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Biomedical subjects

B Bernardo

Publications and source records attributed to B Bernardo.

At least 19 recordsLinked to original sources
PubMed2004

[Diagnosis and management of necrotizing tracheobronchitis].

OBJECTIVE: Necrotizing tracheobronchitis has been described as a complication of mechanical ventilation of newborns with respiratory failure. Neonates with necrotizing tracheobronchitis present a diverse clinical spectrum from asymptomatic disease to severe airway obstruction that causes 45% of mortality. The objective of our study is to analyze our experience in the management of these patients. MATERIAL AND METHODS: In the last three years we have treated eight patients with necrotizing tracheobronchitis The mean age was 0.84 +/- 0.95 months, gestational age of 37.43 +/- 2.3 weeks. The mean weight was 3.07 +/- 1.04 kg. Five patients had a congenital heat disease (62.5%) and three have a respiratory failure (37.5%). We have analyzed the contributing factors, symptoms, diagnosis, treatment and results. RESULTS: All patients presented episodes of shock with treatment of drugs. Five patients have conventional ventilation (62.5%) while three have high frequency oscillatory ventilation (37.5%). There were not significant differences in the ventilator parameters of both groups (PMA, PIP, PEEP). Three patients were supported by ECMO when they developed necrotizing tracheobronchitis. The treatment was bronchoscopic removal of necrotic tissue. There was not any complication after the procedure. A patient suffered a stenosis in the left main bronchus. Three patients have died during follow-up for different causes. The time of pursuit is of 10.33 +/- 7.61 months. CONCLUSIONS: Necrotizing tracheobronchitis may be increasing in the Neonatal Intensive Care Units, due to a bigger survival of patient with serious respiratory failure and shock. Hypotension and shock seems to be a major contributing factor in the development of this lesion. Bronchoscopy is necessary for treatment and survival of the patients.

Bronchitis↗
PubMed2002

[Respiratory deadspace and compliance measurements in neonates with congenital diaphragmatic hernia].

The mortality rate of infants with congenital diaphragmatic hernia (CDH) remains high, despite clinical improvements. Many attempts have been made to find accurate and reliable predictors of outcome. Deadspace (Vd/Vt) and dynamic compliance (DC) measured by single breath CO2 analysis may be useful to evaluate pulmonary function and perfusion. In the present study we analyse both parameters in patients with CDH. Nine patients with CDH were included for Vd/Vt and DC study. Measurements of arterial blood gases (pH, PO2, pCO2) were obtained, oxygenation index and alveolo-arterial difference calculated at diagnosis, preoperatively and postoperatively. Vd/Vt and DC were measured at the same moments by analysis of the CO2 espirogram. Statistical analysis was performed using Fisher exact test, ANOVA and Mann Whitney and Chi-square. The Vd/Vt was significant lower for the group of patients who survived (0.39 +/- 0.07 vs 0.64 +/- 0.14, p = 0.038). DC was significantly higher in the survivors group (1.39 +/- 0.30 vs 0.5 +/- 0.07, p = 0.011). The analysis of the evolutive Vd/Vt and DC (initial and preoperative) showed significant differences within both groups. Respiratory deadspace can be easily quantified in neonates with congenital diaphragmatic hernia providing an important insight regarding the efficiency of the airway-alveolus and its relationship to pulmonary blood flow. Vd/Vt and DC measurement constitute a reliable method to predict outcome in patients with CDH.

Hernia, Diaphragmatic↗
PubMed2001

Outpatient management of superficial temporal artery aneurysms.

BACKGROUND: To evaluate the feasibility and safety of surgical treatment of the superficial temporal artery aneurysms on an outpatient basis. METHODS: The records of 5 patients seen at our institution from 1983 to 1997 were reviewed retrospectively. Preoperative diagnosis was made by patient s history and physical examination, with no further evaluation. RESULTS: Outpatient ligation and excision of four aneurysms of distal branches of the superficial temporal artery (3 frontal, 1 parietal) and one involving its proximal portion was performed under local anesthesia. Supplementation with minimal intravenous sedation facilitated the treatment in an uncooperative child and in the patient affected with proximal STA aneurysm. All procedures were uneventful. Patients were discharged a few hours after surgical treatment. No patient required hospitalization following discharge. No recurrence was noted during follow-up periods of 2 to 16 years. CONCLUSIONS: Outpatient diagnosis and excision of aneurysm of the superficial temporal artery can be performed safely. Significant advantages of this pathway include no hospital admission and cost reduction.

Adult↗
PubMed1999

Arterial homografts in the management of infected axillofemoral prosthetic grafts.

Two lower limb amputees with infected contralateral axillofemoral prosthetic grafts received preserved human arteries after removal of the infected materials. Both grafts grew organisms (Enterococcus species, plus Staphylococcus species in one). Long length arterial conduits were fashioned from freshly harvested (in one patient) and cryopreserved (in another one) cadaveric iliac and femoral arteries. One arterial homograft had ABO-compatibility with the recipient. No immunosuppressive drugs were administered after repeat arterial reconstructions. After 12 and 15 months both grafts are still patent, without parietal changes at ultrasonography; the patients have a viable remaining lower extremity and are free of symptoms or re-infection.

Aged↗
PubMed1997

Combined vascular injuries and limb fractures.

Blunt arterial injuries secondary to bone fractures are frequently associated with nerve, vein and soft tissue lesions. A delayed diagnosis or treatment is the main cause of high amputation rate. Thirty-four patients presenting acute arterial occlusion (15 cases), false aneurysms (13 cases) or AVFs (6 cases) of the extremity were identified between 1983 and 1995. To repair injured arteries, ligation (3 cases), patch angioplasty (6 cases), autogenous vein (15 patients) or PTFE (4 cases) interposition or bypass grafting were made. Percutaneous embolization by coils was performed in 3 AVFs of small limb arteries. Associated venous lesions were treated in 9 patients. External fixation of long bone fractures was made in 29 patients, before vascular reconstruction, to prevent further injury during orthopedic stabilization. Fasciotomies were made in 6 patients to treat compartmental hypertension. Early reexplorations were necessary to correct technical defects in 4 patients. Hyperbaric oxygen therapy was applied in 7 patients to control bacterial contamination and improve wound healing. Primary (2 cases) or secondary (3 cases) amputations were carried out in unsalvageable limbs. Nerve or extensive muscle damage caused poor functional outcome in 4 patients. A multidisciplinary diagnostic and management strategy is required to improve limb and patient survival.

Adolescent↗
PubMed1997

Late arteriovenous fistulas and pseudoaneurysms of the extremity secondary to civilian firearms.

To evaluate the treatment of late sequelae of penetrating arterial injuries associated with civilian firearms, such as false aneurysms and arteriovenous fistulas (AV-Fs) of the extremities, a retrospective clinical study was carried out. Whenever diagnosis or operative management is delayed because of local fibrosis or morphological and structural vessel changes, primary repair is not feasible and segmental resection is required. Twenty-four patients presenting late false aneurysms (14) and AV-Fs (11) of the extremities, caused by firearms (6 rifle wounds, and 18 pistol wounds), were identified between 1983 and 1995. Twenty-three patients were submitted to resection of pseudoaneurysms (13) or AV-Fs (8), while arterial patch angioplasty was applied in two patients. The venous lesions were repaired by an interposition graft (7) or lateral venorraphy (3). Saphenous vein (15) or PTFE (6) grafts were placed in injured arteries. Percutaneous embolization by coils was performed in two patients. Twenty-three out of 24 patients (95.8%) recovered; one patient (4.1%), affected by aneurysmal AV-Fs of a lower limb dating from 12 years, with enlarged and weakened artery, bled to death. No limb loss occurred. A better evaluation of minimal vascular injuries is required to avoid late sequelae of civilian firearms lesions, with significant blood loss, which need segmental excision of the injured vessels.

Adolescent↗
PubMed1997

Popliteal artery entrapment syndrome: diagnosis and management.

A variety of anatomical abnormalities may product an external compression of the popliteal artery, resulting in a thrombotic occlusion. Between 1983 and 1995, 9 patients presented a popliteal artery entrapment syndrome, bilateral in two cases. Ultrasonography, Angio-CT scan and MRI showed the abnormal structures and position of the popliteal artery on popliteal fossa. Arteriography detected an arterial compression in 6 limbs and occlusion in 4 limbs as well as an associated popliteal aneurysm in one patient and distal embolism in four. The abnormal medial head of the gastrocnemius muscle was resected in 8 limbs, while fibrous membranes were resected in 3 limbs. Autogenous vein replacement was performed in 4 cases of popliteal artery occlusion and following resection of a popliteal artery aneurysm in one case. All patients recovered. In the followup period, the occlusion of the arterial reconstruction occurred after 28 months in one patient, with a mild claudication. Noninvasive vascular imaging techniques may allow early diagnosis and management of PAES, avoiding popliteal arterial wall lesions and its occlusion, with a better outcome.

Adolescent↗
PubMed1997

Intra-abdominal acute diseases simulating rupture of abdominal aortic aneurysms.

OBJECTIVE: To assess preoperative diagnosis of intra-abdominal acute diseases manifesting as a RAAA and determine treatment options. DESIGN: Retrospective review, with a mean follow-up period of 4 years. SETTING: Vascular Department, Medical School, University "Federico II" of Naples, Italy. METHODS: In 12 patients (8.7%) with clinical suggestion of RAAA were found other intra-abdominal acute lesions, associated with asymptomatic aortic aneurysm in 10 of them and absence in one; the remainder had an intact common iliac artery aneurysm. Sonography was performed in the operating room in 5 patients (41.6%) in shock, 4 hemodynamically stable patients (33.3%) had CT scanning or MRI investigations, while 3 (25%) underwent surgery directly. INTERVENTIONS: Three patients were not operated; one half of patients were submitted to emergency laparotomy and in the remaining 3 patients a preoperative preparation was made. Simultaneous aneurysm repair and nonvascular procedures were performed in 4 patients; nonvascular operations alone were carried out in 5 patients. 4 patients underwent a successful later treatment of their aneurysms: two aneurysmectomy and two endoluminal stenting were done within 4 months. RESULTS: Weight loss and fever were found at 58.3% and 50% of patients with concomitant intra-abdominal acute diseases; both were present in 41.6%. Noninvasive imaging techniques detected associate lesions in 6 of 8 patients (75%) and absence of aneurysm in one having a bleeding adrenal mass. There were three in-hospital deaths: one patient died of metastatic disease without operation and two after surgery (22.2%). Two late deaths from cancer cachexia occurred at 11 months and 3.6 years. CONCLUSIONS: Atypical findings, such as weight loss and fever may be suggestive of coincident lesions in patients with suspected RAAA. Noninvasive assessment may identify associated diseases simulating aneurysmal rupture, without a delay in the treatment. A selective policy of medical or operative therapy may be effective to minimize risk of complications and mortality rate.

Abdomen, Acute↗
PubMed1996

Popliteal-to-tibial bypass for acute leg ischemia complicating aortic reconstruction.

Between 1983 and 1995, elective aortic surgery was performed on 1018 patients for aneurysmal (417 cases) or occlusive disease (489 cases), or both (112 cases). Intraoperative acute popliteal occlusion, despite of aortic graft patency, developed in 2 patients due to distal embolization (0.19%) and in 5 patients secondary to acute popliteal trifurcation thrombosis (0.49%). Preoperative ankle index was 0.46 +/- 0.12, but intraoperatively it went down to zero; distal popliteal occlusion was confirmed by intraoperative arteriography. A balloon catheter embolectomy was performed in two patients. Distal bypass from popliteal artery above knee (1) and below knee (3) to the posterior tibial artery was implanted in four patients using reversed autogenous saphenous vein. In one patient, revascularization was not feasible because of diffuse calcified obstructive disease of leg arteries. Reoperations resulted in a satisfactory outcome in 6 out of 7 patients (85.7%). The patient, in which revascularization was not possible, was submitted to major amputation. In the four popliteal-to-tibial bypasses evaluated through a follow up period of 43 months, graft patency was 75% and limb salvage rate was 100%. Instead of amputation, popliteal-to-tibial bypass is a useful treatment for acute in situ thrombosis of popliteal trifurcation following aorto-iliac reconstruction.

Acute Disease↗
PubMed1996

[Aneurysms of the external jugular vein].

External jugular vein aneurysms are rare and appear as a soft, compressible mass in the neck. Three cases are herein reported. Ultrasonography is the investigation of choice. Surgical excision is indicated, specially in case of giant and thrombosed venous aneurysm.

Adult↗
PubMed1996

Visceral artery aneurysms secondary to collateral circulation.

OBJECTIVE: To evaluate dilatation of visceral arteries secondary to anomalies and collateral circulation. DESIGN: Case report. SETTING: Department of Vascular Surgery, University Hospital. PATIENTS: Two patients with secondary visceral aneurysms were reported. First patient (case 1) had a mid-aortic dysplastic syndrome with multiple aneurysms of the celiac trunk and right renal artery. Other patient (- case 2) presented an inferior pancreaticoduodenal artery aneurysm associated with proximal common hepatic artery occlusion. INTERVENTIONS: The case 1 was submitted to aortic and left renal artery angioplasty (PTFEE), while in the case 2 the resection of aneurysm was performed. RESULTS: Both patients had complete resolution of symptoms and are alive today. CONCLUSIONS: Clinical observations confirmed the development of visceral artery aneurysms secondary to arterial hypertension and collateral circulation.

Adult↗
PubMed1996

Iatrogenic rupture of internal carotid artery aneurysm. A complication of CT-guided needle biopsy of the neck.

Incidental rupture of an internal carotid artery aneurysm complicating a CT-guided needle biopsy of the neck is reported. A contrast CT scan failed to diagnose the lesion, which was not pulsatile and thought to be a neoplastic cervical lymph node. After leakage of the aneurysm. Color-Doppler scan and MRI identified aneurysmal changes of the carotid artery wall with an intraluminal thrombus. Successful emergency resection with a PTFE interposition graft was performed.

Aged↗
PubMed1985

[Hemorheologic and blood coagulation studies in 94 patients with chronic obstructive peripheral arterial disease].

During the last three years we have analyzed, in 94 patients with chronic arterial occlusive disease, in order to assess the hemorheological and hemocoagulative balance, the following parameters: prothrombin time, partial thromboplastin time, antithrombin III, antiplasmin, fibrinogen, factor VIII, erythrocyte sedimentation rate, platelet aggregation, erythrocyte filterability and hematocrit values. The main findings were: in 56 patients the hematocrit value was higher than 44%; Katz index was above normal values in 61.7% of the cases; ATIII showed a trend to lower values; platelet aggregation was increased; no significant variations in comparison to normal values were found in FVIII, antiplasmin levels, prothrombin time and partial thromboplastin time. Erythrocyte filterability values were decreased at a level as lower as more advanced was the clinical stage of the disease. These findings show, in agreement with those of other authors, the presence of hyperviscosity and hypercoagulative state in patients with chronic arterial occlusive disease.

Aged↗