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G Meneghetti

Publications and source records attributed to G Meneghetti.

At least 19 recordsLinked to original sources
PubMed2006

Low ankle-brachial index predicts an adverse 1-year outcome after acute coronary and cerebrovascular events.

BACKGROUND: Low ankle-brachial Index (ABI) identifies patients with symptomatic and asymptomatic peripheral arterial disease. The aim of this study was to correlate ABI value (normal or low) with 1-year clinical outcome in patients hospitalized for acute coronary syndromes or cerebrovascular diseases (CVD). METHODS: ABI was measured in consecutive patients hospitalized because of acute myocardial infarction, unstable angina, stroke or transient ischemic attack (TIA). An ABI lower than or equal to 0.90 was considered abnormal. The primary outcome of the study was the composite of non-fatal acute myocardial infarction, non-fatal ischemic stroke, and death from any cause during the year following the index event. RESULTS: An abnormal ABI was found in 27.2% of 1003 patients with acute coronary syndromes, and in 33.5% of 755 patients with acute CVD. After a median follow-up of 372 days, the frequency of the primary outcome was 10.8% (57/526) in patients with abnormal ABI and 5.9% (73/1232) in patients with normal ABI [odds ratio (OR) 1.96; 95% CI 1.36-2.81]. Death was more common in patients with abnormal ABI (OR 2.05; 95% CI 1.31-3.22). Cardiovascular mortality accounted for 81.7% of overall mortality. ABI was predictive of adverse outcome after adjustment for vascular risk factors in the logistic regression analysis (OR 1.93; 95% CI 1.24-3.01). The predictive value of ABI was mainly accounted for by patients hospitalized for acute coronary syndromes (adverse outcome: 12.8% in patients with abnormal ABI and 5.9% in patients with normal ABI, OR 2.35; 95% CI 1.47-3.76). CONCLUSIONS: An abnormal ABI can be found in one-third of patients hospitalized for acute coronary or cerebrovascular events and is a predictor of an adverse 1-year outcome.

Acute Disease↗
PubMed2002

Assessment of atherosclerosis using carotid ultrasonography in a cohort of HIV-positive patients treated with protease inhibitors.

OBJECTIVE: Lipid disorders associated with the use of protease inhibitors (PI) may be a risk factor for premature atherosclerosis development. The aim of this study is to evaluate the extent of carotid intima media thickness (IMT) among HIV-positive patients treated with PI containing regimens compared to PI-naïve and HIV-negative subjects. METHODS: We analysed plasma lipid levels and carotid IMT in 28 HIV-positive patients treated with protease inhibitors (PIs) for a mean of 28.7 months (range 18-43) and in two control groups constituted, respectively, by 15 HIV-positive naïve patients and 16 HIV-negative subjects, that were matched for age, risk factors for HIV infection, cigarette smoke use and CD4+ cell count. RESULTS: PI-treated patients had higher triglyceride, HDL and apo B levels than controls. Carotid IMT was significantly increased in PI-treated patients compared to naïve or HIV-negative subjects. A correlation between cholesterol HDL, triglyceride and ApoB levels and IMT was observed among the entire cohort. CONCLUSIONS: Plasma lipid alterations were associated with an increased IMT and intima media thickening was more pronounced in PI-treated patients than in the two control groups. Periodical evaluation of blood lipid profile and, if required, the use of lipid-lowering agents is advisable. Moreover, physicians should address concurrent risk factor for atherosclerosis that can be modified, including smoking, hypertension, obesity and sedentary life-style.

Adult↗
PubMed2000

Carotid endarterectomy in women: early and long-term results.

BACKGROUND: Although many randomized trials and other multicenter studies have demonstrated the benefits of carotid endarterectomy (CEA) in selected symptomatic and asymptomatic patients, including women, there is a remarkable lack of reports regarding the outcome of CEA with respect to sex. To analyze and compare the outcome of CEA in men and women in a single-group experience, we reviewed a consecutive series of 619 CEAs performed in 539 patients, 371 men (423 CEAs) and 168 women (196 CEAs). METHODS: Data collection was retrospective up to August 1, 1992 and prospective for all 405 patients treated thereafter. RESULTS: Women were significantly less likely than men to have overt evidence of coronary artery disease (P < .001) and had a significantly higher incidence of diabetes (P < .001). No perioperative death occurred in the female group (P = NS), and no statistical difference was found in perioperative stroke risk incidence. Women had a significantly higher incidence of late occlusive events (P = .01), which were all asymptomatic. No late stroke occurred in the female group (P = NS). Life-table cumulative survival rates at 1, 3, 5, and 7 years were 99.3%, 90.5%, 85.9%, and 82.3%, respectively, in women, and 98.9%, 91.9%, 85.2%, and 79.6% in men (log-rang P = .8). CONCLUSIONS: These findings show that perioperative stroke risk and mortality rates, as well as late stroke-free, mortality, and recurrence rates, in patients undergoing CEA, are comparable in men and women. Further, larger comparative studies are necessary to provide more information on the benefit and durability of CEA in asymptomatic patients, but the results of this study suggest that the early and late outcomes are excellent and comparable in symptomatic and asymptomatic men and women.

Adult↗
PubMed2000

The quest for early predictors of stroke evolution: can TCD be a guiding light?

BACKGROUND AND PURPOSE: The present study aimed at evaluating the prognostic value of transcranial Doppler ultrasonography (TCD) in the acute phase of ischemic stroke, when major therapeutic decisions must be made. METHODS: Seventy-three patients with a first-ever ischemic hemispheric stroke underwent neurological assessment according to the Unified Neurological Stroke Scale, clinical subgrouping according to the criteria of Bamford, CT scan, cervical duplex sonography, and TCD, all within 12 hours from stroke onset. TCD was repeated on days 2 and 7. Patients were followed for 90 days, during which we calculated the fatality rate and then assessed clinical outcome. RESULTS: Emergency TCD revealed middle cerebral artery (MCA) no-flow in 24 cases and MCA asymmetry in 30 subjects. Serial TCD showed early (<24 hours) MCA recanalization in 6 patients. After 90 days, no patient with MCA occlusion at admission was autonomous, while 17 of 19 patients (89.5%) with a normal baseline TCD were independent. The fatality rate at 3 months was 21% but was 46% in patients with MCA occlusion and 61% in patients without signs of early MCA recanalization. Total anterior circulation infarct and abnormal TCD were significantly correlated (P:<0.001) with higher mortality rate and worse outcome (Barthel Index score </=60), whereas early CT ischemic signs and severe carotid disease were not. Furthermore, TCD identified within the total anterior circulation infarct subgroup 2 prognostic clusters according to MCA patency at admission (P:<0.001). Logistic regression selected normal baseline TCD as an independent predictor of good long-term outcome and MCA no-flow as an independent predictor of disability or death. CONCLUSIONS: TCD findings play an important role in the early prognosis of anterior circulation stroke, providing possible guidance for therapeutic interventions.

Aged↗
PubMed2000

Early detection of melanoma: an educational campaign in Padova, Italy.

To evaluate a public campaign for the early referral and treatment of cutaneous melanoma, an educational programme based on self-selection by subjects was organized in Padova, Italy in 1991. In the period from 1991 to 1996, 90,000 leaflets containing information on naevi, melanoma and skin self-examination were mailed to each household, reaching a population of 243,000 subjects. A total of 2050 individuals requested a skin check as a result of the leaflet. Most were at low risk, the majority being female (68%) and aged under 40 years (51.6%), with no risk factors (58.3%). One hundred and ninety subjects were referred for surgery for pigmented and non-pigmented suspect lesions. Histological diagnoses, obtained for all lesions, comprised 13 melanomas, 17 dysplastic naevi, 17 basocellular carcinomas, 140 pigmented benign lesions and three lesions of other types. The percentage of thin melanomas (< 1.50 mm) was 92.3%. Three hundred and fifty patients considered at risk at the first skin examination attended regular follow-up examinations. The sensitivity and predictive positive value of the visual examination were 92.8% and 6.8%, respectively. The impact of this campaign was evaluated in the Local Health District of Padova, comparing data from the pre-campaign period (1987-1990) with those from the campaign period (1991-1996); a trend towards a lower stage was observed (mean thickness 2.0 mm versus 1.50 mm; P < 0.02).

Adult↗
PubMed2000

Cerebral perfusion in hypertensives with carotid artery stenosis: a comparative study of lacidipine and hydrochlorothiazide.

Focal cerebral hypoperfusion is a common finding in uncomplicated hypertensives even in the absence of large vessel atherosclerosis, and neuropsychological deficits correlate with cerebral hypoperfusion in hypertensive patients with cerebral microangiopathy. We investigated the effects on cerebral perfusion of the dihydropiridine calcium antagonist lacidipine and of hydrochlorothiazide (HCTZ) in asymptomatic hypertensive patients with concomitant atherosclerosis of the carotid arteries. Fifteen essential hypertensives (including 13 males, aged 55-75 years) with at least one 30-60% stenosis of the internal carotid artery at echo-color Doppler examination were treated in a double-blind, randomized, parallel study with lacidipine (4-6 mg od) or HCTZ (25-50 mg od) for 3 months after a 4-week single-blind placebo period. Regional cerebral perfusion was assessed at baseline and at the end of the treatment period with HMPAO-SPECT. Relative perfusion of cortical and subcortical areas was calculated as the ratio between their tracer activity and that of the cerebellum. At baseline, mean relative perfusion (MRP) of the cortical and subcortical areas was similar in the stenotic and the contralateral side. Despite the fall in pressure, lacidipine increased MRP both in the cortical and in the subcortical areas, whereas HCTZ increased MRP only in the cortical areas. The mean change in local vascular resistance, adjusted for initial perfusion value, was -20 A.U. (arbitrary unit) with lacidipine and -12 A.U. with HCTZ (p < 0.001). These differential effects of antihypertensive drugs on subcortical perfusion may be of benefit in the long-term prevention of vascular dementia in hypertensive patients.

Aged↗
PubMed1999

Carotid endarterectomy without angiography: can clinical evaluation and duplex ultrasonographic scanning alone replace traditional arteriography for carotid surgery workup? A prospective study.

BACKGROUND: The aim of this study was to determine whether clinical evaluation and duplex ultrasonography (DUS) alone can replace contrast cerebral arteriography (CA) for the detection of patients suitable for surgery at our institution. METHODS: During an 18-month period, 100 patients underwent DUS and CA during evaluation for carotid endarterectomy (CEA). All patients were studied prospectively; in each case an initial decision for or against CEA on the basis of DUS evaluation of the internal carotid arteries (ICAs) was subsequently compared with the surgeon's final management plan after CA. Of the 200 ICAs evaluated, 113 were considered for CEA but 14 were excluded from the study because the patient could not be evaluated before and after CA. This left 99 ICAs (86 patients) available for comparative analysis. RESULTS: The outcome of the 2 diagnostic modalities was perfectly consistent in 95.3% of the ICAs (kappa = 0.969). The clinical management decision was altered by the CA findings in only 2 cases (2%). Of the 99 ICAs considered suitable, 97 underwent CEA. No arteriographic complications occurred among the 100 patients undergoing CA. The perioperative stroke risk and mortality rates were 0%. CONCLUSIONS: Ninety-eight percent of the ICAs considered for surgery would have received appropriate clinical treatment on the strength of the patients' neurologic history and the outcome of DUS alone. Our results indicate that DUS is sufficient to establish the need for surgery in symptomatic and asymptomatic patients being considered for CEA and can replace CA in most clinical circumstances.

Carotid Artery, Internal↗
PubMed1999

Symptomatic and asymptomatic carotid artery lesions in peripheral vascular disease: a prospective study.

PURPOSE: To assess the incidence and severity of internal carotid artery lesions in patients who were referred to a single institution with peripheral obliterative atherosclerotic disease (POAD) as their chief complaint, in order to identify symptomatic and asymptomatic subjects at risk of stroke who would benefit from surgery. MATERIALS AND METHODS: Consecutive patients with clinically and Doppler scan-proven POAD underwent prospective screening for the presence of carotid symptomatic and asymptomatic atherosclerotic lesions with duplex ultrasound scan (DUS). Associated risk factors for atherosclerosis, i.e. age, sex, diabetes, hypertension, hyperlipidemia, history of smoking and history of coronary artery disease were assessed and recorded. Univariate analysis was performed to correlate the risk factors with the presence of POAD and carotid lesions. RESULTS: Three-hundred and twelve consecutive patients were evaluated over an 18-month period. A 30% or greater carotid stenosis was detected by DUS in 189 patients (19 bilateral); 57 (30%) of these had neurologic symptoms, 19 of whom had a 70-99% carotid lesion, whereas 65 of the 132 asymptomatic patients had 60-99% carotid stenosis. Univariate analysis revealed no differences in the symptomatic and asymptomatic groups between patients who were potential candidates for carotid endarterectomy according to the North American Symptomatic Carotid Endarterectomy Trial and the Asymptomatic Carotid Atherosclerotic Study Group guidelines, respectively, and those who were not as regards associated atherosclerotic risk factors and severity of POAD. All but 2 (n = 17) symptomatic and 18 asymptomatic patients underwent carotid endarterectomy based on DUS criteria alone. The perioperative stroke risk and mortality rates were 0%. CONCLUSIONS: Routine carotid DUS screening of 312 consecutive patients with POAD revealed that 19 patients with symptoms and 65 (5 bilateral) without symptoms would benefit from surgery, representing 27% of the series considered.

Aged↗
PubMed1999

Cranial and cervical nerve injuries after carotid endarterectomy: a prospective study.

BACKGROUND: The purpose of this study was to review the outcome of patients who had cranial and cervical nerve injuries after carotid endarterectomy (CEA). METHODS: This prospective study reviewed 200 consecutive CEAs. Preoperative and postoperative cranial nerve assessment was completed on all patients. Neurologic evaluation included routine direct fiberoptic laryngoscopy. Patients found to have no neurologic injury had no further follow-up. Patients with postoperative peripheral neurologic dysfunction were enrolled for regular long-term follow-up to assess delayed recovery. RESULTS: Overall, 25 (12.5%) nerve injuries were identified in 24 patients. There were 11 (5.5%) hypoglossal, 8 (4%) recurrent laryngeal, 2 (1%) superior laryngeal, 2 (1%) marginal mandibular, and 2 (1%) greater auricular nerve injuries. None of the patients were lost to follow-up. All nerve dysfunctions were transient, with all but 4 nerves recovering completely within 6 months. The recovery took from 1 week to 37 months, with a mean recovery time of 5.8 months. Two patients with recurrent laryngeal nerve dysfunction were found to have prolonged full recovery time (i.e., 31 and 37 months, respectively). Two patients successfully underwent contralateral CEA, although movement of the opposite vocal cord was not fully restored. CONCLUSIONS: Cranial nerve injury after CEA is a common occurrence and can be classified as a "major" or "minor" complication, depending on the severity of the clinical consequences. Extended follow-up will identify the specific subset of patients with a late complete nerve recovery.

Adult↗
PubMed1997

Results of electroencephalographic monitoring during 369 consecutive carotid artery revascularizations.

A continuous intraoperative EEG monitoring was performed in 369 consecutive carotid artery revascularizations (CARs) (321 patients) to minimize the intraoperative neurological morbidity. There were 227 carotid endarterectomies and patch graft angioplasty (198 patients), 79 carotid eversion endarterectomies (70 patients) and 58 internal carotid artery reimplantations into the common carotid artery (48 patients). Indications for CARs were TIAs (141, 43.9%), amaurosis fugax (60, 18.6%) and fixed or partial nonprogressing stroke (14, 4.3%). One hundred and six patients (33.1%) were asymptomatic. EEG abnormalities consistent with cerebral ischemia occurred in 97 (26.3%) operations. The indwelling shunt (IS) was used in 73 cases; in the remaining 24 (24.7%), IS was not used on purpose because the surgical procedure was carried out successfully within 5-6 min after the appearance of EEG changes. All patients awoke from the anesthesia without any neurological deficit. Five patients presented with a major stroke within postoperative day 1 and 2, and 1 patient died on postoperative day 10. In 2 of these cases, the intraoperative EEG monitoring was absolutely normal and the IS was not used: the carotid occlusion was due to technical errors. The most striking finding of this series is the absence of false-negative results in continuous EEG monitoring. EEG monitoring appears an available and useful method for the detection of cerebral ischemia secondary to carotid cross-clamping and contributes to put at zero the intraoperative complications of the surgical procedure.

Adult↗
PubMed1988

[Continuous EEG monitoring in carotid surgery].

From March 1980 to March 1987, at the Department of Vascular Surgery of the University of Padua, 217 patients underwent 252 carotid revascularizations with routine use of an intraluminal shunt (IS) for symptomatic (70%) or asymptomatic (30%) internal carotid artery (ICA) atherosclerotic stenosis. All carotid endarterectomies (CEs) were routinely performed with patch graft angioplasty to prevent restenosis. In the immediate post-operative period, no patient presented permanent or transient neurological deficits; no patient died. In the early post-operative course there was a 0.9% (2 patients) stroke rate and 0.4% (1 patient) mortality rate. These results suggest that the selective use of the IS on the basis of EEG changes is able to reduce the perioperative morbidity and mortality to nearly zero.

Adult↗
PubMed1987

Pineal germinoma: diagnosis, treatment and tumor response.

We report the case of pineal germinoma in a 25 year old man. The neurological signs and symptoms were insidious in onset; Parinaud syndrome allowed a topical diagnosis, confirmed by CT scan. Computerized Tomography and CSF cytological examination were of the utmost importance to diagnosis and treatment and it confirmed the success of radiotherapy.

Adult↗
PubMed1987

Obesity as a risk factor for endometrial cancer.

The epidemiology and risk factors for endometrial cancer are reviewed, with current data. Obesity seems to be the main risk factor for this neoplasia, both because it is very common in the female population, and because the other risk factor (i.e. estrogen replacement therapy) has almost disappeared with the addition of progesterone therapy. The pathogenesis of obesity as risk factor, although it is not completely clear and unique, is examined.

Estrogens↗
PubMed1986

Therapeutic effect of lisuride in advanced Parkinson's disease.

The therapeutic effects of lisuride hydrogen maleate, a central dopamine agonist, were examined in 15 patients with advanced Parkinson's disease no longer satisfactorily responding to levodopa. A significant improvement (p less than 0.01) in the total Parkinson's disease disability score was obtained by the addition of lisuride to levodopa therapy. The clinical assessment in the follow-up was performed with 2 different disability scales that yielded a more precise evaluation of the efficacy of lisuride, an efficacy that, as with other dopaminergic drugs, showed a slight decrease in time after a mean of 3 months. No important adverse effects were noticed. The only limitation of the use of lisuride was the occurrence of reversible psychic disturbances. It is concluded from this study that lisuride is a valuable tool in the management of advanced Parkinson's disease that allows for a reduction of the side effects of levodopa therapy in the long-term treatment of the disease.

Aged↗
PubMed1985

Effect of lymphocytapheresis plus cyclophosphamide on the course of a chronic progressive form of multiple sclerosis.

We report a case of a 16 year old boy with a chronic progressive form of Multiple Sclerosis treated with lymphocytapheresis and a low dose regimen of cyclophosphamide. A progressive improvement in the disability index and slowing of the clinical course were obtained. No side effects were observed. Depletion of lymphocytes and their pharmacological suppression point to their possible role in the induction of an immunoregulation of the disease process.

Adolescent↗
PubMed1984

Crossed cerebellar diaschisis in ischemic stroke: a study of regional cerebral blood flow by 133Xe inhalation and single photon emission computerized tomography.

Seventy measurements of CBF were performed in 12 stroke patients by 133Xe inhalation and a rapidly rotating single photon emission computerized tomograph. CBF was measured every other day during the acute phase and at 2- and 6-month follow-up visits. A persistent contralateral cerebellar blood flow depression was evident in five patients with severe hemispheric low flow areas, which correlated with large, hypodense lesions on the computerized tomographic scan. In a sixth patient with a small, deep infarct, a transient crossed cerebellar low flow was observed, while the clinical symptoms persisted. It is concluded from this serial study that crossed cerebellar diaschisis is a common finding in completed stroke. It is probably caused by disconnection of the corticopontine pathways, a disconnection that tends to persist. The phenomenon is in fact less variable than the stroke-related CBF changes in the infarcted hemisphere, in which a period of relative hyperemia is frequently seen.

Adult↗
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↗