Preoperative Diabetes Mellitus Research Articles

New‐onset diabetes mellitus developing in Asian adult living donor liver transplant recipients: a single‐center experience

New-onset diabetes mellitus (NODM) after liver transplantation is a common complication with a potentially negative impact on patient outcome. To evaluate the incidence of NODM and its impact on Asian adult living donor liver transplant (LDLT) recipients, we investigated 369 adult LDLT cases in our institute. Preoperative diabetes mellitus (DM) was diagnosed in 38 (9 %) patients. NODM was observed in 128/331 (38 %) patients, 56 (44 %) with persistent NODM and 72 (56 %) with transient NODM. The mean interval between LDLT and the development of NODM was 0.6 ± 1.8 (range 0-1.4) months. Multivariate analyssis revealed that older age, being male and having a higher body mass index were independent risk factors among recipients for developing NODM, while hepatitis C virus infection was not a significant risk factor, and DM had no impact on patient outcome. Although the long-term effect of DM on outcome remains to be investigated, the presence of DM after liver transplant, whether it was NODM or preexisting DM, had no impact on LDLT recipients' outcomes in mid-term.

Long Term Outcomes of Aortic Root Replacement: 18 Years' Experience

BackgroundWe reviewed the long-term outcomes of aortic root replacement at Asan Medical Center and investigated the predictors affecting mortality.Materials and MethodsA retrospective analysis was performed on 225 consecutive adult patients undergoing aortic root replacement with mechanical conduits (n=169), porcine aortic root prosthesis (n=23), or aortic homografts (n=33) from January 1992 to September 2009. The median follow-up duration was 6.1 years (range, 0 to 18.0 years).ResultsThe porcine root group was older than the other groups (freestyle 55.9±14.3 years vs. mechanical 46.3±14.6 years, homograft 48.1±14.7 years; p=0.02). The mechanical group had the highest incidence of the Marfan syndrome (mechanical 22%, freestyle 4%, homograft 3%; p=0.01). Surgery performed for infective endocarditis was more frequent in the homograft group (mechanical 10%, freestyle 10%, homograft 40%; p<0.001). The overall 30-day mortality was 5.3% (12/225). Actuarial survival rates in the mechanical, porcine root, and homograft groups were 79.4%, 81.5%, and 83.5% at 5 years and 67%, 61.9%, and 61.1% at 10 years, respectively (p=0.73). By multivariate analysis, preoperative diabetes mellitus, older age, and longer cardiopulmonary bypass time were independent predictors of mortality. Incidence of postoperative complications, including infective endocarditis and thromboembolism were comparable in all of the groups.ConclusionAortic root replacement can be safely performed with different types of prostheses as the outcome was not affected by the choice of prosthesis. Further studies are required to assess the long-term durability of biological prostheses.

Preoperative diabetes mellitus does not impact on postoperative morbidity after pancreatic resections for ductal adenocarcinoma

Preoperative diabetes mellitus does not impact on postoperative morbidity after pancreatic resections for ductal adenocarcinoma

Delayed gastric emptying after pancreaticoduodenectomy in diabetes mellitus

Delayed gastric emptying (DGE) is one of the most troublesome complications of pancreaticoduodenectomy (PD). Diabetes mellitus (DM) is one of the risk factors for pancreatic cancer. Moreover, several studies have shown that diabetic patients tend to have a high incidence of upper gastrointestinal symptoms such as nausea, vomiting and DGE. Here, we compared the influence of DM on the incidence of DGE after PD. We retrospectively analysed 67 cases of PD with pancreaticogastrostomy. These patients were categorized into the following two groups: the DM group included patients with DM, and the NDM group included patients without DM. The incidence of DGE was determined and compared between the two groups. In the DM group, 76.5%, 5.9% and 17.6% of the subjects developed classes A, B and C DGE, respectively; the corresponding values in the NDM group were 58%, 22%, and 20%. The incidence of DGE did not differ between the two groups (P < 0.2771). DM does not accelerate DGE in patients who have undergone PD. Preoperative DM does not appear to play a key role in post-operative DGE after PD.

Human experience with an endoluminal, endoscopic, gastrojejunal bypass sleeve

This report describes the authors' experience with a unique endoluminal, endoscopically delivered and retrieved gastroduodenojejunal bypass sleeve, including short-term weight loss and changes in comorbidities. A prospective, single-center trial was designed. The patients were morbidly obese individuals who met the National Institutes of Health criteria for bariatric surgery. The device used was a unique gastroduodenojejunal bypass sleeve secured at the esophagogastric junction with endoscopic and laparoscopic techniques and designed to create an endoluminal gastroduodenojejunal bypass. At completion of the trial, the device was explanted with endoscopic retrieval. The primary end points were safety and incidence of adverse events. The secondary outcomes included the percentage of excess weight loss and changes in comorbidities, specifically glucose control, use of antihyperglycemic medications, and changes in hemoglobin A1c levels. From July 2008 to February 2010, 24 patients were enrolled in the trial. The gastroduodenojejunal bypass sleeve was implanted, left in situ, and then retrieved. The 7 men and 17 women in the study had a mean preoperative body mass index of 42kg/m(2). The device was successfully delivered in 22 of the 24 patients (92%) and retrieved endoscopically from all 22 patients in whom it was implanted (100%). Two patients were excluded from the study preprocedurally. The one patient was excluded preoperatively due to noncompliance with the preoperative liquid diet. For the other excluded patient, the device was not attempted endoscopically due to significant inflammation at the gastroesophageal junction at the time of laparoscopic evaluation. Of the 22 patients who had the device implanted, 17 maintained it (77%) and completed the full 12-week trial. These patients had 39.7% excess weight loss at completion of the study. The primary reason for early explantation of the device was early postoperative dysphagia. The seven patients with preoperative diabetes mellitus all had normal blood glucose levels throughout the trial, and none required antihyperglycemic medications. All four patients with elevated hemoglobin A1c levels preoperatively showed improvement by the end of the trial. This trial demonstrated that the endoluminal gastroduodenojejunal sleeve can achieve excellent weight loss at 12weeks. No patient safety issues were encountered. Adverse effects were minimal and resolved at endoscopic device removal. Effective glycemic control was demonstrated through use of the device during the trial. Long-term results are needed.

1533 COMPARISON OF RATES AND RISK FACTORS FOR DEVELOPMENT OF ERECTILE DYSFUNCTION AFTER RADICAL OR PARTIAL NEPHRECTOMY

You have accessJournal of UrologySexual Function/Dysfunction/Andrology: Evaluation1 Apr 20111533 COMPARISON OF RATES AND RISK FACTORS FOR DEVELOPMENT OF ERECTILE DYSFUNCTION AFTER RADICAL OR PARTIAL NEPHRECTOMY Ryan Kopp, Jonathan Silberstein, Reza Mehrazin, Aditya Bagrodia, Robert Wake, Anthony Patterson, Jim Wan, and Ithaar Derweesh Ryan KoppRyan Kopp San Diego, CA More articles by this author , Jonathan SilbersteinJonathan Silberstein New York, NY More articles by this author , Reza MehrazinReza Mehrazin Memphis, TN More articles by this author , Aditya BagrodiaAditya Bagrodia Memphis, TN More articles by this author , Robert WakeRobert Wake Memphis, TN More articles by this author , Anthony PattersonAnthony Patterson Memphis, TN More articles by this author , Jim WanJim Wan Memphis, TN More articles by this author , and Ithaar DerweeshIthaar Derweesh San Diego, CA More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.1528AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Nephron Sparing Surgery (NSS) has emerged as a preferred treatment option for small renal masses, comparing favorably with radical nephrectomy (RN) from the standpoint of oncologic efficacy and conferring superior renal functional preservation. Erectile function may be affected by declining renal function. We examined the incidence of and risk factors for development of erectile dysfunction (ED) in patients who underwent RN and NSS. METHODS Retrospective review of 432 patients (264 RN/168 NSS, mean age 58 years, mean follow-up 5.8 years) who underwent RN or NSS for renal tumors at two institutions from 1/1998 to 12/2007. Demographics and disease characteristics, metabolic parameters [estimated Glomerular Filtration Rate (GFR), serum creatinine, hyperlipidemia, diabetes mellitus (DM)], pre- and postoperative ED (Sexual Health Inventory for Men score <22) and response rate to 5-phosphodiesterase inhibitor therapy (5-PDEi) were recorded in sexually active men. Data were analyzed within subgroups based on treatment (RN vs. NSS). Multivariate analysis (MVA) was conducted to elucidate risk factors for development of de novo ED. RESULTS RN and NSS groups had similar demographics and comorbidities. Tumor size (cm) was significantly larger for RN (RN 7.0 vs. NSS 3.7, p<0.001). No significant differences were observed for preoperative eGFR, hyperlipidemia, and DM. Significantly more preoperative ED existed in NSS vs. RN (p=0.042). Postoperatively, significantly higher rates of de novo DM (11.4% vs. 4.2%, p=0.015), eGFR<60 mL/min/1.73m2 (33.0% vs. 9.8%, p<0.001), and ED (29.5% vs. 9.5%, p<0.001) developed in RN vs. NSS cohorts, respectively. Overall response rate to 5-PDEi was 63% without significant difference between the two groups (p=0.896). MVA demonstrated RN (OR 3.56, p<0.001), hyperlipidemia (OR 2.32 p = 0.014), postoperative DM (OR 2.93, p<0.001), preoperative (OR 8.77, p<0.001) and postoperative (OR 2.64, p<0.001) eGFR <60mL/min/1.73m2 were significantly associated with de novo ED. CONCLUSIONS Patients undergoing RN had significantly higher de novo ED compared to a contemporary, well-matched cohort undergoing NSS. RN, DM, and eGFR<60 were associated with development of ED. Further investigation on effects of nephron loss on ED is requisite. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e615-e616 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ryan Kopp San Diego, CA More articles by this author Jonathan Silberstein New York, NY More articles by this author Reza Mehrazin Memphis, TN More articles by this author Aditya Bagrodia Memphis, TN More articles by this author Robert Wake Memphis, TN More articles by this author Anthony Patterson Memphis, TN More articles by this author Jim Wan Memphis, TN More articles by this author Ithaar Derweesh San Diego, CA More articles by this author Expand All Advertisement Advertisement PDF DownloadLoading ...

Computed Tomography Reflected Endocrine Function of the Pancreas

Backgrouns/AimsThere are few studies about the assessment of pancreatic function using computed tomography (CT) volumetry. In this study, we examined the correlation between CT volumetry and endocrine parameters (blood glucose and HbA1c) of the pancreas. MethodsA total of 68 patients underwent enhanced CT for pancreatic disease from January to December in 2008. In particular, we analyzed the correlation of diabetic status and pancreatic CT parameters at 1 year after pancreatoduodenectomy in 32 patients. CT parameters including volume, volume/body weight, arterial phase density, the arterial phase to portal phase density ratio (A/P ratio) of the pancreas, and size of pancreatic duct were also analyzed. Correlation between CT parameters and diabetic status was analyzed preoperatively and postoperatively by ANOVA test. ResultsThe preoperative diabetic status and parameters correlated well with arterial phase density (p = 0.004), A/P ratio, and pancreatic duct size (p < 0.0001). In the patients who underwent pancreatectomy, two out of 25 patients without preoperative diabetes mellitus (DM) had DM, and two out of seven patients with preoperative DM recovered from DM. Postoperative CT parameters correlated with the DM status 1 year after pancreatectomy. ConclusionCT is a useful modality for evaluation of the pancreatic endocrine function and could be used for the prediction of postoperative diabetic outcome.

Impact of Diabetes Mellitus on Perioperative Outcomes after Resection for Pancreatic Adenocarcinoma

Associations between diabetes mellitus (DM) and pancreatic ductal adenocarcinoma (PDAC) are well established; however, the impact of DM on perioperative morbidity and mortality after PDAC resection is unclear. A prospectively maintained database review identified all patients undergoing PDAC resection between January 1, 2000, and December 31, 2008. Diagnosis of DM was established by history and biochemical profile. Records were reviewed for comorbidities, operative variables, and histologic parameters. Postoperative morbidity and mortality were assessed for diabetic and nondiabetic patients using standardized definitions. Of 251 PDAC cases, 116 (46%) patients had preoperative DM. Pancreaticoduodenectomy was performed in 220 (87.6%), left pancreatectomy in 29 (11.6%), and total pancreatectomy in 2 (0.8%). The major complication rate was 25.5%, with 60-day mortality of 3.6%. Delayed gastric emptying (DGE) occurred in 40.1% of patients. Pancreatic fistulas developed in 17 (6.8%) patients; 11 of them were clinically significant (grades B/C). DM patients had a higher likelihood of developing fistulas (DM 10.3%, non-DM 3.7%, p = 0.04). When controlled for age, comorbidities, body mass index, preoperative albumin level, operation type, operative time, and pancreatic quality, DM maintained an independent association with fistula formation (odds ratio 4.3, 95% CI 1.18 to 15.8, p = 0.027). Acute kidney injury was more frequent in the DM group (DM 23.3%, non-DM 12.6%, p = 0.03). DM and non-DM patients had similar frequency of DGE, wound infections, intra-abdominal abscesses, and cardiovascular and pulmonary complications, as well as length of stay and mortality. Comorbid DM does not influence perioperative outcomes dramatically after pancreatectomy for ductal adenocarcinoma. The role of PDAC-associated DM as a risk factor for postresection pancreatic fistula should be further explored. Evaluation of glycemic control and outcomes after PDAC resection may be useful.

Preoperative Diabetes Mellitus and Long-Term Survival After Resection of Pancreatic Adenocarcinoma

To assess clinicopathologic features and postresection survival of diabetes mellitus (DM)-associated pancreatic ductal adenocarcinoma (PDAC). Records of resected PDAC patients from 2000 to 2007 were reviewed. DM was classified as new-onset (<24 months before PDAC) or longstanding (> or =24 months). Clinicopathologic features were compared by univariate and multivariate analyses. Survival was assessed by Kaplan-Meier method and Cox regression. Of 209 patients, 93 (45%) met criteria for DM (35 longstanding DM, 55 new-onset DM, 3 duration unknown). DM patients were older (DM 66 +/- 9 years, non-DM 63 +/- 12 years, P = 0.06); a majority had additional preoperative comorbidities (DM 64.5%, non-DM 25.9%, P < 0.001). Tumor size was larger in patients with DM (DM 3.8 +/- 1.7 cm, non-DM 3.2 +/- 1.5 cm, P = 0.003). Groups were similar in terms of tumor location, perineural/lymphovascular invasion, and node and margin status. On logistic regression, tumor size >/=3.0 cm was independently associated with both overall DM (odds ratio [OR] 3.60; 95% confidence interval [1.79-7.26]) and new-onset DM (OR 3.69, [1.65-8.24]). Median survival was reduced in patients with DM compared with non-DM (15 versus 17 months, P = 0.015). Multivariate analysis controlling for prognostic variables including age, comorbidities, and tumor size demonstrated that DM was independently associated with reduced survival (hazard ratio [HR] 1.55, [1.02-2.35]). This association was more pronounced for patients with new-onset DM (HR 1.75 [1.10-2.78]) than those with longstanding DM (HR 1.30 [0.75-2.25]). Preexisting DM is associated with reduced survival in patients undergoing resection for PDAC. PDAC with new-onset DM may exhibit increased tumor size and decreased postresection survival. Additional investigation is needed to clarify etiology and impact of PDAC-associated DM.

Outbreak of Postoperative Endophthalmitis in a Thai Tertiary Care Center

We performed a study with a 1:3 ratio of case patients (n = 11) to control patients (n = 33) to evaluate risk factors for postoperative endophthalmitis in a Thai tertiary care center. Multivariate analysis revealed that diabetes mellitus and surgeon A were associated risk factors. Preoperative diabetes mellitus control and the improvement of infection control practices led to the termination of the outbreak.

Hyperglycemia predicts mortality after CABG: postoperative hyperglycemia predicts dramatic increases in mortality after coronary artery bypass graft surgery

Objective Risk of morbidity and mortality after coronary artery bypass graft surgery (CABG) is higher in patients with clinical diabetes mellitus (DM). We evaluated whether outcomes are affected by postoperative hyperglycemia in CABG patients independent of preoperative DM diagnosis. Research Design and Methods A total of 2297 consecutive CABG patients were studied. The first glucose value after surgery completion (mean 15 min) was tested as a predictor of outcome. Primary outcome variables were prolonged ventilation (>24 h), deep sternal wound infection, renal failure, permanent stroke, any reoperation, length of stay (>14 days) and mortality. All outcomes except for prolonged ventilation and length of stay were tracked out to 30 days postoperatively. Patients were stratified by glycemic control: Low (glucose <80), normal (referent, glucose 80–110), high (glucose 111–200) and very high (glucose >200 mg/dl). Multivariable logistic regression was used to determine the independent predictive value of glycemic groups, adjusted for outcome specific risk scores from the Society of Thoracic Surgeons model. Results Patient distribution among groups low through very high were 44 (1.9%), 476 (20.7%), 1425 (62.0%) and 352 (15.3%). Greater complication rates were noted in the very high group when compared with the referent group: prolonged ventilation (adjusted odds ratio (OR)=2.66, P<.001), length of stay >14 days (adjusted OR=2.06, P=.004) and mortality (adjusted OR=7.71, P<.001). Conclusion Patients with blood glucose values >200 mg/dl immediately after CABG had an increased risk of complications, including mortality, independent of a clinical diagnosis of DM. This study documents the high risk associated with early postoperative hyperglycemia in this group, suggesting the need for prospective trials of glycemic control.

New-Onset Diabetes Mellitus After Living Donor Liver Transplantation: Possible Association With Hepatitis C

Background The relationship between hepatitis C virus (HCV) infection and new-onset diabetes mellitus (NODM) after liver transplantation is a controversial issue. Methods A total of 223 adult living donor liver transplantation (LDLT) recipients followed for more than 6 months were analyzed for the prevalence of NODM. The prevalence was compared between 62 HCV-positive and 161 HCV-negative patients. All the HCV-positive patients underwent preemptive antiviral treatment with interferon α2b and ribavirin. Results Preoperative diabetes mellitus was more frequently observed in HCV-positive patients (18% vs 4%, P = .001). NODM occurred more frequently in HCV-positive patients (41% vs 22%, P = .003). Multivariate analysis, however, revealed that HCV was not a predictor for NODM. A comparison of 14 HCV-positive patients with persistent NODM and 48 patients without persistent NODM indicated that there was no significant difference in the frequency of the viral response to antiviral therapy nor in HCV-RNA levels. Impaired glucose tolerance did not impact postoperative survival after LDLT. Conclusions HCV was not associated with the prevalence of NODM after LDLT. NODM did not influence patient survival.

Pattern of renal dysfunction associated with myocardial revascularization surgery and cardiopulmonary bypass.

A variable incidence rate of renal dysfunction (3-35%) after cardiac surgery with cardiopulmonary bypass has been reported. The aim was to define the typical pattern of renal dysfunction that follows coronary surgery with cardiopulmonary bypass using albumin, immunoglobulin (IgG), alpha1-microglobulin and beta-glucosaminidase (beta-NAG) excretion as indicators. Twenty patients with preoperative normal renal function, defined by plasma creatinine, creatinine clearance, fractional excretion of sodium and renal excretion of proteins, undergoing elective myocardial revascularization surgery with cardiopulmonary bypass, were prospectively studied. Variables recorded were demographic and haemodynamic variables, duration of cardiopulmonary bypass and aortic clamping, intra- and postoperative urine output, plasma creatinine concentration, creatinine clearance and excretion of sodium, albumin, IgG, beta-glucosaminidase (beta-NAG), and alpha1-microglobulin. Measurements were made preoperatively, immediately before and then during and immediately after cardiopulmonary bypass, and again at 1, 24, 72 h, 7 and 40 days following surgery. Albumin and IgG excretion rose significantly during cardiopulmonary bypass (P < 0.05), remaining at these levels at 24 h postoperatively. An increase of alpha1-microglobulin and beta-NAG concentrations was observed during cardiopulmonary bypass (P < 0.05), which were maintained until the seventh postoperative day and remained elevated in some patients at the 40th postoperative day. This correlated with preoperative diabetes mellitus (P < 0.001), low cardiac output after cardiopulmonary bypass (P < 0.001) and the duration of stay in the intensive care unit (P < 0.001). The pattern of renal dysfunction after cardiopulmonary bypass for myocardial revascularization is characterized by temporary renal dysfunction at both glomerular and tubular levels with an onset within 24 h of surgery and which lasts between 24 h and 40 days, respectively, following surgery.

Impact of Pre-Operative Diabetes Mellitus Upon Early and Late Survival After Heart Transplantation: A Possible Era Effect

The effect of pre- or post-operatively acquired diabetes mellitus on survival after heart transplantation remains controversial. The influence of transplant era on diabetes-associated survival is unknown. A retrospective database analysis was performed on all cardiac transplant recipients followed up at our institution between 1986 and 2003. Diabetes mellitus was diagnosed based on oral glucose tolerance testing. Survival was analyzed in 243 patients (80% male, mean age 52.2 years, mean follow-up 5.22 years). Kaplan-Meier survival analysis demonstrated significantly worse (p = 0.0001) survival both early (months 0 to 12) and late (>5 years) after transplantation in pre-operative diabetics (n = 53) compared with non-diabetics (n = 190). Pre-operative diabetes was identified as the only independent risk factor for decreased long-term (>1 year) survival (p = 0.004). In contrast, no effect on survival (p = 0.5) was demonstrated in patients becoming diabetic only after heart transplantation (n = 39). At 12 months post-transplant renal function was significantly impaired in diabetics (p = 0.025); acute rejection, cytomegalovirus (CMV) infection and transplant vasculopathy occurred with similar frequency. Causes of death were similar in diabetics and non-diabetics. Reduced long-term survival in pre-operative diabetics was seen in the early transplant era (1986 to 1994) (p < 0.0001), but not in the more recent era (1995 to 2003) (p = 0.5). Pre-transplant but not post-transplant diabetes confers an adverse risk for survival (short and long term). Diabetes-associated long-term survival appears to have improved in the recent era, supporting continued transplantation in diabetics under close surveillance and aggressive medical management.

Pattern of renal dysfunction associated with myocardial revascularization surgery and cardiopulmonary bypass

Background and objective: A variable incidence rate of renal dysfunction (3–35%) after cardiac surgery with cardiopulmonary bypass has been reported. The aim was to define the typical pattern of renal dysfunction that follows coronary surgery with cardiopulmonary bypass using albumin, immunoglobulin (IgG), α1-microglobulin and β-glucosaminidase (β-NAG) excretion as indicators. Methods: Twenty patients with preoperative normal renal function, defined by plasma creatinine, creatinine clearance, fractional excretion of sodium and renal excretion of proteins, undergoing elective myocardial revascularization surgery with cardiopulmonary bypass, were prospectively studied. Variables recorded were demographic and haemodynamic variables, duration of cardiopulmonary bypass and aortic clamping, intra- and postoperative urine output, plasma creatinine concentration, creatinine clearance and excretion of sodium, albumin, IgG, β-glucosaminidase (β-NAG), and α1-microglobulin. Measurements were made preoperatively, immediately before and then during and immediately after cardiopulmonary bypass, and again at 1, 24, 72 h, 7 and 40 days following surgery. Results: Albumin and IgG excretion rose significantly during cardiopulmonary bypass (P < 0.05), remaining at these levels at 24 h postoperatively. An increase of α1-microglobulin and β-NAG concentrations was observed during cardiopulmonary bypass (P < 0.05), which were maintained until the seventh postoperative day and remained elevated in some patients at the 40th postoperative day. This correlated with preoperative diabetes mellitus (P < 0.001), low cardiac output after cardiopulmonary bypass (P < 0.001) and the duration of stay in the intensive care unit (P < 0.001). Conclusions: The pattern of renal dysfunction after cardiopulmonary bypass for myocardial revascularization is characterized by temporary renal dysfunction at both glomerular and tubular levels with an onset within 24 h of surgery and which lasts between 24 h and 40 days, respectively, following surgery.

Improvement in the Nutritional and Pulmonary Profiles of Cystic Fibrosis Patients Undergoing Bilateral Sequential Lung and Heart‐Lung Transplantation

Cystic fibrosis (CF) is the most common lethal genetic disease of the white population and is associated with malnutrition. In patients undergoing thoracic surgery, poor nutrition is a risk factor for postoperative complications. The aim of this study is to characterize the nutritional profiles of CF patients undergoing pulmonary transplantation (heart‐lung or bilateral lung) at our medical center between 1988 and 1996 and to assess the significance of their nutritional status on posttransplantation outcomes. We retrospectively reviewed the charts of the 31 CF patients who underwent lung transplantation. Body mass index (weight/height2) was calculated for the adult patients as an index of their relative body fat before transplantation. Preoperative biochemical nutritional parameters and pulmonary function tests were assessed. The data were then compared with data collected at 1 year after transplantation. Multivariate analysis was used to examine the relationship between preoperative parameters and transplantation outcomes. The outcome variables included initial length of hospital stay, the number of infections within the first 90 days, the number of acute rejection episodes within the first year; the occurrence of obliterative bronchiolitis within the first year; and the change in the forced expiratory volume in 1 second, forced expiratory flow between 25% and 75%, and the forced vital capacity, hematocrit, and cholesterol at 1 year. Significant differences were found in all parameters studied at the end of 1 year (p ≥ .002). An inverse correlation was demonstrated between the pretransplantation total protein/albumin ratio and the number of early infections (p = .029); however, albumin concentration alone showed no correlation. Preoperative diabetes mellitus did not correlate with any of the dependent variables. The multivariate analysis suggests that an increase in the globulin fraction of total protein may be associated with a decrease in early postoperative infections. The nutritional parameters and pulmonary function of the CF patients studied normalized by one year after transplantation. There was no increased risk of rejection or infection observed among the CF diabetic patients transplanted.

Early and Late Mortality of Patients Undergoing Aortic Valve Replacement After Previous Coronary Artery Bypass Graft Surgery

In a small number of patients who undergo coronary artery bypass graft surgery (CABG), a hemodynamically significant aortic valve lesion requiring aortic valve replacement (AVR) develops as they grow older. In a limited number of studies in small patient groups, high mortality has been shown in patients undergoing AVR after CABG. We undertook this study to determine the mortality risk factors for patients who undergo AVR after CABG procedures. The outcome of 104 patients treated at our institution between January 1983 and December 1993 was retrospectively reviewed. The initial surgery was CABG in all patients. The patient population included 86 men (83%) and 18 women (17%); their mean age was 67 years. Overall, 70% of patients had congestive heart failure, and 96% had multivessel coronary artery disease. The diagnosis was aortic stenosis in 68% of patients, aortic insufficiency in 16%, and combined aortic stenosis and aortic insufficiency in 16%. Postoperative complications included worsening congestive heart failure (35%), perioperative myocardial infarction (13%), and bleeding (28%). The early mortality was 14%, and the late mortality was 17% (mean follow-up, 35 months). The risk factors for early mortality were number of diseased vessels (P = .028), renal failure (0.000), and prior myocardial infarction (P = .028). A perioperative predictor of early mortality was cardiopulmonary bypass time (P = .000). The risk factors for late mortality included preoperative diabetes mellitus (P = .007), postoperative acute respiratory distress syndrome (P = .011), and ventricular arrhythmias (P = .0001). The survival at 1, 5, and 10 years was 96%, 75%, and 49%, respectively. Risk factors were identified for early and late mortality in patients undergoing AVR after previous CABG. Although early morbidity and mortality were high, the longterm outcome of the survivors was favorable.

Influence of Diabetes Mellitus on the Results of Coronary Bypass Surgery

To determine the long-term influence of the severity of preoperative diabetes mellitus on the results of coronary bypass, a review was made of 212 diabetics operated on between 1968 and 1973, of whom 87 patients (41%) were receiving no drugs, 108 patients (50.9%) were receiving oral hypoglycemic agents, and 17 patients (8%) were receiving insulin. They were compared with 1,222 nondiabetic patients operated on over the same period. Perioperative mortality was similar in the diabetics and nondiabetics: 7.1% vs 4.5%. Improvement in anginal symptoms was similar in all patient groups: 85.9% to 92.7%. Overall 15-year survival probability was .53 for the nondiabetic group, .43 for the diabetics not receiving drugs, .33 for those receiving oral agents, and .19 for the insulin-treated patients. Late graft patency ranged from 78% to 90% and was comparable in all groups. The preoperative blood glucose level was an important predictor of late mortality in all diabetic patients. Thus, coronary bypass surgery was effective in all groups of diabetic patients in long-term relief of anginal symptoms. Intermediate-term survival rates were good in all groups, but the initial severity of the diabetes was an important determinant of long-term survival rates.