The effect of intravenous versus intranasal TRH stimulation was compared in geriatric patients. In patients receiving both iv and nasal tests (N = 35) there was a good correlation between the TSH responses, but in 3 cases the suspicion of inadequate nasal TRH effect arose. The coefficient of correlation of basal to \g=D\TSHwas better in iv tested patients (116 patients in each group, one half having a positive the other half a negative TRH test). In the majority of patients with suspicious incongruity of basal and \g=D\TSH the nasal test was done. The specificity and sensitivity of various basal TSH 'cut-off' points to predict a positive TRH test were better in patients with iv TRH tests (in each group 96 consecutively admitted patients). Insufficiency of the nasal test in geriatric patients is mainly explained by the inability of the old people to aspirate the nasal spray effectively. Besides the advantages of iv TRH application in geriatric patients, the frequency of adverse reactions (14% versus 0%) must be considered. Thus, in a hospitalized geriatric patient, the TRH test should be performed iv in the recumbent position; however, for examination of geriatric outpatients the nasal test is recommended.
There is no need to modify the normal free thyroxine range for hospitalized geriatric patients. Clinical condition, drug treatment, and, to a lesser extent, age are factors that significantly affect the diagnostic value of FT4 in hospitalized chronic geriatric patients, decreasing the specificity of the test in diagnosing clinical hyper- and hypothyroidism.
The prevalence of peripheral arterial occlusive disease (PAOD) is high in elderly patients and its clinical manifestation is often atypical. Comorbidity and morbidity as a consequence of PAOD are significant. Therefore, standardized primary diagnostics are required among geriatric patients. Drawn from a search of the literature, evidence-based recommendations are provided. Pulse palpation and the evaluation of a patient's medical history are obligatory components of primary diagnostics, even in the absence of typical symptoms. In the case of pathological and ambiguous findings, measuring Doppler ankle pressures is suggested as the next diagnostic step. Further measures depend on the following factors: the presence of lesions on the leg with disturbed blood flow, predominantly in the foot and lower leg areas, degree of PAOD-related ailments, and, finally, intended surgery of the affected leg for other medical reasons.
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