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Ann Thorac Surg. 1999 Sep;68(3):1029-33.
Postoperative gastrointestinal complications after lung volume reduction operations.

Cetindag IB, Boley TM, Magee MJ, Hazelrigg SR.

Division of Cardiothoracic Surgery, Southern Illinois University School of Medicine, Springfield 62794-9638, USA.

BACKGROUND: Lung volume reduction operations have been shown to improve the quality of life and functional status of some patients with end-stage emphysema. METHODS: Because of a perceived increase in the occurrence of postoperative gastrointestinal (GI) complications, we reviewed our experience in 287 patients who had lung volume reduction operations to determine the frequency of GI complications and to identify risk factors. RESULTS: Using a broad definition of postoperative GI complications (nausea, vomiting, abdominal distension, gastroesophageal reflux, diarrhea, constipation) there were 137 complications in 67 patients (23%). More severe GI complications (bowel ischemia, GI bleeding, perforation, ulceration, ileus, colitis, cholecystitis, pancreatitis) occurred 49 times in 27 patients (9.4%). Seven of the 27 patients required abdominal operations. Risk factors identified as predictive of severe complications include diabetes (p = 0.0003), lower preoperative hematocrit (p = 0.01), steroid use (p = 0.02), and use of parenteral meperidine analgesic (p = 0.002). Stepwise logistic regression demonstrated that diabetes was 7.02 times more likely to produce severe complications. Other risk factors included steroids (2.81), number of different pain medications (2.59), hematocrit decrease of 5% (1.96), and hematocrit decrease of 1% (1.14). In the patients with severe GI complications there were six of 27 (22%) hospital deaths compared with five of 260 (2%) in those without GI complications (p = 0.0001). CONCLUSIONS: Severe GI complications in patients with emphysema who had lung volume reduction operations are not uncommon (9.4%) and influence the perioperative mortality rate. Heightened awareness to identified r

Nippon Ronen Igakkai Zasshi. 1999 Jun;36(6):396-403.
[Quality of life in elderly patients with cerebral vascular disease and Parkinson's disease]

[Article in Japanese]

Wakayama Y, Maeda M, Sunohara N, Kachi T, Yoneyama S.

Department of Medicine, Showa University Fujigaoka Hospital.

We developed a questionnaire for the study of background factors and quality of life (QOL) in elderly patients with cerebral vascular disease (CVD) and Parkinson's disease (PD). The questionnaire covered the background factors and four sections such as physical, functional, psychological and social health sections. Each section had 15 questions and disease-specific questions for CVD or PD were included in the physical health section. We analyzed 107 patients with CVD (76 elderly patients, aged 65 or more, 31 non-elderly patients under 65) and 136 patients with PD (91 elderly, 45 non-elderly). In the background section, of a total of 243 patients with CVD and PD, the elderly patients needed the assistance of their spouse and their sons wives more frequently than non-elderly patients. With regard to rehabilitation, non-elderly CVD patients had rehabilitation more frequently than the elderly CVD patients, while a higher percentage of elderly patients with PD had rehabilitation training more frequently than the non-elderly PD patients. In the QOL section, there was no difference between elderly and non-elderly CVD patients, while elderly PD patients were statistically more significantly disabled physically and weak-minded psychologically. The physical disabilities of the elderly PD patients in this statistical investigation included slow motion, stooped posture, frozen gait, difficulty in turning and standing up, constipation and dysuria. The psychological problems of elder PD patients included forgetfulness and a feeling of aging. These patients had significantly fewer consultations by family and relatives than the non-elderly PD patients. The overall tendency of QOL in patients with CVD and PD was similar to that of PD p

Am J Gastroenterol. 1999 Oct;94(10):2929-35.
Symptom differences in moderate to severe IBS patients based on predominant bowel habit.

Schmulson M, Lee OY, Chang L, Naliboff B, Mayer EA.

Department of Medicine and Physiology, UCLA School of Medicine, Los Angeles, California, USA.

OBJECTIVE: We sought to determine if irritable bowel syndrome (IBS) patients with different bowel habit predominance differ in self-reported viscerosensory symptoms related to the upper and lower gastrointestinal (GI) tract, somatosensory symptoms, and constitutional functions. METHODS: Six hundred and twenty-five Rome criteria-positive IBS patients completed a bowel symptom questionnaire (BSQ), psychological symptom checklist (SCL-90), and health status (SF-36). Bowel habit predominance for IBS patients was determined using the Rome criteria for functional constipation (IBS-C; n = 140) and functional diarrhea (IBS-D; n = 216). The BSQ included questions about viscerosensory symptoms of the upper (chest pressure, bloating, fullness, early satiety, nausea) and lower GI tract (bloating, pain, incomplete evacuation), somatosensory symptoms related to the musculoskeletal system (pain in neck/shoulders, lower back/hip, muscles/joints), and constitutional functions (sleep, appetite, libido). Analysis was further conducted between the IBS-C and IBS-D patients, controlling for gender and quality of sleep, and using the Bonferroni correction to control for multiple comparisons. RESULTS: Female gender was more prevalent among IBS-C than IBS-D (77% vs 56.1%, p < 0.01), whereas age did not differ (40.2 +/- 1.2 yr vs 39.5 +/- 1.0 yr). Symptoms referred to the upper GI were more prevalent in IBS-C than IBS-D: early satiety (56.7% vs 33.9%, p < 0.004), fullness (63.2% vs 38.5%, p < 0.05), and a trend for upper bloating (80.3 vs 62.6%). IBS-C patients reported higher severity ratings for lower GI bloating (p < 0.001). IBS-C more commonly reported musculoskeletal symptoms (92.2% vs 75.4%, p < 0.001), as well as impairment

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