A Study of Eighty-Two Consecutive Patients Over Sixty Years of Age

Strenger, George

doi:10.1097/00000658-194902000-00008

Cited by 8 publications

(1 citation statement)

References 1 publication

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“…However, when performed as an elective procedure, the risk is slight, but is increased when strangulation occurs. In a study by Strenger (12), 62 patients over 60 years of age had elective herniotomies and only 1 died (a mortality of under 2 per cent); during the same period 20 patients had emergency operations for strangulation; of these, 8 died (a mortality of 40 per cent).…”

Section: Management Of Massive Gastrointestinal Hemorrhagementioning

confidence: 99%

Surgical Experience in the Aged as an Aid to Surgery in the Young†

Elman

1955

J American Geriatrics Society

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Most discussions on surgery of the aged deal first with the increasing incidence of, and need for operation in older patients, and second, with the reduced mortality now experienced in this group. As an example of the latter, at the Barnes Hospital during a one-year period , 714 surgical procedures were carried out in patients aged 70 to 96; death occurred in 27-a mortality rate of 5.5 per cent. There was a similar mortality rate in 239 procedures listed as general surgery; 12 patients died. However, on breaking down these figures into elective procedures, it was found that in 107 cases the following operations were carried out: hernia in 28, gastrectomy in 13, amputation in 18, sigmoid resection in 10, radical mastectomy in 15, and cholecystectomy in 13. There was only 1 deathin a patient operated upon for gallbladder disease but in whom extensive carcinoma was found.The present communication deals with an inquiry into the causes for the reduced mortality in geriatric surgery during the past decade or two and how this knowledge has been applied to surgery in the younger patient. For convenience, these advances in surgical therapy may be partly classified into six arbitrary groups.

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Section: Management Of Massive Gastrointestinal Hemorrhagementioning

confidence: 99%

Surgical Experience in the Aged as an Aid to Surgery in the Young†

Elman

1955

J American Geriatrics Society

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Hernia in General Practice

McLaughlin¹

1949

JAMA

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particularly if the stress of an unpleasant job or boss or a distressing family situation cannot otherwise be handled. Temporary help with work at home or in an office may be indicated.Stopping smoking will often reduce nervousness and fatigue.It is wise to see that the patient understands that he will not necessarily have a smooth course. There will be ups and downs-good days and bad days-often without apparent cause. The patient may feel more exhausted after prolonged rest than he did before, especially if rest brings a let-down after a keyed-up period. THIRD PRINCIPLE-KEEPING THE PATIENT LARGELY SYMPTOM FREE AND PREVENTING RELAPSE Patients who are psychoneurotic and who are sub¬ ject to chronic fatigue and tension and anxiety states generally are vulnerable and likely to have relapses. Consequently, in management of patients with fatigue and nervousness it is important to educate the patient effectively and to aid him in maintaining a proper psychologic balance. Usually by the time he has completed his recovery or is much better the patient has learned fairly well how to manage himself. Most of all, he has recognized the causes of his previous difficulties and has learned to conquer and control conflicts.Barring unexpected strain, he should do reasonably well in preparing for blows and emotional shocks. The physician should ascertain that the patient knows his own limitations, that he knows the precipi¬ tating factors in his illness and that he recognizes the value of the various therapeutic procedures which, with the aid of the physician in whom he has confidence, have led to his recovery. Recognizing these factors, he should be able to manage to keep himself out of serious trouble and in rather good condition generally. How¬ ever, since his problem is a medical one, he should not hesitate to seek advice from his physician at regular intervals or when he gets into difficulties which he cannot resolve himself. PROGNOSISThe prognosis for patients with functional nervous disorders varies greatly and may be very difficult to estimate. In general, it is good for patients with simple tension and fatigue states, particularly when anxiety can be relieved and fatiguing work restricted and rest prolonged. Young persons with emotional and environmental problems which can be solved often improve remarkably and recover completely. For patients with significant constitutional inadequacy, pro¬ nounced emotional disturbance or prolonged economic and environmental problems to which the patient is not accustomed and which cannot be altered or for those patients who have had multiple operations with or without permanent physiologic disturbances, the out¬ look is not too good, but the patient can often be improved. Ten or 20 per cent improvement may be enough to make life worth living again. SUMMARY It is generally believed that one third to two thirds of all patients who seek medical help have as the most significant cause of ill health an emotional or neurotic disturbance. Fatigue and nervousness are the commonest symptoms of...

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Management of inguinal hernias in the aged

Means

1954

The American Journal of Surgery

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A Study of Eighty-Two Consecutive Patients Over Sixty Years of Age

Cited by 8 publications

References 1 publication

Surgical Experience in the Aged as an Aid to Surgery in the Young†

Surgical Experience in the Aged as an Aid to Surgery in the Young†

Hernia in General Practice

Management of inguinal hernias in the aged

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