PubMed · 14743678
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Kim M Chronister. 2003. Divided attention.. https://pubmed.ncbi.nlm.nih.gov/14743678/
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OBJECTIVE: To investigate the risk of falls associated with drugs among the French population using data reported to the French spontaneous reporting system and recorded in the French Pharmacovigilance database. METHODS: All cases including a fall were searched in the French Pharmacovigilance database between 1995 and 1999. Drugs involved and characteristics of patients were investigated. In a second step, we estimated the risk associated with psychotropic and cardiovascular drugs in a case/non case comparison, where cases were reports including a fall and non cases all other reports. This risk was estimated by calculation of crude and age and gender adjusted reporting odds ratios (ROR). RESULTS: During this period, 328 reports including a fall were reported (0.4% of the database). Patients were female in 70%. Mean age was 76 +/- 18 years. Comparisons between cases and non cases showed that cases were more likely to be women (OR: 1.9; 95% confidence interval (CI) [1.5-2.4]) and older. After adjustment on age and gender, falls remained significantly associated with exposure to benzodiazepines (4.7 [3.7-5.9]), imipraminic antidepressants (3.6 [2.5-5.1]), serotonin reuptake inhibitor (SRI) antidepressants (2.2 [1.5-3.1]) or nitrates (1.9 [1.2-2.8]). CONCLUSION: This study confirms that taking psychotropic drugs strongly increases the risk of falls. The role of cardiovascular drugs (except nitrates) remains not significant when confounding factors are taken into account. According to the very high prevalence of psychotropic drug use in the French elderly, further study are needed to investigate the relative effect of some drugs on falls, like for example SRIs or short acting benzodiazepines.
STUDY DESIGN: Case report. OBJECTIVES: To report a rare case of radiation-induced malignant peripheral nerve sheath tumor of the cauda equina 10 years after treatment for testicular seminoma. SUMMARY OF BACKGROUND DATA: Development of malignant peripheral nerve sheath tumor after irradiation is well recognized and often associated with a dismal prognosis. There have been isolated reports of malignant peripheral nerve sheath tumor developing in sites of previous irradiation for testicular seminoma. METHODS: Retrospective review of case records and imaging. RESULTS: A 38-year-old man presented with signs of cauda equina syndrome. Ten years previously, he had undergone right radical inguinal orchidectomy and adjuvant para-aortic radiotherapy as treatment for Stage I testicular seminoma. Magnetic resonance imaging demonstrated an inoperable intra- and extradural tumor leading to significant cauda equina compression. CT-guided biopsy revealed a diagnosis of malignant peripheral nerve sheath tumor, most likely due to previous radiotherapy. His clinical condition did not improve, and he underwent a course of palliative chemotherapy. CONCLUSIONS: Postirradiation malignant peripheral nerve sheath tumors are rare and occur in a population at high risk of developing second malignancies. The authors report the fourth case resulting from adjuvant radiotherapy for testicular seminoma, with the present report being the first report of extensive intradural tumor leading to cauda equina syndrome.
Slips, trips and falls on the level are considered commonplace and are rarely subjected to in-depth analysis. They occur in highly varied circumstances in an occupational situation. In-depth analysis of these accidents was conducted within a company with the aim of understanding them better, to be able to discuss prevention field possibilities and priorities for the company concerned. Firstly, available data on 'accidents on the level' occurring over the last 4 years were analysed and a typology for these accidents was derived, based on individual activity at the time of the accident and accident location. The three most serious accident-causing situations were analysed in-depth from interviews with injured persons, as well as from activity observation and activity-related verbal information obtained from operatives. These most serious situations involved accidents occurring when climbing down from trucks or when walking either in surroundings outside company premises or from (to) a vehicle to (from) a work location. In-depth accident analysis and characterization of accident-causing situations as a whole enhance our understanding of the accident process and allow us to envisage priorities for action in the prevention field, in operational terms. Each accident-causing situation reveals environmental factors that in fact constitute accident factors (obstacle, stone, etc.), when the individual walks or climbs down from a truck. Analysis shows that other events are necessary for accident occurrence. For example, the individual may be subjected to a time constraint or may be preoccupied. Results obtained here, in a company integrating different trades, are discussed and compared with those referred to in the literature. Generalization of some of these results is also considered.