Evaluation of preoperative geriatric assessment of elderly patients with colorectal carcinoma. A retrospective study.

AIMS: Elderly patients with colorectal carcinoma are screened with the Identification of Seniors at Risk (ISAR) questionnaire to identify frail patients. These patients are more at risk for mortality and morbidity and are referred to the geriatric specialist for assessment (Dutch acronym: DOG). The DOG assessment aims to preoperatively optimize the patient in order to improve postoperative outcomes. This study evaluates if the DOG assessment influences postoperative outcome after colorectal surgery. METHODS: Retrospective cohort and match-control study. Elderly patients who underwent elective resection between 01-01-2008 and 01-08-2013 in the Medical Centre Alkmaar were included. Patients with a positive ISAR score were referred to the geriatric specialists for DOG assessment (DOG patients). DOG assessment encompassed comprehensive geriatric assessment and interventions. PRIMARY OUTCOMES: Mortality, delirium and length of hospital stay. SECONDARY OUTCOMES: postoperative complications. COHORT COMPARISON: Cohort ISAR- (2008-2010, no ISAR questionnaire) is compared with cohort ISAR+ (2011-2013, ISAR questionnaire). Match-control comparison: DOG patients are compared with matched controls from cohort ISAR-. RESULTS: Compared to their matched controls, DOG patients were older and had a higher prevalence of certain risk factors for postoperative delirium. In both comparisons, no statistical significant differences were found between the groups in mortality and postoperative delirium. Length of stay was significantly shorter in cohort ISAR+. CONCLUSIONS: While the DOG patients were significantly more at risk for postoperative complications, the DOG patients had comparable postoperative outcomes as their matched controls. We therefore conclude that the DOG assessment has a positive influence on the postoperative outcomes after colorectal surgery.

[Decreased erythropoiesis and biochemical deviations in psychogeriatric patients]. / Gestoorde erythropoïese en biochemische afwijkingen bij psychogeriatrische patiënten.

Laboratory investigations were performed in group of 60 psychogeriatric patients on their admission into hospital, in order to elucidate the interdependence of erythropoiesis and the concentrations of albumin and several vitamins in blood or serum. The results of albumin concentration and ETK activity show that 47 out of 60 the patients (= 78%) are in a poor nutritional condition. In 13 of these 47 subjects (= 28%) deficiency with respect to vitamin B12 or folic acid is presumed from decreased serum concentrations. In 6 of the 47 patients in poor nutritional condition (= 13%) decreased reticulocyte concentrations are shown. Further evaluation of differences between the respective subgroups revealed significantly reduced ETK activity and lower reticulocyte concentrations in the group of delirium patients compared to the other patients groups and to the reference group.

Gadolinium-DTPA enhanced MR imaging of intravenous extension of adrenocortical carcinoma.

A case of magnetic resonance imaging of adrenocortical carcinoma extending into the inferior vena cava is presented. Magnetic resonance was able to outline the intraluminal extent of tumor thrombus accurately. Signal intensity ratios (mean 0.98 +/- 0.02) of tumor thrombus/primary tumor on T1- and T2-weighted sequences were useful for tissue characterization of tumor thrombus. Time course of the signal intensity of thrombus before and after intravenous administration of 0.1 mmol/kg gadolinium-diethylenetriamine pentaacetic acid was identical to the primary tumor which aided in differentiation from nontumor thrombus.

Cholinergic regulation of pancreatic polypeptide secretion in chronic renal failure.

Secretion of pancreatic polypeptide (PP) is regulated mainly by cholinergic mechanisms and we have studied this in patients with chronic renal failure (CRF). Basal serum PP concentrations in 25 patients with CRF (401 +/- 80; 116-2100 pmol/l; mean +/- SEM and range) were significantly higher than in 65 normal subjects (33 +/- 2; 21-120 pmol/l, P less than 0.001). Ingestion of a standard test meal induced significantly larger increases in serum PP in 11 patients with CRF (304 +/- 45; 155-640 pmol/l) than in 11 normal subjects (140 +/- 33; 51-440 pmol/l, P less than 0.005). Insulin-hypoglycaemia (0.1 U/kg i.v.) provoked similar increases in serum PP in five patients with CRF (404 +/- 79; 170-665 pmol/l) as in five normal subjects (449 +/- 92; 180-706 pmol/l). Administration of atropine (1 mg i.v.) did not normalize the elevated basal serum PP concentrations in five patients with CRF. On the other hand, administration of the same dose of atropine 60 min after ingestion of food decreased postprandial serum PP levels to basal values within one hour both in five patients with CRF and in six normal subjects. Sephadex G-50 column chromatography of basal, postprandial and post-atropine sera from three patients with CRF revealed at least three different molecular forms. The PP peak coeluting with the 4200 molecular weight human PP standard comprised more than half of total PP immunoreactivity and was the only peak to be influenced by feeding or atropine. We conclude that in patients with CRF, PP secretion stimulated by cholinergic mechanisms is normal.(ABSTRACT TRUNCATED AT 250 WORDS)

Mechanism of elevated serum pancreatic polypeptide concentrations in chronic renal failure.

Basal serum concentrations of pancreatic polypeptide (PP) in five patients with chronic renal failure (CRF; 165-2100 pmol/liter) were significantly (P less than 0.01) higher than those in six age-matched normal control subjects (18-54 pmol/liter). Ingestion of a mixed meal resulted in significantly (P less than 0.01) larger increases in serum PP in patients with CRF (245-1740 pmol/liter) than in the normal subjects (72-196 pmol/liter). The iv administration of somatostatin (125 micrograms as a bolus injection, followed by infusion of 125 micrograms/h) to two patients with CRF and two normal subjects completely abolished postprandial PP release. By administering the same dose of somatostatin 60 min after ingestion of the meal, the disappearance rate of endogenously released PP could be estimated. The half-life of disappearance for PP in patients with CRF (t1/2 = 13.2 +/- 1.8 min) was significantly (P less than 0.01) increased compared to that in the normal subjects (t1/2 = 5.6 +/- 0.8 min). Sephadex G-50 column chromatography of basal sera from three patients with CRF revealed three major peaks of PP: one eluting in the void volume, one coeluting with the 4200 molecular weight human PP standard, and one in between. The PP peak coeluting with standard PP comprised 64 +/- 3% of total PP immunoreactivity. Ingestion of food, followed by subsequent infusion of somatostatin, resulted in marked changes in the PP peak coeluting with standard PP, while the two larger molecular forms remained relatively unchanged. At least three findings may be related to the mechanism of elevated serum PP concentrations in patients with CRF: 1) the presence of large molecular forms of PP, 2) a slower disappearance rate for postprandially released PP, and 3) increased postprandial secretion of PP indicating hyperresponsiveness of PP cells to physiological stimuli.