Association between the Gensini Score and Carotid Artery Stenosis

BACKGROUND AND OBJECTIVES: The aim of this study was to evaluate the association between the extent of coronary artery disease assessed by the Gensini score and/or the SYNTAX score and the significant carotid stenosis in patients undergoing coronary artery bypass grafting (CABG). SUBJECTS AND METHODS: A total of 225 patients who had carotid doppler ultrasonography prior to CABG were included retrospectively. Significant coronary artery disease was assumed as a lumen diameter stenosis of ≥50% in any of the major epicardial coronary arteries. The severity of carotid stenosis was determined by B-mode and duplex ultrasonography. Clinically significant carotid stenosis was defined as peak systolic velocity greater than 125 cm/s. RESULTS: The mean value of SYNTAX score and Gensini score was highest in patients allocated to significant carotid stenosis (22.98±7.32, p<0.001 and 77.40±32.35, p<0.001, respectively). The other risk factors for significant carotid stenosis were found to be male gender (p=0.029), carotid bruit (p<0.001), diabetes (p=0.021), left main disease (p=0.002), 3-vessel disease (p=0.008), chronic total coronary occlusion (p=0.001), and coronary artery calcification (p=0.001) in univariate analysis. However, only the Gensini score (odds ratio[OR]=1.030, p=0.004), carotid bruit (OR=0.068, p<0.001), and male gender (OR=0.190, p=0.003) were the independent predictors. The Gensini score cut off value predicting significant carotid stenosis was 50.5 with 77% sensitivity (p<0.001). CONCLUSION: The Gensini score may be used to identify patients at high risk for significant carotid stenosis prior to CABG.

rare cause of small bowel transection: metastatic lung cancer

To present a case of small bowel perforation due to metastatic lung cancer. A 78-year-old male patient, who had been diagnosed with lung cancer 3 months earlier, presented to our clinic with acute abdominal pain. He underwent emergency laparotomy. At surgery, there was a circumferential lesion encompassing the ileum with complete transection. There was no obvious macroscopic appearance of metastatic disease. The involved bowel segment was resected and an ileostomy was performed. Postoperative pathologic analysis confirmed metastatic squamous cell carcinoma metastasis to the ileum, arising from the patient's lung cancer. This case report showed that small bowel metastases should always be considered in the differential diagnosis of lung cancer patients presenting with acute abdominal pain

Small bowel tumors: insidious and important abdominal problems for surgeons

To evaluate the major clinical symptoms, etiology and presentation of small bowel tumors so that they can be diagnosed. Retrospective study. Izmir Bozyaka Teaching and Research Hospital, Turkey. Forty-five patients with 46 small bowel tumors over a 15-year period were included in the study. Biopsy or small bowel resection. The data obtained from the medical records including clinical features, diagnostic workup, operative procedures and pathologic diagnosis. The male to female ratio was 1.4:1 with a median age at presentation of 53 years [range, 30 - 83 years]. Thirty [66.7%] patients presented with abdominal emergencies such as bowel obstruction [40%], bowel perforation [24.4%] and intestinal bleeding [2.3%]. Non-urgent presentations were found in 15 [33.3%] patients. The preoperative diagnosis of small bowel tumor was positive in nine [20%] of the elective cases. The tumors were located in the ileum in 68.8%, the jejunum in 26% and the duodenum in 6.6% of patients. Thirty-eight [82.6%] malignant and eight [17.4%] benign tumors were identified. In addition, patients with malignant tumors more commonly presented with bowel obstruction and perforation. Segmental resection was done in 41[91%] patients. These observations suggest that small bowel tumors are difficult to diagnose because of delayed presentations and vague symptoms. Clinicians must have a high degree of suspicion and should perform early laparotomy without hesitation