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A T Donato

Publications and source records attributed to A T Donato.

12 recordsLinked to original sources
PubMed1994

Ability of the carotid duplex scan to predict stenosis, symptoms, and plaque structure.

BACKGROUND: The duplex scan with its improved technology has allowed clinicians to visualize noninvasively the carotid bifurcation. We investigated whether the duplex scan, with its ability to visualize plaque structure, can reliably predict the major components of different plaques seen in pathologic studies. Furthermore, we studied whether it could correlate these findings with the presenting symptoms of patients and predict which patients would benefit from early endarterectomy. METHODS: We performed a retrospective study of 84 patients during a 43-month period. The arteriogram, duplex scans, symptoms, and pathologic examination of the carotid atheroma in each patient were reviewed. The specimens were divided into three categories depending on the major component found in pathologic studies. One group consisted of calcific plaques, another was predominantly fibrosis and cholesterol, and the third was plaques with intramural hemorrhage. The angiograms and duplex scans were separately interpreted. Patients with symptoms (81%) were divided into those with amaurosis fugax (19%), transient ischemic attacks (58%), and cerebral vascular accidents (3%). RESULTS: The agreement between duplex scan findings and arteriograms concerning the percent stenosis was 95%. There was no correlation, however, between the presence or type of symptoms and the plaque structure as seen in pathologic studies or on the duplex scan. CONCLUSIONS: At this stage of technology the duplex scan is most reliable in detecting hemodynamically significant lesions. Its ability to predict symptoms or findings at surgery and possibly to alter treatment is at best limited.

Aged↗
PubMed1994

The simple Fogarty embolectomy: an operation of the past?

We have found in reviewing our vascular cases that the Fogarty embolectomy is definitive treatment in only certain types of cases; in most it is an adjunct to more complex vascular surgery. In our cases, an embolectomy catheter was used as an integral part of the procedure in 130 (18%) cases. In 96 (74%) cases, an embolectomy alone was performed with a success rate of only 48% (46 cases). In 50 (52%) cases, the embolectomy was not adequate, requiring reoperation, a new bypass, or amputation within 7 to 10 days. Mortality rate for the series of 130 patients was 7.0%, and limb loss rate was 5.0%. The majority of cases (92) in this review were diagnosed with an acute exacerbation of diffuse peripheral vascular disease or a clotted graft, and it is in these patients that the success rate was so poor (17%) if embolectomy alone was performed. The population of patients presenting with suspected acute arterial insufficiency has changed over the past 30 years. Now it is the elderly who have an acute exacerbation of their peripheral vascular disease. It is this change in the population that has made the Simple Fogarty Embolectomy an operation of the past--mandating angiography, Fogarty embolectomy, and complex vascular reconstruction for limb salvage.

Aged↗
PubMed1992

Carotid arterial surgery using local anesthesia: a private practice retrospective study.

Carotid endarterectomy has recently become one of the more controversial operations. The tremendous increase in the number of endarterectomies performed, coupled with the apparent increase in morbidity and mortality associated with this operation in some studies, have brought into question the indications and results of the procedure. The potential for complications from the procedure itself, as well as increased morbidity and mortality from surgery on the elderly, make carotid endarterectomy a dangerous operation that must be done carefully and thoughtfully. The authors have performed carotid endarterectomies exclusively under local anesthesia to more closely evaluate the neurologic status of the patient. They believe that the operation performed in this manner obviates the use of a shunt and its inherent complications in greater than 80 per cent of the patients. This, coupled with the fact that many of the patients also have severe cardiac disease and the use of local anesthesia causes less hemodynamic changes and stress, should make carotid endarterectomy under local anesthesia the preferred approach.

Age Factors↗
PubMed1988

Early diagnosis of iliofemoral venous thrombosis by Doppler examination.

The diagnosis of iliofemoral venous thrombosis prior to its progression to phlegmasia cerulea dolens can be difficult and, at times, confusing. The Doppler ultrasound examination in experienced hands can be extremely reliable and rapid in diagnosing the condition. During an 18 month period, we used the Doppler examination to diagnose iliofemoral venous thrombosis in 21 patients, 15 of whom had corroboration by venogram. The key to successful treatment and avoidance of significant complications was early and accurate diagnosis by the Doppler examination. No patient underwent operation or progressed to venous gangrene. Six were treated with streptokinase and the rest, with intravenous heparin, leg elevation, and stockings. We believe that iliofemoral venous thrombosis is a much more common disease than previously recognized and should be vigorously diagnosed and treated when a patient presents with a symptomatic extremity. The Doppler ultrasound examination represents a rapid, reliable alternative to the venogram in the early diagnosis of iliofemoral venous thrombosis.

Adult↗
PubMed1987

Noninvasive differentiation of carotid artery occlusion from high-grade stenosis.

The differentiation of high-grade carotid artery stenosis from occlusion can be a difficult but important diagnostic dilemma. The authors used a combination of duplex scanning, pulsed spectrum analysis, audible analysis of continuous wave doppler signal, and peri-orbital doppler compressions to accurately differentiate high-grade stenosis from occlusion in a series of 24 patients.

Arterial Occlusive Diseases↗
PubMed1979

Bone scanning in the evaluation of patients with lung cancer.

Sixty patients suspected of having lung cancer were evaluated for bone metastasis by means of technetium 99m stannous-polyphosphate bone scanning and correlative radiographic bone survey. Diagnosis of lung cancer was histologically proved in all patients. Scans demonstrated evidence of bone metastasis in 20 patients (33.4%) and radiographs, in 10 patients (16.6%). Twenty-four patients had repeat skeletal evaluation at one to eleven months after the first study. Of these patients, 7 initially demonstrating both negative scans and radiographs showed abnormal scans within five months. Bone scans correlated with radiographs in 53.3% and with accompanying bone pain in 33.3% of patients. False negative and false equivocal results were noted in 4 patients. This study suggests that bone scanning with 99mTc stannous-polyphosphate detected early bone metastasis in patients with lung cancer before these lesions became evident clinically or radiographically. Bone scanning is of value during the initial evaluation to determine operability in patients with lung cancer.

Adult↗
PubMed1975

Fatal air embolism during thoracotomy for gunshot injury to the lung. Report of a case.

Fatal coronary air embolism occurred during thoracotomy in a patient with a gunshot wound involving the hilum of the right lung. Embolism was observed during a second period of failure of heart action. Evidently, air entered the pulmonary veins from the bronchus, which was receiving positive-pressure ventilation. The literature contains reports of only 3 similar cases, but we suspect that air embolism may be responsible for death and morbidity in additional cases in which accidental or iatrogenic lung trauma has produced a pathway between the bronchial tree and the pulmonary veins.

Adult↗