Predrag Pavić

Multidetector-row computed tomography in evaluation of atherosclerotic carotid plaques complicated with intraplaque hemorrhage.

Our aim was to determine the sensitivity and specificity of multidetector-row computed tomography (CT) in detecting atherosclerotic carotid plaques complicated with intraplaque hemorrhage. We examined carotid plaques from 31 patients operated for carotid artery stenosis. Results of preoperative multidetector-row CT analysis of carotid plaques were compared with results of histological analysis of the same plaque areas. Carotid endarterectomy was performed within 1 week of multidetector-row CT. American Heart Association classification of atherosclerotic plaques was applied for histological classification. Median tissue density of carotid plaques complicated with intraplaque hemorrhage was 22 Hounsfield units (HU). Median tissue density of noncalcified segments of uncomplicated plaques was 59 HU (p=0.0062). The highest tissue density observed for complicated plaques was 31 HU. Multidetector-row CT detected plaques complicated with hemorrhage with sensitivity of 100% and specificity of 64.7%, with tissue density of 31 HU as a threshold value. Multidetector-row CT showed a high level of sensitivity and a moderate level of specificity in detecting atherosclerotic carotid plaques complicated with hemorrhage.

Pseudoaneurysm of the Popliteal Artery in a Patient With Multiple Hereditary Exostoses

We present an interesting case of a 14-year-old girl with multiple hereditary exostoses. She presented with a few days history of a pulsative mass in the distal third of the right upper thigh. Leg radiography showed multiple exostoses of distal femur, proximal tibia, and fibula. Large pseudoaneurysm of popliteal artery was found in Doppler sonography. The diagnosis was verified with multi-slice computed tomography of both legs along with the digital subtraction angiography of right leg. The patient then underwent surgery. After surgery the patients vascular status was regular, with no signs of pseudoaneurysm.

Effect of carotid sinus nerve blockade on hemodynamic stability during carotid endarterectomy under local anesthesia

OBJECTIVE To find out whether routine carotid sinus nerve blockade with lidocaine during carotid endarterectomy under local anesthesia results in perioperative changes in blood pressure and heart rate. METHODS This was a prospective, randomized, single-center study, conducted in a university hospital. A total of 120 patients undergoing carotid endarterectomy under local anesthesia were randomly assigned to three equal groups. Patients with previous carotid endarterectomy were excluded from the study. During the operation the carotid sinus area was infiltrated as follows: group 1 received 2 mL of 1% lidocaine; group 2 received 2 mL of 0.9% NaCl; and group 3 received no infiltration. The carotid sinus nerve was spared in all patients. Blood pressure and heart rate were invasively monitored during the operation and 12 hours postoperatively over the radial artery cannula. Preoperative values were calculated as a mean of three noninvasive measurements on the day before surgery. Data comprised of arterial blood pressures and heart rates from 32 time point measurements for each patient were analyzed. RESULTS There was no significant difference among the groups regarding the mean arterial blood pressures and mean heart rates during the follow-up period. There was no significant difference among groups regarding the number of patients that required vasoactive therapy at any time of measurement. CONCLUSION Routine infiltration of carotid sinus area with 1% lidocaine during carotid endarterectomy performed under local anesthesia has no significant impact on mean arterial blood pressure and heart rate during the operative procedure and the following 12 postoperative hours.

The importance of success prediction in angioaccess surgery

Access to the circulation is an “Achilles’ heel” of chronic hemodialysis. According to the current guidelines, autologous arteriovenous fistula is the best choice available. However, the impossibility of immediate use and the high rate of non-matured fistulas place fistula far from an ideal hemodialysis vascular access. The first attempt at constructing an angioaccess should result in functional access as much as possible. After failed attempts, patients and nephrologists lose their patience and confidence, which results in high percentage of central venous catheter use. Predictive models could help, but clinical judgment still remains crucial. Early referral to the nephrologist and vascular access surgeon, careful preoperative examinations, preparation of patients and duplex sonography mapping of the vessels are very important in the preoperative stage. In the operative stage, it is crucial to understand that angioaccess procedures should not be considered as minor procedures and these operations must be performed by surgeons with demonstrable interest and experience. In the postoperative stage, appropriate surveillance of the maturation process is also important, as well as good cannulation skills of the dialysis staff. The purpose of this review article is to stress the importance of success prediction in order to avoid unsuccessful attempts in angioaccess surgery.

Mo1827 The Pentadecapeptide BPC 157 Heals Chronic Lesions and Prevents Recurrences At the Colocutaneous Fistulas Model in Rats

Aim. The pentadecapeptide BPC 157, presently at the end of phase II in clinical trials, has shown its effectiveness in healing different organic lesions including newly formed colocutaneous fistulas (J Pharmacol Sci 2008). In this study we assessed its activity onto the chronic lesions which cannot heal spontaneously. We performed a 16 months long follow up in order to estimate the incidence of possible recurrences.Methods. A colocutaneous fistula has been created according to previously described model (J Pharmacol Sci 2008) at 80 male Wistar Albino rats. After the 4 weeks period without any therapy, the animals whose fistula healed spontaneously were excluded (20/80). Others were randomly assigned into 3 groups of 20 animals: the control group which started to receive the saline (5mL/ kg, i.p.). Two other groups started to receive BPC 157 (10 μg/kg i.p.; 10 ng/kg i.p.) for 4 weeks. The animals were followed up through another 16 months and then sacrificed and assesed (J Pharmacol Sci 2008). Results. Animals treated with BPC 157 started to expose the morphological and functional recovery from the 3rd post treatment day and through 2 weeks of treatment fistulas were closed and animals started to defecate only through anus. In control animals fistula remained and they defecated through it. Animals treated with BPC 157 did not develop recurrences during whole follow up period of 16 months. In addition, during 16 months of follow up at control animals none of the fistulas closed. Conclusions. BPC 157 heals both chronic and newly formed colocutaneous fistulas.