Search

An association between symptomatic carotid stenosis and recent infection with Chlamydia pneumoniae is reported. Thirty-five patients (20 symptomatic and 15 asymptomatic) with carotid stenosis of 70% to 90% underwent carotid endarterectomy. Endarterectomy was performed without patch and shunt; the average occlusion time of the internal carotid artery was 14 ±3 min. The atheromatic plaque and a portion of the thyroid artery were examined with polymerase chain reaction and peripheral vein blood was obtained for serologic detection of systematic infection, and IgG and IgM antibodies to C. pneumoniae by enzyme-linked immunosorbent assay. Twenty of 35 patients (57.1 %) had increased titers of IgG antibodies to C, pneumoniae. Eight patients revealed IgG plus IgM antibodies; two of the eight had IgG, IgM, and positive findings on polymerase chain reaction. No C pneumoniae was detected on the thyroid arteries. Sixty-five percent (13/20) of the patients with increased IgG antibodies to C. pneumoniae, 87.5% (7/8) with IgG + IgM, and 100% with IgG + IgM + positive polymerase chain reaction were symptomatic. Plaque morphology in association with symptoms did not reveal a significant correlation between soft plaques and symptoms, whereas the majority of the symptomatic patients had plaques of type III-V. Patients having recent contamination and positive poly merase chain reaction had a significant relationship between C. pneumoniae infection and symptomatic carotid disease. This supports the hypothesis that C. pneumoniae infection can produce a kind of instability of the carotid plaque. The results of this study demonstrate that patients with advanced atherosclerotic carotid disease have an increased incidence of C. pneu moniae infection. Recent infection could be responsible for instability of the carotid plaque, causing cerebral ischemic episodes.

The term paraganglia best defines the spread in the body of clusters of cells with histological and cytochemical characteristics of neuroendocrine cells originating from the neural crest, with either sympathetic or parasympathetic function. Carotid body hyperplasia is associated with long-standing hypoxia as in native inhabitants in high altitude or in patients with chronic pneumonopathies, while carotid body paraganglioma is a rare parasympathetic tumor with significant morbidity. Tumor extension per se, associated cranial nerve involvement, and the estimated 3–10% malignant potential, particularly at a young age, make early diagnosis and treatment of carotid body paraganglioma mandatory. Biopsy should be avoided, because of the accompanying incidence of hemorrhage, while it is essential in all cases to investigate both sides of the neck to exclude bilateral tumors. The modalities of therapy include preoperative embolization, preoperative and postoperative radiation with ambiguous results of both, and complete surgical removal which constitutes the definite therapy. The current stroke rate is less than 5%. The histological appearance of a carotid body paraganglioma is not a reliable guide to its propensity for malignant behavior and recurrences are most likely to appear in patients who have multiple paragangliomas or a family history of carotid body paraganglioma.

Background: Comparative evaluation of balloon angioplasty following intravascular stenting after experimental stenoses caused by arterial reconstruction with vascular clips and conventional sutures. Materials and methods: A total of 24 arteriotomies were carried out at the carotid and common iliac arteries of pigs following a 10mm longitudinal arteriotomy and provocation of stenosis. Twelve of the arteries were reconstructed with vascular clips and 12 with conventional suture. Ultrasonography revealed stenosis fluctuating from 60–95% (PSV: 1.8–3.5 m/sec EDV: 1.3–1.47 m/sec PSV ratio > 3.5). After 8 weeks, following digital subtraction angiography, which revealed > 50% stenosis in all of the cases, balloon angioplasty followed by placement of intravascular stent was carried out. Results: All the angioplasties remained angiographically and macroscopically patent two months after without thrombus formation. Rupture during dilatation occurred in one of the sutured cases. Histologically no degenerative changes, necrosis or remarkable intimal thickness were observed in either method. Focal inflammatory reaction was seen in 2 sutured and in 1 clipped cases while intimal ulceration was observed in 2 sutured cases. All cases with clips presented an intact endothelial surface. Conclusion: Early experimental results suggested that arterial stenosis provoked by clipped reconstruction could be managed successfully by balloon angioplasty followed by placement of intravascular stent.

Results were as follows: 77 (62%) patients had cryofibrinogen in their blood plasma, 50 (40%) patients had precipitation of cryoglobulins, and 65 (52%) patients had an increase of α2globulin in the serum electrophoresis. Of the immunoglobulins, IgM was found increased in 42 patients (34%). Of the clotting time inhibitors, antithrombin III (AT III) had a lower activity in 50 (40%) patients as compared with that of normal subjects. Protein C, protein S, and α1antitrypsin levels were lower in 21 (16.8%), 13 (10.4%), and 10 (8%) of patients, respectively.Statistical analysis of the results showed that all the protein fractions except for γ-globulin presented a statistically significant difference as compared with those of the controls (P < 0.0001). Immunoglobulins IgG and IgA of the patients were significantly lower than those of the normal controls (P < 0.001). The C3 and C4 factors of the complement presented statistically significant lower values (P < 0.001 and P < 0.0001 respectively). Finally, AT III appeared in lower values than those of the normal controls, being statistically significant (P < 0.0001).These results suggest that patients with primary Raynaud's phenomenon present changes in the levels of certain hematologic parameters, a fact that is probably connected with etiology. Thus further study and assessment might contribute to the diagnosis, discovery of the subjective systemic etiology, and better therapeutic management of Raynaud's phenomenon.

Fourteen pigs with an average weight of 17 kg were used in this study. Under general anesthesia and magnification 1–3 ccm/kg of carbon dioxide were administered in the lymph vessels of the front and rear legs. Imaging of the peripheral lymph vessels, lymph nodes and the thoracic duct was achieved with digital subtraction angiography. The quality of lymphangiography was satisfactory and comparable with that of the standard non-ionic contrast agent. It is anticipated that further technical evolution will permit the application of CO2/DSA lymphangiography to man. Carbon dioxide is non-nephrotoxic and is non-allergic; it is inexpensive, can be administered in unlimited quantity and is quickly eliminated via the pulmonary system.

AIM: The results of the Asymptomatic Carotid Atherosclerosis Study (ACAS) study have provided the first scientific evidence that in patients with asymptomatic carotid stenosis greater than 60% carotid endarterectomy reduces the risk of stroke from 2% to 1% per year. The implications are that approximately 20 operations need to be performed in order to prevent 1 stroke in 5 years. The aims of the Asymptomatic Carotid Stenosis and Risk of Stroke (ACSRS) study are to identify a subgroup or subgroups at a risk for stroke higher than 4% and a group at a risk for stroke less than 1% per year using systemic and local risk factors (plaque characterization) in addition to the degree of stenosis. The aim of this paper is to present the protocol and the results of the quality control. METHODS: The ACSRS is a multicentre natural history study of patients with asymptomatic internal carotid diameter stenosis greater than 50% in relation to the bulb. The degree of stenosis is graded using multiple established ultrasonic duplex criteria. In addition, ultrasonic plaque characterization is performed and clinical risk factors and medications are recorded. Training is provided centrally. All carotid ultrasound examinations are recorded on video-tape which together with CT-brain scans and ECG are analysed at the coordinating centre with feedback information to partner centres. RESULTS: The video recordings and analysis of data centrally with feed back information have provided quality control with a significant improvement not only in the completion of data forms but also in the grading of internal carotid stenosis and plaque recordings using ultrasound. CONCLUSION: The high level of quality of data collected will add credibility to the results of the ACSRS study and may eventually promote the development of international standards of plaque imaging and characterization

The term paraganglia best defines the spread in the body of clusters of cells with histological and cytochemical characteristics of neuroendocrine cells originating from the neural crest. with either sympathetic or parasympathetic function. Carotid body hyperplasia is associated with long-standing hypoxia as in native inhabitants in high altitude or in patients with chronic pneumonopathies. while carotid body paraganglioma is a rare parasympathetic tumor with significant morbidity. Tumor extension per se, associated cranial nerve involvement, and the estimated 3-10% malignant potential. particularly at a young: age, make early diagnosis and treatment of carotid body paraganglioma mandatory. Biopsy should be avoided, because of the accompanying incidence of hemorrhage, while it is essential in all cases to investigate both sides of the neck to exclude bilateral tumors. The modalities of therapy include preoperative embolization, preoperative and postoperative radiation with ambiguous results of both, and complete surgical removal which constitutes the definite therapy. The current stroke rate is less than 5%. The histological appearance of a carotid body paraganglioma is not a reliable guide to its propensity for malignant behavior and recurrences are most likely to appear in patients who have multiple paragangliomas or a family history of carotid body paraganglioma.

Objective: Bilateral carotid stenoses are actually managed by staged endarterectomy. The present study compares the results of the above surgical procedure with simultaneous bilateral carotid endarterectomy. Methods: Sixty-four carotid endarterectomies were carried out on two groups of thirty-two patients with bilateral carotid stenoses. Fifteen patients (group A) were subjected to staged and 17 patients (group B) who were subjected to simultaneous bilateral carotid endarterectomies. Results: The mortality rate was zero in both groups; no statistically significant difference was found concerning complications related to the heart, neurological deficit and postoperative hypertension. Conclusions: Simultaneous carotid endarterectomy is a challenging and technically demanding operation but with limited indications in strictly selected patients. The development of methods of more effective monitoring and protection of the cerebral cells might broaden the indications of such a surgical tactic in the future. Staged carotid endarterectomy, however, remains the method of choice for the management of bilateral carotid occlusive disease.

Background: Comparative evaluation of balloon angioplasty following intravascular stenting after experimental stenoses caused by arterial reconstruction with vascular clips and conventional sutures. Materials and methods: A total of 24 arteriotomies were carried out at the carotid and common iliac arteries of pigs following a 10mm longitudinal arteriotomy and provocation of stenosis. Twelve of the arteries were reconstructed with vascular clips and 12 with conventional suture. Ultrasonography revealed stenosis fluctuating from 60-95% (PSV: 1.8-3.5 m/sec EDV: 1.3-1.47 m/sec PSV ratio > 3.5). After 8 weeks, following digital subtraction angiography which revealed >50% stenosis in all of the cases, balloon angioplasty followed by placement of intravascular stent was carried out. Results: All the angioplasties remained angiographically and macroscopically patent two months after without thrombus formation. Rupture during dilatation occurred in one of the sutured cases. Histologically no degenerative changes, necrosis or remarkable intimal thickness were observed in either method. Focal inflammatory reaction was seen in 2 sutured and in 1 clipped cases while intimal ulceration was observed in 2 sutured cases. All cases with clips presented an intact endothelial surface. Conclusion: Early experimental results suggested that arterial stenosis provoked by clipped reconstruction could be managed successfully by balloon angioplasty followed by placement of intravascular stent.

Objective: Bilateral carotid stenoses are actually managed by staged endarterectomy, The present study compares the results of the above surgical procedure with simultaneous bilateral carotid endarterectomy. Methods: Sixty-four carotid endarterectomies were carried out on two groups of thirty-two patients with bilateral carotid stenoses, Fifteen patients (group A) were subjected to staged and 17 patients (group B) who were subjected to simultaneous bilateral carotid endarterectomies, Results: The mortality rate was zero in both groups; no statistically significant difference was found concerning complications related to the heart, neurological deficit and postoperative hypertension. Conclusions: Simultaneous carotid endarterectomy is a challenging and technically demanding operation but with limited indications in strictly selected patients. The development of methods of more effective monitoring and protection of the cerebral cells might broaden the indications of such a surgical tactic in the future. Staged carotid endarterectomy, however, remains the method of choice for the management of bilateral carotid occlusive disease. (C) 2000 The International Society for Cardiovascular Surgery. Published by Elsevier Science Ltd. All rights reserved.

Isolated arteriosclerotic aneurysms of the superficial femoral artery are rare. In citing the literature a total of 30 cases in 28 patients in the last 25 years were found. In addition to the above cases, two aged patients with ruptured aneurysms of the superficial femoral artery are reported; these were managed successfully with partial aneurysmectomy and restoration of the circulation of the extremity with a synthetic graft. The prognosis for this type of aneurysm following surgical therapy is good, despite the advanced age of the patients, and amputation is relatively rare, occurring in only two out of the 30 aneurysms (6.6%) reported. The risk of rupture is 46.6% (14/30) and is greater than that found in peripheral aneurysms. This, in association with the possibility of the creation of thrombosis (5/30; 16.6%) or embolization (1/30; 3.3%), threatens the extremity itself as well as the life of the patient, increasing the risk of complications and even death at a rate of 66.6% (20/30). Timely diagnosis, immediate surgical reconstruction and prompt mobilization, however, can guarantee a good prognosis for these aged patients.

Introduction. Despite progress in the technical approach to aneurysms, inflammatory aortic aneurysms (IAA) in particular present the surgical team with a unique challenge. This retrospective study investigates immediate and late results after surgical treatment of IAA. Patients and Method. Fifteen cases of IAA among 520 aneurysmectomies of the abdominal aorta were operated during the period 1986-1995. All the patients were males of a mean age of 66 years. Diagnosis was established on preoperative CT-Scan, gross appearance at surgery and histologically. CT scanning could detect the IAA in 13 of 15 cases. In 2 cases MRI was diagnostic. Surgical treatment using the inlay method, constitutes the method of choice due to restricted dissection, as it reduces the possibility of iatrogenic injuries. Results. None of the patients died during the first 30 postoperative days. One patient died at the age of 78, 40 days after the operative procedure, due to a cerebral episode. Four to 120 months later 3 patients had also died from cause unrelated to the operation and one more patient was lost on follow-up. The remaining 10 patients were free of symptoms without any progression of the fibrotic process in the CT scanning. We observed a total regression in 7 and partial regression in 3 patients without detecting any inflammatory findings or renal failure. Conclusion. IAA's are rare. CT and/or MRI establish the diagnosis preoperatively and contribute to the surgical program with immediate and late results equal to those found in arteriosclerotic aneurysms of the abdominal aorta.

Objectives: The non-penetrating Vascular Clip System (VCS) was tested experimentally and compared with the conventional suture method on the venous system. Materials and Methods: In five pigs, 30 transverse venotomies were carried out in the jugular and renal veins, and vena cava. Fifteen venotomies were reconstructed using autosuture clips and 15 using the standard needle and suture method. Eight weeks later, following phlebography, the specimens were examined macro- and microscopically. Results: For both methods, the veins remained patent; however, significant stenosis of 8.9% (95% CI: 0.6-17.1) for the renal vein and 8.5% (95% CI: 1.2-15.7) for the vena cava occurred when the suture technique was used. The intima to media height ratio remained the same. The anastomosis time with the clips was significantly shorter (p

Fourteen pigs with an average weight of 17 kg were used in this study. Under general anesthesia and magnification 1-3 ccm/kg of carbon dioxide were administered in the lymph vessels of the front and rear legs. Imaging of the peripheral lymph vessels, lymph nodes and the thoracic duct was achieved with digital subtraction angiography. The quality of lymphangiography was satisfactory and comparable with that of the standard non-ionic contrast agent. It is anticipated that further technical evolution will permit the application of CO2/DSA lymphangiography to man. Carbon dioxide is non-nephrotoxic and is non-allergic; it is inexpensive, can be administered in unlimited quantity and is quickly eliminated via the pulmonary system.

Recovery time cost, relapse, cosmetic result and fast restoration to previous way of life should be the features of surgical treeatment of primary varicose veins [1], one of the most frequent operative procedures of general surgery [2].

Objectives: The non-penetrating Vascular Clip System (VCS) was tested experimentally and compared with the conventional suture method on the venous system. Materials and Methods: In five pigs, 30 transverse venotomies were carried out in the jugular and renal veins, and vena cava. Fifteen venotomies were reconstructed using autosuture clips and 15 using the standard needle and suture method. Eight weeks later, following phlebography, the specimens were examined macro- and microscopically. Results: For both methods, the veins remained patent; however, significant stenosis of 8.9% (95% CI: 0.6–17.1) for the renal vein and 8.5% (95% CI: 1.2–15.7) for the vena cava occurred when the suture technique was used. The intima to media height ratio remained the same. The anastomosis time with the clips was significantly shorter ( pConclusion: Early and mid-term results show that the VCS clipped anastomotic technique seems to be effective and acceptable for venous reconstructions.