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The aim of this article is to review our experience in surgical treatment of carotid atherosclerosis using eversion carotid endarterectomy (ECEA) in 5,034 patients, with particular attention to temporal changes in patients' characteristics, diagnostic approach, surgical technique, medical therapy, and outcome in the early (group A, 1991-1997) versus late (group B 1998-2004) period of ECEA. From January 1991 to December 2004, 5,034 primary ECEAs were performed for high-grade carotid stenosis. Patients treated for restenosis after previous carotid surgery were excluded from the analysis. Group A consisted of 1,714 patients who underwent surgery between 1991 and 1997, and group B consisted of 3,320 patients who underwent surgery between 1998 and 2004. Follow-up included routine clinical evaluation and noninvasive surveillance, with duplex scanning at 1 month after surgery, after 6 months, and annually afterward. Only 3% of patients in group A and 0.6% in group B were asymptomatic, with 23% and 47% of them having preoperative stroke, respectively. In group A, angiography was used for the final diagnosis in 78% of patients. In group B, duplex scanning was performed in 82% of patients and angiography in only 18% (p < .001). Clamping time was shorter in the latter group (12.4 +/- 3.1 vs 14.5 +/- 4.1 min, p < .01). Introperative shunting and regional anesthesia were rarely performed in both groups (1.4% vs. 0.4%, p < .01, and 2% vs 0.3%, p < .001). Total and neurologic morbidity was significantly higher in group A than in group B (6.41% +/- 0.47% vs 4.81% +/- 0.53%, p < .001, and 2.14% +/- 0.31% vs 1.23% +/- 0.29%, p < .001, respectively). Total mortality was also higher in group A than in group B (1.92% +/- 0.24% vs 1.36% +/- 0.50%, p < .05), but although there was a trend toward lower neurologic mortality, it did not reach statistical significance (1.04% +/- 0.5% vs 0.57% +/- 0.25%, p = .074). There was a lower rate of nonsignificant restenosis (< 50%) in group B (2% vs 5%, p < .01), but the incidence of restenosis > or = 50% was identical between the groups (5.5% for both). Our data show that ECEA is a reliable surgical technique for the treatment of atherosclerotic carotid disease. Temporal trends in our patients demonstrated a decline in periopertive mortality and morbidity, despite a higher incidence of preoperative stroke.

An investigation of the effect of facial lipofilling on patient's satisfaction is a challenging and ongoing research area. Therefore, the aim of this study was to investigate the impact of aesthetic intervention on self-perceived improvement in facial appearance and quality of life (QoL) after 1- and 6-month follow-ups. In the period from October 1, 2014, to March 1, 2015, a total of 63 consecutive subjects who underwent a facial lipofilling were included in the study. The satisfaction with facial appearance was estimated by using the Satisfaction with Facial Appearance Overall scale. QoL was assessed by using the 36-Item Short Form Health Survey (SF-36). Severity of depressive and anxiety symptoms was quantified by using the Hamilton depression and anxiety rating scales. The self-esteem was assessed by Rosenberg self-esteem scale. The average Satisfaction with Facial Appearance Overall scale score at baseline was 45.5 ± 13.0, while this score reached values of 84.5 ± 16.2 after 1 month (Z = -6.744, p < 0.001) and 82.7 ± 12.6 after 6 months (Z = -6.545, p < 0.001) of follow-up. The mean change of Satisfaction with Facial Appearance Overall scale score from baseline to 1-month follow-up was 38.9 ± 21.2 and from baseline to 6-month follow-up was 37.1 ± 18.9. Statistically significant improvement in QoL at each subsequent time point, compared with those at baseline, was detected for all domains of the SF-36 except for subscales of physical functioning and pain. It has been highlighted that advanced social life was strongly associated with improvement in satisfaction with facial appearance, better self-esteem, and lower level of anxiety and depression during the period of follow-up after facial lipofilling. The results of this study supported the hypothesis that the level of self-confidence and mental health-related QoL could be significantly improved following facial lipofilling treatment.

Endovascular treatment of the IJV and azygous veins in patients with CCSVI and MS is a safe procedure with no post-procedural complications followed by significant improvement of IJV flow haemodynamic parameters and decrease in the EDSS score. Whether CCSVI percutaneous treatment might affect clinical improvement in patients suffering from MS is yet to be seen after completion of major multicentric clinical trials, still it seems like that this procedure is not negligible.

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