scholarly journals Fatigue Acetabular Fracture after Lumbopelvic Instrumented Fusion in Elderly

2021 ◽  
Vol 2021 ◽  
pp. 1-5
Author(s):  
Panagiotis Korovessis ◽  
Vasileios Tsekouras ◽  
Alkis Korovesis
Keyword(s):  
Elderly Patients ◽  
Postmenopausal Osteoporosis ◽  
Acetabular Fracture ◽  
Insufficiency Fracture ◽  
Compression Fracture ◽  
Instrumented Fusion ◽  
Open Stabilization ◽  
Fusion Methods ◽  
Review Reports ◽  
The Right

Purpose. Only several cases of acetabular “fatigue”/insufficiency fractures have been reported in elderly patients with osteoporosis. However, fatigue acetabular fracture below lumbopelvic fixation has not been published. This review reports on the frequency and mechanisms of acetabular fatigue fractures in elderly individuals, including postmenopausal osteoporosis, and presents a case of an acetabular “fatigue” fracture in association with lumbopelvic fusion. Methods. We report on a 71-year-old postmenopausal woman who underwent in our department a L2-pelvis instrumented fusion for failed lumbar decompression and interbody fusion performed in another institution. For at least one year, the patient was receiving antiosteoporotic treatment (Alendronate plus Calcium and Vitamin D) and was fully ambulatory without limping. Eighteen months following our surgery, the patient sought again our department because of increasing pain in her right hip and limping without trauma. Results. The physical examination disclosed painful passive motion in her right hip. The roentgenograms and CT-scans disclosed a transverse acetabular fracture with radiolucencies around both iliac screw tips, particularly the right. Additionally, a severe compression fracture of the 12th thoracic vertebral body and upper endplate of the L2 vertebra was disclosed. We recommended open stabilization of the acetabulum and T12 and L2 vertebrae. Immediately before the planned surgeries, the patient had a serious heart infarct, and thus, surgeries were canceled by the patient’s cardiologist because of the high perioperative risk. The patient and relatives denied further surgeries because of the heart disease. In the final telephone call and CT and roentgenographic evaluation that went to us after request, there was an acetabular pseudarthrosis in the right hip without however associated complaints. Since surgery was not accepted, the patient was prescribed Denosumab injection therapy plus Vitamin and Calcium supplement. Conclusion. This case report emphasizes the significance of follow-up observation of elderly patients with postmenopausal osteoporosis following lumbopelvic fusions, for possible fatigue acetabular and vertebral fractures. The authors speculate that this extremely rare acetabular “fatigue”/insufficiency fracture should be the result of increased repetitive mechanical forces acting around the acetabulum in association with osteoporosis.

CASE REPORT: SURGICAL MANAGEMENT OF LUMBAR COMPRESSION FRACTURE

2019 ◽  
Vol 1 (4) ◽  
Author(s):  
Yustinus Robby Budiman Gondowardojo ◽  
Tjokorda Gde Bagus Mahadewa
Keyword(s):  
Spinal Cord ◽  
Left Lung ◽  
Lumbar Vertebrae ◽  
Compression Fracture ◽  
High Mobility ◽  
Early Mobilization ◽  
Cord Injury ◽  
Cardiothoracic Surgeon ◽  
The Right

The lumbar vertebrae are the most common site for fracture incident because of its high mobility. The spinal cord injury usually happened as a result of a direct traumatic blow to the spine causing fractured and compressed spinal cord. A 38-year-old man presented with lumbar spine’s compression fracture at L2 level. In this patient, decompression laminectomy, stabilization, and fusion were done by posterior approach. The operation was successful, according to the X-Ray and patient’s early mobilization. Pneumothorax of the right lung and pleural effusion of the left lung occurred in this patient, so consultation was made to a cardiothoracic surgeon. Chest tube and WSD insertion were performed to treat the comorbidities. Although the patient had multiple trauma that threat a patient’s life, the management was done quickly, so the problems could be solved thus saving the patient’s life. After two months follow up, the patient could already walk and do daily activities independently.

Neurospect Findings in Patients Exposed to Neurotoxic Chemicals

1994 ◽  
Vol 10 (4-5) ◽  
pp. 561-571
Author(s):  
Gunnar Heuser ◽  
Ismael Mena ◽  
Francisca Alamos
Keyword(s):  
Elderly Patients ◽  
Qualitative Analysis ◽  
Right Hemisphere ◽  
Young Patients ◽  
Chronic Fatigue ◽  
Psychiatric Symptomatology ◽  
Elderly Individuals ◽  
Parietal Lobes ◽  
The Right ◽  
The Brain

Exposures to neurotoxic chemicals such as pesticides, glues, solvents, etc. are known to induce neurologic and psychiatric symptomatology. We report on 41 patients 16 young patients (6 males, 10 females, age 34 8 yrs.) and 25 elderly patients (9 males, 16 females, age 55 7 yrs). Fifteen of them were exposed to pesticides, and 29 to solvents. They were studied with quantitative and qualitative analysis of regional cerebral bood flow (rCBF), performed with 30 mCi of Xe-133 by inhalation, followed by 30 mCi of Tc-HMPAO given intravenously. Imaging was performed with a brain dedicated system, distribution of rCBF was assessed with automatic ROI definition, and HMPAO was normalized to maximal pixel activity in the brain. Results of Xe rCBF are expressed as mean and S.D. in ml/min/100g, and HMPAO as mean and S.D. uptake per ROI, and compared with age-matched controls 10 young and 20 elderly individuals. Neurotoxics HMPAO Uptake Young Elderly R. Orbital frontal R. Dorsal frontal .70 .66 p < 0.05 R. Temporal .64 p < 0.001 R. Parietal .66 .66 We conclude that patients exposed to chemicals present with diminished CBF, worse in the right hemisphere, with random presentation of areas of hypoperfusion, more prevalent in the dorsal frontal and parietal lobes. These findings are significantly different from observations in patients with chronic fatigue and depression, suggesting primary cortical effect, possibly due to a vasculitis process.

scholarly journals A Review of Reductionist versus Systems Perspectives towards ‘Doing the Right Strategies Right’ for Circular Economy Implementation

Systems ◽  
2021 ◽  
Vol 9 (2) ◽  
pp. 38
Author(s):  
Raquel Balanay ◽  
Anthony Halog
Keyword(s):  
Circular Economy ◽  
Systems Approach ◽  
Holistic Approach ◽  
Comprehensive Analysis ◽  
Unintended Consequences ◽  
Review Reports ◽  
The Right ◽  
Business As Usual ◽  
Analytical Frameworks ◽  
Reductionist Approach

This systematic review examines the importance of a systems/holistic approach in analyzing and addressing the footprints/impacts of business-as-usual activities regarding the development of a circular economy (CE). Recent works on why current CE approaches have to be examined in terms of reductionist vs. systems perspectives are reviewed to tackle questions pertaining to the right or the wrong way of CE implementation. ‘Doing the right thing right’ is essential for sustainability—the ultimate goal of a CE, which must be viewed as a system to begin with. The limited reductionist approach overlooks and thus cannot prognosticate on the formidable unintended consequences that emerge from ‘doing the right things wrong’, consequences that become too costly to undo. The systems approach, being holistic, is complicated and difficult to pursue but open to exciting opportunities to integrate innovations in CE analysis and implementation. Complexity is an inherent downside of the systems approach. However, both approaches are complementary, as reductionist models can be combined to create a system of comprehensive analysis to correct the approach towards implementation of current CE initiatives. This review reports that advancements in systems analytical frameworks and tools are highly important for creating general guidelines on CE analysis and implementation.

Volumetric reduction in various cortical regions of elderly patients with early-onset and late-onset mania

2010 ◽  
Vol 23 (1) ◽  
pp. 149-154 ◽  
Author(s):  
Shou-Hung Huang ◽  
Shang-Ying Tsai ◽  
Jung-Lung Hsu ◽  
Yi-Lin Huang
Keyword(s):  
Elderly Patients ◽  
Early Onset ◽  
Late Onset ◽  
Cingulate Gyrus ◽  
Posterior Cingulate Gyrus ◽  
Left Caudate ◽  
Cortical Regions ◽  
The Right ◽  
Bipolar Patients ◽  
Left Middle

ABSTRACTBackground: Few studies have examined alterations of the brain in elderly bipolar patients. As late-onset mania is associated with increased cerebrovascular morbidity and neurological damage compared with typical/early-onset mania, we investigated differences in the volume of various cortical regions between elderly patients with early-onset versus late-onset mania.Methods: We recruited 44 bipolar patients aged over 60 years, who underwent volumetric magnetic resonance imaging at 1.5 T. The analytic method is based on the hidden Markov random field model with an expectation-maximization algorithm. We determined the volume of each cortical region as a percentage of the total intracranial volume. The cutoff age for defining early versus late onset was 45 years.Results: The study participants consisted of 25 patients with early-onset mania and 19 patients with late-onset mania; their mean ages were 65.7 years and 62.8 years, respectively. The demographic variables of the two groups were comparable. The volumes of the left caudate nucleus (p = 0.022) and left middle frontal gyrus (p = 0.013) were significantly greater and that of the right posterior cingulate gyrus (p = 0.019) was significantly smaller in the late-onset group. More patients with late-onset mania had comorbid cerebrovascular disease (p = 0.072).Conclusions: The right posterior cingulate gyrus is smaller and the left caudate nucleus and left middle frontal gyrus are larger in patients with late-onset mania compared with those with early-onset mania. Volumetric change in brain regions may vary in elderly bipolar patients with early and late-onset mania.

scholarly journals McCune Albright syndrome - association of fibrous dysplasia, café-au-lait skin spots and hyperthyroidism – case report

2016 ◽  
Vol 89 (4) ◽  
pp. 559-564
Author(s):  
Iulian Raus ◽  
Roxana Elena Coroiu
Keyword(s):  
Fibrous Dysplasia ◽  
Insufficiency Fracture ◽  
Endocrine Disorders ◽  
Appendicular Skeleton ◽  
Laboratory Findings ◽  
Mccune Albright Syndrome ◽  
Magnetic Resonance Imaging Mri ◽  
Albright Syndrome ◽  
The Right ◽  
Mccune Albright

McCune–Albright syndrome is a rare sporadic disease characterized by bone fibrous dysplasia, café-au-lait skin spots and a variable association of hyperfunctional endocrine disorders. Fibrous dysplasia (FD), which can involve the craniofacial, axial, and appendicular skeleton, may range from an isolated, asymptomatic monostotic lesion to a severe disabling polyostotic disease involving the entire skeleton. A twenty-five-year old male patient presented to our clinic with recently developed heart palpitations. He had also been feeling pain in the right femur since he was younger, without any trauma history, leading to difficulties of ambulation and limping occasionally. His physical examination revealed café-au-lait spots with irregular borders and right testicular agenesis. Laboratory findings identified hyperthyroidism with hyperparathyroidism. Radiographs of the pelvis revealed multiple lytic lesions of the right femur and magnetic resonance imaging (MRI) characterized these lesions as specific to fibrous dysplasia of the bone, without any insufficiency fracture at this level.The association of café-au-lait skin spots with bone fibrous dysplasia, and hyperthyroidism in this patient suggested the diagnosis of McCune – Albright syndrome.

92Transcatheter aortic valve implantation improves cerebral blood flow and cognitive function in elderly patients with aortic stenosis - Brain perfusion SPECT imaging study

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
S Tsuchiya ◽  
Y Matsumoto ◽  
H Suzuki ◽  
Y Kikuchi ◽  
J Sugisawa ◽  
...  
Keyword(s):  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Cognitive Function ◽  
Aortic Valve ◽  
Aortic Stenosis ◽  
Elderly Patients ◽  
Continuous Variables ◽  
Aortic Valve Implantation ◽  
The Right ◽  
Valve Implantation

Abstract Background Cognitive impairment and depression are commonly noted in elderly frail patients with severe aortic stenosis (AS). However, their mechanisms and reversibility after treatment remain remain to be examined. Purpose In this study, we examined whether transcatheter aortic valve implantation (TAVI) increases cerebral blood flow (CBF) in cognitive/emotional brain areas, such as the hippocampus, in the elderly patients with severe AS. Methods We examined consecutive 15 right-handed patients with severe AS who were eligible for TAVI (median age 83.2 years, 12 (80%) women). We evaluated the following assessments both at baseline and 3 months after TAVI. Frailty was evaluated based on Fried scale, which consists of 5 items, including gait speed, cognitive function, weight loss, exhaustion, and inactivity. Frail and pre-frail were defined as greater than 3 and 1∼2 in the scale, respectively. Cognitive and emotional status were evaluated with Logical Memory (LM) II, Mini Mental State Examination (MMSE), and geriatric depression scale (GDS). Lower LM II (less than 4 points) and MMSE (less than 24 points) and higher GDS (more than 6 points) indicate worse memory, general cognitive function, and depressive symptoms, respectively. CBF images were recorded with 99mTc single-photon emission computed tomography and were analyzed using SPM12. Briefly, CBF images were firstly normalized to the standard Montreal Neurological Institute space. Then, a voxel-wise parametric analysis was conducted between normalized CBF images at baseline and those after TAVI (P<0.005 at each voxel). Continuous variables were presented as mean ± standard error (SE). Normality was assessed using the Shapiro-Wilk test. Continuous variables were compared with the use of paired t test. Linear mixed-model analysis was performed to evaluate changes in neuropsychological tests and CBF over time. Results In the present study, all patients were not robust but pre-frail (47.3%) or frail (53.7%). LM II score was significantly improved at 3 months after TAVI compared with baseline (baseline, 8.7 vs. 3 months, 13.8, P<0.01) (Figure A), whereas no significant changes in MMSE or GDS scores were noted (baseline, 24.6 vs. 3 months, 25.2 for MMSE; baseline, 4.3 vs. 3 months, 4.2 for GDS). Importantly, although no patients showed clinical symptoms or signs for transient ischemic attack or stroke after TAVI, CBF in the local regions, including the right hippocampus, was significantly increased after TAVI compared with baseline (P<0.005 at each voxel) (green arrowheads) (Figure B). Furthermore, CBF in the right hippocampus were positively correlated with LM II scores (P=0.017) (Figure C). Figure 1 Conclusions These results provide the first evidence that TAVI improves cerebral perfusion (especially that in the hippocampus) and cognitive functions in elderly patients with severe AS.

End-of-Life Decision-Making

2017 ◽  
Author(s):  
Chad D. Kollas ◽  
Beth Boyer Kollas
Keyword(s):  
Decision Making ◽  
Elderly Patients ◽  
End Of Life ◽  
Planning Process ◽  
Legal Reasoning ◽  
The United States ◽  
Medical Decision ◽  
The Right ◽  
End Of Life Decision ◽  
Life Decision

Growth in the size and wealth of the United States’ elderly population, coupled with a trend toward increasing patient autonomy, has created an environment for increased conflict in end-of-life decision-making. This chapter explores the required elements for making decisions at the end of life, including determination of medical decision-making capacity. Also discussed is the development of the legal reasoning that governs situations involving elderly patients who lack the capacity, but retain the right, to make medical decisions. The chapter describes the utility of the advance care planning process, by which elderly patients can make their preferences for medical treatment known in advance of conditions or illness that could result in cognitive impairment that would otherwise hamper their ability to participate personally in end-of-life decisions. Finally, a variety of forms of advance directives are described, critical tools in honoring the medical autonomy of elderly patients.

Compression fracture in the middle of a chronic instrumented fusion that developed into pseudarthrosis after balloon kyphoplasty

2014 ◽  
Vol 20 (6) ◽  
pp. 705-708 ◽  
Author(s):  
Stephen M. Pirris ◽  
Sherri M. Kimes
Keyword(s):  
Lumbar Fusion ◽  
Compression Fracture ◽  
Pedicle Screws ◽  
Balloon Kyphoplasty ◽  
Vertebral Compression Fractures ◽  
Adjacent Segment ◽  
Rare Occurrence ◽  
Instrumented Fusion ◽  
Compression Fractures ◽  
Surgical Options

There are only 2 documented cases of vertebral compression fractures occurring within a solid lumbar fusion mass: one within the fusion mass after hardware removal and the other within the levels of the existing instrumentation 1 year postoperatively. The authors report a case of fracture occurring in a chronic (> 30 years) solid instrumented fusion mass in a patient who underwent kyphoplasty. The pain did not improve after the kyphoplasty procedure, and the patient developed a posterior cleft in the fusion mass postoperatively. The patient, a 46-year-old woman, had undergone a T4–L4 instrumented fusion with placement of a Harrington rod when she was 12 years old. Adjacent-segment breakdown developed, and her fusion was extended to the pelvis, with pedicle screws placed up to L-3 to capture the existing fusion mass. Almost 2 years after fusion extension, she fell down the stairs and suffered an L-2 compression fracture, which is when kyphoplasty was performed without pain relief, and she then developed a cleft in the posterior fusion mass that was previously intact. She refused further surgical options. This case report is meant to alert surgeons of this possibility and allow them to consider the rare occurrence of fracture within the fusion mass when planning extension of chronic spinal fusions.

rTMS age-dependent response in treatment-resistant depressed subjects: a mini-review

CNS Spectrums ◽  
2012 ◽  
Vol 17 (1) ◽  
pp. 24-30 ◽  
Author(s):  
Stefano Pallanti ◽  
Andrea Cantisani ◽  
Giacomo Grassi ◽  
Sarah Antonini ◽  
Chiara Cecchelli ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Rating Scale ◽  
Low Frequency ◽  
Treatment Resistant ◽  
The Third ◽  
Depressed Patients ◽  
Medical Disorders ◽  
Short Period ◽  
The Right ◽  
Low Frequency Rtms

BackgroundIn old age, depressive syndromes often affect people with chronic medical illnesses, cognitive impairment, and disability, which can worsen the outcomes of other medical disorders and promote disability. Repetitive magnetic transcranial stimulation (rTMS) is a simple and effective treatment in patients with treatment-resistant depression. Therefore the use of rTMS could be of particular potential benefit in treatment-resistant elderly patients, who often cannot tolerate the higher doses of drugs needed or show phenomena of intolerance and interaction. However, several studies assessing the efficacy of rTMS found smaller response rates in elderly patients when compared to younger samples. Nevertheless, the correlation between age and response is still a controversial issue, and there is no strong evidence to date. The aim of our study was to retest the effectiveness and safety of low-frequency rTMS in a 3 weeks active treatment in a group of resistant-depressed patients, and to investigate the role of age in the response to stimulation treatment.MethodsEnrolled in this study were 102 treatment-resistant depressed patients. The patients were treated with low-frequency rTMS over the right dorso-lateral prefrontal cortex (DLPFC) for 3 weeks with a simple protocol (420 pulses per session for 15 sessions). At baseline, at the end of the second week, and at the end of the third week of treatment, the Hamilton Depression Rating Scale (HAM-D) and the Hamilton Anxiety Rating Scale (HAM-A) were administered.ResultsLow-frequency rTMS on the prefrontal dorsolateral right area resulted in a statistically significant reduction of mean HAM-D scores in the entire group of patients at the end of treatment. The responder's rate in the whole group at the end of the third week was 56.86%. A significant inverse relationship between HAM-D reduction and age was found in the “older” (>60 years old) group, not in the “younger” (<60 years old) group.ConclusionResults from this study show that low-frequency rTMS over the right DLPFC, with a relatively low number of pulses (420 pulses per session) and a relatively short period of treatment, is effective in the treatment of resistant patients (in a sample also including elderly patients) in a 3-weeks treatment protocol with a low reduction with the progress of age. Furthermore, we found a greater response in younger patients and an inverse correlation between age and treatment response. Adaptations of the protocol according to age are reviewed.

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