RESUMO
The purpose of this study is to evaluate the efficacy and the safety of carotid endarterectomy (CEA) in the octogenarian patient. From January 1995 to December 2000, we have performed 3430 CEAs in 2743 patients: 345 CEAs in 269 octogenarian patients (Group 1) and 3085 CEAs in 2474 younger patients (Group 2). Age was the only selection criteria for including patients in Group 1. Octogenarians' perioperative mortality (1.4%) was greater than that in Group 2 (0.3%) (p<0.05). No differences can be found between the groups' perioperative ipsilateral stroke rates (1.7% in Group 1 vs 1.2% in Group 2) and combined ipsilateral stroke and death rates (2.3% in Group 1 vs 1.3% in Group 2) (p>0.05). The octogenarians' Kaplan-Meier 6-year overall and free-stroke survival rates were 86 and 76% respectively. CEA can be performed in selected octogenarian patients with low early and late mortality and neurologic morbidity rates.
Assuntos
Idoso de 80 Anos ou mais , Endarterectomia das Carótidas/efeitos adversos , Fatores Etários , Idoso , Intervalo Livre de Doença , Endarterectomia das Carótidas/mortalidade , Feminino , Seguimentos , Humanos , Itália/epidemiologia , Masculino , Complicações Pós-Operatórias , Estudos Prospectivos , Acidente Vascular Cerebral/prevenção & controle , Taxa de Sobrevida , Resultado do TratamentoRESUMO
BACKGROUND: We investigated the role of apoptosis and its potential alterations in laryngeal squamous cell carcinomas (LSCCs) by evaluating bax, bcl-2 and p53 protein expression in 50 cases and by characterising the molecular status of the bax and p53 genes. MATERIAL AND METHODS: p53 and bax gene mutations were investigated by means of PCR/SSCP and direct DNA sequencing, and bax, bcl-2 and p53 protein expression by means of immunohistochemistry. RESULTS: We identified p53 gene mutations in 17/50 cases (34%); p53 expression in 26 of the 50 cases (52%); bcl-2 expression in 5/50 cases (10%); bax expression in 32/47 cases (68%). 18/33 cases with a wild type p53 gene overexpressed p53 protein: 12 cases (approximately 66%) were bax+/bcl-2-. Of the remaining cases without p53 protein expression, seven cases (approximately 47%) were bax+/bcl-2-. CONCLUSIONS: Our observations suggest that the overexpression of p53 may contribute to the repression of bcl-2 and the induction of bax expression in LSCCs. However, the fact that a number of cases not expressing p53 did not present any clear up-regulation of bax or down-regulation of bcl-2 suggests that bcl-2 and bax may be regulated by various mechanisms other than p53.
