Psoriasis and smoking: a systematic review and meta-analysis.

Psoriasis is an inflammatory skin disease associated with increased cardiovascular comorbidity. Smoking is associated with an increased risk of cardiovascular disease, and prior studies have suggested that patients with psoriasis are more likely to be active smokers. Smoking may also be a risk factor in the development of psoriasis. We conducted a systematic review and meta-analysis to assess the prevalence of smoking among patients with psoriasis, and we reviewed the contribution of smoking to the incidence of psoriasis. A total of 25 prevalence and three incidence studies were identified. The meta-analysis of prevalence studies included a total of 146 934 patients with psoriasis and 529 111 patients without psoriasis. Random effects meta-analysis found an association between psoriasis and current smoking [pooled odds ratio (OR) 1·78, 95% confidence interval (CI) 1·52-2·06], as well as between psoriasis and former smoking (pooled OR 1·62, 95% CI 1·33-1·99). Meta-regression analysis did not reveal any sources of study heterogeneity, but a funnel plot suggested possible publication bias. A subset of studies also examined the association between moderate-to-severe psoriasis and smoking, with a pooled OR of 1·72 (95% CI 1·33-2·22) for prevalent smoking. The three incidence studies found an association between smoking and incidence of psoriasis, with a possible dose-effect of smoking intensity and duration on psoriasis incidence. These findings suggest that smoking is an independent risk factor for the development of psoriasis, and that patients with established psoriasis continue to smoke more than patients without psoriasis.

A portable nitric oxide scavenging system designed for use on neonatal transport.

OBJECTIVE: To evaluate a portable scavenging system for nitric oxide and its oxides, designed for use on neonatal transport. DESIGN: A prospective evaluation of the nitric oxide scavenging system, using a neonatal transport incubator ventilator and a test lung. SETTING: Laboratory of a tertiary care children's hospital. INTERVENTIONS: The scavenging system was tested, using a neonatal transport incubator with attached ventilator, ventilator circuit, and a neonatal test lung. Nitric oxide was administered on the inspiratory limb, and nitric oxide and its oxides were measured in the expiratory gas after passing through the scavenger. MEASUREMENTS AND MAIN RESULTS: A modified scrubber assembly was filled with 50% activated charcoal and 50% aluminas potassium permanganate pellets (3). Three wire meshes were placed before, in between, and after the two chemicals to facilitate gas flow. Using the maximum FIO2, with a nitric oxide concentration of 120 parts per million (ppm), the test lung continuous flow ventilation (FIO2 of 0.86, peak inspiratory pressure of 30 cm H2O, positive end-expiratory pressure of 6 cm H2O) and respiratory rate of 60 breaths/min) was performed for 4 hrs with each of four freshly prepared scavenging systems. A fifth scavenging system was tested for a 12-hr period. The mean composition of the exhaled gases for 4 hrs were: nitric oxide 0.01 +/- 0.03 (SD) ppm, nitric dioxide 0.06 +/- 0.06 ppm, and other oxides 0.05 +/- 0.09 ppm. After 12 hrs of 120 ppm of inhaled nitric oxide, the fifth scavenger system had undetectable nitric oxide, nitric dioxide, and other oxides in the exhaled gas. Normal room air contained between 0.0 and 0.03 ppm of nitric oxide, 0.0 and 0.02 ppm of nitric dioxide, and 0.0 and 0.02 ppm of other oxides. CONCLUSION: Nitric oxide, nitric dioxide, and other dioxides can be safely scavenged by this portable scavenging system, allowing safe administration of nitric oxide free from environmental contamination with nitric oxide and its oxides.

Usefulness of (Tc 99m) HM-PAO scan in supporting clinical brain death in children: uncoupling flow and function.

OBJECTIVE: To determine the usefulness of (Tc 99m) HM-PAO scan in supporting the clinical diagnosis of brain death. DESIGN: Retrospective review. SETTING: Paediatric Intensive Care Unit. SUBJECTS: A total of 39 paediatric patients had HM-PAO scans conducted to confirm the presence of brain death or to assess the degree of brain injury. INTERVENTIONS: All patients had (Tc 99m) HM-PAO injected before the scan was conducted. MEASUREMENTS AND MAIN RESULTS: Fifty-four scans were done in 39 patients. The majority of cerebral injury was as a result of closed head injury or asphyxia/anoxia. There were 20 scans which demonstrated no cerebral blood flow (CBF); however, in 26 situations patients were clinically brain dead. All of the patients who continued to have CBF in the presence of clinical brain death sustained asphyxial/anoxic injuries. CONCLUSIONS: The HM-PAO scan is a useful non-invasive portable tool for supporting the diagnosis of brain death when there is absent CBF. However, continued flow may be present in asphyxial/anoxic injuries in the presence of clinical brain death.

Aortic valve operation after percutaneous aortic balloon valvuloplasty.

From January 1986 to May 1988, 179 patients underwent percutaneous aortic balloon valvuloplasty at our institution. Forty-five (25%) patients subsequently required operation at this institution or other institutions. The indication for percutaneous aortic balloon valvuloplasty was patient preference in 15 and an estimation of excessive operative mortality in 30. Three patients required emergency operation immediately after valvuloplasty, and the other 42 had an elective operation a mean of 7.8 months afterward. All but 3 of these patients had major progression of symptoms, and all had valvular restenosis. In spite of the high-risk status of these patients, there were only four hospital deaths among the 45 patients. Three additional patients have died a mean of 11.4 months postoperatively. The condition of all survivors remains clinically improved after the valve operations. Percutaneous aortic balloon valvuloplasty must be recognized as a palliative procedure, and should be reserved for patients who are truly not candidates for operation or situations in which a brief period of reduction in gradient might improve a patient's condition before operation.

Successful repair of left ventricular rupture after redo mitral valve replacement.

A patient with an extensive type I left ventricular rupture after a redo mitral valve replacement was successfully treated using a patch of glutaraldehyde-preserved pericardium sutured to the endocardium around the tear.

Percutaneous removal of thoracostomy tubes.

Percutaneous techniques have previously been applied to the removal of retained subcutaneous fragments of thoracentesis catheters. The authors report the removal of two thoracostomy tubes that were entirely retracted within the thoracic cavity. Removal was achieved by adapting methods used to perform percutaneous nephrolithotomy.

Late rupture after dacron wrapping of aortic aneurysms.

We reviewed the entire experience in Hawaii with external wall reinforcement with Dacron graft material as a primary method of surgical treatment of aortic aneurysm. Over the past 11.5 years, 14 such procedures have been performed. Two of the aneurysms were located in the distal aortic arch, eight in the descending thoracic aorta, and four in the abdominal aorta. The operation was done in each instance as a safer alternative to resection and replacement in high-risk patients. There were two postoperative deaths, one unrelated to the surgery. To date, three of the 12 surviving patients have experienced aortic rupture at the graft site, 6 months to 3 years later. Two died of exsanguinating hemorrhage and a third survived corrective surgery. The rupture in each instance occurred through the entire wrap itself. Two of these developed aortobronchial fistulas and one an aortoesophageal fistula. The high incidence of late rupture of wrapped aneurysms, as reported here, has not been documented in the literature and raises serious questions as to the efficacy of this procedure.

Assessment of chronic venous insufficiency using dynamic venous pressure studies.

In this study, 207 consecutive limbs with chronic venous insufficiency were evaluated with dynamic venous pressure studies and they were correlated with the clinical presentation and results of definitive radiologic studies with ascending and descending venography. Multiple methods of performing the pressure studies, by active exercise, passive manual compression, and tourniquet application at the calf and ankle, proved useful in distinguishing the severity and location of venous disease. The limits of confidence that can be ascribed to the dynamic venous pressure studies were also determined.