Increased hs-CRP levels may be related to the presence of macrophages and T lymphocytes in plaque, which is associated with the phenomena of instability that can lead to development of an ischemic event. Thus determination of circulating hs-CRP levels may be a useful additional marker of risk in patients with high-grade carotid stenosis.

Large bilateral aneurysm of the subclavian artery is an infrequent entity that can progress to thrombosis, embolization, or rupture if left untreated. Treatment consists of exclusion of the aneurysm by an endovascular procedure or open surgery. We present a case of large bilateral subclavian artery aneurysm in a patient with Marfan syndrome that was treated by a combination of endovascular and conventional surgery. This therapeutic approach provided good results for patency with lower morbidity and mortality.

There were no instances of persistent recurrent laryngeal nerve palsy in either group, but persistent hypoparathyroidism occurred more frequently after TT. Long after ST, hypothyroidism developed in nearly three of four cases, whereas euthyroidy was maintained in only one-fourth; recurrent hyperthyroidy was rare.

IntroductionOmeprazole is a benzimidazole derivative used as an antisecretory agent for the treatment of peptic acid disorders. It is metabolized by the cytochrome P-450 system in the liver. Like other imidazoles, omeprazole has the potential to inhibit the metabolism of some drugs by a competitive mechanism at the hepatic microsomal enzyme level [1]. It is now recognized that omeprazole interactions are confined to the limited number of drugs metabolized mainly by the cytochrome P-45011c subfamily [2]; it has been shown that this drug decreases phenytoin [3] and diazepam [4] metabolism but does not influence the disposition of drugs metabolized by other subfamilies within the cytochrome P-450 system, such as theophylline [5], propranolol [6] and ciclosporin [7].Studies of the interaction between omeprazole and warfarin have been performed but the results are controversial. Some studies suggest that omeprazole has little or no significant effect on the disposition of warfarin in healthy volunteers [8] or patients treated with anticoagulants [9]. Opposite to these, an increase in warfarin's effect has been reported in one patient after omeprazole addition [I0].Just like warfarin, acenocoumarol is a 3-substituted 4-hydroxycoumarin derivative and is the most commonly used oral anticoagulant in Europe. Acenocoumarol is a racemic mixture containing R(+) and S(-) enantiomers. As opposed to warfarin, the R(+) isomer of acenocoumarol is several times more potent as an anticoagulant than the S(-) enantiomer [I I]. At present, no interaction between omeprazole and acenocoumarol has been reported. We describe one case of potentiation of an acenocoumarol anticoagulant effect by omeprazole.

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