Gender Differences in Aspirin use Among Adults With Coronary Heart Disease in the United States

Background Aspirin reduces mortality for men and women with coronary heart disease (CHD). Previous research suggests women with acute coronary syndromes receive less aggressive care, including less frequent early administration of aspirin. The presence of gender differences in aspirin use for secondary prevention is less clear. Objective To determine if a gender difference exists in the use of aspirin for secondary prevention among individuals with CHD. Design We analyzed data from the nationally representative 2000–2002 Medical Expenditure Panel Surveys to determine the prevalence of regular aspirin use among men and women with CHD. Participants Participants, 1,869, 40 years and older who reported CHD or prior myocardial infarction. Results Women were less likely than men to use aspirin regularly (62.4% vs 75.6%, p < .001) even after adjusting for demographic, socioeconomic and clinical characteristics (adjusted OR = 0.62, 95% CI, 0.48–0.79). This difference narrowed but remained significant when the analysis was limited to those without self-reported contraindications to aspirin (79.8% vs 86.4%, P = .002, adjusted OR = 0.68, 95% CI, 0.48–0.97). Women were more likely than men to report contraindications (20.5% vs 12.5%, P < .001). Differences in aspirin use were greater between women and men with private health insurance (61.8% vs 79.0%, P < .001, adjusted OR = 0.48, 95% CI, 0.35–0.67) than among those with public coverage (62.5% vs 70.7%, P = .04, adjusted OR = 0.74, 95% CI, 0.50–1.11) (P < .001 for gender–insurance interaction). Conclusion We found a gender difference in aspirin use among patients with CHD not fully explained by differences in patient characteristics or reported contraindications. These findings suggest a need for improved secondary prevention of cardiovascular events for women with CHD.     

Disability and patient’s appraisal of general health contribute to depressed mood in rheumatoid arthritis in a large clinical study in Japan

The aim of this study was to evaluate the factors responsible for depressed mood in rheumatoid arthritis (RA). Clinical and laboratory measures were collected from 4558 RA patients enrolled in a large clinical cohort study for RA conducted at the Institute of Rheumatology, Tokyo Women's Medical University (IORRA study). A two-question depressed screening included in the U.S. Preventive Services Task Force recommendation were utilized to identify “depressed patients.” A total of 1875 (41.1%) were identified as “depressed patients” who presented with symptoms suggestive of depression. Patient's Visual Analog Scale (VAS) for general health (43.3 mm vs 24.6 mm, P < 0.0001) and pain (40.9 mm vs 23.8 mm, P < 0.0001) and the disability index scores measured by the Health Association Questionnaire (HAQ) (0.986 vs 0.574, P < 0.0001) were significantly higher in depressed patients than in nondepressed patients. The presence of three or more comorbidities (odds ratio [OR] 2.157, P < 0.0001), infection (OR 1.754, P < 0.0001), and joint surgery (OR 1.878, P < 0.0001) were significantly correlated with depressed mood in RA. The results of the Generalized Linear Model analysis showed that HAQ disability index (P < 0.0001) and patient's VAS for general health (P < 0.0001) were also strongly and significantly associated to the response variable “probability of depressed patients.” Patient appraisal of poor general health and greater disability were associated with depressed mood in RA.     

Invasion and metastasis of hepatocellular carcinoma in relation to urokinase-type plasminogen activator, its receptor and inhibitor

This study was designed to investigate the relationship of urokinase-type plasminogen activator (uPA), uPA receptor (uPAR), and plasminogen activator inhibitor type-1 (PAI-1) to invasion and metastasis of hepatocellular carcinoma (HCC). The expression of uPA, uPAR, and PAI-1 in HCC was determined by immunohistochemistry, Northern blot, and an LCI-D20 nude mouse metastatic model of HCC. The over-expression of uPA, uPAR, and PAI-1 was found in HCC, especially in the patients with portal cancer embolus, tumor invasion, and metastasis. Immunohistochemistry results showed that the rate of positive staining of uPA, uPAR, and PAI-1 were higher in HCC than those in the control groups consisting of cancer-adjacent tissue and normal liver tissue. In the case of HCC invasion, positive uPA and uPAR were seen in 16 and 19 out of 22 patients, respectively (P < 0.01 and P < 0.001, respectively, as compared with the patients without invasion). In those with portal cancer embolus and tumor metastasis, positive uPAR was eight out of eight and six out of six patients. In those with tumor recurrence, positive uPAR was 15 out of 17 patients (P < 0.01 vs no recurrence). In patients who died within 2 years after surgery, positive uPAR was 12 out of 12 patients (P < 0.01 vs survival), and positive PAI-1 was nine out of 12 patients (P < 0.05 vs survival). In those in which uPA, uPAR, and PAI-1 were all positive staining, stronger cancer invasiveness and higher mortality were found (P < 0.05 vs patients with all negative staining). In 30 patients tested with Northern blot analysis, the results were similar to those tested with immunohistochemistry. Higher expression of uPA mRNA and PAI-1 mRNA were detected in tumor tissues and embolus. In the patients with positive signals of uPA mRNA and PAI-1 mRNA, invasive cases were found in seven out of 19 and eight out of 18 patients, respectively, which were significantly higher than those showing negative signals (P < 0.05). In the LCI-D20 nude mouse metastatic model of HCC (MMHCC), PAI-1 activity in plasma and tumor tissue increased with tumor growth, invasion, and metastasis. At an advanced stage of MMHCC, PAI-1 activity rose to 15.4 ± 0.7 Au/ml in plasma and 0.8 ± 0.3 Au/mg in tumor extracts, which was significantly higher than 6.2 ± 1.8 Au/ml in plasma and 0.4 ± 0.1 Au/mg in extracts at an early stage (P < 0.05). PAI-1 activity related to the changes of serum AFP and tumor progress were r=0.9544 and r=0.9648, respectively (P < 0.05). The data suggest that the expression of uPA, uPAR, and PAI-1 is increased in HCC, and related to the invasiveness, metastasis, and prognosis of HCC. Received: 30 September 1999 / Accepted: 10 March 2000     

Inpatients with coronary heart disease have a high prevalence of chronic kidney disease based on estimated glomerular filtration rate (eGFR) in China

The objective of this study was to calculate estimated glomerular filtration rate (eGFR) based on serum creatinine (SCr) and to estimate the prevalence of chronic kidney disease (CKD) in patients with coronary heart disease (CHD) in China. This was a cross-sectional study using data from China Heart Survey (CHS). Glomercular filtration rate was estimated with the Modified Diet in Renal Disease (MDRD) equation. The prevalence of CKD among the 3 513 CHS participants with coronary heart disease was 24.8% (n = 871). Compared with study participants without CKD, study participants with CKD were more likely to have hypertension (49.5% vs 42.8%; P = 0.001), diabetes (43.1% vs 29.5; P < 0.001) and elevated systolic blood pressure. The mean (SD) high-density lipoprotein cholesterol (HDL-C) of the participants with CKD was lower than those without CKD (P = 0.003). Prevalence of CKD among the participants of CHS between different admissions of CHD showed a significant difference (χ² = 32.012, P < 0.001). On average, participants with a lower estimated GFR were older, less likely to be current smokers, and more likely to have hypertension and low HDL-C. The results of our study suggested a high prevalence of CKD (24.8%) in Chinese adults with coronary heart disease. Our study provided further evidence that patients with CKD should be considered at high risk for CHD outcomes and identifies patients with CKD as potential candidates for aggressive risk factor reduction.     

Spondylitis is the most common pattern of psoriatic arthritis in Korea

We assessed the prevalence and clinical features of psoriatic arthritis (PsA) in Korean patients with psoriasis. The prevalence of PsA in patients with psoriasis was 9%. Patients with PsA were older and had a longer duration of skin disease than those with psoriasis alone (median age, 40 vs 35 years, P = 0.03, and 15.3 vs 11.7 years, P = 0.04, respectively). Spondylitis was the most common pattern of PsA (50%). Nail change, dactylitis, and enthesopathy were observed in 36%, 15.4%, and 15.6% of patients with PsA, respectively. Increased erythrocyte sedimentation rate (ESR), antinuclear antibody, and radiological sacroiliitis were more frequent in patients with PsA than in those with uncomplicated psoriasis (25.8% vs 10.3%, P = 0.04; 37.9% vs 16.7%, P = 0.02; and 37.8% vs 1.1%, P < 0.01, respectively). The onset ages of psoriasis and arthritis in the spondylitis group were significantly lower than those in the non-spondylitis group (median age, 21.5 vs 31 years, P = 0.03, and 28.5 vs 43.5 years, P = 0.01, respectively). HLA-B27 was prevalent in 8% of patients with PsA. Received: 11 May 1999 / Accepted: 20 October 1999     

Psychological factors and quality of life in arthritis: a population-based study

Previous studies using clinic or convenience samples have indicated that not only patients with arthritis are at increased risk of depression, but there may also be a link between depression and disability in people with arthritis. We examined the prevalence of psychological distress in a population sample with and without arthritis and the association with health-related quality of life. The WANTS Health and Well-being Survey was a population household telephone interview survey of adults (age ≥18 years) in three states of Australia. Data obtained were weighted to provide population-representative estimates. The survey included questions regarding arthritis, SF-12, the Kessler 10 index of psychological distress and presence of mental health conditions. A total of 7,473 interviews providing information on arthritis were completed, with 1,364 (18.3%) reporting arthritis. Self-reported mental health conditions were more frequent in those with arthritis (14.9 vs 12.0%, p = 0.004), and a higher proportion were at a medium or high risk for anxiety or depression (39.0 vs 31.0%, p < 0.001). People with arthritis had significantly lower scores on the SF-12 physical component summaries compared to those without arthritis. Among those with arthritis, those with coexisting psychological distress had significantly lower scores on the SF-12 physical component summary than those without psychological distress. Psychological distress is common among people with arthritis in the community. In arthritis, psychological distress makes a significant additional negative impact on the physical well-being. Physicians need to recognize and address this additional impact on physical functioning in patients with arthritis.     

Variations in the Associations Between Psychiatric Comorbidity and Hospital Mortality According to the Method of Identifying Psychiatric Diagnoses

Summary Objective Little is known about associations between psychiatric comorbidity and hospital mortality for acute medical conditions. This study examined if associations varied according to the method of identifying psychiatric comorbidity and agreement between the different methods. Patients/Participants The sample included 31,218 consecutive admissions to 168 Veterans Affairs facilities in 2004 with a principle diagnosis of congestive heart failure (CHF) or pneumonia. Psychiatric comorbidity was identified by: (1) secondary diagnosis codes from index admission, (2) prior outpatient diagnosis codes, (3) and prior mental health clinic visits. Generalized estimating equations (GEE) adjusted in-hospital mortality for demographics, comorbidity, and severity of illness, as measured by laboratory data. Measurements and Main Results Rates of psychiatric comorbidities were 9.0% using inpatient diagnosis codes, 27.4% using outpatient diagnosis codes, and 31.0% using mental health visits for CHF and 14.5%, 33.1%, and 34.1%, respectively, for pneumonia. Agreement was highest for outpatient codes and mental health visits (κ = 0.51 for pneumonia and 0.50 for CHF). In GEE analyses, the adjusted odds of death for patients with psychiatric comorbidity were lower when such comorbidity was identified by mental health visits for both pneumonia (odds ratio [OR] = 0.85; P = .009) and CHF (OR = 0.70; P < .001) and by inpatient diagnosis for pneumonia (OR = 0.63; P ≤ .001) but not for CHF (OR = 0.75; P = .128). The odds of death were similar (P > .2) for psychiatric comorbidity as identified by outpatient codes for pneumonia (OR = 1.04) and CHF (OR = 0.93). Conclusions The method used to identify psychiatric comorbidities in acute medical populations has a strong influence on the rates of identification and the associations between psychiatric illnesses with hospital mortality.     

A Sprayable Hydrogel Adhesion Barrier Facilitates Closure of Defunctioning Loop Ileostomy: A Randomized Trial

Purpose  Closure of defunctioning loop ileostomy often is associated with division of complex peristomal adhesions through a parastomal incision with limited exposure. The goal was to determine whether sprayable hydrogel adhesion barrier (SprayGel™) will reduce peristomal adhesions and facilitate closure of ileostomy. Methods  Patients undergoing closure of loop ileostomy were randomized to have hydrogel adhesion barrier sprayed around both limbs of ileostomy for 20 cm (SprayGel™ group, n = 19), or to control without adhesion barrier (control group, n = 21). Ileostomy was reversed at ten weeks after construction. Extent of peristomal adhesions was scored in blinded manner (each quadrant, range, 1–3: 3 = most severe; total, range, 4–12: 12 = most severe). Results  Use of adhesion barrier was associated with significant reduction in overall adhesion scores (mean, 6.11 vs. 9.67; P < 0.0005), four-quadrant adhesion scores (Quadrant A: 1.68 vs. 2.52, P = 0.002; Quadrant B: 1.42 vs. 2.33, P < 0.0005; Quadrant C: 1.42 vs. 2.24, P < 0.0005; Quadrant D: 1.58 vs. 2.48, P = 0.002), and proportion of patients with dense (scores ≥ 8) adhesions (0.11 vs. 0.71; P < 0.0005). Time taken to mobilize (16.53 vs. 21.67 minutes; P = 0.008) and close ileostomy (35.37 vs. 41.90 minutes; P = 0.008) was significantly reduced. Postoperative complications were comparable. Conclusions  A sprayable hydrogel adhesion barrier placed around the limbs of a defunctioning loop ileostomy reduced peristomal adhesions and might facilitate closure of ileostomy. Poster presentation at the meeting of The American Society of Colon and Rectal Surgeons, Dallas, Texas, May 8 to 13, 2004. †Deceased. Supported by the Confluent Surgical Inc., the manufacturer of SprayGel™.     

Technical difficulty grade score for the laparoscopic approach of rectal cancer

Introduction We aimed to categorize laparoscopic rectal resections according to technical difficulty to standardize learning purposes and stratify results, making future studies more comparable. Materials and methods Fifty patients undergoing a laparoscopic total mesorectal excision were prospectively followed. Four preoperatively known facts (gender, body mass index (BMI), tumor localization, and preoperative radiation therapy) were compared to four operative outcomes (operation time, blood loss, a visual analogue score (VAS) for difficulty rewarded by the surgeon, and oncological radicality of the procedure). Results Operating time for male and female patients was 257 vs. 245 min (P = 0.229), blood loss was 300 vs. 300 ml (P = 0.309), the VAS was 8 vs. 6 (P < 0.001), and radicality was 93% vs. 91% (P = 0.806). Operating time was 215, 250, and 305 min for high, mid, and low tumors (Spearman −0.44; P = 0.02), respectively. Blood loss was 105, 300, and 600 ml (Spearman −0.38; P = 0.01). Lower tumors were rewarded a higher VAS (Spearman −0.57; P < 0.001) and were less often radically resected (Spearman 0.32; P = 0.026). Operating time for irradiated and nonirradiated patients was 277 vs. 225 min (P = 0.008), blood loss was 500 vs. 150 ml (P = 0.006), the VAS was 7 vs. 5 (P < 0.001), and radicality was 79% vs. 100% (P = 0.046). Operating time was 240 min for BMI 25–30 and 253 min for BMI > 30 (Spearman 0.13; P = 0.391). Blood loss was 150 ml for BMI 25–30 and 500 ml for BMI > 30 (Spearman 0.38; P = 0.01). Higher BMIs were rewarded a higher VAS (Spearman 0.06; P = 0.704). BMI had no correlation to radicality of the procedure (Spearman −0.12; P = 0.402). There was an association between technical difficulty score and operation time (P = 0.007), blood loss (P < 0.001), VAS (P < 0.001), and radicality of surgery (P = 0.043). Conclusion Laparoscopic surgery in male, irradiated, and obese patients with lower tumors seemed more difficult. A categorization according to technical difficulty, to preoperatively predict difficulty of the procedure, was found feasible.     

Initial clinical experience of remote magnetic navigation system for catheter mapping and ablation of supraventricular tachycardias

Background  A remote magnetic navigation system (MNS) has been developed for mapping and catheter ablation of cardiac arrhythmias. The present study evaluates the safety and feasibility of this system to perform radiofrequency (RF) ablation in patients with supraventricular tachycardias (SVT). Methods  A total of 32 patients (22 female; mean age 44 ± 16 years) with documented SVT underwent mapping and ablation using Helios II (a 4-mm-tip magnetic catheter), under the guidance of the MNS (Niobe II, Stereotaxis, Inc.). Results  Catheter ablation procedure with MNS was successful in 30/32 (94%) patients including all patients (27/27, 100%) with atrioventricular nodal reentrant tachycardia (AVNRT) and three of five patients (60%) with atrioventricular reentrant tachycardia (AVRT) without any complication. The procedural successful rate in patients with AVNRT was significantly higher than those in patients with AVRT (P < 0.001). Overall, the medium number of RF application using the MNS was 2 (mean 2.7 ± 1.6, range 1 to 7), and the medium numbers of RF for AVNRT and AVRT were 2 and 3, respectively. There was no significant difference in the mean procedural time between patients with AVNRT and AVRT (126.3 ± 38.6 vs. 138.0 ± 40.3 min, P = 0.54). However, the mean fluoroscopy time was significantly shorter in patients with AVNRT than those with AVRT (5.7 ± 3.0 vs. 16.5 ± 2.5 min, P < 0.001). Among those patients with AVNRT, the mean procedural time (139.3 ± 45.0 vs. 112.3 ± 24.9 min, P = 0.07) and fluoroscopic time (3.2 ± 1.0 vs. 8.0 ± 2.2 min, P < 0.001) were shorter for the later 13 patients than the first 14 patients, suggesting a learning curve in using the MNS for RF ablation. Conclusions  The Niobe MNS is a new technique that can allow safe and effective remote-controlled navigation and minimize the need for fluoroscopic guidance for ablation catheter of AVNRT. However, further improvement is required to achieve a higher successful rate for treatment of AVRT. Drs. Xu and Yang contributed equally to this work.     

Influence of conditioning regimens and stem cell sources on donor-type chimerism early after stem cell transplantation

We retrospectively analyzed very early chimerism before and ongoing neutrophil engraftment (days 7, 14, 21, 28) and investigated the influence of conditioning regimens and stem cell sources on donor-type chimerism in 59 Japanese patients who had received allogeneic hematopoietic stem cell transplantation. The percentage of donor-type chimerism increased before engraftment in all patients who achieved engraftment. The average percentage of donor-type chimerism in patients who had received reduced-intensity stem cell transplantation (RIST) with total body irradiation (TBI) was significantly higher than that in patients who had received RIST without TBI (98.8% vs 87.5% on day 21, P < 0.01; 99.3% vs 84.3% on day 28, P < 0.01). The average percentage of donor-type chimerism after peripheral blood stem cell transplantation was significantly higher than that after bone marrow transplantation on day 7 (81.5% vs 43.1%, P < 0.01), and the average percentage of donor-type chimerism after cord blood transplantation was significantly lower on day 14 (55.8% vs 84.8%, P < 0.05). Compared with the average percentage of donor-type chimerism in patients who achieved engraftment with each stem cell source, a notable decrease in donor-type chimerism was observed in patients who failed to achieve engraftment. This study suggests that differences in conditioning regimens and stem cell sources should be taken into account when considering donor-type chimerism.     

Long-Term Outcome After Operative Intervention for Rectal Cancer in Patients Aged Over 80 Years: Analysis of 9,501 Patients

Introduction Perceptions of poor outcome may detract caregivers from offering standard therapies to patients over 80 years who have been diagnosed with rectal cancer. We evaluate the effect of operative intervention on their survival. Methods Demographics, tumor characteristics, treatment, and survival for patients over 80 years with rectal and rectosigmoid cancer from 1993 to 2002 in the Surveillance, Epidemiology and End Results Program of the National Cancer Institute were examined. Survival was determined by using the Kaplan-Meier method. Patients who underwent operation (Group A) were compared with those who did not undergo surgery (Group B). Fisher's exact, chi-squared, analysis of variance, and log-rank tests were used as appropriate, and P < 0.05 was considered statistically significant. Results A total of 9,501 patients (19 percent) were aged older than 80 years. Mean age was 85 years, and median survival was 24 months. Stage of disease was unknown for 2,915 patients. Median survival was 58, 53, 39, 27, and 5 months for Stages 0 (n=163), I (n=1,878), II (n=1,796), III (n=1,536), and IV (n=1,213), respectively. A total of 6,900 patients (81 percent) underwent surgery. Median survival for operated patients was significantly longer for all stages (36 vs. 5 months, P < 0.00001), Stage 0 (60 vs. 7 months, P < 0.01), Stage I (55 vs. 11 months, P < 0.0001), Stage II (41 vs. 13 months, P < 0.0001), Stage III (28 vs. 14 months, P < 0.05), and Stage IV (8 vs. 3 months, P < 0.0001). For patients with rectal cancer, local therapy also significantly improved median survival compared with nonoperated patients (P < 0.0001). Conclusions Operative intervention provides sustained benefit in terms of survival to patients aged >80 years with rectal cancer at all stages who are assessed to be a good operative risk. Age older than 80 years should not detract surgeons from offering optimal therapy to good-risk patients. Reprints are not available.     

Septic Complications after Restorative Proctocolectomy do not Impair Functional Outcome: Long-Term Follow-Up from a Specialty Center

Purpose  After restorative proctocolectomy, 7 to 8 percent of patients may have a pouch leak. Concern exists that pouch leak may be associated with impaired functional outcome. We evaluated patients who underwent restorative proctocolectomy to determine whether pouch leak adversely affected long-term functional outcome and quality of life. Methods  We queried our prospectively maintained database of patients who underwent restorative proctocolectomy for demographic and clinical data. We sent a long-term outcome questionnaire to patients, including the validated Fecal Incontinence Severity Index and Cleveland Global Quality of Life scores. Pouch leak was identified by clinical or radiographic evidence of leak. Patients with leak were compared with those without to determine the impact on long-term functional outcome or quality of life. Results  A total of 817 patients were available for follow-up and 374 patients (46 percent) completed questionnaires. The group with (n = 60; 16 percent) and without (n = 314; 84 percent) leak had similar demographics. The median Fecal Incontinence Severity Index score (15.3 vs. 14.7, P = 0.77), Cleveland Global Quality of Life score (0.79 vs. 0.81, P = 0.48), and bowel movements per 24 hours (7.92 vs. 7.88, P = 0.92) were similar. The pouch loss/permanent ileostomy rate was higher in those who leaked (13.3 vs. 0.9 percent, P < 0.001). Conclusions  Anastomotic leak after restorative proctocolectomy does not adversely affect long-term quality of life or functional outcome. However, pouch loss/permanent ileostomy is significantly more likely in patients who have had an anastomotic leak. Read at the meeting of The American Society of Colon and Rectal Surgeons, Boston, Massachusetts, June 7 to 11, 2008. Reprints are not available.     

Hepatic Venous Pressure Gradient in Cirrhosis: Correlation with the Size of Varices, Bleeding, Ascites, and Child's Status

The hepatic venous pressure gradient (HVPG) clearly reflects portal pressure in cirrhotic portal hypertension. Its relation with variceal bleeding has been well studied. We undertook to study the relation of HVPG to variceal size, Child's status, and etiology of cirrhosis. Patients with cirrhotic portal hypertension with esophageal varices underwent HVPG measurement as part of a prospective evaluation. One hundred seventy-six cirrhotics with varices (M:F, 140:36; mean age, 42.6 ± 13.4 years), 104 with CLD related to viral etiology, 40 with alcoholic liver disease, 26 cryptogenic with cirrhosis, and 6 with miscellaneous causes of CLD underwent HVPG measurement. The mean HVPG was lower in patients with small varices (n = 77; 14.6 ± 5.9 mm Hg) than in patients with large varices (n = 99; 19.2 ± 6.6 mm Hg; P < 0.01). In patients with large varices, the mean HVPG in bleeders (n = 37) was higher than in nonbleeders (n = 62) (21.7 ± 7.2 vs 17.9 ± 6.2 mm Hg; P < 0.01). The mean HVPG was significantly higher in Child's B (n = 97; 17.4 ± 6.9 mm Hg) and C (n = 56; 19.0 ± 5.7 mm Hg) compared to Child's A cirrhotics (n = 23; 12.2 ± 5.9 mm Hg; P < 0.01), and Child's C compared to Child's B cirrhotics (P = 0.05). HVPG was higher in alcoholic compared to nonalcoholic cirrhotics (20.8 ± 7.3 vs 16.4 ± 6.3 mm Hg; P < 0.05), but this was not significant in multivariate analysis. The HVPG was comparable between hepatitis B- and hepatitis C virus-related cirrhotics (P = 0.8). Cirrhotics with ascites had a higher HVPG than those without ascites (18.5 ± 5.6 vs 16.6 ± 7.6 mm Hg; P = 0.02). In multivariate analysis, only Child's status, size of varices, and variceal bleed predicted higher HVPG. HVPG is higher in cirrhotics with large varices and a history of bleed. There is a good correlation between HVPG and large varices, bleeder status, and ascites. A higher HVPG reflects more severe liver disease. The etiology of liver disease did not influence the portal pressure.     

The prevalence and significance of periodic leg movements during sleep in patients with congestive heart failure

Purpose  The aim of this study was to evaluate (1) the prevalence of periodic leg movements during sleep (PLMs) in a consecutive sample of congestive heart failure (CHF) outpatients; (2) the presence of correlation between PLMs, subjective daytime sleepiness, and sleep architecture; and (3) the heart rate response to PLMs in CHF. Materials and methods  Seventy-nine [50 men, age 59 ± 11 years, body mass index (BMI) 26 ± 5 kg/m²] consecutive adult stable outpatients with CHF [left ventricular ejection fraction (LVEF) 36 ± 6%] were prospectively evaluated. The patients underwent assessment of echocardiography, sleepiness (Epworth Scale), and overnight in-lab polysomnography. Results  Fifteen patients (19%) had PLM index >5. These subjects were similar in sex distribution, BMI, subjective somnolence, LVEF, and apnea–hypopnea index (AHI), but were significantly older than subjects without PLMs. Sleep architecture was similar in subjects with and without PLMs. There was a small but significant elevation of heart rate after PLMs (80.1 ± 9.4 vs. 81.5 ± 9.2; p < 0.001). The cardiac acceleration was also present in absence of electroencephalogram activation. Conclusion  The prevalence of PLMs in consecutive sample of adult CHF outpatients was 19%. There were no differences in subjective daytime sleepiness, sleep architecture, AHI, and severity of CHF in subjects with and without PLMs. PLMs caused a small but statistically significant cardiac acceleration.     

Tumor Pathology and Long-Term Survival in Emergency Colorectal Cancer

PURPOSE Patients who have an emergency operation for colorectal cancer have poorer long-term survival outcomes compared with elective patients. This study was designed to define the role of tumor pathology as a basis for the differences in survival outcomes. METHODS There were 1,537 elective and 286 emergency patients who had an operation for bowel cancer from 1997 to 2003. Tumor pathology and survival data collected prospectively for these patients were compared by modes of presentation. RESULTS Excluding 30-day mortality, emergency patients as a whole had a five-year all-cause survival rate of 39.2 percent compared with 64.7 percent for elective patients P < 0.0001 they also had more advanced Dukes C and D tumors (P < 0.0001). The rates of early T1 and T2 cancers were 4.7 percent for the emergency and 25 percent for the elective group. Emergency cases had more lymph node-positive patients and N2 patients (57.1 vs. 41.8 percent and 26.6 vs. 15.9 percent, respectively; P < 0.0001). Curatively resected emergency colon patients again had more advanced Dukes staged tumors (P < 0.0001) with a five-year survival rate of 51.6 percent compared with 75.6 percent for elective patients P < 0.0001. On stage-for-stage analysis, the survival rates for curatively resected Dukes B and C colon cancers remained worse for emergency patients (P = 0.003 and P = 0.0002, respectively). Both emergency Dukes B and C groups had more T4 cases (21.5 vs. 10.6 percent; P = 0.017 and 26.4 vs. 15 percent; P = 0.016, respectively). CONCLUSION Advanced tumor pathology is a basis for poor long-term survival in emergency colorectal cancers. Reprints are not available.     

Anti-C1q antibodies are associated with systemic lupus erythematosus disease activity and lupus nephritis in northeast of China

This study aimed to investigate the associations of anti-C1q antibodies with systemic lupus erythematosus (SLE) disease activity and lupus nephritis (LN) in northeast of China. Ninety patients with SLE, 37 patients with other autoimmune diseases, and 40 healthy donors in northeast of China were enrolled. Serum anti-C1q antibodies were measured by ELISA with 20 RU/ml as the threshold of positive results. The prevalence and levels of anti-C1q antibodies in SLE group (50%, 20.54 ± 34.67 RU/ml) were significantly higher than those in autoimmune disease and healthy control groups (P < 0.05), yet no significant difference between LN patients and non-LN lupus patients (57.14% vs 41.46%, P > 0.05; 25.92 ± 39.94 vs 13.07 ± 27.39 RU/ml, P > 0.05). Anti-C1q antibody levels were positively correlated with levels of Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) scores, anti-dsDNA, and anti-cardiolipin and negatively correlated with serum C3 and C4 (P < 0.05). The prevalence of anti-Sm and anti-nucleosome increased in anti-C1q-positive lupus patients (P < 0.05). Compared with anti-C1q-negative lupus patients, patients with 20–40 RU/ml anti-C1q antibodies had comparable disease activity (P > 0.05); patients with 40–80 RU/ml anti-C1q antibodies had significantly lower levels of serum complement (P < 0.05); patients with above 80 RU/ml anti-C1q antibodies had much more severe hypocomplementemia, increased SLEDAI scores, and higher incidence of hematuria and proteinuria (P < 0.05). Furthermore, the specificity and positive predictive value of 80 RU/ml anti-C1q antibodies for LN was 97.56% and 87.50%, respectively. In conclusion, anti-C1q antibodies are associated with SLE and LN disease activity, and the contribution hinges on the titers. Moreover, high-level anti-C1q antibodies are valuable for diagnosing LN.     

Laparoscopic- <Emphasis Type="Italic">vs.</Emphasis> Hand-Assisted Ultralow Anterior Resection: A Prospective Study

Purpose A standard laparoscopic-assisted operation can be conducted with colorectal anastomosis performed after extraction of specimen and insertion of a pursestring via a small left iliac fossa or suprapubic incision, or completed via hand-assisted laparoscopic technique with a 7-cm to 8-cm suprapubic incision. This study compares the short-term outcomes of either technique. Methods Sixty-three consecutive patients undergoing laparoscopic-assisted ultralow anterior resection or total mesorectal excision for rectal cancer were examined. The laparoscopic-assisted group (n = 31) had standard laparoscopic-assisted resection, whereas the hand-assisted laparoscopic group (n = 32) had a 7-cm to 8-cm suprapubic incision to allow an open colorectal anastomosis. In patients who were obese or have had multiple abdominal surgeries, the hand-assisted approach was generally favored. All patients had a diverting ileostomy. Results There was no conversion in either group. Mean operating time was significantly longer in the laparoscopic-assisted group (188.2 vs. 169.8 minutes; P < 0.0001). Mean duration for narcotic analgesia (1.65 vs. 3.38 days, P < 0.0001), mean time to flatus (1.97 vs. 3.19 days, P < 0.0001), and mean duration of intravenous hydration (2.45 vs. 3.88 days, P < 0.0001) were longer in the hand-assisted laparoscopic group. However, the mean length of hospital stay (5.8 vs. 5.9 days, P = 0.379) was similar. There was no major surgical complication in either group; chest infection, wound infection, and thrombophlebitis were similar between the laparoscopic-assisted group and the hand-assisted laparoscopic group. Adequacy of specimen harvest (distal tumor margins, P = 0.995; circumferential resection margin, P = 0.946; number of lymph nodes, P = 0.845) was similar. Conclusions Although both laparoscopic-assisted and hand-assisted laparoscopic surgeries are safe and feasible for ultralow anterior resection, the hand-assisted technique significantly shortens operating time. †Deceased. Read at the meeting of The American Society of Colon and Rectal Surgeons, St. Louis, Missouri, June 2 to 6, 2007.