Monitoring of activated coagulation time in carotid endarterectomy.

BACKGROUND: The objective of the present study was to evaluate the efficacy of monitoring activated coagulation time (ACT) during carotid endarterectomy (CEA) in reducing surgical risks and complications. METHODS: A total of 175 consecutive patients who had CEA between July 2002 and January 2004 were studied. Activated coagulation time was monitored during the procedure in all patients. The results were compared with the data reported in the literature, and with those obtained in 2 previous series, totaling 1924 patients treated at the same service before the use of ACT. RESULTS: Only 4 of the 175 patients had cerebral ischemia, with 3 of them almost completely recovering during hospitalization. Significant morbidity was 0.6% and mortality was 0.6%. No statistically significant difference in the incidence of cerebral ischemia or death was observed between symptomatic and asymptomatic patients. In the 2 previous series used for comparison, operated by the same author, we found 0.7% and 0.8% of significant morbidity and 1.4% and 2.6% of mortality, respectively. Most series in the literature have shown a higher significant morbidity than the present one, mainly in symptomatic patients. The incidence of hematoma in the present series was 5.7%, only 3 (1.7%) of them being significant. No increase in the frequency of hematomas was observed in cases where heparin was not reversed or in those using a shunt. In the 2 other previous series, the incidence of hematomas was 1.5% and 3.6%. CONCLUSIONS: Activated coagulation time monitoring during CEA was effective in evaluating the level of heparinization of patients during surgery and the immediate postoperative period. The comparison of the present series with the literature and with the previous series of the same service, before the use of ACT, permits also to conclude that the control of the level of heparinization seems to reduce the risk of perioperative and immediate postoperative ischemia. In addition, ACT monitoring also seems to be effective in diminishing the risk of postoperative cervical hematoma.

Superficial vs combined cervical plexus block for carotid endarterectomy: a prospective, randomized study.

BACKGROUND: The present study compares combined and superficial cervical plexus block in patients submitted to carotid endarterectomy (CEA) in terms of anesthetic efficacy, satisfaction of the patient and surgeon, complications resulting from the type of anesthesia, and final outcome. METHODS: A total of 125 patients submitted to elective CEA were randomized into 2 groups: the first group was submitted to superficial cervical block and the second group to combined (superficial plus deep) cervical block. RESULTS: No significant difference in anesthetic quality was observed between the 2 types of blocks. Complications related to the anesthetic method were observed in only 1 (1.6%) patient of the superficial block group and in 5 (7.4%) patients of the combined block group (P > .05). Anesthetic supplementation by the surgeon was necessary in 50 (81.96%) patients, with no significant difference between the 2 groups. The surgical conditions were closely similar in the 2 groups, showing no significant difference. The final morbidity and mortality in the present series was 1.6%. CONCLUSIONS: Superficial cervical anesthetic block shows the same efficacy as combined block, with the surgical conditions being closely similar. The incidence of complications related to the anesthetic technique is higher for combined block. The type of block does not influence the final outcome of the patients.

Multifocal osteoclastoma of the skull: case report.

We describe the case of a 35 years old man with a nonspecific complaint of a slow growing solid mass in the frontal region. Radiological exams evidenced two more lesions : in the superior and lateral walls of the orbit. Treated with total excision of the lesions and a cranioplastic procedure at the same act, with favorable outcome. Microscopic findings suggested giant cell tumor in the three lesions that was confirmed by immunohistochemical examination.

Multifocal osteoclastoma of the skull: case report

Descrevemos o caso de homem de 35 anos, com história de lesão endurecida de crescimento progressivo na região frontal direita. Exames radiológicos evidenciaram duas outras lesões: uma na parede superior e outra na parede lateral da órbita direita. Submetido a exérese total das lesões com margem de segurança e cranioplastia no mesmo tempo cirúrgico. O exame anatomo patológico sugeriu tumor de células gigantes nas três lesões, diagnóstico confirmado pela imuno-histoquímica.

[Occlusion of the common carotid artery treated with a subclavian-internal carotid artery bypass]. / Trombose de artéria carótida comum: tratamento cirúrgico com anastomose subclávio-carotidea.

We describe the case of a 62 years old woman with several transient isquemic attacks. The neuroradiological study demonstrated occlusion of the common carotid artery with revascularization of the internal carotid artery by anastomosis with the inferior thyroid artery and an aneurysm of internal carotid artery at the emergency of the anterior choroidal artery. The patient was treated with a bypass between the subclavian artery and the internal carotid artery with complete regression of the symptoms.

Trombose de artéria carótida comum: tratamento cirúrgico com anastomose subclávio-carotidea / Occlusion of the common carotid artery treated with a subclavian-internal carotid artery bypass

Descrevemos o caso de mulher de 62 anos, com história de vários ataques isquêmicos transitórios. Os exames complementares revelaram oclusäo da artéria carótida comum e revascularizaçäo da artéria carótida interna (ACI) através de anastomose com a artéria tiroidiana inferior, bem como aneurisma na ACI supraclinoidea. A paciente foi tratada com "bypass" entre a artéria subclávia e a artéria carótida interna cervical, ocorrendo regressäo completa dos sintomas de isquemia cerebral no pós-operatório