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Liu J, Laperche J, Neill M, Jenkins D. Positive Culture of Atypical Mycobacterium Avium Following Revision Total Knee Arthroplasty. R I Med J (2013) 2024; 107:7-10. [PMID: 38687260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
CASE We report a rare case of mycobacterial periprosthetic joint infection (PJI) after primary total knee arthroplasty 14 years earlier. Progressive knee pain over three years with a negative PJI infectious workup led to revision total knee arthroplasty. A surprising result was isolation of Mycobacterium avium from tissue cultures taken at time of revision surgery. After six months of antibiotic treatment, the patient is alive with well- functioning pain-free TKA at over one-year follow-up. CONCLUSION Periprosthetic joint infection can present acutely or chronically years following total knee arthroplasty. Depending on the infecting organism, patients can present with sepsis, or a more indolent slower course that mimics aseptic loosening. In the absence of positive pre-operative labs and cultures, and based on the Musculoskeletal Infection Society (MSIS) criteria, aseptic loosening is a diagnosis of exclusion. An atypical infectious organism should be considered a possible cause and may require specialized cultures of operative specimens.
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Affiliation(s)
- Jonathan Liu
- Brown University, Department of Orthopedics, Providence, RI
| | - Jacob Laperche
- University Orthopedics, Inc., East Providence, RI; Frank H. Netter School of Medicine, Quinnipiac University, North Haven, CT
| | - Marguerite Neill
- Brown University, Department of Infectious Diseases, Providence, RI
| | - Derek Jenkins
- Brown University, Department of Orthopedics, Providence, RI; University Orthopedics Inc, East Providence, RI
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Barrett CC, Laperche J, Clippert D, Glasser J, Garcia D, Antoci V. The Immediate Impact of Total Knee Arthroplasty Removal From the Medicare Inpatient-Only List on Patient Derived Functional Outcomes and Hospital Satisfaction. J Arthroplasty 2024; 39:1253-1258. [PMID: 37952740 DOI: 10.1016/j.arth.2023.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 11/03/2023] [Accepted: 11/07/2023] [Indexed: 11/14/2023] Open
Abstract
BACKGROUND Total knee arthroplasty (TKA) is the standard of treatment for end-stage knee osteoarthritis. On January 1, 2018, the Centers for Medicare and Medicaid (CMS) officially removed TKA from their inpatient-only list. The clinical impact of this change is not fully understood yet. METHODS Electronic records were retrospectively reviewed for patients who underwent TKA between January 1 to June 30, 2017, or January 1 to June 30, 2018. Patients completed Function and Outcomes Research for Comparative Effectiveness in Total Joint Replacement surveys which assessed patient reported outcomes prior to and following TKA. Hospital statistics for the 2 time points were determined and compared. This was a single institution study resulting in 351 patients in the pre-CMS change group and 350 patients in the post-CMS change group. RESULTS Analysis of the pre-CMS and post-CMS transition cohorts indicated no significant difference in activities of daily living (ADLs), pain, or pain catastrophizing scale preoperatively or 12-months postoperatively. Additionally, there was no difference in the median change between preoperative and postoperative ADL scores (P = .866), yet pain scores approached significance with a P value of .054. The pre-CMS transition group stayed significantly longer in the hospital postoperatively and was more commonly discharged to a skilled nursing facility. No difference was seen in 30-day readmission rates (P = .253). CONCLUSIONS Results showed that patients had similar scores for ADL, quality of life, pain, and pain catastrophizing 12-months following their TKA. Movement of TKA from the Medicare inpatient only list did not have an immediate negative impact for patient reported outcomes and 30-day readmissions at our institution in the 6-month transition period.
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Affiliation(s)
| | - Jacob Laperche
- University Orthopedics Inc, East Providence, Rhode Island; Frank H. Netter School of Medicine, Quinnipiac University
| | - Drew Clippert
- University Orthopedics Inc, East Providence, Rhode Island
| | | | - Dioscaris Garcia
- Warren Alpert Medical School of Brown University, Providence, Rhode Island; Department of Orthopaedic Surgery, Brown University and Rhode Island Hospital, Providence, Rhode Island
| | - Valentin Antoci
- University Orthopedics Inc, East Providence, Rhode Island; Warren Alpert Medical School of Brown University, Providence, Rhode Island; Department of Orthopaedic Surgery, Brown University and Rhode Island Hospital, Providence, Rhode Island
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Laperche J, Barrett CC, Boduch A, Glasser J, Clippert D, Garcia DR, Antoci V. Mechanically stable rifampin antibiotic cement inhibits Pseudomonas aeruginosa biofilm surface growth. J Orthop Res 2024; 42:547-554. [PMID: 37884321 DOI: 10.1002/jor.25720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 10/07/2023] [Accepted: 10/16/2023] [Indexed: 10/28/2023]
Abstract
Rifampin has been proven to be effective in the treatment of prosthetic infections due to its ability to intercalate into biofilms. The use of rifampin in antibiotic spacers is not well described, which would be especially important in the local periprosthetic environment where parenteral doses have poor penetration. The null hypothesis tests if rifampin use in polymethyl methacrylate (PMMA) cement will show no clinically significant impact on mechanical strength at antibiotic concentrations that remain bactericidal. Test antibiotic cement samples supplemented with 0, 30, 50, 100, 150, or 200 mg of rifampin into a standard 40 g bag were tested for compression to failure using published ASTM standards. The samples were then inoculated with Pseudomonas aeruginosa and either evaluated for lipopolysaccharide (LPS) presence as a marker of biofilm or tested by elution as the Kirby Bauer assay. Rifampin concentrations of 30 and 50 mg, showed no statistically different mechanical characteristics from control PMMA (p > 0.05). The 100-mg sample fell within the acceptable range of compressive strength and had significantly less LPS and bacterial presence compared to the control at 12 and 24 h. The ability of PMMA with 100 mg of rifampin to maintain its structural integrity and have significant bacterial inhibition at 12 and 24 h makes it a great candidate as an antibiotic bone cement additive. PMMA loaded with up to 100 mg of rifampin shows promise in the treatment and prevention of periprosthetic joint infection for total knee and total hip arthroplasty.
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Affiliation(s)
- Jacob Laperche
- Joint Replacement Center, University Orthopedics, East Providence, Rhode Island, USA
- Frank H. Netter School of Medicine, Quinnipiac University, North Haven, Connecticut, USA
| | - Caitlin C Barrett
- Joint Replacement Center, University Orthopedics, East Providence, Rhode Island, USA
| | - Abigail Boduch
- Department of Orthopedic Surgery, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Jillian Glasser
- Joint Replacement Center, University Orthopedics, East Providence, Rhode Island, USA
| | - Drew Clippert
- Joint Replacement Center, University Orthopedics, East Providence, Rhode Island, USA
| | - Dioscaris R Garcia
- Department of Orthopedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Valentin Antoci
- Joint Replacement Center, University Orthopedics, East Providence, Rhode Island, USA
- Department of Orthopedic Surgery, Rhode Island Hospital, Providence, Rhode Island, USA
- Department of Orthopedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
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Liu J, Zhao L, Chang K, Laperche J, Smith N, Jenkins D. Tibial Component Revision Arthroplasty Using Porous Tantalum Cone for Symptomatic Progressive Periprosthetic Proximal Tibial Ganglion Cyst about All-Polyethylene Tibia Primary Total Knee Replacement: A Case Report and Review of Literature. J Orthop Case Rep 2024; 14:131-135. [PMID: 38420232 PMCID: PMC10898699 DOI: 10.13107/jocr.2024.v14.i02.4244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Revised: 12/09/2023] [Indexed: 03/02/2024] Open
Abstract
Introduction Intraosseous ganglion cysts are an uncommon variant found in the subchondral bone. We report here the development of an intraosseous ganglion cyst of the proximal tibia in the setting of a prior left total knee arthroplasty (TKA) with an all-polyethylene tibial component. Case Report The cyst was diagnosed on routine follow-up radiographs approximately 4 years status post-TKA. Although initially asymptomatic, 1 year later the patient presented with progressive knee pain and ambulation limitations, so revision TKA was indicated. Computed tomography confirmed an osteolytic lesion suggestive of a penetrating ganglion. Given the absence of malrotation or malalignment of the well-fixed femoral component, the decision was made to proceed with tibial revision to stemmed component cemented through a porous tantalum cone. Postoperatively, the patient had complete resolution of pain and instability with 0-120° of stable range of motion, which has persisted to the latest follow-up at over 6 months post-operative, with radiographic resolution of the cyst. Conclusion This case demonstrates a ganglion cyst surrounding total knee implants as a possible source of persistent pain following TKA. To our knowledge, this is the first report of such a case. This case demonstrates that refractory painful knee implants secondary to tibial ganglion cysts can be treated successfully with revision arthroplasty.
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Affiliation(s)
- Jonathan Liu
- Department of Orthopedics, Brown University, Providence, Rhode Island
| | - Leon Zhao
- Department of Orthopedics, Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Kenny Chang
- Department of Orthopedics, Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Jacob Laperche
- Department of Orthopedics Frank H Netter School of Medicine Quinnipiac University, North Haven, Connecticut
- Department of Orthopedics, University Orthopedics Inc., East Providence, Rhode Island
| | - Nathaniel Smith
- Department of Orthopedics, Brown University, Providence, Rhode Island
| | - Derek Jenkins
- Department of Orthopedics, Brown University, Providence, Rhode Island
- Department of Orthopedics, Warren Alpert Medical School, Brown University, Providence, Rhode Island
- Department of Orthopedics, University Orthopedics Inc., East Providence, Rhode Island
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Dove JH, Laperche J, Schiller J, Tabaddor R, Cohen E. Older age and smaller joint space width are associated with conversion to total hip arthroplasty following hip arthroscopy. J Orthop 2023; 46:174-177. [PMID: 38031628 PMCID: PMC10682505 DOI: 10.1016/j.jor.2023.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 11/03/2023] [Indexed: 12/01/2023] Open
Abstract
Purpose The goal of this study was to define the outcomes of patients following hip arthroscopy and to identify potential factors, found during hip arthroscopy, that were associated with patients' eventual conversion to total hip arthroplasty (THA). Methods Patients who had undergone hip arthroscopy from January 2010 to January 2015 were retrospectively reviewed and patients were reported if they had a THA in the same hip. Patients were followed up to December 2022 resulting in between 7 and 12 years of follow-up. Measures from the hip scope including joint space width and cartilage grades were reported. Differences in these measures and demographics were compared between patients who had THA after hip arthroscopy and those who did not with T-tests. Results Patients who had hip arthroscopy and were then converted to THA were significantly older than those patients who did not have THA (50.3 vs 42.0 years) (p = 0.039). The average time of conversion to THA from index hip arthroscopy was 3.59 years with a range of 0.48-8.91 years. Joint space width in patients converted to THA was significantly less, 3.08 mm ± 1.93 mm, compared to non-THA converted patients, 3.62 mm ± 0.88 mm (p < 0.001). Conclusions Older age and smaller joint space width of the hip was associated with patients who were converted to THA following hip arthroscopy. Level of evidence Level III.
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Affiliation(s)
- James H. Dove
- Brown University Department of Orthopedics, Providence, RI, USA
| | - Jacob Laperche
- Frank H. Netter School of Medicine Quinnipiac University, North Haven, CT, USA
- University Orthopedics, East Providence, RI, USA
| | - Jonathan Schiller
- Brown University Department of Orthopedics, Providence, RI, USA
- University Orthopedics, East Providence, RI, USA
| | - Ramin Tabaddor
- Brown University Department of Orthopedics, Providence, RI, USA
- University Orthopedics, East Providence, RI, USA
| | - Eric Cohen
- Brown University Department of Orthopedics, Providence, RI, USA
- University Orthopedics, East Providence, RI, USA
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Laperche J, Barrett CC, Glasser J, Yang DS, Lemme N, Garcia D, Daniels AH, Antoci V. Chronic obstructive pulmonary disease is an independent risk factor for increased opioid use in total hip arthroplasty: A retrospective PearlDiver study. J Orthop 2023; 46:95-101. [PMID: 37969229 PMCID: PMC10641556 DOI: 10.1016/j.jor.2023.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 09/07/2023] [Accepted: 09/20/2023] [Indexed: 11/17/2023] Open
Abstract
Background Total hip arthroplasty (THA) has become an incredibly common procedure due to its' predictability and high success rate. The success of surgery is related to strict indications and careful optimization of medical comorbidities to decrease risk and improve outcomes. Chronic obstructive pulmonary disease (COPD) has been associated with increased medical and surgical complications. A regulatory focus on opioid utilization does not usually consider COPD as a risk factor, but limited research exists on the impact of COPD on outcomes and risks after THA. Methods Retrospective all-inclusive database analysis of Medicare patients who had undergone THA between 2007 and 2017 included in the PearlDiver Database were studied. Postoperative opioid usage was examined at 1-, 3-, 6-, and 12 months, along with surgical infection, implant complications, and revisions. Post-operative complications within 30 days, either medical or implant related, were identified. Controlling for comorbidities, age, and sex, odds ratios were calculated using multivariable logistic regression with a significant α value of 0.05. Results COPD patients had significantly higher rates of opioid usage postoperatively. COPD patients also had an increased rate of readmissions, medical/implant complications, and revision surgeries. Discussion This is the only study raising concern regarding opioid use in COPD patients after total hip arthroplasty, which may be critical considering the associated respiratory depression further exacerbating the COPD. Considering the evidence of poor outcomes associated with COPD in arthroplasty, appropriately screening for COPD and counseling or planning for post-operative pain control and complications is paramount.
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Affiliation(s)
| | | | | | - Daniel S. Yang
- Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Nicholas Lemme
- Warren Alpert Medical School of Brown University, Providence, RI, USA
- Brown University and Rhode Island Hospital, Department of Orthopaedic Surgery, Providence, RI, USA
| | - Dioscaris Garcia
- Warren Alpert Medical School of Brown University, Providence, RI, USA
- Brown University and Rhode Island Hospital, Department of Orthopaedic Surgery, Providence, RI, USA
| | - Alan H. Daniels
- University Orthopedics Inc., East Providence, RI, USA
- Warren Alpert Medical School of Brown University, Providence, RI, USA
- Brown University and Rhode Island Hospital, Department of Orthopaedic Surgery, Providence, RI, USA
| | - Valentin Antoci
- University Orthopedics Inc., East Providence, RI, USA
- Warren Alpert Medical School of Brown University, Providence, RI, USA
- Brown University and Rhode Island Hospital, Department of Orthopaedic Surgery, Providence, RI, USA
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Laperche J, Testa EJ, Clippert D, Barrett C, Antoci V. Medial Calcar Restoration Using Femoral Head Autograft in Conversion Hip Arthroplasty for Failed Fixation after an Unstable Intertrochanteric Hip Fracture: A Case Report and Technique Description. J Orthop Case Rep 2023; 13:127-132. [PMID: 37753132 PMCID: PMC10519320 DOI: 10.13107/jocr.2023.v13.i09.3902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 07/22/2023] [Indexed: 09/28/2023] Open
Abstract
Introduction The calcar femorale helps manage compressive loads on the femoral head and is an essential component in determining intertrochanteric (IT) femur fracture stability. Fracture fixation can be complicated when primary fixation techniques, such as cephalomedullary nailing fail. Unstable IT femur fractures involving disruption of the medial calcar present additional fixation challenges. Case Report This case reports a patient with unstable IT fracture due to medial calcar disruption that experienced failure of a short cephalomedullary nail. Secondary fixation involved total hip arthroplasty (THA) with medical calcar reconstruction using femoral head autograft. Outcomes were good at 2-year follow-up with a full return to baseline activities. Conclusion The results indicate that femoral head autografting can be a viable option, with good outcomes, for medial calcar reconstruction in cases of failed IT fracture fixations without calcar support, converted to THA.
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Affiliation(s)
- Jacob Laperche
- Frank H. Netter School of Medicine, Quinnipiac University, North Haven, Connecticut
- Department of Orthopedics, University Orthopedics, East Providence, Rhode Island
| | - Edward J Testa
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Drew Clippert
- Department of Orthopedics, University Orthopedics, East Providence, Rhode Island
| | - Cait Barrett
- Frank H. Netter School of Medicine, Quinnipiac University, North Haven, Connecticut
| | - Valentin Antoci
- Department of Orthopedics, University Orthopedics, East Providence, Rhode Island
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island
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Laperche J, Bernstein RA. Cutaneous Paraneoplastic Syndrome Affecting the Hand in a Case of Underlying Waldenström Macroglobulinemia. Hand (N Y) 2023; 18:NP16-NP18. [PMID: 36734296 PMCID: PMC10152533 DOI: 10.1177/15589447231151260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Paraneoplastic syndromes represent the body's immune response to an underlying malignancy. The autoimmune response to cancer can manifest itself in multiple ways, including swelling, thickening, and changes in the hand. We report the case of a 65-year-old man who presented with hand swelling that was initially attributed to a work-related finger laceration. The patient developed edema and stiffness in the hand, which was subsequently diagnosed as Waldenström macroglobulinemia. Hand surgeons should be aware that atypical hand and wrist symptoms should raise the suspicion for the potential of a paraneoplastic syndrome and an underlying malignancy.
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Affiliation(s)
| | - Richard A. Bernstein
- Quinnipiac University, North Haven, CT, USA
- Connecticut Orthopaedics, Hamden, CT, USA
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Laperche J, Feinn R, Myrick K, Halawi MJ. Obesity and total joint arthroplasty: Does weight loss in the preoperative period improve perioperative outcomes? Arthroplasty 2022; 4:47. [PMID: 36329555 PMCID: PMC9635072 DOI: 10.1186/s42836-022-00149-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 08/30/2022] [Indexed: 11/06/2022]
Abstract
Background The obese population is more likely to develop degenerative joint disease requiring total joint arthroplasty (TJA) and also experience increased rates of adverse post-surgical outcomes. This study assessed whether a quantifiable weight loss prior to TJA had any impact on perioperative and 30-day outcomes in obese patients. Method Using the American College of Surgeons-National Surgical Quality Improvement Program database, obese patients who underwent total hip or total knee arthroplasty and lost at least 10% of their total body weight prior to surgery were identified and matched to other obese individuals undergoing the same procedures without weight loss. Perioperative outcomes, including operative time, length of stay, discharge destination, or 30-day adverse events, including complications, re-admissions, re-operations, and mortality, were then compared using conditional Logistic regression analysis. Results Analysis showed no difference between the two groups in terms of operative time, length of stay, discharge destination, or 30-day adverse events, including complications, re-admissions, re-operations, and mortality. Conclusion The results of this study suggest that weight loss alone in the preoperative period may not be sufficient to mitigate the effects of obesity on immediate post-TJA outcomes.
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Affiliation(s)
- Jacob Laperche
- Frank H. Netter School of Medicine, Quinnipiac University, North Haven, CT, 06473, USA
| | - Richard Feinn
- Frank H. Netter School of Medicine, Quinnipiac University, North Haven, CT, 06473, USA
| | - Karen Myrick
- Frank H. Netter School of Medicine, Quinnipiac University, North Haven, CT, 06473, USA.,Department of Nursing, School of Interdisciplinary Health and Science, University of Saint Joseph, West Hartford, CT, 06117, USA
| | - Mohamad J Halawi
- Department of Orthopedic Surgery, Baylor College of Medicine, 7200 Cambridge Street, Suite 10A, Houston, TX, 77030, USA.
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Petermans J, Laperche J, Scheen AJ. [Do statins have a place for cardiovascular prevention in elderly people?]. Rev Med Liege 2006; 61:386-93. [PMID: 16910266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Cardiovascular prevention should only be considered if the treatment reduces the incidence of coronary and cerebrovascular events and death. In elderly people, such treatment should also, and most importantly, help maintain a good quality of life, without increasing the risk of iatrogenic side-effects. These key-elements should be kept in mind when prescription of a statin is envisaged in the old (> 70 years) and especially the very old (> 80 years) individual. Randomised controlled trials in people above 70 years are rather rare. In the field of cardiovascular prevention, two studies provide information, on post-hoc analysis of the Heart Protection Study (HPS) with simvastatin and the PROSPER trial with pravastatin. The protection observed in the general population of HPS was also present in the subgroup of subjects aged above 70, both for coronary and cardiovascular events. The difference was less impressive in PROSPER, without any significant difference as far as the incidence of stroke was concerned. None of these two prospective trials provide specific data on individuals above 80. Interestingly, some experimental and epidemiological observations suggested that statins may prevent Alzheimer disease. However, the data from HPS and PROSPER are not convincing in this respect. Thus, results from new ongoing trials should be awaited, especially in patients with mild to moderate Alzheimer disease. Finally, it is noteworthy that low serum cholesterol level can be used as a marker of poor nutrition in very old people. Such condition is rather common, especially among institutionalised subjects, and is usually associated with a higher risk of morbidity and mortality.
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Bartsch P, Laperche J. [Smoking experimentation in adolescents. Is there a risk for health?]. Rev Med Liege 2006; 61:394-400. [PMID: 16910267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
It is clear that even low rate smoking is hazardous for health, the risk being independently increased by the daily number of cigarettes smoked and by the duration of smoking. The question raised is thus: will an adolescent experimenter be a non smoker, an experimenter for ever, a regular smoker, light or heavy? This short review shows that there are numerous factors from genetics, to familial environment not limited to tobacco issues, smoking situation at school as well as school performances of the student, and also individual psychological characteristics. The experimenter is a very good target for smoking cessation actions and should deserve particular attention from preventive medicine and, thus, from school medicine, before he becomes a regular smoker, who will be more resistant to smoking cessation programs.
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Affiliation(s)
- P Bartsch
- Service de Pneumologie, CHU Sart Tilman, Liège, Belgique.
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