PubMed Health⌕ Search

Biomedical subjects

M Carlino

Publications and source records attributed to M Carlino.

At least 19 recordsLinked to original sources
PubMed2001

Emergency stenting to treat neurological complications occurring after carotid endarterectomy.

OBJECTIVES: The purpose of this study was to assess the efficacy of emergency stent implantation for the treatment of perioperative stroke after carotid endarterectomy (CEA). BACKGROUND: Carotid endarterectomy has been proven safe and effective in reducing the risk of stroke in symptomatic and asymptomatic patients with >60% carotid artery stenosis. However, perioperative stroke has been reported in 1.5% to 9% of CEA cases. The management of such a complication is challenging. Recently, percutaneous transluminal carotid angioplasty with stent deployment has emerged as a valuable and alternative strategy for the treatment of carotid artery disease. METHODS: Between April 1998 and February 2000, 18 of the 995 patients (1.8%) who had CEA in our institution experienced perioperative major or minor neurological complications. Of these, 13 patients underwent emergency carotid angiogram and eventual stent implantation, whereas the remaining five had surgery re-exploration. RESULTS: Carotid angiogram was performed within 20+/-10 min and revealed vessel flow-limiting dissection (five cases) or thrombosis (eight cases). Percutaneous transluminal carotid angioplasty with direct stenting (self-expandable stent) was performed in all 13 cases. Angiographic success was 100%. Complete remission of neurological symptoms occurred in 11 of the 13 patients treated by stent implantation and in one of the five patients treated by surgical re-exploration (p = 0.024). CONCLUSIONS: Stent implantation seems to be a safe and effective strategy in the treatment of perioperative stroke complicating CEA, especially when carotid dissection represents the main anatomic problem.

Aged↗
PubMed2001

Surgical and percutaneous myocardial angiogenesis induction. Part II--neoangiogenesis.

Coronary artery bypass surgery and angioplasty provide symptomatic relief in patients with ischemic heart disease, but despite advancement in technique and devices, these methods are not applicable to a subset of patients with angina refractory to medical treatment. Bypass surgery might not be feasible because of lack of suitable conduits, diffuse coronary disease or poor distal run-off, and coronary angioplasty is sometimes not applicable due to chronic total occlusion, diffuse disease or extreme tortuosity. We have previously reviewed the available experience with laser-induced direct myocardial revascularization, one of the new potential treatment modalities for this patient subset. One of the potential mechanisms of action for laser treatment is the induction of neoangiogenesis. In the second part of our article we review the available experience with the induction of myocardial angiogenesis using different growth factors or the genes encoding for them.

Coronary Disease↗
PubMed2001

Assessment of the functional significance of coronary lesions using a monorail catheter.

Myocardial fractional flow reserve (FFR) < 0.75 is a reliable index of a functionally severe coronary stenosis. FFR is best assessed by a sensor-tipped pressure monitoring guidewire (PW). The purpose of this study was to assess whether a multifunctional probing catheter (MFP), a 3 French dual-lumen monorail catheter, can be used to accurately measure intracoronary pressure and FFR. In 35 lesions (35 patients; learning group), we calculated FFR by both PW (FFRPW) and MFP (FFRMFP). Using ROC analysis, the FFRMFP value of 0.65 had the highest sensitivity with the FFRPW < 0.75. FFRMFP cut-off (0.65) was tested in 40 patients (testing group). In all cases, lumen diameter was documented by an intracoronary ultrasound examination. In the learning group, the FFRPW was 0.82 +/- 0.17 and FFRMFP was 0.70 +/- 0.23 (r = 0.88; p < 0.001). The FFRMFP cut-off value (0.65) correctly predicted the FFRPW in 37/40 cases in the testing group. In the 3 discordant cases, FFR was critical (< 0.65) by MFP and normal (> 0.75) by PW. In all these cases, minimal lumen cross-sectional area was < 2.8 mm2. When FFRMFP is > 0.65, FFRPW is always > 0.75. These data demonstrate that even with larger cross-sectional area than a pressure wire, the MFP catheter can easily and reliably be used to assess the functional severity of coronary stenosis.

Cardiac Catheterization↗
PubMed2000

Enoximone echocardiography for predicting recovery of left ventricular dysfunction after revascularization : a novel test for detecting myocardial viability.

BACKGROUND: The possibility that enoximone, a nonglycoside, noncatechol, positive inotropic agent, in combination with 2-dimensional echocardiography may predict recovery of myocardial dysfunction after revascularization has not been yet evaluated. METHODS AND RESULTS: Forty-five patients with chronic coronary artery disease and left ventricular dysfunction underwent dobutamine (DE, 5 to 10 microg. kg(-1). min(-1)) and enoximone (EE, 1.5 mg/kg, over 10 minutes) echocardiography. Myocardial wall motion was scored from 1 (normal) to 4 (dyskinesia): an asynergic segment was considered to have contractile enhancement when the score decreased by >/=1 grade. Of 478 asynergic segments, 216 (45%) exhibited functional recovery after revascularization. Dobutamine- and enoximone-induced contractile enhancement was observed in 41% and 46% of segments, respectively. Compared with DE, EE had higher sensitivity (88% versus 79%, P<0.01) and negative predictive value (90% versus 84%, P<0.05) in predicting functional recovery. The specificity (89% versus 90%) and positive predictive value (87% for both EE and DE) were similar. Concordant interpretation of EE and DE findings was found in 85% (406 of 478) of affected segments. Prerevascularization coronary angiography showed that stenosis severity of vessels supplying areas which only improved with enoximone was significantly greater (89.9%) than that of vessels (77.7%) supplying areas that responded to both agents (P<0.02). Both dobutamine and enoximone increased heart rate (16% and 10%, respectively), whereas enoximone did not cause changes in systolic blood pressure that increased by 14% with dobutamine. CONCLUSIONS: Enoximone echocardiography provides a novel and reliable approach for the prediction of functional recovery after revascularization. Compared with dobutamine echocardiography, the test yields higher sensitivity and induces lesser hemodynamic alterations.

Adult↗
PubMed2000

Progressive decrease of outflow gradient and septum thickness after percutaneous alcoholization of the interventricular septum in hypertrophic obstructive cardiomyopathy.

BACKGROUND: The aim of this study was to evaluate the immediate- and mid-term results of percutaneous transluminal septal myocardial ablation (PTSMA) of the interventricular septum performed in 15 consecutive patients with hypertrophic obstructive cardiomyopathy between 1996 and 1999. METHODS: Prior to intervention, all patients (7 males, 8 females, mean age 62 +/- 11 years) complained of severe dyspnea (NYHA functional class III-IV) despite medical treatment with beta-blockers and/or verapamil. Family history of hypertrophic cardiomyopathy was present in 2 cases. Dehydrated alcohol (4.8 +/- 1.5 ml/pt) was selectively infused into the first septal perforator artery through over-the-wire balloon catheters. In 5 patients a second or a third septal branch was treated because the intraventricular gradient persisted above 50 mmHg after the initial alcohol infusion. RESULTS: Alcohol infusion induced an average peak creatine phosphokinase level of 1,524 +/- 427 IU/l. No iterating ventricular arrhythmias occurred during the procedure or in the 2-3 days of continuous ECG monitoring after the procedure. Two patients (13%) developed a complete atrioventricular block after the procedure, requiring permanent double-chamber pacing. Electrocardiographic changes included a > 2 mm ST segment elevation and transient right bundle branch block or left anterior/left posterior hemiblock in all patients. Peak basal intraventricular gradient decreased from 80 +/- 27 to 24 +/- 27 mmHg (p < 0.01) during cardiac catheterization and from 81 +/- 27 to 35 +/- 25 mmHg (p < 0.01) at the echocardiographic control performed during the hospital stay. At follow-up (mean 5.1 +/- 3.6 months), all patients were in NYHA functional class I or II. Repeat echocardiography showed a further significant decrease in intraventricular gradient to 25 +/- 26 mmHg (p < 0.01) and a progressive decrease in intraventricular septum thickness (25 +/- 5 mm before treatment, 21 +/- 6 mm before hospital discharge, 17 +/- 3 mm at follow-up, p < 0.01). CONCLUSIONS: PTSMA of the intraventricular septum effectively relieves symptoms in selected patients with hypertrophic obstructive cardiomyopathy. The immediate decrease in intraventricular gradient is followed by a further decline at follow-up with a progressive reduction in the intraventricular septum thickness.

Aged↗
PubMed2000

Surgical and percutaneous myocardial angiogenesis induction. Part I--laser revascularization.

Coronary artery bypass surgery and angioplasty provide symptomatic relief in patients with ischemic heart disease, but despite advancement in technique and devices, these methods are not applicable in a subset of patients with angina refractory to medical treatment. Bypass surgery may not be feasible because of lack of suitable conduits, diffuse coronary artery disease or poor distal run-off, and coronary angioplasty is sometimes not applicable due to chronic total occlusion, diffuse disease or extreme tortuosity. Transmyocardial laser revascularization and the stimulation of neoangiogenesis by a variety of growth factors have recently emerged as a new tool in the management of these patients. In the first part of this article, we review laser-induced direct myocardial revascularization, its indications, potential risks, and published clinical trials. The induction of neoangiogenesis using different growth factors or the genes encoding for them will be the subject of the second part of our review.

Angina Pectoris↗
PubMed1999

Prevention of distal embolization during saphenous vein graft lesion angioplasty. Experience with a new temporary occlusion and aspiration system.

BACKGROUND: Repeat coronary artery bypass graft surgery (CABG) is associated with a high morbidity and mortality, rendering percutaneous treatment of saphenous vein graft (SVG) lesions an attractive alternative. However, percutaneous interventions of degenerated SVGs carries high risk of distal embolization. METHODS AND RESULTS: This study reports our initial experience with the PercuSurge GuardWire, a new device developed to prevent embolization during treatment of degenerated SVG. This device consists of a 190-cm-long, hollow 0.014-in guidewire with a central lumen connected to a distal occlusion balloon. A dedicated inflation device (the MicroSeal Adapter) was used to inflate the distal balloon and maintain complete lumen occlusion during balloon dilatation and stent implantation. A monorail aspiration catheter, connected to a vacuum syringe, was used to evacuate atherosclerotic and thrombotic debris. Angioplasty with stent implantation was performed in 15 degenerated SVGs (18 lesions). Procedural success was achieved in all patients with normal postprocedure flow (Thrombolysis in Myocardial Infarction grade 3). No distal embolization was observed. There were no major in-hospital adverse clinical events, including Q-wave or non-Q-wave myocardial infarction, emergency CABG, or death. All patients were asymptomatic at discharge. CONCLUSIONS: This preliminary series supports the feasible use of the PercuSurge GuardWire for retrieval of plaque debris and prevention of embolization in degenerated SVGs. The good tolerance of temporary occlusions without angiographic or clinical evidence of distal embolization represents encouraging early findings.

Aged↗
PubMed1998

A case study in interdisciplinary care of the critically ill.

The special care unit (SCU) of University Hospitals of Cleveland was established in 1989 specifically for case management of critically ill patients who require long-term habitation in an intensive care setting, usually because of ventilator dependency. This case study exemplifies the interdisciplinary involvement in caring for a patient with complications who was a long-term, critically ill resident of the unit. The discussion shows the importance of the use of the nurse case manager coordinator and an interdisciplinary approach to patient care for successful outcomes in the chronically critically ill population.

Acute Disease↗
PubMed1997

Success of glucocorticoid replacement therapy on fertility in two adult males with 21-CAH homozygote classic form.

A normal gonadal maturation with normal fertility are some of the major goals of long-term replacement therapy in adult males with Congenital Adrenal Hyperplasia (CAH). We describe here two young men, G.O. (case A, 23 years old) and S.S.(case B, 24 years old), both with a well defined diagnosis of CAH due to 21-hydroxylase deficiency classic homozygote form (21-CAH). In case A the diagnosis of the 21-CAH classic virilizing form was made at 3 years of age. The patient has undergone glucocorticoid therapy and is now 170 cm tall; all his hormonal findings are within the normal range. The semen analysis has shown a good fertility potential, with a slight modification when the patient decided to discontinue the therapy. In case B the diagnosis of the 21-CAH salt wasting form was performed at 9 days of age. The patient was initially treated with i.v. normal saline solution and a daily i.m. injection of hydrocortisone and, subsequently, with mineral and glucocorticoid replacement therapy po. A satisfactory adult stature (165 cm) was attained. The patient is still on therapy, with a good hormonal profile. The semen analysis has shown an apparently normal fertility. In conclusion, our experience in adult males with 21-CAH, who have been administered prompt and adequate replacement therapy, shows that these patients can attain normal quality of life, satisfactory growth and development, normal sexual maturation and activity, and adequate sperm fertilizing ability, thereby supporting the usefulness of continuing this therapy during adult age.

Adrenal Hyperplasia, Congenital↗
PubMed1997

Soluble E-selectin and intercellular adhesion molecule-1 plasma levels increase during acute myocardial infarction.

Previous studies have shown that adhesion molecules play a crucial role in leukocyte-endothelium interactions that occur during myocardial ischemia and reperfusion. We assessed the plasma levels of the soluble form of E-selectin (sE-selectin) and intercellular adhesion molecule-1 (sICAM-1) in 15 patients with acute myocardial infarction (AMI) and in 15 controls with chronic stable angina. In patients with AMI, the levels of sE-selectin and sICAM-1 increased significantly during the first 8 h after infarction and subsequently decreased. Soluble E-selectin levels were inversely related to the peak plasma levels of creatine kinase-MB (CK-MB), and the time course of their appearance in plasma correlated with that of neutrophil count and plasma D-dimer. In individual patients, peak and mean sICAM-1 levels correlated respectively with plasma D-dimer concentrations and monocyte count, but no correlation were found when their time courses were analyzed. Eight hours after symptom onset, the mean plasma sE-selectin levels were higher in patients with AMI than in those with stable angina, whereas no significant differences were found in mean plasma sICAM-1 levels between the two groups at every time analyzed. In the acute phase of MI (a) sE-selectin and sICAM-1 levels increase during the first 8 h and subsequently decrease; (b) the increase in sE-selectin probably reflects activation of endothelial cells, correlates with other inflammatory and coagulation parameters, and is inversely related to the degree of myocardial damage; and (c) sICAM-1 plasma levels do not represent a good marker of "cell activation" because they reflect activation of different cells and may be affected by different conditions.

Adult↗
PubMed1997

Impaired left ventricular filling dynamics in patients with angina and angiographically normal coronary arteries: effect of beta adrenergic blockade.

OBJECTIVE: To assess exercise performance and resting left ventricular filling dynamics in patients with syndrome X (SX) in basal conditions and after 10 days treatment with oral atenolol. DESIGN AND PATIENTS: Exercise performance was studied and left ventricular filling assessed by Doppler-derived transmitral flow pattern analysis in 22 patients (16 female, mean (SD) age 53 (4) years) with angina, a positive exercise test, and angiographically smooth coronary arteries. Patients were studied after two 10 day treatment periods with either atenolol or placebo in a single-blind, randomised, crossover trial. The same protocol was followed in 10 patients with documented coronary artery disease (CAD) and in 13 controls (C). RESULTS: Unlike the controls, patients with SX and those with CAD consistently showed exercise-induced ST segment abnormalities and impaired resting left ventricular filling while on placebo. Atenolol significantly reduced episodes of angina, completely prevented exercise-induced ST segment changes in 18 SX patients, and delayed their onset in all patients with CAD: in both groups the agent significantly improved Doppler-derived indices (mean (SD)) of ventricular filling (E/A 0.97 (0.27) v 1.22 (0.32) and 0.84 (0.21) v 1.19 (0.37), respectively). CONCLUSIONS: The objective documentation of left ventricular filling abnormalities may be useful in confirming the clinical diagnosis of SX and in providing objective evidence of therapeutic benefit. The similarity of the symptoms and electrocardiographic and ventricular filling abnormalities found in patients with SX and in those with CAD suggests that ischaemia is involved in both groups.

Adrenergic beta-Antagonists↗
PubMed1996

Thrombolytic therapy reduces the incidence of left ventricular thrombus after anterior myocardial infarction. Relationship to vessel patency and infarct size.

BACKGROUND: Controversial evidence exists as to whether thrombolytic therapy reduces the incidence of left ventricular thrombus in acute myocardial infarction and, if so, how this relates to successful reperfusion. METHODS: Four hundred and eighteen consecutive patients underwent echocardiography and coronary angiography within 3 weeks of an acute myocardial infarction. A dyssynergic score was calculated by analysing regional wall motion in 18 left ventricular segments. The infarct-related artery was considered patent if TIMI grade 2 or 3 flow and less than 90% stenosis were present. Retrograde perfusion by Rentrop's grade 2 or 3 collaterals was considered significant. RESULTS: Large anterior myocardial infarctions were associated with the highest prevalence (39%) of left ventricular thrombosis. Thrombus was also very frequent if the left anterior descending coronary artery was occluded and no collaterals to the infarct area were seen (75%). Anticoagulant therapy reduced the prevalence of left ventricular thrombus, regardless of whether the infarct-related vessel was patent or not. Conversely, in patients undergoing thrombolysis the incidence of left ventricular thrombosis was lower when the left anterior descending coronary artery was patent, and especially when an early creatine kinase peak, suggestive of reperfusion, was recorded (7%). Finally, the presence of left ventricular thrombosis was inversely related to the asynergy score. CONCLUSION: These observations suggest that the presence of left ventricular thrombus is related to the extent of myocardial damage. Thrombolytic therapy reduces thrombus probably by salvaging myocardium at risk.

Adult↗
PubMed1995

A quick method to detect circulating anti-thyroid hormone autoantibodies.

The aim of this study was to evaluate the feasibility of a chromatographic method to easily detect circulating anti-thyroid hormone autoantibodies (THBA), to calculate their affinity constant and the total thyroid hormone (TH) levels in presence of THBA. This method was applied to sera from 4 subject with suspected THBA and 20 controls (10 normal subjects and 10 patients with thyroid dysfunctions). After a short incubation with 125I-T3 or T4 tracer solution containing 8-anilino-1-naphthalenesulfonic acid as inhibitor of the binding of TH to plasma proteins without affecting THBA binding, the samples were chromatographied on prepacked Sephadex LH 20 columns and eluted with TRIS buffer to separate free TH from THBA-bound TH. Samples were considered THBA positive when radioactivity values in TRIS eluates were higher than in controls. THBA-bound TH were subsequently eluted with methanol and used to calculate the total TH present in patients with THBA. After a validation test using two standardized methods, we propose this method to quickly detect TH-BA in samples with suspected spuriously high values of free and total TH.

Anilino Naphthalenesulfonates↗
PubMed1990

[Left atrial enlargement during the exercise test: a new electrocardiographic sign of transitory ischemia].

In patients with coronary artery disease, electrocardiographic signs of left atrial enlargement (LAE-negative P wave deflection greater than or equal to 1 mm2 in lead V1) are associated with increased left ventricular end diastolic pressure (LVEDP). We investigated the possibility that transient LAE could represent an additional criterion for diagnosing myocardial ischemia during exercise testing (EST). We studied 48 consecutive patients with chronic stable angina, positive EST and 201 Tl scintigraphy, and angiographically proven CAD; 200 other consecutive patients with atypical chest pain and normal stress/rest 201 Tl scintigraphy served as controls. During EST, transient LAE developed in 34/48 patients with CAD but in only 1/200 controls (p less than 0.001). When present, LAE preceded ST changes (6.1 +/- 1 min vs 8.2 +/- 2 min) and recovered earlier (4.7 +/- 4 min vs 5.8 +/- 3 min). The prevalence of 2-3 vessel CAD was significantly higher in patients with EST-induced LAE (54% vs 34%, p less than 0.05). In conclusion, transient ECG signs of LAE during EST represent a highly specific sign of reversible ischemia and are frequently associated with multivessel CAD. Although less sensitive than classical ST criteria, this sign may prove useful in patients exhibiting equivocal ST changes and in the presence of ventricular conduction disturbances.

Aged↗
PubMed1983

Study of the pituitary-thyroid axis in euthyroid goiter after partial thyroidectomy.

The aim of this study was to investigate the time involved after hemithyroidectomy in reaching a new steady state in thyroid function and the relationship between thyroid hormones, basal TSH levels and TSH response to TRH. The investigations were performed on 35 patients 12-18 months after partial thyroidectomy in the first investigation and after 24-30 months in the second investigation. Tests included T4, T3, FT4, FT3 serum levels, basal serum TSH and TSH response to TRH. None of the patients received thyroid replacement and 38 healthy subjects of comparable age and sex were used as controls. We conclude that: i) the time involved in reaching a new steady state of thyroid function in hemithyroidectomized patients is variable and may take a long time; ii) TSH response to TRH returns to the normal range later than thyroid hormone and basal TSH levels.

Adult↗