Notice bibliographique
Résumé
The article by Paterson and Holdsworth in this issue (pages 675–676) highlights several important features. First, focal neurological events are rarely cause by aneurysmal disease of the extracranial arteries. Investigations that exclude cardiac sources for emboli are usually followed by investigations of the carotid bifurcation for stenotic disease. It is surprising that duplex did not detect the aneurysm at the bifurcation in the second case reported, but ultrasound is notoriously dependent upon the skill of the operator. Duplex correctly diagnosed an aneurysm of the carotid bifurcation in the third case. Arteriography is known to be unreliable in the diagnosis of arterial aneurysms, as they often contain thrombus. Ultrasound is the first line investigation, followed by either computed tomography or magnetic resonance imaging (MRI). In the first case, however, angiography identified an aneurysm of the innominate artery but neither duplex nor angiography identified aneurysmal disease in the second case. Angiography of the carotid arteries carries a risk of neurological damage, and should by undertaken only after non-invasive investigations such as duplex and/or MRI. However, angiography may be very useful in the diagnosis, as exemplified in cases 1 and 2. Aneurysms of the carotid bifurcation are very rare, accounting for 0.5% of carotid operations performed at one institution in a recent report.1 Most of the aneurysms in this series were false aneurysms following previous carotid surgery. If surgery is excluded, however, most carotid aneurysms are caused by atherosclerosis and are associated with hypertension. Rare causes include fibromuscular dysplasia, radiation, infection, Marian's syndrome, cystic medionecrosis and granulomatous disease. False aneurysms may also be caused by both blunt and penetrating trauma. Patients may present with a pulsating mass in the neck, often noticed by a friend or relative, but the commonest reason is a focal cerebral event. It is rare these days for aneurysms to grow to a size where they might present with compressive symptoms, but cranial nerves and the sympathetic chain are at risk. Dysphagia has also been reported. Ligation of the carotid artery used to be the treatment of choice, but it was associated with a substantial rate of neurological complications.2-4 A meta-analysis showed that the results of carotid ligation carry a high risk of stroke (25%) and death (20%).5 Two recent series show good results from reconstruction. In the first, 67 cases were treated, two by ligation and 65 by reconstruction.1 The stroke and death rate was 9%. In the second, 25 cases were all reconstructed with no deaths and no major strokes,2 although they reported two minor cerebral events and 11 cranial nerve palsies. These results are worse than those reported for carotid endarterectomy.6 However, the surgery is often more difficult and the higher reaches of the carotid artery may be involved.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,001 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,001 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».