Correlates of falling during 24 h among elderly Danish community residents

OBJECTIVES: To identify dietary, medical, and environmental correlates of falling during the last 24 h among elderly community residents. The limited accuracy of recall of falls in the elderly in previous studies was the reason for a 24-h time frame. METHODS: The study composes 4281 community residents aged 66+ years. The statistical analyses included Pearson's chi(2) test and multiple logistic regression. RESULTS: Mutually independent correlates of falls were a family history of fracture (OR, 3.0; 95% CI: 1.3-7.1); osteoarthrosis of the knee (OR, 2.9; 95% CI: 1.3-6.2); dizziness (OR, 4.1; 95% CI: 1.9-8.9); a diet not including sour dairy products (OR, 3.0; 95% CI: 1.4-6.3) or fish (OR, 3.4; 95% CI: 1.5-7.5); drinking tea (OR, 5.8; 95% CI 2.15-15.30); needing help for shopping (OR, 3.9; 95% CI: 1.6-9.3); and for administration of medicine (OR, 9.0; 95% CI: 2.0-40.6). Independent environmental correlates were vinyl on the floor in the bathroom (OR, 6.6; 95% CI: 2.1-20.9) and using indoor footwear without soles (OR, 5.5; 95% CI: 2.3-13.4). CONCLUSION: The present analyses suggest that several factors are associated to the risk of falling among elderly community residents. It appears relevant for further studies to test if modifications of the potential risk factors identified may reduce falls among community dwelling older persons.     

Anal incontinence after vaginal delivery: a prospective study in primiparous women

Objective To investigate the incidence and degree of anal incontinence after vaginal delivery among primiparous women and to define associated risk factors.
Design Prospective observational study.
Setting Karolinska Institutet, Danderyd Hospital, Sweden, a university hospital.
Participants Three hundred and forty-nine primiparous women.
Methods Questionnaires distributed within the first days after delivery and re-distributed five and nine months postpartum. Analysis of delivery records.
Results Eighty percent of the women answered all questionnaires. At five months postpartum, 2% of the women had symptoms of faecal incontinence and 25% had symptoms of involuntary flatus. At nine months postpartum, 1 % of the women had symptoms of faecal incontinence and 26% had symptoms of involuntary flatus. The majority of the women had infrequent symptoms and a decrease in severity was noted at nine months. Symptoms of incontinence were more common in women who sustained a sphincter tear at delivery. Risk factors for incontinence at five months included maternal age, duration of the second stage of labour, instrumental vaginal delivery, and clinically diagnosed sphincter tear at delivery. Development of incontinence at nine months was associated with maternal age and clinically diagnosed sphincter tear at delivery.
Conclusions The present study demonstrates that infrequent involuntary flatus is a common symptom after vaginal delivery in primiparous women. These symptoms of involuntary flatus frequently improved and only a few women suffered from frank faecal incontinence. Factors associated with an increased risk of anal incontinence and sphincter tears should be considered during delivery.     

Cytochemical Population Analyses of Glycogen in Neutrophil Leukocytes of Chronic Myelocytic Leukaemia during Busulfan Treatment

Abstract A comparative investigation of glycogen content and glycogen synthesis in neutrophil leukocytes from patients with untreated chronic myelocytic leukaemia (CML) and CML in remission was undertaken using microspectrophotometry of the periodic acid-Schiff (PAS) reaction and autoradiography after glucose-H³ incorporation into glycogen of single cells. The glycogen content was low and the rate of glycogen synthesis high in neutrophils from untreated CML, indicating an increased glycogen turnover rate in these cells compared to normal neutrophils. Both glycogen content and rate of glycogen synthesis reached normal levels in CML neutrophils in busulfan induced remission. This normalization of glycogen metabolism was not observed until WBC approached normal values after several weeks of treatment. This indicates that the effect of busulfan on normalization acted at the level of the myeloid precursor cell. The mechanism of normalization may be due to busulfan partially or completely eradicating a cytochemically abnormal leukaemic cell population and thereby "unmasking" a cytochemically normal cell population.     

Calcitonin-producing insulinoma: clinical, immunocytochemical and cytogenetical study

The case of a patient with a large goitre associated with hypercaicitoninaemia and fasting hypoglycaemia is reported. Pentagastrin (PG) test was negative. Repeated measurements of fasting glycaemia, insulin and C peptide established the diagnosis of insulinoma. After localization by endoscopic ultrasonography, a distal pancreatectomy was performed and a small insulinoma was recovered. Glycaemia and calcitonin (cT) became normal. The tumour cells a a strong immunoreactivity for insulin and CT. Cytogenetical evaluation of the tumour revealed a translocation t(1;9) (pl3;p22).     

Use of drug-eluting stents in acute myocardial infarction with persistent ST-segment elevation: results of the ALKK PCI-registry

Background

Drug-eluting stents (DES) reduce the rate of in-stent restenosis (ISR) and target vessel revascularization significantly when compared with bare metal stents (BMS). Their beneficial effects have been demonstrated in patients with acute myocardial infarction also, but the use of DES in the latter population seems to be still limited in clinical practice.

Methods and results

From January 2006 to December 2011, 25,424 patients with ST-elevation myocardial infarction were enrolled in the German ALKK PCI-registry. In 5,467 patients (21.5 %), a DES was implanted in the culprit segment, in 16,911 patients (66.5 %) a BMS, and 2,959 patients (11.6 %) received neither DES nor BMS. The rates of DES for typical subgroups were 31.7 % in patients with diabetes, 36.6 % in unprotected left main stenosis, 32.4 % in ostial lesions, 32.0 % for a stent length >15 mm, 26.2 % for a stent diameter ≤3 mm, and 58.5 % for ISR. There was a wide range in the use of DES between the different ALKK hospitals with a minimum of 2.3 % and a maximum of 58.3 % for the total study period (median 22.0 %, quartiles 14.6 and 37.5 %).

Conclusions

Despite convincing data for the use of DES in patients with STEMI, there is still an underuse of DES in this clinical setting in Germany. This is particularly worrying for the subgroups of patients and lesions with a high risk of restenosis. Further efforts are needed to reduce the skepticism about DES and to improve guideline adherent treatment.     

Ist Kinesiophobie während eines anhaltenden Schmerzzustands mit Lateralitäts- und Emotionserkennungsveränderungen assoziiert?

Background

The aim of this study is to investigate the effects of kinesiophobia on emotion recognition and left/right judgement.

Materials and methods

A total of 67 patients with chronic musculoskeletal pain were tested. In all, 24 patients achieved a score >37 on the Tampa Scale of Kinesiophobia and were included in the study. The ability to recognize basic emotions coded through facial expression was assessed using the Facially Expressed Emotion Labeling (FEEL) test. Left/right judgement was evaluated using a special Face-mirroring Assessment and Treatment program. The Toronto Alexithymia Scale-26 (TAS-26) was used to assess if the patients showed signs of alexithymia.

Results

The FEEL score of patients with kinesiophobia was significantly lower (p = 0.019). The recognition of the basic emotions fear (p = 0.026), anger (p = 0.027), and surprise (p = 0.014) showed significant differences in comparison to unaffected subjects. The basic emotion surprise was recognized more often by patients with kinesiophobia (p = 0.014). Only Scale 1 of the TAS-26 (identification problems of emotions) showed a significant difference between patients with kinesiophobia (p = 0.008) and healthy subjects.

Conclusion

The results show that kinesiophobic patients have altered recognition of emotions, problems in left/right judgement, and show signs of alexithymia.

     

Diagnosis of intraductal papillary mucinous neoplasm using endoscopic ultrasound guided microbiopsies:A case report

Pancreatic cysts are increasingly diagnosed due to expanding use of cross-sectional imaging,but current diagnostic modalities have limited diagnostic accuracy.Recently,a novel through-the-needle microbiopsy forceps has become available,offering the possibility of obtaining cyst-wall biopsies.We present a case of 41-year-old male with chronic pancreatitis and a 2-cm pancreatic cyst,initially considered a pseudocyst.Subsequently,endoscopic ultrasou-nd guided microbiopsies were successfully obtained,which surprisingly revealed an intraductal papillary mucinous neoplasm of mixed subtype with low grade dysplasia.In conclusion,obtaining biopsies from the wall of the pancreatic cystic lesions with this novel instrument is feasible and,as demonstrated in this case,can possibly alter the clinical outcome.Microbiopsies offered enough cellular material,allowing supplemental gene mutation analysis,which combined with other modalities could lead to a more individual approach when treating pancreatic cysts.However,prospective studies are warranted before routine clinical implementation.