颈内动脉接近完全闭塞时的处理

目的由于卒中风险随着狭窄严重程度的增加而升高，因此认为颈内动脉（ICA）接近闭塞患者的卒中风险很高。在现有的随机试验中，还没有专门针对这种情况进行探讨，因此其处理尚存在争汶。方法：对相关文献进行系统评价。结果：对ICA接近闭塞患者的处理还存在争议：一些学者支持进行干预，而另一些学者则认为存在风险或没有益处而反对进行干预。在ICA接近闭塞的有症状患者中进行一项比较外科治疗与最佳内科治疗的多中心前瞻性随机试验似乎非常困难，因为这类研究需要大量的患者。尽管如此，基于目前的证据，似乎很难拒绝手术治疗。结论：由于目前对ICA接近闭塞患者的最佳处理方案仍存在着争议，因此需要前瞻性观察性研究以证实其在有症状和无症状人群中的患病率以及相关的卒中风险。基于目前的证据，大多数医疗中心选择手术治疗，但它相对干内科治疗的特粱尚右待证章．     

Severity of asymptomatic carotid stenosis and risk of ipsilateral hemispheric ischaemic events: results from the ACSRS study.

OBJECTIVES: This study determines the risk of ipsilateral ischaemic neurological events in relation to the degree of asymptomatic carotid stenosis and other risk factors. METHODS: Patients (n=1115) with asymptomatic internal carotid artery (ICA) stenosis greater than 50% in relation to the bulb diameter were followed up for a period of 6-84 (mean 37.1) months. Stenosis was graded using duplex, and clinical and biochemical risk factors were recorded. RESULTS: The relationship between ICA stenosis and event rate is linear when stenosis is expressed by the ECST method, but S-shaped if expressed by the NASCET method. In addition to the ECST grade of stenosis (RR 1.6; 95% CI 1.21-2.15), history of contralateral TIAs (RR 3.0; 95% CI 1.90-4.73) and creatinine in excess of 85 micromol/L (RR 2.1; 95% CI 1.23-3.65) were independent risk predictors. The combination of these three risk factors can identify a high-risk group (7.3% annual event rate and 4.3% annual stroke rate) and a low risk group (2.3% annual event rate and 0.7% annual stroke rate). CONCLUSIONS: Linearity between ECST per cent stenosis and risk makes this method for grading stenosis more amenable to risk prediction without any transformation not only in clinical practice but also when multivariable analysis is to be used. Identification of additional risk factors provides a new approach to risk stratification and should help refine the indications for carotid endarterectomy.     

Factors associated with the development of superficial vein thrombosis in patients with varicose veins

Introduction

Superficial vein thrombosis (SVT) is a common and controversial clinical entity. Recent studies have demonstrated that SVT should be seen as a venous thromboembolism (VTE). The objective of this study was to investigate the prevalence of thrombophilia defects and to estimate the role of age, sex and body mass index (BMI) in patients with varicose veins (VVs) and SVT.

Materials and Methods

A total of 230 patients with VVs, 128 with, and 102 without SVT underwent thrombophilia testing included factor V Leiden, prothrombin G20210A, methylenetetrahydrofolate reductase and plasminogen activator inhibitor- 1 mutations, protein C, protein S (PS), anti-thrombin III and plasminogen deficiencies and levels of A₂ antiplasmin, activate protein C resistance and lupus anticoagulant. According to Clinical- Etiology- Anatomy- Pathophysiology (CEAP) classification patients were categorized in two subgroups: moderate disease (C_2,3) and severe disease (C_4,5,6). Age and body mass index were also assessed.

Results

The prevalence of thrombophilia defects was significantly higher in patients with moderate disease and SVT (p = 0.002). In the C_2,3 group, SVT was associated with PS deficiency (p = 0.018), obesity (p < 0.001), male gender (p = 0.047) and age (p < 0.001). There were no significant differences in patients with severe disease.

Conclusions

Age, male sex, obesity and PS deficiency are factors associated with SVT development among patients with VVs having moderate disease (C_2,3).     

Confidentiality of health information in Greece,the birthplace of Hippocrates

It is a doctor's duty to observe the rules of professional secrecy strictly by refraining from disclosing voluntarily to any third party information concerning a patient, that he has learned in the course of his professional practice. Greece is a European Union country with its own tradition, history, culture and beliefs but without political and legislative experience in the statutory handling of medical matters. This paper aims to give emphasis to the obligation of confidence in the area of medical practice and to discuss the legal issues likely to be raised in relation to the current state of Greek legal order.     

Physicians' liability in interventional radiology and endovascular therapy

INTRODUCTION/OBJECTIVE: Modern practice in Radiology has rapidly changed over the last decades incorporating invasive techniques. Additionally, litigation in medical practice has arisen as an important issue. This article aims to highlight issues related to malpractice in interventional radiology and endovascular therapy in order to point out the importance of the written informed consent. METHODS AND MATERIAL: Search of relevant literature from the Pubmed. RESULTS: The role of radiologist has been greatly transformed over the last decades. He is not only entitled to participate in the diagnosis but also he undertakes therapeutic procedures, either alone or as a member of a team. Thus the radiologist is now more exposed to actions that maximize litigation risk. Adequate communication and a written consent form seem to be mandatory before any invasive radiological procedure. Patient should know in detail the benefits and the risks of the scheduled procedure and whether the proposed therapy is a new form of treatment or part of a randomized trial. DISCUSSIONS AND CONCLUSION: Interventional radiologist or physician is exposed to high litigation risk. This certainly requires an urgent adaptation of his practice and attitude to the new reality. Written patient's informed consent remains an integral part of the communication between physicians and patients, and importantly is offering professional protection along these lines.