Medicine
-
Critical acute pancreatitis (CAP) has recently emerged as the most ominous severity category of acute pancreatitis (AP). As such there have been no studies specifically designed to evaluate predictors of CAP. In this study, we aimed to evaluate the accuracy of 4 parameters (Acute Physiology and Chronic Health Evaluation [APACHE] II score, C-reactive protein [CRP], D-dimer, and intra-abdominal pressure [IAP]) for predicting CAP early after hospital admission. ⋯ The latter can be improved by adding CRP (5.8). In conclusion, of the parameters studied, APACHE II score and IAP are the best available predictors of CAP within 24 hours of hospital admission. Given that APACHE II score is rather cumbersome, the combination of IAP and CRP appears to be the most practical way to predict critical course of AP early after hospital admission.
-
Randomized Controlled Trial
Implant augmentation: adding bone cement to improve the treatment of osteoporotic distal femur fractures: a biomechanical study using human cadaver bones.
The increasing problems in the field of osteoporotic fracture fixation results in specialized implants as well as new operation methods, for example, implant augmentation with bone cement. The aim of this study was to determine the biomechanical impact of augmentation in the treatment of osteoporotic distal femur fractures. Seven pairs of osteoporotic fresh frozen distal femora were randomly assigned to either an augmented or nonaugmented group. ⋯ As a result, the BMD as well as the axial stiffness did not significantly differ between the groups. The number of cycles to failure was significantly higher in the augmented group with the BMD as a significant covariate. In conclusion, cement augmentation can significantly improve implant anchorage in plating of osteoporotic distal femur fractures.
-
Multicenter Study
Predictors of mortality in patients with interstitial lung disease treated with corticosteroids: results from a cohort study.
Interstitial lung disease (ILD) has a heterogeneous clinical presentation and establishing prognosis for these patients is challenging. We investigated the clinical characteristics and outcome of patients with idiopathic interstitial pneumonias (IIPs) and patients with connective tissue disease-associated interstitial lung disease (CTD-ILD). We conducted a multicenter prospective study on 104 patients diagnosed with IIPs and 29 patients diagnosed with CTD-ILD, which were newly diagnosed and treated with corticosteroids initially. ⋯ Significant predictors for mortality in patients with IIPs at baseline were lower for performance status and definite usual interstitial pattern (UIP) on HRCT. Patients with UIP experienced worse survival than those with non-UIP. A definite UIP on HRCT and lower baseline performance status have important prognostic implications in patients with IIPs.
-
Dementia is among various diseases affecting the elderly, who is also at a high risk for fractures. This study aimed to evaluate the association between fracture history and sequential risk of dementia in Taiwan. A retrospective cohort study was designed using the claims data of the entire insured residents covered by Taiwan's universal health insurance from 1998 to 2010. ⋯ The occurrence of multiple fractures at a single visit was also significantly associated with an increased risk of dementia. Fracture history is regarded as an independent risk factor of dementia in individuals aged ≥65 years, particularly those who suffered from multiple fractures and/or fractures located in the hip. Further studies are needed to support an independent role of fracture in dementia considering the clinical information and other comorbidities.
-
Observational Study
Positron emission tomography combined with computed tomography as a screening tool for occult malignancy in patients with unprovoked venous thromboembolism: an observational study.
Venous thromboembolism (VTE) can be the first clinical manifestation of an occult malignancy. We aimed to assess the value, in daily practice, of positron emission tomography combined with computed tomography (PET-CT) for occult malignancy diagnosis in patients with unprovoked VTE. All PET-CTs performed over 5-years period (from January 2009 to October 2013) in adult patients followed in the Department of Internal Medicine (Bichat Hospital, Paris, France) were retrospectively reviewed. ⋯ Interestingly, considering CT-scan findings only, no further investigation would have been scheduled. No patient with negative or false positive PET-CT was diagnosed with cancer during a mean follow-up of 22 ± 13.6 months. A diagnosis strategy based on PET-CT screening for malignancy in patients with unprovoked VTE had limited diagnosis value and may lead to unnecessary alarming and money- and time-consuming investigations.