Background Among asymptomatic patients with severe carotid artery stenosis but no recent stroke or transient cerebral ischaemia, either carotid artery stenting (CAS) or carotid endarterectomy (CEA) can restore patency and reduce long-term stroke risks. However, from recent national registry data, each option causes about 1% procedural risk of disabling stroke or death. Comparison of their long-term protective effects requires large-scale randomised evidence.Methods ACST-2 is an international multicentre randomised trial of CAS versus CEA among asymptomatic patients with severe stenosis thought to require intervention, interpreted with all other relevant trials. Patients were eligible if they had severe unilateral or bilateral carotid artery stenosis and both doctor and patient agreed that a carotid procedure should be undertaken, but they were substantially uncertain which one to choose. Patients were randomly allocated to CAS or CEA and followed up at 1 month and then annually, for a mean 5 years. Procedural events were those within 30 days of the intervention. Intention-to-treat analyses are provided. Analyses including procedural hazards use tabular methods. Analyses and meta-analyses of non-procedural strokes use Kaplan-Meier and log-rank methods. The trial is registered with the ISRCTN registry, ISRCTN21144362.
Background: Colorectal cancer is one of the primary causes of cancer-related deaths and 5-fluorouracil (5-FU) therapy remains the cornerstone of treatment in these patients. Resistance to 5-FU represents a major obstacle; therefore, finding new predictive and prognostic markers is crucial for improvement of patient outcomes. Recently a new type of programmed cell death was discovered—necroptosis, which depends on receptor interacting protein 3 (RIPK3). Preclinical data showed that necroptotic cell death is an important effector mechanism of 5-FU-mediated anticancer activity. Purpose: To investigate the predictive and prognostic performance of RIPK3 expression in primary tumors. Methods: Colon cancer patients (n=74) with metastatic stage were included in this retrospective study and all were treated with first-line 5-FU based chemotherapy. Immunohistochemical staining was performed. Results: The progression free survival for the low expression group of RIPK3 was 5.6 months (95% CI, 4.4-6.8) vs 8.4 months (95% CI, 6.4-10.3) of the group with high expression (p=0.02). Moreover, patients with high expression of RIPK3 were associated with lower risk of disease progression HR 0.61 (95% CI, 0.38-0.97; p=0.044). Patients with high expression levels of RIPK3 also had significantly longer mean overall survival (OS) of 29.3 months (95% CI, 20.8-37.8) as compared with those with low expression: 18.5 months (95% CI, 15.06-21.9) (p= 0.036). In addition, univariate analysis showed that high level of RIPK3 expression was associated with a longer OS HR 0.59 (95% CI, 0.35-0.98; p=0.044). Conclusions: This study suggests that expression of RIPK3 in primary tumors of metastatic colon cancer patients should be further investigated for its potential as a promising predictive and prognostic marker.
The overall therapeutic strategy in patients with diabetes mellitus and peripheral arterial disease affecting several arterial segments is problematic. Usually, the greater saphenous vein (GSV) is the gold standard for bypass. However, alternative venous grafts may be necessary when the GSV is not available. The superficial veins of the arm are not suitable for bypass operations in most cases because of anatomical variations, inadequate diameter or very thin walls. However, arterialization of the cephalic vein can dilate and strengthen the walls, thus avoiding postoperative complications.The present patient, whose case was followed for 20 months postoperatively, suffered both from diabetes and peripheral arterial disease in a setting of gangrene and a lack of the GSV. The treament of the patient and the problems it incurred are discussed. The advantages of preoperative temporary arteriovenous shunting to improve the quality of the cephalic vein as an alternative autogenous graft are analyzed. Currently, the patient has excellent postoperative results, with healing of the ulcers and preserved peripheral pulses.
Variations in the anatomical course of the cervical portion of the internal carotid arteries appear to be more common than expected and recognised, reaching a prevalence of 10-43%. A case of atypical course of both internal carotid arteries with medial transposition is described. The general clinical implications are presented in the base of review the literature.In an otherwise healthy adult female pulsating masses on the posterior oropharyngeal wall were observed on transnasal endoscopy for other indications. Contrast enhanced computer tomography revealed bilateral symmetrical tortuous internal carotids, angulated medially at the level of C2 and almost contacting in the midline. However, no significant stenosis was ascertained within any of the evaluated arteries. The patient was informed about potential risk during the prospective surgical procedures around the pharyngeal area. Carotid tortuosity may present a potential threat in otolaryngological surgery. Whereas no symptoms occur in the most of the patients and the condition can be an accidental finding during physical examination as well as endoscopic or radiological evaluation, the frequency in the general population is higher than assumed. The treatment is not indispensable, however, setting down in the patient's medical history is important. Medical specialists should keep in mind that aberrant internal carotid arteries pose a risk of severe haemorrhage when even routine surgical or diagnostic procedures within the head and neck region are performed.
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