Average Age Of Group Research Articles

PERIPROSTATIC NERVE BLOCK AND INTRAPROSTATIC INFILTRATION ON TRUS-P GUIDED BIOPSY

Objective: This study is aimed to determine the effectiveness and complications of periprostatic block and intraprostatic infiltration anesthesia for transrectal prostate biopsy. Material & Method: Two consecutive group of patients, periprostatic block (group A) and intraprostatic infiltration (group B), underwent transrectal ultrasound (TRUS) guided prostate biopsy were entered into the study. Exclusion criteria were severe systemic infection, local infection (prostatitis, proctitis, anorectal abscess, and fissure), hemorrhoid (external and/or internal), and chronic pelvic pain (bladder pain syndrome (BPS) or other pelvic disease. Each group enrolled 58 patients. The patients were requested to choose indicate degree of pain on visual analog score (VAS) 3 times, during probe insertion (VAS1), during anesthesia (VAS2), and during the biopsy (VAS3). Complications from the procedures were recorded. The data were analyzed using Mann-Whitney and independent t-test. Results: There were no significant difference in average age of groups, 65,69 ± 7,019 years for group A and 65,34 ± 7,633 years for group B (p = 0,647). The VAS3 score of group B 5,17 ± 0,653 was significantly lower than group A 5,9 ± 0,612 (p < 0,001). The change in VAS score (VAS3-VAS2) in group B 0,55 ± 0,535 also significantly lower than group A 1,00 ± 0,530 (p = 0,004). The average days with pain were not significant on both group, group A 1,16 ± 0,362 day and group B 1,12 ± 0,329 day (p = 0,594). The duration of bleeding was significantly higher on group B 1,32 ± 0,562 day than group A 1,10 ± 0,307 day (p = 0,026). Conclusion: Intraprostatic infiltration resulted in less pain during prostate biopsy, but also reported more bleeding after the procedure than the periprostatic block.Keywords: Intraprostatic infiltration, periprostatic nerve block, transrectal ultrasound guided prostate biopsy.

Charakterystyka epidemiologiczno-kliniczna 705 nowotworów gruczołów ślinowych

The epidemiological data concerning the rare group of tumors derived from salivary glands recorded in the National Cancer Registry is insufficient because it records only malignant salivary glands tumors. Aims of the studyThe epidemiological and clinical characteristics of 699 patients with salivary glands tumors (n=705). MaterialThe data were retrieved from ENT Department District Hospital in Kielce (01.09.1989–28.02.2001) and from Department of Otolaryngology Head and Neck Surgery Holy Cross Cancer Centre in Kielce (01.03.2001–31.12.2008). Results and conclusionsIn the analyzed group of 699 patients with 705 salivary glands tumors women predominated, consisting 54,2% of all group. The average age in group of malignant tumors was higher than in nonmalignant group. The risk of malignant neoplasms development increased with patient age. In the analyzed group of 705 salivary glands tumors the nonmalignant neoplasms dominated–78,3%. Out of all cases, 547 (77,6%) were localized in the parotid gland, 80 (11,3%) in submandibular gland and 78 (11,1%) in minor salivary glands. Nonmalignant tumors were more frequent in the parotid gland (82,8%) and submandibular gland (71,3%), whereas in minor salivary glands nonmalignant and malignant neoplasms the occurrence was nearly the same. In general–the smaller the salivary gland, the risk of development malignant tumors was higher. In group of nonmalignant salivary gland tumors two histopathological types dominated – pleomorphic adenoma and Warthin's tumor, which comprised 91,8% of the whole group. In the group of 153 malignant salivary gland tumors the most common histopathology were – adenoid cystic carcinoma, mucoepidermoid carcinoma and adenocarcinoma. In the analyzed period of 20 years’ time, the incidence of salivary glands tumors increased with high siginificance, both for nonmalignant, as well malignant tumors.

Comparing the effect of lovastatin and exercise on serum lipid profile in hyperlipidaemic patients

Background : Hyperlipidaemic is a risk factor of cardiovascular diseases. Recently, statins, life style modification and diet have been used to treat hyperlipidaemia. Aim : The present study was performed to evaluate the effect of lovastatin and exercise on hyperlipidaemic patients. Methods : This double-blind randomized clinical trial was performed on 80 patients over 30 years old, whose lipid profile was HDL ≤35 mg/dl, LDL ≥160 mg/dl, triglyceride ≥200 mg/dl, and cholesterol ≥200. At first, 96 hyperlipidemic patients were included in this study, 7 out of them were excluded because of HTN (hypertension) and HLP (hyperlipidaemia) and 9 due to diabetes. The patients were randomly divided into two groups: the first group took lovastatin 40 mg daily, the second group was instructed to walk 35 minutes a day, 3 days a week. After 6 weeks trial, data were analyzed using t-test, Wilcoxon signed sample test, Kolomogorou-Smirnov test, Mann-Whitney test, and Leveus test. Results : The average age was 55.18±9.9. 59 out of 80 (73.7%) were men and 21 were women (26.3%). The average age of group 1(with lovastin) was 55.12±8.4 years and in group 2 (exercise) was 55.35±9.2. The average decrease in TG level in lovastatin treated (I) and subjected to exercise (II) groups was 21.4 mg/dl and 20.5 mg/dl (P Conclusion : The results showed that exercise could reduce LDL, but lovastatin can reduce total cholesterol, TG and can increase HDL. Therefore in the management of hyperlipidaemia, exercise should be combined with lovastatin therapy to achieve a better outcome. Keywords : Hyperlipidaemia, lovastatin, exercise, HDL, LDL, triglyceride

Prophylaxis of childhood migraine: topiramate versus propranolol.

Headache is a common disabling neurological disorder and migraine comprises more than half the causes of recurrent headaches in children. Despite extended prevalence of this type of headache there is lack of evidence about best drug treatment for migraine. So we aimed to compare the therapeutic effects of these drugs on childhood migraine. In the current study, a randomized clinical trial consisting of 78 patients according to 2004 International Headache Association criteria were randomly assigned to two groups that matched by age and sex. One of these two groups was treated with Topiramate, while the other was given Propranolol. After one and four months, the efficiency of these treatments was measured in terms of frequency, severity and duration of migraine attacks. Results obtained from the data collected showed that of these 78 studied patients, 38 patients received Topiramate treatment (group A) and the rest (40 patients; group B) was treated with Propranolol. The average age of group A was 8.5± 2.9 years and that of group B was 8.3 ± 2.8 years. No significant difference was observed between these two groups in terms of reduction in frequency, severity and duration of migraine attacks. Results showed that both treatments had the same efficiency in healing migraine headaches and there was no significant difference between their treating results. However, further studies are needed to examine medical effects of these two medicines.

Initial Dosing of Botox A in Adductor Spasmodic Dysphonia

Objective: 1) Assess effect on voice improvement and duration of breathiness based on initial dose of BotoxA in management of adductor spasmodic dysphonia. 2) Compare voice outcomes for initial bilaterally injected doses of 1.25 units Botox A (Group A) versus 2.5 units (Group B). Method: A retrospective chart review was undertaken of all adductor spasmodic dysphonia patients treated at a tertiary care facility between 1990 and 2011. Demographic data (age and sex), voice rating, duration of voice improvement, and breathiness were evaluated and compared between Groups A and B using Student’s t test and chi-square analysis. Results: Of 478 patients identified, 305 (group A: 223; group B: 82) patients met inclusion criteria. The average age of group A was 56.2 years and group B was 57.4 years ( P = .5). The female/male ratio was 2.91 for group A versus 3.56 for group B ( P = .61). Good voice outcomes (grade 3 or 4) were reported by 91% of group A patients versus 94% of group B ( P = .75). The average duration of voice improvement was 99.7 days for group A and 108.3 for group B ( P = .54). The average duration of breathiness was 10.88 days for group A versus 15.42 for group B ( P = .02). Conclusion: Patients injected with 1.25 units bilaterally had a statistically significant shorter duration period of breathiness without a statistically significant difference in clinical effectiveness or voice outcome. It is therefore recommended that a relatively low initial Botox dose be used with subsequent titration to achieve improved voice outcomes.

P-72 - The influence of single dose of methadone on the QT value in patients from the substitution program

Introduction Methadone treatment may cause prolongation of QT/QTc. Aims/ objectives This study aims to assess the impact of a single dose of methadone on the value of the QT in the patients from the substitution program. Methods Participants: 37 people (10women and 27men) treated with methadone in the substitution program. The average age of respondents was 35 ± 9 years old (min.21, max.59), the mean time of addiction 16 ± 8 years, mean dose of methadone was 80 ± 18 ml. The control group: 17 patients (6men and 11women), healthy, non-addicted to drugs. The average age of group was 29 ± 6 years. QT and QTc (ECG) were measured automatically. The study was performed before and about 60minutes after the administration of a single dose of methadone. Results There is a statistically significant difference between QTc values before and after the administration of a single dose of methadon (p = 0.006). Comparison of the average increase in QTc values in each group, showed that the patients taking methadone up to 70 ml (15.21 ms ) had the highest increase, and those receiving a minimum of 90 ml (4 ms) had the lowest increase. It was found that the QTc value is statistically significantly greater in patients after the intake of methadone (p = 0.048). The average QTc value obtained in these groups differed by 16.13 ms . Conclusions The analysis of the occurrence of statistically significant differences of QTc values before and after the administration of a single dose of methadone shows that methadone causes QT prolongation in the ECG in opioids addicted patients from the substitution program.

Compare the characteristics of liver damage in tsutsugamushi disease during different periods

Objective To compare the characteristics of liver damage in tsutsugamushi disease during different periods. Methods Group A contained 56 cases of tsutsugamushi disease admitted from January 1997 to December 2000,of which 21 cases were complicated by liver damage,while group B contained 80 cased of it admitted from January 2006 to December 2009,including 47 cases complicated by liver damage.Comparative analysis were conducted retrospectively for two groups in terms of liver damage. Results The average age of group A(41.1 ± 14.7)years was significantly lower than that of group B(52.9 ± 15.5)years(t=3.014,P <0.01); The incidences of hepatomegaly and splenomegaly in group A were significantly higher than group B(x2=4.675、6.254,both P <0.05)whereas group B had significantly higher incidences of lack of appetite,abdominal distension and jaundice(all P ＜0.05);The values of various liver function in Group B were significantly higher than group A(all P <0.05). Conclusion The incidence of tsutsugamushi disease is increasing in recent years and the liver damage is becoming more severe. Key words: Scrub typhus; Liver disease

MODIFIABLE CARDIOVASCULAR RISK FACTORS- ARE THEY STILL PROBLEM FOR HYPERTENSIVE PARIENTS?: PP.28.130

Keywords: Modifiable cardiovascular risk factors, hypertension, coronary artery disease. Objectives: Assessment of modifiable risk factors of cardiovascular diseases as a health problem of the population with arterial hypertension. Design and Methods: We examined 58 hospitalized hypertensive patients (38 men and 20 women). They were divided in two groups: A- 28 patients without coronary artery disease (19 men and 9 women) and B- 30 patients with coronary artery disease (19 men and 11 women). The average age in groups was: A- 57,79 yrs, B- 65,67 yrs. Following measurements were taken on each patient: SBP, DBP, level of glycaemia, uric acid, HDL, LDL and total cholesterol, triglycerides, urea, creatinine, BMI. Family history and current treatment were also considered. The t-student test was used for the statistical analysis, ρ Spearmana was taken to analyze the correlation of statistically significant values. Results: We revealed statistically significant differences between the means: total cholesterol: A (5,45 ± 1,2 [mmol/l]) and B (4,55 ± 0,94 [mmol/l]) p <= 0,01; LDL: A (3,47 ± 1,04 [mmol/l]) and B (2,63 ± 0,77[mmol/l]) p <= 0,001. The BMI >30 kg/m2 was noticed: in the group A in 46,43% (women-17,86%, men- 28,57%) and in the group B in 30% (women-10,0%, men-20,0%). Hypercholesterolemia was noticed in the group A in 57,14% (women-17,86%, men-39,29%) and in the group B in 38,23% (women-10%, men- 23,3%). Moreover, in the group A we revealed positive correlations between SBP and BMI (p = 0,0005), also between diastolic blood pressure and BMI (p=0,021). Conclusions: Obesity and hypercholesterolemia are still problem for hypertensive patients, especially for those without coronary artery disease. Better lipid profile and lower percentage of people with hypercholesterolemia and BMI >30 kg/m2 in the group of hypertensive patients with coronary artery disease, are probably the result of intensified nonfarmacological and farmacological treatment of cardiovascular diseases. There is a need to pay special attention to effective prevention of hypertention and other cardiovascular diseases.

Influence of Pregnancy on Bone Mass in Sickle Cell Anemia

Sickle cell disease (SCD) causes osteopenia and osteoporosis, This osteopenia may be further influenced by pregnancy. To find out the effect of pregnancy on bone skeleton density in patients with SCD. Consecutive adult female SCA patients who were treated at the out-patients clinics of King Fahd University Hospital Al-Khobar, Saudi Arabia, between January and July 2007, were the cases of study. Patient's age, number of pregnancies and duration after pregnancy were documented. Weight and height were recorded to calculate body mass index (BMI). Blood was collected for haematology and biochemistry purposes. Bone mineral density (BMD) measurement was done using dual energy X-ray absorbtiometry (DEXA) at upper femur and lumbar spine. Thirty-eight patients were evaluated. There were 20 (52.6%) patients who were delivered in (Group A) and 18 (47.4%) who were nulliparous in Group B. The average age in group A was 27.55 +/- 4.9 years while group B was 26.30 +/- 2.1 years. Thirteen (65%) of the patients in group A were osteoporotic when compared to five (27.7%) in group B (p=0.01). Osteopenic patients in group B were seven (38.9%) versus four (20%) in group A (p=0.2). Osteoporosis in both groups was highest at lumbar spine compared to the hip region (P=0.001). BMD was lower in parous women when compared to the nulliparous women. There was no significant difference in haematological parameters which included the percentage of sickle hemoglobin, hemoglobin level between normal, osteopenic and osteoporotic patient. This study shows that SCA female patients suffer from low bone mass in young age. Pregnancy predisposes the SCA patients to further osteopenia and osteoporosis.

Relationship between postabsorptive respiratory exchange ratio and plasma free fatty acid concentrations

The relationship between overnight postabsorptive (fasting) respiratory exchange ratio (RER) and plasma FFA concentrations was addressed using data from three separate protocols, each of which involved careful control of the antecedent diet. Protocol 1 examined the relationship between fasting RER and the previous daytime RER. In Protocol 2 fasting, RER and plasma palmitate concentrations were measured in 29 women and 31 men (body mass index <30 kg.m(-2)). Protocol 3 analyzed data from Nielsen et al. (Nielsen, S., Z. K. Guo, J. B. Albu, S. Klein, P. C. O'Brien, M. D. Jensen. 2003. Energy expenditure, sex and endogenous fuel availability in humans. J. Clin. Invest. 111: 981-988.) to understand how fasting RER and palmitate concentrations relate within individuals during four consecutive measurements. The results were as follows: 1) Fasting RER was correlated (r = 0.74, P < 0.001) with the previous day's average RER, and less so with RER variability. 2) Fasting RER was correlated (r = -0.39, P = 0.007) with fasting plasma palmitate concentrations. 3) The pattern of the RER/palmitate relationship was similar within individuals and between individuals; a negative slope was observed significantly more often than a positive slope (chi(2) test; P < 0.001). Our findings suggest that, despite a fixed food quotient, the slight departures from energy equilibrium in a controlled General Clinical Research Center environment can effect plasma FFA concentrations. We suggest that including indirect calorimetry as part of FFA metabolism studies may aid in data interpretation.

Newer Generation Colonoscopes Do Increase Detection of Polyps and Adenomas in Patients Undergoing Screening Colonoscopy

Background: Technology in endoscopy is continually advancing to new levels. Optical improvements in newer generation colonoscopes like high definition and wider viewing angle undoubtedly provide better visualization. Coupled with good technique, this new technology may improve quality of a colonoscopic examination. There is a paucity of data regarding using technologically advanced colonoscopes to achieve better quality exams. Aim: To compare the polyp and adenoma detection rates among the 140, 160, and 180 series Olympus colonoscopes. Methods: Consecutive screening colonoscopic exams were reviewed starting 12/2007 until 100 exams each with 180, 160 and 140 series Olympus colonoscopes were encountered. Demographic information including age, sex, and presence of diabetes was recorded. Patients with poor prep/incomplete tests were excluded. Number of polyps, number of adenomas, presence of advanced neoplasia, total exam time, time to cecum, quality of preparation and fellow involvement were also recorded. A Kruskall-Wallis test was used to compare continuous variables and Chi square was used to analyze categorical data. Results: The average age in group 1 (140 scope) was 59.3, group 2 (160 scope) was 61.3 and group 3 (180 scope) was 61.4 years (NS). Of the population, 95.5% were men and 23.8% were diabetic. Fellows were involved in 23.3% of cases. There was no difference in sex, DM, prep quality or fellow involvement among groups. Primary results are listed in table 1. Cecal time was predicted by fellow involvement (p<0.001) and presence of AN (p=0.013). Involvement of a fellow added 4.65 minutes to the cecal time. Six factors were predictive of exam time: cecal time (p<0.001), presence of AN (p=0.001), number of polyps (p<0.001), fellow involvement (p<0.001), quality of preparation (p=0.040), and size of largest polyp (p<0.001). Each additional polyp found added 1.63 minutes and fellow involvement added 4.97 minutes to the total exam time. The presence of advanced neoplasia was not associated with DM, prep quality or the type of scope used. Conclusions: Screening colonoscopy performed with 180 series Olympus colonoscopes was associated with a higher number of polyps and adenomas found, and longer exam times. A wider field of view and enhanced image quality associated with these endoscopes seems to lead to a higher quality examination resulting in detection of more pathology. Table 1 Variable 140 scope 160 scope 180 scope Number of polyps (p=0.013) 1.70 1.73 2.87 Number of adenomas (p=0.005) 0.96 0.92 1.52 Exam time, minutes (p<0.001) 23.74 21.08 25.44 Cecal time, minutes (p=0.001) 10.30 5.82 7.38 Open table in a new tab

Fatores associados à adesão a um programa de tratamento de alcoolistas

OBJETIVO: A medida da adesão tem sido considerada alternativa objetiva e versátil para avaliação do resultado do tratamento de alcoolistas. Este estudo avaliou fatores associados à adesão de alcoolistas atendidos em um programa ambulatorial. MÉTODO: Foram estudados 300 alcoolistas que concluíram a fase de avaliação do programa e avaliada a associação da adesão dos pacientes ao tratamento a todas as mais de mil variáveis do banco de dados do programa, utilizando o teste qui-quadrado de Pearson (p &lt; 0,1). RESULTADOS: Entre as variáveis que se associaram positivamente à adesão foram identificadas: ter filhos; relação conjugal estável; afirmar problemas psicológicos; ter sofrido esquecimento ou fraqueza recentemente; sentir-se irritado quando alcoolizado; beber sozinho; apresentar comorbidade psiquiátrica; já ter procurado tratamento para alcoolismo, tratamento em psiquiatria; uso anterior de antidepressivos etc. Associaram-se negativamente: reduzir consumo por influência familiar; sentir-se auto-suficiente, expansivo, insatisfeito quando sóbrio; sentir-se auto-suficiente ou conformado quando alcoolizado; início do consumo com idade acima da média do grupo; ter-se envolvido em agressão física com amigos etc. CONCLUSÃO: Os resultados sugerem a necessidade de desenvolvimento de estratégias diferenciadas para o cuidado de determinados grupos de pacientes e contribuem para a simplificação das rotinas de avaliação de alcoolistas.

Distinctive histopathologic features of canine optic nerve hypoplasia and aplasia: a retrospective review of 13 cases

Canine optic nerve hypoplasia (ONH) and aplasia (ONA) are significant neuro-ophthalmologic disorders that have been reported in several species. The purpose of this study was to describe the distinctive histopathologic features of ONH and ONA in canine patients identified from a collection of 20 000 ocular submissions at the comparative ocular pathology laboratory of Wisconsin from 1989 to 2006. The following information about ONH and ONA cases was collected: signalment, and clinical and gross findings, including unilateral vs. bilateral involvement. Microscopic evaluation was performed, with attention to optic nerve malformation, retinal ganglion cell (RGC) and nerve fiber layer (NFL) loss, and retinal disorganization. The distribution of retinal vasculature was recorded and a search for unusual findings of ONH and ONA was performed. Information and histologic documentation was available for 13 cases. Eight cases of ONH and five cases of ONA were identified. The average group age was 20.2 months and 16.1 months, respectively. The most common breed was the Shih Tzu (3/13). ONH usually presented bilaterally (7/8); all ONA cases presented as a unilateral disease (5/5). The morphologic findings in the optic nerve (ON) in ONH included variable degrees of ON hypoplasia and gliosis, as well as ectopic vestigial ON remnants within orbital nerves and connective tissues. The NFL was detected in the majority of the ONH cases; however, RGCs were rare or absent. Mild retinal disorganization was seen occasionally. Most cases of ONH were associated with regional peripheral retinal blood vessel extension into the vitreous, leaving the peripheral retina avascular. In ONA cases the retinal blood vessels, NFL and RGCs were totally absent and retinal disorganization was severe. Distinctive microscopic features encountered in ONA included anterior segment dysgenesis in some cases. The retina in these cases was stretched across the posterior lens capsule, never making contact with the posterior pole of the globe. The current study reviews the human and veterinary literature pertaining to ONH and ONA, compares ONH and ONA in dogs, and presents related ophthalmic histopathologic findings that have not been reported previously.

Age-Associated Difference in Gene Expression of Pediatric Myelo-Monocytic and MLL-Rearranged AML.

Acute myelogenous leukemia (AML) is a heterogeneous disease with a variety of genetic alterations including the MLL gene rearrangement. Microarray-based gene expression profiling has been applied to diagnose AML patients and to explore their underlying molecular pathology. In this study, we focused on pediatric myelo-monocytic leukemia and analyzed 40 pediatric AML patients with FAB M4 and M5 subtypes [excluding inv(16) and t(8;21) cases] using Affymetrix HG-U133plus2.0 microarray. Patients consisted of 14 infants (<1 year old) and 26 children (>=1 year old), and 23 patients possessed MLL gene rearrangements. Unsupervised analysis revealed that 10 of the 14 infants display very distinct gene expression and large set of genes were over-expressed among the infants. Among these highly expressed genes, ZFHX1B, ARHGAP26 (GRAF), and FOXO3A (AF6) were included. With the use of these distinctively expressed genes, we were able to divide the 40 pediatric patients into three subgroups: 10 infants with very high expression as Group A, 2 infants and 10 children with medium expression as Group B, and 2 infants and 16 children with low expression as Group C. The average age of Group A was 0.3 year old, Group B was 3.1 years old, and Group C was 6.6 years old. All subgroups included MLL gene rearrangements as well as normal and other complex karyotypes. FAB subtypes were equally distributed among each subgroup. The comparison of the outcomes among the subgroups showed a striking difference where Group C presented extremely poor outcome (3-year EFS 28%). Genes specifically over-expressed among Group C included poor prognostic factors such as WT1 and KIT. In addition, we found that gene expression signature of MLL rearrangement was different among the subgroups as well. For example, EVI1, SOCS2 and MEF2C were up-regulated in MLL-rearranged AML of Group C but not in the others. HOXA9 and HOXA10 were regulated independently of MLL-rearrangement in pediatric myelo-monocytic AML. These results suggest that age is an important factor contributing to the biology of pediatric myelo-monocytic AML and sub-grouping procedures can provide proper stratification so that the poor prognostic subgroup can be distinguished to receive suitable therapy.

Relationship of the patient age and intensity of type 2 diabetes treatment

Analysis of results of research on aging indicates that negative stereotypes about diminished needs and abilities to achieve satisfaction in elderly have negative impact on well-being of persons in late adulthood. These negative stereotypes are shared by older people and the other members of society, including physicians. However, only few research on the impact of negative stereotypes on the way of older patients treatment have been done. To verify a hypothesis that elderly patients with type 2 diabetes are treated less intensively than younger patients. The method of treatment was analyzed in two groups of patients. The first group contained 1199 patients aged 17-93 years, treated for a period of less than one year to 36 years, that were beginning insulin therapy. The second group contained 1693 patients aged 22-97 years, treated for the less than one year till 70 years, that were beginning treatment with insulin analogues. The moderate negative correlation between an age and treatment intensiveness measured as a number of injections per day was found (r = -0.253; p < 0.01), as well as the lower average age in groups of patient receiving more injections of insulin a day (post-hoc Least Significant Difference test: F(891.3) = 25.21; p < 0.0001). The mean age of patients intensively treated with analogues of insulin was lower than those treated less intensively (57.9 vs. 63.4, respectively; t-Student test: t = 8.36, p < 0.0001). The older patients with type 2 diabetes received less intensive treatment than the younger. The stereotype of overestimation of the decrease of cognitive abilities in aging and eventually of difficulties in adherence to more complex by older people may be a reason of their undertreatment.

Bronchoplastic lobectomy: do early results depend on the underlying pathology?A comparison between typical carcinoids and primary lung cancer

This study evaluates the impact of the underlying disease upon the surgical outcome of bronchoplastic lobectomy, comparing typical carcinoid tumours with primary lung carcinoma. This retrospective study includes 98 consecutive patients (78 males, 20 females). Eighteen patients had a typical carcinoid tumour (group 1), and 80 had a primary bronchial carcinoma (group2). Fifty-six patients underwent bronchoplasty with full sleeve resection (10 patients from group 1, 46 from group 2) and 42 patients had a bronchoplasty with bronchial wedge resection (8 from group 1 and 34 from group 2). Right upper lobectomy was the most common procedure. We compared demographic data, surgical indications, the type of bronchoplasty and postoperative complications. The average age in group 1 (38.5+/-16.3 years; range 15-77) was significantly lower than in group 2 (61.4+/-9.5 years; range 14-75) (p<0.001). There were no postoperative deaths. Procedure-specific complications (anastomotic dehiscence and atelectasis) were found in 7 patients (8.75%) in group 2 (of which, three had a combination of two of the above-mentioned complications) but none (0%) in group 1 (p=0.23). Seven patients from group 2 (8.75%) required treatment for a residual pneumothorax for none (0%) in group 1 (p=0.23). The mean duration for air leak was comparable in both groups (p=0.366). Three patients (16.67%) from group 1 had non-surgical complications compared to 17 (21.25%) in group 2 (of which, one had a combination of two non-surgical complications) (p=0.35). Bronchoplastic resection is a safe operation in patients with carcinoid tumours and should be the reference for treatment.

Hipertensão arterial e hipertrofia ventricular esquerda em diabetes mellitus tipo 2

&lt;span class="texto"&gt;Para avaliar a prevalência de hipertensão arterial sistêmica (HAS) e da hipertrofia ventricular esquerda (HVE), bem como a associação entre ambas, em pacientes com diabetes mellitus tipo 2 (DM2), foram estudados 204 pacientes atendidos no Hospital Universitário Alcides Carneiro (HUAC) da Universidade Federal de Campina Grande - PB. Os pacientes apresentavam uma média de idade de 58,0±11,4 anos, sendo 64,2% (n=131/204) do gênero feminino. A HAS esteve presente em 66,7% (n=136/204) da amostra estudada, sendo mais freqüente nas mulheres (69,5%), nos indivíduos do grupo racial branco e ex-tabagistas. Observou-se uma associação estatisticamente significante entre HAS e a idade (p&lt;0,0001), o tempo de evolução do diabetes (p&lt;0,015), o tabagismo (p&lt;0,009) e o aumento da circunferência abdominal (p&lt;0,008). A HVE esteve presente em 11,3% (23/204) dos pacientes, quando diagnosticada por critérios eletrocardiográficos. O ecocardiograma (ECO), realizado em 23% (47/204) dos pacientes, mostrou uma prevalência de HVE de 76,6% (36/47) e, apesar de ocorrer mais em hipertensos (85,2%) que nos não-hipertensos (65,0%), ao se avaliar a relação entre HAS e HVE, observou-se não existir associação estatisticamente significante entre essas variáveis, na amostra estudada (p&gt;0,19). Concluiu-se que a prevalência de HAS foi de 66,7%, na população estudada, relacionandose à idade, ao tempo de evolução do diabetes, ao tabagismo e ao aumento da circunferência abdominal. A HVE mostrou também uma elevada prevalência (76,6%) quando avaliada utilizando-se o ECO, porém não relacionada de forma estatisticamente significante à HAS.&lt;/span&gt;

Comparing outcomes of anterior cervical discectomy and fusion in workman's versus non–workman's compensation population

Background context: Anterior cervical discectomy and fusion (ACDF) is an accepted surgical procedure to treat degenerative conditions, including disc herniations and spinal stenosis. The literature on lumbar spine surgery reports that patients with a workman's compensation claim have less successful clinical results. Regarding the cervical spine, however, different conclusions have been drawn. Purpose: The purpose of this study was to directly compare the functional outcomes of ACDF in patients with and without a workman's compensation claim and to determine whether a compensation claim adversely affected the clinical outcome. Study design: This is a retrospective study examining the long-term results of ACDF in the workman's and non–workman's compensation populations. Patient sample: Eighty consecutive patients undergoing ACDF were retrospectively analyzed. The patients were divided into two groups: 30 patients in Group 1 (workman's compensation) and 50 patients in Group 2 (non–workman's compensation). The average age of Group 1 was 45 years (range, 31 to 57) and Group 2 was 45 years (range, 30 to 79). The patients were followed for an average length of 4 years (range, 2 to 7 years). Outcome measures: We evaluated the surgical results using a functional outcome scoring system (Odom's Criteria), visual analog scale and a radiographic grading scale. The questionnaire was independently administered in a standard question-answer format at the 1-year follow-up. Statistical analyses was performed using a Levene's test. Methods: All surgeries were performed by the same attending physician. A left-sided approach and Smith-Robinson fusion technique with autograft or allograft without instrumentation was used in all cases. A hard cervical orthosis was used postoperatively for 8 weeks. Radiographic examination including lateral flexion and extension views were obtained at a minimum of 12 months postoperatively. Furthermore, radiographic analysis was performed each subsequent postoperative year. The radiographs were analyzed by two independent physicians in a blind fashion for evidence of radiographic fusion. Results: At follow-up no discernible difference was noted for functional outcomes. Eighty-three percent of patients in Group 1 and 90% of patients in Group 2 noted excellent or good results. This was not statistically significant (p=.280). In Group 1, 97% of patients returned to work at an average of 18 weeks, whereas 98% of patients in Group 2 returned to work at an average of 10 weeks postoperatively. Upon radiographic evaluation, 64% of patients in Group 1 were determined to have a solid fusion (Grade 3). The fusion rate in Group 2 was 72%. This was not statistically significant. However, the fusion rate among smokers was 50%, and among nonsmokers it was 80%. This was statistically significant (p=.001). Conclusions: Workman's compensation claims did not adversely affect the functional outcome of ACDF. It should be noted that a significant increase in pseudarthroses was noted with the smoking population. Patient selection is a critical factor in determining functional outcome, with 83% good to excellent results if the pathology, clinical presentation and radiographic findings correlate

Importance of right subcostal incisions in patients undergoing TRAM flap breast reconstruction.

The presence of a preexisting subcostal incision alters the approach to breast reconstruction and is thought to predispose to donor site skin complications and flap loss. The purpose of this study was to determine whether the presence of a subcostal scar affects breast or donor site morbidity adversely after transverse rectus abdominis musculocutaneous (TRAM) flap breast reconstruction. Twenty-six patients with a right subcostal incision (group A) underwent TRAM flap breast reconstruction (13 immediate, 13 delayed). The average age was 51 years, and the patients had an average body mass index of 25.3. There were 15 right, 10 left, and 1 bilateral reconstruction (4 free flaps, 22 pedicled). Outcome measures were compared with 126 age- and risk-matched patients (group B) who underwent TRAM flap reconstruction without any preexisting abdominal scar. The average age in group B was 46.7 years, and the patients had an average body mass index of 24.8. The average length of stay in group A was 5.9 days, compared with 4.8 days in group B ( < 0.05). There were no significant differences in breast-related complications. Donor site complications were higher in group A, with abdominal wall skin necrosis being significantly higher in patients with a subcostal incision (25%) compared with those patients without abdominal wall scars (5%; = 0.02). Multivariate analysis revealed a 6.5-fold increase in donor site complications in patients with a subcostal incision and a smoking history ( < 0.05). When adjusted for radiation treatment, the increased incidence in donor site complication rate was only marginally significant ( = 0.08). TRAM flap breast reconstruction in patients with preexisting right subcostal scars is effective with certain technical modifications; however, there is a slight predisposition to increased abdominal wall complications. Smoking influenced outcome further in patients with a subcostal incision, stressing the importance of proper patient selection.

Patellofemoral complications after posterior-stabilized total knee arthroplasty: A comparison of 2 different implant designs

We conducted a retrospective review of 2 consecutive series of posterior-stabilized total knee arthroplasties (TKAs) to evaluate patellofemoral complications, in particular, significant patellofemoral crepitance or patellar clunk syndrome. Twenty posterior-stabilized Axiom PSK (Wright Medical Technology, Arlington, TN) TKAs (group 1) were compared with 20 posterior cruciateNsacrificed Advance medial pivot (Wright Medical Technology, Arlington, TN) TKAs (group 2). The average age in group 1 was 69 years and in group 2 was 70 years. Preoperative valgus alignment in group 1 was 7.5° and in group 2 was 1.3°. Postoperative valgus alignment for the 2 groups was 4.8° and 5.3° valgus. Postoperative patellar tilt for the 2 groups was 0.9° lateral tilt and 8° lateral tilt. Patellofemoral signs of crepitance ≥2+ and significant box impingement complaints of either snapping or clunking decreased significantly postoperatively from 5 of 20 (25%) in group 1 to 0 of 20 in group 2 (P=.0079). Copyright 2002, Elsevier Science (USA). All rights reserved.