胆石症对心血管疾病发病的影响

目的 探讨胆石症对心血管疾病（cardiovascular disease，CVD）发病的影响。方法 采用前瞻性队列研究方法分析2006、2008年度首次参加开滦总医院健康体检的共计126 847名职工，收集其体检资料。最终纳入118 516例观察对象，分为胆石症组（n=2 901）和非胆石症组（n=115 615），随访并收集两组人群CVD发病情况。用寿命表法计算各组CVD的累积发病率，并用Log-rank检验比较两组中CVD累积发病率的差异，采用Cox比例风险模型分析胆石症对CVD发病风险的影响。按性别进行分层，分析不同性别CVD的风险比和95%可信区间。结果 与非胆石症组相比，胆石症组年龄、男性比例、体质指数（BMI）、甘油三酯（TG）、体育锻炼率、吸烟率、饮酒率、高血压率，组间差异具有统计学意义（P＜0.05）。在平均10.03年的随访期间内，共发生CVD 7 205例，其中心肌梗死1 674例，脑卒中5 695例，脑卒中合并心肌梗死164例；其中缺血性脑卒中4 772例，出血性脑卒中1 101例，出血性脑卒中合并发生缺血性脑卒中的178例。胆石症组CVD、心肌梗死、脑卒中、缺血性脑卒中、出血性脑卒中累积发病率分别为7.98%、1.96%、6.24%、5.01%、1.46%；非胆石症组CVD、心肌梗死、脑卒中、缺血性脑卒中、出血性脑卒中累积发病率分别为5.48%、1.32%、4.28%、3.54%、0.8%，经Log-rank检验，两组间差异均有统计学意义（P＜0.05）。Cox比例风险模型结果显示，校正了混杂因素后，胆石症组发生CVD的HR值（95%CI）为1.31（1.15～1.49），发生心肌梗死的HR值（95%CI）为1.25（0.95～1.64），发生脑卒中的HR值（95%CI）为1.32（1.14～1.52），发生缺血性脑卒中的HR值（95%CI）为1.28（1.09～1.51），发生出血性脑卒中的HR值（95%CI）为1.43（1.05～1.96）。男性胆石症患者CVD、脑卒中、缺血性脑卒中的发病风险要低于女性胆石症患者。结论 胆石症是心血管疾病发病的独立危险因素。     

2型糖尿病合并非糖尿病肾病的临床及病理分析

目的：回顾性分析2型糖尿病合并非糖尿病肾病的临床表现及病理特征。方法：回顾性分析2004年1月～2009年12月临床疑为合并非糖尿病肾病的110例2型糖尿病患者的肾活检资料。根据肾活检结果分为单纯糖尿病肾病（DN）组和糖尿病肾病合并非糖尿病肾病（NDRD）组,并对临床和病理资料进行分析。结果：110例2型糖尿病肾病患者中,50例（45.5%）合并非糖尿病肾病。糖尿病肾病合并非糖尿病肾病组蛋白尿、血尿发生率高于单纯糖尿病肾病组,但糖尿病视网膜病变发生率低于单纯糖尿病肾病组。两组年龄、糖尿病病程、高血压、血肌酐和肾小球滤过率差异无统计学意义。所有合并的非糖尿病肾病中,IgA肾病的比率最高为34%,其他依次为膜性肾病22.0%,系膜增殖性肾小球肾炎14%,HBV相关性肾小球肾炎8.0%,微小病变型肾小球肾炎10%,高血压肾小球硬化4.0%,FSGS4.0%,新月体肾小球肾炎2.0%,狼疮性肾炎2.0%。结论：2型糖尿病肾病合并非糖尿病肾病发生率45.5%,IgA肾病最常见。血尿、蛋白尿同时缺乏糖尿病视网膜病变强烈提示合并非糖尿病肾病。对于临床表现不典型的患者,肾活检是一项排除糖尿病肾脏病变的重要手段。     

聚集蛋白聚糖基因串联重复多态性和肥胖交互作用与中国北方男性腰椎间盘突出症易感性的关系

目的 :探讨中国北方汉族男性人群聚集蛋白聚糖(Aggrecan)基因串联重复多态性(variable number of tandem repeat,VNTR)与肥胖的交互作用对腰椎间盘突出症(LDH)发病的影响。方法 :收集2004年1月～2015年12月在中国医科大学附属第一医院骨科住院且符合纳入及排除标准的299例男性志愿者的资料。病例组为101例临床诊断为LDH患者,对照组为198例无LDH症状的志愿者。对本研究知情同意,每人捐献一份血液样本。测量两组的身高、体重,计算体重指数(BMI);采用PCR技术检测Aggrecan VNTR分布情况;应用Hwang′s模型分析Aggrecan VNTR与肥胖的交互作用对LDH发病的影响。结果 :相较于既无VNTR重复次数≤25次等位基因危险因素也没有肥胖危险因素的个体,仅有VNTR重复次数≤25次等位基因危险因素而没有肥胖危险因素的个体的LDH发病率为1.027倍[P=0.938;95%CI:0.520～2.028];仅有肥胖危险因素而没有VNTR重复次数≤25次等位基因危险因素的个体LDH发病率为1.050倍[P=0.885;95%CI:0.543～2.030];既有VNTR重复次数≤25次等位基因危险因素也有肥胖危险因素的个体LDH发病率为4.521倍[P=0.000016;95%CI:2.277～8.978]。结论:中国北方男性LDH患者中,较短的Aggrecan VNTR串联重复序列片段(≤25)出现频率较高;Aggrecan基因VNTR与肥胖之间存在交互作用,影响LDH的发病。     

全腹腔镜胃转流术治疗肥胖症并2型糖尿病的围手术期护理

<正>肥胖是全球高发病之一,严重影响患者的生存时间及生活质量。我国目前肥胖症患者已超过9 000万,超重者达2.7亿人,文献报道,90%的肥胖患者与2型糖尿病密切相关[1-2],其并发症致残、致死率高,严重危害肥胖人群的健康与生命。2012年10月至2013年12月我们成功为5例肥胖合并2型糖尿病、3例2型糖尿病患者完成全腹腔镜胃转流术,效果良好。现将护理体会报道如下。1资料与方法     

胃转流手术治疗2型糖尿病的可行性

目的对病态肥胖症手术对2型糖尿病的影响及其作用机制做一综述, 同时探讨病态肥胖症手术是否也可用于治疗不伴有肥胖症的2型糖尿病病人. 背景资料全世界有超过1.5亿人罹患2型糖尿病,虽然对高血糖的严格控制使得2型糖尿病并发症的发生率大大减少,但目前的治疗方法还不能达到根治.某些用于治疗病态肥胖症的手术不仅导致显著而持久的体重下降,而且使2型糖尿病得以缓解. 方法复习文献,回顾分析肥胖症手术对继发的糖代谢和内分泌变化的影响. 结果胃转流和胆胰转流术后数天内,80%～100%严重肥胖的糖尿病病人血糖、血胰岛素和糖化血红蛋白达正常水平,胃肠道激素分泌形式发生显著变化.病例报道也证实因其它因素施行胆胰转流的非病态肥胖患者避免罹患2型糖尿病.结论胃转流和胆胰转流术似乎对控制2型糖尿病有原发的、独立的影响,而不是继发于对肥胖症的治疗.虽然还需要对不伴肥胖患者进行对照研究,但胃转流手术的确有可能改变当前对2型糖尿病病理生理的理解,甚至改变该病的治疗方法.     

腹腔镜袖状胃切除术治疗病态性肥胖症合并2型糖尿病的疗效及相关因素分析

目的:探讨腹腔镜袖状胃切除术(LSG)治疗病态性肥胖症合并2型糖尿病的临床疗效,并分析影响疗效的相关因素。方法:回顾分析2013年7月至2018年7月为45例病态性肥胖症合并2型糖尿病患者行LSG的临床资料及随访情况,分析手术对患者体重及血糖的控制情况,并应用单因素与多因素Logistic回归分析影响体重及血糖控制效果的相关因素。结果:45例手术均顺利完成,术后随访1年,患者体重、空腹血糖呈下降趋势,34例减肥效果佳或良好(额外体重减轻百分率≥50%),28例2型糖尿病治疗明显有效,有效率为62.2%。单因素Logistic回归分析显示,BMI、遵循术后指导及术后胃饥饿素水平影响LSG治疗病态性肥胖症的疗效(P<0.05);额外体重减轻百分率、吸烟、空腹胰岛素、胰岛素抵抗指数、术后胆汁酸水平影响LSG对2型糖尿病的疗效(P<0.05)。多因素回归分析显示,BMI、是否遵循术后指导及术后胃饥饿素水平是LSG对病态性肥胖疗效的独立影响因素(P<0.05);额外体重减轻百分率、吸烟及胰岛素抵抗指数是LSG对2型糖尿病疗效的独立影响因素(P<0.05)。结论:LSG不仅治疗病态性肥胖症疗效确切,对于合并的2型糖尿病也有明显缓解作用,值得推广应用。     

减重与代谢手术治疗糖尿病的机制:小肠中心假说

<正>肥胖症、2型糖尿病(type 2 diabetes mellitus,T2DM)是世界范围内广泛流行的重要慢性疾病,发病率逐年递增,严重危害人类健康。2016年中国以高达9千万的肥胖症与1.29亿的糖尿病患者进入了肥胖症与糖尿病"双世界第一"的时代~([1])。目前,我国成人糖尿病患病率为10.96%~([2])。超重、肥胖及缺乏运动是糖尿病的主要风险因素,90%的     

维持性腹膜透析后新发糖尿病患者的临床特征与预后

本研究为单中心回顾性研究,选取新进入腹膜透析并规律随访的患者,随访(39.3±28.1)个月,68例腹膜透析患者新发糖尿病,发病率为3.6%,中位发病时间为8.5(2.8,22.0)个月,1年、3年、5年累积发病率分别是2.0%、3.6%和4.8%。患者生存时间为(81.6±4.4)个月,1年、3年、5年患者生存率分别为97.1%、92.0%和81.9%。多因素Cox分析提示,腹透液肌酐与血肌酐的比值(D/Pcr)≥0.64(HR=7.774)、腹透液留腹时间短(HR=0.843)是新发糖尿病患者死亡的独立危险因素(均P<0.05)。因此,关注基础腹膜转运功能及留腹时间对改善腹膜透析后新发糖尿病患者预后有积极意义。     

糖尿病肾病伴狼疮性肾炎1例

正糖尿病是一组以慢性血糖水平升高为特点的代谢性疾病,而糖尿病肾病是糖尿病最常见的严重并发症之一,也是导致终末期肾病的主要原因。近年来糖尿病肾病合并非糖尿病肾病的发病率呈上升趋势,但糖尿病合并狼疮性肾炎仍较为罕见,隋燕霞等[1]曾报道了177例糖尿病合并肾损害仅1例糖尿病肾病合并狼疮性肾炎,可见此病发病率不高,笔者遇上1例现报道如下:病例1病史患者因"反复胸闷气促2年余,下肢浮肿11月"     

糖尿病血液透析患者并发症及心脑血管事件的临床特征

探讨糖尿病维持性血液透析(MHD)患者并发症的特点.纳入北京清华长庚医院MHD患者为研究对象,按是否合并糖尿病分为糖尿病组和非糖尿病组,比较两组患者透析超滤量、血压、心脑血管事件及并发症的差异.结果 显示,糖尿病组平均超滤量、透析前收缩压、内瘘狭窄率、合并心脑血管疾病占比、急性心脑血管事件发病率均高于非糖尿病组.血钙、血二氧化碳结合力、平均死亡年龄低于非糖尿病组.提示MHD合并糖尿病患者容量控制差,透析前血压高,血二氧化碳结合力低,易发生内瘘狭窄和心脑血管事件,死亡年龄较低.     

肥胖对肝癌患者肝切除术预后的影响

目的 研究分析肥胖对肝癌患者肝切除术预后的影响。方法 前瞻性分析1996年2月至2002年12月之间我院470例行肝切除术的肝细胞癌患者临床资料。根据体质量指数（BMI）,将患者分为非肥胖组和肥胖组,肥胖组105例,其中男94例,女11例,平均年龄53岁,伴有肝硬化76例;非肥胖组365例,其中男311例,女54例,平均年龄50岁,伴有肝硬化263例。对比分析两组肝癌术后的结局。结果 与非肥胖组比较,肥胖组的年龄、术中输血、术中失血量均存在统计学差异（P＜0.05）。单因素分析显示,肥胖组的总生存率及无瘤生存率明显比非肥胖组要低（P＜0.05）。COX多因素分析,影响生存的因素包括肿瘤大小、包膜、术中失血量及MVI、BMI分级;影响肝癌复发的因素包括肿瘤大小、乙肝感染、肝硬化、包膜、术中失血量、术中输血及BMI分级。结论 肥胖是影响肝癌患者肝切除术预后的独立危险因素。     

Long-term incidence of gallstone disease after bariatric surgery: results from the nonrandomized controlled Swedish Obese Subjects study

BackgroundGallstone disease is a known short-term complication of bariatric surgery; little is known of the long-term incidence.ObjectivesThe aim of this study was to investigate the association between bariatric surgery and long-term incidence of gallstone disease.SettingsA total of 25 surgery departments and 480 primary healthcare centers in Sweden.MethodsThe Swedish Obese Subjects study is a prospective, controlled study comparing the effects of bariatric surgery with usual care with a follow-up of 20 years, including 4047 individuals. The current report includes all participants without previous or concomitant cholecystectomy (n = 3597). Operative techniques used in the surgery group (n = 1755) were gastric bypass (n = 236), vertical banded gastroplasty (n = 1202), and gastric banding (n = 317). The control group (n = 1842) received customary treatment for obesity. Gallstone disease was a predefined secondary endpoint in the Swedish Obese Subjects study and the primary endpoint of this report. Data were obtained by cross-checking our study database with the Swedish National Patient Register of diagnosis and procedures.ResultsIn the surgery and control groups, respectively, there were 307 and 252 first-time events of symptomatic gallstone disease and 230 and 170 cholecystectomies (log-rank P < .001, both outcomes). Bariatric surgery was associated with an increased risk of symptomatic gallstone disease, with a more pronounced risk during the first years of follow-up (P = .002) and an increased risk for cholecystectomy but with no time-varying effect (P = .213).ConclusionsBariatric surgery increases the risk for symptomatic gallstone disease and cholecystectomy, especially during the first years following treatment.     

Gallstones: genetics versus environment

OBJECTIVE: The aim of this study was to determine if a significant genetic component contributes to the pathogenesis of symptomatic gallstones. SUMMARY BACKGROUND DATA: Gallstones represent a polygenic disorder that affects more than 30,000,000 Americans and results in more than 750,000 cholecystectomies in the United States annually. Risk factors include age, gender, race, parity, obesity, and diabetes. A family history of gallstones also has been identified as a risk factor suggesting that genetics play a role in gallstone formation. However, the role of genetics in the pathogenesis of gallstone formation has not been determined. METHODS: A gallbladder disease-specific questionnaire was administered to 904 healthy unrelated adult volunteers (association study). The questionnaire ascertained a history of cholecystectomy and gallstone disease in first-degree relatives, as well as medical history, demographic, and anthropometric data. A logistic regression model was used to identify risk factors for symptomatic gallstone disease in a multivariate analysis. A maximum likelihood based variance decomposition approach was then used in 1,038 individuals from 358 families (family study) to estimate the additive genetic heritability of symptomatic gallstone disease. RESULTS: In the association study significant risk factors for symptomatic gallstone disease were female gender (relative risk 8.8, P <.003), obesity (BMI > 30, relative risk 3.7, P <.001), age > 50 (relative risk 2.5, P <.001), and a positive family history of previous cholecystectomy in a first-degree family member (relative risk 2.2, P <.01). In the family study the additive genetic heritability of symptomatic gallstones was 29% (P <.02), age and gender were significant covariates and explained 9.3% of the phenotypic variation in gallbladder disease. CONCLUSIONS: These data suggest that genetic factors are responsible for at least 30% of symptomatic gallstone disease. However, the true role of heredity in gallstone pathogenesis is probably higher because data based on symptomatic gallbladder disease underestimates the true prevalence in the population.     

Incidence of cardiovascular events in renal transplant recipients and clinical relevance of modifiable variables

INTRODUCTION: The aims of this study were to quantify the incidence of cardiovascular events and identify the clinical relevance of modifiable variables. MATERIALS AND METHODS: The 1729 patients who underwent renal transplantation from 1981 to 2004 were evaluated in an observational, prospective follow-up study with no exclusions. A cardiovascular event was defined as the presence of ischemic cardiac disease (chest pain-myocardial infarction), cardiac insufficiency, arrhythmia (auricular fibrillation), peripheral vascular disease, or cerebrovascular accident. A survival analysis was performed using the Kaplan-Meier method. A Cox regression analysis was applied. Having identified the predictive variables of cardiovascular events, the population attributable fraction (PAF) and the etiological fraction (EF) were estimated. A risk score was calculated using Cox regression coefficients. RESULTS: The accumulated incidence of cardiovascular events was 22.2%, with an incidence rate of 468.6 x 10,000 follow-up years. From the Cox regression model, the variables with an independent effect close to statistical significance to predict cardiovascular events were as follows: recipient age (RR = 1.05), smoking at the time of the transplantation (RR = 2.1), left ventricle hypertrophy during follow-up (RR = 2.4), prior diabetes mellitus, and obesity (body mass index >or=30). At the time of transplantation, 41.7% were smokers. During follow-up, a clear difference was observed in the incidence rates of cardiovascular events between smokers and nonsmokers. Similar phenomena were observed for left ventricle hypertrophy and obesity. The resulting scores ranged between 0 and 5. The area under the ROC curve of the score for the prediction of cardiovascular events was 0.74. CONCLUSION: The incidence of cardiovascular events was consistent with the literature. A series of modifiable variables of major clinical relevance exist to decrease the frequency of cardiovascular events following renal transplantation.     

Gallstone disease following antrectomy and gastroduodenostomy with or without vagotomy.

The incidence and prevalence of gallstones has been documented in 289 consecutive patients with peptic ulcer disease, at the time of antrectomy and gastroduodenostomy (with or without truncal or selective vagotomy) and again during a 5-year follow-up period. By comparing the preoperative prevalence of gallstone disease in one age group with the prevalence 5 years after the gastric operation in another group of patients who were 5 years younger at the operation, the incidence of gallstone production due to the gastric operation could be calculated independent of the age factor. Within 5 years of the gastric operation, 18% of the patients who were normal at the time of operation produced gallstones. The incidence of new gallstones during the 5-year postgastrectomy follow-up was the same in men and women, and was increased by 7 to 15% in each age group of men. The incidence of new gallstones was 30% after truncal and 12% after selective vagotomy (p less than 0.05). Gallstone formation seems to be a sequel of Billroth I gastric resection. Truncal vagotomy in addition to the gastrectomy increases the risk of gallstone disease; patients with selective vagotomy and antrectomy had an incidence of postoperative gallstones which was the same as patients with antrectomy alone.     

Correlation of body weight and its change with albuminuria in physical examination population

Objective To study the effect of baseline weight and its change on new-onset albuminuria or increased urine albumin/creatinine ratio (ACR) in the physical examination population. Methods The subjects of this study were those who completed two or more physical examinations at the Physical Examination Center of Sichuan Provincial People's Hospital from September 1, 2013 to September 1, 2018. The general information and laboratory examination results at the first and last physical examinations were collected. According to body mass index (BMI), they were divided into normal BMI group and overweight/obese group. The differences in general clinical data and laboratory test results between the two groups were compared. The primary endpoint events were new-onset albuminuria or urine ACR increase≥30%. Stepwise multiple linear regression method was used to analyze the influencing factors for ACR increase, and Cox proportional hazard model method was used to analyze the impact of baseline weight and its change on new-onset albuminuria or ACR increase≥30%. Results A total of 1 761 physical examination subjects were included in this study. The follow-up time was (16.54±7.87) months. There were 59 patients with new-onset albuminuria, 30 patients with ACR increase≥30%, and 35 patients with albuminuria reversal. Multiple linear regression analysis showed that BMI was an independent influencing factor for ACR ( β=0.127, P＜0.001). Cox regression analysis showed that the older age (HR=1.041, 95%CI 1.018-1.064, P＜0.001), hypertension (HR=2.035, 95%CI 1.278-3.242, P=0.003), diabetes (HR=2.081, 95%CI 1.310-3.305, P=0.002) and hyperuricemia (HR=1.700, 95%CI 1.084-2.668, P=0.021) were independent influencing factors for new-onset albuminuria or ACR increase≥30%, while BMI (HR=1.053, 95%CI 0.975-1.137, P=0.191) and weight change rate (HR=1.030, 95%CI 0.972-1.092, P=0.322) were not independent influencing factors for endpoint events. Subgroup analysis indicated that overweight/obesity had interactions with age, hypertension, diabetes, and hyperuricemia, respectively (P for interaction＜0.05), and the effects of overweight/obesity on the pre-set primary endpoint events in each subgroup were basically consistent. There were interactions between weight gain and hypertension and diabetes (P for interaction＜0.05). Weight gain increased the risk of the primary endpoint events of women (HR=3.355, 95%CI 1.164-9.670, P=0.025), and the effects of overweight/obesity on the pre-set primary endpoint events of each subcomponent were basically the same (all P﹥0.05). The incidence of albuminuria reversal in the group with obvious weight loss was slightly higher than that in the group with obvious weight gain, but the difference was not statistically significant (P﹥0.05), which might be related to the small weight loss range (-6.08%±3.51%). Conclusions Overweight or obesity may increase the risk of albuminuria, and people with diabetes, hypertension, and hyperuricemia may be more likely to occur. Mild weight loss is not enough to reverse albuminuria.     

Diabetes Mellitus and the Incidence of Deep Vein Thrombosis after Total Knee Arthroplasty: A Retrospective Study

We explored if there was an increased risk of DVT in patients with diabetes mellitus undergoing total knee arthroplasty within 14 days followup. We reviewed 245 patients undergoing total knee arthroplasty in our hospital between 2003 and 2011. The incidence of DVT within 14 days after operations was compared between diabetic patients and non-diabetic patients. There were 37 patients with DVT in the diabetes group and 88 in the non-diabetes group within 14 days followup (p = 0.002). The risk of DVT in patients with diabetes mellitus was 2.76 times the risk in patients without diabetes mellitus using logistic regression modeling (OR = 2.76, p = 0.003). Although it is still controversial, patients with diabetes had a higher incidence rate of DVT after total knee arthroplasty in our study.     

内脂素、抵抗素与男性2型糖尿病患者骨密度及骨代谢关系的研究

目的 研究内脂素、抵抗素与男性2型糖尿病患者骨密度及骨代谢指标关系。 方法 收集我院就诊的男性2型糖尿病患者225例,根据体重指数分为肥胖组107例及非肥胖组118例,对照组为120例非糖尿病正常男性。体格检查计算腰臀比（WHR）及体重指数（BMI）,酶联免疫法( ELISA)测定血清内脂素、抵抗素水平,双能X线骨密度仪测定腰椎（L2-L4）及左股骨颈骨密度。 结果 肥胖糖尿病组BMI及WHR高于其他组（P<0.05）;肥胖及非肥胖糖尿病组的内脂素、抵抗素水平高于对照组（P<0.05）,且肥胖组高于非肥胖组（P<0.05）。肥胖及非肥胖糖尿病组的BGP、CTX-1水平低于对照组。非肥胖糖尿病组腰椎及股骨颈骨密度明显低于正常组与肥胖组（P<0.05）,且肥胖组的腰椎骨密度高于对照组,但股骨颈骨密度两组间无明显差异（P>0.05）。直线相关分析显示BMI、WHR、内脂素、抵抗素均与BGP、CTX-1负相关,BMI及WHR与腰椎及股骨颈骨密度正相关,内脂素、抵抗素与腰椎骨密度呈正相关（P<0.05）,但与股骨颈骨密度无明显相关（P>0.05）。 结论 血清内脂素、抵抗素水平与男性2型糖尿病患者骨代谢水平及腰椎骨密度相关。     

Wound complications after median sternotomy. Relationship to internal mammary grafting

Case histories of 2582 patients requiring median sternotomy for coronary artery bypass grafting between January 1982 and August 1986 were retrospectively reviewed. Only saphenous vein grafts were used in 230 patients, one mammary artery graft was used in 1626 patients, and both mammary arteries were used in 726 patients. The relationship of potential risk factors and wound complication was evaluated. The overall incidence of wound complications was 0.81%-0.43% in the saphenous vein graft group, 0.49% in the single mammary group, and 1.65% in the bilateral mammary group. Graft type and a number of potential risk factors were analyzed in a logistic regression analysis to determine significant predictors of wound complications. The results indicated that pneumonia, obesity, reexploration, use of the intraaortic balloon pump, and diabetes were significant risk factors contributing to the probability of wound complications. Bilateral mammary grafting was significantly associated with the increased probability of a wound complication developing. Bilateral mammary grafting increased the chance of wound complication nearly five times that of saphenous vein grafting and three times that of single mammary grafting. Mammary artery grafts have been shown to achieve greater long-term patency than saphenous vein grafts, and their continued use is encouraged. However, the potential for increased wound problems should be considered along with other significant preoperative risk factors such as insulin-dependent diabetes, chronic pulmonary disease, and obesity.