Aktueller Stand der Versorgung vorderer Beckenringfrakturen

The incidence of pelvic injury is increasing. In addition to high-speed trauma among younger patients, low-speed injuries among mainly older people (osteoporotic age-related fractures) play an important role. Pelvic ring stability is the most important consideration in the indication for conservative or surgical therapy. Unstable pelvic ring injuries are combined with severe concomitant injuries in >80% of cases and their primary treatment is usual in the context of multiple trauma management. In the case of anterior pelvic ring injuries (undisplaced/minimally displaced anterior pelvic ring fractures, pelvic rim breaks, type A avulsion fractures), fractures are usually stable and can be treated conservatively. Unstable pelvic ring fractures are generally treated surgically, enabling early functional aftercare in addition to anatomical reconstruction. Established osteosynthesis procedures for the anterior pelvic ring include external fixation, plate osteosynthesis and pubic rami screw. It is too early to say whether, and to what extent, new fixed-angle plate systems can improve the clinical results of surgically treated anterior pelvic ring injuries.     

Semuloparin for the prevention of venous thromboembolic events in cancer patients

Cancer-associated venous thromboembolism increases the morbidity and mortality in patients with cancer, being the second leading cause of death among these patients. As such, it has important clinical and economical consequences and current guidelines recommend thromboprophylaxis for cancer patients who are admitted to the hospital for medical illness or for major cancer surgery but not for routine use in ambulatory patients receiving chemotherapy. Semuloparin (AVE-5026) is a hemisynthetic, ultra-low-molecular-weight heparin, with high anti-factor Xa and residual antithrombin activities that was submitted for approval to the European Medicines Agency and the U.S. Food and Drug Administration in September 2011 for the prevention of venous thromboembolism in cancer patients. In a multicenter trial (SAVE-ONCO), once-daily, subcutaneous semuloparin at 20 mg administered to 1,608 patients receiving chemotherapy for locally advanced or metastatic solid tumors significantly prevented venous thromboembolism without increasing major bleeding, suggesting that semuloparin thrombo-prophylaxis can be beneficial in cancer patients receiving chemotherapy.     

Trastornos del sueño y condiciones ambientales en mayores de 65 años

ObjectivesTo establish the prevalence and characteristics of insomnia and its relationship to other health problems, medication, socio-health status and sleep hygiene in the elderly over 65 years of age.DesignCross sectional study of prevalence.SettingAlbacete (Castilla-La Mancha), 2004–2005.ParticipantsA non-institutionalized elderly patient population (n=424).MethodSemi-structured interview. Study variables were: sleep characteristics, socio-familial repercussions, sleep hygiene, health problems, medication, health care utilization and socio-demographic variables. Primary insomnia (PI) was diagnosed according to DSM-IV criteria.ResultsReported sleeping difficulties, 34.2%; in 95.7% the sleep disturbance was chronic. The most frequent repercussions were: sensation of insufficient night-time sleep (62.1%) and daytime tiredness or sleepiness (52.2%). 20.3% (95% CI, 16.5–24.1) met criteria for PI. Insomnia rates were significantly higher in females and in subjects maintaining irregular hours and expressing dissatisfaction with bedroom environmental conditions. Psychopharmaceuticals were regularly consumed by 26.9% of the subjects (95% CI, 22.7–31.1). The average number of health problems was higher in subjects with insomnia (2.4±1.6 compared with 1.7±1.5 in non-insomniacs; P<.001). By means of logistic regression, female gender (OR=2.8; 95% CI, 1.6–4.8) and the existence of 2 or more health problems (OR=2; 95% CI. 1.2–3.4) were associated with PI.ConclusionsPI affects approximately one fifth of people over the age of 65. It is more frequent in females and is related to the existence of other health problems, medication and inadequate sleep hygiene.     

The metabolic syndrome: marker of cardiovascular risk in hypertensive patients? The importance of definition

INTRODUCTION: Metabolic syndrome (MetS) was defined by association of abdominal obesity, hypertension, glucose intolerance and/or dyslipidemia. The objective of this study was to compare the new International Diabetes Federation (IDF) definition and the National Cholesterol Education Program Adult Treatment Panel III (NCEP) definition and their association with cardio-vascular disease in hypertensive patients. POPULATION AND METHOD: Two hundred and thirty hypertensive patients were hospitalized successively for cardio-vascular disease exploration and hs-CRP measurement. The stratification of cardio-vascular risk was made according to the French recommendations. The IDF definition and the NCEP definition were compared according frequency of resistant hypertension and cardio-vascular disease extension. RESULTS: In our study, high cardio-vascular risk hypertension represented 68.5% of patients. Diabetes was present in 23.5% of them and obesity in 45.5%. Patients with cardio-vascular disease represented 60% of our study population. Prevalence of MetS was 38.5% according to the NCEP definition and 59% according to the IDF definition. The NCEP definition was allowed to select subjects with widespread vascular disease and resistant hypertension whereas the IDF definition did not. These results could be explained by lower waist circumference and glycaemia cuts offs according to the IDF criteria. When diabetic's patients were excluded, MetS was not associated with increase of resistant hypertension frequency. Moreover, hs-CRP was independently associated to the extension of the cardiovascular disease and smoking remained the most powerfully factor associated to the cardio-vascular disease extension. CONCLUSION: In hypertensive patients, the NCEP definition seems more adapted to the diagnosis of MetS than the IDF one. Abdominal obesity could be the indispensable element to the MetS diagnosis but according to the NCEP waist circumference cut off. The use of this syndrome seems to be relevant to select the patients presenting an intermediate cardio-vascular risk in order to adapt treatment.     

How to determine the diagnosis of Helicobacter pylori infection in the elderly?

PURPOSE: The real prevalence of Helicobacter pylori (H. pylori) infection is difficult to determine in the elderly because of the frequency of drug intake (antibiotics or anti-secretory drugs). The aim of this study was to evaluate the diagnostic performance of five tests in the elderly. METHODS: The study population consisted of consecutive patients undergoing a routine endoscopy between August 1998 and December 1999. We evaluated the diagnostic performance of four tests in all of the included patients: culture and histology of biopsy specimens, serology (ELISA) and urea breath test (13C-UBT). Detection of H. pylori antigens in stool samples (HpSA) was realized in a subgroup. Patients were considered H. pylori + when result for culture was positive or when two tests were positive. RESULTS: One hundred and sixty-seven patients were included in this study (55 men, 112 women; mean age: 85.6 +/- 5.1 years). Only 38 (22.8%) patients were H. pylori+. Test performances showed the following results: serology sensitivity: 90.9% (IC 95%: 75.6-98.1) versus 86.9% (IC 95%: 63.6-96.9) for culture versus 77.8% (IC 95%: 60.8-89.9) for histology and 74.3% (IC 95%: 56.7-87.5) for 13C-UBT. Eighty-nine (53.3%) took antibiotics or anti-secretory drugs, only 13C-UBT performances decreased significantly (sensitivity: 94.4% [72.7-99.8] versus 52.9% [27.8-77]; P < 10(-6)). When gastric or duodenal ulcer were endoscopically diagnosed in older patients, both histology and 13C-UBT could not improve the diagnosis of H. pylori infection. HpSA was realized in 107 patients (sensitivity: 74.1%, specificity: 98.7%). We showed no statistical difference between HpSA performances and drug intake. CONCLUSION: Diagnostic performances decreased in older patients especially because of drug intake.     

002 高血压及抗高血压药物与Ⅱ型糖尿病

本文采用前瞻性群体研究旨在确定降压药物的应用与继发Ⅱ型糖尿病的危险之间是否存在独立的相关性。 作者对12 550名(年龄45-64岁)无糖尿病的成年人进行全面健康评价(包括药物的使用及血压测定)。高血压判定标准为收缩压≥140mmH-g(1mmHg=0.1333 kPa)或舒张压≥90mmHg。确定高血压患者3 804例,根据使用降压药物的种类分为血管紧张素转化酶抑制剂(ACEI)162例,β阻滞剂543例,钙拮抗剂96例,噻嗪利尿剂458例,其它单一药物137例,多种药物(≥2种)934例,其余1 474例高血压患者未给予任何抗高血压药物治疗。随访3年及6年后,通过测定空腹血糖浓度[糖尿病判定标准为：空腹血糖≥126m/dl(≥7.0mmol/L)餐后血糖≥200m/dl(≥11.1mmol/L)]评价糖尿病新病例的发生率。     

Progesterone impairs cell respiration and suppresses a compensatory increase in glucose transport in isolated rat skeletal muscle: a non-genomic mechanism contributing to metabolic adaptation to late pregnancy?

Aims/hypothesis The aim of the study was to gain better insight into the mechanisms responsible for impaired glucose metabolism during late pregnancy. We explored the direct effects of progesterone on glucose metabolism of skeletal muscle. Methods Specimens of skeletal muscle from untreated rats were incubated with progesterone and rates of substrate fluxes through the various pathways of glucose metabolism were analysed. Results Progesterone dose-dependently reduced the rates of glucose and pyruvate oxidation (insulin-stimulated rates after 5 h of exposure to 1 and 10 μmol/l progesterone: glucose oxidation, −6 ± 4%, NS, and −39 ± 4%, p < 0.001; pyruvate oxidation, −28 ± 2% and −55 ± 4%, p < 0.001 each) and increased lactate release (+28 ± 4% and +58 ± 9%, p < 0.005 each), which indicated inhibition of mitochondrial respiratory function. Impairment of cell respiration, e.g. by the specific inhibitor rotenone, is known to trigger a compensatory increase in glucose transport, but this response was blunted in the case of progesterone (change of glucose transport in response to 10 μmol/l progesterone vs 60 nmol/l rotenone, both causing a reduction in glucose oxidation by −39%: progesterone, +14 ± 8% vs rotenone, +84 ± 23%, p < 0.03). Further experiments dealt with the underlying mechanisms and revealed a rapid mode of action (50 μmol/l progesterone, reduction in insulin-stimulated glucose oxidation after 30 min: −29 ± 7%, p < 0.01) not affected by blockers of gene expression or the nuclear progesterone receptor. Conclusions/interpretation Progesterone inhibits cell respiration and at the same time suppresses a compensatory increase in glucose transport, causing cellular carbohydrate deficiency in isolated rat skeletal muscle. This effect is mediated by a direct, rapid and non-genomic mechanism and could contribute to pregnancy-associated changes in glucose homeostasis. Electronic supplementary material The online version of this article (doi: ) contains supplementary material, which is available to authorised users.