Stroke prevention and peptic ulcer disease

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Stroke prevention by carotid endarterectomy

Cerebrovascular disease is the third leading cause of death in Hong Kong and stroke is a major cause of disability in the elderly. With increased life span, rehabilitation and care of patients with disabiling stroke has become a substantial economic burden to the society and family. Prevention of stroke by carotid endarterectomy is definitely more cost-effective than treatment of stroke. Prospective randomized trials in North America and Europe have proven the benefit of carotid endarterectomy in symptomatic patients with severe carotid stenosis. The diagnosis of carotid stenosis can be easily confirmed by a duplex scan performed in experienced hands. With increased awareness of this condition, early identification of at risk patients with referral to a tertiary centre for consideration of carotid endarterectomy is able to reduce the risk of future stroke or death.published_or_final_versio

Carotid endarterectomy for carotid stenosis: audit at a tertiary referral centre

Prospective randomised controlled trials performed in North America and Europe have demonstrated that the risk of future stroke or death is substantially reduced by performing carotid endarterectomy in symptomatic patients who have severe carotid stenosis. An audit was conducted to analyse the results of carotid endarterectomy performed during a 3-year period, at a tertiary referral vascular centre in Hong Kong. A total of 35 patients who had significant carotid stenosis underwent 36 carotid endarterectomies from October 1994 to September 1997. All patients recovered uneventfully without neurological complications or mortality. The audit showed that the current results of carotid endarterectomy at this institution fulfilled the criteria advised by the Stroke Council of the American Heart Association in 1995. Therefore, carotid endarterectomy is a validated therapeutic option for carotid stenosis in Hong Kong.published_or_final_versio

Carotid stenting for irradiation-associated carotid stenosis 3 years after previous carotid endarterectomy

Extracranial carotid stenosis is a known complication of external irradiation to the head and neck region. We report on a patient with previous carotid endarterectomy for irradiation-associated carotid stenosis. This patient developed symptomatic carotid stenosis over the ipsilateral common carotid artery proximal to the previous endarterectomy site 3 years later, and was successfully treated with carotid angioplasty and stenting. This case illustrates the importance of Duplex scan surveillance after carotid endarterectomy for patients with irradiation-associated carotid stenosis. The complimentary role of carotid endarterectomy and carotid angioplasty for managing such a patient is highlighted.published_or_final_versio

Repair of Salmonella mycotic aneurysm of the paravisceral abdominal aorta using in situ prosthetic graft

Salmonella infection of the abdominal aorta is associated with a high mortality and morbidity, especially when the paravisceral segment is involved. The presentation may be vague and a high index of suspicion is required in order to make the diagnosis early so that prompt treatment can be instituted. Imaging techniques such as computed tomography and angiogram are useful in arriving at a diagnosis as well as planning of operation. The management of a patient with Salmonella mycotic aortic aneurysm includes potent antibiotics, adequate debridement and revascularization. The method of revascularization, in situ bypass or extra-anatomic bypass, has been the subject of controversy. In situ bypass involves placing a graft in an infected field with potentially fatal graft infection, while extra-anatomic bypass has the problem of inferior patency and the necessity of a future reconstruction. We report here a patient with Salmonella mycotic aneurysm of the paravisceral abdominal aorta successfully treated with in situ prosthetic bypass graft.published_or_final_versio

Carotid endarterectomy: a 3-year audit of the Francis YH Tien vascular disease centre

Conference Theme: Challenges to specialists in the 21st centurypublished_or_final_versio

Differential expression of sphingosine-1-phosphate receptors in abdominal aortic aneurysms

Objective. Inflammation plays a key role in the pathophysiology of abdominal aortic aneurysms (AAAs). Newly discovered Sphingosine-1-Phosphate Receptors (S1P receptors) are critical in modulating inflammatory response via prostaglandin production. The aim of the current study was to investigate the expression of different S1P receptors in AAAs and compared with normal aortas at the protein level. Materials and Methods. Aortic specimens were harvested during aortic reconstructive surgery for the AAA group or during organ transplant for the control group. The protein expression of S1P1, 2 and 3 in AAAs and normal aortas was assessed by Western blotting and immunohistochemical analysis. Results. There were 40 AAAs and 20 control aortas collected for the receptor analysis. For Western blot analysis, S1P1 expression was not detected in either group; S1P2 protein was constitutively detected in both types of aortas but its expression level was significantly decreased by 73 (P < 0.05) in AAAs compared with the control group. In contrast, strong S1P3 expression was detected in AAAs aortas but not in normal aortas. Immumohistochemical staining showed similar results, except a weak S1P3 signal was detectable in normal aortas. Conclusions. Western blot and staining results consistently showed the down-regulation of the S1P2 protein with simultaneous up-regulation of the S1P3 protein in AAAs. Since those newly discovered receptors play an important role in the inflammatory cascade, the modulating of S1P signaling, particularly via S1P2 and S1P3, could represent novel therapeutic targets in future AAA treatments. Copyright 2012 Z. Qu et al.published_or_final_versio

Effectiveness of proximal intra-operative salvage Palmaz stent placement for endoleak during endovascular aneurysm repair

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Angioplasty of forearm arteries as a finger salvage procedure for patient with end-stage renal failure

Case Reportpublished_or_final_versio

Epidemiological updates of venous thromboembolism in a Chinese population

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