The incidence of ischemic heart disease in white South Africans cremated in Pretoria, 1978-1985

The prevalence of ischaemic heart disease was studied in a population selected on the basis of an application for cremation by the next of kin. In the age group 35-44 years 15.2% of the deaths were ascribed to ischaemic heart disease (IHD), while the corresponding figure in the general population was 27.2%. In females in the age group 45-54 years IHD was responsible for 9.3% of the deaths; the corresponding prevalence in the general population was 18.3%. The figures for all age groups and both sexes were 22% for the cremation group and 24.5% for the general population. In the economically active group (20-65) years, the figures were 20.0% for the cremation group and 30% for the general population. There was no significant difference in the IHD deaths between Afrikaans-speakers and other language groups. These findings are not necessarily applicable to the general population, as the cremation group is not truly representative, but the consistently lower prevalence of IHD suggests that there is over-reporting of this disease in unmonitored death certification.     

Cardiac valve replacement in the elderly: clinical performance of biological prostheses

From 1975 to 1987, 1,127 elderly patients underwent 1,223 valve replacements with the Carpentier-Edwards standard or supraannular porcine bioprostheses in 1,147 operations. Of the total patient population seen during these years, 33.5% receiving a standard porcine bioprosthesis and 48.6% receiving a supraannular bioprosthesis were 65 years of age or older. Of this elderly patient population, 465 patients were between 65 and 69 years old; 618 patients, 70 and 79 years old; and 52 patients, 80 years old and older. Aortic valve replacement was performed in 635 patients, mitral valve replacement in 417 patients, tricuspid valve replacement in 2 patients, and multiple-valve replacement in 80 patients. The cumulative follow-up was 3,957 patient-years. Early mortality was 9.5%: 7.3% for the 65- to 69-year-old group, 10.7% for the 70- to 79-year-old group, and 15.4% for the group 80 years old and older. Late mortality was 5.5% per patient-year: 4.2% per patient-year for the 65- to 69-year-old group, 6.3% per patient-year for the 70- to 79-year-old group, and 14.1% per patient-year for the group 80 years old and older. Valve-related causes contributed to 7 early deaths and 33 late deaths. The overall patient survival, including operative deaths, was 70.7% +/- 1.6% at 5 years and 47.8% +/- 3.7% at 10 and 12 years. The freedom from all valve-related complications was 52.1% +/- 6.1% at 10 and 12 years. The overall rate of valve-related complications was 5.0% per patient-year (fatal complications, 1.13% per patient-year). The overall rate of thromboembolism was 2.3% per patient-year and the freedom from thromboembolism, 69.6% +/- 5.2% at 10 and 12 years. The freedom from structural valve deterioration was 80.8% +/- 8.1% at 10 and 12 years: 71.7% +/- 11.0% at 10 and 12 years for the 65- to 69-year-old group, 97.9% +/- 1.2% at 10 years for the 70- to 79-year-old group, and 100% at 12 years for the group 80 years old and older. At 10 and 12 years, the freedom from valve-related death was 83.7% +/- 4.3% and the freedom from reoperation, 73.3% +/- 8.6%. The freedom from valve-related death, residual morbidity from thromboembolism and anticoagulant-related hemorrhage, and reoperation was 61.7% +/- 7.0% at 10 and 12 years. The clinical performance of porcine bioprostheses in the elderly patient population has been excellent. The early mortality increases in patients 70 years old or older.(ABSTRACT TRUNCATED AT 400 WORDS)     

Prevalence of Urolithiasis in Kaizuka City, Japan—An Epidemiologic Study of Urinary Stones

Background: According to the results of nationwide surveys, the prevalence of urolithiasis has been steadily increasing in Japan. However, these surveys relied on hospital statistics, and there has been no survey of the prevalence of urolithiasis in Japan utilizing postal questionnaires. We surveyed the prevalence of urolithiasis among the inhabitants of Kaizuka City.
Methods: A total of 3,000 inhabitants ranging from 20 to 59 years old were randomly selected from the census register in numbers consistent with the population distribution of each district and sex by municipal computerized system.
Results: A total of 1,975 postal questionnaires were returned, and 1,972 (65.7%) were considered valid. Of the respondents, 137 (6.95%) had a history of stones (men; 9.64%, women; 4.51%). The annual incidence of urolithiasis for Kaizuka citizens aged from 20 to 59 years old in 1991 was 0.97%, and the lifetime prevalence of urolithiasis increased linearly with age, and it was 10.3% for respondents in their 50s. In the total survey population of 7,568, which included the respondents and their family members, 342 (4.52%) had a history of stones. Male administrative workers had a significantly higher prevalence than any other occupational group. The monthly expenditure on food by the families of stone formers was significantly greater than that by the families of non-stone formers.
Conclusion: Extrapolation of the findings suggests that ≥1 0% of the general population (≥13% of men and >7% of women) can be expected to suffer from urolithiasis at least once in their lifetime.     

Study on the prevalence and incidence of urolithiasis in Germany comparing the years 1979 vs. 2000

OBJECTIVES: In 1979, we conducted a representative study to determine the prevalence and incidence of urolithiasis in Germany. Significant progress in stone therapy and changes in nutritional and environmental factors since then consequently led to a second study in 2001 under the same conditions as in 1979. METHODS: A representative sample of 7500 persons from all over Germany was questioned on the occurrence of urinary stones during their lifetimes (prevalence) and on acute urolithiasis in 2000 (incidence). Additionally, data were collected on urinary stone therapy and metaphylaxis. The current data were then compared with those from 1979. RESULTS: Prevalence has risen from 4% to 4.7% from 1979 to 2001. 9.7% of the 50-64 year old males in 2000 had already had urinary stones (females: 5.9%). The current recurrence rate of urinary stones was estimated to be 42%.In the year 2000, the incidence of urolithiasis in Germany was found to be 1.47% (1979: 0.54%). Over 40% of the stones were passed spontaneously. CONCLUSION: There has been a marked increase in the prevalence and incidence of urolithiasis in Germany within the last 22 years. This probably results from improvements in clinical-diagnostic procedures, changes in nutritional and environmental factors and a general apathy towards metabolic clarification and metaphylaxis.     

Adult urolithiasis in a population-based study in Iran: prevalence,incidence, and associated risk factors

The aim of this study was to determine the prevalence, incidence, and risk factors of adult urolithiasis in Iran. A total of 8,413 persons aged over 14 years enrolled in this cross-sectional study. They were questioned on the occurrence of urinary stones during their lifetime (prevalence) and on acute urolithiasis in 2005 (incidence) by 62 general practitioners. The subjects were randomly identified from 30 counties of Iran. Data on risk factors for urolithiasis including age, race, education, body mass index, hypertension, and current use of medication were also obtained by self-administered questionnaire. Of the 7,649 participants who provided information, 5.7% (436) [95% confidence interval (CI) 4.2–5.4], reported urinary stones. The prevalence increased from 0.9% in adults aged 15–29 years to 8.2% in those aged 60–69 years (test for trend, P = 0.001). Urolithiasis was slightly more frequent and persisted in males (6.1%) than females (5.3%) giving a male-to-female ratio of 1.15:1 [odds ratio (OR) 1.03; 95% CI 0.64–1.36; P = 0.814]. The annual incidence of urolithiasis in 2005 was 145.1. The average cumulative recurrence rate was 16% after 1 year, 32% after 5 years, and 53% after 10 years. Urinary stones were more in number among men and women who lived in south central and southwest counties, with odds increasing from west to east and from north to south. A positive association was found between urolithiasis and obesity (OR 1.74; 95% CI 1.21–2.31; P = 0.04), diuretic use (OR 1.62; 95% CI 1.18–2.70; P = 0.03), hypertension (OR 1.88; 95% CI 1.26–2.18; P = 0.04), unemployment (OR 2.10; 95% CI 1.43–2.14; P = 0.04), consumption of tea (OR 1.64; 95% CI 1.32–2.62; P = 0.03), consumption of cola (OR 1.49; 95% CI 1.23–2.19; P = 0.02), and meat consumption (OR 1.38; 95% CI 1.29–2.21; P = 0.02). This study provides a quantitative estimate of the prevalence, incidence, and main risk factors for adult urolithiasis in the Iranian population. Further studies are warranted in order to determine the incidence and prevalence of urolithiasis in different ethnic groups.     

Renal failure in Yemen

Renal failure remains a serious cause of mortality in Yemen. Our region has 1.25 million population and our hospital is the central hospital, which has a nephrology department and performs dialysis for the region. Between January 1998 and December 2002, we admitted 547 patients; including children, with acute renal failure (ARF) and chronic renal failure (CRF). CRF was observed in 400 patients, an incidence of 64 per million per year and a prevalence of 320 per million. ARF occurred in 147 persons with an incidence of 23.5 per million per year and a prevalence of 117.5 patients per million. Of all patients, 72% were adults (age range, 20-60 years) with a male preponderance. As a tropical country, malaria (27.9%), diarrhea (13.6%), and other infectious diseases were the main causes. Next most common were obstructive diseases causing CRF and ARF (26.8% and 12.9%, respectively), mainly urolithiasis, Schistosomiasis, and prostatic enlargement. However the cause of CRF in 57.5% of patients was unknown as most persons presented late with end-stage disease (64.7%), requiring immediate intervention. Other causes, such as hepatorenal syndrome, snake bite, diabetes mellitus, and hypertension, showed low occurrence rates. Patients presented to the hospital mostly in severe uremia and without a clear history of prior medications. The major findings were vomiting, acidosis, and hypertension with serum creatinine values ranging between 2.8-45 mg/dL (mean value, 13.4 mg/dL). Anemia was observed in 80.4% of CRF versus 62.6% of ARF patients. Hypertension prevalence was 65.5% among CRF patients, of whom 25% were in hypertensive crisis, whereas among ARF the prevalence was only 26.5%.     

Prevalence of urolithiasis in the autonomous city of Buenos Aires, Argentina

Urolithiasis is the third most common pathological disease afflicting the urinary tract, and usually occurs between the third and fourth decades of an individual’s life. Epidemiological studies about this condition are lacking in our country. In 1998, we performed an epidemiological, cross-sectional study of the prevalence of urolithiasis in a sample of 1,086 subjects, which included men and women of all ages, selected from the general population of the city of Buenos Aires. The method used to gather basic information was an auto administered questionnaire about the present or past history of urolithiasis that was handled at the dwelling by a trained volunteer. We found a 3.96% lifetime prevalence of urolithiasis in the general population of Buenos Aires. The rate was slightly higher in men (4.35%) than in women (3.62%), with a male to female ratio of 1.19:1. No case of urolithiasis was found in subjects under the age of 20. In subjects over 19 years, the prevalence rate of the disease was 5.14%; 5.98% for men (CI 3.41–8.55%) and 4.49% for women (CI 2.61–6.37%). Prevalence increased with age, ranging from 2.75% in the 20–39 age group to 7.79% in those ≥60 years. The life time prevalence rate of urolithiasis observed in Buenos Aires is similar to that reported in a few other studies performed among males and females in the general population of USA and Europe. Prevalence of urolithiasis increases with age both in men and in women. Héctor J. Boffi-Boggero: Deceased     

The impact of chronic diseases of lifestyle and their major risk factors on mortality in South Africa.

The purpose of this study was to determine the impact of chronic diseases of lifestyle on the mortality pattern of South Africans and to estimate the number of South Africans affected by major risk factors for these diseases. The proportion of deaths due to chronic diseases of lifestyle was calculated from the deaths reported to the Central Statistical Services. This group of diseases was responsible for 24.5% of deaths of all South Africans and 28.5% of those aged 35-64 years whose deaths were reported in 1988. The major causes of death contributing to these figures were cerebrovascular diseases (7.2% of all deaths and 7.9% of deaths of persons aged 35-64 years) and ischaemic heart disease (8.7% of all deaths and 9.6% of deaths of persons aged 35-64 years). The age-standardised prevalence rates for the major risk factors reported in five cross-sectional studies in different areas and groups are compared. Estimates from the reported prevalence rates, based on the size of the South African population recorded in the 1985 census figures, were calculated for the major risk factors. Overall 4.88 million South Africans smoked, the largest group of smokers being black males (2.6 million). for hypertension 5.5 million South Africans had blood pressures above 140/90 mmHg; again the largest groups were blacks (3.0 million). For hypercholesterolaemia and raised low-density lipoprotein cholesterol levels, 4.8 million and 3.1 million South Africans respectively had an increased risk for ischaemic heart disease, blacks having the lowest levels.(ABSTRACT TRUNCATED AT 250 WORDS)     

Prevalence of erectile dysfunction in Asian populations: a meta-analysis

We searched for published studies on the prevalence of erectile dysfunction (ED) in Asian populations, through Medline, PubMed, PsychInfo and scanned through reference lists. Data on prevalence rates were obtained and summarized for each Asian region, and were used to calculate pooled prevalence estimates using fixed and random effects models. As significant heterogeneity existed in certain age group categories, the random effects model was preferred. Twenty general population studies were identified. Six studies were eligible to be entered into the pooling of results, and provided 8653 subjects for analysis. The prevalence of ED increased with age. Pooled random effects age-specific prevalence rates were 15.1% (12.2-18.1), 29.6% (19.7-39.6), 40.6% (23.6-57.7), 54.3% (36.0-72.6) and 70.0% (62.3-77.7) for age groups 20-29, 30-39, 40-49, 50-59 and 60-69 years, respectively. Homogeneity of results in age groups 20-29 and 60-69 years suggested equally low and high prevalences of ED across Asian regions in these age groups, respectively. The overall reported prevalence in individual studies ranged from 2 to 81.8%. Prevalence rates and related information were summarized for each Asian region and for each study.     

Oral calcium loading test and response to diuretics in normal taiwanese school children

To investigate possible mechanisms of increased urinary calcium excretion and increased prevalence of urolithiasis in 16- to 20-year-old children, oral calcium loading and diuretic tests were performed in 120 normal children in three age groups (7–8, 12–13, and 17–18 years of age). Urinary calcium/creatinine ratios and 24-h urinary calcium excretion were significantly increased following the oral calcium loading test in 17- to 18-year-olds compared with the two younger age groups. Oral furosemide resulted in increased urinary calcium excretion in the 17- to 18-year age group, while hydrochlorothiazide was less effective in reducing urinary calcium excretion in this age group. These results suggest that increased intestinal calcium absorption and decreased renal tubular reabsorption of calcium in 17- to 18-year-olds may be contributing factors in the increased prevalence of nephrolithiasis in older Taiwanese children.     

The first epidemiology study of urolithiasis in New Brunswick

IntroductionUnderstanding the composition of a kidney stone is crucial in leading to proper treatment and preventing reoccurring urolithiasis. This study aimed to investigate the prevalence of urolithiasis in the province of New Brunswick (NB), Canada.MethodsA total of 3828 kidney stone analysis reports from October 1, 2016 to September 30, 2019, were reviewed from laboratory information systems. Among them, 3311 were identified as new cases. Stone compositions were analyzed by the Fourier transform infrared spectrometry. Incident rates were compared using Chi-squared analysis of different age, sex, and regional health authority (RHA) zones.ResultsThe prevalence of urolithiasis in NB was 147.8 per 100 000 person-years. Males had a significantly higher (X²=254, p<0.001) incident rate of 189 (95% confidence interval [CI] 182–198) than females (107 [95% CI 102–114]) per 100 000 person-years. Zone 1 had significantly higher (245 per 100 000 person-years, p<0.001) prevalence compared to other RHA zones. Age group over 65 years had the highest incidence rate of 253 per 100 00 person-years of all groups. The predominant kidney stone types in NB were calcium oxalate monohydrate (60.68%) and calcium oxalate dihydrate (11.58%). Those patients aged 0–18 years had a high percentage of struvite (4.32%) vs. the provincial average (2.19%) (p<0.001).ConclusionsThe prevalence of NB’s urolithiasis is slightly higher than that of Ontario. Since both zones 1.1 and 1.2 have significantly high prevalence and are situated in the Moncton area (combined zone 1), it may suggest that geographical factors play a role in the prevalence of urolithiasis in NB.     

Prevalence of renal malformation in Turner syndrome

The presence of renal malformation was evaluated in 43 patients with Turner syndrome (TS) and compared with the karyotype in each case; 28 patients (65%) had a mosaic karyotype and the other 15 (35%) had only 45,X metaphases. Renal malformations characteristic of TS were found in 24% of the complete sample group. Of the 15 cases of pure 45,X karyotype, 8 (53%) had abnormal renal findings, while these were found in only 2 of the 28 mosaic cases (7.1%). The probability of this distribution having occurred by chance is P <0.05. More than 50% of girls with TS are said to have a renal anomaly. In this study renal malformations were found in 25% of the sample group. A significantly greater association of renal malformation was found with monosomy 45,X than with mosaicism. As mosaicism occurs in up to 60% of all girls with TS, the lower figure reported here represents a truer prevalence than that quoted in older series, where the figures quoted applied only to the 45,X syndrome. Received June 20, 1995; received in revised form and accepted November 30, 1995     

Prevalence of HPV DNA in cervical specimens in women with renal transplants: a comparison with dialysis-dependent patients and patients with renal impairment

The aim of this study was to assess the prevalence of humanpapillomavirus (HPV) DNA in women who had received a renal transplantand to compare this with two control groups. Women who had a functioning renal transplant for greater than6 months (n = 69) were compared with women on maintenance dialysis(n = 89) and women with impaired renal function (creatinine0.15-0.39 mmol/l) (n=22). Women were excluded if they had hada hysterectomy, were older than 65 years, or were not yet sexuallyactive. A questionnaire and cervical scrape were obtained fromeach participant. The cervical scrape was analysed for HPV DNAusing PCR and the Li consensus primers. The participation rate of transplant patients, dialysis patientsand those with impaired renal function ("normal" group) was69, 68, and 78% respectively. The characteristics of the threegroups of women at enrollment were similar. No cytological abnormalitieswere present in the "normal" population but 11 of 89 patientson maintenance dialysis and nine of 69 transplant patients hadcytological abnormalities of atypia or greater (P=0.08 and P=0.07,for "normal" compared to dialysis and transplant groups respectively).One (4.5%) of the "normal" women had evidence of HPV DNA, while18 (20%) of patients on maintenance dialysis and 15 (22%) oftransplant patients were positive (P=0.07 and P=0.05, for "normal"compared to dialysis and transplant groups respectively). This study suggests that not only transplant recipients butalso dialysis patients may have a higher prevalence of riskfactors (cytological abnormalities and HPV DNA) for the developmentof cervical cancer.     

Prevalence of pelvic Paget's disease of bone in the United States.

The objective of this article was to estimate the prevalence of Paget's disease of bone in the United States from a statistically derived sample of the general population. Pelvic radiographs obtained in the First National Health and Nutrition Examination Survey (NHANES-I) were reviewed for the presence of Paget's disease. Age, sex, and geographic distribution of Paget's disease of the pelvic region were determined. The overall prevalence of Paget's disease in the United States was estimated. Pelvic Paget's disease is estimated to be present in 0.71 + 0.18% of the radiographs of the general population. The disease was higher in frequency in people who were in the older decades of life with the highest prevalence of 2.32 + 0.54% in the 65- to 74-year-old people. There is a slight male predominance in the 45- to 74-year age group. The regional distribution suggests the highest prevalence in the Northeast (1.48 + 0.52%) with the lowest prevalence in the South (0.26+0.25%). The prevalence was equal in white people and black people. An estimate of the overall prevalence of Paget's disease in the United States was at least 1% and perhaps as much as 2 % of the general population with near equal sex distribution and the highest prevalence in the northeastern United States.     

Long-term results after simultaneous pancreas-kidney transplantation using donors aged 45 years or older

With the shortage of organ donors, there is a critical need to use all available pancreas grafts for transplantation. METHODS: From June 1994 to December 2006 we performed 340 pancreas transplantations (317 simultaneous pancreas-kidney 5 pancreas only, 18 pancreas after kidney) including 69 (20%) transplantations from donors aged 45 years or older. Pancreas grafts from older donors were analyzed for graft and patient survival as well as surgical complications, compared with results from younger donors. RESULTS: Recipient characteristics were comparable in both groups. The older donor group mean age was 47.8 years (+/-2.1) versus 27.9 years (+/-10.3) for the younger group. Cumulative patient survival was 96% versus 98% after 1, 82% versus 91% after 5 and 82% versus 88% after 10 years with 1-5- and 10-year kidney graft survivals of 82%, 72%, 57% versus 93%, 83%, 73%, respectively. Pancreas transplant survival after 1, 5, and 10 years were 69%, 60%, 45% in older and 88%, 76%, and 72% in younger donor cohorts. There were 14 (20%) cases of venous thrombosis in the older group and 25 (9%) in the younger group (P = .012). CONCLUSION: Our results demonstrated that utilization of pancreas grafts from donors over 45 years resulted in acceptable outcomes after simultaneous pancreas-kidney transplant and could expand the donor pool. Among the older donor group, patient survival was slightly lower than the younger group, whereas pancreas graft function was significantly inferior (P < .01). Since venous thrombosis was the main reason for pancreas graft loss in older group, anticoagulation is essential.     

Greater Short-Term Weight Loss in Women 20–45 versus 55–65 Years of Age Following Bariatric Surgery

Background

Whether and how sex and age affect bariatric-surgery outcome is poorly understood. Estrogens regulate body composition in women and animals, and increase weight loss in a rodent model of gastric bypass, suggesting that premenopausal women may lose more weight following bariatric surgery.

Methods

One thousand three hundred fifty-six female gastric-bypass or gastric-banding patients were retrospectively grouped as 20–45 years old (presumptively premenopausal; n?=?1,199) and 55–65 years old (presumptively postmenopausal; n?=?157). Mixed-model ANCOVA followed by Bonferroni-corrected t tests were used to categorically test the effect of age on percent excess body weight loss (%EBWL) at 1 and 2 years post-surgery, controlling for preoperative EBW and surgery type. Age effects were also tested dimensionally in all women and in 289 male patients.

Results

Twenty- to forty-five-year-old women showed greater %EBWL 1 and 2 years post-surgery than 55–65-year-old women (p’s?<?0.0005). No age effect was detected in 20–25- vs. 30–35-, 30–35- vs. 40–45-, or 20–25- vs. 40–45-year-old women (p’s?>?0.2) This age effect was detected only after gastric banding, with 20–45-year-old women losing ～7 kg more than 55–65-year-old women after 2 years. Dimensional analysis confirmed a significant inverse effect of age on bariatric surgery outcome in women, but did not detect any effect in men.

Conclusions

Results indicate that 55–65-year-old women lose less weight than 20–45-year-old women in the initial 2 years after bariatric surgery, especially gastric banding; this may be mediated by age- or menopause-associated changes in physical activity, energy expenditure, or energy intake.     

Lifestyle and low-back pain. The influence of smoking and obesity

The authors examined associations between back pain prevalence and lifestyle factors (smoking and obesity) using national survey data. Back pain prevalence rose with increasing levels of smoking, with a relative risk of 1.47 for persons reporting 50 or more pack-years of smoking. This association was strongest in persons under the age of 45 years, however, for whom the corresponding relative risk was 2.33. There were similar trends toward greater prevalence with increasing body mass index, but prevalence rose substantially only in the most obese 20% of subjects (1.7 times higher than the lowest 20%). In a logistic regression, smoking and obesity contributed independent risk, even after controlling for age, education, exercise level, and employment status. Programs for back pain prevention may wish to test interventions for these lifestyle-related factors.     

Traumatic brain injuries in a well-defined population: epidemiological aspects and severity

The aim was to describe epidemiological and medical aspects of 449 cases of traumatic brain injury (TBI) from a well-defined geographical area with a population of 137,000 inhabitants. An episode of disturbed consciousness was a prerequisite for inclusion in the study. The incidence of TBI was 354/100,000 inhabitants. Median age was 23 years, range 0-91 years; 55% were men and 45% were women; 33% children 0-14 years, 50% adults 15-64 years, and 17% elderly persons 65-91 years old. Severity classification was based on Glasgow Coma Scale (GCS) on arrival; mild TBI 97% (GCS 13-15), moderate 1% (GCS 9-12), and severe 2% (GCS 3-8). The most common injury events were falls (55%) and vehicle-related events (30%). The percentage of falls was high among children and elderly persons but among adults vehicle-related injury events were also prominent. At least 17% of all patients were under the influence of alcohol, especially adult male bicyclists. CT was performed on 163 cases (36%) revealing 34 cases with intracranial hemorrhage (ICH) which is 21% of the examined or 8% of all the injured. The rate of ICH increased with increasing age (from 3% among children to 17% among the elderly persons) and also increased with decreasing GCS from 6% in the group of mild TBI to 60% among those with severe TBI. Attention should be directed to acute management of mild TBI in order to detect potentially dangerous ICH as well as to preventive actions against falls and vehicle related accidents.     

The prevalence of chronic critical lower limb ischaemia in a population of 20,000 subjects 40-69 years of age.

OBJECTIVE: To study the prevalence and possible risk factors for chronic critical lower limb ischaemia (CLI) in an unselected population of 20,291 Norwegian men and women 40-69 years of age. METHODS: Between 1995 and 1997, all residents 20 years or older in Nord-Tr?ndelag County, Norway, were invited to participate in a population study (the HUNT 2 Study). Among the 71.2% who attended, 20,291 participants 40-69 years of age responded to questions specifically aimed at identifying CLI. Chronic critical ischaemia was suspected if participants indicated: (1) ulcers on toes, foot or ankle that had failed to heal and/or; (2) persistent pain in the forefoot while in the supine position, but with relief of this pain when standing up. Using logistic regression analyses, we estimated the association between the prevalence of CLI and smoking, diabetes mellitus, previous cardiovascular events, blood lipids and glucose levels, and body mass index (BMI). RESULTS: The age-adjusted prevalence of CLI was 0.26% among men and 0.24% among women, and there was no gender difference in any age group (age-adjusted OR = 0.91, 95% CI = 0.52-1.58). The presence of increased age, diabetes mellitus, angina pectoris, high triglyceride levels, and high BMI were all independently associated with higher prevalence of CLI. CONCLUSION: The prevalence of CLI was 0.24%, similar for both genders, and increased with age. Risk factors usually seen in atherosclerotic patients were associated with suspected CLI.     

Endourologic management of pediatric urolithiasis: proposed clinical guidelines

BACKGROUND AND PURPOSE: Pediatric urolithiasis can be managed with various endourologic techniques, which are challenging and demanding. With the availability of advanced minimally invasive techniques, one has to select the appropriate modality. We analyzed the results of various techniques selected prospectively on the basis of our guidelines for the management of pediatric urolithiasis. PATIENTS AND METHODS: We analyzed the results of percutaneous nephrolithotomy (PCNL), ureteroscopy (URS), and extracorporeal shockwave lithotripsy (SWL) in 45 children treated at our institute between January 2004 and May 2005. There were 35 boys and 10 girls ranging from 12 months to 17 years age (median age 8.2 +/- 5.72 years), with 25 children (55.6%) under the age of 8 years. Stone-free rate, complications, and hospital stay were assessed. RESULTS: Extracorporeal lithotripsy was performed in 13 children (15 renal units) with average stone surface area of 50.8 +/- 35.8 mm(2). The stone-free rate was 92.3%. The total number of shocks per treatment ranged from 450 to 1400 (mean 856.3 +/- 189.6). A total of 25 PCNLs were done. Stone extraction was completed in a single stage in 20 units (80%), whereas 5 units (20%) required a second stage. Stone-free status was achieved in 23 renal units (95.8%). In the URS group, 9 procedures were planned in 8 children, and rigid ureteroscopy was successful in 6 (66.7%). CONCLUSIONS: With the availability of various alternative approaches, proper treatment planning and judicious use of minimally invasive techniques can cure most patients. On the basis of our experience and results, we recommend an algorithm for the management of pediatric stone disease.