Risk factors for 30-day complications after cancer surgery in geriatric patients: a secondary analysis.

BACKGROUND: The aim was to analyse the association between severity of complications up to 30 days after surgery and pre-operative nutritional and physical performance parameters. METHODS: The participants were a subsample of the previously published PERATECS study (ClinicalTrials.gov: NCT01278537) and included 517 onco-geriatric patients aged ≥ 65 years, undergoing thoracoabdominal, gynaecological, or urological surgery. Post-operative complications were classified according to the Clavien Classification System (CCS). Independent risk factors related to the severity of complications, defined as major complications (CCS IIIa-V) and graded complications (CCS grade 0-V), were analysed using logistic and ordinal regression, respectively. RESULTS: In total, 132 patients suffered major post-operative complications. The development of major post-operative complications was independently associated with body mass index (BMI) < 20 kg/m2 , hypoalbuminaemia (< 30 g/l), longer duration of surgery, and specific tumour sites (upper gastrointestinal, gynaecological, colorectal) (all P < 0.05). Higher-grade complications were predicted by Timed Up and Go (TUG) > 20 s, hypoalbuminaemia (< 30 g/l), higher American Society of Anesthesiologists (ASA) status III-IV, longer duration of surgery (> 165 min), and specific tumour sites (upper gastrointestinal, gynaecological) (all P < 0.05). Mini Nutritional Assessment (MNA) scores and weight loss were not independent risk factors for the severity of complications. CONCLUSIONS: Nutritional and physical performance risk factors that predicted the severity of complications differed between major and higher-grade post-operative complications, but hypoalbuminaemia independently predicted both. The results support the need for pre-operative risk screening. Due to the explorative nature of the study, further research is required in larger cohorts to corroborate these findings.

Vacuum-Assisted Abdominal Closure Is Safe and Effective: A Cohort Study in 74 Consecutive Patients.

BACKGROUND: Vacuum-assisted closure (VAC) has, in many instances, become the treatment of choice in patients with abdominal catastrophes. This study describes the use and outcome of ABThera KCI® VAC in the Region Southern Denmark covering a population of approximately 1.202 mill inhabitants. METHOD: A prospective multicenter study including all patients treated with VAC during an eleven-month period. RESULTS: A total of 74 consecutive patients were included. Median age was 64.4 (9-89) years, 64% were men, and median body mass index was 25 (17-42). Duration of VAC treatment was median 4.5 (0-39) days with median 1 (0-16) dressing changes. Seventy per cent of the patients attended the intensive care unit. The 90-day mortality was 15%. A secondary closure of the fascia was obtained in 84% of the surviving patients. Only one patient developed an enteroatmospheric fistula. Patients with secondary closure were less likely to develop large hernias and had better self-evaluated physical health score (p < 0,05). No difference in mental health was found. CONCLUSION: The abdominal VAC treatment in patients with abdominal catastrophes is safe and with a relative low complication rate. Whether it might be superior to conventional treatment with primary closure when possible has yet to be proven in a randomized study.

Prevalence of skin diseases in hospitalized geriatric patients : Association with gender, duration of hospitalization and geriatric assessment.

BACKGROUND: Improvement of quality of life in old age and prevention of age-associated diseases have become the main focus of research into aging; however, information regarding the skin health status of geriatric patients still remains sparse. GOAL: To investigate the extent of dermatological diseases in hospitalized geriatric patients, map the most prevalent ones, check for any gender differences and document any correlations with duration of hospitalization and results of geriatric assessments. PATIENTS AND METHODS: A total of 110 hospitalized geriatric patients underwent a complete dermatological examination at the Evangelical Geriatric Hospital (Evangelisches Geriatriezentrum) Berlin. The collected information was stratified according to dermatological diagnosis, results of geriatric assessments, duration of hospitalization, age and gender of the patients. RESULTS: The average number of diagnosed skin diseases per patient was 3.7 ± 1.8 for the female population and 4.3 ± 2.0 for the male population. After categorizing all diagnosed skin diseases, infectious diseases were found to be most common in both female and male patients (55 % and 58 %, respectively) followed by vascular diseases (46.7 % and 54 %, respectively). Precancerous skin lesions and epithelial skin cancer were more frequent in men than in women (20 % vs. 6.7 %, p < 0.037 and 34 % vs. 13.3 %, p < 0.010, respectively). Pruritus showed a positive correlation with the duration of hospitalization and a negative correlation with the Barthel index and Tinetti score on the day of discharge, indicating that pruritus may have a significant impact on the physical condition of elderly multimorbid patients and on the static and dynamic balance abilities. CONCLUSION: Our results demonstrate that skin health in the elderly is compromised and disregarded and this should constitute one of the top priorities of healthcare specialists and physicians in the future.

Prevalence and definition of sarcopenia in community dwelling older people. Data from the Berlin aging study II (BASE-II).

BACKGROUND: Sarcopenia describes the age-associated loss of muscle mass, strength and function. The aim of this study was to compare the prevalence of sarcopenia in a cohort of community dwelling elderly people living in Berlin, Germany, according to the criteria proposed by current consensus statements and to study the respective impact on self-reported physical performance. MATERIAL AND METHODS: This study included 1405 participants from the Berlin aging study II (BASE-II). The appendicular skeletal muscle mass index (SMI) was assessed with dual energy X-ray absorptiometry (DXA), muscle strength was measured by hand grip strength and the timed up and go" test (TUG) was performed as a functional parameter to reflect mobility. RESULTS: The prevalence of sarcopenia was 24.3 % in terms of reduced SMI only and considerably lower for sarcopenia with reduced grip strength (4.1 %) and sarcopenia with limited mobility (2.4 %). Only 0.6 % of the participants fulfilled all three criteria. Of the subjects with a normal SMI, 8.6 % had reduced grip strength and 5.1 % had limited mobility, whereas 1.3 % subjects fulfilled both criteria. Participants with reduced strength or function reported severe difficulties in performing physical tasks significantly more often than participants with normal or reduced SMI alone (p <0.029-p <0.0001). CONCLUSION: In BASE-II low skeletal muscle mass was much more frequent than reduced grip strength or poor function. Reduced strength and function were found to be associated with a greater impact on physical performance than reduced muscle mass. Low SMI does not seem to be a prerequisite for low strength or limitations in mobility.

[Polypharmacy and drug prescription in the elderly. Strategies for optimization]. / Polypharmazie und Arzneimitteltherapiesicherheit im Alter. Strategien zur Verbesserung.

BACKGROUND: When used appropriately, drugs are an effective and efficient intervention in the care of patients. However, elderly, multimorbid patients are especially prone to adverse side effects caused by the simultaneous intake of many drugs--this effect is called polypharmacy. Furthermore, adverse medical effects occur more frequently with elderly people compared to younger patients. This is due to age-specific metabolic changes and issues with compliance and adherence. Therefore, the indication for medication should be taken carefully and individually especially for elderly patients, in order to develop a realistic risk-benefit ratio, taking into consideration questions like quality of life and life expectancy. MATERIALS AND METHODS: In this paper, the current medical care situation of elderly people is presented; problems are identified and analyzed. RESULTS: Supported by a selected literature search, recommendations for improving medication safety are summarized.

[Cross-sectional field Q7"medicine of aging and the elderly" at the Charité - Universitätsmedizin Berlin : Curriculum and evaluation by students]. / Der Querschnittsbereich Q7 "Medizin des Alterns und des alten Menschen" an der Charité - Universitätsmedizin Berlin : Curriculum und Evaluation durch Studierende.

AIMS: There have only been a few publications focussing on how the curriculum Q7 "medicine of aging and the elderly" is implemented at German medical schools. In order to stimulate discussion about the implementation of Q7 the authors present the results of a survey of medical students of the Charité - Universitätsmedizin Berlin. The aim of the survey was to identify items that contribute to a good course and thus improve the quality of lectures and courses in geriatric medicine with the overall aim to encourage more students to become geriatricians after their studies. MATERIALS AND METHODS: Medical students from the fifth clinical semester were interviewed in anonymous form following each course using standardized questionnaires for organizational and didactic topics. Factor analysis, proof of reliability, descriptive statistics and correlation analysis were performed as statistical methods. RESULTS: The proof of reliability of questionnaires showed good internal consistency with Cronbachs alpha values of 0.88 (seminars), 0.91 (lectures) and 0.92 (bedside teaching). The overall response rate was very high (95.3%, n = 803 questionnaires). The ratings for questionnaire items in the three teaching formats (i.e. seminars, lectures, bedside teaching) ranged mostly from good to very good. In the correlation analysis across all three teaching formats clear communication of learning objectives, the treatment of topics according to their own expectations and the learning experience were rated as most relevant overall. CONCLUSIONS: The evaluation results indicate a high level of satisfaction with the curriculum of geriatrics at the Charité, which can therefore be recommended across faculties taking into account the criteria named.

[Neurological lower torso function test. A new assessment]. / Neurologischer Funktionstest unterer Rumpf. Ein neues Assessment.

The neurological lower torso function test was developed in addition to the Berg Balance Scale as an assessment for diagnosis and follow-up of lower torso stability and functioning in neurological patients, used for example in subjects in the early rehabilitation phase or still showing low motoric recovery after suffering a stroke. Due to the ground effect for changes in severely affected neurological patients, other tests currently available do not provide an adequate level of sensitivity. The neurological function test was integrated into the study "Combined whole body vibration and balance training using Vibrosphere" with 66 inpatient/partial inpatient neurological subjects ≥ 60 years. Based on six tasks, a qualitative assessment of the selective function of movement and posture tone of the lower extremity, the muscular system around the hip, and the lower torso are performed. Analogous to the Berg Balance Scale, a 5 point scale is used. It shows a high degree of reliability and responsiveness and can be performed with little effort of time and personnel.

[Skin diseases in geriatric patients. Epidemiologic data]. / Hauterkrankungen beim geriatrischen Patienten. Epidemiologische Daten.

The incidence of skin diseases more common in older patients, e.g. inflammatory and autoimmune diseases, benign and malignant tumors and paraneoplastic syndromes, is increasing worldwide rapidly mainly due to early or lifelong UV-overexposure and to an aging population. In order to transform this demographic change into a chance a better understanding of the pathomechanisms of these diseases, an early diagnosis and therapy are essential steps. In addition, a joint effort to raise public awareness, patient education, preventive measures and consistent monitoring of high-risk groups is of great importance. In this article, the relationship between aging and associated skin diseases will be presented with a particular focus on the epidemiology and risk factors.

Combined whole body vibration and balance training using Vibrosphere®: improvement of trunk stability, muscle tone, and postural control in stroke patients during early geriatric rehabilitation.

Strokes are a leading cause of disability, immobility, and reduced ability to perform activities of daily living (ADLs) among the elderly. Balance and postural control are often affected in stroke patients. Physical therapy for the lower back to improve posture, mobility, and ADLs can be very time consuming. In this randomized, controlled study of 66 geriatric patients (mean age 74.5 years) with stroke-related paresis or hemiplegia, it was demonstrated that stroke patients may benefit more from 3 additional weeks of combined whole body vibration and balance training than from a comprehensive inpatient geriatric rehabilitation program in terms of trunk stability, postural control, and muscle tone.

Nuclear cardiology and coronary surgery.

Rising age, repeated percutaneous coronary revascularizations, and co-morbidity such as overweight, diabetes, and hypertension, characterize a change over the last 20-30 years in coronary patients referred to coronary artery bypass grafting (CABG). This patient group represents a great part of today's large and increasing patient population with heart failure, and their treatment remains a limited success. CABG may lead to symptomatic and prognostic improvement, but the limited risk of operative complications has to be balanced against the chances of symptomatic and prognostic benefit from the operation. Identification of culprit lesions and estimation of the severity of coronary stenoses of intermediate or uncertain degree are important in preoperative decision-making. Location and extent of a perfusion abnormality must reflect the anatomical distribution of an angiographic stenosis, supporting or arguing against the decision to revascularize . Myocardial perfusion imaging by single photon emission computed tomography or positron emission tomography before surgery will increase the level of information about coronary hemodynamics and myocardial viability before surgical intervention and is therefore highly recommended to increase the chances of successful coronary surgery, as well as to reduce the small risk of operative complications.

[Prognosis of the facial profile line using the finite element method]. / Zur Prognose des Profilverlaufes bei interdisziplinären Therapieplanungen mit der Finite-Elemente-Methode.

AIM: The aim of the present study was to verify how realistic the prediction of the clinical appearance of the patient's profile is by using the finite element method to simulate orthodontic and surgical intervention. MATERIAL AND METHOD: This single-case study explains step by step interdisciplinary treatment planning in a case with angle class III. Orthodontic and surgical procedures can be simulated and visualized using the lateral cephalogram and the Onyx Ceph software. The facial profile line is calculated over the skeletal surface using the finite element method. The morphing feature of the Onyx Ceph software is used to create an image of the predicted appearance of the patient's profile using a preoperative lateral photograph. RESULTS: The comparison of the simulated profile and the clinical result after bimaxillary surgery showed high concordance. CONCLUSION: The finite element method represents a useful tool for the prediction of the postoperative appearance in patients undergoing fixed orthodontic appliance and orthognathic surgery.

Diffusion-bonded stacks of periodically poled lithium niobate.

We constructed diffusion-bonded stacks of periodically poled lithium niobate (PPLN). Such crystals combine the advantages of planar processing used to make PPLN wafers with the power-handling capability of large apertures. We demonstrated an optical parametric oscillator that uses a 3-mm-thick diffusion-bonded stack consisting of three 1-mm-thick PPLN crystals.

Cascaded optical parametric oscillations.

We have observed the spectral and temporal characteristics of a 1.064-mm pumped, continuously tunable optical parametric oscillator (OPO) using a periodically poled lithium niobate nonlinear crystal. An efficient secondary OPO pumped by the resonant signal of the primary OPO was observed. Predictions obtained from theory agree with observed results and provide insight into the dynamics of pulsed parametric oscillation. 1997 Optical Society of America.

Identification of talinolol metabolites in urine of man, dog, rat and mouse after oral administration by high-performance liquid chromatography-thermospray tandem mass spectrometry.

A new specific HPLC-TSP-MS/MS assay for identification of beta-blocking drug talinolol and its metabolites in urinary samples of man, dog, rat and mouse after single oral administration has been developed. Centrifuged urines were directly injected into the HPLC-TSP-MS system. Based on thermospray MS/MS studies of 10 reference compounds, several selective CID-MS/MS reactions were found, which were typical of substructure elements of potential phase I metabolites. In this way the differentiation of various stereochemical positions of the hydroxyl group in the cyclohexyl ring moiety of metabolites was possible. Renal metabolic profiles for all investigated species were generated by HPLC-multiple reaction monitoring (MRM). The detected metabolites were characterized by TSP full scan and MS/MS analysis in relation to synthesized reference compounds. The major metabolic pathway in all species results in the hydroxylation of the cyclohexylring moiety of talinolol. In dog urine, a phase II metabolite, the O-glucuronide of talinolol (I) was found. In order to identify this structure, the use of electrospray ionization was also necessary.

Multigrating quasi-phase-matched optical parametric oscillator in periodically poled LiNbO(3).

We report a widely tunable quasi-phase-matched optical parametric oscillator that uses periodically poled LiNbO(3)with a multigrating structure. The device is tuned by translation of the crystal through the resonator and pump beam, with no realignment needed. With a 1.064-microm acousto-optically Q-switched Nd:YAG pumplaser, we produced noncritically phase-matched tunable IR output from 1.36 to 4.83 microm. The threshold was 6 microJ for a 26-mm interaction length. The extraordinary polarization of LiNbO(3) has better IR transmission than does the ordinary polarization, permitting operation at longer wavelengths with d(33) quasi-phase matching than with conventional Type I birefringent phase matching.

Quasi-phase-matched 1.064-microm-pumped optical parametric oscillator in bulk periodically poled LiNbO(3).

We report a quasi-phase-matched optical parametric oscillator, using bulk periodically poled LiNbO(3). The optical parametric oscillator, pumped by a 1.064-microm Q-switched Nd:YAG laser, was temperature tuned over the wavelength range 1.66-2.95 microm. The oscillation threshold of approximately 0.1 mJ was more than a factor of 10 below the damage limit. The LiNbO(3) crystal, fabricated by application of an electric field to a sample with liquid and metal surface electrodes, was 0.5 mm thick with a 5.2-mm interaction length and a quasi-phase-matched period of 31 microm.

1.9-W cw ring-cavity KTP singly resonant optical parametric oscillator.

We report high-power and single-frequency operation of a continuous-wave singly resonant potassium titanyl phosphate (KTiOPO(4)) optical parametric oscillator in a ring-cavity configuration. The ring singly resonant optical parametric oscillator threshold is 4.3 W. When the oscillator is pumped by 6.7 W of 532-nm radiation from an 11.2-W single-frequency resonantly doubled Nd:YAG laser, 1.9 W of single-axial-mode output is generated at the idler wavelength of 1039 nm.

Continuous-wave total-internal-reflection optical parametric oscillator pumped at 1064 nm.

We report what is to our knowledge the first cw 1064-nm-pumped optical parametric oscillator (OPO), using a critically phase-matched (theta(pm) = 45.5 degrees ), monolithic total-internal-reflection, doubly resonant OPO fabricated from congruent LiNbO(3). Frustrated total-internal-reflection provides variable output coupling for the signal and the idler. The measured finesse of 6000 at 2014 nm implies a round-trip power loss of 0.1%. The low round-trip power losses compensate the 2 degrees Poynting vector walk-off and give a threshold of 130 mW. A passive thermal feedback mechanism causes the OPO to oscillate stably in a single axial-mode pair for more than 30 min. The OPO output tunes in 0.1-nm steps from 2040 to 2225 nm by tuning the pump frequency.