Coronary angiography in octogenarians: results and implications for revascularization.

PURPOSE: To determine the risks and the consequences of coronary angiography performed on octogenarians with symptomatic coronary artery disease. PATIENTS AND METHODS: In order to define angiographic findings, procedural complications, and therapeutic consequences, a retrospective evaluation was made of 115 consecutive patients with angina, aged 80 or above, who underwent coronary angiography in our institution between 1988 and 1992. RESULTS: In all, 115 patients (68 men) aged 82 +/- 2 years, 70% with unstable angina, underwent coronary angiography corresponding to 1.4% of all the procedures performed between 1988 and 1992. Three-vessel or left main coronary artery disease, or both, was found in 42% of cases, but this proportion decreased over the years. Revascularization by means of percutaneous transluminal angioplasty (PTCA) or bypass grafting followed angiography in 54% of cases. Use of revascularization has markedly increased, from 33% in 1988 to 64% in 1992 (P < 0.05), and now tends to be performed more often by PTCA. Eight patients (7%) suffered minor periprocedural complications and 8 patients (7%) died in the hospital, but none of the deaths was directly related to the diagnostic procedure itself. At follow-up (28 +/- 16 months), 68% and 44% of the survivors were free of angina after revascularization and medical treatment, respectively (P < 0.05), and there was a nonsignificant trend for better survival after revascularization. Of the survivors, 80% were able to pursue an independent life. CONCLUSIONS: Coronary angiography may be done in symptomatic octogenarians with an acceptably low complication rate. Following diagnostic evaluation, revascularization procedures are performed in an increasing proportion of patients, and despite a relatively high procedural complication rate, they result in definite symptomatic improvement.

[Non-compliant drug taking in elderly subjects]. / La non-compliance médicamenteuse chez les sujets âgés.

Particular consequences of a poor therapeutic compliance by elderly patients are discussed in the context of three selected case reports. They comprise: dosage-errors, discontinuation of therapy (also transient), neglecting of time schedule or rhythm of intake, concomitant therapies. This lacking therapeutic compliance is particularly important because of following situations or interaction between: the elderly patient, that has to be appreciated specific life values, dietary habits, culture and motoric, sensory and/or psychic handicaps and his, lay environment (acquaintances or relatives, inexpert in subsequent medical problems), or last his, medical environment and the positive or harmful interactions of the physicians and/or different therapeutic options.

Surgery in primary leiomyosarcoma of the heart.

Primary leiomyosarcoma of the heart is uncommon and we were able to find only 15 cases reported in the literature. Few of these cases were discovered during life and, as a result, even fewer have been treated surgically. We report a case of a right atrial leiomyosarcoma which was proven pathologically (histologically, immunohistochemically and ultrastructurally) after surgical resection. The clinical presentation, morphological, appearances and outcome are compared with those reported in the literature.