Annelies E. Aquarius

Depressive symptoms in peripheral arterial disease: A follow-up study on prevalence, stability, and risk factors

BACKGROUND Depressive symptoms are associated with poor prognosis in coronary artery disease, but there is a paucity of research on these symptoms in peripheral arterial disease (PAD). We examined the clinical correlates and 18-month course of depressive symptoms in PAD patients. METHODS 166 patients with symptomatic lower-extremity PAD (39% women; M age=64.9 +/- 10 years) completed the 10-item Center for Epidemiological Studies Depression scale. A score > or =4 indicates clinically relevant depressive symptoms. Depressive symptoms were re-assessed at 6, 12, and 18 months follow-up. Ankle-brachial index (ABI) and treadmill walking distance were used to assess PAD severity. RESULTS At baseline, depressive symptoms (CES-D > or =4) were present in 16% of the patients. Depressed patients performed worse regarding pain free (p=0.003) and maximum (p=0.005) walking distance. After adjusting for age, sex, education, ABI, psychotropic medication use, cardiovascular risk factors, and comorbidity, depressive symptoms remained stable in initially depressed patients. Using mixed modelling, three subgroups were identified in the total sample. The majority of PAD patients did not have depressive symptoms (58%), but there were two groups who persistently experienced either subclinical (27%) or clinically manifest (15%) depressive symptoms. LIMITATIONS Only baseline data of ABI and treadmill walking performance were available. CONCLUSIONS Depressive symptomatology was present in a substantial number of PAD patients, tended to be stable, and was associated with reduced walking distance. These apparently evident results are overlooked thus far in this patient group and deserve further attention in research and clinical care.

Risk factors for failure of retropubic and transobturator midurethral slings

OBJECTIVE The aim of our study was to identify and compare risk factors for failure of retropubic and transobturator procedures. STUDY DESIGN This was a retrospective cohort study. Women with predominant stress urinary incontinence who underwent a retropubic (n = 214) or transobturator tape procedure (n = 173) were included. Therapy was considered to have failed in women reporting any amount of urine leakage during stress after 2 and/or 12 months. RESULTS Risk factors for failure were mixed urinary incontinence (MUI; odds ratio [OR], 3.7; 95% confidence interval [CI], 1.5-9.1) and the observation of detrusor overactivity (DO) at urodynamics (OR, 8.6; 95% CI, 1.9-39.4) in the retropubic group. Reporting a history of previous incontinence surgery (OR, 3.9; 95% CI, 1.3-11.7) and a low mean urethral closure pressure (MUCP) at urodynamics (OR, 14.5; 95% CI, 1.5-139.0) were risk factors for failure in the transobturator group. CONCLUSION Women with previous incontinence surgery or a low MUCP might benefit more from a retropubic sling, whereas a transobturator procedure might be preferable in women with MUI or DO.

Type D personality and mortality in peripheral arterial disease : A pilot study

BACKGROUND Type D personality refers to the tendency to experience negative emotions and to inhibit self-expression in social interaction and has been shown to be an independent predictor of mortality in cardiac disease. Information about the effects of psychological traits on prognosis is lacking in cases of peripheral arterial disease (PAD). OBJECTIVE To examine whether type D personality predicts all-cause mortality in PAD. DESIGN Pilot follow-up study. SETTING Vascular surgery department of a teaching hospital. PATIENTS A total of 184 patients with symptomatic PAD (mean [SD] age, 64.8 [9.8] years) were followed up for 4 years (interquartile range, 3.5-4.5 years). MAIN OUTCOME MEASURES Patients completed the type D Scale-14 measure of type D personality at baseline. Information about all-cause mortality was obtained from patient medical files. RESULTS During 4-year follow-up, 16 patients (8.7%) died. Adjusting for age and sex, type D personality was predictive of mortality (P = .03). Ankle-brachial index (P = .05), age (P = .009), diabetes mellitus (P = .02), pulmonary disease (P = .09), and renal disease (P = .02) were also predictive of mortality. Multivariable logistic regression revealed that age, diabetes, and renal disease were independent predictors of all-cause mortality (odds ratios, 1.1-2.3). After adjustment for these clinical predictors, patients with type D personality still had a more than 3-fold increased risk of death (odds ratio, 3.5; 95% confidence interval, 1.1-11.1; P = .04). CONCLUSIONS Type D personality predicts an increased risk of all-cause mortality in PAD, above and beyond traditional risk factors. Further research is needed to confirm these findings, but this pilot study suggests that the assessment of type D personality may be useful for detecting high-risk patients with PAD.

Predictive value of urodynamics on outcome after midurethral sling surgery for female stress urinary incontinence

OBJECTIVE The aim of this study was to evaluate the value of urodynamic investigation in the preoperative workup of midurethral sling surgery and to identify risk factors for failure after 3 different midurethral sling procedures. STUDY DESIGN Retrospective cohort study. 437 women who underwent a tension-free vaginal tape, Monarc, or tension-free vaginal tape-obturator procedure without other simultaneously performed urogynecological surgery were included. Preoperative data were collected from the medical files. Patients who reported any amount of leakage were considered failures. The mean follow-up of the study population was 14 months. RESULTS After multivariate analysis, mixed urinary incontinence (P = .04), previous incontinence surgery (P = .022), and detrusor overactivity (P = .02) were significantly related to failure of midurethral sling procedures. There were no predictive urodynamic parameters for failure in patients with mixed urinary incontinence or previous incontinence surgery. CONCLUSION The standard use of urodynamic investigation in the preoperative workup of midurethral sling surgery needs to be revisited.

Does diabetes mellitus as a comorbid condition affect the health-related quality of life in prostate cancer survivors? Results of a population-based observational study.

To assess the health‐related quality of life (HRQoL) of long‐term, disease‐free prostate cancer survivors and compare it with that of prostate cancer survivors with diabetes mellitus (DM), and a Dutch normative population, as comorbidity can have a major impact on HRQoL in cancer survivors.

Risk factors predicting mortality after blunt traumatic cervical fracture

OBJECTIVE Risk factors for mortality after blunt cervical trauma have received little attention within the literature. Therefore, we performed a study, to determine which factors are associated with mortality in patients with blunt cervical trauma. STUDY DESIGN A retrospective study of 88 trauma patients, with cervical fractures, who were admitted to the emergency department of the St. Elisabeth hospital, Tilburg, The Netherlands. SUMMARY OF BACKGROUND DATA A retrospective cohort study was performed within the trauma department of the St. Elisabeth Hospital, in Tilburg, The Netherlands. From January 2000 to December 2005, all patients with cervical fractures after blunt trauma were included (N=88). All patient records were reviewed. Patient and trauma characteristics were registered within a standardised electronic database. Our follow-up period was 1 year. RESULTS In total, 12 (13.6%) patients died after a traumatic cervical fracture. Age (p=0.005), gender (p=0.005), involvement of the third cervical vertebrae (p=0.003), involvement of three cervical vertebrae (p=0.010) and involvement of the spinous process (p=0.032) were associated with mortality. The multivariate analysis showed that age and the involvement of the third cervical vertebrae (both p=0.016) are both independently associated with mortality. CONCLUSION Age and involvement of the third cervical vertebrae were both independent predictors of mortality. Age has been previously described as a risk factor for adverse prognosis in different diseases and traumas. However, involvement of the third cervical vertebrae has not yet been described as a significant risk factor. Before implementation within trauma support further research is needed to evaluate the role of the third cervical vertebra regarding adverse prognosis and mortality in trauma patients.

Age-related differences in invasive treatment of peripheral arterial disease: Disease severity versus social support as determinants

OBJECTIVE Social support may influence the seeking of appropriate treatment. We examined social support and peripheral arterial disease (PAD) severity as determinants of treatment for PAD in younger and older patients. METHODS Consecutive PAD patients (N=203) completed the Perceived Social Support Scale. Treadmill-walking distance and ankle-brachial pressure index (ABPI) were measured. The main outcome was invasive treatment for PAD in the year following diagnosis. RESULTS During follow-up, 48% of the patients underwent invasive treatment for PAD. Younger patients (<or=64 years) tended to be more often invasively treated as compared to older patients. In younger patients, a high level of social support predicted invasive treatment above and beyond PAD severity. In older patients, low ABPI predicted invasive treatment. CONCLUSION Younger patients with inadequate social support may fail to seek appropriate treatment, suggesting the need to consider psychosocial factors in optimizing treatment of atherosclerotic vascular disease in this high-risk group.

Risk Factors for Neurological Deficiency One Year after Blunt-Induced Traumatic Cervical Fracture

Background/Aims: Little is known about the risk factors of neurological deficiency after blunt cervical fracture. This study was performed to identify factors predicting neurological deficiency after blunt cervical fracture. Methods: Within our Level I Trauma Center, we performed a retrospective case-control study. Patients with a cervical fracture after blunt trauma between January 2000 and December 2005 were identified. In total, 76 patients sustained a cervical fracture and survived 1 year after trauma. All patient files were reviewed. Patient and trauma characteristics were registered in an electronic database. Results: 26 patients were referred to the Neurology Department. Of these, 14 patients had complaints of sensory or motor loss and 12 patients were seen for sensory and motor loss. Involvement of the seventh cervical vertebrae (p = 0.030) and spinal cord compression were found to be independent significant risk factors for sensory or motor loss. The injury severity score (p = 0.001) and involvement of the vertebral body (p = 0.042) were significantly associated with sensory and motor loss. Conclusion: During patient evaluation, the identified variables should be taken into account. If one understands the risk factors, then it is possible to explain the expected outcome after the spine fracture.

Depression and screening cardiovascular events.

To the Editor: —Peripheral arterial disease (PAD) remains an under-treated disease1, and information about risk factors and prognosis is poorly disseminated in the population2. Nevertheless, PAD and coronary artery disease (CAD) patients share the same risk factors, and risks of future cardiovascular events in PAD patients are comparable with those in CAD patients3. Depression may adversely impact prognosis in CAD patients4, but little is known about depression and prognosis in PAD. Therefore, we read with great interest the work of Cherr and colleagues5 on the relation between psychological factors and cardiovascular events in PAD. Their study generated interesting findings, but there are also a number of issues we would like to address here. First, the screening method the authors used probably led to an overestimation of depression rates. The General Health Questionnaire is not a depression scale, but rather was developed to assess non-specific psychological distress in community samples6, and a higher cut-off score (≥8) has been recommended to screen for depressive symptoms in patients with chronic somatic disease7. Second, 80% of depressed patients received antidepressant therapy. Analyses were not adjusted for type of antidepressant, while studies warn against the use tricyclic antidepressants in cardiovascular populations because they are associated with an increased risk of myocardial infarction8,9. Therefore, we cannot rule out the influence of antidepressant use on adverse outcomes in depressed patients. Finally, in the adjusted analyses, only a rough parameter of disease severity was included (indication for intervention). Table 2 shows us that the group that underwent revascularization was very heterogeneous in terms of disease severity; indication for intervention ranged from claudication to critical leg ischemia and gangrene or tissue loss. It would have been more appropriate to include the lowest ankle-brachial index in the adjusted analyses due to its strong prognostic value for adverse cardiovascular events in PAD10. Likewise, in CAD, the relation between depression and increased risk of mortality seems to be confounded by cardiac disease severity or left ventricular dysfunction11. Future studies examining the link between psychological factors and prognosis in PAD need to take into account reliable indices of disease severity.