Stroke is one of the leading causes of death and disability and it is more likely to occur in those who are older. Because people are living longer, the definition of "old" continues to evolve. Age alone should not influence the healthcare that a patient receives, however, evidence indicates that this does occur, especially in older patients. On the basis of the available evidence, it is time to reconsider whether or not stroke care should differ in older survivors of stroke and if so, why. This is a narrative review of stroke-related health care in those with a recent ischemic stroke. It seeks to answer the following question: Should patients aged ≥80 years who have experienced a recent ischemic stroke receive standard care or something different, and if they should receive something different, what should they receive and why? The review focusses on long-term survival, hyper-acute care, secondary prevention, and rehabilitation. The authors propose a number of recommendations in relation to stroke care in older survivors of a recent ischemic stroke.
Rosenberg of Worthing referred to my Outpatient Department at Guy's Hospital a female child, aged 5 months, with a swelling of the right lower jaw. This swelling had been first noticed six weeks previously and the mother was of the opinion
Acute pancreatitis is an uncommon abdominal emergency. It is known by a variety of descriptive terms which are dependent upon the gross pathological features revealed at operation-"acute haemorrhagic pancreatitis," "acute pancreatic necrosis," "acute suppurative pancreatitis," "acute glassy oedema of the pancreas"-but all these conditions represent essentially the same disease. Aetiology Acute pancreatitis is almost always associated with chronic disease of the biliary tract: usually calculous cholecystitis, with or without stones in the common bile duct, but sometimes a chronically inflamed gall bladder without calculus formation. In view of this association with gall bladder disease it would be expected that pancreatitis would be commoner in women than men: actually it occurs with at least equal frequency in men, and some statistics show a greater incidence in the male sex. Apart from its occurrence as a complication of mumps, and occasionally of typhoid fever, it is a disease of later life, commonest in the fifth and sixth decades. The primary affection of the pancreas is probably an auto-digestion due to activation of the pancreatic enzymes trypsinogen, diastase and lipase. The factors responsible for this enzyme slow formation of a collection of fluid in the lesser sac, a "psuedo-pancreatic cyst." Commonly,
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