Visualization of atherosclerosis as detected by coronary artery calcium and carotid intima-media thickness reveals significant atherosclerosis in a cross-sectional study of psoriasis patients in a tertiary care center.

BACKGROUND: Psoriasis is a chronic inflammatory disease of the skin and joints that may also have systemic inflammatory effects, including the development of cardiovascular disease (CVD). Multiple epidemiologic studies have demonstrated increased rates of CVD in psoriasis patients, although a causal link has not been established. A growing body of evidence suggests that sub-clinical systemic inflammation may develop in psoriasis patients, even from a young age. We aimed to evaluate the prevalence of atherosclerosis and identify specific clinical risk factors associated with early vascular inflammation. METHODS: We conducted a cross-sectional study of a tertiary care cohort of psoriasis patients using coronary artery calcium (CAC) score and carotid intima-media thickness (CIMT) to detect atherosclerosis, along with high sensitivity C-reactive protein (hsCRP) to measure inflammation. Psoriasis patients and controls were recruited from our tertiary care dermatology clinic. Presence of atherosclerosis was defined using validated numeric values within CAC and CIMT imaging. Descriptive data comparing groups was analyzed using Welch's t test and Pearson Chi square tests. Logistic regression was used to analyze clinical factors associated with atherosclerosis, and linear regression to evaluate the relationship between psoriasis and hsCRP. RESULTS: 296 patients were enrolled, with 283 (207 psoriatic and 76 controls) having all data for the hsCRP and atherosclerosis analysis. Atherosclerosis was found in 67.6 % of psoriasis subjects versus 52.6 % of controls; Psoriasis patients were found to have a 2.67-fold higher odds of having atherosclerosis compared to controls [95 % CI (1.2, 5.92); p = 0.016], after adjusting for age, gender, race, BMI, smoking, HDL and hsCRP. In addition, a non-significant trend was found between HsCRP and psoriasis severity, as measured by PASI, PGA, or BSA, again after adjusting for confounders. CONCLUSIONS: A tertiary care cohort of psoriasis patients have a high prevalence of early atherosclerosis, increased hsCRP, and psoriasis remains a risk factor for the presence of atherosclerosis even after adjustment of key confounding clinical factors. Psoriasis may contribute to an accelerated systemic inflammatory cascade resulting in increased risk of CVD and CV events.

In the same boat? An online group career counseling with a group of young adults in the time of COVID-19.

An online group of career counseling for unemployed young adults during the COVID-19 pandemic was developed. Twelve participants were involved in online group career counseling intervention, based on the Life Design for an inclusive and sustainable future. Results indicated at post-test on increased scores on career adaptability, resilience, future orientation, and propensity to identify inclusive and sustainable actions for the future than pre-test. Overall, the online group career counseling intervention effectively promoted particular aspects of young adults' life design for an inclusive e-sustainable future.

Dans le Même Bateau : Un Groupe de Conseil en Orientation Professionnelle En Ligne avec un Groupe de Jeunes Adultes à l'Époque du COVID-19 Un groupe de conseil en orientation professionnelle en ligne pour les jeunes adultes sans emploi pendant la pandémie de COVID-19 a été développé. Douze participant·e·s ont été impliqués dans une intervention de conseil en en orientation de groupe en ligne, basée sur le Life Design pour un avenir inclusif et durable. Les résultats indiquent que les scores sur l'adaptabilité de la carrière, la résilience, l'orientation future et la propension à identifier des actions inclusives et durables pour l'avenir ont augmenté au post-test par rapport au pré-test. Dans l'ensemble, l'intervention de conseil en orientation professionnelle de groupe en ligne a efficacement promu des aspects particuliers du Life Design chez jeunes adultes pour un avenir inclusif et durable.

En el mismo barco: un asesoramiento profesional grupal online con un grupo de adultos jóvenes en tiempos del COVID-19 Se desarrolló un grupo online de asesoramiento profesional para adultos jóvenes desempleados durante la pandemia de COVID-19. Doce participantes fueron involurados en una experiencia de asesoramiento profesional grupal online basada en el Life Design para un futuro inclusivo y sostenible. Los resultados del post-test de la experiencia indicaron un aumento significativo de las puntuaciones en adaptabilidad profesional, resiliencia, orientación futura y propensión a identificar acciones inclusivas y sostenibles para el futuro de las obtenidas antes de la aplicación de la prueba. En general, la intervención de asesoramiento profesional grupal online promovió efectivamente aspectos particulares del proyecto de vida de los adultos jóvenes para un futuro inclusivo y sostenible.

Changes in the aortic wall oxygen tensions of hypertensive rabbits. Hypertension and aortic wall oxygen.

Hypertension is a known risk factor for atherosclerosis. We hypothesize that hypertension causes artery wall hypoxia that contributes to the formation of atherosclerotic lesions. Therefore, we examined the effect of hypertension on the transarterial wall oxygen gradient of the rabbit aorta. Hypertensive rabbits were created by unilateral nephrectomy and contralateral renal artery narrowing. Transarterial wall oxygen gradients of the infrarenal aorta were measured using an oxygen microelectrode 14-16 weeks (short-term hypertension) and 56-58 weeks (long-term hypertension) after the rabbits were made hypertensive. The transarterial wall oxygen gradients showed significant differences among the groups. Short-term hypertension caused significantly higher oxygen tensions in the outer 30% of the artery wall and significant thinning of the artery wall when compared with long-term hypertension and control groups. Long-term hypertension caused significantly lower oxygen tensions in the inner 40% of the artery wall and significant thickening of the artery wall when compared with short-term hypertension and control groups. These changes were noted despite no difference in the partial pressure of oxygen in arterial blood or visual evidence of atherosclerotic lesion formation in the three groups. These findings suggest that hypertension alters the transarterial wall oxygen gradient. This altered transarterial wall oxygen gradient may contribute to the formation of atherosclerotic lesions.

The influence of perioperative myocardial infarction on long-term prognosis following elective vascular surgery.

STUDY OBJECTIVE: The present study was performed to determine the influence of a perioperative myocardial infarction on long-term mortality in patients who have undergone elective vascular surgery. STUDY DESIGN: This was a 4-year follow-up of patients who had undergone elective vascular procedures at a Veterans Affairs Medical Center. Between January 1989 and December 1990, 115 consecutive patients underwent surgery for either an expanding abdominal aortic aneurysm (AAA) (38%) or for pain in the lower extremities (62%). RESULTS: Vital status at 4 years postsurgery was determined for all patients. Thirty-day postoperative mortality was 3%, while estimates at 1, 2, 3, and 4 years were 19%, 26%, 35%, and 39%, respectively. Of the 45 patients who died within 4 years following surgery, the major causes of death were cardiac (40%), cancer (18%), cerebrovascular (13%), and peripheral vascular disease (11%). Univariate predictors of 1-year mortality on preoperative evaluation were an abnormal ECG, moderate or greater sized exercise thallium defect and left ventricular ejection fraction < or =40%, and a perioperative myocardial infarction. Univariate predictors of 4-year mortality were non-AAA surgery and diabetes mellitus. Perioperative myocardial infarction was a marginally significant independent predictor of 1-year mortality (p=0.06), while the need for non-AAA surgery was a strong independent predictor at 4 years. CONCLUSIONS: Cardiac mortality is the major cause of late death among patients undergoing elective vascular surgery. Although preoperative indicators of symptomatic coronary artery disease and nonfatal perioperative myocardial infarction identified those individuals at increased mortality in the first postoperative year, the extent of vascular disease at presentation may be a more important determinant of long-term survival. A randomized trial in such patients is needed to assess the best strategy for treating patients with coexistent coronary artery and vascular diseases.

Saphenous vein in situ bypass.

Revascularization of the ischemic diabetic extremity presents a significant diagnostic and technical challenge. The in situ saphenous bypass provides a conduit that allows revascularization to arteries at the ankle and proximal foot. Evaluation of the distal circulation, the adequacy of the saphenous vein, and routine follow-up after bypass, along with the operative procedure, are described. Balloon inflow occlusion arteriography, duplex mapping of the saphenous vein, operative technique, and follow-up protocol are discussed.

Predictors of total and low-density lipoprotein cholesterol change after partial ileal bypass.

POSCH is a prospective, randomized secondary intervention trial examining the effect of maximal lipoprotein modification achieved by partial ileal bypass on overall mortality and the course of coronary heart disease. In the initial 189 surgical patients, total cholesterol levels decreased from 256.7 +/- 2.6 mg/dl to 166.6 +/- 2 mg/dl, and low-density lipoprotein cholesterol levels decreased from 181.5 +/- 2.7 mg/dl to 94.1 +/- 1.7 mg/dl 3 months after operation. These significant decreases were sustained through 5 years of follow-up (p less than 0.001). The total cholesterol level was 29.2 +/- 0.9 percent lower and the low-density lipoprotein cholesterol level was 43.2 +/- 1 percent lower at 5 years compared with the baseline level. Decreases of similar magnitude were seen in each of the common WHO lipoprotein phenotypes. The baseline total cholesterol level was the only significant independent preoperative predictor of the 5 year total cholesterol level (correlation coefficient 0.547; p less than 0.001), and the baseline low-density lipoprotein cholesterol level was the only significant independent preoperative determinant of the 5 year low-density lipoprotein cholesterol level (correlation coefficient 0.599; p less than 0.001). These relationships are expressed by the following equations: 5 year total cholesterol = 0.54 X baseline total cholesterol + 42.3, and 5 year low-density lipoprotein cholesterol = 0.455 X baseline low-density lipoprotein cholesterol + 19.2. The decrease in total and low-density lipoprotein cholesterol levels after partial ileal bypass are greater than reported by any trial of drug or diet intervention, including the Lipid Research Clinics Coronary Primary Prevention Trial which examined cholestyramine. Estimation of the change in total and low-density lipoprotein cholesterol levels after partial ileal bypass can be made based on preoperative lipid analysis and is essential in comparing different therapeutic modalities and assessing the role of partial ileal bypass among strategies aimed at lowering coronary heart disease risk.

Wound infection after infrainguinal bypass operations: multivariate analysis of putative risk factors.

Reported wound infection rates for infrainguinal bypass operations range from 17% to 44%, but there is limited appreciation of which characteristics of patients or operations are reliable markers of increased wound infection risk. The purpose of the present study was to analyze all wound infections observed after infrainguinal bypass operations during 20 years of practice in a large teaching institution. Independent risk factors for wound infection development were identified. During the 20-year period ending 31 December, 1997, 978 male patients underwent infrainguinal bypass operations at the Minneapolis Department of Veterans Affairs Medical Center. Wound infections complicated the recovery of 129 of these patients during a 30-day postoperative surveillance interval. Multivariate logistic regression analysis was used to test the association between wound infection occurrence and putative risk factors that were either features of patients or characteristics of the operations. The following variables were examined: obesity, prosthetic graft placement, diabetes mellitus, steroid use, anticoagulation use, length of preoperative hospital stay, development of incisional hematoma, duration of operation, and the preoperative presence of a non-healing wound in the extremity being revascularized. The overall wound infection rate was 13.2% (129/978). In a final logistic regression model, obesity was a significant and independent predictor of wound infection (Relative Risk 2.6, 95% confidence interval, 1.35-4.90), as was development of a post-operative incisional hematoma (Relative Risk 6.44, 95% confidence interval, 2.95-14.08). No other explanatory variable was significantly associated with wound infection development.

Lumbar root compression by a gas-containing cyst in the extradural space. Case report.

The case report describes a patient with acute sciatica of three months duration, resulting from lumbar root compression by a gas containing cyst in the extradura space. This condition is related to vacuum disc phenomenon, because the gas appears to have originated from within the adjacent disc space.

Comparison of preoperative standard angiography with preoperative balloon occlusion femoral angiography of the lower extremity.

The use of saphenous vein in situ bypass for limb salvage has increased the need for adequate visualization of distal lower extremity vessels. Preoperative angiographic techniques are often inadequate, requiring multiple films, extensive patient manipulation, or excessive dye loads. Intraoperative prereconstructive angiography permits adequate distal vessel visualization, but at a significant waste of time and expense if no usable distal vessels are found. There is a need for a reliable means of preoperative angiography in patients being evaluated for saphenous vein in situ bypass. Preoperative balloon occlusion femoral angiography was compared to preoperative standard angiography of the lower extremity in 39 patients referred to the University of Minnesota for limb salvage. Balloon occlusion femoral angiography significantly improved the preoperative ability to visualize lower extremity vessels distal to the superficial femoral artery in this group of patients.

Warm-Up Active Wound Therapy: a novel approach to the management of chronic venous stasis ulcers.

This preliminary study investigates the use of a radiant-heat bandage, Warm-Up Active Wound Therapy, as a new approach to the treatment of patients with chronic venous ulcers. Thirteen patients were randomly assigned to either conventional therapy or Warm-Up Active Wound Therapy for inpatient treatment of chronic venous stasis ulcers. Our results indicated that Warm-Up Active Wound Therapy is more effective than conventional therapy in healing chronic venous ulcers, and patients reported a significant reduction in wound pain. Warm-Up Active Wound Therapy also was found to be a safe treatment modality with no adverse events occurring in any patient.

Diagnosis and treatment of abdominal aortic aneurysms.

Abdominal aortic aneurysms occur in 5 to 7 percent of people over age 60 in the United States. An aneurysm is defined as a permanent localized dilatation of an artery, with an increase in diameter of greater than 1.5 times its normal diameter. Abdominal aortic aneurysms may be manifested by catastrophic rupture, signs of pressure on other viscera or an embolism originating in the aneurysmal wall, but most cases are asymptomatic. The diagnosis is often made by physical examination of the abdomen, which reveals a pulsatile mass left of the midline, between the xyphoid process and the umbilicus. The diagnosis may be confirmed by B-mode ultrasound. Ultrasound screening should be considered for individuals at risk for abdominal aortic aneurysms. This group includes individuals over age 60 who smoke, have hypertension or have vascular disease. Elective surgical intervention is indicated for most patients with abdominal aortic aneurysms greater than 5 cm in diameter to prevent rupture and death. Smaller abdominal aortic aneurysms should be monitored by regular ultrasound measurements. Screening and identification of abdominal aortic aneurysms by primary care physicians can have a significant impact on patient survival.

Elderly patients' preferences for long-term life support.

OBJECTIVE: To study elderly patients' preferences regarding mechanical ventilation and tube feeding and to compare their preferences for short-term use with their preferences for long-term use of these life support interventions. DESIGN: Interviews with patients by clinicians during routine office visits. SETTING: Hospital-based, primary care geriatrics clinic in downtown Denver, Colo. PATIENTS: Two hundred eighty-seven elderly persons (mean age, 77 years; range, 60-99 years). MAIN OUTCOME MEASURES: Preferences to use or withhold: (1) short-term mechanical ventilation; (2) long-term mechanical ventilation; (3) short-term tube feeding; and (4) long-term tube feeding. RESULTS: Of the total sample, 253 patients (88%) would prefer short-term mechanical ventilation if the chance of recovering was reasonably good but only 11 (3.5%) would prefer long-term mechanical ventilation. One hundred eighty-nine (65%) would prefer short-term tube feeding, but only 13 (4.5%) would prefer long-term tube feeding in the setting of significant cognitive impairment. CONCLUSIONS: Most elderly persons opt for short-term mechanical ventilation or tube feeding if the chance of recovering is reasonably good. Only a small minority would opt for long-term mechanical ventilation or tube feeding.

Chronic critical limb ischemia: diagnosis, treatment and prognosis.

Chronic critical limb ischemia is manifested by pain at rest, nonhealing wounds and gangrene. Ischemic rest pain is typically described as a burning pain in the arch or distal foot that occurs while the patient is recumbent but is relieved when the patient returns to a position in which the feet are dependent. Objective hemodynamic parameters that support the diagnosis of critical limb ischemia include an ankle-brachial index of 0.4 or less, an ankle systolic pressure of 50 mm Hg or less, or a toe systolic pressure of 30 mm Hg or less. Intervention may include conservative therapy, revascularization or amputation. Progressive gangrene, rapidly enlarging wounds or continuous ischemic rest pain can signify a threat to the limb and suggest the need for revascularization in patients without prohibitive operative risks. Bypass grafts are usually required because of the multilevel and distal nature of the arterial narrowing in critical limb ischemia. Patients with diabetes are more likely than other patients to have distal disease that is less amenable to bypass grafting. Compared with amputation, revascularization is more cost-effective and is associated with better perioperative morbidity and mortality. Limb preservation should be the goal in most patients with critical limb ischemia.