Carotid endarterectomy in a low volume vascular centre.

BACKGROUND: Carotid endarterectomy (CEA) is considered the golden standard of treatment for carotid artery disease in selected patients. METHODS: We studied retrospectively 246 CEAs performed in our centre from 2000-2008, and assessed the complications occurring during the first 30 days postoperatively. Surgical indications included symptomatic carotid stenosis > or = 60% and asymptomatic carotid stenosis > or = 75%. All patients underwent CEA with systematic use of a shunt, under general anesthesia. All arteriotomies were patched. All patients were transferred to ICU for 24 hours postoperatively. Mean hospital stay was 4.2 +/- 0.9 days. Ultrasound was performed 1 month postoperatively. RESULTS: Death, stroke, myocardial infarction (MI) and transient ischemic attack (TIA) were considered as major postoperative complications during the first 30 days after surgery. One death (0.4%), one nonfatal MI (0.4%) and two TIAs (0.81%) were recorded, while no stroke was present. CONCLUSIONS: We demonstrated that carotid endarterectomy can be safely performed in our low volume vascular centre. (246 CEAs in a nine year period).

Bone marrow micrometastasis might not be a short-term predictor of survival in early stages non-small cell lung carcinoma.

OBJECTIVE: To determine the presence of occult micrometastasis (OM) in a selected population of surgically resectable patients presenting with non-small cell lung carcinoma (NSCLC) and to evaluate its prognostic value on relapses and survival. METHODS: From February 1996 to December 1999, 99 patients undergoing surgical treatment for NSCLC were prospectively investigated for the presence of occult bone marrow micrometastasis. Tumor cells were detected with monoclonal primary antibodies directed against low molecular weight cytokeratins. RESULTS: Median follow-up time was 14.3 months (range 0.2-45.6 months). Overall prevalence of OM was 22.2% (22 out of 99). The presence of OM was not correlated to pathology, T status, or N status. In survival analysis, the only independent predictors of overall survival were N0 status and Stage I (P=0.016 and 0.004, respectively), while T1 was a predictor of disease-free survival (P=0.044). Metastasis and loco-regional recurrence were observed at follow-up in 18.2 (four out of 22) and 9% (two out of 22) of patients OM(+) and in 14.3 (11 out of 77) and 7.8% (six out of 77) of patients OM(-), respectively (P=not significant). OM was a predictor neither of overall survival nor of disease-free survival (P=0.52 and 0.97, respectively). In Stage I patients, 1-year overall survival and 1-year disease-free survival were 89 and 98% for OM(-) patients and 88 and 90% for OM(+) patients, respectively (P=0.57 and P=0.75). CONCLUSIONS: OM was present in >20% of surgically treated NSCLC patients and did not correlate to pathological variables. In contrast to previous published data, in this study the presence of OM had no influence on overall or disease-free survival.