Background: Postoperative cognitive dysfunction (POCD) after noncardiac surgery is strongly associated with increasing age in elderly patients; middle-aged patients (aged 40-60 yr) may be expected to have a lower incidence, although subjective complaints are frequent.
Methods: The authors compared the changes in neuropsychological test results at 1 week and 3 months in patients aged 40-60 yr, using a battery of neuropsychological tests, with those of age-matched control subjects using Z-score analysis. They assessed risk factors and associations of POCD with measures of subjective cognitive function, depression, and activities of daily living.
Results: At 7 days, cognitive dysfunction as defined was present in 19.2% (confidence interval [CI], 15.7-23.1) of the patients and in 4.0% (CI, 1.6-8.0) of control subjects (P < 0.001). After 3 months, the incidence was 6.2% (CI, 4.1-8.9) in patients and 4.1% (CI, 1.7-8.4) in control subjects (not significant). POCD at 7 days was associated with supplementary epidural analgesia and reported avoidance of alcohol consumption. At 3 months, 29% of patients had subjective symptoms of POCD, and this finding was associated with depression. Early POCD was associated with reports of lower activity scores at 3 months. 相似文献
BACKGROUND: Bronchial responsiveness (BR) to histamine or methacholin is a common finding in adult non-asthmatic patients with allergic rhinitis. OBJECTIVE: We tested whether BR is also present in children with a comparatively short history of allergic rhinitis in a paediatric cohort. METHODS: We performed pulmonary function tests and histamine challenges in a total of 654 children (age 7 years, participants of the German Multicenter Allergy Study) and compared PC20 FEV1 values in children with asthma, allergic rhinitis, asymptomatic allergic sensitization and non-atopic controls. RESULTS: Most pronounced BR to histamine was observed in allergic asthmatics (n = 28), irrespective of the presence or absence of allergic rhinitis. Furthermore, PC(20)FEV(1) values in non-asthmatic children with allergic rhinitis (n = 24) were not significantly different from those seen in asymptomatic atopic (n = 54) or non-atopic controls (n = 92). CONCLUSIONS: In contrast to adult study populations, 7-year-old non-asthmatic children with allergic rhinitis do not show a higher degree of BR than asymptomatic atopic or non-atopic controls. Therefore, secondary preventive measures in non-asthmatic children with allergic rhinitis (such as regular local anti-inflammatory therapy or specific immunotherapy) should be studied and applied more intensely to prevent bronchial hyper-responsiveness (BHR) and asthma in this high-risk group. 相似文献
The classic approach to anterior skull base lesions uses bifrontal craniotomies together with lateral rhinotomies. This approach requires frontal lobe retraction and is associated with postoperative anosmia and the development of frontal lobe encephalomalacia. The transglabellar/subcranial approach permits removal of anterior skull base lesions without frontal lobe retraction and avoids facial scars. No studies to date, however, have directly compared the two approaches in terms of patient morbidity. The present retrospective study compares the two approaches when used for the removal of anterior skull base lesions in terms of estimated blood loss, number of transfusions, number of days in the hospital and intensive care unit, and postoperative complications. Twenty patients with anterior skull base lesions were examined. The classic approach was used on 10, and the transglabellar/subcranial route was used on 10. When compared with the classic approach, the transglabellar/subcranial approach resulted in a lower estimated blood loss and subsequent transfusion rate, fewer days in the hospital and intensive care unit, and lower numbers and less severe types of complications. Furthermore, visualization of the tumors before resection with the transglabellar/subcranial approach allowed preservation of olfaction in virtually all of these patients. Although this study represents a small sample population, the results are sufficiently impressive to favor the transglabellar/subcranial approach for the removal of a variety of anterior skull base lesions. (Otolaryngol Head Neck Surg 1997;116:642-6.) 相似文献
Background: The presence and the pathogenetic role of
circulating IgA reacting with neutrophil cytoplasmic antigens (IgA-ANCA) in
patients with Henoch-Schonlein purpura (HSP) is still debated. This study
was aimed to investigate some characteristics of serum IgA and
macromolecular IgA in HSP patients, focusing on IgA-ANCA.
Methods: Eighty-seven HSP patients with biopsy proved
renal involvement (51 adults and 36 children) enrolled in a multicentre
study of the Italian Group of Immunopathology were investigated.
Results: Significantly high levels of IgA immune
complexes were found in both adults (P <0.05) and children (P
<0.01), while the binding of IgA to jacalin, was significantly low
in children with HSP (P <0.01) only. Two series of ELISA were done
for IgA-ANCA, in two different laboratories. Increased binding to PMN crude
extracts (P <0.01) without any modification in IgA binding to
proteinase 3 was found by either specific ELISA. Conversely, the binding of
IgA to myeloperoxidase (MPO) was found to be significantly (P <0.05)
increased with positive values in 25% of patients by one assay only. Three
of four sera with positive IgA-MPO ANCA exhibited binding in Western-blot
studies with the MPO preparation used in ELISA to a 28-kDa species.
D-galactose and N-acetyl-glucosamine decreased the binding of serum IgA to
MPO more in HSP than in controls (P <0.05).
Conclusions: The conflicting reports on IgA-ANCA may
reflect some atypical characteristics of the reaction which can be detected
only by some ELISAs. We suggest that not an antigen-antibody reaction but a
lectinic interaction due to abnormal composition of IgA carbohydrate side
chains may account for the IgA-ANCA reaction in patients with HSP
nephritis. 相似文献
A randomised controlled trial of 554 women was carried out to compare the effects of late and early umbilical cord clamping on the time of cord separation. In addition data were collected on maternal and neonatal outcomes. There were no significant differences between the two groups in the duration of cord adherence and neonatal and maternal outcomes. There appeared to be a higher rate of jaundice in the late clamped group which did not reach statistical significance. There was an unexpectedly higher rate of breast feeding at home in the late clamped group which did reach statistical significance. Overall the trial provides no clear evidence for the benefit of early cord clamping (the current policy as part of the active management of the third stage in the UK) on the outcomes considered. 相似文献