Remaining Life Span Research Articles

Bariatric surgery and diabetes

Obesity is a relatively new and serious world-wide epidemic. Obesity is a stronger predictor in mortality than either poverty or smoking, and obesity is also now more prevalent than malnutrition. The prevalence of obesity continues to increase, ironically, the rate of increase of obesity is highest amongst the morbidly obesity. Obesity is the result of many factors resulting in concert, including poor dietary habits, reduced physical activity and genetic predisposition. With the rapid increase in obesity there has been a pronounced increase in obesity-related metabolic disorders including type 2 diabetes, hyperlipidemia, hypertension and many others. These co-morbidities are responsible for more than 2.5 million deaths, worldwide. The loss of life expectancy due to obesity is profound. In comparison to a normal weight individual Caucasian, a 25-year-old morbidly obese man has a 22% reduction in the expected remaining life span, representing an approximate loss of 12 years of life.

Changes in behaviors of male C57BL/6J mice across adult life span and effects of dietary restriction

Behavioral analysis is a high-end read-out of aging impact on an organism, and here, we have analyzed behaviors in 4-, 22-, and 28-month-old male C57BL/6J with a broad range of tests. For comparison, a group of 28-month-old males maintained on dietary restriction (DR) was included. The most conspicuous alteration was the decline in exploration activity with advancing age. Aging also affected other behaviors such as motor skill acquisition and grip strength, in contrast to latency to thermal stimuli and visual placement which were unchanged. Object recognition tests revealed intact working memory at 28 months while memory recollection was impaired already at 22 months. Comparison with female C57BL/6J (Fahlström et al., Neurobiol Aging 32:1868-1880, 2011) revealed that alterations in aged males and females are similar and that several of the behavioral indices correlate with age in both sexes. Moreover, we examined if behavioral indices in 22-month-old males could predict remaining life span as suggested in the study by Ingram and Reynolds (Exp Aging Res 12(3):155-162, 1986) and found that exploratory activity and motor skills accounted for up to 65% of the variance. Consistent with that a high level of exploratory activity and preserved motor capacity indicated a long post-test survival, 28-month-old males maintained on DR were more successful in such tests than ad libitum fed age-matched males. In summary, aged C57BL/6J males are marked by a reduced exploratory activity, an alteration that DR impedes. In light of recently published data, we discuss if a diminishing drive to explore may associate with aging-related impairment of central aminergic pathways.

Parkinson’s disease permanent care unit: managing the chronic-palliative interface

Background:Parkinson’s disease (PD) eventually leads to severe functional decline and dependence. Specialized care units for PD patients in need of permanent care are lacking.Methods:Patients with severe PD are referred to the PD permanent care unit harboring 30 patients with specialized medical and health care provided by trained staff. Patients need to have intensive medical and care needs, and be no longer able to stay at home or at an ordinary institution. A written and continuously reviewed care plan is made for each patient at admission, with the overriding aim to preserve quality of life and optimize functionality.Results:After five years, the PD permanent care unit has cared for 70 patients (36 men and 34 women) with a mean age of 76.6 years and a mean duration of Parkinsonism of 11.8 years. Hoehn and Yahr severity of disease was 3.7, cognition was 25.3 (Mini-Mental State Examination), and the mean daily levodopa dose was 739 mg. The yearly fatality rate was seven, and the mean duration of stay was 26.9 months. Only five patients moved out from the unit.Conclusion:A specially designed and staffed care unit for Parkinsonism patients seems to fill a need for patients and caregivers, as well as for social and health care authorities. This model is sensitive to the changing needs and capacities of patients, ensuring that appropriate services are available in a timely manner. There was a rather short duration of patient stay and remaining life span after admission to the unit. Despite the chronic/palliative state of patients at the PD permanent care unit, there are many therapeutic options, with the overriding objective being to allow the patients to end their days in a professional and comfortable environment.

Trehalose extends longevity in the nematode Caenorhabditis elegans

Trehalose is a disaccharide of glucose found in diverse organisms and is suggested to act as a stress protectant against heat, cold, desiccation, anoxia, and oxidation. Here, we demonstrate that treatment of Caenorhabditis elegans with trehalose starting from the young-adult stage extended the mean life span by over 30% without any side effects. Surprisingly, trehalose treatment starting even from the old-adult stage shortly thereafter retarded the age-associated decline in survivorship and extended the remaining life span by 60%. Demographic analyses of age-specific mortality rates revealed that trehalose extended the life span by lowering age-independent vulnerability. Moreover, trehalose increased the reproductive span and retarded the age-associated decrease in pharyngeal-pumping rate and the accumulation of lipofuscin autofluorescence. Trehalose also enhanced thermotolerance and reduced polyglutamine aggregation. These results suggest that trehalose suppressed aging by counteracting internal or external stresses that disrupt protein homeostasis. On the other hand, the life span-extending effect of trehalose was abolished in long-lived insulin/IGF-1-like receptor (daf-2) mutants. RNA interference-mediated inactivation of the trehalose-biosynthesis genes trehalose-6-phosphate synthase-1 (tps-1) and tps-2, which are known to be up-regulated in daf-2 mutants, decreased the daf-2 life span. These findings indicate that a reduction in insulin/IGF-1-like signaling extends life span, at least in part, through the aging-suppressor function of trehalose. Trehalose may be a lead compound for potential nutraceutical intervention of the aging process.

Auswirkungen der Asbestfaserstaub-Exposition auf die Lungenfunktion – ein systematisches Review

Asbestos-induced lung diseases are in addition to skin diseases and hearing impairment due to noise the most frequent occupational diseases. In this connection, many questions arise. They particularly refer to the fine diagnostics and the compensation in case of early stages. This systematic review questions the prevailing practice of getting medical expert opinions. It was shown that already pleural plaques and low stages of lung fibrosis due to asbestos are significantly associated with symptoms of chronic obstructive bronchitis, lymphocytic alveolitis and significant functional restrictions, i. e. FVC, FEV (1) and TLC restrictions, gas exchange impairments (P ((A-a),O2), P (a,O2)), diffusion disorders (D (L,CO)) and an obstructive ventilation pattern (FEV (1)/FVC, FEF values, D (L,CO)). The asbestos fibre dose shows some relation to reductions of FVC, FEV (1), FEF values, and D (L,CO). Only about half of the asbestos-induced functional impairments are related to radiological (inclusive CT) findings. To a lesser degree, these findings also apply to exposed people without pathological chest X-ray findings. The diffusion capacity reduction, at first still within the reference range, is an early indication of a lung lesion caused by asbestos fibres. The same applies to spiroergometric parameters (P ((A-a),O2), V (E/)V (O2), V (D)/V (T)). Reduced lung compliance can also be determinable at an early asbestosis stage. The results of literature research confirmed by statements of international groups of experts indicate continuous pathophysiological processes due to asbestos fibres deposited in peripheral airways and in the lung. These processes are neither radiologically nor histopathologically detectable and occur with a chronic lymphocytic alveolitis. Therefore, diagnostics of asbestos-induced non-malignant lung and pleural changes require comprehensive lung function tests. The outcome may help to estimate the probable remaining life span.

Malignant pleural effusion in the presence of trapped lung. Five-year experience of PleurX tunnelled catheters

Malignant pleural effusions in the presence of trapped lung remain notoriously difficult to treat. Various methods exist ranging from minimally invasive procedures including repeated needle thoracocentesis to the need for a formal surgical procedure such as placement of a pleuroperitoneal shunt and even thoracotomy and decortication. Controversy exists as to what is the optimum treatment for this condition. Any planned treatment should balance the therapeutic benefit provided against convalesce for a disease with a limited life expectancy. Patients should not spend a significant proportion of their remaining life span recovering from palliative procedures. In a series of patients with malignant pleural effusion the medial survival time was 20 weeks, with 30 days and 1 year mortality rates of 12.8% and 83.6%, respectively. We describe our five-year experience with the use of indwelling PleurX catheters in patients with malignant pleural effusions in the presence of confirmed trapped lung on radiological or VATS investigation. Patient health related quality of life was investigated by telephone questionnaire. The parameters analysed were symptomatic relief, mobility and ease of management following insertion. One hundred and sixteen patients underwent PleurX catheter insertion by a single operator, 48 questionnaires were completed. Of the 48 cases analysed, improvement in all three quality of life indices was recorded following catheter insertion. Ease of mobility was recorded as moderately satisfied and very satisfied in 50% and 15% of patients, respectively. Symptomatic improvement was found to have been increased with 42% and 6% of patients responding to moderately satisfied and very satisfied, respectively. Ease of management was recorded as 'slightly satisfied' and moderately satisfied in 50% and 33% of patients, respectively, demonstrating a high satisfaction index in patients with chronic progressively debilitating malignancies. Complications were either transient or readily correctable. Pain was the predominant complication occurring in 35% of patients lasting <3 days. No patient required catheter removal for resolution of discomfort. Our findings support the use of PleurX catheters for palliative patients with malignant pleural effusions in the presence of trapped lung. The catheters are not only easy to insert and discrete but they can be managed effectively by patients and community nurse practitioners and prevent repeated admissions to hospital in palliative patients with compromised life expectancy.

Expression of hsp22 and hsp70 Transgenes Is Partially Predictive of Drosophila Survival Under Normal and Stress Conditions

Drosophila Hsp70 is a highly conserved molecular chaperone with numerous cytoplasmic targets. Hsp22 is an alpha-crystallin-related chaperone (small hsp) that localizes to the mitochondrial matrix. The hsp70 and hsp22 genes are induced in response to acute heat and oxidative stress and are also upregulated during normal aging. Here the hsp22 promoter (-314 to +10) and the hsp70 promoter (-194 to +10) were used to drive expression of the fluorescent reporter proteins green fluorescent protein (GFP) and Discosoma sp. red fluorescent protein (DsRED) in transgenic flies. Multiple transgenic lines were analyzed under normal culture conditions and under oxidative stress and heat stress conditions that significantly shorten life span. Flies were individually housed, and GFP (or DsRED) was quantified at young-age time points using the fluorescence stereomicroscope and image analysis software. Expression of the hsp reporters in young flies was partially predictive of remaining life span: Young flies with high expression tended to die sooner under both control and stress conditions.

Evaluation and comparison of two prognostic scores and the physicians’ estimate of survival in terminally ill patients

BackgroundMost terminally ill patients request information about their remaining life span. Professionals are not generally willing to provide prognosis on survival, even though they are expected to be able to do so from their clinical experience. This study aims to find out whether the standardized instruments Palliative Prognostic Index (PPI) and the Palliative Prognostic Score (PaP-S) are appropriate, specific, and sensitive to estimate survival time in patients receiving inpatient palliative care in Germany.MethodPPI and PaP-S were assessed in addition to the core documentation data set of the Hospice and Palliative Care Evaluation for patients admitted to the palliative care units in Aachen, Bonn, and Cologne. Time of survival was assessed with repeated phone calls to the family and was defined as the difference between the day of completion of the instruments (excluded) and the day of death (included).ResultsSurvival time was compared with physicians’ estimations and prognostic scores in 83 patients. Whereas the estimates of the PPI and the PaP-S correlate highly, even higher correlations are found for the physicians’ prognosis and the scores. Correlations between survival time and the prognostic scores or physicians’ prognosis were lower. Physicians’ estimations overestimated survival time on average fourfold. Estimations were more often correct for very good and very bad prognosis.DiscussionThe prognostic scores are not able to produce a precise reliable prognosis for the individual patient. Nevertheless, they can be used for ethical decision making and team discussions. Estimating survival time from clinical experience seems to be easier for very bad or very good prognosis for physicians.

Simultaneous tracking of movement and gene expression in multiple Drosophila melanogaster flies using GFP and DsRED fluorescent reporter transgenes

BackgroundFluorescent proteins such as GFP (Green Fluorescent Protein) and DsRED (Discosoma sp.Red Fluorescent Protein) are often used as reporter molecules for transgene expression in Drosophila and other species. We have recently reported methods that allow simultaneous tracking of animal movement and GFP expression in real time, however the assay was limited to single animals and a single transgene. Numerous studies would be facilitated by methods that allow for assay of multiple animals and multiple transgenes.FindingsHere we report an improved fly video tracking system that allows multiple transgenic flies to be tracked simultaneously using visible light, GFP fluorescence and DsRED fluorescence. The movement of multiple flies could be accurately tracked at real time rates, while simultaneously assaying the expression level of two different transgenes marked with GFP and DsRED. The individual flies could be accurately tracked and distinguished even during periods when transgene fluorescence was undetected. For example, characteristic patterns of hsp70 and hsp22 transgene induction could be simultaneously quantified and correlated with animal movement in aging flies, and as groups of flies died due to dessication/starvation.ConclusionThe improved methods allow for more efficient assay of the correlation between gene expression, behavior, aging and mortality: multiple animals can be assayed with simultaneous quantification of multiple transgenes using GFP and DsRED fluorescence. These methods should allow for increased flexibility in experimental designs. For example, in the future it should be possible to use gene expression levels to predict remaining life span more accurately, and to quantify gene expression changes caused by interactions between animals in real time.

Demography and life history of two rattan species, Eremospatha macrocarpa and Laccosperma secundiflorum, in Côte d'Ivoire

Abstract:Two rattans species were studied in Côte d'Ivoire using a stage-classified matrix model to compare their demography and life histories. Respectively 854 and 1009 genets ofEremospatha macrocarpa(pleonanthic) andLaccosperma secundiflorum(hapaxanthic) were censused every 6 mo over 18 mo. The population growth rates ofE. macrocarpa(λ = 0.979) andL. secundiflorum(λ = 0.959) were not significantly different from 1. This indicates that the populations were close to equilibrium. However, the difference between the stable stage distributions and the observed distributions indicated temporal variation in vital rates. Elasticity analysis showed that growth and fecundity had lower contributions to λ than the survival rates for the two species. A Life Table Response Experiment revealed that the survival of the first juvenile stage (all stems &amp;lt; 6 m in length), fecundity, growth of the second juvenile stage (at least one stem &amp;gt; 6 m in length) and adult (reproductive) survival highly contribute to the differences between the demography of the two species. Reproduction is postponed longer forL. secundiflorumthan forE. macrocarpaand the mean remaining life span for adult genets is shorter forL. secundiflorumthan forE. macrocarpa. Finally, our results suggest the existence of two trade-offs within reproduction which suggest that, although the two species have different demographic features, the λ of their populations are not significantly different from 1.

Estimated longevity and changes in spirituality in the context of advanced congestive heart failure

To examine (1) advanced congestive heart failure (CHF) patients' estimates of their longevity and changes in these estimates over time; (2) clinical, functional, and psychological adjustment correlates of these longevity estimates; and (3) correspondence of changes in longevity and changes in multiple dimensions of spirituality over time. Longitudinal questionnaire-based study of 111 patients diagnosed with severe CHF assessed at two time points separated by 6 months. Nearly half of the participants estimated their longevity as at least 5-10 years, and there was very little change in estimates across the assessment periods. Longevity estimates were minimally related to clinical or functional indicators, but longer estimates were related to fewer depressive symptoms and higher levels of life satisfaction. Multivariate regression analyses indicated that shifting longevity estimates toward less time or toward uncertainty was related to increases in religious life meaning and forgiveness and to decreased spiritual struggle over the 6-month interval. No effects were observed for daily spiritual experiences. Because very little is known about how individuals estimate their remaining life span, these results establish information regarding their basis (i.e., not clinical or functional) and stability, at least in the context of advanced heart failure. In addition, the notion that individuals become more spiritual as they perceive the approach of death was borne out in terms of multiple aspects of spirituality.

Health care costs, long-term survival, and quality of life following intensive care unit admission after cardiac arrest

IntroductionThe purpose of this study was to investigate the costs and health status outcomes of intensive care unit (ICU) admission in patients who present after sudden cardiac arrest with in-hospital or out-of-hospital cardiopulmonary resuscitation.MethodsFive-year survival, health-related quality of life (Medical Outcome Survey Short Form-36 questionnaire, SF-36), ICU costs, hospital costs and post-hospital health care costs per survivor, costs per life year gained, and costs per quality-adjusted life year gained of patients admitted to a single ICU were assessed.ResultsOne hundred ten of 354 patients (31%) were alive 5 years after hospital discharge. The mean health status index of 5-year survivors was 0.77 (95% confidence interval 0.70 to 0.85). Women rated their health-related quality of life significantly better than men did (0.87 versus 0.74; P < 0.05). Costs per hospital discharge survivor were 49,952 €. Including the costs of post-hospital discharge health care incurred during their remaining life span, the total costs per life year gained were 10,107 €. Considering 5-year survivors only, the costs per life year gained were calculated as 9,816 € or 14,487 € per quality-adjusted life year gained. Including seven patients with severe neurological sequelae, costs per life year gained in 5-year survivors increased by 18% to 11,566 €.ConclusionPatients who leave the hospital following cardiac arrest without severe neurological disabilities may expect a reasonable quality of life compared with age- and gender-matched controls. Quality-adjusted costs for this patient group appear to be within ranges considered reasonable for other groups of patients.

Inoperable brain metastases from non-small cell lung cancer: what part does whole brain radiotherapy play in standard treatment?

Lung cancer is the second commonest cancer in the UK with an incidence in 2006 of 37 100, and is the commonest cause of death from cancer, causing more than 33 000 deaths (22% of cancer deaths) each year.1 More than three-quarters of lung cancers fall into the histological category of non-small cell lung cancer (NSCLC). Currently, 10% of patients with NSCLC present with symptomatic brain metastases, and between a quarter and a third of those who initially survive radical treatment for stage III NSCLC will go on to develop brain metastases during their remaining life span.2 It is anticipated that over the next decade, an increasing proportion will develop brain metastases as adjuvant chemotherapy, concurrent chemoradiotherapy for locally advanced disease and chemotherapy for metastatic disease result in longer overall survival times. For several decades, administration of steroids followed by whole brain radiotherapy (WBRT) has been standard treatment for inoperable multiple brain metastases of any primary cancer. The duration of survival for patients with a diagnosis of multiple brain metastases is strongly influenced by their performance status and also by the presence or absence of active extracranial disease. Data from three North American clinical trials which studied dose and fractionation for WBRT were used to divide patients with brain metastases from a variety of primary sites into three prognostic subgroups using recursive partitioning analysis (RPA).3 The group identified as having the best survival were aged less than 65 years, had a Karnofsky Performance Status score ⩾70 and had controlled primary disease with no metastases outside the brain. In this group, termed RPA class I, median survival was …

Cumulative index of health disorders as an indicator of aging-associated processes in the elderly: Results from analyses of the National Long Term Care Survey

Background We employ an approach based on the elaborated frailty index (FI), which is capable of taking into account variables with mild effect on the aging, health and survival outcomes, and investigate the connections between the FI, chronological age and the aging-associated outcomes in the elderly. Methods Cross-sectional analysis of pooled data from the National Long Term Care Survey (NLTCS) assessing health and functioning of the U.S. elderly in 1982, 1984, 1989, 1994, and 1999. Results Distributions of frequency, residual life span, mortality rate, and relative risk of death are remarkably similar over age and FI. Coefficients of correlation between FI and age are low both for males (0.127, p < .01) and females (0.221, p < .01). The FI-specific age patterns show deceleration at advanced ages. The FI can provide order of magnitude better resolution in estimating mean remaining life span compared to age. Males have smaller FI than females while males’ mortality risks are higher. For short-time horizons, the FI and age are largely independently associated with mortality risks. Conclusions The FI: (i) can be considered as an adequate sex-specific indicator of the aging-associated processes in the elderly, (ii) can characterize these processes independently of age, and (iii) is a better characteristic of the aging phenotype than chronological age.

A case of reversed pituitary dysfunction with intrasellar mass

Hypopituitarism can be caused by tumor, inflammation, granuloma and injuries. Once pituitary function is disturbed, hormone replacement therapy is necessary for the remaining life span in most cases. We have experienced a rare case of a unique intrasellar mass associated with pituitary dysfunction in which both spontaneously reversed. A 61-yr-old woman developed hypoadrenalism and central diabetes insipidus (cDI). Magnetic resonance (MR) imaging revealed a lobular, strong hypointense lesion with spotty signal in the middle of the hypophysis. This spotty lesion showed isointensity on T1- and high-intensity on T2-weighted MR images. The spotty signal as well as the normal pituitary lobe were enhanced by the administration of gadolinium. As replacement therapies for hypoadrenalism and cDI, 10 mg of hydrocortisone and 2.5 microg of desmopressin acetate were prescribed. Three months later, slight shrinkage of intrasellar mass and spontaneous improvement of pituitary functions were found. Hydrocortisone was then discontinued. Furthermore, because polyuria and polydipsia were improved nine months later, desmopressin acetate was stopped. Currently, the intrasellar mass continues to shrink, and the patient shows no symptoms without medication. Based upon the unique features of MR images, we suspect that the origin of the mass is an intrasellar hemangioma.

Dislocation of the cervical oesophagus: a rare cause of oesophageal obstruction

We describe a case of obstruction of the cervical oesophagus in which ultrasonography and computed tomography revealed characteristic dislocation of the cervical oesophagus and food impaction in a segmental canal. Although the patient presented with complete obstruction initially, spontaneous recovery of passage was achieved with conservative therapy. One recurrent episode was noted during her remaining life span. To our knowledge, no similar case has been described previously.

Thoracolumbar vertebral reconstruction after surgery for metastatic spinal tumors: long-term outcomes

Metastatic spinal tumors continue to represent a major problem for patients and treating physicians. The purpose of this study was to assess quantitatively the functional outcome, quality of life, and survival rates of patients after major reconstructive spine surgery. A prospective database was established and 58 patients were identified who had undergone thoracolumbar vertebral reconstruction for metastatic spinal tumors between March 1993 and October 1999. Surgical indications included disabling pain (92%) and/or progressive neurological dysfunction (60%). Forty-nine patients (85%) had clinical improvement in pain as determined based on the Oswestry pain scale (p < 0.05); 60% demonstrated improvement in their neurological status. The mean neurological improvement in Frankel grade was 1.2 (p < 0.05). The 12-month survival rate was 65%, and all patients who were ambulatory after surgery remained so until the time of death. Instrumentation failure requiring repeated operation occurred in two patients (3.5%), and in 12 patients (21%) local tumor recurrence necessitated repeated surgery. There were no cases of neurological deficit or death related to surgery. Major anterior thoracolumbar vertebral reconstruction is an effective treatment for local tumor control. More importantly, the authors have demonstrated that surgical treatment can significantly improve the quality of life by improvement of pain control and maintenance of ambulation during the patient's remaining life span.

The level of telomere dysfunction determines the efficacy of telomerase-based therapeutics in a lung cancer cell line

Telomerase is the ribonucleoprotein enzyme that maintains telomeres of eukaryotic chromosomes. Activation of telomerase is a common feature of the majority of human cancers, and inhibition of this enzyme has been proposed as a novel target for cancer therapeutics. Here, we investigated the effects of telomerase inhibition in the non-small cell lung cancer cell line NCI-H460, using a genetic approach by ectopic expression of dominant-negative (DN)-hTERT. Five clones were selected in which telomerase activity was completely abolished. As a result, telomere erosion was observed leading to proliferation arrest after a lag period of 20-28 population doublings. Although overall telomere length was similar between the different clones as measured by quantitative fluorescence in situ hybridization (Q-FISH), striking differences were found in telomere length of individual chromosomes. In particular, lack of individual telomeres and formation of end-to-end fusions were variable. Interestingly, this level of individual telomere dysfunction was positively correlated with the remaining life span of the different clones in vitro. In addition, the amount of telomere dysfunction induced by DN-hTERT was twice as high compared to the small molecule telomerase inhibitor BIBR1532, which induced growth arrest after >100 population doublings. Thus, pharmacological strategies that aim at inhibition of telomerase in cancer cells should take into account that not only overall telomere shortening, but rapid induction of a high level telomere dysfunction appears to be the crucial surrogate parameter for the development of future telomerase-based therapeutics.

Four Years Experience in Bladder Preserving Management for Muscle Invasive Bladder Cancer

Objectives: To evaluate the bladder preservation strategy in invasive bladder cancer particularly relapse, progression and complications. Materials and methods: From January 2000 to May 2004 a total of 24 patients (mean age of 81 years; range 68–92) with muscle invasive bladder cancer who had refused or were not eligible for cystectomy were followed up for a period of up to four years. Results: 24 (21 M/3 F) patients were followed up for a mean time of 680 (182–1253) days. All patients complained of frequency, urgency and severe nocturia. The second most frequent complication was bleeding which required a salvage cystectomy in 7 cases. Other major complications were intestinal occlusion in three cases, an enterovesical fistula, brain metastasis requiring neurosurgical intervention and radiation therapy of the brain, bone metastasis in the cervical spinal column and chronic renal failure. The mean re-admission rate was 8 per patient and the mean time spent at the hospital was 109 (range 13–253) days. Conclusion: In our series the bladder preserving strategy does not confirm the optimistic results of other authors. The complications forced us to carry out a salvage cystectomy in nearly half of the cases. The other half of the patients complained of other severe complications reducing the quality of life of the remaining life span.

Life expectancy of patients with neovascular glaucoma drained by Molteno implants.

To determine the survival of patients with sighted eyes who had Molteno implants inserted for neovascular glaucoma. Patients who had Molteno implants inserted for neovascular glaucoma between October 1977 and March 2001 at Dunedin Hospital, New Zealand, were reviewed. Relative survival analysis was then used to compare survival in this group to survival of the New Zealand population of the same age. A total of 114 patients had 131 Molteno implants inserted for neovascular glaucoma. Neovascular glaucoma was secondary to central retinal vein occlusion in 66 eyes (50%) and diabetes in 42 eyes (32%), and patients lost 52% or 6.53 years of their expected remaining life span. Age, sex and postoperative intraocular pressure control did not predict survival. The only predictor of improved survival was a preoperative visual acuity of 6/48 or better. These patients lost 21% (or 2.43 years) of expected remaining life compared to 62% (or 10.78 years) in those patients who had a presenting visual acuity of 6/60 or worse. Patients with neovascular glaucoma had a markedly reduced life expectancy, which has improved in recent years when compared to that of the normal sex and age-matched New Zealand population. Patients presenting with better vision (6/48 or better) survived significantly longer than those presenting with poorer vision.