Is psychological stress a risk factor for cerebrovascular disease?

OBJECTIVE: This prospective study was conducted to assess functional results obtained after pseudo-continent perineal colostomy using the Schmidt procedure. METHODS: Functional outcome was assessed in 40 patients who had undergone amputation of the rectum for cancer and pseudo-continent perineal colostomy reconstruction between 1989 and 1995 in our institution. The cancer pathology, operative procedure and post-operative care were noted. Morbidity, functional outcome and degree of patient satisfaction were recorded. Mean follow-up was 45 months (18-87) in 100% of the patients. RESULTS: There were no operative deaths. Twenty patients had post-operative complications and 2 patients required early conversion to definitive abdominal colostomy due to severe perineal complications. Function outcome showed normal continence in 4 patients, air incontinence in 23, occasional minimal leakage in 9 and incontinence requiring iliac colostomy in 2. Eighty-six percent of the patients were highly satisfied or satisfied with their continence capacity. DISCUSSION: Pseudo-continent perineal colostomy is a reliable technique which can be proposed as an alternative to left iliac colostomy after amputation of the rectum for cancer if a rigorous procedure is applied: careful patient selection, informed consent, rigorous surgical procedure, daily life-long irrigation of the colon.     

Is insulin an independent risk factor for hypertension? The Paris Prospective Study

BACKGROUND: The link between hyperinsulinaemia and hypertension has been examined in few prospective studies and often diminished after adjustment for obesity, central adiposity and baseline blood pressures. METHODS: The incidence of hypertension was studied as a function of baseline insulin and glucose in 4149 Caucasian, non-hypertensive, non-diabetic middle-aged men from the Paris Prospective Study. Blood pressures were measured over the 3 years of follow-up; hypertension incidence was defined as systolic blood pressure > or = 160 mmHg or diastolic blood pressure > or = 95 mmHg or drug treatment for hypertension. RESULTS: Fasting and 2-hour glucose and insulin were predictive of hypertension, after controlling for the known risk factors: age, excessive alcohol consumption and family history of hypertension (FHH). However, after further controlling for body mass index and central adiposity (the iliac circumference), insulin was no longer predictive in men without an FHH. When weight variation was also taken into account, and further adjustment made for baseline blood pressure and heart rate, fasting insulin, only, was predictive when the subject had a weight increase, independently of FHH. Fasting glucose was predictive of hypertension except in the case of no change or weight decrease and a negative FHH; 2-hour glucose was predictive in the presence of a positive FHH. CONCLUSIONS: Insulin and glucose levels were both risk factors for hypertension, and this risk was enhanced in the case of a positive FHH. However, obesity, especially central obesity, confounded these relationships and might be an intermediary factor in the relationship between insulin and hypertension.     

Is low AT III a significant risk factor for coronary artery disease? Anecdotal observations

I report on my 6-year experience identifying the correlation of low antithrombin III (AT III) levels with coronary artery disease in a rural Missouri family practice setting. I measured plasma AT III levels in 78 patients who were at risk for coronary artery disease. I also tracked lipid profiles, HBA1C, blood pressure, body mass index, hostility, and nicotine use. I measured AT III levels using Baxter Diagnostic AG Dade antithrombin III chromogenic coagulation assays of antithrombin III (normal range, 88% to 126%) at the Boone County Hospital Laboratory, Columbia, Missouri. I analyzed the patient records and looked for the worst recording of each of the above risk factors, selecting the highest blood pressure, total cholesterol, LDL cholesterol, triglycerides, HBA1C, weight, and age. I selected the lowest AT III level, which often occurred when the patient was stressed. When the worst risk factors were picked over a long period of time, low AT III correlated with an arbitrary coronary artery disease scale 24% of the time. This negative correlation (r = -.49) was higher than any other risk factor in these selected patients.     

Is there really a schizophrenogenic parent?

Therapists who treat schizophrenics (SCZs) generally report a parenting interaction different from that usual to neurotic patients. Communication deviance, measured from parental interaction, the Rorschach Inkblot Test, and the Thematic Apperception Test (TAT) has been found to characterize parents and adoptive parents of SCZs. Expressed emotion (intrusive hostility) of parents increases rehospitalization. Genetic factors, at most, represent increased vulnerability. Pathogenesis, based on clinical observations, is measured from the TAT and is defined as the degree to which the parent unconsciously acts in terms of the parent's needs without regard to the potentially conflicting needs of the child. In a series of studies (e.g., R. G. Meyer and B. P. Karon, 1967) mothers of normals averaged 35% pathogenic. Mothers of SCZs averaged 65% pathogenic. Fathers of SCZs were nearly as high. Clinical examples of the meaning of pathogenesis are provided. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Homocysteine and coronary heart disease. Is slight or moderate homocysteinemia related to increased risk of coronary heart disease?

Homocystinuria, a rare inherited disturbance of amino acid metabolism is associated with severe atherosclerosis and thromboembolism already in childhood. The incidence of the homozygous disease of cystathionine beta synthase is estimated to be 1:200,000, that of the heterozygous form 1:300. There are, however, numerous other causes of a mild to moderate homocysteinemia, for example, a deficiency of the cofactors vitamin B6, B12 and folic acid. The question as to whether a mild to moderate elevation of homocysteine in the plasma is also associated with an increased risk of CAD has been investigated in a number of studies in recent years. In summary, however, the presently available data do not provide a basis of proof that a mild to moderate homocysteinemia is an independent risk factor for CAD. Our present knowledge suggests that only when the family history is clearly positive does it appear reasonable to undertake a diagnostic search for possible homocysteinemia.     

Lipoprotein(a) as a risk factor for ischemic heart disease: metaanalysis of prospective studies

Although in vitro studies support a pathophysiologic role for lipoprotein(a) [Lp(a)] in the development of atherosclerosis, and retrospective studies consistently report that there is a relationship between Lp(a) and ischemic heart disease (IHD), the conclusions drawn from prospective studies about this relationship have been inconsistent. To address this issue, we have performed a metaanalysis of data available from prospective studies. Lp(a) concentrations expressed as mass units vary markedly between studies, reflecting the need for assay standardization. In 12 of 14 prospective studies, Lp(a) concentrations are higher in subjects who later develop IHD (cases) than in those who do not (controls), although there is variation in the size of the effect. Sample storage temperature may contribute to this variability. When the studies are analyzed collectively, Lp(a) concentrations are significantly higher in cases than in controls, and the extent of the effect is similar in men and women. These findings provide evidence in support of a causal role for Lp(a) in the development of atherosclerosis. Measurement of Lp(a) may be useful to guide management of individuals with a family history of IHD or with existing disease. The separation in values between cases and controls is not, however, sufficient to allow the use of Lp(a) as a screening test in the general population.     

Ambulatory tonsillectomy. Is postoperative hemorrhage a risk factor?

The aim of this study was to investigate the usefulness of chemosensory event-related potentials (CSERPs) in response to both olfactory and intranasal trigeminal stimulation in the diagnosis of anosmia. Forty-four patients participated. Gaseous CO2 was used for trigeminal stimulation, vanillin and H2S were used as olfactory stimulants. Event-related potentials to olfactory stimuli could not be obtained in any of the anosmic patients, indicating the complete loss of the sense of smell. However, all patients responded to stimulation of the trigeminal nerve with CO2. These data clearly demonstrate the clinical significance of CSERPs in the assessment of anosmia.     

Is diabetes mellitus a risk factor for pressure ulcers?

Among patients hospitalized in 1983-1992 were 416 (239 women) who were immobilized for at least 2 hours due to stroke, orthopedic surgery, or sepsis. 128 (30.8%) had pressure ulcers (PU); 100 (31.2%) had diabetes (DM), including 12 with IDDM and 118 with NIDDM; age (mean +/- SD) was 74.3 +/- 9.5 years. Those with IDDM and NIDDM were younger (70.9 +/- 10.5 and 71.5 +/- 8.4 years, respectively) than the nondiabetic (75.7 +/- 9.6 years; p > 0.05 and < 0.001, respectively). Those with PU were older (76.6 +/- 9.0 vs 73.3 +/- 9.6 years, p < 0.01). Incidence of PU in patients without DM was similar to that in those with NIDDM (30.4 vs 27.1%; no difference even after age-adjustment). However, incidence of PU was significantly higher in those with IDDM than in those without DM (75.0 vs 30.4%, p < 0.01). According to Medline (last 2 years screened), and EBSCO Physician Medline Plus (last 5 years screened), only 5 publications referred to DM as a risk factor for PU. According to our data NIDDM does not appear to be a risk factor for PU, but a causative role for IDDM deserves further study. Increased risk of diabetic foot, infections in ulcers and wounds, and slow healing in DM do not justify considering NIDDM a risk factor for PU.     

Depression as a risk factor for ischaemic heart disease in men: population based case-control study

OBJECTIVE: To determine the relation between depression, anxiety, and use of antidepressants and the onset of ischaemic heart disease. DESIGN: Population based case-control study. SETTING: All 5623 patients registered with one general practice. SUBJECTS: 188 male cases with ischaemic heart disease matched by age to 485 male controls without ischaemic heart disease; 139 female cases with ischaemic heart disease matched by age to 412 female controls. MAIN OUTCOME MEASURE: Adjusted odds ratios calculated by conditional logistic regression. RESULTS: The risk of ischaemic heart disease was three times higher among men with a recorded diagnosis of depression than among controls of the same age (odds ratio 3.09; 95% confidence interval 1.33 to 7.21; P=0.009). This association persisted when smoking status, diabetes, hypertension, and underprivileged area (UPA(8)) score were included in a multivariate model (adjusted 2.75; 1.13 to 6.69; P=0.03). Men with depression within the preceding 10 years were three times more likely to develop ischaemic heart disease than were the controls (3.13; 1.27 to 7.70; P=0.01). Men with ischaemic heart disease had a higher risk of subsequent depression [corrected] than men without ischaemic heart disease (adjusted 2.34; 1.34 to 4.10; P=0.003). Depression was not a risk factor for ischaemic heart disease in women on multivariate analysis (adjusted 1.34; 0.70 to 2.56; P=0.38). Anxiety and subsequent ischaemic heart disease were not significantly associated in men or women. CONCLUSION: Depression may be an independent risk factor for ischaemic heart disease in men, but not in women.     

Coagulation factor VII and the risk of coronary heart disease in healthy men

Numerous investigations have demonstrated the role of thrombus formation in the pathogenesis of coronary heart disease (CHD). A tendency to thrombosis may also be indicated by elevated levels of coagulation factor VII clotting activity (FVIIc). Significant associations of FVIIc with increased coronary risk, however, have been found only in the Northwick Park Heart Study. Here we present the results of the 8-year follow-up of FVIIc measurements in 2780 healthy men of the Prospective Cardiovascular Münster study. In the study population (age at entry, 49.3 +/- 6.1 years, mean +/- SD), 130 CHD events occurred during follow-up. FVIIc was significantly higher in subjects with coronary events than in those without (112.4 +/- 20.1% vs 108.7 +/- 21.4%, P = .023). Compared with individuals without coronary events, FVIIc was not significantly higher in men with nonfatal events (111.7 +/- 20.4%; P = .196, n = 93), but there was a tendency toward higher FVIIc activity in subjects with fatal events (114.6 +/- 19.5%; P = .076, n = 37). In the multiple logistic regression analysis, we did not find FVIIc to be an independent risk factor for CHD, and the significance of FVIIc disappeared after total cholesterol, LDL-cholesterol, and triglycerides were taken into account. The increase in the number of CHD events through higher levels of FVIIc was more pronounced in the presence of additional cardiovascular risk factors: smoking; myocardial infarction events in family; angina pectoris; high levels of fibrinogen, total cholesterol, LDL cholesterol, and triglycerides; and a low level of HDL cholesterol. We conclude that FVIIc is a risk factor for CHD, especially in the presence of additional risk factors, and must be taken into account when assessing cardiovascular risk in men.