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Laparoscopic cholecystectomy (LC) has been widely accepted as an alternative to laparotomy and has many advantages, including short hospital stay and very limited surgical invasion. However, this procedure may impair hepatic function in elderly patients because high pressure is maintained in the peritoneal cavity for an extended period. We observed the effect of pneumoperitoneum on the middle hepatic venous blood flow (MHVBF) in elderly patients undergoing LC. LC patients were anesthesized with inhaled and epidural anesthesia, after which MHVBF was continuously measured by transesophageal echocardiography. MHVBF decreased significantly during a period of high intraperitoneal pressure, and recovery of MHVBF after deflation was significantly lower in elderly patients (65-75 yr), but not in younger patients (24-62 yr). In contrast, MHVBF remained almost constant in elderly patients during open cholecystectomy, and thus was significantly different from that in patients who underwent LC with pneumoperitoneum. Laparoscopic cholecystectomy may impair hepatic function in elderly patients because high pressure is maintained in the peritoneal cavity for an extended period.

SummarySeveral recent studies have suggested that arterial stiffness parameters such as peripheral pulse pressure (PPP), central blood pressure (CBP), and pulse wave velocity (PWV) are more accurate markers than brachial blood pressure for prediction of cardiovascular (CV) events. However, it remains unknown which arterial stiffness parameter is the most useful for predicting CV risk in the general population. Participants in the present study were randomly selected from the 40 to 79 year age group in the general population (n = 973; mean age, 59). PPP was determined in the upper arm with an oscillometric device. CBP was estimated noninvasively by radial pulsatile analysis, and brachial-ankle PWV was measured using a validated automatic device. A follow-up survey assessing the incidence of CV events including CV death was carried out after the baseline study. The mean follow-up duration was 7.8 years. Subjects were divided into quartiles according to PPP, CBP, or PWV. Event-free rates among the PWV quartiles were clearly divergent (P < 0.001); however, the rates among quartiles for the other parameters were not significant. In a multivariate Cox regression model, both the 90th percentile level of PWV (HR = 2.51, 95% CI; 1.21 -5.22: P = 0.014) and the increase in PWV per one standard deviation (HR = 1.42, 95% CI; 1.06 -1.90: P = 0.019) were significantly associated with risk of CV events. The area under the curves of the receiver operating characteristics analysis for CV event prediction of PWV was significantly larger than the others (P = 0.002 versus PPP; P = 0.043 versus systolic CBP). The measurement of brachial-ankle PWV is more useful than determination of PPP or CBP for identifying subjects at high risk of CV events within the general population. (Int Heart J 2013; 54: 160-165) Key words: Blood pressure, Central blood pressure, Pulse pressure, Pulse wave velocity I t has been reported that several types of arterial stiffness parameters are independent predictors apart from brachial blood pressure (BP) levels for cardiovascular (CV) events.1,2) Several previous studies have demonstrated that pulse wave velocity (PWV), peripheral pulse pressure (PPP), and central blood pressure (CBP) are useful for evaluation of arterial stiffness and prediction of CV events and mortality in clinical and screening settings. [3][4][5][6] However, a few studies to date have compared the utility of brachial-ankle PWV (baP-WV), PPP, and CBP for predicting CV risk in communitybased populations. It thus remains uncertain which of the pulsatile hemodynamic measures is the best screening marker for predicting future CV events in the general population. The aim of the present study was to clarify this issue. MethodsSubjects: Subjects were recruited from the general population aged 40 -79 years in Higashiyama district of Ichinoseki city, Iwate prefecture, northern Japan. The total population of the district at the time of baseline survey was 8,425 (men, 4,140; women, 4,285) with 4,651 (men, 2,263; women, 2,388) falling within th...

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