Assuntos
Diagnóstico por Imagem , Doenças Vasculares/diagnóstico , Doenças Vasculares/fisiopatologia , Arteriopatias Oclusivas/diagnóstico , Arteriopatias Oclusivas/fisiopatologia , Doença Crônica , Humanos , Fluxometria por Laser-Doppler , Fluxo Sanguíneo Regional , Ultrassonografia Doppler , Doenças Vasculares/diagnóstico por imagem , Insuficiência Venosa/diagnóstico , Trombose Venosa/diagnósticoRESUMO
The purpose of the study was to determine the association between cerebral infarction seen on CT scan and macroscopic ulceration of atheromatous carotid plaques in patients undergoing carotid endarterectomy. Following carotid endarterectomy in 65 patients, specimens were examined for the presence of ulceration without knowing the result of the preoperative CT brain scan. The 65 patients thus investigated underwent 68 carotid endarterectomies: 36 for a history of transient ischemic attacks (TIAs), 13 for amaurosis fugax, and six for prior strokes; 13 asymptomatic patients had prophylactic carotid endarterectomy prior to coronary bypass. A macroscopic ulcer was present in 42 specimens. Twenty-six (62%) of the patients with ulceration had one or more ipsilateral cerebral infarcts on CT scan. Only two (8%) of the 26 patients without an ulcer had cerebral infarcts. Of the 36 patients who presented with TIAs, 26 (72%) had carotid plaque ulcers and 23 (88%) of these had cerebral infarcts on CT scan also. In contrast, only three of 13 asymptomatic patients had plaque ulcers and only one of these had a cerebral infarct. There is a high incidence of cerebral infarction seen on CT scan in patients presenting with TIAs. These infarcts occur predominantly in patients with ulcerated atheromatous carotid lesions.
Assuntos
Doenças das Artérias Carótidas/patologia , Infarto Cerebral/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Idoso , Cegueira/epidemiologia , Doenças das Artérias Carótidas/complicações , Doenças das Artérias Carótidas/cirurgia , Infarto Cerebral/epidemiologia , Endarterectomia , Feminino , Humanos , Ataque Isquêmico Transitório , Masculino , Pessoa de Meia-Idade , Risco , Úlcera/patologiaRESUMO
One hundred fifty patients over the age of 30 who had undergone major abdominal operations were stratified according to the risk of deep venous thrombosis and randomized into three groups to receive different prophylactic regimens: group A, electrical calf stimulation; group B, low-dose subcutaneous heparin; group C, intermittent sequential compression and thromboembolism-deterrent (TED) stockings. All the patients were scanned with the 125I-fibrinogen test for the whole stay in hospital. The incidence of 125I-fibrinogen detected deep venous thrombi was 18% in group A, 9% in group B, and 4% in group C. The results indicate that the regimen of intermittent sequential compression and TED stockings is as effective as low-dose subcutaneous heparin. Electrical calf stimulation is less effective.
