study of intrinsic and extrinsic risk factors in falls among the elderly

The aim of this study is to identify the intrinsic and extrinsic risk factors involved in falls in elderly focusing on the kinematic, temporal and phasic characteristics of gait using the 2-dimentional motion analysis system. One hundred elderly fallers, 100 elderly non fallers matched for age and sex and 50 apparently healthy young individuals were subjected to the following to achieve the purpose of the study: a questionnaire which was developed to identify intrinsic and extrinsic factors associated with falls, clinical evaluation of neuromuscular system, functional performance tests, visual examinations, routine laboratory investigations, radiological investigations and two dimensional gait analysis. There was a significant difference as regard the time of fall in favor of daytime [P<0.001]. Higher frequency of falls in elderly with neurological insult, impaired cognitive functions, multiorgan affection and those receiving higher number of medications [P<0.001]. All members of both elderly groups complaining from osteoarthritis [OA] knees, there was a significantly higher number of fallers in higher grades of radiological severity [P<0.001]. Also, higher incidence of knee and ankle joint synovitis in fallers [P<0.001] As regard the antigravity muscle power, there was a highly significant [P<0.001] weakness in four groups tested in fallers. There were highly significant differences [P<0.001] as regard heel rise, toe rise and timed up and go tests of functional performance, denoting the possibility of using these tests as screening for predilection of falls. As regard the visual parameters, there was a significantly higher incidence [P<0.001] of poor vision, cataractus lenses and constricted field of vision in fallers group. Examination of averaged hip, knee and ankle joints kinematics showed significant differences [P<0.001], [P<0.05] between groups, except for knee joint extension at terminal stance [P>0.05]. There was insignificant difference [P>0.05] between non fallers and fallers elderly groups except for hip joint extension at terminal stance, knee joint flexion at initial swing and ankle joint planter flexion at preswing [P<0.05]. As regard the results of general phasic and temporal gait parameters among the three groups, showed highly significant difference of all parameters [P<0.001]. From these results we can concluded that, most of the falls occur at the daytime while the elderly is moving and for those receiving higher numbers of medications. Elderly complaining from neurological, visual, musculoskeletal and multiorgan disorders are more prone to fall. Timed up and go [TUG], heel rise and toe rise tests are advisable as screening tools to predict falls in elderly. Limited hip extension at terminal stance, limited knee flexion at initial swing, limited ankle planter flexion at preswing, increased temporal parameters and decreased stride length, step length, cadence and velocity have a significant role in fall in elderly

Assessment of fatigue in rheumatoid arthritis

This study was carried out to assess the level of fatigue in patients with rheumatoid arthritis [RA] and to determine its Correlation to demographics, psychosocial and disease-related variables. Forty RA patients and 20 matched healthy controls were subjected to thorough clinical assessment, routine laboratory investigations and measurement of serum cortisol level Questionnaires included the Multidimensional Assessment of Fatigue Scale, Sleep Survey, Health Assessment Questionnaire, Social Support List-Interactions, Social Index, State Trait Anxiety Inventory, and Beck Depression Inventory. Our results showed that fatigue scores were significantly higher [P>0.001] in patients with RA than in controls. Fatigue most affected exercise and work. No significant correlations [p<0.05] were found between fatigue and demographic variables but highly significant correlations [p>0.001] were found between fatigue and both psychosocial and disease-related variables. With multiple regression analyses, the best predictors of increased fatigue were higher levels of cortisol, prolongation of morning stiffness, more depressive symptoms, and higher functional disability. Form this study, we concluded that, fatigue was a prevalent and persistent symptom in our RA patients. Effective management is needed to control clinical manifestations that were found to be strongly associated with fatigue such as disease activity, functional disability, depression, and poor sleep

Macroscopic and microscopic evaluation of pleomorphic adenoma

This study included 13 cases of pleomorphic adenoma, representing 68.42 percent of all cases complaining of salivary gland tumours attending the Kuwait Dental Center in a 18 month period. The palate was the main site of occurrence of the lesion with a predominance in females. Microscopically, myxochondroid stroma and hyaline cells were seen in 8 cases [61.5 percent]

Prognostic value of tissue polypeptide antigen [TPA] plasma levels in patients with malignant salivary gland tumors

Nine subject with various malignant salivary gland tumors were monitored with tissue polypeptide antigen [TPA] pre and post operatively utilizing TA radio-immunoassay kit. The TPA radioimmunoassay proved to be a specific and sensitive method aiding in diagnoses monitoring and a postoperative follow up in malignancies

Uses of magnetic resonance imaging [MRI] in presurgical evaluation of internal derangement of temporomandibular joint [TMJ]

Nine cases of unilateral internal derangement of TMJ indicated for surgical intervention were selected for this study. The affected joints were imaged by MRI presurgically. The non-affected joints were also imaged as controls MRI findings were correlated with intraoperative surgical findings. The results were absolutely accurate as regards degenerative joint pathosis and capsular rupture, and with high degree of accuracy [85.7 percent] in detection of disc displacement. Two cases of disc perforation were not detected by MRI. The results were promising and encouraging the use of this non-invasive Imaging technique as presurgical aid in TMJ disorders

Diuresis sonography for early assessment of pelviureteroplasty

The results of reconstructive surgery for pelviureteric junction obstruction are difficult to assess, because a long follow-up period is always required to improve the radiological appearance. Good early clinical results-as disappearance of pain, mass and fever are frequently met with but the long-term results are not always satisfactory. Operative correction of failed pyeloplasty surgery should be performed as soon as possible after the diagnosis of a poor result. Diuresis sonography is a safe and non- invasive technique and can identify obstruction even in Kidneys with poor function. Twenty-one cases of pyeloplasties of different techniques were studied 4-6 weeks after the operation. Failure of pyeloplasty was detected in 6 cases inspite of the concomittant good clinical results. Higher incidence of failure was found following flap pyeloplasties than after Dismembering operations [Anderson-Hyne]

place of direct vision internal urethrotomy in the management of urethral strictures

Direct vision internal urethrotomy is a safe and effective means to treat urethral strictures only on proper choice of the case, otherwise serious complications can occur. During a 2-year period urethral strictures in 60 patients were treated by cold knife urethrotomy with a success rate of 95% with 6 months of follow up, although a longer interval may be necessary for a more accurate record. This high rate of success can be attributed to two main factors, the proper choice of case and some technical points. The criteria of the urethral stricture we found ideal for internal urethrotomy are 1-Its length is within 1 cm. 2-Single. 3-It must have a visible lumen through which a guide catheter can be passed. 4-Not complicated by severe periurethral fibrosis [as in post traumatic cases] or false passages [from prior dilatation]. The technical points, we found them of importance are: 1-Proper antimicrobial therapy according to culture and sensitivity of urine, to be started one day before the procedure and continued for one week after. 2-Calibration of the urethrotomy up to 24 or 26 ch., because the appearance of the incised stricture is not sufficient to judge the adequacy of the procedure. 3-20 F Silicon catheter for one week after urethrotomy. 4-Corticosteroids [systemic] for one month after the procedure

Urodynamic study of vesicourethral dysfunction following abdomino-perennial resection of the rectum for cancer

Vesico-urethral dysfunction following A.P.R. in 14 cases out of 36 cases [39%] was studied urodynamically by combined Pressure-flow and Electromyography. Detrusor areflexia was found in all of the 14 cases while the external sphincter was normal in 9 cases, areflexic in 3 cases and atonic in 2 cases. The functional status of the striated external spincter is the decisive factor for the proper management, while prostatic obstruction is the second factor. Cases of detrusor areflexia associated with a normal external spincterr have been successfully managed by urecholine therapy, but those who had prostatic obstruction in addition, needed T.U.R. prior to cholinergic stimulation. Cases with combined detrusor and external sphincter areflexia responded well to intermittent catheterization. Prostatectomy resulted in incontinence of urine in one of the cases with atonic external sphincter