PubMed · 14608706
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Laura M Wagner, David Richards, Marianne Oliver. 2003. Falls: successful programming.. https://pubmed.ncbi.nlm.nih.gov/14608706/
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Autogenous tibial cancellous bone has been used for reconstructive operations in oral and maxillofacial surgery for over 10 years, and has reduced many of the problems associated with conventional sites of autogenous grafts such as the iliac crest. The ease of access for harvesting, the speed of the operation, and the abundance of bone, are advantages of this donor site. We report a patient who had a graft taken from the proximal tibia and had a displaced fracture 2 weeks later after a fall. Five similar cases have been reported previously, of which none has required surgical intervention.
Falls are one of the most serious complications of gait disturbances in patients with Parkinson's disease (PD). Among previous reports, the percentage of patients with PD who fall varies between 38% to 68%. We sought to determine the frequency of falls and the factors associated with falls in a group of patients with idiopathic PD who attended an outpatient, tertiary movement disorders clinic. 350 ambulatory, non-demented patients (230 males) were studied. Mean age was 69.7+/-10.6 years (range: 43-97 yrs) and mean duration of PD symptoms was 8.6+/- 6.2 years (range: 1-33 yrs). Assessments included characterization of demographics, disease duration, disease severity as measured by the Hoehn and Yahr Scale (H&Y), co-morbidities, the presence of depressive symptoms, the presence of urinary incontinence, use of anti-parkinsonian medications, and two performance-based tests of balance and gait (tandem standing and Timed Up & Go). Fall history was determined during three time periods: previous week, previous month, and previous year. Univariate and multivariate logistic regression models were applied to evaluate the relationship between the above-mentioned factors and falls. 46% of the subjects reported at least one fall in the previous year and 33% reported 2 or more falls and were classified as Fallers. Fallers had significantly more prolonged and advanced PD compared with Non-fallers (p=0.001 and p<0.001, respectively). Urinary incontinence was the factor most closely associated with falls (crude and adjusted OR were 1.95 and 5.89, respectively). Other factors significantly associated with fall status included increased Timed Up & Go times and increased PD duration. These findings confirm that falls are a common problem among patients with advanced PD and suggest easily measurable features that may be used to prospectively identify those PD patients with the greatest risk of falls.
BACKGROUND: Although frequently used in the assessment of patients with falls, it is unclear whether 24-hour ambulatory electrocardiography contributes to their assessment in older persons. OBJECTIVE: To identify electrocardiographic abnormalities in patients with recurrent falls and case controls, and determine whether 24-hour ambulatory electrocardiography identifies causal arrhythmias for falls. DESIGN: Prospective case-control study. METHODS: 24-hour ambulatory electrocardiography recordings were compared for the type and prevalence of arrhythmias and symptom correlation in consecutive older subjects with recurrent falls attending the accident and emergency department and in case controls (no previous falls or syncope). ECG abnormalities were categorised as major (ventricular arrhythmia, pauses, <30 b.p.m., Mobitz II, complete heart block) and minor (multiple ectopics, paroxysmal atrial arrhythmia and other bradyarrhythmias). RESULTS: 128 fallers (76 +/-6 years) and 100 case controls (75 +/-5 years) were recruited. Co-medication and co-morbidity were similar in both groups. 49% (63) of recordings in fallers and 41% (41) of recordings in controls were abnormal. There was no difference between groups in the prevalence of major or minor abnormalities or of symptoms during recording (breathlessness, fatigue, chest pain and dizziness). Palpitations occurred in 10% of fallers and 13% of controls. One patient fell during monitoring with no associated rhythm abnormality. CONCLUSION: Multiple abnormalities are present on 24-hour ambulatory electrocardiography in older people whether or not they have experienced falls. 24-hour electrocardiography does not discriminate between fallers and non-fallers and is not helpful in the investigation of recurrent falls.