Near-Infrared Spectroscopy-Guided, Individualized Arterial Blood Pressure Management for Carotid Endarterectomy under General Anesthesia: A Randomized, Controlled Trial.

Background: Differences in blood pressure can influence the risk of brain ischemia, perioperative complications, and postoperative neurocognitive function in patients undergoing carotid endarterectomy (CEA). Methods: In this single-center trial, patients scheduled for CEA under general anesthesia were randomized into an intervention group receiving near-infrared spectroscopy (NIRS)-guided blood pressure management during carotid cross-clamping and a control group receiving standard care. The primary endpoint was postoperative neurocognitive function assessed before surgery, on postoperative days 1 and 7, and eight weeks after surgery. Perioperative complications and cerebral autoregulatory capacity were secondary endpoints. Results: Systolic blood pressure (p < 0.001) and norepinephrine doses (89 (54-122) vs. 147 (116-242) µg; p < 0.001) during carotid cross-clamping were lower in the intervention group. No group differences in postoperative neurocognitive function were observed. The rate of perioperative complications was lower in the intervention group than in the control group (3.3 vs. 26.7%, p = 0.03). The breath-holding index did not differ between groups. Conclusions: Postoperative neurocognitive function was comparable between CEA patients undergoing general anesthesia in whom arterial blood pressure during carotid cross-clamping was guided using NIRS and subjects receiving standard care. NIRS-guided, individualized arterial blood pressure management resulted in less vasopressor exposition and a lower rate of perioperative complications.

Portomesenteric Reconstruction during Whipple Procedure Using Autologous Left Renal Vein Patch Graft in a Patient with a Gastric Cancer Recurrence.

The case of vascular reconstruction of the superior mesenteric and portal vein confluence using a left renal vein (LRV) graft has been researched in this paper. The patient was a 66-year-old female who presented with features of biliary obstruction. A contrast-enhanced computed tomography scan revealed bile duct dilatation and a common bile duct tumor mass. Four years ago, she underwent stomach resection with subsequent Billroth II gastrojejunostomy due to gastric cancer. After surgical resection, on histopathological and immunohistochemistry examination, a recurrence of previously resected poorly cohesive gastric cancer was found.

Association of 1166A>C AT1R, -1562C>T MMP-9, ACE I/D, and CCR5Δ32 Polymorphisms with Abdominal Aortic Aneurysm in Croatian Patients.

AIM: The purpose of this case-control study was to assess the association of abdominal aortic aneurysm (AAA) in Croatian patients with four genetic polymorphisms: SNP 1166A>C in the angiotensin II type 1 receptor gene (AT1R); SNP -1562C>T in the matrix metalloproteinase-9 gene (MMP-9); the deletion of 32 bp in the chemokine receptor 5 gene (CCR5); and the insertion/deletion (I/D) of 287 bp in the angiotensin-converting enzyme gene (ACE). METHODS: Case-control study conducted with 117 patients with confirmed AAA (AAA+) and 117 control subjects (AAA-). Genotyping was performed using PCR or PCR-RFLP analysis. Statistical analyses were performed using MedCalc 12.1 software. RESULTS: The deletion of 287 bp in the ACE gene (allele D) was more frequently found among AAA+ patients than AAA- subjects (66.7% vs. 47.9%, p = 0.0001), due principally to a higher percentage of DD homozygotes (46.2% vs. 15.4%, p < 0.0001). The associated increased risk for AAA was detected in both the nonadjusted recessive model of inheritance (odds ratio [OR] = 3.00, 95% confidence interval [CI] = 1.88-4.79, p = < 0.0001) and when adjusted for age, sex, smoking, hypertension, and hyperlipidemia (OR = 4.96; 95% CI = 1.68-14.59, p = 0.004). The adjusted recessive models also showed increased risk for AAA for the carriers of MMP-9 T allele (OR = 15.69, 95% CI = 1.40-175.41, p = 0.025). Patients with small aneurysms compared with those with large ones were more frequent carriers of the AT1R allele C (37.8% vs. 23.2%, p = 0.029), and logistic regression analysis showed decreased risk for developing large aneurysms in both adjusted models, dominant and recessive (OR = 0.3929, 95% CI = 0.1554-0.9932, p = 0.0483 and OR = 0.1728, 95% CI = 0.0331-0.9023; p = 0.0374, respectively). No difference among any type of the studied groups or subgroups was observed regarding the CCR5Δ32 polymorphism. CONCLUSIONS: ACE I/D is associated with AAA, and 1166A>C AT1R with the size of the aneurysm, while -1562C>T MMP-9 and CCR5Δ32 polymorphisms are most probably not associated with AAA in Croatian patients.