Is there an association between pseudoexfoliation syndrome and knee osteoarthritis?

AIM

The purpose of this study was to investigate whether there is an association between pseudoexfoliation (PEX) syndrome and knee osteoarthritis (OA), and compare to compare patients with PEX and OA to a control group without PEX.

DESIGN AND METHODS

This observational case-control study examined 254 subjects: 127 cases with PEX in at least one eye and 127 controls without PEX. A full ophthalmic examination including slit lamp biomicroscopy, gonioscopy, applanation tonometry, pupil dilation, and fundus examination was performed for the diagnosis of PEX. Knee pain was evaluated using a visual analogue scale (VAS). Knee OA was diagnosed according to American College of Rheumatology (ACR) criteria and graded according to the Kellgren and Lawrence (KL) grading scale on radiographic examination.

RESULTS

Of the 254 subjects, 171 (67.3%) had severe OA and 83 (32.7%) mild OA. Of the 171 patients with severe knee OA, 93 (54.4%) had ocular PEX and the remaining 78 (45.6%) had normal ophthalmologic examination results. Both the PEX and the control groups contained 127 patients; the number of patients with moderate-severe OA was significantly (p = 0.032) higher in the PEX group as compared to controls: 93 patients (73.2%) in the PEX group and 78 (61.5%) in the control group. VAS score (p = 0.037) and KL grade (p = 0.024) were significantly higher in the PEX group than in controls. As evidenced by the odds ratios (ORs) pertaining to the severity of OA, age (OR = 1.112; 95% confidence interval, CI: 1.054-1.173) and PEX (OR = 2.044; 95% CI: 1.164-3.584) had a significant influence, but gender did not.

CONCLUSION

This study suggests a probable relationship between OA and ocular PEX. Further studies are needed to analyze the molecular basis of this association. Patients with severe knee OA should be informed about the possibility of having PEX and may be referred for ophthalmologic examination.

Predictors of reintervention after coronary artery bypass grafting

AIM

Percutaneous and surgical reintervention after coronary artery bypass grafting (CABG) is frequent. The purpose of this study was to determine the predictors of reintervention in patients with symptoms of recurrent ischemia after coronary artery bypass graft surgery (CABG).

PATIENTS AND METHODS

The data of 20000 patients who had coronary angiography (CAG) from 2003 to 2010 in our centre were retrospectively analysed. 485 of these patients with CABG who had CAG were included in this study. Demographic characteristics, the presence of coronary artery disease (CAD), risk factors for CAD, electrocardiographic (ECG) changes, troponin and CKMB levels, and left ventricular function were evaluated in terms of time elapsed after CABG.

RESULTS

Reintervention was performed significantly more frequent in patients with acute coronary syndrome, diabetes mellitus (DM), hypertension (HT), family history of CAD, ECG changes, positive troponin level, elevated CKMB, ejection fraction (EF) > 50% and in smoker patients (p < 0.05). Multivariate backward logistic regression analysis revealed that DM, smoking, family history of CAD, HT, ECG changes and patients with EF > 50% were found the independent predictors of reintervention.

CONCLUSIONS

Reintervention after CABG is especially higher in patients with risk factors for atherosclerosis and those who have ECG changes and normal EF. Knowledge of these risk factors is useful in the determination of CAG requirement and modification of risk factors for  atherosclerosis may play an important role in reducing reintervention.

Evaluating adult cor triatriatum with total anomalous pulmonary venous connections by multidetector computed tomography angiography

A 19-year-old female patient was admitted to our hospital with dyspnea, chest pain, and shortness of breath. A chest radiograph showed mild cardiomegaly. Echocardiography revealed an extra chamber in the heart. To evaluate this abnormality, ECG-gated 16-detector-row computed tomography angiography was performed. Multidetector computed tomography (MDCT), showing cor triatriatum with total anomalous pulmonary venous connections (TAPVC), clearly revealed cardiac and vascular anatomy. ECG-gated cardiac MDCT is a useful tool for detection and characterisation of cor triatriatum and related anomalies.