Cardiac surgery in septuagenarians: is there a difference in mortality and morbidity?

Open heart surgery is being performed with increased frequency in elderly patients. Results vary considerably probably as the profile of the surgical population changes. A comparison was established by means of univariate analysis between two consecutive series of 100 patients undergoing bypass grafting or valvular replacement. Group A patients were 70 years of age or older; group B patients were less than 65 years of age. Various clinical, operative, and postoperative parameters were monitored. A significant difference was found between the two groups. Elderly patients tended to be white, female, with poor left ventricular and renal function, had carotid or peripheral vascular disease, and new onset of symptoms. Fewer patients had single-vessel disease and received internal mammary artery grafts. Operative mortality rate was higher in group A subjects and postoperative neurologic complications were also more frequent in this group. Factors influencing operative mortality were the association between vascular disease, presence of left main coronary artery disease, and urgency of the procedure. The mortality rate was 17.2% in 29 patients with associated vascular disease and 4.8% (3/63) in those without vascular disease (p = 0.048). Operative mortality was 4.1% without left main coronary artery disease, 15% with left main coronary artery disease (p = 0.083), and 4% in 84 patients having elective operations versus 31.2% in patients having 16 emergency procedures (p = 0.001). Short-term follow-up revealed a higher late mortality rate in elderly subjects and suggested an increased incidence of early pulmonary embolus. Nevertheless, elective cardiac surgery may be safely performed in septuagenarians with an expected operative mortality rate under 5%.

Coronary artery bypass grafting with saphenous vein.

Occlusion rate of the saphenous vein is around 12-20% during the 1st year and 2-4% annually for the next 4 or 5 years. Subsequently, this rate doubles, so that at 10 years, approximately 50% of grafts become occluded due to the occurrence of graft atherosclerosis. A similar percentage of patent grafts show atherosclerotic changes at the end of the 1st decade. Sequential vein grafts probably suffer the same fate although late follow-up is lacking. Reoperation is estimated to be 30% at 10 years, as judged by angiographic criteria. The operative risk of reoperation is at least double that of primary operation; symptomatic relief appears to be of shorter duration. Recent technical changes to better preserve medial and endothelial function and to pharmacologically inhibit platelet function may lead to longer duration of the venous conduit.

Comparison of ceftazidime with cefamandole for therapy of community-acquired pneumonia.

Ceftazidime and cefamandole were compared in the treatment of pneumonia. The median MIC of ceftazidime for all Streptococcus pneumoniae (n = 17) and Haemophilus influenzae (n = 10) isolates was 0.125 microgram/ml. All other isolates were inhibited by less than 0.5 microgram of ceftazidime per ml, with the exception of a group B streptococcus (MIC = 4 micrograms/ml). Satisfactory clinical responses were observed in 91% (20 of 22) of cefamandole-treated patients and 85% (17 of 20) of ceftazidime-treated patients.

Plasma beta-thromboglobulin levels in lung cancer.

beta-Thromboglobulin (beta-TG) is a platelet-specific protein that is released into plasma when platelets are activated in vivo. The involvement of platelets in tumor metastasis has been shown in animal studies. To study the role of platelets in tumor metastasis in humans, we measured plasma concentrations of beta-TG in 20 patients with newly diagnosed lung cancer and 11 healthy control subjects. The mean plasma concentration of beta-TG was significantly elevated in patients with advanced or metastatic lung cancer when compared with concentrations in healthy controls or patients with limited disease. This study suggests there is in vivo activation of platelets in patients with advanced or metastatic lung cancer.

Clinical evaluation of cefotaxime for therapy of lower respiratory tract infections.

A clinical trial was designed to evaluate the efficacy and safety of cefotaxime, a new semisynthetic, broad-spectrum cephalosporin, in the therapy of community-and hospital-acquired pneumonias. Thirty-nine males (mean age, 65 years) were treated for 41 episodes of pneumonia. Only five patient did not have a serious underlying disease; 15 had two or more significant disorders. Sixty-six percent of these pneumonias were due to Streptococcus pneumoniae or Haemophilus influenzae. The minimal inhibitory concentrations for all bacterial isolates ranged from 0.008 to 4 micrograms/ml. Peak serum cefotaxime levels during therapy ranged from 12 to 124 micrograms/ml 1 h after a 1-g dose. Satisfactory bacteriological and clinical responses were observed in 85% of the cases. Four episodes of pulmonary superinfections due to cefotaxime-resistant gram-negative bacilli were noted, each in a patient being mechanically ventilated. Pseudomonas was involved in each of these superinfections, and three were fatal. No serious toxicity or adverse reaction to cefotaxime was seen. The results of this study suggest that cefotaxime is an affective and well-tolerated new cephalosporin antimicrobial agent for the therapy of pneumonia due to susceptible organisms.