Association of Mammary Gland Disease With Metabolic Syndrome Factors in Japanese Women-Case-Control Study Based on Health Screening Results.

Background: The association of obesity with breast cancer is clear. Although body mass index (BMI) is used as an indicator of obesity, its accuracy remains questionable. Although, there factors for diagnosing metabolic syndrome are caused by obesity, the association with breast cancer has not been clarified. Methods: Women who underwent breast cancer screening with mammography and measurements of metabolic syndrome factors, including waist circumference, blood glucose, triglycerides, HDL (high-density lipoprotein) cholesterol levels, and systolic and diastolic pressure, twice within a 2-year period were enrolled (n = 314), with a final sample size of 256. To determine the presence of mammary gland disease, 2 expert physicians interpreted radiogram findings, with category 3 or higher shown by mammography considered to indicate an abnormality. Results and Conclusions: Waist circumference at the initial measurement was marginally significant as a risk factor for onset of mammary gland disease (odds ratio [OR] = 1.036, P = .045) and thus was concluded to be a risk factor for disease onset. Although not significant, a 2-year increase in systolic and diastolic blood pressure has been presumed to be risk factors (systolic: OR = 1.020, P = .085, diastolic: OR = 1.040, P = .065), while high levels of HDL cholesterol have been presumed to protect against the disease (OR = 0.982, P = .064). Based on these results, waist circumference and blood pressure are speculated to be related to development of mammary gland disease.

Poor survival of dialysis patients with unhealed wounds because of critical limb ischemia: Limb salvage and survival requires wound healing.

Maintenance of blood flow in the wound area is required to heal wounds of critical limb ischemia (CLI) in dialysis patients. However, many dialysis patients have both a stenotic lesion in below-knee blood vessels and a cardiovascular event as complications, and thus, it may be difficult to ensure sufficient blood flow. Therefore, many deaths occur because of problems with wound healing. The aim of this study is to identify the optimal treatment, including revascularisation and amputation, from the perspective of wound healing by analysing the survival of hemodialysis patients with CLI who had healed or unhealed wounds in a lower extremity. The subjects were 52 patients who received maintenance dialysis at our clinic, including 27 with healed CLI wounds and 25 with unhealed CLI wounds. The Kaplan-Meier method was used to compare survival between the two groups. Multivariate analysis was conducted to examine the effect of an unhealed wound on mortality. The mean follow-up period was 1.7 ± 1.1 years. In the unhealed wound group, the 1-, 2-, and 3-year survival rates were 48%, 20%, and 12%, respectively. The overall survival rate was significantly lower in the unhealed wound group compared with the healed wound group (12% vs 63%, P = .0002 by log-rank test). In multivariate analysis, unhealed CLI wounds had a significant independent association with mortality (hazard ratio 3.32; 95% confidence interval [CI]: 1.41-8.77, P = .0054). In this study, the 3-year survival rate suggested a significantly poorer prognosis of hemodialysis patients with unhealed CLI wounds compared with those with healed wounds. An unhealed wound is an independent risk factor for mortality in hemodialysis patients with CLI.

Use of Beta-Blockers on Maintenance Dialysis Patients and Ischemic Cerebral and Cardiovascular Deaths: An Examination Using Propensity Score.

Beta-blockers are frequently used in dialysis patients because of their cardioprotective properties. However, the effect of beta-blockers on reducing dialysis mortality has not been sufficiently examined to date. Thus, we sought to examine the effects on cardiovascular prognosis of beta-blockers using our outpatient dialysis database. From 389 dialysis patients registered in our database, subjects taking beta-blockers were extracted and matched with patients not taking beta-blockers using propensity scores based on 39 variables. Cardiovascular mortality, mortality of heart failure/sudden cardiac death, and mortality of ischemic cerebral and cardiovascular death were estimated using Kaplan-Meier method, and a log-rank test was used to analyze the difference between these survival curves for significance. A total of 216 patients, 108 matched pairs, were extracted from the whole cohort. There was no difference in background factors between the two groups. During mean observation periods of 4.4 years, 76 patients died, including 51 cases of cardiovascular death. Cardiovascular deaths included 30 heart failure/sudden deaths and 13 ischemic cerebral and cardiovascular deaths. For both cardiovascular and heart failure/sudden death, the survival curves did not indicate a significant difference between the 2 groups. On the contrary, in case of ischemic cerebral and cardiovascular deaths, 11 patients died in the beta-blocker group, with a significantly poor prognosis observed in the survival curve (p = 0.0132). Through the use of beta-blockers, a significant increase in ischemic cerebral and cardiovascular deaths was observed. The administration of beta-blockers to dialysis patients was found to worsen the cardiovascular prognosis, so sufficient examination will be needed in the future.

Efficacy of antihistamines on mortality in patients receiving maintenance hemodialysis: an observational study using propensity score matching.

Antihistamines are widely used to treat pruritus in patients receiving hemodialysis. In a previous cross-sectional study, we reported an association between antihistamine use and the absence of eccentric cardiac hypertrophy in patients receiving hemodialysis. Therefore, in this study, we sought to evaluate the efficacy of antihistamines on all-cause and cardiovascular mortality in patients receiving hemodialysis according to our outpatient dialysis database. We used a propensity score matching method. Among the 389 patients receiving hemodialysis according to our database, we extracted those taking antihistamines and matched them with patients not taking antihistamines using propensity scores based on 38 variables. All-cause mortality and cardiovascular mortality were estimated by the Kaplan-Meier method, and a log-rank test was used to examine the differences between the survival curves. We included 154 patients, or 77 matched pairs, from the entire cohort (c-statistic = 0.78, p < 0.0001). There were no differences in any background factor between the antihistamine and non-antihistamine group. During the mean observational period of 5.4 years, 50 patients died, and the all-cause mortality rate was 27.3% (21 patients) in the antihistamine group and 37.3% (29 patients) in the non-antihistamine group (p = 0.0314). The cardiovascular mortality rate was 16.9% (13 patients) in the antihistamine group and 25.9% (20 patients) in the non-antihistamine group (p = 0.0417). The results of this study suggest that all-cause and cardiovascular mortality improved with antihistamine use in patients receiving hemodialysis. However, the clinical efficacy of antihistamines needs to be confirmed in a prospective randomized study in the future.

Prediction of Development of Critical Limb Ischemia in Hemodialysis Patients.

Hemodialysis (HD) patients with critical limb ischemia (CLI) suffer chronic inflammation and repeated infection, require intervention, and may have a protracted hospital stay. Therefore, early prediction is particularly important for management of CLI in patients with suspected peripheral artery disease. The purpose of this study is to develop a simple score for predicting the incidence of CLI in HD patients with suspected peripheral artery disease. The subjects were 139 asymptomatic patients receiving maintenance HD and with ABI <1.0. Multivariate logistic regression analysis was used to identify factors associated with development of CLI. These factors were subsequently weighted and integrated into a scoring system for the prediction of onset of CLI. Twenty-five patients had onset of CLI. Five factors selected from the multivariate model were weighted proportionally using their respective odds ratio (OR) for incidence of CLI (history of cerebral vascular disease, OR 6.42 [3 points]; diabetes, OR 3.92 [2 points]; hypoesthesia, OR 4.21 [2 points]; left ventricular ejection fraction <50%, OR 3.89 [2 points]; serum albumin <3.5 g/dL, OR 4.39 [2 points]). Three strata of risk were defined (low risk, 0 to 3 points; intermediate risk, 4 to 6 points; and high risk 7 to 11 points) with excellent prognostic accuracy for progression to CLI using the Kaplan-Meier method. Five factors were identified that increased the risk of progression to CLI in HD patients with suspected peripheral artery disease. A combination of those factors permitted establishment of three risk strata for accurate prediction of onset of CLI.

Left atrial dilatation and ST-T changes predict cardiovascular outcome in chronic hemodialysis patients.

The left atrium (LA) is afterload-sensitive, meaning that it responds to changes in left ventricular diastolic pressure, and left atrial volumetric remodeling has been reported. We prospectively examined the effects of LA enlargement and ST-T changes on cardiovascular outcome of chronic hemodialysis (HD) patients. Echocardiography was performed twice, a mean interval of 2.1 ± 0.4 years apart, and LA size, left ventricular mass index (LVMI), and other indices were evaluated. The prognostic value of ST-T changes and LA dilatation for cardiovascular events was investigated in a cohort of 112 HD patients. The LVDd, interventricular septum thickness, fractional shortening, and LVMI values were higher in the HD patients with ST-T changes and LA dilatation at the second echocardiography. Moreover, LV hypertrophy (LVH) and new cardiovascular events were more common in HD patients with both ST-T changes and LA dilatation (p = 0.0127). Interdialysis weight gain, presence of ST-T changes and LA dilatation, and use of calcium channel blockers were significantly associated with LVH, and the odds ratios were 1.740, 2.870, and 0.304, respectively. Over a mean follow-up period of 2.1 ± 0.4 years, 27 patients experienced new cardiovascular event. A Cox proportional hazard analysis revealed that complication of coronary artery diseases, the presence of ST-T changes and LA dilatation, and serum albumin levels were significantly associated with incident cardiovascular events, and the hazard ratios were 3.898, 5.182, and 0.185 (1 g/dl per year increase), respectively. In a Kaplan-Meier analysis, incident cardiovascular events were significantly less common in HD patients without ST-T changes and LA dilatation than those with (p < 0.0001), 50% event-free period was about 2 years in HD patients with ST-T changes and LA dilatation. In conclusion, ST-T changes and LA dilatation predict the cardiovascular outcome of chronic HD patients. Detecting ST-T changes on ECG and LA dilatation is useful for monitoring cardiovascular risk in chronic HD patients.

The use of H1-receptor antagonists and left ventricular remodeling in patients on chronic hemodialysis.

Suppression of left ventricular (LV) remodeling secondary to heart failure seems critical to improve the prognosis of hemodialysis (HD) patients. This is a retrospective study on the relationship of an antiallergic drug and antihistamines with LV hypertrophy. A total of 149 patients (88 males and 61 females) were entered in the study. Mean age was 66.7 years and mean duration of dialysis 14.4 years. Twenty-three patients received oral treatment with an antiallergic drug or second-generation antihistamines, 3 with the antiallergic drug and 20 with antihistamines. The multivariate analysis using LV mass index (LVMI) as the objective variable extracted the following independent factors: male sex, erythropoietin (EPO)/w, uric acid (UA), total cholesterol, antihistamines, antiallergic drug, and calcium channel blocker (CCB), with a standard regression coefficient of 0.187, 0.196, 0.212, -0.262, -0.215, -0.149 and -0.173, respectively. This study suggests a suppressive role of second-generation antihistamines on LV remodeling. Male sex, high-dose EPO/w, and elevated UA were considered as aggravating factors, and CCB as a suppressive factor.

PEG with introducer or pull method: a prospective randomized comparison.

BACKGROUND: PEG by the conventional pull method has the potential drawback of being associated with a higher frequency of wound infection, presumably caused by contamination of the gastrostomy catheter as it passes through the oral cavity. This study investigated the occurrence of peristomal wound infection after PEG placement by using the pull and introducer techniques. METHODS: Between September 1999 and May 2002, consecutive patients with dysphagia for whom PEG was recommended were enrolled in the study and randomly assigned to two groups: PEG with the introducer method (Group I) or PEG with the pull method (Group II). The peristomal area of each patient was evaluated on a daily basis for one week after PEG. Erythema and exudate were scored on a scale from 0 to 4 and induration on a scale of 0 to 3. Criteria for infection were a maximum combined score of 8 or higher, or the presence of microscopic and microbiologic evidence of suppurating exudate. In each group, the endoscope was passed once during the procedure, and an antibiotic (piperacillin) was given prophylactically. All procedures were performed by one investigator with the assistance of another physician. RESULTS: Of the 60 patients enrolled, 30 were assigned to each group. PEG was successful in all patients. One patient was excluded from each group because of death (Group I, stroke; Group II, myocardial infarction) within one week of the procedure. Therefore, 58 patients, 29 in each group, were evaluated. There was no significant difference between the groups in terms of clinical parameters (age, gender, disease, performance score, mode of previous feeding, and recent antibiotic exposure). The occurrence of peristomal infection within one week of PEG was lower in Group I (introducer method) (0 vs. 9; p = 0.00094). The mean daily combined scores in Group I were significantly lower than those in Group II. Median of maximum parameter scores in Group I were significantly lower than those in Group II. There were no procedure-related mortalities or clinically significant wound infections that required surgical intervention. CONCLUSIONS: The risk of peristomal wound infection after PEG is lower with the introducer method compared with the pull method.