ABSTRACT
INTRODUCTION: The higher complication rate associated with the surgical treatment of restenosis following carotid endarterectomy (CEA) has led several authors to advocate angioplasty as the treatment of choice in the management of restenosis. We describe our experience with internal carotid artery angioplasty for post-endarterectomy restenosis over 7 years. PATIENTS AND METHODS: From January 1994 to April 2001, all patients with a >90% restenosis following CEA were considered for angioplasty. Thirty angioplasties were carried out in 25 patients, 80% (24/30), for asymptomatic recurrent stenosis. There was no difference between those who had intervention for recurrent stenosis (n=31) and those who did not (n=545) in age, sex, smoking status or incidence of diabetes or hypertension. A significantly greater number of patients who underwent angioplasty were hypercholesterolaemic (p<0.05, Chi-squared test). RESULTS: Mean time from surgery to angioplasty was 13 months (range 1-23). Angioplasty was technically successful in 29 cases (97%). Three patients (10%) experienced transient neurological symptoms during the procedure. There were no strokes. Ninety-six percent (28/29) of patients were followed up with duplex scanning. Mean follow-up was 20 months (range 2-48). Three patients developed a greater than 90% restenosis. CONCLUSION: Angioplasty is an acceptable alternative to surgery in the management of internal carotid artery restenosis following endarterectomy.
Subject(s)
Angioplasty, Balloon , Carotid Stenosis/therapy , Endarterectomy, Carotid , Aged , Carotid Artery, Internal , Carotid Stenosis/surgery , Case-Control Studies , Female , Follow-Up Studies , Humans , Male , Recurrence , Time FactorsABSTRACT
BACKGROUND: Bilateral atherosclerotic subclavian artery occlusion is rare. AIM: To describe the surgical treatment of a patient with symptomatic bilateral subclavian artery occlusion. METHODS: A midline sternotomy and bilateral aorto-subclavian bypass was performed in a male with upper limb, exercise-induced vertigo. RESULTS: Postoperatively symptomatic improvement paralleled an increase in brachial systolic arterial blood pressure readings. CONCLUSION: Bypass grafting is the more durable option for subclavian artery occlusion, as angioplasty with or without stenting is associated with a higher rate of late stenosis.
Subject(s)
Subclavian Steal Syndrome/surgery , Aortography , Blood Vessel Prosthesis Implantation , Humans , Male , Middle Aged , Subclavian Steal Syndrome/diagnostic imagingSubject(s)
Diabetes Mellitus, Type 1/epidemiology , Adolescent , Adult , Child , Diabetes Mellitus/genetics , Female , Humans , Infant , MothersABSTRACT
Fifty-four unrelated children with steroid responsive nephrotic syndrome of childhood were studied for 24 alleles at the HLA--A and B loci. A significantly increased incidence of HLA--B8 (Pc less than 0.01) was observed compared to controls. No association between response to cyclophosphamide therapy and HLA antigens was seen.
Subject(s)
Adrenal Cortex Hormones/therapeutic use , HLA Antigens/genetics , Nephrotic Syndrome/immunology , Child , Child, Preschool , Cyclophosphamide/therapeutic use , Haploidy , Humans , Nephrotic Syndrome/drug therapy , Nephrotic Syndrome/etiologyABSTRACT
PIP: Your editorial of Jan. 26 and the multi-signatory letter in your issue of Feb. 2 support the 1967 Abortion Act and suggest that Mr. Corrie's Bill is a retrograde step. The implication is that our professional knowledge should lead us to that conclusion. To take the opposite view risks being regarded as a member of a pressure group or a conscientious objector, but to remain silent might be construed as being in agreement. As I see it the great majority of people of varying ethnic groups, including those adhering to the Jewish, Muslim, and Christian faiths, subscribe to a behavioral code which regards human life as sacred: to take a life is to be countenanced only to save another. Abortion should be regarded as taking human life and morally wrong; making abortion legal does not make it morally right. Doctors are in a very difficult position, and cannot, no more than politicians can, make moral decisions for other people. Traditionally, however, the profession has a role in the responsibility for protection of life, and perhaps the public have a right to expect this protection. Human life begins at conception and some human rights begin at this time. Life (and its protection) seems to be a most basic right. The World Medical Association, in the Declaration of Oslo (1970), stated: "1. The first moral principle imposed upon the doctor is respect for human life as expressed in a clause of the Declaration of Geneva: 'I will maintain the utmost respect for human life from the time of conception.'" The 1967 Abortion Act did not result from a general referendum, much less a medical referendum. If the Corrie Bill is passed and abortions are cut by 2/3 as you suggest, this would, in my view, be a step, not back, but in the right direction.^ieng
