Peripheral neuropathy is an important factor of disability in the elderly. In order to learn more on the usefulness of intensive evaluation of patients over 65 years of age with subacute or chronic disabling peripheral neuropathy, we reviewed the clinical and nerve biopsy findings of the last 100 patients of this age group who suffered from a peripheral neuropathy severe enough to justify performance of a nerve biopsy for a diagnostic or prognostic purpose. Normal nerve biopsy findings led to the diagnosis of lower motor neuron disease in three patients and pointed to lesions of the spinal roots in six other patients. Necrotizing arteritis was demonstrated in the biopsy specimens of 23 patients, and non-necrotizing vasculitis in five. In five additional patients the diagnosis of vasculitic neuropathy was kept in spite of non-contributive biopsy findings. In two diabetic patients who had a multifocal neuropathy the biopsy also revealed the presence of vasculitis. Thus 35% of the patients included in this series had one form or another of vasculitic neuropathy. Fourteen patients had a chronic inflammatory demyelinating polyneuropathy. In 11 patients the neuropathy was associated with monoclonal gammopathy, which was benign in nine and associated with malignant plasma cell dyscrasia in two. Among the six patients with diabetes mellitus, two patients who presented with a multifocal neuropathy were found to have vasculitis in the nerve specimen; in the others the biopsy was performed because of uncommonly severe pains or motor involvement due to an extremely severe diabetic neuropathy. Six patients suffered from a long-lasting disability secondary to a drug-induced neuropathy. The remaining 15% had neuropathies of different origin, including amyloidosis, lepromatous leprosy, carcinomatous neuropathy and alcoholic neuropathy. Six patients had a mild, non-progressive or slowly progressive axonopathy of unknown origin, ageing of the peripheral nervous system may have played a role in its development. Our findings show that vasculitis is an important and treatable cause of disabling neuropathy in the elderly and that the proportion of patients with severe neuropathy of unknown origin is small.

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Lobular breast cancer metastasis to bowel is rare, however, when it occurs, the prognosis is poor. Possible benefits of investigation with screening endoscopy for gastrointestinal metastases are discussed in order to optimize prognosis for patients.

Patient endpoints were cholecystectomy (laparoscopic, conversion to open, or open), tube removal, mortality, and loss to follow-up. Results: Of the 147 patients, 62 (42.2%) received a cholecystectomy (46 [74.2%] laparoscopic, 10 [16.1%] conversion to open, 6 [9.7%] open); 22 (15.0%) expired with the tube in place; 21 (14.3%) had the tube removed as definitive treatment; 7 (4.8%) continued indefinite tube management; 35 (23.8%) were lost to follow-up.Conclusions: Currently, general surgery clinically manages patients after PCT placement with minimal interventional team involvement. While a portion of these patients will be bridged to surgery, some remain too high risk to undergo cholecystectomy. In our hospital, the conversion to open rate for our patients exceeds reported averages of 6.1-10% in patients with chronic and acute cholecystitis [1]. Due to the severity of these patients' chronic comorbidities, there is a need for closer clinical management of their PCTs and possible alternative definitive treatment options. Interventionalists are uniquely positioned to take on primary management role with this population. Definitive management including criteria for catheter removal, utilizing fluoroscopic and endoscopic stone removal, as well as, gallbladder ablation has been concept proven [2][3][4]; however, integrating interventionalists as part of an interdisciplinary treatment algorithm for patients suffering from acute cholecystitis needs to be addressed.

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Indicators Experts from the 35 OECD countries. The OECD gratefully acknowledges their effort in supplying most of the data contained in this publication. The OECD also acknowledges the contribution of other international organisations, especially the World Health Organization and Eurostat, for sharing some of the data presented here, and the European Commission for supporting data development work.

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