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Gastrointestinal symptoms are frequently reported adverse effects of antidepressants, but antidepressants are also a treatment modality in functional gastrointestinal disorders. We aimed to assess the association between antidepressant use and gastrointestinal symptoms in the general adult population.

Purpose: To compare differences in the applicability and incidence of postoperative adverse events among stent-grafts used for repair of infrarenal aortic aneurysms.Methods: An analysis of 6787 patients from the EUROSTAR Registry database was conducted to compare aneurysm morphological features, patient characteristics, and postoperative events for the AneuRx, EVT/Ancure, Excluder, Stentor, Talent, and Zenith devices versus the Vanguard device (control) and each other. Annual incidence rates of complications were determined, and risks were compared using the Cox proportional hazards analysis.Results: The annual incidence rates were: device-related endoleak (types I and III) 6% (range 4%-10%), type II endoleak 5% (range 0.3%-11%), migration 3% (range 0.5%-5%), kinking 2% (range 1%-5%), occlusion 3% (range 1%-5%), rupture 0.5% (range 0%-1%), and all-cause mortality 7% (range 5%-8%). After adjustment for factors influencing outcome, AneuRx, Excluder, Talent, and Zenith devices were associated with a lower risk of migration, kinking, occlusion, and secondary intervention compared to the Vanguard device. Significant increased risk for conversion (EVT/Ancure) and reduced risk of aneurysm rupture (AneuRx and Zenith) and all-cause mortality (Excluder) were found compared to the Vanguard device.Conclusions: Significant differences exist between stent-grafts of different labels in terms of applicability and complications during intermediate to long-term follow-up. Since each stent-graft has its drawbacks, no single label can be identified as the best. It is reassuring that developments in stent-grafts indeed result in better performance than the early stent-grafts. However, a single device incorporating all the perceived improvements should still be pursued.

Purpose: To investigate the influence of diabetes mellitus on outcome after endovascular abdominal aortic aneurysm (AAA) repair.Methods: Of 6017 patients enrolled in the EUROSTAR registry after undergoing endovascular AAA repair between May 1994 and December 2003, 731 (12%) had diabetes mellitus (690 men; mean age 72 years, range 37–100). Patient demographics, risk factors, aneurysm morphology, operative and procedural details, complications, major events, and regular follow-up information were compared. The relationships of complications and events to diabetes mellitus, which were tested with multivariate logistic regression analysis and Cox proportional hazards modeling, are expressed as odds ratios (OR) and hazard rates (HR) with 95% confidence intervals (CI). Survival was compared with life-table analysis.Results: A significantly higher risk of device-related complications was observed in diabetic patients (8% versus 6%, p < 0.049; OR 1.35, 95% CI 1.00 to 1.82). The greatest difference in the groups was in mortality, which was significantly higher in the diabetic population (13%) compared to the nondiabetic patients (10%, p < 0.039; OR 1.27, 95% CI 1.01 to 1.59). Deaths, which occurred at a higher frequency within the 30-day perioperative period in diabetic patients, were primary due to cardiac complications. Insulin-controlled type 2 diabetic patients had significantly lower rates of early and late endoleaks and secondary interventions than diet-controlled type 2 diabetics (p=0.002, p=0.0001, and p=0.0008, respectively) and nondiabetic patients (p=0.002, p=0.0005, and p=0.0025, respectively). The cumulative survival after 48 months did not differ significantly: 74% in diabetics and 79% in the population without diabetes.Conclusions: Patients with diabetes mellitus had a significantly higher early mortality rate after EVAR, but their long-term survival was similar to nondiabetic patients.

Purpose: To assess health-related quality of life outcomes after endovascular versus open abdominal aortic aneurysm repair.Methods: Participants were randomly assigned to receive either endovascular or open abdominal aortic aneurysm (AAA) surgery according to a rate of 3 endovascular patients to 1 with open repair. Data on patient characteristics, operative aspects, and procedural and device-related complications were compiled at a single center. Health-related quality of life was assessed before treatment and 1 and 3 months following operation using the Medical Outcomes Study Short-Form 36-item Health Survey (SF-36) and the EuroQol questionnaire.Results: Between 1996 and 1999, 57 patients (54 men; mean age 69 years, range 52–82) underwent endovascular and 19 patients (16 men; mean age 68 years, range 52–81) underwent open AAA repairs. Preoperatively, comparable scores were recorded in both treatment groups. One month after operation, patients of both groups scored significantly lower on the SF-36 domains of Role Limitations due to physical problems and Pain compared to preoperative scores. Three months after operation, both groups had scores in all domains comparable to preoperative levels of functioning. There was a significant benefit for the endovascular group 1 month after operation in the SF-36 domains of Physical Functioning, Role Limitations due to physical problems, Vitality, and Pain; their score on the EuroQol Usual Activities item was also significantly better. After 3 months, there were no longer differences between groups.Conclusions: Short-term health-related quality of life benefits were found after endovascular repair compared with standard open surgery.

Purpose: To determine from the EUROSTAR registry the incidence of stent-graft kink, predictive factors for kinking, and the consequences of this complication on graft patency and aneurysm exclusion.Methods: From January 1994 to June 2002, 4613 patients who underwent endovascular aneurysm repair were registered in the EUROSTAR registry. Presence of kink was determined according to the information available on the follow-up Case Record Form. The population was divided into those with and without stent-graft kink. Patient characteristics, morphological aneurysm features, team experience, type of device, period of implantation, and outcome were compared between the groups by univariate analysis. Significant factors were subsequently submitted to a multivariate Cox proportional hazard analysis.Results: One hundred seventy (3.7%) patients were reported as having a kink of the stent-graft during a mean follow-up of 21 months (range 1–72). Gender, neck angulation, team experience, period of implantation, ASA classification, and device type were independent predictors of kink. The presence of a kink was significantly associated with type I endoleaks (proximal and distal), type III endoleaks (midgraft), graft stenosis, graft limb thrombosis, graft migration, and conversion to open repair. No relationship was found between a decrease in the aneurysm diameter and the occurrence of stent-graft kink.Conclusions: Kinks of stent-grafts were infrequent events in the intermediate term. Patients most at risk were women with angulated aortic necks treated by a minimally experienced team. Kinks are potentially damaging events because they may lead to delayed device-related endoleaks, graft stenosis, thrombosis, and conversion to open repair. They appear more closely associated to graft migration than to aneurysm diameter reduction.

Glutathione S-transferases (GSTs) play critical roles in providing protection against electrophiles and products of oxidative stress, by catalysing the formation of glutathione conjugates and by eliminating peroxides. Most extensively studied are four main families of human cytosolic GST: GSTAlpha(A), GSTMu(M), GSTPi(P) and GSTTheta(T). Absence of GSTM1 or GSTT1 can be attributed to absence of the GSTM1 or GSTT1 gene products (null genotype) in approximately 50% and 20% of the Caucasian population, respectively. We investigated whether polymorphisms in the GSTM1, GSTT1 and GSTP1 genes modified the risk for chronic pancreatitis (CP). DNA samples were obtained from 142 adult CP patients with alcoholic (n = 79), hereditary (n = 21) or idiopathic (n = 42) origin. DNA from 204 healthy controls and from 57 alcoholic controls was analysed for comparison. Patients and controls were all of Caucasian origin. Genetic polymorphisms in GSTs were determined by PCR, eventually followed by restriction-fragment-length-polymorphism analyses in all subjects. The rates of GSTT1 and GSTP1 genotypes did not differ between CP patients and healthy controls. However, GSTM1 null genotypes were significantly less common in alcoholic CP patients (OR = 0.56, 95% CI: 0.33–0.95) as compared to healthy controls and to alcoholic controls (OR = 0.52, 95% CI: 0.26–1.04). Age- and sex-adjustment bolstered our finding (adjusted OR = 0.48, 95% CI: 0.26–0.89). The frequency of the GSTM1 null genotype is significantly lower in alcoholic CP patients, especially young female. This suggests that GSTM1 null alcohol users, particularly young female, are less susceptible to CP. © 2003 Wiley-Liss, Inc.

Purpose:The purpose of this study was to assess and to compare perioperative changes in left ventricular function and the incidence of adverse cardiac events in two groups of patients with abdominal aortic aneurysms, one during endovascular aneurysm repair (EAR) and the other during open aneurysm repair (OAR). Methods:One hundred twenty consecutive patients who underwent EAR (49 patients) or OAR (71 patients) were prospectively studied. During the operation, the left ventricular function was assessed by the recording of the left ventricle stroke work index (SWI) and the cardiac index (CI) with a pulmonary artery catheter. Measurements were performed before, during, and after stent-graft deployment or aortic cross-clamping. Both maneuvers were defined as aortic occlusion (AO). Transesophageal echocardiography was performed to identify signs of wall motion abnormalities of the left ventricular wall, which indicated myocardial ischemia. Six-lead electrocardiograph monitoring was maintained until discharge from the intensive care unit. Postoperative cardiac complications were diagnosed by clinical observation, 12-lead ECG analysis at 1, 3, and 7 days after the operation, transthoracic echocardiography at 1 month, and measurement of cardiac enzymes. Results:The two study groups were comparable with regard to most clinical aspects. The baseline myocardial performance was worse in patients who underwent EAR compared with patients who underwent OAR, as indicated by a reduced SWI (33.1 and 37.4, respectively; P=.03). During AO there was a comparable increase of the CI in both groups. However, after AO the rise in CI was higher in patients who underwent OAR compared with patients who underwent EAR (0.7 and 0.2, respectively; P<.01), representing a more pronounced hyperdynamic state. In addition, the SWI demonstrated a decrease in patients who underwent OAR compared with an increase in patients who underwent EAR during AO (–1.4 and +1.9, respectively; P=.04) and after AO (–0.9 and +2.6, respectively; P=.01). These findings represent more severe myocardial stress in patients who underwent OAR. The incidence of postoperative clinical cardiac adverse events was comparable in the two study groups. However, myocardial ischemia, as indicated by electrocardiography and transesophageal echocardiography, had a higher incidence in patients who underwent open surgery as compared with patients whose condition was managed endovascularly (57% and 33%, respectively; P=.01). Conclusion:Hemodynamic alterations during endovascular repair were not as severe as those in patients with open surgery and indicated less myocardial stress in the former category. These findings may explain a lower incidence of myocardial ischemia that was observed during endovascular repair. A lower frequency of clinical perioperative cardiac events in patients undergoing endovascular treatment may ultimately be expected. (J Vasc Surg 2001;33:353-60.)