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J J Castronuovo

Publications and source records attributed to J J Castronuovo.

At least 19 recordsLinked to original sources
PubMed2000

Laparoscopic-assisted abdominal aortic aneurysmectomy.

PURPOSE: The technical elements and early results of laparoscopic-assisted abdominal aortic aneurysmectomy are described. METHODS: From February 1997 to May 1999, 60 patients underwent elective laparoscopic surgery for infrarenal abdominal aortic aneurysm. Patients ranged in age from 53 to 87 years (mean age, 70.6 years). The mean aneurysm size was 5.7 cm (range, 4.4-8.0 cm). All patients underwent aortography and computed tomography scanning preoperatively. Patients were not deemed candidates for the procedure when visceral arterial abnormalities requiring surgical treatment were present or an aortic aneurysm neck shorter than 0.5 cm was found. A risk-stratification system was used as a means of quantitating risk factors and excluding high-risk patients. Aortic reconstruction was performed with retroperitoneal laparoscopy, with the patient in a modified right lateral decubitus position. An Endo TA 30 and an Endo TA 60 laparoscopic staplers (US Surgical, Norwalk, Conn) were used in occluding the common iliac arteries and aneurysm sac. Laparoscopic hemoclips were used as a means of occluding the lumbar arteries and other branches of the aneurysm sac. An aortobifemoral or aortobi-iliac bypass grafting procedure was performed by means of the laparoscope to position the graft and visualize the end-to-end aorta-to-graft anastomosis, with distal anastomoses performed through counter incisions. RESULTS: Three patients died within 30 days of surgery (mortality rate, 5.0%). Complications included left ureteral injury (1), postoperative myocardial infarction (1), ileofemoral deep venous thrombosis (1), acute renal failure (2), colon ischemia (1), and infected graft limb requiring revision (1). The mean operative time was 7.7 hours, and the mean aortic cross-clamping time was 112 minutes. Compared with a contemporary consecutive series of 100 patients undergoing open transabdominal or retroperitoneal aneurysmectomy performed by the same group of surgeons, the laparoscopic patients had decreased length of stays in the intensive care unit and the hospital, with less need for ventilator support, earlier resumption of a regular diet, and an earlier return to normal activity. At the follow-up examinations, all bypass grafts were patent. CONCLUSION: Laparoscopic-assisted aneurysmectomy is safe and effective and can be performed with good results. The longer operation time required is well tolerated in patients who are at good and moderate risk. Prior training in laparoscopic aortic surgery is necessary for surgeons to obtain the required level of expertise needed to perform these procedures. With these caveats, the results of our study suggest that laparoscopic-assisted aortic aneurysmectomy is appropriate for moderate-to-good risk (American Society of Anesthesiologists class of III or lower) operative candidates meeting standard criteria for aneurysm resection in whom preoperative computed tomography scan and biplane arteriography demonstrate a proximal aneurysm neck of 0.5 cm or larger and no need for visceral or internal iliac artery reconstruction. A randomized trial would be required to confirm the benefits of this procedure over open aneurysmectomy.

Aged↗
PubMed2000

Skin perfusion pressure of the foot is a good substitute for toe pressure in the assessment of limb ischemia.

PURPOSE: Noninvasive measurements of limb systolic pressures are used routinely in the assessment of the severity of peripheral arterial disease, including the evaluation for critical limb ischemia. However, ankle pressures cannot be measured reliably in patients with medial calcification, which is especially common among patients with diabetes. Skin lesions on the toes or previous digital amputations may preclude the measurement of toe pressures. Measurements of skin perfusion pressure (SPP) are not subject to such limitations and were shown to be useful in the assessment of the severity of peripheral arterial disease. Because toe pressure is often used in the evaluation of severity of arterial disease and in the assessment for critical ischemia, we undertook to study whether there is a sufficient correlation between toe pressure and foot SPP that would allow the use of SPP measurements when toe pressures cannot be measured. METHODS: Measurements were carried out in 85 limbs of 71 patients referred to the vascular laboratory for evaluation for peripheral arterial disease. Diabetes mellitus was present in 43 patients. Each patient had foot SPP and toe pressure measurements. Toe pressures measured with photoplethysmography were correlated with foot SPP measured with laser Doppler scanning. RESULTS: There was a strong linear correlation between SPP and toe pressure (r = 0.87; P <.01). Also, significant correlation was found in both the patients with diabetes and the patients without diabetes (r = 0.85 and 0.93, respectively; P <.01 in both cases). CONCLUSIONS: We concluded that SPP measured in the foot correlates well with toe pressure and can be substituted for toe pressure measurement in patients in whom toe pressures cannot be measured.

Adult↗
PubMed1998

Effects of chronic wound fluid on the structure and biological activity of becaplermin (rhPDGF-BB) and becaplermin gel.

In this study, the effects of chronic wound fluid on the structure and biological activity of becaplermin (recombinant human platelet-derived growth factor-BB [rhPDGF-BB]) were evaluated. Wound fluid was collected from 12 subjects with diabetic ulcers or pressure ulcers. Wound fluid +/- becaplermin was added to cell cultures before- and after incubation for 12 hours at 37 degrees C or after 12 hours' topical treatment. Biological activity, concentration, and immunogenicity were determined by [3H]thymidine incorporation into quiescent human foreskin fibroblasts, enzyme-linked immunosorbent assay (ELISA), and Western blot analysis, respectively. No PDGF-BB or mitogenic activity was detected in chronic wound fluid alone. Mitogenic activity was present in post-treatment samples from becaplermin-treated subjects but not placebo-treated subjects. Exposure to chronic wound fluid for 12 hours did not alter the amount, banding pattern, or mitogenic activity of becaplermin. Biologically active becaplermin remains in wound fluid 12 hours after topical application of becaplermin gel.

Adult↗
PubMed1997

Skin perfusion pressure measurement is valuable in the diagnosis of critical limb ischemia.

PURPOSE: Critical limb ischemia (CLI) is equated with a need for limb salvage. Arterial reconstruction and major amputation are the therapies ultimately available to such patients. We studied whether measurements of skin perfusion pressure (SPP) can be used to accurately identify those patients with CLI who require vascular reconstruction or major amputation and distinguish them from patients whose foot ulcer would heal with local wound care or minor amputation. METHODS: Fifty-three patients with a total of 61 limbs with a nonhealing foot ulcer (age range, 47 to 88 years; mean, 70.8 +/- 9.8 years; 33 men, 20 women) who were referred to the Vascular Laboratory at Morristown Memorial Hospital for evaluation of arterial insufficiency were studied in a prospective, double-blinded fashion. Patients were included in the study if informed consent was obtained, and patients were excluded if there was uncontrolled sepsis or if they required guillotine amputation. The size and site of the foot ulcer was recorded. If gangrene was present, the location and extent was also noted. The pulses were examined and recorded, and the ankle-brachial index was determined for each limb. Measurements of SPP were made at the proximal margin of the ulcer in viable tissue (not in the bed of the ulcer). SPP measurements were made independent of the vascular surgeon's evaluation of the limb and were not part of his clinical decision regarding management of the foot ulcer. The SPP measurements were compared (Fischer's exact test) with the clinical decision for therapy (group I, arterial reconstruction or major amputation; or group II, wound debridement, minor amputation, or both). SPP was also compared with the outcome (ulcer healed or failed to heal) of therapy in group II. From contingency tables we calculated the sensitivity, specificity, positive and negative predictive values (PPV, NPV), and the overall accuracy of SPP measurement as a diagnostic test for critical limb ischemia. RESULTS: There was no difference in the size or location of foot ulcers between groups I and II, nor was there a difference in ulcer size or location between limbs that healed and did not heal in group II. The prevalence of diabetes was similar in all groups and subgroups. The ABI was not predictive of the need for reconstruction or major amputation nor the outcome of local therapy. SPP measurements identified 31 of 32 limbs diagnosed as having CLI by clinical evaluation (i.e., group I, those limbs that required vascular reconstruction or major amputation). Of those patients who were clinically assessed as not having CLI (group II), SPP measurements diagnosed 12 of the 14 limbs that did not heal as having CLI (PPV, 75%) and 11 of 15 limbs that did heal as not having CLI (NPV, 85%). The sensitivity of SPP less than 30 mm Hg as a diagnostic test of CLI was 85%, and the specificity was 73%. The overall diagnostic accuracy of SPP less than 30 mm Hg as a diagnostic test of critical limb ischemia was 79.3% (p < 0.002, Fischer's exact test). CONCLUSIONS: We conclude that SPP measurement is an objective, noninvasive method that can be used to diagnose critical limb ischemia with approximately 80% accuracy.

Aged↗
PubMed1995

Technical elements of successful laparoscopic cholangiography as defined by radiographic criteria.

OBJECTIVE: To define the elements of successful laparoscopic cholangiography. DESIGN: Retrospective review of 130 consecutive patients who underwent laparoscopic cholangiography. SETTING: Community hospital with a surgical residency. PATIENTS: Thirty-four males and 96 females, aged 16 to 86 years, with acute and chronic cholecystitis. INTERVENTION: Laparoscopic cholecystectomy during intraoperative cholangiography. MAIN OUTCOME MEASURE: A cholangiogram that satisfactorily delineates biliary anatomy as defined by accepted radiologic criteria. RESULTS: A successful laparoscopic cholangiogram was obtained in 98.5% of the study group. CONCLUSION: A safe and reliable technique to obtain a laparoscopic cholangiogram is described and validated using accepted radiologic criteria.

Adolescent↗
PubMed1995

Cytokine therapy for arterial restenosis: inhibition of neointimal hyperplasia by gamma-interferon.

Inhibition of neointimal hyperplasia by gamma-interferon (gIFN) treatment was evaluated. Four groups of Sprague-Dawley rats (n = 72) weighing 500 g underwent endothelial injury of the carotid artery using the previously described Fogarty catheter technique. Group I (controls, n = 8) received one phosphate-buffered saline (PBS) injection 24h before injury and every 24h thereafter for a total of eight injections. Groups II (n = 8) and III (n = 8) received daily injections of 200,000 units of gIFN according to the same schedule except that group III did not receive the preoperative dose. Animals were killed on postoperative day 14. Histologic sections were analyzed morphometrically and immunohistochemically. Both gIFN groups had a statistically significant 50% reduction of the cross-sectional area of the neointimal hyperplasia compared with that of the controls (P < 0.01). Cell replication analysis of smooth muscle cells in the media and neointima revealed no statistically significant difference between controls and gIFN-treated groups. Group IV consisted of 48 rats that were treated with either PBS or gIFN on a schedule similar to that of groups I and II. Animals were killed at frequent time intervals during the first 7 days after injury. Their arteries were analyzed histologically and immunohistochemically. The results confirm previous findings that gIFN reduces the development of neointimal hyperplasia following arterial injury. The results also indicate that smooth muscle cells restore their proliferative activity by 7 days after discontinuation of gIFN treatment. It is proposed that efficacy of gIFN can be enhanced by lengthening the period of treatment.

Animals↗
PubMed1995

Delayed rupture of aortic aneurysms following endovascular stent grafting.

BACKGROUND: Deployment of transfemoral, endovascular stent grafts for treatment of abdominal aortic aneurysms is appealing for several reasons: avoidance of abdominal incision, lack of aortic cross-clamping, potential for regional anesthesia, and shortened hospital stay. Concerns remain, however, regarding the ability of these devices to completely exclude the aneurysm and prevent aneurysm rupture and the long-term integrity of the device. The availability of endografts and the likely development of percutaneous devices have also raised the delicate issue of personnel training for patient selection, endograft implantation, and postoperative follow-up. PATIENTS AND METHODS: The cases of 2 patients are reported in which Dacron endovascular grafts, anchored proximally and distally by Palmaz stents, were deployed for treatment of infrarenal abdominal aortic aneurysms. RESULTS: In a patient with and absent distal cuff, choosing this procedure represented a clear error in patient selection. The endograft failed to reach the aortic bifurcation and the aneurysm ruptured, with the death of the patient 4 months postimplantation. In a patient with anatomy suitable for endograft placement, a perigraft leak persisted at the distal anastomosis following device placement. The aneurysm ruptured 14 days postprocedure. Although the patient survived emergent aneurysm repair, he developed acute renal failure. CONCLUSION: Careful preoperative assessment of aortic anatomy is crucial in selection of patients for transfemoral endovascular graft placement. Lack of a distal cuff of at least 1 cm precludes tube graft implantation. Patients with a perigraft leak are not protected by the endograft from aneurysm rupture. Vascular surgeons must be involved in the preoperative evaluation of these patients and are the only specialty group who can provide the prerequisite care in evaluation and management of postoperative complications.

Aged↗
PubMed1995

Prediction of amputation wound healing with skin perfusion pressure.

PURPOSE: The purpose of this study was to determine whether laser Doppler skin perfusion pressure (LD-SPP) could accurately predict amputation wound healing. METHODS: We studied a total of 62 limbs in 52 patients (28 men and 24 women) with a mean age of 62.2 years (range 34 to 93 years). From this, 39 limbs underwent major amputation (15 above-the-knee, 24 below-the-knee), and 23 limbs underwent minor amputations (4 transmetatarsal and 19 toes). There were five postoperative deaths, leaving a total of 57 limbs available for analysis. RESULTS: Three of 13 above-knee amputations failed to heal. Twenty-one of 23 below-knee amputations healed. Three of four transmetatarsal amputations failed to heal and eight of 17 toe amputations failed to heal. Binary table analysis showed that an LD-SPP value of 30 mm Hg or greater had a negative predictive value (healing occurred) of 90%. An LD-SPP value of less than 30 mm Hg at the amputation site had a positive predictive value (healing failure) of 75%, (p < 0.001, chi square analysis). For major amputations, negative predictive value was 100%, and positive predictive value was 83%, (p < 0.001). For minor amputations, negative predictive value was 75% and positive predictive value was 66.7%, (p < 0.09). CONCLUSION: These data support the use of the LD-SPP test in the selection of major amputation level consistent with healing in ischemic limbs. Further study of the value of this parameter in the determination of minor amputation wound healing is necessary.

Adult↗
PubMed1992

The correlation between three methods of skin perfusion pressure measurement: radionuclide washout, laser Doppler flow, and photoplethysmography.

The most accurate measurement of skin perfusion pressure is made with use of radioisotopic clearance techniques. We compared the skin perfusion pressure using radioisotope to the skin perfusion pressure measured simultaneously by placing laser Doppler and photoplethysmography probes within a transparent polyvinylchloride plastic blood pressure cuff in 13 subjects. A new device, which was created for this experiment, consisted of a plastic bladder into which light-emitting probes can be placed, so that the pressure applied to the skin was transmitted by the surface of the bladder, rather than by the surface of a rigid probe. The cuff was inflated to a supra-systolic pressure over the intradermal injection site of technetium Tc 99m, then deflated in 10 mm Hg decrements at 3-minute intervals. The pressures at which radioisotope clearance began, at which microcirculatory flow was detected by laser Doppler, and at which deflection of the photoplethysmography (DC mode) output occurred, were recorded as the skin perfusion pressure. The range of radioisotopic determined skin perfusion pressure was 0 to 100; skin perfusion pressure-laser Doppler was 0 to 100; and skin perfusion pressure-photoplethysmography was 60 to 100, with 7 of 13 limbs demonstrating no clear deflection point and thus an unobtainable skin perfusion pressure-photoplethysmography reading. Linear regression revealed a coefficient of correlation of 0.991 for skin perfusion pressure when the radioisotopic and laser Doppler methods were compared. Our study is not in agreement with previous reports of the successful determination of skin perfusion pressure with use of photoplethysmography. This may be due to differences in our technique when compared with previous reports of skin perfusion pressure-photoplethysmography determination.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

Hepatoblastoma in a patient with familial polyposis coli.

Two cases of hepatocellular carcinoma in patients with familial polyposis coli (FPC) have recently been reported in the literature. Hepatoblastoma was also reported in five children with maternal ancestors with FPC. We report a case of hepatoblastoma in a female infant whose father has FPC as further evidence of an association between hepatoblastoma and FPC.

Adenomatous Polyposis Coli↗
PubMed1988

Infected cyst localization with gallium SPECT imaging in polycystic kidney disease.

This case report describes a 43-year-old woman with polycystic renal disease and cyst infection. Infected cysts of the left kidney were successfully localized with Ga-67 citrate SPECT imaging and CT. Other imaging, including planar gallium imaging, was helpful diagnostically, but could not determine the exact location of infection within the kidney.

Adult↗
PubMed1985

Peripheral vascular trauma from close-range shotgun injuries.

This report summarizes an eight-year experience (1976 to 1983) with 49 close-range shotgun blasts with associated major vascular injuries seen in a large urban hospital. Injuries to the upper extremity (40%), lower extremity (56%), and neck (4%) were seen. A high frequency of associated deep venous injury (82%), nerve injury (37%), fracture (33%), massive soft-tissue loss (43%), and compartmental hypertension (39%) was observed. There were no deaths in this series, and the limb salvage rate was 96%. Neither patient with multiple carotid artery injuries suffered a neurologic deficit. We attribute our success in the management of these complex injuries to rapid fracture immobilization, early and aggressive use of fasciotomy, adequate débridement of devitalized tissue, repair of deep venous injuries, arterial repair with autogenous tissue, and extra-anatomic bypass grafting in selected cases.

Adolescent↗
PubMed1985

Altered distribution of technetium-99m sodium pertechnetate associated with antimicrobial therapy.

Three patients underwent brain scanning for evaluation of central nervous system disease and were simultaneously treated for infectious diseases unrelated to the central nervous process. All revealed intense vascular pooling on their brain images. The imaging studies had been performed following the administration of Tc-99m pertechnetate. None of the patients had prior nuclear medicine examinations to suggest the causal effect of stannous ion as a source of interference. All of the patients were on combination antimicrobial drugs: two on sulfamethoxazole and trimethoprim, and one on isoniazid and ethambutol. One patient revealed 75% Tc-99m red cell tagging. Another patient's repeat brain scan with Tc-99m DTPA revealed normal distribution. Our findings suggest that patients on antimicrobial combination drug regimens who require brain scans should be imaged routinely with agents other than Tc-99m.

Aged↗
PubMed1984

Crossover femorofemoropopliteal sequential bypass for combined ipsilateral iliac and femoropopliteal occlusive disease.

We evaluated the effectiveness of crossover femorofemoropopliteal sequential bypass in 13 patients with combined ipsilateral iliac and femoropopliteal disease. Of them, eight underwent bypass grafting for limb salvage, and five, for disabling claudication. Four of the patients with claudication had relief of symptoms and significant increases in treadmill walking time. The cumulative limb salvage rate in the patients operated on for limb salvage was 88%. At 42 months, the cumulative patency rate for the femorofemoral portion of the graft was 91%, and for the distal segment, 63%. Mean ankle-brachial indices increased from 0.37 +/- 0.12 preoperatively to 0.76 +/- 0.16 postoperatively in the recipient limb. Early experience suggests that crossover sequential femorofemoropopliteal bypass grafts are effective in achieving limb salvage and relief of claudication, especially in patients with relative contraindications to major intra-abdominal surgery.

Aged↗
PubMed1984

Prediction of improvement in ankle blood pressure following arterial bypass.

Percutaneous femoral artery pressures and lower extremity segmental Doppler-derived blood pressures in 116 lower extremities were analyzed to determine if postbypass ankle/brachial indices (ABIs) could be predicted based on preoperative pressures. Predicted ABIs were calculated by increasing the prebypass ABI by the same percentage that the extremity/brachial index at the distal end of the bypass would be increased, assuming a postbypass index of 1.0 at the distal graft. The correlation between predicted ABI and actual postbypass ABI was strong for aortofemoral bypass (r = 0.8735) and moderate for infrainguinal bypass (r = 0.5961), with 75% of the postinfrainguinal bypass ABIs being greater than predicted. Minimum postoperative increases in ABI can be predicted based on preoperative hemodynamic measurements, thus providing important information relative to choosing the appropriate level of revascularization in patients with multisegmental disease.

Ankle↗
PubMed1983

Early experience with popliteal to infrapopliteal bypass for limb salvage.

In an attempt to improve graft patency and limb salvage in patients with isolated tibial vessel and/or popliteal-tibial vessel occlusive disease, bypass grafts from the popliteal or distal superficial femoral artery to infrapopliteal arteries were used in patients requiring bypass for limb salvage. During a 2 1/2-year period, 23 patients with patent axial vessels and hemodynamically normal inflow to the level of the knee underwent such bypasses. Cumulative graft patency and limb salvage rates at 31 months were 84% and 70%, respectively. Five of the six patients who required below-knee amputation did so because of progressive gangrene in the presence of a patent bypass. Short bypasses between the popliteal and infrapopliteal arteries can significantly contribute to limb salvage in patients with tibial vessel occlusive disease and may be particularly useful in patients with saphenous veins too short for longer bypasses.

Adult↗