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.
89 patients were operated on for pheochromocytoma. 61 patients (37 women and 24 men) were available for extended follow-up. The final survey, performed 79.1 +/- 66.9 months postoperatively, provided data on survival, blood pressure tumor recurrence, malignant metastatic lesions, cardiovascular complications and coexisting diseases. There were 4 deaths during the follow-up period, including 2 instances of malignant pheochromocytoma. Permanent normalization of blood pressure was achieved in 38 patients (62.3%). This hypotensive effect was noted in 79.2% of patients with preoperative paroxysmal hypertension and in 40.8% of those with sustained hypertension. Permanent or re-developing postoperative hypertension was noted in 23 (37.7%) patients. This includes 4 cases of malignant pheochromocytoma, 4 cases of recurrent benign pheochromocytoma and 15 cases of essential hypertension. Cardiovascular complications during follow-up were rare and concerned the patients with essential hypertension diagnosed postoperatively.
The aim of the prospective study was to assess the exact kidney temperature and the effect of surface cooling of the kidney during the time of vascular anastomosis. Twenty‐two renal graft recipients were incorporated into our study. We used an electronic temperature measurer provided with a needle‐shaped probe pierced into the body of the kidney. The temperature was recorded every 5 min. The mean temperature of the kidney at the beginning of anastomosis (To) was 8.87 ± 3.97 °C and 17.95 ± 5.1 °C at the end (Tend). The striking finding of this study was that the mean Tend delayed kidney function‐negative in [ATN(‐)] recipients was significantly lower than in the ATN(+) group; respectively, 14.86 ± 3.6 °C and 19.71 ± 5.07 °C. Therefore, we have divided all recipients according to Tend (< 1.5 °C and > 15 °C) in an attempt to assess the direct influence of kidney temperature on early graft function. In nine cases, a temperature below 15 °C was recorded and in 13 cases it exceeded 15 °C at the end of anastomosis. The mean cold ischemia time and anastomosis time were not different in these recipients. Delayed graft function occurred in 14 recipients; in 3 of (33.3 %) recipients from group Tend < 15 °C; and in 11 of 13 (8.5 %) from group Tend > 15 °C. One case of primary non‐function was observed (Tend > 15 °C). This study documents the value of effective cooling of the kidney during the time of vascular anastomosis. Since in most clinical reports the significance of the second warm ischemia was assessed only by the duration of the anastomosis, without measurement of the actual organ temperature, this may explain the different findings in our studies.
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