Intraoperative duplex scanning for carotid endarterectomy.

OBJECTIVES: To evaluate the results of intraoperative duplex scans during carotid endarterectomy. DESIGN: Retrospective case review. MATERIALS: One-hundred consecutive intraoperative carotid duplex scans performed during carotid endarterectomy between July 1993 and December 1995 at a university teaching hospital. METHODS: Abnormalities of the B-mode image and/or the Doppler flow analysis were classified. The result of intraoperative carotid duplex scans (ICDS) were related to the events of the intraoperative course, perioperative neurologic morbidity and mortality, and to residual carotid stenosis. RESULTS: Abnormalities of the ICDS were demonstrated in 13 cases (13%). Abnormalities were classified into four types: I, internal carotid artery spasm (n = 9); II, high distal resistance flow (n = 2); III, high grade residual stenosis (n = 1); IV, intraluminal thrombosis (n = 1). Immediate intraoperative exploration and revision of the endarterectomy was performed based on the ICDS in two cases (type III and IV) and the findings of ICDS were confirmed. The other 11 cases with abnormal ICDS (types I, II) were not revised and duplex scans done 1 month postoperatively (available in 10 cases) showed normal carotid artery flow. Intraoperative angiography was performed selectively in five cases and confirmed the results of ICDS. Reversible abnormalities of the ICDS were not associated wit perioperative morbidity or residual carotid stenosis. CONCLUSIONS: Intraoperative carotid duplex scanning can be used to assess the immediate technical adequacy of carotid endarterectomy. B-mode image and Doppler flow abnormalities which are reversible can be distinguished from those which require immediate revision.

[Effect of ranitidine on blood alcohol and glucose levels after ingestion of alcohol]. / Effet de la ranitidine sur l'alcoolémie et la glycémie après ingestion d'alcool.

Are alcohol and glucose blood levels modified in fasting subjects taking ranitidine? This experience tries to simulate normal life conditions. Nine men, volunteer, aged from 24 to 29 years old, without any digestive symptoms, ate a standard lunch after five hours of fasting, took 0.35 g of alcohol per kg. Ethanol blood levels, glycemia and blood levels of insulin and glucagon were taken at regular intervals every 10 to 15 minutes during all the experiment (120 minutes). After the initial experiment, all subjects took 150 mg of ranitidine p.o. b.i.d. during seven days. Afterward they were submitted to the same protocol. Between both experiments no differences were found on blood levels of ethanol. Peak concentration, decreasing rate, and biodisponibility (estimated by area under the curve) did not change. There was a tendency to have a faster decrease in glucose blood level (p < 0.05). This study does not show any significant modification of ethanol metabolism after taking ranitidine p.o.; those results are differing from data already found with studies using cimetidine.

Geographic and birth cohort associations of Kaposi's sarcoma among homosexual men in Canada.

The authors conducted an analysis of all 677 cases of Kaposi's sarcoma among the 3,047 cases of acquired immunodeficiency syndrome diagnosed in homosexual/bisexual men in Canada between 1980 and 1989. The proportion with Kaposi's sarcoma declined from 32.2% during 1980-1985 to 15.0% in 1989. The proportion with Kaposi's sarcoma was significantly higher in primary epidemic centers (Vancouver, Toronto, and Montreal) and in men in the 1945-1954 birth cohort independent of year of diagnosis. These data are consistent with an environmental cofactor for Kaposi's sarcoma which is likely to be a sexually transmitted agent.

Underreporting of AIDS cases in Canada: a record linkage study.

To estimate the rate of underreporting of AIDS (acquired immune deficiency syndrome) to the Federal Centre for AIDS (FCA), in 1988 the initials, date of birth and place of residence of 66 patients with AIDS known to the Toronto Sexual Contact Study (TSCS), 65 patients with AIDS known to the Vancouver Lymphadenopathy-AIDS Study (VLAS) and other participants in both studies who did not have AIDS were sent to the Bureau of Epidemiology and Surveillance, FCA. The FCA conducted a manual record linkage to link these data to the national registry of reported cases. The rate of underreporting was 12% (8/65) for the VLAS and 18% (12/66) for the TSCS. The specific diagnosis was not related to the rate of underreporting. For the TSCS the rate of underreporting had increased from 0% in 1983-84 to 44% in 1987-88 (p = 0.001). Differences in the observed rates of underreporting between the two studies are likely the result of differences in the reporting responsibilities of physicians involved in the studies.

Acne fulminans with osteolytic lesions.

Multifocal lytic bone lesions were found in a patient with a severe form of acne. The clinical presentation was suggestive of "acne fulminans." Propionibacterium acnes was isolated from a subculture of bone tissue. The association of acne fulminans and osteolytic lesions is rare and the pathophysiology is unknown. However, the use of corticosteroids for systemic effect combined with local measures seems to give excellent treatment results.