Cerebral Protection During Coronary Artery Bypasses Grafting in Bilateral Total Internal Carotids Occlusion: Case Report

Introduction: The best management for the patient with coronary artery disease (CAD) that requires emergent coronary bypass graft surgery (CABG) with bilateral total internal carotid artery occlusions previously reported. Here we report two successful cases of CABG with additional occlusion in the circle of Willis anterior or posterior communicating artery “incomplete cow” with onpump technique and cerebral protection considerations. Case Presentation: Bilateral carotid artery occlusion, coronary artery disease, and emergency operation with cardiopulmonary bypass are associated with increased stroke, especially when there is one additional occlusion of the cerebral artery in the circle of Willis. Routine preoperative carotid artery sonography and selective carotid angiography revealed bilateral total carotid occlusion in both cases in addition, CT-angiography also confirmed occlusions of right posterior communicating in the first case and left posterior communicating artery in the second case. Collateral circulation feeding in the intracranial circulations originated mainly from the vertebrobasilar system (compensatory phase) preoperative physical examinations showed no neurological deficit. Operation was done successfully with moderate hypothermia and different cerebral protection considerations and postoperative courses were uneventful and patients discharged from hospital seven days post operation. Conclusions: Anesthesia should consider hemodynamic management and avoid significant tachycardia or bradycardia and severe hypertension or hypotension

A Retrospective Study Of Gastric Cancers In Tehran

Background: Gastric cancer is one of the most common cancers in our country. Recent studies have shown that adenocarcinoma of the cardia and distal stomach has increased in the past 25 years. However demographic data is lacking in this regard. Methods: This study is a retrospective case series study. All records from 460 consecutive patients who were documented pathologically to have gastric cancer and had been referred for diagnosis and follow-up to a private clinic from 1992 to 2002 in Tehran were evaluated. Results: 71 records were dismissed due to incomprehensive data. Among 389 remaining records 68.5% were males; mean age was 59.4 years (range 13 to 92 years), 31.1% of patients were 40 years old or less (which is very high). Also 85% (331) of patients had adenocarcinoma and 5.9% (23) had lymphoma, 8.1% (31) had undifferentiated carcinoma while only 1% (4) of cases had gastrointestinal stromal tumor (GIST). 64% of tumors were located in the middle part of the stomach, 19% in the lower and 17% in the upper part. In our study the association between H. pylori and adenocarcinoma was 23.2% in cases younger than 40 years (P<0.001) and 56% in cases older than 40 years. Cases with lymphoma had the highest correlation with H. pylori. There was a significant difference between cancer pathology and sex (P< 0.001). Conclusion: Our data is somehow in conflict with the western data. We do not recommend blind H. pylori eradication based on positive serology (at least in Tehran) and we suggest conduction of larger multicenter studies in this field in our country