RESUMEN

BACKGROUND: To evaluate the use of temporary intraluminal shunt (IS) during operations in our patients for asymptomatic carotid stenosis (ACS) of the internal carotid artery (ICA). METHODS: Complications of ICA endarterectomy were reviewed in two groups of asymptomatic patients. In group A (144 patients, operation 1972-1985) temporary IS was used in 43 patients with the intraoperatively measured ICA back pressure <50 mmHg. In group B (170 patients, operation 1986-1998) shunt was used in all cases. RESULTS: The incidence of neurologic deficit was higher ia group A than in group B (5.6% vs 1.2%, p<0.05). Within group A, the incidence of neurologic deficit was significantly higher in the subgroup with back pressure >50 mmHg, and thus without shunt, than in group B with routine use of shunt (6.0% vs 1.2%, p<0.05). There were no differences in the incidence of shunt-related complications between the groups (3.0% vs 4.0%, p>0.05). We had no mortality after operations of asymptomatic patients. CONCLUSIONS: The routine use of IS reduced the rate of intraoperative and early postoperative neurologic complications of asymptomatic carotid endarterectomy, and it was not associated with a higher incidence of complications.

Asunto(s)

RESUMEN

Diabetic foot occurs due to the loss of protective sense and circulation disorder and a marked proneness to infections. Mechanical stress of bone growths frequently leads to ulcerations. The prevention and timely treatment of diabetic foot requires the participation of both patients and all health care levels. This consensus is given for the purpose of procedure standardization. Education is the basis of prevention and should be carried out with every patient suffering from diabetes mellitus and those with a sensory defect in particular. Appropriate footwear significantly contributes to prevention and treatment of ulcers. As regards the treatment, the necessity of surgical approach with a long term and often manifold antibiotic therapy should be pointed out. Infections are usually mixed. The deeper the ulceration, the more likely the infection with anaerobes and Gram-negative bacteria occurs in addition to Gram-positive ones which are normally present in surface lesions. Strict metabolic control is a precondition for successful treatment. In conclusion, diabetic foot is a major health problem which requires multidisciplinary approach with permanent patient education as its essential part, and a specific cooperation of all levels and different health care specialties.

Asunto(s)

RESUMEN

Complications of carotid artery reconstruction were reviewed in two groups of patients. In group A (213 patients, operation 1978-85) the surgical procedure varied according to intraoperatively measured back pressure in the internal carotid artery (ACI), with temporary intraluminal shunt when the ACI pressure was < 50 mmHg, but no shunt when the pressure was higher. In group B (339 patients, operation 1986-93), shunt was used in all cases. The incidence of complications was higher in group A than in group B (21.6% vs 13%). Temporary or permanent neurologic deficit occurred in 11.3% of the group A patients and in 5.6% of the group B patients. Routine use of temporary intraluminal shunt thus resulted in fewer complications of carotid artery surgery and allowed the surgeon to work undisturbed, a prerequisite for a successful outcome.

Asunto(s)

RESUMEN

When working experimentally on dogs we have investigated the possibility of using an autogenous vein graft and polytetrafluoroethylene (Gore-Tex) prosthesis in the construction of the portacaval shunt. The portacaval shunt flow has been examined under similar hemodynamic conditions by experimenting on surviving dogs with the internal jugular vein and the above prosthesis. This study presents methods of research, hemodynamic measurements and the technique of portacaval shunt construction. After performance of the arteriovenous mesenteric-renal fistula we have succeeded in raising partially the portal vein pressure with the increase in the venous blood flow markedly higher. The portacaval shunt flow and the mesenteric-renal fistula have been verified by aortography and on autopsy. The jugular vein employed in the construction of the portacaval shunt remained unobstructed in 6 dogs (75 per cent) and the Gore-Tex prosthesis in 4 (50 per cent).

Asunto(s)

RESUMEN

Cerebral ischemic attack is a common disease and a major health, social and economic problem. The authors discuss the diagnostics of cerebrovascular insufficiency, and the indications for a surgical intervention. They analyse the frequency of surgical and early postoperative complications in patients undergoing surgery for stenotic changes in the arteries of the aortic arch. In 625 reconstructive procedures performed, operative and early postoperative neurologic deficits were observed in 16 (2.5%) patients. In 5 patients (0.8%), neurologic deficit disappeared during the early postoperative period, while in 11 (1.7%) patients persisted after the patient's discharge from the hospital. This paper also reports the late results of surgical treatment in a group of 62 patients followed up at 4 to 6 years or approximately for five years after operation. The authors also investigate the results of pharmacotherapy in a group of 32 patients who were not willing to accept the recommended surgery and who were followed up for a period of 3 to 6 years or approximately for 4.5 years postangiography. The results of surgical treatment were correlated with the pharmacotherapy results. There is a statistically significant difference to the advantage of surgically treated patients (P less than 0.001). It is concluded that reconstructive interventions on the cervical part of cerebral arteries indicated in the case of obliterative arteriosclerosis seem to prevent or considerably decrease the incidence of recurrent cerebral attack. In addition, the incidence of neurologic surgical deficit is considerably decreased by the routine application of a temporary intraluminal bypass.

Asunto(s)

Asunto(s)