Biomedical subjects

G Melissano

Publications and source records attributed to G Melissano.

47 records · Page 3Linked to original sources

PubMed1992

The role of transcranial Doppler in carotid artery surgery.

In order to evaluate the usefulness of transcranial Doppler (TCD) in carotid artery surgery, 90 patients who underwent carotid endarterectomy were studied. Transcranial Doppler was performed preoperatively with digital compression of the carotid artery and intraoperatively at the time of cross-clamping, together with routine EEG monitoring. The percentage residual middle cerebral artery velocity (%MCAV) during carotid artery compression or cross-clamping was considered. The intraoperative %MCAV at cross-clamping was compared with the values obtained in the preoperative examination during the compression test and with the EEG data; the EEG records were blindly reviewed by a neurologist and divided into three groups: group A, normal; group B, moderate anomalies and group C, major anomalies. There were no significant differences between preoperative %MCAV (compression test) and intraoperative %MCAV (cross-clamping) by separate analysis of the data related to systolic, diastolic and mean velocity. The systolic, diastolic, mean %MCAV and the Gosling index after cross-clamping were then compared with the EEG data: no significant differences were seen between groups A and B; on the other hand, in all patients with major EEG anomalies (group C) the %MCAV at TCD was reduced to 0. In conclusion, preoperative TCD associated with carotid artery compression appears a safe and useful way of identifying patients at risk of cerebral ischaemia during carotid artery cross-clamping. Patients with no residual flow at intraoperative TCD need to be considered as presenting a very high risk of ischaemia and in this group the use of a shunt is mandatory.

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PubMed1991

Implantable pharmacological defibrillator (AIPhD): preliminary investigations in animals.

The treatment of ventricular fibrillation (VF) by means of automatic implantable cardioverter defibrillators (AICD) poses many severe problems and limitations at the present time. In order to overcome these problems, we propose a totally new way to terminate VF or ventricular sustained tachycardia (VST). Our proposal consists of replacing the electric shock, which is dangerous, delayed, and sometimes ineffective, with a "chemical" shock: i.e., a chemical bolus retroperfused in the coronary sinus (CS) immediately after VF arises. The possible device is hypothesized and preliminary investigations in animals, performed to verify the theoretical assumption, are presented. In rabbits, and in larger animals (sheep and swine). Drugs were perfused in the coronary bed: lidocaine was used in 86% and bretylium tosylate in 14% of the animals. The results were: lidocaine immediately terminated VF in 100% and sinus rhythm was restored in rabbits; lidocaine terminated VF in VST in sheep; and in swine, bretylium immediately produced sinus rhythm in one case; in another one, only delayed sinus rhythm was achieved but lasted a short time; in the last case ventricular tachycardia at 128 beats/min appeared. Because new drugs, which are really "defibrillating" drugs, are available (bretylium tosylate, bethanidine, clofilium, tricyclic antidepressants, phenotiazine derivatives), we plan to investigate these defibrillating drugs in isolated hearts, found in suitable animals like dogs (sheep and swine are difficult to defibrillate) and in humans during routine electropharmacological studies.

Animals↗

PubMed1991

[Coarctation and hypoplasia of the abdominal aorta].

In this study we report one case of abdominal aortic coarctation of unknown etiology, probably congenital or connatal, and two cases of aortoiliac occlusion in young non-diabetic patients, with an intrinsically small aortoiliac tree. These syndromes usually appear in young age; the principal clinical features are arterial insufficiency involving the lower extremities, often well tolerated, and hypertension. The differential diagnosis is with primitive atherosclerotic or inflammatory pathology. Echography and Doppler-echography can be helpful in the diagnosis, but intra arterial digital angiography is mandatory in confirming it. Medical therapy is usually unsuccessful, especially in controlling blood pressure, therefore surgery still remains the treatment of choice, together with PTA that can be applicable in selected cases.

Adult↗

PubMed1990

[Treatment of obliterating arteriopathies of the lower limbs using angioplasty. Comparison of 2 techniques of recanalization: Nd-YAG laser and radiofrequency thermal probe].

The Authors report their experience about 20 cases of femoro-popliteal revascularization: in 15 cases a Nd-YAG Laser was used; in 5 cases a unity which employs radiofrequency energy to heat the tip (Thermoprobe) was utilized. We obtained an immediate recanalization in 19 out of 20 superficial femoral arteries with two early thrombosis. In 12 patients of the first group a significant increase of the ankle-brachial index (45%) was seen; it remained unchanged during the follow-up. We had successful revascularization in all the 5 patients of the second group (Thermoplaster). In selected cases, when the lesion is shorter than 10 cm, not completely calcified, and there is a valid run-off, Laser angioplasty could be a valid alternative to surgery or medical therapy.

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PubMed1989

High-dose aprotinin: hemostatic effects in open heart operations.

Two groups of patients were prospectively studied to evaluate the hemostatic effects of high-dose aprotinin in open heart operations. Group A patients (n = 22) received aprotinin during the entire surgical procedure. Group B patients (n = 12) served as controls. The groups were homogeneous for base variables and for cardiopulmonary bypass duration. Postoperative bleeding was lower in group A (mean, 486 mL) than in group B (830 mL) (p less than 0.01). The need for banked blood decreased by approximately half in the aprotinin patients (mean: group A, 213 mL; group B, 409 mL). Hemoglobin levels were similar in the two groups (postoperative day 7: group A, 11.29 g/100 mL; group B, 11.26 g/100 mL; NS). Platelet count decreased at the end of operation in both groups (99,000 and 95,000/mL, respectively; NS) and then increased beyond baseline levels before discharge. No complications were observed that could be attributed to aprotinin. In conclusion, we believe that the use of high-dose aprotinin is safe and effective. It decreases blood loss and reduces the need for banked blood in cardiac operations, particularly in select groups of patients (eg, those undergoing reoperation, Jehovah's Witnesses, those with renal failure).

Adult↗

PubMedDate not supplied

Combined carotid endarterectomy and myocardial revascularization: personal experience.

A significant percentage of patients undergoing myocardial revascularization suffer from extracranial cerebrovascular disease; recognition of such combined lesions identifies patients at risk for cerebrovascular accidents during the cardiac procedure. Simultaneous or staged coronary artery bypass graft (CABG) and carotid endarterectomy operations have been performed for the last 20 years, however, the clinical indications and the timing of the procedures remain controversial issues. Between November 1988 and January 1994, 1122 patients underwent myocardial revascularization at our Institute and in 35 cases (3.7%) carotid endarterectomy was simultaneously performed; 502 isolated carotid endarterectomies were performed in the same period. Trivascular coronary artery disease was found in 27 cases and low ejection fraction in six. Each patient received an average of 3.7 coronary grafts. Hospital mortality was 5.7% and major neurologic morbidity 2.8%. We believe that a simultaneous approach is recommended in patients with unstable angina and symptomatic carotid artery disease; in patients with a critical but asymptomatic carotid artery stenosis the indication for operation is subject to individual clinical judgment.

Journal Article↗

PubMedDate not supplied

Endovascular treatment of thoracic aortic pathology: lessons learned.

INTRODUCTION: Endovascular repair has emerged as a very important treatment modality in the management of thoracic aortic diseases due to its reduced invasiveness especially in patients at increased risk for open surgery. Aim of this study is to analyze the lessons learned in our experience of thoracic aortic endografting. MATERIAL AND METHODS: From June 1999 to January 2006, 145 selected patients (121 men and 24 women with a mean age of 70 +/- 9 years) with thoracic aorta disease received endovascular treatment with one of four different commercially produced stent grafts (Cook, Gore, Endomed, Medtronic). Indications for treatment included disease of the descending thoracic aorta in 92 cases, of the aortic arch in 43 cases and of the thoracoabdominal aorta in 10 cases. In 48 patients, an hybrid surgical and endovascular approach was required. RESULTS: Primary technical success was achieved in 137/145 (94.5%) cases. One patient died intraoperatively and seven patients had a type "I a" endoleak. In-hospital complications included perioperative stroke in three patients, acute renal failure in two patients, acute respiratory failure in one. Initial clinical success was obtained in 128/145 patients (88.3%) with a mortality rate of 9/145 (6.2%). At 38 +/- 16 months, mid-term clinical success was obtained in 89.5% of the followed patients. Two patients died from fatal aneurysm rupture. One type I endoleak was successfully treated with a rescue endovascular procedure, four cases of type I endoleak resolved completely without any further intervention, no new onset endoleak was discovered. One patient underwent a successful open conversion. Aneurysm expansion was observed in one patient. CONCLUSION: Endovascular surgery is changing the management of complex aortic disease. Synergy between endovascular and surgical procedures may provide a solution for many challenging clinical problems.

Adult↗

PubMedDate not supplied

Ruptured abdominal aortic aneurysm in the elderly patient.

The authors discuss several aspects of the management of ruptured abdominal aortic aneurysm in elderly patients. The cost-effectiveness and indications of repair of rAAA in elderly patients are analysed. A literature survey of risk-factors and results of open treatment of rAAA in elderly patients is made. The challenge of endovascular repair of rAAA in the elderly patient is discussed. Finally, the authors report their personnal experience with AAA repair in 163 patients aged 75 years and older, operated on between January 2003 and September 2005(89 endoaneurysmal stentgrafts and 74 open repairs, 42 rAAA,23 symptomatic AAA and 98 selective asymptomatic AAA).

Aged↗

PubMedDate not supplied

Results of carotid endarterectomy performed with preoperative duplex ultrasound assessment alone.

Contrast injection cerebral angiography has been considered for several decades the "gold-standard" technique for diagnosis and operative planning of carotid disease. More recently, however, an increasing number of institutions are using duplex ultrasound as the single independent preoperative test. The objective of this investigation was to evaluate the impact of the utilization of duplex ultrasonography as the only preoperative test on the outcome of the procedure. Between 1993 and 1996, the authors performed 1,149 carotid procedures. Duplex ultrasound as the only preoperative test was employed with increasing frequency in a total of 728 cases. In 1995 and 1996, a cerebral arteriogram was performed only if duplex ultrasound was technically inadequate or questionable or showed an atypical pattern of disease. During the 4 years analyzed in this study, the number of the procedures increased from 165 in 1993 to 412 in 1996. The thirty-day mortality rate was 0.43%, and neurologic morbidity was 1.65%. According to the year in which the procedure was performed, the mortality/morbidity rates were 1.2/2.4 in 1993, 0.52/2.08 in 1994, 0.26/1.57 in 1995, and 0.24/1.21 in 1996. Indication to perform an arteriogram became very selective in 1995. Regardless of these changes in the diagnostic work-up, some degree of reduction in both 30-day mortality and neurologic morbidity was recorded. Considering a cost of 724 European Currency Units (ECU) per arteriogram, 527,072 ECU were saved in this period. In the last 4 years, duplex ultrasound has replaced arteriography as the first-choice technique for preoperative assessment of carotid disease at the authors' institution. There was definitely no detrimental effect on the clinical results that, on the contrary, improved during the same period. This policy has allowed a significant reduction in the cost of the procedure and has most likely prevented several arteriography-related complications. The authors recommend this policy to all institutions in which accurate duplex ultrasound is available.

Aged↗

PubMedDate not supplied

[Open repair of pararenal aortic aneurysms].

Surgical treatment of pararenal aortic aneurysms, if compared to open repair of infrarenal aneurysms, is characterized by more technical difficulties and haemodynamic problems. Since endovascular repair has become feasible in most cases of infrarenal aneurysms, surgical treatment of pararenal aneurysms is a matter of great interest for vascular surgery. Detection of pararenal aneurysms needs a careful preoperative diagnosis, assessment of cardiac, renal and pulmonary status of the patient and planning of the surgical intervention. The surgeon needs to face an extended proximal aorta exposure, to manage the left renal vein and to choose an appropriate clamping site. Then a skilled and quick reconstruction of the visceral arteries is fundamental to minimize organ disfunction. Coupled intraoperative selective perfusion of visceral arteries and systemic administration of nephroprotective drugs optimizes organ protection during ischemia. To better define challenges, risks and results, we reviewed our experience with the treatment of pararenal aortic aneurysms. In the period between January 1993 and May 2003, 98 consecutive patients underwent surgery for pararenal aneurysms at our Institution. We treated 98 pararenal aneurysms, divided in 68 juxtarenal and 30 pararenal ones. In the juxtarenal aneurysms group, the 30 days mortality rate was 5.8% (4/68); 3 of these patients underwent urgent operation for ruptured aneurysm. In the suprarenal aneurysms group, the 30 days mortality rate was 3.3% (1/30). In conclusion pararenal aneurysm repair is a safe procedure, especially if performed electively, and represents an interesting field of research to improve surgical and anesthesiologic techniques.

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PubMedDate not supplied

[Localized dissection of the abdominal aorta. Diagnosis and surgical treatment].

Abdominal aortic dissection is a rare pathology. As far as we are concerned, only 59 cases have been reported in the English literature. In the last two years, two cases were treated at our Institution. Both were males, over 70 years of age. They were evaluated with ultrasonography, angiography (1 case) and Magnetic Resonance Imaging which showed localised dissection of the abdominal aorta with aneurysmal dilatation. They underwent surgical treatment with good results. At 1 and 2 years from operation both patients are alive and well. A postoperative ultrasonography didn't show any residual dissection.

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