RESUMEN
This study was conducted to evaluate the significance of duplex ultrasound performed soon after carotid endarterectomy. The records of patients with 150 carotid endarterectomies and postoperative duplex ultrasound within 24 h were reviewed. Eleven (7.3%) had abnormal studies with > or =50% stenosis. Two patients with abnormal studies sustained a perioperative stroke and three patients underwent reoperation for persistent lesions (P<0.0001). Preoperative and postoperative cerebral imaging studies (computed tomography (CT) or magnetic resonance imaging (MRI)) were performed on 114 patients. Seven of these demonstrated areas of infarction and all seven had abnormal duplex ultrasound studies. Twenty-six CT scans were performed with two positive for cerebral infarction in the two patients with clinical stroke. In the 88 MRI studies, five demonstrated small, subcortical focal areas of ischemia, which were clinically silent. The relationship of infarction on postoperative cerebral studies and abnormal postoperative duplex ultrasound was significant (P<0.0001). It was concluded that early postoperative duplex ultrasound studies of > or =50% stenosis demonstrate significant association with postoperative stroke or reoperation, as well as with ischemic changes on brain imaging studies. Earlier detection with intraoperative duplex would probably be more advantageous than postoperative duplex ultrasound.
Asunto(s)
Estenosis Carotídea/cirugía , Endarterectomía Carotidea , Complicaciones Posoperatorias/diagnóstico por imagen , Ultrasonografía Doppler Dúplex , Anciano , Anciano de 80 o más Años , Implantación de Prótesis Vascular , Isquemia Encefálica/diagnóstico por imagen , Isquemia Encefálica/cirugía , Estenosis Carotídea/diagnóstico por imagen , Infarto Cerebral/diagnóstico por imagen , Infarto Cerebral/cirugía , Femenino , Oclusión de Injerto Vascular/diagnóstico por imagen , Oclusión de Injerto Vascular/cirugía , Humanos , Procesamiento de Imagen Asistido por Computador , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/cirugía , Recurrencia , Reoperación , Factores de Riesgo , Sensibilidad y Especificidad , Resultado del TratamientoRESUMEN
PURPOSE: The purpose of this study is to characterize microembolic signals (MS) that occur during the various phases of carotid endarterectomy (CEA) and to consider their relationship to postoperative changes on magnetic resonance imaging (MRI). METHODS: This was a retrospective study of 76 patients who underwent 78 carotid endarterectomies at a referral center. Perioperative transcranial Doppler monitoring and MRI were performed before and after CEA. The types of MS that occurred during phases of surgery were analyzed and compared with MRI changes. RESULTS: We observed a clinical stroke in one patient (1.3%) and ipsilateral small areas of silent ischemic change on seven postoperative MRI studies (9.0%). In 95% of CEAs, MS were detected. Only those MS observed in the recovery room that occurred at a rate of more than five per 15 minutes were associated with postoperative MRI ischemic changes (p < 0.0001). CONCLUSIONS: Ischemic changes on MRI after CEA are related to postoperative MS.
Asunto(s)
Isquemia Encefálica/etiología , Endarterectomía Carotidea/efectos adversos , Embolia y Trombosis Intracraneal/etiología , Complicaciones Posoperatorias/etiología , Isquemia Encefálica/clasificación , Isquemia Encefálica/diagnóstico , Arteria Carótida Interna/cirugía , Electroencefalografía , Endarterectomía Carotidea/estadística & datos numéricos , Humanos , Embolia y Trombosis Intracraneal/clasificación , Embolia y Trombosis Intracraneal/diagnóstico , Imagen por Resonancia Magnética , Complicaciones Posoperatorias/diagnóstico , Estudios Retrospectivos , Ultrasonografía Doppler TranscranealRESUMEN
Peristomal varices occasionally form in patients with chronic liver disease who have surgically created intestinal anastomoses and stomas. Hemorrhage from these varices carries an estimated mortality of 3%-4% per episode, as opposed to the 30%-40% mortality associated with gastroesophageal variceal bleeding. The cases of four patients who underwent transhepatic mesenteric vein catheterization with embolization of stomal varices for recurrent, intractable bleeding are presented. In three of the four patients there was no additional hemorrhage for at least 5 months. One patient was lost to follow-up. There were no complications. Since stomal variceal hemorrhage has a low mortality, transhepatic embolization is presented as a means of hemorrhage control when sclerotherapy fails and when shunt surgery presents an unacceptably high rate of morbidity and mortality relative to the underlying disease.
Asunto(s)
Embolización Terapéutica , Hemorragia Gastrointestinal/terapia , Ileostomía , Complicaciones Posoperatorias/terapia , Várices/terapia , Anciano , Humanos , Masculino , Persona de Mediana EdadRESUMEN
Developmental stenosis of the cervical spine results in a reduction of the caliber of the cervical spinal canal that is greatest in the anteroposterior dimensions. This usually becomes symptomatic in adults when a myelopathy may result from compression of the cervical cord by small osteophytes or by hyperextension injury without fracture or dislocation. Although incidence and prevalence data are not available, this condition does occur in the pediatric population since we have encountered three adolescents with this condition. The diagnosis of cervical spinal stenosis can be suggested when narrowing of the sagittal diameter of the spinal canal on a lateral cervical radiograph is identified. Subsequent corroboration can be obtained with myelography, computed tomography, or magnetic resonance imaging.