Increased systolic daily ambulatory blood pressure in adult women born preterm

We have studied 24-h ambulatory blood pressure and kidney function in three groups of adult women: (1) born full term but with birth weights below the 3rd percentile for gestational age (n =18), (2) born preterm before gestational week 33 (median birth weight 1,250 g, range 950–2,040 g) (ex-preterm, n =14), and (3) those born full term with normal birth weights (comparison group n =17). We have previously published the results from the study. We recalculated the daily ambulatory blood pressure and redefined the time interval from 6:00–24:00 to 8:00–20:00, since this better corresponds to daily active life. We found significantly increased mean daily systolic ambulatory blood pressure in the ex-preterm group. The result supports the suggestion that disturbance and/or disruption of the normal prenatal milieu seem to affect arterial blood pressure in adult life.     

Pre-anesthesia systolic blood pressure increases with age regardless of sex

Purpose

Pre-anesthesia hypertension (PAH) is the temporary elevation of blood pressure (BP), compared with normal ambulatory recorded BP or self-measured BP at home, in patients waiting for operation in the operating room (OR) before anesthesia induction. In general, the incidence of sustained hypertension (SH) increases progressively with age and the increase is greater in males than in females. In this study, we investigated the influence of age and sex on PAH.

Methods

Sampling data on consecutive patients who were more than 20?years old and who had undergone surgery under general, intrathecal, or epidural anesthesia were retrospectively collected from hospital records and anesthesia records. Patients with SH, which was defined as a past history of hypertension and taking oral antihypertensive medications, were excluded from the analyses, and the data of 231 patients, 102 males and 129 females, were used for the analyses.

Results

The proportions of male and female patients with a systolic BP (sBP) of more than 140?mmHg in the OR before anesthesia induction were 55.9 and 42.6?%, respectively. The proportions of male and female patients with a diastolic BP (dBP) of more than 90?mmHg were 34.3 and 23.3?%, respectively. There was no difference in the proportions of male and female patients with PAH. The differences in sBP between measurements in the hospital room (HR) before the operation and those in the OR (ΔsBP) in males and females were 22.9?±?25.6 and 19.0?±?24.0?mmHg, respectively. The differences in dBP between measurements in the HR and those in the OR (ΔdBP) in males and females were 12.7?±?16.5 and 8.4?±?17.9?mmHg, respectively. There were no differences in ΔsBP and ΔdBP between males and females. The sBP in the OR and the ΔsBP increased significantly with age in both males and females.

Conclusion

Age is an important clinical factor related to PAH. Pre-anesthesia sBP and the change in pre-anesthesia sBP increase progressively with age regardless of sex. These findings suggest that the higher BP seen in the elderly in the OR before anesthesia induction, as reported previously, might be explained in part by a greater impact of PAH in older people.     

Pretransplantation systolic blood pressure and the risk of delayed graft function in young living-related renal allograft recipients

Delayed graft function (DGF) is associated with decreased long-term renal allograft survival, however, the entire mechanism of action of DGF has not yet been established. The goal of this study was to determine possible risk factors for DGF in young living-related renal allograft recipients. We retrospectively analyzed the outcome of 142 renal transplant recipients (115 men and 27 women; mean age, 29.7 +/- 9.43 years; 114 living-related donors and 28 cadaveric donors). Data recorded for each patient and donor included gender, age at transplantation, duration of pretransplantation dialysis (recipients only), body mass index, number of human leucocyte antigen mismatches, panel-reactive antibodies, donor creatinine clearance, body weight, systolic and diastolic blood pressure levels, lipid profile, and biochemical parameters. Having obtained the transplant from a cadaveric donor (P<.000, odds ratio [OR]=17.556, confidence interval [CI]=5.961-51.743) and a pretransplantation systolic blood pressure level in the recipient of <120 mm Hg (P<.021, OR=3.600, CI=1.214-10.672) were possible risk factors for DGF. When only living-related recipients were considered, the systolic blood pressure level was significantly associated with DGF. We concluded that a pretransplantation systolic blood pressure level <120 mm Hg is a risk factor for DGF and that preoperative blood pressure control and intervention may help to decrease the risk of DGF.     

Early menopause: increased fracture risk at older age

The aim of this study was primarily to determine the relationship between early menopause and the presence of fractures later in life, and secondly, to check for the significance of confounding factors (such as smoking habits, body mass index (BMI), weight and use of hormones). In this cross-sectional population based study, the subjects were 4725 postmenopausal women, 50-80 years of age, registered with 23 general practitioners (GPs). For the purpose of the present study, the total population was analyzed as well as the subgroup of 2757 women (the study population) with a natural menopause. Medical history questionnaire, weight, height and bone mineral density measurements were taken. Bivariate and multivariate analyses were carried out with documented fractures in three categories: during lifetime; after menopause and after age 50 years) as dependent variable and age, BMI, bone mineral density, weight, smoking habits, use of hormones and early menopause as independent variables. The total study population as well as the subgroups "early" and "normal menopause", stratified in three 10-year and in six 5-year categories, were analyzed. Results are expressed as odds ratio and 95% confidence intervals (CI). Multivariate logistic regression analysis revealed that over 70 years of age, BMD< or =0.800 ( t-score<2.5) and early menopause were the only systemic independent predictors of all three fracture categories. Comparing the subgroups normal menopause and early menopause, the early menopause group showed a statistically significant higher overall fracture rate (OR=1.5; CI 1.2-1.8). Over age 70, the difference in the prevalence of fractures reached statistical significance in each age category (OR: 1.8 and 2.1, respectively). Smoking was found to be associated with early menopause (OR=1.5; CI 1.2-1.8) but not with the presence of fractures. Height above 165 cm was found to be associated with a higher prevalence of fractures during lifetime. The present study shows that early menopause is statistically significant associated with the presence of fractures during lifetime, after age 50 years and after menopause. Especially at older age, early menopause is an important predictor of fractures.     

Increased blood pressure but normal renal function in adult women born preterm

It has been suggested that children born small for gestational age may develop hypertension and renal dysfunction in adulthood due to impaired fetal kidney development. Very little information on this issue is available on children born preterm. The objective of this study was to investigate the relationship between birth weight, blood pressure, and kidney function in adult subjects who were born preterm or born small for gestational age (SGA). Study design: Subjects (n=50), all women born between 1966 and 1974, were evaluated at a mean age of 26±1.9 years. They were allocated to three groups: (1) born before gestational week 32 (n=15), (2) born full term with birth weight <2600 g (n=18) (SGA), and (3) controls, born full term with appropriate birth weight (n=17). Casual blood pressure, ambulatory 24-h blood pressure (ABPM), glomerular filtration rate (GFR), renal plasma flow (ERPF) and urinary albumin excretion were determined. Results: Preterms had significantly higher casual systolic and mean arterial blood pressure levels compared to controls (123±13 vs 110±7 mmHg, P<0.01, and 87±9 vs 79±6 mmHg, P<0.005, respectively). ABPM was not significantly different between the groups. When the number of systolic recordings >130 mmHg/subject during ABPM was calculated, the preterms had significantly more recordings above this value (P<0.05) as well as a significantly increased area under the curve >130 mmHg and >140 mmHg systolic (P<0.05) compared to the controls. SGA subjects were not significantly different from controls. There were no significant differences in GFR, ERPF or urinary albumin excretion between the three groups. Conclusion: Women born preterm seem to have a disturbance in blood pressure regulation in adulthood, a finding that is not observed for those born small for gestational age. Kidney function in early adulthood seems to be normal in subjects born preterm or small for gestational age. Received: 29 December 1999 / Revised: 13 June 2000 / Accepted: 15 June 2000     

Maternal age as a risk factor for hypospadias

PURPOSE: Hypospadias incidence rates have been widely reported to be increasing. During the last 20 years there has been a significant increase in the number of women who delay childbearing until their mid 30s. Therefore, it was of interest to determine if increasing maternal age is an independent risk factor for hypospadias. MATERIALS AND METHODS: Data from the New York State Department of Health and California Birth Defects Monitoring Program were analyzed from 1983 to 1996 by maternal age groups of less than 20, 20 to 24, 25 to 29, 30 to 34, and 35 or greater years. A Poisson model was fitted to the data from each state using maternal age and year of birth from which relative rates were calculated. RESULTS: Our analysis revealed that advancing maternal age is significantly associated with hypospadias and is most evident for severe cases. For example, in California a 50% increase in severe cases was demonstrated for children of mothers older than 35 years compared to mothers younger than 20 years (p <0.05). CONCLUSIONS: Hypospadias is significantly associated with increasing maternal age. Women who elect to delay childbearing until their mid 30s or later should be aware that their offspring are at increased risk of hypospadias.     

Hyperhomocysteinemia is a risk factor for postoperative ischemia in adult patients with moyamoya disease

Neurosurgical Review - Growing evidence has suggested that hyperhomocysteinemia (HHcy) is a risk factor for cerebral infarction. However, the effect of HHcy on postoperative cerebral ischemia is...     

Advanced donor age alone is not a risk factor for graft survival in kidney transplantation

Background

The use of kidneys from elderly deceased donors has substantially increased organ supply, although it is associated with worse graft function and survival rates. The risk of kidneys from elderly donors as well as expanded criteria donors (ECDs) on kidney transplant outcome was investigated.

Patients and methods

Seventy-five kidney transplants from ECDs over a 5-year period were reviewed retrospectively. Old age and increased donor risk variables were analyzed separately in relation to graft function and survival.

Results

Sixty-four of 75 (85.3%) recipients had functioning grafts 5 years posttransplant. The overall actuarial graft survivals from 1 to 5 years were 87.5%, 68.1%, 57.3%, 55.4%, and 47.3%, respectively. Early graft function gave 47 (62.7%) kidneys remarkable actuarial survivals of 100.0%, 88.3%, 75.8%, 75.8%, and 68.4% at 1 to 5 years posttransplant, and 28 (37.3%) kidneys had delayed graft function with substantially decreased actuarial survival rates, ranging from 66.7% to 23.2%. Kidneys from elderly donors had considerable actuarial graft survival rates of 100.0%, 83.3%, 76.9%, 76.9%, and 67.0% from 1 to 5 years, respectively; these were the best graft survival rates compared with kidneys from the other donor categories. The other donor risk variables when associated with advanced age of any had an adverse effect on recipient graft function and survival, but no single risk variable alone, or a combination of any two, showed any statistically significant variability.

Conclusion

Elderly kidney donors provided a substantial organ pool expansion without affecting patient and graft survival in many patients. ECDs can be utilized safely if adequate measures are taken.     

Lung function at one month of age as a risk factor for infant respiratory symptoms in a high risk population

BACKGROUND: Abnormal premorbid lung function is a risk factor for subsequent wheezing in children with one or no atopic parent. This study was undertaken to establish whether early lung function in high risk infants (both parents atopic) was a risk factor for respiratory symptoms in infancy and to examine the influence of maternal asthma, smoking, and allergen exposure during pregnancy on any association. METHODS: Infants were recruited from the NAC Manchester Asthma and Allergy Study cohort at birth. Partial forced expiratory flow volume technique under sedation was carried out to determine maximal flow at FRC (V'maxFRC). Children were followed prospectively and parents completed a standard respiratory questionnaire at one year of age. RESULTS: Sixty nine term infants (34 boys; 88% mothers non-smokers; no household pets) underwent respiratory function testing. Size adjusted V'maxFRC was significantly lower in infants who had recurrent wheeze during the first year of life (mean 1.3 ml/s/cm, 95% CI 0.99 to 1.60) than in those who did not (mean 2.03 ml/s/cm, 95% CI 1.71 to 2.36; p=0.01). V'maxFRC was also significantly lower in infants who had recurrent cough symptoms. In multivariate regression analysis, when adjusted for age at test, sex, maternal asthma, smoking and maternal mattress Der 1 levels, a lower size adjusted V'maxFRC score remained strongly associated with wheezing (OR 0.37, 95% CI 0.18 to 0.77, p=0.007). Maternal smoking also remained an independent risk factor (OR 29.85, 95% CI 2.46 to 362.5, p=0.008). CONCLUSION: Significantly diminished lung function was present in high risk infants who subsequently wheezed and coughed. This was independent of maternal exposure to mite allergen, asthma, and smoking during pregnancy.     

Heavy smoking is an important risk factor for erectile dysfunction in young men

Clinical and basic science studies provide strong indirect evidence that smoking may affect penile erection. The objective of this retrospective research was to investigate the role of smoking for erectile dysfunction (ED) in order to obtain some insight into the prevention of ED. We reviewed the data from 860 male patients aged between 18 and 44 visited during the period January 1999 to December 2002. The patients were divided into three groups: smokers, never smokers and former smokers. All patients were submitted of medical history, such as, IIEF 5 Questionnaire, physical examination, serum levels of glucose, cholesterol, prolactin and free testosterone. Our data were compared with ISTAT (Italian Institute of Statistics) and data on the Italian population of smokers. We have stratified the data by age and area of residence. The 860 patients, mean age 32.4 y old (range 18-44), are distributed into three groups: smokers 460 (53.5%), never smokers 320 (37.2%) and former smokers 80 (9.3%). Current smokers in our series are 460 (53.5%) in comparison to 34.7% of male current smokers in Italy, in the same range (18-44). Out of 860, 337 are patients who smoked more than 20 cigarettes per/day (39.2%) and these data are extremely interesting; while comparing the same aged men through ISTAT, it is found that only 4% are heavy smokers. On analysing the incidence of heavy smoking in middle-aged patients affected by ED with the whole Italian population by means of ISTAT, taking into account males with the same age range and area of residence, it was shown that the data of our population (sample) compared all Italian middle-aged patients are 39.2 vs 4%; this explains the need for education within a comprehensive smoking cessation programme, and should be reserved especially for young smokers, in order to be aware and informed of the effect of tobacco on erectile function.     

Diabetes prevention in BB rats by frequent blood withdrawal started at a young age

The BB rat diabetic syndrome has been prevented by various immunosuppressive and reconstitution measures. We observed an effect of multiple blood samplings on diabetes incidence and examined its immunological correlates. Individual litters were divided into two groups; one was sampled and the other was sham sampled as the control group. Sixty-four diabetes-prone and 59 non-diabetes-prone rats were studied. The sampled rats had blood removed at 15 (28% of total blood volume), 30 (30%), 50 (21%), 75 (16%), and 120 days of age. The sham-sampled control rats had blood removed only at 120 days of age. The incidence of diabetes in the sampled group was markedly lower than that of their sham-sampled littermates (22 vs. 78%). This result was associated with a correction of their OX19+ (pan-T-lymphocytes) and W3/25+ (helper/inducer) T-lymphocyte-number defects. An increase in lymphocyte subsets was also seen in the non-diabetes-prone BB rats, significant for all but the OX19+ cells. Islet pathology and pancreatic insulin content were consistent with metabolic outcomes. The effect of blood withdrawal thus has implications for understanding the pathogenesis of both the diabetes syndrome and the lymphopenia of the BB rat. Furthermore, it suggests that a stimulation of lymphopoiesis by blood withdrawal (analogous to that of erythropoiesis) may be a hitherto unrecognized physiological response in normal animals.     

Smoking is a risk factor for incisional hernia

HYPOTHESIS: A number of risk factors for incisional hernia have been identified, but the pathogenesis remains unclear. Based on previous findings of smoking as a risk factor for wound complications and recurrence of groin hernia, we studied whether smoking is associated with incisional hernia. DESIGN: Cohort study. Clinical follow-up study for incisional hernia 33 to 57 months following laparotomy for gastrointestinal disease. Variables predictive for incisional hernia were assessed by multiple regression analysis. SETTING: Department of Surgery, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark. PATIENTS: All 916 patients undergoing laparotomy from 1997 through 1998. Surgeons performed clinical examination in 310 patients; patients who failed to meet for examination, died, or were lost to follow-up were excluded. MAIN OUTCOME MEASURES: Thirty-four variables related to patient history, preoperative clinical condition, operative severity and findings, and the surgeon's training. RESULTS: The incidence of incisional hernia was 26% (81/310). Smokers had a 4-fold higher risk of incisional hernia (odds ratio [OR], 3.93 [95% confidence interval (CI), 1.82-8.49]) independent of other risk factors and confounders. Relaparotomy was the strongest factor associated with hernia (OR, 5.89 [95% CI, 1.78-19.48]). Other risk factors were postoperative wound complications (OR, 3.91 [95% CI, 1.99-7.66]), age (OR, 1.04 [95% CI, 1.02-1.06]), and male sex (OR, 2.17 [95% CI, 1.21-3.91]). CONCLUSION: Smoking is a significant risk factor for incisional hernia in line with relaparotomy, postoperative wound complications, older age, and male sex.     

Age at trauma exposure and PTSD risk in young adult women

The aim of the current study was to test the independent and joint contributions of 8 different types of trauma to posttraumatic stress disorder (PTSD) risk using data from a young adult female cohort. Associations of traumatic events with PTSD onset were examined using Cox proportional hazards models. Differences in risk as a function of age at trauma were tested. Childhood sexual assault, physical abuse, and neglect were stronger predictors of PTSD onset than adolescent and early adult occurrence of these events in individual models. In a model including all traumatic events, differential risk by age remained for sexual assault and physical abuse. Early sexual assault was the strongest predictor of risk, but additional traumatic events increased risk even in its presence.