ABSTRACT
Several authors believe the crus of the diaphragm or the arcuate ligament is largely implicated in the etiology of the celiac artery compression syndrome (CACS). An unusual case of CACS successfully treated with laparoscopic decompression is reported. While under general anesthesia, the patient underwent laparoscopic division of the hypertrophic median arcuate ligament and dissection free of the celiac trunk. Postoperative angiography demonstrated improved flow in the celiac artery. The patient was discharged on the second postoperative day. At 6 months, Doppler ultrasound scanning and magnetic resonance angiography revealed good patency of the celiac trunk. The patient reported complete resolution of symptoms and increased weight. A laparoscopic approach allows the surgeon to sufficiently dissect the celiac axis. An excellent clinical result at short-term follow-up was attained. This is the second reported experience with this new procedure and the first successfully performed with only four port sites.
Subject(s)
Arterial Occlusive Diseases/surgery , Celiac Artery , Decompression, Surgical/methods , Laparoscopy , Arterial Occlusive Diseases/diagnostic imaging , Female , Humans , Magnetic Resonance Angiography , Middle Aged , Radiography , Ultrasonography, Doppler , Vascular PatencyABSTRACT
OBJECTIVE: to determine the effect of specific antibiotic treatment with roxithromycin in the eradication of Chlamydia pneumoniae from carotid artery plaques. DESIGN: prospective open randomised treatment study. PATIENTS AND METHODS: we analysed 32 patients (16 females, mean age 70.1+/-14.7 years) who underwent surgery for the removal of atherosclerotic plaques from carotid arteries. During surgery samples of lingual vein and superior thyroid artery were also taken. Before surgery, patients were randomised to receive either roxithromycin 150 mg twice daily or no treatment. Sixteen patients were treated with antibiotic for a mean of 26 days (range 17-35 days). The two groups of patients were comparable in terms of age, sex, risk factors, and seroprevalence for C. pneumoniae. We applied a semi-nested polymerase chain reaction (PCR) technique to the carotid plaques, lingual vein, and thyroid artery samples. Blood samples were obtained from the patients for the determination of C. pneumoniae IgG, IgA, and IgM antibody titres by a microimmunofluorescence technique. RESULTS: in twelve out of sixteen non-treated patients we found evidence of C. pneumoniae DNA in the carotid plaques. Conversely, C. pneumoniae DNA was detected in only five out of sixteen treated patients (p=0.034, Chi-squared test). In all cases PCR was negative for the lingual vein and thyroid artery samples. CONCLUSIONS: Roxithromycin seems effective in reducing the bacterial burden of C. pneumoniae within atherosclerotic plaques, although extended follow-up is needed to determine whether antibiotic treatment benefits long-term patient outcome.
Subject(s)
Anti-Bacterial Agents/therapeutic use , Arteriosclerosis/prevention & control , Carotid Stenosis/prevention & control , Chlamydia Infections/drug therapy , Chlamydophila pneumoniae/isolation & purification , Roxithromycin/therapeutic use , Aged , Aged, 80 and over , Antibodies, Bacterial/analysis , Arteriosclerosis/microbiology , Arteriosclerosis/surgery , Carotid Stenosis/microbiology , Carotid Stenosis/surgery , Chlamydia Infections/microbiology , Chlamydophila pneumoniae/genetics , Chlamydophila pneumoniae/immunology , DNA Primers/chemistry , DNA, Bacterial/analysis , Endarterectomy, Carotid , Female , Fluorescent Antibody Technique , Humans , Male , Middle Aged , Polymerase Chain Reaction , Prospective Studies , Treatment OutcomeABSTRACT
The presence of Chlamydia pneumoniae in atheromas has been demonstrated in several studies. Culture of the organism from arterial tissue has been difficult. We report the use of a reverse transcriptase polymerase chain reaction to detect viable Chlamydia pneumoniae in carotid atheromas. We analyzed 30 patients (14 females, mean age 69.6 +/- 8.8 years) who underwent surgery for the removal of atherosclerotic plaques from carotid arteries. During surgery, samples of lingual vein and superior thyroideal artery were also taken. We applied two molecular biology techniques to the carotid plaques on lingual vein or thyroideal artery samples: 1) polymerase chain reaction (PCR) and 2) reverse transcriptase-PCR (RT-PCR) for the detection of bacterial mRNA, employing PCR primers designed to detect a fragment of the 16S rRNA gene. Blood samples were obtained from the patients for determination of Chlamydia pneumoniae IgG, IgA, and IgM antibody titers by a microimmunofluorescence technique. The results of the present study confirmed the presence of viable Chlamydia pneumoniae in atheromas and support the hypothesis that the organism may be an active factor in the pathogenesis of atherosclerosis.
Subject(s)
Carotid Artery Diseases/microbiology , Chlamydia Infections/diagnosis , Chlamydophila pneumoniae/isolation & purification , Intracranial Arteriosclerosis/microbiology , Aged , Carotid Artery Diseases/surgery , Endarterectomy, Carotid , Female , Humans , Intracranial Arteriosclerosis/surgery , Male , Polymerase Chain Reaction , Reverse Transcriptase Polymerase Chain ReactionSubject(s)
Acetazolamide/therapeutic use , Respiratory Insufficiency/drug therapy , Acetazolamide/administration & dosage , Acid-Base Imbalance/drug therapy , Acute Disease , Brain Injuries/drug therapy , Chronic Disease , Humans , Hypercapnia/drug therapy , Lung Neoplasms/drug therapy , Myocardial Infarction/drug therapy , Pulmonary Edema/drug therapyABSTRACT
The effect of priming extracorporeal perfusion pumps with 50% and 80% diluted homologous blood on the serum electrolytes, acid-base status and plasma osmolality has been investigated in 103 patients undergoing open-heart surgery for congenital and acquired heart disease. The value in prognosis of plasma osmolality is discussed.
