Hyperglycemic Episodes Are Associated With Postoperative Infections After Cardiac Surgery.

BACKGROUND AND AIMS: To describe the incidence of and risk factors for postoperative infections and the correlation between postoperative hyperglycemia despite tight blood glucose control with infectious and other complications after contemporary cardiac surgery. MATERIAL AND METHODS: The study comprised 1356 consecutive adult patients who underwent cardiac surgery between January 2013 and December 2014 and were followed up for 6 months. Patients surviving the first 2 days were included in the analysis. Preoperative demographic information, medical history, procedural details, and the postoperative course were recorded. The target range for blood glucose levels was 4-7 mmol/L and repeated arterial blood samples were obtained during the intensive care unit stay. The associations of blood glucose levels during the first postoperative day and the occurrence of postoperative infections and other significant complications were analyzed. RESULTS: Of the study cohort, 9.8% developed infectious complications which were classified as major surgical site infections in 2.2%, minor surgical site infections in 1.1%, lung infections in 2.0%, unclear fever or bacteremia in 0.3%, cannula or catheter related in 2.6%, multiple in 1.5%, and other in 0.2%. The incidence of deep sternal wound infection was 2.0%. Repeated hyperglycemia occurred in 39.7% of patients and was associated with increased rates of postoperative infections, 12.1% versus 8.2%, p = 0.019; stroke, 4.9% versus 1.5%, p < 0.001; and mortality, 6.1% versus 2.1%, p < 0.001, when compared to patients with single or no hyperglycemia. CONCLUSION: Every 10th patient develops infectious complications after cardiac surgery. Repeated hyperglycemia is associated with increased rates of infectious complications, stroke, and mortality.

Long-Term Prognosis and Causes of Death After Pleural Infections.

BACKGROUND AND AIMS: The development of pleural infection may imply a worse state of health and prognosis. The objective of this study was to ascertain the long-term survival and causes of death after pleural infections and to compare them to those of matched controls. MATERIAL AND METHODS: Altogether 191 patients treated for pleural infections at a single University Hospital between January 2000 and December 2008 and 1910 age- and gender-matched controls were included. Survival data and the causes of death for non-survivors were obtained from national databases and compared between the groups. RESULTS: The etiology of pleural infection was pulmonary infection in 70%, procedural complication in 9%, trauma in 5%, malignancy in 4%, other in 7%, and unknown in 5% of patients. The course of treatment was surgical in 82%, drainage only in 12%, and conservative in 5% of included patients. The median follow-up time was 11 years. Mortality rates were 8.4% versus 0.8% during the first 90 days, p < 0.001, and 46.6% versus 24.5% overall, p < 0.001, in patients and controls, respectively. Mortality was significantly higher in patients with pulmonary infection, procedural complication, or malignancy as the etiology of pleural infection. In multivariable analysis, advanced age, previous malignancies, institutional care, alcoholism, and malignant etiology for the infection were associated with inferior survival. Deaths caused by malignancies, respiratory diseases, and digestive diseases were significantly more common in patients than in controls. CONCLUSION: Long-term survival in patients with pleural infections is significantly inferior to that of age and gender-matched controls.

Lifestyle factors and varicose veins: does cross-sectional design result in underestimate of the risk?

OBJECTIVES: To assess whether smoking, alcohol drinking and dietary factors are linked with varicose veins. METHODS: A middle-aged general population of 4903 was studied, and prevalence rates at entry and five-year incidence of varicose veins were assessed. Lifestyle habits were recorded at entry and at the end of the follow-up. RESULTS: New varicose veins were significantly more common in individuals with regular alcohol intake, incidence odds ratio (OR) 1.5 (95% confidence interval [CI]: 1.05-2.3) in a multivariate analysis (of 2202 individuals). The association was particularly strong in women. Smokers had a higher incidence of varicose veins compared with non-smokers, OR 1.3 (95% CI: 0.9-1.8), but without statistical significance. Having daily meals of meat implied less new varicose veins than having 0-2 weekly meals of meat. CONCLUSION: Alcohol was likely to increase the risk of varicose veins in women and smoking in both genders. These findings were seen in the follow-up design, but not when the data of these risk factors were compared with varicose veins prevalent at entry.

The risk of congestive heart failure is increased in persons with varicose veins.

AIM: Varicose veins are a common condition but their etiology and relationship with other cardiovascular diseases are not well established. The aim of the study was to find out if persons with varicose veins have a higher risk of congestive heart failure (CHF) than persons without varicose veins. METHODS: The prevalence of CHF at entry and the incidence of CHF during a five-year follow-up period were studied in persons with and without varicose veins. A study was conducted with a questionnaire in a population of 4903 middle-aged residents in Tampere, Finland. RESULTS: Marginally higher prevalence of CHF was found in persons with varicose veins than in those without (2.9% vs. 1.9%) with OR 1.6 (1.0-2.3) and sex and age adjusted OR 1.2 (0.8-1.9). The incidence of CHF was higher in subjects with varicose veins than in others (4.9 vs. 2.6 per 1000 person-years) with IDR 1.9 (1.1-2.9) and sex and age adjusted IOR 2.5 (1.4-4.6). The result was further adjusted for body mass index, arterial disease and hypertension; multi-adjusted IOR for the incidence of CHF by varicose veins was 2.1 (1.1-4.0). CONCLUSIONS: Our longitudinal observation is consistent with the hypothesis that persons with varicose veins have a higher risk of CHF which is not mediated through sex, age, overweight, arterial disease or hypertension.

Arterial disease but not hypertension predisposes to varicose veins.

OBJECTIVES: The aim of the study was to find out if persons with cardiovascular diseases (CVD) (arterial disease or hypertension) have additional risk of varicose veins (VV) compared with those without arterial disease (AD) or hypertension. METHODS: We studied, using a validated questionnaire, the prevalence and incidence of VVs in those with and without CVD in a population of 4903 including 40-, 50- and 60-year-old men and women in Tampere, Finland. During the five years of follow-up, we had a special interest on the appearance of new VVs in those without VVs at entry (n = 3065). RESULTS: We found a higher prevalence of VVs in persons with CVD than in those without CVD (with sex and age adjusted odds ratio [OR] 1.3 [95% confidence interval, CI 1.1-1.5]). The prevalence of VVs was higher in persons with AD (OR 1.7 [CI 1.4-2.2]), but not in persons with hypertension (OR 1.1 [CI 0.9-1.2]) than in those who were free of AD or hypertension, respectively. Subjects with AD had higher incidence of VVs (incidence odds ratio, IOR 1.4 [CI 0.8-2.7]) than subjects without AD and the effect was statistically significant in women (IOR 2.2 [CI 1.1-4.5]). Also the incidence of VVs was more affected by AD than by hypertension (IOR 1.1 [CI 0.7-1.8]). CONCLUSION: There seems to exist a relatively strong additional risk of VVs in persons with AD and practically none in those with hypertension compared to those without.

Incidence of varicose veins in Finland.

BACKGROUND: Incidence of varicose veins in the population is unknown. The study aimed at estimating the incidence of varicose veins in complete cohorts of 40-60 year-olds in a general population. PATIENTS AND METHODS: The study was conducted in the city of Tampere, Finland. A validated questionnaire (with 93% sensitivity and 92% specificity) was used in a general population of 6874 individuals (aged 40, 50 or 60). Initially, 3065 of them had no varicose veins and 78% were followed-up for 5 years. RESULTS: 157 individuals reported new varicose veins during the follow-up. The overall incidence was 13.5 per 1000 person years (8.5 for men and 19.2 for women). Female sex was an independent and statistically significant risk indicator of varicose veins (adjusted odds ratio, OR 2.4). The incidence was significantly higher at the age of 50-55 years (OR 1.6). Higher body mass index seemed to be related to higher risk of new varicose veins (OR 1.2-1.8), but the association failed to reach statistical significance. The level of education did not affect the incidence. CONCLUSIONS: New varicose veins appear also in the middle-aged population, and the rate is linked with the female gender, especially at the beginning of the 6th decade.

Effects of a novel pneumatic vest on postoperative pain and lung function after coronary artery bypass grafting.

A prospective study to evaluate the efficacy of a novel inflatable vest in supporting the sternotomy wound during the early period after coronary artery bypass grafting was carried out in 35 patients. The outcome variables were subjective pain score during cough, and peak expiratory flow (PEF) and vital capacity (VC) on postoperative days 2 and 3. The values without pressure in the vest were used as controls in the individual patients. Use of the vest significantly reduced the cough-associated subjective sternotomy pain score on days 2 and 3, when significant reduction of PEF and VC was also observed. The alleviation of pain by the inflatable vest may improve the efficacy of coughing and bronchial clearance in the immediate postoperative period.

Adenosine-enhanced ischemic preconditioning decreases infarct in the regional ischemic sheep heart.

BACKGROUND: Recently we have reported a myoprotective protocol, adenosine-enhanced ischemic preconditioning, that extends the protection afforded by ischemic preconditioning in the isolated crystalloid-perfused heart. In this report the efficacy of adenosine-enhanced ischemic preconditioning in the in situ blood-perfused heart was investigated. METHODS: Sheep were subjected to 60 minutes of regional ischemia and 120 minutes of reperfusion. Ischemic preconditioned hearts received 5 minutes of zero flow regional ischemia and 5 minutes of reperfusion before regional ischemia. Adenosine-enhanced ischemic preconditioned hearts received a bolus injection of 10 mmol adenosine at the immediate start of ischemic preconditioning. Adenosine-treated hearts received an adenosine bolus, 10 minutes before regional ischemia. The ratio of infarct size to area at risk and mechanical function were determined. RESULTS: The infarct size to area at risk ratio in regional ischemia was 55.4%+/-2.1%. This ratio was significantly decreased with ischemic preconditioning and adenosine (22.2%+/-2.2% and 19.3%+/-1.4%, respectively; p < 0.001 versus regional ischemia) and adenosine-enhanced ischemic preconditioning (8.0%+/-2.0%, p < 0.001 versus regional ischemia and ischemic preconditioning, and p < 0.01 versus adenosine). CONCLUSIONS: Adenosine-enhanced ischemic preconditioning significantly decreases infarct size in the in situ blood-perfused heart and provides superior protection compared with ischemic preconditioning.