Hip fracture in men-survival and subsequent fractures: a cohort study with 22-year follow-up

OBJECTIVES: To evaluate the influence of age on survival and risk of subsequent fracture in men with hip fracture, applying a residual lifetime perspective. DESIGN: Retrospective cohort study with 22‐year follow‐up. SETTING: Skåne University Hospital, Malmö, Sweden. PARTICIPANTS: Men aged 60 and older (N=226) with an index hip fracture during 1984/85. MEASUREMENTS: Twenty‐two‐year survival (mortality) and risk of new fractures evaluated in 5‐year age bands and age groups (<75, 75–84, ≥85). RESULTS: Mean age was 78±9. Mortality at 22 years was 98%. Survivors were all younger than 75 at inclusion. Mortality was dependent on age at all time points (18%, 38%, 69% at 1 year, increasing to 71%, 93%, 100% by 10 years in <75, 75–84, ≥85, respectively). Median survival was 5.4 years, 2.0 years, and 3 months, respectively, in these age groups, and 33%, 27%, and 13% of each age‐group sustained subsequent fractures, generally within 5 years. Overall 10‐year fracture risk was 29% (95% confidence interval (CI)=19–38%), increasing to 44% (95% CI=30–58%) when adjusted for mortality. Residual lifetime risk of new fracture was 33% (95% CI=23–43%), and mortality‐adjusted risk was 63% (95% CI=45–81%). Participants younger than 75 at index hip fracture were at greatest risk of new fracture (hazard ratio=2.7, 95% CI=1.1–6.4, P=.03). CONCLUSION: Almost one‐third of men with hip fracture have subsequent fractures during their remaining lifetime. Time at risk is highly dependent on age. Most new fractures occur in relatively younger men and within 5 years, whereas most aged 75 and older die before experiencing a new fracture.     

Hepatitis C virus infection and bone marrow transplantation: a cohort study with 10-year follow-up.

Before the introduction of routine blood donor screening in 1991, marrow transplant recipients were at significant transfusion-associated risk for infection with hepatitis C virus (HCV). We followed a cohort of 355 patients undergoing transplant in Seattle during 1987 to 1988 to determine (1) the impact of pretransplant HCV infection on the occurrence and severity of venocclusive disease (VOD); (2) the impact of HCV infection on liver dysfunction, other than VOD, occurring between 21 and 60 days after transplantation; and (3) the natural history of post-transplant HCV liver disease with a 10-year follow-up. HCV-RNA status was determined on serum stored before transplant and at day 100 post-transplant. Sixty-two (17%) patients were HCV-RNA positive before transplant, and 113 (32%) were HCV-RNA positive by day 100 post-transplant (or before death). Severe VOD developed in 22 of 46 (48%) evaluable patients with pretransplant HCV infection and in 150 of 229 (14%) evaluable patients without HCV (P <.0001). In multivariable analysis of risk factors for developing VOD, pretransplant HCV infection associated with elevated serum aspartate transaminase (AST) levels predicted the development of severe VOD (relative risk, 9.6; P =.0001). The presence of HCV with normal AST levels before transplant was not a risk factor for severe VOD. Between 21 and 60 days after transplant, HCV-RNA positive-patients had higher AST levels (median 101 U/L), but similar alkaline phosphatase and total bilirubin levels compared with HCV-negative patients, suggesting that cholestatic liver disease (particularly graft-versus-host disease [GVHD]) was not related to HCV infection. An acute flare of hepatitis (AST >10 times the upper limit of normal) developed at a mean of 136 +/- 58 days in 31% of HCV-positive patients; no patients developed fulminant hepatitis. Between 5 and 10 years after transplant, 57% of HCV-positive and 6% of HCV-negative patients had mild to moderate elevations of AST (P <. 0001), but HCV infection was not associated with excess mortality between 3 and 10 years after bone marrow transplantation. In summary, HCV infection with elevated AST levels is a significant risk factor for severe VOD after marrow transplant. However, the decision to proceed to transplantation in HCV-positive patients must balance the absolute risk of death from VOD against the risks of the underlying disease. In long-term survivors, HCV infection is not associated with excess mortality over 10 years of follow-up.     

Rosiglitazone increases small dense low-density lipoprotein concentration and decreases high-density lipoprotein particle size in HIV-infected patients

After 12 weeks of rosiglitazone treatment, significant increases in total and small dense low-density lipoprotein, and the total: high-density lipoprotein (HDL)-cholesterol ratio were found. The large HDL concentration and HDL particle size decreased significantly with rosiglitazone compared with placebo. These data indicate the production of a more atherogenic lipid profile with rosiglitazone, a consideration when selecting treatment for the growing population of HIV-infected patients with type 2 diabetes and dyslipidemia.     

Weight change modulates epicardial fat burden: a 4-year serial study with non-contrast computed tomography

IntroductionEpicardial fat volume (EFV) is linked to cardiovascular event risk. We aimed to investigate the relationships between EFV and weight change.MethodsFrom the EISNER (Early Identification of Subclinical Atherosclerosis using Non-invasive Imaging Research) Registry with baseline and follow-up coronary calcium scans (1248 subjects), we selected a cohort of 374 asymptomatic subjects matched using age decade, gender and coronary calcium score (CCS) as a measure of subclinical cardiovascular risk, who underwent 2 scans at an interval of 4.1 ± 0.4 years. Using semi-automated validated software, pericardial contours were generated on all slices by spline interpolation from 5 to 10 control points. EFV was computed as fat volume within the pericardial contours. Weight gain/loss was defined as >5% change.ResultsAt baseline, EFV was moderately correlated to weight, body mass index (BMI) and waist circumference (r = 0.51, 0.41 and 0.50, p < 0.0001). EFV change was weakly correlated to change in weight (r = 0.37, p < 0.0001), BMI (r = 0.39, p < 0.0001) and waist circumference (r = 0.21, p = 0.002). On multivariable linear regression analysis, weight change [β = 1.2, 95% confidence interval (CI) 0.9–1.5, p < 0.001], BMI change (β = 1.2, 95% CI 0.9–1.5, p < 0.001), gender (β = ?6.4, 95% CI ?10.9 to ?1.8, p = 0.006) and hypertension (β = 4.7, 95% CI 0.5–9.0, p = 0.03) predicted EFV change. EFV decreased in 54 subjects with weight loss and increased in 71 subjects with weight gain (?2.3 ± 21.1% vs. 23.3 ± 24.4%, p < 0.001).ConclusionsEFV is related to body weight, BMI and waist circumference. Reduction in weight may stabilize or reduce EFV, while weight gain may promote EFV increase.     

Diet and low-density lipoprotein particle size

Small, dense low-density lipoprotein (LDL) particles are being increasingly recognized as an important risk factor for cardiovascular disease. This paper provides an overview of how different diets and macronutrients modulate the LDL size phenotype. Data reviewed indicated that several components of the LDL size phenotype should be measured concurrently in order to fully appreciate the impact of diet on this complex trait. Data also suggested that numerous dietary elements have a significant impact on several characteristics of the LDL size phenotype, thus providing further evidence to the concept that specific dietary modifications can beneficially alter cardiovascular disease risk beyond their known and demonstrated effects on plasma LDL cholesterol concentrations.     

Early complications after stoma formation: a prospective cohort study in 100 patients with 1-year follow-up

Purpose

This study aims to provide an overview of all complications that may occur after construction of an ileostomy or colostomy (loop or end) in daily practice.

Methods

Between July 2007 and April 2008, all adult patients who underwent any type of intestinal stoma formation were asked to participate in this prospective cohort study. All relevant patient characteristics were gathered. Patients were evaluated for complications eight times in a 1-year postoperative period. Enterostomal therapy nurses scored complications on specially designed forms.

Results

One hundred patients were included; two patients were lost before initial follow-up (FU). During FU, 21% of the patients deceased, and 15% were lost, physically unable to visit the outpatient clinic or withdrew from FU. In 37% of the patients, bowel continuity was restored. Only 26% of the patients were able to complete FU. Overall, 82% of all the patients had one or more stoma-related complications. Most common complications were skin irritation (55%), fixation problems (46%) and leakage (40%). Superficial necrosis, bleeding and retraction occurred in 20%, 14% and 9% of patients, respectively. More stoma related complications were found in stoma’s on inappropriate locations.

Conclusions

In this heterogenic patient population with formation of different stoma types, a high complication rate was detected.     

Weight change amongst Nauruans over 6.5 years: extent, and association with glucose intolerance

We are reporting here the extent of weight change over 6.5 years of follow-up amongst 366 randomly selected Nauruans initially surveyed in 1975-1976. Although the initial level of obesity was high (mean body mass index: males 30.8 kg/m2, females 33.0 kg/m2), further increase in body mass index subsequently occurred in 285 subjects (78%). The weight loss that occurred amongst the other 81 subjects was generally mild (mean = 5.3 kg), and only 12 persons lost more than 10 kg. Weight loss was far more common amongst the older subjects: 40% of those older than 50 years compared with 10% of those less than 30 years showed a decrease in body mass index (P less than 0.001). After age adjustment, greater initial obesity was associated with subsequent weight loss (P less than 0.001), and higher baseline plasma glucose (P less than 0.001), and triglyceride levels (P less than 0.05) and lower plasma uric acid levels (P less than 0.01) were also predictive of some weight loss. Obesity and diabetes remained the major predictors of weight loss in the multivariate analysis. Subjects who lost weight showed similar deterioration in glucose tolerance over the 6.5 years (mean increase = 1.8 mmol/l) to those not losing weight (mean = 1.0 mmol/l) and weight loss was not associated with glucose tolerance improvement (or less deterioration) for either those diabetic, or those not diabetic initially. This result suggests that weight loss is not invariably associated with improvement in glucose tolerance amongst Nauruans.     

Death and survival in a cohort of heroin addicts from London clinics: a 22-year follow-up study

Data are presented on the 43 people who died over a 22-year follow-up period of a cohort of 128 heroin addicts drawn in 1969 from the newly opened London clinics. The main causes of death were drug-related, with 18 deaths specifically determined as due to overdose, of which the great majority were among people being prescribed opiates at the lime. The mortality rate was a mean of 1.84% annually, and the excess mortality ratio was 11.9. This excess was highest at the beginning and varied over the period of study, appearing higher at the opening of the clinics and again in the mid-1980s. No sex differences in mortality rates were demonstrated but the excess mortality wan concentrated at younger ages. No prediction of the 85 survivors could be made on the basis of length of heroin use prior to study intake, nor on age at intake.     

Seronegative oligoarthritis: a 23-year follow-up study

The aim of the study was to investigate the long-term outcome of non-specific seronegative oligoarthritis in adults. The study included 64 adult patients with recent (<6 months) seronegative oligoarthritis (rheumatoid factor negative, number of swollen joints 1–4 during the first 6 months). Follow-up examinations were carried out at onset and at 1, 3 and 8 years from entry. A total of 47 patients attended the 23-year follow-up. The endpoint outcome was good. Seven had mild erosions in the hands or feet. Only one patient with HLA-B27 developed bilateral sacroiliitis. Three patients had retired from work because of joint disease. The functional outcome of the patients analysed by HAQ was very good after 23 years: 0 in 33 and 0.1–0.9 in 12 of the 47 patients. Reclassification revealed a certain heterogeneity: one case each of rheumatoid arthritis, SLE and ankylosing spondylitis, two cases of post-traumatic arthritis, four of osteoarthrosis, and six of possible reactive arthritis. Out of the remaining 49 patients 15 were HLA-B27 positive and 16 had at least one of the psoriasis-related HLA antigens (HLA-B13, 17, w16). In conclusion, our 23-year prospective follow-up study of patients with seronegative oligoarthritis confirms their favourable outcome. The reason is that the endpoint diagnoses seemed to be similar to those of mild spondylarthropathies. Received: 23 August 2001 / Accepted: 6 March 2002     

Prediction of readmission in a cohort of alcoholics: a 2-year follow-up

A cohort of 1,192 first admissions to metropolitan public alcohol treatment programs was examined after 2 years. With the sample sub-divided by number of readmissions, discriminant analysis based on demographic data, social history, and current drinking behavior provided only modest prediction of group membership (k = .46), but may be sufficient to provide an alerting function for recidivism.     

Deep vein thrombosis: a 7-year follow-up study

Abstract. Objectives. To study the sequelae of deep venous thrombosis (DVT) in terms of symptoms and objective signs of deep venous insufficiency (DVI) and their relationship to the initial extension of DVT, and to assess the control legs in the same way. Design. Follow-up study after an average of 89 (range 79–102) months. Setting. Out-patient clinic, University Hospital, Oslo. Subjects. Seventy-six patients with DVT 7 years previously. At follow-up 41 patients were dead and 10 were not available for restudy, thus twenty-five patients were studied in all. Main outcome measures. Symptom rating. Objective verification of DVI by invasive pressure recordings (DVI-I) and by the Doppler ultrasound technique (DVI-D). Results. At follow-up, 42% of the patients had symptoms, half of these severe, while 68% had DVI. Eighty-two per cent of symptomatic patients and 60% of the asymptomatic patients had DVI. There were no more symptoms in proximal than in distal DVT, but slightly more DVI. Control legs had neither symptoms nor DVI. Conclusions. Seven years after DVT few patients had severe symptoms, although objective signs of DVI were common. Symptoms were no more frequent after proximal than after distal DVT. We found no symptoms or DVI in control legs.     

Isolated office hypertension: a 3-year follow-up study

The study aimed to evaluate, over a 3-year period, the progression towards sustained hypertension and left ventricular (LV) changes in patients with isolated office (IO) hypertension (office BP>140 and/or 90 mmHg, daytime BP<130/80 mmHg). After 3 years from the basal evaluation, 38 subjects with basal normal BP and 42 subjects with basal IO hypertension underwent a second 24-h BP monitoring and echocardiography; 19 patients of the basal IO hypertension group were not revaluated because they had already developed ambulatory hypertension and were on antihypertensive treatment. At the second evaluation, the 38 normotensive subjects had unchanged BP and LV parameters; 25 IO hypertensives have developed sustained hypertension. Considering them together with the 19 patients already treated, 72% of 61 IO hypertensives developed ambulatory hypertension over a 3-year period. The patients who subsequently developed hypertension differed from the group who did not only for lower basal values of LV diastolic parameters; all the patients with basal LV hypertrophy and/or preclinical diastolic impairment subsequently developed sustained hypertension. In conclusion, IO hypertensive patients show a high rate of progression towards sustained hypertension. Basal LV hypertrophy and/or preclinical diastolic dysfunction were the only markers of a greater risk of becoming hypertensives.     

Long-term consequences in lung and bone associated with hospital-acquired severe acute respiratory syndrome: a 15-year follow-up from a prospective cohort study

Background

Severe acute respiratory syndrome (SARS) broke out in China and spread to all over the world in 2003. Without comprehensive protection, during a severe hospital outbreak in the Peking University People's Hospital (PKUPH), there were 78 patients diagnosed with SARS and two deaths. During treatment, most patients received large doses of steroid shock therapy, which may result in complications of femoral head necrosis and pulmonary fibrosis. We aimed to follow up the condition of lung and bone in those patients.