Coronary angioplasty in patients eighty years of age or older.

Percutaneous transluminal coronary angioplasty (PTCA) was performed on 58 lesions in 53 patients 80 years of age or older with unstable angina. Most patients had previous myocardial infarction, abnormal left ventricular contraction patterns, and multivessel coronary disease. In most (48) patients only one vessel was dilated. PTCA was successful in 48 (82.8%) lesions, but complications were frequent. Eight patients died, six after anatomically successful PTCA (three with cardiac complications, two with noncardiac complications, and one with both cardiac and noncardiac complications). Two patients died after unsuccessful PTCA (one of cardiac complications and one of noncardiac complications), and 11 patients with PTCA were alive with significant complications (all noncardiac). Twenty-nine patients had successful PTCA with no complications; 40 (74.5%) patients were discharged with clinically successful PTCA. It is concluded that PTCA is feasible in patients 80 years of age or older but that both cardiac and noncardiac complications are common in this group of very fragile patients.     

2型糖尿病并发症对患者治疗费用的影响评估

目的 测量与评估中国大城市2型糖尿病并发症对患者年治疗费用的影响。方法 将2型糖尿病患者分为无并发症组、仅有微血管并发症组、仅有大血管并发症组以及同时伴有大、小血管并发症组，并分别计算四组患者的年治疗费用。结果 ①在医院接受治疗的患者中，仅46．7％的患者无任何并发症；而53．3％的患者至少伴有一种并发症。其中仅有大血管并发症的患者占13．3％，仅有微血管并发症的患者占22．3％，同时伴有大、小血管并发症的患者占17．7％。②在微血管并发症患者中，外周神经病变占39．55％，视网膜病变37．69％，肾病13．81％，糖尿病足6．16％。在大血管并发症患者中，短暂性脑缺血发作38．24％，心绞痛31．01％，脑卒中16．80％，慢性心衰6．20％。⑧有并发症的2型糖尿病患者的年直接医疗费用是无并发症患者的3．71倍。但是，若同时伴有大、小血管并发症的2型糖尿病患者年直接医疗费用则是无并发症的10．35倍。④中国大城市2001年治疗2型糖尿病及其并发症的直接医疗总费用为187．5亿元，占卫生总费用3．94％。其中81％的费用用于治疗与2型糖尿病相关的并发症，治疗无并发症的直接医疗费用仅占19％。结论研究结果证明并发症是影响2型糖尿病年治疗费用的重要因素。     

Impact of MAFLD on the complications after hepatectomy in patients with HBV-related hepatocellular carcinoma

Metabolic dysfunction-associated fatty liver disease (MAFLD) is a term that was proposed in 2020 by a group of international experts. However, the impact of MAFLD on complications after hepatectomy in patients with hepatocellular carcinoma is not clear. The aim of this study is to explore the influence of MAFLD on the complications after hepatectomy in patients with hepatitis B virus-related hepatocellular carcinoma (HBV-HCC). Patients with HBV-HCC who underwent hepatectomy between January 2019 and December 2021 were consecutively enrolled. The predictors of complications after hepatectomy in HBV-HCC patients were retrospectively analyzed. Among the 514 eligible HBV-HCC patients, 117 (22.8%) were diagnosed with concurrent MAFLD. Post hepatectomy complications occurred in 101 patients (19.6%), including 75 patients (14.6%) with infectious complications and 40 patients (7.8%) with major complications. Univariate analysis showed that MAFLD was not the risk factor for complications after hepatectomy in patients with HBV-HCC (P > .05). However, univariate and multivariate analysis revealed that lean-MAFLD was an independent risk factor for post hepatectomy complications in patients with HBV-HCC (odds ratio 2.245; 95% confidence interval 1.243–5.362, P = .028). Similar results were found in the analysis of predictors for infectious and major complications after hepatectomy in patients with HBV-HCC. MAFLD commonly coexists with HBV-HCC and is not directly associated with complications after hepatectomy, but lean-MAFLD is an independent risk factor for post hepatectomy complications in patients with HBV-HCC.     

The relationship between HBV-DNA levels and cirrhosis-related complications in Chinese with chronic hepatitis B

We studied the hepatitis B virus (HBV)-DNA levels below which the development of cirrhosis-related complications became unlikely in chronic hepatitis B (CHB). Seventy-nine Chinese CHB patients with cirrhosis-related complications and 158 age-, sex- and HBeAg status-matched patients without complications were enrolled. The precore and core promoter mutations were detected by the Line Probe assay (LiPA). HBVDNA levels were determined by Digene assay and Cobas Amplicor Monitor test. Patients with complications had higher HBVDNA levels than those without complications (P = 0.02). HBeAg-positive patients with complications had similar alanine transferase (ALT) and HBVDNA levels and frequency of precore mutations, but higher frequency of core promoter mutations (P = 0.003), compared with those without complications. Anti-HBe-positive patients with complications had higher ALT and HBVDNA levels (P < 0.01) but similar frequency of precore and core promoter mutations, compared with those without complications. Anti-HBe patients (24.5%) with complications had HBVDNA levels <10(4) copies/mL. The major factor for the development of cirrhotic complications was viral loads but cirrhotic complications continued to develop in patients with HBVDNA levels below 10(4) copies/mL.     

128例老年胃癌患者手术风险因素分析

目的分析老年胃癌患者的临床特点和手术风险,以期对老年胃癌患者的围手术期治疗提供一定的参考。方法回顾性分析上海复旦大学附属华东医院2009年1月～2011年12月290例胃癌手术患者的临床资料,其中老年组128例,对照组162例。分析比较老年组胃癌患者的年龄、术前各种合并症与术后并发症发生率的关系。结果老年组患者术前合并症总发生率为71．1％,高于对照组的27．8％。术后两组并发症的发生率差异无统计学意义。在老年组临床指标中,术前合并症、手术时间及是否联合脏器切除与术后并发症发生率相关。老年组患者高、中分化腺癌所占比例较高;两组患者临床分期上均以Ⅲ、Ⅳ期为主,差异无统计学意义。结论年龄不是影响术后并发症发生率的一个独立因素,而术前合并症和手术方式是老年胃癌患者术后并发症的高危因素。对术前存在合并症的老年患者,通过加强围手术期的处理,可减少术后并发症及手术风险。     

Medical complications and outcomes after hip fracture repair

BACKGROUND: Most evidence guiding perioperative medical risk management of patients undergoing hip fracture repair focuses on cardiac and thromboembolic risk. Little is known of the relative clinical importance of other complications. OBJECTIVE: To systematically map incidence and outcomes of a broad spectrum of medical complications after hip fracture repair. METHODS: Retrospective cohort study of patients 60 years or older in 20 academic, community, and Veterans Affairs hospitals. Data on complications and mortality were abstracted from medical records by trained abstractors using standardized, pretested forms or the National Death Index. RESULTS: Of 8930 patients, 1737 (19%) had postoperative medical complications. Cardiac and pulmonary complications were most frequent (8% and 4% of patients, respectively). Similar numbers of patients had serious cardiac or pulmonary complications (2% and 3%, respectively). Other complications were gastrointestinal tract bleeding (2%), combined cardiopulmonary complications (1%), venous thromboembolism (1%), and transient ischemic attack or stroke (1%). Renal failure and septic shock were rare. After the index complication, 416 patients had 587 additional complications. Mortality was similar for serious cardiac or pulmonary complications (30 day: 22% and 17%, respectively; 1 year: 36% and 44%, respectively) and highest for patients with multiple complications (30 day: 29%-38%; 1 year: 43%-62%). Complications and death occurred significantly earlier for serious cardiac than for serious pulmonary complications (1 vs 4 days, 2 vs 8 days, P<.001); length of stay for patients surviving these complications was similar. CONCLUSIONS: Most patients had no medical complications after hip fracture repair. Serious cardiac and pulmonary complications were equally important in frequency, mortality, and survivors' length of stay. Patients with multiple complications had especially poor prognosis.     

Denver管腹腔静脉分流术的并发症及其处理

目的：分析Denver管腹腔静脉分流术（PVS）临床运用的并发症及其处理的效果。方法：回顾性分析20例行PVS术后患者的近远期并发症的类型和发生率，统计各项处理措施的效果和术后患者生存率。结果：共有29例次9类（12种）并发症发生，近期（＜1月）19例次，中远期（＞1月）10例次，1年堵管率为5％。共有13例（65％）患者出现并发症，9例（45％）为近期并发症，9例（65％）为中远期并发症，有4种并发症导致了随后患者的死亡。肝硬化难治性腹水者术后1年生存率为24％，生存期小于半年的主要影响因素是高龄和Child C级。与PVS术直接相关的死亡原因是败血症、上消化道出血和DIC。结论：Denver管PVS术后半数以上患者出现并发症，经积极处理后大多数近期并发症可以缓解，不少可积极预防，中远期并发症缓解率极低，部分可能原因是随访指导不够和不能及时治疗。只要合理选择患者，术前积极准备，改善置管技术，术后积极预防并发症，加强随访和及时治疗并发症，PVS在肝硬化难治性腹水及癌性腹水治疗中仍可发挥一定作用。     

Health suggestibility,optimism and sense of responsibility for health in diabetic patients

The study examined the relationship between sense of responsibility for health, health suggestibility, and dispositional optimism in diabetic patients (n?=?110) with (n?=?56) and without (n?=?54) complications/accompanying diseases. The two groups of patients did not differ significantly in their sense of responsibility for heath, but health suggestibility was significantly higher and optimism was significantly lower in patients with complications. Health suggestibility and optimism had positive significant correlations with sense of responsibility for health in patients without complications, but in patients with complications, these correlations were not significant. However, the correlations between the two groups did not differ significantly suggesting lack of significant moderation effects due to complications. While it is understandable that suggestibility scores are higher and optimism lower in patients with complications, it is not easy to explain as to why the correlations were significant in patients without complications, but not in patients with complications. Further studies are warranted to draw any clinical implications of these results.     

Oxidative protein damage in type I diabetic patients with and without complications

To examine the influence of oxidative stress on oxidative protein damage, we studied 47 Type I diabetic patients with and without complications. We determined plasma protein carbonyl, plasma protein thiol and nitrotyrosine levels as markers of oxidative protein damage, plasma lipid hydroperoxide levels as markers of oxidative stress, and plasma total thiol, plasma nonprotein thiol, erythrocyte glutathione, plasma ceruloplasmin, transferrin and total iron binding capacity as markers of free radical scavenging. There were no significant differences in nitrotyrosine, total plasma thiol, protein thiol, and erythrocyte glutathione levels between diabetic patients with complications and without complications. However, plasma protein carbonyl, lipid hydroperoxide, and nonprotein thiol levels were significantly increased in diabetic patients with complications compared with diabetic patients without complications. Although redox status of plasma is impaired in diabetic patients, we suppose these significantly different markers reflect enhanced oxidative protein damage in diabetic patients with complications.     

破裂性腹主动脉瘤腔内治疗并发症的单中心回顾性研究

目的:探究腔内修复治疗破裂性腹主动脉瘤后围术期并发症出现的相关特征。方法:回顾性分析自2013年10月到2019年10月期间,于首都医科大学附属北京安贞医院血管外科,住院并行腔内修复治疗的破裂性腹主动脉瘤患者53例。其中围术期未出现并发症者29例(54.7%),出现并发症者24例(45.3%)。将并发症组患者分为术后介入相关并发症组8例,术后系统性并发症组13例,术中死亡3例。比较并发症患者与无并发症患者在基线资料、动脉瘤解剖条件、术中及术后理化指标方面的差异。结果:系统性并发症患者在年龄、就诊时收缩压及舒张压、有无反复搬动、近端瘤颈成角,以及术中尿量、术后24 h内腹腔内压、PT、APTT、CKMB、TnI等改变较无并发症组,差异有统计学意义(P<0.05);介入相关并发症患者在近端瘤颈成角方面较无并发症组,差异有统计学意义(P<0.05)。结论:患者年龄、就诊时血压、近端瘤颈成角以及术前多次搬动可能对破裂动脉瘤腔内治疗后系统性并发症产生影响,术中尿量和术后24 h内的腹内压、凝血功能及心肌标志物的监测,对预测系统性并发症发生十分重要。     

Role of surgical treatments in patients with fibrocavernous pulmonary tuberculosis

Three hundred and seventy patients operated on at the Institute Surgical Clinic underwent 638 surgical interventions: 356 and 282 in Groups 1 and 2 patients, respectively. Intraoperative complications occurred in 24 (3.8%) cases, in 6.5% of the patients operated on. Twenty-two complications were successfully eliminated, 2 patients died. Postoperative complications were established in 25 (14.8%) of the 169 patients of Group 1 and in 12 (6.0%) of the 201 patients of Group 2. The incidence of complications largely depended on the type of an operation. Complications were observed in 8 (36.4%) of the 22 patients undergone pulmonectomy. The active phase of a specific process as a surgical risk factor is prime consideration. In patients operated for emergency indications in the phase of an non-arrested exacerbation of tuberculosis, pleuropulmonary complications occur 2.5 times as frequently as those in patients with relative process stabilization.     

Improving depression care in patients with diabetes and multiple complications

BACKGROUND: Depression is common in patients with diabetes, but it is often inadequately treated within primary care. Competing clinical demands and treatment resistance may make it especially difficult to improve depressive symptoms in patients with diabetes who have multiple complications. OBJECTIVE: To determine whether a collaborative care intervention for depression would be as effective in patients with diabetes who had 2 or more complications as in patients with diabetes who had fewer complications. DESIGN: The Pathways Study was a randomized control trial comparing collaborative care case management for depression and usual primary care. This secondary analysis compared outcomes in patients with 2 or more complications to patients with fewer complications. PATIENTS: Three hundred and twenty-nine patients with diabetes and comorbid depression were recruited through primary care clinics of a large prepaid health plan. MEASUREMENTS: Depression was assessed at baseline, 3, 6, and 12 months with the 20-item depression scale from the Hopkins Symptom Checklist. Diabetes complications were determined from automated patient records. RESULTS: The Pathways collaborative care intervention was significantly more successful at reducing depressive symptoms than usual primary care in patients with diabetes who had 2 or more complications. Patients with fewer than 2 complications experienced similar reductions in depressive symptoms in both intervention and usual care. CONCLUSION: Patients with depression and diabetes who have multiple complications may benefit most from collaborative care for depression. These findings suggest that with appropriate intervention depression can be successfully treated in patients with diabetes who have the highest severity of medical problems.     

Periannular extension of infective endocarditis

OBJECTIVES: This prospective study was designed to assess the current clinical course, risk factors, microbiologic profile and echocardiographic findings of patients with left-sided endocarditis and perivalvular complications. BACKGROUND: Periannular complications worsen the prognosis of patients with endocarditis. The relation between these complications and the clinical and microbiologic data has not been clearly defined. METHODS: In this clinical cohort study, 211 patients with left-sided endocarditis, according to the Duke criteria, were prospectively recruited. All patients underwent conventional and transesophageal echocardiography. The mean follow-up interval was 151 days. RESULTS: Perivalvular complications were detected in 78 patients (37%). The incidence of periannular extension of infection in native and prosthetic valves was 29% and 55%, respectively. The presence of prosthesis (relative risk [RR] 1.88, 95% confidence interval [CI] 1.35 to 2.64) and previous endocarditis (RR 1.78, 95% CI 1.16 to 2.7) were the only pre-existing heart conditions associated with perivalvular complications. Aortic infection (RR 1.8, 95% CI 1.23 to 2.66) and the development of atrioventricular (AV) block (RR 2.55, 95% CI 1.91 to 3.41) were related with the existence of these complications. Coagulase-negative staphylococci were very common in patients with perivalvular complications (RR 1.77, 95% CI 1.21 to 2.59), and small vegetations were more frequent in these patients (RR l.45, 95% CI 0.95 to 2.22). An operation was more frequently performed in patients with perivalvular complications, but mortality was similar in patients with and without these complications. CONCLUSIONS: Aortic infection, prosthetic endocarditis, new AV block and coagulase-negative staphylococci were independent risk factors of periannular complications. The period between symptom onset and diagnosis, the incidence of pericardial effusion and persistent signs of infection were similar between patients with and without perivalvular complications. Patients with perivalvular complications did not demonstrate a difference in the presence or size of vegetations or the frequency of embolism. An operation was more frequently performed in these patients, but mortality was similar in both groups.     

Cytokines and C-reactive protein production in hip-fracture-operated elderly patients

BACKGROUND: The study aim was to determine the kinetics of serum pro- and anti-inflammatory cytokines and C-reactive protein (CRP) in hip-fracture patients over a month postfracture, and their relationship to postoperative (postop) complications and cognitive level. METHODS: Forty-one elderly hip-fracture patients were prospectively followed. Serum was obtained during the first 10 hours postfracture and presurgery, 48-60 hours postop, 7 and 30 days postop, measuring CRP, interleukin-1beta (IL-1beta), IL-6, IL-8, tumor necrosis factor-alpha (TNF-alpha), IL-10, and IL-1 receptor antagonist (IL-1RA). RESULTS: A significant increase was found postop for CRP, IL-6, TNF-alpha, IL-1RA (p <.001), IL-10 (p <.002), and IL-8 (p =.05). CRP kinetics curves were higher in patients with complications as a group, and in those suffering from infections, delirium, and cardiovascular complications (p <.05). IL-6 increase in patients with complications approached significance. Additional complications appeared in patients with impaired mental status (IMS) versus cognitively normal patients (p =.037). Higher kinetics curves in the IMS patients were found for CRP and IL-6 (p <.05). Analyzing the interaction effect of complications and IMS on CRP and cytokines production demonstrated that the increase in CRP was independently related to complications and IMS. IL-6, IL-8, and IL-10 were higher in IMS patients but not in patients with complications without IMS (p <.05). CONCLUSIONS: Serum CRP and cytokines increased drastically in postop hip-fracture elderly patients. Only CRP significantly and independently increased in IMS patients and in patients with complications, whereas cytokines significantly increased only in IMS patients. This study raises questions about possible effects that cytokine generation, after hip-fracture repair, might have on cognition and complications.     

Advanced glycation end-products in senile diabetic and non-diabetic patients with cardiovascular complications

Advanced glycation end products (AGEs) have been reported to contribute to aging and cardiovascular complications. In the present study, the immunoreactivity of AGEs in human serum samples of healthy older subjects (n = 31), senile diabetic patients without cardiovascular complications (n = 33), senile diabetic patients with cardiovascular complications (n = 32), senile non-diabetic patients with cardiovascular complications (n = 30) ,and healthy young subjects (n = 31) were investigated. The patients were selected on clinical grounds from the National Institute of Cardiovascular Disease, Karachi and the Jinnah Postgraduate Medical Centre, Karachi, Pakistan. Fasting blood glucose, HbA_1C and serum fructosamine levels were significantly (P < 0.001) increased in senile diabetic patients with and without cardiovascular complications as compared to non-diabetic senile patients with cardiovascular complications and healthy older subjects. Additionally, serum AGEs were found to be significantly (P < 0.001) increased in senile diabetic patients with cardiovascular complications and senile non-diabetic patients with cardiovascular complications, followed by diabetic patients without cardiovascular complications as compared to healthy older subjects and young control subjects. However, no significant difference was found in the senile diabetic patients without cardiovascular complications and senile non-diabetic patients with cardiovascular complications. In contrast to all four senile groups, serum AGEs were significantly (P < 0.001) lower in young control subjects. The AGEs distribution in the senile groups corroborates the hypothesis that the advanced glycation process might play a role in the development of cardiovascular complications, which are more severe in diabetic patients compared with non-diabetic patients with cardiovascular complications.     

Urinary protein excretion in Type 2 diabetes with complications

This study examined the association between urinary markers of early diabetic nephropathy and non-renal diabetic complications in 946 patients with type 2 diabetes mellitus. The association with hypertension was also studied. Data on macrovascular complications (ischaemic heart disease, stroke, peripheral vascular disease) and microvascular complications (retinopathy, peripheral neuropathy) were obtained from case records and clinical examination. Urine samples collected were analysed for albumin, beta(2)-microglobulin, retinol-binding protein (RBP), and N-acetyl-beta-D-glucosaminidase (NAG). Results showed that urinary albumin, RBP and beta(2)-microglobulin levels were higher in patients with macro- and/or microvascular complications, compared to those without. NAG levels were higher only in patients with both types of complications. A higher proportion of patients with complications had abnormally raised urinary protein and enzyme levels, compared to those without. Patients with associated hypertension had higher urinary levels of albumin and beta(2)-microglobulin, regardless of whether complications were present or not. RBP excretion was, however, markedly higher only in patients with microvascular complications, whereas hypertension did not influence NAG excretion. Urine albumin and RBP excretion were predictive of microvascular, as well as both macrovascular and microvascular complications, whereas NAG excretion was predictive of macro- and microvascular complications. These findings could mean that increased urinary protein and enzyme excretion were associated with more severe disease in these patients.     

C-反应蛋白在骨髓移植后并发症早期诊断及疗效评估中的应用价值

目的探讨C-反应蛋白(CRP)在骨髓移植后患者临床并发症诊断及疗效评估中的价值。方法选取北京大学人民医院血液病研究所2004—2005年骨髓移植后出现不同并发症的患者66例,在不同时间点进行CRP定量检测,分析不同CRP值与所对应的并发症的关系。结果骨髓移植后不同并发症患者中,其CRP是否升高及升高程度明显不同,在细菌感染、合并细菌感染的混合感染、超急性移植物抗宿主病(GVHD)及抗胸腺细胞球蛋白(ATG)反应中可出现CRP明显升高,细菌感染、真菌感染、细菌合并病毒感染、急慢性GVHD等并发症均可出现CRP轻度升高,而单纯病毒感染CRP不升高。在细菌感染临床症状最明显时,CRP可达最高;治疗有效者CRP逐渐降低;CRP恢复正常后又出现增高者,临床上出现新并发症。结论CRP在骨髓移植后患者并发症的早期鉴别诊断及治疗效果的评估中有一定的应用价值。     

80岁以上高龄患者冠状动脉旁路手术63例报告

目的:探讨80岁以上高龄患者冠状动脉旁路手术治疗冠心病。方法:连续63例80岁以上高龄冠心病患者在体外循环(CPB)和非CPB下行冠状动脉旁路手术。结果:全组患者无手术死亡。术后并发症有心房纤颤、液气胸、胸骨感染、肾功能衰竭及呼吸功能不全等,均经积极治疗痊愈。不停跳冠状动脉旁路移植术(OPCAB)组患者危重并发症发生率显著低于CPB下手术者(P<0.02)结论:只要术前准备充分,手术方法精确,术后积极处理并发症,80岁以上高龄患者行冠状动脉旁路手术是安全可行的。     

Long-term bone loss in insulin-dependent diabetic patients with microvascular complications

Insulin-dependent diabetic patients have an approximately 10% decreased bone mineral content (BMC) when they are studied a few years after clinical onset of diabetes. After that time, patients without diabetic microvascular complications have no, or only very little, further bone loss. The aim of the present study was to investigate if any substantial long-term bone loss occurs in diabetic patients with microvascular complications. We studied 19 insulin-dependent diabetic patients with neither physiologic nor pathologic conditions known to interfere with bone metabolism, other than diabetes. BMC was determined twice, with an interval of 11 years. At initial examination, no patient had diabetic microangiopathy, but at final examination 7 patients had developed diabetic microvascular complications while 12 patients had not. As compared with gender- and age-matched controls, both subgroups had significantly decreased BMC at the initial examination. During the study period, the patients with complications showed further bone loss, whereas the subgroup without complications had unchanged decreased BMC. At final examination, BMC was significantly lower in patients with microvascular complications than in patients without them. The biochemistry of bone metabolism showed a significantly increased fasting urinary excretion of calcium and hydroxyproline in patients with complications, but not in the group without complications, and there was a negative correlation between plasma BGP (osteocalcin) and hemoglobin A_1c for all patients. These findings indicate that, in addition to a decreased BMC (before or shortly after clinical onset of diabetes), patients who develop microvascular complications also develop ongoing bone loss. This loss may be caused by an increased bone resorption, but decreased bone formation during periods of poor diabetic control may be involved as well.