The Western journal of medicine
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The value of preoperative examinations done by internists on ophthalmology patients was assessed. A retrospective chart review of 258 consultations was conducted and information about surgical risk, as defined by strict criteria, was abstracted. A total of 59 surgical risk conditions and 62 incidental problems were detected. ⋯ Most of these benefits were in patients older than 60 years and very few important problems were detected in those younger than 50. The average cost of the consultation and additional laboratory tests was $146.60. It is concluded that significant benefit was derived at a reasonable cost by patients older than 50 years.
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During the hospital course of 225 nonagenarian patients who underwent 285 major operations-80% on the general, vascular, orthopedic and urologic services-overall morbidity was 37% and mortality 7.5%. The 100 emergency operations were associated with a higher morbidity and mortality rate. ⋯ Compared with all surgical patients, the nonagenarians were admitted twice as often to the surgical intensive care unit, required twice the number of hospital days, underwent intraoperative hemodynamic monitoring twice as frequently and incurred 200% greater hospital charges. We conclude that with careful evaluation and management, a nonagenarian patient presenting with a surgical condition can safely undergo necessary operative procedures.
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The relationship between diagonal earlobe crease and coronary risk factors, controlling for age and sex effects, was tested in 686 persons. A positive correlation (rho=.86, P<.001) is obtained between age and percentage of persons with earlobe creases in each one-year age interval; no sex difference is seen. ⋯ None of these variables differs significantly between cases and controls, indicating that the previously documented association between earlobe crease and coronary heart disease may be independent of these risk factors. Although coronary heart disease has often been shown to aggregate in families, no familial aggregation is found for earlobe creases.
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Relatively little is known about the circumstances in which decisions not to resuscitate, documented by no-code orders, are made. By review of medical records and interviews with house staff officers, we studied all medical service patients for whom no-code orders were written and those patients who received cardiopulmonary resuscitation (CPR) between October and December 1980 in the Portland Veterans Administration Medical Center. Among 1,780 patients admitted, 56 (3.1%) received no-code orders. ⋯ Comparing these with 20 patients who experienced cardiac arrest and did receive CPR, cancer, dementia, incontinence, non-ambulatory, divorced-separated and unemployed statuses were all more prevalent among no-code patients (P<.05). No-code orders in this Veterans Administration teaching hospital were relatively common and appeared to be made collectively. Participation of patients and attending physicians in the decisions, however, was limited.