Biomedical subjects

A Nora

Publications and source records attributed to A Nora.

5 recordsLinked to original sources

PubMed1999

Intraoperative assessment of technical perfection in carotid endarterectomy: a prospective analysis of 1305 completion procedures. Collaborators of the EVEREST study group. Eversion versus standard carotid endartectomy.

OBJECTIVE: to define the incidence of technical defects and the impact of technical errors on ipsilateral carotid occlusion, ipsilateral stroke, and early restenosis rates, we analysed 1305 patients undergoing carotid completion procedures. DESIGN: prospective multicentre study. PATIENTS AND METHODS: adequacy of CEA was assessed intraoperatively by angiography in 1004 (77%), by angioscopy in 299 (22%), and by duplex scan in two patients (1%). Arteriograms and angioscopic findings were interpreted at the time of the procedure by the operating surgeon, who also established the need for immediate surgical revision. RESULTS: perioperatively, 13 major strokes (0.9%, all ipsilateral) and six deaths (0.4%) were recorded. Overall, 112 defects (9%) were identified intraoperatively: 81 (72%) were located in the common carotid artery (CCA) or internal carotid artery (ICA), and 31 (28%) in the external carotid artery. In 48 patients (4%) the defects were revised. Logistic regression analysis revealed that carotid plaque extension >2 cm on the ICA was a positive independent predictor of CEA defects (odds ratio (OR) 1.5p=0.03). A significant association was found between the incidence of revised defects of the CCA and ICA and perioperative ipsilateral stroke (OR 11.5p=0.0002). In contrast, patients with minor non-revised defects had an ipsilateral stroke rate comparable to that of patients with no defects (p=0.4). No significant association was found between revised or non-revised defects and occurrence of restenosis/occlusion at 6-month follow-up. CONCLUSIONS: the incidence of major technical defects during CEA is low, yet the perioperative neurological prognosis of patients with major defects warranting revision is poor. Completion angiography or angioscopy and possible correction of defects did not protect per se from an unfavourable early outcome after CEA. Therefore, surgical excellence is mandatory to achieve satisfactory results after CEA.

Adult↗

PubMed1986

[Bile acids in chronic hepatopathies].

The clinical value of measuring biliary acids in various chronic liver disease was investigated. The sample examined included 17 healthy subjects, 16 patients with active chronic hepatitis, 15 with cirrhosis of the liver and 14 with cholestatic cirrhosis. The following parameters were considered in each patient: blood bilirubin, gamma GT, alkaline phosphatase, cholinesterase, blood cholesterol, Quick time. The total pool of biliary acids was assayed by the enzymatic method on samples taken in the morning before breakfast and two hours after intake of 600 mg ursodeoxycholic acid. Total biliary increased with the progression of the pathological condition. Unlike all other indicators biliary acid assays after oral loading with ursodeoxycholic acid makes it possible to distinguish between subjects with active chronic hepatitis and those with cirrhosis of the liver.

Adult↗

PubMed1979

Cytogenetic studies in an acute leukemia patient following cerebellar astrocytoma.

Acute, monomyelogenous leukemia (AMML) was diagnosed in a patient with a derived 13;14 translocation and prior treatment for a cerebellar astrocytoma. A bone marrow aspirate at the time of diagnosis of leukemia showed abnormalities of chromosome 11, 12 and 16 in addition to the constitutional aberration. The patient's mother carried the same 13;14 translocation, as did 2 siblings, a maternal uncle, and four of his six children. The father had a reciprocal translocation between numbers 1 and 19 which was incidental to the present study.

Astrocytoma↗

PubMedDate not supplied

[Peripheral arteriopathy in ESRD dialysed patients: when and how to intervene].

Critical limb ischemia secondary to chronic peripheral occlusive disease is common in chronically dialysed patients, with an incidence rate of 25-30%. Atherosclerotic lesions are more frequent in the infrainguinal arteries and long infrapopliteal occlusions often occur. Due to diabetes, hypertension and ischemic cardiopathy, the surgical prognosis is very poor in these patients; medical treatment should always be attempted associated with analgesia, without an excessive delay in surgical therapy if needed. Both spinal stimulation and lumbar simpaticectomy often fail; open and endovascular surgery are the best options before major amputation, which has a high incidence in this patient subgroup. Between 2000 and 2003, 23 chronically dialysed patients underwent surgery. Nine open and 13 endovascular procedures were performed, associated with four immediate and five late minor amputations. Despite an immediate mortality rate of 8.6%, we obtained immediate patency and limb salvage in all cases. In a medium follow-up of 25 months (range 3-36), five thromboses were found in subinguinal procedures; not one in iliac procedures. The five patients underwent major amputation. Another two patients underwent amputation despite arterious patency. Seven patients died due to cardiovascular diseases during the follow-up. Our experience confirms that the association between POAD and dialysis is a prediction factor for medium-term death and that the surgical risk is highly increased. It is important to select patients undergoing surgical treatment to check for the lowest invasivity.

Aged↗

PubMedDate not supplied

[Carotid endarterectomy using the classical technique and by eversion].

After a brief introduction on the history of the surgical treatment of carotid stenosis the authors illustrate both the classical endarterectomy and the eversion endarterectomy. The constant search for a technique which could be of easy execution and also reduce the risk of complication (especially late ones, such as restenosis), brought the authors to adopt the eversion endarterectomy with reimplantation of internal carotid artery. From 1990 through 1995, 1034 carotid endarterectomies were performed, of which 611 with eversion technique and 423 with others techniques. The average follow-up was 38 months. The eversion endarterectomy group had lower neurological morbidity and mortality rates, both early and late. Even more important, they had a lower incidence rate of hemodynamically relevant restenosis (0.37% in the eversion endarterectomy group vs 1.97% in the other group).

Adult↗