bluuebunny/crossref_metadata_2025 huggingface dataset:
Randomized clinical trial of stapled haemorrhoidopexy versus conventional diathermy haemorrhoidectomy
Authors: Ortiz H , Marzo J , Armendariz P
Published: October 2002

Background

The aim of this study was to compare the results of stapled haemorrhoidopexy (commonly called stapled haemorrhoidectomy) with those of conventional diathermy haemorrhoidectomy.

Methods

Fifty-five patients with symptomatic third- and fourth-degree haemorrhoids were randomized to either stapled haemorrhoidopexy (n = 27) or conventional diathermy haemorrhoid ectomy (n = 28). Operating time, postoperative pain, time to return to work, postoperative complications and effectiveness of haemorrhoidal symptom control were recorded. The mean follow-up was 15·9 months in the stapled haemorrhoidopexy group and 15·2 months in the conventional haemorrhoidectomy group.

Results

Mean pain intensity was significantly less in the stapled group (P = 0·001). There were no significant differences in the total number of complications, the length of absence from work or control of symptoms. Seven patients in the stapled group re-presented with prolapse compared with none in the conventional haemorrhoidectomy group (P = 0·004). This difference was also observed in the subset of patients with fourth-degree haemorrhoids (P = 0·003).

Conclusion

The stapled operation was significantly less painful than conventional haemorrhoidectomy. However, the rate of recurrent prolapse was higher after stapled haemorrhoidopexy than after conventional diathermy haemorrhoidectomy.
Meta-analysis of techniques for closure of midline abdominal incisions
Authors: van 't Riet M , Steyerberg E W , Nellensteyn J , Bonjer H J , Jeekel J
Published: October 2002

Background

Various randomized studies have evaluated techniques of abdominal fascia closure but controversy remains, leaving surgeons uncertain about the optimal method of preventing incisional hernia.

Method

Medline and Embase databases were searched. All trials with a follow-up of at least 1 year that randomized patients with midline laparotomies to closure of the fascia by different suture techniques and/or suture materials were subjected to meta-analysis. Primary outcome was incisional hernia; secondary outcomes were wound dehiscence, wound infection, wound pain and suture sinus formation.

Results

Fifteen studies were identified with a total of 6566 patients. Closure by continuous rapidly absorbable suture was followed by significantly more incisional hernias than closure by continuous slowly absorbable suture (P < 0·009) or non-absorbable suture (P = 0·001). No difference in incisional hernia incidence was found between slowly absorbable and non-absorbable sutures (P = 0·75), but more wound pain (P < 0·005) and more suture sinuses (P = 0·02) occurred after the use of non-absorbable suture. Similar outcomes were observed with continuous and interrupted sutures, but continuous sutures took less time to insert.

Conclusion

To reduce the incidence of incisional hernia without increasing wound pain or suture sinus frequency, slowly absorbable continuous sutures appear to be the optimal method of fascial closure.
Chronic pain after laparoscopic and open mesh repair of groin hernia
Authors: Kumar S , Wilson R G , Nixon S J , Macintyre I M C
Published: October 2002

Background

The aim of this study was to compare the incidence of chronic pain or discomfort after laparoscopic totally extraperitoneal (TEP) repair and open mesh repair of groin hernia, and to assess the impact of such pain on patients' physical activity.

Methods

A postal questionnaire was sent to patients who had TEP or open mesh repair of groin hernia between January 1998 and December 1999. The patients were asked about any persistent pain or discomfort in relation to the groin hernia repair and whether this pain or discomfort restricted their ability to undertake physical or sporting activity.

Results

Of the 560 available patients 454 (81·1 per cent) replied. Laparoscopic TEP repair was performed in 240 patients (52·9 per cent) and open mesh repair in 214 (47·1 per cent). Of the 454 patients, 136 (30·0 per cent) reported chronic groin pain or discomfort, which was significantly more common after open repair than after laparoscopic repair (38·3 versus 22·5 per cent; P < 0·01). Chronic groin pain or discomfort restricted daily physical or sporting activity in 18·1 per cent of the patients. The patients who had open repair complained of significantly more restriction of daily physical activity than patients who underwent laparoscopic repair (walking, P < 0·05; lifting a bag of groceries, P < 0·01).

Conclusion

Chronic pain or discomfort was reported by 30·0 per cent of patients after groin hernia repair and was significantly more common after open mesh repair than after laparoscopic TEP repair. It restricted physical or sporting activities in 18·1 per cent of the patients and significantly more so after open mesh repair.
Appraisal of compliance with the UICC/AJCC staging system in the staging of gastric cancer
Authors: Mullaney P J , Wadley M S , Hyde C , Wyatt J , Lawrence G , Hallissey M T , Fielding J W L
Published: October 2002

Background

In the surgical management of gastric carcinoma, regional lymphatic spread is of prognostic importance. The fifth edition of the Union Internacional Contra la Cancrum classification has been shown to be reproducible, practical and of significant prognostic use. The tumour node metastasis (TNM) system requires at least 15 lymph nodes to be acquired and examined for staging to be accurate. This has raised concern over the consistency with which the requisite numbers of nodes would be acquired. This study was performed to assess how consistently surgically managed cases of gastric cancer in the West Midlands fulfilled this requirement to allow accurate staging.

Methods

Data from the West Midlands Cancer Intelligence Unit on all cases of gastric cancer registered from 1998 to 1999 were obtained and the number of lymph nodes documented for each surgically managed case was assessed.

Results

Overall, only 31.0 per cent of surgically resected cases could be assessed accurately according to the TNM system. The proportion staged accurately varied widely across hospitals from 10·9 to 76·0 per cent.

Conclusion

These results reflect the need for improved N staging across the region to aid the appropriate multimodal treatment of patients.
Effects of the combination of rapamycin with tacrolimus or cyclosporin on experimental intimal hyperplasia
Authors: Waller J R , Murphy G J , Bicknell G R , Toomey D , Nicholson M L
Published: October 2002

Background

Allograft vasculopathy remains the leading cause of late allograft failure following transplantation and can be inhibited by the antiproliferative drug rapamycin. This study assessed the efficacy of combining rapamycin therapy with calcineurin inhibition.

Methods

Male Sprague–Dawley rats received rapamycin 0·05 mg/kg daily and either tacrolimus 0·1 mg/kg or cyclosporin 5 mg/kg daily, and findings were compared with those in an untreated control group. Animals underwent left common carotid artery balloon angioplasty; the artery was explanted after 2 weeks. Morphometric analysis was performed on transverse sections and the intima: media ratio was calculated. Profibrotic gene expression was measured with competitive reverse transcriptase–polymerase chain reaction at 14 and 28 days. Proliferation was determined with proliferating cell nuclear antigen at 14 and 28 days. Extracellular matrix deposition was quantified with Sirius red.

Results

The combination of rapamycin and tacrolimus was associated with the greatest reduction in intimal thickening. Furthermore, treatment with rapamycin and tacrolimus significantly attenuated extracellular matrix deposition compared with rapamycin and cyclosporin (P < 0·02).

Conclusion

The effects of rapamycin in combination with tacrolimus were better than those observed with rapamycin and cyclosporin.
Pathogenesis and clinical management of hereditary non-polyposis colorectal cancer
Authors: Lawes D A , SenGupta S B , Boulos P B
Published: October 2002

Background

Hereditary non-polyposis colorectal cancer (HNPCC) is an inherited genetic condition associated with microsatellite instability; it accounts for around 5 per cent of all cases of colorectal cancer. This review examines recent data on management strategies for this condition.

Methods

A Medline-based literature search was performed using the keywords ‘HNPCC’ and ‘microsatellite instability’. Additional original papers were obtained from citations in articles identified by the initial search.

Results and conclusion

The Amsterdam criteria identify patients in whom the presence of an inherited mutation should be investigated. Those with a mutation should be offered counselling and screening. The role of prophylactic surgery has been superseded by regular colonoscopy, which dramatically reduces the risk of colorectal cancer. Screening for extracolonic malignancy is also advocated, but the benefits are uncertain. Chemoprevention may be of value in lowering the incidence of bowel cancer in affected patients, but further studies are required.
Cryotherapeutic ablation of liver tumours
Authors: Sheen A J , Poston G J , Sherlock D J
Published: October 2002

Background

This paper reports a 7-year experience of cryoablation for colorectal and non-colorectal liver metastases.

Methods

A retrospective review was undertaken of patients treated in two adjacent UK centres in the north-west of England.

Results

Over a 7-year period (1993–2000), 57 patients underwent cryotherapy for malignant hepatic tumours (41 colorectal, 16 non-colorectal). In the patients with colorectal metastases, preoperative carcinoembryonic antigen (CEA) levels fell significantly, from a mean of 444·1 to 6·22 µg/l (P = 0·002). One patient died, two developed cryoshock and six had cardiorespiratory complications. All patients with colorectal metastases subsequently received 5-fluorouracil-based chemotherapy. The remaining 16 patients with non-colorectal tumours (seven neuroendocrine metastases, five hepatocellular carcinomas, three sarcomas, one cholangiocarcinoma) all received cryotherapy alone, with no major complications. The median survival for patients with non-colorectal metastases was 37 months, compared with 22 months for those with colorectal metastases (P = 0·005).

Conclusion

Hepatic cryotherapy is effective and safe, as demonstrated by the significant reduction in postoperative CEA concentration and the low risk of complications. However, this initial short-term success was not reflected in 5-year survival rates. Cryotherapy for non-colorectal metastases had a greater long-term survival benefit and is a useful means of controlling symptoms.
Emergency surgeon-performed hepatobiliary ultrasonography
Authors: Kell M R , Aherne N J , Coffey C , Power C P , Kirwan W O , Redmond H P
Published: October 2002

Background

Acute hepatobiliary pathology is a common general surgical emergency referral. Diagnosis requires imaging of the biliary tree by ultrasonography. The accuracy and impact of surgeon-performed ultrasonography (SUS) on the diagnosis of emergent hepatobiliary pathology was examined.

Methods

A prospective study, over a 6-month period, enrolled all patients with symptoms or signs of acute hepatobiliary pathology. Patients provided informed consent and underwent both SUS and standard radiology-performed ultrasonography (RUS). SUS was performed using a 2–5-MHz broadband portable ultrasound probe by two surgeons trained in ultrasonography, and RUS using a 2–5-MHz fixed unit. SUS results were correlated with those of RUS and pathological diagnoses.

Results

Fifty-three consecutive patients underwent 106 ultrasonographic investigations. SUS agreed with RUS in 50 (94·3 per cent) of 53 patients. SUS accurately detected cholelithiasis in all but two cases and no patient was inaccurately diagnosed as having cholelithiasis at SUS (95·2 per cent sensitivity and 100 per cent specificity). As an overall complementary diagnostic tool SUS provided the correct diagnosis in 96·2 per cent of patients. Time to scan was significantly shorter following SUS (3·1 versus 12·0 h, P < 0·05).

Conclusion

SUS provides a rapid and accurate diagnosis of emergency hepatobiliary pathology and may contribute to the emergency management of hepatobiliary disease.
Different expression of surfactant protein B mature peptide and proprotein at 21 weeks’ gestation in human fetal pulmonary epithelial cells
Authors: Mori Kazuhiro , Ikeda Kazushige , Tanaka Mamoru
Published: October 2002

Aim
: The aim of this study is to evaluate the maturation of pulmonary epithelial cells in human fetal lungs at 21 weeks’ gestation.

Methods
: Eight fetuses at 21 weeks’ gestation were evaluated. The maturation of pulmonary epithelial cells was assessed by immunohistochemical examination for surfactant proteins and by electron microscopy.

Results
: Surfactant protein B mature peptide was detected slightly in the epithelial lining of the bronchioles, but was totally absent in the terminal airways. Surfactant protein B proprotein was clearly detected in the epithelial lining of both bronchioles and terminal airways. Transmission electron microscopy of terminal airway cells showed abundant glycogen granules and few intracellular organelles.

Conclusions
: The production of mature surfactant protein B in terminal airways is scarce at 21 weeks’ gestation, which is associated with the immature mechanism of proprotein processing in the cytoplasm.
Prevalence of Mycoplasma pneumoniae in children in Diyarbakir, the south‐east of Turkey
Authors: Bosnak Mehmet , Dikici Bunyamin , Bosnak Vuslat , Dogru Omer , Ozkan Ilker , Ceylan Ali , Haspolat Kenan
Published: October 2002

Background
: Mycoplasma pneumoniae is a well known causative agent of infection in childhood but clinical presentation may be variable. History and physical examination may not be so helpful for the diagnosis. It is difficult to culture this infectious agent, with the culture technique for the multiplication of the organism for routine investigation hard to obtain. The determination of exposure and prevalence of the disease of any region should be helpful for clinical diagnosis. In this study, we aimed to determine the seroprevalence of M. pneumoniae in children aged 0−14 years in Diyarbakir and establish the distribution of infection prevalence of various age groups of children.

Methods
: Thirty streets were determined according to the cluster method for the 0−6 years age group. In this age group, a total of 180 blood samples were collected; so that there were 30 samples for each age. For children aged 7−14 years, elementary school children were selected. There were 70 elementary schools in the city and 14 schools were randomly selected according to the randomized numbers table with a 20% sample. Finally, 276 blood samples were collected. Mycoplasma pneumoniae was determined by using the enzyme immunoassay method. For this method MELOTEST Mycoplasma IgG reagent was used.

Results
: The highest seropositivity rate was encountered at 10 years of age (65%) and lowest was at 2 years of age (0%). The overall M. pneumoniae seropositivity was 27% when all ages were considered together. The first 2 years of age excluded this rate and was 31.9%. A sudden increase of seropositivity was observed at 7 years of age.

Conclusions
: Increasing seroprevalence rates of M. pneumoniae after 2 years of age should alert clinicians to consider the organism in the differential diagnosis of infectious diseases in this age group. The low seroprevalence rates in the first 2 years of age was thought to be due to low risk of community‐based spread of the organism in this age group. The most prominent increase in seroprevalence was at 10 years of age. This data indicated that M. pneumoniae should be kept in mind while making differential diagnosis of infections. The spreading of disease and community‐based transmission is also important to consider. In our study, seroprevalence rates increased at 6 and 7 years of age, at the beginning of the school age as community‐based transmission takes place most commonly in crowded circumstances. In conclusion, M. pneumoniae should be thought as an important infectious agent in childhood for all age groups.
Comparison of treatments of chronic hepatitis B in children with lamivudine and α‐interferon combination and α‐interferon alone
Authors: Dikici Bunyamin , Bosnak Mehmet , Bosnak Vuslat , Dagli Abdullah , Davutoglu Mehmet , Yagci Rasit Vural , Haspolat Kenan
Published: October 2002

Background
: The aim of this study was to compare the efficacy of the α‐interferon treatment with treatment using α‐interferon and lamivudine in combination for cases of childhood chronic hepatitis B infection.

Methods
: Patients were evaluated in two groups retrospectively. In group 1, 27 patients were simultaneously given α‐interferon 2b 10 MU/m2, 3 days a week by s.c. injection plus lamivudine 4 mg/kg a day (maximum 100 mg) for 12 months. In group 2, there were 13 patients who only received the same dosage of α‐interferon and no lamivudine over the same period of time.

Results
: In group 1 the initial mean value of alanine aminotransferase (ALT) was 121 ± 66 IU/L and decreased to 27.8 ± 11.5 IU/L; in group 2, initial mean values of ALT was 129 ± 46 IU/L and decreased to 60 ± 6 IU/L at the end of the twelfth month of the therapy (P < 0.05). Hepatitis B virus DNA (HBV‐DNA) clearance was obtained in all group 1 patients and six of 13 patients in group 2 at the end of the therapy (P < 0.001). The rates of hepatitis B early (HBe) antigen clearance and anti‐HBe seroconversion were 59 and 37% in group 1 and 46 and 30.7% in group 2 (P > 0.05). The number of patients with complete response was found to be 10 out of 27 (37%) in group 1 and four out of 13 cases (30.7%) in group 2, 6 months after the end of the therapy. There was no statistically significant difference between both groups (P > 0.05).

Conclusion
: α‐Interferon and lamivudine combination therapy had a more beneficial effect than α‐interferon monotherapy in normalization of ALT and clearance of HBV‐DNA; however, the complete response rate at 6 months after the end of the therapy was not statistically significantly different between both groups.
Response of anti‐oxidant enzymes mRNA in the neonatal rat liver exposed to 1,2,3,4‐tetrachlorodibenzo‐p‐dioxin via lactation
Authors: Kono Yumi , Okada Shin’ichi , Tazawa Yusaku , Kanzaki Susumu , Mura Tetsuo , Ueta Etsuko , Nanba Eiji , Otsuka Yuzuru
Published: October 2002

Background
: The aim of this study was to assess the response to dioxin‐induced oxidative stress in neonates via lactation in the model we have described previously.

Methods
: Maternal rats were treated with a single dose of 50 or 100 µmol/kg 1,2,3,4‐tetrachlorodibenzo‐p‐dioxin (TCDD) on the first day postpartum (day 1). Messenger RNA levels of the key anti‐oxidant enzymes (AOE), phospholipid hydroperoxide‐glutathione peroxidase (PH‐GPx), cellular‐glutathione peroxidase (cell‐GPx), copper‐zinc superoxide dismutase (CuZn SOD), manganese superoxide dismutase (Mn SOD) and catalase (CAT) in the neonatal and maternal livers were determined by a competitive reverse transcription− polymerase chain reaction method.

Results
: Lactational transfer of 1,2,3,4‐TCDD induced an inhibition of PH‐GPx and cell‐GPx mRNA in the neonatal liver on day 2 to 68 (P < 0.01) and 62% (P < 0.05) of the control at 100 µmol/kg, respectively. Both GPx mRNA returned to control levels on day 6 and thereafter increased to levels higher than the controls on day 10. In the dam rat, 10 days after the treatment, no remarkable change of PH‐GPx or cell‐GPx mRNA was observed. Copper‐zinc superoxide dismutase and CAT mRNA of neonates on day 2 were also suppressed at 100 µmol/kg and then slightly increased on day 10. However, Mn SOD mRNA was not suppressed, but increased to a 2.1‐fold level of the control (P < 0.05) on day 10 with 100 µmol/kg 1,2,3,4‐TCDD.

Conclusion
: Quantitative analysis of AOE mRNA showed that PH‐GPx and cell‐GPx mRNA, as well as CuZn SOD and CAT mRNA in the neonatal liver were suppressed for a short period of time by 1,2,3,4‐TCDD exposure via lactation. Dioxin induced oxidative stress by lactational transfer may alter pretranslation regulation of protective AOE in neonates.
Prevalence of gastro‐esophageal reflux‐related symptoms in Japanese infants
Authors: Miyazawa Reiko , Tomomasa Takeshi , Kaneko Hiroaki , Tachibana Atsushi , Ogawa Tetsushi , Morikawa Akihiro
Published: October 2002

Background
: To obtain precise information on the natural course of gastro‐esophageal reflux (GER)‐related symptoms in Japanese children, we surveyed the prevalence of regurgitation or vomiting and other GER‐related symptoms and complications in infants visiting for healthy baby check‐ups.

Methods
: We interviewed the mothers of 921 infants who had visited for baby check‐ups at 1, 4, 7 and 12 months after birth, about the number of regurgitation or vomiting episodes per day, other GER‐related symptoms, milk volume, feeding interval, and the body position after feeding.

Results
: Of 1‐month‐old infants, 47.1% had one or more regurgitation or vomiting episode per day. This proportion decreased to 28.8% at 4 months old and 6.4% at 7 months old. The proportion of infants with three or more episodes of these symptoms per day showed a similar pattern. There was no significant difference in the prevalence of regurgitation or vomiting between breast‐fed infants and formula‐fed or mixed‐feeding infants either at 1 or 4 months of age. There was no significant difference in the bodyweight gain of 3‐month‐old infants among those with various degrees of regurgitation. There was no significant difference in the frequency of regurgitation or vomiting episodes between infants placed in a vertical position and those placed in a horizontal position after feeding. No infant had a history of chronic coughing, wheezing, bleeding or other serious conditions.

Conclusions
: Regurgitation is a common symptom in Japanese infants and decreases spontaneously with age. The natural history of GER must be taken into consideration when deciding the treatment.
Randomized controlled trial of magnesium sulfate infusion for severe birth asphyxia
Authors: Ichiba Hiroyuki , Tamai Hiroshi , Negishi Hirokuni , Ueda Toru , Kim Tae‐Jang , Sumida Yutaka , Takahashi Yukihiro , Fujinaga Hideshi , Minami For The Kansai Magnesium Study Group Hirotaka
Published: October 2002

Objective: To determine whether postnatal MgSO4infusion (250 mg/kg per day) for 3 days is both safe and able to improve outcome in infants with severe birth asphyxia, as had been suggested by a small pilot study.

Methods: A multicenter randomized controlled trial was conducted. Entry criteria included 5‐min Apgar score of seven or less and either failure to initiate spontaneous respiration at 10 min after birth because of asphyxia, or occurrence of clinically apparent seizures within 24 h after birth. Number of subjects was calculated to detect a 50% reduction in incidence of adverse outcomes.

Results: Distributions of perinatal factors, neonatal baseline characteristics and severity of hyoxic‐ischemic encephalopathy were similar in treated and control groups. No significant differences were observed in duration of clinical seizures, or need for assisted ventilation. Survival with normal results of cranial computed tomography, electroencephalography and establishment of oral feeding by 14 days of age, was significantly more frequent in the treated group than in the control group (12/17vs5/16,P = 0.04). No significant differences in blood pressure, heart rate or respiratory rate were observed between groups.

Conclusion: Postnatal MgSO4infusion as above is safe and can improve short‐term outcome in infants with severe birth asphyxia.
Development of chronic lung disease in preterm infants treated with surfactant
Authors: Hammoud Majeda S , Thalib Lukman
Published: October 2002

Background
: Chronic lung disease (CLD) is generally known to develop among preterm infants who have severe respiratory distress syndrome (RDS) at birth. Many clinical trials have established the efficacy of surfactant replacement therapy to treat RDS at birth with differing doses. In this study, the preterm infants diagnosed to have RDS at birth and treated with one or two doses of surfactant, depending on the severity of the RDS, were studied to evaluate the effect of surfactant on the later development of CLD.

Methods
: A retrospective examination of case records of preterm infants who were born at ≤28 weeks gestation period were studied. The subjects received a natural surfactant product (survanta) between September 1994 and April 1996 at the Monash Medical Center, Australia.

Results
: Despite less severe initial lung disease, the subsequent respiratory outcome of infants who received one dose of surfactant, showed a trend towards being poorer compared to those who were diagnosed as having severe RDS at birth and received two doses of surfactant. At the corrected gestational age of 36 weeks, 54% of those infants began with mild RDS required oxygen, while only 44% of those who started with a severe RDS required supplemental O2.

Conclusion
: This study reports the infants with severe RDS at birth had responded slightly better or equally, compared to those with mild RDS, in terms of later development of CLD under surfactant treatment proportional to the severity.
Follow‐up study of auditory brainstem responses in infants with high unbound bilirubin levels treated with albumin infusion therapy
Authors: Hosono Shigeharu , Ohno Tsutomu , Kimoto Hirofumi , Nagoshi Ren , Shimizu Masaki , Nozawa Masayo , Harada Kensuke
Published: October 2002

Background
: Several authors reported that there was a close relationship between unbound bilirubin concentrations and abnormal results of auditory brainstem responses. Full‐term infants with high‐unbound bilirubin concentrations who were treated with human albumin were followed to evaluate their hearing abilities by using auditory brainstem responses.

Methods
: Fifty‐eight infants (gestational age, 39.4 ± 1.4 weeks; birthweight, 3245 ± 435 g) with high unbound bilirubin concentrations (≥0.9 µg/dL) were treated with intensive phototherapy. Twenty infants (control group) received only phototherapy, while 38 others (albumin‐treated group) were also given i.v. human albumin administration (1 g/kg bodyweight) during the first 2 h of phototherapy. The follow‐up study of auditory brainstem responses was carried out at 6 and 12 months of age. Development quotient tests were carried out at 18 months of age.

Results
: Abnormalities of auditory brainstem response were detected in three infants in the albumin‐treated group and six infants in the control group at 6 months. Two infants in the albumin‐treated group and four infants in the control group had improved at 12 months. The results of the follow‐up study at 18 months of age in the both groups were normal with development quotient >85. No patients with hearing disability and cerebral palsy were clinically detected at the age of 2 years.

Conclusion
: The results suggest that albumin priming might be effective for decreasing the rate of auditory brainstem response abnormalities at 6 months.
Current respiratory syncytial virus prevention strategies in high‐risk infants
Authors: Weisman Leonard E
Published: October 2002

Respiratory syncytial virus (RSV) was initially isolated in 1956. Since then it has become recognized as a major pathogen worldwide. It is a ubiquitous pathogen that produces seasonal epidemics. Primary infection occurs in children before 2 years of age. In older children and adults, RSV usually manifests itself as an upper respiratory tract infection. In immunecompromised patients, those with underlying cardiopulmonary disorders, premature infants, and other vulnerable individuals, RSV infection can produce severe bronchiolitis or pneumonia. In recent years we have observed exciting new information about the prevention of serious RSV infection in high‐risk infants including infection control practices, active immunity and passive immunity. Two immunoprophylaxis products (RSV i.v. immune globulin and palivzumab) have been developed for clinical use in the prevention of serious RSV infection. Many other agents including vaccines, super monoclonal antibodies, and antivirals are under development. Although clinicians now have the ability to provide their most vulnerable patients with meaningful prevention strategies, much more needs to be done before we can regard RSV as a preventable disease.
Management of childhood diseases during the Byzantine period: V − Hydrocephalus
Authors: Ramoutsaki Ioanna A , Dimitriou Helen , Markaki Erasmia‐A , Kalmanti Maria
Published: October 2002

Abstract Hydrocephalus was a recognizable medical problem during the Byzantine period. In the medical texts of the time it was attributed to the pressure that was applied on the newborn's head during labour. The suggested treatments focused on the relief of the symptoms only and surgical methods were believed to be helpful in very rare cases.
Management of childhood diseases during the Byzantine period: VI − Ocular diseases
Authors: Ramoutsaki Ioanna A , Dimitriou Helen , Kalmanti Maria
Published: October 2002

Abstract Ocular manifestations were recognizable and are reported in the Byzantine medical treatises from the 4th to the 15th century AD. Herbal, mineral and chemical substances in the form of collyria were used by the Byzantine physicians for the treatment of ocular abnormalities and ophthalmic diseases of the childhood. Surgical intervention was not recommended at this age.
Management of childhood diseases in the Byzantine period: VII − Epilepsy
Authors: Ramoutsaki Ioanna A , Dimitriou Helen , Kalmanti Maria
Published: October 2002

Abstract Epilepsy was referred to as a serious medical problem with poor outcome by the Byzantine physicians. For the treatment they suggested herbal or animal substances in many different forms, but they stressed the importance of a proper diet. In their efforts to elucidate the mechanisms involved in the onset as well as the course of the disease they were influenced by the Hippocratic tradition of juices.
Financial Effect of a Hospital Outpatient Senior Clinic on an Academic Medical Center
Authors: Dang Stuti , Baker Glen , Lipschitz David A.
Published: October 2002

OBJECTIVES: To estimate the billed charges generated for the university hospital (UH) by patients seen in a UH outpatient senior clinic over a 6‐month period. To estimate the average billed charges per geriatric patient generated for the UH over the same 6‐month period.

DESIGN: Retrospective analysis.

SETTING: Hospital‐based outpatient senior clinic at a university medical center.

PARTICIPANTS: Outpatients aged 65 and older.

MEASUREMENTS: The total inpatient, outpatient, and professional fee charges generated for the UH by the senior health center (SHC) patients were estimated for a 6‐month period, with the use of billing data from the professional and hospital billing systems. To estimate the multiplier effect and average charges per SHC patient per year, our analysis focused on professional charges generated directly in the SHC and professional fees and hospital charges generated by secondary referral (inpatient and outpatient).

RESULTS: One thousand nine hundred ninety‐eight patients were seen in the SHC during the 6‐month period. For every $1 billed in professional charges in the SHC, $17 was billed elsewhere in the hospital system. Geriatric medicine professional charges generated by the 1,998 SHC patients over the 6‐month period totaled $546,691. The 6‐month charges by the rest of the hospital system for the same 1,998 patients included hospital inpatient charges of $4,684,195 for all departments; hospital outpatient charges (ancillary plus technical, including facility fees for the SHC) of $3,027,212; and professional fees of $1,606,287 for other departments, thereby producing a multiplier factor of 17. The average overall charges per geriatric patient per 6 months totaled $4,937, which included hospital inpatient, hospital outpatient, and professional fees. The UH generated an average of $3,860 in hospital charges per SHC patient per 6 months. The average hospital charges generated per established SHC patient per 6 months were $2,936. The average hospital charges for a new SHC patient were $7,187 per 6 months. The average professional charges were $1,078 per patient per 6 months.

CONCLUSIONS: This study provides a reasonable estimate of the substantial multiplier, or “flow‐through,” effect of a senior clinic on its parent medical center. Although senior clinics may be a cost center when viewed in isolation, these clinics are actually revenue generators when viewed from the perspective of the entire health system.
Central Nervous System–Active Medications and Risk for Falls in Older Women
Authors: Ensrud Kristine E. , Blackwell Terri L. , Mangione Carol M. , Bowman Paula J. , Whooley Mary A. , Bauer Douglas C. , Schwartz Ann V. , Hanlon Joseph T. , Nevitt Michael C. , For The Study of Osteoporotic Fractures Research Group
Published: October 2002

OBJECTIVES: To determine whether current use of central nervous system (CNS)‐active medications, including benzodiazepines, antidepressants, anticonvulsants, and narcotics, increases the risk for subsequent falls.

DESIGN: Prospective cohort study.

SETTING: Four clinical centers in Baltimore, Maryland; Portland, Oregon; Minneapolis, Minnesota; and the Monongahela Valley, Pennsylvania.

PARTICIPANTS: Eight thousand one hundred twenty‐seven women aged 65 and older participating in the fourth examination of the Study of Osteoporotic Fractures between 1992 and 1994.

MEASUREMENTS: Current use of CNS‐active medications was assessed with an interviewer‐administered questionnaire with verification of use from medication containers. A computerized dictionary was used to categorize type of medication from product brand and generic names. Incident falls were reported every 4 months for 1 year after the fourth examination.

RESULTS: During an average follow‐up of 12 months, 2,241 women (28%) reported falling at least once, including 917 women (11%) who experienced two or more (frequent) falls. Compared with nonusers, women using benzodiazepines (multivariate odds ratio (MOR) = 1.51, 95% confidence interval (CI) = 1.14–2.01), those taking antidepressants (MOR = 1.54, 95% CI = 1.14–2.07), and those using anticonvulsants (MOR = 2.56, 95% CI = 1.49–4.41) were at increased risk of experiencing frequent falls during the subsequent year. We found no evidence of an independent association between narcotic use and falls (MOR = 0.99 for frequent falling, 95% CI = 0.68–1.43). Among benzodiazepine users, both women using short‐acting benzodiazepines (MOR = 1.42, 95% CI = 0.98–2.04) and those using long‐acting benzodiazepines (MOR = 1.56, 95% CI = 1.00–2.43) appeared to be at greater risk of frequent falls than nonusers, although the CIs overlapped 1.0. We found no evidence to suggest that women using selective serotonin‐reuptake inhibitors (MOR = 3.45, 95% CI = 1.89–6.30) had a lower risk of frequent falls than those using tricyclic antidepressants (MOR 1.28, 95% CI = 0.90–1.84).

CONCLUSIONS: Community‐dwelling older women taking CNS‐active medications, including those taking benzodiazepines, antidepressants, and anticonvulsants, are at increased risk of frequent falls. Minimizing use of these CNS‐active medications may decrease risk of future falls. Our results suggest that fall risk in women taking benzodiazepines is at best marginally decreased by use of short‐acting preparations. Similarly, our findings indicate that preferential use of selective serotonin‐reuptake inhibitors is unlikely to reduce fall risk in older women taking antidepressants.
Hip Fracture Incidence in Nursing Home Residents and Community‐Dwelling Older People, Washington State, 1993–1995
Authors: Sugarman Jonathan R. , Connell Frederick A. , Hansen Amy , Helgerson Steven D. , Jessup Michael C. , Lee Helan
Published: October 2002

OBJECTIVES: To establish and validate a method of linking data from the Minimum Data Set (MDS) and Medicare hospital claims, to estimate hip fracture incidence rates for Medicare beneficiaries aged 65 and older in Washington State, and to compare the incidence rates of hip fractures in nursing home and non‐nursing home residents.

DESIGN: Retrospective analysis of Medicare population‐based enrollment, hospital claims, and nursing home administrative data sets.

SETTING: Nursing home and non‐nursing home setting.

PARTICIPANTS: Medicare beneficiaries in Washington State residing in the community or in skilled nursing facilities.

MEASUREMENTS: Crude age‐ and sex‐specific and standardized age‐ and sex‐adjusted hip fracture incidence for persons residing and not residing in nursing homes.

RESULTS: From October 1, 1993, through September 30, 1995, 7,812 Medicare beneficiaries aged 65 or older were hospitalized for hip fractures (6,566 fractures for 1,155,234 person‐years of exposure in non‐nursing home residents and 1,246 fractures for 42,986 person‐years of exposure in nursing home residents). The standardized age‐ and sex‐adjusted hip fracture rate of nursing home residents (23.0 per 1,000 person‐years) substantially exceeded that of non‐nursing home residents (5.7 per 1,000 person‐years) (incidence rate ratio = 4.0, 95% confidence interval = 3.7–4.5).

CONCLUSION: The incidence of hip fracture in nursing home residents far exceeds that in noninstitutionalized older people. Linkage of MDS and Medicare hospital claims data is a useful tool for epidemiological surveillance regarding events in nursing homes that are likely to result in hospitalization.
Mortality, Disability, and Nursing Home Use for Persons with and without Hip Fracture: A Population‐Based Study
Authors: Leibson Cynthia L. , Tosteson Anna N. A. , Gabriel Sherine E. , Ransom Jeanine E. , Melton L. Joseph
Published: October 2002

OBJECTIVES: To compare persons with and without hip fracture for subsequent mortality and change in disability and nursing home (NH) use.

DESIGN: Population‐based historical cohort study.

SETTING: Olmsted County, Minnesota.

PARTICIPANTS: All residents who experienced a first hip fracture between January 1, 1989, and December 31, 1993, and, for each case, a resident of the same sex and similar age who had not experienced a hip fracture and was seen by a local care provider.

MEASUREMENTS: Data on disability (Rankin score), comorbidity (Charlson Index), and NH residency before baseline (fracture date for cases and registration date for controls) were obtained by review of complete community‐based medical records. The records were then reviewed from baseline through December 31, 1994, for Rankin disability at 1 month and 1 year, all NH admissions and discharges, and date of death for those who died.

RESULTS: There were 312 cases and 312 controls (81% female, mean age ± standard deviation = 81 ± 12 years). Before baseline, cases had higher comorbidity (45% vs 30% had Charlson Index ≥ 1, P < .001) and disability (mean Rankin score = 2.5 ± 1.1 vs 2.2 ± 1.1, P < .001) and were more likely to be in a NH (28% vs 18%, P < .001) than controls. One year after baseline, estimated mortality was 20% (95% confidence interval (CI) = 16–24) for cases vs 11% (95% CI = 8–15) for controls, 51% of cases versus 16% of controls had a level of disability one or more units worse than before baseline (P < .001), and the cumulative incidence of first NH admission was 64% (95% CI = 58–71) for cases versus 7% (95% CI = 4–11) for controls. The risk of NH admission for cases relative to controls diminished over time, but remained elevated 5 years after the event (risk ratio = 20.0 at 3 months and 2.1 at 5 years), but, in persons admitted to a nursing home, cases were two times more likely than controls to be discharged alive within a year (P < .001).

CONCLUSIONS: Hip fracture is an important contributor to disability and NH use, but the potential savings from hip fracture prophylaxis may be overestimated by studies that fail to consider differential risk, mortality, and long‐term follow‐up.
The Effect of Comorbid Illness on Receipt of Cancer Screening by Older People
Authors: Heflin Mitchell T. , Oddone Eugene Z. , Pieper Carl F. , Burchett Bruce M. , Cohen Harvey Jay
Published: October 2002

OBJECTIVES: To identify associations between the type and number of diagnoses and receipt of screening for breast, cervical, and colorectal cancer by older people.

DESIGN: Sixth annual follow‐up of a community‐based survey with 4,162 participants aged 65 and older at baseline in 1986.

SETTING: Piedmont area of North Carolina

PARTICIPANTS: Two thousand two hundred twenty‐five subjects with a mean age of 79 who responded in 1992.

MEASUREMENTS: Self‐reported receipt of clinical breast examination, mammography, Papanicolaou (Pap) smear, and fecal occult blood testing (FOBT) within the 2 years before the survey.

RESULTS: Hip fracture was associated with lower rates of mammography (odds ratio (OR) = 0.53, 95% confidence interval (CI) = 0.32–0.87) and cognitive impairment with lower rates of FOBT (OR = 0.71, 95% CI = 0.54–0.94). Hypertension was associated with higher rates of breast examination (OR = 1.56, 95% CI = 1.18–2.07), Pap smear (OR = 1.41, 95% CI = 1.09–1.83), and FOBT (OR = 1.37, 95% CI = 1.12–1.66) and a trend toward increasing rates of mammography (OR = 1.28, 95% CI = 0.98–1.69). The presence of three or more comorbid conditions was associated with an increased rate of mammography (OR = 1.35, 95% CI = 1.06–1.71), breast examination (OR = 1.46, 95% CI = 1.12–1.89), and Pap smear (OR = 1.31, 95% CI = 1.04–1.65).

CONCLUSIONS: With few exceptions, the presence of comorbid conditions is not associated with a decreased rate of receipt of screening. In fact, hypertension and the presence of a higher number of comorbid conditions are associated with a higher rate of receipt of cancer screening. This finding may be due to an increase in the frequency of office visits increasing the opportunity for cancer screening.
Survival Benefits of Angiotensin‐Converting Enzyme Inhibitors in Older Heart Failure Patients with Perceived Contraindications
Authors: Ahmed Ali , Kiefe Catarina I. , Allman Richard M. , Sims Richard V. , DeLong James F.
Published: October 2002

OBJECTIVES: To determine the association between angiotensin‐converting enzyme (ACE) inhibitor therapy and survival of older heart failure patients with conditions perceived by physicians as contraindications to ACE inhibitors.

SETTING: Hospital.

DESIGN: Retrospective follow‐up study.

PARTICIPANTS: Hospitalized older heart failure patients with systolic blood pressure of 90 mmHg or less, serum creatinine of 2.5 mg/dL or more, serum potassium of 5.5 mmol/L or more, or severe aortic stenosis.

MEASUREMENTS: One‐year postdischarge mortality (with and without adjustment for various patient and care characteristics). Logistic regression analyses were used to estimate the effect of the perceived contraindications on subsequent use of ACE inhibitors. Using Cox proportional hazards models, crude and adjusted hazard ratios (HRs) of 1‐year mortality with 95% confidence intervals (CIs) were estimated for patients discharged on ACE inhibitors and compared with those without. HRs were estimated for all patients and were repeated after stratifying patients based on the presence of perceived contraindications to ACE inhibitor use.

RESULTS: Of the 295 subjects, 52 (18%) had conditions perceived as contraindications, 186 (63%) received ACE inhibitors, and 107 (40%) died within 1 year of discharge. Presence of a perceived contraindication was independently associated with underutilization of ACE inhibitors on discharge (adjusted OR = 0.35, 95% CI = 0.17–0.71). ACE inhibitor prescription at discharge was associated with lower 1‐year mortality overall (HR = 0.58, 95% CI = 0.40–0.85) and for the groups of patients with (HR = 0.34, 95% CI = 0.14–0.81) and without (HR = 0.66, 95% CI = 0.42–1.02) perceived contraindications.

CONCLUSIONS: ACE inhibitor use was associated with a significant survival benefit in this cohort of hospitalized older heart failure patients with perceived contraindications.
Bloodstream Infection: Differences Between Young‐Old, Old, and Old‐Old Patients
Authors: Gavazzi Gaetan , Mallaret Marie‐Reine , Couturier Pascal , Iffenecker Anne , Franco Alain
Published: October 2002

OBJECTIVES: To compare the epidemiological and microbiological characteristics of bloodstream infection (BSI) between the young old (65–75), old (76–85), and old old (>85).

DESIGN: Retrospective study.

SETTING: Forty‐six hospitals in southeast France.

PARTICIPANTS: One thousand seven hundred forty patients aged 65 and older with BSI, seen between January 1 and December 31, 1998.

MEASUREMENTS: Epidemiological and microbiological data and outcome.

RESULTS: Community‐acquired BSIs (CABSIs) were significantly more frequent in the old old, but microbiological data were similar to those in the young‐old group. Conversely, microbiological data were significantly different for nosocomial BSIs (NSBIs). Escherichia coli was the main pathogen in the old old and Staphylococcus aureus in the young old. Mortality was independently associated with the presence of methicillin‐resistant S. aureus in NSBI and CABSI.

CONCLUSIONS: The differences in NBSI are important in serious infectious diseases and often require empirical antibiotic therapy. Age is also a risk factor but only for CABSI and suggests that the old‐old patients represent a frail population in the community. Further prospective studies are needed to confirm these findings and analyze predisposing factors.
Detecting Helicobacter Pylori Infection in Hospitalized Frail Older Patients: The Challenge
Authors: Salles‐Montaudon Nathalie , Dertheil Sylvia , Broutet Nathalie , Gras Nathalie , Monteiro Lurdes , De Mascarel Antoine , Megraud Francis , Emeriau Jean‐Paul
Published: October 2002

OBJECTIVES: Helicobacter pylori infection has not been well studied in older people, especially in hospitalized, frail patients. The aim of our study was to evaluate the prevalence of the infection in this population using five H. pylori diagnostic tests.

DESIGN: Prospective observational study.

SETTING: Geriatric acute care unit of the Department of Geriatrics (Hôpital Xavier Arnozan, Pessac, France).

PARTICIPANTS: One hundred seven consecutively hospitalized patients with a diagnostic indication for upper gastrointestinal endoscopy.

MEASUREMENTS: Geriatric assessment, information on drug intake, indication/results of gastric endoscopy, and results of H. pylori infection diagnostic tests (culture and histological analysis on biopsy specimens, serology, 13carbon‐urea breath test (13C‐UBT), detection of H. pylori stool antigens (HpSA)) were assessed for each included patient.

RESULTS: Fifty‐one patients (47.7%) were H. pylori positive with at least one test. 13C‐UBT was more frequently positive than the other four tests, with a significant difference from culture, histological analysis, and HpSA (P < .05). Positive 13C‐UBT results were significantly associated with H. pylori presence using histological analysis and neutrophil activity of the antrum and corpus. Antibiotic treatments significantly decreased the positivity rate of all of the tests performed, and severe corpus atrophy decreased the positivity rate of culture, histological analysis, and HpSA.

CONCLUSIONS: Almost one‐third of the H. pylori–positive patients would have remained undetected without performing the 13C‐UBT. The low prevalence of H. pylori detection in these hospitalized, frail patients may be explained by the high frequency of current and previous antibiotic treatments.