You're never too old

Article Abstract:

A model was used to assess the risks and benefits of aortic-valve replacement compared with medical therapy in an 87-year-old woman with aortic stenosis and congestive heart failure. Aortic stenosis is a narrowing of the aorta. The life expectancy of a healthy 87-year-old woman is five years, but the life expectancy of patients with aortic stenosis and congestive heart failure is two years or less. Ordinarily, valve-replacement significantly improves heart function and relieves symptoms, but surgery in the elderly is associated both with substantial short-term complications such as respiratory failure and long-term complications including stroke and heart attack. According to the model, the woman's life would be prolonged by 5.1 years with surgery and by 1.6 years with medical therapy. In this case, prolonged survival was the major benefit of surgery. Her quality of life would improve only slightly more with surgery than with medical therapy.

Aged, Elderly, Prognosis, Surgery, Aortic valve stenosis

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Treating before knowing

Article Abstract:

Treatment with drugs may be started for some patients before a conclusive diagnosis is reached. A 52-year-old man was admitted to the hospital with increasing shortness of breath, a cough and a fever. He had developed symptoms two weeks before admission to the hospital and had been prescribed the antibiotic cephalexin. A chest X-ray revealed fluid in his lungs, a possible sign of viral pneumonia. He also had increased levels of blood and protein in his urine. Treatment with immunosuppressive drugs was started for treatment of syndrome affecting the lungs and kidneys. A renal biopsy revealed that he was suffering from glomerulonephritis, an inflammation of the kidney, caused by a streptococcal infection. Treatment with immunosuppressive drugs was discontinued and his antibiotic was switched to penicillin.

Case studies, Streptococcal infections, Glomerulonephritis

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Contentious screening decisions: does the choice matter?

Article Abstract:

When the benefit from medical screening is very small, physicians should explain this to patients and let the patient decide. In 1997, a debate arose about the effectiveness of mammography in women in their 40's. Several prestigious scientific organizations took opposing views, leading to confusion among many women. The same debate occurred over screening men for prostate cancer. There is little evidence that screening for prostate cancer reduces mortality rates and mammography in 40-year-old women has a small benefit, if any.

Editorial, Diagnosis, Ethical aspects, Breast cancer, Medical screening, Health screening, Mammography

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