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Available from: Gianmarco de Donato, Feb 25, 2014
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    ABSTRACT: Patients undergoing major surgery are at risk for postoperative cognitive dysfunction (POCD). The consciousness of the POCD arises new ethical and medico---legal issues that should be identified, managed and, if possible, prevented. Elderly patients still represent a real challenge for physicians and medical science. This challenge can be surmounted not only through technical progress but also by safeguarding the correct ethical behavior at the base of each relationship between a patient and his physician. Effective communication with the elderly patient is a prerequisite for clear and complete information, involving family members and caregivers when necessary. In every case, the identification of patients with pre---existing risk factors of POCD, shortening the period of time preceding the surgery and a proper technique of the procedure as well as physical and intellectual exercises, nutrition and medication play an important role in decreasing the incidence of neurocognitive deficits in the elderly.
    Full-text · Article · Sep 2014 · The Journal of cardiovascular surgery
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    ABSTRACT: Objective: To investigate therapeutic effect of carotid artery stenting versus endarterectomy for patients with high-risk carotid stenosis. Methods: A total of 130 carotid stenosis patients at high-risk of stroke were randomly divided into stenting group and endarterectomy group, including 65 patients in each group. The patients in the endarterectomy group underwent endarterectomy and those in the stenting group received carotid artery stenting for treatment. Results: After operation, carotid intima-media thickness (IMT), plague areas and carotid artery resistance indexes in both groups decreased significantly, and the carotid artery peak blood flow velocities increased significantly and had significant differences with that before operation (P < 0.05). After operation, total cholesterol (TC), triglyceride (TG) and low density lipoprotein (LDL) values in two groups all significantly decreased, and intragroup and intergroup differences were statistically significant (P < 0.05). Postoperative three months of followed-up found that the mortality rate in stenting group was 1.5% and that in the endarterectomy group was 9.2%; the mortality rate in the stenting group was significantly lower than the endarterectomy group (P < 0.05). Conclusion: Compared with carotid endarterectomy, application of carotid artery stenting can effectively promote patency of blood flow in the carotid artery, and exertion of its effect is related to lowering lipid and lowering inflammatory factor expression.
    No preview · Article · Oct 2014 · International Journal of Clinical and Experimental Medicine
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    ABSTRACT: 607 Tiffany et al. clearly reported 5 that POCD involves problems with thinking and memory after surgery. In the literature the term is mostly used to represent a decline in a variety of neuropsychological domains including memory, executive functioning, and speed of processing. In a consensus statement POCD has been defined as " a spectrum of postop-erative central nervous system (CNS) dysfunction both acute and persistent…. including brain death, stroke, subtle neurologic signs and neuropsychologi-cal impairment ". A diagnosis of POCD cannot be reached through the evaluation of symptoms alone, but should be formulated taking into account any differences in performance between preoperative (baseline performance) and postoperative 6 neuropsychological tests. The syndrome was first described by Bedford in 1955. 7 Its most basic pathogenetic mechanisms remain unknown, although its pathogenesis must be assumed to be multifactorial, given that, with the exception of age, no certain cause and no specific associated risk factors have yet been identified.
    Full-text · Article · May 2015 · The Journal of cardiovascular surgery
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