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Background: The role of the willisian collaterals during carotid endarterectomies (CEAs) is a debated issue. The aim of the present work was to test whether an incomplete or non-functional circle of Willis (CoW) is a risk factor for ischemic events during CEA. Patients and methods: CEAs were performed under local anesthesia. Patients were considered symptomatic (SY) if neurological signs appeared after the cross-clamping phase. In SY patients shunt insertion was performed. CoW on CT angiograms (CTa) were analyzed offline and categorized as non-functional (missing or hypoplastic collaterals) or functional collaterals by three neuroradiologists. Near-infrared spectroscopy (NIRS) was performed throughout the procedure. Results: Based on CTa, 67 incomplete circles were found, 54 were asymptomatic (ASY) and 13 were SY. No complete CoW was found among the SY patients. Significant differences could be detected between incomplete and complete circles between ASY and SY groups (Chi-square: 6.08; p = 0.013). The anterior communicating artery was missing or hypoplastic in 5/13 SY cases. There were no cases of the non-functional anterior communicating arteries in the ASY group (Chi-square: 32.9; p = 10-8). A missing or non-functional bilateral posterior communicating artery was observed in 9/13 SY and in 9/81 ASY patients (Chi-square: 24.4; p = 10-7). NIRS had a sensitivity of 76.9% and a specificity of 74.5% in detecting neurological symptoms. Conclusions: Collateral ability of the CoW may be a risk factor for ischemic events during CEAs. Further studies should delineate whether the preoperative assessment of collateral capacity may be useful in decision-making about shunt use during CEA.
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BACKGROUND: Intravenous thrombolysis (IVT) improves acute ischemic stroke (AIS) outcomes, but with limited success. In addition, ethanol potentiates the effect of r-tPA in ischemia models. METHODS: The effect of acute alcohol consumption on IVT outcomes was investigated in a retrospective cohort study. AIS patients with detectable blood alcohol concentration (BAC) during IVT were included (alcohol group; n = 60). For each case, 3 control subjects who underwent IVT but denied alcohol consumption were matched in terms of age, sex, affected brain area, and stroke severity. Outcomes were determined using the NIHSS at 7 days and the modified Rankin scale (mRS) at 90 days. RESULTS: Patients were younger and had a less severe stroke than in a standard stroke study. Favorable long-term outcomes (mRS 0-2) occurred significantly more frequently in the alcohol group compared to controls (90% vs. 63%, p < 0.001). However, the rates of hemorrhagic transformation were similar. Multiple logistic regression models identified elevated BAC as a significant protective factor against unfavorable short-term (OR: 0.091, 95% CI: 0.036-0.227, p < 0.001) and long-term outcomes (OR: 0.187, 95% CI: 0.066-0.535, p = 0.002). In patients with BAC > 0.2%, significantly lower NIHSS was observed at 3 and 7 days after IVT vs. in those with 0.01-0.2% ethanol levels. CONCLUSION: Elevated BAC is associated with improved outcomes in IVT-treated AIS without affecting safety.
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Összefoglaló. Bevezetés: Veseátültetést követoen a graft és a beteg túlélésére hatással lehetnek a posztoperatív intervenciót igénylo szövodmények. Fontos szempont a mutéttechnikai eredményesség monitorozása. Többek között az irodalomban számos lehetoség ismert a veseátültetés sarokpontjának számító ureteranastomosis elkészítésére is, de az éranastomosisok technikája szintén dönto lehet. Célkituzés és módszer: Retrospektíven vizsgáltuk a 2010 és 2020 között végzett veseátültetéseket a Debreceni Egyetem Sebészeti Klinikáján. Célul tuztük ki a sebészeti szövodmények vizsgálatát, melyeket rendszereztünk, a módosított Clavien-féle beosztás alapján. A legnagyobb figyelmet az ureteranastomosisokra fordítottuk. Minden betegnél az adott kategóriában legsúlyosabb szövodményt vettük alapul a beosztáshoz. A minimális utánkövetési ido 1 év volt. Az adatokat az SPSS statisztikai program segítségével elemeztük. Eredmények: A vizsgált periódusban 406 veseátültetés történt, melybol 24,4% (n = 99) vesetranszplantáltnál alakult ki intervenciós (sebészeti, radiológiai, urológiai) szövodmény. A betegek átlagéletkora 49,5 ± 13,7 év, 60,8% férfi volt. A kumulatív mortalitás 10,1% volt. Grade 4-es szövodmény a betegek 6,9%-ánál (n = 28), Grade 3-as a 6,7%-ánál (n = 27), Grade 2-es a 3%-ánál (n = 12), Grade 1-es a 7,9%-ánál (n = 32) jelentkezett. A veseátültetés után 20,4%-ban (n = 83) alakult ki késon induló graftfunkció. Következtetés: A legenyhébb kategóriába (Grade 1.) került a legtöbb beteg, a szövodmények jelentos része sebészi, intervenciós radiológiai és urológiai közremuködéssel megoldható volt. Az ureteranastomosisok mutéti technikája és a releváns szövodmények kialakulása között nincs szignifikáns összefüggés. Megfelelo és idoben alkalmazott korrekciós kezelés mellett a graft- és betegtúlélést nem rontja szignifikánsan az enyhe és középsúlyos (Grade 1-3.) szövodmények kialakulása. Orv Hetil. 2021; 162(26): 1038-1051. INTRODUCTION: Complications associated with postoperative intervention may affect graft and patient survival after kidney transplantation. Monitoring the effectiveness of surgery is an important aspect. Ureter anastomosis can be the pivot of kidney transplant, the same as vascular anastomosis, so efficiency of the surgical technique is important to follow up. OBJECTIVE AND METHOD: We retrospectively examined kidney transplants performed between 2010 and 2020 at the Department of Surgery of the University of Debrecen. Data were analyzed by the SPSS statistical program. We aimed to investigate surgical complications, which were systematized based on the modified Clavien classification. In one patient, the most severe complication was used as the basis for the schedule. The minimum follow-up time was 1 year. RESULTS: 406 kidney transplants were performed in the examined period, of which 24.4% (n = 99) developed renal transplant complications (surgical, radiological, urological). The mean age of the patients was 49.5 ± 13.7 years, and 60.8% were male. The cumulative mortality was 10.1%. Grade 4 complication developed in 6.9% (n = 28) of the recipients, Grade 3 in 6.7% (n = 27), Grade 2 in 3% (n = 12), and Grade 1 in 7.9% (n = 32). 20.4% of the recipients had delayed graft function. CONCLUSION: The Grade 1 group had the biggest case number, so a significant part of the complications could be solved with the help of interventional radiology and urologists. There is no significant association between the surgical technique of ureteral anastomoses and the development of related complications. With appropriate therapy, graft and patient survival are not significantly impaired by the development of Grade 1-3 complications. Orv Hetil. 2021; 162(26): 1038-1051.