PubMed · 14743678
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Kim M Chronister. 2003. Divided attention.. https://pubmed.ncbi.nlm.nih.gov/14743678/
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OBJECTIVE: To investigate the risk of falls associated with drugs among the French population using data reported to the French spontaneous reporting system and recorded in the French Pharmacovigilance database. METHODS: All cases including a fall were searched in the French Pharmacovigilance database between 1995 and 1999. Drugs involved and characteristics of patients were investigated. In a second step, we estimated the risk associated with psychotropic and cardiovascular drugs in a case/non case comparison, where cases were reports including a fall and non cases all other reports. This risk was estimated by calculation of crude and age and gender adjusted reporting odds ratios (ROR). RESULTS: During this period, 328 reports including a fall were reported (0.4% of the database). Patients were female in 70%. Mean age was 76 +/- 18 years. Comparisons between cases and non cases showed that cases were more likely to be women (OR: 1.9; 95% confidence interval (CI) [1.5-2.4]) and older. After adjustment on age and gender, falls remained significantly associated with exposure to benzodiazepines (4.7 [3.7-5.9]), imipraminic antidepressants (3.6 [2.5-5.1]), serotonin reuptake inhibitor (SRI) antidepressants (2.2 [1.5-3.1]) or nitrates (1.9 [1.2-2.8]). CONCLUSION: This study confirms that taking psychotropic drugs strongly increases the risk of falls. The role of cardiovascular drugs (except nitrates) remains not significant when confounding factors are taken into account. According to the very high prevalence of psychotropic drug use in the French elderly, further study are needed to investigate the relative effect of some drugs on falls, like for example SRIs or short acting benzodiazepines.
STUDY DESIGN: Case report. OBJECTIVES: To report a rare case of radiation-induced malignant peripheral nerve sheath tumor of the cauda equina 10 years after treatment for testicular seminoma. SUMMARY OF BACKGROUND DATA: Development of malignant peripheral nerve sheath tumor after irradiation is well recognized and often associated with a dismal prognosis. There have been isolated reports of malignant peripheral nerve sheath tumor developing in sites of previous irradiation for testicular seminoma. METHODS: Retrospective review of case records and imaging. RESULTS: A 38-year-old man presented with signs of cauda equina syndrome. Ten years previously, he had undergone right radical inguinal orchidectomy and adjuvant para-aortic radiotherapy as treatment for Stage I testicular seminoma. Magnetic resonance imaging demonstrated an inoperable intra- and extradural tumor leading to significant cauda equina compression. CT-guided biopsy revealed a diagnosis of malignant peripheral nerve sheath tumor, most likely due to previous radiotherapy. His clinical condition did not improve, and he underwent a course of palliative chemotherapy. CONCLUSIONS: Postirradiation malignant peripheral nerve sheath tumors are rare and occur in a population at high risk of developing second malignancies. The authors report the fourth case resulting from adjuvant radiotherapy for testicular seminoma, with the present report being the first report of extensive intradural tumor leading to cauda equina syndrome.
Falling is a frequent cause of serious injury in older adults and trips are a dominant cause of falls in this rapidly growing population. Although there are few laboratory protocols that induce actual trips, there are many protocols that utilize surrogate tasks. These surrogate tasks, which are time-critical but do not involve an obstacle, appear to share a number of biomechanical characteristics with stepping responses following a trip. However, although rapid and safe negotiation of the obstacle and restoration of dynamic equilibrium are common requisites for success, we expected that stepping response kinematics during a successful recovery from a trip over a previously unseen obstacle would be substantially different than those of surrogate tasks without an obstacle. Unexpected trips were induced in 13 older men and women by an obstacle, the presence of which the subjects were previously unaware. Selected kinematics of the leading and trailing limb stepping responses during recovery from the induced trip were compared to those of two surrogate tasks that did not involve an obstacle. Multivariate analysis of variance (MANOVA) revealed that step height, step length, peak horizontal velocity, and peak vertical velocity of the leading and trailing limbs were significantly different during recovery from the induced trip compared to the surrogate tasks. These between-task performance differences may limit the extent to which performance of the surrogate tasks accurately and precisely reflect the potential to recover dynamic equilibrium following a trip. Therefore, these findings may be applicable in the design of new or modification of existing interventions to reduce falls in older adults.