1/3. Carotid endarterectomy complicated by vein patch rupture.saphenous vein patch angioplasty has been used to improve the results of carotid endarterectomy by decreasing the incidence of postoperative occlusion and recurrent stenosis. A rare but potentially lethal complication of this technique is aseptic necrosis and rupture of the vein patch during the postoperative period. We report three cases of this phenomenon and review an additional 13 cases from the literature. This event generally occurs without warning 2 to 7 days postoperatively and may result in death or stroke. At reoperation, the central portion of the vein patch is necrotic, without evidence of infection. Technical considerations in the harvesting and preparation of these grafts are reviewed, as are the physical parameters predisposing certain vein patches to rupture. saphenous vein harvested from the ankle has been linked to every reported case. Small diameter veins in particular appear to carry a higher risk of rupture.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/3. radiation-associated atheromatous disease of the cervical carotid artery: report of seven cases and review of the literature.The natural history of postirradiation extracranial cerebrovascular disease is uncertain. Previous reported cases spanning 20 years of carotid surgery are difficult to evaluate, because patients may sometimes have unspecified symptoms, physical examinations, postoperative results, and follow-up. Also, the evolution of carotid surgery over the past two decades makes it impossible to compare earlier operative technique with the state-of-the-art technique of today. Our series of 7 patients underwent 9 carotid endarterectomies with an average follow-up period of 46 months. The number of patients is small, and although technically this is a more difficult operation, we feel the results are favorable and may be comparable with endarteerctomy procedures in nonirradiated patients. These patients should be approached as if radiation changes are not a major factor when they are considered for reconstructive arterial surgery.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
3/3. Reversible depression in Binswanger's disease.The authors describe four elderly patients with Binswanger's disease in whom depression was prominent. Therapy with antidepressant drugs in three patients produced major improvement in psychological and physical functions. The one patient who could not be given an adequate course of antidepressant therapy because of intercurrent illness improved spontaneously after many months. The authors conclude that depression associated with Binswanger's disease is reversible despite persistence of neurological abnormalities. They speculate that this depressive syndrome is an example of organic affective disorder due to diffuse subcortical white matter ischemic lesions of the cerebral hemispheres and discuss the possible neuroanatomical basis of the depression.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |