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At least 19 recordsLinked to original sources

PubMed1993

Accuracy of the death certificate in a population-based study of asthmatic patients.

OBJECTIVE: To quantify the reliability of death certificate data concerning asthma. DESIGN: The complete medical records of decedents were reviewed by a physician certified in allergy and pulmonology who determined the cause of death without having access to the original death certificate. Disagreements between the death certificate and the reviewer were adjudicated by an expert panel. SETTING: The community of Rochester, Minn. PATIENTS: The mortality cohort included 339 deaths from a larger cohort of 5241 Rochester residents who received medical treatment for asthma between 1964 and 1983. MAIN OUTCOME MEASURES: Kappa coefficients were used to measure agreement beyond that expected by chance between the reviewer and the death certificate. The sensitivity and specificity of the death certificate diagnosis of asthma were calculated against the standard of the reviewer/panel diagnosis. RESULTS: Death certificates reported asthma as an immediate or underlying cause of death in 22 instances (6%), whereas the reviewer/panel identified asthma in 53 cases (16%). In four cases, the death certificate listed asthma and the panel identified another cause of death. The death certificate had a sensitivity of 42% and a specificity of 99% compared with the reviewer/panel. Agreement between death certificates and the reviewer was not influenced by whether an autopsy was performed. CONCLUSIONS: Death certificate diagnosis of asthma as an underlying cause of death had a low sensitivity but a high specificity. Increases in mortality due to asthma are not likely caused by false-positive diagnoses of asthma as an underlying cause of death. Asthma mortality rates, determined from death certificate data, may indeed underestimate actual asthma-related mortality.

Adolescent↗

PubMed1994

Immunization coverage and infant mortality rate in developing countries.

We examined whether immunization coverage (IMC) is one of the predictors of infant mortality rate (IMR), as a single indicator representing the availability of primary health care (PHC) services in developing countries. Multiple regression analysis showed that partial correlation coefficients for IMR with immunization coverage (-0.224), logarithm of per capita GNP (-0.294), total fertility rate (0.269), and adult literacy rate (-0.325) were all statistically significant (p < 0.001) in 97 developing countries which make up more than 97% of the population in all the developing countries of the world. Multiple correlation coefficients of IMR with these four variables in 97 countries was 0.921. Thus, more than 80% of variation of IMR in developing countries were explained by the variation of the four variables. The study also showed that IMC was well correlated (simple correlation) with the four indicators of the availability of primary health care services; access to local care (0.730), care of pregnant women (0.603), delivery care (0.666), and infant care (0.553), all of which were statistically significant (p < 0.001) in the 48 developing countries which make up 42% of the population of all developing countries. Multiple correlation coefficients of these four variables was 0.787. About 60% of the variation of IMC will be explained by the variation of the four variables. Thus we conclude that immunization coverage is one of the main predictors of the infant mortality rate. It represents one of the health intervention components which can be used as a proxy indicator of the availability of PHC service in developing countries.

Adult↗

PubMed1987

Incidence of motor neurone disease in the northern region.

The incidence of motor neurone disease in the Northern Region was studied for the year 1981 by means of hospital activity analysis records and questionnaire. The crude incidence rate was 2.2 per 100,000. This was not significantly different from the rate determined by using death certification. The age standardised incidence ratio for the region was 163 using the 1976 population and deaths from motor neurone disease in England and Wales as the reference. The female to male ratio was 1:1.8 and the average age of diagnosis was 63 years. No meaningful intraregional variation was observed. Thus mortality appears to reflect incidence fairly accurately.

Adult↗

PubMed1996

Sales of tranquillizers, hypnotics/sedatives and antidepressants and their relationship with underprivileged area score and mortality and suicide rates.

OBJECTIVE: This study analyses the correlation between the Swedish underprivileged area score and sales of tranquillizers, hypnotics/sedatives, neuroleptics and antidepressants, and the correlation between these sales and mortality and suicide rates, with the aim of using sales data to identify areas with poor socioeconomic conditions. SETTING: Southern Sweden, 33 municipalities in Skåne, 1987 and 1994. DESIGN: Ecological study. Determined and undetermined cases of suicide were taken from the local death register for the years 1987-1993. Suicide rates (determined and undetermined cases) were calculated as the ratio between observed and expected number of suicides. Mortality for people aged 20-64 years was calculated from life tables for the decade 1981-1990. The underprivileged area score was calculated for municipalities using the proportion of persons in the following groups: elderly living alone, under 5 years of age, one-parent families, unskilled, unemployed, living in crowded households, those moving house in the previous year, and ethnic groups. After transformation (square root of arc sine) and standardization, each of the eight variables was weighted by the British general practitioners average weighting and added to give the underprivileged area score. The selection of the eight variables was based on general practitioners' perceptions of the effect of the social characteristics of the populations in their respective residential areas on their workload or pressure on services. The total drug sales figures for tranquillizers, hypnotics/sedatives, neuroleptics and antidepressants are expressed in Defined Daily Doses per 1000 inhabitants per day. The relationship between these variables was analysed using Pearson's correlation coefficient. RESULTS: There was a moderate correlation (0.41-0.68) between the sales expressed as in Defined Daily Doses per 1000 inhabitants per day of tranquillizers and hypnotics/sedatives and underprivileged area score. Furthermore, the sales of tranquillizers and hypnotics/sedatives seemed to be moderately correlated with both mortality (0.44-0.67) and suicide (0.47-0.58). CONCLUSION: Sales of tranquillizers or hypnotics/sedatives could be used with caution as markers for socioeconomic conditions on the basis of their moderate ecological correlation with a composite socioeconomic index such as the Swedish underprivileged area score and their moderate correlation with mortality and suicide.

Antidepressive Agents↗

PubMed1993

Cloning, sequence determination, and regulation of the ribonucleotide reductase subunits from Plasmodium falciparum: a target for antimalarial therapy.

Malaria remains a leading cause of morbidity and mortality worldwide, accounting for more than one million deaths annually. We have focused on the reduction of ribonucleotides to 2'-deoxyribonucleotides, catalyzed by ribonucleotide reductase, which represents the rate-determining step in DNA replication as a target for antimalarial agents. We report the full-length DNA sequence corresponding to the large (PfR1) and small (PfR2) subunits of Plasmodium falciparum ribonucleotide reductase. The small subunit (PfR2) contains the major catalytic motif consisting of a tyrosyl radical and a dinuclear Fe site. Whereas PfR2 shares 59% amino acid identity with human R2, a striking sequence divergence between human R2 and PfR2 at the C terminus may provide a selective target for inhibition of the malarial enzyme. A synthetic oligopeptide corresponding to the C-terminal 7 residues of PfR2 inhibits mammalian ribonucleotide reductase at concentrations approximately 10-fold higher than that predicted to inhibit malarial R2. The gene encoding the large subunit (PfR1) contains a single intron. The cysteines thought to be involved in the reduction mechanism are conserved. In contrast to mammalian ribonucleotide reductase, the genes for PfR1 and PfR2 are located on the same chromosome and the accumulation of mRNAs for the two subunits follow different temporal patterns during the cell cycle.

Amino Acid Sequence↗

PubMed1983

Premature rupture of membranes: the role of C-reactive protein in the prediction of chorioamnionitis.

A group of 52 patients with premature rupture of the membranes (PROM) before 34 weeks' gestation were evaluated prospectively and managed expectantly. Of 42 patients who were delivered of their infants, 26 (61.9%) had significant chorioamnionitis on histopathology, and 18 had positive microbial cultures at delivery. However, only seven patients (16.7%) developed clinical signs of chorioamnionitis. There were no maternal deaths or perinatal deaths attributable to sepsis. Only two infants (less than 5%) had positive blood cultures. All patients were assessed daily for the development of chorioamnionitis. Amniocenteses were not routinely performed. White blood cell counts, band neutrophil counts, and erythrocyte sedimentation rate determinations were found to be unreliable. C-reactive protein determinations were found most reliable with a high sensitivity and specificity. Elevated C-reactive protein levels correlated better with pathologic confirmation of chorioamnionitis than with the clinical febrile morbidity. Clinical implications for the management of PROM are discussed.

Amnion↗

PubMed1993

Involved-field radiotherapy and intra-Ommaya methotrexate/cytarabine in patients with AIDS-related lymphomatous meningitis.

PURPOSE: To evaluate combined limited-field radiotherapy and concentration times time (C X T) intra-CSF chemotherapy in patients with AIDS-related lymphomatous meningitis (LM). PATIENTS AND METHODS: Fourteen men and one woman with AIDS had cytologically documented LM. Eleven patients had systemic non-Hodgkin's lymphoma (NHL) (all B-cell histology, including six immunoblastic, four large cell, one small cell) with leptomeningeal metastases and four patients had primary CNS lymphoma (PCNSL) (all B-cell histology, including two immunoblastic, two large cell) with CSF dissemination. Presenting neurologic examinations included cranial neuropathies (n = 7), normal (n = 4), abulia (n = 2), paraparesis (n = 2), ataxia (n = 1), hemiparesis (n = 1), and aphasia (n = 1). Standardized pretreatment evaluations included contrast cranial magnetic resonance/computed tomography (MR/CT), placement of an intraventricular reservoir, CT myelogram/contrast spine MR, ophthalmologic examination, and indium 111-pentetic acid (DTPA) CSF flow studies. Regions of bulky or symptomatic disease were treated with limited-field radiation therapy, which included whole brain in 10 patients combined with spinal cord irradiation in five patients. Concurrent systemic chemotherapy was administered in 12 patients. All patients were scheduled to receive intraventricular methotrexate (MTX) 2 mg/d for 5 consecutive days biweekly for 8 weeks (induction), followed in cytologically responding patients by MTX administered in a similar manner every 4 weeks (maintenance). In MTX-responsive and consenting patients with cytologic relapse, intraventricular cytarabine (ara-C) was administered, 25 mg/d for 3 consecutive days weekly for 4 weeks (induction), followed by ara-C administered in a similar manner every 4 weeks (maintenance). CSF cytology and neurologic examinations were performed biweekly. RESULTS: In 13 assessable patients (two patients refused CNS directed therapy following standardized pretreatment evaluations), median time to tumor progression was 60 days (range, 3 to 260) and median survival duration was 125 days (range, 44 to 260). Response rate, determined clinically (four of 13 patients) and cytologically (nine of 13), was 69%. Complications included reservoir infection (n = 2) and myelosuppression (n = 11); the latter was felt to be a consequence of coadministered systemic chemotherapy. CONCLUSION: There were no treatment-related deaths. We conclude that involved-field irradiation and intraventricular MTX/ara-C is effective palliative treatment of AIDS-related LM.

Adult↗

PubMed1992

Acute arsenic intoxication: forensic and toxicologic aspects (an observation).

The authors report on an acute suicidal arsenic intoxication (di-arsenic-trioxide). Death can occur one week after ingestion, despite intensive care. The forensic, anatomopathological and toxicologic aspects are reported. Forty titrations are realized at the level of the biologic fluid in viscera, by absorption spectrophotometry. These data are compared with those in standing literature, especially with the rates determined in normal subjects, following simple environmental impregnation.

Adult↗

PubMed1986

Acute nonvariceal upper gastrointestinal bleeding. Care in three different San Diego practice settings.

We compared the care of all adults admitted directly for acute nonvariceal upper gastrointestinal bleeding in 1981 to three types of hospitals: private (n = 138), health maintenance organization (HMO) (n = 105), and university (n = 72). Some patient characteristics differed, but most indices of blood loss, all final diagnoses, and rates of surgery (less than 9%) and death (less than 5%) were similar. Use of intensive care and blood products differed from published guidelines. Health maintenance organization patients had the shortest stays and the fewest transfusions, limited almost completely to packed red cells. Intensive care unit use and duplicate diagnostic testing were greatest for university patients. Rebleeding rates, determined by including readmissions within 1 week of discharge, were less than 7% and similar at the three institutions. Endoscopic signs of recent hemorrhage from an ulcer were significant signposts to rebleeding. Patients endoscoped early and those without endoscopic signs of recent hemorrhage went home sooner than the others.

Aged↗

PubMed1989

Growth rate determination of heterogeneous microbial population in swine manure.

The effect of manure concentration on the growth of the heterogeneous microbial population under batch condition was studied. Four manure concentrations were used in the study. The dehydrogenase activity was used as a measure of the active biomass in the manure. The chemical oxygen demand test was used to measure the change in organic material caused by biological activities. The growth curve of the heterogeneous microbial population in swine manure was essentially similar to that of a pure culture grown batchwise in that it had the four principle phases: lag, exponential growth, stationary, and death. The exponential growth phase followed a diauxic growth pattern. High concentration of manure had an inhibitory effect on the microbial growth. Manure diluted less than 1:3 (manure:water) depressed the specific growth rate of the microbial population.

Animals↗

PubMedDate not supplied

Seasonality of vital events in a Pacific Island population.

Analyses of vital data derived from a family record register for the native population of Guam reveal significant variations in births, deaths, and marriages over the period 1901-41. Although lacking marked photoperiod or temperature changes of temperate zones, the tropical island is subject to marked seasonal differences in rainfall characteristic of western Pacific islands. Marital patterns exhibit troughs associated respectively with the Lenten period and with Christmas celebrations. Infant and childhood deaths show close correspondence with rainfall patterns, consistently exceeding expected values during the rainy season (July-November) when conditions are optimal for the spread of communicable and gastrointestinal diseases. Births attain a peak in November, or at the beginning of the more advantageous season for infant health and survival. Seasonality in vital events, reported for many Euroamerican and some African and Asian populations of modern and historical periods, has rarely been documented for native populations of the tropical Pacific. Comparisons of differences in these patterns among different populations in varied environments provide unique opportunities to evaluate causal models of interactions among biological, sociocultural, and physioenvironmental factors.

Delivery, Obstetric↗

PubMed1987

Heart rate and cardiovascular mortality: the Framingham Study.

The relation of resting heart rate on biennial ECG examinations to mortality rates over 30 years of follow-up of the Framingham cohort was examined based on 1876 total deaths and 894 cardiovascular deaths, evolving out of 5070 subjects free of cardiovascular disease at entry into the study. In both sexes, at all ages, all-cause, cardiovascular, and coronary mortality rates increased progressively in relation to antecedent heart rates determined biennially. A more impressive association to cardiovascular disease was observed in men than in women, which was independent of associated cardiovascular risk factors. Case fatality rates following coronary events also increased with antecedent heart rate and the fraction of coronary deaths as sudden death increased strikingly with heart rate in men 35 to 64 years of age. There was also a substantial excess of noncardiovascular deaths at high heart rates, and the proportion of all deaths resulting from cardiovascular disease did not increase with heart rate. The excess cardiovascular deaths with more rapid heart rates were also noted, excluding those with interim overt cardiovascular disease, suggesting an effect independent of preexisting cardiac damage.

Adult↗

PubMed1994

Prognostic value of Doppler transmitral flow patterns in patients with congestive heart failure.

OBJECTIVES: This study was designed to determine whether Doppler echocardiographic transmitral flow patterns can predict cardiac mortality in patients with congestive heart failure. BACKGROUND: Previous studies have indicated that Doppler transmitral flow patterns are related to New York Heart Association functional class and exercise capacity in patients with congestive heart failure. However, the prognostic significance of these flow patterns is not known. METHODS: We analyzed the relation of transmitral flow patterns and cardiac mortality in 100 consecutive patients (76 men, 24 women; mean [+/- SD] age 60 +/- 11 years) with congestive heart failure symptoms and left ventricular ejection fraction < 40%. At the time of entry into the study, functional class and ejection fraction by radionuclide angiography were determined, and Doppler echocardiography was performed in all patients. Transmitral flow was obtained from the apical four-chamber view at the mitral annulus level. Measurements included early (E) and atrial (A) filling velocities, E/A ratio and deceleration time of the E wave. The patients were assigned to two groups according to E/A ratio or deceleration time of transmitral flow patterns, or both: a non-restrictive group (42 patients) with E/A < or = 1 or E/A = 1 to 2 and deceleration time > 140 ms, and a restrictive group (58 patients) with E/A > or = 2 or E/A = 1 to 2 and deceleration time < or = 140 ms. RESULTS: Of 100 patients, 26 died during a mean follow-up period of 16 +/- 8 months. The cumulative cardiac mortality rate determined by the Kaplan-Meier method was 14% at 1 year and 35% at 2 years. Cox proportional hazards model analysis revealed that transmitral flow (restrictive vs. nonrestrictive, chi-square 6.99, p = 0.008), patient gender (female vs. male, chi-square 4.59, p = 0.03) and New York Heart Association functional class (IV vs. II, chi-square 3.95, p = 0.05) were significantly related to cardiac mortality in patients with congestive heart failure. Mortality rate in the restrictive group was markedly higher than that in the nonrestrictive group at 1 year (19% vs. 5%, respectively, p < 0.05) and at 2 years (51% vs. 5%, respectively, p < 0.01) by log-rank test. Relative risk for cardiac death was estimated as 4.1 at 1 year and 8.6 at 2 years in the restrictive group compared with the nonrestrictive group. CONCLUSIONS: In patients with congestive heart failure, a restrictive transmitral flow pattern, female gender and advanced functional class are predictive of higher cardiac mortality. The restrictive transmitral flow pattern by Doppler echocardiography is the single best clinical predictor for cardiac death in patients with congestive heart failure.

Aged↗

PubMed1996

Evolution of simple sequence repeats.

Simple Sequence Repeats (SSRs) are common and frequently polymorphic in eukaryote DNA. Many are subject to high rates of length mutation in which a gain or loss of one repeat unit is most often observed. Can the observed abundances and their length distributions be explained as the result of an unbiased random walk, starting from some initial repeat length? In order to address this question, we have considered two models for an unbiased random walk on the integers, n (n0 < or = n). The first is a continuous time process (Birth and Death Model or BDM) in which the probability of a transition to n + 1 or n - 1 is lambda k, with k = n - n0 + 1 per unit time. The second is a discrete time model (Random Walk Model or RWM), in which a transition is made at each time step, either to n - 1 or to n + 1. In each case the walks start at length n0, with new walks being generated at a steady rate, S, the source rate, determined by a base substitution rate of mutation from neighboring sequences. Each walk terminates whenever n reaches n0 - 1 or at some time, T, which reflects the contamination of pure repeat sequences by other mutations that remove them from consideration, either because they fail to satisfy the criteria for repeat selection from some database or because they can no longer undergo efficient length mutations. For infinite T, the results are particularly simple for N(k), the expected number of repeats of length n = k + n0 - 1, being, for BDM, N(k) = S/k lambda, and for RWM, N(k) = 2S. In each case, there is a cut-off value of k for finite T, namely k = T lambda ln2 for BDM and k = 0.57 square root of T for RWM; for larger values of k, N(k) becomes rapidly smaller than the infinite time limit. We argue that these results may be compared with SSR length distributions averaged over many loci, but not for a particular locus, for which founder effects are important. For the data of Beckmann & Weber [(1992), Genomics 12, 627] on GT.AC repeats in the human, each model gives a reasonable fit to the data, with the source at two repeat units (n0 = 2). Both the absolute number of loci and their length distribution are well represented.

DNA↗

PubMed1996

Cigarette smoking among U.S. adults by state and region: estimates from the current population survey.

BACKGROUND: Cigarette smoking is responsible for at least one third of all cancer deaths annually in the United States. Few sources exist in the peer-reviewed literature documenting state and regional differences in smoking behavior, despite the fact that cancer prevention and control efforts are increasingly being implemented below the national level. PURPOSE: Our goals were to determine smoking prevalence rates among men and women, by region, and for each of the 50 states and the District of Columbia from census survey data collected in 1992 and 1993 and to compare these rates with rates determined in 1985. METHODS: Every month, the U.S. Bureau of the Census collects labor force statistics on more than 100000 individuals on its Current Population Survey (CPS). For the September 1992, January 1993, and May 1993 CPS, the National Cancer Institute sponsored a 40-item Tobacco Use Supplement. The definition of a current smoker changed slightly between 1985 and 1992-1993. For the 1985 CPS, individuals were considered current smokers if they had smoked 100 cigarettes in their lifetime and were smoking at the time of interview; for the 1992-1993 CPS, current smokers included anyone who had smoked 100 cigarettes and was currently smoking every day or just on some days. We calculated current smoking rates (every day and some days combined) based on more than a quarter million adults (n = 266988) interviewed in 1992-1993. RESULTS: Substantial geographic variation exists in rates of current cigarette use among adults within the United States. In general, adults in the southern United States have higher rates of smoking and adults in the western states have lower rates of smoking and adults in the rest of the country, although differences in smoking behavior between men and women and among various racial and ethnic populations strongly influence these patterns. Only two states, Kentucky and West Virginia, exhibited adult smoking rates (men and women combined) of 30% or higher in 1992-1993; in contrast, in 1985, such rates were reported from 20 states. The only states in which the prevalence was below 20% in 1992-1993 were Utah (17.1%) and California (19.5%). Rates approaching 20% were reported from New Jersey (20.7%), Massachusetts (21.5%), and Nebraska, New York, and Hawaii (22.0% each) in 1992-1993. Rhode Island experienced the greatest relative decline in smoking prevalence from 1985 to 1992-1993, with a calculated relative change of -30.7% (based on a change in rate from 33.5% to 23.2%), followed by Delaware (-25.9%) the District of Columbia and New Jersey (-23.9% each), Connecticut (-23.2%), California (-22.9%), Alaska (-22.8%), Georgia (-22.6%), Massachusetts (-22.1%), and New York (-22.0%). CONCLUSIONS: Smoking rates are not uniform in the United States but vary considerably from state to state, even within the same region of the country. The CPS is the only mechanism currently capable of simultaneously monitoring smoking trends nationally, regionally, and on a state-by-state basis.

Age Distribution↗

PubMed1987

Altered mitochondrial respiration in selectively vulnerable brain subregions following transient forebrain ischemia in the rat.

Mitochondrial respiratory function, assessed from the rate of oxygen uptake by homogenates of rat brain subregions, was examined after 30 min of forebrain ischemia and at recirculation periods of up to 48 h. Ischemia-sensitive regions which develop extensive neuronal loss during the recirculation period (dorsal-lateral striatum, CA1 hippocampus) were compared with ischemia-resistant areas (paramedian neocortex, CA3 plus CA4 hippocampus). All areas showed reductions (to 53-69% of control) during ischemia for oxygen uptake rates determined in the presence of ADP or an uncoupling agent, which then recovered within 1 h of cerebral recirculation. In the ischemia-resistant regions, oxygen uptake rates remained similar to control values for at least 48 h of recirculation. After 3 h of recirculation, a significant decrease in respiratory activity (measured in the presence of ADP or uncoupling agent) was observed in the dorsal-lateral striatum which progressed to reductions of greater than 65% of the initial activity by 24 h. In the CA1 hippocampus, oxygen uptake rates were unchanged for 24 h, but were significantly reduced (by 30% in the presence of uncoupling agent) at 48 h. These alterations parallel the development of histological evidence of ischemic cell change determined previously and apparently precede the appearance of differential changes between sensitive and resistant regions in the content of high-energy phosphate compounds. These results suggest that alterations of mitochondrial activity are a relatively early change in the development of ischemic cell death and provide a sensitive biochemical marker for this process.

Adenosine Diphosphate↗

PubMed1993

Increased reproductive losses in cattle infected with bovine pestivirus around the time of insemination.

Unmated heifers seronegative to bovine pestivirus were used to investigate the effects on conception and embryo-fetal survival of pestivirus infection around the time of artificial insemination. The reproductive performances of three groups were compared; the control group did not become infected during pregnancy, group 1 heifers were infected by contact with a persistently infected cow and calf four days after insemination and group 2 heifers were infected intranasally nine days before insemination. Conception rates and embryo-fetal survival were monitored by serial serum progesterone assays, transrectal ultrasonography and manual palpation of the uterus. The conception rates (determined 20 days after insemination) of 60 per cent (nine of 15) and 44 per cent (eight of 18) for groups 1 and 2 were lower than the 79 per cent (11 of 14) achieved by the control group. The group 1 heifers subsequently experienced significant embryo-fetal loss, resulting in a pregnancy rate (determined 77 days after insemination) of 33 per cent (five of 15), significantly lower than the control group's 79 per cent (11 of 14). The pregnancy rate of the group 2 heifers (39 per cent, seven of 18) was also significantly lower than that of the controls, largely as a result of the group's poor conception rate. All the heifers diagnosed pregnant 275 days after insemination were induced to calve. No persistently infected calves were born.

Animals↗

PubMed1989

[Carotid endarterectomy. Risks and benefits of treatment].

From 1980 to 1985, 210 endarterectomies of the carotid artery were performed in 187 patients (50 female, 127 male). In 55 cases there were asymptomatic filiform stenoses with concomitant high grade stenosis or occlusion of the contralateral artery. 155 stenoses of the carotid artery of mostly the highest degree were symptomatic. Patients were examined by means of the direct CW-doppler ultrasound immediately postoperatively and every six months up to six years. In 9 cases (4.3%) there was a perioperative (central) neurologic incident, which in 5 (2.3%) cases was followed by permanent neurologic deficits. Three of these incidents were caused by an early occlusion of the reconstruction. The stroke rate (including perioperative stroke rate) determined by life table analysis for the whole group after 6 years was 5.6%. The rate of TIA's was 4.5%. The rate of local recurrence (stenosis greater than 50% or occlusions) after six years was 15.3%. Except for the above mentioned early occlusions only one recurrent stenosis was symptomatic. We believe that asymptomatic, non multimorbid patients with doublesided high grade stenoses and symptomatic patients profit from an endarterectomy of the carotid artery, as long as the perioperative stroke rate and mortality do not exceed 3-4%.

Adult↗