Risk factors for myocardial infarction during carotid endarterectomy in high-risk patients with coronary artery disease

Aim. To determine the value of various risk factors for predicting the myocardial infarction (MI) during carotid endarterectomy in high-risk patients with coronary artery disease (CAD).Material and methods. The single-center cohort prospective study included 204 high-risk patients with CAD who required carotid endarterectomy (CEA). Before surgery, all patients underwent treatment of CAD, and all patients were clinically stabilized. The first step was CEA. Clinical and diagnostic factors associated with the risk of perioperative MI were studied. There were following end points of the study: stroke, MI, death due to MI. The diagnosis of MI was established when there was a combination of an increase in cTn-I troponin above the 99th percentile upper reference limit with electrocardiographic manifestations of myocardial ischemia, or with chest pain or equivalent symptoms consistent with myocardial ischemia.Results. There were no strokes. There were no deaths due to MI. Perioperative MI developed in 8 (3,9%) patients. There were following most significant predictors of perioperative MI: severe impairment of local left ventricular (LV) contractility (hazard ratio (HR), 13,57; 95% confidence interval (CI), 1,427-124,782, p<0,05) and a decrease in left ventricular ejection fraction <50% (HR, 10,909; 95% CI, 1,052-271,229, p<0,05). However, following factors were insignificant for predicting perioperative MI (p>0,05): SYNTAX score, prior cerebrovascular accident, myocardial infarction, insulin-dependent diabetes mellitus, obesity, chronic obstructive pulmonary disease.Conclusion. In high-risk patients with CAD, severe impairment of local LV contractility and global LV systolic dysfunction are the most significant risk factors for perioperative MI during CEA

Galactic Cosmic Rays - Clouds Effect and Bifurcation Model of the Earth Global Climate. Part 2. Comparison of Theory with Experiment

The solution of energy-balance model of the Earth global climate and the EPICA Dome C and Vostok experimental data of the Earth surface palaeotemperature evolution over past 420 and 740 kyr are compared. In the framework of proposed bifurcation model (i) the possible sharp warmings of the Dansgaard-Oeschger type during the last glacial period due to stochastic resonance is theoretically argued; (ii) the concept of climatic sensitivity of water in the atmosphere, whose temperature instability has the form of so-called hysteresis loop, is proposed, and based of this concept the time series of global ice volume over the past 1000 kyr, which is in good agreement with the time series of delta O-18 concentration in the sea sediments, is obtained; (iii) the so-called "CO2 doubling" problem is discussedComment: 19 pages, 4 figure

Carotid chemodectoma in the otorhinolaryngological practice: a clinical case

Aim. To describe a clinical case of carotid chemodectoma in a patient seeking treatment from an otorhinolaryngologist.Results. A 79-year-old woman complained of sore throat and difficulty swallowing. Mesopharyngoscopy revealed a significant asymmetry of the pharynx on the right with a sagging soft palate. Computed tomography revealed the asymmetry of the pharynx on the right due to compression from outside. An irregularly shaped formation intensely accumulating contrast medium was detected in the periopharyngeal space on the right, near the bifurcation of the carotid artery. Carotid chemodectoma was suspected. The patient underwent surgical removal of the chemodectoma followed by the autoarterial reconstruction of the carotid artery on the right. The postoperative period was uneventful.Conclusion. The management of patients with carotid chemodectoma requires an interdisciplinary approach with participation of vascular surgeons, otorhinolaryngologists and radiologists. This approach ensures timely surgical treatment leading to complete recovery without neurological consequences and profuse blood loss. The disease can be mistaken for a peritonsillar abscess with the possibility of serious complications during surgical treatment