ABSTRACT
Cardioembolic stroke is one of the most devastating complications of non-ischemic dilated cardiomyopathy (NIDCM). However, in clinical trials of primary prevention, the benefits of anticoagulation are hampered by the risk of bleeding. Indices of cardiac blood stasis may account for the risk of stroke and be useful to individualize primary prevention treatments. We performed a cross-sectional study in patients with NIDCM and no history of atrial fibrillation (AF) from two sources: 1) a prospective enrollment of unselected patients with left ventricular (LV) ejection fraction <45% and 2) a retrospective identification of patients with a history of previous cardioembolic neurological event. The primary endpoint integrated a history of ischemic stroke or the presence intraventricular thrombus, or a silent brain infarction (SBI) by imaging. From echocardiography, we calculated blood flow inside the LV, its residence time (RT) maps and its derived stasis indices. Of the 89 recruited patients, 18 showed a positive endpoint: 9 had a history stroke or TIA and 9 were diagnosed with SBIs in the brain imaging. Averaged RT, performed good to identify the primary endpoint (AUC (95% CI)= 0.75 (0.61-0.89), p= 0.001). When accounting only for identifying a history of stroke or TIA, AUC for was 0.92 (0.85-1.00) with and odds ratio= 7.2 (2.3 - 22.3) per cycle, p< 0.001. These results suggest that, in patients with NIDCM in sinus rhythm, stasis imaging derived from echocardiography may account for the burden of stroke.
ABSTRACT
The surgical treatment of colorectal pathology can often lead to the need for a stoma, either colostomy or ileostomy. This surgery is associated with a high rate of complications. OBJECTIVE: The objective of this study is to describe the frequency of stomas complications, identify associated risk factors as well as new prevention strategies. MATERIALS AND METHODS: Prospective observational cohort study on patients who underwent an ileostomy or colostomy at the Hospital U. Infanta Leonor between April 2016 and October 2017. RESULTS: A total of 87 stomas were performed in 83 patients, of which 77.01% had at least one complication. The most presented complication was dermatitis (54.02%), followed by detachment (40.23%) and flat stoma (21.84%). The greatest number of complications occurred in the second week of the postoperative period. The average height of the stomas made was 10.6 mm. BMI was associated as a risk factor for the development of stoma complications. Of all the patients, 55 had follow-up until 6 months. CONCLUSION: Although our complication rate is high, this outcome is similar to others studies previously published. BMI was the unique risk factor associated with the development of stoma complications. New strategies related to the surgical technique can be developed to decrease our complication rate.
Subject(s)
Colostomy/adverse effects , Ileostomy/adverse effects , Postoperative Complications/epidemiology , Postoperative Complications/etiology , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Postoperative Complications/prevention & control , Prospective Studies , Risk FactorsABSTRACT
El tratamiento quirúrgico de la patología colorrectal puede conllevar en muchas ocasiones la necesidad de realizar un estoma, ya sea colostomía o ileostomía. Este tipo de cirugía se asocia a una alta tasa de complicaciones. Objetivo: El objetivo de este estudio es describir la frecuencia de las complicaciones, identificar factores de riesgo así como estrategias de prevención. Materiales y métodos: Estudio de cohorte observacional prospectiva, de pacientes a los que se les realizó ileostomía o colostomía en el Hospital Universitario Infanta Leonor entre abril de 2016 y octubre de 2017. Resultados: Se realizaron un total de 87 estomas en 83 pacientes, de los cuales un 77,01% presentó al menos una complicación. La complicación más presentada fue la dermatitis (54,02%), seguida del desprendimiento (40,23%) y del estoma plano (21,84%). El mayor número de complicaciones se dieron en la segunda semana del postoperatorio. La altura media de los estomas realizados fue 10,6 mm. Se ha encontrado el índice de masa corporal como factor de riesgo asociado al desarrollo de complicaciones de las ostomías, no existiendo significación estadística en nuestros pacientes con respecto al resto de factores estudiados. Conclusiones: Nuestra tasa de complicaciones es similar a lo publicado previamente en la literatura. El índice de masa corporal ha sido el único factor de riesgo de nuestra serie. Se han encontrado puntos susceptibles de mejora con respecto a la técnica quirúrgica para reducir el número de complicaciones.
The surgical treatment of colorectal pathology can often lead to the need for a stoma, either colostomy or ileostomy. This surgery is associated with a high rate of complications. Objective: The objective of this study is to describe the frequency of stomas complications, identify associated risk factors as well as new prevention strategies. Materials and methods: Prospective observational cohort study on patients who underwent an ileostomy or colostomy at the Hospital U. Infanta Leonor between April 2016 and October 2017. Results: A total of 87 stomas were performed in 83 patients, of which 77.01% had at least one complication. The most presented complication was dermatitis (54.02%), followed by detachment (40.23%) and flat stoma (21.84%). The greatest number of complications occurred in the second week of the postoperative period. The average height of the stomas made was 10.6 mm. BMI was associated as a risk factor for the development of stoma complications. Of all the patients, 55 had follow-up until 6 months. Conclusion: Although our complication rate is high, this outcome is similar to others studies previously published. BMI was the unique risk factor associated with the development of stoma complications. New strategies related to the surgical technique can be developed to decrease our complication rate.
