A randomized controlled trial was performed to evaluate patch angioplasty for patients undergoing carotid endarterectomy. There were 213 patient episodes affecting 148 men and 65 women, with 109 allocated to patch angioplasty. Following surgery six patients suffered transient ischaemic attacks but these did not delay discharge from hospital. Six individuals (four patched operations, two not patched) required re-exploration for postoperative haemorrhage and eight (two patched procedures, six not) had potentially serious neurological problems after operation. Of these eight patients, four (none receiving patch angioplasty) underwent re-exploration and in each case a clot was removed and a patch inserted; three of the four made a good long-term recovery. The other four patients suffered completed strokes from which one died. Two further patients (one patched procedure, one not) died after operation from myocardial events, giving an overall 30-day stroke or mortality rate of 2.8 per cent. Objective follow-up assessment with duplex scanning at 1 year was completed by 94.8 per cent of patients; significantly more vessel restenoses and occlusions were observed in those not receiving patches (P < 0.01). Patch angioplasty reduces the number of immediate postoperative complications, and significantly lowers vessel restenosis and occlusion rates at 1 year after operation.

Aged↗

PubMed1992

The optimum pressure of oxygen for radiotherapy of a mouse tumour.

Our previous studies have shown that there is more regrowth delay in mammary tumours irradiated in C3H mice after 25 Gy when breathing normobaric oxygen than in those breathing air, as might be expected. However, in both cases this radiation response was reduced in anaesthetized animals in comparison with unanaesthetized control mice, when a time interval of only 10 min was allowed after anaesthesia. After 25 min, however, the response in air returned to the control level and the oxygen group now showed significantly more radiosensitization. We have now found that when tumour-bearing mice were exposed to different pressures of oxygen for that 25-min period after the induction of anaesthesia, before the tumours were treated with 25 Gy, there was even more regrowth delay with 2 atm pressure than 1, but that there was no further advantage from using 3 atm pressure of oxygen. Our data suggest that 2 atm may be the optimal pressure to use in anaesthetized mice and there is even a small benefit from using this pressure in unanaesthetized animals for a transplanted C3H mammary tumour.

Anesthesia↗

PubMed1992