RESUMO
We describe a 47-year-old female patient with a carotid web and ischemic stroke. A carotid web is a membrane-like shelf of tissue, predominantly affecting the intimal layer of the arterial wall, usually extending from the posterolateral wall of the carotid artery into the lumen, typically at the origin of the internal carotid artery just beyond the bifurcation. It is considered to be an under-recognized etiology of ischemic stroke in young and middle-aged patients. Typically, these patients do not show any coexistent or only few vascular risk factors. Digital subtraction angiography, computer tomography angiography, magnetic resonance angiography, and color-coded duplex sonography are able to identify carotid webs. Therapy strategies include conservative therapy with intake of antiplatelet agents and anticoagulants, or carotid endarterectomy or carotid artery stenting. Optimal therapy strategy remains open. A considerable rate of recurrent cerebrovascular ischemic events has been reported in patients with a symptomatic carotid web and conservative therapy. More data are needed on prevalence, diagnosis, prognosis and therapy of patients with an asymptomatic or a symptomatic carotid web. Subject Codes: [13] Cerebrovascular Disease/Stroke, [44] Acute Cerebral Infarction, [193] Clinical Studies.
RESUMO
PURPOSE: Kidney transplantation (KT) is the treatment of choice for end-stage chronic kidney disease (CKD) and is well known to improve the clinical outcome of patients. However, the impact of KT on comorbid psychological symptoms, particularly depression and anxiety, is less clear, and recipients of living-donor (LD) organs may have a different psychological outcome from recipients of dead-donor (DD) organs. DESIGN/METHODOLOGY/APPROACH: In total, 152 patients were included and analyzed using a cross-sectional design. Of these patients, 25 were pre-KT, 13 were post-KT with a LD transplant and 114 were post-KT with a DD transplant. The patients were tested for a variety of psychometric outcomes using the Hospital Anxiety and Depression Scale, the 12-Item Short Form Health Survey (assessing physical and mental health-related quality of life), the Resilience Scale, the Coping Self-Questionnaire and the Social Support Questionnaire. FINDINGS: The mean age of the patients was 51.25 years and 40 per cent of the patients were female. As expected, the post-KT patients had significantly better scores on the physical component of the Short Form Health Survey than the pre-KT patients, and there were no significant differences between the two post-KT groups. There were no significant differences among the groups in any of the other psychometric outcome parameters tested, including anxiety, depression and the mental component of health-related quality of life. RESEARCH LIMITATIONS/IMPLICATIONS: KT and the origin of the donor organ do not appear to have a significant impact on the psychological well-being of transplant patients with CKD. Although the diagnosis and early treatment of psychological symptoms, such as depression and anxiety, remain important for these patients, decisions regarding KT, including the mode of transplantation, should not be fundamentally influenced by concerns about psychological impairments at the population level. ORIGINALITY/VALUE: CKD is a serious condition involving profound impairment of the physical and psychological well-being of patients. KT is considered the treatment of choice for most of these patients. KT has notable advantages over dialysis with regard to the long-term physical functioning of the renal and cardiovascular system and increases the life expectancy of patients. However, the data on the improvement of psychological impairments after KT are less conclusive.