Restenosis after carotid surgery.

On the basis of personal experience and reports in the literature, the paper examines the incidence of restenosis after carotid surgery, its potential morbidity and the results of its treatment. The incidence of stenosis after carotid surgery is described in a series of 253 patients given carotid TEAs in 1992-98 and followed up at 1, 3, 6 and 12 months with yearly check-ups thereafter. The group's age range was 64-70 and it included 35% females, 65% males. The initial surgical procedure was a standard TEA with or without patching. Identified by colour Doppler scan, cases of restenoses were examined angiographically in the presence of significant symptoms and haemodynamic disorders. This group constituted 7.5% of the personal series and was classified on the basis of clinical, morphological, topographical and haemodynamic criteria. Only 21% of the restenosis cases required repeat surgery: 2 classic procedures and 2 endovascular operations. No complications ensued and all these patients were symptom-free at 84 months' follow-up. A comparison of these data with reports in the literature confirms an increasing incidence of restenosis after carotid surgery in recent years, which partly reflects more accurate diagnosis. It is concluded that indications to surgery should take greater account of the lesion's histological and clinical characteristics and the increased risk of peripheral nerve damage in repeat surgery. The alternative endovascular approach will need to be examined on the basis of bigger case series and longer, more meaningful follow-ups before any definitive conclusions can be reached though the endovascular approach does seem to represent the future of treatment in this particular sector.

In vitro IgE synthesis in neonates with different family history of atopy.

In this study we want to correlate family history of atopy and in vitro synthesis of IgE, IL4 and IFN gamma in 5 neonates with biparental (group A), 5 with uniparental (group B) and 5 with absent family history of atopy (group C). An aliquot of neonatal blood mononuclear cells (NBMC) was incubated in presence of PHA in combination with the phorbol ester acetate (TPA). The supernatants of cultures were harvested after 48-72 hours of incubation and stored at -20 degrees C until testing for lymphokine production by ELISA kits. Only one neonate of group B showed detectable in vitro synthesis of IL4 (45 pg/ml) after PHA + TPA stimulation. All the others failed to produce detectable levels either of IL4 or IFN gamma. Another aliquot of NBMC was cultured in the presence of saturating concentrations of rhIL4 for 48 h. After this pre-incubation step, the non-adherent cells were cultured in the presence of: 1) rhIL4; 2) rhIL4 + anti-IL4 antibody (Ab); 3) rhIL4 + anti-IFN gamma Ab; 4) rhIFN gamma, 5) rhIFN gamma + anti-IFN gamma Ab + rhIL4; 6) PWM + rhIL4; 7) unstimulated culture. The supernatants of these cultures were tested for their IgE content. In general, spontaneous IgE production by NBMC was very low, rhIL4 did not induce a significant increase of IgE synthesis. The other modalities of stimulations did not produce significative changes. We did not observe significative differences among the three groups of neonates. On the basis of our results, we conclude that NBMC aren't able to produce significative amounts of IgE in vitro either spontaneously or after IL4 stimulation. This test and the evaluation of IL4 and IFN gamma in vitro production aren't useful markers of atopy predisposition.