Hereditary hyperferritinemia-cataract syndrome: two novel mutations in the L-ferritin iron-responsive element.
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Adult↗
Biomedical subjects
J Lindsay
Publications and source records attributed to J Lindsay.
New devices enhance hospital results of coronary angioplasty.
After rigorous screening by means of registries and controlled trials, various atherectomy devices, excimer laser catheters, and endoluminal stents were approved for general clinical use. Few data are available describing their safety and effectiveness after approval. This analysis was undertaken to assess the impact on patient outcomes of the unrestricted clinical application of new transcatheter devices for coronary angioplasty. Thirty-six cardiologists performed 3,113 transcatheter procedures during 1995. Each chose the transcatheter modality best suited to the clinical and angiographic features of the patient. Baseline clinical and angiographic data and initial outcome were recorded by cardiac catheterization laboratory personnel. In-hospital events were obtained by independent chart review. Balloon angioplasty alone was employed in 1,089 (35.0%) patients. A stent was deployed after balloon angioplasty in 1,029 (33.1%) patients. An atherectomy or laser device was used without stent support in 631 (20.3%) patients, and stent support was added in an additional 364 (11.7%) patients. In all three new device categories the angiographic success (final luminal narrowing <50%) rate was better than in balloon angioplasty for type-C lesions and for chronic occlusions. The frequency of adverse events in the aggregate was not increased with device use, but the frequency of coronary artery bypass surgery was reduced with stent use. The frequency of non-Q-wave myocardial infarction was greater with devices than with balloon angioplasty alone. After adjustment for the differences in baseline clinical and angiographic variables by means of multivariate analysis, each of the three new device categories was independently associated with an increased chance of angiographic and procedural success compared to balloon angioplasty. The availability of new transcatheter devices for clinical practice enhances patient outcomes during hospitalization for the procedure.
Aged↗
Routine stress testing for triage of patients with chest pain: is it worth the candle?
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Chest Pain↗
A comparison of coronary artery bypass grafting and percutaneous transluminal coronary angioplasty in patients on hemodialysis.
The hospital records of 22 patients on hemodialysis undergoing coronary artery bypass grafting, and 19 others undergoing percutaneous transluminal coronary angioplasty were reviewed to compare the outcomes of these procedures in this population. Evidence of previous myocardial infarction or triple vessel or left main coronary artery disease was more common in patients undergoing coronary artery bypass graft than those undergoing percutaneous transluminal coronary angioplasty. Perioperative mortality and complication rates following coronary artery bypass graft (4.5% and 41%, respectively) were similar to those following percutaneous transluminal coronary angioplasty (5.3% and 42%). Cardiac event-free rates at 18 months by life-table analysis following coronary artery bypass graft and percutaneous transluminal coronary angioplasty were 87 +/- 16% and 40 +/- 14%, respectively. Survival at 18 months were 67 +/- 17% following coronary artery bypass graft and 69 +/- 14% following percutaneous transluminal coronary angioplasty. Cardiac events were observed to occur in three patients undergoing coronary artery bypass graft at a median of 10 months, and in nine patients following percutaneous transluminal coronary angioplasty at a median of 6 months. One patient required percutaneous transluminal coronary angioplasty after the initial coronary artery bypass graft. Seven patients required repeat percutaneous transluminal coronary angioplasty, and two patients underwent coronary artery bypass graft after initial percutaneous transluminal coronary angioplasty. Although these conclusions are limited by the retrospective nature of the study, it is concluded that coronary artery bypass graft can be performed with morbidity and mortality equivalent to percutaneous transluminal coronary angioplasty, and provides better cardiac event-free rates than percutaneous transluminal coronary angioplasty in patients on hemodialysis. Percutaneous transluminal angioplasty does not appear to be justified in this population because of its unacceptably high restenosis and cardiac event rates.
Angioplasty, Balloon, Coronary↗
Chronic conditions and disabilities among seniors: an analysis of population-based health and activity limitation surveys.
PURPOSE: To describe the prevalence of disabilities and the medical conditions and risk factors associated with mobility and agility disabilities among seniors. METHODS: In the 1986 and 1991 Canadian Census, every fifth person answered a screening question about activity limitation and disabilities. A probability sample of both those reporting and not reporting disability was selected to complete the Health and Activity Limitations Surveys (HALS) in 1986 and 1991. These two cross-sectional surveys conducted five years apart collected detailed activity limitation information about persons over 15 years of age. The current analysis was based on only respondents aged 65 years and older. The sample size for 65 years and older was 38518 in 1986 and 5106 in 1991. A computer link with the Census data provided household income and additional socio-demographic data for all respondents. RESULTS: Over 40% of Canadian seniors reported at least one disability, and approximately a quarter of disabled seniors were classified as severely disabled. Mobility and agility disabilities accounted for over 80% of all disabilities reported by seniors, and senior women were more likely than men to report having a mobility or agility disability. Arthritis/rheumatism was reported as the cause of over 30% of all mobility and agility disabilities. CONCLUSIONS: The continued monitoring of disabilities through surveys such as HALS will help determine the prevalence as well as aid in the identification of the causes of disabilities. Such information may be used to guide the implementation of appropriate public health interventions that will meet the changing health care needs of seniors.
Activities of Daily Living↗
Age-specific patterns of factors related to fatal motor vehicle traffic crashes: focus on young and elderly drivers.
This population-based study examines patterns of fatal motor vehicle traffic crashes (MVTCs) by age group (16-24, 25-64, 65+) among Canadian drivers. The Canadian Traffic Accident Information Databank (TRAID) provided information about fata MVTCs between 1984 and 1993. Distribution of risk factors was compared by age group. Crude odds ratios and 95% CIs were calculated for both young and elderly drivers compared with middle-aged drivers. The middle-age group was selected as reference population since it demonstrates the lowest risk of fatality. Compared to the middle-aged group, young drivers demonstrated excess risk for (1) risk-taking behaviours and conditions, specifically alcohol and illicit drug use, speeding, non use of seat belts, fatigue and falling asleep, and inexperience; (2) crashes during the summer, during weekends and at night; and (3) single-vehicle collisions and on performing overtaking manoeuvres. Excess risk among elderly drivers was noted for (1) medical and physical conditions, inattention and inexperience; (2) driver actions, for example, improper turning, failure to yield right-to-way; (3) occurrence on weekdays and during the day; and (4) collisions at intersection and vehicle--vehicle sideswipes. The results show notable differences in risk factors by age group and confirm the need for preventive efforts that incorporate age-specific strategies.
Accidents, Traffic↗
Nursing across cultures: the Vietnamese client.
Asian Americans are the most rapidly growing immigrant group in the United States today. Home care nurses will be caring for increasing numbers of patients originating from the Southeast Asian peninsula in the countries of Vietnam, Cambodia, and Laos. A Vietnamese case study explores some of the beliefs, values, and practices held by this group of Asian Americans. The case study highlights the problems that can occur when a nurse is unaware of the impact that culture has on a client from a different ethnic and cultural background. Six steps to provide culturally competent care are outlined.
Aged↗
Accuracy of two-dimensional echocardiographic planimetry of the mitral valve area before and after balloon valvuloplasty.
The purpose of this study was to assess the accuracy of planimetry after percutaneous balloon mitral valvuloplasty (PBMV). The mitral valve area (MVA) was estimated in 34 patients before and after PBMV, using two-dimensional echocardiographic planimetry, Doppler pressure half-time (PHT), and the Gorlin formula. There was no significant difference in the correlation of planimetry and PHT before (r = 0.53, p = 0.001) and after PBMV (r = 0.56, p < 0.001). A similar correlation was found between planimetry and the Gorlin formula (r = 0.44, p = 0.01 before PBMV, r = 0.37, p = 0.03 after PBMV). The concordance between planimetry, PHT, and the Gorlin formula in classifying patients into mild, moderate, or severe mitral stenosis was not worse after PBMV. Planimetry-derived MVA was not less accurate after PBMV than before PBMV. However, the correlation between the two echocardiographic measurements and the Gorlin formula was only moderate.
Blood Flow Velocity↗
Evaluation of bipolar technology for laparoscopic supracervical hysterectomy.
One particularly controversial form of laparoscopic hysterectomy is subtotal hysterectomy (LSH). LSH was first described by Semm. Since that report, several authors have reported their initial experience with vanous methods for LSH. A recent clinical commentary by Munro discussed the pros and cons of LSH in an editorial entitled "Supracervical Hysterectomy: A Time for Reprisal. In a recently published report, we discussed our initial experience with laparoscopic subtotal hysterectomy. The article reported our experiences utilizing bipolar instruments, an electromechanical morcellator, and other modifications of LSH we feel simplify and reduce the procedural operaríve time and potential intraoperative and postoperative complications.
Journal Article↗
Monograph series on aging-related diseases: X. Prostate cancer.
Prostate cancer is the most commonly diagnosed cancer among Canadian men, excluding non-melanoma skin cancer. Prostate cancer incidence increases almost exponentially with age; most cases are diagnosed in men aged 65 years or older. With the possible exception of animal fat consumption, no known widespread modifiable risk factors have been identified. Although the prognosis is good if appropriate treatment occurs in the early stages of disease, the ability of existing early detection techniques to decrease mortality has not yet been demonstrated. The considerable economic and societal burden of prostate cancer and its treatment, coupled with the projected large increase in the number of new prostate cancer cases as the population ages, make this disease a very important public health issue.
Aged↗
Predictors of coronary arterial remodeling patterns in patients with myocardial ischemia.
Preangioplasty intravascular ultrasound in 81 patients showed that adaptive remodeling occurred in 35% and constrictive remodeling in 34%. Multivariate analysis showed that smoking and fibrocalcific plaques were associated with constrictive remodeling, whereas small vessel size and hypercholesterolemia were associated with adaptive remodeling.
Aged↗
Diagnosis and treatment of diseases of the aorta.
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Aortic Dissection↗
Eating in side-lying facilitates rehabilitation in neurogenic dysphagia.
A 26-year-old man who had sustained a traumatic head injury aspirated when fed in the upright position. By contrast, when fed in the side-lying position swallowing improved and there was no aspiration. Implications for management are discussed.
Adult↗
The Canadian Study of Health and Aging: risk factors for vascular dementia.
BACKGROUND AND PURPOSE: The Canadian Study of Health and Aging (CSHA) was conducted in communities and institutions in 10 Canadian provinces. One objective of the study was to study risk factors for vascular dementia (VaD). METHODS: This was a population-based case-control study. It included 129 patients clinically diagnosed with VaD with duration of symptoms no more than 3 years and 535 control subjects, frequency matched by age group, study center, and residence in community or institution, who were clinically confirmed to be cognitively normal. Odds ratios (ORs) were calculated using unconditional logistic regression for potential risk factors for VaD. RESULTS: Risk of VaD was associated with history of arterial hypertension (OR, 2.08; 95% confidence interval, 1.29 to 3.35). Other significantly elevated ORs were seen for history of alcohol abuse (2.45), history of heart condition (1.71), use of aspirin (3.10), and occupational exposure to pesticides and herbicides (2.60), as well as liquid plastic or rubber (2.59). The OR for less than 6 years of education compared with 10 or more years was 4.02. CONCLUSIONS: The study confirmed some previously reported risk factors for VaD, such as history of heart disease. Higher levels of education seemed to lower the risk or delay onset of symptoms of VaD. Use of aspirin may be a predictor of survival rather than a risk factor. The occupational associations, particularly with pesticides and fertilizers, need further study.
Aged↗
Life expectancy and dementia in Canada: the Canadian study of health and aging.
Using the 1991 Canadian life table and estimates of the prevalence of dementia from the Canadian Study of Health and Aging, we have partitioned the expectation of life at age 65 into years spent in the community and in institutions, with and without different forms of dementia. The total expectation of life for women was 26% greater than that for men, but women's expectations of life with dementia and of life in institutions were more than twice the corresponding expectations for men. The difference between sexes was greater for Alzheimer's disease than for vascular and other types of dementia.
Age Distribution↗
Timing of ventricular septal rupture after acute myocardial infarction and its relation to thrombolytic therapy.
The clinical and treatment characteristics of 71 patients who had acute myocardial infarction complicated by ventricular septal rupture were assessed retrospectively. A history of hypertension was strongly associated with "early" septal rupture (p < 0.001); other clinical and treatment characteristics, including the use and timing of thrombolytic therapy, were not.
Aged↗
High blood pressure and dementia.
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Aged↗
Effects of endoluminal coronary stents on the frequency of coronary artery bypass grafting after unsuccessful percutaneous transluminal coronary vascularization.
Coronary artery stents have been rapidly incorporated into clinical practice so that they are currently deployed in nearly 50% of all patients undergoing angioplasty procedures in a busy laboratory. A decline in the frequency of coronary bypass surgery for unsuccessful angioplasty is associated with this change in practice-a decline in the use of atherectomy devices and no increase in length of stay for angioplasty patients.
Angioplasty, Balloon, Coronary↗