Mortality in healthy elderly patients after ICU admission

Purpose  The aim of this study was to assess mortality in healthy elderly patients after non-elective medical ICU admission and to identify predictive factors of mortality in these patients. Methods  Patients ≥65 years living at home and with full-autonomy (Barthel index, BI > 60), without cognitive impairment, and non-electively admitted to a medical ICU were prospectively recruited. A full comprehensive geriatric assessment was made with validated scales. Results  A total of 230 patients were included, 110 (48%) between 65 and 74 years and 120 (52%) ≥75 years. No significant differences were observed between the two groups in premorbid functional and cognitive status, main diagnosis at ICU admission, APACHE II and SOFA scores, use of mechanical ventilation or haemodialysis or length of ICU stay. Over a mean follow-up of 522 days (range 20–1,170 days) the cumulative mortality of the whole group was 55%, being significantly higher in older subjects (62 vs. 47%; P = 0.024). On multivariate analysis, only parameters related to quality of life (QOL) and functional status were independent predictors of cumulated mortality (P < 0.01, both). Thus, in patients with EQ-5D_vas (<70) or baseline Lawton index (LI) (<5) the hazard ratio for cumulated mortality was 2.45 (95% CI: 1.15–5.25; P = 0.03) and 4.10 (95% CI: 1.53–10.99; P = 0.006), respectively, compared to those with better scores. Conclusions  Healthy elderly non-elective medical patients admitted to the ICU have a high mortality rate related to premorbid QOL. The LI and/or EQ-5D_vas may be useful tools to identify patients with the best chance of survival.     

The Effect of Isolated Phlebectomy on Reflux and Diameter of the Great Saphenous Vein: A Prospective Study

ObjectivesTo evaluate the effect of phlebectomy on venous reflux and diameter of the great saphenous vein (GSV).DesignProspective cohort study.MethodPatients presenting with reflux in the GSV resulting in varicose veins were included in this series. Patients were treated by phlebectomy for dilated and incompetent tributaries of the GSV with conservation of the incompetent GSV. We measured reflux duration (RD), peak reflux velocity (PRV) and the diameter of the GSV using duplex ultrasound imaging at inclusion and 1 month after surgery.PatientsWe included 55 limbs in 54 patients (30 women and 24 men) aged from 37 to 83 (mean age 63) years.ResultsFollowing treatment we observed a significant reduction of the mean RD (0.81s vs. 1.5 s p < 0.01, t-test), mean PRV (120 mm s^?1 vs. 249 mm s^?1 p < 0.01, t-test) and mean diameter of the GSV (SFJ = 5.6 mm vs. 6.7 mm, p < 0.01, sub-terminal valve 4.8 mm vs. 4.4 mm p < 0.05, mid-thigh 5.0 mm vs. 4.2 mm, p < 0.01, knee 4.0 mm vs. 5.3 mm p < 0.01, mid-calf 2.7 mm vs. 4.0 mm, p < 0.01, t-test).ConclusionsWe noted reduced reflux in the GSV after phlebectomy with a significant reduction in RD and PRV. Phlebectomy also led to a significant reduction in GSV diameter. These data suggest that the haemodynamics and the diameter of the SV can be improved by using a treatment focussing on the saphenous tributaries.     

Osteoarthritis and osteomyelitis due to Kingella kingae in children. Apropos of 5 cases and review of the literature

Bone infection caused by Kingella kingae (Kk) is rare since there are only 15 published cases. We report 5 additional cases with isolation of Kk from fluid or bone aspiration. Kk was sensitive to the most common antibiotics. The outcome was favorable in every case.     

Tibial tubercle osteotomy for access during revision knee arthroplasty: Ethibond suture repair technique

Background  

Tibial Tubercle Osteotomy has shown much promise in revision total knee replacement. Methods of repair previously described include screw and wire fixation. Both methods have significant complications.     

"Determination of venous hemodynamics". Contribution of air plethysmography

Plethysmographic techniques based on the variation of a parameter linked to venous stasis, have permitted an approach to venous hemodynamics. The use of a new technique of air-plethysmography, which cold be quantified in volume variation, and permitting to study the progression of the venous stasis from a static as well as a dynamic standpoint, enable us to better assess the overall venous function. The first results obtained in healthy patients, are presented and the advantages of this new technique are discussed.