Biomedical subjects
Publications and source records attributed to C Maraglino.
The authors present a case of post-traumatic intracranial meningioma, selected according to the criteria specified in the relevant literature. Assessment of the clinical characteristics of our patient and those reported in the literature seems to confirm that, in some cases, head trauma may be a factor contributing to the development of meningioma.
OBJECTIVES: Studies comparing transcranial Doppler ultrasonography (TCD) with other intraoperative monitoring techniques for detecting clamping ischaemia during carotid endarterectomy under general anaesthesia suggest that a reduction of > two-thirds in the mean middle cerebral artery velocity (mMCAv) or a reduction of > 0.4 in the preclamping mMCAv: clamping mMCAv ratio warrants cerebral protection. Our aim was to study the relationship between mMCAvs and clamping ischaemia during carotid endarterectomy in awake patients. MATERIALS AND METHODS: In a consecutive series of 57 patients undergoing carotid endarterectomy under locoregional anaesthesia 51 were monitored by intraoperative TCD, continuous EEG, and neurologic awake testing. RESULTS: Five of the 51 (9.8%) patients had transient clamping ischaemia, which carotid shunting reversed. TCD showed that these five patients had significant lower mean mMCAvs than the other 46 patients, who had no deficits (1.8 +/- 1.1 cm/s vs. 26.2 +/- 8.5, p = 0.0003). Current TCD criteria indicated that four other patients (7.8%) should have been shunted. All four had significantly higher clamping mMCAvs than the five shunted patients (11.5 +/- 1.9 vs. 1.8 +/- 1.1, p = 0.0012). CONCLUSIONS: Intraoperative TCD detected cerebral ischaemia and yielded no false-negative. An mMCAv of 10 cm/s or less may indicate the risk of clamping ischaemia better than the higher threshold currently proposed. This would avoid unnecessary shunting due to false-positives.
The transcranial doppler is a kind of pulsed doppler (frequency 2 Mhz) which, by arrangement of the probe in particular regions of the skull (temporal, orbital, and occipital fenestra), permits the assessment of the flow velocity on the level of the main intracranial arteris, giving information about the perviety and the characteristics of the flow and about Willis polygon being functional. This non-invasive vascular diagnostic is methodology concerned, and, therefore, fundamental in the evaluation of patients suffering from cerebral-vascular insufficiency and likely to be operated by carotid-TEA.
One of the most common source of lower extremity atheroembolization is the aorta and particularly the infrarenal segment. Complex atherosclerotic plaque can lead the patient to gangrene and major amputation. When the origin of embolization is a focal lesion, endoluminal methods could be an alternative to surgical treatment. Although the experience with aortic stent is limited, the results obtained so far seem to be encouraging. The case of a mid-age heavy smoker woman with a history of the abrupt onset of painfull cyanotic toes in the left foot and subsequent complete gangrene of the first digit in the same foot is herein reported. Angiography and CT scan revealed an high-grade calcified aortic infrarenal plaque. Because of the discrete characteristic of the lesion, an endovascular approach with a Palmaz stent was elected. The stenosis was successfully treated: the patient experienced the complete resolution of the toe painfull cyanosis within 3 months, the stent remained patent through a 24 months follow-up and no subsequent embolic episodes were observed.