Determinants of aggression, and adaptive and maladaptive behaviour in older people with Down's syndrome with and without dementia

In a cross-sectional study of aggression, and adaptive and maladaptive behaviour in 128 subjects with Down's syndrome (DS), 29 of whom had dementia, the current authors found that the presence of dementia was not predictive of aggression or maladaptive behaviour. However, the level of adaptive behaviour was shown to be lower in subjects with dementia, and in those with lower levels of cognitive functioning, as measured on a rating instrument, the Test for Severe Impairment. Although the presence of aggressive behaviours is not higher in subjects with dementia and DS on cross-sectional review, it remains to be seen whether aggression will increase in individual cases with the onset or progression of dementia. The decline in adaptive behaviour shown in the present study confirms the findings of previous studies and indicates a direction for service development for persons with the dual diagnosis of dementia and DS.     

Small-bowel necrosis associated with jejunal tube feeding

Objectives

To report 3 cases of small-bowel necrosis after jejunal tube feeding and to review the literature concerning this condition.

Design

A 5-year retrospective review.

Setting

A 560-bed university-affiliated tertiary-care teaching hospital.

Patients

Three patients who had bowel necrosis out of 386 who received jejunal tube feedings.

Results

The patients experienced small-bowel necrosis as a consequence of jejunal feeding. The ischemic necrosis was preceded by progressive abdominal pain, distension and high nasogastric output. All 3 patients required extensive small-bowel resection. Although survival was rare in previous reports, our 3 patients survived after prompt surgical intervention and small-bowel resection.

Conclusions

Although the death rate for this condition approaches 70%, timely recognition and surgical intervention can save the patient’s life.     

A minimal-incision technique in total hip arthroplasty does not improve early postoperative outcomes. A prospective, randomized, controlled trial

BACKGROUND: Minimally invasive total hip arthroplasty has stirred substantial controversy with regard to whether it provides superior outcomes compared with total hip arthroplasty performed through longer incisions. The orthopaedic literature is deficient in well-designed scientific studies to support the clinical superiority of this approach. The objective of this study was to compare the results of a single mini-incision approach with those of a standard-incision total hip arthroplasty in the early postoperative period. METHODS: Two hundred and nineteen patients (219 hips) admitted for unilateral total hip arthroplasty between December 2003 and June 2004 were randomized to undergo surgery through a short incision of 相似文献   

Endovascular management of traumatic thoracic aortic injuries.

BACKGROUND: Endovascular surgery has recently been extended to the treatment of blunt traumatic aortic injuries. Since most of these injuries occur at the aortic isthmus, graft fixation in proximity to the origin of the left subclavian artery (LSA) has been a concern. Covering the LSA with graft fabric lengthens the proximal fixation site and should minimize proximal endoleaks. We therefore wished to evaluate the feasibility and safety of endovascular repair of thoracic aortic injuries after blunt trauma, both with and without deliberate coverage of the LSA. METHODS: At a tertiary care teaching hospital in London, Ont., we reviewed our experience with endovascular repair of 7 traumatic aortic injuries. We reviewed the technical success rate and the incidence of left subclavian coverage. Major morbidity, including rates of paraplegia and death were noted. The patients were followed-up with serial CT to look for endoleaks, stent migration or aneurysm growth and to determine whether they had symptoms related to left subclavian coverage. RESULTS: The time from injury to treatment ranged from 7 hours to 7 days (mean 36 h). The mean Injury Severity Score was 36. All injuries were at the aortic isthmus, and among the 7 patients treated, 6 had deliberate coverage of the LSA. One patient underwent carotid-to-subclavian artery bypass, but the other 5 did not. There were no cases of paraplegia; 1 patient had symptoms of claudication in the left arm but did not want revascularization. No procedure-related complications occurred, and all patients survived the event. Follow-up ranged from 2 to 30 (mean 13) months, and no endoleaks, stent migration or aneurysm expansion were noted in follow-up. CONCLUSIONS: Although long-term results are unknown, we conclude that endovascular repair of traumatic aortic injuries after blunt trauma can be performed safely with low morbidity and mortality and that coverage of the LSA without revascularization is tolerated by most patients.     

Endovascular repair of thoracic aortic disease: early and midterm experience

Thoracic aorta disease remains a challenging problem, and despite improvements, open repair techniques are still associated with significant morbidity and mortality. This is a retrospective review of 53 consecutive patients with thoracic aortic pathology who were treated with endovascular repair between September 1998 and December 2004 at a tertiary-care hospital. Endovascular stent graft placement was performed on 23 elective and 30 emergent patients (34 male patients, mean age 66 years, 21 to 85 years). Completion angiography revealed no endoleak in 47 (89%) patients, a type I endoleak in 4 patients, and a type II endoleak in 2 patients. Operative 30-day mortality for elective aneurysms (n = 22), emergent aneurysms (n = 10), dissection (n = 3), penetrating aortic ulcers (n = 7), and trauma (n = 11) was 0%, 40%, 0%, 29%, and 9%, respectively. In total, 46 (87%) patients survived 30 days, and 36 (78.3%) of the survivors were discharged home free of complications. Two patients (4%) experienced paraplegia. Median follow-up was 22 months (1 to 72 months). Intermediate-term results revealed 41 (89%) patients free of endoleak, stent migration, or aneurysmal expansion. Two (4%) patients required reintervention with an additional stent graft. There were 2 (4%) patients with late aortic-related deaths and four (9%) patients with non-aorticrelated late deaths. Endovascular stent graft placement for thoracic aorta disease can be performed successfully and safely with good perioperative and intermediate-term outcomes. Stent graft complication and reintervention rates are low, whereas intermediate survival rates are good. Long-term efficacy still needs to be evaluated.     

Do women exhibit greater differences in established and novel risk factors between diabetes and non-diabetes than men? The British Regional Heart Study and British Women’s Heart Health Study

Aims/hypothesis  

Type 2 diabetes is associated with greater relative risk of CHD in women than in men, which is not fully explained by conventional cardiovascular risk factors. We assessed whether cardiovascular risk factors including more novel factors such as markers of insulin resistance, inflammation, activated coagulation and endothelial dysfunction differ more between diabetic and non-diabetic women than between diabetic and non-diabetic men, and the role of insulin resistance.