Individual mesh size for open anterior inguinal hernia repair: an anthropometric study in Turkish male patients.

PURPOSE: To conduct a study to determine the measurements of the inguinal region in male patients with inguinal hernias to reveal the proper mesh size for each patient. METHODS: In this prospective study, the anthropometric measurements were obtained from 100 consecutive adult male patients with unilateral primary inguinal hernias. First, the distance between the pubic tubercle and the medial border of the deep inguinal ring was measured (x). Second, the distance between the inner edge of the inguinal ligament and the uppermost level of the internal oblique aponeurosis at the midpoint of the inguinal ligament corresponding to the Hesselbach triangle was measured (y). Individual mesh sizes were calculated according to the original recommendations for mesh overlap. RESULTS: The mean x value was 41.6 mm (22-55 mm), the mean y value was 45.2 mm (30-68 mm). The mean dimensions of the mesh were 126.6 mm × 65.2 mm. The largest mesh was 140 mm × 88 mm, and the smallest one was 107 mm × 62 mm. The mean mesh area was 8320 mm2. It was larger than the index mesh area recommended by the Lichtenstein Hernia Institute in 45 patients and smaller in 55 patients. CONCLUSIONS: The intraoperative measurements for ideal mesh size in Lichtenstein repair of inguinal hernias may present somewhat different mesh dimensions in many patients. Individualization of mesh size may be of importance in surgical outcomes.

Surface anatomy and anatomical planes in the adult turkish population.

Surface anatomy and anatomical planes are widely used in education and clinical practice. The planes are largely derived from cadaveric studies and their projections on the skin show discrepancies between and within anatomical reference textbooks. In this study, we reassessed the accuracy of common thoracic and abdominopelvic anatomical planes using computed tomography (CT) imaging in the live adult Turkish population. After patients with distorting pathologies had been excluded, CT images of 150 supine patients at the end tidal inspiration were analyzed. Sternal angle, transpyloric, subcostal, supracristal and pubic crest planes and their relationships to anatomical structures were established by dual consensus. The tracheal bifurcation, azygos vein/superior vena cava (SVC) junction and pulmonary bifurcation were usually below the sternal angle while the concavity of the aortic arch was generally within the plane. The tip of the tenth rib, the superior mesenteric artery and the portal vein were usually within the transpyloric plane while the renal hila and the fundus of the gallbladder were below it. The inferior mesenteric artery was below the subcostal plane and the aortic bifurcation was below the supracristal plane in most adults. Projectional surface anatomy is fundamental to medical education and clinical practice. Modern cross-sectional imaging techniques allow large groups of live patients to be examined. Classic textbook information regarding anatomy needs to be reviewed and updated using the data gathered from these recent studies, taking ethnic differences into consideration.

Seguridad y eficacia de la cirugía retrógrada intrarrenal en pacientes de diferentes grupos de edad / Safety and efficacy of retrograde intrarenal surgery in patients of different age groups

Objetivos: Evaluar la eficacia y seguridad de la cirugía intrarrenal retrógrada (CIRR) para tratar los cálculos renales en pacientes de diferentes grupos de edad. Pacientes y métodos: Se realizó un análisis retrospectivo de 947 pacientes que se sometieron a CIRR para cálculos renales entre enero de 2008 y enero de 2014. La edad en la CIRR se analizó tanto como una variable continua como categórica, y los pacientes fueron clasificados en 3 grupos de edad; ≤ 15 años en la cirugía (grupo i, n = 51), 16-60 años (grupo ii, n = 726) y> 60 años (grupo iii, n = 170). Se compararon los 3 grupos con respecto a las características del cálculo, los parámetros operativos y los resultados postoperatorios. Resultados; La tasa de ausencia de cálculos fue del 78,4% en el grupo i, 77,5% en el grupo ii, y 81,1% en el grupo iii (p = 0,587). Un análisis de regresión logística multivariante mostró que solo el tamaño del cálculo y el número de cálculos tuvieron una influencia significativa en las tasas de ausencia de cálculos después de CIRR. Se produjo un 13,7% de complicaciones intraoperatorias en el grupo i, 5,6% en el grupo ii, y 7,6% en el grupo iii. Las tasas de complicación global en niños eran más altas que en pacientes adultos, pero las diferencias no fueron estadísticamente significativas. Se descubrió que solo el tiempo de operación esataba asociado con el aumento del riesgo de complicaciones intraoperatorias. Las complicaciones médicas perioperatorias se desarrollaron en 8 pacientes (0,8%) en el grupo ii y 2 pacientes (1,1%) en el grupo iii. Un hombre de 48 años de edad murió a causa de shock séptico 5 días después de la cirugía. Conclusiones; Se observó que la CIRR era un procedimiento seguro y eficaz en todos los grupos de edad de pacientes con cálculos, por lo tanto, la edad no debe ser considerada como un factor limitante

Objectives: To assess the efficacy and safety of retrograde intrarenal surgery (RIRS) to treat renal stones in different age groups of patients. Patients and methods: We performed a retrospective analysis of 947 patients who underwent RIRS for renal calculi between January 2008 and January 2014. Age at RIRS was analysed both as a continuous and categorical variable and patients were categorized into three age groups; aged ≤ 15 years at surgery (group i, n = 51), 16 - 60 years (group Ii, n = 726) and > 60 years (group iii, n = 170). We compared the 3 groups with the regard to stone characteristics, operative parameters and postoperative outcomes. Results: The stone-free rate was 78.4% in group i, 77.5% in group ii, and 81.1% in group iii (P = .587). A multivariate logistic regression analysis showed that only stone size and stone number had significant influence on the stone-free rates after RIRS. Intraoperative complications occurred 13.7% in group i, 5.6% group ii, and 7.6% in group iii. Overall complication rates in children were higher than adult patients but the differences were not statistically significant. We found that only operation time was associated with the increased risk of intraoperative complications. Peroperative medical complications developed in 8 patients (.8%) in group ii and 2 patients (1.1%) in group iii. A 48-year-old man died from septic shock 5 days after the surgery. Conclusions: RIRS was observed to be a safe and effective procedure in all age groups of patients with stone disease, therefore age should not be considered as a limiting factor

The role of cardiac biomarkers as predictors of trastuzumab cardiotoxicity in patients with breast cancer.

AIM: Identification of patient with increased risk of cardiotoxicity would allow not only prevention and early diagnosis of chemotherapy related cardiotoxicity but also administration of optimal dose and duration of chemotherapy. MATERIALS AND METHODS: Fifty-two women with HER2(+) breast cancer treated with trastuzumab were included in this study. Patients were prospectively followed with routine cardiac evaluation. Before and after administration of trastuzumab blood samples for NT-proBNP were also taken. RESULTS: The median age was 48.5 year (range: 26-74). Hypertension and obesity were two most common co-morbidities. The median duration application of trastuzumab was 52 weeks. During median 14.5 (3-33) months follow-up cardiac adverse events occurred in 5 (9.6%) patients and 2 out of 5 was grade III-IV heart failure. Both patients had preserved left ventricular ejection fraction and no symptom of heart failure before trastuzumab but older than 65 years old and had diabetes mellitus and obesity. High level of NT-proBNP (> 300 ng/ml) was observed in both patients and heart failure recovery was not observed. There was statistically significant difference regarding body mass index (p = 0.004) and diabetes mellitus (p = 0.002) between patients with and without cardiotoxicity. CONCLUSION: Although, cardiac biomarkers still cannot replace routine cardiac monitoring, natriuretic peptides may provide additional tool for detection of patients with high risk of cardiotoxicity and early detection of cardiotoxicity.

Safety and efficacy of retrograde intrarenal surgery in patients of different age groups.

OBJECTIVES: To assess the efficacy and safety of retrograde intrarenal surgery (RIRS) to treat renal stones in different age groups of patients. PATIENTS AND METHODS: We performed a retrospective analysis of 947 patients who underwent RIRS for renal calculi between January 2008 and January 2014. Age at RIRS was analysed both as a continuous and categorical variable and patients were categorized into three age groups; aged ≤ 15 years at surgery (group i, n=51), 16 - 60 years (group Ii, n=726) and>60 years (group iii, n=170). We compared the 3 groups with the regard to stone characteristics, operative parameters and postoperative outcomes. RESULTS: The stone-free rate was 78.4% in group i, 77.5% in group ii, and 81.1% in group iii (P=.587). A multivariate logistic regression analysis showed that only stone size and stone number had significant influence on the stone-free rates after RIRS. Intraoperative complications occurred 13.7% in group i, 5.6% group ii, and 7.6% in group iii. Overall complication rates in children were higher than adult patients but the differences were not statistically significant. We found that only operation time was associated with the increased risk of intraoperative complications. Peroperative medical complications developed in 8 patients (.8%) in group ii and 2 patients (1.1%) in group iii. A 48-year-old man died from septic shock 5 days after the surgery. CONCLUSIONS: RIRS was observed to be a safe and effective procedure in all age groups of patients with stone disease, therefore age should not be considered as a limiting factor.

Sonographic examination of the common extensor tendon of the forearm at three different locations in the normal asymptomatic population.

PURPOSE: The aim is to examine the common extensor tendon (CET) thicknesses at three locations in the normal population with ultrasound (US), to determine changes related to dominancy, age, gender, body mass index and to evaluate structural changes in normal tendons. METHODS: The study included 100 normal volunteers (200 elbows). CET was examined at three landmark locations bilaterally (humeral, articular and radial) and if present, other structural abnormalities such as tendinosis (focal or diffuse tendon echogenicity changes), tears, bone changes (enthesophytes, spurs, irregularities), tendon calcification, effusion and neovascularization were noted. RESULTS: Common extensor tendon was thicker on the dominant side at all three locations (humeral 4.60 versus 4.22 mm, articular 3.55 versus 3.23 mm, radial 3.17 versus 2.88 mm, p < 0.001) and gradually tapered from proximal to distal, moderate relation with age and BMI was present, most pronounced at the humeral location. Bone changes (spurs, irregularities) correlated positively with age and CET thickened in the dominant arm after 42.5 years of age which was also a cut-off age for bone changes (p < 0.05). Asymptomatic tendinosis (12%) within the normal population was significantly related to the dominancy (p = 0.032) but was not influenced by age, gender, BMI, bone degeneration or tendon thickening. CONCLUSION: When interpreting CET thickness, caution should be placed on tendon measurement points in addition to variables such as age, gender, BMI, dominancy and bone changes. Structural tendon changes (tendinosis) may be encountered in the symptom free (healthy), normal population and, not tendon thickening but dominancy is a feature of this asymptomatic tendinosis.

Mesh size in Lichtenstein repair: a systematic review and meta-analysis to determine the importance of mesh size.

PURPOSE: Small mesh size has been recognized as one of the factors responsible for recurrence after Lichtenstein hernia repair due to insufficient coverage or mesh shrinkage. The Lichtenstein Hernia Institute recommends a 7 × 15 cm mesh that can be trimmed up to 2 cm from the lateral side. We performed a systematic review to determine surgeons' mesh size preference for the Lichtenstein hernia repair and made a meta-analysis to determine the effect of mesh size, mesh type, and length of follow-up time on recurrence. METHODS: Two medical databases, PubMed and ISI Web of Science, were systematically searched using the key word "Lichtenstein repair." All full text papers were selected. Publications mentioning mesh size were brought for further analysis. A mesh surface area of 90 cm(2) was accepted as the threshold for defining the mesh as small or large. Also, a subgroup analysis for recurrence pooled proportion according to the mesh size, mesh type, and follow-up period was done. RESULTS: In total, 514 papers were obtained. There were no prospective or retrospective clinical studies comparing mesh size and clinical outcome. A total of 141 papers were duplicated in both databases. As a result, 373 papers were obtained. The full text was available in over 95 % of papers. Only 41 (11.2 %) papers discussed mesh size. In 29 studies, a mesh larger than 90 cm(2) was used. The most frequently preferred commercial mesh size was 7.5 × 15 cm. No papers mentioned the size of the mesh after trimming. There was no information about the relationship between mesh size and patient BMI. The pooled proportion in recurrence for small meshes was 0.0019 (95 % confidence interval: 0.007-0.0036), favoring large meshes to decrease the chance of recurrence. Recurrence becomes more marked when follow-up period is longer than 1 year (p < 0.001). Heavy meshes also decreased recurrence (p = 0.015). CONCLUSION: This systematic review demonstrates that the size of the mesh used in Lichtenstein hernia repair is rarely discussed in clinical studies. Papers that discuss mesh size appear to reflect a trend to comply with the latest recommendations to use larger mesh. Standard heavy meshes decrease the recurrence in hernia repair. Even though there is no evidence, it seems that large meshes decrease recurrence rates.

Comparison of laparoscopy and laparotomy in surgical staging of clinical early stage endometrial cancer: a report of early experiences from Turkey.

The objective of this study was to assess the feasibility of laparoscopy (LS) in endometrial carcinoma staging. Clinical early stage endometrial cancer patients (n = 153) staged by LS or laparotomy (LT) were compared. A total of 40 (26.1%) patients were treated by LS and 113 (73.9%) by LT. All patients underwent pelvic lymphadenectomy. Lymphadenectomy has been extended to para-aortic space in 55% of the LS group and 70% of the LT group. The majority of patients had stage I-II disease. The median numbers of removed pelvic and para- aortic lymph nodes were similar in two groups (p values 0.213 and 0.199, respectively). Body mass index (BMI) (kg/m(2)) was higher in the LT group (31.2 vs 27.4, p < 0.05). Operation time, age, tumour histology, para-aortic lymphadenectomy and complication rates were similar in the two groups. Four (10%) patients in the LS group and 12 (10.6%) in the LT group had recurrence of disease (p = 1.0). There was no statistical difference for overall survival between the two groups. In conclusion, these findings showed that in endometrial carcinoma cases, laparoscopy has provided adequate staging and similar survival rates with laparotomy.

The effects of exercise on portal venous system in splenectomized adults.

OBJECTIVES: This study was designed to assess the effects of exercise on the portal venous system in splenectomized adults. BACKGROUND: Splenectomy is a surgical intervention commonly performed at surgery clinics and recognized as a cause of portal vein thrombosis. Intensive exercise increases blood flow to the contracting muscles, causes hypercoagulability and vasoconstriction in the splanchnic area, hence the portal vein diameter, blood flow velocity and discharge decrease. METHODS: Forty adults participated in this investigation. Subjects were trained to run for twenty minutes on a treadmill at a velocity of 6 km/h and ten-degree elevation. We compared the white blood cell count, portal vein diameter, portal venous blood flow velocity and discharge of splenectomized and healthy adults before and after exercise. RESULTS: After exercise, the blood leukocyte count was significantly increased and the portal vein diameter was significantly reduced in both groups (p<0.001) but there were no statistically significant differences between the two groups. The portal venous blood flow rate in splenectomy group were significantly lower than in the control group (p<0.001). Furthermore the portal venous blood flow rates in both groups were significantly reduced after exercise (p<0.001). CONCLUSION: Exercise in splenectomized individuals can cause serious problems in form of decreasing splanchnic flow and increasing blood viscosity. After splenectomy, both healthy individuals and patients with hematologic diseases ought to avoid intensive exercises (Tab. 2, Ref. 16).

Clinical evaluation of DIAGNOdent in detection of occlusal caries in newly erupted noncavitated first permanent molars in caries-active children.

OBJECTIVE: The aim of this study was to compare the in vivo diagnostic ability of a laser fluorescence system (DIAGNOdent, KaVo, Biberac, Germany) with that of visual inspection in the early detection of occlusal caries in newly erupted noncavitated first permanent molars among caries-active children. MATERIALS AND METHODS: A total of 505 mandibular first permanent molar teeth in 307 children aged 6 to 7 years with decayed, missing, and filled tooth surfaces (DMFS)>8 were examined. Visual examination and DIAGNOdent measurement of caries were compared for teeth with intact occlusal surfaces or varying degrees of fissure discoloration, but with no radiologic evidence of enamel or dentin caries. Teeth were classified according to caries status as sound, enamel caries, or dentin caries using visual examination and DIAGNOdent scoring systems corresponding to histologic definitions of caries depth. Analysis of the results was performed using Cohen's unweighted kappa statistic. RESULTS: Statistical analysis revealed "poor" agreement between the two diagnostic methods (κ=0.231). CONCLUSION: Clinical results suggest that the DIAGNOdent device does not seem to be suitable for accurate diagnosis of early caries lesions in newly erupted first permanent molars.

Growth and trends in publications about abdominal wall hernias and the impact of a specific journal on herniology: a bibliometric analysis.

PURPOSE: The aim of this systematic review was to determine the exact volume and growth pattern of articles on abdominal wall hernias, in particular the effect of the journal Hernia on publications about hernias. METHODS: A PubMed search was performed for every year between 1965 and 2010, using the title words "inguinal hernia," "incisional hernia," and "umbilical hernia." Then, two consecutive 10-year periods were chosen for a systematic PubMed search, before and after 2001--the year in which Hernia began to be indexed in PubMed. The main keywords used were as follows: "inguinal hernia" "incisional hernia" "umbilical hernia" "mesh" "laparoscopic" and "experimental." RESULTS: The number of all articles indexed in PubMed increased 1.6-fold between the periods 1991-2000 and 2001-2010. The number of articles with the title word "inguinal hernia" increased 1.7-fold, whereas the rises for incisional and umbilical hernias were more prominent: 3.9- and 2.6-fold. Article titles with the combined keywords "hernia and mesh" and "hernia and laparoscopic" increased 2.8- and 2.4-fold. The most striking combined search was for "umbilical hernia and mesh" with a 20.5-fold rise. The percentage of articles published in the journal Hernia among all articles in all 25 selected journals, including Hernia was 30% on average. Hernia, Surgical Endoscopy and the British Journal of Surgery were the leading journals for publications for inguinal hernia in the last decade. CONCLUSIONS: Growth in hernia papers is greater than the overall growth in PubMed. Articles on incisional hernia increased faster than did those on inguinal and umbilical hernias. The establishment and indexing of Hernia decreased the proportion of hernia publications in other journals. The core journals for herniology are Hernia, Surgical Endoscopy, and the British Journal of Surgery.

Single stapler technique in laparoscopic donor nephrectomy.

BACKGROUND: Laparoscopic donor nephrectomy (LDN) is usually performed with at least 2 separate vascular staplers for division of the renal artery and vein. However, we used a single stapler regardless of the number of renal arteries and veins. Furthermore, the graft was quickly retrieved by hand without using an extraction bag using our technique. Herein we have presented our experience with LDN of grafts with single or multiple renal arteries and/or veins using a single stapler and hand removal. METHODS: We reviewed demographic data, operative and warm ischemia times, postoperative complications, and graft function. RESULTS: Between December 2005 and September 2009, we performed 85 cases with 1 renal artery (group LDN-1), 8 cases with two renal arteries (group LDN-2), and 5 cases with 3 or more renal arteries (group LDN-3). The demographic data among the groups were similar. The mean operative time was significantly longer among groups LDN-2 (100.3 ± 9.5 minutes) and LDN-3 (120.6 ± 10.3 minutes) compared with LDN-1 (76.1 ± 9.3 minutes; P < .001). Similar results were observed with respect to warm ischemia times. There were no significant differences related to graft function and outcomes among these groups. CONCLUSION: The single stapler and hand removal technique was safe, technically feasible, and cost effective regardless of the number of renal arteries and veins. This technique removes the necessity of additional staplers and extraction bags, lowers the operative and warm ischemia times, and thus decreases the cost.

Pure laparoscopic versus open live donor nephrectomy: evaluation of health survey and graft functions.

BACKGROUND: Laparoscopic donor nephrectomy (LDN) has become the gold standard in many kidney transplantation centers seeking to increase the number of potential live donors. This study was designed to compare the health surveys and graft functions between LDN and open donor nephrectomy (ODN). METHODS: We retrospectively analyzed all patients who underwent donor nephrectomy between December 2005 and September 2009 who had at least 1 year of follow-up. We reviewed demographic data, operative time, warm ischemia period, graft function, and quality of life. RESULTS: Among the 132 cases, 98 were pure LDN and 34 were ODN. Demographic data were similar in both groups. Operative times were significantly longer in the ODN group but warm ischemia times significantly longer in the LDN group. However, graft functions were similar in both groups. There was 1 graft loss due to arterial thrombosis of the transplanted kidney among the LDN group. Short-Form 36 health survey scores were similar except for the role-physical subscale. CONCLUSION: Although we failed to observe a significant difference between ODN and LDN as far as the quality of life and graft functions were concerned, the previously documented advantages of laparoscopy with similar operative results suggest? LDN to be the gold standard for this procedure in our institution.

Gynecologic symptoms and sexual function in female kidney allograft recipients.

BACKGROUND: There is little information in the literature about changing menstrual patterns, sexuality, and fertility after kidney transplantation. The purpose of this study was to describe gynecologic symptoms, menstrual characteristics, sexual functions, details of pregnancies and gynecologic care before and after women underwent renal transplantation. METHODS: A detailed Turkish questionnaire was prepared for gynecologic evaluation. Fifty women of reproductive age who underwent renal transplantation took part in this study. The questionnaires were filled out at the time of the postoperative follow-up. RESULTS: The mean age and body mass index of all study participants at the time of interview was 33.9 years (range, 18-52) and 23.5 kg/m(2) (range, 16.5-33.3), respectively. There were no differences between bleeding between periods, heavy period, painful period, and period duration before and after transplantation. Eight women left active working life after grafting on their own accord. Thirteen women ceased sexual activity after transplantation. None of the women reported pregnancy after grafting. A total of 98% of women reported that they were never instructed about regular gynecologic care. CONCLUSION: We found that restrictions in the lives of women with transplanted kidneys included ceasing sexual activity and leaving active working life and that these were due to fear of possible organ damage. Women with transplanted kidneys must be informed about posttransplant sex life and the requirement for regular examinations by a gynecologist. Hence, close collaborations should be formed between patients, primary care physicians, and gynecologists.

Association between GSTP1 gene polymorphism and serum alpha-GST concentrations undergoing sevoflurane anaesthesia.

BACKGROUND AND OBJECTIVES: The measurement of alpha-glutathione-S-transferase enzyme is one of the most sensitive indicators of hepatocellular function. Variation in the glutathione-S-transferase P1 gene clusters has been intensively investigated and polymorphism has been described. The aim of the study was to assess whether an association exists between glutathione-S-transferase P1 gene polymorphism and serum alpha-glutathione-S-transferase concentrations for the first postoperative day in patients who underwent anaesthesia with sevoflurane. METHODS: In all, 54 unrelated patients were enrolled in this study. Anaesthesia was induced with thiopental and fentanyl. Vecuronium was used for neuromuscular relaxation before endotracheal intubation. Anaesthesia was maintained with sevoflurane in a gas mixture containing 50% nitrous oxide in oxygen. Peripheral venous blood samples to determine serum alpha-glutathione-S-transferase concentrations were collected before induction (T1), at the end of anaesthesia (T2) and at 24-h postoperatively (T3). Enzyme-linked immunosorbent assay (ELISA) immunoassay was used to measure alpha-glutathione-S-transferase levels. Genomic DNA was isolated from serum samples using a genomic DNA purification kit. In order to detect the variants of glutathione-S-transferase P1, polymerase chain reaction-restriction fragment length polymorphism analysis was employed. RESULTS: Early postoperative serum alpha-glutathione-S-transferase levels for all patients were significantly increased when compared with preanaesthetic and 24-h postoperatively (P 0.05). CONCLUSIONS: Although alpha-glutathione-S-transferase levels were elevated in all patients after sevoflurane anaesthesia, levels remained high at 24 h in patients with glutathione-S-transferase P1 Ile105Val genotypes compared to controls.

Carotid artery tortuosity, kinking, coiling: stroke risk factor, marker, or curiosity?

Although abnormalities in course and geometry (tortuosity, kinking, and coiling) of the internal carotid arteries (ICA) are commonly identified, their etiology and relationship with stroke and stroke risk factors remain unclear This study assessed the clinical and ultrasonographic features of the patients with abnormalities in course and geometry of the ICA. Carotid color duplex ultrasound studies of 345 consecutive patients referred to the Neuroultrasound Lab were prospectively evaluated. Abnormalities in direction and course of the ICA were classified according to the criteria of Weibel-Fields and Metz modified by the authors. Kinking was categorized as mild (> 60 degrees), moderate (30 degrees-60 degrees), and severe (< 30 degrees). Carotid abnormalities (CA) were found in 85/345 (24.6%), 60/85 (70.6%) were female. More CA were seen in females older than 60 y/o (p < 0.001), but there was no gender difference in patients 60 y/o or younger CA were bilateral in 41 patients (48%), but in those with unilateral CA, most were on the left. The most common CA was kinking (71 arteries, 56%), followed by tortuosity (48 arteries, 38%), and coiling (7 arteries, 6%). None of the atherosclerotic vascular diseases or risk factors was associated with CA. Mild atheromatous plaques predominated in patients with CA, but moderate and large plaques were more common in the others (p = 0.001). Maximal systolic velocity at the level of CA was higher in patients with kinking or coiling compared with tortuosity (p = 0.001). Lumen diameter at the level of CA was inversely correlated to the severity of CA (p < 0.001). However, carotid stenosis was equally present in all groups. This study suggests that CA have no clear importance as a stroke risk factor or marker of atherosclerotic vascular disease. Our results suggest that CA do not develop as a consequence of vascular risk factors or atherosclerotic lesions, and they are not related to ischemic stroke, TIA or the presence of carotid stenosis. In women, CA was related with advanced age. It appears that CA frequently identified by color duplex sonography are more of curiosity than a clinically significant finding.