“HAR/S”, the Product of Heart Rate, Age, and Respiratory Rate Divided by Systolic Blood Pressure, as a New Index for Detecting Infection in Patients with Impaired Consciousness / 日本農村医学会雑誌

Infection is a known cause of impaired consciousness. Sometimes, the absence of fever delays diagnosis and treatment of infections in patients with impaired consciousness. This study aimed to identify a better index than body temperature for detecting infection in patients with impaired consciousness by using area under the receiver operating characteristic (AUROC) curves (≥ 0.7 was significant) and stratum-specific likelihood ratios (SSLRs, ＜0.2 or ＞5 was significant) according to patients’ vital signs (blood pressure, heart rate, body temperature, respiratory rate, and SpO2) or age. Of the 1,853 consecutive patients with impaired consciousness aged ≥15 years who were transported to our hospital between 2011 and 2014, 451 (24.3％) had infection. The AUROC for body temperature was 0.701 for diagnosing infection, whereas the AUROCs for other vital signs were ＜ 0.7. Because no strata of body temperature showed values ＜ 0.2 for diagnosing infection, we could not exclude infection in patients with impaired consciousness with low body temperatures. Next, we developed a novel index called HAR/S, the product of heart rate (beats/min), age (years), and respiratory rate (breaths/min) divided by systolic blood pressure (mmHg). The AUROC for HAR/S was 0.809 for diagnosing infection; this value was higher than that for body temperature; the SSLR for HAR/S ＜700 was 0.190 for diagnosing infections, which was ＜0.2. HAR/S ≥700 can be a new index for detecting infections in patients with impaired consciousness regardless of their body temperature, with sensitivity, specificity, and negative predictive values of 0.911, 0.468, and 0.941, respectively.

Surgical Management of Abdominal Aortic Aneurysm Complicated with Ischemic Heart Disease / 日本心臓血管外科学会雑誌

We studied the incidence of associated ischemic heart disease (IHD) among 143 consecutive patients (male 118, female 25, mean age 68.5±6.9 years) operated upon for abdominal aortic aneurysm (AAA), excluding ruptured aneurysms. The screening of IHD was routinely performed by using dipyridamole thallium scintigraphy, and when it was positive, the lesion was further confirmed by selective coronary angiography. More than 50% luminal stenosis of the major coronary arteries was judged positive for IHD. Sixty-two patients (43%) with AAA were simultaneously afflicated with IHD. We also compared the 62 AAA patients with IHD with the remaining 81 AAA patients in this series. The patients with IHD had higher incidences of risk factors such as diabetes mellitus (<i>p</i>=0.0031) and hyperlipidemia (<i>p</i>=0.0029) than those without IHD. Five patients were operated on for AAA after coronary artery bypass grafting (CABG), 11 were operated on for AAA and IHD (CABG) simultaneously, 10 were operated on after PTCA, thirty-two patients underwent elective surgery for AAA and four had emergency procedures due to impending rupture of AAA with continuous infusion of nitroglycerin with or without diltiazem. There was no significant difference in surgical mortality between AAA patients with IHD and those without IHD (3%vs2%), and no cardiac death in this series. When both AAA and IHD are severe enough to warrant surgical treatments at the earliest opportunity, we recommend concomitant operations for AAA and IHD (CABG) since these have been performed quite successfully in our series.

Surgical Management for Arteriosclerosis Obliterans Complicated with Ischemic Heart Disease / 日本心臓血管外科学会雑誌

We studied the incidence of associated ischemic heart disease (IHD) among 110 consecutive patients (males 99, females 11, mean age 66.0±8.8 years) operated upon for arteriosclerosis obliterans (ASO). The screening of IHD was routinely conducted by using dipyridamole thallium scintigraphy, and when results were positive, the lesion was further confirmed by selective coronary angiography. More than 50% luminal stenosis of the major coronary arteries was judged as positive for IHD. Forty-eight patients (44%) of ASO were simultaneously afflicted with IHD. Ten patients were operated on for ASO after coronary artery bypass grafting (CABG), five for ASO and IHD (CABG) simultaneously, eight for ASO after PTCA. Twenty-five patients underwent surgery for ASO only with infusion of nitroglycerin, with or without diltiazem. We also compared 15 patients with thrombotic obliteration at the end of the abdominal aorta o: Leriche's syndrome with the remaining 95 patients in this series. The patients with Leriche's syndrome were younger and had higher incidences of hyperlipidemia (<i>p</i>=0.0254) and IHD (<i>p</i>=0.0225) than those without Leriche's syndrome. In surgical treatment for ASO, particularly for Leriche's syndrome, meticulous attention to complications is needed due to the frequent association of IHD. When both ASO and IHD are severe enough to warrant surgical treatment at the earliest opportunity, we recommend concomitant operations for ASO and IHD (CABG).