The improvement of cognition and personality after carotid endarterectomy.

Seventeen patients with at least 50% carotid artery stenosis were given intelligence and personality tests just prior to and 6 weeks after carotid endarterectomy. When compared with nine control patients, the endarterectomy patients showed increases in verbal-comprehension I.Q., perceptual-organization I.Q., decreases in time to complete perceptual motor tasks, decrease in asphasic signs, and significant reductions in anxiety, suspicion, confusion, disorientation, and other personality symptoms generally associated with senility. Statistical evaluation showed these results to be valid.

Carotid endarterectomy: review of 276 cases in a community hospital.

Two hundred seventy-six carotid endarterectomies performed on 232 patients in a community hospital were reviewed. All the surgery was performed in a routine manner utilizing systemic heparinization and an indwelling shunt. There were three deaths in this series, giving a mortality of 1.08%. A transient neurological deficit occurred in seven patients. All of these cleared within a 7-day period; this represents 2.5%. Only one patient had a permanent deficit. Long-term followup from 6 months to 9 years showed that the majority of deaths occurred from myocardial disease and malignancies. Only eight patients later died from stroke.

The three wheeler (adult tricycle): an unstable, dangerous machine.

Three-wheel motor vehicular accidents are a common occurrence, yet we found little publicity or published research dedicated to exposing the dangers of this popular recreational vehicle, and manufacturers have released few warnings. In a 3-year period, 125 patients were seen in the emergency department in one east Alabama referral area, a far higher rate of accidents than caused by other similar types of vehicles. The most common mechanism of these accidents was rollover of the machine; fractures were the most frequent injury suffered. The very young are common victims. Accident prevention must begin with education of both parents and children about the potential dangers of three-wheelers--they are, indeed, dangerous, unstable machines.

Chain saw injuries: review of 330 cases.

Three hundred thirty chain saw injury patients arriving at the emergency clinic of a community hospital in the southeast United States between 1972 and 1979 were reviewed. Forty-eight patients were admitted to the hospital with severe injuries requiring extensive repair; another was dead on arrival at the emergency clinic. The retrospective study reveals a typical pattern in chain saw injuries as injuries caused by other power tools have typical patterns: the majority of the injuries occur on the left side. Most injuries are caused by saw kickback, upward or downward; the face (not usually eyes), neck, hands and feet are most frequently injured. The findings suggest that many of these extensive, expensive injuries can be prevented by proper equipment and training, and by operator compliance with safety procedures. An automatic motor brake is now being installed on many saws, and laws are being prepared to make its use mandatory.

Breast necrosis complicating anticoagulation therapy.

Two patients had breast necrosis after sodium warfarin (Coumadin) therapy. This well recognized, but rare, complication of anticoagulation therapy also occurs in other areas of the body. The cause is not known. We present these cases and discuss the literature.

Endoscopic evaluation of 125 cases of upper gastrointestinal bleeding.

The fiberoptic panendoscope has been shown to be superior to the UGI series in diagnosing the site(s) of upper gastrointestinal bleeding (UGIB). Recent data has shown that gastritis has replaced peptic ulcer disease (PUD) as the leading cause of UGIB since the diagnosis can now be made with the endoscope. Our clinical experience differs from this. One hundred twenty five cases of UGIB from December 1975 to December 1978 were reviewed. The patients ranged in age from 11 to 91 years. There were 83 males and 42 females included in the study. Twenty-four per cent of the patients were actively bleeding at the time of endoscopic examination, and 62% received two or more units of blood. Endoscopic examination was technically successful in all patients, and there were no deaths or complications. One hundred twenty three lesions were found in 117 patients for a diagnostic accuracy of 93.9%. In eight patients, no bleeding site was found, resulting in a failure rate of 6.1%. PUD accounted for 74.9% of the bleeding sites, while gastritis accounted for only 0.8%. Mallory-Weiss tears of the esophagus accounted for 9.8% and esophageal varices for 4.9%. Thirty-five per cent of the patients had associated lesions, with gastritis and esophagitis being the most common. Eighteen patients (14.4%) required surgical intervention. Seventeen patients had PUD. There was one death, for a mortality rate of 5.5%. The medical mortality rate was 0.9%. The benefits of endoscopy in UGIB are still controversial. An important subgroup of patients with the "visible vessel" in the ulcer bed has been identified recently by others. If not bleeding at the time of endoscopy, 70% will rebleed. It is our opinion that it is important to identify this patient, as well as to know if one is treating gastritis, PUD, or varices. Finally, electrocoagulation of bleeding points, as well as the development of the laser and application of adhesives or clotting agents through the endoscope, will change the management of UGIB.

Intellectual and personality changes associated with carotid endarterectomy.

Eleven patients with at least 40-50% carotid artery stenosis were given intelligence and personality tests just prior to and 6 weeks after carotid endarterectomy, a surgical procedure designed to remove arteriosclerotic blockage. When compared with 8 control patients, endarterectomy patients showed increases in Perceptual-Organization IQ, decreases in time to complete a perceptual motor task, and significant reductions in suspicion, confusion, disorientation, and other personality symptoms generally associated with senility.