Prognostic factors that modify outcomes of vestibular rehabilitation in elderly patients with falls.

BACKGROUND: Our previous study has shown that vestibular rehabilitation (VR) is an effective technique to reduce falls in elderly patients. It would be interesting to establish patients' clinical characteristics in which vestibular rehabilitation is expected to be more effective. AIMS: Evaluate factors that could modify rehabilitation outcomes in elderly patients with previous falls. METHODS: Fifty-seven patients randomized to one of the intervention group (computerized dynamic posturography-CDP-training, optokinetic stimulus or exercise at home) and with previous falls were analyzed. Patients were assessed with objective outcome measures (sensorial organization test and limits of stability-LOS-of CDP, modified timed up and go test-TUG-and number of falls) and with subjective outcome measures (dizziness handicap inventory and Short falls efficacy scale-international-Short FES-I) during a 12-month follow-up period. RESULTS: In the logistic regression model, a worse score in the maximum excursion (MXM), and a shorter time in the TUG significantly associated with a reduction > 50% of falls. Also, association with a higher score in the Short FES-I was close to a statistical significance. There was no statistical significance association with other covariables. DISCUSSION: In patients with reduced limits of stability, VR seems to be more effective and they should be encouraged to perform it. But on the other hand, patients with longer time in the TUG show worse outcomes and may benefit more with gait training. CONCLUSIONS: VR in elderly people with previous falls is effective regardless of their age and gender.

Optimising costs in reducing rate of falls in older people with the improvement of balance by means of vestibular rehabilitation (ReFOVeRe study): a randomized controlled trial comparing computerised dynamic posturography vs mobile vibrotactile posturography system.

BACKGROUND: Accidental falls, especially for the elderly, are a major health issue. Balance disorders are one of their main causes. Vestibular rehabilitation (VR) has proven to be useful in improving balance of elderly patients with instability. Its major handicap is probably its cost, which has prevented its generalisation. So, we have designed a clinical trial with posturographic VR, to assess the optimum number of sessions necessary for a substantial improvement and to compare computerised dynamic posturography (CDP) (visual feedback) and mobile posturography (vibrotactile feedback). METHODS: Design: randomized controlled trial. It is an experimental study, single-center, open, randomized (balanced blocks of patients) in four branches in parallel, in 220 elderly patients with high risk of falls; follow-up period: twelve months. SETTING: Department of Otorhinolaryngology of a tertiary referral hospital. PARTICIPANTS: people over 65 years, fulfilling two or more of the following requirements: a) at least one fall in the last twelve months. b) take at least 16 s or require some support in perform the "timed up and go" test. c) a percentage of average balance in the sensory organization test (SOT) of the CDP < 68%. d) at least one fall in any of the conditions in SOT-CDP. e) a score in Vertiguard's gSBDT > 60%. INTERVENTION: Four differents protocols of vestibular rehabilitation (randomization of the patients). MAIN OUTCOME MEASURE: The percentage of average balance in the SOT-CDP. Secondary measures: time and supports in the "timed up and go" test, scores of the CDP and Vertiguard, and rate of falls. DISCUSSION: Posturographic VR has been proven to be useful for improving balance and reducing the number of falls among the aged. However, its elevated cost has limited its use. It is possible to implement two strategies that improve the cost-benefit of posturography. The first involves optimising the number of rehabilitation sessions; the second is based on the use of cheaper posturography systems. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT03034655. Registered on 25 January 2017.

Vestibular rehabilitation in elderly patients with postural instability: reducing the number of falls-a randomized clinical trial.

BACKGROUND: Our previous study had shown the effectiveness of vestibular rehabilitation (VR) in improving balance in elderly patients, assessed immediately afterwards. AIMS: The main goal of the present study is to consider whether this improvement in balance assessment turns out in a reduction of the number of falls. METHODS: 139 elderly patients with high risk of falls were included and randomized to one of the following study arms: computerized dynamic posturography (CDP) training, optokinetic stimulus, exercises at home or control group. Patients were assessed with objective outcome measures (sensorial organization test and limits of stability of CDP, number of falls and number of hospital admissions due to falls) and subjective outcome measures (dizziness handicap inventory and short falls efficacy scale-international) during a 12-month follow-up period. RESULTS: Average number of falls significantly declined from 10.96 (before VR) to 3.03 (12-month follow-up) in the intervention group (p < 0.001); meanwhile, in the control group, the average number of falls changed from 3.36 to 2.61 during a 12-month follow-up period (p = 0.166). DISCUSSION: The present study provides evidence that VR can decisively improve balance in elderly patients with instability, which can lead in turn to a significant reduction of falls. CONCLUSION: We recommend performing VR in any older person with high risk of falls.

Short-term effectiveness of vestibular rehabilitation in elderly patients with postural instability: a randomized clinical trial.

Balance becomes more precarious with age, and even without pathological disorders, the physiological decline in balance that occurs with age is a factor that also favors falls. So the aim of the present study is to assess the short-term effectiveness of three different methods of vestibular rehabilitation, compared to a control group, in improving balance in elderly patients with postural instability. 139 elderly patients with high risk of falls were included and randomized to one of the following study arms: computer dynamic posturography (CDP) training, optokinetic stimulus, exercises at home, or control group. Patients were assessed with objective and subjective outcome measures. The individuals that trained using CDP improved significantly more than the control group on the average balance score (p < 0.001) and reducing the number of falls in the sensorial organization test (p < 0.001). In addition, the analysis showed a statistically significant effect in the limits of stability only with the CDP training in comparison with the control group (p < 0.001). In our present study, supervised and customized exercises with CDP were more effective than the control group in the posturographic short-term assessment. An increased age did not affect the potential for improvement after training. So we conclude that elderly patients with high risk of falling should begin vestibular rehabilitation as soon as possible in order to avoid the potential harm of falls, mainly injuries and psychological consequences due to fear of falling again.

Impact of obesity in elderly patients with postural instability.

OBJECTIVE: The aim of the study is to assess whether obesity affects balance in elderly patients with postural instability. STUDY DESIGN: It is a case-control study, with cases defined by BMI ≥30 kg/m(2), and developed in a third level university hospital. METHODS: We included 135 patients aged 65 years old or more who presented postural instability. Balance assessment was through the sensory organisation test (SOT), limits of stability (LOS) and rhythmic weight shift (RWS) of computerised dynamic posturography (CDP) and the modified timed up-and-go (TUG) test. The patients also completed the Dizziness Handicap Inventory and short Falls Efficacy Scale-International questionnaire. RESULTS: Patients with obesity took longer to perform the modified TUG and required more steps. Also these patients had poorer scores in the subjective tests. In the CDP there were no significant differences in the SOT nor the LOS, and only there was a statistical significant difference in the anterior-posterior directional control of the RWS. Obese patients have a higher risk of fallings compared to non-obese patients. CONCLUSION: In essence, our results indicate that obesity interferes in the balance of elderly patients with postural instability, putting them at a greater risk of fallings, performing worse dynamic tasks and feeling more disabled. Although continued education on training balance may be useful in older population, since the obese group shows more rate of fallers, rehabilitation programmes focus on dynamic tasks in these patients could be useful to reduce their fall risk and improve their quality of life.

Disability perception in Menière's disease: when, how much and why?

The purpose of the study was to evaluate self-perceived handicap in patients with definite Menière's disease (MD). A cross-sectional study was conducted. To examine the self-perception of disability, participants completed a DHI (Dizziness Handicap Inventory). Parameters compared with DHI scores: sex, age, unilateral/bilateral affectation, time elapsed since the onset of symptoms, pure-tone average (PTA), stages of MD, audiometric change (last 6 months), PTA in low frequencies (PTAl) and audiometric change in PTAl, subjective perception of fluctuating hearing threshold, tinnitus between attacks, number of vertiginous episodes (last 6 months), time elapsed since last attack, subjective perception of instability intercrises and Tumarkin attacks. 90 patients were included; they completed a total of 104 questionnaires. DHI scores ranged from 2 to 100 (average: 47.08, SD 24.45). In 29 cases (27.9 %) the disability perception was mild, in 43 (41.3 %) moderate, and in 32 (30.8 %) severe. Correlation between disability perception and some vestibular symptoms was found: number of typical attacks (last 6 months), time elapsed since last attack, instability intercrises and Tumarkin attacks. No relationship was found with the rest of variables. Disability perception in patients with MD depends primarily on vestibular symptoms (particularly, instability and frequency of attacks). So, we suggest to design a new staging system of MD taking into account both auditory criteria and also vestibular symptoms.

Factors affecting peri-implant bone loss: a post-five-year retrospective study.

INTRODUCTION: Although peri-implant bone loss is one of the parameters included in the criteria for determining implant success, its prevention is of vital importance. The goal of this article is to assess the factors that affect peri-implant bone loss. MATERIAL AND METHODS: An observational, longitudinal, retrospective study was conducted in 148 partially edentulous patients rehabilitated with implants and with a follow-up period of 5 years or more. A total of 585 implants were included in the study. Radiographic peri-implant bone loss was compared with radiographic periodontal bone loss, and other characteristics such as prosthesis design, hygiene, and implant size were studied as potential peri-implant bone loss modification factors. RESULTS: In the univariate analysis, a statistically significant relationship between peri-implant bone loss and gender (P < 0.05), implant system (P < 0.01), reason for extraction (P < 0.05), splinting (P < 0.0001), and distance between the implant platform and the horizontal component of the prosthesis (P < 0.0001) were observed. In multivariate analysis, the relationship between this peri-implant loss and gender (P < 0.05), implant system (P < 0.05), splinting (P < 0.001), and the aforementioned distance (P < 0.01) remains. CONCLUSIONS: The distance implant platform-horizontal component of the prosthesis has the greatest effect on peri-implant bone loss This distance must be >3.3 mm and <6 mm, above this range, it no longer influences in peri-implant bone loss and favors the appearance of embrasures and the buildup of bacterial plaque.

Reduction of falls in older people by improving balance with vestibular rehabilitation (ReFOVeRe study): design and methods.

MAIN OBJECTIVE: Evaluate the effectiveness of vestibular rehabilitation (VR) to improve the balance in older people, assessed immediately afterwards. SECONDARY OBJECTIVES: (a) To verify the maintenance of improvement of the balance achieved in the medium term (6-12 months). (b) To consider whether this improvement results in a reduction in the number of falls. (c) To compare among themselves the effectiveness of three different methods of VR in improving balance and to explore whether there are differences to achieve a reduction in the number of falls. DESIGN: Experimental study, single-centre, open, randomised (balanced blocks of patients) in four branches in parallel, in 220 elderly patients (over 64 years) with high risk of falls and a follow-up period of 12 months. SETTING: Department of Otolaryngology of the University Hospital of Santiago. PARTICIPANTS: People over 64 years, fulfilling one of the following requirements: (a) At least one fall in the last year. (b) Take at least 16 s or require some support in perform the test "timed up and go". (c) A percentage of average balance in the sensory organisation test (SOT) in the dynamic posturography (CDP) <68%. (d) At least one fall in any of the conditions in the SOT of CDP. INTERVENTION: Three different protocols of VR. MAIN OUTCOME MEASURE: The percentage of average balance in the SOT in CDP. Secondary measures: time and supports in the test of "timed up and go", scores of the dynamic posturography and SwayStar system, and rate of falls.

Is there a relationship between objective and subjective assessment of balance in elderly patients with instability?

To assess whether a subjective questionnaire that measures the disability caused by balance disorders in daily life activities is correlated to objective assessment of balance in elderly patients with age-related instability. We included 37 subjects aged 65 years or more who presented balance disorders induced solely by age. Balance assessment was through the sensory organisation test and limits of stability of computerised dynamic posturography, the SwayStar system and the modified timed up and go test. The patients also completed the dizziness handicap inventory (DHI) questionnaire. The SwayStar balance control index (BCI) was most significantly correlated to the DHI score and the score of its different scales. When we divided the patients into subgroups according to DHI score, we only found statistically significant differences in the BCI and number of falls. In our population of elderly patients with instability, there is practically no correlation between the DHI and the static balance assessment. However, there is greater correlation with the BCI, which could show that dynamic balance is perceived as more disabling for these patients. In this case, when designing a rehabilitation protocol we should focus more on dynamic activities such as gait.

Impact of subject's position and acoustic stimulus type on vestibular evoked myogenic potentials (VEMPs) in normal subjects.

Vestibular evoked myogenic potentials (VEMPs) are currently considered a diagnostic tool for studying the vestibular system, specifically the saccule and inferior vestibular nerve. This prospective study aimed at evaluating the impact of patient position and type of acoustic stimulus on VEMPs results using 60 healthy subjects who underwent otoscopy, pure tone audiometry and VEMPs in different conditions affecting their position and the type of acoustic stimulus. Corrected amplitude is significantly greater when the patient is seated and latency difference and amplitude asymmetry do not change with either patient position or type of stimulus. The results obtained in different test conditions are not comparable. Being seated is the most appropriate position for the test.

[Validation of the short FES-I scale in Spanish population over 70 years]. / Validación de la escala Short FES-I en población española mayor de 70 años.

INTRODUCTION: Falls deteriorate the quality of life of the elderly and the fear of falling has been shown to be an independent risk factor for frailty, so having tools for its evaluation is a priority. The short FES-I scale, short version (7 items) of the FES-I scale (16 items), assesses fear of falling. The objective of this study is to validate the short FES-I scale in the Spanish population over 70 years and to analyze the relationship between fear of falling, risk of falls and frailty. MATERIAL AND METHODS: Cross-sectional observational study. SAMPLE: 227 subjects (50.7% male; mean age 75.8 years). SETTING: northern Spain. VARIABLES: sociodemographic, clinical, short physical performance battery (SPPB) and timed up and go test (TUG) execution tests, FES-I and short FES-I. Analysis of psychometric properties: validity and reliability. RESULTS: The short FES-I scale shows excellent internal consistency (Cronbach's alpha = 0.90, intraclass correlation coefficient = 0.89) and test-retest reliability (rho Spearman = 0.76). It has a high concomitant criterion validity analyzed by its correlation with FES-I (rho Spearman = 0.90). The discriminant construct validity has been confirmed for both SPPB and TUG. Short FES-I presents good capacity for frailty classification (defined by SPPB) with AUC = 0.715. As a cut-off point, a short FES-I value > 8 is proposed for moderate/high fear of falling. CONCLUSIONS: The short FES-I scale is a good instrument to study fear of falling in the Spanish population over 70 years and is valid for clinical and research use.

Insulin resistance (HOMA-IR) cut-off values and the metabolic syndrome in a general adult population: effect of gender and age: EPIRCE cross-sectional study.

BACKGROUND: Insulin resistance has been associated with metabolic and hemodynamic alterations and higher cardio metabolic risk. There is great variability in the threshold homeostasis model assessment of insulin resistance (HOMA-IR) levels to define insulin resistance. The purpose of this study was to describe the influence of age and gender in the estimation of HOMA-IR optimal cut-off values to identify subjects with higher cardio metabolic risk in a general adult population. METHODS: It included 2459 adults (range 20-92 years, 58.4% women) in a random Spanish population sample. As an accurate indicator of cardio metabolic risk, Metabolic Syndrome (MetS), both by International Diabetes Federation criteria and by Adult Treatment Panel III criteria, were used. The effect of age was analyzed in individuals with and without diabetes mellitus separately. ROC regression methodology was used to evaluate the effect of age on HOMA-IR performance in classifying cardio metabolic risk. RESULTS: In Spanish population the threshold value of HOMA-IR drops from 3.46 using 90th percentile criteria to 2.05 taking into account of MetS components. In non-diabetic women, but no in men, we found a significant non-linear effect of age on the accuracy of HOMA-IR. In non-diabetic men, the cut-off values were 1.85. All values are between 70th-75th percentiles of HOMA-IR levels in adult Spanish population. CONCLUSIONS: The consideration of the cardio metabolic risk to establish the cut-off points of HOMA-IR, to define insulin resistance instead of using a percentile of the population distribution, would increase its clinical utility in identifying those patients in whom the presence of multiple metabolic risk factors imparts an increased metabolic and cardiovascular risk. The threshold levels must be modified by age in non-diabetic women.

Method to calculate the protamine dose necessary for reversal of heparin as a function of activated clotting time in patients undergoing cardiac surgery.

Activated clotting time (ACT) has been used to monitor coagulation and guide management of anticoagulation control in patients undergoing cardiac surgery for decades. However, reversal of heparin with protamine is typically empirically based on total heparin administered. Dose-related adverse effects of protamine are well described. The aim of this study was to evaluate a heparin reversal strategy based on calculation of the protamine dose based on ACT measurements. We present a method using a mathematical formula based on the dose-response line (1). To check the formula, we performed a retrospective observational cohort study of 177 patients undergoing cardiac surgery with cardiopulmonary bypass (CPB). The study group of 80 patients was administered the dose of protamine obtained using our formula, and the control group of 97 patients was administered the empirically calculated dose. The ACT returned to normal values in patients who were given doses of protamine that were calculated using our formula; all but two had a final ACT of 141. The application of the formula resulted in a significant reduction in the dose of protamine (p < .023). The formula we present is a valid method for calculating the dose of protamine necessary to neutralize heparin. This same method can be used working with a target ACT to adjust the dose of heparin. As a result of its functionality, it allows application on a daily basis standardizing the process. We believe that the formula we developed can be applied in all those procedures in which it is necessary to anticoagulate patients with heparin and later neutralization (cardiac surgery with or without CPB, vascular surgery, procedures of interventional cardiology, and extracorporeal depuration procedures).

The role of p21Waf1/CIP1 as a Cip/Kip type cell-cycle regulator in oral squamous cell carcinoma (Review).

Oral Squamous Cell Carcinoma (OSCC) is biologically characterized by the accumulation of multiple genetic and molecular alterations that end up clinically characterized as a malignant neoplasm through a phenomenon known as multistep. The members of the Cip/Kip family, specifically p21Waf1/CIP1, are responsible for cell cycle control, blocking the transition from phase G1 to phase S. We made a search of articles of peer-reviewed Journals in PubMed/ Medline, crossing the keywords. The goal of this paper is to determine the relationship between p21Waf1/CIP1 expression and several clinical and pathological aspects of OSCC, their relationship with p53 and HPV, as well as genetic alterations in their expression pattern, their use as a prognosis market in the evolution of precancerous lesions and their roles in anticancer treatments. The results of p21WAF1/CIP1 expression in OSCC showed mixed results in terms of positivity/negativity throughout different studies. It seems that, although p21Waf1/CIP1 expression is controlled in a p53-dependent manner, coexpression of both in OSCC is not intrinsically related. Although the presence of HPV viral oncoproteins increases p21Waf1/CIP1 levels, the small number of studies, have forced us to disregard the hypothesis that HPV infected lesions that present better prognosis are due to a p21Waf1/CIP1-dependent control. The role of p21WAF1/CIP1 as cell-cycle regulator has been well described; however, its relationship to OSCC, the clinical and pathological variables of tumors, HPV and different treatments are not entirely clear. Thus, it would be very interesting to pursue further study of this protein, which may have a significant value for the diagnosis, prognosis and therapy of this type of tumors.

Evaluating the Performance of the Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes With Early Implementation of the ACC/AHA Guidelines (CRUSADE) bleeding score in a contemporary Spanish cohort of patients with non-ST-segment elevation acute myocardial infarction.

BACKGROUND: The Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes With Early Implementation of the ACC/AHA Guidelines (CRUSADE) model provides a risk score that predicts the likelihood of major bleeding in patients hospitalized for non-ST-elevation acute myocardial infarction. The aim of the present work was to evaluate the performance of this model in a contemporary cohort of patients hospitalized for non-ST-elevation acute myocardial infarction in Spain. METHODS AND RESULTS: The study subjects were 782 consecutive patients admitted to our center between February 2004 and June 2009 with non-ST-elevation acute myocardial infarction. For each patient, we calculated the CRUSADE risk score and evaluated its discrimination and calibration by the C statistic and the Hosmer-Lemeshow goodness-of-fit test, respectively. The performance of the CRUSADE risk score was evaluated for the patient population as a whole and for groups of patients treated with or without >or=2 antithrombotic medications and who underwent cardiac catheterization or not. The median CRUSADE score was 30 points (range, 18 to 45). A total of 657 patients (84%) were treated with >or=2 antithrombotic, of whom 609 (92.7%) underwent cardiac catheterization. The overall incidence of major bleeding was 9.5%. This incidence increased with the risk category: very low, 1.5%; low, 4.3%; moderate, 7.8%; high, 11.8%; and very high, 28.9% (P<0.001). For the patients as a whole, for the groups treated with or without >or=2 antithrombotics, and for the subgroup treated with >or=2 antithrombotics who did or did not undergo cardiac catheterization, the CRUSADE score showed adequate calibration and excellent discriminatory capacity (Hosmer-Lemeshow P>0.3 and C values of 0.82, 0.80, 0.70, and 0.80, respectively). However, it showed little capacity to discriminate bleeding risk in patients treated with >or=2 antithrombotics who did not undergo cardiac catheterization (C=0.56). CONCLUSIONS: The CRUSADE risk score was generally validated and found to be useful in a Spanish cohort of patients treated with or without >or=2 antithrombotics and in those treated with or without >or=2 antithrombotics who underwent cardiac catheterization. More studies are needed to clarify the validity of the CRUSADE score in the subgroup treated with >or=2 antithrombotics who do not undergo cardiac catheterization.

Balance Disorders in the Elderly: Does Instability Increase Over Time?

OBJECTIVES: To analyze the equilibriometric differences between 2 populations of elderly patients (young elderly and very elderly) with instability induced solely by age. METHODS: Cross-sectional study, with 2 study groups classified according to patient age (cut-points in twenty-fifth and seventy-fifth percentiles of the age of the sample). POPULATION: 64 patients aged 65 years or more. Two groups of 32 subjects were established: group A (people 65 years of age or older but less than 72.6, twenty-fifth percentile) and group B (patients 82.5 years, seventh-fifth percentile, or older). Main analyzed variables: timed up-and-go test, sensory organization test of the computerized dynamic posturography, Dizziness Handicap Inventory (DHI), and Short Falls Efficacy Scale-International (FES-I) questionnaires. Student's t test or the Mann-Whitney test were used. RESULTS: The older patients obtain poorer scores in the equilibriometric tests but not in all of them. In the sensory organization test, the older patients make poorer use of visual and vestibular information; they also require more time and steps for the timed up-and-go. With regards to the questionnaires, fear of falling is greater (higher Short FES-I scores) but not subjective perception of disability (DHI scores without differences). CONCLUSIONS: There is a need to establish aged subgroups of elderly patients with instability, adapting therapeutic strategies.

Is there a relationship between short FES-I test scores and objective assessment of balance in the older people with age-induced instability?

Fear of falling (FOF) is a common problem among the elderly. The purpose of this study is to evaluate whether there is a correlation between FOF, estimated via the short FES-I test, and objective evaluation of balance in a group of elderly patients with age-related instability. The balance of 139 subjects of more than 65 years of age is evaluated by the timed up and go test and the computerised dynamic posturography (CDP). Different groups of elderly patients were established according to the number of falls in the previous 12 months, and the correlation with short FES-I test scores was evaluated. Based on the results, ROC curves were calculated. The short FES-I test presents a good capacity to distinguish between subjects with ≤ 3 falls/year and subjects with ≥ 4 falls/year (AUC 0.719, 95%CI 0.627-0.810). A test score of 14.5 is the best cut-off point (74% sensitivity, 51% specificity). Using this cut-off point, the study sample comprises two groups: subjects with test scores of 7-14 vs 15-28, with the first group obtaining best results with statistical significance (Student's t-test and the Mann-Whitney test) in most of the balance tests. The short FES-I is an excellent instrument that measures FOF in the elderly, and it is correlated with their number of falls both in real life and on the CDP. It is simple and fast, and so can be considered an extraordinary screening test relative to real risk of falls in the elderly.

Assessment of morbidity in gynaecologic oncology laparoscopy and identification of possible risk factors.

BACKGROUND: The aim of this study was to ascertain the incidence of and the risk factors associated with morbidity in laparoscopy performed on patients with cervical cancer and endometrial cancer. METHODS: This was an observational study of a cohort of 128 women, 89 with endometrial cancer and 39 with cervical cancer from January 2000 to December 2011. We used the Student's t-test or the Mann-Whitney U test for continuous variables, and the Chi-square or Fisher's exact test for categorical variables. RESULTS: Complications were found in 44 patients (34.4%). After a multivariate analysis, among the risk factors associated with the presence of complications as the only type of surgery was found to be statistically significant (p = 0.043), more frequent in the most complex procedures such as Wertheim operation, trachelectomy, and para-aortic lymphadenectomy. Type of surgery (p = 0.003) and tumour type (p = 0.003) were risk factors associated with conversion to laparotomy. It was more frequent among the most complex procedures and cervical cancer cases. Regarding the need for transfusion, significant differences were observed in terms of surgery duration (p < 0.001), more frequent in longer surgery. CONCLUSION: Morbidity in laparoscopic surgical oncology is related to the surgery complexity, where the basal characteristics of the patient are not a factor of influence in the development of complications.

Can we predict the risk of falls in elderly patients with instability?

OBJECTIVE: The aim of this study is to determine whether clinical and instrumental examination of balance can predict the risk of falls in elderly patients with instability. STUDY DESIGN: It is a case control study, with cases defined by falls in the last year, developed in a third level university hospital. PATIENTS: Seventy patients aged 65 years or more who met at least one of the following inclusion criteria: (a) at least one fall in the last year; (b) spend more than 15s during the timed up and go test (TUG); (c) a score of less than 68% average balance in the sensory organisation test (SOT) of the computerised dynamic posturography (CDP); or (d) at least one fall in the CDP-SOT. INTERVENTION: TUG test, CDP-SOT, CDP centre of gravity balancing (CG) and limits of stability (LOS), Dizziness Handicap Inventory (DHI) test and short FES-I test. MAIN OUTCOME MEASURES: Number of steps and time (TUG), average balance and use of sensorial information (CDP-SOT), speed and directional control (CDP-CG and LOS), DHI score and short FES-I score. RESULTS: Comparing subjects without falls (non-fallers) vs subjects with at least one fall (fallers) in the last year, fallers obtain worse scores than non-fallers in condition 2 (p=0.043) and use of somatosensory information (p=0.039). Comparing subjects with five falls or less (non-multiple-fallers) vs subjects with more than five falls (multiple-fallers), multiple-fallers obtain worse scores than non-multiple-fallers in overall balance (p=0.023), condition 6 (p=0.036), directional control (swaying (p=0.006) and LOS (p=0.023)) and short FES-I score (p=0.007). CONCLUSION: The three most useful parameters for identifying unstable elderly patients at particularly high risk of repeated falls are mean balance in the CDP SOT, directional control of CDP LOS and short FES-I score.