Mark S. Lesney

Dr. Michael Ellis DeBakey, pioneer heart surgeon and medical device innovator, died July 11, 2008, in Houston, about 2 months shy of his 100th birthday on Sept. 7.

In his lifetime, Dr. DeBakey was renowned for his immense contributions to the progress of medical science, such that he was declared a "living legend" by the Library of Congress and was this year awarded a Congressional Gold Medal for his lifetime achievements, in particular his pioneering work as a heart surgeon.

And although it was as a heart surgeon that Dr.DeBakey gained greatest fame, his accomplisments in vascular surgery were unique and profound, from his development of the Dacron graft to his active membership in the SVS, and his role as founder and first editor of the Journal of Vascular Surgery.

Even before Dr. DeBakey received his medical degree from Tulane University in 1932, he began his contributions to modern medicine by developing a small continuous flow-roller pump designed to improve blood transfusion--a device that would later be used by Dr. John Gibbon as a crucial component of his heart-lung machine. And in 1939, with his mentor, Dr. Alton Ochsner, Dr. DeBakey suggested a strong link between smoking and lung cancer.

After internships in New Orleans and surgical training in Europe, Dr. DeBakey volunteered for service during World War II and was assigned to the U.S. Army Surgeon General's office. From his observations in the field, he became convinced of the need for a mobile surgical unit that would give soldiers access to high-level medical treatment on the combat field and convinced the surgeon general to form what would become the mobile army surgical hospitals (MASH units)--an innovation that gained him the U.S. Army Legion of Merit in 1945.

His government service continued throughout his civilian career, as he helped to establish the Veterans Administration medical center research system. He also initiated the movement that in 1956 took the Army's poorly housed medical library and used it to create the National Library of Medicine, of which he was first board member and then chairman. He served three terms on the National Heart, Lung, and Blood Advisory Council as well. He was responsible for helping establish health care systems in a host of countries, including Belgium, China, Egypt, England, Germany, Saudi Arabia, Australia, and numerous other Middle Eastern and Central and South American nations.

According to the Web site of Baylor College of Medicine's department of surgery, where he spent almost his entire postwar career, Dr. DeBakey operated on more than 60,000 patients in the Houston area alone. But these were not all just standard operations. In 1953, he performed the first successful carotid endarterectomy, as well as the first successful removal and graft replacement of a fusiform thoracic aortic aneurysm, and in 1954, the first successful resection and graft replacement of an aneurysm of the distal aortic arch and upper descending thoracic aorta.

In 1955 he performed the first successful resection of a thoracoabdominal aortic aneurysm using the DeBakey Dacron graft--the first artificial arterial graft of its kind.

"If we now tried to develop the Dacron graft the way we developed it, I am not sure we would have it today with the way they regulate things. …When I went down to the department store ... they said, 'We are fresh out of nylon, but we do have a new material called Dacron.' I felt it, and it looked good to me. So I bought a yard of it. ... I took this yard of Dacron cloth, I cut two sheets the width I wanted, sewed the edges on each side, and made a tube out of it. .. . We put the graft on a stent, wrapped nylon thread around it, pushed it together, and baked it. ... After about two or three years of laboratory work on my own [including experiments in dogs], I decided that it was time to put the graft in a human being. I did not have a committee to approve it. ... In 1954, I put the first one in during an abdominal aortic aneurysm. That first patient lived, I think, for 13 years and never had any trouble," Dr. DeBakey related in an interview published in 1996 in the Journal of Vascular Surgery.

And among his other pioneering surgical developments, in 1964, Dr. DeBakey was the first to perform a successful coronary artery bypass, using a portion of leg vein as the graft, in what is now one of the most commonly performed heart operations--coronary artery bypass grafting.

As if surgically repairing failing hearts was not enough, Dr. DeBakey became a pioneer of artificial heart research and of cardiac assist devices. On July 18, 1963, after years of animal research, he performed the first successful human implantation of a left ventricular assist device (LVAD), one which he devised; the patient died after 4 days from causes unrelated to the technology. In 1966, Dr. DeBakey's redesigned, extracorporeal pneumatic pump was used in a 37-year-old woman who could not be weaned from the heart-lung machine after dual valve replacement. After 10 days of LVAD support, she recovered sufficiently for the pump to be removed and she survived. This pump served as the basis of Dr. DeBakey's first total artificial heart model, created in 1968.

Dr. DeBakey was honored profusely throughout his lifetime by the medical community and the general public. Numerous medical facilities are named after him in this country and around the world. He received countless awards for his technical and social achievements in medicine. Among these honors were the American Medical Association's Distinguished Service Award (1959), the Albert Lasker Award for Clinical Medical Research (1963), the Presidential Medal of Freedom (1969), and the National Medal of Science (1987). More recently, he was the first foreign member elected to the Russian Academy of Sciences (1999), was given the Library of Congress Bicentennial Living Legend Award (2000), and was awarded the Congressional Gold Medal in April 2008.

In his death, Dr. DeBakey was the first Houston resident given the honor of lying in state at City Hall and, at the request of his family, he lay dressed in his characteristic glasses, scrubs, and white coat for viewing by long lines of the general public.

Sources and suggested readings

Heart Fail. Clin. 2007;3:117-20.J. Vasc. Surg. 1996;23:1031-4.

Dr. Michael Ellis DeBakey, pioneer heart surgeon and medical device innovator, died July 11, 2008, in Houston, about 2 months shy of his 100th birthday on Sept. 7.

In his lifetime, Dr. DeBakey was renowned for his immense contributions to the progress of medical science, such that he was declared a "living legend" by the Library of Congress and was this year awarded a Congressional Gold Medal for his lifetime achievements, in particular his pioneering work as a heart surgeon.

And although it was as a heart surgeon that Dr.DeBakey gained greatest fame, his accomplisments in vascular surgery were unique and profound, from his development of the Dacron graft to his active membership in the SVS, and his role as founder and first editor of the Journal of Vascular Surgery.

Even before Dr. DeBakey received his medical degree from Tulane University in 1932, he began his contributions to modern medicine by developing a small continuous flow-roller pump designed to improve blood transfusion--a device that would later be used by Dr. John Gibbon as a crucial component of his heart-lung machine. And in 1939, with his mentor, Dr. Alton Ochsner, Dr. DeBakey suggested a strong link between smoking and lung cancer.

After internships in New Orleans and surgical training in Europe, Dr. DeBakey volunteered for service during World War II and was assigned to the U.S. Army Surgeon General's office. From his observations in the field, he became convinced of the need for a mobile surgical unit that would give soldiers access to high-level medical treatment on the combat field and convinced the surgeon general to form what would become the mobile army surgical hospitals (MASH units)--an innovation that gained him the U.S. Army Legion of Merit in 1945.

His government service continued throughout his civilian career, as he helped to establish the Veterans Administration medical center research system. He also initiated the movement that in 1956 took the Army's poorly housed medical library and used it to create the National Library of Medicine, of which he was first board member and then chairman. He served three terms on the National Heart, Lung, and Blood Advisory Council as well. He was responsible for helping establish health care systems in a host of countries, including Belgium, China, Egypt, England, Germany, Saudi Arabia, Australia, and numerous other Middle Eastern and Central and South American nations.

According to the Web site of Baylor College of Medicine's department of surgery, where he spent almost his entire postwar career, Dr. DeBakey operated on more than 60,000 patients in the Houston area alone. But these were not all just standard operations. In 1953, he performed the first successful carotid endarterectomy, as well as the first successful removal and graft replacement of a fusiform thoracic aortic aneurysm, and in 1954, the first successful resection and graft replacement of an aneurysm of the distal aortic arch and upper descending thoracic aorta.

In 1955 he performed the first successful resection of a thoracoabdominal aortic aneurysm using the DeBakey Dacron graft--the first artificial arterial graft of its kind.

"If we now tried to develop the Dacron graft the way we developed it, I am not sure we would have it today with the way they regulate things. …When I went down to the department store ... they said, 'We are fresh out of nylon, but we do have a new material called Dacron.' I felt it, and it looked good to me. So I bought a yard of it. ... I took this yard of Dacron cloth, I cut two sheets the width I wanted, sewed the edges on each side, and made a tube out of it. .. . We put the graft on a stent, wrapped nylon thread around it, pushed it together, and baked it. ... After about two or three years of laboratory work on my own [including experiments in dogs], I decided that it was time to put the graft in a human being. I did not have a committee to approve it. ... In 1954, I put the first one in during an abdominal aortic aneurysm. That first patient lived, I think, for 13 years and never had any trouble," Dr. DeBakey related in an interview published in 1996 in the Journal of Vascular Surgery.

And among his other pioneering surgical developments, in 1964, Dr. DeBakey was the first to perform a successful coronary artery bypass, using a portion of leg vein as the graft, in what is now one of the most commonly performed heart operations--coronary artery bypass grafting.

As if surgically repairing failing hearts was not enough, Dr. DeBakey became a pioneer of artificial heart research and of cardiac assist devices. On July 18, 1963, after years of animal research, he performed the first successful human implantation of a left ventricular assist device (LVAD), one which he devised; the patient died after 4 days from causes unrelated to the technology. In 1966, Dr. DeBakey's redesigned, extracorporeal pneumatic pump was used in a 37-year-old woman who could not be weaned from the heart-lung machine after dual valve replacement. After 10 days of LVAD support, she recovered sufficiently for the pump to be removed and she survived. This pump served as the basis of Dr. DeBakey's first total artificial heart model, created in 1968.

Dr. DeBakey was honored profusely throughout his lifetime by the medical community and the general public. Numerous medical facilities are named after him in this country and around the world. He received countless awards for his technical and social achievements in medicine. Among these honors were the American Medical Association's Distinguished Service Award (1959), the Albert Lasker Award for Clinical Medical Research (1963), the Presidential Medal of Freedom (1969), and the National Medal of Science (1987). More recently, he was the first foreign member elected to the Russian Academy of Sciences (1999), was given the Library of Congress Bicentennial Living Legend Award (2000), and was awarded the Congressional Gold Medal in April 2008.

In his death, Dr. DeBakey was the first Houston resident given the honor of lying in state at City Hall and, at the request of his family, he lay dressed in his characteristic glasses, scrubs, and white coat for viewing by long lines of the general public.

Sources and suggested readings

Heart Fail. Clin. 2007;3:117-20.J. Vasc. Surg. 1996;23:1031-4.

Dr. Michael Ellis DeBakey, pioneer heart surgeon and medical device innovator, died July 11, 2008, in Houston, about 2 months shy of his 100th birthday on Sept. 7.

In his lifetime, Dr. DeBakey was renowned for his immense contributions to the progress of medical science, such that he was declared a "living legend" by the Library of Congress and was this year awarded a Congressional Gold Medal for his lifetime achievements, in particular his pioneering work as a heart surgeon.

And although it was as a heart surgeon that Dr.DeBakey gained greatest fame, his accomplisments in vascular surgery were unique and profound, from his development of the Dacron graft to his active membership in the SVS, and his role as founder and first editor of the Journal of Vascular Surgery.

Even before Dr. DeBakey received his medical degree from Tulane University in 1932, he began his contributions to modern medicine by developing a small continuous flow-roller pump designed to improve blood transfusion--a device that would later be used by Dr. John Gibbon as a crucial component of his heart-lung machine. And in 1939, with his mentor, Dr. Alton Ochsner, Dr. DeBakey suggested a strong link between smoking and lung cancer.

After internships in New Orleans and surgical training in Europe, Dr. DeBakey volunteered for service during World War II and was assigned to the U.S. Army Surgeon General's office. From his observations in the field, he became convinced of the need for a mobile surgical unit that would give soldiers access to high-level medical treatment on the combat field and convinced the surgeon general to form what would become the mobile army surgical hospitals (MASH units)--an innovation that gained him the U.S. Army Legion of Merit in 1945.

His government service continued throughout his civilian career, as he helped to establish the Veterans Administration medical center research system. He also initiated the movement that in 1956 took the Army's poorly housed medical library and used it to create the National Library of Medicine, of which he was first board member and then chairman. He served three terms on the National Heart, Lung, and Blood Advisory Council as well. He was responsible for helping establish health care systems in a host of countries, including Belgium, China, Egypt, England, Germany, Saudi Arabia, Australia, and numerous other Middle Eastern and Central and South American nations.

According to the Web site of Baylor College of Medicine's department of surgery, where he spent almost his entire postwar career, Dr. DeBakey operated on more than 60,000 patients in the Houston area alone. But these were not all just standard operations. In 1953, he performed the first successful carotid endarterectomy, as well as the first successful removal and graft replacement of a fusiform thoracic aortic aneurysm, and in 1954, the first successful resection and graft replacement of an aneurysm of the distal aortic arch and upper descending thoracic aorta.

In 1955 he performed the first successful resection of a thoracoabdominal aortic aneurysm using the DeBakey Dacron graft--the first artificial arterial graft of its kind.

"If we now tried to develop the Dacron graft the way we developed it, I am not sure we would have it today with the way they regulate things. …When I went down to the department store ... they said, 'We are fresh out of nylon, but we do have a new material called Dacron.' I felt it, and it looked good to me. So I bought a yard of it. ... I took this yard of Dacron cloth, I cut two sheets the width I wanted, sewed the edges on each side, and made a tube out of it. .. . We put the graft on a stent, wrapped nylon thread around it, pushed it together, and baked it. ... After about two or three years of laboratory work on my own [including experiments in dogs], I decided that it was time to put the graft in a human being. I did not have a committee to approve it. ... In 1954, I put the first one in during an abdominal aortic aneurysm. That first patient lived, I think, for 13 years and never had any trouble," Dr. DeBakey related in an interview published in 1996 in the Journal of Vascular Surgery.

And among his other pioneering surgical developments, in 1964, Dr. DeBakey was the first to perform a successful coronary artery bypass, using a portion of leg vein as the graft, in what is now one of the most commonly performed heart operations--coronary artery bypass grafting.

As if surgically repairing failing hearts was not enough, Dr. DeBakey became a pioneer of artificial heart research and of cardiac assist devices. On July 18, 1963, after years of animal research, he performed the first successful human implantation of a left ventricular assist device (LVAD), one which he devised; the patient died after 4 days from causes unrelated to the technology. In 1966, Dr. DeBakey's redesigned, extracorporeal pneumatic pump was used in a 37-year-old woman who could not be weaned from the heart-lung machine after dual valve replacement. After 10 days of LVAD support, she recovered sufficiently for the pump to be removed and she survived. This pump served as the basis of Dr. DeBakey's first total artificial heart model, created in 1968.

Dr. DeBakey was honored profusely throughout his lifetime by the medical community and the general public. Numerous medical facilities are named after him in this country and around the world. He received countless awards for his technical and social achievements in medicine. Among these honors were the American Medical Association's Distinguished Service Award (1959), the Albert Lasker Award for Clinical Medical Research (1963), the Presidential Medal of Freedom (1969), and the National Medal of Science (1987). More recently, he was the first foreign member elected to the Russian Academy of Sciences (1999), was given the Library of Congress Bicentennial Living Legend Award (2000), and was awarded the Congressional Gold Medal in April 2008.

In his death, Dr. DeBakey was the first Houston resident given the honor of lying in state at City Hall and, at the request of his family, he lay dressed in his characteristic glasses, scrubs, and white coat for viewing by long lines of the general public.

Sources and suggested readings

Heart Fail. Clin. 2007;3:117-20.J. Vasc. Surg. 1996;23:1031-4.

An alternative on-field warm-up program reduced the risk of anterior cruciate ligament injury in collegiate female soccer players, especially those with a previous history of such injuries.

The Prevent Injury and Enhance Performance (PEP) program consists of warm-up, stretching, strengthening, plyometrics, and sports-specific agility exercises intended to address potential deficits in the stabilizing muscles around the knee joint.

The study tested the PEP program during the fall 2002 soccer season and involved 69 participating Division I National Collegiate Athletic Association women's soccer teams.

A certified athletic trainer for each team supervised each training session and communicated the results, including participation and injury reports. A total of 34 interventional teams (583 athletes) performed the PEP program regimen, and 35 control teams (852 athletes) performed their regular warm-up routine; 8 interventional programs dropped out of the study before completion and were not included in the analysis, wrote Dr. Julie Gilchrist of the Centers for Disease Control and Prevention and her colleagues.

An anterior cruciate ligament (ACL) injury was counted only if the certified athletic trainer reported confirmation by magnetic resonance imaging, arthroscopy, or direct visualization during repair. A contact injury was defined as an ACL injury sustained as a result of direct contact to the knee or another body part during play. A noncontact injury was one resulting without extrinsic contact with another player or object (Am. J. Sports Med. 2008;36:1476–83).

A comparison of noncontact ACL injury rates between the interventional and control groups showed the most substantial differences in injury rates. The ACL injury rates tended to be lower for all interventional and control comparisons.

The researchers attributed the lack of significant differences in other areas of injury, despite the downward trend, to the fact that it takes time for the benefits of neuromuscular training to manifest, which would explain why differences in ACL injury rates were more pronounced toward the end of the season. Overall, the program seems to reduce the risk of noncontact ACL injuries, especially in athletes with a history of ACL injury, they concluded.

Several authors of this paper participated in the development of the PEP program but had no financial interests in it.

Athletes with a history of ACL injury stand to benefit in particular from the program. ©Sirena Designs/

An alternative on-field warm-up program reduced the risk of anterior cruciate ligament injury in collegiate female soccer players, especially those with a previous history of such injuries.

The Prevent Injury and Enhance Performance (PEP) program consists of warm-up, stretching, strengthening, plyometrics, and sports-specific agility exercises intended to address potential deficits in the stabilizing muscles around the knee joint.

The study tested the PEP program during the fall 2002 soccer season and involved 69 participating Division I National Collegiate Athletic Association women's soccer teams.

A certified athletic trainer for each team supervised each training session and communicated the results, including participation and injury reports. A total of 34 interventional teams (583 athletes) performed the PEP program regimen, and 35 control teams (852 athletes) performed their regular warm-up routine; 8 interventional programs dropped out of the study before completion and were not included in the analysis, wrote Dr. Julie Gilchrist of the Centers for Disease Control and Prevention and her colleagues.

An anterior cruciate ligament (ACL) injury was counted only if the certified athletic trainer reported confirmation by magnetic resonance imaging, arthroscopy, or direct visualization during repair. A contact injury was defined as an ACL injury sustained as a result of direct contact to the knee or another body part during play. A noncontact injury was one resulting without extrinsic contact with another player or object (Am. J. Sports Med. 2008;36:1476–83).

A comparison of noncontact ACL injury rates between the interventional and control groups showed the most substantial differences in injury rates. The ACL injury rates tended to be lower for all interventional and control comparisons.

The researchers attributed the lack of significant differences in other areas of injury, despite the downward trend, to the fact that it takes time for the benefits of neuromuscular training to manifest, which would explain why differences in ACL injury rates were more pronounced toward the end of the season. Overall, the program seems to reduce the risk of noncontact ACL injuries, especially in athletes with a history of ACL injury, they concluded.

Several authors of this paper participated in the development of the PEP program but had no financial interests in it.

Athletes with a history of ACL injury stand to benefit in particular from the program. ©Sirena Designs/

An alternative on-field warm-up program reduced the risk of anterior cruciate ligament injury in collegiate female soccer players, especially those with a previous history of such injuries.

The Prevent Injury and Enhance Performance (PEP) program consists of warm-up, stretching, strengthening, plyometrics, and sports-specific agility exercises intended to address potential deficits in the stabilizing muscles around the knee joint.

The study tested the PEP program during the fall 2002 soccer season and involved 69 participating Division I National Collegiate Athletic Association women's soccer teams.

A certified athletic trainer for each team supervised each training session and communicated the results, including participation and injury reports. A total of 34 interventional teams (583 athletes) performed the PEP program regimen, and 35 control teams (852 athletes) performed their regular warm-up routine; 8 interventional programs dropped out of the study before completion and were not included in the analysis, wrote Dr. Julie Gilchrist of the Centers for Disease Control and Prevention and her colleagues.

An anterior cruciate ligament (ACL) injury was counted only if the certified athletic trainer reported confirmation by magnetic resonance imaging, arthroscopy, or direct visualization during repair. A contact injury was defined as an ACL injury sustained as a result of direct contact to the knee or another body part during play. A noncontact injury was one resulting without extrinsic contact with another player or object (Am. J. Sports Med. 2008;36:1476–83).

A comparison of noncontact ACL injury rates between the interventional and control groups showed the most substantial differences in injury rates. The ACL injury rates tended to be lower for all interventional and control comparisons.

The researchers attributed the lack of significant differences in other areas of injury, despite the downward trend, to the fact that it takes time for the benefits of neuromuscular training to manifest, which would explain why differences in ACL injury rates were more pronounced toward the end of the season. Overall, the program seems to reduce the risk of noncontact ACL injuries, especially in athletes with a history of ACL injury, they concluded.

Several authors of this paper participated in the development of the PEP program but had no financial interests in it.

Athletes with a history of ACL injury stand to benefit in particular from the program. ©Sirena Designs/

The prevalence of osteoarthritis was comparable in patients undergoing anterior cruciate ligament reconstruction using either bone-patellar tendon-bone or hamstring tendon autografts, according to a retrospective study.

The presence of meniscal injuries, however, increased the prevalence of osteoarthritis (OA), the researchers said.

A total of 113 patients at a single institution who had symptomatic unilateral chronic anterior cruciate (ACL) reconstruction between April 1995 and May 1998 as part of three prospective randomized studies and who were available for follow-up were examined, according to Dr. Mattias Lidén and colleagues from the Sahlgrenska University Hospital, Göteborg, Sweden.

Ipsilateral bone-patellar tendon-bone (BPTB) autografts were used for reconstruction in 72 patients; the remaining 41 patients, referred to as the hamstring tendon autograft (HT) group, had reconstruction with either ipsilateral triple semitendinosus autografts (32) or quadruple semitendinous autografts (9).

The patients' median age was 28 years at the time of surgery, which was performed at a median of 18 months after injury. There were 49 men in the BPTB group and 29 in HT group. Most of the injuries were caused by contact sports (71%) and noncontact sports (15%), with no significant difference in degree of injury between sources of injury. Meniscal injuries were present in 69% of the BPTB group and in 68% of the HT group.

A single surgeon performed the procedures, in which fixation of both types of graft was done using interference screws. After standard rehabilitation, patients who attained full functional stability were permitted to resume running at 3 months and contact sports at 6 months.

Standard radiographic follow-up, performed according to the rating systems of Ahlbäck and Fairbank, was interpreted by a radiologist blinded to the type of graft used. Independent physiotherapists not involved in the rehabilitation process assessed patients pre- and postoperatively. The follow-up radiographic and clinical assessments were made at a median of 86 months after reconstruction (Arthroscopy 2008;24:899–908).

There was no significant radiological difference between the BPTB and HT groups with respect to osteoarthritis, according to radiological assessments. Overall, OA was found in 23% of patients, according to the Ahlbäck rating system (25% of BPTB and 20% of HT), and in 74% of patients, according to the Fairbank rating system (76% in the BPTB and 71% in the HT groups). However, patients with meniscal injuries treated before, during, or after the index operation had significantly more OA findings in both systems than did patients without such injuries, the authors stated.

On the basis of the slight yet significant correlation between time of injury to reconstruction and the cumulative number of positive Fairbank changes, the authors said patients should undergo reconstruction as soon as possible after injury to minimize future meniscal injuries and the development of OA.

The prevalence of osteoarthritis was comparable in patients undergoing anterior cruciate ligament reconstruction using either bone-patellar tendon-bone or hamstring tendon autografts, according to a retrospective study.

The presence of meniscal injuries, however, increased the prevalence of osteoarthritis (OA), the researchers said.

A total of 113 patients at a single institution who had symptomatic unilateral chronic anterior cruciate (ACL) reconstruction between April 1995 and May 1998 as part of three prospective randomized studies and who were available for follow-up were examined, according to Dr. Mattias Lidén and colleagues from the Sahlgrenska University Hospital, Göteborg, Sweden.

Ipsilateral bone-patellar tendon-bone (BPTB) autografts were used for reconstruction in 72 patients; the remaining 41 patients, referred to as the hamstring tendon autograft (HT) group, had reconstruction with either ipsilateral triple semitendinosus autografts (32) or quadruple semitendinous autografts (9).

The patients' median age was 28 years at the time of surgery, which was performed at a median of 18 months after injury. There were 49 men in the BPTB group and 29 in HT group. Most of the injuries were caused by contact sports (71%) and noncontact sports (15%), with no significant difference in degree of injury between sources of injury. Meniscal injuries were present in 69% of the BPTB group and in 68% of the HT group.

A single surgeon performed the procedures, in which fixation of both types of graft was done using interference screws. After standard rehabilitation, patients who attained full functional stability were permitted to resume running at 3 months and contact sports at 6 months.

Standard radiographic follow-up, performed according to the rating systems of Ahlbäck and Fairbank, was interpreted by a radiologist blinded to the type of graft used. Independent physiotherapists not involved in the rehabilitation process assessed patients pre- and postoperatively. The follow-up radiographic and clinical assessments were made at a median of 86 months after reconstruction (Arthroscopy 2008;24:899–908).

There was no significant radiological difference between the BPTB and HT groups with respect to osteoarthritis, according to radiological assessments. Overall, OA was found in 23% of patients, according to the Ahlbäck rating system (25% of BPTB and 20% of HT), and in 74% of patients, according to the Fairbank rating system (76% in the BPTB and 71% in the HT groups). However, patients with meniscal injuries treated before, during, or after the index operation had significantly more OA findings in both systems than did patients without such injuries, the authors stated.

On the basis of the slight yet significant correlation between time of injury to reconstruction and the cumulative number of positive Fairbank changes, the authors said patients should undergo reconstruction as soon as possible after injury to minimize future meniscal injuries and the development of OA.

The prevalence of osteoarthritis was comparable in patients undergoing anterior cruciate ligament reconstruction using either bone-patellar tendon-bone or hamstring tendon autografts, according to a retrospective study.

The presence of meniscal injuries, however, increased the prevalence of osteoarthritis (OA), the researchers said.

A total of 113 patients at a single institution who had symptomatic unilateral chronic anterior cruciate (ACL) reconstruction between April 1995 and May 1998 as part of three prospective randomized studies and who were available for follow-up were examined, according to Dr. Mattias Lidén and colleagues from the Sahlgrenska University Hospital, Göteborg, Sweden.

Ipsilateral bone-patellar tendon-bone (BPTB) autografts were used for reconstruction in 72 patients; the remaining 41 patients, referred to as the hamstring tendon autograft (HT) group, had reconstruction with either ipsilateral triple semitendinosus autografts (32) or quadruple semitendinous autografts (9).

The patients' median age was 28 years at the time of surgery, which was performed at a median of 18 months after injury. There were 49 men in the BPTB group and 29 in HT group. Most of the injuries were caused by contact sports (71%) and noncontact sports (15%), with no significant difference in degree of injury between sources of injury. Meniscal injuries were present in 69% of the BPTB group and in 68% of the HT group.

A single surgeon performed the procedures, in which fixation of both types of graft was done using interference screws. After standard rehabilitation, patients who attained full functional stability were permitted to resume running at 3 months and contact sports at 6 months.

Standard radiographic follow-up, performed according to the rating systems of Ahlbäck and Fairbank, was interpreted by a radiologist blinded to the type of graft used. Independent physiotherapists not involved in the rehabilitation process assessed patients pre- and postoperatively. The follow-up radiographic and clinical assessments were made at a median of 86 months after reconstruction (Arthroscopy 2008;24:899–908).

There was no significant radiological difference between the BPTB and HT groups with respect to osteoarthritis, according to radiological assessments. Overall, OA was found in 23% of patients, according to the Ahlbäck rating system (25% of BPTB and 20% of HT), and in 74% of patients, according to the Fairbank rating system (76% in the BPTB and 71% in the HT groups). However, patients with meniscal injuries treated before, during, or after the index operation had significantly more OA findings in both systems than did patients without such injuries, the authors stated.

On the basis of the slight yet significant correlation between time of injury to reconstruction and the cumulative number of positive Fairbank changes, the authors said patients should undergo reconstruction as soon as possible after injury to minimize future meniscal injuries and the development of OA.

Diabetes is not an independent risk factor for adverse early outcomes after coronary artery bypass grafting surgery, according to a large, retrospective study of patients who underwent the procedure over a 10-year period at a single institution.

This result may be due to improvements in management of glucose levels, according to a report by Dr. Pedro E. Antunes and colleagues.

Up to one-quarter of the patients undergoing coronary artery bypass grafting surgery (CABG) have diabetes. Previous reports have been conflicting regarding the negative impact of diabetes on short-term mortality and morbidity in patients undergoing CABG, with older studies finding a clearer relationship between diabetes and worse outcomes, the authors wrote.

In this study, 4,567 patients underwent isolated CABG over a 10-year period at the Hospitais da Universidade, Coimbra, Portugal. Overall, the rate of diabetes mellitus was 22% in these patients, ranging from 19% at the beginning of the study in 1992 to 27% at the end of the study in 2001—a significant decade trend (Eur. J. Cardiothorac. Surg. 2008;34:370–5). The study did not distinguish type 2 from type 1 diabetes.

The diabetic patients showed a significantly worse case-mix, compared with the nondiabetic patients according to the researchers. Diabetic patients had a higher mean age, a higher mean body mass index, and a higher proportion of patients with dyslipidemia, anemia, cardiomegaly, renal failure, peripheral vascular disease, cerebrovascular, and other comorbidities.

Perioperative glucose control in diabetic patients aimed at between 120 and 160 mg/dL. They received a standard sliding scale of subcutaneous insulin injection pre- and postoperatively, and in the operative room and ICU they received continuous intravenous insulin infusions.

The overall in-hospital mortality was 0.96% (44 individuals). There was no significant difference in mortality rate for the diabetic and nondiabetic groups (0.9% and 1.0%, respectively). Multivariate analysis showed that the presence of diabetes was not an independent predictor of in-hospital mortality.

As for in-hospital morbidity events, univariate analysis showed that diabetes was significantly associated only with cerebrovascular accident and prolonged length of stay. However, these associations disappeared in multivariate analysis, and only the development of mediastinitis in the diabetic patients showed significance.

“Better blood glucose management in the perioperative period improves early outcomes in diabetic patients subjected to CABG,” the authors reported.

Limitations to the study reported by the authors include that it is observational and retrospective.

Diabetes is not an independent risk factor for adverse early outcomes after coronary artery bypass grafting surgery, according to a large, retrospective study of patients who underwent the procedure over a 10-year period at a single institution.

This result may be due to improvements in management of glucose levels, according to a report by Dr. Pedro E. Antunes and colleagues.

Up to one-quarter of the patients undergoing coronary artery bypass grafting surgery (CABG) have diabetes. Previous reports have been conflicting regarding the negative impact of diabetes on short-term mortality and morbidity in patients undergoing CABG, with older studies finding a clearer relationship between diabetes and worse outcomes, the authors wrote.

In this study, 4,567 patients underwent isolated CABG over a 10-year period at the Hospitais da Universidade, Coimbra, Portugal. Overall, the rate of diabetes mellitus was 22% in these patients, ranging from 19% at the beginning of the study in 1992 to 27% at the end of the study in 2001—a significant decade trend (Eur. J. Cardiothorac. Surg. 2008;34:370–5). The study did not distinguish type 2 from type 1 diabetes.

The diabetic patients showed a significantly worse case-mix, compared with the nondiabetic patients according to the researchers. Diabetic patients had a higher mean age, a higher mean body mass index, and a higher proportion of patients with dyslipidemia, anemia, cardiomegaly, renal failure, peripheral vascular disease, cerebrovascular, and other comorbidities.

Perioperative glucose control in diabetic patients aimed at between 120 and 160 mg/dL. They received a standard sliding scale of subcutaneous insulin injection pre- and postoperatively, and in the operative room and ICU they received continuous intravenous insulin infusions.

The overall in-hospital mortality was 0.96% (44 individuals). There was no significant difference in mortality rate for the diabetic and nondiabetic groups (0.9% and 1.0%, respectively). Multivariate analysis showed that the presence of diabetes was not an independent predictor of in-hospital mortality.

As for in-hospital morbidity events, univariate analysis showed that diabetes was significantly associated only with cerebrovascular accident and prolonged length of stay. However, these associations disappeared in multivariate analysis, and only the development of mediastinitis in the diabetic patients showed significance.

“Better blood glucose management in the perioperative period improves early outcomes in diabetic patients subjected to CABG,” the authors reported.

Limitations to the study reported by the authors include that it is observational and retrospective.

Diabetes is not an independent risk factor for adverse early outcomes after coronary artery bypass grafting surgery, according to a large, retrospective study of patients who underwent the procedure over a 10-year period at a single institution.

This result may be due to improvements in management of glucose levels, according to a report by Dr. Pedro E. Antunes and colleagues.

Up to one-quarter of the patients undergoing coronary artery bypass grafting surgery (CABG) have diabetes. Previous reports have been conflicting regarding the negative impact of diabetes on short-term mortality and morbidity in patients undergoing CABG, with older studies finding a clearer relationship between diabetes and worse outcomes, the authors wrote.

In this study, 4,567 patients underwent isolated CABG over a 10-year period at the Hospitais da Universidade, Coimbra, Portugal. Overall, the rate of diabetes mellitus was 22% in these patients, ranging from 19% at the beginning of the study in 1992 to 27% at the end of the study in 2001—a significant decade trend (Eur. J. Cardiothorac. Surg. 2008;34:370–5). The study did not distinguish type 2 from type 1 diabetes.

The diabetic patients showed a significantly worse case-mix, compared with the nondiabetic patients according to the researchers. Diabetic patients had a higher mean age, a higher mean body mass index, and a higher proportion of patients with dyslipidemia, anemia, cardiomegaly, renal failure, peripheral vascular disease, cerebrovascular, and other comorbidities.

Perioperative glucose control in diabetic patients aimed at between 120 and 160 mg/dL. They received a standard sliding scale of subcutaneous insulin injection pre- and postoperatively, and in the operative room and ICU they received continuous intravenous insulin infusions.

The overall in-hospital mortality was 0.96% (44 individuals). There was no significant difference in mortality rate for the diabetic and nondiabetic groups (0.9% and 1.0%, respectively). Multivariate analysis showed that the presence of diabetes was not an independent predictor of in-hospital mortality.

As for in-hospital morbidity events, univariate analysis showed that diabetes was significantly associated only with cerebrovascular accident and prolonged length of stay. However, these associations disappeared in multivariate analysis, and only the development of mediastinitis in the diabetic patients showed significance.

“Better blood glucose management in the perioperative period improves early outcomes in diabetic patients subjected to CABG,” the authors reported.

Limitations to the study reported by the authors include that it is observational and retrospective.

A simple protocol can assess the diabetic foot for the presence of predisposing factors for ulcerations and amputation, and can be used to guide treatment, according to recommendations developed by an American Diabetes Association task force.

The protocol consists of a history, general examination, and an assessment of dermatologic, musculoskeletal, neurologic, and vascular factors. Details of the protocol were issued by the American Diabetes Association, with the endorsement of the American Association of Clinical Endocrinologists, in a report by Dr. Andrew J. M. Boulton and his colleagues in a task force of the ADA's Foot Care Interest Group.

The history should explore previous foot ulceration or amputation, neuropathic or peripheral vascular symptoms, impaired vision, renal replacement therapy, and tobacco use.

Key components of the diabetic foot exam include dermatologic inspection for skin status, sweating, infection, ulceration, and calluses, as well as musculoskeletal inspection for deformity (claw toes, prominent metatarsal heads, Charcot's joint) or muscle wasting.

Neurologic assessment for loss of protective sensation (LOPS) should include the use of a 10-g monofilament test, with the device placed at specific points on the bottom of the foot while the patient's eyes are closed, as well as one of these additional tests:

▸ Vibration with 128-Hz tuning fork.

▸ Pinprick sensation.

▸ Ankle reflexes.

▸ Vibration perception threshold testing.

Vascular assessment using ankle brachial pressure index testing should be performed to determine the presence of peripheral arterial disease (PAD) in two groups of patients: those who are symptomatic (claudication, rest pain, or nonhealing ulcer) and those who have absent posterior tibial or dorsalis pedis pulses (Diabetes Care 2008;31:1679–85).

Patients assessed using the protocol should be assigned to a foot risk category from 0 to 3, with 0 being no LOPS, no PAD, and no deformity, 1 being LOPS with or without deformity, 2 being PAD with or without LOPS, and 3 being a history of ulcer or amputation.

Subsequent therapy and follow-up care should be provided according to the category: Primary care monitoring is appropriate for risk categories 0 and 1, and specialist care is indicated for risk categories 2 and 3.

A simple protocol can assess the diabetic foot for the presence of predisposing factors for ulcerations and amputation, and can be used to guide treatment, according to recommendations developed by an American Diabetes Association task force.

The protocol consists of a history, general examination, and an assessment of dermatologic, musculoskeletal, neurologic, and vascular factors. Details of the protocol were issued by the American Diabetes Association, with the endorsement of the American Association of Clinical Endocrinologists, in a report by Dr. Andrew J. M. Boulton and his colleagues in a task force of the ADA's Foot Care Interest Group.

The history should explore previous foot ulceration or amputation, neuropathic or peripheral vascular symptoms, impaired vision, renal replacement therapy, and tobacco use.

Key components of the diabetic foot exam include dermatologic inspection for skin status, sweating, infection, ulceration, and calluses, as well as musculoskeletal inspection for deformity (claw toes, prominent metatarsal heads, Charcot's joint) or muscle wasting.

Neurologic assessment for loss of protective sensation (LOPS) should include the use of a 10-g monofilament test, with the device placed at specific points on the bottom of the foot while the patient's eyes are closed, as well as one of these additional tests:

▸ Vibration with 128-Hz tuning fork.

▸ Pinprick sensation.

▸ Ankle reflexes.

▸ Vibration perception threshold testing.

Vascular assessment using ankle brachial pressure index testing should be performed to determine the presence of peripheral arterial disease (PAD) in two groups of patients: those who are symptomatic (claudication, rest pain, or nonhealing ulcer) and those who have absent posterior tibial or dorsalis pedis pulses (Diabetes Care 2008;31:1679–85).

Patients assessed using the protocol should be assigned to a foot risk category from 0 to 3, with 0 being no LOPS, no PAD, and no deformity, 1 being LOPS with or without deformity, 2 being PAD with or without LOPS, and 3 being a history of ulcer or amputation.

Subsequent therapy and follow-up care should be provided according to the category: Primary care monitoring is appropriate for risk categories 0 and 1, and specialist care is indicated for risk categories 2 and 3.

A simple protocol can assess the diabetic foot for the presence of predisposing factors for ulcerations and amputation, and can be used to guide treatment, according to recommendations developed by an American Diabetes Association task force.

The protocol consists of a history, general examination, and an assessment of dermatologic, musculoskeletal, neurologic, and vascular factors. Details of the protocol were issued by the American Diabetes Association, with the endorsement of the American Association of Clinical Endocrinologists, in a report by Dr. Andrew J. M. Boulton and his colleagues in a task force of the ADA's Foot Care Interest Group.

The history should explore previous foot ulceration or amputation, neuropathic or peripheral vascular symptoms, impaired vision, renal replacement therapy, and tobacco use.

Key components of the diabetic foot exam include dermatologic inspection for skin status, sweating, infection, ulceration, and calluses, as well as musculoskeletal inspection for deformity (claw toes, prominent metatarsal heads, Charcot's joint) or muscle wasting.

Neurologic assessment for loss of protective sensation (LOPS) should include the use of a 10-g monofilament test, with the device placed at specific points on the bottom of the foot while the patient's eyes are closed, as well as one of these additional tests:

▸ Vibration with 128-Hz tuning fork.

▸ Pinprick sensation.

▸ Ankle reflexes.

▸ Vibration perception threshold testing.

Vascular assessment using ankle brachial pressure index testing should be performed to determine the presence of peripheral arterial disease (PAD) in two groups of patients: those who are symptomatic (claudication, rest pain, or nonhealing ulcer) and those who have absent posterior tibial or dorsalis pedis pulses (Diabetes Care 2008;31:1679–85).

Patients assessed using the protocol should be assigned to a foot risk category from 0 to 3, with 0 being no LOPS, no PAD, and no deformity, 1 being LOPS with or without deformity, 2 being PAD with or without LOPS, and 3 being a history of ulcer or amputation.

Subsequent therapy and follow-up care should be provided according to the category: Primary care monitoring is appropriate for risk categories 0 and 1, and specialist care is indicated for risk categories 2 and 3.

An initially successful healing rate in patients who were hospitalized with diabetic foot ulcers did not lead to comparable long-term outcomes in a prospective study of 94 consecutive patients.

The presence of nephropathy was found to be an important predictor of poorer outcomes, whereas age was an independent predictor of global therapeutic success (GTS), according to a report presented in Diabetes Care.

Of 94 consecutive diabetic patients hospitalized for diabetic foot ulcers between January 1998 and December 2000, 89 (63 men) were successfully followed up for an average of nearly 80 months. The mean age of the patients was nearly 64 years.

Researchers calculated the rates of primary healing, new ulcers, amputations, mortality, and disability, and evaluated the GTS of foot care management (defined as primary healing without recurrence or disability at the end of follow-up). To their knowledge, this was the first time that disability and dependency, which were measured using Katz's index of activities of daily living, were considered as end points of a prospective diabetic foot study, according to Dr. Edouard Ghanassia and colleagues from the Centre Hospitalier Universitaire Montpellier (France).

Primary healing without major amputation occurred in 69 patients (nearly 78%). Amputations were performed in 39 patients (44%), with 30 minor and 9 major amputations; of the minor amputations, 24 occurred in the primary healing group. Ulcers recurred in nearly 61% of patients. Ultimately, 46 patients (nearly 52%) died, including 23 from cardiovascular events.

At the end of the follow-up period, 25 patients (28%) were dependent and 40 patients (nearly 45%) had achieved GTS.

Using multivariate analysis, the researchers found that smoking and renal impairment were independent predictors of healing failure; an age older than 70 years was the only independent predictor of GTS. There were no independent predictors of disability.

Insulin treatment prior to admission was the only predictor of ulcer recurrence, and diabetic nephropathy was the only independent predictor of first amputation. The only independent predictors of cardiovascular mortality were insulin therapy before admittance and renal impairment.

Diabetic nephropathy was also seen to be an important marker of other factors in long-term prognosis, with impaired renal function being an independent predictor of healing failure and all-cause mortality; in conjunction with albuminuria, it was associated with amputations. Using univariate analysis, popliteal stenosis (diagnosed by Doppler ultrasound) was found to be an independent predictor of amputation, "confirming that vascular involvement in diabetic patients with foot ulcers is particularly important," the authors stated (Diabetes Care 2008;31:1288–92).

One limitation of the study, according to the authors, was that interview follow-up was conducted by telephone rather than in person.

An initially successful healing rate in patients who were hospitalized with diabetic foot ulcers did not lead to comparable long-term outcomes in a prospective study of 94 consecutive patients.

The presence of nephropathy was found to be an important predictor of poorer outcomes, whereas age was an independent predictor of global therapeutic success (GTS), according to a report presented in Diabetes Care.

Of 94 consecutive diabetic patients hospitalized for diabetic foot ulcers between January 1998 and December 2000, 89 (63 men) were successfully followed up for an average of nearly 80 months. The mean age of the patients was nearly 64 years.

Researchers calculated the rates of primary healing, new ulcers, amputations, mortality, and disability, and evaluated the GTS of foot care management (defined as primary healing without recurrence or disability at the end of follow-up). To their knowledge, this was the first time that disability and dependency, which were measured using Katz's index of activities of daily living, were considered as end points of a prospective diabetic foot study, according to Dr. Edouard Ghanassia and colleagues from the Centre Hospitalier Universitaire Montpellier (France).

Primary healing without major amputation occurred in 69 patients (nearly 78%). Amputations were performed in 39 patients (44%), with 30 minor and 9 major amputations; of the minor amputations, 24 occurred in the primary healing group. Ulcers recurred in nearly 61% of patients. Ultimately, 46 patients (nearly 52%) died, including 23 from cardiovascular events.

At the end of the follow-up period, 25 patients (28%) were dependent and 40 patients (nearly 45%) had achieved GTS.

Using multivariate analysis, the researchers found that smoking and renal impairment were independent predictors of healing failure; an age older than 70 years was the only independent predictor of GTS. There were no independent predictors of disability.

Insulin treatment prior to admission was the only predictor of ulcer recurrence, and diabetic nephropathy was the only independent predictor of first amputation. The only independent predictors of cardiovascular mortality were insulin therapy before admittance and renal impairment.

Diabetic nephropathy was also seen to be an important marker of other factors in long-term prognosis, with impaired renal function being an independent predictor of healing failure and all-cause mortality; in conjunction with albuminuria, it was associated with amputations. Using univariate analysis, popliteal stenosis (diagnosed by Doppler ultrasound) was found to be an independent predictor of amputation, "confirming that vascular involvement in diabetic patients with foot ulcers is particularly important," the authors stated (Diabetes Care 2008;31:1288–92).

One limitation of the study, according to the authors, was that interview follow-up was conducted by telephone rather than in person.

An initially successful healing rate in patients who were hospitalized with diabetic foot ulcers did not lead to comparable long-term outcomes in a prospective study of 94 consecutive patients.

The presence of nephropathy was found to be an important predictor of poorer outcomes, whereas age was an independent predictor of global therapeutic success (GTS), according to a report presented in Diabetes Care.

Of 94 consecutive diabetic patients hospitalized for diabetic foot ulcers between January 1998 and December 2000, 89 (63 men) were successfully followed up for an average of nearly 80 months. The mean age of the patients was nearly 64 years.

Researchers calculated the rates of primary healing, new ulcers, amputations, mortality, and disability, and evaluated the GTS of foot care management (defined as primary healing without recurrence or disability at the end of follow-up). To their knowledge, this was the first time that disability and dependency, which were measured using Katz's index of activities of daily living, were considered as end points of a prospective diabetic foot study, according to Dr. Edouard Ghanassia and colleagues from the Centre Hospitalier Universitaire Montpellier (France).

Primary healing without major amputation occurred in 69 patients (nearly 78%). Amputations were performed in 39 patients (44%), with 30 minor and 9 major amputations; of the minor amputations, 24 occurred in the primary healing group. Ulcers recurred in nearly 61% of patients. Ultimately, 46 patients (nearly 52%) died, including 23 from cardiovascular events.

At the end of the follow-up period, 25 patients (28%) were dependent and 40 patients (nearly 45%) had achieved GTS.

Using multivariate analysis, the researchers found that smoking and renal impairment were independent predictors of healing failure; an age older than 70 years was the only independent predictor of GTS. There were no independent predictors of disability.

Insulin treatment prior to admission was the only predictor of ulcer recurrence, and diabetic nephropathy was the only independent predictor of first amputation. The only independent predictors of cardiovascular mortality were insulin therapy before admittance and renal impairment.

Diabetic nephropathy was also seen to be an important marker of other factors in long-term prognosis, with impaired renal function being an independent predictor of healing failure and all-cause mortality; in conjunction with albuminuria, it was associated with amputations. Using univariate analysis, popliteal stenosis (diagnosed by Doppler ultrasound) was found to be an independent predictor of amputation, "confirming that vascular involvement in diabetic patients with foot ulcers is particularly important," the authors stated (Diabetes Care 2008;31:1288–92).

One limitation of the study, according to the authors, was that interview follow-up was conducted by telephone rather than in person.

An initially successful healing rate in patients who were hospitalized with diabetic foot ulcers did not lead to comparable long-term outcomes in a prospective study of 94 consecutive patients.

The presence of nephropathy was found to be an important predictor of poorer outcomes, whereas age was an independent predictor of global therapeutic success (GTS), according to a report presented in Diabetes Care.

Of 94 consecutive diabetic patients hospitalized for diabetic foot ulcers between January 1998 and December 2000, 89 (63 men) were successfully followed up for an average of nearly 80 months. The mean age of the patients was nearly 64 years.

Researchers calculated the rates of primary healing, new ulcers, amputations, mortality, and disability, and evaluated the GTS of foot care management (defined as primary healing without recurrence or disability at the end of follow-up). To their knowledge, this was the first time that disability and dependency, which were measured using Katz's index of activities of daily living, were considered as end points of a prospective diabetic foot study, according to Dr. Edouard Ghanassia and colleagues from the Centre Hospitalier Universitaire Montpellier (France).

Primary healing without major amputation occurred in 69 patients (nearly 78%). Amputations were performed in 39 patients (44%), with 30 minor and 9 major amputations; of the minor amputations, 24 occurred in the primary healing group. Ulcers recurred in nearly 61% of patients. Ultimately, 46 patients (nearly 52%) died, including 23 from cardiovascular events.

At the end of the follow-up period, 25 patients (28%) were dependent and 40 patients (nearly 45%) had achieved GTS.

Using multivariate analysis, the researchers found that smoking and renal impairment were independent predictors of healing failure; an age older than 70 years was the only independent predictor of GTS. There were no independent predictors of disability.

Insulin treatment prior to admission was the only predictor of ulcer recurrence, and diabetic nephropathy was the only independent predictor of first amputation. The only independent predictors of cardiovascular mortality were insulin therapy before admittance and renal impairment.

Diabetic nephropathy was also seen to be an important marker of other factors in long-term prognosis, with impaired renal function being an independent predictor of healing failure and all-cause mortality; in conjunction with albuminuria, it was associated with amputations. With use of univariate analysis, popliteal stenosis (diagnosed by Doppler ultrasound) was found to be an independent predictor of amputation, “confirming that vascular involvement in diabetic patients with foot ulcers is particularly important,” the authors stated (Diabetes Care 2008;31:1288-92).

One limitation of the study, according to the authors, was that interview follow-up was conducted by telephone rather than in person.

An initially successful healing rate in patients who were hospitalized with diabetic foot ulcers did not lead to comparable long-term outcomes in a prospective study of 94 consecutive patients.

The presence of nephropathy was found to be an important predictor of poorer outcomes, whereas age was an independent predictor of global therapeutic success (GTS), according to a report presented in Diabetes Care.

Of 94 consecutive diabetic patients hospitalized for diabetic foot ulcers between January 1998 and December 2000, 89 (63 men) were successfully followed up for an average of nearly 80 months. The mean age of the patients was nearly 64 years.

Researchers calculated the rates of primary healing, new ulcers, amputations, mortality, and disability, and evaluated the GTS of foot care management (defined as primary healing without recurrence or disability at the end of follow-up). To their knowledge, this was the first time that disability and dependency, which were measured using Katz's index of activities of daily living, were considered as end points of a prospective diabetic foot study, according to Dr. Edouard Ghanassia and colleagues from the Centre Hospitalier Universitaire Montpellier (France).

Primary healing without major amputation occurred in 69 patients (nearly 78%). Amputations were performed in 39 patients (44%), with 30 minor and 9 major amputations; of the minor amputations, 24 occurred in the primary healing group. Ulcers recurred in nearly 61% of patients. Ultimately, 46 patients (nearly 52%) died, including 23 from cardiovascular events.

At the end of the follow-up period, 25 patients (28%) were dependent and 40 patients (nearly 45%) had achieved GTS.

Using multivariate analysis, the researchers found that smoking and renal impairment were independent predictors of healing failure; an age older than 70 years was the only independent predictor of GTS. There were no independent predictors of disability.

Insulin treatment prior to admission was the only predictor of ulcer recurrence, and diabetic nephropathy was the only independent predictor of first amputation. The only independent predictors of cardiovascular mortality were insulin therapy before admittance and renal impairment.

Diabetic nephropathy was also seen to be an important marker of other factors in long-term prognosis, with impaired renal function being an independent predictor of healing failure and all-cause mortality; in conjunction with albuminuria, it was associated with amputations. With use of univariate analysis, popliteal stenosis (diagnosed by Doppler ultrasound) was found to be an independent predictor of amputation, “confirming that vascular involvement in diabetic patients with foot ulcers is particularly important,” the authors stated (Diabetes Care 2008;31:1288-92).

One limitation of the study, according to the authors, was that interview follow-up was conducted by telephone rather than in person.

An initially successful healing rate in patients who were hospitalized with diabetic foot ulcers did not lead to comparable long-term outcomes in a prospective study of 94 consecutive patients.

The presence of nephropathy was found to be an important predictor of poorer outcomes, whereas age was an independent predictor of global therapeutic success (GTS), according to a report presented in Diabetes Care.

Of 94 consecutive diabetic patients hospitalized for diabetic foot ulcers between January 1998 and December 2000, 89 (63 men) were successfully followed up for an average of nearly 80 months. The mean age of the patients was nearly 64 years.

Researchers calculated the rates of primary healing, new ulcers, amputations, mortality, and disability, and evaluated the GTS of foot care management (defined as primary healing without recurrence or disability at the end of follow-up). To their knowledge, this was the first time that disability and dependency, which were measured using Katz's index of activities of daily living, were considered as end points of a prospective diabetic foot study, according to Dr. Edouard Ghanassia and colleagues from the Centre Hospitalier Universitaire Montpellier (France).

Primary healing without major amputation occurred in 69 patients (nearly 78%). Amputations were performed in 39 patients (44%), with 30 minor and 9 major amputations; of the minor amputations, 24 occurred in the primary healing group. Ulcers recurred in nearly 61% of patients. Ultimately, 46 patients (nearly 52%) died, including 23 from cardiovascular events.

At the end of the follow-up period, 25 patients (28%) were dependent and 40 patients (nearly 45%) had achieved GTS.

Using multivariate analysis, the researchers found that smoking and renal impairment were independent predictors of healing failure; an age older than 70 years was the only independent predictor of GTS. There were no independent predictors of disability.

Insulin treatment prior to admission was the only predictor of ulcer recurrence, and diabetic nephropathy was the only independent predictor of first amputation. The only independent predictors of cardiovascular mortality were insulin therapy before admittance and renal impairment.

Diabetic nephropathy was also seen to be an important marker of other factors in long-term prognosis, with impaired renal function being an independent predictor of healing failure and all-cause mortality; in conjunction with albuminuria, it was associated with amputations. With use of univariate analysis, popliteal stenosis (diagnosed by Doppler ultrasound) was found to be an independent predictor of amputation, “confirming that vascular involvement in diabetic patients with foot ulcers is particularly important,” the authors stated (Diabetes Care 2008;31:1288-92).

One limitation of the study, according to the authors, was that interview follow-up was conducted by telephone rather than in person.

Long-distance running among older adults has no effect on the development of radiographic osteoarthritis, according a small, prospective study comparing a population of runners with community-matched controls.

The study looked at 45 runners and 53 controls who were at least 50 years of age. After almost 12 years of observation, the runners did not exhibit more severe radiographic osteoarthritis (OA) or replaced knees than the controls.

As a result of these findings, “long-distance running or other routine vigorous activities should not be discouraged among healthy older adults out of concern for progression of knee OA,” the investigators reported.

The question of whether strenuous weight-bearing exercise can lead to increased OA had not been conclusively answered before this study.

The researchers assembled a set of runners 50 years of age or older from the Fifty-Plus Runners Association and a set of demographically matched controls from the Stanford Lipid Research Clinics Prevalence Study.

Bilateral anteroposterior weight-bearing radiographs of the knees were taken serially in 1984, 1986, 1996, and 2002. A total of 45 runners (64.4% men) and 53 matched controls (69.8% men) completed at least two sets of radiographs that were used for the analysis.

The mean age for both groups was around 60 years at the first radiograph. Digitized radio-graphic films were read for narrowing, sclerosis, and osteophytes (each graded on a scale from 0 to 3) in the medial and lateral compartments of each knee by two readers blinded to group assignment, according to Dr. Eliza F. Chakravarty and colleagues from the Stanford (Calif.) University.

The primary outcome measure was the total knee score (TKS), which is the sum of each of the scores from the digitized radiographs mentioned above, from the medial and lateral compartments of both knees.

The secondary measure was the worst joint space width (JSW) in millimeters among the four compartments, which represented the knee with the worst OA. The lower the score, the worse the condition. A joint that was fully replaced was arbitrarily assigned a JSW of zero.

At baseline, runners had a significantly higher TKS than controls (1.29 vs. 0.40, respectively). The JSW of the worst knee was significantly lower in runners (4.54 vs. 4.84).

The prevalent radiographic OA expressed in percent was not significantly different between groups, although it was higher in runners (6.7% vs. 0% in the controls).

Runners also had a greater prevalence of knee injuries than controls, although this difference was not statistically significant. Runners had a lower body mass index (BMI) than controls, higher minutes per week of vigorous exercise and of running, and higher current runner status.

By the end of the study, the last radiograph showed that significant differences remained only in BMI, running minutes a week, minutes of vigorous exercise a week, and current runner status. TKS and JSW were no longer significantly different. Prevalent radiographic OA percent was still not significantly different, though the actual relationship of the values had flipped: 20% of runners compared with 32.1% of controls (doi:10.1016/j.amepre.2008.03.032

“In this analysis, long-distance running was not associated with accelerated incidence or severity of radiographic OA,” the investigators reported. “Over the prolonged period of observation (mean 11.7 years) and despite more prevalent OA and worse radiographic scores at the baseline, runners did not have more severe OA or replaced knees than controls. Although there were some suggestions that runners may have less OA than controls, these did not meet statistical significance.”

The authors suggested that larger studies are needed to determine if running has a positive effect on preventing OA development.

The authors pointed out that the strength of their study was its prospective nature and the length of follow-up; the weaknesses were lack of analysis of clinical symptoms in the radiographic OA evaluation, and the fact that the runners were a self-selecting group of individuals (they chose to run and join a runners' group) who were healthy and continued running into their 6th decade of life.

Dr. Chakravarty and her colleagues stated there were no conflicts to disclose with regard to this study.

Long-distance running among older adults has no effect on the development of radiographic osteoarthritis, according a small, prospective study comparing a population of runners with community-matched controls.

The study looked at 45 runners and 53 controls who were at least 50 years of age. After almost 12 years of observation, the runners did not exhibit more severe radiographic osteoarthritis (OA) or replaced knees than the controls.

As a result of these findings, “long-distance running or other routine vigorous activities should not be discouraged among healthy older adults out of concern for progression of knee OA,” the investigators reported.

The question of whether strenuous weight-bearing exercise can lead to increased OA had not been conclusively answered before this study.

The researchers assembled a set of runners 50 years of age or older from the Fifty-Plus Runners Association and a set of demographically matched controls from the Stanford Lipid Research Clinics Prevalence Study.

Bilateral anteroposterior weight-bearing radiographs of the knees were taken serially in 1984, 1986, 1996, and 2002. A total of 45 runners (64.4% men) and 53 matched controls (69.8% men) completed at least two sets of radiographs that were used for the analysis.

The mean age for both groups was around 60 years at the first radiograph. Digitized radio-graphic films were read for narrowing, sclerosis, and osteophytes (each graded on a scale from 0 to 3) in the medial and lateral compartments of each knee by two readers blinded to group assignment, according to Dr. Eliza F. Chakravarty and colleagues from the Stanford (Calif.) University.

The primary outcome measure was the total knee score (TKS), which is the sum of each of the scores from the digitized radiographs mentioned above, from the medial and lateral compartments of both knees.

The secondary measure was the worst joint space width (JSW) in millimeters among the four compartments, which represented the knee with the worst OA. The lower the score, the worse the condition. A joint that was fully replaced was arbitrarily assigned a JSW of zero.

At baseline, runners had a significantly higher TKS than controls (1.29 vs. 0.40, respectively). The JSW of the worst knee was significantly lower in runners (4.54 vs. 4.84).

The prevalent radiographic OA expressed in percent was not significantly different between groups, although it was higher in runners (6.7% vs. 0% in the controls).

Runners also had a greater prevalence of knee injuries than controls, although this difference was not statistically significant. Runners had a lower body mass index (BMI) than controls, higher minutes per week of vigorous exercise and of running, and higher current runner status.

By the end of the study, the last radiograph showed that significant differences remained only in BMI, running minutes a week, minutes of vigorous exercise a week, and current runner status. TKS and JSW were no longer significantly different. Prevalent radiographic OA percent was still not significantly different, though the actual relationship of the values had flipped: 20% of runners compared with 32.1% of controls (doi:10.1016/j.amepre.2008.03.032

“In this analysis, long-distance running was not associated with accelerated incidence or severity of radiographic OA,” the investigators reported. “Over the prolonged period of observation (mean 11.7 years) and despite more prevalent OA and worse radiographic scores at the baseline, runners did not have more severe OA or replaced knees than controls. Although there were some suggestions that runners may have less OA than controls, these did not meet statistical significance.”

The authors suggested that larger studies are needed to determine if running has a positive effect on preventing OA development.

The authors pointed out that the strength of their study was its prospective nature and the length of follow-up; the weaknesses were lack of analysis of clinical symptoms in the radiographic OA evaluation, and the fact that the runners were a self-selecting group of individuals (they chose to run and join a runners' group) who were healthy and continued running into their 6th decade of life.

Dr. Chakravarty and her colleagues stated there were no conflicts to disclose with regard to this study.

Long-distance running among older adults has no effect on the development of radiographic osteoarthritis, according a small, prospective study comparing a population of runners with community-matched controls.

The study looked at 45 runners and 53 controls who were at least 50 years of age. After almost 12 years of observation, the runners did not exhibit more severe radiographic osteoarthritis (OA) or replaced knees than the controls.

As a result of these findings, “long-distance running or other routine vigorous activities should not be discouraged among healthy older adults out of concern for progression of knee OA,” the investigators reported.

The question of whether strenuous weight-bearing exercise can lead to increased OA had not been conclusively answered before this study.

The researchers assembled a set of runners 50 years of age or older from the Fifty-Plus Runners Association and a set of demographically matched controls from the Stanford Lipid Research Clinics Prevalence Study.

Bilateral anteroposterior weight-bearing radiographs of the knees were taken serially in 1984, 1986, 1996, and 2002. A total of 45 runners (64.4% men) and 53 matched controls (69.8% men) completed at least two sets of radiographs that were used for the analysis.

The mean age for both groups was around 60 years at the first radiograph. Digitized radio-graphic films were read for narrowing, sclerosis, and osteophytes (each graded on a scale from 0 to 3) in the medial and lateral compartments of each knee by two readers blinded to group assignment, according to Dr. Eliza F. Chakravarty and colleagues from the Stanford (Calif.) University.

The primary outcome measure was the total knee score (TKS), which is the sum of each of the scores from the digitized radiographs mentioned above, from the medial and lateral compartments of both knees.

The secondary measure was the worst joint space width (JSW) in millimeters among the four compartments, which represented the knee with the worst OA. The lower the score, the worse the condition. A joint that was fully replaced was arbitrarily assigned a JSW of zero.

At baseline, runners had a significantly higher TKS than controls (1.29 vs. 0.40, respectively). The JSW of the worst knee was significantly lower in runners (4.54 vs. 4.84).

The prevalent radiographic OA expressed in percent was not significantly different between groups, although it was higher in runners (6.7% vs. 0% in the controls).

Runners also had a greater prevalence of knee injuries than controls, although this difference was not statistically significant. Runners had a lower body mass index (BMI) than controls, higher minutes per week of vigorous exercise and of running, and higher current runner status.

By the end of the study, the last radiograph showed that significant differences remained only in BMI, running minutes a week, minutes of vigorous exercise a week, and current runner status. TKS and JSW were no longer significantly different. Prevalent radiographic OA percent was still not significantly different, though the actual relationship of the values had flipped: 20% of runners compared with 32.1% of controls (doi:10.1016/j.amepre.2008.03.032

“In this analysis, long-distance running was not associated with accelerated incidence or severity of radiographic OA,” the investigators reported. “Over the prolonged period of observation (mean 11.7 years) and despite more prevalent OA and worse radiographic scores at the baseline, runners did not have more severe OA or replaced knees than controls. Although there were some suggestions that runners may have less OA than controls, these did not meet statistical significance.”

The authors suggested that larger studies are needed to determine if running has a positive effect on preventing OA development.

The authors pointed out that the strength of their study was its prospective nature and the length of follow-up; the weaknesses were lack of analysis of clinical symptoms in the radiographic OA evaluation, and the fact that the runners were a self-selecting group of individuals (they chose to run and join a runners' group) who were healthy and continued running into their 6th decade of life.

Dr. Chakravarty and her colleagues stated there were no conflicts to disclose with regard to this study.

The order in which panretinal laser photocoagulation and cataract surgery were performed had no effect on postoperative retinopathy, but the rate of progression of macular edema decreased in the surgery-first group, according to a small, randomized, prospective study of diabetes patients.

Up to 25% of all cataract surgery is performed on diabetic patients, according to Dr. Chikako Sutto and her colleagues in the June issue of the Journal of Cataract and Refractive Surgery. Such patients frequently have diabetic retinopathy, which requires treatment with panretinal laser photocoagulation (PRP).

Previous research in an era of more invasive surgery indicated that better results were obtained when PRP was performed prior to surgery. To test whether the same holds true in today's era of less invasive surgery, the researchers from Tokyo and Saitama (Japan), evaluated outcomes in contralateral eyes of patients with diabetic retinopathy who had PRP first followed by cataract surgery in one eye, and cataract surgery followed by PRP in the other.

A total of 58 eyes in 29 patients with similar bilateral cataracts and severe nonproliferative or early proliferative diabetic retinopathy were randomly assigned to one eye treated with PRP first, followed by surgery, and the other with surgery first, followed by PRP. The main outcome measured was best-corrected visual acuity (BCVA) 12 months after surgery. Secondary outcome measures were laser parameters, progression of retinopathy and macular edema, and aqueous flare intensity.

Patients had a mean age of 66 years and all had type 2 diabetes, with a mean duration of diabetes of 12.2 years; nine of the patients were men. Patient treatment regimens were diet only (9 patients), oral hypoglycemic agent (10), and insulin therapy (17). There were no significant differences between treatment groups in baseline characteristics.

The percentage of eyes with a BCVA of 20/40 or better was statistically significantly higher in the surgery-first group (96.6%) than in the PRP-first group (69%, P = .012), and the rate of macular edema progression was significantly decreased in the surgery-first group (P = .033). Laser parameters, progression of retinopathy, and aqueous flare intensity were not significantly different between the two groups (J. Cataract Refract. Surg. 2008;34:1001-6).

“Our results suggest that if small-incision cataract surgery is performed first, PRP can be performed in time to prevent diabetic retinopathy from worsening and that potential treatment of macular edema must be considered when determining the timing of cataract surgery,” the authors concluded.

The authors reported that they had no financial interest in any material or method mentioned.

The order in which panretinal laser photocoagulation and cataract surgery were performed had no effect on postoperative retinopathy, but the rate of progression of macular edema decreased in the surgery-first group, according to a small, randomized, prospective study of diabetes patients.

Up to 25% of all cataract surgery is performed on diabetic patients, according to Dr. Chikako Sutto and her colleagues in the June issue of the Journal of Cataract and Refractive Surgery. Such patients frequently have diabetic retinopathy, which requires treatment with panretinal laser photocoagulation (PRP).

Previous research in an era of more invasive surgery indicated that better results were obtained when PRP was performed prior to surgery. To test whether the same holds true in today's era of less invasive surgery, the researchers from Tokyo and Saitama (Japan), evaluated outcomes in contralateral eyes of patients with diabetic retinopathy who had PRP first followed by cataract surgery in one eye, and cataract surgery followed by PRP in the other.

A total of 58 eyes in 29 patients with similar bilateral cataracts and severe nonproliferative or early proliferative diabetic retinopathy were randomly assigned to one eye treated with PRP first, followed by surgery, and the other with surgery first, followed by PRP. The main outcome measured was best-corrected visual acuity (BCVA) 12 months after surgery. Secondary outcome measures were laser parameters, progression of retinopathy and macular edema, and aqueous flare intensity.

Patients had a mean age of 66 years and all had type 2 diabetes, with a mean duration of diabetes of 12.2 years; nine of the patients were men. Patient treatment regimens were diet only (9 patients), oral hypoglycemic agent (10), and insulin therapy (17). There were no significant differences between treatment groups in baseline characteristics.

The percentage of eyes with a BCVA of 20/40 or better was statistically significantly higher in the surgery-first group (96.6%) than in the PRP-first group (69%, P = .012), and the rate of macular edema progression was significantly decreased in the surgery-first group (P = .033). Laser parameters, progression of retinopathy, and aqueous flare intensity were not significantly different between the two groups (J. Cataract Refract. Surg. 2008;34:1001-6).

“Our results suggest that if small-incision cataract surgery is performed first, PRP can be performed in time to prevent diabetic retinopathy from worsening and that potential treatment of macular edema must be considered when determining the timing of cataract surgery,” the authors concluded.

The authors reported that they had no financial interest in any material or method mentioned.

The order in which panretinal laser photocoagulation and cataract surgery were performed had no effect on postoperative retinopathy, but the rate of progression of macular edema decreased in the surgery-first group, according to a small, randomized, prospective study of diabetes patients.

Up to 25% of all cataract surgery is performed on diabetic patients, according to Dr. Chikako Sutto and her colleagues in the June issue of the Journal of Cataract and Refractive Surgery. Such patients frequently have diabetic retinopathy, which requires treatment with panretinal laser photocoagulation (PRP).

Previous research in an era of more invasive surgery indicated that better results were obtained when PRP was performed prior to surgery. To test whether the same holds true in today's era of less invasive surgery, the researchers from Tokyo and Saitama (Japan), evaluated outcomes in contralateral eyes of patients with diabetic retinopathy who had PRP first followed by cataract surgery in one eye, and cataract surgery followed by PRP in the other.

A total of 58 eyes in 29 patients with similar bilateral cataracts and severe nonproliferative or early proliferative diabetic retinopathy were randomly assigned to one eye treated with PRP first, followed by surgery, and the other with surgery first, followed by PRP. The main outcome measured was best-corrected visual acuity (BCVA) 12 months after surgery. Secondary outcome measures were laser parameters, progression of retinopathy and macular edema, and aqueous flare intensity.

Patients had a mean age of 66 years and all had type 2 diabetes, with a mean duration of diabetes of 12.2 years; nine of the patients were men. Patient treatment regimens were diet only (9 patients), oral hypoglycemic agent (10), and insulin therapy (17). There were no significant differences between treatment groups in baseline characteristics.

The percentage of eyes with a BCVA of 20/40 or better was statistically significantly higher in the surgery-first group (96.6%) than in the PRP-first group (69%, P = .012), and the rate of macular edema progression was significantly decreased in the surgery-first group (P = .033). Laser parameters, progression of retinopathy, and aqueous flare intensity were not significantly different between the two groups (J. Cataract Refract. Surg. 2008;34:1001-6).

“Our results suggest that if small-incision cataract surgery is performed first, PRP can be performed in time to prevent diabetic retinopathy from worsening and that potential treatment of macular edema must be considered when determining the timing of cataract surgery,” the authors concluded.

The authors reported that they had no financial interest in any material or method mentioned.

Diabetes is not an independent risk factor for adverse early outcomes after coronary artery bypass grafting surgery, according to a large, retrospective study of patients who underwent the procedure over a 10-year period at a single institution.

This result may be due to improvements in management of glucose levels, according to a report by Dr. Pedro E. Antunes and his colleagues.

Up to one-quarter of the patients who undergo coronary artery bypass grafting (CABG) surgery have diabetes.

Previous reports have been conflicting regarding the negative impact of diabetes on short-term mortality and morbidity in patients undergoing CABG, with older studies finding a clearer relationship between diabetes and worse outcomes, the authors wrote.

In this study, 4,567 patients underwent isolated CABG over a 10-year period at the Hospitais da Universidade, Coimbra, Portugal.

Overall, the rate of diabetes mellitus was 22% in these patients, ranging from 19% at the beginning of the study in 1992 to 27% at the end of the study in 2001—a significant decade-long trend (Eur. J. Cardiothorac. Surg. 2008;34:370–5).

The study did not distinguish type 2 from type 1 diabetes, the authors noted.

The diabetic patients showed a significantly worse case mix, compared with the nondiabetic patients, according to the researchers.

Diabetic patients had a higher mean age, a higher mean body mass index, and a higher proportion of patients with dyslipidemia, anemia, cardiomegaly, renal failure, peripheral vascular disease, and cerebrovascular and other comorbidities.

Perioperative glucose control in diabetic patients was aimed at achieving levels between 120 and 160 mg/dL. They received a standard sliding scale of subcutaneous insulin injection pre- and postoperatively; in the operating room and the ICU they received continuous intravenous insulin infusions.

The overall in-hospital mortality was 0.96% (44 patients). There was no significant difference in mortality rate for the diabetic and nondiabetic groups: The mortality rates for the two groups were 0.9% and 1.0%, respectively, Dr. Pedro E. Antunes and his colleagues reported.

Multivariate analysis showed that the presence of diabetes was not an independent predictor of in-hospital mortality.

However, increasing age, reoperation, peripheral vascular disease, left ventricular dysfunction with an ejection fraction less than 40%, and nonelective surgery were all independent predictors of in-hospital death.

As for in-hospital morbidity events, univariate analysis showed that diabetes was significantly associated only with cerebrovascular accident and prolonged length of stay.

However, these associations disappeared in multivariate analysis, and only the development of mediastinitis in the diabetic patients showed significance.

“Better blood glucose management in the perioperative period improves early outcomes in diabetic patients subjected to CABG,” the authors reported.

The researchers concluded that “despite the worsening case mix, in our experience diabetic patients could be surgically revascularized with low mortality and morbidity rates, comparable to those of nondiabetic patients.”

Limitations of the study reported by the authors include that it is observational and retrospective, although they commented that it was based on prospectively collected data and had a large cohort size, which adds strength to the power of the analysis.

Diabetes is not an independent risk factor for adverse early outcomes after coronary artery bypass grafting surgery, according to a large, retrospective study of patients who underwent the procedure over a 10-year period at a single institution.

This result may be due to improvements in management of glucose levels, according to a report by Dr. Pedro E. Antunes and his colleagues.

Up to one-quarter of the patients who undergo coronary artery bypass grafting (CABG) surgery have diabetes.

Previous reports have been conflicting regarding the negative impact of diabetes on short-term mortality and morbidity in patients undergoing CABG, with older studies finding a clearer relationship between diabetes and worse outcomes, the authors wrote.

In this study, 4,567 patients underwent isolated CABG over a 10-year period at the Hospitais da Universidade, Coimbra, Portugal.

Overall, the rate of diabetes mellitus was 22% in these patients, ranging from 19% at the beginning of the study in 1992 to 27% at the end of the study in 2001—a significant decade-long trend (Eur. J. Cardiothorac. Surg. 2008;34:370–5).

The study did not distinguish type 2 from type 1 diabetes, the authors noted.

The diabetic patients showed a significantly worse case mix, compared with the nondiabetic patients, according to the researchers.

Diabetic patients had a higher mean age, a higher mean body mass index, and a higher proportion of patients with dyslipidemia, anemia, cardiomegaly, renal failure, peripheral vascular disease, and cerebrovascular and other comorbidities.

Perioperative glucose control in diabetic patients was aimed at achieving levels between 120 and 160 mg/dL. They received a standard sliding scale of subcutaneous insulin injection pre- and postoperatively; in the operating room and the ICU they received continuous intravenous insulin infusions.

The overall in-hospital mortality was 0.96% (44 patients). There was no significant difference in mortality rate for the diabetic and nondiabetic groups: The mortality rates for the two groups were 0.9% and 1.0%, respectively, Dr. Pedro E. Antunes and his colleagues reported.

Multivariate analysis showed that the presence of diabetes was not an independent predictor of in-hospital mortality.

However, increasing age, reoperation, peripheral vascular disease, left ventricular dysfunction with an ejection fraction less than 40%, and nonelective surgery were all independent predictors of in-hospital death.

As for in-hospital morbidity events, univariate analysis showed that diabetes was significantly associated only with cerebrovascular accident and prolonged length of stay.

However, these associations disappeared in multivariate analysis, and only the development of mediastinitis in the diabetic patients showed significance.

“Better blood glucose management in the perioperative period improves early outcomes in diabetic patients subjected to CABG,” the authors reported.

The researchers concluded that “despite the worsening case mix, in our experience diabetic patients could be surgically revascularized with low mortality and morbidity rates, comparable to those of nondiabetic patients.”

Limitations of the study reported by the authors include that it is observational and retrospective, although they commented that it was based on prospectively collected data and had a large cohort size, which adds strength to the power of the analysis.

Diabetes is not an independent risk factor for adverse early outcomes after coronary artery bypass grafting surgery, according to a large, retrospective study of patients who underwent the procedure over a 10-year period at a single institution.

This result may be due to improvements in management of glucose levels, according to a report by Dr. Pedro E. Antunes and his colleagues.

Up to one-quarter of the patients who undergo coronary artery bypass grafting (CABG) surgery have diabetes.

Previous reports have been conflicting regarding the negative impact of diabetes on short-term mortality and morbidity in patients undergoing CABG, with older studies finding a clearer relationship between diabetes and worse outcomes, the authors wrote.

In this study, 4,567 patients underwent isolated CABG over a 10-year period at the Hospitais da Universidade, Coimbra, Portugal.

Overall, the rate of diabetes mellitus was 22% in these patients, ranging from 19% at the beginning of the study in 1992 to 27% at the end of the study in 2001—a significant decade-long trend (Eur. J. Cardiothorac. Surg. 2008;34:370–5).

The study did not distinguish type 2 from type 1 diabetes, the authors noted.

The diabetic patients showed a significantly worse case mix, compared with the nondiabetic patients, according to the researchers.

Diabetic patients had a higher mean age, a higher mean body mass index, and a higher proportion of patients with dyslipidemia, anemia, cardiomegaly, renal failure, peripheral vascular disease, and cerebrovascular and other comorbidities.

Perioperative glucose control in diabetic patients was aimed at achieving levels between 120 and 160 mg/dL. They received a standard sliding scale of subcutaneous insulin injection pre- and postoperatively; in the operating room and the ICU they received continuous intravenous insulin infusions.

The overall in-hospital mortality was 0.96% (44 patients). There was no significant difference in mortality rate for the diabetic and nondiabetic groups: The mortality rates for the two groups were 0.9% and 1.0%, respectively, Dr. Pedro E. Antunes and his colleagues reported.

Multivariate analysis showed that the presence of diabetes was not an independent predictor of in-hospital mortality.

However, increasing age, reoperation, peripheral vascular disease, left ventricular dysfunction with an ejection fraction less than 40%, and nonelective surgery were all independent predictors of in-hospital death.

As for in-hospital morbidity events, univariate analysis showed that diabetes was significantly associated only with cerebrovascular accident and prolonged length of stay.

However, these associations disappeared in multivariate analysis, and only the development of mediastinitis in the diabetic patients showed significance.

“Better blood glucose management in the perioperative period improves early outcomes in diabetic patients subjected to CABG,” the authors reported.

The researchers concluded that “despite the worsening case mix, in our experience diabetic patients could be surgically revascularized with low mortality and morbidity rates, comparable to those of nondiabetic patients.”

Limitations of the study reported by the authors include that it is observational and retrospective, although they commented that it was based on prospectively collected data and had a large cohort size, which adds strength to the power of the analysis.