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A practical guide to the definitive treatment for patients with carotid artery disease who otherwise run a major risk of life-threatening or debilitating strokes. Multi-centre trials in both Europe and the United States have shown conclusively that carotid endarterectomy significantly reduces the risk of a life-threatening or debilitating stroke. Given these positive results, it will surely follow that more of these procedures will be carried out. Carotid Endarterectomy: a practical guide provides the surgeon with a comprehensive and practical guide to this type of operation. The editors have drawn together an impressive list of contributors from both the United Kingdom and the United States and operative procedures are described by leading exponents in the field. Assuming little prior knowledge, the editors begin by outlining the basic principles, as well as advising on patient selection and diagnosis. Pre- and post-operative investigations and patient care are also covered, ensuring that this book is a landmark text in its area. Profusely illustrated with both colour and black and white photographs, Carotid Endarterectomy: a practical guide is an essential purchase for vascular surgeons as well as general surgeons with an interest in vascular surgery.
Carotid endarterectomy is a commonly performed but controversial procedure. The authors developed from the literature a list of 864 possible reasons for performing carotid endarterectomy, and asked a panel of nationally known experts to rate the appropriateness of each indication using modified Delphi technique. On the basis of the panel's ratings, they determined the appropriateness of carotid endarterectomy in a random sample of 1,302 Medicare patients in three geographic areas who had had the procedure in 1981. Thirty-five percent of the patients in the sample had carotid endarterectomy for appropriate reasons, and 32 percent for inappropriate reasons. Of the patients having inappropriate surgery, 48 percent had less than 50 percent stenosis of the carotid artery that was operated on. Fifty-four percent of all the procedures were performed in patients without transient ischemic attacks in the carotid distribution. Of these procedures, 18 percent were judged appropriate, as compared with 55 percent judged appropriate in patients with transient ischemic attacks in the carotid distribution. After carotid endarterectomy, 9.8 percent of patients had a major complication (stroke with residual deficit at the time of hospital discharge or death within 30 days of surgery). The authors conclude that carotid endarterectomy was substantially overused in the three geographic areas they studied. Furthermore, in situations in which the complication rate is equal to or above the study's aggregate rate, carotid endarterectomy would not be warranted, even in cases with an appropriate indication, because the risks would almost certainly outweigh the benefits.
Although carotid endarterectomy is a controversial and frequently performed surgical procedure, little is known about the clinical appropriateness of its use in actual practice. Are the majority of procedures performed for highly accepted clinical reasons? The authors studied the clinical appropriateness of 107 procedures performed on 95 patients in 1981 in five Veterans Administration teaching medical centers. Standards for judging appropriate use were based on the recommendations of a multidisciplinary panel of nine physicians. Fifty-five percent of the procedures studied were judged clearly appropriate, 32 percent equivocal, and 13 percent clearly inappropriate. The rate of serious operative complications was 5.6 percent. These results suggest that carotid endarterectomy is overutilized within at least some segments of the Veterans Administration population.
Transient Ischaemic Attacks are an important clinical syndrome which indicates an increased risk of major ischaemic stroke and other serious vascular events. In this fully up-to-date volume, the authors provide the clinician with valuable information on the pathophysiological basis of TIAs as well as practical guidance on differential diagnosis, investigation and treatment. They also review and analyse the latest epidemiological information on risk factors and prognosis. This is the only comprehensive resource concerning TIAs exclusively and, drawing on the authors' own broad experience in this area, the book is both an authoritative practical guide and an exhaustive review that gives a unique insight into this fascinating clinical phenomenon.
Dedicated to the surgical management and treatment of cerebrovascular diseases, this excellent and thoroughly comprehensive text is authored by respected experts in various surgical fields, such as general, neurological, cardiac, and vascular surgery. Chapters cover natural history, diagnosis, pathology, pathogenesis, and medical management. This essential surgical volume has been revised to include current developments and more technique.
This revised edition provides a concise yet comprehensive presentation of extracranial occlusive vascular disease. Contains new chapters on carotid endarterectomy in patients with contralateral carotid occulsion, carotid endarterectomy in elderly patients, moyamoya disease, and heparin-induced thrombocytopenia and hypercoagulability in ischemic stroke. This text features detailed illustrations of the surgical anatomy and approaches, and also provides a clinical and diagnostic evaluation.
This comprehensive text provides practical management guidelines for those managing the patient with stroke. The first part of the book reviews emergency management of the stroke patient, subacute management in the ICU, stroke rehabilitation, management in the first two months post-stroke including discussion of risk management, and chronic stroke problems including post-stroke brain, depression, aphasia, sexual relationships, and physical activities. The second part of the book addresses the specific causes of stroke and the underlying pathophysiology. Common and uncommon causes are reviewed.
Text written for physicians interested in the state-of-the-art of vascular surgery, including current therapeutic management of vascular diseases. Designed to be very accessible, with short chapters, recommendations for management, comprehensive referencing and full color illustrations.
Focuses on the therapeutic management of medical disorders as practiced by 13 of the leading private clinics in the U.S.--Cleveland, Geisinger, Guthrie, Henry Ford, Joslin, Lahey, Lovelace-Bataan, Marshfield, Mayo, Ochsner, Palo Alto, Scripps, and Scott & White. Provides clear, practical guidelines on how specific disorders are managed. Emphasizes outpatient management and treatment of adults. Presents concise and detailed aspects of drug and non-drug treatment, allowing the reader to select the therapeutic regimen most appropriate for a specific situations. Shows how high-standard medicine is practiced on a day-to-day and cost-effective basis.
This definitive neuroanesthesiology reference integrates basic scientific knowledge with clinical applications. The clinically oriented chapters are clearly organized and cover key clinical points, case presentations, and discussions. The 4th Edition is comprehensively updated to reflect all of the latest developments in neurosurgical anesthesia, and features contributions from many new experts in the field. Provides a user-friendly organization in each chapter that progresses from key clinical points...through case presentations...to in-depth discussions. Includes more than 350 superb illustrations demonstrating key concepts and techniques. Contains new material on transcranial Doppler ultrasonography, the anesthesia management of patients with neurological disease for non-neurosurgical procedures, perioperative control of cerebral perfusion pressure, functional brain imaging, and jugular and transcranial oxygen measurements. Offers expanded information on osmolality, oncotic pressure, and intravascular volume anesthesia management of patients undergoing neuroradiologic procedures anesthesia for pediatric neurosurgery and spinal cord injury. Presents contributions from numerous new authors, reflecting a wealth of new insights. Spanish version also available, ISBN: 84-8174-633-9
The Second Edition of this highly regarded text provides a current reference source on the clinical and research applications of Transcranial Doppler (TCD) ultrasonography. All of the chapters have been updated to reflect the rapid evolution that has taken place in the field. New information has been included on the increased use of TCD in the operating room, the introduction of contrast media, and the development of new softwares that permit the detection of microemboli. * The most comprehensive resource for neurologists seeking information on the current applications of TCD * Contains 38 color images and over 175 black and white photographs * Written by a contingent of well-respected experts who have demonstrated leadership in the field for new applications
The latest edition of a comprehensive surgical text that incorporates the past knowledge in the specialty together with the present progress, providing in-depth coverage of the basic principles and surgical techniques of management of the vascular system. In particular, this revised and updated edition features complex coverage of imaging, preoperative evaluations, an authoritative section on exposure of vessels, an expanded section on carotid endarterectomy, occlusive arterial diseases, and lymphatic surgery, amputation, and rehabilitation. Thoroughly illustrated in bandw throughout, with a section of 67 color plates. Annotation copyright by Book News, Inc., Portland, OR

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