Sagittal abdominal diameter may effectively predict future complications and increased mortality in intensive care unit patients with severe sepsis.

PURPOSE: To investigate whether increased visceral adipose tissue is a risk factor for increased morbidity and mortality in intensive care patients with severe sepsis. MATERIALS AND METHODS: In this prospective cohort study, body mass index (BMI) and sagittal abdominal diameter (SAD) were measured in all patients with severe sepsis immediately after admission in the intensive care unit (ICU). The patients were followed up until death or discharge from ICU. The study's primary outcome measure was mortality until day 60 after admission, while secondary outcomes were morbidity, length of stay, and length of ventilation in ICU. RESULTS: Of the 30 patients, 24 (80%) developed septic shock, 6 (20%) multiple organ dysfunction syndrome, 13 (43.3%) necessitated continuous venovenous hemodiafiltration, while 6 (20%) of them died. BMI and SAD had a statistically significant positive linear correlation with ICU length of stay (P < .001) and length of ventilation (P ≤ .001). However, only SAD was significantly correlated with the development of multiple organ dysfunction syndrome (P = .033), the need for continuous venovenous hemodiafiltration (P = .004), and death (P = .033). CONCLUSION: An increased SAD may effectively predict future complications and increased mortality in intensive care unit patients with severe sepsis.

High prevalence of subclinical peripheral artery disease in Greek hospitalized patients.

BACKGROUND: Peripheral artery disease (PAD) represents a common manifestation of systemic atherosclerosis that is associated with an increased risk of cardiovascular death and ischemic events but one that may be underdiagnosed in clinical practice. The purpose of this study was to identify PAD using the ankle-brachial index (ABI) in hospitalized patients from a Department of Internal Medicine and to further investigate the association of this index with traditional cardiovascular risk factors. METHODS: We measured ABI in 990 consecutive patients (400 men and 590 women) aged 50 years or older (71.2+/-9.1) without a history or symptoms suggestive of PAD. ABI values below 0.90 were considered abnormal. RESULTS: PAD was detected in 356 patients (36%), and men had a higher prevalence than women (p<0.001). Hypertension (p<0.001), smoking (p<0.001), diabetes (p<0.05), male sex (p<0.001), and dyslipidemia (p<0.05) were statistically more frequent in patients with PAD, whereas obesity had no significant relation to PAD in our series. In a stepwise, logistic regression analysis, hypertension, male sex, diabetes mellitus, smoking, and dyslipidemia were found to be independent risk factors with odds ratios (95% confidence intervals) of 2.46 (1.85-3.27), 2.25 (1.66-3.05), 1.80 (1.32-2.47), 1.78 (1.31-2.42), and 1.64 (1.22-2.19), respectively. CONCLUSIONS: A simple ABI measurement revealed a large number of patients with unrecognized PAD. It is, therefore, recommended that ABI measurement should be included in the evaluation of cardiovascular risk in hospitalized patients aged 50 years or older.

A case of acute pancreatitis possibly associated with combined salicylate and simvastatin treatment.

CONTEXT: Drug-induced acute pancreatitis is a rather rare clinical entity. From time to time, several cases have been reported in which statins or salicylates have been associated with the development of acute pancreatitis. There is only one report which implies the involvement of both drugs in pancreatic inflammation. CASE REPORT: A 58-year-old Caucasian male with a history of coronary heart disease and hypercholesterolemia, under treatment with acetyl-salicylate for 6 years and simvastatin for 2 months, presented to the Emergency Department of our hospital with epigastric pain and vomiting of 24-hour duration. The clinical and laboratory investigation led to the diagnosis of acute pancreatitis. Conservative and rich-in-fluid treatment resulted in clinical and laboratory amelioration, and the patient was discharged on day 15, after full restoration of his health. In our patient, all possible common causes of acute pancreatitis were excluded. CONCLUSION: Conclusion It is a rational assumption to connect this case to the co-administration of simvastatin and acetyl-salicylate. However, the pathophysiological mechanism behind the onset of acute pancreatitis due to a statin, or, even more, due to its combination with salicylate, remains vague.