Invasive treatment for coronary artery disease in the elderly

Article Abstract:

Most studies that compare the various treatments for coronary artery disease involve patients under the age of 65. Few data are available on the safety and efficacy in elderly patients of such treatments as coronary artery bypass grafting surgery (CABG) or percutaneous transluminal coronary angioplasty (PTCA), which is the procedure in which a balloon-tipped catheter is used to open partially blocked coronary arteries. As the population ages, there are more people living well past the age of 65, and these are the patients most likely to have coronary artery disease. Elderly patients who undergo CABG are known to have a higher mortality associated with surgery, and probably have greater complication rates as well. Age alone does not seem to be the determining factor in the increasing rate of complications among the elderly. Rather, those patients with the higher rates of accompanying illness seem to be the most likely to experience post-CABG complications. Because PTCA does not require general anesthesia and open heart surgery, it would appear to be the procedure of choice for the elderly with coronary artery disease, but it is most suited for those patients who have the least complicated disease, and the elderly often have very complicated coronary artery disease. Choosing aggressive interventions such as CABG or PTCA for elderly patients with coronary artery disease requires a knowledge not only of the risks faced by the individual patients, but also a realistic assessment of the outcome that can be achieved by the procedure. For example, a patient who is over 80 years old has an average life expectancy of only six more years, and CABG and PTCA may offer very little in terms of increased survival time to such a patient. More realistic treatment goals include an improved quality of life, and that might be achieved by an invasive procedure. (Consumer Summary produced by Reliance Medical Information, Inc.)

Aged, Elderly, Therapeutics, Demographic aspects, Coronary heart disease, Diseases, Coronary artery bypass, Transluminal angioplasty, Balloon angioplasty

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Exacerbation of rheumatoid arthritis by sodium fluoride treatment of osteoporosis

Article Abstract:

Experimental evidence suggests that sodium fluoride may be an effective treatment for osteoporosis, or thinning of the bones of the spine, as fluoride can increase new bone formation. The preliminary studies suggest that there are some side effects involved with the use of fluoride, however. A case of a woman with rheumatoid arthritis which worsened dramatically on fluoride is discussed. The patient's arthritis had been reasonably well-controlled with a series of medications. Fluoride was added to treat osteoporosis, and the patient experienced a flare of her joint pains, which disappeared when the fluoride was stopped. Resumption of the fluoride therapy twice resulted in the recurrence of pains in the joints, thus suggesting that the fluoride treatment itself precipitated the arthritis flare. Fluoride can cause white blood cells found in joints to metabolize oxygen to what are called oxygen radicals, molecules with the potential to cause serious joint damage. This is presumed to be the mechanism by which the fluoride exacerbated the arthritis in the patient described. If fluoride gains wider use in the treatment of osteoporosis, other side effects may manifest themselves. (Consumer Summary produced by Reliance Medical Information, Inc.)

Physiological aspects, Rheumatoid arthritis, Osteoporosis, Fluorides, Sodium fluoride

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