Perioperative stroke in coronary artery bypass patients.

BACKGROUND AND AIMS: Stroke has remained one of the most frustrating complications in coronary artery bypass surgery (CABG). The purpose of this study was to describe the incidence and correlates of stroke in CABG patients operated on in a hospital with low annual volume of open-heart surgery procedures. The aim was moreover to clarify subsequent outcome and self-reported satisfaction-based quality of life of patients who had experienced a stroke. MATERIAL AND METHODS: The material was a cohort of 1318 consecutive CABG patients operated on over a 6-year period. Data was collected prospectively but the final analysis was retrospective. Questionnaires supplemented the estimation of survival and subsequent functional status. RESULTS: The incidence of stroke was 2.6 %. Age > 70 years, chronic obstructive pulmonary disease (COPD), peripheral vascular disease (PVD), cerebral vascular disease (CVD), number of aortic anastomoses and significant atherosclerosis of the ascending aorta were univariate predictors of stroke. Postoperative stroke was experienced in 55.9% of cases delayed appearing from 2nd postoperative day on. Stroke patients had a higher rate of mortality (14.7% vs. 1.0%, p = 0.001) and poorer survival than no-stroke patients (82.4% and 97.4% at one year and 61.2% and 89.7% at six years, p < 0.001). CONCLUSIONS: The incidence of stroke seems to be on the same level in CABG patients from a low volume hospital as in reports from centres with a high volume of annual procedures. Stroke predicts higher mortality, longer intensive care unit (ICU) stay, longer hospitalisation and poorer survival. A relatively high number of stroke patients need permanent institutional care. Satisfaction-based quality of life in CABG patients also remains on a lower level in comparison to patients without neurological complications.

Peripheral vascular disease as predictor of outcome after coronary artery bypass grafting.

BACKGROUND AND AIMS: Understanding and objective assessment of risks is crucial in cardiac surgery. The aim of this study was to assess the influence of peripheral vascular disease (PVD) on morbidity, mortality and outcome in coronary artery bypass grafting (CABG) patients. MATERIAL AND METHODS: The ankle-brachial pressure index (ABPI) was used as indicator of PVD and was measured in 178 CABG patients. Two groups were established: 1. normal ABPI (0.9-1.3) (n = 136) and 2. lowered ABPI (< 0.9) (n = 35). The mean follow-up was 26 months. RESULTS: The presence of PVD was 20.5 %. Patients with PVD were older (p < 0.05), more often of female sex (p < 0.05), had higher Higgins's risk score (p = 0.001) and more often intermittent claudication (IC) (p < 0.001). PVD significantly predicted atrial fibrillation (FA) (p < 0.05) and relatively postoperative myocardial infarction (MI) (p = 0.058). CONCLUSIONS: The presence of PVD is relatively high in CABG patients and increases with age. PVD predicts some morbidity but seems to have fairly little influence on short-term or middle-term outcome of CABG patients. ABPI may be of only limited value in identifying patients with high operative risk in CABG.

Use of obstetric forceps in Finland today--experience at Vaasa Central Hospital 1984-1998.

BACKGROUND: Forceps delivery has become rare in Finland since the introduction of the vacuum extractor. Our aim was to survey the number of forceps deliveries in Finland and analyze our own material of 130 forceps deliveries during a 15-year period between 1984 and 1998. During this period there were 17,887 deliveries at Vaasa Central Hospital. METHODS: A retrospective study of 130 forceps deliveries and 11 trial forceps cases, which subsequently resulted in a cesarean section. RESULTS: There was no maternal or neonatal mortality. In 39 cases a cesarean section could be avoided by use of forceps after a failed vacuum extraction. Only in one case was maternal morbidity regarded as serious. There was no serious neonatal morbidity. Anal sphincter ruptures occurred in three cases (2.3%). All the women in the trial forceps group were nulliparous, in 73% of these the fetus was in a persistent occipito-posterior position. Failed vacuum extraction and trial forceps did not significantly influence neonatal outcome. CONCLUSIONS: Forceps delivery appears to be a safe alternative in our setting.

Intrapartum sonography and persistent occiput posterior position: a study of 408 deliveries.

OBJECTIVE: To use intrapartum sonography as a tool to investigate the development of the persistent occiput posterior position during labor, as well as to identify parameters correlating with the outcome of labor. METHODS: A prospective study of 408 women in labor after 37 weeks' gestation with a singleton fetus in a vertex position using sonography at the onset of labor was performed. Fetal position, placental location, and maternal BMI (body mass index) were recorded. Outcome of labor was monitored for all relevant parameters. RESULTS: Most (68%) of persistent occiput posterior positions develop through a malrotation during labor from an initially occipitoanterior position. Only 32% of persistent cases were occipitoposterior (dorsoposterior) at the onset of labor; operative interventions were required in 87.5% of these. Of the 61 (15%) occipitoposterior positions at the onset of labor, 53 (87%) rotated into an occiput anterior position. Persistent occiput posterior position was more common in the initially occipitoposterior group (P < 0.01, Fisher exact test), and posterior placental locations were fewer (z test, P = 0.05). Also, operative deliveries were more common in the group remaining occipitoposterior throughout labor (P < .01, Fisher exact test). A higher maternal BMI correlated with neonatal weight (P < .01, Pearson correlation), an increase in operative deliveries (P = .032, Pearson correlation), lower Apgar scores at 1 minute (P = .02, Spearman correlation), and increase in posterior placental locations (P = .037, two-tailed t test). CONCLUSION: In most cases, persistent occiput posterior position develops through a malrotation and only in a little more than one-third of cases through absence of rotation from an initially occipitoposterior position. Higher maternal BMI correlates with higher fetal weight, increased operative deliveries, lower Apgar scores at 1 minute, and posterior placental locations. Intrapartum sonography proved to be useful in investigating the development of the persistent occipitoposterior position.

The nutritional status of Finnish home-living elderly people and the relationship between energy intake and chronic diseases.

The nutritional status and the impact of non-progressive chronic diseases on energy intake were determined in 90 home-living people aged from 73 to 94 years. The nutritional status was assessed by dietary, anthropometric, biochemical and haematological methods. Energy intake (6.0, SD 1.7 MJ) in women was low compared with the Nordic Nutrient Recommendation but in men it (8.0, SD 2.1 MJ) was in keeping with this recommendation. Despite the low energy intake the mean BMI value of women was moderately high (27, SD 5.3 kg/m2). In men the mean was 26, SD 4.0 kg/m2. The intakes of vitamins and minerals met the recommendation, except for those of folic acid and zinc. The blood levels of both these two nutrients were within reference limits. Men suffering from chronic diseases received less (p < 0.015) energy (7.5, SD 1.76 MJ) than other men (8.9, SD 2.0 MJ). This relationship was not found in women. In conclusion, the nutritional status of people aged over 70 years old living at home was good. The presence of chronic diseases affected the energy intake in men but not in women.