Search PubMed⌕ Search

Biomedical subjects

A Saia

Publications and source records attributed to A Saia.

At least 19 recordsLinked to original sources
PubMed1994

Carotid artery endarterectomy in patients with contralateral carotid artery occlusion: perioperative hazards and late results.

The aim of this study was to analyze and compare the perioperative hazards and late results of internal carotid endarterectomy (CEA) in patients with and without contralateral internal carotid artery occlusion. From March 1980 to April 1990, 375 consecutive patients underwent 439 CEAs at the First Department of Vascular Surgery of Padova Medical School. Patients were divided into two groups; group 1 (61 patients) had contralateral internal carotid artery occlusion and group 2 (314 patients) did not (378 CEAs, 64 bilateral). Indications for CEA were similar in both groups. The only significant difference in patient characteristics was a higher rate of previous stroke in group 1 (11% vs. 3%, p < 0.001). General anesthesia, continuous EEG monitoring, selective intraluminal shunt, and arteriotomy closure with a polytetrafluoroethylene patch (PTFE) were used routinely in both groups. An intraluminal shunt was inserted more frequently in group 1 than in group 2 (69% vs. 17%, p < 0.001). Major perioperative stroke occurred in one patient in each group (1.7% vs. 0.31%, respectively; NS). Early fatal stroke rates were 0% and 0.95% in groups 1 and 2, respectively (NS). All patients had neurologic examinations and duplex scans every 6 months (range 6 to 118 months; mean 42 months). Kaplan-Meier survival curves were virtually identical in the two groups; the majority of deaths were caused by myocardial infarction and cancer. There were no stroke-related deaths in group 1 as compared with 8.2% in group 2 (NS). New neurologic symptoms appeared in 4.7% of patients in group 1 and 6% in group 2 (NS) whereas the late stroke rates were 0% and 3.1%, respectively (NS).(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1988

Stroke risk reduction in asymptomatic and symptomatic patients treated surgically: the effectiveness of carotid endarterectomy with patch graft angioplasty.

From March 1980 to March 1987, 217 consecutive patients underwent 252 carotid revascularisations with routine use of continuous EEG monitoring and selective use of an intraluminal shunt for symptomatic (70%) or asymptomatic (30%) internal carotid artery (ICA) atherosclerotic stenosis. All carotid endarterectomies were routinely performed with a patch graft angioplasty. None of the patients suffered permanent or transient neurological deficits in the immediate postoperative period and none of them died. There was an 0.8% stroke rate and 0.4% mortality rate in the early postoperative course. Neurological assessment, Doppler and Echo doppler sonography of both the operated and the contralateral ICA was performed every 6 months. One-hundred and twenty-one patients (142 carotid revascularisations) operated on up to December 31st 1985 were reassessed in July 1986. The mean follow-up time was 35 months (range: 6 months to 6 years). New neurological symptoms were present in 7.4% of the patients; 2.5% of patients developed a stroke and 8.9% showed progression of stenosis in the contralateral ICA. One patient had a common carotid artery stenosis 2 years after surgery. Re-stenosis of the ICA was found in two patients who underwent re-operation without difficulty. The late mortality was 21.4% (11.9% of the overall series). In only two patients (7.6%) was stroke the cause of death.

Blood Vessel Prosthesis↗
PubMed1984

Continuous intraoperative EEG monitoring during carotid surgery.

Continuous intraoperative EEG monitoring and stump pressure measurements were studied during 85 carotid revascularizations performed in 40 symptomatic cerebrovascular patients and in 32 asymptomatic subjects with a cervical bruit. The decision to place a temporary shunt was made on the basis of intraoperative EEG abnormalities regardless of stump pressure values. 11 patients with contralateral carotid lesions showed marked EEG alterations, at the moment of clamping, which returned to normal after the placement of an indwelling shunt. Stump pressure values showed a wide variation and a poor correlation with intraoperative EEG changes. In the early postoperative period there were no deaths; no new neurological deficits were detected. In the follow-up there was only 1 asymptomatic carotid rethrombosis, not revealed by the EEG, which was suspected by Doppler sonography and confirmed by angiography. The authors conclude that EEG gives valuable information about cerebral functions during carotid revascularization and can reduce the intraoperative complications of the procedure. Stump pressure measurement cannot be used alone as a safe indicator of cerebral ischemia during carotid cross-clamping.

Aged↗
PubMed1983

The Prader-Willi syndrome: neuroendocrine study of identical twins.

Identical twins with the Prader-Willi syndrome are reported. Apart from hypogonadism, hypomentia, hypotonia and obesity, they presented shorter than normal stature and the peculiar facies of this syndrome. Both twins also suffered from arterial hypertension with secondary hyperaldosteronism, an abnormality never previously recorded. The endocrinological study showed the presence of hypogonadotrophic hypogonadism in both twins. The GnRH and clomiphene tests suggested a hypothalamic disorder. Although the vast majority of cases with the Prader-Willi syndrome are isolated, the expression of this disorder in two identical twins enhances the possibility of a genetic determination.

Adolescent↗
PubMed1983

Subclavian steal diagnosis: Doppler sonography vs. angiography.

Continuous-wave Doppler sonography is a reliable technique for the diagnosis of subclavian steal. This tool also allows us to identify incipient steals, characterized by either alternating flow or systolic flow deceleration in the vertebral artery, which might escape detection by conventional angiography. Diagnostic criteria are reported and results of a 48-patient study are compared with angiographic data. The different patterns of vertebral flow depend on the degree of proximal subclavian or innominate artery functional stenosis. The Doppler examination is a useful method because it is non invasive, harmless to the patient and allows for the evaluation of associated lesions in other extracranial vessels. It is of particular interest for the diagnosis when the clinical picture is still apparently normal and in the absence of both neurological findings and asymmetrical blood pressure in the arms.

Angiography↗
PubMed1981

Carotid Doppler examination: a correlation with angiography.

The Doppler ultrasound technique is a useful tool for the screening and follow-up of patients with extracranial atheromatous lesions of the carotid tree. Doppler examination was performed on 654 patients and compared with angiographic visualization of a total of 261 carotid arteries in 171 patients. The Doppler diagnostic criteria and their reliability are reported and discussed. This technique is not alternative but complementary to angiography.

Adult↗
PubMed1978

Long-term treatment of Parkinson's disease with L-Dopa and Dopa-decarboxylase inhibitor: therapeutic results and side effects.

The authors present a review of their clinical experience in the treatment of 127 Parkinsonian patients with L-Dopa alone and in association with a Dopa-decarboxylase inhibitor; the follow-up lasted more than 7 years. In all cases the dosages of L-Dopa, either alone or associated with the decarboxylase inhibitor, were fairly low; the strategy was to reach in each case the minimal effective dose instead of the maximal tolerable one. After 7 years of treatment about 60-65% of the patients had shown improvement, even though to a lesser degree than during the first and second year of therapy; the remaining 35-40% were unchanged or worse. The authors conclude that, despite the decreased efficacy of the therapy with time, the L-Dopa treatment remains of great significance in lengthening and in improving the quality of life of Parkinsonian patients.

Aromatic Amino Acid Decarboxylase Inhibitors↗
PubMed1975

Motor neurone disease: an immunological study.

The state of the immune system, both humoral and cell-mediated, was evaluated in motor neurone disease (MND) patients. The data obtained for the MND patients were confronted with normal controls and a group of patients affected by nervous diseases not involving the immune system. Some differences were observed between MND patients and normal subjects, namely: increase of WBC and gamma-globulin in MND patients. However, such differences were not observed between MND patients and pathological controls, and therefore are probably due to a higher frequency of infectious complications in MND patients in respect to normal controls. The capacity of the immune system to respond to an adequate stimulus was normal, and no precipitating anti-CNS antibodies were detected in MND sera. Furthermore, no sex-linked differences were observed and the CSF abnormalities observed in 2 out of 16 MND patients were probably reflecting only destruction of CNS cells. The data are discussed in view of the possible pathogenetic mechanisms of MND.

Amyotrophic Lateral Sclerosis↗
PubMedDate not supplied

MR imaging in a case of Hallervorden-Spatz disease.

Magnetic resonance using a 0.5 T system and a T2-weighted spin-echo pulse sequence revealed symmetric areas of marked hypointensity of the globi pallidi in a case with a family history of and presenting with clinical features consistent with Hallervorden-Spatz disease. No such findings were seen in any of 16 normal volunteers of similar age. Magnetic resonance may be useful for diagnosing Hallervorden-Spatz disease.

Adult↗
PubMedDate not supplied

The rationale for patch-graft angioplasty after carotid endarterectomy: early and long-term follow-up.

A prospective study was undertaken in March 1980, at the Vascular Surgery Department of the Padua University, Medical School, to establish whether patch graft angioplasty is useful in preventing restenosis after carotid endarterectomy (CE). Seventy-four patients underwent 86 CE (bilateral in 12 cases) for atherosclerotic disease involving the carotid bifurcation. Thirty-eight (51.4%) patients presented TIA's or non hemispheric symptoms of cerebrovascular insufficiency; 30 (40.5%) were asymptomatic and 6 (8.1%) had partial nonprogressing or fixed strokes. All operations were performed under general anesthesia, with pharmacologic hypertension and systemic heparinization; in all cases, continuous EEG monitoring and 'stump pressure' measurement were employed. The operation was performed without a temporary intraluminal shunt in the patients showing tolerance to carotid clamping. The protection of the shunt was required only in patients with EEG monitoring changes (17). All carotid arteriotomies were extended into the internal carotid artery to overpass the end of the endarterectomy. Overpass was also used in the proximal edge of the arteriotomy, in the common carotid artery. The distal intima was never fixed with stitches and the arteriotomy was routinely closed with a PTFE patch graft angioplasty. Early results of cerebral protection were excellent. No patient presented permanent or transient postoperative neurological problems and no patient died in the postoperative period for causes related to the operation. This is substantiated by results we achieved during the period 1970-1979 in 192 patients, when all carotid endarterectomies were routinely performed without a shunt, with figures of 2.5% of postoperative stroke and 1.5% of mortality. Longterm follow-up (from 6 to 36 months) was completed in 51 patients (60 operations).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMedDate not supplied

[A case of polymyositis in autoimmune thyroiditis with hyperthyroidism].

A young woman, during an autoimmune thyroiditis with hyperthyroidism, suffered from progressive proximal weakness at her four limbs. The diagnosis of a concomitant polymyositis was indicated by a marked increase of plasma CPK, myopathic findings at EMG and a clearcut picture of inflammatory alterations at muscle biopsy. Steroid therapy brought a full recovery of both thyroid and muscular symptoms. In the following months, the patient suffered from a second episode of thyroiditis and subsequently from another poussée of polymyositis. The possible pathogenesis underlying the unusual association of an autoimmune thyroiditis with a polymyositis is discussed.

Adult↗
PubMedDate not supplied

Surgical management of extracranial vertebral artery occlusive disease.

Thirty-seven consecutive patients underwent vertebral artery (VA) reconstruction over a 6 years period (1983-1989). Detailed neurologic, medical, and angiographic information was obtained for all patients. Indications for surgery were as follows: (1) stenosis of VA with symptoms of vertebrobasilar insufficiency; (2) very tight stenosis (greater than 75%) of the dominant VA with stenosis or occlusion of the contralateral VA; (3) very tight stenosis of VA with bilateral occlusion of the internal carotid artery (ICA); (4) very tight stenosis of VA with homolateral ICA lesion eligible for simultaneous repair; (5) very tight stenosis of VA and very tight stenosis of the homo or contralateral carotid siphon. There were 15 isolated vertebral lesions (group I), and 22 were VA lesions associated with lesions of the supraaortic trunks which were simultaneously treated (group II). The reconstructions of the first portion of the VA were 30 (12 of group I and 18 of group II) and reimplantation of the VA into the common carotid artery was the procedure of choice. There were 7 revascularizations of the third portion of the VA at C1-C2 level (3 of group I and 4 of group II): carotid-vertebral bypass, using an autogenous vein graft, was the procedure of choice. Three patients in group II died in the immediate postoperative period from myocardial infarction but no patient presented immediate postoperative neurologic deficits. All symptomatic patients but one were relieved of their symptoms in a median follow-up of 31 months. No postoperative complications were observed. Long-term results were satisfactory in all the 28 patients at their last follow-up visit.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗