A radiological study of the hip in cerebral palsy in relation to pathogenesis of dislocations

In recent years it has been reported that dislocation of the hip in cerebral palsy (CP) occurs most frequently in the non-ambulatory patient. This study compares the radiographic anatomy of the hip in CP with normal values and suggests the cause of dislocation. The cases of CP were divided into three groups according to ambulation and dislocation: group 1 consisted of 111 hips in a total of 64 ambulatory children, group 2, 116 hips in 72 non-ambulatory children, and group 3, 37 hips including 13 dislocated hips and 24 subluxated hips in 32 children. Of these 37 hips, patients with a dislocated hip and 3 subluxated hips were ambulatory but the beginning of their independent walking was as late as 5 years of age or even later. The following results were obtained. Femoral antetorsion was markedly increased in CP, and the difference was statistically very significant for all groups 1, 2 and 3 (p less than 0.001, and p less than 0.01 between groups 1 and 2). In CP groups there was no regression with age. Significant increases in femoral inclination were found in CP groups (p less than 0.001). There was, however, no significant differences among groups 1, 2 and 3, and so the degree to which these were the cause for dislocation was less than that of femoral antetorsion. Significant shortness of the femoral neck was noted between groups 1 and 3 (p less than 0.01), with significant regression with age in all CP groups. The mean value of the acetabular index in group 3 was 34.5 +/- 5.9, which was significantly higher than in group 1, and group 2 (p less than 0.001). In groups 2 and 3 there was no regression with age. Thus dislocation and subluxation of the hip in CP can be caused by the increase of antetorsion of the femur and acetabular dysplasia and depend on the ability of walking.     

Is shock wave lithotripsy efficient for the elderly stone formers? Results of a matched-pair analysis

The aim of the study was to evaluate the impact of age on the efficacy of extracorporeal shock wave lithotripsy (SWL), in a comparative study based on the principles of matched-pair analysis. Over a period of 4 years, 2,311 patients were treated with SWL in a tertiary referral center. Patient and stone data were recorded in a prospective electronic database. Among these patients, 115 (4.97%) were older than 70 years of age and fulfilled the criteria for inclusion in the study (Group A). For the purposes of the comparative analysis, Group A patients were matched for gender and stone parameters (side, location of stone, and diameter ±2 mm) with a control group of patients under the age of 70 (Group B). Following matching, the patients' electronic medical records were reviewed, to identify SWL success rates at 3 months and McNemar's test was used to compare the efficacy of SWL between the two groups. Matching was possible in all cases. The results indicate that there were no statistically significant differences in the mean number of SWL sessions or in the mean number of impulses per session between the two groups. The overall stone clearance rate achieved by SWL alone was 71.3% for Group A and 73.9% for group B. Discordant pairs were found in 37 cases (in 17 pairs only patients in Group A became stone-free, while in 20 pairs only patients in Group B became stone-free). By using McNemar's test, the difference in stone clearance rates between the two groups was not found to be statistically significant (p = 0.742). A total of 22 patients (19.1%) in Group A and 17 patients (14.7%) in Group B underwent an adjuvant procedure to achieve stone clearance. McNemar's test also revealed the absence of any statistically significant difference in SWL success rates between older and younger patients in the subgroups of patients presenting with either ureteric or renal stones (p = 0.727 and p = 0.571, respectively). In conclusion, SWL is still considered one of the first-line tools for geriatric patients suffering from urolithiasis, as increased age alone does not seem to adversely affect the efficacy of SWL.     

Beta risk: an unrecognized risk of statistical error

Data collected in a medical study should, from a methodological point of view, be considered as a sample taken from a larger population. The purpose of the statistical analysis is to check whether the differences in the experimental results observed in different subgroups are related to chance or not. The risks of error must be known to assess the validity of the conclusions. The first order risk, also called the alpha risk, is the risk of announcing a wrongly positive conclusion, that is to conclude that there is a significant difference that in reality does not exist. By convention, an alpha risk of 5 p. 100 is generally accepted. This means that it is acceptable to announce a statistically positive test when no difference exists in at most 5 p. 100 of the cases. After recording and processing the data, the statistical analysis produces a value called p that is the exact value of the first order risk in the given situation. If p is less than or equal to the alpha risk accepted before the study, it can be concluded that the observed difference is statistically significant at the chosen alpha level and that the p value represents the risk of first order risk in the given situation. If p is greater than the initially accepted alpha, the observed difference is not considered to be significant at the alpha level. But the assertion that two samples are equivalent, also involves a second order risk, also called the beta risk, that must be known. The beta risk is the risk of announcing wrongly negative results, that is to conclude that two samples are equivalent while in reality they are different. The number of elements in each sample necessary to demonstrate a difference becomes greater as the size of the difference becomes smaller. The beta risk increases as the alpha risk decreases, the number of cases becomes smaller, and the difference to detect becomes smaller. If a difference is not statistically significant at the chosen alpha level, the beta risk of an erroneous conclusion of equivalence is generally less than or equal to 20 p. 100. In most cases, the beta risk is not determined before the study but after, being calculated from the alpha risk, the sample size, and the non-significant difference observed. If the beta risk is found to be greater than 20 p. 100, no conclusion can be drawn and the study data are useless. It is therefore preferable to define both the alpha and beta risk and the smallest clinically pertinent difference, and to calculate the necessary sample size, before initiating the study. Let us take a numerical example where two different treatments, A and B, are given to two groups of 100 patients each. Treatment A produced success in 70 cases and treatment B in 80 cases. The chi-squared test yields a p value of 0.10. The observed difference is thus not statistically significant at an alpha level of 5 p. 100. In this case, the calculated beta risk is 54 p. 100. With 200 patients and a beta risk of 20 p. 100, a difference of 20 p. 100 in the success rates between the two groups cannot be detected. If it is accepted that a difference of 10 p. 100 between the success rates is clinically pertinent, to have an acceptable beta risk of 20 p. 100 and detect the difference, the study would have to include 500 patients instead of 200. In conclusion, when a comparative study concludes that there is no significant difference between two groups, one cannot deduct that these two groups are identical unless the beta risk is less than 20 p. 100. If the beta risk is greater than 20 p. 100, or if it is not mentioned, one cannot conclude that the two groups are equivalent.     

The relationship of serum testosterone to erectile function in normal aging men

PURPOSE: We evaluated the variation in serum testosterone in normal aging men and its relationship with erectile function. MATERIALS AND METHODS: In a study that was not community based and during a free screening program for prostate cancer 1,071 men were invited to complete a sexual activity questionnaire, that is the abridged 5-item version of the International Index of Erectile Function (IIEF-5), as a diagnostic tool for erectile dysfunction. Possible scores on the IIEF-5 are 1 to 25 and erectile dysfunction was classified into 5 categories based on the scores, namely severe-1 to 7, moderate-8 to 11, mild to moderate-12 to 16, mild-17 to 21 and none-22 to 25. Serum total testosterone was measured between 8:00 and 10:00 a.m. in all men. RESULTS: Of the 1,071 men 965 (90.1%) were included in this study, of whom 88% were white and 12% were black. Mean age was 60.7 years. In this sample the prevalence of all degrees of erectile dysfunction was estimated to be 53.9%. The degree of erectile dysfunction was mild in 21.5% of cases, mild to moderate in 14.1%, moderate in 6.3% and severe in 11.9%. According to age the erectile dysfunction rate was 36.4% in the 40 to 49, 42.5% in the 50 to 59, 58.1% in the 60 to 69, 79.4% in the 70 to 79 and 100% in the 80 years and older groups (p <0.05). The variation in mean serum total testosterone in the age groups was not statistically significantly different (p >0.05). Pearson coefficients of age and total testosterone did not reveal any significant correlation (r = 0.00376, p = 0.907), similar to IIEF-5 score and total testosterone (r = 0.0163, p = 0.612). However, analysis of the variables IIEF-5 and age showed a statistically significant inverse or negative relationship (r = -0.3449, p <0.05). CONCLUSIONS: Erectile dysfunction showed a clear association with aging but no consistent correlation of total testosterone with erectile condition was identified.     

p53 tumor suppressor gene mutation and prognosis in 105 cases of bladder cancer--the relationship between mutation of the p53 gene with clinicopathological features and smoking]

PURPOSE: Alterations of the p53 tumor suppressor gene are the most common genetic change detected in human cancers. The incidence of p53 gene mutation in bladder tumor patients were studied and were compared with clinicopathological findings, smoking history and prognosis. MATERIALS AND METHODS: Polymerase chain reaction single-strand conformation polymorphism (PCR-SSCP) was used for analysis from exon 4 to 9 of p53 gene in 105 cases of primary bladder tumors. RESULT: p53 matations were detected in 38 or 105 patients (36.2%). Kaplan-Meier Survival curves fo groups wit or without p53 gene mutation show a statistically significant difference (p = 0.0098). The mutation of p53 gene in stages pT 1 pT 1. pT 2, pT 3, pT 4 was found in 2 of 12 (16.7%), 8 of 32 (25.0%), 10 of 25 (40.0%), 12 of 20 (60.0%), 6 of 16 (37.5%) and in grades I, II, III, was noted in 1 of 17 (5.9%), 16 of 49 (32.7%), 21 of 39 (53.8%) cases, respectively. Significant differences were found for groups with grade I and grade II-III (p = 0.0045) cancers and in cases of superficial (stage pTa-1) and muscle-invasive (pT 2-4) tumors (p = 0.0148). However, mutation of p53 was not related to either age or sex in 105 patients. Recurrence rates in stage pTa-1 superficial tumor group with or without p53 mutation showed a statistically significant difference (p = 0.0419). No statistically significant difference was noted between p53 mutation and habitual smoking as well as durations of smoking. CONCLUSIONS: p53 mutations occur more commonly in higher grades and later stages of bladder tumors. Our results suggest that the prognostic factor is linked to not only histological findings but also to the presence of p53 mutation. The mutations of the p53 gene may be involved in the late events of tumorigenesis and might be used as good molecular markers for prognosis in bladder tumor.     

精索静脉曲张患者手术前后抗精子抗体的变化及意义

目的 探讨手术治疗精索静脉曲张(VC)对患者血清中抗精子抗体(ASAB)的影响.方法 分析60例左侧Ⅱ.VC患者.20例作为观察对照(A组);20例行保留睾丸动脉的精索静脉高位结扎术(B组);20例行不保留睾丸动脉的精索静脉高位结扎术(C组).酶联免疫法定量测定血清中抗精子抗体IgG、IgM含量.SPSS16.0软件进...     

两种后路椎间植骨方法治疗腰椎滑脱的疗效比较研究

目的探讨后路椎间融合(pasterior lumber interbody fusion,PLIF)应用Cage及椎弓根钉技术后,有无必要加用椎间自体植骨治疗腰椎滑脱. 方法 2003年3月～2004年3月,对27例腰椎滑脱症患者行后路椎间植骨融合术.采用Cage及椎弓根钉技术治疗15例(A组),其中男4例,女11例;年龄53～68岁.病变部位位于L4节段9例,L5节段6例;术前平均椎间隙高度为5.4±2.3 mm,平均滑脱率为36.8%±7.2%.采用Cage及椎弓根钉技术加用椎间自体植骨治疗12例(B组),其中男3例,女9例;年龄53～65岁.病变部位位于L4节段8例, L5节段4例;术前平均椎间隙高度为5.7±2.5 mm,平均滑脱率为37.8%±6.2%.对两组患者进行失血量、住院日、疼痛度和缓解程度、融合率及并发症,以及术后椎间隙高度、滑脱率及融合率进行分析比较. 结果术后患者均获随访24～38个月,A组随访时间24～36个月,B组随访时间24～38个月.两组患者随访时间,性别,病变部位,术前椎间隙高度,平均滑脱率,失血量,住院日,融合时间均无统计学差异(P>0.05);但疼痛度及缓解程度、融合率,B组均好于A组,差异有统计学意义(P<0.05).A组最后随访平均椎间隙高度5.8±2.2 mm,平均滑脱率为25.6%±7.2%,B组为6.2±2.5 mm和24.1%±7.4%,两组比较差异有统计学意义(P<0.05). 结论 PLIE手术应用Cage及椎弓根钉技术加用椎间自体植骨,有助于恢复和保持腰骶椎生理曲度,防止后期的椎间隙高度丢失及滑脱率的增加,可能利于手术后长期疗效的保持.     

2015至2020年广西医科大学第一附属医院老年脊髓损伤的特征分析

目的回顾2015至2020年就诊于广西医科大学第一附属医院的老年脊髓损伤的临床资料,分析老年脊髓损伤的流行病学特征。 方法利用电子病历查询系统对患者的相关数据进行提取,我们收集了2015~2017年与2018~2020年相同时间区域内患者的性别、年龄、病因、职业、损伤部位、并发症、是否为完全性损伤、是否合并高血压和糖尿病等数据,比较两个时间段患者流行病学特征的差异。 结果本研究共收集患者269例,男183例（68.0%）,女86例（32.0%）。2018~2020年157例,其中男101例（64.3%）,女56例（35.7%）,中位年龄67岁（62~72岁）;2015~2017年112例,其中男82例（73.2%）,女30例（26.8%）,中位年龄66岁（62.5~70岁）。79岁以下患者达263例（97.8%）,两个时间段内颈段脊髓损伤发生率最高,2015~2017年为70例（62.5%）,2018~2020年为77例（49.0%）,近年有下降趋势;两个时间段最常见致伤因素为外伤,2015~2017年为60例（53.6%）,2018~2020年为60例（38.20%）,近年发病有下降趋势;两个时间段中占比最高的职业均为农民,其中2015~2017年57例（50.1%）、2018~2020年94例（59.9%）,近年来农民发病率有上升的趋势;两个时间段的患者在性别、年龄、脊髓损伤部位、合并高血压和糖尿病方面的差异无统计学意义,在致伤因素、职业、并发症的差异有统计学意义。 结论老年患者发病数量有增加的趋势,主要人群为79岁以下的老年患者,颈段脊髓损伤最常见,多为不完全性脊髓损伤,最常见并发症为肺炎,深静脉血栓有增加的趋势,农民占比最高,主要致伤因素为外伤。     

Clinical studies on pulmonary metastases from differentiated thyroid carcinoma--characteristics of patients with pulmonary metastases which appear before thyroid operation or afterward

At Ito Hospital we have experienced 70 primary cases of differentiated thyroid carcinoma with pulmonary metastasis during the last 32 years. These patients were divided into two groups; patients who presented with the metastasis before thyroid operation (M-1 cases) and afterward (M-O cases). Contrary to our expectation, the over-all survival rate was more favorable in M-1 cases. We therefore studied on the clinical characteristics of these patients to see if there may be any differences between the two groups. The over-all survival rate of M-1 and M-0 cases was 85.7% and 42.9%, respectively. This difference was statistically significant (p less than 0.001). In M-1 cases percentage of male patients was higher, mean age was lower, papillo-follicular carcinoma was more predominant, and the outcome of RI therapy was more favorable. There were no significant differences on the roentgenographical type of metastatic foci and on the intraoperative findings between the two groups. From these results it is suggested that differentiated thyroid carcinoma with pulmonary metastasis in younger patients may be pathogenetically different from those in the older, and that biological characteristics of the disease that shows pulmonary metastasis in early stage differ from that which shows later.     

Maternal, Foetal and Neonatal Blood Creatine-Phosphokinase-Activities and Creatine-Phosphokinase-Isoenzymes after Labour with and without Epidural Analgesia and after Caesarean Section

Maternal, cord and neonatal blood creatine-phosphokinase (CK) activities and CK-isoenzymes were determined in connection with 24 labours after normal pregnancies. In eight cases there was a normal vaginal delivery; in another eight cases there was a normal vaginal delivery with segmental epidural analgesia; and In the remaining eight cases there was an elective caesarean section under general anaesthesia.
The lowest maternal blood CK-activities were seen in connection with caesarean section. There was a statistically significant difference in the maternal CK levels after delivery between cases with caesarean section and normal labour ( P <0.05) and between cases with caesarean section and labour with segmental epidural analgesia ( P <0.001). Most of the maternal CK-activity was of muscular type, and there were no statistically significant differences in isoenzyme fractions between the different groups.
The neonatal blood CK-activities were at their peak at the age of 1 day in all groups. Between the groups there were no statistically significant differences in cord or neonatal blood CK-activities at any time. Most of the cord and neonatal blood CK-activity was also of muscular type, and there were no significant differences in the CK-isoenzyme fractions between the groups.     

The use of the harmonic scalpel to reduce morbidity during open total abdominal hysterectomies with bilateral salpingo-oophorectomy (TAH/BSO)

The ultrasonic scalpel (USS) is a hemostatic surgical instrument used for incising and dissecting tissues. It works by using ultrasonic waves to denature collagen forming a coagulum. This study was designed to examine the effectiveness of the ultrasonic scalpel in open total abdominal hysterectomies with bilateral salpingo-oophrectomies.This study was a nonrandomized study, with 16 cases of total abdominal hysterectomy with bilateral salpingo-oophorectomy being done with the ultrasonic scalpel, and 21 cases being done with the traditional methods of dissection and ligation. The 2 groups were compared in terms of intraoperative blood loss, time, and cost, as well as in terms of postoperative complication and length of stay.Demographically, no significant differences in age or weight existed among the patients in the 2 operative groups. (p = 0.71, p = 0.64, respectively). A statistically significant reduction did occur in the estimated blood loss with the use of the harmonic scalpel (p = 0.05). No significant differences existed between the 2 patient groups in terms of operative time (p = 0.77), intraoperative costs (p = 0.11), or length of hospital stay (p = 0.45). However, 52% of the patients in the traditional method group suffered from postoperative complications that included acute myocardial infarction (N = 1), ileus (N = 5), urinary retention (N = 1), urinary incontinence (N = 1), respiratory failure (N = 1), and failure to thrive (N = 1). Only 25% of the patients undergoing the USS resection suffered from complications. These complications included urinary retention (N = 2), respiratory failure (N = 1), and ileus (N = 1).A statistically significant reduction occurred in estimated blood loss with the use of the USS (p < 0.05). There is also decreased intraoperative time, as well as decreased postoperative complications and length of stay in this same group; however, these differences were not statistically significant. Also, more complications are reported in the traditional resection group (62% compared with 31%). It would be beneficial to accrue a higher patient population and study the use of the USS in this procedure as well as other open abdominal procedures.     

Comparison of urinary proteins in calcium stone formers and healthy individuals: a case-control study

OBJECTIVE: This study aimed at comparing the urinary protein levels in calcium stone formers with those of healthy individuals. PATIENTS AND METHODS: From January 2002 until June 2004, 100 calcium stone formers (mean age 38.6 +/- 10.3 years), who had at least two episodes of calcium stone formation, were compared with 100 healthy individuals (mean age 33.8 +/- 9.7 years). Their 24-hour urinary protein levels, using SDS-PAGE, were measured. RESULTS: The mean 24-hour urinary Tamm-Horsfall protein (THP) levels were 3.3 +/- 0.8 mg in the case group and 4.6 +/- 1.9 mg in the controls, and the difference was not statistically significant (p = 0.53). However, the THP levels in individuals with and without bacteriuria were significantly different (15.8 +/- 3.3 mg vs. 2.6 +/- 1.0 mg, p = 0.0001). The mean 24-hour urinary albumin concentrations were 163.31 +/- 15.1 mg in the case group and 74.26 +/- 4.6 mg in the controls. The mean 24-hour urinary transferrin levels were 8.09 +/- 2.7 mg in the case group and 0.40 +/- 0.3 mg in the controls. The differences were statistically significant for both albumin and transferrin (p < 0.0001 and p = 0.0063, respectively). There were no significant differences in any other mean urinary protein concentrations between cases and controls. CONCLUSIONS: The THP level in the urine of stone formers is not quantitatively different from that of healthy individuals, but it increases in association with bacteriuria. Albumin and transferrin may play a presumptive role in stone formation.     

Value of alignment osteotomy of the proximal tibia in the endoprosthesis period]

AIM OF THE STUDY: To evaluate the value of high tibial osteotomy in times of growing numbers of endoprostheses we compared our personal with other results of this method as well as of the unilateral sledge prosthesis. MATERIAL AND METHODS: Between 1972 and 1993 the high tibial osteotomy as described by Coventry was performed in 105 patients. 98 patients could be examined clinically-radiologically and evaluated with a questionnaire. The indication for surgery was given in patients with unilateral arthrosis without affection of the retropatellar joint and without significant ligamentous instability. The varus deviation was in no case more than 10 degrees. The average follow-up for the clinical-radiologic examination was 9.4 years. RESULTS: 77 patients (78.6%) were satisfied with the outcome of the surgery. Here it was seen that neither age nor pain or instability had an influence on this judgement. The walking distance on the other hand had a significant influence. Stair climbing and range of motion were significantly important as well. 23 patients gave the judgement "excellent", 31 "good", 36 "satisfactory" and 8 patients were "not satisfied". A significant influence of patient age on the judgement could not be proven. The division in the Japanese Score showed "good" results in 14%, "moderate" in 81% and "poor" in 5%. 13 knee joints (13.3%) were absolutely pain-free and in 67 cases (68.4%) there were a definite pain reduction. A significant correlation between the preoperative axis deviation and pain could not be found. An average flexion of 97.5 degree and an extension deficit of 3.3 degree on average was seen. A significant difference of range of motion dependent on age groups could not be found. In 42 knees (42.9%) the lateral ligaments were clinically stable, in 35 cases (35.7%) there was a first degree lateral stress gap and in 21 cases (21.4%) there was a second degree lateral instability. A significant correlation between the instability and age or pain could not be proven. 13 revision surgeries including 9 endoprosthesis implantations were performed. CLINICAL RELEVANCE: The study showed a high level of satisfaction with an exact surgical indication. When seeing the growing number of implanted uni- or tricompartmental endoprostheses the procedure of tibial osteotomy can be suggested for patients with unilateral arthrosis without retropatellar arthrosis, with an axis deviation less than 15 degrees, with unaffected cartilage of the contralateral compartment and without ligamentous insufficiency independent of patient age.     

Sliding hip screw versus the Targon PF nail in the treatment of trochanteric fractures of the hip: a randomised trial of 600 fractures

In a randomised trial involving 598 patients with 600 trochanteric fractures of the hip, the fractures were treated with either a sliding hip screw (n = 300) or a Targon PF intramedullary nail (n = 300). The mean age of the patients was 82 years (26 to 104). All surviving patients were reviewed at one year with functional outcome assessed by a research nurse blinded to the treatment used. The intramedullary nail was found to have a slightly increased mean operative time (46 minutes (sd 12.3) versus 49 minutes (sd 12.7), p < 0.001) and an increased mean radiological screening time (0.3 minutes (sd 0.2) versus 0.5 minutes (sd 0.3), p?相似文献   

Pitfalls of skeletonized internal thoracic artery: comparison of graft kinking between skeletonized and pedicled grafts based on postoperative angiography findings

BACKGROUND AND AIM OF THE STUDY: Skeletonization of the internal thoracic artery (ITA) has several advantages: sequential bypass grafting can be easily performed, and a graft of increased length can make the distal coronary artery accessible. However, kinking of the grafts has been observed on postoperative angiograms in a few cases. We investigated whether there were significant differences in the frequency of graft kinking and stenosis degree at the kink site between pedicled and skeletonized grafts. METHODS: Postoperative angiography was performed for all cases. In pedicled (n = 65) and skeletonized (n = 129) groups, the results of postoperative graft angiography were analyzed to investigate the presence of graft kinking and stenosis degree at the kink site. RESULTS: Kinking was observed in 4 (5.9%) and 9 (3.9%) arteries in the pedicled and skeletonized groups, respectively (p = 0.341). The stenosis degree at the kink site (mean +/- SD) was significantly higher in the skeletonized group (47.2 +/- 16.8%) than in the pedicled group (23.5 +/- 13.7%), (p = 0.032). In four patients in whom early postoperative angiography showed a kink with more than 50% stenosis, late-term angiography was performed. All four cases showed regression of the stenosis degree at the kink site. CONCLUSIONS: When the ITA had a kink, the stenosis degree at the kink site was significantly higher in the skeletonized group than in the pedicled group. Late angiography often reveals regression of stenosis at the kink site. Immediate intervention need not always be performed if the patient has no angina caused by a stenotic lesion at the kink site.     

Long-term renal transplant function in recipient of simultaneous kidney and pancreas transplant maintained with two prednisone-free maintenance immunosuppressive combinations: tacrolimus/mycophenolate mofetil versus tacrolimus/sirolimus

BACKGROUND: It is not known how different steroid-free immunosuppressive combinations affect long-term kidney transplant function in recipients of simultaneous kidney and pancreas transplant (SPK). Here, we sought to evaluate, in SPK recipients, the impact on long-term renal allograft function of two Tac-based prednisone-free maintenance immunosuppressive protocols: tacrolimus (Tac)/mycophonelate mofetil (MMF) versus Tac/ sirolimus (SRL). METHODS: In this single-center, retrospective, sequential study, we analyzed 59 SPK transplant patients with at median follow up of 5 years. All patients received induction therapy with thymoglobulin and maintenance immunosuppression with Tac/MMF (n=22) or Tac/SRL (n=37). There were no differences between the two groups in regards to age, gender, race, panel reactive antibodies, degree of mismatch, donor age, incidence of delay graft function, and Tac trough levels at different time points after transplantation. RESULTS: Kaplan-Meier patient survival at 6 years after transplantation was not statistically different between the two groups. Rate of ACR was similar. Kidney survival, even if not statistically significant, was better in the Tac/MMF group than in the Tac/SRL (90.7% vs. 70.7%, P=0.09). The slope of glomerular filtration rate decline per month at 5 years after transplantation was not statistically different between the two groups. Both groups had the same decline over time in glomerular filtration rate of 0.40+/-0.06 mL/min/1.73/month. Pancreas survival at 6 years after transplantation was 100% in both treatment groups. CONCLUSIONS: Our data suggest that, in SPK recipients, long-term kidney allograft survival and function are not statistically different. A trend toward an increased rate of renal allograft loss was found in the Tac/SRL-treated group.     

The significance of pre‐operative coronary interventions on outcome after pancreas transplantation

Pancreas transplant candidates are at very high risk of coronary vascular disease. We hypothesized that the requirement for pre‐operative coronary intervention (PCI) may be associated with an adverse impact on short‐ and long‐term outcomes. Retrospective analysis of 366 consecutive primary pancreas transplants was undertaken. Outcomes were compared between recipients who had undergone PCI (n = 48) and those who had not (n = 318). In 48% (23/48) of instances, the PCI was initiated by the transplant cardiology evaluation. The recipients undergoing PCI were older than those not undergoing PCI (47.6 yr vs. 41.9 yr, respectively, p < 0.0001). Although not statistically significant, there was a higher rate of post‐operative major cardiovascular events (MCVE) in the PCI group (10.4%) compared with those not undergoing PCI (4.7%) (RR [95% CI]: 2.0 [0.90–4.5]; p = 0.17). In the long term, there were no differences in the rate of death with graft function (p = 0.77) or rejection (p = 0.17). There were no statistically significant differences between the groups with respect to patient (p = 0.54), kidney (p = 0.76), or pancreas (p = 0.63) graft survival. PCI is not a risk factor for short‐term perioperative events, and long‐term transplant outcomes are equivalent to patients not requiring PCI. PCI, by itself, should not be considered a contraindication for pancreas transplantation, but should raise awareness of perioperative risk.     

Male age is not an independent factor to affect the outcome of assisted reproductive techniques

Controversy exists whether advanced male age is associated with poor sperm quality and subsequent failure in the assisted reproductive techniques (ART). The purpose of this study was to evaluate the effect of male age on sperm quality and the outcome of ART as well as the association of male age with other relevant factors, particularly with the female age. A retrospective study was performed in order to evaluate the effect of male age on the sperm parameters in 880 routine seminal analyses. Additionally, sperm parameters were also compared among different age groups in 919 cases with male factor infertility who had been included in an ART programme. The laboratory and clinical results of ART (fertilization rate, number and quality of embryos transferred, as well as pregnancy rates) were compared according to different age groups. The results were also evaluated by one-way correlation and also step-wise logistic regression analysis to identify the interactions and correlations between different parameters. There were no statistically significant differences between male age groups in terms of sperm concentration, motility and morphology either in routine seminal analyses or in ART groups. In the ART group, a statistically significant linear correlation was present between male and female ages. Male age was increasing in parallel to female age. Female age was also correlated significantly with ART results. In one-way correlation analysis, male age was found to be correlated with the pregnancy rate, but not with fertilization rate and the quality of the transferred embryos. However, regression analysis revealed that correlation between male age and pregnancy results was simply dependent on the effect of the female age. Seminal parameters did not reveal a significant change with the increasing male age. The effect of male age on ART results in cases with male factor infertility is not a direct effect but a reflection of the negative impact of the parallel increase in the female age.     

Trend of hip fracture incidence in Germany 1995–2004: a population-based study

We analyzed hip fracture incidence trends in Germany 1995-2004, using national hospital discharge register. Crude incidences per 100,000 increased from 121.2 (95% CI 120.5-121.9) in 1995 to 140.9 (140.2-141.7) in 2004. Age-sex-adjusted annual incidence ratios showed a statistically significant, but only slight increase (1.01, p < 0.01), compared to higher rises in the past. Trends differed markedly with sex, age, and regions. INTRODUCTION: Data concerning actual trends of the hip fracture incidence and differences for sex, age, and region are limited. We analyzed hip fracture incidence trends in Germany 1995-2004, using the national hospital discharge register. Crude incidences per 100,000 increased from 121.2 (95% CI 120.5-121.9) in 1995 to 140.9 (140.2-141.7) in 2004. Age-sex-adjusted annual incidence ratios showed a statistically significant, but only slight increase (1.01, p < 0.01), compared to higher rises in the past. Trends differed markedly with sex, age, and regions. METHODS: Analysis of annual hip fracture incidences using the national hospital discharge register. Estimate of age-sex-adjusted changes was found by using Poisson regression (incidence rate ratios, IRR). RESULTS: The number of patients with at least one hospital admission for hip fracture increased (1995: n = 99,141; 2004: n = 116,281). Crude incidences per 100,000 were 121.2 (95% confidence interval 120.5-121,9) and 140.9 (140.2-141.7), respectively. The age-sex-adjusted hip fracture incidence increased statistically significantly, but only slightly (IRR per year: 1.01; 1.00-1.01; IRR 1995-2004: 1.05, p < 0.01). In men aged 40 years or older, incidences increased. In women, there was a tendency of a decrease up to 74 years of age, but also a significant increase in higher age groups. In people 0-39 years, the incidence declined markedly (IRR 1995-2004, men 0.74; 0.69-0.79, women 0.62; 0.55-0.69, both p < 0.01). The increase was significantly higher in Eastern compared to Western Germany (interaction: p = 0.002), and differences between East and West decreased. CONCLUSIONS: In contrast to earlier years, the hip fracture incidence in Germany 1995-2004 increased only slightly, with a decline in younger people, but increases in older ages, particularly in men. Regional differences decreased.     

Local anesthesia in transrectal ultrasound-guided prostate biopsy: EMLA cream as a new alternative technique

OBJECTIVES: The aims of the present study were to evaluate the efficacy of eutectic mixture of local anesthetics (EMLA) cream in transrectal-guided prostate biopsy and to compare its effect with that of other injectable anesthetic procedures. MATERIAL AND METHODS: Eighty male patients with prostate-specific antigen (PSA) levels > 4 ng/ml or who had prostate nodules on digital rectal examination were randomly divided into four groups. In Group 1 (controls), prostate biopsy was performed after application of a placebo cream. In Group 2, local surface anesthesia with EMLA cream was performed 15 min before biopsy. Periprosthetic nerve blockade was performed with 1% prilocaine and 1% lidocaine in Groups 3 and 4, respectively. Pain was evaluated using a visual analog scale (VAS) after each core biopsy. In addition, blood pressure, heart rate and oxygen saturations were recorded after each biopsy and then at 5-min intervals for 15 min. RESULTS: Average VAS scores in Groups 1-4 were 5.5, 2.9, 2.4 and 2.2, respectively. There was a statistically significant difference in VAS scores between the treatment groups and the placebo group (p = 0.000). There were no statistically significant differences in VAS scores between the three treatment groups (p2-3 = 0.126, p2-4 = 0.303, p3-4 = 0.537). We detected no statistically significant differences between the groups based on the hemodynamic data (pMAP = 0.899). Moreover, these measurements did not show statistically significant changes with time in any of the groups (p > 0. 05). CONCLUSION: Intrarectal application of EMLA cream provides equal anesthesia to periprostatic nerve blockade with prilocaine and lidocaine.