Ovarian varices in healthy female kidney donors: incidence,morbidity, and clinical outcome

OBJECTIVE: Kidney donation is associated with ligation of the ovarian vein and is comparable to ovarian vein embolization. We evaluated the incidence, morbidity, and clinical outcome of ovarian varices in healthy female kidney donors before and 6 months after nephrectomy. MATERIALS AND METHODS: Between 1994 and 2001, 273 healthy female kidney donors underwent preoperative abdominal aortography. The study group consisted of 27 women (9.9%) in whom retrograde flow in an incompetent left ovarian vein was noted during the venous phase of imaging. All patients underwent left nephrectomy with left ovarian vein ligation. Only women with retrograde flow in the left ovarian vein were asked to complete a questionnaire about the incidence and intensity of pelvic pain before and 6 months after nephrectomy. RESULTS: Twenty-two of the 27 left-kidney donors with retrograde flow in the ovarian vein were available for follow-up. Thirteen (59%) of those 22 reported chronic pelvic pain. After nephrectomy, the pelvic pain completely resolved in seven (54%), improved in three (23%), and persisted in three (23%). CONCLUSION: Our study found a 9.9% prevalence of ovarian varices in the general population. Our findings suggest that more than half (59%) the patients with ovarian varices have pelvic congestion syndrome and that most (77%) of them might benefit from ovarian vein embolization or ligation.     

Early rebleeding after coiling of ruptured cerebral aneurysms: incidence, morbidity, and risk factors

BACKGROUND AND PURPOSE: The purpose of this study was to assess the incidence of early rebleeding after coiling of a ruptured cerebral aneurysm, assess the clinical outcome, and identify risk factors for this event. METHODS: Early rebleedings occurred in 6/431 (1.4%) consecutive patients after coiling of a ruptured aneurysm. Clinical condition at the time of treatment, aneurysm location and size, initial aneurysm occlusion, timing of coiling, and the presence of an adjacent intracerebral hematoma in the six patients with early rebleedings were compared with the remaining 425 patients. RESULTS: Incidence of early rebleeding after coiling of a ruptured aneurysm was 1.4%, and mortality was 100%. Independent risk factors are the presence of an adjacent intracerebral hematoma and small aneurysm size. Dependent risk factors are location on the anterior communicating artery, initial incomplete aneurysm occlusion, and poor clinical condition at the time of treatment. CONCLUSION: Early rebleeding after coiling of ruptured aneurysms is a major concern, in particular because the mortality is very high. A more restricted postembolization anticoagulation strategy in high-risk aneurysms may possibly prevent the occurrence of this devastating event.     

Organophosphorus poisoning: victim specific analysis of mortality and morbidity

The aim of this study was to evaluate the pattern of acute organophosphorous (OP) poisoning cases including death, duration of hospitalization and time lapse before arrival at hospital. All OP poisoning cases admitted to the Emergency Department of MKCG Medical College Hospital and other fatal cases received at the mortuary between September 1999 and August 2001 were prospectively studied. Males outnumbered females and most OP poisoning occurred in the 21-30 year age group. In 68 (97.1%) cases the motive was suicide and more than 80% were from rural areas. Nearly one-third of cases occurred during the summer and in the later part of the day. Married females and unmarried males were most frequently affected. Most of the married females were housewives and the males were students or farmers. Fifty-four per cent of cases were admitted for treatment within three hours with a mean time lapse of 6.2 hours. The mean hospital stay for all OP poisoning cases was 5.1 days. Twenty-nine out of 66 admitted OP poisoning cases were fatal. There is a high incidence of OP poisoning with mortality in the region. OP compounds are readily available at low cost in the market. A time of stress and frustration can lead to their use as a common poison with which to commit suicide.     

The role of morbidity and mortality meetings in interventional radiology

Purpose

To understand the current practice of interventional radiology (IR) morbidity and mortality (M&;M) meetings among interventional radiologists in Europe, and to develop a set of results-based recommendations to increase the prevalence of IR M&;M meetings.

Materials and methods

Online electronic surveys were sent to members of the Cardiovascular and Interventional Radiology Society of Europe (CIRSE). Each survey consisted of 18 questions pertaining to IR M&;M meetings.

Results

A total of 150 CIRSE members responded to the survey. Approximately 47% of respondents held IR M&;M meetings in their departments. Among those who held IR M&;M meetings, 42% held them monthly and 68% rated the quality of the meetings as good or excellent. Of those who did not have M&;M meetings, 94% were interested in incorporating M&;M meetings into their future practice. The most common reasons for not holding IR M&;M meetings were lack of time (68%) and small IR practice groups (43%). A total of 85% were interested in learning more about IR M&;M meetings. The preferred method of education about M&;M meetings included annual radiology meetings (44%), peer-reviewed articles in radiology journals (31%), websites (26%), and newsletters (15%).

Conclusions

The data demonstrate that although current practice of M&;M meetings in European IR departments is limited, the majority of respondents believe that M&;M meetings are beneficial to their practice. There is a need for guidelines or standards of practice to incorporate such meetings in IR departments to prevent medical errors, which may ultimately lead to enhanced patient safety and outcomes.     

Feasibility, procedural morbidity and mortality, and long-term follow-up of endovascular treatment of 321 unruptured aneurysms

BACKGROUND AND PURPOSE: The purpose of our study was to evaluate the technical feasibility, morbidity and mortality, and durability of occlusion of unruptured aneurysms treated with Guglielmi detachable coils (GDCs) with a long-term follow-up.MATERIALS AND METHODS: Between January 1998 and January 2005, we treated 321 unruptured aneurysms with GDCs in 5 neuroradiologic institutions. During this period, 63% of unruptured aneurysms were treated by endovascular technique. Procedural feasibility, technical complications, morbidity and mortality, and acute and long-term angiographic occlusion were assessed.RESULTS: Overall technical feasibility of coiling treatment was 94%; 302 aneurysms were treated by endovascular technique. At the end of the initial procedure, acute occlusion was classified as complete in 207 cases (70%), subtotal in 84 cases (26.1%), and incomplete in 11 cases (3.9%). Ischemic complications were observed in 28 patients (9%); 8 patients (2.6%) had perforation of their aneurysms. Treatment-related morbidity was 14.4%, and morbidity with clinical complications was evaluated at 7.7% (n = 23 patients). Five patients (1.7%) died as a result of aneurysm perforation. Final follow-up angiograms, after 9 secondary treatments, demonstrated complete occlusion in 193 patients (69.5%), subtotal in 80 aneurysms (28.5%), and incomplete occlusion in 5 (1.8%). Nineteen patients were lost to follow-up (6.3%).CONCLUSION: Endovascular coiling with detachable coils is an attractive option for treatment of unruptured aneurysms. This method of treatment is safe with a low rate of complications. Prospective studies with longer follow-up periods are needed to assess the long-term durability of occlusion in unruptured aneurysms.

Asymptomatic aneurysms may be defined as incidental aneurysms found in patients with a symptomatic aneurysm (which are not responsible for the clinical presentation), patients imaged for reasons unrelated to aneurysms who happen to have an incidental aneurysm that was completely unexpected, and those found in patients investigated because they are at risk of harboring an aneurysm (familial aneurysm disease, polycystic kidney disease).^1–3 Incidental unruptured aneurysms are defined as those found unexpectedly in patients undergoing investigation for other suspected pathology.The management of unruptured aneurysms may include observation, surgery, endovascular embolization, or a combination of these. Since 1991 and the introduction of detachable coils and more recently the results of the International Subarachnoid Aneurysm Trial,^4,5 endovascular treatment is an accepted alternative to surgical treatment of intracranial ruptured aneurysms. The question remains, however, as to which treatment offers the better outcome and what risks are involved. Surgical treatment, which has been in use for more than 40 years, has fairly clearly defined risks and morbidity.⁶ Endovascular treatment appears to offer lower risks but is still developing. Most recent evidence on the relative risks of treatment and of observation comes from the International Study of Unruptured Intracranial Aneurysms (ISUIA).⁷ The treating physician must weigh the natural history of aneurysms and the potential consequences of subarachnoid hemorrhage (SAH) with the efficacy, morbidity, and mortality of the intervention. Ideally, the morbidity and mortality rate of endovascular treatment should be lower than that of the natural history rupture rate. A measure of complications caused by the treatment itself would be ideal so that the impact of therapy could be isolated from other aspects of presentation or medical care.     

Periprocedural morbidity and mortality associated with endovascular treatment of intracranial aneurysms

BACKGROUND AND PURPOSE: Despite experience and technological improvements, endovascular treatment of intracranial aneurysms still has inherent risks. We evaluated cerebral complications associated with this treatment. METHODS: From October 1998 to October 2002, 180 consecutive patients underwent 131 procedures for 118 ruptured aneurysms and 79 procedures for 72 unruptured aneurysms. We retrospectively reviewed their records and images to evaluate their morbidity and mortality. RESULTS: Thirty-seven (17.6%) procedure-related complications occurred: 27 and six with initial embolization of ruptured and unruptured aneurysms, respectively, and four with re-treatment. Complications included 22 cerebral thromboembolisms, nine intraprocedural aneurysm perforations, two coil migrations, two parent vessel injuries, one postprocedural aneurysm rupture, and one cranial nerve palsy. Fourteen complications had no neurologic consequence. Three caused transient neurologic morbidity; 10, persistent neurologic morbidity; and 10, death. Procedure-related neurologic morbidity and mortality rates, respectively, were as follows: overall, 4.8% and 4.8%; ruptured aneurysms, 5.9% and 7.6%; unruptured aneurysms, 1.4% and 1.4%; and re-treated aneurysms, 10% and 0%. Combined procedure-related morbidity and mortality rates for ruptured, unruptured, and re-treated aneurysms were 13.5%, 2.8%, and 10%, respectively. Nonprocedural complications attributable to subarachnoid hemorrhage in 118 patients with ruptured aneurysm were early rebleeding before coil placement (0.9%), symptomatic vasospasm (5.9%), and shunt-dependent hydrocephalus (5.9%); mortality from complications of subarachnoid hemorrhage itself was 11.9%. CONCLUSION: Procedural morbidity and mortality rates were highest in ruptured aneurysms and lowest in unruptured aneurysms. Morbidity rates were highest in re-treated aneurysms and lowest in unruptured aneurysms. No procedural mortality occurred with re-treated aneurysms. The main cause of morbidity and mortality was thromboembolism.     

Procedural morbidity and mortality of elective coil treatment of unruptured intracranial aneurysms

BACKGROUND AND PURPOSE: To report morbidity, mortality, and angiographic results of elective coiling of unruptured intracranial aneurysms. METHODS: In a 10-year period, 176 unruptured aneurysms in 149 patients were electively treated with detachable coils. Seventy-nine aneurysms were additional to another ruptured aneurysm but were coiled more than 3 months after subarachnoid hemorrhage, 59 aneurysms were incidentally discovered, and 38 aneurysms presented with symptoms of mass effect. Mean size of the 176 unruptured aneurysms was 10.6 mm (median, 8 mm; range, 2-55 mm). One hundred thirteen aneurysms (64%) were small (<10 mm), 44 aneurysms (25%) were large (10-25 mm), and 19 aneurysms (11%) were giant (25-55 mm). Thirty wide-necked aneurysms (17%) were coiled with the aid of a supporting device. RESULTS: Procedural mortality of coiling was 1.3% (2 of 149; 95% confidence interval [CI], 0.7-5.1%), and morbidity was 2.6% (4 of 149, 95% CI, 0.8-7.0%). The 4 patients with permanent morbidity were independent (GOS 4). Initial aneurysm occlusion was complete (100%) in 132 aneurysms, nearly complete (90%-98%) in 36 aneurysms, and incomplete (60%-85%) in 8 aneurysms. Six-month follow-up angiography was available in 132 patients with 154 coiled aneurysms (87.5%); partial reopening occurred in 25, mainly large and giant aneurysms (16.2%). Additional coiling was performed in 22 aneurysms and additional parent vessel occlusion in 1 aneurysm. There were no complications of additional treatments. CONCLUSION: Elective coiling of unruptured intracranial aneurysms has low procedural mortality and morbidity. For the management of unruptured aneurysms, endovascular treatment should be considered.     

Cancer incidence and mortality among flight personnel: a meta-analysis

BACKGROUND: Increased cancer risk among flight personnel have previously been noted, including breast cancer among flight attendants and acute myeloid leukemia among pilots. Hypothesis: Exposure to cosmic radiation and other physical or chemical agents may pose health risks for flight personnel. METHODS: We performed an exhaustive search for published and unpublished cohort studies of flight personnel from 1986-98. We combined relative risks (RR) for selected causes from four mortality and/or incidence studies of pilots and two incidence studies of flight attendants, using standard meta-analytic methods. Heterogeneity among the combined studies was explored and adjustments were made for possible confounding by socioeconomic status (SES), where indicated, using correction factors from published studies. RESULTS: SES-adjusted combined RRs were elevated (>1.2) among male pilots for mortality from melanoma 11.97 (95%, CI: 1.02-3.82)] and brain cancer [1.49 (0.89-2.20)], and for cancer incidence of the prostate [1.65 (1.19-2.29)] and the brain [1.74 (0.87-3.30)]. Among female flight attendants, increases were seen for incidence of all cancers [1.29 (0.98-1.70)], melanoma [11.54 (0.83-2.87)], and breast cancer [1.35 (1.00-1.83)]. CONCLUSIONS: Flight personnel appear to be at increased risk for several types of cancer. Both occupational exposures and well-established non-occupational risk factors may contribute to this increased risk. To better control for confounding factors and to identify exposures potentially amenable to preventive measures, future studies should compare risks within cohorts by flight routes, work history, and exposure to cosmic and UV radiation, electromagnetic fields, and chemical substances.     

急性心肌梗塞、脑卒中患病与死亡性别分析

我院急诊科 1996年 1月～ 1999年 1月抢救脑卒中、急性心肌梗塞 (ＡＭＩ)共 10 74例。通过对不同性别患病 ,病死率存在的差异及发病后得到院前急救情况进行统计分析 ,发现加强院前急救对提高抢救成功率 ,减少致残有重要意义 ,现报告如下。1　资料和方法1 1　资料　 10 74例中 ,脑卒中 917例 ,男 5 2 3例 ,女 394例 ,得到院前急救 (包括本院急救站 ,外院单位急救处理 :吸氧、脱水 ,扩冠止痛等 )的有 42 5例 ;ＡＭＩ 15 7例 ,男 98例 ,女 5 9例 ,得到院前急救的有 6 5例。1 2　方法　将脑卒中 (脑血栓 ,脑出血 )及ＡＭＩ按年龄、性别分组做患…     

Cardiorespiratory fitness,incidence and mortality of lung cancer in men: A prospective cohort study

Objectives

To evaluate the association between cardiorespiratory fitness (CRF), lung cancer incidence and cancer mortality in men.

Prevalence and incidence of lower extremity injuries in male marathon runners

The aim of this study is to describe the prevalence and incidence of lower extremity injuries occurring before and during the Rotterdam marathon, and to evaluate the impact of the injuries. A cohort study was compiled of recreational male participants in the 2005 Rotterdam marathon. Demographic data and information on previous injuries were obtained from participants using a baseline questionnaire. Information on injuries sustained shortly before or during the marathon was obtained from a post-race questionnaire. Seven hundred and twenty-five (48.3%) participants returned the baseline questionnaire. The 1-year prevalence of running injuries was 54.8%. In the post-race questionnaire, 15.6% of all respondents reported at least one new lower extremity injury in the month preceding the Rotterdam marathon. The incidence of lower extremity injuries occurring during the marathon was 18.2%; most of these injuries occurred in the calf, knee and thigh. Immediately after the marathon the median score of pain intensity at rest was 2 points vs 4.5 points during physical exercise. Hence we can conclude that running injuries are very common among recreational male marathon runners. However, the pain severity and consequences for work and daily activities seem to be relatively low 1 week after the marathon.     

The impact of a helicopter emergency medical services program on potential morbidity and mortality

INTRODUCTION: The evaluation of the effectiveness of helicopter emergency medical services is currently a major focus of air transport research, and dispatch judgment likely will play a significant role in any research aimed at measuring outcome or impact. SETTING: Two rotor-wing programs in Alberta, Canada. METHODS: A panel of experts evaluated the effectiveness of a helicopter service in Canada. Four hundred sequential patient records were examined and categorized into four risk levels. Level 1 included patients who required critical intervention. Level 2 included patients in whom a major deterioration of vital signs could be expected. Level 3 patients were those for whom transport by an advanced life support ground unit would have been adequate. Level 4 was strictly for missions in which patient transport by any other means would have been impractical, such as remote locations (these cases were double-rated). RESULTS: Risk level 1 included 98 cases (24.5%); risk level 2, 266 cases (66.5%); risk level 3, 36 cases (9%); and risk level 4, 16 cases, two of which were rated level 1, 11 rated level 2, and three rated level 3. CONCLUSION: The results indicate that in 91% of the reviewed cases, helicopter transport was appropriate, representing a reasonable and judicious use of a helicopter emergency medical service.     

POSSUM评分预测骨科高龄患者髋关节置换术后并发症发生率和死亡率的价值

目的探讨POSSUM评分预测骨科高龄患者术后并发症发生率和死亡率的价值。方法对200例骨科高龄患者进行POSSUM评分,预测术后并发症和死亡例数,并与实际值进行比较。结果根据POSSUM系统预测,55例发生并发症,而实际发生并发症49例,差异无统计学意义(P=0.871);预测术后死亡人数为16例,实际死亡人数为2例,差异有统计学意义(P=0.031)。结论 POSSUM评分能较好地预测骨科高龄患者术后并发症,但对术后死亡存在过度预测。     

Establishing the possible radiogenicity of morbidity and mortality from participation in UK nuclear weapons development

To succeed in compensation claims for radiogenic injuries induced by their participation in the United Kingdom's atomic and nuclear weapons tests of the 1950s and 1960s, the 22,000 nuclear test veterans will have to satisfy Hill's Principles of Causation. Although they are blocked by legal restraints from suing the Crown, the evidential case for the veterans has been strengthening in recent years to a point where it would probably succeed in a UK court of law. The delay in mounting such a case has worked in favour of the veterans; if the legal constraints are removed, their chances of success are greater than if they had gone into court a decade ago. The article examines the evidence in support of their claims in relation to each of Hill's Principles.