Mortality and morbidity after spinal surgery in patients with Parkinson's disease: a retrospective matched-pair cohort study

Background Context

There is a lack of information about postoperative outcomes and related risk factors associated with spinal surgery in patients with Parkinson's disease (PD).

Staphylococcus aureus bacteremia after thermal injury: The clinical impact of methicillin resistance

Objective

To evaluate the impact of methicillin resistance in Staphylococcus aureus bacteremia (SAB) on mortality and length of stay in burn patients.

Design

Retrospective cohort study.

Setting

A 750-bed tertiary care university hospital in Cologne, Germany.

Patients

Patients registered in the database of the burn intensive care unit (BICU) between 1989 and 2009 with complete data sets (n = 1688).

Results

Over the 21-year study period, 74 patients with SAB were identified; 33 patients had methicillin-resistant S. aureus (MRSA) and 41 methicillin-susceptible S. aureus (MSSA). Comparing the MRSA with the MSSA population the following parameters were significantly different in the univariate analysis: BMI (27.2 kg/m² vs. 23.6 kg/m²; P = 0.05), extent of deep partial thickness burns (17.8% vs. 9.0% of total body surface area; P = 0.007), antibiotic requirement on admission (45.5% vs. 22.0%; P = 0.046), median length of hospitalization prior SAB (24 days vs. 7 days; P < 0.001), packed red blood cells administration (47.6 units vs. 26.1 units; P = 0.003), intubation requirement (100% vs. 80.5%; P = 0.007), intubation period (43.5 days vs. 26.8 days; P = 0.008), catecholamine requirement (90.9% vs. 61.0%; P = 0.004), sepsis (60.6% vs. 34.1%; P = 0.035) and organ failures (81.8% vs. 39.0%; P < 0.001). Regarding outcome parameters, methicillin resistance was not significantly related with mortality (adjusted OR 1.55, 95% CI 0.56–4.28; P = 0.40) and length of BICU stay after SAB (Kaplan–Meier analysis log-rank test P = 0.32; Cox's proportional hazards regression HR 1.22, 95% CI 0.65–2.27, P = 0.535) in the univariate and multivariate analyses.

Conclusion

Our data suggest that methicillin resistance is not associated with significant increases in mortality and length of BICU stay among burn patients with SAB.     

不同T2WI信号子宫肌瘤超声造影分析

目的对行高强度聚焦超声(HIFU)消融治疗的不同T2信号的子宫肌瘤行CEUS定量分析及动态血管模型(DVP)参数成像。方法对16例行HIFU治疗的单发子宫肌瘤患者,依据术前MRI T2WI信号不同分为高信号组(n=6)、等信号组(n=4)、低信号组(n=6),于HIFU治疗前行CEUS并利用SonoLiver CAP软件对其行定量分析,以子宫肌瘤与周围肌层增强水平差值为参数行DVP参数成像构建。结果 3组峰值强度、上升时间、达峰时间、平均渡越时间分别为:高信号组为(235.40±35.46)%、(22.80±3.16)s、(25.09±2.44)s、(125.78±27.63)s,等信号组为(71.97±2.43)%、(24.85±3.22)s、(32.81±3.92)s、(66.52±3.48)s,低信号组为(16.17±2.83)%、(25.42±2.66)s、(32.82±3.76)s、(64.27±3.33)s,3组间各参数比较差异均有统计学意义(P均0.05)。高信号、低信号组子宫肌瘤的DVP曲线主要表现为未消退型和负向型。结论 CEUS参数成像分析和DVP参数图可直观、动态、定量地反映不同T2信号子宫肌瘤的血流灌注差异,为HIFU治疗子宫肌瘤提供重要信息。     

Chronobiological Patterns of Aneurysmal Subarachnoid Hemorrhage in Central China

Background:Aneurysmal subarachnoid hemorrhage (aSAH) is an acute and sometimes fatal cerebrovascular disease. The chronobiological patterns of aSAH are still unclear worldwide. This 15-year time-series study aims to clarify the chronobiological patterns including seasonal, monthly, weekly, and circadian distributions of aSAH.Methods:We retrospectively analyzed the medical records of aSAH patients in central China. To investigate seasonal and weekly distributions, we used the χ2 goodness-of-fit test to analyze the uniformity of the onset time. To explore monthly and circadian distributions, we established Fourier models to show the rhythmicity in chronobiological patterns. Subgroup analyses were conducted to assess the impact of age, gender, hypertension statuses, and aneurysmal characteristics (number, size, and location) on the chronobiological patterns of aSAH.Results:A total of 1469 patients with aSAH were recruited in the study. The seasonal and monthly distribution exhibited significantly higher incidence in winter and January/December and lower incidence in summer and July. The weekly distribution of aSAH onset showed no significant uneven variation. The circadian distribution of aSAH exhibited a significant pattern (p = 0.0145), with a morning peak around 8:00, and a late afternoon peak at 16:00–20.00. The circadian rhythmicity varied in subgroups of different ages, genders, and aneurysmal locations.Conclusion:The occurrence of aSAH exhibits significant circannual and circadian patterns among the Chinese population. Patients with aSAH of different ages, genders, and aneurysmal locations would present different chronobiological patterns.     

POSSUM、P-POSSUM和Cr-POSSUM对结直肠癌患者住院期间病死率预测能力的比较

目的 比较并发症和病死率的生理和手术严重性评分(physiological and operative severity score for the enumeration of mortality and morbidity,POSSUM)、并发症和病死率的生理和手术严重性评分(Portsmouth POSSUM,P-POSSUM)、结直肠切除的并发症和病死率的生理和手术严重性评分(colorectal POSSUM,Cr-POSSUM)对结直肠癌患者住院期间病死率的预测能力.方法 调查北京大学第三医院1992-2005年903例结直肠癌外科手术切除的资料.903例中,结肠癌518例,直肠癌385例.用ROC曲线分析判断评分的判别能力,用Hosmer-Lemeshow检验判断评分的拟合优度,用不同危险因素群的O∶E值判断评分的预测能力.结果 903例患者住院期间的病死率为1.0%(9/903).POSSUM、P-POSSUM、Cr-POSSUM预测的病死率分别为5.6%、2.8%、4.8%,三种评分预测的病死率明显高于实际的病死率,O:E值分别为0.18、0.35、0.2.结论 POSSUM、P-POSSUM和Cr-POSSUM在结直肠癌手术中预测的病死率高于实际病死率.     

Smoking, Lung Function and the Prognosis of Abdominal Aortic Aneurysm

Background the UK Small Aneurysm Trial was established to test the benefit of prophylactic elective surgery for small abdominal aortic aneurysms (4.0–5.5 cm in diameter) and identify prognostic risk factors, including smoking. Patients, methods and outcomes one thousand and ninety patients (902 men and 188 women, mean age 69.3 years) were randomised to either early elective surgery or ultrasonography surveillance until the aneurysm diameter exceeded 5.5 cm, mean follow-up was 4.6 years. Baseline assessments included lung function tests and cotinine (a smoking marker). The principal outcome measures were all-cause mortality and aneurysm rupture. Results during the course of the trial, aneurysm rupture was diagnosed in 25 patients and 309 patients died. Whereas self-reported smoking status was not significantly associated with survival, patients without any trace of plasma cotinine had a significantly improved long-term (6-year) survival,p =0.02. Current smokers had a lower FEV₁than past- and never-smokers. FEV₁was the most powerful predictor of long-term (6-year) survival, the crude death rates per 100 person-years were 9.1, 6.9 and 4.6 for those with FEV₁<1.9 l, 1.9–2.5 l and >2.5 l respectively, p=0.001. Moreover, the rupture rate was 1.9% per year for patients positive for plasma cotinine compared with 0.5% in those without trace of plasma cotinine,p =0.004. Conclusions self-reported smoking status underestimates the effect of continued smoking on the prognosis of patients with small abdominal aortic aneurysm. Patients with high plasma cotinine concentrations (smokers) have an increased risk of aneurysm rupture and poorer long-term survival.     

Quantitative Ultrasound and Mortality: A Prospective Study

Previous studies suggest that low bone mineral density (BMD) is associated with increased mortality, but the relationship between quantitative ultrasound (QUS) and mortality is unknown. We studied 5816 women over age 70 years enrolled in the Study of Osteoporotic Fractures. QUS of the calcaneus, and BMD of the calcaneus and hip, were measured at baseline, and women were contacted every 4 months to determine vital status. All reported deaths were confirmed by review of the death certificate or hospital records, and classified by ICD-9 code. During 5.0 years of follow-up, 677 women died. Women in the lowest quintile of QUS had the highest mortality during follow-up. After adjustment for age, grip strength, weight, height, health status, estrogen use, smoking, physical activity, and history of hypertension, diabetes, cardiovascular disease, cancer and stroke, each 1 SD reduction in broadband ultrasonic attenuation (BUA) was associated with a 16% increase in mortality (RH = 1.16; 95% CI: 1.07, 1.26). Mortality from cardiovascular disease, cancer and other causes were all increased among women with low QUS, but the association with cancer deaths was not statistically significant after multiple adjustments (RH = 1.09; CI: 0.93, 1.27). Low BMD was also associated with an increased risk of total and cause-specific mortality, but we found little evidence that BUA and BMD were independent predictors of mortality. Results were similar among women who did not fracture during follow-up. In this large population-based study of older women, low QUS is associated with both total and cause-specific mortality. This relationship was independent of other factors associated with mortality, such as age and health status, and suggests QUS and BMD may reflect some aspect of aging not captured by these traditional factors. Received: 16 March 2001 / Accepted: 19 February 2002     

不稳定型骨盆骨折的疗效探讨

目的 探讨不稳定型骨盆骨折(Tile B和Tilec型)的治疗和疗效。方法 比较78例骨盆骨折患者使用和非使用骨盆外固定支架手术疗效。结果 在38例骨盆骨折患者未使用骨盆外固定支架治疗中，失血性休克的纠正率为76％，死亡率10．6％，平均ISS评分11．6。而在使用骨盆外固定支架治疗的40例患者中，失血性休克的纠正率为90％，死亡率为2．5％，平均ISS评分9．87结论 骨盆外固定支架治疗不稳定型骨盆骨折合并失血性休克，手术简单，疗效可靠，大大降低了患者的死亡率。     

改良POSSUM评分系统在预测老年人股骨粗隆间骨折手术风险中的应用价值

目的 探讨应用POSSUM评分系统预测老年人股骨粗降间骨折术后病死率及并发症发牛率的价值.方法 2007年1月至2008年12月回顾性分析119例老年股骨粗隆间骨折患者,按照适用于骨科的改良型POSSUM评分系统评估量表对每例患者进行生理学评分及手术严重度评分,将数据代人原始POSSUM回归公式计算出术后死亡概率及术后并发症发生概率,据此概率计算出预测死亡人数和发生并发症人数,并与观察到的实际死亡人数和发生并发症人数进行比较.结果 POSSUM评分系统预测术后30 d内42例(35.3%)发生并发症,实际发生并发症39例(32.8%),(χ2=0.168,P=0.682);预测术后30 d内死亡11例(9.2%),实际死亡5例(4.2%)(χ2=2.412,P=0.120).结论 改良POSSUM评分系统能较好的预测老年患者股骨粗隆间骨折术后30 d内的并发症发生率及病死率,对于高危患者(预测病死率>20%)的预测结果更加准确;其生理学评分量表可用于老年股骨粗隆间骨折患者的术前评估;肺部疾病是导致老年股骨粗隆间骨折患者术后死亡的首要因素.     

Time to surgery and 30-day morbidity and mortality of periprosthetic hip fractures

Background and aim

The management of femoral periprosthetic fractures following hip replacement surgery is a complex and challenging situation. Whilst the early complications for both primary hip arthroplasty and proximal femoral fracture surgery have been widely documented, there is a paucity of published data regarding early outcomes following periprosthetic fracture surgery.Delay to surgery for native proximal femoral fractures has been clearly documented as a predictor towards adverse outcome. This study therefore aims to correlate the timing of operative intervention with the complication rate following periprosthetic fracture surgery. In addition, the study aims to identify further factors in the perioperative period that positively predict a poor postoperative outcome.

Methods

Sixty patients who were operatively managed for a femoral implant periprosthetic fracture were identified and each case assessed retrospectively.

Results and conclusion

There was an overall complication rate of 45% including a 30-day mortality of 10%. An abbreviated mental test score of 8 out of 10 or less and a delay to surgery of >72 h were found to be significant risk factors for adverse outcome. Both the patient cohort in this study and the predictors for poor postoperative outcome were comparable to those for native proximal femoral fractures.