Treatment of esophageal perforation in octogenarians : a multicenter study

Esophageal perforation is associated with significant mortality, and this may markedly increase with advanced age. This multicenter study investigates this issue in patients older than 80 years. Data on 33 patients\u2009>80 years old who underwent conservative (10 patients), endoclip (one patient), stent grafting (11 patients), or surgical treatment (11 patients) for esophageal perforation were collected from nine centers. Surgical repair consisted of repair on drain in one patient, primary repair in seven patients, and esophagectomy in two patients. Among patients who underwent stent grafting, one required repeat stenting and another stent graft repositioning. One patient was converted to surgical repair after stent grafting. Thirteen patients (39.4%) died during the 30-day and/or in-hospital stay. Their mortality was significantly higher than in a series of patients\u2009<80 years old (13.0%, 21/161 patients, P = 0.001). Three patients (30.0%) died after conservative treatment, one (100%) after treatment with endoclips, five (45.5%) after stent grafting, and four (36.4%) after surgical repair (P = 0.548). Early survival with salvaged esophagus was 42.4% (conservative treatment: 70.0% endoclips 0%, stent grafting: 54.5%, and surgical repair: 54.5%, respectively, P = 0.558). Estimated glomerular filtration rate\u2009<60\u2009mL/minute/1.73\u2009m2 (70.0% vs. 25.0%, P = 0.043) and sepsis (100% vs. 32.1%, P = 0.049) at presentation were associated with increased risk of early mortality in univariate analysis. Esophageal perforation in octogenarians is associated with very high early and intermediate high mortality irrespective of the treatment method used

Anton Dolin as The Prodigal Son (held horizontal), Dimitri Rostoff as the Father (kneeling centre), with Kira Abricossova and Tamara Tchinarova as the Sisters of The Prodigal Son, in Le fils prodigue, Covent Garden Russian Ballet, Australian tour, His Majesty's theatre, Melbourne, March 1939 [picture] /

Also performed 11-12 April 1939.; From: Le fils prodigue (The prodigal son) : scene in three tableaux / music by Sergey Prokofiev.; Inscription: "2E/37".; Part of the collection: Hugh P. Hall collection of photographs, 1938-1940.; Choreography by David Lichine ; scenery and costumes by Georges Roualt ; scenery executed by Prince A. Schervachidze ; costumes executed by V. Soudeikine.; Also available in an electronic version via the internet at: http://nla.gov.au/nla.pic-vn4175297. One of a collection of photographs taken by Hugh P. Hall of 28 ballet productions performed by the Covent Garden Russian Ballet (toured Australia 1938-1939) and the Original Ballet Russe (toured Australia 1939-1940). These are the second and third of the three Ballets Russes companies which toured Australasia between 1936 and 1940. The photographs were taken from the auditorium during a live performance in His Majesty's Theatre, Melbourne and mounted on cardboard for display purposes. For conservation and storage, the photographs have been demounted. The original arrangement of the photographs has been recorded, and details are available from the Pictures Branch of the National Library

Influence of tinnitus on pain severity and quality of life in patients with temporomandibular disorders

OBJECTIVE: The aim of this cross-sectional study was to evaluate the relationship among pain intensity and duration, presence of tinnitus and quality of life in patients with chronic temporomandibular disorders (TMD). MATERIAL AND METHODS: Fifty-nine female patients presenting with chronic TMD were selected from those seeking for treatment at the Bauru School of Dentistry Orofacial Pain Center. Patients were submitted to the Research Diagnostic Criteria anamnesis and physical examination. Visual analog scale was used to evaluate the pain intensity while pain duration was assessed by interview. Oral Health Impact Profile inventory modified for patients with orofacial pain was used to evaluate the patients' quality of life. The presence of tinnitus was assessed by self report. The patients were divided into: with or without self report of tinnitus. The data were analyzed statistically using the Student's t-test and Pearson's Chi-square test, with a level of significance of 5%. RESULTS: The mean age for the sample was 35.25 years, without statistically significant difference between groups. Thirty-two patients (54.24%) reported the presence of tinnitus. The mean pain intensity by visual analog scale was 77.10 and 73.74 for the groups with and without tinnitus, respectively. The mean pain duration was 76.12 months and 65.11 months for the groups with and without tinnitus, respectively. The mean OHIP score was 11.72 and 11.74 for the groups with and without tinnitus, respectively. There was no statistically significant difference between groups for pain intensity, pain duration and OHIP scoreS (p>0.05). CONCLUSION: Chronic TMD pain seems to play a more significant role in patient's quality of life than the presence of tinnitus