| 1. |
- Edlund, A, et al.
(author)
-
Clinical profile of delirium in patients treated for femoral neck fractures
- 1999
-
In: Dementia and Geriatric Cognitive Disorders. - : S. Karger AG. - 1420-8008 .- 1421-9824. ; 10:5, s. 325-329
-
Journal article (peer-reviewed)abstract
- The incidence of delirium, its predisposing factors, clinical profile, associated symptoms and consequences were investigated in 54 consecutive patients, 19 men and 35 women, mean age 77.1 years, admitted to an 'ortho-geriatric unit' with femoral neck fractures. The incidence of postoperative delirium was 15/54 (27.8%) and a logistic regression model found that dementia and a prolonged waiting time for the operation increased the risk of postoperative delirium. Delirium during the night was most common but in 5 patients the delirium was worst in the morning. Patients with delirium suffered more anxiety, depressed mood, emotionalism, delusions and hallucinations. A larger proportion of patients with delirium could not return to their previous dwelling, and a larger proportion of delirious patients were either dead, wheelchair-bound or bedridden at the 6-month follow-up (p < 0.005). The conclusion is that delirium is common and has a serious impact on the outcome after hip fracture surgery.
|
|
| 2. |
- Hallengren, Bengt, et al.
(author)
-
No increase in fracture incidence in patients treated for thyrotoxicosis in Malmo during 1970-74. A 20-year population-based follow-up
- 1999
-
In: Journal of Internal Medicine. - : Wiley. - 0954-6820 .- 1365-2796. ; 246:2, s. 139-144
-
Journal article (peer-reviewed)abstract
- Objectives. To study whether there is an increased fracture incidence following thyrotoxicosis. Design. A case-control study. Setting. Malmo University Hospital, Malmo, Sweden. Subjects: All patients (n = 333) from the population of Malmo who were treated for thyrotoxicosis for the first time during the 5-year period 1970-74. A total of 618 controls were selected from the local municipality registry in Malmo. For each case the aim was to randomly select two age- and gender-specific controls, alive in 1993 and born the same year and month as the case. Main outcome measures. Fracture incidence. Results. Comparing survivors, there were no differences in the percentage of individuals with fractures (all, fragility, non-fragility) between the patients and the controls. Comparing all individuals and including all fractures, the percentage of individuals with fractures in the entire female patient group (24.6%) was lower (P < 0.05) than in female controls (33.1%). There was a similar but non-significant pattern between male patients and controls. The mean number of all fractures was lower in male patients than in controls (P < 0.05), but no significant difference was noted between female patients and controls. For fragility fractures, there were no significant differences in the percentage of individuals with fractures or in the mean number of fractures between female or male patients and controls. Conclusion. In conclusion we found no increased incidence of fragility fractures in patients with previous thyrotoxicosis as compared with controls. Our results do not support the suggestion that screening for osteoporosis should be performed in patients with previous thyrotoxicosis.
|
|
| 3. |
- Lundström, Maria, et al.
(author)
-
Reorganization of nursing and medical care to reduce the incidence of postoperative delirium and improve rehabilitation outcome in elderly patients treated for femoral neck fractures
- 1999
-
In: Scandinavian Journal of Caring Sciences. - : Wiley. - 0283-9318 .- 1471-6712. ; 13:3, s. 193-200
-
Journal article (peer-reviewed)abstract
- The aim of this study was to evaluate the effectiveness of a nursing and medical intervention programme for the prevention and treatment of delirium in elderly patients treated for femoral neck fractures. Forty-nine patients consecutively admitted to an orthogeriatric rehabilitation unit in a county hospital in northern Sweden were compared with historical cohorts of corresponding patients in the same and other hospitals. There was a total reorganization of nursing and medical care of patients with femoral neck fractures. The intervention programme consisted of staff education, co-operation between orthopaedic surgeons and geriatricians, individual care and planning of rehabilitation, improved ward environment, active nutrition, improved continuity of care and prevention and treatment of complications associated with delirium. The main result of the study was that the incidence of delirium was significantly lower than in all previously published studies. The incidence of other postoperative complications was also lower, and a larger proportion of the patients regained independent walking ability and could return to their previous living conditions on discharge. It can be concluded that the intervention programme reduced the incidence and duration of delirium and improved functional outcome for elderly patients treated for femoral neck fractures.
|
|
| 4. |
- Siennicki-Lantz, Arkadiusz, et al.
(author)
-
How to interpret differing cerebral blood flow patterns estimated with 99tcm-hmpao and 99tcm-ecd spet in a healthy population
- 1999
-
In: Nuclear Medicine Communications. - : Ovid Technologies (Wolters Kluwer Health). - 0143-3636. ; 20:3, s. 219-226
-
Journal article (peer-reviewed)abstract
- Two radiopharmaceuticals, 99Tcm-hexamethyl propylene amine oxime (99Tcm-HMPAO) and 99Tcm-ethyl cysteinate dimer (99Tcm-ECD), are currently used to determine cerebral blood flow. 99Tcm-ECD is, by virtue of its greater stability, superceding 99Tcm-HMPAO for routine examinations. Since the clinical assessment of 99Tcm-ECD images is usually based on experience with 99Tcm-HMPAO, we used both radiopharmaceuticals to compare regional cerebral blood flow in the same individuals. Eleven healthy subjects aged 67.1 ± 6.3 years (mean ± S.D.) underwent 99Tcm-ECD followed by 99Tcm-HMPAO single photon emission tomography. Cerebral blood flow was quantified in cortical and central regions of interest (basal ganglia, ventricles, white matter) in relation to cerebellar uptake. The intra-subject comparison of cerebral blood flow in the cortical areas revealed higher levels of perfusion in the posterior parietal, parieto-occipital and temporo-occipital areas using 99Tcm-ECD. In contrast to the cortical areas, cerebral blood flow in the central areas was greater using 99Tcm-HMPAO, especially in the centrum semiovale, basal ganglia, frontal white matter and frontal horns. This difference in cerebral blood flow when imaging healthy individuals with 99Tcm-ECD and 99Tcm-HMPAO should be taken into account in clinical practice when changing from one radiopharmaceutical to the other.
|
|
| 5. |
- Siennicki-Lantz, A., et al.
(author)
-
Orthostatic hypotension in Alzheimer's disease : Result or cause of brain dysfunction?
- 1999
-
In: Aging clinical and experimental research. - 0394-9532. ; 11:3, s. 155-160
-
Journal article (peer-reviewed)abstract
- In Alzheimer's disease (AD), an association was found between autonomic dysfunction and frontal hypoperfusion in brain during orthostatic testing. To ascertain whether frontal hypoperfusion is dependent on longitudinal effects of hemodynamic disturbances, or contributes to them, we studied the relationship between the presence of orthostatic hypotension (OH) and resting cerebral blood flow (CBF) in late stages of AD. Twelve women with senile dementia of Alzheimer type (SDAT), and 15 non-demented women (mean age 82.6 years, SD 3.8 vs 81.8 years, SD 3.5) were examined with the orthostatic test. Four of 12 patients with SDAT, and 9 controls had OH (defined as systolic blood pressure fall ≥ 20 mmHg). CBF was determined under resting conditions using 600 Mbq 99mTc HMPAO single photon emission computerized tomography (SPECT), and quantified in cortical areas in relation to cerebellum. In patients with SDAT and OH, CBF was lower in frontal and parieto-frontal cortical areas than in SDAT patients without OH. The former group was younger and had a shorter dementia duration. No significant differences in CBF were observed between controls with vs without OH. No differences in SDAT patients with or without OH were observed in the Berger dementia scale or Katz' ADL index. No difference in incidence of symptoms related to autonomic disturbances (diarrhea, obstipation, dysphagia, vertigo) was observed in either the SDAT or control group with regard to OH presence. We conclude that during the course of AD, OH can contribute to frontal brain changes and may exacerbate the disease. The further involvement of frontal dysfunction in aggravating blood pressure dysregulation in the elderly is discussed.
|
|
| 6. |
- Sjöbeck, Martin, et al.
(author)
-
Neuronal loss in the brainstem and cerebellum--part of the normal aging process? A morphometric study of the vermis cerebelli and inferior olivary nucleus
- 1999
-
In: Journals of Gerontology. Series A: Biological Sciences & Medical Sciences. - 1758-535X. ; 54:9, s. 363-368
-
Journal article (peer-reviewed)abstract
- Based on the known age-related loss of Purkinje cells (PC) in the cerebellum, this study focuses on whether a marked loss of PC occurs in individuals of very high age. The inferior olive, which is intimately connected with the cerebellum anatomically as well as functionally, was also studied. The study group included 15 nondemented and basically healthy cases aged 32-104 years. Linear neuronal density was expressed as number of PC per millimeter tissue measured in the vermis and as neuronal numbers per square millimeter tissue in the inferior olive. The linear PC density clearly decreased with increasing age, R2 = 0.82 and p < .001. The inferior olive showed a small but insignificant age-related neuronal loss. We conclude that aging results in reduced PC density in the vermis cerebelli, further accentuated in the very late stages of life.
|
|
