Treatment strategy for bilateral carotid stenosis: 2 cases of carotid endarterectomy for the symptomatic side followed by carotid stenting.

Since the introduction of carotid stenting (CAS), a combined treatment for bilateral lesions using carotid endarterectomy (CEA) and CAS has been developed. However, there has been only 1 report about CEA then CAS. Herein we describe 2 patients with bilateral severe carotid stenosis who were treated by CEA for the symptomatic side and CAS for the contralateral asymptomatic side. A 71-year-old man underwent CEA for the symptomatic side. Although the patient suffered hyperperfusion syndrome after CEA, he recovered fully after 3 weeks of rehabilitation. Two months later, CAS was performed for the asymptomatic side, and he was discharged with no deficit. A 67-year-old man underwent CEA for the symptomatic side. The patient developed no postoperative neurologic deficits except for hoarseness. Four weeks later, CAS was performed for the contralateral asymptomatic side. After the procedure, however, severe hypotension occurred, and treatment by continuous injection of catecholamine was necessary to maintain systematic blood pressure. The patient was ultimately discharged with no deficit. The combined therapy of CAS for the asymptomatic side and then CEA for the symptomatic side has been recommended by several authors. However, one of the problems of this strategy is the higher incidence of postprocedural hemodynamic complications, and hypotension after CAS may be dangerous for the symptomatic hemisphere. We suggest a combined therapy using CEA for the symptomatic side and then CAS for the asymptomatic side can be 1 beneficial treatment option for patients with bilateral carotid stenosis without coronary artery disease.

[Clinical case study of lung cancer accompanied by pulmonary aspergillosis].

We retrospectively studied clinical cases of lung cancer complicated by pulmonary aspergillosis. A total of 19 cases with average age of 69.5 years were encountered over the last 9 years. All had a history of smoking and 18 were men. In 2 cases, pulmonary aspergillosis and lung cancer were diagnosed concurrently. Pulmonary aspergillosis was diagnosed first in 4 cases and lung cancer was diagnosed first in 13 cases, in 11 of which pulmonary aspergillosis developed after surgery for lung cancer. In the non-operated group 5 cases had complications at the same site and 3 had complications at a different site. In the operated group, 10 cases subsequently had ipsilateral pulmonary aspergillosis and 1 case had contralateral pulmonary aspergillosis. Thirteen cases received antifungal medication. Lung cancer therapy is a risk factor for pulmonary aspergillosis. Careful medication is recommended.

Simultaneous stratospheric gas and aerosol retrievals from broadband infrared occultation measurements.

The inversion method for simultaneous gas (O3, NO2, HNO3, N2O, CH4, H2O, CFC-11, CFC-12, N2O5, and ClONO2) and aerosol retrievals from broadband continuous IR spectra of occultation measurements is described. Both gas and aerosol physical modeling with consideration of the multicomponent character of aerosol and polar stratospheric clouds (PSCs) are used to minimize the difference between measured and modeled transmittance spectra under smoothness constraints imposed on particle-size distributions for each PSC component and positive constraints on all gas and aerosol parameters. The method is tested by numerical simulations in which synthetic occultation measurements inherent to the improved limb atmospheric spectrometer are used. The study reveals that the method has significant advantages over other approaches based on offset or gas-window-channel aerosol correction for accurate gas retrievals and provides additional information on the particle-size composition, volume density, and chemical component character of PSCs.