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Ouellette, Nadine, Robert Bourbeau, and Carlo G. Camarda. "Regional disparities in Canadian adult and old-age mortality: A comparative study based on smoothed mortality ratio surfaces and age at death distributions." Canadian Studies in Population 39, no. 3-4 (February 14, 2013): 79. http://dx.doi.org/10.25336/p61p53.
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This paper examines adult and old-age mortality differentials in Canada between 1930 and 2007 at the provincial level, using theCanadian Human Mortality Database and the flexible smoothing P-spline method in two-dimensions well-suited to the study of smallpopulations. Our analysis reveals that provincial disparities in adult mortality in general, and among the elderly population in particular,are substantial in Canada. Moreover, based on the modal age at death and the standard deviation of ages at death above the mode,provincial disparities at older ages have barely reduced over time, despite the great mortality improvements in all provinces since the early 20th century. In the last few years studied, evidence of the shifting mortality regime was found among females in most Western and Central provinces, while all males were still undergoing an old-age mortality compression regime.
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Fries, James F. "The Theory and Practice of Active Aging." Current Gerontology and Geriatrics Research 2012 (2012): 1–7. http://dx.doi.org/10.1155/2012/420637.
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“Active aging” connotes a radically nontraditional paradigm of aging which posits possible improvement in health despite increasing longevity. The new paradigm is based upon postponing functional declines more than mortality declines and compressing morbidity into a shorter period later in life. This paradigm (Compression of Morbidity) contrasts with the old, where increasing longevity inevitably leads to increasing morbidity. We have focused our research on controlled longitudinal studies of aging. The Runners and Community Controls study began at age 58 in 1984 and the Health Risk Cohorts study at age 70 in 1986. We noted that disability was postponed by 14 to 16 years in vigorous exercisers compared with controls and postponed by 10 years in low-risk cohorts compared with higher risk. Mortality was also postponed, but too few persons had died for valid comparison of mortality and morbidity. With the new data presented here, age at death at 30% mortality is postponed by 7 years in Runners and age at death at 50% (median) mortality by 3.3 years compared to controls. Postponement of disability is more than double that of mortality in both studies. These differences increase over time, occur in all subgroups, and persist after statistical adjustment.
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HARRIS, BERNARD. "Growing Taller, Living Longer? Anthropometric History and the Future of Old Age." Ageing and Society 17, no. 5 (September 1997): 491–512. http://dx.doi.org/10.1017/s0144686x97006594.
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In recent years, economic and social historians have made increasing use of anthropometric records (principally, records of human height and weight) to investigate changes in human health and well-being. This paper summarises some of the main findings of this research and demonstrates the remarkable increases in human height which have occurred during the course of the present century. The paper also examines the relationship between changes in average height and changes in life expectancy. Although most of the evidence assembled by anthropometric historians has been derived from records relating to schoolchildren and young adults, their work has profound implications for the study of health in old age. The concluding section examines the relevance of this work to current debates on the decline of mortality, the ‘compression of morbidity’ and the future of social policy.
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EDIEV, DALKHAT M. "Decompression of Period Old-Age Mortality: When Adjusted for Bias, the Variance in the Ages at Death Shows Compression." Mathematical Population Studies 20, no. 3 (July 2013): 137–54. http://dx.doi.org/10.1080/08898480.2013.816218.
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Chi Tieu, Duc, and Hoa Quoc Hoang. "Tracheomalacia due to trachea compression related to benign goiter." MedPharmRes 4, no. 1 (March 30, 2020): 10–12. http://dx.doi.org/10.32895/ump.mpr.4.1.3.
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Introduction: Tracheomalacia can result from long-standing compression by a large goiter. The cartilaginous rings of the trachea may be weakened or destroyed by long-standing compression, causing loss of structural support. Tracheomalacia after resectioning of benign goiter compressing trachea was an important issue. It has extended the time of mechanical ventilation, increased the risk of failure extubating and mortality. Materials and Methods: Descriptive and prospective study. From November 2014 to January 2017, we have collected 102 patients who had benign goiter compressing trachea and had thyroidectomy. Tracheomalacia was diagnosed and managed intra and postoperatively. Results: Recognition of women accounted for the majority of 81.4%. The average age was 54.5 years old and the average duration of goiter was 5 years. The patients were hospitalized with the main symptom of dysphagia accounting for 21.6% and difficulty breathing when lying down was 16.7%. On CT scan, the average Goiter was 270g, the average narrow airway diameter was 8.4 mm, of which 12.7% of patients had narrow tracheal diameter <5mm. The rate of tracheomalacia was 4.9%. There were statistically significant differences between the 2 groups with and without tracheomalacia: elderly patients (p = 0.041); goiter long-standing time (p = 0.07); symptoms of positional dyspnea on lying (p = 0.003) and tracheal diameter compressed (p = 0.001). Conclusion: Tracheomalacia should be noted in patients older than 65 years old, goiter exist longer than 5 years and goiter is over 200g.
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Colli, Benedicto Oscar, Carlos Gilberto Carlotti Junior, João Alberto Assirati Junior, Marcius Benigno Marques dos Santos, Luciano Neder, Antonio Carlos dos Santos, and Nayara Cioffi Batagini. "Olfactory groove meningiomas: surgical technique and follow-up review." Arquivos de Neuro-Psiquiatria 65, no. 3b (September 2007): 795–99. http://dx.doi.org/10.1590/s0004-282x2007000500012.
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BACKGROUND: Olfactory groove meningiomas comprise 4-10% of the intracranial meningiomas. Generally they give signs of brain compression due to great size they reach before diagnosis. In this study, the clinical outcome of patients with olfactory groove meningiomas surgically treated was analyzed. METHOD: 17 patients operated on from 1988-2006. Female: 16, Male: 1. Age: 19-76 years-old (mean=53.12± 13.11). Follow-up: 1-209 months (mean=51.07±12.73. Bifrontal/bifrontal-bi-orbital approaches were used. Outcome was analyzed using survival/recurrence-free Kaplan-Mayer curves. RESULTS:16 had WHO grade 1; one grade 2 meningiomas. Resection Simpson's grade 1 was in achieved in 64.7%, grade 2 in 29.4% and grade 3 in 5.9%. There was no recurrence during the follow-up. Global and operative mortality were 11.8%. Main postoperative complications were osteomielitis (11.8%) and pneumonia (5.9%). CONCLUSION: Extensive approaches allowed total resection of most olfactory groove meningiomas with no recurrence during the follow-up, but operative mortality and local complications were high.
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Govindasamy, Rajesh, Ramkumar Gnanasundaram, Saravanan Kasirajan, Jimmy J. Meleppuram, and Kumar Archit. "Proximal femur locking compression plate in complex proximal femoral fractures: a retrospective analysis." International Journal of Research in Orthopaedics 2, no. 3 (September 3, 2016): 104. http://dx.doi.org/10.18203/issn.2455-4510.intjresorthop20162805.
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<p class="abstract"><strong>Background:</strong> Proximal femoral fractures are one of the most common fractures in old age patients. Fixation of these fractures is technically high demanding owing to the high risk of complications. The aim of our study is to analyze the outcomes of proximal femoral locking compression plate (PF-LCP) in these fractures.</p><p class="abstract"><strong>Methods:</strong> We retrospectively analyzed 18 proximal femoral fractures treated with PF-LCP from May 2012 to May 2015. There were 12 females (67%) and six males (33%) with an average age of 59.6 years (range, 32 to 84 years). The peritrochanteric fractures constituted by intertrochanteric and subtrochanteric fractures were classified by Boyd and Griffin classification along with Seinshemier’s classification, respectively. Among that, 14 cases (77%) were of intertrochanteric and four cases (23%) were of subtrochanteric fracture pattern. The functional outcome was evaluated by harris hip score and the parker palmer mobility score one year after surgery.<strong></strong></p><p class="abstract"><strong>Results:</strong> Among 18 patients, 16 patients obtained fracture union without further intervention; two patients required additional bone grafting. There were no cases of hip screw cutting the femoral head. There was no post-operative mortality in our study. The average harris hip score was 85.5 (83-94). The assessment by parker and palmar mobility score was 7.6 (range 4-9).</p><strong>Conclusions:</strong> The PF-LCP is a good stable alternative in the treatment of complex proximal femoral fractures. It provides good to excellent bone healing with limited complications.
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Alqaydi, K., J. Turner, L. Robichaud, D. Hamad, X. Xue, and M. Afilalo. "P001: Age-adjusted D-dimer and two-site compression point of care ultrasonography to rule out acute deep vein thrombosis - a pilot study." CJEM 20, S1 (May 2018): S57. http://dx.doi.org/10.1017/cem.2018.199.
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Introduction: Deep vein thrombosis (DVT) can lead to significant morbidity and mortality if not diagnosed and treated promptly. Currently, few methods aside from venous duplex scanning can rule out DVT in patients presenting to the Emergency Department (ED). Current screening tools, including the use of the subjective Wells score, frequently leads to unnecessary investigations and anticoagulation. In this study, we sought to determine whether two-site compression point-of-care ultrasound (POCUS) combined with a negative age-adjusted D-dimer test can accurately rule out DVT in ED patients irrespective of the modified Wells score. Methods: This is a single-center, prospective observational study in the ED of the Jewish General Hospital in Montreal. We are recruiting a convenience sample of patients presenting to the ED with symptoms suggestive of DVT. All enrolled patients are risk-stratified using the modified Wells criteria for DVT, then undergo two-site compression POCUS, and testing for age-adjusted D-dimer. Patients with DVT unlikely according to modified Wells score, negative POCUS and negative age-adjusted D-dimer are discharged home and receive a three-month phone follow-up. Patients with DVT likely according to modified Wells score, a positive POCUS or a positive age-adjusted D-dimer, will undergo a venous duplex scan. A true negative DVT is defined as either a negative venous duplex scan or a negative follow-up phone questionnaire for patients who were sent home without a venous duplex scan. Results: Of the 42 patients recruited thus far, the mean age is 56 years old and 42.8% are male. Twelve (28.6%) patients had DVT unlikely as per modified Wells score, negative POCUS and negative age-adjusted D-dimer and were discharged home. None of these patients developed a DVT on three-month follow-up. Thirty patients (71.4%) had either a DVT likely as per modified Wells score, a positive POCUS or a positive age-adjusted D-dimer and underwent a venous duplex scan. Of those, six patients had a confirmed DVT (3 proximal & 3 distal). POCUS detected all proximal DVTs, while combined POCUS and age-adjusted D-dimer detected all proximal and distal DVTs. None of the patients with a negative POCUS and age-adjusted D-dimer were found to have a DVT. Conclusion: Two-site compression POCUS combined with a negative age-adjusted D-dimer test appears to accurately rule out DVT in ED patients without the need for follow-up duplex venous scan. Using this approach would alleviate the need to calculate the Wells score, and also reduce the need for radiology-performed duplex venous scan for many patients.
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Stojilkovic-Gnjatovic, Jelena. "Theoretical and conceptual framework for population ageing research." Stanovnistvo 57, no. 2 (2019): 13–33. http://dx.doi.org/10.2298/stnv1902013s.
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The ageing of the population is a contemporary phenomenon, but its foundations were laid decades ago. Changing age structures and the consequent demographic ageing has only recently become the subject of theoretical (re)consideration, since the theory of demographic transition only values fertility and mortality trajectories. The emergence of ?new? demography takes into account the momentum created by the previous trends in population dynamics and explains the future rejuvenation or ageing of the population. The importance of inherited age structure can be illustrated using an approach that represents distorted cohort flows, showing that baby booms and baby busts can play a crucial role in the future ageing of the population. While in the past it was fertility that predominantly affected age structure, recent research has revealed that changes in life expectancy are becoming a more prominent factor in shaping expected population ageing trends. The general theory of population ageing would have to consider the possible compression of morbidity, dynamic equilibrium, or the expansion of morbidity, since the future course of (healthy) life expectancy is determining the scope of the old and fragile population. The status of theory in demography has long been problematic, since the ?grandiose? theory of demographic transition had to be reevaluated. Modern approaches apply more flexible theoretical frameworks to explain contemporary demographic changes and provide a conceptual background. As such, the important paradigm for the demography of ageing should be the prospective paradigm, which uses information about the longevity of the population and transposes it to population ageing research. The theory of population metabolism seems to adequately define why population ageing is important for cohorts and generation change, especially in cases where distorted cohort flows create prominent cohort oscillation. The need to create adequate policies for changing age composition morphology is highlighted in the domain of institutional adaptation, where the concept of population balance can provide the appropriate framework. Also, as life events tend to take place more often at certain points in the life cycle - for example during adulthood and entering old age - the idea of population densities should be further explored.
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Graf, Akua, James Welch, Sunita Agarwal, Craig Cochran, Vaishali Parekh, William F. Simonds, Lee Weinstein, et al. "Thymoma and Not Just Thymic Carcinoid Can Be Associated With Multiple Endocrine Neoplasia Type 1." Journal of the Endocrine Society 5, Supplement_1 (May 1, 2021): A1007—A1008. http://dx.doi.org/10.1210/jendso/bvab048.2061.
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Abstract Background: Multiple endocrine neoplasia type 1 (MEN1) is an inherited tumor syndrome with autosomal dominant inheritance. Thymic neuroendocrine tumors (NETs) are known manifestations of MEN1 occurring in 2-8% of patients. However, thymomas, a type of thymic epithelial tumors, have only been described in rare case reports. They markedly differ from thymic NETs in their natural history, morphology, prognosis, and therapeutic options. Here we present a case of an aggressive, recurrent thymoma associated with MEN1. Case Report: A 58-year-old Caucasian female with a family history of MEN1 was diagnosed with a prolactinoma at age 15 when she presented with irregular menses, galactorrhea, headaches and visual field defects. She was referred to our institution for further evaluation where genetic testing confirmed the diagnosis of MEN1. Throughout the years, she developed primary hyperparathyroidism, non-functional pancreatic neuroendocrine tumors, Zollinger-Ellison syndrome, bilateral adrenal hyperplasia, and bronchial carcinoid. At the age of 49, magnetic resonance imaging (MRI) and computed tomography (CT) scan of the chest incidentally demonstrated a 2.5 x 6 x 10-cm anterior mediastinal mass, with marked compression of the left brachiocephalic vein and encasement of the superior vena cava. Biopsy was consistent for malignant cells of thymic epithelial origin. A median sternotomy with en bloc resection with SVC resection and reconstruction, mediastinal lymph node dissection and placation of the right hemidiaphragm were performed. Pathology revealed WHO type B3 thymoma extending into the pulmonary parenchyma with positive tissue margins but negative lymph node involvement. Following surgery, she underwent adjuvant radiation therapy with a total dose of 59 Gy. Annual screening showed disease remission. However, nine years after initial presentation, surveillance CT scans revealed a pleural base mass with mass effect on the superior portion of the IVC, as well as hypoattenuated masses within the liver. Positron emission tomography with fluorodeoxyglucose (18FDG PET-CT) confirmed multiple metastatic lesions involving thorax and abdomen. Biopsy of the retrocaval soft tissue subxiphoid mass revealed epithelioid cells in a background of lymphocytes consistent with recurrent thymoma. She was subsequently staged as IV B thymoma and was recommended to start systemic chemotherapy. Conclusion: We described a case of an aggressive thymoma in a patient with MEN1 syndrome demonstrating that their association exists and the clinical presentation can be aggressive. Thus, it is important for practitioners to screen for thymic tumors routinely in patients with MEN1 for early detection as they can be a major cause of mortality. Although further studies are needed, improving the detection of these tumors could significantly contribute to reducing MEN1-related deaths.
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Fiala, Mark A., Jesse Keller, Keith E. Stockerl-Goldstein, Michael H. Tomasson, Ravi Vij, and Tanya M. Wildes. "Front-Line Radiotherapy Is Associated with Shortened Survival in Newly Diagnosed Multiple Myeloma Patients." Blood 124, no. 21 (December 6, 2014): 5696. http://dx.doi.org/10.1182/blood.v124.21.5696.5696.
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Abstract Background: Bone lesions and extramedullary plasmacytomas, present in ~70% and ~15% of multiple myeloma (MM) patients at diagnosis, respectively, are a major source of morbidity. Extensive bone or extramedullary disease is often associated with severe pain, fracture, or spinal cord compression requiring immediate medical attention. Palliative radiation to the afflicted area(s) can provide relief or reduction of the associated symptoms. The presence of bone lesions or extramedullary plasmacytomas at MM diagnosis have been linked to poorer prognosis, but to date, the prognosis of patients with extensive bone or extramedullary disease requiring radiotherapy during front-line treatment is unclear. In a single institution retrospective study of 162 newly diagnosed MM patient’s, including 87 who received front-line radiotherapy, Yaneva, et al (J Buon, 2006) found no survival difference between patients who received radiotherapy during front-line treatment and those who did not. Methods: Using the SEERStat software, we extracted the case listings of 85,115 patients diagnosed with MM from 1973 through 2010 in Surveillance Epidemiology and End Results (SEER)-18 registries database based on the November 2012 submission. Children (under 18 years old) were excluded. Autopsy or death certificate only cases were excluded. As non-black minorities have been historically underrepresented in the SEER databases, patients identified as any race other than white or black were excluded. Patients were followed for OS through December 2011. Disease-specific-survival was defined as death from myeloma. Patients were classified as having radiotherapy during front-line treatment or not. Patients who refused radiotherapy (n = 184) or for whom radiotherapy status was unknown (n = 973) were excluded. Results: 77,714 patients were eligible for analysis. The median age at diagnosis was 70 years (range 18-85+); 54% were male; 19% were black. The median follow-up was 22 months (range 0-441). 25% (n = 19,295) of patients received radiotherapy during front-line treatment. Radiotherapy during front-line treatment was more common among patients under the age of 60 at diagnosis (30.9% vs 21.4%; p < 0.001), white patients (25.5% vs 21.8%; p < 0.001), and male patients (26.2% vs 23.2%; p < 0.001). The frequency of radiotherapy during front-line treatment decreased in the most recent decade (22.8% vs 27.3%; p < 0.001). Patients who received radiotherapy during front-line treatment had an estimated median disease-specific-survival of 38 months compared to 46 months for patients without (p < 0.001). In a multivariate cox regression model of age, race, sex, and radiotherapy during front-line treatment, all four variables were independently significant (Table 1). Radiotherapy was associated with a 17% (95% CI 15-20) increase in disease-specific mortality. The impact of radiotherapy was relatively stable over the time frame studied (Table 2). Conclusions: Radiotherapy during front-line treatment, a surrogate for extensive bone or extramedullary disease at MM diagnosis, is independently associated with increased disease-specific mortality. It has remained a relatively stable predictor of poorer prognosis throughout the timeframe tested, suggesting that MM treatment advances have not overcome the poor prognosis associated with extensive bone lesions or extramedullary disease at MM diagnosis. Table 1 Multivariate Overall Survival Analysis Overall Age HR1 (95% CI) p value <65 1 65+ 1.73 (1.69-1.76) < 0.001 Race White 12 Black 0.91 (0.89-0.93) < 0.001 Sex Female 12 Male 0.98 (0.96-1.00) 0.013 Radiotherapy No 12 Yes 1.17 (1.15-1.20) < 0.001 1- Hazard Ratio is adjusted for all other variables within the model 2- Used as the Reference level Abstract 5696. Table 2 Multivariate Overall Survival Analysis by Era 1973-1990 1991-2000 2001-2010 Age HR1 (95% CI) p value HR1 (95% CI) p value HR1 (95% CI) p value <65 12 12 12 65+ 1.37 (1.32-1.43) < 0.001 1.68 (1.62-1.75) < 0.001 2.00 (1.93-2.07) < 0.001 Race White 12 12 12 Black 0.85 (0.81-0.90) < 0.001 0.93 (0.89-0.98) 0.005 0.95 (0.92-1.00) 0.012 Sex Female 12 12 12 Male 1.02 (0.99-1.06) 0.212 0.96 (0.93-1.00) 0.026 0.95 (0.92-1.00) 0.153 Radiotherapy No 12 12 12 Yes 1.13 (1.09-1.18) < 0.001 1.18 (1.13-1.22) < 0.001 1.14 (1.10-1.18) < 0.001 1- Hazard Ratio is adjusted for all other variables within the model 2- Used as the Reference level Disclosures No relevant conflicts of interest to declare.
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Dhakal, Ajay, Anuradha Avinash Belur, and Abhinav B. Chandra. "Bortezomib Induced Pulmonary Toxicity." Blood 124, no. 21 (December 6, 2014): 5731. http://dx.doi.org/10.1182/blood.v124.21.5731.5731.
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Abstract Background: Bortezomib (BTZ), a proteasome inhibitor, is a promising agent against Multiple Myeloma (MM). BTZ induced lung injury (BLI), although not appreciated during the introductory time of the medication, has now been highlighted in multiple case reports. Two primary hypotheses for the cause of pulmonary toxicity are: A. BTZ withdrawal leads to reactivation of Nuclear Factor (NF)- κB causing inflammatory changes in the lungs, which explains the rapid improvement of BLI with steroid therapy reported in several cases. B. BTZ not only affects NF- κB, but also various other unclear signaling pathways. Its metabolite may accumulate in lungs causing direct toxicity. It may explain cases, which don't improve with steroid therapy. Some anecdotes claim that genetic predisposition (especially Japanese population) and history of prior Stem Cell Transplant (SCT) might be risk factors for BLI. The objective of this study is to report a case of BLI, review current literature, and determine the predictors of mortality in BLI. Case report: A 64-year-old male with chronic low back pain presented to the emergency department with new onset severe mid back pain radiating to bilateral shoulders. CT scan, performed to rule out aortic dissection, demonstrated multiple lytic lesions throughout the bony skeleton and a compression fracture at T7 vertebral body with epidural extension of soft tissue. A bone survey confirmed CT scan findings, and subsequent bone marrow biopsy confirmed the diagnosis of MM. He received radiation therapy to the thoracic spine and completed 2 cycles of CyBorD regimen (Cyclophosphamide 300 mg/m2 by mouth, BTZ 1.5 mg/m2 sub-cutaneous, and Dexamethasone 40 mg by mouth each on day 1, 8, 15 and 22). Three days after the completion of the second cycle, he was admitted to hospital with respiratory distress. CT chest (Image 2) showed new interval appearance of bilateral perihilar groundglass opacities, peribronchial and interstitial thickening predominantly in the upper lobes not seen in prior scan (Image 1). There were no other signs or symptoms of pneumonia such as leukocytosis, fever or cough. After some benefit from oral prednisone, he was discharged with a tapering dose of the same. Unfortunately, patient was readmitted with worsening respiratory distress 4 days later. A repeat CT scan of the chest showed resolution of previously well-defined areas of perihilar ground glass opacities but development of hazy areas of ground-glass opacification throughout both lungs with more confluent abnormalities in bilateral lower lobes (Image 3). Patient was treated with high dose methyl-prednisone and noninvasive positive pressure ventilation without any improvement. Family requested do-not-resuscitate and do-not-intubate status. Patient died on 10th day of the admission. Methodology: A case report, review of current literature on BLI, and analysis of available data. Results: An extensive Pubmed search for BLI yielded 29 cases, 5 of which occurred with re-administration of BTZ after resolution of a BLI. Mean (Standard Deviation, Minimum, Maximum) age is 60.72 years (10.12, 31, 74). 69% were males, 13.8% have smoking history, 20.7% have history of lung diseases, and 34.5% have underwent SCT for MM. 62.1% patients were on steroids concurrent with or just prior to BTZ and almost 80% were treated with high dose steroids for BLI. Mean total BTZ dose 4.62 mg (2.75, 1,9), mean duration from the 1st dose to onset of BLI 21.77 days (16.72, 0.5, 60), and mean duration from the last dose to onset of BLI was 3.27 days (2.82, 0, 10). 41.4% patients died of BLI. Mann Whitney test showed no significant difference in median age, median number of BTZ doses, and median duration from the 1st dose of BTZ to the onset of BLI between diseased and survivors. But the difference in median duration (Minimum, Maximum) from the last dose of BTZ to the onset of BLI between deceased (1.00 day, 0, 5) and survivors (4.00 days, 0, 10) were found to be statistically significant (p= 0.007). No significant association could be found between the outcome of BLI and different factors like sex, history of SCT, previous lung diseases, history of smoking, concurrent/prior steroids and treatment of BLI with steroids. Conclusion: BLI is a serious condition as 41.4% of the reported cases were fatal. Early onset of respiratory distress after the last dose of BTZ can be a predictor of mortality in BLI. Figure 1 Figure 1. Figure 2 Figure 2. Figure 3 Figure 3. Disclosures No relevant conflicts of interest to declare.
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Thomopoulos, Theodoros, Styliani Mantziari, Penelope St-Amour, Emilie Uldry, and Michel Suter. "Management of a Complicated Internal Herniation After Roux-en-Y Gastric Bypass in a 28-Week Pregnant Woman." Obesity Surgery 30, no. 12 (September 29, 2020): 5177–78. http://dx.doi.org/10.1007/s11695-020-04997-0.
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Abstract Background Small bowel obstruction (SBO) due to internal hernia (IH) is a well-known late complication after laparoscopic Roux-en-Y gastric bypass (LRYGB), with an incidence between 0.5 and 10% as reported by Iannelli et al. (Obes Surg. 17(10):1283–6, 2007). It is reported most frequently 1–2 years after surgery because of the greater weight loss at that time, with rapid loss of the mesenteric fat consequently as discussed by Stenberg et al. (Lancet. 387(10026):1397–404, 2016). Currently, women constitute more than 50% of the patients undergoing bariatric surgery and most of them are of childbearing age as reported by the World Health Organization (2015). SBO, due to IH, is a rare complication during pregnancy, mostly occurring during the third trimester as discussed by Torres-Villalobos et al. (Obes Surg 19(7):944–50, 2009), and can result in fetal and maternal morbidity and even mortality as reported by Vannevel et al. (Obstet Gynecol. 127(6):1013–20, 2016). Moreover, the physiologic changes of pregnancy can mask the symptoms of SBO after LRYGB, leading to significant diagnostic and therapeutic delays as detailed by Wax et al. (Am J Obstet Gynecol 208(4):265–71, 2013). Therefore, an early surgical exploration is necessary in this particular and uncommon situation as discussed by Webster et al. (Ann R Coll Surg Engl 97(5):339–44, 2015). Methods A 32-year-old female patient, with Ehlers-Danlos syndrome and chronic pain, was in the 28th week of her first pregnancy after bariatric surgery. She had had an antecolic LRYGB 6 years ago in another institution, resulting in a 35-kg weight loss. She presented to the emergency department with severe and persistent epigastric pain associated with nausea and vomiting during 24 h. On physical examination, her abdomen was painful and tender at the epigastrium and left hypochondrium, and her vital signs were normal. The blood tests were in the normal range except the white blood cell count at 12′000 G/l. The obstetric and neonatal team was involved, and fetal heart monitoring was normal. Abdominal ultrasonography ruled out other causes of pain. An abdominal MRI was performed and displayed a distended proximal small bowel, free abdominal fluid, and bowel mesenteric edema in the left upper quadrant with compression of the superior mesenteric vein. Internal hernia with intestinal suffering was suspected, and the patient consented for emergency laparoscopy. Results The laparoscopic exploration, reduction of the internal hernia, and closure of the mesenteric defects are demonstrated step-by-step in the presented intraoperative video. The postoperative course was uncomplicated for both patient and fetus. Oral feeding was resumed at day 1, with no residual symptom, and the patient was discharged on postoperative day 3. At 1-month follow-up, she had no complaint and her pregnancy had resumed a normal course. She delivered a healthy baby at 36 weeks without any complication. Conclusions Internal herniation after LRYGB represents a rare, high-risk complication during pregnancy. A low threshold for imaging, preferably by abdominal MRI, is recommended. Multidisciplinary management, including obstetricians and bariatric surgeons, is necessary in order to avoid maternal and fetal adverse outcomes. During surgery, recognition of the anatomy is often difficult, and parts of the bowel are distended and fragile. Starting to run the bowel backwards from the ileocecal valve is a crucial surgical step for reducing internal hernias during LRYGB, and reduces both the risk to worsen the situation and of bowel injury, making its management less hazardous.
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Hou, Lachlan, Sunita Dhanda, and Dan Xu. "Rare complication of a type IV paraoesophageal hiatal hernia in a Marfan syndrome patient." BMJ Case Reports 14, no. 4 (April 2021): e239641. http://dx.doi.org/10.1136/bcr-2020-239641.
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A 77-year-old female patient with Marfan syndrome presented with a 1-week history of worsening malaise and poor appetite. This was associated with a dramatic unintentional loss of weight as well as shortness of breath worsened by exertion. She has significant medical histories of a hiatal hernia and chronic type B aortic dissection. CT scan of the chest was able to confirm a type IV paraoesophageal hiatal hernia compressing on the lower lobe of her left lung without any progression of her aortic dissection. As surgical intervention was contraindicated in light of her advanced age and comorbidities, she was managed conservatively with a clinically satisfied outcome in the short term. Her long-term prognosis, however, is still poor with a high mortality of 1 and 5 years.
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Pantovic, Sveto, Radmila Sparic, and Radovan Mijalcic. "Metastatic brain tumour in pregnancy: A case report." Srpski arhiv za celokupno lekarstvo 140, no. 5-6 (2012): 365–70. http://dx.doi.org/10.2298/sarh1206365p.
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Introduction. Malignant tumours of the central nervous system in pregnancy are rare and are most frequently diagnosed in the second part of pregnancy Of all malignant tumours which may occur in pregnancy, intracranial tumours bear the highest risk of maternal and foetal morbidity and mortality. Case Outline. A 29-year-old primipara was admitted to our hospital as an emergency in the twenty-ninth week of pregnancy due to headache, right eye sight disorders (double vision), nausea and vomiting. The patient had a total thyroidectomy and a dissection of lymph glands of the neck at the age of seven years due to papillary carcinoma of the thyroid glands. The clinical and sonographic test revealed regular foetal growth and morphology. The MRI showed expansive changes in the brain parenchyma corresponding to metastatic lesion with the subtentorial herniation of the uncus of the hippocampus by compressive effect onto the right cerebral peduncle of the mesencephalon. Emergent neurosurgical intervention was indicated. Having in mind the age at pregnancy, it was decided to perform a caesarean operation. Alive female child was born weighing 1,370 grams. The post-operative procedure was normal. The patient was transferred to the neurosurgery department on the first post-operative day, where she underwent emergent surgery. Immunohistochemistry confirmed the metastatic tumour originating from the primary papillary adenocarcinoma of the thyroid gland. Conclusion. Neurosurgical diseases in pregnancy simultaneously jeopardize two lives and represent both medical and ethical problem. Upon confirming the presence of intracranial malignancy in pregnancy, further procedure is very individual and it implies cooperation of gynaecologists, neurologists, neurosurgeons, oncologists, anaesthesiologists and neonatologists.
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Vidal Urrutia, V., P. Garcia Gonzalez, J. L. Perez Bosca, D. Escribano Alarcon, J. M. Simon Machi, J. Gradoli Palmero, J. Abdala Lizarraga, et al. "1112 Discovering the origin of a mysterious heart cavity." European Heart Journal - Cardiovascular Imaging 21, Supplement_1 (January 1, 2020). http://dx.doi.org/10.1093/ehjci/jez319.657.
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Abstract Left atrial appendage aneurysm is an infrequent cardiac malformation, with less than 150 cases reported in the literature. It is a congenital anomaly in the majority of cases, related to a dysplasia of pectinate muscles and atrial muscle bands, which tends to grow with age. At the present time, and despite of being not considered in current guidelines, surgical resection is the standard of treatment in the current literature, even in asymptomatic cases, based on cardiovascular morbidity and mortality by predisposing to atrial tachyarrhythmia, thromboembolism, and other rare conditions as coronary or left ventricular compression and rupture of the aneurysm. We report the case of a 53-year-old male patient presenting an episode of supraventricular paroxysmal tachycardia with the casual finding of a mysterious cavity in the transthoracic echocardiography. We found out the presence of a 50 mm cavity adjacent to the left atrium and left ventricle, with a bidirectional blood flow between the left atrium and the cavity when applying Doppler color and with contrast echocardiography. Given this finding, several differential diagnosis had to be considered, including vascular and structural disorders. In order to clarify the diagnosis, a cardiac magnetic resonance was performed. It revealed the presence of a huge aneurysm of the left atrial appendage (50 x 53 mm) causing a mild compression of the left ventricle, with no thrombus and no other significant findings. Due to its size, the compression of the left ventricle and the history of atrial arrhythmia we decided to manage it with an invasive approach by performing a middle thoracotomy, in order to prevent potentially serious complications. Abstract 1112 Figure. CMR 3D reconstruction; echocardiography
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Fujii, Takayuki, JUNYA KOSHIZAKA, NOBUAKI YAMAUCHI, MAYU MORIMOTO, NORIKO TERASAKI, HIROAKI TANAKA, and SATOSHI SUZUKI. "P1400ASSOCIATION BETWEEN MEAN SERUM MAGNESIUM LEVEL DURING THE FIRST 3 YEARS OF HEMODIALYSIS AND THE RISK OF SUBSEQUENT BONE FRACTURES." Nephrology Dialysis Transplantation 35, Supplement_3 (June 1, 2020). http://dx.doi.org/10.1093/ndt/gfaa142.p1400.
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Abstract Background and Aims Serum magnesium levels are an important factor associated with vital prognosis, cardiovascular disease, and vascular calcification in hemodialysis patients. Moreover, low serum magnesium levels are reportedly associated with an increased risk of hip fractures. Previously we reported that mean magnesium level during the first 3 years of hemodialysis was associated with all-cause mortality in ERA-EDTA 2018. Here, we investigated whether mean magnesium level during the first 3 years of hemodialysis can predict fracture risk. Method A retrospective cohort study was conducted in 283 patients who started hemodialysis at our hospital between March 2004 and the present and who could be followed for at least 3 years or had a fracture within 3 years. To assess the association between mean serum magnesium level during 3 years after the start of hemodialysis or until fracture and fracture risk, a multivariate analysis was performed using the Cox proportional hazard model with factors related to fractures as covariates, with all fractures such as hip fracture and spinal compression fracture as the outcome. Results The mean follow-up period was 6.1 years, and the mean age of patients was 64 years, with women accounting for 31%. Of all 283 patients, 62 developed fractures. A univariate analysis of factors associated with fractures revealed that high serum magnesium level was a significant fracture suppressor (hazard ratio [HR]: 0.31 [0.12–0.73]). Multivariate analysis conducted with significant factors in univariate analysis (mean serum albumin level, serum phosphorus level, hemoglobin level, C-reactive protein level, age, history of heart disease, history of bone fractures, and use or nonuse of phosphate binder during the 3 years) as the covariates revealed that the serum magnesium level was not significantly associated with bone fractures (HR: 0.95 [0.33–2.78]), whereas, old age, history of fractures, low albumin level, high CRP level, and nonuse of phosphate binder were significantly associated with fractures. Conclusion Serum magnesium levels during 3 years after the initiation of hemodialysis did not predict the risk of subsequent fractures, whereas a high level of inflammatory response, malnutrition, and nonuse of phosphate binder did.
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Iskandar, Kristy, Sunartini, Andika Priamas Nugrahanto, Nissya Ilma, Alvin Santoso Kalim, Guritno Adistyawan, Siswanto, and Roni Naning. "Use of air stacking to improve pulmonary function in Indonesian Duchenne muscular dystrophy patients: bridging the standard of care gap in low middle income country setting." BMC Proceedings 13, S11 (December 2019). http://dx.doi.org/10.1186/s12919-019-0179-4.
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Abstract Background Duchenne Muscular Dystrophy (DMD) is a fatal X-linked recessive neuromuscular disease, characterized by progressive loss of muscle strength. Respiratory failure is the main cause of morbidity and mortality in DMD patients. Respiratory devices have been reported to increase the effectiveness of cough and pulmonary function, thus prolong the survival rate. However, there is scarcity of studies about DMD patients’ respiratory profiles and usage of respiratory devices in Indonesia. Methods We recruited 8 Indonesian DMD patients in Dr. Sardjito Hospital and UGM Academic Hospital, Yogyakarta. Baseline pulmonary function was measured using spirometry. Peak Cough Flow was measured at baseline, with chest compression, after air stacking with manual ventilation bag, and with the combined techniques. Data recorded was presented as mean ± SD and analysed using ANOVA. Results Here we show the respiratory profiles from 8 non-ambulatory DMD patients (mean age: 13.25 ± 3.96 years old) confirmed by genetic testing. None of them had access to respiratory devices. Spirometry measurements showed 7 of 8 patients had severe restrictive pulmonary function with mean FEV1/FVC 22.40 ± 10.30% of predictive values (normal ratio > 70%). In addition, all patients showed poor cough performances measured by peak cough flowmeter (160 ± 44.58 L/min (normal value > 270 L/min)) that were improved by air stacking using a manual ventilation bag (167.4 ± 46.72 L/min). Three patients who had nocturnal hypoventilation did not have daytime hypercapnia. Manual ventilation bag or mechanical in−/ex-sufflation was indicated in 75% of patients while nocturnal assisted ventilation was indicated in 50% of patients. Neither daytime assisted ventilation nor tracheostomy was indicated in these patients. Conclusion Use of manual exsufflation in combination with the manual ventilation bag for air stacking to improve cough performance is recommended as the first step of respiratory management in DMD patients. Provision of manual ventilation bag serve as an affordable and effective device for respiratory support in the early stage of respiratory involvement in those non-ambulatory patients with DMD.
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Enroth, Linda, Jani Raitanen, Pauliina Halonen, Kristina Tiainen, and Marja Jylhä. "Trends of Physical Functioning, Morbidity, and Disability-Free Life Expectancy Among the Oldest Old: Six Repeated Cross-Sectional Surveys Between 2001 and 2018 in the Vitality 90+ Study." Journals of Gerontology: Series A, June 7, 2020. http://dx.doi.org/10.1093/gerona/glaa144.
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Abstract Background It remains unclear whether increasing longevity is accompanied by a compression or expansion of poor health and disability. We examined trends of physical functioning and morbidity in a population aged 90 and older, and disease- and disability-free life expectancy (LE) at age 90 between 2001 and 2018 in Finland’s third most populated city. Methods We used survey data from the Vitality 90+ Study, which comprises a series of six repeated mailed surveys (7,590 observations). Information on mortality came from Statistics Finland. We examined trends of functioning (activities of daily living [ADL] and mobility) and cardiovascular and dementia morbidity using age-adjusted generalized estimating equation models stratified by sex. In addition, age-, sex-, and period-specific health expectancies were calculated using Sullivan’s method. Results Over time, functioning improved, especially, in women, and morbidity increased in men. From 2001 to 2018, LE at age 90 increased by 5.3 months for men and 6.4 months for women. LE without ADL disability increased by 5.0 months for men and 8.4 months for women, and LE without mobility disability by 6.0 months for men and 4.4 months for women. LE without cardiovascular and dementia morbidity decreased for men (2.6 months) and increased for women (1.9 months). Conclusions In relative terms, we found a compression of disability for both sexes and an expansion of morbidity for men. Although the trends overall are rather positive, the increase in absolute morbidity and, to some extent, in disability will inevitably mean increasing care needs with population aging.
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Laichuthai, Nitchakarn, and Thiti Snabboon. "SUN-288 Atypical Teratoid Rhabdoid Tumor of the Sellar Region: An Unusual Cause of Hypopituitarism." Journal of the Endocrine Society 4, Supplement_1 (April 2020). http://dx.doi.org/10.1210/jendso/bvaa046.004.
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Abstract Background: Atypical teratoid/rhabdoid (AT/RT) tumor of the sellar region is an extremely rare malignant tumor in adults. To date, there are no definitive guidelines for optimal treatment and the prognosis of this tumor is poor. The pituitary insufficiency was rarely mentioned in previous literature and might be overlooked. Clinical case: A 43 years old female presented to our clinic with severe periorbital pain. The magnetic resonance imaging of the brain revealed a 1.5x1.5x 3 cm sellar mass which showed inhomogeneous enhancement after gadolinium administration. Hormonal work up showed 8AM cortisol of 1.86 mcg/dL, free T4 1.0 (0.8–1.8 ng/dL), TSH 0.05 (0.3 - 4.1 uIU/ml), FSH 6.0 (1.6–9.3 IU/L), LH 1.8 (2.4–9.3 IU/L), estradiol <18.35 (80–790 pmole/L), IGF-1 96.6 (50.6–263.7 ng/ml), prolactin 56.6 ng/ml. She underwent transsphenoidal surgery with tumor removal. The pathological result showed a mixture of pleomorphic spindle cell, oval shape tumor and poorly differentiated cell. The tumor was negative for INI1 (SMARCB1) compatible with AT/RT WHO grade IV. She developed pan hypopituitarism after surgery. She received 6 courses of 5950 cGy/25 fractions cranial irradiation and 6 courses of ifosfamide, cisplatin and etoposide. She completed the treatment regimen without significant toxicity. She continued hormonal replacement for panhypopituitarism and is still being followed at our clinic for 4 years without tumor progression or other complications. In previously reported cases, all of the sellar AT/RT were female with a median age of 45 years old (range 20–61). The clinical presentations are rapidly enlarged sellar mass with compressive symptoms to the adjacent structures. The radiological findings of sellar AT/RT are non-specific. The diagnosis is based on histopathological findings. Presence of rhabdoid cells on histopathology and polyphenotypic immunopositivity for epithelial, mesenchymal, and neuroectodermal markers along with loss of expression of SMARCB1/INI1 help in establishing a diagnosis of AT/RT. Currently, there are no definitive guidelines for optimal treatment. Multimodality treatment consisted of surgery, radiation and chemotherapy are the mainstays of treatment of the AT/RT. Of the 16 adults reported in the literature, 9 patients survived more than 12 months resulted in 47% of one-year survival rate. To our knowledge, this case is the sellar AT/RT with the longest survival to date. Conclusion: AT/RT is one of the most aggressive tumors in the sellar area. Due to its aggressiveness, hypopituitarism is anticipated. Our patient had postoperative secondary adrenal insufficiency, secondary hypothyroid and hypogonadotropic hypogonadism. Apart from multimodality treatment required for tumor control, pituitary hormones should be evaluated preoperatively to prevent perioperative mortality and long-term improvement in the quality of life.