Blood glucose concentration for predicting poor outcomes in patients with and without impaired glucose metabolism undergoing off-pump coronary artery bypass surgery - long-term observational study.

INTRODUCTION: Strict glucose control is an everyday practice in the perioperative period. Elevated glucose level has a deleterious impact on clinical results, but a therapeutic target has not been stated yet. AIM: To determine a glucose concentration range affecting long-term outcomes after coronary artery bypass surgery (CABG). MATERIAL AND METHODS: This study is a retrospective evaluation of consecutive patients treated in a university hospital in Poland from 2004 to 2008. Patients were divided into 2 groups: an impaired glucose metabolism group (IGM) if they had 1) known DM or 2) perioperative hyperglycaemia defined as ≥ 200 mg/dl; and a non-IGM group. The end point (EP) was all-cause mortality. RESULTS: One thousand two hundred and eleven patients were covered by the analysis. The observation time was from 01.01.2004 until 01.08.2012. Patients who had maximal glucose concentrations < 242 mg/dl had the lowest mortality risk (EP in 21.1%); a higher risk was noted in the group with glucose concentrations 242-324 mg/dl (EP in 30.8%); and a very high risk was found for the group where glucose concentration was > 324 mg/dl (EP in 44.2%) (p = 0.041). Patients with IGM had a shorter survival at the end of the study (p < 0.001). The longest survival was observed in patients whose maximal glucose level was ≤ 242 mg/dl (p < 0.001) and the minimal glucose concentration was in the range 61-110 mg/dl (p < 0.001). CONCLUSIONS: Tight glucose concentration control should be performed irrespective of a diabetes diagnosis and proper treatment introduced when necessary. Maximal glucose concentration should be kept < 242 mg/dl, while the minimum should be in the range 60-110 mg/dl.

Co-existence of chronic non-communicable diseases and common neoplasms among 2,462 endocrine adult inpatients - a retrospective analysis.

OBJECTIVE: To analyze the coexistence of chronic non-communicable diseases (NCDs) and common neoplasms among endocrine adult inpatients. MATERIALS AND METHOD: The retrospective analysis was performed using clinical data of 2,462 adult patients (2,003 women and 459 men), hospitalized in the reference endocrine department. Diagnoses of 18 types of benign tumours and 16 types of malignant tumours, together with the most common 25 NCDs and demographic parameters, were all collected from the medical records. The most frequently found 6 types of benign tumours (of thyroid, pituitary, uterus, breast, adrenal and prostate) and 4 types of malignant tumours (of thyroid, breast, prostate and uterus) were taken for further statistical analyses. RESULTS: Age predicted the existence of accumulated as well as individual types of benign and malignant tumours, whereas BMI predicted the occurrence of accumulated and some individual types of benign tumours. Accumulated as well as individual types of benign and malignant tumours coexisted more frequently with several NCDs, such as diabetes, hypertension, metabolic syndrome, osteoporosis, Graves' disease, coronary artery disease, state after cholecystectomy, thus being disorders usually resulting from excessive exposure to harmful environmental factors. The most distinct coexistence was found between breast cancer and metabolic syndrome, between breast cancer and Graves' disease, between cancer of the uterus and type 2 diabetes, between cancer of the uterus and metabolic syndrome, and between cancer of the uterus and dyslipidemia. CONCLUSION: The results obtained indicate a significant relationship between the most common NCDs and several cancers in endocrine adult patients, which suggests that the prevention of the former may reduce the frequency of the latter.

Trends in pharmacological therapy of patients referred for coronary artery bypass grafting between 2004 and 2008: a single-centre study.

BACKGROUND: Previous reports of pharmacological treatment concerning the surgical approach to coronary artery disease emphasise the underused possibilities of pharmacological treatment. AIM: To evaluate trends in the level of compliance between the pharmacological treatment administered in clinical practice and formal guidelines in patients undergoing coronary artery bypass grafting (CABG). METHODS: For this retrospective study, medical data from 2827 consecutive patients treated in a single cardiac surgery centre from 2004 to 2008 were collected. Among them, 1253 underwent surgical procedures as isolated CABG and were enrolled in the study. The pharmacological treatment was analysed at two points of the perioperative period: the day of admission to hospital and the day of discharge from hospital. We collected information about the following groups of drugs prescribed: aspirin, b-blockers, angiotensin converting enzyme inhibitors (ACEI), statins, and sartans. RESULTS: Before surgery, 89.78% of the total population of patients received b-blockers, 81.56% ACEI, 88.27% statins, and 3.19% sartans. After CABG, 94.48% of patients received aspirin, 96.04% b-blockers, 85.16% ACEI, 92.09% statins, and 2.14% sartans. During the years analysed, a declining trend away from preoperative prescription of b-blockers (p < 0.001), ACEI (p < 0.001), and statins (p < 0.001) was observed. In contrast, sartans (p < 0.01) were more often administered over time. At the date of discharge, the tendency to prescribe b-blockers (p < 0.05), ACEI (p < 0.001), and statins (p < 0.001) was also declining. CONCLUSIONS: Pharmacological treatment of ischaemic heart disease in the pre- and postoperative period was underutilised. Positive changes were observed in comparison to previous reports from other countries.

Change in the clinical profile of patients referred for coronary artery bypass grafting from 2004 to 2008. Trends in a single-centre study.

BACKGROUND AND AIMS: The aim of this study is to describe the changes that occurred between 2004 and 2008 in the profile of patients referred for off-pump surgical treatment of coronary artery disease, by determining changes in their clinical characteristics, surgical procedures, and their results. METHODS AND RESULTS: This study is a retrospective evaluation of 2827 consecutive patients treated in the units of the 1st Chair of Cardiology of the Medical University of Warsaw from 2004 to 2008. We identified and retrieved 133 preoperative, intraoperative, and postoperative parameters. The statistical analysis was performed on measurable data in the analysed subgroups, but the relationship between immeasurable data was also examined. Significant declines in duration of hospitalisation, systolic and diastolic blood pressure on admission, left ventricular ejection fraction, stable coronary disease on admission, relationship between venous and arterial conduits used as graft, and in-hospital infections were observed. Meanwhile, the prevalence of arterial hypertension, of chronic pulmonary diseases, smoke, neurological dysfunction, heart rate on admission, diagnosis of two- and three-vessel disease and acute coronary syndrome/unstable angina, additive and logistic EuroScore, and average number of postoperative days in intensive care unit increased. More operations were performed as urgent/emergency cases, with higher numbers of grafts - which were more often arterial - per patient. An increase of length of the operation, blood loss and need for transfusion were observed as well as increased need for reoperation for bleeding. CONCLUSIONS: Patients referred for coronary artery surgery are becoming higher-risk patients with a greater number of comorbidities, and surgical techniques are becoming progressively more sophisticated.

TSH receptor antibodies have predictive value for breast cancer - retrospective analysis.

BACKGROUND: Associations between breast cancer and thyroid disorders are reported in numerous studies. Relationships between thyroperoxidase antibodies (TPOAb), thyroglobulin antibodies (TgAb) and breast cancer have been previously demonstrated. However, no analysis has been performed concerning an association between thyrotropin (TSH) receptor antibodies (TSHRAb) and breast cancer. The aim of the study was to evaluate the prevalence of breast cancer or benign breast tumors in patients with Graves' disease and to analyze a possible relationship between Graves' disease and these two groups of breast diseases with emphasis to epidemiology and laboratory findings. PATIENTS AND METHODS: Clinical and laboratory details of 2003 women hospitalized for endocrine disorders were retrospectively analyzed, using an unpaired Student's t-test, logistic regression analysis, χ2 test of independence or the two-sided ratio comparison test. RESULTS: The coexistence of Graves' disease and breast cancer was statistically significant. We observed TSHRAb and TgAb more frequently in patients with breast cancer. We found that TSHRAb is the only variable possessing predictive value for breast cancer. CONCLUSIONS: The strong relationship between Graves' disease and breast cancer is proposed. We suggest that TSHRAb could be described as a positive determinant of breast cancer. The present data call attention to the usefulness of screening for breast cancer in long-term follow-up of patients with autoimmune thyroid disorders, especially of those with Graves' disease. Similarly, screening for autoimmune thyroid disorders should be performed in patients with nodular breast disease. Additionally, the article draws ideas for further research in order to develop targeted treatment for more successful outcome in patients with breast cancer.