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Biomedical subjects

L Irace

Publications and source records attributed to L Irace.

54 records · Page 3Linked to original sources
PubMed1988

The salvage of the lower limbs: choice of the prosthetic material in femoro-distal and axillo-femoral bypass.

The choice of the prosthetic material in arterial surgery of patients with rest pain and/or impending gangrene of the lower limbs still presents several problems. The poor run-off, the small caliber of the distal vessels, the crossing of the joint areas and the length of the bypass may lead to early occlusion of the prosthesis. This experience is based on 268 femoro-distal (214 femoro-popliteal below the knee and 54 femoro-tibial) and on 121 axillo-femoral/popliteal bypasses (89 axillo-femoral, 28 axillo-bifemoral and 4 axillo-popliteal). In the 389 surgical procedures we have employed the autologous saphenous vein in 208 cases, Polytetrafluoroethylene (PTFE) straight or tapered in 66, PTFE external supported (EXS) in 33, Dacron in 12, homologous saphenous vein in 7 and PTFE EXS Thin Wall in 5. In 58 cases a composite graft (autologous saphenous vein plus synthetic prosthesis) was used. The cumulative long term (12-96 months) patency is 75.96% for autologous saphenous vein bypass, 62.12% for PTFE, 75.75% for PTFE EXS, 41.66% for Dacron, 42.85% for homologous saphenous vein and 84.48% for the composite graft. All the PTFE EXS Thin Wall grafts are still patent (12 months).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1988

Doppler C.W. study of the lower limb venous hemodynamics during pregnancy and prevention of thrombotic complications.

Thirty-two women (14 primiparae and 18 multiparae) were submitted to clinical and ultrasound investigations during the 1st, 2nd and 3rd quarter of pregnancy and after childbirth, for the evaluation of the lower limb venous system. An increase of the venous pressure in the standing position was present in all the women during the last quarter of pregnancy. In 14 cases varices (6 primiparae, 8 multiparae) with incontinence of the saphenous-femoral valve in 10 (3 primiparae, 7 multiparae), were detected during pregnancy. In these patients a compressive bandage associated, in selected cases, to calcium-heparin therapy (25000 IU/daily) was employed. After childbirth the venous pressure resumed physiological values in 20 of the 32 women while the varices remained in 12 cases. No thrombotic complication of the superficial and/or deep venous system neither hemorrhagic episodes related to calcium-heparin therapy occurred.

Adult↗
PubMed1985

Haemodynamic effects of indenolol at rest and after a submaximal workload in essential hypertension.

The effect of indenolol on heart rate and blood pressure at rest and after submaximal workload has been studied in 19 patients with established essential hypertension. A stepwise increase from moderate to submaximal exercise was chosen to mimic challenges normally occurring in daily life. After 4 weeks of once a day indenolol therapy a significant, gradual reduction in the following cardiovascular parameters was observed: heart rate at rest fell by 20%, 30% after exercise and 31% after recovery; systolic blood pressure showed a fall of 15% at rest, 19% after workload and 14% after recovery; the reduction in diastolic blood pressure was 15% at rest, 11% after exercise and 12% after recovery. The rate-pressure product was decreased by 32% at rest, 43% after exercise and 42% after recovery. It is concluded that the most important pharmacological effect of indenolol is the significant decrease in myocardial oxygen demand. In patients with essential hypertension indenolol not only produces a definite antihypertensive effect, but it also increases workload tolerance and decreases subjective symptoms during physical activity. Compliance was good and no severe side effects were observed.

Adult↗
PubMed1985

Isolated symptomatic lesions of the vertebral artery: cure after surgical repair.

Nine patients with uni-or bilateral stenosis of vertebral arteries, not associated with other lesions of supraaortic trunks are reported. They showed a vertebrobasilar insufficiency syndrome not due to other assessable causes. Seven of them underwent surgical treatment always as reimplantation of the vertebral into the subclavian artery. The procedure was unilateral also in cases with bilateral lesions. In all 7 patients a favourable result was obtained: 5 patients recovered completely and 2 showed a marked improvement. The study demonstrates that the surgical repair of symptomatic unilateral lesions of vertebral arteries is able to cure the vertebrobasilar insufficiency syndrome.

Adult↗
PubMed1983

Arterial reconstruction of the limbs in poor run off conditions and surgical repair of vena cava with expanded PTFE (IMPRA-grafts).

Seventy eight arterial and venous reconstructions using expanded microporous PTFE (IMPRA-grafts) are reported. This prosthetic material has been employed, by itself or in addition to autogenous vein segments when the saphenous vein was not available or inadequate in length or quality. Long term results show that 83% of vascular repairs are patent up to 36 months post-operatively. Since the prosthesis has been used in vena cava reconstructions, in patients with severe impairment of the distal arterial tree and in some cases in whom previous surgical treatment had failed, these results are favorable and encouraging.

Arterial Occlusive Diseases↗
PubMedDate not supplied

Efficacy of an intravenous low-molecular-weight dermatan sulphate (Desmin) in patients with acute proximal deep venous thrombosis and silent pulmonary embolism. A pilot study.

Ten patients affected by proximal deep venous thrombosis were treated in an open study with a low-molecular-weight dermatan sulphate (Desmin), administered at doses of 400 mg (intravenous bolus) followed by 1200 mg/day infused intravenously for 10 days, without activated partial thromboplastin adjustment. The evolution of the deep vein thrombosis and the presence of silent pulmonary embolism were evaluated by phleboscintigraphy and lung scan, performed before treatment and after 10 days of treatment, and by repeated echocolour-Doppler examination (every 2 days during treatment). The evolution of deep vein thrombosis showed a considerable improvement; similarly, lung scan showed a substantial reperfusion of lung, with regression of perfusional deficit. Repeated echocolour-Doppler examination of the deep venous system during treatment did not document further thrombus extension in any patient. Tolerance and safety were excellent. No adverse effects were observed. These preliminary results indicate that the tested dose of Desmin can be effective in treating deep vein thrombosis and silent pulmonary embolism.

Acute Disease↗
PubMedDate not supplied

[Mitral prolapse and the ergometric findings].

In evaluating the significance of arrhythmias and ECG changes during exercise, 42 consecutive patients (pts) with mitral valve prolapse (MVP) underwent a symptom-limited cycloergometer Exercise Stress Test (EST) with load increase of 25 watts every 3 minutes. Eight patients (19%) were positive for anamnestic cardiopalm. The patients were divided in 2 groups, according to echocardiographic evidence of the MPV: group A (12 patients, mean age 32 +/- 13) with prolapse of one mitral leaflet and group B (30 patients, mean age 30 +/- 13) with prolapse of both mitral leaflets. Exercise duration doesn't differ significantly in the two groups. No arrhythmias during EST were found in group A, while arrhythmias were present in 6 patients (20%) in group B. A strong correlation was found between anamnestic cardiopalm and arrhythmias during EST (6/8 = 75%). Three of four patients (75%) with ST impairment during EST, showed at thallium myocardial scintigraphy a non reversible perfusion defect after exercise. These data showed a higher incidence of arrhythmias during EST in patients with MVP of both leaflets and good relationship with symptomatology of cardiopalm.

Adolescent↗
PubMedDate not supplied

[The diagnosis of the cardiologic risk in patients destined for lung removal surgery].

The expanding role of pulmonary surgery could be expected to lead to an increase in postoperative morbidity and mortality unless surgical risk factors are identified by means of a careful preoperative assessment. A careful and intelligent preoperative evaluation can reduce the morbidity and mortality after lung resection by ensuring the appropriate selection of patients and a rational choice of operative procedure. To evaluate the cardiologic risk in patients undergoing lung resection, 18 of them underwent a diagnostic protocol based on non invasive analysis including ECG, stress test with basal and exercise blood gas analysis, M- and B-mode and Doppler echocardiography. This protocol was able to identify possible cardiologic risk in the perioperative period without applying invasive techniques and with a good cost-benefits ratio.

Adult↗
PubMedDate not supplied

[Ergometric test in the diagnostic and prognostic evaluation of arrhythmia].

One thousand three hundred patient's stress tests were analyzed to value arrhythmia outline and its relationship with anamnesis and clinical data. The patients were divided into two groups: group A, with no arrhythmias at rest, and group B with arrhythmias at rest. All classic nosographic arrhythmias were considered. In some teenager patients with arrhythmias at rest and no organic cardiopathy, anomalies disappeared during stress, showing the benignity of the phenomenon. Supraventricular stress induced arrhythmias has 1.2% of incidence in normal subjects, but 81% in heart disease patients. Supraventricular tachycardia was induced in 6 patients. Ventricular stress induced arrhythmias are found in 4.9%. Two cases of sudden death occurred in our groups.

Adolescent↗
PubMedDate not supplied

[Behavior of systolic blood pressure during recovery phase after bicycle ergometric test. Its value in the diagnosis of ischemic heart disease].

The diagnostic utility of an abnormal decrease in systolic blood pressure (PAS) after exercise, have been evaluated by an index obtained by the ratio between PAS at the maximal stage of exercise and PAS at the 1', 3' and 5' of recovery (PAS index). The 58 patients studied have been divided in two groups: group A, 32 patients, aged 33-66 (means 51.5) with angina pectoris and significant coronary stenosis; group B, 26 subjects, aged 27-39 (mean 34.7), asymptomatic, without coronary stenosis (control group). PAS index at 1' of recovery have been 0.82 +/- 0.08 in the group B and 0.94 +/- 0.07 in the group A (p less than 0.0005); at the 3' of recovery 0.72 +/- 0.07 in the group B and 0.86 +/- 0.11 in CAD group (p less than 0.0005); at 5' of recovery 0.66 +/- 0.07 in the group B and 0.79 +/- 0.11 in the group A (p less than 0.0005). Diagnostic accuracy have been of 60%, 75% and 75% for PAS index respectively at first, third and fifth minute of recovery, while ST depression diagnostic accuracy have been of 88%.

Adult↗
PubMedDate not supplied

Prevention of deep venous thrombosis in vascular surgical procedures by LMW-heparin.

The risk of Deep Venous Thrombosis (DVT) in the immediate postoperative period varies from 0.8 to 96% of cases depending on major or minor operations and on age of patients. We have employed 8,000 I.U. AXa/daily of LMW-Heparin injected subcutaneously from one day preoperatively and prolonged for 8 days after surgical procedures in 40 patients operated upon by an aorto-femoral bypass in 25 cases, a femoro-popliteal below the knee in 8 and an extra-anatomical bypass in 7. The onset of DVP in the lower limbs was investigated by clinical examination, venous Doppler pressure evaluation, waveform analysis and echotomography and the 125I-Fibrinogen uptake test. There was no intraoperative increased bleeding and the preclotting of the prosthetic grafts was inaffected. A DVT was detected during the second postoperative day, by means of the 125I-Fibrinogen test in the calf of only one patient (1/40-2.5%), submitted to an aorto-bifemoral bypass, in whom the clinical pattern and ultrasound investigations were negative. The single daily subcutaneous administration has never caused side effects in the site of injection and it seems a real improvement in the heparin treatment. These results emphasize the advantage of the use of LMW-Heparins in patients submitted to arterial surgical reconstructions of the lower limbs for the prevention of the DVT.

Aged↗
PubMedDate not supplied

Arterial repair of the lower limbs: prevention of prosthetic grafts occlusion by LMW-heparin.

The postoperative thrombosis of prosthetic grafts may be due to many factors: technical errors, poor run-off, prosthetic material, graft length, trauma by subcutaneous tunnellization or repeated microtrauma across the joint areas, evolution of atherosclerotic lesions, emorheological changes. In 50 patients submitted to surgical arterial repair of the lower limbs, we have employed 8,000 I.U. AXa/daily of LMW-Heparin, injected subcutaneously for 6 months after the operations to prevent immediate and late thrombosis. During the follow-up, one patient died, four stopped any treatment and in two the medication was changed. Hence our results are based on 43 cases: 10 patients operated upon by aorto-femoral bypass, 19 femoro-popliteal and 14 extra-anatomical procedures. During the follow-up all the patients were investigated by ultrasounds (pressure measurement, waveform analysis and duplex scanning echotomography); moreover 13/43 (30%) were studied by angioscintigraphy and 11/43 (25.5%) by a conventional or digital subtraction angiography. Thrombosis of the grafts at one year term occurred in none aorto-femoral, in one femoro-popliteal (5.2%) and in one extra-anatomical bypass (7.1%). This figure compares favourably with the results obtained in our experience in the patients treated by a variety of drugs. In such group the incidence of occlusion is 3.9% in aorto-femoral, 9.3% in femoro-popliteal and 11% in extra-anatomical grafts. Those results emphasize the possibility to improve the patency of the grafts in the arterial repair of the lower limbs by LMW-Heparin overall in femoro-popliteal and extra-anatomical areas.

Aged↗
PubMedDate not supplied

[Myocardial infarct without Q wave in the elderly: diagnostic evaluation using vectorcardiography].

The diagnosis of previous non-Q wave myocardial infarction by standard electrocardiographic investigation is uncertain, particularly in elderly patients because of concomitant disease. We have studied 31 elderly patients (aged 63-72 years) with a diagnosis of non-Q wave myocardial infarction between 1-6 months after this acute event. The patients underwent clinical-anamnestic examination, standard electrocardiography, vectorcardiography according to the Frank system and M-mode and 2-D echo-cardiography with continuous and pulsated Doppler. The ECG showed ST-T anomalies in 12 patients (38.7%) whereas the VCG showed anomalies of QRS-loop normal convexity in 27 patients (87%) and 16 of these (51.6%) showed bites criteria (duration > or = 10 msec, voltage > or = 0.1 mV, present at least on two planes). By echocardiography, regional hypo-akinesia was observed in 19 patients (61.3%). Although bites are not only present in myocardial infarction, they indicate an interruption of myocardial gradual electric activation, compatible with fibrous areas, and should be evaluated as a part of the clinical-anamnestic, laboratory and instrumental data.

Age Factors↗