Epidemiological characteristics of patients with tibial pilon fracture / 中华创伤骨科杂志

Objective:To explore the epidemiological characteristics of inpatients with tibial pilon fracture in The Third Hospital of Hebei Medical University from 2016 to 2019.Methods:The data of all the patients who had been hospitalized for pilon fracture from January 2016 to December 2019 in The Third Hospital of Hebei Medical University were collected using the medical image computer archiving and transmission system and the medical record query system. The patients' age, gender, occupation, residence, season, cause of injury, Rüedi-Allg?wer classification, and AO classification were analyzed.Results:A total of 234 inpatients with tibial pilon fracture were collected, including 179 males and 55 females, with a ratio of male to female of 3.3∶ 1. The prevalence age ranged from 41 to 50 years in male patients (31.3%, 56/179) and from 51 to 60 years in female patients (25.5%, 14/55). In the 234 patients, farmers (101 cases, 43.2%), rural area (166 cases, 70.9%) and spring season (77 cases, 32.9%) accounted for a higher proportion. The proportions of high-altitude falling (41.0%, 96/234) and high-energy injury (61.5%, 144/234) were the highest. Of the 234 patients by the Rüedi-Allg?wer classification, 23 (9.8%) had type Ⅰ fracture, 90 (38.5%) type Ⅱ fracture, and 121 (51.7%) type Ⅲ fracture, with type Ⅲ fracture prevalent in males (58.1%, 104/179) and type Ⅱ fracture prevalent in females (16.4%, 9/55). Of the 234 patients by the AO classification, 131 (56.0%) had type 43B fracture and 103 (44.0%) type 43C fracture, with a higher proportion of type 43B fractures in women (67.3%, 37/55) than in men (52.5%, 94/179). In type 43B fractures, type 43B3 (43.5%, 57/131) and type 43B3.3 (75.4%, 43/57) were the most common; in type 43C fractures, type 43C3 (74.8%, 77/103) and type 43C3.3 (51.9%, 40/77) were the most common.Conclusions:In the recent 4 years in The Third Hospital of Hebei Medical University, pilon fractures increased year by year and occurred more frequently in spring. They were more common in farmers and in the rural areas. They prevailed in the patients aged from 41 to 50 years. The Rüedi-Allg?wer type Ⅲ fractures and the AO type 43B fractures were the most common.

Risk factors and etiology in young adults with ischemic stroke / 国际脑血管病杂志

Objective To investigate the risk factors and etiology in young adults with ischemic stroke.Methods From June 2014 to June 2017,consecutive patients with first-ever ischemic stroke aged from 18 to 45 years and admitted to the Department of Neurology,the Third People's Hospital of Chengdu were collected retrospectively.The demographic data,vascular risk factors,National Institutes of Health Stroke Scale score,location of infarction,and etiological subtypes were documented.They were divided into either a male group or a female group according to the gender,and they were divided into 2 age groups of 18-35 years and 36-45 years.Results A total of 103 young adults with ischemic stroke were enrolled during the study.Among them,the proportion of men was higher than that of women (73.8％ vs.26.2％).The most common 5 risk factors were smoking,abnormal lipid metabolism,drinking alcohol,hypertension,and large atherosclerosis,respectively.The proportions of abnormal glucose metabolism (37.2％ vs.11.8％),hypertension (46.5％ vs.11.8％),and large artery atherosclerosis (37.2％ vs.11.8％) in the age group of 36-45 years were significantly higher than those in the age group of 18-35 years (all P＜0.05).The proportions of smoking (67.1％ vs.14.8％) and drinking alcohol (51.3％ vs.18.5％) in the male group were significantly higher than those in the female group (all P＜ 0.05).In the etiological aspect,the proportion of cryptogenic stroke in the age group of 18-35 years was significantly higher than that in the age group of 36-45 years (47.1％ vs.15.1％;P=0.006),while the proportion of the large artery atherosclerotic stroke was significantly lower than that in the age group of 36-45 years (11.8％vs.41.9％;P =0.019).There were no significant differences in the etiological subtypes between different sex groups.Conclusion The distribution of risk factors and etiological subtypes in young patients with ischemic stroke have some differences in different gender and age groups.Some common modifiable risk factors (such as smoking,drinking,abnormal lipid metabolism,etc.) still account for a higher proportion in young adults with ischemic stroke.

Effects of aging on midgastric transverse band and gastric emptying / 中华老年医学杂志

Objectives To explore the effects of aging on midgastric transverse band(MTB)and gastric emptying.Methods In our prospective study,57 healthy volunteer were divided into young, middle and old-age groups.After taking test meal labeled by 99mTc-iethylenetriaminepentaacetic acid(99mTc-DTPA), the pictures were collected using double probe single photon emission computed tomography(SPECT).Stomach in each frame of the pictures was divided into proximal, midgastric transverse band(MTB)and distal parts.And half gastric emptying time,gastric remnant rate at 90 min, areas of different gastric parts were tested and calculated respectively.Results Half gastric emptying time of whole stomach was(43.24± 11.87)min,(42.07 ± + 9.31)min and(45.81 ± 10.73)min in young,middle and old-age groups, respectively, with P＞0.05.Among young, middle and oldage groups, half gastric emptying time was(38.09 ± 10.26)min,(37.33 ± 9.28)min and(26.74 ± 12.07)min in proximal stomach, and it was(38.35 ± 12.96)min,(37.73 ± 7.46)min and(46.41 ± 10.74)min in distal stomach,respectively.The half gastric emptying time was significantly reduced in proximal stomach and increased in distal stomach in old-age group(both P＜0.05).The gastric nuclide remnant rate at 90min in total stomach was(30.38 ± 19.32)％,(29.03 ± 10.36)％ and(31.92 ± 13.47)％ ,in young, middle and old-age groups, respectively, with P＞0.05.This rate in proximal stomach was(25.01 ± 12.35)％,(26.36± 15.29)％ and(19.54±8.47)％ among three group, respectively.The rate in proximal stomach was(42.25 ± 12.36)％,(41.56 ±± 9.33)％ and(56.05 ± 11.72)％ among three group,respectively.The gastric remnant rate at 90min was reduced in proximal stomach and was increased in distal stomach significantly in old-age group(both P＜0.05).Compared with young and middle-age group,the old-age group showed no difference in areas of total stomach in all the time, while the areas were reduced in proximal stomach and increased in distal stomach significantly from 30 min to 90 min(all P＜0.05).Total stomach versus proximal and distal stomach showed no difference in count/pixel ratio in all time,while a count/pixel ratio was reduced in proximal stomach and increased in distal stomach significantly from 30 min to 90 min(both P＜ 0.05).Both areas and count/pixel ratio of MTB at 60 min and 90 min were significantly increased in old-age group(both P＜0.05).Conclusions The total gastric emptying is not delayed along with aging, while the gastric emptying is increased in proximal stomach and reduced in distal stomach in the elderly.This abnormity of intragastric distribution of food might be related with larger area of midgastric transverse band.

Effects of age factors on pharmacokinetics of ropivacaine during combined lumbar plexus-sciatic nerve block / 中华麻醉学杂志

Objective To evaluate the effects of age factors on the pharmacokinetics of ropivacaine during combined lumbar plexus-sciatic nerve block in patients.Methods Twenty patients of both sexes,aged ≥ 18 yr,weighing 50-75 kg,of American Society of Anesthesiology physical status Ⅰ or Ⅱ,scheduled for elective lower extremity surgery,were divided into 2 groups (n=10 each) according to age:young and middle-aged group (18-59 yr) and elderly group (≥ 60 yr).Combined lumbar plexus-sciatic never block was performed using an ultrasonic instrument and a nerve stimulator.Lumbar plexus block was performed with 0.5％ ropivacaine 30 ml.Sciatic never block was performed with 2％ lidocaine 10 ml plus 0.75％ ropivacaine 10 ml.Before administration and at 5,10,15,20,30,45,60,120,180 and 360 min after administration,blood samples were collected from the radial artery for determination of the blood concentration of ropivacaine by high-performance liquid chromatography.The area under the concentrationtime curve,maximum concentration (Cmax),time to C terminal elimination half-life and clearance were calculated.Results Compared with young and middle-aged group,the blood concentration of ropivacaine was significantly decreased at 5-45 min after administration,the Cmax was significantly decreased,terminal elimination half-life was significantly prolonged (P＜0.05),and no significant change was found in area under the concentration-time curve,the time to C and clearance in elderly group (P＞ 0.05).Conclusion Age factors can affect the pharmacokinetics of ropivacaine during combined lumbar plexus-sciatic nerve block,and both absorption and metabolism of ropivacaine are slower in elderly patients than in young and middle-aged patients.

Effect of Acupuncture plus Medication on Pregnancy RateAfter IVF in Different Age Groups / 上海针灸杂志

ObjectiveTo observe the effect of Chinese medication and acupuncture-moxibustion plus Western medication on the pregnancy rate after in-vitro-fertilization and embryo transfer (IVF-ET) in different age groups.MethodTotally 810 eligible patients enrolled between 1st January 2010 and 31st December 2013 from the Reproduction and Infertility Department were categorized into 3 groups according to the age, respectively 20-29 years old, 30-39 years old, and 40-49 years old. The pregnancy rates of the three groups were compared, and the pregnancy rate of IVF-ET after the treatment of the integrated treatment of Chinese and Western medicine was also statistically analyzed.ResultThe pregnancy rate was 54.3% in the group of 20-29 years old, versus 46.4% in the group of 30-39 years old and 26.0% in the group of 40-49 years old, and the total pregnancy rate of IVF-ET was 47.2%. ConclusionThe younger, the higher the pregnancy rate of IVF-ET, and intervention of traditional Chinese medicine following the assisted reproductive technique can enhance the pregnancy rate of IVF-ET.

Effect of age on the association between normal thyroid hormone level and coronary artery disease / 中华老年医学杂志

Objective To investigate the effect of age on the association between normal thyroid hormone level and coronary artery disease (CAD).Methods A total of 1163 euthyroid patients undergoing coronary angiography (CAG) from January 2013 to June 2014 were enrolled and categorized into 2 groups:the young and middle-aged group (＜60 years,n=602) and the elderly group (≥60 years,n=561),and each group was sub grouped into the CAD and non-CAD group according to CAG.Height,body weight,and levels of serum lipid,fasting blood glucose,glycosylated hemoglobin,free triiodothyronine (FT3),free thyroxine (FT4) and thyroid-stimulating hormone (TSH) were measured.Results In the youth and middle-aged group,309 patients (51.3％) were diagnosed as CAD,and there was no significant difference in the levels of FT3,FT4 and TSH between CAD and non-CAD patients [(5.3±0.6)mmol/L vs.(5.3±0.5)mmol/L,(11.8 ±1.9)mmol/L vs.(11.8±1.8) mmol/L,(2.0±1.1) mIU/L vs.(2.0±1.0)mIU/L,all P＞0.05].In the elderly group,357 patients (63.6％) were diagnosed as CAD,and the FT3 level was lower in the CAD patients than in the non-CAD patients[(5.1±0.6)mmol/L vs.(5.2±0.5) mmol/L,P＜0.01].Logistic regression demonstrated that FT3 was an independent influencing factor for CAD in elderly patients (OR=0.564,P＜0.01).Conclusions The association between normal thyroid hormones levels and CAD varies along with age.Thyroid hormones have no relationships with CAD in the young and middle-aged people.The decline of FT3 level may increase the risk of CAD in the elderly.

Factor analysis of hepatic cirrhosis combined with hospital infection in elderly patients / 中华老年医学杂志

Objective To explore and analyze the related factors for cirrhosis patients with hospital infection.Methods Clinical data of 750 patients with cirrhosis in our hospital were retrospectively analyzed.Related factors for hospital infection including gender,age,length of hospital stay,Child-Pugh classification,accompanying invasive procedures,associating the underlying disease,using antibacterial drugs and the sites of hospital infection and pathogen distribution were analyzed.Results The infection rate was 20.7％ (155/750).The infections were mainly spontaneous bacterial peritonitis [54.8％ (85/155)],followed by respiratory,digestive,urinary tract and skin.Pathogenic bacteria were mainly Gram-negative bacteria [56.1％ (101/1)],followed by Gram-positive bacteria and fungi.Patients aged over 70 years,with hospital stay over 4 weeks,with higher Child-Pugh classification,associated with invasive procedures,combined with underlying diseases,and treated with antimicrobial drugs were much easier to get hospital infection (x2=12.2,16.3,49.46,55.2,20.95,26.24,all P＜0.05).Conclusions Patients aged over 70 years with long hospital stay and more severe liver damage,accompanied by invasive procedures,combined with basic diseases and treated with antimicrobial agents are the related factors for hospital infection in patients with cirrhosis.

Cystic Lesions in the Greater Tuberosity of the Humerus: The Relation to Rotator Cuff Tears and Age

PURPOSE: This study was designed to investigate the location of cystic lesions in the greater tuberosity of the humerus and the relationship to rotator cuff tears and age. MATERIALS AND METHODS: A total of 78 patients (age range, 19-82 years; mean age, 51 years) who underwent arthroscopy or open surgery after MR arthrography (MRA) for a painful shoulder were enrolled in the study. The location of the cystic lesions were classified as 'A' for a supraspinatus insertion site, as 'C' for an infraspinatus insertion site, as 'B' for both a supraspinatus and infraspinatus insertion site, as 'BG' for a site posterior to the bicipital groove and as 'P' for a site at the bare area of the humeral head. The location of cystic lesions and supraspinatus and infraspinatus tears were evaluated on MRA. Statistical analyses used the chi-squared test and logistic regression. RESULTS: 'BG' and 'A' cystic lesions were related to the presence of a supraspinatus tear, 'C' cystic lesions were related to the presence of an infraspinatus tear and 'B' cystic lesions were related to the presence of both supraspinatus and infraspinatus tears (p < 0.05). 'P' cystic lesions were not related to the presence of rotator cuff tears. The incidence of cystic lesions increased with age, but with no statistical correlation. CONCLUSION: Cystic lesions at the supraspinatus and infraspinatus insertion sites are useful to predict the presence of a rotator cuff tear, but cystic lesions were not age related.

Coronary Artery Bypass Graft Surgery in Patients 70 Years of Age and Older / 대한흉부외과학회지

BACKGROUND: There has been an increase in the number of elderly patients considered for coronary artery bypass grafting (CABG). Recently, there were many satisfactory reports of coronary artery bypass grafting (CABG) in old age due to the development in operative technique and postoperative management. We evaluated operative and follow-up results of patients 70 years of age and older compared to 60 years old. MATERIAL AND METHOD: We retrospectively studied the cases of 74 consecutive patients 70 years or older (group A) who underwent a elective CABG from January 2000 to December 2003 and compared that of relatively young age group (group B, 60-69 years old). We compared preoperative characteristics, operation technique, postoperative results that effect outcome, also we investigated late mortality and cardiac events at follow-up periods. RESULT: Preoperative demographic and clinical characteristics of two groups were not different, except preoperative renal dysfunction(serum creatinine: > or= 1.4 mg/dl) (group A 17, 23% vs group B 14, 9%) (p=0.024). There was no difference of the mean number of distal anastomosis and the left ventricular ejection fraction in group A decreased significantly from 53.7+/-13% preoperatively to 49.9+/-12% postoperatively (p=0.02), but not changed in group B. There was no difference at operative mortality rate and postoperative major morbidity rate, but wound problem of saphenous vein harvest site was significantly higher in group A than group B (6.8% vs 0.7%, p=0.02). The mean follow up duration was 24.3+/-13 months and the cumulative survival were 95.4% at 2 year and 79.9% at 4 year in group A and 95.4% at 2 year and 90.1% at 4 year in group B (p=ns). CONCLUSION: We conclude that age is not a factor of determination when we decide about operation because coronary artery bypass grafting in elderly more than 70 years old can be performed with a low mortality rate and acceptable morbidity rate.

The Clinical Outcomes of Off-Pump Coronary Artery Bypass Grafting in the Octogenarians / 대한흉부외과학회지

BACKGROUND: With the increasing age of the population, coronary artery bypass grafting in the elderly patients is becoming common. Off-pump coronary artery bypass grafting (OPCAB) has been proven to be less morbidity and to facilitate early recovery. The elderly patients may have benefits by avoiding the adverse effects of the cardiopulmonary bypass. The purpose of this study is to evaluate our results of OPCAB in elderly patients. MATERIAL AND METHOD: A retrospective chart review was carried out for 12 patients aged over 80 years who underwent isolated OPCAB from January 2001 and March 2004. Data were collected risk factors for disease, extent of coronary disease, and in-hospital outcomes. Postoperative graft patency was evaluated in 9 patients by multi-slice computed tomography. RESULT: Eleven patients had triple vessel disease or left main disease. Four patients were suffered from preoperative CVA, and 4 patients had chronic obstructive pulmonary disease. Two patients had myocardial infarction (MI), among them 1 patient was suffered from pulmonary edema after preoperative MI. There was no perioperative death, perioperative MI, and no ventricular arrhythmia. Also there was no perioperative stroke and renal failure. But there was one deep sternal infection who recovered by treating of muscle flap. Atrial fibrillation was newly developed in 1 patient, but was well controlled by medication. Mean intubation time was 15.9+/-4.4 (8~20 hrs) hrs and mean ICU stay was 2.9+/-0.8 (2~4 days) days. Mean hospital day was 21.6+/-14.3 (13~56 days) days. Postoperative mean CK-MB was 11.3+/-14.1 ng/mL. Early postoperative graft patency rate was 100% (24/24). Follow-up was completed in all patients. In this time, there was no patients with angina or death. CONCLUSION: The results of this study suggest that OPCAB reduces morbidity and favors hospital outcomes. Therefore, OPCAB is safe, reasonable and might be preferable operative strategy in elderly patients.

Comparison of chemotaxis during the peripheral nerve regeneration in rats of different ages / 中华创伤骨科杂志

Objective To compare the differences of chemotaxis at the tissue specific level and topographic specificity level during peripheral nerve regeneration after the severance injury of the sciatic nerve in rats of different ages. Methods 40 specific pathogen free Sprague Dawley 18 day old rats (called as young group) were chosen to correspond as nearly as possible to humans of about 1 year of age. 40 adult rats (called as adult group) were chosen to correspond as adult humans. The tissue and topographic specificity models were set up respectively after the severance of the sciatic nerve at the right side. Electromyography and morphological evaluations were conducted for determination of the nerve regeneration on 3 and 6 weeks postoperatively. Results On 3 and 6 weeks after operation, the recovery rate of nerve conduction velocity, the exact rate of nerve regeneration, the ratio of nerve conduction velocity between tibial and peroneal nerve, the ratio of amplitude of CMAP between tibial and peroneal nerve, the ratio of the number of myelinated axon between the tibial and peroneal nerve at the distal part in the young group were lower than those in the adult group respectively. There were statistically significant differences between the 2 groups. The recovery rate of amplitude in compound muscle action potential (CMAP) was lower in the young group than in the adult group, but the difference was not significant enough. Conclusion Since the tissue and topographic specificities in the young rats are both inferior to those in the adult rats, co contraction between agonists and antagonists may result from cross innervation during the peripheral nerve regeneration.

Analysis of clinical features and prognostic factors in young women with stage Ⅰ to Ⅲ breast cancers / 中国现代普通外科进展

Objective: To explore the clinical features and prognosis of breast cancers with different stages in young women. Methods: A retrospective study was made in 61 cases of young patients with breast cancer (≤35 years as young group) and 74 cases of breast cancer patients of control group (36-69 years), who were with stageⅠto Ⅲ disease underwent surgical treatment. Results: The significant differences were observed in pTNM staging and differentiation between two groups. There were no differences between the two groups in stage Ⅰand Ⅱ patients. Significant differences were found between the two groups in stage Ⅲ patients. Conclusion: Breast cancer was with strong invasion in young patients. Early diagnosis and treatment of young women with breast cancer were important to improve the survival rate.

Characteristics of exudative age-related macular degeneration optical coherence tomography / 中华眼底病杂志

Objective To verifying the characteristics of optical coherence tomography(OCT) in exudative age related macular degeneration (AMD). Methods The patients being investigated in this series included 16 cases (19 eyes) of exudative age related macular degeneration diagnosed by FFA and OCT examinations, among them 4 cases (6 eyes) were examined with ICGA. The color photographs of ocular fundi, FFA, ICGA and OCT were investigated by contrasting each other. Results As compared with the FFA and ICGA examinations, the characteristic findings found in OCT in patients with exudative AMD in this series were as the following:①serous detachment of neurosensory epithelium in 11 eyes,②retinal hemorrhage in 2 eyes,③serous detachment of retinal pigment epithelium in 5 eyes,④hemorrhagic detachment of retinal pigment epithelium in 10 eyes,⑤disciform scar in 4 eyes,⑥fibrovascular pigment epithelial detachment and occult CNV in 12 eyes. Conclusion OCT can supply a comprehensive survey of exudative AMD, in making the diagnosis as an important complementary examination of FFA and ICGA.

Histopathologic changes of macula lutea retinae in elderly Chinese autopsy eyes / 中华眼底病杂志

Purpose To investigate the histopathologic changes of macula lutea retinae in the elderly Chinese population,and to provide information for the cause of visiual disturbance in an autopsy study. Methods Two hundred and twelve eyes from 108 consecutive cases of postmortem (mean age of 78.4 years old) sections of the area of macula lutea retinae were studied by histopathology. Results Among the 212 eyes,hard drusen were found in 36.3% of eyes and soft drusen in 19.3% of eyes.The eyes with both of the above mentioned 2 types of drusens were found to be combined with RPE atrophy and RPE detachment;and subretinal neovascularization were found in 5.7% of these eyes and they were associated with obvious RPE atrophy and photoreceptor loss;3.2% eyes had posterior scleral staphyloma showing thinning of the sclera and choroid,RPE atrophy and apparent photoreceptor loss;2.4%eyes showed CME with the history of cataract surgery. Conclusion The macular affections,age related macular degeneration,myopic macular degeneration and post operative cystoid macular edema are varying in number in the above mentioned order successively,in elderly Chinese at an autopsy study.

Coronary Artery Bypass Graft Surgery in the Elderly / 대한흉부외과학회지

BACKGROUND:The number of old patients receiving coronary artery bypass grafting(CABG) is increasing. With the more recent advances in operative techniques, the age at which CABG is indicated has also increased. This study evaluated the risk factors associated with the hospital mortality and the morbidity following CABG in elderly patients. MATERIAL AND METHOD: Between March 1991 and June 1998, we retrospectively reviewed 45 consecutive patients aged 65 years or older who underwent CABG. We compared the data with the results of 179 patients under the age 65 years operated during the same period. RESULT: Mean age was 68+/-1.41 years(range 65 to 74 years). Emergency surgery was required in 4, and elective surgery in 41 patients. The mean number of distal anastomosis per patient was 3.62 +/-0.81 and mean aortic cross-cramp time was 69.84+/-18.5 minutes. Thirty patients had Canadian class III or IV preoperatively, but 43 patients had class I or II postoperatively. The left ventricular ejection fraction increased significantly from 54.23+/-10.62% preoperatively to 58.14+/-9.88% postoperatively(p.05). Incremental risk factors for hospital deaths in the elderly were emergent operation, preoperative PTCA, postoperative use of IABP and postoperative ARF(p<0.05). The duration of hospital stay after operation was significantly longer for the elderly group than the younger group(19.27+/-12.51 vs 15.55+/-6.99 days; p<0.05). Follow-up was complete for 34 of the hospital survivors and ranged from 1 to 73 months(mean: 23.58+/-19.56 months). There was no late mortality of cardiac origin. CONCLUSION: Age is an important factor in selecting optimal management for elderly patients with coronary compromise, but age alone should not dictate the choice of therapy. Coronary artery bypass surgery in the elderly is associated with acceptable early mortality and excellent long-term results.

Analysis of Age-related Distribution of the Tracheal Diameter and Cross-sectional Area Among Koreans: Compuerized Tomographic Measurement / 대한흉부외과학회지

INTRODUCTION: Understanding the normal distribution of the tracheal diameter and crross- sectional area is one of the key elements in the management of various tracheal pathologies or tracheal reconstruction for the patients in growing age. However, data for Korean standard has been lacking. This study was designed to analyze retrospectively the distribution of tracheal diameter and cross-sectional area in young Koreans, which can afford fundamental data for the management of tracheal diseases. MATERIAL AND METHOD: Of the patients who underwent computerized tomogram of the chest between May 1996 and August 1998, one hundred six young patients(age range: 0-20 years) were included. Patients with any conditions which might affect the tracheal cross-sectional area or diameter, such as tracheal disease, previous operation, mediastinal tumor, or obstructive lung disease were excluded from the study. Gender distribution was 69 males and 37 females. Tracheal diameters, anterior-posterior and transverse, were measured at the level of the thoracic inlet(level I) and the aortic arch(level II). Types of the trachea were divided into round, oval, or horseshoe shaped on cross-sectional view, and the dimension was calculated by using the equation of A=1/4(pi)ab(A; area, (pi); 3.14, a; anterior-posterior diameter, b; transverse diameter). We analyzed the distribution of the diameter at each level and compared the cross-sectional area with respect to age and gender. A p-value lower than 0.05 wa considered significant. RESULT: The trachea of patients less than 5 years old were round in shape at both of level I and II, and no differences in cross-sectional area was observed between the levels(p=NS). As the age increased, the trachea become oval in shape at level I while it remained round in shape at level II(p=0.020). The tracheal diameter and cross-sectional area increased as the age increased with a linear correlation(r>0.9). In patients less than 5 years of age, female patients showed larger cross-sectional area than male patients (p=0.020), and it was reversed in patients older than 15 years of age(p=0.002). CONCLUSION: From the above results, we suggest chest computerized tomogram as a safe and reliable tool in measuring the tracheal diameter and cross-sectional area. We also provide the data as a standard for distribution of the tracheal diameter and cross-sectional area in young Korean population.

Open Heart Surgeries in Septuagenarians / 대한흉부외과학회지

BACKGROUND: An increasing number of elderly are referred for open heart surgeries(OHS). These patients are assumed to have significantly increased morbidity and mortality because of compromised functional reserves in their vital organs. We reviewed the results of OHS patients who were 70 years old or older. MATERIAL AND METHOD: Thirty six consecutive septuagenarians underwent OHS from 1995 to 1997. Operations were coronary artery bypass grafting(CABG) in 26 including 3 left main surgical angioplasty, valve replacement in 7, MVR+CABG in 2, and ASD closure+TAP in 1. Statistical tests were carried out to compare survivor group with nonsurvivor group in respect to risk factors including NYHA functional class, LVEF, emergent operation, IABP support, CPB/ACC time, ventilator time cardiac index, ICU stay and hospital stay for operative mortality. RESULT: Operative mortality rate and postoperative complication were 16%(6/36) and 50%(18/36). One-year and 3-year actuarial survival rates were 76%. Nine patients(25%) had major complications including third-degree A-V block(2), respiratory failure(1), stroke(3), renal failure requiring dialysis(3) and postoperative hemorrhage(2). The causes of death were pneumonia(1), bleeding(1), acute renal failure(1), low cardiac output(1), third-degree A-V block(1), and ventricular tachycardia(1). The univariate analysis of mortality shows that NYHA class IV, LVEF<40%, lesser values for C.I, and longer time for ventilatory support were associated with the risk factors(p value=0.03, 0.001, 0.007, and 0.014). The emergent operation, CPB/ACC time, IABP support, ICU stay and hospital stay were not significant. CONCLUSION: We conclude that cardiac operation can be performed in septuagenarians with acceptable outcomes when done in patients with normal to moderately depressed left ventricular function and adequate functional reserves in their vital organs.

Tourniquet Induced Hypertension and Vital Sign Changes in Elderly Patients Associated with Tourniquet Use under General or Epidural Anesthesia for Total Knee Arthroplasty / 대한마취과학회지

BACKGROUND: Tourniquet is associated with tourniquet induced hypertension (T-HTN) and with occasional circulatory collapse. These changes can be well tolerated by young healthy patients; however, in elderly patients with reduced physiologic cardiovascular reserve and blunted baroreflex, these alterations could be significantly detrimental. So we studied that whether there was any difference in hemodynamic changes in elderly patients receiving general or epidural anesthesia. METHODS: One hundred twenty patients underwent total knee arthroplasty were classified into four groups; general anesthesia in control ( or = 65 years, group II, n=30), epidural anesthesia in control (group III, n=30), epidural anesthesia in elderly (group IV, n=30). Mean blood pressure (MAP), heart rate (HR) and PETCO2 were recorded throughout the experiments. RESULTS: MAP in the general anesthesia was higher than that in the epidural anesthesia after tourniquet inflation and there was pronounced occurrence of T-HTN in the group II (43.3%). After tourniquet deflation, MAP was more reduction in the group II than that in the group IV (23.3+/-10.9% vs 17.4+/-9.4%, p<0.05), and heart rate was increased in all groups except group II. Tourniquet time did not correlate with the magnitude of the changes in MAP and HR associated with tourniquet application. CONCLUSIONS: In elderly patients associated with general anesthesia, occurrence of "tourniquet hypertension" is more frequent and reduction in MAP after deflation is more marked without compensatory increasing of HR than epidural.

Clinical Study of Cataract Surgery in Patients Over 80 Years of Age

To analyze the preoperative and postoperative characteristics of the patients over 80 years of age who had undergone cataract extraction, we reviewed the clinical records of 120 patients(167 eyes) over 80 years of age. The preoperative visual acuity was worse than 2/20 in 139 eyes(84%) and the preoperative visual acuity of 76 eyes(45%) were hand motion or worse. One hundred and twelve eyes(67%) had cataract more dense than nucleosclerosis of grade III and 54 eyes had total cataract. Seven patients were not cooperative enough to check the postoperative visual acuity. Among the 113 patients(156 eyes) with the measured postoperative visual acuity, 73 eyes(47%) resulted in the visual acuity of 20/40 or better. Among 83 patients with the postoperative visual acuity less than 20/40, the ocular 28 eyes. In conclusion, 25%(39 eyes among 156 eyes) of the patients older than 80 years could not see better than 20/40 after cataract surgery without any ocular organic pathologies. Age factor can have the predictive value of visual outcome after cataract extraction.