Search results

1

Influence of Internal Carotid Endarterectomy on Patients' Life Quality

100%

Kaźmierski P., Kasielska A., Bogusiak K., Łysakowski M., Stelągowski M.

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EN

Appropriate treatment of symptomatic carotid artery stenosis can reduce ischemic cerebral strokes' risk and in some cases eliminate neurological symptoms. Endarterectomy is the most common surgical treatment.The aim of the study was to examine the influence of carotid endarterectomy on neurological symptoms and patients' life quality.Material and methods. The material comprised of 102 patients who underwent endarterectomy. All of the patients were given a questionnaire with a list of neurological symptoms (vertigos, headaches, left hemiparesis, right hemiparesis, numbness, acroparaesthesia, single syncope, recurrent syncopies, diplopia, tinnitus, concentration disturbances and aphasia) and with a numerical life quality scale to fill in before and a year after the surgery.Results. Vertigo, headache, single and recurrent syncopies and aphasia as well as cerebral stroke and amaurosis fugax were significantly more rarely observed after endarterectomy. The mean value of patients' life quality evaluated on a 10-point Likert scale after the surgery increased (3.9 vs 6.3).Conclusions. A year after carotid endarterectomy patients' life quality improves which is connected with neurological symptoms' regression and no further symptoms' occurrence due to a preventive role of the surgery.

2

Obturacyjny bezdech podczas snu u pacjentów zakwalifikowanych do endarterektomii tętnic szyjnych – badanie wstępne

88%

Migacz E., Proczka R., Krzeski A., Kukwa W.

Otolaryngologia Polska

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2018

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vol. 72(4)

17-20

PL

Wstęp: Związek między obturacyjnym bezdechem podczas snu (OBPS) a miażdżycą jest potwierdzony od wielu lat, choć patomechanizm tego zjawiska nadal nie jest poznany. Celem badania było określenie częstości OBPS u pacjentów zakwalifikowanych do endarterektomii oraz określenie wpływu tej procedury na parametry badania snu i występowanie senności dziennej. Materiał i metody: Do badania włączono 46 pacjentów zakwalifikowanych do endarterektomii otwartej. Przed zabiegiem wykonano badanie snu i zastosowano skalę senności Epworth. U 11 z 46 osób przeprowadzono badania snu także po operacji. Wyniki: Średnia wieku w grupie badanej wyniosła 69,9 lat (± SD = 8,6), 21 pacjentów (45,7%) stanowiły kobiety. Średnia wartość pAHI, ODI, pRDI i procent czasu chrapania wyniosły odpowiednio 16.2 (± SD=15.2), 10.4 (± SD=12.2), 18.9 (± SD=14.9) oraz 9,9 (± SD=17). Prawidłowe wartości pAHI uzyskało 14 pacjentów (30%), podczas gdy łagodny OBPS (pAHI 5–15) zaobserwowano u 13 pacjentów (38%), umiarkowany OBPS (pAHI 15–30) u 11 pacjentów (24%), a ciężki OBPS (pAHI >30) u pacjentów 8 (18%). Średnia wartość skali senności Epworth u 27 z 46 pacjentów wyniosła 6,3 (± SD = 5,6). Pooperacyjne wartości parametrów badania snu u 11 pacjentów nie zmieniły się statystycznie znamiennie. Wnioski: Badanie wykazało występowanie OBPS w stopniu umiarkowanym i ciężkim u 42% pacjentów zakwalifikowanych do endarterektomii, natomiast nie stwierdzono nadmiernej senności w tej grupie. Pokazuje to, że u pacjentów kwalifikowanych do endarterektomii tętnic szyjnych należy wykonać diagnostykę snu w celu wykluczenia OBPS.

3

Clinical Evaluation of Near-Infrared Cerebral Oximetry in the Awake-Patient Carotid Endarterectomy

88%

Wojciechowski J., Sidorowicz M., Szyndler K., Znaniecki Ł., Trenkner M., Halena G., Brzeziński M., Rogowski J.

Polish Journal of Surgery

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2007

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vol. 79

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issue 8

519-525

EN

The aim of the study was to evaluate the usefulness of continuous monitoring of regional cerebral oxygen saturation (rSO2) for detection of brain ischemia during carotid endarterectomy.Material and methods. We performed 44 carotid endarterectomies using regional anesthesia, with simultaneous regional cerebral oxygen saturation monitoring in both hemispheres of the brain.Results. Oxygen saturation in the hemisphere ipsilateral to the operated carotid artery dropped from 65.1±8.1 to 58.2±10.7 after carotid artery cross-clamping. The difference was statistically significant (p<0.005). Oxygen saturation in the hemisphere contralateral to the operated artery did not demonstrate a difference between that before or after carotid artery closure (65.7±9.2 and 66.1±10.2, respectively, p=0.1). In five patients (11.4%) carotid artery clamping was associated with the appearance of neurological deficits. Shunt usage was necessary in four cases; the rSO2 decreased by 19.2±14% in this group. In the group without neurological deficit during carotid clamping, the rSO2 decreased by 9.7±10.3% (the difference between groups with and without neurological deficit was not statistically significant, p=0.5). In patients with a rSO2 drop above 20%, the sensitivity of the cerebral oximetry was 20% and specificity 97.5%, while the negative predictive value was 90.7%.Conclusions. Continuous cerebral oximetry is a simple and non-invasive method of patient monitoring during carotid endarterectomy. The rSO2 decreases significantly after the ICA clamping. The sensitivity of cerebral oximetry in prediction of neurological deficit during the procedure is low. Defining the threshold value of rSO2 decrease after ICA clamping as an indication for shunt was not possible with the results of this study.

4

Obturacyjny bezdech podczas snu u pacjentów zakwalifikowanych do endarterektomii tętnic szyjnych – badanie wstępne

88%

Migacz E., Proczka R., Krzeski A., Kukwa W.

Polish Journal of Otolaryngology

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2018

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vol. 72

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issue 4

17-20

PL

Wstęp: Związek między obturacyjnym bezdechem podczas snu (OBPS) a miażdżycą jest potwierdzony od wielu lat, choć patomechanizm tego zjawiska nadal nie jest poznany. Celem badania było określenie częstości OBPS u pacjentów zakwalifikowanych do endarterektomii oraz określenie wpływu tej procedury na parametry badania snu i występowanie senności dziennej. Materiał i metody: Do badania włączono 46 pacjentów zakwalifikowanych do endarterektomii otwartej. Przed zabiegiem wykonano badanie snu i zastosowano skalę senności Epworth. U 11 z 46 osób przeprowadzono badania snu także po operacji. Wyniki: Średnia wieku w grupie badanej wyniosła 69,9 lat (± SD = 8,6), 21 pacjentów (45,7%) stanowiły kobiety. Średnia wartość pAHI, ODI, pRDI i procent czasu chrapania wyniosły odpowiednio 16.2 (± SD=15.2), 10.4 (± SD=12.2), 18.9 (± SD=14.9) oraz 9,9 (± SD=17). Prawidłowe wartości pAHI uzyskało 14 pacjentów (30%), podczas gdy łagodny OBPS (pAHI 5–15) zaobserwowano u 13 pacjentów (38%), umiarkowany OBPS (pAHI 15–30) u 11 pacjentów (24%), a ciężki OBPS (pAHI >30) u pacjentów 8 (18%). Średnia wartość skali senności Epworth u 27 z 46 pacjentów wyniosła 6,3 (± SD = 5,6). Pooperacyjne wartości parametrów badania snu u 11 pacjentów nie zmieniły się statystycznie znamiennie. Wnioski: Badanie wykazało występowanie OBPS w stopniu umiarkowanym i ciężkim u 42% pacjentów zakwalifikowanych do endarterektomii, natomiast nie stwierdzono nadmiernej senności w tej grupie. Pokazuje to, że u pacjentów kwalifikowanych do endarterektomii tętnic szyjnych należy wykonać diagnostykę snu w celu wykluczenia OBPS.

5

NEUROMARKERS OF ANXIETY IN A PATIENT WHO HAD EXPERIENCED A TRANSIENT ISCHEMIC ATTACK (TIA) OF THE LEFT BRAIN HEMISPHERE AS A RESULT OF A CRITICAL STENOSIS OF THE INTERNAL CAROTID ARTERY (ICA) PERATED ON BY ENDARTERECTOMY (CEA)

88%

Wilczek-Rużyczka E., Mirski A., Korab M., Trystuła M.

Acta Neuropsychologica

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2021

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vol. 19(1)

1-9

EN

The search for neuromarkers is a very promising way to improve psychiatric and psychological care. They are now considered to be an innovative diagnostic tool in psychiatry and neuropsychology, but more broadly in all human health sciences. The aim of our study was to find the neuromarker of anxiety in a patient who had experienced a Transient IschemicAttack (TIA) of the left brain hemisphere as a result of a critical stenosis of the Internal Carotid Artery (ICA) operated on byendarterectomy (CEA). We will present the case of a 54-year-old man,an architect, who experienced a Transient Ischemic Attack (TIA) of the left brain hemispherecaused by a critical stenosis of theInternal Carotid Artery (ICA) and was treated successfully with surgical endarterectomy (CEA). One year after the surgery itself, the patient developed severe postoperative anxiety, headaches, difficulty in sleepingas well as the inability to continue working in his profession. Strong anxiety was notedon the adapted 100-millimeter Visual Analogue Anxiety Scale (VAAS). The patient was assessed using the Human Brain Index (HBI) methodology (Kropotov 2009; 2016; 2017; Pąchalska, Kaczmarek&Kropotov 2014) which consisted of recording 19-channel EEG in resting state conditions, during the cued GO/NOGO task and comparing the parameters of EEG spectra and Event-Related Potentials (ERPs) with the normative and patient databases of the Human Brain Index(HBI). No signs of cognitive dysfunction was found, however an excessive Rolandic beta was observed. In line with the working hypothesis as to the presence of an anxiety neuromarker, the patient’s studies confirmed an increased P1 time wave in the left hemisphere of the brain in ERP in response to visual stimuli, i.e. an anxiety neuromarker. Following the detection of this neuromarkera specific anodic Transcranial Direct Current Stimulations (tDCS) pro- tocol was proposed (see: Kropotov 2016; Pąchalska, Kaczmarek & Kropotov 2020). Ten tDCS sessions were performed and the postoperativeanxiety was found to be resolved. The patient returned to work. The use of Human Brain Index (HBI) methodologyenabling the isolation of the Event Related Potentials (ERPs) patterns revealed the presence of a distinct anxietyneuromarker. Neurotherapy with the use of tDCS allowed the reduction of anxiety symptoms and the patient’s return to work. The above case study indicates the necessity to use new neurotechnologies in the diagnosis of mental diseases, with particular emphasis on postoperative anxiety. ------------------------------------------------------------------------------------------------------------------------------------

6

Influence of Atheromatous Lesions in the Ilio-Femoral Segment on the Occurrence of Stentgraft Thrombosis After Endovascular Treatment of an Abdominal Aortic Aneurysm

63%

Solonynko B., Gałązka Z., Jakimowicz T., Szmidt J.

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EN

Limb graft thrombosis (LGT) is one of the most frequent severe complications after endovascular repair of abdominal aortic aneurysms. The aim of the study was to assess the influence of atherosclerosis in ileo-femoral segment on the incidence of LGT as well as to analyze the methods of treatment of LGT. Material and methods. The medical records of 564 consecutive patients operated endovascularly for abdominal aortic aneurysm by means of bifurcated stentgrafts in the Department of General, Vascular and Transplantat Surgery of Medical University of Warsaw were analyzed. The minimal observation time after surgery was one year. Patients with inflammatory, ruptured and falls aneurysms as well as those with the observation period below 12 months were excluded from the study. Patients were divided into two groups: test (B) and control (K) depending on the progression of atherosclerosis in the iliac arteries. Group B included 184 patients (13 women and 171 men), with advanced atherosclerotic lesions of ilio-femoral segment, corresponding to the A - C class in the TASC classification. The remaining 380 patients (25 women and 355 men) without significant blood flow disorders in the iliac arteries, constituted the group K. The computed tomography was done in all patients with acute limb ischemia. Results. During the observation time up to 114 month, the LGT occurred in 43 (7.6%) cases: [group B - 34/184 (18.5%), group K - 9/380 (2.4%)]. The treatment of LGT included an attempt of patency restoring of the prosthesis by means of thrombolysis or thrombectomy combined with stenting. In case of failure the cross-over femoro-femoral bypass was implanted. Thrombectomy was successful in 21 of 40 cases (52.5%), the local thrombolysis was done in 5 patients and it was successful in three cases and in the remaining two patients the thrombectomy was done. In 16 of 24 patients after patency restoring of the prosthesis the angioplastics and stenting was done. In 17 cases the femoro-femoral bypass was implanted. Conclusions. The atherosclerosis in ileo-femoral segment significantly increases the risk of LGT. An attempt of patency restoring (thrombectomia or thrombolysis) combined with stenting and cross-over femoro- femoral bypass implantation in case of failure seems to be the successful method of LGT treatment.

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Influence of Internal Carotid Endarterectomy on Patients' Life Quality

Obturacyjny bezdech podczas snu u pacjentów zakwalifikowanych do endarterektomii tętnic szyjnych – badanie wstępne

Clinical Evaluation of Near-Infrared Cerebral Oximetry in the Awake-Patient Carotid Endarterectomy

Obturacyjny bezdech podczas snu u pacjentów zakwalifikowanych do endarterektomii tętnic szyjnych – badanie wstępne

NEUROMARKERS OF ANXIETY IN A PATIENT WHO HAD EXPERIENCED A TRANSIENT ISCHEMIC ATTACK (TIA) OF THE LEFT BRAIN HEMISPHERE AS A RESULT OF A CRITICAL STENOSIS OF THE INTERNAL CAROTID ARTERY (ICA) PERATED ON BY ENDARTERECTOMY (CEA)

Influence of Atheromatous Lesions in the Ilio-Femoral Segment on the Occurrence of Stentgraft Thrombosis After Endovascular Treatment of an Abdominal Aortic Aneurysm