Letter to editor re: endovascular repair of para-anastomotic aortic aueurysms.
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Anastomosis, Surgical↗
Biomedical subjects
M Monaco
Publications and source records attributed to M Monaco.
An outbreak of Acinetobacter baumannii in an intensive care unit: epidemiological and molecular findings.
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Acinetobacter Infections↗
Endovascular stent grafts as a safe secondary option for para-anastomotic abdominal aortic aneurysm.
OBJECTIVE: To describe our experience of endovascular repair of para-anastomotic aortic aneurysm. METHODS AND RESULTS: From March 2001 to December 2004 we identified 6 patients with a para-anastomotic aortic aneurysms following previous open repair of abdominal aortic aneurysm. All patients were treated with endovascular surgery under epidural anaesthesia. There were no major complications, surgical conversions or deaths. Four patients received a bifurcated aortic stent-graft, and two an aorto-uniliac stent-graft followed by a femoro-femoral bypass. At follow-up (mean 26.1+/-10.2 months) there were no deaths, endoleaks or graft migrations observed. CONCLUSION: Endovascular surgery, avoiding general anesthesia and re-laparotomy, is the ideal technique for treatment of this complication resulting from failed primary conventional AAA repair.
Aged↗
Aortic valve replacement and coronary artery surgery: determinants affecting early and long-term results.
BACKGROUND: We studied factors influencing early and late results in patients operated on for aortic valve replacement and coronary artery bypass graft. METHODS: 175 patients were retrospectively analysed over a 10-year period ending in December 2002. There were 135 males and 40 females with a mean age of 62.7 +/- 8.9 years; 109 were in NYHA class III/IV; 45 required an urgent operation, and 103 mechanical valves and 72 biological valves were implanted. RESULTS: There were 11 operative deaths (6.3 %). Statistical analysis (logistic regression) showed that previous myocardial infarction, poor NYHA class, and low LVEF had a significant effect on early death. There were 52 late deaths at a mean follow-up of 82.7 +/- 38.8 months. Using a Cox survival analysis for any causes, age, urgent operation, low LVEF, and creatinine had a strong impact on unfavourable late outcome. CONCLUSIONS: A combination of a patient-related factor (age), cardiac-related condition (low LVEF), co-morbid condition (renal dysfunction), and operative cause (urgent operation) is the most important predictor of late clinical outcome for this combined surgical procedure.
Aged↗
[Percutaneous radio frequency thermal ablation of non-resectable lung cancer: state of the art].
BACKGROUND: Unfortunately, as of yet, most lung cancers are not operable as soon as diagnosis is available; in these situations chemo- and radio-therapy still play a key role, albeit palliative, improving survival rate moderately, but are not lacking in toxic effects, especially in case of concurrent pathology, reduced cardio-respiratory functionality or being advanced in years. Therefore thermal ablation mini-invasive techniques, already employed as ancillary treatments of hepatic cancer or in place of surgery, have been performed for these pathologies. AIM: Aim of this work is to define the current state of the art for Radio-Frequency Ablation (RFA) to be performed on non-resectable lung cancer, also by means of a thorough review of international literature, from which to infer purposes, suggestions, methodologies, effectiveness, safety, complications and achievements, also in terms of the possible improvement of life quality and/or survival expectancy. PATIENTS AND METHODS: Patients have been carefully selected. Pulmonary nodules have been treated with TC or echo-guided percutaneous thermal ablation and, afterwards, evaluated by radiological and clinical (sometimes histopathological) follow-up. RESULTS: The size of the RFA-treated nodules is necessary in order to evaluate full or partial necrosis extent and, therefore, average survival rate. CONCLUSIONS: Availability of more extensive and homogeneous case histories, as well as standard follow-up (TC and/or histopathological sampling) methodologies, is required. Nevertheless several authors agree that RFA is a safe and effective technique within the framework of a substitutive or complementary treatment of non-operable lung cancer. The best results can be achieved for cancers less than 3 cm wide; RFA, performed before chemo- and/or radio-therapy, plays a neoadjuvant role for larger cancers, decreasing cancer volume and weakening the symptoms.
Catheter Ablation↗
Discrete subaortic stenosis: long-term prognosis on the progression of the obstruction and of the aortic insufficiency.
BACKGROUND: We sought to determine the long-term rate of progression of left ventricular outflow tract (LVOT) obstruction and aortic insufficiency (AI) in adult patients operated on for discrete subaortic stenosis (DSS). METHODS: Between 1975 and 1995, 52 patients underwent surgery for DSS; their mean age was 25.4 +/- 14.8 years. Mean preoperative LVOT gradient was 72.8 +/- 25.7 mm Hg. Excision of the subaortic membrane was carried out in all patients, myectomy of the interventricular septum was additionally carried out in 8 patients (15.4 %), and aortic valve replacement (AVR) was performed in 15 patients (28.8 %). RESULTS: There were 2 operative deaths (3.8 %). Early postoperative LVOT gradient was 9.7 +/- 6.5 mm Hg. Follow-up ranged from 8.1 to 26.6 years. There were 8 late deaths (16.3 %), and mean LVOT gradient was 13.3 +/- 10.7 mm Hg. Five patients required reoperation for recurrent obstruction; 4 patients had a gradient of more than 30 mm Hg. The AI, in patients who did not undergo aortic valve replacement, did not substantially change during follow-up. CONCLUSIONS: DSS is a variable, unpredictable and progressive disease; recurrent obstruction may reappear despite the adequacy of surgical excision, and is not related to preoperative gradient. Mild AI remains substantially unchanged and AVR is indicated in severe AI.
Adult↗
Clinical outcome for on-pump myocardial revascularization in patients with mild renal dysfunction.
BACKGROUND: Coronary artery disease is the major cause of death in patients with chronic renal failure. We studied the early and long-term outcome of patients with mild chronic renal impairment, preoperative regular diuresis, and normal potassium levels having undergone pump myocardial revascularization. METHODS: From January 1992 to December 2000, 67 patients with serum creatinine level higher than 1.7 mg/dl and less than 2.5 mg/dl underwent on-pump myocardial revascularization. The patients were divided into 2 groups and treated with renal doses of dopamine in the postoperative or preoperative period, respectively. A homogeneous group of 100 patients was selected as control. RESULTS: There were no statistically significant differences in mortality and morbidity between the two groups A, while there was a significant difference in cardiac and respiratory complications, ICU stay and LOS between the A and B group in the early and long-term follow-up. Survival at 12-year follow-up is significantly higher in the B group. CONCLUSIONS: Patients with relatively mild renal insufficiency should be evaluated carefully for open cardiac surgery due to the significant increase in early and long-term morbidity and mortality.
Aged↗
Endovascular vs. open surgery of abdominal aortic aneurysm in high-risk patients: a single center experience.
BACKGROUND: We compared two groups of high-risk patients with abdominal aortic aneurysm to assess the safety and efficacy of endovascular repair vs. open surgery. METHODS: From January 1998 to July 2003, sixty-two high-risk patients were divided into two groups: group A consisted of 28 (46 %) open surgery patients and group B consisted of 34 (54 %) patients who underwent endovascular repair. RESULTS: Four patients (14.3 %) in the open surgery group died, while no deaths occurred in the endovascular group ( p < 0.05). There were 14 complications in 8 patients of the open surgery group versus 2 complications in 2 patients of the endovascular group ( p = 0.01). At follow-up there were 4 (16.6 %) deaths in group A and 3 (8.8 %) in the endovascular group ( p = n. s.). CONCLUSIONS: While the use of endovascular repair in patients who are physiologically fit for open surgical repair remains controversial, we believe that patients with multiple or advanced comorbidities, i.e. high-risk patients, can benefit from the endografting procedure.
Aged↗
Epidemic and endemic spread of Klebsiella pneumoniae producing SHV-5 beta-lactamase in Dubrava University Hospital, Zagreb, Croatia.
Plasmid-encoded resistance to broad-spectrum cephalosporins and aztreonam is becoming a widespread phenomenon in clinical medicine. These antibiotics are inactivated by an array of different extended-spectrum beta-lactamases (ESBLs) which have evolved by point mutations of parental TEM or SHV beta-lactamases. In a previous study conducted during 1994-1995, SHV-2, SHV-2a and SHV-5 beta-lactamases were found among Klebsiella pneumoniae isolates in Dubrava University Hospital. High prevalence of ESBLs among K. pneumoniae strains in this hospital (20%) required further investigation. In this investigation, beta-lactamases from 42 K. pneumoniae strains collected in 1997 and 15 in 2004 from Dubrava University Hospital, were characterized in order to study the evolution of plasmid-encoded resistance to extended-spectrum cephalosporins and aztreonam in that hospital over a prolonged study period. Susceptibility to antibiotics was determined by disk-diffusion and broth microdilution method. beta-lactamases were characterized by isoelectric focusing, determination of hydrolysis of beta-lactam substrates, polymerase chain reaction and sequencing of bla(SHV) genes. All K. pneumoniae strains and their Escherichia coli transconjugants produced beta-lactamase with an isoelectric point of 8.2. Based on sequencing of bla(SHV) genes enzymes of all transconjugants were identified as SHV-5 beta-lactamase which conferred on the producing isolates high level of ceftazidime and aztreonam resistance. In this study, an outbreak of nosocomial infections caused by SHV-5 producing K. pneumoniae was described in 1997 which evolved to endemic spread of SHV-5 producing K. pneumoniae due to multiple plasmid transfer in the Dubrava University Hospital. The strains from 1997 and 2004 were not clonally related. Hospital hygiene measures should be applied in order to control the spread of epidemic strains through the hospital wards and the consumption of the broad-spectrum cephalosporins needs to be restricted to reduce the selection pressure which enables the proliferation of ESBL producers in hospital.
Anti-Bacterial Agents↗
[Bronchial arteries: anatomical and clinical studies and strategies in surgical approach].
One of the most important and controversial aspects of thoracic surgery is due to the topographical and surgical anatomy of the vascular structures involving the mediastinum. The knowledge of the so-called "vascular time", in fact, allows to face more complicated surgical situations, typical of the most specialistic thoracic surgery. The bronchial arteries represent a paradigm of what we have just stated. The study of their anatomy (number, position, origin, distribution and relationships with the mediastinal structures) is of relevant importance, not only for the interest the bronchial vascular tree arises in tracheo-bronchial surgery and in pulmonary transplantology, but also for the knowledge of the pathogenesis of some processes regarding pulmonary and pleural pathologies. The aim of this paper is to evaluate the real clinical interest of bronchial arteries, with an analytic study of the anatomy of vessels, and with the possibility to show the most frequent and characteristic anomalies involving the origin and course of these arteries.
Bronchial Arteries↗
[Combined video-thoracoscopic, surgical and endovascular treatment in a case of ascites and recurrent bilateral pleural effusion].
Among recurrent pleural effusions a role of remarkable importance is held by those combined with ascitis due to the difficulty of their treatment, even using widely tested techniques. The incidence of such pathology varies from 4% to 6% of patients suffering from cirrhotic pathology, reaching 10% in cases with advanced illnesses. Pleural effusions involve the right emithorax more frequently than the left one, but it can show up bilaterally too. Its etiopathogenesis is tied up to the direct passage of ascitic liquid into the chest and, during the past years, numerous theories have been described to explain this migration. The Authors report the case of a patient with interesting considerations for the diagnostic difficulties and the peculiarity of the treatment performed.
Adult↗
[Surgical treatment of celomic cysts].
Celomic cysts (pericardiopleural or serous cysts) are rare, as they account for about 30% of all the homoplastic disembryogenetic lesions of the mediastinum. There is not usually a characteristic symptomatology associated with this anomaly, which is, however, easily diagnosed by means of the most common radiologic techniques. The TC together with the MRI provides all the necessary data for an appropriate management of the patient. The Authors report on their five year experience of the surgical treatment of celomic cysts, pointing out that surgery must be aimed at preserving pulmonary function as much as possible. They finally maintain that the first surgical approach should be video-thoracoscopic with the aid of a minithoracotomy, if necessary.
Adolescent↗
Activity of moxifloxacin in combination with vancomycin or teicoplanin against Staphylococcus aureus isolated from device-associated infections unresponsive to glycopeptide therapy.
We tested the in vitro bactericidal activity of moxifloxacin, a new 8-methoxyquinolone, alone and in combination with vancomycin or teicoplanin at different multiples of minimum inhibitory concentration (MIC) against 8 methicillin-ciprofloxacin-resistant Staphylococcus aureus (M-C-RSA) and 1 methicillin-ciprofloxacin susceptible S. aureus (M-C-SSA) recently isolated from device-associated infections unresponsive to or relapsing after glycopeptide therapy, despite device removal. MICs of vancomycin ranged from 1 to 4 microg/ml, MICs of teicoplanin ranged from 2 to 8 microg/ml; MICs of moxifloxacin were always 2 microg/ml against M-C-RSA isolates and 0.125 microg/ml against the M-C-SSA isolate. The 9 strains resulted tolerant when tested for vancomycin, teicoplanin, and moxifloxacin used alone at 2 x MIC. In all cases the combination of moxifloxacin and teicoplanin or vancomycin appeared to be bactericidal already at MIC concentration for glycopeptides plus 0.5 x MIC concentration for moxifloxacin. If these results are confirmed in vivo in animal experiments, the combination of moxifloxacin with glycopeptides might be useful for treating device-associated infections, and in preventing the frightening phenomenon of increasing MICs for glycopeptides.
Anti-Infective Agents↗
[Intraoperative pleural lavage for restaging of bronchogenic carcinoma].
BACKGROUND: Although lung cancer staging has been recently reviewed, a significant number of recurrences and an increased incidence of mortality is common also in the initial stages of the disease. All that is probably due to disease staging underestimation and emphasizes that an exact system of staging cannot be considered a stand-alone prognostic and therapeutic index. METHODS: Between October 2000 and November 2001, 37 patients have undergone surgical intervention for NSCLC in our Surgical Unit; 28 of them were male (75.7%), 9 female (24.3%), aged between 55 and 70. Neither cancer-related pleural effusion, nor mediastinal lymphoadenopathy had been detected under Rx and TC inspection in any patient. RESULTS: Pre-surgical pleural washing (PLC), which defines the positiveness of the cytological result (D+), in 17 patients (45.9%) was positive, in the remaining 20 (54.1%) negative. The positiveness of PLC was 35.3% (6/17) and 64.7% (11/17) in the initial stage of T (T1 and T2) and in the advanced stage (T3 and T4) respectively. CONCLUSIONS: On the basis of personal experience, the authors, suggest that pre-surgical resection pleural washing searching premature microscopic pleural disseminations in NSCLC-affected patients should become an important prognostic factor for the disease outcome. Moreover, they emphasize how this procedure is easy, with a small increase in the surgical intervention time, and nearly costless.
Aged↗
[Evaluation of lung function as a prognostic index before and after surgical resection due to NSCLC].
BACKGROUND: Although there were several studies on survival, death and morbidity rates after lung resection, considering both limited and extended resections, lung exercise capacity has been quite seldom taken into account as an index for prognosis. The aim of this study compare the consequences of three kinds of lung resections (pneumonectomy, lobectomy and wedge resection), to test pre- and post-surgery exercise capacity for patients affected by NSCLC in order to obtain more detailed prognostic indices. METHODS: All the patients were studied by means of thorough lung static function and hemogas analytical tests before and after surgical resection, from 15 days to 12 twelve months' time past surgery. RESULTS: In fact, in relation to lung resection due to neoplasms, several studies pointed out that zone-limited resections show an obvious anatomical benefit in terms of parenchyma spair compared to lobectomy; however, it is underlined that the functional benefits of small resections don't really prevail over post-lobectomy anatomical advantages. Furthermore local relapses are more common after small resections rather than after lobectomy. CONCLUSIONS: Neither limited lung resection nor lobectomy alone, therefore, in accordance with nearly all the recent and still ongoing studies in this huge research field, has a significant effect on exercise capacity. Only pneumonectomy is associated with impaired exercise performance, and, nevertheless, quite below our expectations.
Carbon Dioxide↗
Quality of vision with presbyopic contact lens correction: subjective and light sensitivity rating.
PURPOSE: To quantify the quality of vision achieved with multifocal and bifocal contact lenses. METHODS: We analyzed differential light sensitivity by computerized automatic perimetry in 21 patients wearing monofocal soft contact lenses (group 1, controls) and multifocal and bifocal contact lenses (groups 2 and 3, respectively). Seven patients each were fitted with multifocal or bifocal contact lenses; seven patients were without contact lenses (without correction for testing the visual periphery and with near-vision correction using monofocal contact lens for testing the central 30 degrees of vision). The type of correction was randomly changed in a crossover fashion so that each eye was examined at different times with different corrections. Humphrey 640 VFA computerized automated perimetry was used to test visual fields at baseline, 45 days, and 3, 4.5, and 6 months. RESULTS: A statistically significant difference was found between the global sensitivities (GS) of the central visual field in patients with near-vision monofocal contact lenses and with bifocal contact lenses (P=0.0273) and between the GS of the central visual fields with multifocal contact lenses and with bifocal contact lenses (P=0.0261). In both cases, the GS were significantly reduced with bifocal contact lenses (total GS: group 1, 11256 dB (Decibels); group 2, 11154 dB; group 3, 10679 dB). CONCLUSIONS: The results indicate that there is reduced differential light sensitivity in the central 30 deg of the visual field with bifocal contact lenses compared with multifocal contact lenses and monofocal contact lenses (controls).
Contact Lenses, Hydrophilic↗
In vitro activity of moxifloxacin against Stenotrophomonas maltophilia blood isolates from patients with hematologic malignancies.
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Anti-Bacterial Agents↗
[Treatment of bleeding esophageal varices: sclerotherapy or surgery?].
To evaluate therapeutic options to improve the prognosis of haemorrhage from oesophageal varices, a study was performed on 422 patients observed from 1983 to 1998. Patients were classified according Child-Campbell method after improvement of general conditions (class A: 7%; B: 68%; C: 25%). Thirty-two patients (7.8%) died during emergently pharmacologic treatment in the first 24 hours; 182 patients (44.6%) because of persistent haemorrhage underwent endoscopic sclerotherapy. In 164 (90.1%) bleeding stopped and 14 cases (7.6%) underwent emergency surgical treatment (9 splenectomies and splenorenal shunts, 5 mesenterico-caval shunts). Teu other patients (with rebleeding 3-7 days after sclerotherapy) underwent emergency surgical treatment (7 azygos-portal thoracotomic deconnections, 3 splenectomies and spleno-renal shunts). The rates of therapeutic success were respectively 80% for surgical treatment and 90% after sclerotherapy. Factors of prognostic improvement of these emergently disease are examined. The advantages of both endoscopic and surgical treatment are outlined.
Esophageal and Gastric Varices↗