Amputation of a crossover 2nd toe in the presence of hallux valgus

Background: There are many surgical procedures for the correction of hallux valgus and crossover 2nd toe deformity. Amputation of a crossover 2nd toe is often performed as a salvage procedure if the primary 2nd toe corrective procedure fails.Aims: To assess the outcomes of amputating a crossover 2nd toe in the presence of hallux valgus in elderly patients above 70 years old; as a primary procedure.Materials and methods: Seven patients (8 ft) underwent amputation of their crossover 2nd toe. A disease specific questionnaire using a Visual Analogue Scale (VAS) was implemented measuring pain, deformity, discomfort, and walking distance.Results: The mean age of the patients was 82 years old, range 74–89 years old. Amputation of the 2nd toe significantly reduces pain, discomfort and the appearance of deformity, there was no difference in the patient’s walking distance after surgery.Conclusion: We recommend this type of surgery as a primary procedure in elderly patients above 70 years old, if the first ray is not causing symptoms.     

Experiences of pain and distress in hip fracture patients

The aims were to investigate: (1) experiences of physical pain in elderly patients with hip fracture; (2) if background variables, confusion, experiences of pain and distress and interventions aimed at reducing pain and distress, functional ability, pain in the ambulance, and type of fracture varied between patients with more intense physical pain and patients with less intense physical pain. The sample included 49 patients, 70 years or older, with hip fracture. Structured instruments were used to interview and observe the patients on four occasions during the hospital stay. The patients’ experiences of physical pain decreased during the hospital stay. Physical pain at rest was lower than pain with movement. Patients who scored physical pain as more intense (group B) during the visit to the hospital had significantly more unfavourable experiences in the sensory, emotional, and existential dimensions the day before discharge from the hospital compared with the patients who scored pain as less intense (group A). The patients in group B perceived the interventions as less favourable than group A. Furthermore, group B had more intense physical pain in the ambulance than the patients in the other group. More patients in group B than in group A had additional health problems.     

舒降之治疗老年人高脂血症的疗效观察

目的：观察舒降之（辛伐他汀）20mg每日一次降脂的临床疗效。方法：选35例老年高脂血症患者接受舒降之20mg,每日1次（晚上顿服）治疗,疗程8周。观察治疗前后血清总胆固醇（TC）、三酰甘油（TG）、低密度脂蛋白胆固醇（LDL-C）、高密度脂蛋白胆固醇（HDL-C）。结果：治疗8周后,血清TC、TG、LDL-C较入组前分别降低了29.20%、24.75%、32.87%（均P〈0.01）,其中,降低TC的总有效率为93.54%、降低TG的总有效率为59.26%。HDL-C较入组前升高了14.12%（P〈0.01）,升高HDL-C的总有效率为54.54%。结论：舒降之20mg,每日1次服用,安全有效,对改善老年人高脂血症有显著疗效。     

Risk of gallstones following gastrectomy in Japanese men

The risk of gallstones developing after gastrectomy in middle-aged Japanese men was investigated in a study of 2,738 men aged between 48 and 56 years who underwent both gallbladder ultrasonography (US) and a barium study of the upper digestive tract. It was revealed that 61 men had gallstones, 37 had had their gallbladder removed previously, and 55 had a history of gastrectomy. The prevalence of gallstones was 3.5 times higher in the men who had previously undergone gastrectomy (7.7%) than in those who had not (2.2%) (P=0.03). Moreover, gallstones tended to be more prevalent in those who had undergone Billroth II gastrectomy (12.5%) compared with those who had undergone Billroth I gastrectomy (5.6%); however, the difference was not significant. These results indicate that gastrectomy using either Billroth I or Billroth II reconstruction predisposes to gallstone formation. Nevertheless, it was estimated that prior gastrectomy was responsible for no more than 5% of gallstones in the study population.     

人右心室肌纤维方向的解剖

对１１个人心标本沿右心室流入道和流出道各壁长轴纵行切开，再将各壁横切为上、中、下３份，各份按１ｍｍ厚度逐层切开，观察其各层肌纤维方向的角度并绘成坐标图。结果表明，右心室流入、流出道游离壁的肌纤维方向由浅入深基本上是渐变的。流入道游离壁的下１／３和流出道的上１／３，浅中层与内层之间可有纤维方向的突变。流入道隔壁的纤维方向从右向左逐渐移行，偶在左、右室内膜面有方向的改变。流出道右室面的中上部有一纤维方向变动较大的层次。对右心室各壁肌纤维方向的排列特或、分层、功能及其临床意义进行了探讨。     

天津市和平区354名老年人生活质量调查分析

目的 了解老年人的生存质量。方法 以健康状况调查问卷SF—36对天津市和平区新兴街354名印岁以上的老人进行调查。结果 天津市新兴街老年人的生活质量水平较高，但经济状况和慢性疾病是影响老年人生活质量的两个重要因素。结论 改善老年人的经济状况，预防和延缓老年性疾病的发生是提高老年人生活质量的重要措施。     

老年人腹腔镜胆囊切除术172例报告

目的 :探讨老年人腹腔镜胆囊切除术的安全性、可行性及注意点。方法 :对 172例老年人胆囊良性病变进行腹腔镜胆囊切除术。其中伴有并存病 96例 (5 5 .81% )。结果 :172例病人均恢复良好 ,无并发症发生 ,无中转开腹病例。结论 :只要做好围手术处理 ,老年人行腹腔镜胆囊切除术是安全可行的。     

A Study of Fluoxetine in Obese Elderly Patients with Type 2 Diabetes

In order to establish the safety and efficacy of fluoxetine in subjects over 60 years of age with Type 2 diabetes, a randomized, double-blind, parallel study of 30 obese subjects was undertaken, comparing the use of fluoxetine 60 mg daily with placebo. Subjects were diet controlled with an HbA₁ < 14% (reference range 6–9%) and BMI > 29 kg m². Those taking fluoxetine had a median weight loss of 2.6 kg at 3 months (p < 0.001) and 3.9 kg at 6 months (p < 0–02), compared with weight loss in the placebo group of 0.1 kg and 0.0 kg at 3 and 6 months, respectively. Improved glycaemic control was also demonstrated in the fluoxetine group compared with placebo, initial HbA₁ levels of 8.0% vs 8.7% (NS) falling at 4 months by 0.9% (p < 0.02) and at six months by 0.9% (p < 0.02). No sustained improvement in fasting blood glucose levels was demonstrated. Reporting of adverse events was similar in both groups. Fluoxetine in the short term aids weight loss and improves glycaemic control without a significant increase in adverse events in elderly Type 2 diabetic subjects.     

Impairment of bone turnover in elderly women with hip fracture

Summary Hip fracture is one of the most severe consequences of osteoporosis affecting aged women. However, abnormalities of bone turnover responsible for bone loss in this condition have not been clearly defined. To further evaluate the bone metabolic status of women sustaining hip fracture, we have prospectively measured serum osteocalcin as a marker of bone formation and urinary excretion of pyridinoline (Pyr) and deoxypyridinoline (D-pyr) cross-links as markers of bone collagen degradation in 174 independently living women (80 ± 8 years) within a few hours after a hip fracture. Comparison was made with 77 age-matched controls (80 ± 5 years) and 17 premenopausal women (39 ± 3 years). In addition 15 of the patients were followed with daily measurements during the first postoperative week. At the time of admission osteocalcin was 20% lower in the fractured women compared to the elderly controls (7.6 ± 3.8 vs. 9.5 ± 4.5 nglml,P = 0.001). Pyr and D-pyr were 36% and 40% higher, respectively (P = 0.0001), than in elderly controls and 85% and 76% higher than in premenopausal controls (P = 0.0001). Serum osteocalcin did not correlate with the cortisol level measured at the same time (r = 0.03, ns), nor with serum albumin and creatinine. Serum osteocalcin remained unchanged within 18 hours after fracture, whereafter it progressively decreased until the third postoperative day. No correlation was noted between the excretion of pyridinoline cross-links and the time elapsed from fracture.These data suggest that the abnormal levels of osteocalcin and pyridinolines are unrelated to traumatically induced acute changes, but reflect abnormalities of bone turnover existing prior to the fracture. Thus, hip-fracture patients have biochemical evidence of decreased bone formation and increased bone resorption when compared to age-matched controls. We suggest that these abnormalities may play a role in the decrease of the bone mass and the consequently increased bone fragility that characterize the osteoporotic hip fracture in the elderly.