Introduction Atrial fibrillation (AF) is associated with dementia. Anticoagulation may modify this relationship, but it is unclear if this is due to stroke reduction alone. Methods Age- and sex-matched individuals from the U.K. Clinical Practice Research Datalink (2008–2016) with and without an incident diagnosis of AF were followed for a new dementia diagnosis. We estimated adjusted hazard ratios (aHRs) for incident dementia diagnosis in the AF cohort, overall and stratified by anticoagulation status, using the matched non-AF cohorts as reference. We performed a sensitivity analysis excluding individuals with stroke/transient ischaemic attack (TIA) before the observation period. Results Over 193,082 person-years (mean follow-up 25.7 ± 0.1 months), 347/15,276 AF (2.3%) and 1,085/76,096 non-AF (1.4%) were newly diagnosed with dementia (aHR, 1.31, 95% confidence interval, 1.15–1.49). The AF group had more co-morbidity and higher rates of dementia, both with and without anticoagulation, than non-AF. When those with history of stroke/ TIA before the observation period were excluded and those with incident stroke/TIA during the observation period were censored, AF individuals not on anticoagulation had significantly higher rates of dementia compared with non-AF, aHR 1.30 (1.06–1.58). Conclusion Our findings support the hypothesis that AF is a distinct risk factor for dementia, independent of stroke/TIA and other vascular risk factors. In those without stroke/TIA, risk of dementia is increased only in those who are not on anticoagulation, suggesting anticoagulation is protective presumably through reduction of sub-clinical embolic events. Further prospective research is needed to better ascertain the role of anticoagulation amongst targeted therapeutic strategies to reduce cognitive decline in AF.

Background Venous thromboembolism (VTE) is a major cause of death in cancer patients. Although patients with cancer have numerous risk factors for VTE, the relative contribution of cancer treatments is unclear. Objective The objective of this study is to evaluate the association between cancer therapies and the risk of VTE. Methods From UK Clinical Practice Research Datalink, data on patients with first cancer diagnosis between 2008 and 2016 were extracted along with information on hospitalization, treatments, and cause of death. Primary outcome was active cancer-associated VTE. To establish the independent effects of risk factors, adjusted subhazard ratios (adj-SHR) were calculated using Fine and Gray regression analysis accounting for death as competing risk. Results Among 67,801 patients with a first cancer diagnosis, active cancer-associated VTE occurred in 1,473 (2.2%). During a median observation time of 1.2 years, chemotherapy, surgery, hormonal therapy, radiation therapy, and immunotherapy were given to 71.1, 37.2, 17.2, 17.5, and 1.4% of patients with VTE, respectively. The active cancers associated with the highest risk of VTE—as assessed by incidence rates—included pancreatic cancer, brain cancer, and metastatic cancer. Chemotherapy was associated with an increased risk of VTE (adj-SHR: 3.17, 95% confidence interval [CI]: 2.76–3.65) while immunotherapy with a not significant reduced risk (adj-SHR: 0.67, 95% CI: 0.30–1.52). There was no association between VTE and radiation therapy (adj-SHR: 0.91, 95% CI: 0.65–1.27) and hormonal therapies. Conclusion VTE risk varies with cancer type. Chemotherapy was associated with an increased VTE risk, whereas with radiation and immunotherapy therapy, an association was not confirmed.

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SANTRAUKAReikšminiai žodžiai: mikotinė aneurizma, infekcinė aneurizma, bakterinė infekcija, endovaskulinis gydymas, chirurginis gydymas. Mikotinė aneurizma -tai aneurizma su mikrobiologiškai patvirtinta infekcija arterijos sienelėje. Mikotinės aneurizmos sudaro 1,3-2,3 proc. visų arterinių aneurizmų. Dažniausiai pažeidžiamos pilvo aorta ir šlaunies arterija. Mikotinės aneurizmos atsiranda dėl greta arterijos esančio septinio židinio, septinės embolijos, taip pat dėl septicemijos metu į arterijos sienelę patekusio infekcijos sukėlėjo. Predisponuojantys veiksniai tokiai aneurizmai atsirasti: cukrinis diabetas, rūkymas, šeiminė mikotinių aneurizmų anamnezė, imunosupresantų vartojimas, inkstų nepakankamumas. Mikotinių aneurizmų prognozė paprastai būna bloga, nes tokios aneurizmos linkusios greitai augti ir plyšti. Dažniausia mirties priežastis -sepsis. Diagnozei nustatyti svarbi echoskopija ir kompiuterinė tomografija. Gydymas susideda iš aneurizmos rekonstrukcijos (chirurginiu arba endovaskuliniu būdu) ir antibiotikų terapijos. Dėl gana nedidelio paplitimo mikotinių aneurizmų problema tebėra mažai tyrinėta. Šiame straipsnyje aptariami diskusiniai klausimai ir gydymo perspektyvos remiantis naujausia moksline literatūra. ABSTRACTKey words: mycotic aneurysm, infectious aneurysm, bacterial infection, endovascular repair, open repair. Mycotic aneurysm is an aneurysm with microbiologically confirmed infection of the arterial wall. It is a rather uncommon, though life-threatening disease, which makes up only 1.3-2.3 % of all the aneurysms. Mycotic aneurysms most commonly manifest in abdominal aorta and iliac artery. Mycotic aneurysms may form in the presence of adjacent infection (for example, an abscess), septic embolism or arise due to contamination of the arterial wall during septicemia. Predisposing factors are diabetes, smoking, immunosuppression, renal failure and positive family history. Main diagnostic tools are ultrasound and computer tomography. Patients with mycotic aneurysms usually have poor prognosis because these aneurysms have a tendency to enlarge and rupture. Most common cause of death is sepsis. Treatment of mycotic aneurysm involves the repair of the aneurysm (either surgically or endovasculary) and antibiotic therapy. Due to relatively low prevalence of mycotic aneurysms many questions concerning best treatment option remain unanswered. This article reviews newest scientific articles on mycotic aneurysms and discusses treatment alternatives. ĮVADASMikotinė aneurizma (MA) -tai aneurizma su mikrobiologiškai patvirtinta infekcija arterijos sienelėje. Mikotines aneurizmas, kaip infekcinio endokardito (IE) komplikaciją, pirmą kartą aprašė seras Williamas Osleris 1851 m. Terminas "mikotinė aneurizma" dėl asociacijos su grybeline infekcija iki šių dienų neretai klaidina įvairių medicinos sričių specialistus, kadangi grybelinė infekcija niekada nebuvo pagrindinis MA sukėlėjas [1]. Pastarojo dešimtmečio literatūros šaltiniuose terminas "mikotinė aneurizma" vartojamas aprašant bet kokią aneurizmą, kuri išs...

SANTRAUKAReikšminiai žodžiai: endovaskulinė, recidyvas, chirurgija, venos, varikozė. Tikslas. Nustatyti poodžio venų varikozės recidyvų dažnį, atsirandantį po endoveninės lazerinės chirurgijos operacijų. Tyrimo medžiaga ir metodai. Tyrimas retrospektyvinis, atliktas Vilniaus miesto klinikinėje ligoninėje. Buvo ištirti 2011-2013 m. lazeriu operuoti 555 pacientai (598 apatinės galūnės) C3-C4 pagal CEAP stadijos. Operacijos metu panaudotos lazerio energijos kiekis svyravo nuo 7 J iki 9 J vienam mm venos spindžio. Pacientai vertinti kliniškai ir dvigubu ultragarso skenavimu prieš operaciją ir 1-3 metai po jos. Vertinta veninė kraujotaka tik operuotoje galūnėje. Gydytos galūnės vertintos kaip atskiri atvejai. ABSTRACTKey words: endovascular, relapse, surgery, veins ,variuosis. Objective. To determine the rate of recurrence of the varicose veins after endovenous laser treatment. Materials and methods. The retrospective analysis in Vilnius' city clinical hospital was made. 555 patients (598 limbs) were treated for varicose veins in 2011-2013. Selected patients were in C3-C4 stages of chronic venous disease (CEAP). From 7 J to 9 J of energy was used during the operation for 1 mm of vein's length. Clinical and ultrasound tests were performed before and 1-3 years after the operation. Only limbs which were treated were evaluated. Results were analysed in limbs as separate cases. Results. 102 men (18 %) and 453 women (82 %) were treated. Mean age was 49,7 ± 12,8. Dispersion was from 18 to 87. Reflux before intervention was determined in vena saphena magna (96 %); vena saphena parva (3 %); in both veins -1 % of cases. The rate of recurrences was 0,5 %.Conclusions. There were no major compications in the follow up period. The rate cof recurrences was 0,5 proc. In all cases recanalization after endovenous laser treatment occured in women. ĮVADASLazeriai medicinos srityje taikomi nuo 1960 metų kraujagyslių malformacijoms gydyti. 1998 m. Ispanijoje pirmą kartą lazeris panaudotas išsiplėtusioms kojų venoms gydyti.Per mažą pjūvį kateteris su lazeriu įstumtas į išsiplėtusios venos spindį ir atlikta užakinanti operacija.Endovaskulinis gydymas lazeriu šiuo metu labai paplitęs tarp minimaliai invazyvių operacijų ir plačiai naudojamas