Surgical morbidity in patients with neurologic dysfunction

Mortality and morbidity data were collected on 388 patients treated by operations to correct extremity deformities caused by stroke, head trauma and neurologic disease. A total of 613 procedures were performed, requiring 524 general, 2 spinal and 16 regional anesthesias. There were no postoperative deaths. None of the patients showed further neurologic deterioration. The incidence of medical complications was 6.4% and all patients responded to medical treatment. Sixteen wound complications responded to routine care. Age appeared to be the primary risk factor to postoperative morbidity. It is generally safe to perform elective orthopedic surgery to correct extremity deformities in the neurologically involved patient.

Survival of patients ventilated in an intensive therapy unit

The survival of patients who were artificially ventilated in an intensive therapy unit (ITU) of a district general hospital was studied. The first 100 such patients admitted were followed up for at least four years. Of these, 67 survived treatment in the ITU, 47 were discharged from hospital, and 30 survived four years. (Survival in the ITU of patients who did not require ventilation was 89%.) The effects of age, duration of ventilation, and disease were studied, and a higher survival was found in children, in patients ventilated for under 24 hours, and in patients admitted with drug overdosage. Survival was poor in patients aged over 75 and in those who required ventilation after cardiac arrest or myocardial infarction or for chronic obstructive lung disease. The cost of a bed in an ITUs to be used to the greatest effect it is important to define those patients who are most likely to benefit from the facilities they offer.

Electrical wiring configurations and childhood cancer

An excess of electrical wiring configurations suggestive of high current-flow was noted in Colorado in 1976--1977 near the homes of children who developed cancer, as compared to the homes of control children. The finding was strongest for children who had spent their entire lives at the same address, and it appeared to be dose-related. It did not seem to be an artifact of neighborhood, street congestion, social class, or family structure. The reason for the correlation is uncertain; possible effects of current in the water pipes or of AC magnetic fields are suggested.

The pattern of mortality in severe neuroses

Is there an increased relative risk of death in severe neurosis? 1,482 patients from three psychiatric units in different hospitals in Birmingham were followed-up after a mean of 10.9 years. 91 per cent of the sample were traced and 139 patients were found to have died; a highly significant increased mortality for both sexes for all causes of death. Although suicide and accidents contributed disproportionately, particularly in early follow-up, there was still a markedly increased mortality from the combined categories of nervous respiratory and cardiovascular disease, more evenly distributed in time.

Alcoholism and correlates of mortality. Implications for epidemiology

In 935 alcoholics, alcoholism increased the risk of death more in upper-class than in lower-class alcoholics, the middle-class alcoholics holding an intermediate position closer to that of the upper-class alcoholics.

[Age, duration of disease and survival period of patients with involvement of the nervous system by malignant lymphomas. A statistical comparison of mycosis fungoides with lymphogranulomatosis (author's transl)]

A statistical comparison dealing with age, duration of disease and survival period of patients with involvement of the nervous system by malignant lymphomas revealed the following data: 1. With mycosis fungoides, involvement of the nervous system occurs later in life than with lymphogranulomatosis; this difference is statistically highly significant (P less than 0.001). 2. There is no statistical difference (P greater than 0.05) in the duration of either type of malignant lymphoma before the nervous system becomes involved. 3. It is of high statistical significance (P less than 0.001) that, once the nervous system has become involved, the survival period is lower with mycosis fungoides than with lymphogranulomatosis. It can be expected that involvement of the nervous system by mycosis fungoides leads with 79% probability (confidential limits 99% = 47.29--96.22%) to death within 6 months.

Neuroepidemiology. Incidents, incidence, and coincidence

Neuroepidemiology is concerned with the study of incidents of neurological disease occurring in a community. It deals with the distribution and dynamics of neurological disease in human populations and the factors that affect these patterns. To estimate the magnitude of the disease burden in the population, the neuroepidemiologist calculates indices of disease, such as mortality, prevalence, and incidence. In studying factors associated with disease, the investigator must establish whether the relationship (1) is artifactual, (2) appears to be the result of a chance occurrence or coincidence, and (3) has any biologic significance. The clinical neurologist is the central figure in neuroepidemiologic investigations. The greater the accuracy and completeness of the neurologist's information, the better the quality of neuroepidemiologic studies based on these data.

A fatal encephalopathy in chronic haemodialysis patients

A distinct neurological syndrome in twelve chronic haemodialysis patients is described. This syndrome is currently the leading cause of death in one Denver dialysis unit. The hallmarks of this syndrome are progressive speech difficulties, mental changes, and a markedly abnormal electroencephalogram which may be present months before the clinical signs appear. Additional clinical features including seizures, myoclonus, asterixis, apraxia, focal neurological signs, and psychiatric symptoms may also be observed. Neuropathological changes are slight and non-specific. The aetiology of this syndrome is unknown but the clinical and pathological features suggest a toxic/metabolic disorder. To date, this disorder has been refractory to several therapeutic measures.

Do the right children have necropsies? Analysis of selected determinants

An analysis of the frequency of post-mortem examinations was conducted in the paediatric age group. Among the factors found to influence necropsy rates were (i) age at death, the frequency of necropsy decreasing with age; (ii) cause of death, necropsy frequency varying with major diagnostic groups; (iii) investigation conducted before death, necropsy frequency decreasing when the clinical picture was ill-defined; and (iv) place of death, necropsy being less frequent when death occurred outside hospital. These findings imply (a) that necropsy practices may be governed by habit and convenience as well as by desire to complete the clinical picture, and (b) that more equitable balances in such practices should be sought if there is to be improvement in the quality of mortality data.

Neurologic disorders following surgery for peptic ulcer disease

The neurologic status of 2,000 veterans who had had surgery for peptic ulcer between 1952 and 1957 was evaluated. In 1970, a total of 156 of these men were examined, 97 of whom had procedures that disrupted the normal continuity of the upper gastrointestinal tract. Twenty-one had neurologic disorders, including 17 patients with peripheral neuropathies. Procedures bypassing the ampulla of Vater were performed in 15 of these. The only detected factor associated with neurologic manifestations was weight loss since surgery. A mortality study of the total population revealed 865 patients had died by the end of 1973. There were seven deaths attributed to neurologic causes, one in a patient with amyotrophic lateral sclerosis and one in another with spinal paralysis. All seven were among the 70% of the deceased who had had surgery that disrupted the continuity of the upper gastrointestinal tract. Thus, we conclude that the type of surgery influenced the likelihood of neurologic complications, but at least for motor neuron disease, the increased risk was not appreciable.

Very low birthweight and subsequent neurological defect (with special reference to spastic diplegia)

Of a total of 170 children who weighed 1500g or less at birth and who were born in or admitted shortly after birth to Hammersmith Hospital, London, between the years 1961-70 inclusive, 165 have been followed to ascertain the incidence of neurological handicap, with particular reference to spastic diplegia. This condition occurred in six children (3-6 per cent), all of whom were born during the 1961-64 period, an incidence in those years of 10-3 per cent, compared with 0-0 per cent in the period 1965-70 (times 2 equal to 8-72, p equal to 0-0032). These findings are considered in the context of perinatal illness and care. The one statistically significant difference found between the children with and without spastic diplegia in the earlier period was a somewhat lower mean minimum rectal temperature on the first day of life only.

Mortality of newspaper workers from lung cancer and bronchitis 1952-66

Moss, E., Scott, T. S., and Atherley, G. R. C. (1972).Brit. J. industr. Med,29, 1-14. Mortality of newspaper workers from lung cancer and bronchitis 1952-66. The mortality experience of 3 485 men who worked full-time in the newspaper printing industry in London and Manchester and died in the period 1952-66 has been analysed for occupation and cause of death. There was an excess of deaths from cancer of the lung and bronchus (I.C.D. 162, 163) in printing trade workers as a whole compared with the male population of the region in which they worked, adjusted for age and calendar year of death. The excess was about 30% in London and about 40% in Manchester. Both these excesses are significant at the 1% level. In Manchester, but not in London, there was a concentration of excess (about 100%) in machine room men, again significant at the 1% level. White collar workers showed no difference between observed and expected deaths in London and only a small excess (20%, not significant at the 5% level) in Manchester. There were small deficits of deaths from bronchitis (I.C.D. 500 to 502), about 10% for printing trade workers, and 30 to 40% for white collar workers, with little difference between London and Manchester. Neither deficit is significant at the 5% level because of the small numbers involved. This survey does not provide any evidence about the cause of the overall small excess of deaths from lung cancer, which might or might not be occupational. The larger excess in the Manchester machine room men is more likely to be due to an occupational hazard.