Characteristics of geriatric and somatic status in patients with osteoporosis

BACKGROUND: Older adults with osteoporosis (OP) and high risk of falls are the most vulnerable group of patients with respect to the development of fractures. Falls and fractures in elderly patients with OP are associated with geriatric syndromes and worse functional status.AIM: To аssess comorbidity and geriatric status in elderly and senile patients with and without OP.MATERIALS AND METHODS: The study included 607 patients over 60 years of age hospitalized in the geriatric department. According to the presence of OP, the patients were divided into 2 groups: group 1 — patients with OP (n=178, 29.3%), group 2 — patients without OP (n=429, 70.7%). All patients underwent a general clinical study, an assessment of comorbidity according to the Charlson index, and a comprehensive geriatric score.RESULTS: OPs had 178 (29.3%) patients, more often these were women. 55.6% of patients with OP were disabled. Age-related diseases such as Alzheimer’s disease, Parkinson’s disease, osteoarthritis, anemia, thyroid disease, varicose veins were significantly more common in patients with OP. With almost all of these diseases, a univariate analysis revealed an association with OP. Geriatric syndromes such as frailty, hypodynamia, malnutrition, polypharmacy, urinary incontinence were significantly more common in group 1 patients. Patients with OP were more likely to live alone and use mobility aids compared to patients without OP.The univariate analysis demonstrated that OP is associated (OR 1.54 to 2.00) with frailty, hypodynamia, the use of aids in movement, sleep disorders, sensory vision deficiency, urinary incontinence. The Functional status of patients with OP was worse compared to patients without OP. Patients with OP suffered more fractures, and vertebral fractures were significantly more frequent.CONCLUSION: Patients with OP have a high comorbidity, a burdened geriatric status. In elderly patients, it is necessary not only to screen and diagnose OP, to assess the risk of 10-years probability of major pathological fractures using the FRAX algorithm, but also to conduct a comprehensive geriatric assessment to diagnose geriatric syndromes that weaken the course of OP and lead to more serious consequences.

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Effektivität der Sklerosierungstherapie in Abhängigkeit vom Alter der Patienten

Phlebologie ◽

10.1055/s-0037-1622314 ◽

2010 ◽

Vol 39 (04) ◽

pp. 202-207

Author(s):

K. Denk ◽

D. Schliephake ◽

A. Recke ◽

B. Kahle

Keyword(s):

Elderly Patients ◽

Varicose Veins ◽

Pearson Correlation ◽

Compression Therapy ◽

Injection Sclerotherapy ◽

Aesthetic Outcome ◽

Efficient Treatment ◽

Significant Difference ◽

Group 2 ◽

Group 1

SummaryIn clinical practice sclerotherapy of intradermal varicose veins seems to be more effective in elderly patients. Patients, methods: After prior duplex-sonographic investigation 48 patients with intradermal varicose veins (diameter 1–2 mm, C1,EP, AS, PR) were included. 24 patients (group 1) received Polidocanol (0.25% Aethoxysklerol®) injection sclerotherapy and 24 patients (group 2) received sodium chloride injections. In all subjects an area of 100 square centimetres of the lower limb was treated. The borders of each area were marked and photo documented. The injections were performed by an examiner who was unaware of which liquid had been injected. Compression therapy was performed for one week after the treatment. One and four weeks later the results were controlled by the physician who performed the injections and documented by an independent photographer. The glossy prints of the areas before and four weeks after the treatment were sent to two blinded independent external reviewers. The reviewers noted their evaluation on a visual analogue scale (VAS). The reviewers received each anonymous photodocument twice within 3 weeks. Results: The VAS of both experts showed a significant difference between the results in group 1 and group 2 (p < 0.0001). Median of efficacy was 58.5% in group 1 (verum) and 0.5% in group 2 (placebo). Both experts had a stable intraindividual reliability of 85% and further both raters didn´t differ concerning their ratings. In group 1 (verum) the Pearson correlation coefficient showed a significant correlation between the therapeutic outcome and the age of the treated patients. Conclusions: Injection sclerotherapy of intradermal varicose veins using 0.25 %Polidocanol (Aethoxysklerol) is an efficient treatment that leads to a good aesthetic outcome. In elderly patients sclerotherapy is more efficient.

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Features of postoperative period in patients with chronic venous insufficiency: phlebectomy versus thermal ablation

Hirurg (Surgeon) ◽

10.33920/med-15-2001-05 ◽

2020 ◽

pp. 64-75

Author(s):

E. Burleva ◽

O. Smirnov ◽

S. Tyurin

Keyword(s):

Postoperative Period ◽

Chronic Venous Insufficiency ◽

Thermal Ablation ◽

Venous Insufficiency ◽

Clinical Symptoms ◽

Varicose Veins ◽

Statistical Processing ◽

Group 3 ◽

Group 2 ◽

Group 1

The purpose of the study was to conduct a comparative assessment of the course of the postoperative period after phlebectomy and thermal ablation in patients with varicose veins of the lower extremities in the system of the great saphenous vein (GSV) with class C2 of chronic venous insufficiency (CVI) — CEAP class C2. Materials and methods: 455 patients (455 limbs) with CEAP class C2. Group 1 (n = 154) received stripping + minimally invasive phlebectomy; Group 2 — endovenous laser ablation (EVLA) of GSV trunk + sclerotherapy of varicose veins; 3 group (n = 150) — radiofrequency ablation (RFA) of the GSV + sclerotherapy. All patients were united by a single tactical solution — the elimination of pathological vertical reflux in GSV. In each group, patients were with similar hemodynamic profile were selected (Group 1 = 63; Group 2 = 61; Group 3 = 61). The course of the postoperative period (from 2 days to 2 months) was compared for pain (visual analog scale — VAS), clinical symptoms of chronic venous insufficiency, degree of satisfaction (Darvall questionnaire), and duration of disability. Statistical processing was carried out using Excel programs for Windows XP, MedCalc® (version 11.4.2.0., Mariakerke, Belgium). Results: Postoperative pain is more pronounced (during day 1 for Group 1–4.0, Group 2–3.0, Group 3–2.0) and more prolonged (up to 4 days) after open surgeries (p < 0.05). The dynamics of the clinical symptoms of CVI (including varicose syndrome and use of compression therapy) could not be fully evaluated in connection with the ongoing sclerotherapy procedures for patients of Groups 2 and 3. Satisfaction of patients with aesthetic aspects was higher than expected in all groups. Reliable statistical differences proved decrease in days of disability (Group 1–14; Group 2–4; Group 3–3) and earlier return to physical activities and work in patients after thermal ablation in comparison with phlebectomy. Conclusion: The study shows that all three methods for eliminating vertical reflux in the GSV can be proposed for a large category of patients with CEAP of class C3 and C2. Medical and social rehabilitation of patients using endovascular thermal ablation technologies proceeds faster, which is beneficial both for the patients and for society.

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Transvenous lead extraction: procedural outcomes and in-hospital mortality in octogenarian patients

European Heart Journal ◽

10.1093/ehjci/ehaa946.0829 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

M Giannotti Santoro ◽

L Segreti ◽

G Zucchelli ◽

V Barletta ◽

A Di Cori ◽

...

Keyword(s):

Elderly Patients ◽

Hospital Mortality ◽

Electronic Device ◽

Clinical Success ◽

Similar Efficacy ◽

Lead Extraction ◽

Tertiary Referral Center ◽

Major Complications ◽

Group 2 ◽

Group 1

Abstract Background Managing elderly patients with infection or malfunction deriving from a cardiac implantable electronic device (CIED) may be challenging. The aim of this study was to evaluate safety and efficacy of mechanical transvenous lead extraction (TLE) in elderly patients. Methods Patients who had undergone TLE in single tertiary referral center were divided in two groups (Group 1: ≥80 years; group 2:<80 years) and their acute and chronic outcomes were compared. All patients were treated with manual traction or mechanical dilatation. Results Our analysis included 1316 patients (group 1: 202, group 2: 1114 patients), with a total of 2513 leads extracted. Group 1 presented more comorbidities and more pacemakers, whereas the dwelling time of the oldest lead was similar, irrespectively of patient's age. In group 1 the radiological success rate for lead was higher (99.0% vs 95.9%; P<0.001) and the fluoroscopy time lower (13.0 vs 15.0 minutes; P=0.04) than in group 2. Clinical success was reached in 1273 patients (96.7%), without significant differences between groups (group 1: 98.0% vs group 2: 96.4%; P=0.36). Major complications occurred in 10 patients (0.7%) without significative differences between patients with more or less than 80 years (group 1: 1.5% vs group 2: 0.6%; P=0.24). In the elderly group no in-hospital mortality occurred (0.0% vs 0.5%; P=0.42). Conclusions Mechanical TLE in elderly patients is a safe and effective procedure. In the over-80s, a comparable incidence of major complications with younger patients was observed, with at least a similar efficacy of the procedure and no procedural-related deaths. Funding Acknowledgement Type of funding source: None

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Geriatric Proximal Femur Fractures During the Covid-19 Pandemic - Fewer Cases, But More Comorbidities

Geriatric Orthopaedic Surgery & Rehabilitation ◽

10.1177/21514593211009657 ◽

2021 ◽

Vol 12 ◽

pp. 215145932110096

Author(s):

Christina Polan ◽

Heinz-Lothar Meyer ◽

Manuel Burggraf ◽

Monika Herten ◽

Paula Beck ◽

...

Keyword(s):

Nursing Home ◽

Elderly Patients ◽

Proximal Femur ◽

Minor Trauma ◽

Proximal Femur Fractures ◽

Femur Fractures ◽

Number Of Patients ◽

Group 2 ◽

The Impact ◽

Group 1

Background: The COVID-19 pandemic is challenging healthcare systems worldwide. This study examines geriatric patients with proximal femur fractures during the COVID-19 pandemic, shifts in secondary disease profile, the impact of the pandemic on hospitalization and further treatment. Methods: In a retrospective monocentric study, geriatric proximal femur fractures treated in the first six months of 2020 were analyzed and compared with the same period of 2019. Pre-traumatic status (living in a care home, under supervision of a legal guardian), type of trauma, accident mechanism, geriatric risk factors, associated comorbidities, time between hospitalization and surgery, inpatient time and post-operative further treatment of 2 groups of patients, aged 65-80 years (Group 1) and 80+ years (Group 2) were investigated. Results: The total number of patients decreased (70 in 2019 vs. 58 in 2020), mostly in Group 1 (25 vs. 16) while the numbers in Group 2 remained almost constant (45 vs. 42). The percentage of patients with pre-existing neurological conditions rose in 2020. This corresponded to an increase in patients under legal supervision (29.3%) and receiving pre-traumatic care in a nursing home (14.7%). Fractures were mostly caused by minor trauma in a home environment. In 2020, total number of inpatient days for Group 2 was lower compared to Group 1 (p = 0.008). Further care differed between the years: fewer Group 1 patients were discharged to geriatric therapy (69.6% vs. 25.0%), whereas in Group 2 the number of patients discharged to a nursing home increased. Conclusions: Falling by elderly patients is correlated to geriatric comorbidities, consequently there was no change in the case numbers in this age group. Strategic measures to avoid COVID-19 infection in hospital setting could include reducing the length of hospital stays by transferring elderly patients to a nursing home as soon as possible and discharging independent, mobile patients to return home.

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Outcomes of coaxial microincision cataract surgery versus conventional phacoemulsification surgery

Asian Journal of Ophthalmology ◽

10.35119/asjoo.v16i3.458 ◽

2019 ◽

Vol 16 (3) ◽

pp. 168-178

Author(s):

Anu Malik ◽

Smruti Ranjan Dethi ◽

Yogesh Kumar Gupta ◽

Alka Gupta

Keyword(s):

Cataract Surgery ◽

Randomized Study ◽

Corrected Visual Acuity ◽

Age Related ◽

Significant Difference ◽

Induced Astigmatism ◽

The Mean ◽

Group 2 ◽

Surgically Induced ◽

Group 1

Aim: To compare surgical parameters and visual outcomes of coaxial microincision cataract surgery (MICS) with standard phacoemulsification. Methods: A prospective randomized study was conducted on 60 eyes of 60 patients with age-related uncomplicated cataract who underwent: standard phacoemulsification surgery (30 eyes) i.e., Group 1, or coaxial MICS (30 eyes) i.e., Group 2. Intraoperative parameters were mean effective phacoemulsification power (EPP), effective phacoemulsification time (EPT), and total volume of balanced salt solution (BSS) used. Best-corrected visual acuity (BCVA) and surgically induced astigmatism (SIA) were evaluated pre- and postoperatively. Results: Mean BCVA at 6 weeks was 0.04 ± 0.07 in Group 1 and 0.05 ± 0.08 in Group 2. No significant difference was observed in SIA between the two groups. Mean EPT was 29.80 ± 3.67 seconds in Group 1 and 31.93 ± 4.08 seconds in Group 2. The mean total EPP in Group 1 was 35.77 ± 5.17%, whereas it was 33.70 ± 3.05% in Group 2. There was a significant statistical difference between mean EPP and EPT in the two groups. Mean total BSS volume used in Group 1 was 128.83 ± 19.81 ml, whereas it was 139.33 ± 13.57 ml in Group 2. Conclusion: Although EPT and BSS volume used were significantly higher in coaxial MICS, the postoperative results of the two techniques were comparable.

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The effect of hormonal disbalance on the aging rate change in the patients with arterial hypertension and comorbid endocrinopathies

Reports of Vinnytsia National Medical University ◽

10.31393/reports-vnmedical-2019-23(2)-17 ◽

2019 ◽

Vol 23 (2) ◽

pp. 277-282

Author(s):

V. D. Nemtsova ◽

I. A. Ilchenko ◽

V. V. Zlatkina

Keyword(s):

Arterial Hypertension ◽

Premature Aging ◽

Endocrine Disorders ◽

Anthropometric Parameters ◽

Aging Rate ◽

Age Related ◽

Number Of Patients ◽

Group 3 ◽

Group 2 ◽

Group 1

Due to the growing number of patients with age-related diseases, the aim of the study was to investigate in the changes of aging rate (AR) in patients with comorbid course of arterial hypertension (H), type 2 diabetes mellitus (T2DM) and subclinical hypothyroidism (SH) and to study the features of these changes depending on hormonal imbalance. 118 patients (63 women and 55 men, average age — 53.6±4.3 years) were divided into 3 groups: group 1 (n=37) with isolated H; group 2 (n=42) — with H and T2DM; group 3 (n=39) — with H, T2DM and SH. The investigation program included: measurement of anthropometric parameters (blood pressure, height, body weight (BW), body mass index (BMI)), carbohydrate and thyroid metabolism using standard methods, biological age (BA) by V.P. Voitenko et al. Statistical processing was performed using the Statistica for Windows 8.0 software package. When evaluating AR, physiological aging was found in 8 patients (21.6%) of group 1, in 4 (9.5%) patients of group 2 and 3 (7.7%) of patients in group 3. In the overwhelming majority of the examined patients, premature aging (PA) was noted, however, the acceleration of PA between patients of groups 2 and 3 was not differ significantly (p>0.05). The increase in AR in group 2 patients was accompanied by an increase in BA by 7.2 years, in 3 group patients — by 7.3 years compared with their chronological age. A correlation analysis revealed a positive relationship between BMI and coefficient of aging rate (CAR) (r=0.679; p<0.05); BMI and BA (r=0.562; p<0.05) and CAR and the TSH level (r=0.050; p=0.388) in the 3rd group. Thus, the presence of hypertension and comorbid endocrinopathies — T2DM and SH significantly increases the AR and when assessing the effect of endocrine disorders, the presence of T2DM is more important than SH.

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1260Transvenous lead extraction: efficacy and safety of the procedure in octogenarian patients

EP Europace ◽

10.1093/europace/euaa162.015 ◽

2020 ◽

Vol 22 (Supplement_1) ◽

Author(s):

M Giannotti Santoro ◽

L Segreti ◽

G Zucchelli ◽

V Barletta ◽

F Fiorentini ◽

...

Keyword(s):

Elderly Patients ◽

Electronic Device ◽

Clinical Success ◽

Lead Extraction ◽

Efficacy And Safety ◽

Cardiac Implantable Electronic Device ◽

Major Complications ◽

Group 2 ◽

Manual Traction ◽

Group 1

Abstract Introduction the management of patients with infection or malfunction of a cardiac implantable electronic device (CIED) may be challenging. Purpose The aim of the study is to evaluate the safety and efficacy of transvenous lead extraction (TLE) in elderly patients. Methods a retrospective analysis of patients who underwent to TLE in our center was performed. Patients were divided in two groups: 1) patients 80 years of age or older, 2) patients younger than 80 years. All patients were treated with manual traction or mechanical dilatation. Results our analysis included 1316 patients, with a total of 2513 leads extracted. Group 1 (≥80 years) counted 202 patients and group 2 (<80 years) 1114 patients. The group of elderly patients presented more comorbidities, as hypertension, chronic kidney disease, atrial fibrillation and pulmonary disease. Patients 80 years of age or older had more pacemakers than ICDs, whereas the dwelling time of the oldest lead, the number of leads and the presence of abandoned leads was similar despite patients age. In group 1 the rate of radiological success for lead was higher than in group 2 (99.0% vs 95.9%; P < 0.001). The clinical success was obtained in 1273 patients (96.7%), without significative differences between groups (98.0% vs 96.4%; P = 0.36). Major complications occurred in 10 patients (0.7%), without significative differences (1.5% vs 0.6%; P = 0.24) (figure 1). Conclusion TLE in elderly patients is a safe and effective procedure. In patients older than 80 years there are not more major complications than in younger patients, and the efficacy of the procedure seems to be superior. Abstract Figure 1

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Intestinal Obstruction due to Bezoar in Elderly Patients: Risk Factors and Treatment Results

Emergency Medicine International ◽

10.1155/2019/3647356 ◽

2019 ◽

Vol 2019 ◽

pp. 1-7 ◽

Cited By ~ 1

Author(s):

Fatih Altintoprak ◽

Eyup Gemici ◽

Yasin Alper Yildiz ◽

Mustafa Yener Uzunoglu ◽

Taner Kivilcim

Keyword(s):

Risk Factors ◽

Peptic Ulcer ◽

Surgical Technique ◽

Abdominal Surgery ◽

Elderly Patients ◽

Intestinal Obstruction ◽

History Of ◽

Group 2 ◽

Length Of Hospitalization ◽

Group 1

Purpose. Bezoars are foreign particles from the accumulation of indigestible materials in the gastrointestinal system and a rare cause of mechanical intestinal obstruction. We aimed at investigating differences in risk factors for the development of intestinal obstruction associated with bezoar in elderly patients.Methods. Hospital records of patients who underwent surgery associated with phytobezoar between January 2004 and May 2016 were retrospectively evaluated. Patients were divided into two groups [<65 years (Group 1) and ≥65 years (Group 2)]. Data were examined regarding presence of comorbidity, history of abdominal surgery, operation time, bezoar site, surgical technique, length of hospitalization, morbidity, and mortality.Results. Of 121 patients enrolled, 48 (39.7%) were male and 73 (60.3%) were female (range: 24-86 years). Group 1 consisted of 69 patients aged < 65, while Group 2 consisted of 52 patients aged ≥ 65. Comorbidity was reported in 52 (42.9%) patients (mostly diabetes mellitus, 20.7%), while 60 patients (49.6%) had history of abdominal surgery (mostly peptic ulcer, 27.3%). No statistical differences were found between the two groups in terms of sex, bezoar site, surgical technique preferred, history of abdominal surgical intervention, pre- and postoperative CT examination, morbidity rates, and length of hospitalization. But, ratio of peptic ulcer operations history, presence of total comorbidity, and time of surgery decision was higher in Group 2 patients.Conclusion. In bezoar-related intestinal obstruction, duration and outcome of treatment are not affected by age distribution. Possibility of bezoar should primarily be considered in elderly patients with history of peptic ulcer operation.

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The Effect of Diagnostic Ureterorenoscopy on Intravesical Recurrence in Patients Undergoing Nephroureterectomy for Primary Upper Tract Urinary Carcinoma

Urologia Internationalis ◽

10.1159/000511650 ◽

2020 ◽

pp. 1-7

Author(s):

Volkan İzol ◽

Mutlu Deger ◽

Ender Ozden ◽

Deniz Bolat ◽

Burak Argun ◽

...

Keyword(s):

Proportional Hazards ◽

Proportional Hazards Model ◽

Univariate Analysis ◽

Upper Urinary Tract ◽

Cox Proportional Hazards ◽

Cox Proportional Hazards Model ◽

Recurrence Time ◽

Tumor Biopsy ◽

Group 2 ◽

Group 1

Objective: The objective of this study is to evaluate the effect of diagnostic ureterorenoscopy (URS) prior to radical nephroureterectomy (RNU) on intravesical recurrence (IVR), in patients with primary upper urinary tract urothelial carcinoma (UTUC). Materials and Methods: Retrospective analysis of 354 patients, who underwent RNU for UTUC from 10 urology centers between 2005 and 2019, was performed. The primary endpoint was the occurrence of IVR after RNU. Patients were divided into URS prior to RNU (Group 1) and no URS prior to RNU (Group 2). Rates of IVR after RNU were compared, and a Cox proportional hazards model was used to evaluate potential predictors of IVR. Results: After exclusion, a total of 194 patients were analyzed: Group 1 n = 95 (49.0%) and Group 2 n = 99 (51.0%). In Group 1, a tumor biopsy and histopathological confirmation during URS were performed in 58 (61.1%). The mean follow-up was 39.17 ± 39.3 (range 12–250) months. In 54 (27.8%) patients, IVR was recorded after RNU, and the median recurrence time within the bladder was 10.0 (3–144) months. IVR rate was 38.9% in Group 1 versus 17.2% in Group 2 (p = 0.001). In Group 1, IVR rate was 43.1% in those undergoing intraoperative biopsy versus 32.4% of patients without biopsy during diagnostic URS (p =0.29). Intravesical recurrence-free survival (IRFS) was longer in Group 2 compared to Group 1 (median IRFS was 111 vs. 60 months in Groups 2 and 1, respectively (p< 0.001)). Univariate analysis revealed that IRFS was significantly associated with URS prior to RNU (HR: 2.9, 95% CI 1.65–5.41; p < 0.001). In multivariate analysis, URS prior to RNU (HR: 3.5, 95% CI 1.74–7.16; p < 0.001) was found to be an independent prognostic factor for IRFS. Conclusion: Diagnostic URS was associated with the poor IRFS following RNU for primary UTUC. The decision for a diagnostic URS with or without tumor biopsy should be reserved for cases where this information might influence further treatment decisions.

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VENTRICULOPERITONEAL SHUNTING AFTER ANEURYSMAL SUBARACHNOID HEMORRHAGE

Neurosurgery ◽

10.1227/01.neu.0000317310.62073.b2 ◽

2008 ◽

Vol 62 (3) ◽

pp. 618-627 ◽

Cited By ~ 38

Author(s):

Andrew S. Little ◽

Joseph M. Zabramski ◽

Madelon Peterson ◽

Pamela W. Goslar ◽

Scott D. Wait ◽

...

Keyword(s):

Risk Factors ◽

Subarachnoid Hemorrhage ◽

Functional Status ◽

Posthemorrhagic Hydrocephalus ◽

Ventriculoperitoneal Shunting ◽

Group 3 ◽

Group 2 ◽

Ventricle Size ◽

Group 1

Abstract OBJECTIVE The goals of this study were to investigate the risk factors, indications, complications, and outcome for patients with ventriculoperitoneal shunts (VPSs) after subarachnoid hemorrhage and to define a subgroup eligible for future prospective studies designed to clarify indications for placement of a VPS. METHODS Clinical characteristics of 236 prospectively evaluated patients with subarachnoid hemorrhage and 6 months of follow-up were analyzed. Hydrocephalus was estimated by the relative bicaudate index (RBCI) measured on computed tomographic scans at the time of shunting. Patients were divided into three groups by ventricle size: Group 1 included 121 patients with small ventricles (RBCI <1.0), Group 2 included 88 patients with borderline ventricle size (RBCI 1.0–1.4), and Group 3 included 27 patients with markedly enlarged ventricles (RBCI >1.4). RESULTS Initially, 86 patients (36%) underwent ventriculoperitoneal shunting: 19 in Group 1 (16%), 43 in Group 2 (49%), and 24 in Group 3 (90%). Indications for placement of a VPS, risk factors, and outcome differed markedly by group. Four patients (3% of those not initially shunted) developed delayed hydrocephalus requiring a VPS, including one in Group 2 (2%). The 6-month shunt complication rate was 13%. Evaluation of patients in Group 2 indicated that functional status was an important factor in selecting candidates for shunting, and that patients receiving shunts and shunt-free patients demonstrated improvement in functional status during follow-up. CONCLUSION Although we currently use a proactive shunting paradigm for posthemorrhagic hydrocephalus, this report demonstrates that a conservative approach to patients with borderline ventricle size (i.e., RBCI of 1.0–1.4) and normal intracranial pressure should be evaluated in a prospective randomized trial.

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