Superabsorbent dressings for copiously exuding wounds.

Exudate control is important in the management of both acute and chronic wounds. A new category of absorbent dressings that contain superabsorbent particles promises high absorbency. The aim of this multicentre, prospective, non-comparative observational study was to evaluate the clinical efficacy and absorbent capacity of a superabsorbent dressing. Fifteen inpatients and outpatients with highly exuding wounds were included. Most patients (n=8) (53%) had chronic wounds; 20% (n=3) had ulcerating tumours. The superabsorbent dressing was used as a primary or a secondary dressing. Assessment was on day 0 (start), day 3 and day 7 (end of study). The study looked at wound bed and periwound skin condition, exudate production, pain upon dressing removal, reason for dressing removal, and frequency of dressing changes. A clinical visual scoring tool was used, together with digital photographs, which were assessed by the same experienced clinician. All 15 patients completed the study, during which no adverse events were noted. At day 7, maceration had reduced from 46.7% (n=7) at day 0 to 6.7% (n=1). After only 3 days, dressing change frequency was reduced from once daily to twice weekly in 80% (n=12) of patients. The superabsorbent dressing seems to reduce complications associated with exudate production, stimulate wound healing and increase patient comfort; it may also save time and costs for caregivers.

Predictive factors for all-cause mortality in the hospitalized elderly subject: the importance of arrhythmia.

BACKGROUND: In elderly patients traditional cardiovascular (CV) risk factors are poorly correlated with mortality and few data are available on determinants and consequences of supra-ventricular arrhythmia. In a cohort of 331 hospitalized elderly patients (mean age+/-SD=85+/-7 years), we assessed which CV characteristics were associated with all-cause mortality. AIM OF THE STUDY: We wished to determine whether the presence of arrhythmia was associated with an increase of overall mortality in the hospitalized elderly population, and to ascertain which factors were associated with arrhythmia, in order to better understand the underlying mechanisms of both arrhythmia and arrhythmia-related mortality in these patients. RESULTS: The relative hazard for overall mortality in the presence of arrhythmia was 2.40 (95% CI: 1.41-4.07; p<0.001), independent of major confounding factors, compared to sinus rhythm. Both arrhythmia and low DBP were independent predictors of mortality but no association or interaction between arrhythmia and DBP was observed. The left atrium diameter was found to be a predictor of arrhythmia, and when entered in the Cox regression analysis, it suppressed arrhythmia from the model predicting all-cause mortality. CONCLUSION: In the hospitalized elderly, arrhythmia is an independent predictor of all-cause mortality, and left atrium size is an independent predictor of both arrhythmia and mortality, suggesting that links exist. Therapeutic management could therefore focus more on prevention of heart structure remodelling than on traditional risk factors.

Diastolic blood pressure and mortality in the elderly with cardiovascular disease.

Isolated systolic hypertension is predominantly observed in the elderly because of increased arterial stiffness. Aggressive treatment leads to excessive lowering of diastolic blood pressure and favors the presence of a J-shaped curve association with mortality. We investigated whether, in the elderly, this pattern of association is a simple epiphenomenon of increased arterial stiffness and impaired cardiac function. In a cohort of 331 hospitalized subjects >70 years old (mean age+/-SD: 85+/-7 years), aortic pulse wave velocity and pressure wave reflections, by pulse wave analysis, and cardiac function, by ultrasound, were assessed. During a 2-year follow-up period, 110 subjects died. No association of prognosis with systolic pressure, pulse pressure, or pulse wave velocity was observed. A J-shaped association between diastolic pressure and overall and cardiovascular mortality was observed. Unadjusted Cox regression analysis showed that patients in the first tertile of diastolic pressure (< or =60 mm Hg) had higher mortality. In Cox regression analysis, diastolic pressure < or =60 mm Hg was a predictor of mortality independently from cardiac-vascular properties, cardiovascular risk factors, and drug treatment. Multivariate regression analysis showed that increased age and low total peripheral resistance, but not left ventricular function, were the cardinal determinants of low diastolic pressure. An "optimal" diastolic pressure of 70 mm Hg in subjects with isolated systolic hypertension was found. We showed that, in the frail elderly, a value of diastolic blood pressure < or =60 mm Hg is associated with reduced survival, independent from large artery stiffness and left ventricular function, suggesting that more rational antihypertensive therapy, not only based on systolic pressure level, is needed.

[Metabolic syndrome, obesity and urolithiasis]. / Syndrome métabolique, obésité et lithiase urinaire.

The current concept of metabolic syndrome comprises abdominal obesity and cardiovascular risk factors (HT and metabolic disorders). Compared to a control group, individuals with metabolic syndrome have a fourfold higher risk of cardiovascular disease and an increased risk of diabetes. Apart from cardiovascular morbidity, these patients also appear to have an increased incidence of urolithiasis. Urologists must therefore recognize this syndrome in order to identify this particular subgroup of urolithiasis patients. The objective of this article is to review the metabolic syndrome in order to help urologists to recognize this syndrome so that they can identify patients requiring more specific management and medical follow-up.

Arterial stiffness, isolated systolic hypertension, and cardiovascular risk in the elderly.

Isolated systolic hypertension is an important cardiovascular risk factor in the elderly. In addition to systolic blood pressure, pulse pressure, pulse wave velocity, and carotid wave reflections are also strong cardiovascular risk factors in the elderly, as a consequence of the two main determinants of systolic hypertension: increased arterial stiffness and early wave reflections. Taken together, all these findings should help to optimize drug treatment, which has been shown to produce important but thus far insufficient beneficial effects on cardiovascular morbidity and mortality.

Carotid intima-media thickness and carotid and/or iliofemoral plaques: comparison of two markers of cardiovascular risk in hypertensive patients.

OBJECTIVE: In order to optimize cardiovascular risk assessment, we compared the association of common carotid artery intima-media thickness (CCA-IMT) with carotid and/or iliofemoral (C/IF) plaques according to the presence or absence of cardiovascular disease (CVD) and belonging to a high cardiovascular risk group. DESIGN: The study was conducted in 323 subjects presenting one or several cardiovascular risk factors in an internal medicine hospital department; 96 patients had one or more manifestations of cardiovascular disease. RESULTS: Compared with patients with no C/IF plaques, patients with plaques at 1-4 sites presented an adjusted odds ratio (OR) [95% confidence interval] of presenting CVD of respectively [1: OR = 1.79 (0.64-5.04); 2: OR = 3.35 (1.27-8.85); 3: OR = 3.40 (1.09-10.62); 4: OR = 14.41 (3.75-55.40)]. On the other hand, the OR of CVD for 1 SD increment of CCA-IMT was: 0.95 (0.69-1.31). In the group of 199 patients, for which Framingham-based calculations of CV risks were methodologically accessible, both CCA-IMT and C/IF plaques were associated with all cardiovascular risks. Comparison of areas under receiver operating characteristic curves among association of C/IF plaques and CCA-IMT with the presence of CVD showed a statistically significant difference (0.78 +/- 0.09 versus 0.64 +/- 0.09, P < 0.001). CONCLUSION: Arterial plaques may constitute a better marker of the presence of CVD than CCA-IMT. Comparisons according to 10-year Framingham equations did not show statistical significance, but both measures seemed to be highly predictive and possibly complementary. Prospective studies are needed to confirm these findings.