Vyresnio amžiaus žmonių apendicito ypatumai

Donatas Venskutonis1, Virmantas Daubaras1, Juozas Kutkevičius1, Jelena Kornej21 Kauno medicinos universiteto Bendrosios chirurgijos klinika, 2-oji Kauno klinikinė ligoninė2 Kauno medicinos universitetas Įvadas / tikslas Apendicitas yra viena iš dažniausių ūminių chirurginių pilvo ligų. Per gyvenimą ūminiu apendicitu suserga apie 7 % visos populiacijos. Literatūros duomenimis, ūminis apendicitas sudaro apie 5 % visų ūminių pilvo ligų vyresnio amžiaus grupėje. Šio darbo tikslas – išanalizuoti KMU Bendrosios chirurgijos klinikoje (II KKL) 1991–2000 metais gydytų vyresnio amžiaus žmonių apendicito formas, diagnostinio laikotarpio trukmę, bendrą gulėjimo stacionare laiką, komplikacijų ir baigčių aspektus, šiuos duomenis palyginti su jaunesnių kaip 65 metų ūminiu apendicitu sergančių ligonių grupe. Metodai Tyrimo metu retrospektyviai buvo išanalizuotos 1991–2000 m. gydytų nuo įvairių ūminio apendicito formų asmenų ligos istorijos, siekiant įvertinti ligos trukmę, diagnostinio laikotarpio trukmę, ligos formą, gulėjimo stacionare trukmę, komplikacijas, mirštamumą ir palyginti šiuos duomenis dviejų amžiaus grupių: iki 65 metų ir daugiau kaip 65 metų. Tiriant istorijas buvo kreipiamas dėmesys į diagnostinio laikotarpio trukmę iki operacijos, operacijos metu nustatytą apendicito formą, stacionarinio gydymo trukmę, buvusias komplikacijas ir baigtį. Rezultatai 1991–2000 m. nuo įvairių ūminio apendicito formų iš viso buvo gydyti 2378 ligoniai: pirmoje grupėje (iki 65 m.) buvo 2220 ligonių (92,51 %), antroje – 158 ligoniai (7,49 %). Pirmos grupės operuota 2130 ligonių (95,94 %), antros – 145 ligoniai (91,7 %). Vertinant apendicito formas, antroje amžiaus grupėje buvo gerokai daugiau gangreninių perforacinių nei pirmoje grupėje (p = 0,0014), o šioje – daugiau flegmoninių (p < 0,0010). Pirmos grupės ligoniai iki operacijos ligoninėje gulėjo 2,3 val., antros – 4,11 val. (p < 0,05). Bendras gulėjimo laikas pirmos grupės ligonių buvo 6,77 paros, antros – 11,14 paros (p < 0,05).Pooperacinių komplikacijų pirmoje grupėje buvo 151 (7,1 %), antroje – 31 (21,3 %), (p = 0,0151). Mirštamumas antroje grupėje sudarė 3,4 %, pirmoje grupėje mirusių nebuvo. Išvados Vyresnio amžiaus žmonės serga sunkesnėmis apendicito formomis, jų ikioperacinis ir bendras gulėjimo laikas yra ilgesnis (skirtumas statistiškai patikimas), pooperacinės komplikacijos sunkesnės ir dažnesnės (skirtumas statistiškai patikimas), visi mirusieji buvo vyresnio amžiaus žmonės, sirgę sunkiomis perforacinio apendicito formomis. Prasminiai žodžiai: apendicitas, vyresnio amžiaus ligoniai. Appendicitis - peculiarities in elderly patients Donatas Venskutonis1, Virmantas Daubaras1, Juozas Kutkevičius1, Jelena Kornej2 Background / objective Appendicitis is one of the most prevailing acute surgical abdominal diseases. According to literature data, acute appendicitis makes 5% of all acute diseases among elderly patients. The aim is to analyse the forms of appendicitis among elderly patients treated in KMU General Surgery Clinic (II KKL) in 1991–2000, as well as the duration of the diagnostic period, general duration of patients’ stay in hospital, the aspects of complications and mortality as compared to those in patients under 65 years of age. Methods Medical histories of the patients treated for acute appendicitis in 1991–2000 were analysed retrospectively. The patients were divided into two age groups: group 1 – under 65 years of age; group 2 – older than 65. The following criteria were evaluated: form of the disease, duration of diagnostic period; duration of stay in hospital; complications, mortality. These data were compared in both age groups. Results In 1991–2000, a total of 2378 patients were treated for various forms of acute appendicitis. There were 2220 patients (91.1%) in group 1 and 158 (7.49%) in group 2. In group 1, 2130 patients (95.94%) and in group 2, 145 (91.7%) were operated on. In group 2 there were more gangrenous perforated acute appendicitis forms than in group 1 (p = 0.0014) and in group 1 there were more phlegmonic forms of appendicitis (p < 0.001). As to the time of stay in hospital before operation, in group 1 it was 2.3 h and in group 2 4.11 h (p < 0.05). The mean stay in hospital in group 1 was 6.77 days and in group 2 11.14 days (p < 0.05). The number of postoperative complications was 151 (7.1%) in group 1 and 31 (21.3 %) in group 2 (p = 0.0151). Mortality in group 2 was 3.4%, while in group 1 nobody died. Conclusions Elderly people fall ill with more grave forms of appendicitis; their stay in hospital before the operation and total stay in hospital is longer, the postoperative complications are more severe and more fequent; the differences are statistically reliable; all lethal cases were elderly patients ill with severe forms of perforated appendicitis. Keywords: appendicitis, elderly patients

PR interval duration is associated with the presence of white matter hyperintensities: Insights from the epidemiologic LIFE-Adult Study

Background: PR interval prolongation is a preliminary stage of atrial cardiomyopathy which is considered as an intermediate phenotype for atrial fibrillation (AF). AF is a known risk factor for cerebrovascular adverse outcomes including stroke. Cerebral ischemia is one cause of white matter hyperintensities (WMHs), and cognitive dysfunction. Aim: To analyze the relationship between PR interval and WMHs. Materials and methods: We performed a cross-sectional analysis with individuals from the LIFE-Adult-Study (a population-based cohort study of randomly selected individuals from Leipzig, Germany) with available brain MRI and ECG. The Fazekas stages were used to quantify WMHs (0 = none; 1 = punctate foci; 2 = beginning confluence; 3 = large confluent areas). Stages 2-3 were defined as advanced WMHs. The PR interval was measured from resting 12-lead ECG. PR duration >200ms was defined as PR interval prolongation. We used a binary logistic regression for statistical analysis. We examined the relationship between MRI and ECG measures and adjusted them for clinical risk factors. Results: We included 2464 individuals (age 59±15 years, 47% women) into analyses. The median PR interval was 160ms (interquartile range 143-179), and 319 (13%) individuals with advanced WMHs, were significantly older, had more cardiovascular comorbidities and risk factors compared to individuals without WMHs (all p Conclusion: PR interval duration is associated with advanced WMHs beside advanced age, hypertension, and history of stroke. Further research is needed to determine whether changes in PR interval indices are clinically relevant for changes in WMHs

Heart Failure and Stroke.

PurposeIschemic stroke significantly contributes to morbidity and mortality in heart failure (HF). The risk of stroke increases significantly, with coexisting atrial fibrillation (AF). An aggravating factor could be asymptomatic paroxysms of AF (so-called silent AF), and therefore, the risk stratification in these patients remains difficult. This review provides an overview of stroke risk in HF, its risk stratification, and stroke prevention in these patients.Recent findingsStroke risk stratification in HF patients remains an important issue. Recently, the CHA2DS2-VASc score, originally developed to predict stroke risk in AF patients, had been reported to be a predictive for strokes in HF patients regardless of AF being present. Furthermore, there are several independent risk factors (e.g., hypertension, diabetes mellitus, prior stroke) described. Based on the current evidence, HF should be considered as an independent risk factor for stroke. The CHA2DS2-VASc score might be useful to predict stroke risk in HF patients with or without AF in clinical routine. However, there is only a recommendation for the oral anticoagulation use in patients with concomitant HF and AF, while in patients with HF and no AF, individualized risk stratification is preferred. Current guidelines recommend to prefer non-vitamin Kantagonist anticoagulants over warfarin

Impact of single versus double transseptal puncture on outcome and complications in pulmonary vein isolation procedures

Background: The aim of the current study was to analyze the impact of single versus double transseptal puncture (TSP) for atrial fibrillation (AF) ablation.Methods: Consecutive patients undergoing AF ablation were prospectively included in the AF ablation registry and were analyzed according to single versus double TSP.Results: A total of 478 patients (female 35%, persistent AF 67%) undergoing AF ablation between 01/2014 and 09/2014 were included. Single TSP was performed in 202 (42%) patients, double TSP in 276 (58%) patients. Age, gender, body mass index, CHA2DS2-VASc score, left ventricular ejection fraction and operator experience (experienced operator defined as ≥ 5 years of experience in invasive electrophysiology) were equally distributed between the two groups. Repeat procedures (re-dos) were more frequently performed using single TSP access (p < 0.001). Left atrial (LA) diameter was larger in patients with double TSP (p = 0.001). Procedure duration in single TSP was identical to double TSP procedures (p = 0.823). Radiation duration was similar between the two groups (p = 0.217). There were 49 (10%) patients with complications after catheter ablation. There were no differences between complication rates and TSP type (p = 0.555). Similarly, recurrence rates were comparable between both TSP groups (p = 0.788).Conclusions: There was no clear benefit of single or double TSP in AF ablation

Attenuation of the heartbeat-evoked potential in patients with atrial fibrillation

Background The heartbeat-evoked potential (HEP) is a brain response to each heartbeat, which is thought to reflect cardiac signaling to central autonomic areas and suggested to be a marker of internal body awareness (e.g., interoception). Objectives Because cardiac communication with central autonomic circuits has been shown to be impaired in patients with atrial fibrillation (AF), we hypothesized that HEPs are attenuated in these patients. Methods By simultaneous electroencephalography and electrocardiography recordings, HEP was investigated in 56 individuals with persistent AF and 56 control subjects matched for age, sex, and body mass index. Results HEP in control subjects was characterized by right frontotemporal negativity peaking around 300 to 550 ms after the R-peak, consistent with previous studies. In comparison with control subjects, HEP amplitudes were attenuated, and HEP amplitude differences remained significant when matching the samples for heart frequency, stroke volume (assessed by echocardiography), systolic blood pressure, and the amplitude of the T-wave. Effect sizes for the group differences were medium to large (Cohen’s d between 0.6 and 0.9). EEG source analysis on HEP amplitude differences pointed to a neural representation within the right insular cortex, an area known as a hub for central autonomic control. Conclusions The heartbeat-evoked potential is reduced in AF, particularly in the right insula. We speculate that the attenuated HEP in AF may be a marker of impaired heart–brain interactions. Attenuated interoception might furthermore underlie the frequent occurrence of silent AF

Association Between Frailty and Atrial Fibrillation in Older Adults: The Framingham Heart Study Offspring Cohort

Background: Frailty is associated bidirectionally with cardiovascular disease. However, the relations between frailty and atrial fibrillation (AF) have not been fully elucidated. Methods and Results: Using the FHS (Framingham Heart Study) Offspring cohort, we sought to examine both the association between frailty (2005-2008) and incident AF through 2016 and the association between prevalent AF and frailty status (2011-2014). Frailty was defined using the Fried phenotype. Models adjusted for age, sex, and smoking. Cox proportional hazards models, adjusted for competing risk of death, assessed the association between prevalent frailty and incident AF. Logistic regression models assessed the association between prevalent AF and new-onset frailty. For the incident AF analysis, we included 2053 participants (56% women; mean age, 69.7+/-6.9 years). By Fried criteria, 1018 (50%) were robust, 903 (44%) were prefrail, and 132 (6%) were frail. In total, 306 incident cases of AF occurred during an average 9.2 (SD, 3.1) follow-up years. After adjustment, there was no statistically significant association between prevalent frailty status and incident AF (prefrail versus robust: hazard ratio [HR], 1.22 [95% CI, 0.95-1.55]; frail versus robust: HR, 0.92 [95% CI, 0.57-1.47]). At follow-up, there were 111 new cases of frailty. After adjustment, there was no statistically significant association between prevalent AF and new-onset frailty (odds ratio, 0.48 [95% CI, 0.17-1.36]). Conclusions: Although a bidirectional association between frailty and cardiovascular disease has been suggested, we did not find evidence of an association between frailty and AF. Our findings may be limited by sample size and should be further explored in other populations