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Methods@#We examined 242 patients (age >60 years) who underwent surgery for thoracic to lumbar spine fractures from 2010 to 2020. Subsequently, the maxVB was classified into three groups: maxVB (0), maxVB (2–8), and maxVB (9–18), and parameters, including fracture morphology (new Association of Osteosynthesis classification), fracture level, and neurological deficits were compared. In a sub-analysis, 146 patients with thoracolumbar spine fractures were classified into the three aforementioned groups based on the maxVB and compared to determine the optimal operative technique and evaluate surgical outcomes. @*Results@#Regarding the fracture morphology, the maxVB (0) group had more A3 and A4 fractures, whereas the maxVB (2–8) group had less A4 and more B1 and B2 fractures. The maxVB (9–18) group exhibited an increased frequency of B3 and C fractures. Regarding the fracture level, the maxVB (0) group tended to have more fractures in the thoracolumbar transition region. Furthermore, the maxVB (2–8) group had a higher fracture frequency in the lumbar spine area, whereas the maxVB (9–18) group had a higher fracture frequency in the thoracic spine area than the maxVB (0) group. The maxVB (9–18) group had fewer preoperative neurological deficits but a higher reoperation rate and postoperative mortality than the other groups. @*Conclusions@#The maxVB was identified as a factor influencing fracture level, fracture type, and preoperative neurological deficits. Thus, understanding the maxVB could help elucidate fracture mechanics and assist in perioperative patient management.
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The case is that of a 90-years-old man. A previous doctor performed abdominal graft replacement for an abdominal aortic aneurysm 5 years earlier and continued outpatient CT follow-up. Follow-up CT showed the right aortic arch and dilation of the thoracic aortic aneurysm, and the patient was referred to our hospital. Contrast-enhanced CT showed an aortic arch aneurysm ; the aneurysm diameter was 62 mm in major axis and 60 mm in minor axis, which was judged to be suitable for surgery. It was a rare right-sided aortic arch with no congenital heart malformation and no situs inversus. Endovascular treatment was considered because he was 90 years old and very elderly, but there were concerns about the risk of embolism, irregular manipulation and central landing. For the surgical method, we selected total arch replacement using a frozen elephant trunk technique. We succeeded in avoiding serious complications by selecting an appropriate treatment method through careful evaluation.
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<b>Background</b> : This study was performed to evaluate surgical outcomes after cardiovascular surgery (including urgent surgery) in patients 85 or older. <b>Methods</b> : A retrospective analysis was performed on 39 patients (mean age, 86.3 years ; age range, 85-90 years) who underwent total arch replacement (<i>n</i>=4), ascending aorta replacement (<i>n</i>=4), descending aorta replacement (<i>n</i>=1), aortic valve replacement (AVR ; <i>n</i>=13), mitral valve replacement or valvuloplasty (<i>n</i>=3), coronary artery bypass grafting (CABG ; <i>n</i>=9), CABG+AVR (<i>n</i>=4), tumor resection (<i>n</i>=1) between June 2008 and December 2012 at Dokkyo Medical University Hospital. <b>Results</b> : Six hospital deaths occurred. One patient died due to bleeding from a ruptured descending thoracic aortic aneurysm, and another patient died due to gastrointestinal perforation from non-occlusive mesenteric ischemia (NOMI) after urgent AVR. The other deaths were related to various complications, including lung cancer, cholecystitis, myocardial infarction, and Takotsubo cardiomyopathy, during the postoperative period. Overall 30-day mortality was 2.6%, hospital mortality was 12.8%, duration of hospital stay after surgery was 41.3 days, duration of intensive care unit (ICU) stay was 3.8 days and ventilator time was 49.1 h. Twenty patients underwent elective surgery, and 19 patients underwent urgent surgery. The two groups had similar preoperative characteristics, except for the number of patients with aortic disease. No significant difference was evident in hospital mortality (26.3% vs. 5%, <i>p</i>=0.065) or 30-day mortality (0% vs. 5.3%, <i>p</i>=0.3) when comparing the two groups. However, the duration of hospital stay (58.9 days vs. 27.5 days, <i>p</i>=0.049), ICU stay (6.74 days vs. 1.05 days, <i>p</i>=0.002) and ventilator time (89.9 h vs. 8.2 h, <i>p</i>=0.006) was significantly longer in the urgent surgery group than in the elective surgery group. Fourteen patients (70%) in the elective surgery group and four patients (21.1%) in the urgent surgery group were able to be discharged from the hospital to their homes within 30 days after surgery. These data demonstrated that cardiovascular surgery in patients 85 years of age or older was associated with satisfactory outcomes, and outcomes associated with elective surgery were even better than those associated with urgent surgery. <b>Conclusions</b> : Therefore, advanced age does not represent a contraindication of conventional cardiovascular surgery. Rather, the decision for surgery should take the patient's preoperative condition, the severity of concurrent medical disease, the wishes of the patient, and the predicted functional outcomes into account.
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We experienced a case of severe alcoholic hepatitis. Combination treatment of continuous hemodiafiltration and steroid hormone was started immediately after admission. This treatment was very effective for severe alcoholic hepatitis, resulting in the shortening of the length of hospital stay. The reasons why this treatment was effective were; 1. The patient was younger, so the regeneration ability of liver cells was stronger. 2. The infection and bleeding of digestive organs except for acute renal failure were not found, resulting in the enhancement of the effectiveness for steroid hormone treatment. 3. The intensive blood purification treatment was started immediately. From this experience, we realized again that a fine collaboration of doctors, nurses and clinical engineers was very important in the intensive care of the severe diseases.
Subject(s)
Hepatitis, AlcoholicABSTRACT
Although maximal oxygen uptake (VO<SUB>2</SUB>max) or oxygen uptake corresponding to lactate threshold (VO<SUB>2</SUB>@LT) is considered the single best determinant of one's cardio-respiratory endurance or aerobic capacity, the direct measurement of these attributes requires elaborate equipment, trained personnel, special knowledge, and/or a maximal effort on the part of the subject who is tested. In addition, the measurement is time consuming. The current investigation was designed to examine the validity of aerobic capacity estimated from submaximal cycling exercise and field performance tests in the elderly. The subjects tested were 18 sedentary men and women aged 63 to 75 years (69.7±3.4) . Indirect VO<SUB>2</SUB>max tests were selected from those proposed by Astrand and Ryhming, Siconolfi et al., and Margaria et al. (step test), and YMCA. The VO<SUB>2</SUB>max values estimated by these methods, with the exception of the Siconolfi method, were found to have large errors when compared to the errors obtained in previous studies for younger subjects. There were no significant correlations between step test scores and VO<SUB>2</SUB>max and VO<SUB>2</SUB>@LT in the elderly. Correlations of 12-min distance walk with VO<SUB>2</SUB>max (r=.711) and VO<SUB>2</SUB>@LT (r=.714) were significant. Our findings suggest that 12min distance walk be a better aerobic capacity test than other indirect VO<SUB>2</SUB>max tests including Astrand and Ryhming test.
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Maximal oxygen uptake (Vo<SUB>2</SUB>max) and lactate threshold were measured during an incremental bicycle ergometer test in 40 healthy middle-aged and older runners between 43 and 79 years of age. Although the 10-km run time slowed with increasing age, there were no significant differences in recent training habits or relative amount of body fat between four age groups. However, our cross-sectional data revealed an annual decrement of -0.74 m<I>l</I>/kg/ min/yr, which was significantly greater than that reported in previous studies. Vo<SUB>2</SUB>max values for the runners were greater than those for sedentary men of similar ages by about 50% in each age group. Significant correlations were found between the age at the onset of running training and Vo<SUB>2</SUB>max (r=-0.600, p<0.05) . Vo<SUB>2</SUB>@LT declined significantly but less rapidly with age (r=0.686, p<0.05) than Vo<SUB>2</SUB>max. Both the mean maximal heart rate (HRmax) and HR@LT also declined with age. No significant differences in HRmax were observed between the runners and sedentary men of the respective age groups. Significant correlations were also found between the estimated HRmax and directly measured HRmax (r=0.600) . Neither systolic blood pressure nor diastolic blood pressure during submaximal-maximal exercise were found to increase with age. We suggest that maintenance of a higher lactate threshold in older runners when expressed as a percentage of Vo<SUB>2</SUB>max is attributable to a greater age-dependent decline in Vo<SUB>2</SUB>max with a smaller change in Vo<SUB>2</SUB>@LT.
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The purpose of this study was to measure the effectiveness of RPE on exercise intensity for senior citizens. A maximum workload test was administered with the use of a bicycle ergometer on older male and female subjects. The results of our study can be summarized as follows:<BR>1. Two trials were performed on separate days. A high correlation coefficient for the first trial and the second trial was found. The reliability for the male group was r=0.76 (p<0.01) and that for the female group r=0.90 (p<0.01) .<BR>2. A correlation range of r=0.55-0.79 (p (0.01) was found for RPE and physiological exercise intensity (which includes oxygen intake and heart rate) . A higher result was found when the relative value was used in the analysis of the oxygen intake and the heart rate instead of the absolute value.<BR>3. Significant correlation coefficients of r=0.63-0.64 (p<0.01) were found for RPE and the work load in terms of watt units.<BR>4. The majority of the physiological variables were statistically determined ; however, there were no correlations between RPE and systolic blood pressure.<BR>In conclusion, based on our study, we have found that RPE and HR ; RPE and %Vo<SUB>2</SUB>max: RPE and watts grouped individually had a high correlation for effectiveness. The only exception in our study was the RPE and the blood pressure group because no correlation was found overall. Therefore, the overall effectiveness of RPE was proven to be quite sensitive even for senior citizens, and as a result RPE can be utilized when exercise is prescribed for evaluatory measurement in senior citizens.
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In 31 asthmatic children, we investigated the change of the structure on the time of living, an amount of exercise by pedmeter and measured pulmonary ventilatory function during 28 weeks swimming training.<BR>The result showed 58.07% of contribution factor to the structure on the time of living on children with asthma and dynamic play time after school were significantly shorter in asthmatic than non-asthmatic children (p<0.05) . After 28 weeks, we could not find any significantly differences of dynamic play time between asthmatic and nonasthmatic children.<BR>An amount of exercise in daily life from the point of view of walking step number by pedmeter were significantly less in aged 6-9 years boys and girls, and aged 10-12 years boys than non-asthmatic children (respectively, p<0.05, p<0.01) . However, after 28 weeks, we could not find any differences between asthmatic and non-asthmatic children.<BR>Forced vital capacity (FVC) and rate of forced expiratory volume on one second (% FEV<SUB>1.0</SUB>) were increased after 28 weeks than the begining of swimming, and we found the strength of their breathing muscles.<BR>On according to perform the great swimming distances (averages 220m in boys, 325m in girls), all asthmatic children became very lively and actively.
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The purpose of this study is to investigate the prevalence of and to classify the types of silicosis patients who were working at that time as migrant workers in the eastern part of Toyama Prefecture. Migrant workers are known in Japanese as “dekasegi” This term refers to workers who migrate seasonally from their home towns to areas where work is more available.<BR>Questionnaires were sent to all male inhabitants aged 30 or over in the selected five areas. Eighty-seven percent of the questionnaires were answered and returned. Based on the results, 482 inhabitants were selected as migrant workers with experience in jobs where they were exposed to large amount of dust. Chest roentgenography and subjective symptoms were examined in these subjects.<BR>The results obtained were follows;<BR>(1) Eight hundred and eighty-five of the respondents (41%) had worked as migrant workers.Of these, 580 men (66%) had worked in jobs with exposure to dust.<BR>(2) Of the 482 migrant workers whose jobs exposed them to dust, 424 silicosis cases (88%) were found by chest roentgenographic examination. Silicosis is classified into four types according to the national Pneumoconiosis Law on the basis of chest roentgenographic findings. These patients included 195 cases of type 1, 123 cases of type 2, 59 cases of type 3 and 47 cases of type 4 silicosis.<BR>(3) The prevalence of disease symptoms in the silicosis patients included ; cough 39%, phlegm 40%, shortness of breath 41%, palpitations 17% and wheezing in 20% of the cases. The silicosis patients showed a higher frequency of respiratory disease symptoms than those dust-exposed workers who did not evidence signs of silicosis.<BR>(4) The silicosis patients were found in 98% of the migrant workers whose exposure to dust lasted a period of more than 20 years, 89% in men whose work was between 10 and 19 years and 76 % in men who had worked less than 10 years.<BR>(5) The silicosis in 297 cases (70% of the total number of disease patients) was first detected during the examinations in the course of this research.