ABSTRACT
AIMS: Self-expanding metal stents provide rapid improvement of dysphagia in oesophageal cancer but are associated with complications. The aim of the present study was to test the effectiveness of an alternative treatment of combining biodegradable stents with radiotherapy. MATERIALS AND METHODS: A Simon two-stage single-arm prospective phase II trial design was used to determine the efficacy of biodegradable stents plus radiotherapy in patients with dysphagia caused by oesophagus cancer who were unsuitable for radical treatment. Fourteen patients were recruited and data from 12 were included in the final analyses. RESULTS: Five of 12 patients met the primary end point: one stent-related patient death; four further interventions for dysphagia within 16 weeks of stenting (41.7%, 95% confidence interval 15.2-72.3%). The median time to a 10-point deterioration of quality of life was 2.7 weeks. Nine patients died within 52 weeks of registration. The median time to death from any cause was 15.0 weeks (95% confidence interval 9.6-not reached). CONCLUSION: The high re-intervention observed, which met the pre-defined early stopping criteria, meant that the suggested alternative treatment was not sufficiently effective to be considered for a larger scale trial design. Further work is needed to define the place of biodegradable stents in the management of malignant oesophageal strictures.
Subject(s)
Deglutition Disorders , Esophageal Neoplasms , Esophageal Stenosis , Deglutition Disorders/etiology , Esophageal Neoplasms/complications , Esophageal Neoplasms/radiotherapy , Esophageal Stenosis/etiology , Esophageal Stenosis/radiotherapy , Humans , Palliative Care , Prospective Studies , Quality of Life , Stents , Treatment OutcomeABSTRACT
BACKGROUND: Enhanced recovery programmes improve outcomes in surgery, but their implementation after upper gastrointestinal resection has been limited. The aim of this study was to compare short-term outcomes for patients undergoing oesophagogastric surgery in an enhanced recovery programme (EROS). METHODS: EROS was developed after a multidisciplinary meeting by multiple rounds of revision. EROS was applied to all patients undergoing major upper GI resection at a university teaching hospital in the UK from 20/9/13, with data reviewed at 18/09/15. EROS was assessed to identify predictors for compliance. RESULTS: One hundred six patients underwent major upper GI resection including 81 oesophagectomies, 24 gastrectomies and 1 colonic interposition graft. Major complications (Clavien Dindo ≥3) occurred in 12 patients with 1 in-hospital death. Thirty-five patients (44%) were discharged on target day 8 of the EROS programme. Age and complications were independently associated with missing this discharge target. CONCLUSION: Enhanced recovery is feasible and safe after major upper gastrointestinal surgery.
Subject(s)
Esophagectomy , Gastrectomy , Perioperative Care/methods , Adult , Age Factors , Aged , Aged, 80 and over , Colon/transplantation , Early Ambulation , Esophagectomy/adverse effects , Female , Gastrectomy/adverse effects , Humans , Length of Stay , Male , Middle Aged , Patient Discharge , Program Development , Treatment OutcomeABSTRACT
Healthy elderly as a group have a wider range for serum copper, ceruloplasmin, and serum zinc than the adjusted ranges for the laboratory. In disease serum copper and/or ceruloplasmin act as acute-phase reactants in vascular disease, inflammation, and malignancy. Serum zinc values likewise are affected by the presence of inflammation and malignancy. The reported low level of copper in patients with osteoporosis was not confirmed by the present study. Neither was there any evidence found for zinc deficiency in patients with dementia.
Subject(s)
Copper/blood , Geriatrics , Zinc/blood , Age Factors , Aged , Ceruloplasmin/blood , Dementia/blood , Female , Humans , Inflammation/blood , Male , Neoplasms/blood , Osteoporosis/blood , Sex Factors , Zinc/deficiencySubject(s)
Osteomalacia/epidemiology , Age Factors , Aged , Female , Humans , Male , Middle Aged , Osteomalacia/drug therapy , Vitamin D/therapeutic useABSTRACT
A study was made of the erythrocyte sedimentation rate (ESR) in 258 normal nonhospitalized elderly subjects (189 women and 69 men). Their ages ranged from 70 to 89 years. Those who had been followed for at least one year showed a mean ESR of 13 mm/hr, with a range of 3-65 mm. A subgroup of 55 (47 women and 6 men) who had been followed for periods of 3 to 11 years showed a mean ESR of 14 mm/hr, with a range of 3-69 mm. The findings indicate that an ESR above the accepted normal range may be consistent with continued good health in the elderly. Thus the ESR determination may be of very limited diagnostic value in this age group.
Subject(s)
Aged , Blood Sedimentation , Blood Proteins/analysis , Female , Fibrinogen/blood , Humans , Male , Reference ValuesSubject(s)
Alkaline Phosphatase/blood , Fractures, Bone/enzymology , Aged , Female , Humans , Isoenzymes/blood , Male , Middle AgedABSTRACT
The value of the estimation of liver and bone isoenzyme of alkaline phosphatase in a series of 500 admissions to a geriatric unit is described. A raised total alkaline phosphatase was found in 40 patients and this was due to raised levels of the bone isoenzyme in about two-thirds of these. Its value in diagnosis of treatable bone disease is emphasized.
