Tumors of the vaterian region indications, findings and prognosis : about 49 cases

This retrospective study is about 49 cases of tumors of the vaterian region collected between 1976 and 2001. Tumors of the vaterian region represented 7% of the bilio-pancreatic tumors. The study was about 18 women and 31 men, with sex-ratio of 1.7. The mean age was 61 years. Treatment was surgical : cephalic duodeno-pancreatectomy (28 patients) or ampullectomy (5 patients). Rate of tumor resectability was 69.4%. Bilio-digestive derivation was practiced on 13 patients and therapeutic abstention was decided for 3 patients. Age over 65 years, rate of bilirubine superior to 120 mmol/l and surgery done in emergency were elements of bad prognosis that increased post-operative mortality of following cephalic duodeno-pancreatectomy. Global mortality and morbidity were respectively 16% and 24%. Factors of poor prognosis were essentially: Tumor of large size, infiltration of the surrounding structures and tumor with metastases. The survival after bilio-digestive derivation didn't pass the 8 months. Five year survivals cephalic duodeno-pancréatectomy represented 20%. It depended on the degree of the local invasion. This 5 years survival rate to was 85% for stage I (classification of Martin) and 10% for stage IV.     

Septic arthritis in the elderly: about 21 cases

BACKGROUND: Septic arthritis (SA) is a serious disease especially if occurring in elderly debilitated by frequent comorbidities and diminished immunity. AIM: The authors discuss diagnosis difficulties, prognosis and, therapeutic consequences of the occurrence of septic arthritis in elders. METHODS: It is a retrospective study about 21 cases of septic arthritis (SA) occurring in the elderly aged 65-year-old or more, hospitalized over a ten year period [1994-2005] at the department of Rheumatology of Charles Nicolle's Hospital of Tunis. RESULTS: Mean age was 70.8 years [65y-83y] with a sex-ratio of 1.1. A history of rheumatologic and/or systemic diseases was present in 62% of cases. Clinic presentation was atypical explaining the long mean diagnosis delay; 23 days for pyogenic SA, 9.3 months for tuberculous arthritis. The germ involved, isolated in 11 cases, was a Staphylococcus Aureus in most ones. Tuberculous arthritis represented 28.6% of cases. The outcome was favourable in 19 cases (90%) after antibiotherapy. CONCLUSION: Because of its seriousness, SA should be evocated in front of any articular inflammation occurring in elderly. Adequate management must be started as soon as possible.     

Morgagni hernia in elderly patients: a study about two cases

Two cases of retrocostoxiphoid hernia are reported. Both patients were adults. The hernia was strangled in one case and symptomatic in the second case. The diagnosis was confirmed by radiology. Reduction of the visceral hernia and closure of the orifice was carried out after laparotomy. A review of literature and of clinicopathological features are given in the present article. Histogenesis and differential diagnosis are also discussed.     

Konno aortoventriculoplasty: indications and results. 13 cases

BACKGROUND: Konno procedure is used to enlarge the aortic root and increase the size of the aortic valve implanted. AIM: The aim of this study is to present the indications of the Konno procedure in congenital and acquired aortic lesions, in young patients with normal or hypoplastic aortic annulus or adults with small aortic annulus. METHODS: We reported our experience of this technique with a retrospective study of 13 patients operated on between 1998 and 2004. RESULTS: The mean diameter of aortic annulus measured in echocardiography is 16.2 mm, and the mean prosthetic valve diameter in post operative control is 20.3 mm. The early Death rate was 16%. In the late follow up of 2 years, the only predictor of myocardial hypertrophy regression was the presence of aortic insufficiency before the operation. In the literature, Konno procedure is reported as a good surgical option for the enlargement of the left ventricular outflow tract, but the results with the Ross-Konno operation are more promising.     

3901例外周血染色体分析及临床意义

目的 研究染色体异常检出的情况及其与疾病的关系.方法 对3 901例待检者抽取外周血,采用染色体培养、G显带、C显带,必要时行荧光原位杂交技术进行核心分析.结果 3 901例受检者中共检出染色体异常核型484例,异常检出率为12.41%,异常核型中男性293例,女性191例;异常核型中常染色体异常179例,占受检者的4.59%;性染色体异常168例,占4.31%,多态性137例,占3.51%.平衡易位核型中11例为世界首报.染色体异常检出类型与临床表现有显著性相关(r=0.013,P=0.000).结论 对不良孕产史、智力低下、性分化异常的患者进行染色体核型分析具有重要的临床意义.     

Changes in glucose tolerance in elderly

Glucose tolerance declines with age, resulting in a high prevalence of type 2 diabetes and impaired glucose tolerance in the elderly population. The pathogenesis of the age-related glucose intolerance is multifactorial; includes the interaction of many variables associated with aging including increased visceral adiposity, decreased physical activity, the use of diverse medications, coexisting illness, diminished insulin secretion and sensitivity, however the age-related effect over glucose metabolism is still controversial. In Mexico glucose intolerance is present in 15-20% of the population older than 60 years and increases the risk for developing diabetes and cardiovascular disease. Patients diagnosed with diabetes at an advanced age have particular characteristics; tend to be less obese, have more beta cell dysfunction and may be diagnosed with a hyperosomolar state. Lifestyle modifications are particularly effective in preventing diabetes in this age group.     

Age,revaccination, and tolerance effects on pneumococcal vaccination strategies in the elderly: A cost-effectiveness analysis

Optimal pneumococcal polysaccharide vaccination (PPV) policy is unknown for cohorts aged ≥65 years. Using a Markov model, we estimated the cost-effectiveness of single- and multiple-dose PPV strategies in 65-, 75-, and 80-year-old cohorts. PPV at age 65 cost $26,100 per QALY (quality adjusted life years) gained. Vaccination at ages 75 and 80 cost $71,300–75,800 per QALY; revaccination strategies cost more. When prior vaccination and loss of vaccine effectiveness due to tolerance are assumed, cost-effectiveness ratios increase substantially. Single-dose PPV is worth considering in patients aged 65–80 from clinical and economic standpoints. Revaccination strategies for the elderly are less cost-effective, particularly when prior vaccination and vaccine tolerance are considered.     

Glucose tolerance and cognitive impairment in an elderly population

We investigated the associations between abnormal glucose tolerance and cognitive impairment in elderly subjects, taking into account some other known determinants of cognitive function. The study population consisted of community-living northern Finnish subjects aged 70 y or over (n=379, of whom were 141 men). Thirty-one percent of the men and women (n=43 for the men and n=75 for the women) scored 23 or less in the Mini Mental State Examination. A low level of basic education and high age were the most powerful predictors of impaired cognition. When adjusted for age, gender, educational level, presence of cardiovascular disease (or hypertension), use of alcohol, number of depressive symptoms and poor vision, abnormal glucose tolerance (including IGT) was also weakly associated with impaired cognitive function among these elderly subjects. Public Health (2001) 115, 197–200.     

9420例剖宫产手术指征临床分析

目的 通过对剖宫产手术指征的临床分析,探讨如何降低剖宫产率.方法 对笔者所在医院2005年1月～2009年6月住院分娩的孕妇13 791例,其中剖宫产9420例进行回顾性分析.结果 （1）5年来,笔者所在医院剖宫产率为68.3%,主要手术指征依次为社会因素占44.4%,胎儿窘迫占13.3%,羊水过少10.2%,ICP占7.8%,胎位异常占5.2%,巨大儿占3.5%,瘢痕子宫占3.2%,头位难产占2.9%.（2）5年来,以社会因素、胎儿窘迫、头位难产、巨大儿,臀位、癍痕子宫为剖宫产手术指征的比例明显增高,是笔者所在医院剖宫产率上升的主要原因.结论 剖宫产率的上升不单纯是医学问题,也是社会问题,应加强围产期保健,加强孕妇学校及多种媒体对孕妇及家属进行分娩宣教,减少妊娠合并症及巨大儿的发生率,正确处理头位难产,早期纠正胎位异常,指导孕期合理膳食及营养,严格掌握剖宫产指征,降低剖宫产率.     

Appendiculoureteroplasty: about 6 cases

OBJECTIVE: Through this work we want to specify the place of ureteroappendiculoplasty as an important technical procedure for ureteral substitution. MATERIAL AND METHODS: Between January 1997 and September 2002, 6 patients had an appendiculoureteroplasty. RESULTS: four women and two men with a mean age of 37 years (range 12 to 55 years) had a lesion of the right ureter. The decision is use the appendix was taken peroperatively in front of the difficulties associated with other procedures. The mean length of ureteral loss was 12 cm (6-15 cm), the pelvic portion of ureter was more damaged than other segments (4 cases). The appendix was suspended between the 2 ureteric extremities in 2 cases and between the ureter and the bladder in 4 cases. After a mean follow-up of 3 years (1-5 years), we noted a recovery of the kidney function in all cases. CONCLUSIONS: autotransplantation of the appendix can be considered a simple procedure that allows sometimes to reestablish the continuity of the ureter with good results.     

2373例剖宫产指征分析

目的:探讨分析剖宫产手术指征。方法:将2373例剖宫产患者手术指征进行统计分类分析。结果:剖宫产发生率持续偏高(63.23%),指征主要为胎儿宫内窘迫、妊娠合并疾病、产力异常及社会因素,并且呈逐年增加趋势。结论:降低剖宫产率需医务人员和社会力量共同努力。     

Intestinal transplantation: indications, results and strategy

The term 'intestinal failure' is now often used to describe gastrointestinal function insufficient to satisfy body nutrient and fluid requirements. The first recognized condition of intestinal failure was short bowel syndrome. Severe motility disorders such as chronic intestinal pseudo-obstruction syndrome in children as well as congenital intractable intestinal mucosa disorders are also forms of intestinal failure, because no curative treatment for these diseases is yet available. Parenteral nutrition and home parenteral nutrition remain the mainstay of therapy for intestinal failure, whether it is partial or total, provisional or permanent. However, some patients develop complications while receiving standard therapy for intestinal failure and are considered for intestinal transplantation. Indeed, recent advances in immunosuppressive treatment and the better monitoring and control of acute rejection have brought intestinal transplantation into the realm of standard treatment for intestinal failure. Although it has been used in humans for the past two decades, this procedure has had a slow learning curve. According to the current results, this challenging procedure may be performed in children or adults, only under certain conditions.