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.
SummaryAim: Authors performed a retrospective analysis of causes of recurrent varicose veins following surgery. Methods: They evaluated 89 patients (65 women and 24 men, mean age 49.7 years). All patients previously underwent same surgical procedures (long saphenous vein stripping with/without local multiple avulsions). For the purpose of the study, colour/duplex examinations were applied (Siemens Sonoline Elegra unit). Results: Depending on the type and area of recurrent varicose veins, patients were classified into 4 groups. Group I – 22 patients (persistence of varicose tributaries of LSV in thigh or thigh perforator). Group II – 27 patients (recurrence along the LSV in the calf). Group III – 26 patients (recurrence due to left incompetent short saphenous vein). Group IV – 14 patients (isolated incompetent perforators). Authors conclude, that colour-coded duplex scanning is currently a method of choice in the diagnosis of recurrent varicose veins. High incidence of recurrence due to short saphenous vein incompetence should draw particular attention to this vein in the preoperative assessment of venous system. Recurrence of varicose veins at thigh level is not caused by deep vein insufficiency, but is related to inadequate vein surgery or might be linked to the problem of neovascularisation in this area.
Case report of the patient who underwent two-stage surgical treatment due to pathological fracture of vertebral column (L3 due neoplasm infiltration) in the course of kidney cancer is presented. Decompression of vertebral canal from the posterior approach in lumbar segment (L3 and partially L2) was performed due to sudden neurological functions impairment. Lumbar segment of vertebral column was stabilized via the transpedicular approach with Clix system (Synthes). In the second stage anterior approach via laparotomy was performed, urological team excised the kidney tumour, the next team vascular surgeon and neurosurgeon, performed resection of L3 and L2 vertebras (L3 was pathological fractured and compressed of cauda equine structures, L2 was partially cancer infiltrated). During the attempt of anterior column stabilization it was found, that the longest vertebral prosthesis of Synex set (Synthes) is shorter than the distance measured between L1 and L4 vertebras for about 5-7 mm. The anterior column stabilizing set consisting of two vertebral prostheses from Synex set connected permanently with the crosspieces -crossbars rods used in transpedicular stabilizations was constructed ad hoc using the available elements. Stable set ready to use was obtained. After preparation, the set was placed between the vertebral bodies, than extended .Control X -ray revealed its appropriate location and supporting function. The ad hoc formed set of such type could be only used in normal transpedicular posterior stabilization of the vertebral column, Distance between the vertebral bodies after the resection probably resulted from the constitutional patient traits (app. 200cm tall) The patient was assessed in Out Patient Clinic, his life was improved after the operation, was independently, Lovett score 4/ 5. After the operation was performed four courses of chemotherapy during 18 months.
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