[Perioperative risk assessment of geriatric patients undergoing noncardiac surgery]. / Perioperative Risikostratifizierung geriatrischer Patienten bei nichtkardialen Eingriffen.

BACKGROUND: Older patients more often suffer perioperative complications than younger people. Especially geriatric patients who require emergency treatment represent a high-risk group. Therefore, perioperative risk assessment supports the treatment team in identifying patients at risk and in defining the treatment plan accordingly. MATERIALS AND METHODS: A thorough medical history and clinical examination are pivotal elements of any risk stratification. The organ-specific risk assessment is primarily used to plan the surgical and anesthesiological procedures. RESULTS: For a comprehensive risk assessment in geriatric patients, the organ-specific risk stratification is insufficient. Assessment instruments that reflect the idiosyncrasies of multidimensional disease in geriatric patients can complement risk stratification. These should include the assessment of multimorbidity, frailty, nutrition, activities of daily living, and cognition. In addition to risk prediction, geriatric assessment has the major advantage of providing both a diagnostic and a planning perspective. This allows the implementation of supporting measures for optimal perioperative care, which is the goal of any risk stratification. Risk scores provide a global assessment, but they have their limitations in predicting individual patient risk.

[A drug addict presenting with complicated tricuspid valve endocarditis]. / Komplikationsreiche Trikuspidalklappenendokarditis bei einem Drogenabhängigen.

The right-sided heart valves are affected in about 10% of patients with infective endocarditis. However, the tricuspid valve is the most frequently involved valve in intravenous drug users with infective endocarditis. When treated with antibiotics, the prognosis is considered favorable. Reported here is the case of a drug-addicted patient with polymicrobial (Staphylococcus aureus and Streptococcus pneumoniae) infective endocarditis of the tricuspid valve and a lethal outcome due to multiple organ failure. The indications and options to perform cardiac surgery in patients with infective endocarditis of the tricuspid valve are discussed.

[Clinical manifestations of CHARGE association in the area of the mouth, jaw and face]. / Klinische Manifestationen der CHARGE-Assoziation im Mund-, Kiefer- und Gesichtsbereich.

Clinical experience of 11 patients with CHARGE association is reviewed. The study comprised six girls and five boys. All presented with congenital heart disease. Eight had bilateral choanal atresia. Coloboma affecting either one or both eyes was detected in nine children. Nine patients suffered abnormal pinnae or deafness. In addition to major abnormalities, further anomalies of the orofacial region and the upper airways occurred in all patients. All children exhibited velopharyngeal incoordination and swallowing problems often resulting in recurrent aspiration pneumonia. Three patients had cleft lip and palate. Both micrognathia and high-arched palate were present in two patients. Facial palsy was observed in six patients. Optimal management requires a multidisciplinary approach with active coordination and cooperation between the appropriate specialties. The anatomical repair of bilateral choanal atresia should be performed as early as possible. In our experience, the transpalatal approach is far more satisfactory than the transnasal. It gives the surgeon the opportunity of direct access and anatomical repair. After the child has grown stronger, a long-term management is desirable including developmental and feeding training.

[Physical and psychological status of 60-70-year-old citizens of Bern with neurotic symptoms in childhood--a study over more than 50 years (Emmental cohort)]. / Körperliches und psychisches Befinden bei 60-70jährigen Bernerinnen und Bernern mit neurotischen Symptomen im Kindesalter--Eine Untersuchung über mehr als 50 Jahre (Emmental-Kohorte).

The present study was undertaken to assess the influence of childhood variables (physical and emotional) to later well-being in a group of rural Swiss (Emmental Cohort). Our study is the first prospective cohort over a time period of more than 50 years. It includes 1537 children who were listed and assessed in 1942 (T1) because they had difficulties in school or were otherwise behaviorally disturbed. In 1995 (T2) more than 60% of the initial population could be reassessed by our study group. We found more subjects at T2 who had been rated as intelligent at T1. More subjects responding to T2 belonged to a higher social class, were more anxious, and had more psychosocial problems at T1. Social income at T2 is correlated to the social class at T1. More subjects have died since who were rated at T1 as being less intelligent, less neurotical, and having higher psychosocial problems. Twice as many men died than women. The emotional situation at T2 is significantly correlated to psychological well-being at T1. The somatic complaints at T2 correlate significantly to neurotic symptoms in childhood (T1). The more intelligent the children were rated at T1, the less emotional and somatic complaints were voiced at T2 and the better the psychic well-being was rated (T2). In addition, the former social milieu (T1) significantly determined somatic and psychological complaints at T2. Our data discern a significant correlation between actual status and former childhood variables more than 50 years later in a rural Swiss cohort (Emmental Cohort).

Hospital pager systems may cause interference with pacemaker telemetry.

Electromagnetic interference (EMI) is a well-known cause of pacemaker dysfunction. The communication between pacemakers and programmers, enabled by telemetry, is also susceptible to EMI. We have observed that hospital pager systems have the potential to interfere with pacemaker telemetry. Measurements in our pacemaker clinic and in a technical laboratory have shown that inductive pager systems may disturb telemetry in the form of inaccurate battery voltage, current and impedance measurements, disturbances in intracardiac electrogram tracings, or total interruption of telemetric communications. The reason for EMI was an overlap of carrier frequencies of some pacemaker programmers (32-37 kHz) with those of our inductive pager system (36.11 kHz). Radiofrequency pager systems using higher frequencies (in MHZ range) are unlikely to cause such interference. Awareness of this interference potential may have practical implications in choosing the carrier frequencies of inductive hospital pager systems, as well as pacemaker programmers, and in planning the location of pacemaker clinics.

The meaning of a nonspecific abdominal gas pattern.

RATIONALE AND OBJECTIVES: The radiology report is the primary means of communication between the radiologist and the referring physician. A lack of precision in this report may adversely affect patient care. We examined how radiologists would define "nonspecific abdominal gas pattern" and how referring physicians would perceive the meaning. METHODS: A questionnaire was distributed to radiologists and referring physicians in Flint, Michigan. They were asked to categorize their definition or interpretation, respectively, of "nonspecific abdominal gas pattern" into "normal"; "either normal or abnormal"; or "abnormal, representing either mechanical obstruction or adynamic ileus." RESULTS: Thirty-three radiologists responded, 23 (69.7%) of whom used the term. One hundred fifty-seven referring physicians responded, 127 of whom assigned a specific definition to the term. Using a 2 x 3 chi-square test (df = 2), we found a statistically significant difference (p < .03) between the distribution of the meaning of the term between radiologists and their referring physicians. CONCLUSION: The term "nonspecific abdominal gas pattern" should be abandoned because it may signify a normal condition or a pathologic state. We found the definition to be dichotomous and asynchronous between radiologists and their referring physicians.

Cardiopulmonary exercise capacity in healthy normals of different age.

Sixty-nine healthy normals from the 3rd to the 6th decade were stressed to exhaustion by means of a cardiopulmonary exercise test on a bicycle ergometer. Peak VO2, VCO2 and ventilation differed significantly between the four decades: peak VO2 (mean +/- SD) was 3,393 +/- 516; 3,061 +/- 444; 2,817 +/- 801 and 2,589 +/- 687 ml/min (p < 0.001). The mean value for respiratory gas exchange ratio (R) at ventilatory threshold (VT) was 0.86 and for ventilatory equivalent O2 (EqO2) 0.24. Mean VO2 at VT was 1,662 +/- 521; 1,462 +/- 308; 1,474 +/- 559 and 1,268 +/- 232 ml/min (p < 0.05). The VO2 of the four age groups at VT was between 47 and 49% of peak VO2 (n.s.), and both parameters correlated significantly (r = 0.67, p < 0.001). The average increase of VO2 in relation to work rate (ml/W/min) was 11.5 +/- 1.2 for the total exercise and was below VT lower (9.4 +/- 1.9) than above VT (12.9 +/- 1.2) (p < 0.001).

Unusual patterns of glenohumeral joint injuries in adolescent ski-jumpers.

We report on two 16.5-year-old ski-jumpers who sustained unusual glenohumeral joint injuries. The first fell on landing, the other while running out. Neither could give any indications as to the pathomechanics of the injuries, thus illustrating the high speed nature of the trauma.

[What is the value of stable osteosynthesis of the distal radius?]. / Was leistet die stabile Osteosynthese am distalen Radius?

127 or 4% of the fractures of the distal radius seen in our department between 1968 and 1979 have been treated by internal fixation. 85 of these wrists could be reviewed after an average of 4.8 years. 70% of the fractures were multifragmentary and 87% involved the joint surface. In this difficult group correct length of the radius was restored in two thirds, and physiological angles of the joint in one third of the cases. In spite of frequent limitation of motion of the wrist joint, 80% of the patients were satisfied with the result. Careful selection of cases for internal fixation is necessary. It is indicated mainly in the Smith type fractures but may be replaced by percutaneous K-wire pinning, the external fixator or a delayed osteotomy.