Impact of preoperative cardiology consultation prior to intermediate-risk surgical procedures.

BACKGROUND: Patients undergoing noncardiac, nonvascular surgery (NCNVS) are at risk of perioperative cardiovascular events. However, benefits of cardiology consultation (CC) in patients with known or suspected cardiac disease undergoing intermediate-risk NCNVS is unknown. METHODS: The study group included 700 consecutive patients referred for CC before intermediate-risk NCNVS in a tertiary-care teaching hospital. The control group included 1200 age-matched and sex-matched consecutive patients proceeded to the intermediate-risk surgery without preoperative CC during the same period. Patients older than 18 years who underwent an elective, NCNVS were enrolled. Requests for consultation were made either by surgeon or an attending anaesthesiologist. All patients underwent a complete preoperative clinical evaluation. RESULTS: Of the 700 patients who were referred for CC in the study group, 530 patients (75.7%) had no additional recommendations, and 170 patients (24.3%) underwent additional preoperative tests or had a change in preoperative therapy. Only 20 (2.8%) patients' NCNVS were delayed based on the cardiologists' recommendation and 680 patients eventually had their surgeries. Major cardiovascular and noncardiovascular complication rates were similar in the study and in the control groups (12.9% vs 13.6%, P = 0.273 and 25.2% vs 26%, P = 0.432 respectively). CONCLUSIONS: Preoperative CC in patients who underwent intermediate-risk NCNVS does not affect either perioperative management or outcome of surgery.

Impact of perioperative acute ischemic stroke on the outcomes of noncardiac and nonvascular surgery: a single centre prospective study.

BACKGROUND: Although ischemic stroke is a well-known complication of cardiovascular surgery it has not been extensively studied in patients undergoing noncardiac surgery. The aim of this study was to assess the predictors and outcomes of perioperative acute ischemic stroke (PAIS) in patients undergoing noncardiothoracic, nonvascular surgery (NCS). METHODS: We prospectively evaluated patients undergoing NCS and enrolled patients older than 18 years who underwent an elective, non-daytime, open surgical procedure. Electrocardiography and cardiac biomarkers were obtained 1 day before surgery, and on postoperative days 1, 3 and 7. RESULTS: Of the 1340 patients undergoing NCS, 31 (2.3%) experienced PAIS. Only age (odds ratio [OR] 2.5, 95% confidence interval [CI] 1.01-3.2, p < 0.001) and preoperative history of stroke (OR 3.6, 95% CI 1.2-4.8, p < 0.001) were independent predictors of PAIS according to multivariate analysis. Patients with PAIS had more cardiovascular (51.6% v. 10.6%, p < 0.001) and noncardiovascular complications (67.7% v. 28.3%, p < 0.001). In-hospital mortality was 19.3% for the PAIS group and 1% for those without PAIS (p < 0.001). CONCLUSION: Age and preoperative history of stroke were strong risk factors for PAIS in patients undergoing NCS. Patients with PAIS carry an elevated risk of perioperative morbidity and mortality.

CONTEXTE: Même si l'AVC ischémique est une complication bien connue de la chirurgie cardiovasculaire, elle n'a pas fait l'objet d'études approfondies chez les patients soumis à une chirurgie non cardiaque. Le but de cette étude était d'évaluer les prédicteurs et les conséquences de l'AVC ischémique aigu périopératoire (IAPO) chez des patients soumis à une chirurgie non cardiothoracique et non vasculaire (NCNV). MÉTHODES: Nous avons évalué de manière prospective les patients soumis à une chirurgie NCNV et inscrit les patients de plus de 18 ans qui subissaient une intervention chirurgicale ouverte non urgente nécessitant une hospitalisation. L'électrocardiogramme et les biomarqueurs cardiaques étaient obtenus 1 jour avant la chirurgie et aux jours 1, 3 et 7 suivant la chirurgie. RÉSULTATS: Parmi les 1340 patients soumis à une chirurgie NCNV, 31 (2,3 %) ont présenté un AVC IAPO. Seuls l'âge (rapport des cotes [RC] 2,5, intervalle de confiance [IC] de 95 % 1,01­3,2, p < 0,001) et des antécédents préopératoires d'AVC (RC 3,6, IC de 95 % 1,2­4,8, p < 0,001) ont été des prédicteurs indépendants de l'AVC IAPO selon l'analyse multivariée. Les patients victimes d'un AVC IAPO avaient davantage de complications cardiovasculaires (51,6 % c. 10,6 %, p < 0,001) et non cardiovasculaires (67,7 % c. 28,3 %, p < 0,001). La mortalité perhospitalière a été de 19,3 % dans le groupe victime d'AVC IAPO et de 1 % chez les patients indemnes d'AVC IAPO (p < 0,001). CONCLUSION: L'âge et les antécédents préopératoires d'AVC sont des facteurs de risque importants à l'égard de l'AVC IAPO chez les patients soumis à une chirurgie NCNV. Les patients victimes d'un AVC IAPO sont exposés à un risque élevé de morbidité et de mortalité périopératoires.

Increased prevalence of metabolic syndrome in patients with psoriatic arthritis.

OBJECTIVE: The increased incidence of cardiovascular disease (CVD) in patients with psoriatic arthritis (PsA) has been reported previously. We aimed to evaluate the presence of metabolic syndrome and to assess the insulin resistance associated with chronic inflammation in patients with PsA. METHODS: Fifty-nine (34 females, 25 males) consecutive PsA patients were enrolled in this study. The control group consisted of 82 (46 females, 36 males) healthy volunteers. All subjects were questioned about criteria of National Cholesterol Education Program Adult Panel III (NCEP ATP III) and also the modified World Health Organization (WHO) definition. Disease activity, damage, and functional activity were assessed by using functional indices [Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Psoriasis Area and Severity Index (PASI), Disease Activity Score in 28 joints (DAS28), The Multi-Dimensional Health Assessment Questionnaire-function (MDHAQ-function), The Multi-Dimensional Health Assessment Questionnaire-Routine Assessment of Patient Index Data scores (MDHAQ-RAPID-3)]. Fasting blood samples were collected for complete biochemical analysis. RESULTS: According to the NCEP criteria, 21 (35.5%) of PsA patients and 12 (14.6%) of healthy controls were classified as having metabolic syndrome (P=0.004). According to the NCEP criteria, hypertension and hyperglycemia were more common in the PsA group than the healthy controls (P=0.000 and P=0.043, respectively). According to the WHO criteria, 14 (23.7%) of the patients and 14 (17%) of the healthy controls had metabolic syndrome (P=0.328). No correlation was observed between functional indices and cardiovascular risks factors that were among the metabolic syndrome components. CONCLUSIONS: This study demonstrated an increase in the frequency of metabolic syndrome, which is a major risk factor for atherosclerosis in patients with PsA. Patients with PsA should be closely followed in terms of cardiovascular events, and aggressive treatment should be performed for both cardiovascular risk factors and the disease itself.

Factor V Leiden mutation-related chronic skin ulcers.

Chronic skin ulcers require extensive, systemic differential diagnosis; thus, they are difficult to diagnose and treat. Transient or persistent hypercoagulable states are among the rare causes of skin ulcers. Here, we present the case of a 27-year-old woman patient with recurrent, nonhealing skin ulcers of 8 years' duration, who had been treated unsuccessfully with various medications under different diagnoses at different clinics. On admission, a skin biopsy demonstrated occlusive vasculopathy, and the search for an inherited hypercoagulable state revealed a heterozygous factor V Leiden mutation. The patient was treated with anticoagulants and hyperbaric oxygen. On treatment, the skin lesions healed and did not recur.

Thyroid autoimmunity and Behçet's disease: is there a significant association?

BACKGROUND: Behcet's disease (BD) could be regarded as an autoimmune disease in many aspects. Autoimmune thyroid disease (ATD) is frequently accompanied by other various autoimmune diseases. Nevertheless, there is not still enough data showing the association between BD and ATD. In addition, no controlled study is present in the PubMed, which evaluates thyroidal autoimmunity using antithyroid peroxidase antibody in a large series of patients with BD. METHODS: We aimed to investigate the frequency of ATD in patients with BD. The study included 124 patients with BD and 99 age- and sex-matched healthy volunteers. RESULTS: Autoimmune thyroiditis was noted in 21 cases (16.9%) with BD. In the control group, 22 cases (22.22%) were diagnosed as autoimmune thyroiditis. There was no difference between the groups in respect to thyroid autoantibodies (P>0.05). There were no statistically significant differences between baseline TSH levels of the BD patients and of the controls (P>0.05). Statistically, the mean serum free T4 levels of the patients with BD were higher than those of the controls (P<0.001). CONCLUSIONS: No association could be found between BD and ATD. Therefore, it is not of significance to investigate thyroid autoimmunity in BD.

Does smoking affect thyroid gland enlargement and nodule formation in iodine-sufficient regions?

OBJECTIVES: The present study aimed to investigate the effect of smoking on thyroid nodule formation and goiter development in healthy subjects living in Istanbul, an iodine-sufficient region. This study was designed as a prospective, randomized, and observational study. METHODS: Included in the study were voluntary hospital staff and relatives of patients between the ages of 28 and 71 who had no known disease or drug use, who have been living in Istanbul and had been smoking more than 10 cigarettes per day for at least 10years. Nonsmoker volunteers (45) shared similar demographic characteristics and were matched for age to the (46) smokers. By means of thyroid ultrasounds performed in all participants, volumes of the right and left lobes of the thyroid gland, and number, diameter and characteristics of nodules were evaluated. RESULTS: Comparing the smokers and nonsmokers, no statistically significant difference was determined in terms of presence of nodules and volumes of the left and right thyroid lobes (P=0.68, P=0.09, and P=0.63, respectively). Making enhanced diffuse enlargement of the thyroid gland, but not to a statistically significant degree. Smoking was observed to have no effect on non-toxic nodules, or the levels of thyroid-stimulating hormone, free thyroxin, free triiodothyronine, anti-thyroid peroxidase, or anti-thyroglobulin antibodies. CONCLUSIONS: Smoking does not effect, to a statistically significant degree goiter development thyroid nodule formation in iodine-sufficient regions like Istanbul.