Early anthropometry,strength, and function in survivors of critical illness

BackgroundCritically ill patients experience acute muscle wasting and long-term functional impairments, yet this has been inadequately categorised early in recovery.ObjectiveThis observational study aimed to evaluate anthropometry, strength, and muscle function after intensive care unit discharge.MethodsAdult patients able to complete study measures after prolonged intensive care unit stay (≥5 d) were eligible. Demographic and clinical data were collected, and bodyweight, height, triceps skinfold, trunk length, handgrip strength, 6-minute walk test, whole-body dual-energy x-ray absorptiometry, and mid-thigh, knee, and above-ankle circumferences were measured. Body cell mass was calculated from these data. Data are presented as mean (standard deviation) or median [interquartile range].ResultsFourteen patients (50% male; 57 [10.5] years) were assessed 11.1 (6.9) d after intensive care unit discharge. Patients lost 4.76 (6.66) kg in the intensive care unit. Triceps skinfold thickness (17.00 [8.65] mm) and handgrip strength (12.60 [8.57] kg) were lower than normative data. No patient could commence the 6-minute walk test. Dual-energy x-ray absorptiometry–derived muscle mass correlated with handgrip strength (R = 0.57; 95% confidence interval = 0.06–0.85; p = 0.03), but body cell mass did not.ConclusionsAnthropometry and strength in intensive care unit survivors are below normal. Muscle mass derived from dual-energy x-ray absorptiometry correlates with handgrip strength but body cell mass does not.     

Obstructive Sleep Apnea Severity and the Risk of Occupational Injury: A Prospective Observational Cohort

Objective

To determine whether patients with obstructive sleep apnea (OSA) are at increased risk of occupational injury (OI)

Methods

Working patients (aged 18 to 65 who reported more than 10 h of work per week) who were referred to the University of British Columbia Sleep Laboratory for suspected OSA for polysomnogram (PSG) were recruited from 2003 to 2011. Patients completed an extensive survey the night of their PSG. Validated OI was obtained by linking patient data to Workers Compensation Board Claims Data.

Results

1109 workers were studied; mean age was 47.1 years, median AHI was 15.0/h, median BMI was 30 kg/m², 70.2% were male and 29% of patients worked in physical or manual related occupations. 78 patients (7.03%) suffered 140 OI in the 5 years after PSG. In a multivariate logistic regression model, OSA severity [defined as a log(AHI + 1)] was a significant predictor of OI (p = 0.04) after controlling for age, sex, BMI, and physical or manual related occupations. Patients with moderate and severe OSA had approximately two times the odds of an OI compared to patients without OSA (OR 1.99, 95% CI 0.96–4.44 and 2.00, 95% CI 0.96–4.49 for moderate and severe OSA groups, respectively).

Conclusions

In this prospective study, OSA severity was independently associated with an increased risk of OI.

     

Robotic radical prostatectomy as the initial step in multimodal therapy for men with high-risk localised prostate cancer: initial experience of 160 men

Study Type – Therapy (case series) Level of Evidence 4 What's known on the subject? and What does the study add? The choice of therapy with high‐risk localised prostate cancer is difficult and, in the stark absence of any randomised trials, comparative retrospective analyses of case series continue to be necessary. Radical surgery has been considered by many to be inferior to a combination of radiotherapy (RT) and androgen deprivation therapy (ADT), but this changing perhaps coincidentally with the widespread acceptance of robot‐assisted laparoscopic prostatectomy surgery (RALP). Further evidence has now described the long‐term toxicities related to ADT, and this has strengthened a desire amongst many to at least defer, if not avoid, ADT unless absolutely necessary. This article presents a single‐centre experience of RALP in the setting of high‐risk localised disease, and concludes that RALP incorporating the use of post‐operative RT represents a strong perhaps optimum management strategy.

OBJECTIVES

• ? To report the outcome of robotic‐assisted laparoscopic radical prostatectomy (RALP) for men with localised high‐risk prostate cancer at diagnosis.
• ? Although commonly managed by radiotherapy (RT) with prolonged androgen‐deprivation therapy (ADT), we hypothesize that initiation of multimodal therapy with RALP is oncologically efficacious and may allow many men to avoid ADT.

PATIENTS AND METHODS

• ? Between December 2003 and September 2010, 1480 men underwent RALP of whom 160 fulfilled the National Comprehensive Control Network criteria for high‐risk disease (prostate‐specific antigen (PSA) >20 ng/mL and/or clinical stage, cT ≥ 3 and/or biopsy Gleason score ≥8).
• ? Biochemical recurrence (postoperative PSA ≥ 0.2) was used to assess outcome after RALP monotherapy.
• ? Treatment failure was defined as either a rising PSA level after salvage RT or the initiation of ADT.

RESULTS

• ? The mean age ± standard deviation was 63.1 ± 6.3 years. Median PSA level was 9.95 ng/mL (interquartile range 6.0–21.4).
• ? Analysis of prostatectomy specimen showed Gleason 8–10 cancers in 65 (41%), and extracapsular disease, pT ≥ 3, in 96 (60%) of which seminal vesicle invasion was evident in 36 (23%). Downgrading by prostatectomy occurred in 64 (40% of total group) and five (3%) were downstaged to pT2 disease. By contrast, any upgrading occurred in 29 (18% of total group) and upstaging occurred in 68 (43%). The overall positive surgical margin rate was 38%, correlating with stage pT2 (15%) or pT3 (53%).
• ? With median follow‐up of 26.2 months (interquartile range 5.5–37.3), two non‐cancer‐related deaths have occurred (overall survival 98.8%; cancer‐specific survival 100%), and biochemical recurrence has occurred in 53 men (33%). RALP surgery has served as monotherapy (n= 117, 73%), or has been followed by salvage RT (n= 24, 15%) and/or ADT (n= 43, 27%). Overall 2‐year and 3‐year treatment failure was 31 and 41%, respectively.
• ? Serum PSA level was the only independent predictor of overall treatment failure (hazard ratio [HR] 1.02, P= 0.001) although a strong trend was observed for both clinical stage (HR 1.22, P= 0.058) and the number of positive biopsy cores on transrectal biopsy (HR 1.06, P= 0.057).

CONCLUSIONS

• ? RALP incorporating the use of postoperative RT is a good multimodal management strategy for men with this aggressive variant of prostate cancer.
• ? At median follow‐up in excess of 2 years, we found low rates of treatment failure enabling a high proportion of men to remain free of ADT.

     

The incidence of post operative venous thromboembolism in patients undergoing varicose vein surgery recorded in Hospital Episode Statistics

INTRODUCTION

The aim of this study was to establish the incidence of post-operative venous thromboembolism (VTE) following varicose vein treatment.

METHODS

Hospital Episode Statistics (HES) data were obtained for all patients undergoing varicose vein treatment between April 2006 and April 2007 to identify those reattending with either deep vein thrombosis or pulmonary embolism within 12 months.

RESULTS

The incidence of VTE was 0.51%, which was comparable with the incidence for those undergoing open surgery (0.54%), sclerotherapy (0.19%) and endovenous laser therapy (EVLT) (0.47%). The incidence of VTE in those undergoing combined EVLT and phlebectomy was 1.26% (p=0.01). In contrast to unilateral treatment (all modalities), where bilateral treatment was performed an increase in the incidence of VTE was seen in those undergoing redo (1.62%) and short saphenous system (1.16%) treatments.Overall, 1.02% of cases were performed under local anaesthesia with zero incidence of VTE in this cohort.

CONCLUSIONS

The overall incidence of VTE recorded in HES was 0.51% and appears to be highest in those undergoing bilateral redo or short saphenous system surgery as well as those undergoing a combination of EVLT and phlebectomy. The use of VTE prophylaxis, particularly in these groups, is recommended.     

Current trends in tonsillitis and tonsillectomy

IntroductionThe aim of this study was to assess tonsillitis and tonsillectomy trends, both from a local and national perspective.MethodsRetrospective analysis was carried out of tonsillitis admissions and tonsillectomy rates over a ten-year period in a university teaching hospital from 2003 to 2012.ResultsSince 2003 tonsillitis admissions have increased locally by 118% in adults and 179% in children despite negligible changes in tonsillectomy rates. Similar trends have been observed nationally.ConclusionsThe findings of this study may be considered to be the result of current National Health Service policy. A reconsideration of agreed indications for tonsillectomy could potentially reduce hospital admissions of patients with tonsillitis in the long term.