Biomedical subjects

M D'Addato

Publications and source records attributed to M D'Addato.

At least 73 records · Page 4Linked to original sources

PubMedDate not supplied

Indobufen vs acetylsalicylic acid plus dipyridamole in long-term patency after femoropopliteal bypass.

To compare the effects of indobufen (INB) with those of ASA+dipyridamole (DP) on graft patency, 113 patients undergoing femoropopliteal bypass surgery were randomly and blindly assigned to treatment with INB 400 mg daily or with ASA 900 mg daily plus DP 225 mg daily. Treatment started 2 days before surgery and lasted for 12 months. All patients underwent two angiographic examinations: the first early after surgery (mean 6 days) and the second at the end of the study (mean 368 days). The 1 year cumulative patency rate for INB was 60% higher but not statistically different from the ASA-DP group (53.2%). The relative risk (INB/ASA+DP) calculated by the Mantel-Haenszel test was 0.86 (confidence limits 0.54-1.35). Only the site of operation (above-knee or below-knee) has a significant prognostic value on the fate of the graft.

Aged↗

PubMedDate not supplied

Interaction between vascular prostheses and rifampicin in the prevention of the grafts infection. An experimental study.

Infections caused by synthetic prostheses are relatively rare (1.5-6%) but serious complication in vascular surgery. There is no doubt that during and immediately after surgery bacterial contamination may occur. An in vitro study was carried out in the Vascutek laboratories, which revealed a high affinity between prostheses in Dacron gel and Rifampicin. This affinity, the result of an ionic bond, was demonstrated by the fact that after 5 days Rifampicin was still present on the prostheses. Encouraged by this result, an experimental study was carried out in sheep. Five sheep were operated on making a prosthetic graft in both of the common carotid arteries: on one side a Gelseal Dacron prosthesis was implanted after being soaked for 15 minutes in a solution containing 1 mg/ml Rifampicin. A Knitted Dacron prosthesis was implanted in the contralateral carotid artery, again after pretreatment with Rifampicin. Explants were made after 2, 24, 48, 72 and 96 hours, and the concentration of Rifampicin on the prostheses was assessed on the basis of the diameter of the inhibition area on Staphylococcus aureus cultures. The results showed that the Gelseal Dacron prostheses maintained Rifampicin concentrations with an antibacterial activity up to 72 hours; this property disappears with the Knitted Dacron prostheses after only 24 hours. These results confirm the high affinity of Gelseal Dacron and Rifampicin also in in vivo experimental models.

Animals↗

PubMedDate not supplied

[Thoraco-abdominal aneurysms of type IV].

AIM OF THE STUDY: Aims of the study were: 1. to evaluate the results of surgical treatment of type IV thoraco-abdominal aneurysms (TAA), with relationship to other types, 2. to evaluate results obtained with an approach different from the traditional thoraco-phreno laparatomy, with specific attention to postoperative respiratory function. MATERIAL AND METHODS: We have retrospectively compared type IV TAA with all other types of thoraco-abdominal aneurysms electively treated between January 1st, 1994 and May 31st, 2003. Data on perioperative mortality, spinal cord ischemia and renal failure (both temporary and permanent) occurring in the first 30 postoperative days were considered. Protection from spinal cord ischemia was accomplished through liquor drainage and prostaglandin E1 (PGE1) infusion. When the aneurysm extension was limited to the celiac axis an extrapleuric access with removal of XI rib was performed. In this subgroup of patients we have considered postoperative recovery time of respiratory function (intubation time, number of days in intensive care unit, postoperative pulmonary complications) postoperative renal failure, perioperative mortality and morbidity. RESULTS: Seventy-eight TAA have been treated in the period of time of the study. Twenty cases were type IV TAA (25.6%) of which 2 due to chronic dissection. Cumulative postoperative mortality has been 19.2%. The single perioperative death in the group of type IV TAA (5%) occurred in post-operative day 15 for multiple organ failure. No spinal cord ischemia occurred in this group. Temporary renal failure occurred in 3 cases (15%) with one case requiring dialysis. In 10 cases (50%) an extrapleuric access with removal of XI rib was performed, with adequate control of the proximal aorta. Postoperative respiratory failure requiring and intubation time longer than 12 hours occurred in 2 cases (20%). In the remaining 8 cases the mean intubation time was 5.3 hours (range 4-8 hrs). Tracheostomy was not necessary in any case. Mean time of intensive care unit stay was 3.5 days (range 0-15 days). CONCLUSION: The appropriate treatment of type IV TAA leads to low mortality and morbidity with results similar to those of pararenal aneurysms rather than those of other TAA forms. Left extrapleuric access when feasible allows faster recovery of a normal respiratory function.

Adult↗

PubMedDate not supplied

Morbidity and mortality following carotid surgery.

The records of 920 patients who underwent carotid endarterectomy by the same surgeon (M. D'A) between 1976 and 1989 were reviewed. Particular attention was paid to both the neurological and general complications and to how and when the neurological symptoms appeared. Among these patients, a cumulative stroke plus death rate of 3.1% was observed. Complications were classified as clamping ischemia (2.2%), postoperative embolism (1.5%), postoperative thrombosis (2.4%), and cerebral haemorrhage (0.3%). Two patients (0.2%) died from myocardial infarction. In 3.5% of patients, neurological symptoms were transient. The incidence of clamping ischemia was higher when 40 mmHg was considered as the safety limit of the back-pressure; this incidence fell by raising this limit to 50 mmHg, and introducing, in recent years, SEPs monitoring. Intraoperative monitoring of SEPs, in fact, reduced the neurological complications to 1.4%, while intraoperative angiography reduced the need for intraoperative reoperation from 10% to 2%. The use of antiplatelet drugs and an accurate surgical technique are useful steps in the prevention of postoperative embolism or thrombosis.

Cerebrovascular Disorders↗

PubMedDate not supplied

Carotid endarterectomy in young adults.

The results of carotid endarterectomy in 521 patients were analyzed to verify whether the early and late outcome in young patients is worse than in older patients, such as the results observed in peripheral arterial reconstruction in young adults. The patients were subdivided into 3 groups: 105 under 55 years, 397 aged between 56 and 74 years and 19 over 75 years. Young patients presented less risk factors and associated diseases than older ones, with the exception of smoking-habit; on the other hand, they presented a higher incidence of early post-operative thrombosis, myocardial infarction and of recurrent stenosis at follow-up. This trend has already been observed in other series. Young age and smoking habit have also been significantly related with recurrent carotid stenosis. In spite of these complications, carotid endarterectomy is indicated in severe stenosis or complicated carotid plaques, in young adults, because of a low operative mortality and a better trend in the follow-up period; however, the pre-operative evaluation needs a more accurate study and, when possible, the normalization of metabolic risk factors and the elimination of smoking.

Adult↗

PubMedDate not supplied

Carotid endarterectomy. Pre- and post-operative monitoring with cerebral SPECT.

In the pre-operative evaluation of carotid endarterectomy, the knowledge of ischemic areas may be helpful to reduce the operative risk. A positive CT scan is often correlated with an increased operative risk. The single photon emission computed tomography (SPECT) allows us to visualize ischemic areas not shown by the CT; these areas are almost always correlated to neurological symptomatology. In patients with positive CT scan, the ischemic areas shown by SPECT are generally larger, because this technique visualize the ischemic area surrounding the cerebral infarct (penumbra). After carotid EA, SPECT is useful to show the hemodynamic modifications induced by this operation. In a series of 15 patients we observed an improvement of the cerebral blood perfusion characterized by the normalization of the blood flow in 7/12 (58%) of the ischemic areas observed pre-operatively), an improvement in 3/12 and a normalization or an improvement in the contralateral hemisphere in 5/7 of the areas. In conclusion SPECT is a useful technique to study the cerebral pathophysiology of both cerebrovascular disease and its surgical treatment.

Aged↗

PubMedDate not supplied