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Relevance of Primitive Carotidobasilar Anastomosis for Internal Carotid Artery Stenosis

100%
Udelnow A., Goertler M., Meyer F., Halloul Z.
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vol. 86
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issue 4
166-171
EN
Primitive carotido-basilar anastomoses (PCA) are persistent fetal vessels. The aim of the study was to compare the clinical characteristics of patients operated on for internal carotid artery (ICA) stenosis with or without PCA in order to evaluate the impact of PCA on the treatment. Material and methods. Consecutive patients operated on for ICA stenosis at our university hospital were included. Surgical treatment consisted in carotid endarterectomy (CEA) with patch plastic. Results. Of the 380 CEA performed between 2006 and 2012, PCA were found in six patients (1.6%). All patients with PCA were symptomatic vs. 54% of patients without PCA (p=0.035). Significantly less posterior collateral flow was present in patients with PCA (33%) compared to those without PCA (85%, p=0.01). Only two of the six patients with PCA were diagnosed prior to surgery, none was ligated intraoperatively. PCA was not associated with stroke and restenosis at long-term follow up. Conclusions. PCA are rarely diagnosed prior to surgery in patients with ICA stenosis and need not to be ligated during CEA
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In Vitro Chemo-Sensitivity Assay Guided Chemotherapy is Associated with Prolonged Overall Survival in Cancer Patients

76%
Udelnow A., Schönfelder M., Würl P., Halloul Z., Meyer F., Lippert H., Mroczkowski P.
Polish Journal of Surgery
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2013
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vol. 85
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issue 6
340-347
EN
The overall survival (OS) of patients suffering From various tumour entities was correlated with the results of in vitro-chemosensitivity assay (CSA) of the in vivo applied drugs. Material and methods. Tumour specimen (n=611) were dissected in 514 patients and incubated for primary tumour cell culture. The histocytological regression assay was performed 5 days after adding chemotherapeutic substances to the cell cultures. n=329 patients undergoing chemotherapy were included in the in vitro/in vivo associations. OS was assessed and in vitro response groups compared using survival analysis. Furthermore Cox-regression analysis was performed on OS including CSA, age, TNM classification and treatment course. Results. The growth rate of the primary was 73-96% depending on tumour entity. The in-vitro response rate varied with histology and drugs (e.g. 8-18% for methotrexate and 33-83% for epirubicine). OS was significantly prolonged for patients treated with in vitro effective drugs compared to empiric therapy (log-rank-test, p=0.0435). Cox-regression revealed that application of in vitro effective drugs, residual tumour and postoperative radiotherapy determined the death risk independently. Conclusions. When patients were treated with drugs effective in our CSA, OS was significantly prolonged compared to empiric therapy. CSA guided chemotherapy should be compared to empiric treatment by a prospective randomized trial.
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