ABSTRACT
AIMS: The aim of this study was to utilize a national paediatric inpatient database to determine whether obesity influences the operative management and inpatient outcomes of paediatric limb fractures. PATIENTS AND METHODS: The Kids' Inpatient Database (KID) was used to evaluate children between birth and 17 years of age, from 1997 and 2012, who had undergone open and closed treatment of humeral, radial and ulna, femoral, tibial, and ankle fractures. Demographics, hospital charges, lengths of stay (LOS), and complications were analyzed. RESULTS: Obesity was significantly associated with increased rates of open reduction and internal fixation (ORIF) for: distal humeral (odds ratio (OR) = 2.139, 95% confidence interval (CI) 1.92 to 3.44; p < 0.001); distal radius and ulna fractures (OR = 1.436, 95% CI 1.14 to 2.16; p < 0.05); distal femoral (OR = 2.051, 95% CI 1.69 to 3.60; p < 0.05); tibial and fibula shaft (OR = 2.101, 95% CI 2.10 to 3.50; p < 0.001); and ankle (OR = 1.733, 95% CI 1.70 to 2.39; p < 0.001). Older age was significantly associated with ORIF for all fractures (p < 0.05). LOS, hospital charges, and complications were significantly increased in obese patients following ORIF for upper and lower limb fractures (p < 0.05). CONCLUSION: Obese paediatric patients are more likely to undergo ORIF in both upper and lower limb fractures and have more inpatient complications. These findings may assist in informing obese paediatric fracture patients and their families regarding the increased risk for open operative fixation and associated outcomes. Cite this article: Bone Joint J 2019;101-B:491-496.
Subject(s)
Fracture Fixation, Internal/methods , Fractures, Bone/surgery , Hand Injuries/surgery , Inpatients , Leg Injuries/surgery , Open Fracture Reduction/methods , Pediatric Obesity/complications , Adolescent , Child , Child, Preschool , Female , Follow-Up Studies , Fractures, Bone/complications , Hand Injuries/complications , Humans , Incidence , Infant , Infant, Newborn , Leg Injuries/complications , Male , Postoperative Complications/epidemiology , Retrospective Studies , Treatment Outcome , United States/epidemiologyABSTRACT
Diabetes mellitus is associated with an increased susceptibility to cardiovascular disease and it has been suggested that alterations in myocardial function may contribute to the development of diabetic cardiovascular complications. The objective of the present study is to examine the left ventricular (LV) function in streptozotocin (STZ)-induced diabetic rats in a definite course of time by non-invasive methods, i.e. M-mode and Doppler echocardiography. From the results, it was found that treatment of animals with STZ resulted in increase in blood glucose, triglycerides, cholesterol, low density lipoproteins (LDL) and decrease in serum total protein levels. Echocardiographic studies revealed that LV internal dimension (mm) during systole was significantly increased after 12 weeks of diabetes when compared to base line data of the same animals and with control animals 6.50+/-0.13 versus 4.25+/-0.17, versus 4.34+/-0.25 (P<0.05), however there was no significant change after 4-8 weeks of diabetes. Also LV internal dimension (mm) during end diastole increased significantly only after 12 weeks of diabetes than to base line data of the same animals and with control animals 7.71+/-0.34 versus 6.18+/-0.25, versus 6.25+/-0.18 (P<0.05). Fractional shortening (%), 15.69+/-5.1 versus 31.22+/-1.7, versus 30.56+/-2.1 (P<0.05), and ejection fraction (%) 37+/-2.31 versus 68.18+/-2.8, versus 60.32+/-3.5 (P<0.05), differ significantly after 12 weeks of diabetes when compared to base line data of the same animals and with control animals. E-wave (cm/s) was significantly decreased after 12 weeks of diabetes 21.11+/-1.5 versus 35.19+/-4.5, versus 32.75+/-3.0 (P<0.05), and A-wave (cm/s) was significantly increased after 12 weeks of diabetes 34.88+/-4.2 versus 19.21+/-2.8, versus 20.59+/-2.1 (P<0.05); thus, diabetic animals after 12 weeks had an inversed E/A ratio. Histological studies revealed that after 8 weeks of diabetes, necrosis was minimal, but after 12 weeks of diabetes extensive focal endomyocardial necrosis was observed. From this study, we conclude that overt LV systolic and diastolic dysfunction was fully visible at 12 weeks of diabetes on echocardiography and this non-invasive technique of echocardiography is useful in diagnosing LV dysfunction in diabetic rats without the need of invasive histopathological procedures.
Subject(s)
Cardiomyopathies/pathology , Diabetes Mellitus, Experimental/pathology , Animals , Blood Glucose/metabolism , Cardiomyopathies/diagnostic imaging , Cardiomyopathies/etiology , Diabetes Mellitus, Experimental/complications , Diastole/physiology , Disease Progression , Echocardiography , Lipids/blood , Myocardium/pathology , Rats , Rats, Sprague-Dawley , Systole/physiology , Ventricular Function, LeftABSTRACT
By themselves, clinical examination and palpation do not provide an accurate assessment of metastatic neck nodes. They do not yield sufficient information to ascertain the benign or malignant nature of nodes or to determine the presence of extracapsular spread and vascular invasion. The use of real-time ultrasonography with high-frequency transducers can significantly improve the evaluation of patients with neck masses. We studied the use of ultrasound in evaluating metastatic neck disease in 25 patients. We found that it is useful not only in detecting neck nodes, but in assessing their characteristics and the degree of vascular invasion. We recommend that ultrasonography be routinely performed as part of the evaluation of all patients with head and neck masses. It is also valuable in the postoperative or postirradiation followup of patients whose necks are otherwise difficult to evaluate.
