10 research outputs found
Carotid Artery Stenting-Induced Hemodynamic Instability
Purpose: To present a systematic review and meta-analysis investigating
the incidence of carotid artery stenting (CAS) induced hemodynamic
instability (HI) and to explore differences in periprocedural risk among
patients with and without CAS-associated HI.
Methods: Multiple electronic health databases were searched for all
articles published between January 2000 and December 2011 describing
CAS-associated hemodynamic instability. Twenty-seven studies with a
total of 4204 patients were analyzed, placing emphasis on the HI
incidence and its correlation with postprocedure morbidity and
mortality. A meta-regression analysis was conducted to investigate the
role of potential meaningful modifiers upon HI.
Results: The meta-analysis for overall HI rate showed a pooled
proportion of 39.4%. The pooled estimate for hypotension was 12.1%,
12.2% for bradycardia, and 12.5% for both hypotension and bradycardia.
Persistent HI was found to occur in a pooled rate of 19.2%. No
statistically significant differences were found between patients with
and without HI after CAS with respect to death, stroke, transient
ischemic attack (TIA), or major adverse events. The meta-regression
analysis revealed statistically significant associations of mean age
with HI, of <= 10-mm distance between the carotid bifurcation and the
site of minimum lumen diameter with bradycardia, and of prior
ipsilateral CEA with persistent HI.
Conclusion: CAS-induced HI occurs in a considerable percentage of
patients without increasing the perioperative risk. However, applying
the appropriate prophylactic measures and strictly monitoring blood
pressure and heart rate during the procedure and immediately after
should be encouraged for early recognition and correction of these
hemodynannic disturbances. J Endovasc Ther. 2013;20:48-6
Arterial Stiffness Assessed by Cardio-Ankle Vascular Index in Patients With Abdominal Aortic Aneurysm and Its Alterations After Treatment
Purpose: The aim of the present study was to investigate a potential difference on the arterial stiffness among aneurysm patients and non-aneurysm controls, as well as to explore potential changes between patients treated either with endovascular or open repair. Materials and Methods: A 110 patients with an infrarenal AAA were prospectively enrolled in this study. Fifty-six patients received an EVAR, whereas 54 patients received an open surgical repair. Moreover, 103 gender and age-matched subjects without AAA served as controls. The cardio-ankle vascular index (CAVI) was applied for measurement of the arterial stiffness. Results: CAVI values were statistically higher in the AAA patients when compared with control subjects. Although at 48 hours postoperatively the CAVI values were increased in both groups when compared to baseline values, the difference in CAVI had a tendency to be higher in the open group compared to the endovascular group. At 6 months of follow up the CAVI values returned to the baseline for the patients of the open repair group. However, in the endovascular group CAVI values remained higher when compared with the baseline values. Conclusion: Patients with AAAs demonstrated a higher value of CAVI compared to healthy controls. A significant increase of arterial stiffness in both groups during the immediate postoperative period was documented. The increase in arterial stiffness remained significant at 6 months in EVAR patients. Further studies are needed to elucidate the impact of a decreased aortic compliance after stentgraft implantation on the cardiac function of patients with AAA
Elevated Serum Leptin Levels: A Risk Factor for Non-Small-Cell Lung Cancer?
Objective: Leptin is intimately intertwined in the molecular
pathophysiology of several cancer types; with regard to lung cancer,
however, limited research has been conducted, with overall conflicting
results. Methods: The present case-control study comprises 66
non-small-cell lung cancer (NSCLC) cases and 132 healthy controls
matched for gender and age. Lifestyle, sociodemographic and medical
history information has been obtained in addition to body mass index
(BMI) measurements and weight change during the last 2 months. Serum
leptin and adiponectin levels were determined following a standard
protocol. Results: In multiple logistic regression analyses, elevated
serum leptin emerged as a risk factor for NSCLC independent of central
obesity, more pronounced after controlling for BMI and recent weight
loss (odds ratio = 4.58, 95% confidence interval: 1.94-10.82).
Additionally, smoking and animal foods consumption were strongly
associated with the disease, whereas plant foods consumption showed a
protective association. Conclusions: The observed higher serum leptin
levels in NSCLC cases might be attributed to direct or indirect effects
mediated by cancer-or cachexia-related cytokines. In line with the
growth-promoting properties of leptin in the lung tissue documented
elsewhere, increased serum leptin concentration may represent a
tumor-promoting event during non-small-cell lung carcinogenesis.
Copyright (C) 2008 S. Karger AG, Base
Validity of intraoperative gross examination of myometrial invasion in patients with endometrial cancer: a meta-analysis
Objective. The current recommended endometrial cancer surgical treatment
is abdominal extrafascial total hysterectomy with bilateral
salpingo-oophorectomy followed by pelvic lymphadenectomy if >50%
myometrial invasion is estimated by intraoperative gross examination
(IGE). This meta-analysis aims to quantify evidence regarding the
validity/predictive value of IGE staging compared with final histology.
Design. Meta-analysis of studies published until October 2011. Setting.
Systematic search, according to PRISMA guidelines, of the six major
medical literature databases Medline, Scopus, EMBASE, Google Scholar,
Ovid, Cochrane. Population. Sixteen eligible studies including 2567
endometrial cancer patients. Methods. Pooled sensitivity/specificity,
accuracy, negative/positive predictive value (NPV/PPV) and diagnostic
odds ratio (DOR) of IGE were calculated and the summary receiver
operator characteristic (sROC) curve was constructed. A meta-regression
analysis was used to explore the role of potential modifiers of
sensitivity and specificity. Main outcome measures. Pooled diagnostic
measures of IGE indices. Results. Sixteen studies (15 retrospective, one
prospective) meeting the inclusion criteria were qualitatively analyzed.
Pooled IGE estimates were: sensitivity = 0.75 (95%CI: 0.720.78),
specificity = 0.92 (95%CI 0.900.94), accuracy = 0.87 (95%CI 0.860.88),
NPV = 0.89 (95%CI 0.870.92), PPV = 0.80 (95%CI 0.760.84) and DOR =
36.9 (95%CI 28.747.4). No significant modifiers were identified for
sensitivity or specificity. Conclusions. The synthesized measures
presented here for the first time showed that accuracy, sensitivity and
specificity of IGE were 87, 75 and 92%, respectively, which indicates
that IGE is useful for estimating depth of myometrial invasion and
staging of endometrial cancer in clinical practice. The degree to which
the relatively low values of some of its performance indicators could be
improved remains to be elucidated in order for the values to be
comparable with those from frozen section biopsies
Arterial Stiffness Assessed by Cardio-Ankle Vascular Index in Patients With Abdominal Aortic Aneurysm and Its Alterations After Treatment
Purpose: The aim of the present study was to investigate a potential
difference on the arterial stiffness among aneurysm patients and
non-aneurysm controls, as well as to explore potential changes between
patients treated either with endovascular or open repair. Materials and
Methods: A 110 patients with an infrarenal AAA were prospectively
enrolled in this study. Fifty-six patients received an EVAR, whereas 54
patients received an open surgical repair. Moreover, 103 gender and
age-matched subjects without AAA served as controls. The cardio-ankle
vascular index (CAVI) was applied for measurement of the arterial
stiffness. Results: CAVI values were statistically higher in the AAA
patients when compared with control subjects. Although at 48 hours
postoperatively the CAVI values were increased in both groups when
compared to baseline values, the difference in CAVI had a tendency to be
higher in the open group compared to the endovascular group. At 6 months
of follow up the CAVI values returned to the baseline for the patients
of the open repair group. However, in the endovascular group CAVI values
remained higher when compared with the baseline values. Conclusion:
Patients with AAAs demonstrated a higher value of CAVI compared to
healthy controls. A significant increase of arterial stiffness in both
groups during the immediate postoperative period was documented. The
increase in arterial stiffness remained significant at 6 months in EVAR
patients. Further studies are needed to elucidate the impact of a
decreased aortic compliance after stentgraft implantation on the cardiac
function of patients with AAA
Insulin resistance: an independent risk factor for lung cancer?
Insulin resistance is closely associated with numerous metabolic
disorders. Although studies have supported the importance of insulin
resistance in carcinogenesis, the existing data have not established its
relevance in the context of lung cancer. The aim of the present
case-control study was to evaluate the association between insulin
resistance and lung cancer after adjusting for possible confounders.
Homeostasis model assessment of insulin resistance (HOMA-IR) and serum
leptin and adiponectin levels were determined in 81 lung cancer cases
and 162 age-and sex-matched controls; anthropometric and lifestyle
variables were recorded. Mean HOMA-IR in the cases was more than 2-fold
higher compared with the mean value of controls (P < .001). Among
controls, HOMA-IR correlated positively with serum leptin (r = 0.16; P =
.04), body mass index (r = 0.43; 13 = .0001), and waist-to-hip ratio (r
= 0.21; P = .01) but negatively with serum adiponectin (r = -0.29; P =
.0002). As expected, smoking was associated with an approximately
10-fold increase in lung cancer risk in multiple logistic regression
models. A positive association between HOMA-IR, treated as continuous
variable, and lung cancer (odds ratio [OR] = 1.52, 95% confidence
interval [CI]: 1.16-1.99, P = .002, model 1) was demonstrated, which
persisted after adjustment for somatometric and lifestyle variables (OR
= 2.36, 95% CI: 1.00-5.55, P =.05, model 2). When serum adiponectin was
also taken into account, the association seemed fairly robust (OR =
2.58, 95% CI: 1.11-6.01, P = .03, model 3); on the contrary, when serum
leptin was added, the association remained positive, but lost its
statistical significance (OR = 1.76, 95% CI: 0.78-3.98, P = .17, model
4). In the fully adjusted model, HOMA-IR was still positively, but only
marginally, associated with lung cancer risk (OR = 2.02, 95% CI:
0.88-4.65, P = .10, model 5). Insulin resistance may represent a
meaningful risk factor for lung cancer. (C) 2011 Elsevier Inc. All
rights reserved
Statins Influence Long Term Restenosis and Cardiovascular Events Following Carotid Endarterectomy
Objective: To evaluate the impact of statins on carotid restenosis (CR)
>50% and future cardiovascular events (CVE), in patients undergoing
carotid endarterectomy (CEA).
Methods: 570 consecutive patients (656 CEAs) operated between 1990 and
2009, were included in this retrospective study. The study cohort was
followed for an average of 82 months (median 80, range 12180 months).
Endpoints were the development of CR >50%, the occurrence of CVE
(myocardial infarction, stroke) and overall mortality. Kaplan-Meier
curves and Cox regression models were used to assess outcomes.
Results: 92 restenosis events were recorded. Freedom from restenosis
>50% at 5, 10 and 15 years of follow-up was 92, 82 and 69%,
respectively. Compared with statin-receivers, statin-free patients had a
significantly higher 15-year restenosis rate (41 vs 10%; P = .001), a
significantly higher CVE rate (49 vs 14%; P = .001) and a significantly
higher mortality rate (24 vs 18%; P = .034). Adjusting for other
covariates statins were independently associated with lower restenosis
rate (hazard ratio [HR], 0.52; 95% CI, 0.31-0.88; P = .016),
cardiovascular events (HR, 0.40; 95% CI, 0.26-0.61; P < 0.001) and
long-term mortality (HR, 0.56; 95% CI, 0.33-0.95; P = .032).
Conclusion: Statins not only reduce cardiovascular events and mortality
but may also have an important effect on the anatomic durability of CEA.
These data support the use of statins in patients with carotid stenosis
undergoing CEA