment of bleeding esophageal varices over an 8-year period in 155 patients are reviewed. Primary treatment of bleeding was conservative, with intravenous administration of vasopressin and balloon tamponade. Emergency operations were carried out after 48 hours in persons with persistent bleeding who were surgical candidates. Operative mortality was higher in this group (40%) than in those undergoing elective or urgent operations (each 10%). Postoperative encephalopathy occurred in 35% of patients and was correlated closely to late death after establishment of a shunt. The mesocaval shunt is no better than the portacaval but appears to be a good alternative in an emergency. In a controlled trial the distal splenorenal shunt was found to be associated with a lower rate of postoperative encephalopathy than the portacaval shunt, but thus far the long-term survival rates have not differed.     

Wederzijdse stereotypen van jongeren en ouderen en hun relatie met zelfbeeld en zelfwaardering

Mutual stereotypes of younger and older adults and their relation with self-concept and self-esteem In this study younger and older persons were compared with regard to their stereotypes about both age groups, their self-concept and self-esteem. We examined the relation between age and stereotypes about younger and older adults, the relation between stereotypes about one’s own age group and self-concepts, and the relation between self-concepts and self-esteem. Stereotypes and self-concepts were measured on two dimensions, warmth and competence. Twenty-eight younger adults (16-25 years) and 26 older adults (65-85 years) participated in this study. Both age groups perceived younger persons as more competent than older persons and older persons as more warm than younger persons. Older persons rate themselves higher than their in-group on competence and warmth. Younger respondents did the same, but on warmth only. A rating of the own person as more competent than the stereotype of their own age group, is related to self-esteem for older persons. Distancing oneself from negative stereotypes about one’s own age group is an important key in maintaining high levels of self-esteem, but only in old age.     

Ultrastructural changes in the cerebral cortex of an 100 1/2-year-old man

Age changes in fields 39 and 40 (after Broadman) have been studied in a 100 years and 6 months old man died from peritonitis resulted from the surgical intervention, performed in connection with strangulation of the hernia. In the medical history there were no ++neuro-physical signs. The material was taken in 1 h 15 min after clinical death had been stated. The results obtained have been compared with those studied in the brain of persons, who had not yet reached the age of 100 years and had not any signs of ++neuro-physical disturbances and died after urgent surgical interventions in the abdominal cavity. In this group of persons the material for investigation was taken in 15-30 min after clinical death had been stated. The technique for treatment the material, its preparation for electron-microscopical examination is identical. Immersion fixation has been applied. The material obtained from an old animal fixed by means of vital perfusion of 2.5% glutaraldehyde solution is also used. In the person of 100 years and 6 months old the changes do not practically differ from those obtained from persons of younger age, however, the time from the statement of clinical death up to obtaining the material essentially influences preservation of the synaptic apparatus components.     

Paediatric cardiac surgical mortality in England after Bristol: descriptive analysis of hospital episode statistics 1991-2002

Objective To describe trends in mortality of open cardiac surgery in children in Bristol and England since 1991.Design Retrospective analysis of hospital episode statistics data.Setting All open cardiac surgery of children in England.Population Patients younger than 16 undergoing open cardiac surgical procedures in England between April 1991 and March 2002. Three time periods were defined: epoch 3 (April 1991 to March 1995), epoch 5 (April 1996 to March 1999), epoch 6 (April 1999 to March 2002).Main outcome measure Mortality in hospital within 30 days of a cardiac procedure.Results We identified 5221 open operations between April 1996 and March 2002 in children under 1 year and 6385 in children aged 1-15 years. Mortality for all centres combined fell from 12% in epoch 3 to 4% in epoch 6. Mortality in children under 1 year at Bristol fell from 29% (95% confidence interval 21% to 37%) in epoch 3 to 3% (1% to 6%) in epoch 6, below the national average. The reduction in mortality did not seem to be due to fewer high risk procedures or an increase in the numbers of low risk cases. Oxford had a significantly higher mortality than the national average in all three epochs (11% (5% to 18%) in epoch 6), which was not affected by adjusting for procedure or the inclusion of cases with missing outcomes.Conclusions At Bristol, mortality for open operations in children aged under 1 year has fallen markedly, to below the national average. Nationwide mortality has also fallen. Improved quality of care may account for the drop in mortality, through new technologies or improved perioperative and postoperative care, or both.     

Mortality in Svalbard reindeer

Mortality rates in Svalbard reindeer followed the "U"-shaped pattern, with higher mortality rate among calves and old animals than in middle aged individuals. Assuming a stable population size, the mortality data predict a 16.2% annual mortality and recruitment rate among 6 months and older animals, and a male:female sex ratio of 48.5:51.5 among 1-yr old and older. Both predictions are supported by field data. Female mortality rate increased and differed from the male rate in the age interval 2-4 yr, while the male rate increased sharply and differed permanently from the female rate in the age interval above 6 yr. First and last breeding are thought to cause the increased mortality among 2–4 and 11–13 yr-old females. Increased involvement in rutting activities with age associated with lower grazing activity and depletion of fat reserves probably cause the increasing mortality rate among the 6+ yr males. Maximum life span was 17 yr in females and 12 yr in males. Apart from the unknown but possibly high neonatal calf-mortality, only few animals died during summer or during the rut in autumn. Death among calves, yearlings and most of the females occurred before antler-shedding in May-June. Most of the 2-yr and older males died after antler shedding, which occurs from December among the oldest and during April-May among the younger males. Hence, the major part of the mortality takes place in spring. The lack of visible subcutaneous and femur fat in most carcasses indicated starvation as the major mortality cause.     

Distinct Clinical and Experimental Characteristics in the Patients Younger than 60 Years Old with Myelodysplastic Syndromes

Myelodysplastic syndromes (MDS) mainly occur in elderly individuals in Western countries. However, MDS is commonly found in young individuals (<60 years) in Asia. The reason for the high incidence in younger individuals is still unclear, and the differences in disease features between young and elderly patients with MDS have been not well recognized. To explore these issues, in this study, we analyzed the clinical and experimental characteristics of MDS in the patients younger and older than 60 years old and characterized the potential age-associated differences. The results showed that over half of the patients with MDS (61.9%) were younger than 60 years old upon the first diagnosis. The younger patients were more likely to be female, who have lower risk and less advanced MDS. The occurrence of trisomy 8 and bone marrow failure were more frequent in the younger patients than the older ones. The marrow CD34+ cells in the younger patients showed lower proliferation and higher apoptosis in comparison with that in the older ones. Obvious amplification of T cells and low CFU formation could be found in the younger patients. CFU formation was significantly increased in the younger patients after the removal of activated T cells. In addition, the younger patients had a lower frequency of p15^INK4B methylation, longer survival expectancy and less AML transformation. In summary, the younger patients with MDS in China may show more benign disease features than the older ones. Enhanced immunological response may be involved in the pathogenesis of MDS in the patients younger than 60 years.     

Surgical Procedures in Nonagenarians

During the hospital course of 225 nonagenarian patients who underwent 285 major operations—80% on the general, vascular, orthopedic and urologic services—overall morbidity was 37% and mortality 7.5%. The 100 emergency operations were associated with a higher morbidity and mortality rate. Nonsurvivors were more likely to have associated cardiac or cerebral medical conditions, higher utilization of intraoperative invasive hemodynamic monitoring and greater use of surgical intensive care units. Compared with all surgical patients, the nonagenarians were admitted twice as often to the surgical intensive care unit, required twice the number of hospital days, underwent intraoperative hemodynamic monitoring twice as frequently and incurred 200% greater hospital charges. We conclude that with careful evaluation and management, a nonagenarian patient presenting with a surgical condition can safely undergo necessary operative procedures.     

OPERATING ROOM DEATHS—An Analysis of Mortality in a Veterans Administration Hospital Over a Ten-Year Period

A study of operating room and recovery room deaths which occurred during a ten-year period from 1948 through 1957 at one hospital revealed that there were 59 deaths associated with 57,132 surgical procedures.Factors which directly influenced the rate of operating room and recovery room death were the age of the patient and the length of operating time. Seventy-five per cent of the deaths occurred in cases in which the operation took longer than one hour. Combined anesthesia techniques may have indirectly contributed to death in some cases.Complications of operation requiring another surgical procedure sometimes occur. In this series, reoperation proved to be more hazardous in terms of mortality rate than did single operations. This is not surprising for most complications occur in the poorer risk patients.The operating room death rate steadily increased during the ten-year period studied. This increasing death rate can largely be attributed to the more intricate operations which are being done on poorer risk patients. The use of the curariform drugs had no influence on the increasing death rate.     

Operating room deaths; an analysis of mortality in a Veterans Administration hospital over a ten-year period

A study of operating room and recovery room deaths which occurred during a ten-year period from 1948 through 1957 at one hospital revealed that there were 59 deaths associated with 57,132 surgical procedures. Factors which directly influenced the rate of operating room and recovery room death were the age of the patient and the length of operating time. Seventy-five per cent of the deaths occurred in cases in which the operation took longer than one hour. Combined anesthesia techniques may have indirectly contributed to death in some cases. Complications of operation requiring another surgical procedure sometimes occur. In this series, reoperation proved to be more hazardous in terms of mortality rate than did single operations. This is not surprising for most complications occur in the poorer risk patients. The operating room death rate steadily increased during the ten-year period studied. This increasing death rate can largely be attributed to the more intricate operations which are being done on poorer risk patients. The use of the curariform drugs had no influence on the increasing death rate.     

Growth and morphological response of old-forest lichens transplanted into a young and an old Picea abies forest

This experimental study focuses on why old-forest lichens such as Lobaria scrobiculata and Platismatia norvegica are scarce in younger spruce stands. Understanding the factors limiting the distribution of species is important for developing appropriate methods for forest management aiming to maintain biodiversity. A successful growth of L. scrobiculata and P. norvegica was found in the young planted stand as the rate of growth did not differ between the young stand and the old spruce forest where they naturally occurred, during 14 months of transplantation. In the young forest environment, L. scrobiculata showed a significantly higher specific thallus weight, and a slightly higher water-holding capacity. This morphological response is probably due to a higher light exposure in the young stand and consequently a higher rate of desiccation. The ubiquitous species Platismatia glauca showed a significantly higher rate of growth in the young forest than in the old forest, and a positive relationship between growth rate and light exposure was found. This transplant study has shown that the environmental conditions in younger planted forests are not necessarily unfavourable for growth of old-forest lichens. Other factors, such as limited dispersal ability and poor diaspore production, are probably important for explaining the species scarcity in younger stands.     

Aging, Obesity, and Mortality: Misplaced Concern About Obese Older People?

Although there is widespread agreement that obesity (body mass index [BMI] ≥ 30 kg/m(2)) raises health risks, debate has ensued on whether obese older adults are also at greater risk. This study examines the effect of obesity on mortality for younger and older adults to determine whether the risk of obesity is lessened in later life. Data from a 20-year follow-up of a national sample of adults were used to examine the risk of obesity on mortality (N = 6,767). Cox models reveal that obesity raises mortality risk for adults of all ages, but this relationship is nearly twice as strong for persons younger than 50 years of age. Being slightly overweight in later life is associated with lower mortality risk, but obesity raises mortality risk, especially for ischemic heart disease. Obesity in middle age is a grave public health concern, but obesity in later life also merits attention.     

The impact of co-resident spouses and sons on elderly mortality in rural Bangladesh

This paper uses prospective data from the Matlab surveillance system in rural Bangladesh to demonstrate that initially co-resident spouses and sons have a major impact on the subsequent mortality of old people, with significant differences by the sex of the elderly person, and the age of the son. Spouses significantly reduce mortality by similar magnitudes for both elderly men and women. On the other hand, co-resident adult sons reduce mortality for elderly women much more than for elderly men, with younger sons being more beneficial than older sons. Furthermore, both married and unmarried females appear to benefit equally from co-resident adult sons. Finally, this analysis suggests that the impact of spouses and sons on mortality in old age is not substantially mediated through changes in elderly economic status.     

Leukocytes of exceptionally old persons display ultra-short telomeres

With a view to understanding the association between leukocyte telomere length and the human lifespan, we performed genome-wide telomere length analyses by the terminal restriction fragment length (TRFL) and single molecule telomere length analysis (STELA) of the X and Y chromosomes in leukocytes of exceptionally old (aged 90-104 yr) and younger (aged 23-74 yr) individuals. We found that the mean TRFL of 82 exceptionally old individuals was within a range projected by age-dependent TRFL attrition of 99 younger individuals. However, compared with the younger individuals, exceptionally old persons exhibited peaking of the TRFL distribution with overrepresentation of ultra-short telomeres. These findings were confirmed by the STELA. Women had longer mean TRFL than men (6.10 vs. 5.86 kb), and exceptionally old women exhibited fewer ultra-short telomeres than exceptionally old men. Our results have implications for gerontological studies of the limitation of lifespan in humans.     

Emergency geriatric surgical admissions

The emergency surgical work load created by patients aged 80 and over in a district hospital was assessed and the results of treatment examined. Over one year 248 patients aged 80 or over were admitted as emergencies, and the overall mortality rate was 21·8%. When terminal disease was excluded mortality rate was 12·5%. These elderly patients had an average length of stay in the acute surgical ward of 14·7 days compared with a mean of 8·4 days for all patients, and all but seven patients were discharged to their original place of referral.Elderly patients do exacerbate the bed shortage in acute surgical wards because they tend to stay longer than younger patients, but these elderly surgical patients imposed only a small load on the inpatient geriatric services, as 78% were discharged straight to their own homes and a further 17% went home after a period on the surgical convalescent wards.     

Introduction

A review of the present status of neurosurgical vascular bypass for problems of cerebrovascular occlusive disease is presented. In 70 patients who have undergone operations by one surgical team, the results are most encouraging in cases of transient ischemic attacks with hemodynamic lesions previously considered inoperable or inaccessible in the cerebral vasculature. The morbidity rate is acceptable and the present operative mortality rate is 1.4 percent.     

佛山市2004—2009年麻疹流行病学分析和防治措施探讨

通过分析近年来佛山市麻疹流行病学特征,为探讨麻疹控制措施提供理论依据。对2004—2009年麻疹发病情况进行描述性流行病学分析。结果显示,佛山市2004—2009年共报告麻疹病例3 599例,年平均发病率为10.19/10万;发病数前3位的区为顺德区、南海区、禅城区,占全市病例数的94.50%;4～8月为高发季节,占总病例数的66.60%;6岁以下儿童及15岁以上人群是麻疹发病主要人群,分别占总病例数的62.86%、31.54%;8月龄以下儿童发病数占14.48%;病例以流动人口为主,占总病例数的94.78%;有明确免疫史病例仅占总病例数10.22%。佛山市麻疹发病有回升趋势,疫情形势严峻。实施麻疹疫苗强化免疫和查漏补种是控制麻疹的有效措施;同时应采取加强流动人口管理,提高麻疹疫苗常规免疫接种率和及时率,加强麻疹监测和入学、入托查验证管理,控制医院内感染,强化疫区处理等综合防控措施。