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Morbidity
Kinds of Morbidity Terms modified by Morbidity Selected AbstractsMORBIDITY AND OUTCOMES OF UROGYNECOLOGICAL SURGERY IN ELDERLY WOMENJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 1 2010Patrick F. Vetere MD No abstract is available for this article. [source] Previous transurethral resection of the prostate is not a contraindication to high-dose rate brachytherapy for prostate cancerBJU INTERNATIONAL, Issue 11 2009Hao Lun Luo OBJECTIVE To analyse retrospectively the morbidity and efficacy of high-dose rate (HDR) brachytherapy in patients who had a previous transurethral resection of the prostate (TURP). PATIENTS AND METHODS Morbidities documented in the records of 32 patients with previous TURP and 106 with no previous TURP, treated with HDR brachytherapy for prostate cancer at our institution, were analysed and compared. All patients received HDR brachytherapy as a boost before conformal external beam radiotherapy. We recorded and analysed genitourinary complications, rectal morbidity, and the biochemical control rate as assessed by the prostate-specific antigen (PSA) level. RESULTS All complications of patients who received HDR brachytherapy were recorded during the follow-up. All gastrointestinal and genitourinary complications were not significantly different in patients with or without previous TURP. There was little incontinence or severe morbidity associated with HDR brachytherapy. The PSA-based biochemical control rates were similar in patients with or without previous TURP in each risk group. CONCLUSIONS HDR brachytherapy is a reasonable treatment for localized prostate cancer in patients who have had a previous TURP, with the expectation of low morbidity and satisfactory biochemical control. [source] Selective Application of the Pediatric Ross Procedure Minimizes Autograft FailureCONGENITAL HEART DISEASE, Issue 6 2008David L.S. Morales MD ABSTRACT Objective., Pulmonary autograft aortic root replacement (Ross' operation) is now associated with low operative risk. Recent series suggest that patients with primary aortic insufficiency have diminished autograft durability and that patients with large discrepancies between pulmonary and aortic valve sizes have a low but consistent rate of mortality. Therefore, Ross' operation in these patients has been avoided when possible at Texas Children's Hospital. Our objective was to report outcomes of Ross' operation when selectively employed in pediatric patients with aortic valve disease. Methods., Between July 1996 and February 2006, 55 patients (mean age 6.8 ± 5.5 years) underwent Ross' procedure. Forty-seven patients (85%) had a primary diagnosis of aortic stenosis, three (5%) patients had congenital aortic insufficiency, and five (9%) patients had endocarditis. Forty-two (76%) patients had undergone prior aortic valve intervention (23 [55%] percutaneous balloon aortic valvotomies, 12 [29%] surgical aortic valvotomies, 12 [29%] aortic valve replacements, 2 [5%] aortic valve repairs). Fourteen (25%) patients had ,2 prior aortic valve interventions. Thirty-two patients (58%) had bicuspid aortic valves. Follow-up was 100% at a mean of 3 ± 2.5 years. Results., Hospital and 5-year survival were 100% and 98%, respectively. Morbidity included one reoperation (2%) for bleeding. Median length of hospital stay was 6 days (3 days,3 months). Six (11%) patients needed a right ventricular to pulmonary artery conduit exchange at a median time of 2.3 years. Freedom from moderate or severe neoaortic insufficiency at 6 years is 97%. Autograft reoperation rate secondary to aortic insufficiency or root dilation was 0%. Conclusions., By selectively employing Ross' procedure, outcomes of the Ross procedure in the pediatric population are associated with minimal autograft failure and mortality at mid-term follow-up. [source] Early Surgical Morbidity and Mortality in Adults with Congenital Heart Disease: The University of Michigan ExperienceCONGENITAL HEART DISEASE, Issue 2 2008Ginnie L. Abarbanell MD ABSTRACT Objectives., To review early surgical outcomes in a contemporary series of adults with congenital heart disease (CHD) undergoing cardiac operations at the University of Michigan, and to investigate possible preoperative and intraoperative risk factors for morbidity and mortality. Methods., A retrospective medical record review was performed for all patients ,18 years of age who underwent open heart operations by a pediatric cardiothoracic surgeon at the University of Michigan Congenital Heart Center between January 1, 1998 and December 31, 2004. Records from a cohort of pediatric patients ages 1,17 years were matched to a subset of the adult patients by surgical procedure and date of operation. Results., In total, 243 cardiac surgical operations were performed in 234 adult patients with CHD. Overall mortality was 4.7% (11/234). The incidence of major postoperative complications was 10% (23/234) with a 19% (45/23) minor complication rate. The most common postoperative complication was atrial arrhythmias in 10.8% (25/234). The presence of preoperative lung or liver disease, prolonged cardiopulmonary bypass and aortic cross clamp times, and postoperative elevated inotropic score and serum lactates were significant predictors of mortality in adults. There was no difference between the adult and pediatric cohorts in terms of mortality and morbidity. Conclusions., The postoperative course in adults following surgery for CHD is generally uncomplicated and early survival should be expected. Certain risk factors for increased mortality in this patient population may include preoperative presence of chronic lung or liver dysfunction, prolonged cardiopulmonary bypass and aortic cross-clamp times, and postoperative elevated inotropic score and serum lactate levels. [source] Effects of Candesartan on Mortality and Morbidity in Patients With Chronic Heart Failure: The CHARM-Overall ProgrammeCONGESTIVE HEART FAILURE, Issue 2 2004Sricharan Kantipudi MD No abstract is available for this article. [source] AORTO-DUODENAL FISTULA: MULTIDETECTOR COMPUTED TOMOGRAPHY AND GASTRODUODENOSCOPY FINDINGS OF A RARE CAUSE OF UPPER GASTROINTESTINAL HEMORRHAGEDIGESTIVE ENDOSCOPY, Issue 3 2007Massimo De Filippo An aorto-enteric fistula is a serious complication of abdominal aortic aneurysm. Acute upper gastrointestinal bleeding may be a life-threatening condition that calls for immediate diagnosis and action. Morbidity and mortality remain high despite progress in diagnosis and therapeutic procedures. In the literature, the aorto-enteric fistula diagnostic suspicion by multidetector computed tomography scan is assumed on the basis of the interruption of the aortic wall, with the presence of duodenal gas situated to tightened contact with the aorta. We report a patient with an aorto-duodenal fistula associated with inflammatory abdominal aortic aneurysm detected by gastro-duodenoscopy and multidetector computed tomography scan, with gas found in the lumen of the abdominal aorta, between the aneurysm wall and the thrombus. [source] Simulation-based Morbidity and Mortality Conference: New Technologies Augmenting Traditional Case-based PresentationsACADEMIC EMERGENCY MEDICINE, Issue 1 2006John Vozenilek MD Abstract The authors describe the use of a high-fidelity simulation laboratory to re-create a patient encounter for the purposes of enhancing a morbidity and mortality conference. The use of two separate technologies were enlisted: a METI high-fidelity patient simulator to re-create the case in a more lifelike fashion, and an audience response system to collect clinical impressions throughout the case presentation and survey data at the end of the presentation. The re-creation of the patient encounter with all relevant physical findings displayed in high fidelity, with relevant laboratory data, nursing notes, and imaging as it occurred in the actual case, provides a more engaging format for the resident,learner. This technological enhancement was deployed at a morbidity and mortality conference, and the authors report the impressions collected via the audience response system. Guidelines for those who wish to re-create this type of educational experience are presented in the discussion. [source] Trends and opportunities in the metabolic syndromeDRUG DEVELOPMENT RESEARCH, Issue 7 2006John H. "Wick" JohnsonArticle first published online: 16 NOV 200 Abstract Metabolic Syndrome consists of a multifactoral set of indications and, unfortunately, definitions. There is, at present, no consensus definition for Metabolic Syndrome and physicians who recognize the syndrome use different definitions. Some of the major stakeholder associations do not believe that Metabolic Syndrome is an approvable indication and no regulatory agency has weighed in on the matter. This has been the cause of confusion among many physicians resulting in different emphasis on intervention. However, there is close agreement between physicians surveyed in major markets as to the top three indications. The largest unmet medical need among these indications is obesity and obesity represents the largest opportunity. However, any single NCE or combination of existing drugs that can treat 3 indications will be a major advance. Any therapy will be an intervention and will have to have a very clean safety profile. Morbidity and mortality studies with existing therapies and combinations will be needed to establish outcomes. Drug Dev. Res. 67:539,544, 2006. © 2006 Wiley-Liss, Inc. [source] Paediatric lap-belt injury: A 7 year experienceEMERGENCY MEDICINE AUSTRALASIA, Issue 1 2006Michael Shepherd Abstract Objective:, To highlight the injuries that result from lap-belt use and make recommendations for prevention, the recent experience of a regional paediatric trauma centre was reviewed. Methods:, Retrospective review of admissions to Starship Children's Hospital from 1996 to 2003, with significant injury following involvement in a motor vehicle crash, while wearing a lap-belt. Patients were identified from two prospectively collected databases and discharge coding data. Results:, In total, 19 patients were identified over the 7 year period. The morbidity sustained includes 15 patients with hollow viscus injury, 13 laparotomies, 7 spinal fractures, 2 paraplegia and 1 fatality. A total of 11 patients required laparotomy with a median delay of 24 h. Of patients in the present series, 58% were aged less than 8 years and thus were inappropriately restrained. Conclusions:, Lap-belt use can result in a range of life-threatening injuries or permanent disability in the paediatric population. The incidence of serious lap-belt injury does not appear to be decreasing. Morbidity and mortality could be reduced by the use of three-point restraints, age appropriate restraints and booster seats. [source] Factors affecting outcome in liver resectionHPB, Issue 3 2005CEDRIC S. F. LORENZO Abstract Background. Studies demonstrate an inverse relationship between institution/surgeon procedural volumes and patient outcomes. Similar studies exist for liver resections, which recommend referral of patients for liver resections to ,high-volume' centers. These studies did not elucidate the factors that underlie such outcomes. We believe there exists a complex interaction of patient-related and perioperative factors that determine patient outcomes after liver resection. We sought to delineate these factors. Methods. Retrospective review of 114 liver resections by a single surgeon from 1993,2003: Records were reviewed for demographics; diagnosis; type/year of surgery; American Society of Anesthesiologists (ASA) score; preoperative albumin, creatinine, and bilirubin; operative time; intraoperative blood transfusions; epidural use; and intraoperative hypotension. Main outcome measurements were postoperative morbidities, mortalities and length of stay (LOS). Data were analyzed using a multivariate linear regression model (SPSS v10.1 statistical analysis program). Results. Primary indications for resections were hepatocellular carcinoma (HCC) (N=57), metastatic colorectal cancer (N=25), and benign disease (N=18). There were no intraoperative mortalities and 4 perioperative (30-day) mortalities (3.5%). Mortality occurred in patients with malignancies who were older than 50 years. Morbidity was higher in malignant (15.6%) versus benign (5.5%) disease. Complications included bile leak/stricture (N=6), liver insufficiency (N=3), postoperative bleeding (N=2), myocardial infarction (N=2), aspiration pneumonia (N=1), renal insufficiency (N=1), and cancer implantation into the wound (N=1). Average LOS for all resections was 8.6 days. Longer operative time (p=0.04), lower albumin (p<0.001), higher ASA score (p<0.001), no epidural use (p=0.04), and higher creatinine (p<0.001) all correlated positively with longer LOS. ASA score and creatinine were the strongest predictors of LOS. LOS was not affected by patient age, sex, diagnosis, presence of malignancy, intraoperative transfusion requirements, intraoperative hypotension, preoperative bilirubin, case volume per year or year of surgery. Conclusions. Liver resections can be performed with low mortality/morbidity and with acceptable LOS by an experienced liver surgeon. Outcome as measured by LOS is most influenced by patient comorbidities entering into surgery. Annual case volume did not influence LOS and had no impact on patient safety. Length of stay may not reflect surgeon/institution performance, as LOS is multifactorial and likely related to patient population, patient selection and increased high-risk cases with a surgeon's experience. [source] Minimising blood loss and transfusion requirements in hepatic resectionHPB, Issue 1 2002Luke L Bui Background Substantial blood loss and the requirement for blood transfusion remain major considerations for hepatic surgeons. We analysed the impact of a systematic protocol aimed at reducing intraoperative blood loss and homologous blood (HB) transfusion associated with hepatic resection. Methods Prospective clinical data were collected from 151 elective liver resections performed during the period between 1980 and 1999. Further data directly related to blood loss and anaesthesia were retrospectively collected from the anaesthetic intra-operative record. Strategies implemented in 1991 included preoperative autologous blood donation, low central venous pressure anaesthesia, aprotinin administration, ultrasonic dissection, hepatic vascular inflow occlusion and a Cell Saver. Blood loss and transfusion requirements were studied before and after the implementation of these strategies. Results There was no difference in the patient demographics, indications for operation or the scope of resections in the two time periods evaluated. Blood-saving strategies resulted in decreased estimated blood loss (4500 mL vs. 1000 mL p < 0.001). In addition, the number of patients requiring transfusion decreased (91.8% vs. 25.5% respectively, p < 0.001) and the mean number of units of HB transfusion was lower (13.7 vs. 2.3, p < 0.001). Morbidity and mortality were also decreased (57.1% vs. 25.5%, p < 0.001 and 10.2% and 4.9% p < 0.001, respectively). No complications directly referrable to low CVP anesthesia were identified. Conclusion Systematic implementation of strategies designed to control blood loss are effective and may reduce morbidity and mortality associated with hepatic resections. [source] MF59® -adjuvanted vaccines for seasonal and pandemic influenza prophylaxisINFLUENZA AND OTHER RESPIRATORY VIRUSES, Issue 6 2008Angelika Banzhoff Abstract, Influenza is a major cause of worldwide morbidity and mortality through frequent seasonal epidemics and infrequent pandemics. Morbidity and mortality rates from seasonal influenza are highest in the most frail, such as the elderly, those with underlying chronic conditions and very young children. Antigenic mismatch between strains recommended for vaccine formulation and circulating viruses can further reduce vaccine efficacy in these populations. Seasonal influenza vaccines with enhanced, cross-reactive immunogenicity are needed to address these problems and can confer a better immune protection, particularly in seasons were antigenic mismatch occurs. A related issue for vaccine development is the growing threat of pandemic influenza caused by H5N1 avian strains. Vaccines against strains with pandemic potential offer the best approach for reducing the potential impact of a pandemic. However, current non-adjuvanted pre-pandemic vaccines offer suboptimal immunogenicity against H5N1. For both seasonal and pre-pandemic vaccines, the addition of adjuvants may be the best approach for providing enhanced cross-reactive immunogenicity. MF59®, the first oil-in-water emulsion licensed as an adjuvant for human use, can enhance vaccine immune responses through multiple mechanisms. A trivalent MF59-adjuvanted seasonal influenza vaccine (Fluad®) has shown to induce significantly higher immune responses to influenza vaccination in the elderly, compared with non-adjuvanted vaccines, and to provide cross-reactive immunity against divergent influenza strains. Similar results have been generated with a MF59-adjuvanted H5N1 pre-pandemic vaccine, which showed higher and broader immunogenicity compared with non-adjuvanted pre-pandemic vaccines. [source] Multilevel generalized linear models for modelling age-related gender difference in violent behaviour and associated factors in the general household populationINTERNATIONAL JOURNAL OF METHODS IN PSYCHIATRIC RESEARCH, Issue 3 2005Min Yang Senior Statistician Abstract It is preferable to use longitudinal data when studying patterns of violence and antisocial behaviour over the lifespan together with the associated risk factors in the general population. From the statistical modelling perspective, random samples of cross-sectional data, representative of the population, can be a reliable alternative. Sampling, weighting, and possible geographical clustering of the behaviour must be considered in the analysis together with correct choice of model as a function of age, although cohort effects and age effects are not separated from the analysis. This paper demonstrates the use of multilevel generalized linear models in the British National Survey of Psychiatric Morbidity in 2000. A multilevel logistic model as a special case of a generalized linear model with individual weightings was adapted for a dichotomous measure of violence and extended to Poisson and negative binomial outcomes. Three types of age function, discrete age effects, continuous age effects, and piecewise polynomial function of age intervals were evaluated for goodness of fit, and for their practical advantages and disadvantages. Models were developed for possible risk factors in relation to specific age groups of interest. Copyright © 2005 John Wiley & Sons, Ltd. Copyright © 2005 John Wiley & Sons, Ltd. [source] Morbidity following dental treatment of children under intubation general anaesthesia in a day-stay unitINTERNATIONAL JOURNAL OF PAEDIATRIC DENTISTRY, Issue 1 2004S. Atan Summary. Objectives., To determine which variables were best related to the overall morbidity of a child undergoing dental general anaesthetic (GA) and then to use these variables to determine those factors that might influence the extent and severity of morbidity experienced by healthy children following dental GA. Sample and methods., Data were collected on anxiety, pain and morbidity, GA procedure and dental procedure from 121 children attending a day stay GA unit for dental treatment. Patients were interviewed preoperatively, postoperatively before discharge then four further times over the next 148 h. Data were analysed using multivariate regression. Results., Thirty-one per cent of subjects had restorative work, 60% had at least one tooth extracted, 54% had a surgical procedure. Use of local analgesia reduced postoperative pain whilst an increase in the number of surgical procedures increased it. Increase in anaesthetic time was related to increased odds of feeling sleepy and nauseous, females were more likely to complain of sleepiness or weakness. Feelings of dizziness were increased if the patient was given local analgesia during the procedure. Conclusions., Pain following dental GA was the most prevalent and long lasting symptom of postoperative morbidity in this study. Reductions in operating time and improvement in pain control have the potential to reduce reported morbidity following dental GA. [source] Functional and Cognitive Consequences of Silent Stroke Discovered Using Brain Magnetic Resonance Imaging in an Elderly PopulationJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 7 2004Wolf-Peter Schmidt MD Objectives: To evaluate the prevalence of silent stroke and its associated consequences on physical, cognitive, and emotional functioning in an elderly population. Design: Population-based cross-sectional survey. Setting: The Memory and Morbidity in Augsburg Elderly project in the Augsburg region of southern Germany. Participants: Two hundred sixty-seven community-dwelling persons aged 65 to 83. Measurements: The presence of silent stroke was determined using magnetic resonance imaging brain scan and a single question asking for physician-diagnosed stroke in each participant. The health effect of silent stroke was assessed using rating scales for self-perceived health status (36-item short-form health survey), activities of daily living (ADLs) and instrumental ADLs, cognitive function, and depression (Center for Epidemiologic Studies Depression scale). Results: Just fewer than 13% (12.7%) of participants were affected by silent stroke. Silent stroke was associated with a history of hypertension, heart surgery, and elevated C-reactive protein. Individuals with silent stroke showed impairments on the Mini-Mental State Examination test and in the cognitive domains of memory, procedural speed, and motor performance. Conclusion: The presence of silent stroke has a considerable effect on cognitive performance in those affected. Determining the presence of silent stroke using brain imaging may contribute to identifying individuals at risk for developing gradual neurological deficits. [source] Estimating Hip Fracture Morbidity, Mortality and CostsJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 3 2003R. Scott Braithwaite MD OBJECTIVES: To estimate lifetime morbidity, mortality, and costs from hip fracture incorporating the effect of deficits in activities of daily living. DESIGN: Markov computer cohort simulation considering short- and long-term outcomes attributable to hip fractures. Data estimates were based on published literature, and costs were based primarily on Medicare reimbursement rates. SETTING: Postacute hospital facility. PARTICIPANTS: Eighty-year-old community dwellers with hip fractures. MEASUREMENTS: Life expectancy, nursing facility days, and costs. RESULTS: Hip fracture reduced life expectancy by 1.8 years or 25% compared with an age- and sex-matched general population. About 17% of remaining life was spent in a nursing facility. The lifetime attributable cost of hip fracture was $81,300, of which nearly half (44%) related to nursing facility expenses. The development of deficits in ADLs after hip fracture resulted in substantial morbidity, mortality, and costs. CONCLUSION: Hip fractures result in significant mortality, morbidity, and costs. The estimated lifetime cost for all hip fractures in the United States in 1997 likely exceeded $20 billion. These results emphasize the importance of current and future interventions to decrease the incidence of hip fracture. [source] Does Low Vitamin D Status Contribute to "Age-Related" Morbidity?JOURNAL OF BONE AND MINERAL RESEARCH, Issue S2 2007Neil Binkley MD Abstract It is increasingly appreciated that vitamin D plays important physiological roles beyond the musculoskeletal system. As such, it is plausible that endemic vitamin D deficiency contributes to much nonskeletal morbidity that adversely affects quality of life with advancing age among older adults. This overview will explore the evidence for, and potential involvement of, vitamin D deficiency in nonbone conditions that are currently accepted as "age-related" morbidity among older adults. [source] Perineal Trauma and Postpartum Perineal Morbidity in Asian and Non-Asian Primiparous Women Giving Birth in AustraliaJOURNAL OF OBSTETRIC, GYNECOLOGIC & NEONATAL NURSING, Issue 4 2008Hannah Dahlen ABSTRACT Objectives: To describe the postpartum perineal morbidity of primiparous women who had a vaginal birth and compare outcomes between Asian and non-Asian women in the first 2 days following the birth and at 6 and 12 weeks postpartum. Design: Data from a randomized clinical trial of a perineal management technique (perineal warm packs) were used to address the study objective. Setting: Two maternity hospitals in Sydney, Australia. Participants: Primiparous women who had a vaginal birth in the trial were included (n=697). One third of the women were identified as "Asian." Results: Compared with non-Asian women, Asian women were significantly more likely to have an episiotomy; require perineal suturing; sustain a third- or fourth-degree perineal tear; and report their perineal pain as being moderate to severe on day 1 following the birth. Asian women were less likely to give birth in an upright position or to resume sexual intercourse by 6 or 12 weeks following the birth. Conclusion: More research is needed into methods that could reduce the high rates of perineal trauma experienced by Asian women, and midwives need to be able to offer appropriate support for Asian women. [source] Morbidity and mortality associated with pre-eclampsia at two tertiary care hospitals in Sri LankaJOURNAL OF OBSTETRICS AND GYNAECOLOGY RESEARCH (ELECTRONIC), Issue 1 2007Vajira H. W. Dissanayake Abstract Aim:, To report the occurrence of morbidity and mortality associated with carefully phenotyped pre-eclampsia in a sample of nulliparous Sinhalese women with strictly defined disease. Methods:, A phenotyping database of 180 nulliparous women with pre-eclampsia and 180 nulliparous normotensive pregnant women who were recruited for a study into genetics of pre-eclampsia was analyzed. Results:, Women who developed pre-eclampsia had significantly higher systolic blood pressure (SBP; P = 0.002) and diastolic blood pressure (DBP; P = 0.002) at booking (at approximately 13 weeks of gestation). 38.3%, 28.3% and 33.3% of women delivered at <34 weeks, at 34,36 weeks, and at term, respectively. 78% required a cesarean section. Complications included SBP , 160 mmHg (75.5%); DBP , 110 mmHg (83.8%); proteinuria ,3 + (150 mg/dL) in the urine protein heat coagulation test (87%); renal failure requiring dialysis (2%); platelet counts <100 × 109/L (13%); ,70 U/L in aspartate and/or alanine aminotransaminase (15%); placental abruption (4%); eclampsia (9%); and one maternal death. Maternal complications indicative of severe disease, apart from the incidence of SBP , 160 mmHg and DBP , 110 mmHg, were not significantly different in early and late-onset pre-eclampsia; fetal outcome was better with late-onset disease. 48% of babies were small for gestational age. Only 80 of 135 babies of women with pre-eclampsia whose condition could be confirmed at 6 weeks post-partum were alive. Conclusions:, Pre-eclampsia in Sinhalese women is associated with severe maternal morbidity and fetal morbidity and mortality, suggesting that modification of the Western diagnostic criteria and/or guidelines for medical care may be necessary. There is an urgent need to improve neonatal intensive care services in Sri Lanka. [source] The natural history and osteodystrophy of mucolipidosis types II and IIIJOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 6 2010Grace David-Vizcarra Aim: To assess the natural history and impact of the secondary bone disease observed in patients with mucolipidosis (ML) II and III. Methods: Affected children and adults were ascertained from clinical genetics units around Australia and New Zealand. Diagnoses were confirmed by the National Referral Laboratory in Adelaide. The study encompassed all patients ascertained between 1975 and 2005. Data focussing on biochemical parameters at diagnosis, and longitudinal radiographic findings were sought for each patient. Where feasible, patients underwent clinical review and examination. Examinations included skeletal survey, bone densitometry, and measurement of serum and urine markers of bone metabolism. In a subset of patients, functional assessment using the Pediatric Evaluation and Disability Inventory (PEDI) and molecular analysis of GNPTAB were performed. Results: Twenty-five patients with mucolipidosis were ascertained over a 30-year period. Morbidity and functional outcomes on living patients were described. Serum calcium and phosphate were normal. All, but one patient, had normal alkaline phosphatase. Serum osteocalcin and urine deoxypyridinoline/creatinine were elevated. Two radiological patterns were observed (i) transient neonatal hyperparathyroidism in infants with ML II and (ii) progressive osteodystrophy in patients with ML intermediate and ML III. Molecular analyses of GNPTAB in nine subjects are reported. Conclusion: ML is characterised by a progressive bone and mineral disorder which we describe as the ,osteodystrophy of mucolipidosis'. The clinical and radiographic features of this osteodystrophy are consistent with a syndrome of ,pseudohyperparathyroidism'. Much of the progressive skeletal and joint pathology is attributable to this bone disorder. [source] A randomized trial of enteral feeding volumes in infants born before 30 weeks' gestationJOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 6 2000C A Kuschel Objective: To compare the effect of two volumes of enteral feeds on postnatal growth in infants born before 30 weeks gestation. Methodology: Fifty-four infants, less than 30 weeks gestational age, who reached full enteral feeds were randomized to remain on 150 mL/kg per day (150 group) or increase to 200 mL/kg per day (200 group). The primary outcome measure was growth at 35 weeks corrected gestational age (CGA). Results: There were no statistically significant differences in demographic or clinical parameters between the study groups at commencement of the study, although there was a trend for infants in the 150 group to be lighter (895 g vs 1020 g, P = 0.27). Milk intakes were increased in 43% of the infants in the 150 group, whereas 54% of the infants in the 200 group required reduced intakes. Infants in the 200 group had greater daily weight gains (16.7 g/kg per day vs 15.2 g/kg per day, P = 0.047) and at 35 weeks CGA were heavier (2020 g vs 1885 g, P = 0.014) and had a greater arm fat area (282 mm2vs 218 mm2, P = 0.009). There was no difference in length or head circumference at 35 weeks CGA, and no difference in any growth parameter at 1 year of age. Morbidity was not different between the groups. Conclusions: The individual milk volume requirements for adequate weight gain without significant adverse effects vary between 150 and 200 mL/kg per day in extremely premature infants. For many infants in both groups, the assigned target volume was not appropriate. Increased milk intakes (and therefore higher caloric and mineral intakes) are associated with increased daily weight gains and a greater weight at 35 weeks CGA. The weight gain may be due to an increase in fat deposition. [source] Morbidity and Health-Care Use in People with Intellectual Disabilities in General Practice: First Results of a Survey in the NetherlandsJOURNAL OF POLICY AND PRACTICE IN INTELLECTUAL DISABILITIES, Issue 2 2004H. M. J Van Schrojenstein Lantman-de Valk Abstract, Reported here are the preliminary results of the second Dutch National Survey of General Practice in which data were collected on all contacts with general practitioners (GPs) during a 12-month period to determine characteristics of patients with intellectual disabilities (ID). Sociodemographic characteristics differed significantly between people with ID and controls, indicating significant differences in morbidity between the two groups (people with ID were found to have more psychological problems, more digestive problems, more ear problems, more neurological problems, and more general and unspecified problems). [source] Impact of the extent and duration of cytoreductive surgery on postoperative hematological toxicity after intraperitoneal chemohyperthermia for peritoneal carcinomatosisJOURNAL OF SURGICAL ONCOLOGY, Issue 4 2005Dominique Elias MD Abstract Background Peritoneal carcinomatosis (PC) is a major disease, currently treated using complete cytoreductive surgery and intraperitoneal chemohyperthermia (IPCH). Morbidity is a significant limitation of this procedure, usually related to the extent of surgery, and hematological toxicity, which is considered as dependent upon the chemotherapy dosage alone. The aim of our study was to investigate whether surgery alone had an impact on the hematological toxicity associated with the standardized drug protocol that we routinely prescribed. Methods Data were prospectively recorded from 83 consecutive patients who underwent complete cytoreductive surgery followed by IPCH with intraperitoneal oxaliplatin (360 mg/m2) and irinotecan (360 mg/m2), in 2 L/m2 of dextrose over 30 min at 42,45°C, using the Coliseum technique. Sixty minutes prior to IPCH, patients also received an intravenous perfusion of leucovorin (20 mg/m2) and 5-fluorouravyl (400 mg/m2). The doses and volume of IPCH were determined on the basis of the body surface area, so that all patients received the same concentration of drugs. Severe aplasia were defined as a leucocyte count of <500/ml, platelets <50,000/ml, and reticulocytes <6.5 g Hb/L. Results Postoperatively, severe aplasia was seen in 40 of the 83 patients (48%). There was no difference in the characteristics of patients with and without aplasia, other than the extent of surgery. The incidence of severe aplasia was only related to the duration of surgery (537 min in the aplastic group versus 444 min in the non aplastic group) (P,=,0.002), and to the extent of the peritoneal disease (peritoneal index of 19.5 in the aplastic group, vs. 15.3 in the nonaplastic group) (P,=,0.02). Conclusion We report for the first time that the duration of surgery may increase the incidence of hematological toxicity following intraperitoneal chemotherapy. We also hypothesized that intra- and postoperative transient biochemical disorders, such as hypoalbuminemia, hemodilution, liver, and renal insufficiency and stress can be involved in this process. These hypotheses may allow improved postoperative care. J. Surg. Oncol. 2005;90:220,225. © 2005 Wiley-Liss, Inc. [source] Model choice in time series studies of air pollution and mortalityJOURNAL OF THE ROYAL STATISTICAL SOCIETY: SERIES A (STATISTICS IN SOCIETY), Issue 2 2006Roger D. Peng Summary., Multicity time series studies of particulate matter and mortality and morbidity have provided evidence that daily variation in air pollution levels is associated with daily variation in mortality counts. These findings served as key epidemiological evidence for the recent review of the US national ambient air quality standards for particulate matter. As a result, methodological issues concerning time series analysis of the relationship between air pollution and health have attracted the attention of the scientific community and critics have raised concerns about the adequacy of current model formulations. Time series data on pollution and mortality are generally analysed by using log-linear, Poisson regression models for overdispersed counts with the daily number of deaths as outcome, the (possibly lagged) daily level of pollution as a linear predictor and smooth functions of weather variables and calendar time used to adjust for time-varying confounders. Investigators around the world have used different approaches to adjust for confounding, making it difficult to compare results across studies. To date, the statistical properties of these different approaches have not been comprehensively compared. To address these issues, we quantify and characterize model uncertainty and model choice in adjusting for seasonal and long-term trends in time series models of air pollution and mortality. First, we conduct a simulation study to compare and describe the properties of statistical methods that are commonly used for confounding adjustment. We generate data under several confounding scenarios and systematically compare the performance of the various methods with respect to the mean-squared error of the estimated air pollution coefficient. We find that the bias in the estimates generally decreases with more aggressive smoothing and that model selection methods which optimize prediction may not be suitable for obtaining an estimate with small bias. Second, we apply and compare the modelling approaches with the National Morbidity, Mortality, and Air Pollution Study database which comprises daily time series of several pollutants, weather variables and mortality counts covering the period 1987,2000 for the largest 100 cities in the USA. When applying these approaches to adjusting for seasonal and long-term trends we find that the Study's estimates for the national average effect of PM10 at lag 1 on mortality vary over approximately a twofold range, with 95% posterior intervals always excluding zero risk. [source] Incidence and Precipitating Factors of Morbidity among Israeli Travelers AbroadJOURNAL OF TRAVEL MEDICINE, Issue 5 2002Lihi Winer Background: During recent years international travel, including visits to the developing world, has become increasingly popular. Many of these travelers suffer from some sort of health problem during their trip or after their return. Travelers clinics that give pretravel immunization and counseling have emerged. This study analyzes the incidence and risk factors for health problems among Israelis traveling abroad. Methods: The study surveyed by telephone 200 people who visited the traveler's clinic at Soroka Medical Center in Beer-Sheva during the years 1998 to 1999. The travelers were questioned after returning from their journey about the type and duration of the trip, compliance with medical advice given in the travel clinic, and health problems during the trip. Results: The mean age was 26.4 ± 9.4 years, 7% went on an organized tour, 23% traveled alone, and 77% traveled with a friend. The mean duration of the trip was 14.7 ± 13.4 weeks. Of the travelers, 70% reported some health impairment. Problems reported most frequently were gastrointestinal tract diseases (43%), respiratory tract diseases (25%), and injuries (10%). Only 4% were admitted to a hospital during their trip. After their return, 19.5% consulted a physician. Comparing the group of travelers who were sick with the rest, a correlation between noncompliance with the keeping of food hygiene and illness was found (p = .008). Additional risk factors for illness were long duration (p < .001), solitary trip (p = .04), and young age (p < .001). Of the people who were advised to take antimalaria chemoprophylaxis, 55% reported regular use of these drugs. Compliance with treatment correlated with older age (p < .001), short duration of stay (p = .01), previous experience, and travel to Africa (p < .001). Conclusions: Most of the travelers to developing countries are young, travel for long periods, and live in basic conditions during their stay abroad. For these reasons travelers are at increased risk for morbidity. High risk travelers should be identified and counseled in order to increase their compliance with the medical advice and immunizations. A screening program for returning travelers should be considered. [source] Long-term oral branched chain amino acids in patients undergoing chemoembolization for hepatocellular carcinoma: a randomized trialALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 7 2004R. T.-P. Summary Background :,Patients undergoing transarterial chemoembolization for hepatocellular carcinoma have advanced tumour or severe cirrhosis and frequently have associated protein-calorie malnutrition. The role of nutritional supplements for such patients is unclear. Aim :,To investigate, in a randomized controlled trial, any benefit of the long-term administration of branched chain amino acids in patients undergoing chemoembolization for hepatocellular carcinoma. Methods :,Forty-one patients received oral branched chain amino acids for up to four courses of chemoembolization and 43 patients did not receive any nutritional supplement. Morbidity, liver function, nutritional status, quality of life and long-term survival were compared between the two groups. Results :,The administration of branched chain amino acids resulted in a lower morbidity rate compared with the control group (17.1% vs. 37.2%, P = 0.039). In particular, the group given branched chain amino acids showed a significantly lower rate of ascites (7.3% vs. 23.2%, P = 0.043) and peripheral oedema (9.8% vs. 27.9%, P = 0.034). Significantly higher serum albumin, lower bilirubin and a better quality of life were observed after chemoembolization in the group given branched chain amino acids. However, there was no significant difference in survival between the two groups. Conclusions :,Nutritional supplementation with oral branched chain amino acids is beneficial in increasing the serum albumin level, reducing the morbidity and improving the quality of life in patients undergoing chemoembolization for inoperable hepatocellular carcinoma. [source] Minimally Invasive Vein Surgery: Latest Options for Vein DiseaseMOUNT SINAI JOURNAL OF MEDICINE: A JOURNAL OF PERSONALIZED AND TRANSLATIONAL MEDICINE, Issue 3 2010FACPhArticle first published online: 20 MAY 2010, Steven Elias MD Abstract The goal of treatment for venous disease is to decrease ambulatory venous hypertension. Various strategies are employed. These can be divided into exogenous and endogenous treatments. Exogenous methods concern those employed from the outside of the limb, such as compression and elevation. Endogenous modalities treat from inside the limb the underlying venous pathology due to venous valvular dysfunction or venous obstruction. Traditional endogenous procedures include stripping, ligation, and phlebectomy. All these procedures require incisions, anesthesia, and perhaps hospitalization, and involve significant discomfort. Newer minimally invasive vein surgery procedures now exist. These are all same-day, outpatient procedures, usually involving local anesthesia. Most can be performed percutaneously without incisions. Patients ambulate the day of the procedure. Morbidity is less than 1%. This article summarizes the concept of minimally invasive vein surgery and summarizes new technologies to manage all forms of venous disease. Mt Sinai J Med 77:270,278, 2010. © 2010 Mount Sinai School of Medicine [source] Early administration of surfactant in spontaneous breathing with nCPAP: feasibility and outcome in extremely premature infants (postmenstrual age ,27 weeks)PEDIATRIC ANESTHESIA, Issue 4 2007ANGELA KRIBS MD Summary Background:, Spontaneous breathing supported by nasal continuous positive airway pressure (nCPAP) is thought to have some advantages compared with mechanical ventilation in extremely premature infants. In addition, early or prophylactic surfactant administration has been shown to be superior to delayed use. A strategy to combine these two principles was tested in our neonatal intensive care unit (NICU). The aim of this feasibility study was to describe the procedure and compare short-term results with a historical control. Methods:, The study took place in a level III NICU. In the observational period all extremely premature infants with clinical signs of moderate to severe respiratory distress syndrome despite nCPAP received 100 mg·kg,1 of a natural surfactant preparation via an intratracheal catheter during spontaneous breathing. In the historical control period those infants were intubated and ventilated to receive surfactant. Results:, Twenty-nine of 42 infants fulfilled the criteria and were treated with the new approach. In five cases ventilation with manual bag was necessary after administration of surfactant but all infants could be retransferred to nCPAP within a few minutes. Ten infants were intubated later during the first 3 days. Mortality was 7% in the group of infants treated in this way and 12% in all infants treated during the observational period. Mortality was 35% in the historical control period. Morbidity was within ranges reported by other authors. Conclusions:, Surfactant administration during nCPAP is feasible. First results indicate that early complications are rare. This warrants a prospective randomized trial. [source] Time Spent on Treatment of Atopic Dermatitis: A New Method of Measuring Pediatric Morbidity?PEDIATRIC DERMATOLOGY, Issue 6 2004Elisabeth A. Holm M.D. The TSOT (min/day) was studied in a group of 42 children with atopic dermatitis (AD) (16 girls and 26 boys; mean age 7.07 years). The TSOT included time spent on all types of topical treatment, on extra cleaning, and on visits to doctors. Objective Scoring Atopic Dermatitis (SCORAD) assessment was performed at each visit. A significant correlation was found between TSOT and SCORAD scores for all visits (p < 0.0001). There was no correlation between TSOT and age or sex or between TSOT/SCORAD and age (p < 0.08). For the 65 visits (by 42 children), TSOT/SCORAD ranged from 0.08 min/point to 28.67 min/point. Older children (10,15 years of age) had a lower TSOT/SCORAD ratio compared to younger children (1,5 years of age). Our data suggest that TSOT in itself may be a useful measure of morbidity among pediatric AD patients. It is speculated that patients with a very high TSOT/SCORAD rate or a very low rate have coping problems and would therefore be suitable candidates for intensified efforts in programs such as "eczema schools." [source] Morbidity in former sawmill workers exposed to pentachlorophenol (PCP): A cross-sectional study in New ZealandAMERICAN JOURNAL OF INDUSTRIAL MEDICINE, Issue 4 2009David McLean PhD Abstract Background From 1950 to 1990 pentachlorophenol (PCP) was used widely in the New Zealand sawmill industry, and persistent claims of long-term health effects have been made. Methods We surveyed surviving members of a cohort enumerated to study mortality in sawmill workers employed from 1970 to 1990. Estimates of historical exposure were based on job titles held, using the results of a PCP biomonitoring survey conducted in the 1980s. The survey involved interviews and clinical examinations, with interviewers and examiners blinded to exposure status. Results Of the 293 participants 177 had not been exposed, and of the 116 exposed all but 10% had low or short-term PCP exposure. Nevertheless, a number of significant associations between PCP exposure and the prevalence of various symptoms were observed including associations between: (i) exposure levels and self-reported tuberculosis, pleurisy or pneumonia (P,<,0.01) and a deficit in cranial nerve function (P,=,0.04); (ii) duration of employment and thyroid disorders (P,=,0.04), and neuropsychological symptoms including often going back to check things (P,=,0.04), low libido (P,=,0.02) and heart palpitations (P,=,0.02), and a strong dose,response trend for frequent mood changes without cause (P,<,0.01); and (iii) cumulative exposure and frequent mood changes without cause (P,=,0.02), low libido (P,=,0.04), and in the overall number of neuropsychological symptoms reported (P,=,0.03). Conclusions PCP exposure was associated with a number of physical and neuropsychological health effects that persisted long after exposure had ceased. Am. J. Ind. Med. 52:271,281, 2009. © 2009 Wiley-Liss, Inc. 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