RESUMEN
BACKGROUND: Long-term cognitive problems are common among elderly patients after surgery, and it has been suggested that inhalation anaesthetics play a role in the development of dementia. This study aims to investigate the hypothesis that patients with dementia have been more exposed to surgery and inhalational anaesthetics than individuals without dementia. METHODS: Using 457 cases from a dementia-registry and 420 dementia-free controls, we performed a retrospective case-control study. The medical records were reviewed to determine exposure to anaesthesia occurring within a 20-year timeframe before the diagnosis or inclusion in the study. Data were analysed using multivariate logistic regression and propensity score analysis. RESULTS: Advanced age (70 years and older, with the highest risk in ages 80-84 years) and previous head trauma were risk factors for dementia. History of exposure to surgery with anaesthesia was a risk factor for dementia (OR = 2.23, 95% CI 1.66-3.00, P < 0.01). Exposure to inhalational anaesthetics with halogenated anaesthetics was associated with an increased risk of dementia, compared to no exposure to anaesthesia (OR = 2.47, 95% CI 1.17-5.22, P = 0.02). Exposure to regional anaesthesia was not significantly associated with increased risk of dementia (P = 0.13). CONCLUSION: In this 20-year retrospective case-control study, we found a potential association between dementia and prior anaesthesia. Exposure to general anaesthetics with halogenated anaesthetic gases was associated with an increased risk of dementia.
Asunto(s)
Anestesia/efectos adversos , Demencia/epidemiología , Demencia/etiología , Factores de Edad , Anciano , Anciano de 80 o más Años , Anestesia por Inhalación/efectos adversos , Anestésicos/efectos adversos , Anestésicos por Inhalación/efectos adversos , Estudios de Casos y Controles , Traumatismos Craneocerebrales/complicaciones , Traumatismos Craneocerebrales/epidemiología , Femenino , Cirugía General/estadística & datos numéricos , Humanos , Masculino , Puntaje de Propensión , Sistema de Registros , Estudios Retrospectivos , Factores de RiesgoRESUMEN
OBJECTIVE: The aim of this study was to examine mortality causes and cancer incidence in a population cohort that have resided in close proximity to highly metal-contaminated sources, characterized by contamination of, in particular, arsenic (As), cadmium (Cd), and lead (Pb). METHODS: Data from Swedish registers were used to calculate standardized mortality and cancer incidence ratios. An attempt to relate cancer incidence to metal contamination levels was made. RESULTS: Significantly elevated cancer incidences were observed for overall malignant cancers in both genders, cancer in the digestive system, including colon, rectum, and pancreas, and cancers in prostate among men. Dose-response relationships between Cd and Pb levels in soil and cancer risks were found. CONCLUSIONS: Cancer observations made, together with previous studies of metal uptake in local vegetables, may imply that exposure to local residents have occurred primarily via oral intake of locally produced foodstuffs.
Asunto(s)
Neoplasias del Sistema Digestivo/epidemiología , Exposición a Riesgos Ambientales/efectos adversos , Metales Pesados/toxicidad , Neoplasias de la Próstata/epidemiología , Neoplasias del Sistema Respiratorio/mortalidad , Enfermedades Cardiovasculares/mortalidad , Causas de Muerte , Neoplasias del Sistema Digestivo/inducido químicamente , Neoplasias del Sistema Digestivo/mortalidad , Exposición a Riesgos Ambientales/análisis , Femenino , Vidrio , Humanos , Incidencia , Masculino , Instalaciones Industriales y de Fabricación , Neoplasias de la Próstata/inducido químicamente , Sistema de Registros , Enfermedades Respiratorias/mortalidad , Factores Sexuales , Suelo/química , Suecia/epidemiologíaRESUMEN
BACKGROUND: The reported long-term outcomes of the treatment of radial head and neck fractures with excision of the radial head have been mixed. The purpose of the present study was to evaluate the long-term outcomes of primary or delayed radial head excision for the treatment of these fractures. METHODS: Sixty-one individuals (mean age, forty-four years) with thirty-nine Mason type-II, ten Mason type-III, and twelve Mason type-IV fractures were evaluated subjectively, objectively, and radiographically at a mean of eighteen years (range, eleven to thirty-three years) after treatment. Forty-three fractures were treated with primary radial head excision, and the remaining eighteen were treated with delayed radial head excision at a median of five months (range, one to 238 months) after the injury. RESULTS: At the time of follow-up, twenty-eight individuals had no symptoms, twenty-seven had occasional elbow pain, and six had daily pain. Four individuals with daily pain had had a Mason type-IV fracture. The range of motion of the formerly injured upper extremities was slightly less than that of the uninjured upper extremities in terms of flexion (139 degrees +/- 11 degrees compared with 142 degrees +/- 8 degrees ), extension (-7 degrees +/- 12 degrees compared with -1 degrees +/- 6 degrees ), and supination (77 degrees +/- 20 degrees compared with 85 degrees +/- 10 degrees ) (all p < 0.01). A higher percentage of formerly injured elbows than uninjured elbows had cysts, sclerosis, and osteophytes (73% compared with 7%; p < 0.001), but none had a reduced joint space. No differences were found between the outcomes for individuals treated with a primary radial head excision and those for individuals treated with a delayed excision. CONCLUSIONS: Following a displaced radial head or neck fracture, excision of the radial head often leads to a good or fair result. We found no differences in outcome between primary and delayed radial head excisions following a Mason type-II, III, or IV fracture. The outcomes are associated with the type of fracture, with Mason type-IV fractures having the worst results, rather than with the timing of the radial head excision (primary or delayed).