Smoking as a risk factor for wound healing and infection in breast cancer surgery.

AIM: Clinical studies suggest that smoking is associated with wound necrosis after breast cancer surgery. However, the significance of smoking as a risk factor for wound infection, skin flap necrosis, and epidermolysis when adjusting for other potential risk factors remains to be studied. METHODS: From June 1994 through August 1996, 425 patients underwent breast cancer surgery as simple mastectomy, modified radical mastectomy, or breast conserving surgery. The patients were evaluated postoperatively for wound infection, skin flap necrosis, and epidermolysis. Association between these complications and 17 patient, operative, and postoperative variables were analysed by three separate multiple logistic regression analyses. RESULTS: When compared to non-smoking, smoking was significantly associated with wound infection after all types of surgery (light smoking (1-14 grams per day): [odds ratio (OR)=2.95, 95% confidence interval (95% CI)=1.07-8.16], and heavy smoking (>/=15 grams per day): OR=3.46 (1.52-7.85). A similar significant association was found as regards skin flap necrosis and epidermolysis after simple mastectomy and modified radical mastectomy: both light and heavy smoking were predictive for skin flap necrosis: light smoking: OR=6.85 (1.96-23.90), heavy smoking: OR=9.22 (2.91-29.25) and for epidermolysis: light smoking: OR=3.98 (1.52-10.43) and heavy smoking: OR=4.28 (1.81-10.13). No significant dose-response relation was disclosed. Other risk factors and confounders associated with complicated wound healing were adjusted for in the analysis: diabetes, obesity, alcohol, NSAIDs, duration of surgery, and surgical experience. CONCLUSION: Independent of other risk factors, smoking is predictive for post-mastectomy wound infection, skin flap necrosis, and epidermolysis.

[Double contrast arthrography as a screening method of suspected meniscal lesions]. / Dobbeltkontrastartrografi som screeningsundersøgelse ved mistanke om menisklaesion.

On reevaluation after one year of experience with double-contrast-arthrography (DCA) we found in 83 consecutive patients with suspected meniscal lesion a true positive diagnostic frequency of 0.84, a true negative diagnostic frequency of 0.75, a true positive nosografic frequency of 0.87 and a true negative nosografic frequency of 0.70. This gives an increased diagnostic accuracy compared to the initial evaluation of the arthrografies. No complications of the examination were registered. As DCA demands fewer resources than arthroscopy, this method is suggested as a screening procedure in patients with possible tears of the menisci.

High density lipoprotein cholesterol and arteriography in intermittent claudication.

Overnight fasting plasma lipoprotein and lipid concentrations were measured in a group of 76 patients with peripheral arterial disease (PAD)--main symptom: intermittent claudication--and compared to those of 21 controls, matched with the patients according to age, sex, body-mass index, alcohol and tobacco consumption, but without any signs of peripheral arterial disease. Significantly lower median values of high density lipoprotein cholesterols (HDL-C) (P less than 0.01), and significantly higher median values of low density lipoprotein cholesterols (LDL-C) (P less than 0.05) were found in the PAD group. The results also showed significantly lower ratios of HDL-C/LDL-C and HDL-C/total cholesterol in the PAD group when compared to the controls (both P less than 0.005). No significant differences were demonstrated concerning very low density lipoprotein, total cholesterol, or triglyceride plasma concentrations. Evaluation of arteriograms showed a significant negative correlation between HDL-C concentrations and the extent of arteriosclerotic lesions in the lower extremities (P less than 0.05). Thus, not only were the HDL-C and LDL-C levels different in the PAD group, but we also found a correlation between HDL-C and the severity of vascular disease.

Relation of serum lipoproteins and lipids to the ABO blood groups in patients with intermittent claudication.

UNLABELLED: In the present study we investigated the serum lipoprotein and lipid levels in patients with intermittent claudication (n = 66), divided according to their blood groups in the ABO system (bloodtype A, n = 40 and bloodtype "non-A", n = 26). We again found the expected predominance of blood type A (61%). However, we found no significant differences in any of the biochemical variables between patients belonging to blood group A and "non-A". Fifty-seven of the patients had arteriographies done and the arteriograms were evaluated blindly by a radiologist according to occlusive and stenotic atherosclerotic lesions. However, as previously suggested by other investigators, we were not able to demonstrate any significant differences between the number of occlusions and stenotic lesions when dividing the patients into blood group A and "non-A". The biochemical differences between patients with either occlusive or stenotic atherosclerotic lesions were also tested and found without any significance. IN CONCLUSION: the serum lipoprotein and lipid levels in the present study do not give an obvious explanation, why patients with blood group A seem more liable to develop atherosclerosis than those with blood group "non-A".

Calculi in female urethral diverticulum.

A case of two calculi found in the same urethral diverticulum in a 41-year-old woman with recurrent urinary tract infections is reported. The diagnostic procedures are discussed.

The effect of a serotonin antagonist ketanserin on acute urinary retention.

The serotonin antagonist ketanserin has in a single case been found effective in promoting bladder emptying in a patient with first time acute urinary retention on basis of benign prostatic hypertrophy. The mechanism behind is probably an alpha-receptor blockade.

Hip fractures in previously amputated patients.

In four previously amputated patients with hip fractures, the ratios between the mean thickness of the femoral cortex and the total width of the femoral shaft in two patients with a low degree of prior mobilization (0.03 and 0.07) are compared to those of two formerly fully ambulatory patients (0.17 and 0.31). These are then compared to the ratios in a group of twenty age-matched and previously normal, non-amputated patients with hip fractures (median 0.23, range: 0.16-0.29). The obvious difference between the ratios of those patients who suffered perioperative problems, and those who did not, appears to be related to the degree of prior mobilization.