Acute lymphoblastic leukemia in the elderly

We report our findings in 18 patients with acute lymphoblastic leukemia (ALL) aged 60 years or older. A preleukemic syndrome was observed in 2 patients. Compared to younger adults with ALL, L3 morphology was unexpectedly frequent (4/16). T-ALL was not observed. Other criteria of poor prognosis (high white blood cell count, CNS involvement, organomegaly, high serum LDH) were similar to those reported in young adults. 12 patients were treated with an OPAL-derived regimen, 4 with the MAV regimen, 1 with vincristine and prednisone, 1 with 6-mercaptopurine. Complete remission was achieved in 8 patients but proved short-lived. 5 patients died in aplasia and 5 failed to achieve remission. Median survival for the whole group was 3 months. ALL in the elderly raises the dilemma of an aggressive disease in patients with poor tolerance to intensive therapy.     

Analysis of exercise-induced changes in R wave amplitude in asymptomatic men with electrocardiographic ST-T changes at rest

Fifty asymptomatic men, 44 (88 percent) of whom were pilots or allied aviation personnel, were referred because of resting ST-T electrocardiographic changes indistinguishable from those of myocardial ischemia. Because of the nature of their occupations, cardiac catheterization was performed to establish the presence or absence of coronary artery disease. Exercise tests were performed and analyzed retrospectively with respect to exercise-induced changes in the S-T segment and R wave amplitude. The results were correlated with coronary angiographic and echocardiographic findings.The 50 subjects were classified into two groups: Group I, 5 men with angiographically proved coronary artery disease, and Group II, 45 men without significant coronary arterial obstruction. Analysis of the S-T segment changes at peak exercise showed 21 subjects (42 percent) with a positive exercise test and 29 (58 percent) with a negative test. All subjects in Group I had a positive test. Sixteen subjects (35 percent) in Group II had a false positive result. Analysis of exercise-induced changes in R wave amplitude revealed that six subjects had a positive R wave response on the basis of sum of the changes in voltage in the leads measured (Δ∑R). Four of the six subjects had coronary artery disease and the other two were thought to have a cardiomyopathy. One subject with coronary artery disease had a negative R wave response. Echocardiography revealed five subjects with asymmetric septal hypertrophy; two of these had a positive exercise test and three a negative test on the basis of S-T segment criteria.Thus, symptom-limited treadmill exercise testing of asymptomatic men with resting ST-T electrocardiographic changes produced a high incidence rate of false positive results when S-T segment criteria were used, whereas analysis of changes in R wave amplitude yielded only two false positive results, both in men who had evidence of other heart disease.     

The PARTNER 3 Bicuspid Registry for Transcatheter Aortic Valve Replacement in Low-Surgical-Risk Patients

ObjectivesThe study compared 1-year outcomes between transcatheter aortic valve replacement (TAVR) patients with bicuspid aortic valve (BAV) morphology and clinically similar patients having tricuspid aortic valve (TAV) morphology.BackgroundThere are limited prospective data on TAVR using the SAPIEN 3 device in low-surgical-risk patients with severe, symptomatic aortic stenosis and bicuspid anatomy.MethodsLow-risk, severe aortic stenosis patients with BAV were candidates for the PARTNER 3 (Placement of Aortic Transcatheter Valves 3) (P3) bicuspid registry or the P3 bicuspid continued access protocol. Patients treated in these registries were pooled and propensity score matched to TAV patients from the P3 randomized TAVR trial. Outcomes were compared between groups. The primary endpoint was the 1-year composite rate of death, stroke, and cardiovascular rehospitalization.ResultsOf 320 total submitted BAV patients, 169 (53%) were treated, and most were Sievers type 1. The remaining 151 patients were excluded caused by anatomic or clinical criteria. Propensity score matching with the P3 TAVR cohort (496 patients) yielded 148 pairs. There were no differences in baseline clinical characteristics; however, BAV patients had larger annuli and they experienced longer procedure duration. There was no difference in the primary endpoint between BAV and TAV (10.9% vs 10.2%; P = 0.80) or in the rates of the individual components (death: 0.7% vs 1.4%; P = 0.58; stroke: 2.1% vs 2.0%; P = 0.99; cardiovascular rehospitalization: 9.6% vs 9.5%; P = 0.96).ConclusionsAmong highly select bicuspid aortic stenosis low-surgical-risk patients without extensive raphe or subannular calcification, TAVR with the SAPIEN 3 valve demonstrated similar outcomes to a matched cohort of patients with tricuspid aortic stenosis.     

Recent clinical features of Wilson’s disease with hepatic presentation

Background We carried out this study to evaluate recent clinical features of Wilsons disease (WD) with hepatic presentation, especially in terms of age, degree of liver injury, and association with hepatocellular carcinoma (HCC).Methods Sixteen patients with hepatic manifestations were diagnosed with WD in the period 1976–2003. We divided this period into two periods, past and recent. The diagnosis was based on the presence of Kayser-Fleisher rings, low serum copper levels, low serum ceruloplasmin levels, increased urinary copper concentrations before or after D-penicillamine challenge, and increased hepatic copper concentrations. This retrospective study was done at Ehime University Hospital.Results Four patients, including a pair of siblings, had a family history of WD. Four patients had parental consanguinity. There were 6 patients aged over 40 years in the recent period, whereas no patients in the past period were over 40. Four patients had neurological manifestations. Ten patients had liver cirrhosis and 5 had chronic hepatitis. Two had fatty liver without obesity. All patients in the past period had liver cirrhosis. Three patients with liver cirrhosis were found to have HCC during the follow up. All patients were treated with either D-penicillamine or trientine chloride, or both. However, four patients had to discontinue these agents due to the side effects.Conclusions Recently, the number of patients diagnosed with WD has been increasing, not only in terms of those with classical-type WD but also in terms of elderly patients or patients with non-cirrhotic liver injury such as fatty liver and chronic hepatitis. The various clinical features of WD should be recognized and particular attention should focus on HCC as a complication.     

老年特发性便秘直肠肛门压力测试59例分析

目的　探讨老年慢性特发性便秘 (CIC)患者直肠肛门运动功能变化 ,　 方法 　采用瑞典Medtronic公司生产的 8通道水灌注式消化道压力检测系统对 5 9例老年CIC患者及 36例老年对照者进行直肠肛门压力测定。　 结果 　老年CIC患者最大缩榨压、模拟排便时肛管压力变化低于老年对照组 (P <0 0 5 ) ,直肠初始感觉阈值、排便阈值和最大耐受容量均高于老年对照组 (P <0 0 5 ) ,2 8例 (47 5 % )老年CIC患者模拟排便时出现肛管压力异常升高。　 结论 　老年CIC与直肠低敏感、高耐受及排便时直肠肛管运动不协调有关     

Type and intensity of activity and risk of mobility limitation: the mediating role of muscle parameters

OBJECTIVES: To investigate the association between different types of physical activity behavior and incident mobility limitation in older men and women and to examine whether muscle parameters mediate these associations. DESIGN: Cohort study with 4.5-year follow-up. SETTING: Metropolitan areas surrounding Pittsburgh, Pennsylvania, and Memphis, Tennessee. A random sample of white Medicare beneficiaries and all age-eligible blacks. PARTICIPANTS: Three thousand seventy-five black and white men and women aged 70 to 79 with no self-reported difficulty walking one-quarter of a mile or climbing 10 steps, enrolled in the Health, Aging and Body Composition (Health ABC) Study. MEASUREMENTS: Participants were classified as exercisers (reporting > or = 1,000 kcal/wk of exercise activity), lifestyle active (reporting < 1,000 kcal/wk of exercise activity and > or = 2,719 kcal/wk of total physical activity), or inactive (reporting < 1,000 kcal/wk of exercise activity and < 2,719 kcal/wk of total physical activity). The study outcome, incident mobility limitation, was defined as two consecutive, semiannual self-reports of any difficulty walking one quarter of a mile or climbing 10 steps. Thigh muscle area, thigh muscle attenuation (a marker of fat infiltration in muscle), appendicular lean soft tissue mass, and isokinetic knee extensor strength were examined as potential mediators. RESULTS: Over 4.5 years, 34.3% of men and 47.4% of women developed mobility limitation. Inactive persons had twice the risk of incident mobility limitation as exercisers (hazard ratio (HR)=2.08, 95% confidence interval (CI)=1.60-2.70, for men, HR=1.98, 95% CI=1.51-2.60, for women). Lifestyle-active men and women had an intermediate risk (HR=1.47 and 1.44, respectively). For the lifestyle active and inactive, absence of walking activity conferred an additional risk of mobility limitation. Muscle parameters did not mediate the relationship between physical activity and mobility limitation, except for knee extensor strength in men. CONCLUSION: Exercise and an active lifestyle that includes walking protect against mobility loss in older men and women. Activity effects on muscle parameters do not explain this association.     

Octogenarians on hemodialysis: a prospective study

Octogenarians represent the fastest growing group of patients on hemodialysis. These patients were previously treated with conservative measures, while they were believed to have too poor prognosis on renal replacement therapy. We investigated clinical characteristics and outcome of patients prospectively after at least 2 years of follow-up. Six male and six female patients who were older than 80 years at the start of hemodialysis were followed up. Their clinical characteristics, comorbidities, etiology of renal disease, nutritional status, complications, vascular access, hospitalizations, compliance and outcome were recorded. The primary renal disease was unknown in 42.8% of patients. All patients had one or more comorbid conditions. Dialysis was initiated in an emergency situation in 64.3%. Vascular access was long-term hemodialysis catheter in 71.4%. Only 14.2% of them received erythropoietin. There were no major bleedings with reduced doses of heparin. The most common complications were catheter-related ones (infections, ruptures). All patients together required seven hospitalizations per year (0.58 per patient). The octogenarians tended to be underdialyzed with the mean adequacy of dialysis (Kt/V) 0.92. The 1-year survival was 71.4%, and 2-year survival was 50%, i.e., they had good survival on hemodialysis. Most of them died from causes that were not related to the uremia. Their treatment requires a careful planning of renal service expansion while more octogenarians who need renal replacement treatment may be expected.     

Alkaline phosphatase activity in chronic streptozotocin-induced insulin deficiency in the rat: Effect of insulin replacement

Alterations in circulating alkaline phosphatase have been described in both man and the experimental animal with chronic insulin deficiency. We evaluated plasma and tissue alkaline phosphatase levels in freely-fed control, streptozotocin-induced diabetic and insulin-treated diabetic rats, seven weeks after the induction of diabetes. Circulating alkaline phosphatase activity was markedly elevated in the insulin deficient animal (p < 0.001) and completely normalized following insulin administration. The elevated plasma alkaline phosphatase activity observed in the insulin deficient animals was heat-resistant and phenylalanine-sensitive, a pattern typical of the intestinal isoenzyme. Small intestinal alkaline phosphatase activity was significantly higher (p < 0.01) in the diabetic animals, but comparable in the insulin-replaced and control rats. The intestinal isoenzyme activity was found to be strikingly insulin-sensitive; withholding insulin therapy for 36 hr prior to sacrifice resulted in an abrupt rise in both plasma and intestinal alkaline phosphatase values comparable to those observed in the insulin-deficient state. In contrast to these observations, skeletal alkaline phosphatase activity was decreased in the insulin deficient animal (p < 0.01) and this abnormality was corrected by insulin replacement. Neither insulin deficiency nor insulin replacement resulted in any significant changes in the hepatic alkaline phosphatase isoenzyme.     

Adaptation and validation of the Moroccan Arabic version of the Psychosocial Impact of Dental Aesthetics Questionnaire (PIDAQ)

Objective

The aims of this study were to translate and culturally adapt the PIDAQ native English version into Moroccan Arabic, and to assess the psychometric characteristics of the version thereby obtained.

Materials and methods

The PIDAQ original English version was sequentially subjected to translation into Moroccan Arabic, back-translation into English, committee review, and pre-testing in 30 subjects seeking orthodontic treatment.

Results

The final Moroccan Arabic version further underwent an analysis of psychometric properties on a random sample of 99 adult subjects (84 females and 15 males, aged 20.97 ± 1.10 years). The intraclass coefficient correlation of the scores of the responses obtained after administration of the questionnaire twice at a 1-month interval to a random sample of 30 subjects ranged from 0.63 for “Self-confidence” to 0.85 for “Social Impact”. Cronbach α coefficients ranging from 0.78 for “Aesthetic Concerns” to 0.87 for “Self-confidence” were obtained; the different subscales of the Moroccan Arabic version of the PIDAQ showed good correlation with the perception of aesthetics and orthodontic treatment need.

Conclusion

The results of the present study indicate that the Moroccan Arabic version of the PIDAQ obtained following thorough adaptation of the native form is both reliable and valid. It is able to capture self-perception of orthodontic aesthetic and treatment need and is consistent with normative need for orthodontic treatment.     

舒适护理对老年维持血液透析病人心理指标及并发症的影响

[目的]探讨舒适护理对老年维持血液透析病人心理指标及并发症的影响。[方法]选取112例进行维持血液透析的老年病人,随机分为对照组和观察组各56例,对照组采取常规护理,观察组在对照组的基础上实施舒适护理。采用焦虑自评量表(SAS)和抑郁自评量表(SDS)比较两组病人护理前后心理状态,同时统计两组病人血液透析期间并发症的发生率。[结果]观察组病人采用舒适护理后的心理焦虑、抑郁程度明显低于对照组(P<0.05),透析期间并发症发生率明显低于对照组(P<0.05)。[结论]舒适护理可以提高老年维持血液透析病人的生活质量,消除病人的不良情绪,减少并发症的发生。