Objective: The purpose of this study was to estimate the effect of age on the risk of in-hospital mortality and morbidity following urogynecologic surgery and to compare risks associated with obliterative versus recon...Objective: The purpose of this study was to estimate the effect of age on the risk of in-hospital mortality and morbidity following urogynecologic surgery and to compare risks associated with obliterative versus reconstructive procedures for prolapsein elderly women. Study design: We conducted a retrospective cohort study utilizing data from 1998 to 2002 from the Nationwide Inpatient Sample. Multivariable logistic regression was performed to obtain odds ratios estimating the effect of age on risk of death and complications, adjusting for comorbidities and demographic factors. Results: There were 264,340 women in our study population. Increasing age was associated with higher mortality risks per 1000 women ( < 60 years, 0.1; 60- 69 years,0.5; 70- 79 years, 0.9; ≥ 80 years, 2.8; P < .01) and higher complication risks per 1000 women ( < 60 years, 140; 60- 69 years, 130; 70- 79 years, 160; ≥ 80 years, 200; P < .01). Using multivariable logistic regression, increasing age was associated with an increased risk of death (60- 69 years, odds ratio [OR]3.4[95% CI 1.7- 6.9]; 70- 79 years, OR 4.9 [95% CI 2.2- 10.9]; ≥ 80 years, OR 13.6 [95% CI 5.9- 31.4]), compared with women < 60 years. The risk of perioperative complications was also higher in elderly women 80 years of age and older (OR 1.4 [95% CI 1.3- 1.5]) compared with younger women. Elderly women 80 years and over who underwent obliterative procedures had a lower risk of complication compared with those who underwent reconstructive procedures for prolapse (17.0% vs 24.7% , P < .01). Conclusion: Although the absolute risk of death is low,elderly women have a higher risk of mortality and morbidity following urogynecologic surgery.展开更多
Background: Recently, we identified and described dermoscopic aspects, present with a higher frequency in congenital melanocytic lesions with respect to acquired naevi. We also classified small- and medium-sized conge...Background: Recently, we identified and described dermoscopic aspects, present with a higher frequency in congenital melanocytic lesions with respect to acquired naevi. We also classified small- and medium-sized congenital naevi (CN) into nine subtypes according to their macroscopic and dermoscopic aspects. Objectives: Because the recognition of dermoscopic features may be instrument dependent, in this study, we wanted to check whether dermoscopic patterns specific for CN can be identified in digital images acquired by means of different instruments. We also wanted to check the validity of our previously proposed classification and assess possible age- and site-dependent variations of dermoscopic patterns and naevus subtypes. Patients/methods: Images corresponding to 384 small- or medium-sized CN were collected in eight different centres employing four different instruments. Lesion images were evaluated and checked for the presence of specific dermoscopic criteria, classified, and compared with a database of 350 acquired naevi. Results: Specific and unspecific dermoscopic features were identifiable in images acquired by means of all four instrument types The mean number of identified features per lesion did not vary according to the instrument employed for the acquisition of the images; however, it was lower for lesions recorded employing low magnifications. The previously proposed classification was easily applied to the whole image database. The variegated naevus type was identified as a highly specific clinical/dermoscopic pattern. Dermoscopic features varied according to age and location. The globular type prevailed in subjects under 11 years of age and on the trunk, whereas the majority of reticular lesions were located on the limbs. Conclusions: Because definite clinical and histological criteria for the diagnosis of the congenital nature of naevi are lacking, the use of dermoscopy can be of great help in identifying those lesions where the presence of specific dermoscopic features makes the diagnosis of CN more likely. Moreover, dermoscopy can be useful both for the classification of lesions already identified as congenital according to definite clinical and anamnestic data and for a possible correlation of naevus phenotype and dermoscopic patterns to the risk of developing a malignant melanoma in prospective studies.展开更多
文摘Objective: The purpose of this study was to estimate the effect of age on the risk of in-hospital mortality and morbidity following urogynecologic surgery and to compare risks associated with obliterative versus reconstructive procedures for prolapsein elderly women. Study design: We conducted a retrospective cohort study utilizing data from 1998 to 2002 from the Nationwide Inpatient Sample. Multivariable logistic regression was performed to obtain odds ratios estimating the effect of age on risk of death and complications, adjusting for comorbidities and demographic factors. Results: There were 264,340 women in our study population. Increasing age was associated with higher mortality risks per 1000 women ( < 60 years, 0.1; 60- 69 years,0.5; 70- 79 years, 0.9; ≥ 80 years, 2.8; P < .01) and higher complication risks per 1000 women ( < 60 years, 140; 60- 69 years, 130; 70- 79 years, 160; ≥ 80 years, 200; P < .01). Using multivariable logistic regression, increasing age was associated with an increased risk of death (60- 69 years, odds ratio [OR]3.4[95% CI 1.7- 6.9]; 70- 79 years, OR 4.9 [95% CI 2.2- 10.9]; ≥ 80 years, OR 13.6 [95% CI 5.9- 31.4]), compared with women < 60 years. The risk of perioperative complications was also higher in elderly women 80 years of age and older (OR 1.4 [95% CI 1.3- 1.5]) compared with younger women. Elderly women 80 years and over who underwent obliterative procedures had a lower risk of complication compared with those who underwent reconstructive procedures for prolapse (17.0% vs 24.7% , P < .01). Conclusion: Although the absolute risk of death is low,elderly women have a higher risk of mortality and morbidity following urogynecologic surgery.
文摘Background: Recently, we identified and described dermoscopic aspects, present with a higher frequency in congenital melanocytic lesions with respect to acquired naevi. We also classified small- and medium-sized congenital naevi (CN) into nine subtypes according to their macroscopic and dermoscopic aspects. Objectives: Because the recognition of dermoscopic features may be instrument dependent, in this study, we wanted to check whether dermoscopic patterns specific for CN can be identified in digital images acquired by means of different instruments. We also wanted to check the validity of our previously proposed classification and assess possible age- and site-dependent variations of dermoscopic patterns and naevus subtypes. Patients/methods: Images corresponding to 384 small- or medium-sized CN were collected in eight different centres employing four different instruments. Lesion images were evaluated and checked for the presence of specific dermoscopic criteria, classified, and compared with a database of 350 acquired naevi. Results: Specific and unspecific dermoscopic features were identifiable in images acquired by means of all four instrument types The mean number of identified features per lesion did not vary according to the instrument employed for the acquisition of the images; however, it was lower for lesions recorded employing low magnifications. The previously proposed classification was easily applied to the whole image database. The variegated naevus type was identified as a highly specific clinical/dermoscopic pattern. Dermoscopic features varied according to age and location. The globular type prevailed in subjects under 11 years of age and on the trunk, whereas the majority of reticular lesions were located on the limbs. Conclusions: Because definite clinical and histological criteria for the diagnosis of the congenital nature of naevi are lacking, the use of dermoscopy can be of great help in identifying those lesions where the presence of specific dermoscopic features makes the diagnosis of CN more likely. Moreover, dermoscopy can be useful both for the classification of lesions already identified as congenital according to definite clinical and anamnestic data and for a possible correlation of naevus phenotype and dermoscopic patterns to the risk of developing a malignant melanoma in prospective studies.
