Bone mineral density among elderly patients with chronic obstructive pulmonary disease patients in India

Background:

Osteoporosis is one of the major extra-pulmonary manifestations of chronic obstructive pulmonary disease (COPD), which limits the physical activity. The present study was undertaken to study the bone mineral density (BMD) and osteoporosis in the elderly COPD patients.

Materials and Methods:

This was a cross-sectional study carried out among elderly COPD patients. After a detailed clinical history spirometry was done to stage the severity of COPD. DEXA scan of the lumbar spine was performed using bone densitometer to determine osteoporosis. Statistical analysis was based on Chi-square test. Risk factors were identified by univariate and multivariate logistic regression analysis.

Results:

A total of 70 elderly COPD patients were included. Fourty-six patients (65.7%) had osteoporosis and 13 (18.6%) had osteopenia. Majority of the osteoporosis patients had stage III or stage IV COPD disease (77.2%). As the severity grade of COPD increased, the risk of osteoporosis also increased. Also, with the increasing severity of COPD, BMD decreased. Patients with lower body mass index (BMI) had higher prevalence of osteoporosis (45.7%). Using multivariate regression analysis, stage IV COPD, number of acute exacerbations >3 and steroid cumulative dose >1000 mg were independent risk factors for osteoporosis in elderly COPD patients.

Conclusions:

The prevalence of osteoporosis was 65.7%, and 18.6% had osteopenia. Stage III and IV patients had significantly lower BMI in elderly COPD patients. High clinical suspicion and early diagnosis and treatment are required in the evaluation of osteoporosis in elderly COPD patients.     

Cause analysis and therapeutic methods of chylous leakage after pancreaticoduodenectomy

Objectives:

To study and analyze the causes of chylous leakage after pancreaticoduodenectomy.

Methods:

We retrospectively analyzed 381 patients who underwent pancreaticoduodenectomy (including pylorus-preserving pancreaticoduodenectomy) in Shanghai Chang Hai Hospital Affiliated to the Second Military Medical University, Shanghai, China between January 2010 and December 2012. We also studied the relationship between postoperative chylous leakage and age, gender, surgical approach, and the tumor nature.

Results:

The chylous leak was placed in 23 patients and the incidence of chylous leakage in patients was 0.6%. There was no significant difference in gender, age and tumor pathological pattern between the chylous leakage group and non-chylous leakage group. The incidence of chylous leakage in patients with N1 grade cancer was significantly higher than that in patients with N0 grade cancer (p=0.001). The incidence of chylous leakage in patients suffering R0 resection was significantly higher than that in patients suffering non-R0 resection (p=0.008). All patients were successfully treated conservatively.

Conclusion:

The incidence of chylous leakage was 0.6% and the chylous leakage was closely linked with the tumor''s grade malignancy and the range of radical resection.Pancreaticoduodenectomy (PD) or pylorus-preserving pancreaticoduodenectomy (PPPD) is the standard surgical method of pancreatic head region tumors.1 However, one of the common complications after PD is chylous leakage, and it may lead to longer hospital stays, increasing hospital costs, and even to more serious complications. Therefore, it is necessary to analyze and discuss the occurrence and treatment of chylous leakage. Clinical reports on chylous leakage after PD are relatively rare. The aim of this study is to analyze the causes of chylous leakage after PD and summarize the experience of chylous leakage prevention and treatment.     

Clinicopathological Characteristics and Prognosis of Colorectal Cancer in Chinese Adolescent Patients

Background:

Colorectal adenocarcinoma rarely occurred in adolescent. Clinical feature and prognosis of this population are not clear until now. In addition, DNA mismatch repair (MMR) status may relate to the early disease occurrence. The present study aimed to perform a retrospective analysis of adolescent patients with colorectal cancer, including clinicopathological characteristics and prognosis.

Methods:

The medical records of 11,503 patients diagnosed as colorectal cancer in Cancer Hospital, Chinese Academy of Medical Sciences from January 1999 to December 2009 were retrospectively reviewed. Finally, 19 patients who were between 10 and 20 years old were selected as the study group. We summarized the clinicopathological characteristics, analyzed the association with prognosis and assessed the expression of MMR protein by immunohistochemical method.

Results:

The most common primary site was the right colon in 7 patients. Ten patients had Stage III colorectal cancer, 5 patients had Stage IV disease. Signet ring cell carcinoma was the most frequent pathological type (7/19). Deficient MMR was identified in 2 patients. The 5-year survival rate and median survival time were 23.2% and 26 months. Distant metastasis was identified as an independent prognostic factor (P = 0.02).

Conclusions:

Colorectal cancer in Chinese adolescents was very rare. The chinese adolecents with colorectal cancer were frequently diagnosed in the right colon, as Stage III/IV disease with signet ring cell carcinoma. The prognosis was relatively poor.     

A Special Electroencephalography Pattern Might Help in the Diagnosis of Antibody-positive Encephalitis

Background:

Patterns observed with electroencephalography (EEG) for patients who have encephalitis are usually known as generalized nonspecific cerebral abnormalities. The aim of this study was to investigate the presence of a special EEG pattern for patients with encephalitis and to explore features related to this special and uncommon pattern.

Methods:

EEG monitoring was performed for every patient aged >15 years with encephalitis who was hospitalized between December 2011 and March 2014. Clinical characteristics and EEG recordings were collected and evaluated.

Results:

Fifty-two patients with encephalitis were enrolled in our study with a 2-h median EEG recording time, and extreme beta brushes (EBBs) occurred in 17 patients (32.7%). Its presence was not significant regarding gender, age, psychiatric medication use, EEG rhythmic disorganization (P > 0.05). Nevertheless, among the patients with EBBs, nine patients (52.9%) had epileptic seizures that had a significant detection rate (P < 0.05); moreover, the cerebrospinal fluid (CSF) or serum of 15 patients (88.2%) with EBBs was positive for antibodies (P < 0.05). Four patients (23.5%) who had EBB had corresponding regional distributions on neuroimaging scans. The EBBs completely correlated with the regional distributions of spike discharges for four patients.

Conclusion:

EBB is a special EEG pattern for patients with encephalitis, especially those with epileptic seizures or who have antibody-positive CSF/serum, and should be considered in clinical practice.     

Cranial computed tomographic findings in Nigerian women with metastatic breast cancer

Introduction:

Brain metastases (BM) occur in up to one-fifth of patients with metastatic breast cancer (MBC). Imaging plays a key role in diagnosis. The pattern and distribution of these changes are also crucial to their management. These patterns have not been fully studied in Nigerian women.

Materials and Methods:

Retrospective analysis of the findings on the cranial Computed Tomography (CT) scans performed in 59 breast cancer patients with suspected BM treated at the University Teaching Hospital in Ibadan, between 2005 and 2010. The imaging features were evaluated in relation to their clinical characteristics.

Results:

In the 59 patients studied (mean age 50.9 years ± 11.75 SD), headache (40.7%) and hemiparesis/hemiplegia (16.9%) were the commonest clinical presentation. Lytic skull lesions were seen in 15 patients (25.4%), most commonly in the parietal bones. Thirty-nine patients (66.1%), had parenchymal brain lesions, and only 8 (20.5%) of these were single lesions. Most of the lesions were isodense (19/39; 51.4%) the parietal lobe was the most common site with 50.8% (30/59) occurrence and the leptomeninges the least with 13.6% (8/59). Orbital or sellar region involvement occurred in only two patients. The size of the lesions, was <2 cm in 17 (28.8%), 2-5 cm in 14 (23.7%) and >5 cm in 5 patients. Sixteen (27.1%) patients were free of any lesion either in the skull or brain. Patient presenting with multiple brain lesions were more likely to have skull lesions though this was not statistically significant (P = 0.584).

Conclusion:

The brain continues to be a sanctuary site for breast cancer metastases and CT imaging remains an invaluable tool in the clinical evaluation and therapeutic management of Nigerian women with BM from MBC. It also appears that the demographic and imaging findings in these patients are similar to other racial groups.     

Posterior spinal decompression,stabilization and arthrodesis in Nigerian adults: Profile and outcome

Background:

The availability of intraoperative fluoroscopy and improved access to varieties of spinal titanium implants has revived posterior spinal stabilization techniques with their distinct advantages. Our aim is to describe the profile of various spine pathologies requiring subaxial posterior spinal decompression, stabilization (using titanium implants), and arthrodesis, and to determine the rate of postoperative complications and factors affecting outcome.

Materials and Methods:

This is a prospective single institution study of consecutive adult patients seen during the study period. Data collected included the patients’ demographics, radiological findings, indication for surgery, surgical procedure, operation time, intraoperative blood loss, and postoperative complications.

Results:

There were 26 patients (15 males and 11 females). Their ages ranged between 24 and 78 years (median = 42 years). The most common indications for surgery were spinal trauma and degenerative spine disease (24 patients). The region that was most commonly stabilized was the lumbar- 12 cases (46.2%). No patients experienced neural or vascular injury as a result of screw position; likewise no patient had screw loosening. There was a case each of superficial surgical site infection and transient cerebrospinal fluid leak but no case of implant failure was encountered. The outcome was significantly associated with the etiology (0.030) of the indication for surgery and preoperative power grade (0.000).

Conclusion:

Spinal trauma and degenerative spine disease are the two most common indications for posterior spinal decompression, stabilization and fusion in our center. It is associated with acceptable postoperative complication rate when done under fluoroscopic guidance. Outcome is related more to the preoperative neurological deficit and etiology of the indication for surgical stabilization.     

Natural History of Small Renal Masses

Objective:

To review the natural history and growth kinetics of small renal masses (SRMs).

Data Sources:

The literature concerning natural history and growth kinetics of SRMs was collected from PubMed published from 1990 to 2014.

Study Selection:

We included all the relevant articles on the active surveillance (AS) or delayed treatment for SRMs in English, with no limitation of study design.

Results:

SRMs under AS have a slow growth potential in general. The mean linear growth rate is 0.33 cm/year, the mean volumetric growth rate is 9.48 cm³/year. The rate of metastasis during AS is below 2%. Some factors are associated with the growth rate of SRMs, including tumor grade, histological subtype, initial tumor size, age, radiographic characteristics, and molecular markers. No definite predictor of growth rate of SRMs is defined at present. SRMs with high tumor grade and the subtype of clear cell renal cell carcinoma may have aggressive growth potential.

Conclusions:

AS is a reasonable choice for elderly patients with SRMs, who are at high risk from surgery. Progression during observation is the biggest concern while performing AS. There is no definite predictor of progression for SRMs under AS. Percutaneous renal biopsy providing immunohistological and genic biomarkers may improve the understanding of natural history of SRMs.     

Primary non-alcoholic fatty liver disease in hypertensive patients

Background

Non-alcoholic fatty liver disease (NAFLD) is considered the most common liver disease affecting 15–25% of the general population.

Aims

The aim of this study was to investigate the prevalence of NAFLD and the relationship between insulin sensitivity and NAFLD in grade III high and very high cardiovascular additional risk essential hypertensive patients according to the circadian blood pressure (BP) rhythm.

Method

This four-year prospective study was conducted at the Department of Internal Medicine at Cluj-Napoca’s Diagnosis and Treatment Centre in Romania. The study included grade III essential hypertensive patients. Hypertensive patients were divided into four groups according to the diurnal index (DI) from ABPM monitoring: dipper (D), non-dipper (ND), reverse-dipper (RD), and extreme-dipper (ED). All hypertensive patients underwent 24 ABPM, blood tests and abdominal ultrasonography for the diagnosis of fatty liver disease.

Results

Thirty-five hypertensive patients were included in the study, with 31.42% ND, 11.43% RD, 8.57% ED and 48.57% D. The prevalence of NAFLD was significantly higher in ND, RD and ED when compared to D. When compared to the dipper group of hypertensive patients a statistically significantly higher level of plasma insulin was observed: in non-dipper [86.3±17.9pmol/l vs. 62.2±203pmol/l, p<0.05], in reverse dipper [88.3±18.6pmol/l vs. 62.2±20.3pmol/l] and in extreme-dippers [86.7±16.88pmol/l vs. 62.2±20.3 pmol/l, p<0.05].

Conclusion

The altered dipping status (ND, RD, ED) of hypertension associated with a higher insulin resistance could be the pathogenetic link between the NAFLD and altered blood pressure status. Altered BP status could be a marker of NAFLD in hypertensive patients.     

Early outcome of incisional hernia repair using polypropylene mesh: A preliminary report

Background:

The use of prosthetics for open repair of incisional hernia is very recent in our practice. We highlight our experience repairing incisional hernias with polypropylene mesh.

Patients and Methods:

Patients presenting with incisional hernia >5 cm in length or width received open polypropylene mesh repair and were followed for two years. Data obtained included age, sex, primary surgery causing the hernia, the length of the fascial defect and previous attempts at repair. Post-operative wound complications were recorded. The integrity of the scar and patient satisfaction or concerns with the repair was assessed at each visit.

Results:

Nineteen females with a mean age of 35 years (range 30-54) underwent repair; most arising from obstetric or gynaecological procedures. Sixteen (82.2%) had midline, 2 (10.5) transverse and 1 (5.3) Pfannenstiel scars. One patient had no previous repair (R0), 7 had undergone one repair (R1), 9 had undergone two repairs (R2) and 1 had three previous repairs (R3). The length of fascial defects ranged from 8 to 18 cm and seroma collection and stitch sinus were the common problems encountered. Two (10.5%) recurrences were recorded in two years.

Conclusion:

Open mesh repair of incisional hernia carries a low risk of infection and recurrence in two years.     

Tension-free Polypropylene Mesh-related Surgical Repair for Pelvic Organ Prolapse has a Good Anatomic Success Rate but a High Risk of Complications

Background:Food and Drug Administration announcements have highlighted the standard rate of mesh-related complications.We aimed to report the short-term results and complications of tension-free polypr...     

Prognostic Factors Predicting the Postoperative Survival Period Following Treatment for Primary Retroperitoneal Liposarcoma

Background:Liposarcomas,which represent 20％ of all adult sarcomas,are the most common histological type of malignant soft tissue tumors.The aim of this study was to define the prognostic factors that p...     

Comparison of total hip and knee joint replacement in patients with rheumatoid arthritis and osteoarthritis: a nationwide,population-based study

INTRODUCTION

Patients with rheumatoid arthritis (RA) and osteoarthritis (OA) may require total hip replacement (THR) or total knee replacement (TKR). The present study aimed to compare the demographic characteristics and medical costs of RA and OA patients from Taiwan who underwent either THR or TKR.

METHODS

The medical records of patients who had undergone THR or TKR from 1 January 1996 to 31 December 2010 were obtained from the Taiwan National Health Insurance Research Database (NHIRD). In all, we found 49 and 146 RA patients who received THR and TKR, respectively, and 1,191 and 6,574 OA patients who received THR and TKR, respectively. The gender, age, Charlson comorbidity index (CCI), hospital grade, age at registration in the catastrophic illness dataset, and medical utilisation costs of the different groups were compared.

RESULTS

There were statistically significant differences in age, CCI score, drug costs and surgery costs between RA and OA patients. Joint replacement incidence was lower in RA patients than in OA patients, and among patients who underwent THR, total medical costs incurred were higher for RA patients than OA patients. RA patients who underwent THR incurred a significantly greater total medical utilisation cost in the outpatient department (3 months before surgery and 12 months after surgery) than OA patients who underwent THR.

CONCLUSION

Analysis of Taiwan NHIRD with regard to patients who had undergone either THR or TKR indicated that RA patients were younger than OA patients, and that significantly more medical resources were used for RA patients before, during and after hospitalisation for these procedures.     

Arthroscopic Patelloplasty and Circumpatellar Denervation for the Treatment of Patellofemoral Osteoarthritis

Background:Patellofemoral osteoarthritis commonly occurs in older people,often resulting in anterior knee pain and severely reduced quality of life.The aim was to examine the effectiveness of arthrosco...     

Syndecan-1 is a potential biomarker for triple-positive breast carcinomas in Asian women with correlation to survival

INTRODUCTION

While overexpression of syndecan-1 has been associated with aggressive breast cancer in the Caucasian population, the expression pattern of syndecan-1 in Asian women remains unclear. Triple-positive breast carcinoma, in particular, is a unique subtype that has not been extensively studied. We aimed to evaluate the role of syndecan-1 as a potential biomarker and prognostic factor for triple-positive breast carcinoma in Asian women.

METHODS

Using immunohistochemistry, staining scores of 61 triple-positive breast carcinoma specimens were correlated with patients’ clinicopathological variables such as age, ethnicity, tumour size, histological grade, lymph node status, lymphovascular invasion, associated ductal carcinoma in situ grade, recurrence and overall survival.

RESULTS

Syndecan-1 had intense staining scores in triple-positive invasive ductal breast carcinomas when compared to normal breast tissue. On multivariate analysis, syndecan-1 epithelial total percentage and immunoreactivity score showed statistical correlation with survival (p = 0.02).

CONCLUSION

The intense staining scores of syndecan-1 and their correlation with overall survival in patients with triple-positive breast carcinoma suggest that syndecan-1 may have a role as a biological and prognostic marker in patients with this specific subtype of breast cancer.     

Six-year retrospective study of bull-riding injuries in central Queensland

Background

Bull riding is an increasingly popular and growing professional sport in Australia. This is the first national study that investigates bull riding-related injuries.

Method

A six-year retrospective study of patients admitted to Rockhampton Base Hospital with acute injuries sustained whilst bull riding. Patients were identified from the Rockhampton Hospital international coding system and surgical audit excel databases. Supporting information was found from patient chart review.

Results

Thirty-eight patients were admitted during the study. Injuries increased from 2008. The most common injuries were to limbs (52%), chest (15%) and brain (10%). Life- threatening injuries were all caused by a direct kick or trampling by the bull; 5% of patients needed air transfer to Brisbane, and 10% to Rockhampton for their acute care. The only complication was infection of open wounds. The average hospital stay was 2.2 (range= 1-5, SD= 1.1) days and 64% of patients required operative intervention.

Conclusion

Patients that had been kicked or trampled should be identified as having potentially life-threatening injuries, and transferred for review at an appropriate facility. Due to the high risk of infection all contaminated wounds should be washed out formally and receive antibiotics. Protective equipment should be encouraged among riders.     

Evaluation of Eight Different Clinical Staging Systems Associated with Overall Survival of Chinese Patients with Hepatocellular Carcinoma

Background:Hepatocellular carcinoma (HCC) is a common cancer in China,an area of high hepatitis B virus (HBV) infection.Although several staging systems are available,there is no consensus on the best ...     

Subclinical haemorrhagic tendency exists in patients with β-thalassaemia major in early childhood

Background

Alterations of coagulation profile have been reported in patients with β-thalassaemia major (β-TM).

Method

To investigate this in the paediatric population, we studied haemostatic parameters in pre-transfusion blood samples from 50 non-splenectomised transfusion-dependent children with β-TM (mean age 6±2.5 years) and in blood from 25 healthy controls.

Results

Laboratory evaluation showed thrombocytopenia in 40%, prolongation of prothrombin time (PT) in 12% and prolongation of activated partial thromboplastin time (APTT) in 6% of the patients. Mean values for PT, APTT and platelet count (PC) were all raised in the patient population compared with the controls. The alteration of coagulation status was significant for PT (p value <0.005) and APTT (p value <0.0001). However, the change for PC was not significant (p value <0.05). No significant liner correlation could be identified between PT, APTT, PC of the patients and interval between transfusions (in days) or days since last transfusion.

Conclusion

The findings from this study suggest that a subclinical haemorrhagic tendency exists in patients with β-TM at a very early age. The intrinsic pathway appears to be more affected than the extrinsic pathway.