ABSTRACT
INTRODUCTION: The optimal treatment of asymptomatic carotid disease is being debated again. The conclusions of the large randomised controlled trials of the early 1980s and 1990s are increasingly being questioned due to advances in modern medical treatment. This study investigates how patients are actually managed medically related to general risk factors prior to carotid endarterectomy in a German health-care region. MATERIALS/METHODS: A prospective data bank including 95 consecutive patients was used. The effectiveness of lipid lowering and diabetes management were investigated as well as the use of anti-thrombotic and blood pressure medication. RESULTS: A total of 108 carotid endarterectomies in 95 patients were performed between January 2009 and March 2010. All 95 patients (70 male, 25 female; 39 symptomatic/56 asymptomatic) were included in the study. Nearly half (54%) of the patients were on statins; of these, 45% had low-density lipoprotein (LDL) levels >100 mg dl(-1). Of 32 patients with diabetes, one had glycohaemoglobin (HbA(1c)) <6.0. Overall, four patients were on clopidogrel. Three patients were severely hypertensive (systolic blood pressure >180 mmHg). CONCLUSIONS: The best medical therapy for carotid disease is not optimal in the part of the German health-care system observed in this study. We strongly advocate similar audits in other health-care areas and systems.
Subject(s)
Cardiovascular Agents/therapeutic use , Carotid Artery Diseases/drug therapy , Cerebrovascular Disorders/prevention & control , Outcome and Process Assessment, Health Care , Practice Patterns, Physicians' , Aged , Aged, 80 and over , Antihypertensive Agents/therapeutic use , Asymptomatic Diseases , Carotid Artery Diseases/complications , Cerebrovascular Disorders/etiology , Chi-Square Distribution , Clinical Audit , Endarterectomy, Carotid , Evidence-Based Medicine , Female , Fibrinolytic Agents/therapeutic use , Germany , Guideline Adherence , Humans , Hypoglycemic Agents/therapeutic use , Hypolipidemic Agents/therapeutic use , Male , Middle Aged , National Health Programs , Outcome and Process Assessment, Health Care/statistics & numerical data , Practice Guidelines as Topic , Practice Patterns, Physicians'/statistics & numerical data , Prospective Studies , Risk Assessment , Risk Factors , Treatment OutcomeABSTRACT
OBJECTIVE: Carotid endarterectomy (CEA) reduces stroke risk among selected patients. To achieve this, low operative risk is crucial. Outcome may depend on whether local (LA) or general (GA) anaesthesia is used. The aim of our study was to assess the risks of CEA under LA compared with that under GA. Primary endpoint was neurological outcome. DESIGN: Retrospective study, prospective data bank. PATIENTS AND METHODS: Analysis was performed of hospital charts from 1341 consecutive patients undergoing carotid endarterectomy between January 1995 and December 2004. The patients were divided into two groups according to intraoperative anaesthesia (LA 465 patients or GA 876 patients). RESULTS: Cerebral complications (transient ischemic attacks and stroke combined) were more common in the GA group (6.9% vs. 3.4%, p<0.009, relative risk 0.48, 95% confidence interval (CI) 0.272-0.839). Mortality was 0.5% (LA) vs. 0.8% (GA). Combined death and stroke rate were not different between groups (4.1% vs. 3.2%). Postoperative hypertension episodes were more common in the LA group (47.7%, vs. GA 20.4%, p <0.001). Haematomas requiring surgery were more common in the GA group (6.4% vs. 3.0%, p<0.02). CONCLUSION: CEA can be performed safely under LA. It may improve the results and lead to better neurological outcome as compared to GA. Risk factor analysis did not reveal specific risk groups.
Subject(s)
Anesthesia, General/adverse effects , Anesthesia, Local/adverse effects , Carotid Stenosis/surgery , Endarterectomy, Carotid/adverse effects , Ischemic Attack, Transient/etiology , Stroke/etiology , Aged , Carotid Stenosis/complications , Carotid Stenosis/mortality , Female , Hematoma/etiology , Humans , Hypertension/etiology , Ischemic Attack, Transient/mortality , Male , Odds Ratio , Retrospective Studies , Risk Assessment , Risk Factors , Stroke/mortality , Treatment OutcomeSubject(s)
Aortic Valve Stenosis/diagnosis , Aortic Valve Stenosis/etiology , Carotid Artery, Internal/diagnostic imaging , Carotid Artery, Internal/pathology , Carotid Stenosis/diagnosis , Carotid Stenosis/etiology , Cerebrovascular Disorders/surgery , Endarterectomy, Carotid , Humans , Magnetic Resonance Angiography , Male , Middle Aged , Postoperative Complications/diagnosis , Postoperative Complications/etiology , Radiography , Tunica Intima/diagnostic imaging , Tunica Intima/pathology , Ultrasonography, Doppler, DuplexABSTRACT
Dentin sensitivity is one of the most painful, ubiquitous, and least satisfactorily treated chronic problems of the teeth. The purpose of this clinical trial was to test the sensitivity-reducing effectiveness of five dentifrices over a six-week period. For the study, 176 adults, ages 18 to 63, exhibiting a total of 486 hypersensitive surfaces, were randomly allocated to five experimental groups to use one of the following: a strontium chloride dentifrice, a 0.4% stannous fluoride gel, a pluronic F-127-sodium citrate gel, a pluronic F-127 gel, or a control dentifrice. No specific instructions were provided as to the frequency or method of toothbrushing; thus, the participants brushed their teeth in their usual manner. The analysis of the data was limited to 168 persons who complied with study procedures. Chi-square analysis examined the statistical differences between the four test agents and the control formulation. The desensitizing effect of the pluronic plus sodium citrate gel was highly significant, and the plain pluronic F-127 preparation was effective to a lesser degree. Patients using the strontium chloride or stannous-fluoride-containing dentifrices did not exhibit a significant improvement over the control group. This study demonstrated that a pluronic polyol gel containing sodium citrate is highly effective in controlling tooth hypersensitivity.
