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Biomedical subjects

A Odero

Publications and source records attributed to A Odero.

At least 19 recordsLinked to original sources
PubMed2006

Endovascular treatment of acute haemoptysis secondary to aortobronchial fistula.

INTRODUCTION: Aortobronchial fistula is a rare but potentially fatal condition. We report our experience in the endovascular treatment of acute haemoptysis in high risk patients with aortobronchial fistula. REPORT: Between May 2002 and December 2004 five patients presenting with acute haemoptysys due to aortobronchial fistula were treated by endovascular stent grafting of the descending thoracic aorta. We did not observe intraoperative or perioperative mortality, stent-graft infection or paraplegia. In one case endoleak occurred. CONCLUSION: Endovascular stent-grafting represents an effective therapeutic option for the management of aortobronchial fistula. Careful follow up of the patients is mandatory.

Acute Disease↗
PubMed2004

Near infrared spectroscopy monitoring during carotid endarterectomy: which threshold value is critical?

OBJECTIVES: Retrospectively to verify which decreasing percentage in regional oxygen saturation (rSO(2)) identified patients with good collateralisation during carotid artery cross clamp. MATERIALS AND METHODS: During 594 endarterectomies under general anaesthesia the decreasing percentage from preclamp value to value detected in the first 2 min after clamping the CCA and/or ICA was calculated in real time. No temporary shunt was placed in any case. ROC analysis was performed to determine the optimal cut-off for rSO(2) decrease to identify the occurrence of neurological complications. RESULTS: A cut-off of 11.7% was identified as optimal. Sensitivity and specificity were 75% (95% CI 71-78) and 77% (95% CI 74-80), respectively. The cut-off of 20% had a lower sensitivity (30%) and a higher specificity (98%) to identify patients with complications, with positive and negative predictive value of 37 and 98%, respectively. CONCLUSIONS: The study suggest that a relative decrease in rSO(2) of <20% from preclamp to early cross clamp value has a high negative predictive value, i.e. if rSO(2) does non decrease more than 20%, ischemia by hypoperfusion is unlikely and a shunt should not be necessary. Moreover, a relative decrease >20% may not always indicate intraoperative neurological complications.

Aged↗
PubMed2002

Vascular prosthetic graft infection: epidemiology, bacteriology, pathogenesis and treatment.

UNLABELLED: Vascular prosthetic graft infection remains a major surgical challenge. Prevention of risk factors and antibiotic therapy can reduced but not eradicate it. Management of infected vascular grafts depends on several factors, including the location of the infected prosthesis, the extent of infection, and the underlying micro-organism. Classic treatment consists of extra-anatomic bypass grafting. The disappointing results due to the high mortality and amputation rate have kindled interest in alternative approaches, such as in situ reconstruction with antibiotic-bonded prostheses, autogenous veins or arterial allografts. PURPOSE: We focused on the treatment of aortic graft infection by means of both fresh and cryopreserved arterial allograft. Here, the experience of the Italian Collaborative Vascular Homograft Group is reported. METHODS: Between March 1994 and December 2000 seventy-nine patients with aortic graft infection were treated. The results of 68 patients are analysed. Eleven patients were treated with fresh, and 57 with cryopreserved homograft. Emergency surgical procedures were performed in 12 patients (17%). Aortoenteric fistula was diagnosed in 22 patients. The mean interval between the first procedure and the insertion of a homograft for patients with infected aortic graft was 3 years (range 1-15). The mean duration of follow-up was 30 months (range 1-68). Clinical and duplex scanning evaluation were routinely performed. Computer tomography (CT), magnetic resonance (MR), or arteriography were performed on the basis of duplex scanning results. RESULTS: The analysis was performed on 68 cases for which there were sufficient reliable data. Eleven deaths occurred during the early postoperative period (30 days), a mortality rate of 16%. There were also seventeen late deaths, a mortality rate of 25%. Eleven patients had graft occlusion; six cases were successfully treated with thrombectomy. In three cases leg amputation was necessary. The results of fresh and cryopreserved homografts were compared. No significant differences of early postoperative mortality, late mortality, homograft-related mortality, graft failure were observed. The presence of aortoenteric fistula is a negative predicting factor of perioperative early mortality, which causes a rapid decline in the survival curve. Thirty-six months after the surgery the actuarial survival of the patients was 57% and the actuarial patency of the allograft was 41%. CONCLUSION: No significant difference in terms of clinical outcome was observed when using fresh, rather than cryopreserved homografts. The only factor that significantly influenced the survival rate appeared to be the aorto-enteric fistula.

Anti-Bacterial Agents↗
PubMed2001

A rapid D-dimer assay in patients presenting at the emergency room with suspected acute venous thrombosis: accuracy and relation to clinical variables.

BACKGROUND AND OBJECTIVES: The measurement of D-dimer is claimed to have potential value in excluding deep vein thrombosis (DVT). New rapid methods have been proposed, but few clinical trials have assessed their performance in an emergency context. The different accuracies found between the D-dimer assays have been related to the test used (latex or ELISA), but other variables (such as population investigated, thrombus extension, duration of symptoms or concomitant heparin treatment) may be important, even if not sufficiently investigated. DESIGN AND METHODS: We evaluated the accuracy of a rapid semi-quantitative D-dimer test (Dimertest, Dade Behring), with reference to: a) its use at an emergency unit; b) concomitant heparin administration; c) location of venous thrombosis (VT) (in the deep or superficial venous system limited to the great saphenous vein) and d) symptoms older than 14 days. RESULTS: Two hundred and ninety-eight patients suspected of having DVT and 116 suspected of thrombosis of the great saphenous vein (GSV) were investigated. In the DVT patients, the sensitivity, specificity, positive and negative predictive values were 77.4% (95% CI 68.9-85.9), 81.4% (95% CI 76.1-86.7), 65.4% (95% CI 56.5-74.3) and 88.8% (95% CI 84.2-93.4), respectively. Excluding patients receiving heparin and those with symptoms older than 15 days, the sensitivity and negative predictive value increased to 86.3% (95% CI 78.4-94.2) and 92.8% (95% CI 88.4-97.2), respectively. In patients with GSV thrombosis, the sensitivity, specificity, positive and negative predictive values were 48% (95% CI 34.5-61.5), 90.6% (95% CI 83.2-97.9), 80.6% (95% CI 66.6-94.6) and 68.2% (95% CI 57.8-78.6), respectively. Excluding patients receiving heparin and those with symptoms older than 15 days, did not change the sensitivity or negative predictive value significantly. INTERPRETATION AND CONCLUSIONS: Our results show that previous or concomitant heparin administration, non-acute symptoms and thrombosis localized to superficial veins reduce the clinical usefulness of the D-dimer test as the rate of false negative results is increased.

Acute Disease↗
PubMed1998

Fresh and cryopreserved arterial homografts in the treatment of prosthetic graft infections: experience of the Italian Collaborative Vascular Homograft Group.

Following the experience of cardiac surgeons with homografts in the treatment of infective aortic valve endocarditis, cardiovascular surgeons have investigated in situ revascularization by means of homografts in the management of vascular prosthetic graft infections. Preliminary results are encouraging, but their late fate in long-term follow-up and the influence of preservation techniques are still under investigation. This article reports the experience of the Italian Collaborative Vascular Homograft Group, with the use of fresh and cryopreserved arterial homografts for the treatment of prosthetic graft infections. Between March 1994 and December 1996, 44 patients with prosthetic graft infection were treated with homografts (13 preserved at 4 degrees C, 31 cryopreserved). The mean age of the patients was 65 years. Emergency surgical procedures were performed in eight patients (18%). Sepsis was diagnosed in 11 patients, aortoenteric fistula in 13, and false aneurysms in 10. Staphylococcus was the main cause of infection. The types of vascular reconstruction with homograft were: 32 aortobifemoral, 3 aortoaortic, 2 iliofemoral, 4 peripheral, and 3 axillobifemoral. Human lymphocyte antigen (HLA) and antibody (ABO) blood group system compatibility between donors and recipients was not respected. The mean duration of follow-up was 15 months (range 1-33). Clinical and duplex scanning evaluations were routinely performed. Computed tomography (CT) or magnetic resonance (MR) scanning or arteriography were performed on the basis of duplex scanning results. There were six deaths during the early postoperative period (30 days) with a mortality rate of 13.6%. During the follow-up there were five late deaths with a mortality rate of 11.4%. Eight patients had graft occlusion. Three cases were successfully treated with thrombectomy. Two cases were successfully treated with femoropopliteal bypass with autologous vein. In three cases leg amputation was necessary. The results of fresh and cryopreserved homograft were compared. No significative differences of early postoperative mortality, late mortality, homograft related mortality, and graft occlusion were observed. We have evaluated the actuarial survival of the patients and the actuarial patency of the homografts on the aortoiliac reconstructions. Twelve months after the surgery the actuarial survival of the patients was 73% and the actuarial patency of the homografts was 56%. In our preliminary experience, we have not observed any significant difference in terms of clinical outcome by using fresh rather than cryopreserved homografts. In the near future it will be our policy to employ only cryopreserved homografts. Moreover, we will extend vessel harvesting to nonheart-beating donors, thus maximizing retrieval. The aforementioned solutions will supply the best graft availability to obtain dimensional and ABO compatibility between donors and recipients.

Adult↗
PubMed1994

Ultrasonic endarterectomy: experimental and initial clinical results in carotid stenosis.

PURPOSE: The effects of ultrasonic endarterectomy, evaluated experimentally and clinically, were compared with the results obtained with controversial endarterectomy. METHODS EXPERIMENTAL: An ultrasonic vascular dissector with a frequency of 29 kHz was used for ultrasonic endarterectomy. Gross and histologic observation was made on 22 fresh human cadaver atherosclerotic vessels, of which 16 were treated with ultrasound endarterectomy and 6 conventionally. Clinical: Twenty-eight patients requiring carotid endarterectomy were chosen at random. Seven patients underwent ultrasonic endarterectomy after traditional access surgery, while 21 patients were treated with conventional endarterectomy. In the clinical study, an intraoperative gross observation of the endarterectomized surfaces was made, followed by duplex scanning after 18 and 24 months. RESULTS: Histologic observation of the cadaveric revealed particularly smooth surfaces in 87.5%; there was no debris, flaps, or vessel damage in any of the ultrasonically treated samples. In contrast, the traditional technique produced regular surfaces without residual debris in only 50% of the experimental cases. Favorable results were also seen in the clinical carotid experience, in which there was no need to surgically correct the ultrasonically endarterectomized surface in any case. In fact, achieving a satisfactory outcome was greatly facilitated by the use of ultrasound. In the conventionally treated patients, however, only 19% (4) demonstrated a smooth luminal surface on gross observation even after surgical correction. No postoperative complications were encountered in either group, and no restenosis has occurred in ultrasonic endarterectomy-treated patients after 2 years. CONCLUSIONS: Favorable experimental results using ultrasonic endarterectomy prompted the successful clinical application of this new technique in carotid stenosis treatment. Whether or not ultrasonic endarterectomy can reduce postoperative morbidity and restenosis is still under study.

Aged↗
PubMed1993

Aplasia of the radial artery.

A 2-year-old girl with asymmetrical upper limbs and underdevelopment of the bones of the left forearm, wrist and hand with associated muscular and osteal hypoplasia is described. Doppler ultrasonography of the arterial trunks of the upper limb suggested a normal ulnar trunk in the left upper arm, an arterial vessel extending from the bend of the elbow to the distal third of the forearm, and the absence of any other arterial trunks in the radial region. Angiography confirmed that vascularization of the forearm was sustained by the ulnar artery, which supported the dorsal arch of the carpus and digital arteries arising from it. The interosseal artery was morphologically normal but there was aplasia of the radial artery. It is suggested that this malformation is the result of suppressed development of the vascular system of the left radial segment as other pathologies normally associated with the condition were absent.

Angiography↗
PubMed1988

Myocardial hydatid cyst ruptured into the pericardium: cross-sectional echocardiographic study and surgical treatment.

We describe a patient with a large intramyocardial hydatid cyst lying in the postero-lateral segment of the left ventricle near the atrioventricular groove level which ruptured into the pericardial sac, resulting in cardiac tamponade. Cross-sectional echocardiographic examination from a modified four-chamber apical view showed the multiloculated cyst and the breach connecting it to the pericardial sac, allowing for the definitive diagnosis and indication for emergency cardiac surgery. The risks of pericardiocentesis and invasive diagnostic procedures could thus be avoided.

Adult↗
PubMed1988

Xibornol: multiple dose pharmacokinetics and diffusion in lung, tonsillar tissue and laryngeal mucosa.

In ten patients with severe chronic bronchitis and in a further 23 with planned resection of lung, tonsils or larynx, 500 mg doses, single or multiple, of xibornol (6-isobronyl-3, 4-xylenol) were administered for an antibacterial effect. The pharmacokinetics and diffusion of the drug in the tissues were studied. A high diffusion and distribution value of xibornol was observed, with levels in the tissues constantly higher than that in the serum. The concentrations reached within the respiratory tract were adequate for their antibacterial effect.

Administration, Oral↗
PubMed1987

Ciprofloxacin: multiple-dose pharmacokinetic and clinical results in patients with hypercrinic bronchopulmonary diseases.

Ciprofloxacin, a 4-quinolone derivative with a wider spectrum of activity as compared to classic quinolones employed in the therapy of urinary tract infections, was studied in view of its possible application in the therapy of bronchopulmonary infections. An oral dose of 500 mg every 12 h was administered and both the clinical response and the pharmacokinetic profile were investigated. A complete recovery was reached in 87.5% of patients and an improvement in 12.5%; no failure was recorded. A very good penetration in sputum was confirmed by the sputum/serum area under curve ratio, providing evidence for a high bioavailability in bronchial secretion. Lung tissue concentrations confirmed the good peripheral distribution of ciprofloxacin. A twelve-hour administration schedule allows high peripheral concentrations to be obtained superior or equal to the minimum inhibitory concentrations for many pathogens.

Adult↗