BACKGROUND: Acute symptomatic occlusion of extracranial internal carotid artery (eICA) can lead to a critical and potentially devastating stroke associated with high morbidity and mortality. Optimal treatment remains unclear. We analyzed our institutional experience with emergent surgical recanalization of acutely occluded eICA. METHODS: Retrospective analysis of hospital records, surgical reports, imaging studies and outpatient records. Final outcome was assessed according to modified Rankin Scale (mRS). RESULTS: Between January 2010 and September 2013, 22 patients underwent emergent surgical recanalization. There were 17 men and five women, mean age 65.4 years (range 37-85). Mean admission National Institute of Health Stroke Scale (NIHSS) was 12 (range 6-21). All patients had evidence of salvageable penumbra on perfusion computed tomography. Tandem intracranial lesion was present in nine patients. Surgical recanalization was successful in 16 patients (72.7 %). Twenty-four hours after surgery, 17 patients (77.2 %) improved by a minimum of 1 point on NIHSS, 14 patients (63.6 %) improved by three and more points; two patients deteriorated by two and five points, the latter treated initially with systemic thrombolysis due to intracranial hemorrhage. No other intracranial hematoma was observed. During 30 days following surgery, two patients died (9 % mortality rate) due to severity of initial stroke. On discharge, four patients were classified as mRS 0, five patients as mRS 1, five patients as mRS 2 and six patients as mRS 4. Favorable recovery (mRS 0-2) was achieved in 14 patients (63.6 %). No change in mRS was observed at three months. CONCLUSIONS: Our results suggest that emergent surgical desobliteration of occluded eICA can lead to favorable recovery in a majority of patients. Patient selection based on penumbra imaging is crucial. Given the popularity and simplicity of carotid endarterectomy, the procedure should by no means be abandoned in the treatment of acute eICA occlusion.
- MeSH
- arteria carotis interna radiografie chirurgie MeSH
- arteriální okluzní nemoci mortalita radiografie chirurgie MeSH
- dospělí MeSH
- hodnocení výsledků zdravotní péče * MeSH
- karotická endarterektomie metody MeSH
- lidé středního věku MeSH
- lidé MeSH
- nemoci arterie carotis mortalita radiografie chirurgie MeSH
- retrospektivní studie MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- duplikátní publikace MeSH
BACKGROUND: Ischemia reperfusion injury (IRI) is a serious problem of transplanted kidneys from a non-heart-beating donor (NHBD). IRI is probably the main cause of primary disfunction or delayed graft function. The aim of this study was to demonstrate the reduction of IRI by intravenous application of antioxidants or immunosuppressives to the recipient before the kidney transplantation in an experimental model. METHOD: Piglets weighing between 20-25 kg were used (n=45) for the experiment. Intravenous application of multivitamins (GI) and a combination of immunosuppressives (GII) was tested one hour before the kidney transplantation from the NHBD. In control group (GIII) simple NHBD modelling was used. Plasma levels of malondiadehyde (MDA) and reduced glutathione (GSH) were assessed at intervals of 0, 20, 60 and 120 minutes after the kidney transplantation. Concentrations of both MDA and GSH were also assessed in the transplanted kidney before and 120 minutes after transplantation. RESULTS: A permanent increase in MDA plasma concentrations occurred in GIII. In GI and GII, after a transient increase in MDA plasma levels within the first 20 minutes after reperfusion, it decreased permanently (p<0.05, p<0.01). MDA plasma levels were not significantly different between GI and GII groups, but both groups differed from GIII (p<0.001). GSH plasma levels and tissue concentrations of MDA and GSH were not statistically significant in any group in the course of the experiment. CONCLUSION: Intravenous application of multivitamins or immunosuppressives before kidney transplantation could have a significant influence on the immediate function of transplanted kidneys from a NHBD (Tab. 3, Fig. 1, Ref. 13). Full Text (Free, PDF) www.bmj.sk.
- MeSH
- antiflogistika aplikace a dávkování MeSH
- antioxidancia aplikace a dávkování MeSH
- glutathion krev MeSH
- hydrokortison aplikace a dávkování MeSH
- imunosupresiva aplikace a dávkování MeSH
- intravenózní infuze MeSH
- kyselina mykofenolová analogy a deriváty aplikace a dávkování MeSH
- malondialdehyd krev MeSH
- reperfuzní poškození prevence a kontrola MeSH
- Sus scrofa MeSH
- transplantace ledvin MeSH
- vitaminy aplikace a dávkování MeSH
- zvířata MeSH
- Check Tag
- mužské pohlaví MeSH
- zvířata MeSH
- Publikační typ
- duplikátní publikace MeSH
- práce podpořená grantem MeSH
Over the past few years, the ENT clinic in Motol has noticed an alarming increase in the number of cases of severe upper GIT injury in children, in the majority of cases caused by accidental ingestion of corrosives. Suicidal and homicidal cases in the paediatric population are rare. The following case study describes an interesting episode involving ingestion of granules of the lye NaOH in 13 children of school age. We furthermore stress the importance of early endoscopic investigation in every patient with possible corrosive injury of the oesophagus. We include a brief description of the diagnostico-therapeutic algorithm applied to each such patient that was developed through interdepartmental research in Motol Faculty Hospital.
- MeSH
- chemické popálení diagnóza etiologie MeSH
- dítě MeSH
- ezofagitida chemicky indukované MeSH
- ezofágoskopie metody MeSH
- ezofágus zranění MeSH
- hydroxid sodný škodlivé účinky MeSH
- kaustika škodlivé účinky MeSH
- lidé MeSH
- následné studie MeSH
- ústa zranění MeSH
- výsledek terapie MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- duplikátní publikace MeSH
