Carotid artery disease in octogenarians: endarterectomy or stenting?

AIM: Carotid endarterectomy (CEA) is the gold standard for the treatment of carotid stenosis, but carotid angioplasty and stenting (CAS) has emerged as a potential less invasive therapeutic alternative to patients who would otherwise be considered as high risk for open surgery. The aim of this review was to pool the most current studies of the growing body of literature in which outcomes of CEA or CAS are compared in octogenarians and non-octogenarians to determine the current safety and efficacy of these therapeutic procedures, due to a lack of randomized controlled trials. METHODS: An electronic search of Medline, PubMed and Cochrane databases was supplemented by a review of bibliographies of relevant articles, as well as manual searches of relevant journals. Outcomes included 30-day stroke rate, death rate, combined stroke/death rate and myocardial infarction rate between octogenarians and non-octogenarians. RESULTS: Randomized clinical trials or studies comparing CEA and CAS in the same study population were not identified. CEA and CAS outcomes, in octogenarians compared to younger cohorts, were evaluated in 10 and 5 studies, respectively. Analysis of data indicates no significant difference in adverse events reported in the two groups in the majority of studies of CEA, as opposed to the findings of CAS studies. CONCLUSION: The current review supports the viewpoint that CEA remains the standard of care in octogenarians, towards which other procedures to prevent stroke should be compared. It also challenges the definition of the ''high-risk''/age blanket classification and suggests that until the longevity, safety and efficacy of CAS is established, wide applicability of CAS to such ''high-risk'' patients should be questioned and limited to ongoing controlled clinical trials.

Clinical, radiological and histological correlation in the diagnostic work-up of cemento-ossifying fibroma of the maxilla: case report.

Cemento-ossifying fibroma is a relatively rare tumor classified between fibro-osseous lesions. This lesion appears within the bone although in some occasions it involves the gingivae soft tissues. It is a slow growing and well-defined tumorous lesion, because of this, it is considered as a benign lesion. We report a case of a young female presenting a mass in the right cheek. The evolution of the process was 4 years. She was treated with surgical resection via a Weber-Fergusson approach. The histology was that of a benign fibro-osseous proliferation composed of bony spicules and spherules admixed with a fibrous stroma. Clinical and radiological information was essential for the final diagnosis. The histologic findings alone may be similar to other pathologies such as osteoblastoma, low-grade osteosarcoma and particularly to fibrous dysplasia. An accurate diagnosis requires careful clinical, radiological and histological correlation in order to make an optimal treatment and an excellent outcome.

Branchial cysts. A report of 4 cases.

OBJECTIVE: Cysts presented in the lateral aspect of the neck are relatively uncommon anomalies. Many theories have been proposed to explain the aetiology of these cysts, grouped in two main categories: the congenital and the cervical lymph nodes cystic transformation hypotheses. SETTINGS: In this paper we present 4 patient-cases documented in the department of Maxillofacial Surgery, and try to trace the profile of these lesions and investigate their origin. RESULTS: All lesions were well circumscribed by Computed Tomography, and prior to surgery they were assessed by means of fine needle aspiration cytology. Neutrophils, debris and mature squamous epithelial cells including degenerate forms, were the key-features in the cytological diagnosis. Histologic examination of the excised surgical specimen established the diagnosis in all cases. CONCLUSIONS: Our findings, compatible with the congenital theory lead us to the conclusion that the branchial cysts are the result of imperfect obliteration of the branchial clefts, arches, and pouches.