Comparison of two surgical techniques for carotid endarterectomy: conventional and eversion.

BACKGROUND: The role of carotid endarterectomy for the treatment of atherosclerotic carotid bifurcation disease is now well established. The aim of this study was to compare durability, postoperative death, stroke, minor strokes, cranial nerve injuries, neck hematomas, myocardial infarctions, or surgical defects and restenosis at the operative site following short- and mid-term duration of the advantages eversion carotid endarterectomy (E-CEA) compared to conventional carotid endarterectomy (C-CEA). PATIENTS AND METHODS: Between March 2003 and November 2012, primary CEAs were performed in 380 consecutive patients by the same surgical groups. These patients were evaluated retrospectively. C-CEA was performed in 202 patients, and E-CEA was performed in 178 patients. Carotid duplex ultrasonography was performed in all patients at 1, 6, 12 and 24 months after CEA to identify residual atherosclerotic carotid disease. RESULTS: Mean age was 67.3±13.4 years in the E-CEA group and 64.8±14.8 years in the C-CEA group. Mean cross-clamping time in the E-CEA group was 9.54±2.6 minutes and 12.62±2.7 minutes for C-CEA group (P=0.236). Three postoperative strokes occurred (one after E-CEA and two after C-CEA). In the E-CEA group and C-CEA group respectively, carotid stenosis rates were found in 4 patients (2.24%) and in 5 (2.97%) at a follow-up period of 26 months. CONCLUSION: Classical endarterectomy still remains the gold standard surgical technique for patients who are selected for coronary artery disease surgery. Nevertheless, we believe that eversion endarterectomy, which has some advantages, must be kept in mind as an alternative approach.

Protection of the spinal cord from ischemia: comparative effects of levosimendan and iloprost.

BACKGROUND: The purpose of the study was to investigate and compare iloprost and levosimendan on spinal cord ischemia in an experimental model. MATERIALS AND METHODS: The study was done in two stages. For the 4-hour short survival study, 50 New Zealand white rabbits were randomly allocated into five groups. Spinal cord ischemia was induced by clamping the aorta just below the left renal artery and just proximal to the aortic bifurcation with bulldog artery clamps. The aortic clamps were removed after 40 min and restoration of blood flow was verified visually. The groups were analyzed at 1 and 4 h after reperfusion. For the 48-hour survival study, two different groups (iloprost plus levosimendan, n = 10; saline-treated controls, n = 10) were analyzed at 24 and 48 h after reperfusion. RESULTS: The neurologic status of the animals in the treatment and sham groups was better than that in the control group both at 1 and 4 h after reperfusion. Viability index values in the levosimendan, iloprost and iloprost plus levosimendan groups were statistically higher than in the control group indicating less or no neuronal damage. DISCUSSION: The results suggest that levosimendan, as well as iloprost, may reduce ischemic damage in transient spinal ischemia and provide better neurologic outcome.

A novel approach: ascending venous arterialization for atherosclerosis obliterans.

OBJECTIVE: Lower limb arterial occlusion with no patent distal artery suitable for revascularisation is a common problem. The aim of this study was to assess the role of revascularisation to distal veins (ascending venous arterialization) in patients not reconstructable by conventional bypass. METHOD: Ascending venous arterialization is a distal arteriovenous fistula. Reversed great saphenous vein grafts, from above the knee, were anastomosed to the common femoral artery, superficial femoral artery or popliteal artery and distally to the saphenous vein at the level of medial malleolus. No intervention was done to destroy the venous valves. The great saphenous vein was ligated below the knee. In this way, oxygenated blood could reach to dorsal venous arch and the tissues below the knee in an ascending fashion through the great saphenous vein, which was not removed. RESULTS: All of the patients recovered immediately after the operation. The lesions on the feet and on the toes of the patients improved in a short time. Intermittent claudication of the patients disappeared. Strong pulses were detected on the dorsal venous arch with manual Doppler in 3 weeks. The below knee tissues were perfused with the applied technique. CONCLUSION: Ascending venous arterialization can be applied for limb salvage to the patients who do not have a suitable arterial bed to revascularize with conventional techniques.

Effect of postnecrotic and alcoholic hepatic cirrhosis on development of benign prostatic hyperplasia.

BACKGROUND: The object of this study was to investigate the effects of hepatic cirrhosis on the development of benign prostatic hyperplasia and consequent effects on prostatic volume, serum prostate-specific antigen (PSA), and prostatism symptoms. METHODS: Sixty patients with postnecrotic cirrhosis and alcoholic cirrhosis at age 40 and over, and 20 voluntary subjects in the same age group with normal hepatic functions, were evaluated with prostatic volume calculation by transrectal ultrasound, symptom scoring according to American Urology Association (AUA) criteria, measurement of serum prostate-specific antigen (PSA), serum total testosterone (TT), free testosterone (FT), estradiol (E2), and calculation of E2/FT ratios, and the results were analyzed statistically by the Mann-Whitney U-test. RESULTS: Serum FT and TT levels were significantly lower in the hepatic cirrhosis group compared to the control group (P = 0.0000 and P = 0000, respectively). Though mean serum E2 level was a little higher in cirrhotic patients compared to controls, the difference was not significant; however, the higher E2/FT ratio in the cirrhotic group was statistically significant (P = 0.27 and P = 0.0002, respectively). In the cirrhotic group, the decrease in FT and TT levels was greater, as the disease advanced. While E2 and E2/FT ratio increase, correlate with poor prognosis, no statistically significant differences were found. Mean prostatic volume, serum PSA level, and total symptom score were significantly higher in the control group, compared to the cirrhotic group (P = 0.0001, P = 0.0006, and P = 0.002, respectively). Prostatic volume decreased parallel to severity of disease in cirrhotic patients. CONCLUSIONS: The main reason for the decrease in mean prostatic volume in cirrhotic patients compared to subjects in the same age group with normal hepatic functions was the decrease in serum FT and TT levels, and the secondary cause was the increase in E2/FT ratio, indicating estrogenic predominance.