Anaesthesia for vascular surgery on the extremities

Peripheral arterial surgery is challenging; operations are frequently long and associated with insidious blood loss. Because of the high incidence of comorbidities these patients are a high-risk group with a high incidence of morbidity and mortality. They key to successful outcome is meticulous attention to detail by all those professions involved in their care.     

Anaesthesia for vascular surgery on the extremities

Peripheral arterial surgery is challenging; operations are frequently long and associated with insidious blood loss. Because of the high incidence of comorbidities these patients are a high-risk group with a high incidence of morbidity and mortality. They key to successful outcome is meticulous attention to detail by all those professions involved in their care.     

The effectiveness of prophylactic anticonvulsants following neurosurgery

Summary One hundred and two patients who underwent supratentorial procedures for neurosurgical conditions, which are known to carry a high incidence of postoperative seizures, have been given prophylactic anticonvulsant medication. This preliminary analysis has failed to demonstrate any dramatic effect on the postoperative incidence of seizures in the first six months as the result of this policy. There has been a high incidence of serious side effects, but compliance has not been a major problem. This long-term study is continuing, though with a modified protocol.     

Familial vesicoureteral reflux

PURPOSE: Vesicoureteral reflux is known to occur in families. We summarized worldwide data on the incidence and nature of vesicoureteral reflux in siblings of children with vesicoureteral reflux. MATERIALS AND METHODS: We searched MEDLINE using the words siblings vesicoureteral reflux, familial vesicoureteral reflux, offspring vesicoureteral reflux and vesicoureteral reflux screening. All articles that we identified that were published from 1972 to 2002 were analyzed for the incidence of renal damage in siblings of patients with vesicoureteral reflux. RESULTS: Siblings of patients with vesicoureteral reflux have a much higher incidence of reflux than the normal population. There is a direct relationship of patient age to the incidence and severity of reflux. Most investigators advocate screening asymptomatic siblings of patients with vesicoureteral reflux. CONCLUSIONS: The incidence of sibling reflux is significant. When vesicoureteral reflux is discovered in symptomatic siblings, it is usually high grade and associated with a high incidence of reflux nephropathy. Randomized controlled studies are needed to compare renal damage in patients with reflux detected through screening to renal damage in those diagnosed after urinary tract infection to establish how much renal damage may be prevented by screening in asymptomatic siblings.     

高度近视合并白内障治疗手段的研究进展

随着近年来我国民众生活方式、用眼习惯发生改变，导致高度近视全球发病率呈现明显攀升趋 势。高度近视在疾病发展过程当中，与白内障疾病发生率有密切关联，并逐渐出现年轻化发展状态，对患 者视力水平造成严重损害。同时，高度近视合并特殊病理变化，可导致患者在接受手术治疗后并发症发生 几率高于普通白内障患者。而患者术后视觉质量要求较高，对于临床医师而言，面临的挑战较大。对此， 应高度关注高度近视合并白内障患者手术治疗手段，以此改善患者视力水平。本文对高度近视与白内障之 间的相关性进行分析，对相关治疗方式及并发症进行阐述，进而增强高度近视合并白内障的认知，深入掌 握两者之间的联系及可能导致的并发症，以期为其治疗提供参考依据。     

Osteosarcoma of the foot: A review of 52 patients at the Mayo Clinic

This is a review of 52 osteosarcomas of the foot. The incidence of osteosarcoma of the foot is very low. It appears to affect older patients and the calcaneus is a common site. The incidence of chondroblastic tumors is high and most tumors are high grade. In many cases, amputation is required for local control of disease.     

The epidemiology of fractures in children

A retrospective study of all paediatric fractures presenting to hospital in Edinburgh, Scotland in 2000 was undertaken. It showed that the incidence of fractures was 20.2/1000/year and that 61% of children's fractures occurred in males. Analysis of paediatric fractures shows that there are six basic fracture distribution curves with six fractures showing a bimodal distribution but most having a unimodal distribution affecting younger or older children. The incidence of fractures increases with age with falls from below bed height (<1m) being the commonest cause of fracture. The majority of fractures in children involve the upper limb. Lower limb fractures are mainly caused by twisting injuries and road traffic accidents. The incidence of fractures in cyclists and pedestrians remains relatively high whereas the incidence in vehicle occupants is low suggesting that road safety programs have been successful. Similar programs should be instituted for young cyclists. The importance of accident prevention programmes in the home is also highlighted.     

Osteosarcoma of the foot: a review of 52 patients at the Mayo Clinic

This is a review of 52 osteosarcomas of the foot. The incidence of osteosarcoma of the foot is very low. It appears to affect older patients and the calcaneus is a common site. The incidence of chondroblastic tumors is high and most tumors are high grade. In many cases, amputation is required for local control of disease.     

EPIDEMIOLOGICAL CHARACTERISTICS OF PROSTATE CANCER IN GUNMA PREFECTURE, JAPAN

Background Prostate cancer is rare in Asia, but the number of patients is increasing in Japan. We conducted an epidemiological study of prostate cancer in Gunma Prefecture, Japan, to investigate the trends and characteristics of the disease.
Methods: The subjects were 1.411 prostate cancer patients newly diagnosed between 1985 and and 656 patients who died from prostate cancer between 1981 and 1992. The incidence and mortality rates were calculated by year, demographic region and age.
Results: The yearly incidence rate showed an increase but the mortality rate showed no marked fluctuations. There was no significant difference between urban and ruraI districts in either incidence or mortality rate. The incidence rate tended to be high in the northern part of the prefecture, but no marked variation in mortality rate was seen. The incidence and mortality rates in districts with a history of manganese mining were high compared to those in districts without mining. In contrast, the incidence and mortality rates in districts with a history of zinc mining were comparatively lower. Both incidence and mortality rates showed a marked increase with age. The age-specific incidence showed a double logarithmic relationship to age.
Conclusions: The increase of the yearly incidence rate might be due to changes in lifestyle and environmental factors, improved diagnostic techniques, and increased awareness among the general public regarding prostate disease. Further investigation is needed to clarify the pattern and the causes of regional differences in the incidence and mortality rates. The possibilities that manganese and zinc might be related to prostatic carcinogenesis are suggested. Int J Urol 1995:2:191–197     

Is juvenile diabetes determined by a single gene closely linked to HLA?

The transmission behavior of insulin-dependent juvenile diabetes mellitus (JDM) has been studied with respect to its frequency in the relatives of JDM probands and its possible linkage to the HLA complex. Mathematical analysis shows that under a single locus hypothesis a very restricted range of incidence rates is possible in the full siblings of probands once the concordance rate in monozygotic (MZ) twins is specified. Specifically, for a given population prevalence of the disease, high concordance rates in MZ twins require high incidence rates in siblings, and low rates require low incidence rates, if a single locus model is th be valid. Moreover, if these rates do conform to a single locus model, then they give additional information about possible linkage between the purported JDM susceptibility gene and the HLA complex. By using observations on the identity by descent scores at the HLA locus of sibling pairs, both of whom are affected with JDM, it is shown that tight linkage of a disease susceptibility locus is possible only when the MZ twin and sibling incidence rates are low, whereas high rates support loose linkage. If the single locus model is rejected, then an alternative hypothesis, involving epistasis between a JDM susceptibility locus and genes in (or close to) the HLA complex can be suggested as a mechanism whereby JDM would appear to be linked to HLA within families while maintaining an association with HLA at the population level.     

Occurrence of lymphoproliferative disorder after heart transplantation is related to the total immunosuppressive load

Heart transplant recipients are at a high risk for the development of post-transplant lymphoproliferative disorders (PTLD). We explored the relationship between the incidence of PTLD and the immunosuppressive therapy in 150 consecutive patients who received a cardiac transplant at our centre. None of our patients treated with cyclosporin A and prednisone only (n = 41) developed PTLD. In contrast, 6 of 101 patients who were previously treated with anti-T-cell preparations suffered from PTLD. No relationship was found between the type of anti-T-cell therapy and the incidence of PTLD. We conclude that the high incidence of PTLD in heart transplant recipients is related to the total immunosuppressive load and not related to a single agent like OKT3.     

Analysis of persistent disease on the ear following Mohs surgery

A retrospective study of 338 patients with malignant lesions of the auricle is presented. The results of treatment using Mohs microscopically controlled surgery and conventional surgical excision are compared and the high incidence of recurrence is stressed. The incidence, etiology, pathology, and subclinical extension of auricular tumors are discussed. The treatment of choice is Mohs microscopically controlled surgery and a plea is made for a more radical therapeutic approach to these often casually treated neoplasms.     

(iii) Proximal fixation stems yield optimal fixation

Distal fixation with extensively porous-coated stems has demonstrated good fixation, but a high incidence of proximal stress-shielding. Proximal femoral fixation was developed to load the femur proximally to avoid the problem of stress-shielding. First generation proximal fixation stems had a high percentage of thigh pain and loosening. Second generation designs with mechanical fixation only in the diaphysis (smooth distal stems) improved fixation, but still demonstrated a relatively high incidence of thigh pain. It is now evident that biologic fixation is required in the diaphysis. Still, proximal fixation must occur in the cortical bone of the proximal femur. Stems with a geometry that primarily load the proximal femur, and yet achieve biologic (osseous) fixation in the diaphysis, result in ‘transitional stress transfer’ to the femur. Contemporary designs that employ these principles are successful in providing durable fixation, a low incidence of thigh pain, and avoid the problem of stress-shielding.     

The incidence of major abdominal surgery after septic abortion--an indicator of complications due to illegal abortion

That there is a high morbidity associated with illegal abortion is well known, but its exact extent is difficult to assess, since detailed statistics are not available and the nature of the morbidity is diffuse. We have assumed that abortal sepsis is a consequence of illegal interference with pregnancy. The incidence of major abdominal surgery after a septic abortion is used as an indicator of serious complications. This incidence is compared with that following legal abortion.     

A pathologic-anatomical feature of carcinoma of large bowel in Japan

Summary The pathologic-anatomical features of large bowel carcinoma were compared between Japan and the United States in gross as well as histological type using 197 surgical specimens from western Japan during the period of 1963 through 1970. The result together with the materials collected from the literature suggested that there seemed to be definite difference in the anatomical distribution. A relatively high incidence of carcinoma of the rectum and concomitant low incidence of carcinoma of the sigmoid and descending colons in Japan was found to be the major difference when compared with the data published in the American literature. Some difference was also noted in a relatively high incidence of polypoid-type carcinoma and in a relatively low incidence of annular-type carcinoma among Japanese materials in contrast to those of American materials. The reason for these difference is not clearly understood at present and further collection of materials and pertinent data are necessary.     

Bloodflow in the Finger in Dupuytren's contracture

Summary 1. There is a high incidence of latent vasospastic changes in the hands of patients with DC regardless of the state of the disease. 2. The high incidence of vasospasm and ulnar nerve lesions in DC suggest, that in some ways these are related to the pathogenesis. 3. Comparing patients with a normal finger plethysmogram with those with a vasospastic vessel-reaction, there is no correlation concerning the ulnar nerve lesions in DC. Therefore we assume that these are independent constitutional factors. — 4. The disturbance in blood flow in the hand in DC is usually asymptomatic and is probably a different phenomenon from that seen in Raynaud's Syndrome.Partly read at the International Hand Surgery Congress, Melbourne, Australia, November 14, 1979     

Postoperative sore throat related to tracheal tube cuff design

Recent reports of the incidence of postoperative sore throat following anaesthesia with trachéal intubation have claimed that low volume high pressure cuffs are preferable to those with high volume and low pressure. In this study similar methods were used for evaluating postoperative sore throat. Randomly selected trachéal tubes were used in 56 patients undergoing elective abdominal surgery, followed by direct questioning about sore throat on the first postoperative day. The incidence of postoperative sore throat was 41 per cent with high volume low pressure cuffed tubes and 55 per cent with low volume high pressure cuffed tubes. This difference is not statistically significant, but the tendency of the results is contradictory to those published earlier. The incidence of postoperative sore throat varies greatly if direct or indirect questioning is used and also varies between studies using the same method of questioning. Therefore the validity of this method for evaluating the influence of cuff design must be questioned. Postoperative sore throat is a symptom caused by many factors, such as the intubation procedure and the use of stylets or lubricants. The incidence of postoperative sore throat does not necessarily reflect damage caused by the trachéal tube cuff.     

Cardiovascular Complications in Diabetic Kidney Disease

Diabetes mellitus (DM) is the leading cause of chronic kidney disease (CKD). Due to an explosion in the incidence and the prevalence of Type 2 DM, the burden of CKD is expected to increase proportionately. Both DM and CKD are associated with a high incidence of cardiovascular (CV) morbidity and mortality, and it is important to understand the unique nature of CV disease in patients with the combination of these two conditions. In this report, we review the traditional and nontraditional risk factors that underlie the high risk of CV disease in this population, with a particular focus on vascular calcification, mineral metabolism, and therapeutic paradigms for the treatment of cardiovascular disease in this unique and high‐risk population.     

Prävention von Methicillin-resistentem S. aureus durch Screeninguntersuchungen

In Germany, methicillin-resistant S. aureus (MRSA) is increasing continuously. To control the spread of MRSA, active surveillance and admission screening are recommended. In most cases, screening cultures of patients at risk for MRSA will be sufficient. Screening of all patients admitted to an ICU is cost-effective when the incidence of MRSA and nosocomial MRSA infections is high (>2 cases/100 patients and 0.3 MRSA infections/100 patients, respectively): Under these circumstances, a decrease in the incidence of nosocomial MRSA infections of 50% leads to cost-effectiveness at costs of 16 Euro/sample (including subsequent costs). If the incidence of nosocomial MRSA infections decreases by 75%, costs of 24 Euro/sample (including subsequent costs) are cost-effective. If the incidence of MRSA is high, screening by PCR may be cost-effective for patients at high risk for MRSA, especially if they are isolated prophylactically. Recently, PCR methods have been developed which allow the specific identification of MRSA even from nasal swabs.     

Factors in the differential rate of arteriosclerosis (AS) between long surviving renal transplant recipients and dialysis patients.

In this study, the incidence of clinical and autopsy arteriosclerosis (AS) was studied in over 300 renal transplant patients (RTP) followed in our clinic up to 13 years post-transplant. Of 45 RTP followed a mean of 10.45 years, the incidence of clinical AS was 6% or 0.58% per year at risk. The incidence of death from AS was 2.2% over 10 years or 0.22% per year at risk. There was no apparent tendency for increase of the risk incidence with increasing time post-transplantation up to 13 years. This incidence of clinical and death-related AS in long term RTP contrasts sharply with a quite high incidence of both clinical and death-related AS in long-term dialysis patients as reported by Scribner's group and both the European and U.S. Dialysis Registry. Of our RTP surviving a decade or more, 77% have normal serum triglycerides and 92% are normotensive, again contrasting sharply with a 70-80% incidence of hyperlipidemia and a 60-80% incidence of hypertension in long-term dialysis patients. These studies suggest that the high rate of accelerated AS in dialysis patients is largely reversed by successful renal transplantation, probably due to a lowering of both blood pressure and hyperlipidemia in the long-term RT patients. Practically, these results suggest that the superior survival of transplant patients over dialysis patients already evident at 10 year mark will widen further during the second post-transplantation decade.