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Selected Abstracts From
Other Journals
Edited by: A. A.
Gehani and M. Hammoudeh
Hamad Medical Corporation, Doha, Qatar
Neurologic Worsening During
the Acute Phase of Ischemic Stroke
Christian
Weimar ,
MD; Thomas Mieck, MD; Joachim Buchthal,
MD; Christiane E. Ehrenfeld, MD;
Elisabeth Schmid, MD; Hans-Christoph
Diener, MD
German Stroke Study Collaboration
Background: Although capacities for
intensive monitoring
of patients with stroke are still limited,
patients at risk for early neurologic worsening
are poorly defined.
Objective: To identify patients at
risk for neurologic
worsening.
Design: An inception cohort was
assessed using the National
Institutes of Health Stroke Scale (NIH-SS) at
hospital admission and again 48 to 72 hours
later.
Setting: Eleven
neurologic departments with acute stroke
units.
Patients: A total of 1964
consecutive patients admitted
within 4 hours of the onset of acute cerebral
ischemic symptoms.
Main Outcome Measures: Underlying
reasons for and possible
predictors of neurologic worsening.
Results: A total of 256 patients
(13.0%) had an increased
score of 1 point or more on the NIH-SS after 48
to 72 hours. Neurologic worsening was attributed
to progressive stroke in 33.6% of patients,
increased intracranial pressure in 27.3%,
recurrent cerebral ischemia in 11.3%, and
secondary parenchymal hemorrhage in 10.5%. A
multivariate logistic regression analysis
identified internal carotid artery occlusion,
medial cerebral artery (M1) occlusion,
territorial infarction, brainstem infarction,
and diabetes mellitus as independent predictors
of neurologic worsening on the NIH-SS. Worsening
of key neurologic functions (consciousness,
gaze, arm or leg motor function, and speech)
occurred in 223 patients (11.4%), and worsening
of 4 points or more on the NIH-SS total score
occurred in 148 patients (7.5%).
Conclusion:
Besides initial stroke severity and comorbid
conditions, ultrasound and imaging can provide
valuable information about the risk of worsening
of stroke symptoms in the acute phase and thus
can identify patients who could benefit most
from intensive monitoring.
Weimar C, Mieck T, Buchthal j,
et al. Arch Neurol. 2005; 62: 393-397
Increased Prevalence of
Chronic Rhinosinusitis in Carriers of a
Cystic Fibrosis Mutation
Objective:
To explore whether there is an increased
prevalence of chronic rhinosinusitis (CRS) in
known cystic fibrosis (CF) carriers.
Self-reported CRS affects 13% to 14% of the US
population and clusters in families, which
suggests that genetic factors may play an
etiologic role. Cystic fibrosis is an inherited
recessive disorder that invariably affects the
sinuses. The frequency of CF mutations has been
reported to be higher in patients with CRS than
in unaffected controls.
Patients: Obligate CF carriers
(parents of patients with
CF) were recruited from the Johns Hopkins CF
clinic. The presence of signs and symptoms of
CRS was assessed by a sinus disease
questionnaire. A subgroup of participants was
evaluated by a physician experienced in the
diagnosis of CRS.
Results: Fifty-three (36%) of 147
obligate CF carriers
who returned a completed questionnaire had
self-reported CRS. Twenty-three CF carriers (14
with and 9 without CRS based on self-reporting
in the questionnaire) were clinically evaluated.
Seven were diagnosed as having CRS (all 7 with
self-reported CRS), while another 6 had allergic
rhinitis or recurrent acute rhinosinusitis (all
6 with self-reported CRS), and 10 had no
evidence of active sinus disease (1 with
self-reported CRS). The sensitivity (100%) and
specificity (56%) of the questionnaire for
physician-diagnosed CRS was similar to that of
other survey instruments used to estimate the
prevalence of self-reported CRS in the general
population.
Conclusion: Carriers of a
single CF mutation have a higher
prevalence of CRS than the general population.
Wang X, Kim J,
Mcwilliams R, et al. 2005; 131: 237-240
Interest in Facial Plastic and
Reconstructive Surgery
Among Otorhinolaryngologists
A Survey in the Netherlands
Objective:
To assess the
interest of Dutch otorhinolaryngologists in
facial plastic and reconstructive surgery (FPRS).
Methods: We conducted a
22-question survey among otorhinolaryn-gology
physicians and residents concerning their
experience with and interest in FPRS. The
response rate was 71% (335/475; 275 physicians
and 60 residents).
Results: Most respondents associated
FPRS with rhinoplasty,
otoplasty, and the reconstruction of skin cancer
defects. Of the physicians, 81% said that 1% to
33% of their practice involves FPRS; 62% were
satisfied with this percentage, whereas 36%
would like it to be higher. Approximately 70% of
physicians regarded their training in FPRS as
insufficient, although most (70%) had taken
supplementary courses. Moreover, 73% of the
otorhinolaryngology physicians and 72% of all
respondents said that FPRS should be taught
during and after residency, with a preference
for hands-on courses. Finally, 84% of all
respondents thought that FPRS should be part of
the field of otorhinolaryngology, whereas 48%
thought that it should become a subspecialty.
Conclusion: There is interest in
integrating FPRS training
into the Dutch otorhinolaryngology residency
program, as it is in the United States.
Van Pinxteren SAT, Lohuis PJFM,
Ingels KJAO, et al,2005; 7: 138-142
Need for Eye Care Among Older
Adults With Diabetes Mellitus in
Fee-for-Service and Managed Medicare
Objective:
To compare rates of need for eye care among
Medicare beneficiaries with network-model
Medicare+Choice (MC) and fee-for-service (FFS)
health insurance.
Methods: Cross-sectional study of a
random sample of MC
and FFS community-dwelling Medicare
beneficiaries with diabetes who are older than
65 years of age in Los Angeles County. Study
ophthalmologists masked to the participants’
type of health insurance performed standardized
dilated eye examinations and indicated the need
for ophthalmic care during the next 6 months. To
evaluate the association between type of
insurance and need for treatment, we constructed
logistic regression models adjusted for
participant sociodemographic and clinical
characteristics.
Results: The 311 MC and 107 FFS
respondents reported comparable
rates of eye care provider visits and
preexisting eye diseases. However, on masked
clinical examination, MC respondents were more
likely to have diabetic retinopathy, visually
significant cataract, glaucoma, or suspected
glaucoma than FFS participants (68% vs 46%,
P<.001). In multivariate analyses, persons
enrolled in MC were significantly more likely
than FFS participants to require further
treatment during the next 6 months (42% vs 24%,
P = .01).
Conclusions: Data from standardized
study ophthalmic examinations
suggest high rates of unrecognized and untreated
eye diseases among Medicare beneficiaries
enrolled in both FFS and MC and significantly
higher rates of need for care among MC
participants.
Brown AF, Jiang L, Fong DS, et
al. 2005; 123: 669-675
Hemodynamic Changes During
Laparoscopic Gastric Bypass Procedures
Dominick
Artuso, MD; Michael Wayne, DO; Sebastiano
Cassaro, MD;
Thomas Cerabona, MD; Julio Teixeira, MD; Robert
Grossi, MD
Hypothesis:
Significant
detrimental intra-operative hemodynamic and
respiratory changes occur in the morbidly obese
during laparoscopic gastric bypass.
Design: Case series.
Setting: Tertiary care university
hospital.
Patients: Thirteen patients, 10 women
and 3 men, undergoing
uncomplicated laparoscopic gastric bypass for
morbid obesity.
Interventions: Using a pulmonary
artery catheter and an
arterial line, we intraoperatively monitored
hemodynamic and respiratory parameters.
Parameter values were recorded at set points of
the procedure, and the changes were
statistically analyzed.
Results: Significant hemodynamic and
respiratory changes,
mostly unfavorable, occur in the morbidly obese
when creating the pneumoperitoneum in
preparation for laparoscopic gastric bypass. The
hemodynamic changes are attenuated when the
patient is placed in the reverse Trendelenburg
position and almost completely corrected when
the abdomen is deflated at the completion of the
procedure. The respiratory changes are more
persistent.
Conclusions: Laparoscopic gastric
bypass surgery for morbid
obesity leads to a number of predominantly
detrimental, if temporary, respiratory and
hemodynamic changes, which are most pronounced
at the time of creation of the pneumoperitoneum.
In the presence of significant cardiopulmonary
comorbidities, the use of invasive
intra-operative hemodynamic monitoring of the
morbidly obese undergoing laparoscopic gastric
bypass appears therefore justified.
Arch Surg. 2005; 140: 289-292.
Postoperative Mortality and
Morbidity in French Patients Undergoing
Colorectal Surgery:
Results of a Prospective Multicenter Study
Arnaud Alves,
MD, PhD; Yves Panis, MD, PhD; Pierre Mathieu,
MD;
Georges Mantion, MD; Fabrice Kwiatkowski, MD;
Karem Slim, MD;
f
or the Association Française de Chirurgie
Hypothesis: Better knowledge of
independent risk factors
might decrease mortality and morbidity rates
following colorectal surgery.
Design: Prospective multicenter
study.
Interventions: From June to
September 2002, consecutive
patients undergoing open or laparoscopic surgery
(electively or on an emergent basis) for
colorectal cancers or diverticular disease were
prospectively included. Exclusion criteria were
colectomy for other causes (eg, inflammatory
bowel diseases, benign polyps). The structured
sheet of data collection included more than 200
items on all perioperative data concerning the
patient, the disease, and the operating
surgeons. Postoperative mortality and morbidity
were defined as in-hospital death and
complications.
Results: Among 1421 patients, the
in-hospital death rate
was 3.4% and the overall morbidity rate was 35%.
Four independent preoperative risk factors of
mortality were found: emergency surgery, loss of
more than 10% of weight, neurological
comorbidity, and age older than 70 years. Six
independent risk factors of morbidity were
found: age older than 70 years, neurologic
comorbidity, hypoalbuminemia, cardiorespiratory
comorbidity, long duration of operation, and
peritoneal contamination.
Conclusion: Colorectal resection in
France is associated
with a 3.4% mortality rate and a 35% morbidity
rate. Knowledge of the risk factors could help
surgeons manage cases.
Arch Surg. 2005; 140:
278-283 |
