Biomedical subjects

N Bernardo

Publications and source records attributed to N Bernardo.

7 recordsLinked to original sources

PubMed2000

Coronary revascularization in heart transplant recipients by excimer laser angioplasty.

BACKGROUND AND OBJECTIVE: Aggressive development of allograft coronary artery disease is a major cause of death in heart transplant recipients. Percutaneous balloon angioplasty is considered suboptimal for complex lesions in native coronary vessels and heart transplant recipients, alike. Excimer laser energy (308-nm wavelength) can successfully remove and vaporize atherosclerotic plaques in native coronary vessels; however, its application in heart transplant recipients has not been studied clinically yet. STUDY DESIGN/MATERIALS AND METHODS: Six heart transplant recipients underwent percutaneous excimer laser (CVX-300, Spectranetics, Colorado Springs, CO) coronary angioplasty for treatment of a total of 10 discrete, obstructive coronary artery lesions. By using concentric or eccentric multifiber laser catheters, energy parameters were set at a fluence of 45 mJ/mm(2) or 60 mJ/mm(2) with a frequency of 25 Hz and 40 Hz, respectively, with a pulse duration of 135 ns and output of 200 mJ/pulse. The "saline flush" and "pulse and retreat" lasing techniques were used. In each case, adjunct balloon angioplasty was performed; in five lesions, an intracoronary stent was implanted. Angiographic evaluation was performed by visual assessment. RESULTS: Each procedure was successful as defined by laser recanalization of the target lesion (reduction of target lesion stenosis in more than 20%) and subsequent adequate final luminal patency (reduction of target lesion stenosis to less than 50%) and absence of any major in-cardiac catheterization complication (such as perforation, acute closure, dissection, emergency coronary artery bypass surgery), or in-hospital complications (such as death, myocardial infarction, cardiac enzyme elevation, major bleeding), or need for surgical revascularization. A 92 +/- 5% preprocedural percent diameter stenosis was reduced by laser to 35 +/- 16% and by adjunct balloon angioplasty in all lesions and stenting in five lesions, to final residual stenosis of 2 +/- 6%. Angiographic follow-up between 2 and 6 months after the procedure demonstrated a target lesion restenosis rate of 22%. CONCLUSION: Percutaneous excimer laser is safe and efficacious in the treatment of focal obstructive lesions caused by allograft coronary artery disease. These data represent an early clinical experience; thus, the long-term outcome of this revascularization method in recipients of heart transplantation will have to be determined by a large scale prospective, randomized, multicenter clinical study.

Adult↗

PubMed1999

Acute thrombotic-ischemic coronary syndromes: the usefulness of TEC.

Transluminal extraction catheter (TEC) is a percutaneous device that performs simultaneous thrombus aspiration and plaque excision. Clinical indications for its application are acute myocardial infarction, unstable angina, and stable angina caused by atherosclerotic, thrombotic lesions located within native coronary arteries and degenerated saphenous vein grafts. The device is useful in management of ischemic patients with contraindications to either pharmacologic thrombolytics or platelet GPIIb/IIIa receptor inhibitors, and can also effectively be used in combination with these agents. A successful TEC procedure requires careful patient selection, strict adherence to recommended indications, optimal equipment selection, familiarity with mechanical components of the device, full understanding of safe and efficacious techniques for deployment and activation, as well as recognition of unique associated angiographic manifestations such as the "empty-pouch phenomenon." As with other debulking devices, the incidence of restenosis post-TEC appears to be directly related to acute luminal gain at the time of procedure and therefore requires the need for adjunct stenting. This communication describes and illustrates various clinical, technical, and angiographic aspects of TEC procedure in patients with acute ischemic-thrombotic coronary syndromes. Cathet. Cardiovasc. Intervent. 48:406-420, 1999.

Acute Disease↗

PubMed1999

Endopyelotomy review.

UNLABELLED: Open pyeloplasty remained the standard treatment until the mid-1980s. The advantages of the open pyeloplasty include mucosa-to-mucosa anastomosis and excision of redundant renal pelvis and diseased ureter. Over the past decade, antegrade endopyelotomy has evolved as the treatment of choice for obstructions of the UPJ. Further experience has shown that primary UPJ obstruction responded equally well, with long-term success rates for both groups of patients approaching 85%. Endopyelotomy results in significantly less morbidity, and should this technique fail, subsequent open pyeloplasty is no more difficult than had it been performed initially. A 20% incidence of stones associated with UPJ obstruction has been reported. Antegrade endopyelotomy can treat these patients simultaneously. Our series of more than 400 endopyelotomies showed that success was based on the degree of preoperative hydronephrosis and renal function. The presence of massive hydronephrosis had a pejorative influence on endopyelotomy, lowering the success rate from 96% to 50%. Similarly poor renal function (less than 25% of total function) reduced the success rate from 92% to 54%. Although not as extensively reported in the urologic literature, indeed fewer patients with fewer follow-ups have undergone a ureteroscopic endopyelotomy compared with an antegrade endopyelotomy, success rates have ranged between 79% and 94%. Nephrectomy was required in 2.5% for bleeding and 5% for poor renal function. In patients with primary UPJ obstruction, Acucise has a success rate that is 15% lower than antegrade endopyelotomy. Acucise endopyelotomy is a blind procedure, with 1.5% of bleeding reported requiring transfusion and 3% has undergone postoperative embolization. Laparoscopic pyeloplasty is also a relatively new technique which has only been reported with some extensive experience in two institutions, although the success rate has been extremely high, despite a short follow-up. Overall, the incidence of crossing vessels at the UPJ is approximately 50%. The greatest problem lies in determining whether a crossing vessel is etiologically or clinically significant. Thus, the presence of a crossing vessel was potentially causally related to endopyelotomy failure in 4% of the patients. Our overall success rate of 78% for endopyelotomy is comparable and sometimes higher than the reported success rate for open pyeloplasty for horseshoe kidneys, which ranged from 55 to 80%. However, endopyelotomy has become an established treatment modality in the adult, with a decreased morbidity in comparison with open pyeloplasty. The benefits of endourologic management of pediatric UPJ obstruction are less well established. CONCLUSIONS: Endopyelotomy is a safe and effective treatment for primary and secondary UPJ obstruction for most patients. The biggest experience with better results has been reported with antegrade endopyelotomy, which permits the treatment of associated stones. Laparoscopic pyeloplasty, which is technically demanding, may be considered the best treatment in patients with severe hydronephrosis and poor renal function, which resulted in a success rate of only 38% and 57%, respectively, with endopyelotomy. If we are going to minimize morbidity for our patients, open pyeloplasty is only the first choice for neonates and younger children, and should be considered in patients after failed endopyelotomy.

Adult↗

PubMed1997

[Correlation between computed axial tomography and ileum obturating lymphadenectomy in localized adenocarcinoma of the prostate].

OBJECTIVE: To correlate the findings of CT and ileoobturator lymphadenectomy in patients with localized adenocarcinoma of the prostate. METHODS: 94 patients with adenocarcinoma of the prostate were evaluated. Ileoobturator lymphadenectomy and brachytherapy were performed in 61.1%, radical prostatectomy in 22.5% and lymphadenectomy with prostatic labeling for subsequent external radiation therapy in 5%. Lymph node CT and pathology findings were correlated. RESULTS: Of 92 patients with a normal CT scan, 18 had positive nodes and 19.1% were understaged. Two patients with a CT scan suggestive of metastatic adenopathy had negative pathology findings. Seventy-two of the 92 patients with normal CT scans had negative nodes, accounting for a specificity of 76.6%. CONCLUSION: Pelvic lymph node involvement changes the prognosis of prostate cancer. However, the ability of CT to detect lymph node metastasis is limited. It is therefore not a reliable method and raises the costs of staging unnecessarily.

Adenocarcinoma↗

PubMed1996

[Treatment of the regional lymph nodes in squamous carcinoma of the penis].

OBJECTIVES: We evaluated the management of the regional lymph nodes to determine the appropriate treatment for carcinoma of the penis. METHODS: The records of 36 patients with carcinoma of the penis were reviewed. Lymphadenectomy was performed in 18 patients, 17 were managed conservatively (watchful waiting) and 1 patient had a biopsy and received radiotherapy. RESULTS: Positive nodes were found in 2 of 2 pT4, 2 of 3 pT3, 8 of 13 pT2 and 2 of 12 pT1 patients submitted to lymphadenectomy. Concerning the histological grade, positive nodes were found in all of the 4 G3, 5 of 12 G2 and 3 of 20 G1 patients. The survival rate was 100% for the patients with negative lymph nodes (pNO = 6) or a single positive inguinal lymph node (pN1 = 5). A correlation was found between the T and the histological grade and the likelihood of lymph node invasion. CONCLUSIONS: The T and the histological grade of the primary lesion must be considered when deciding the approach in the management of the lymph nodes as unnecessary lymphadenectomy can be avoided and those at high risk of lymph node invasion can be treated radically and timely.

Adult↗

PubMed1996

[Correlation between specific prostatic antigen and findings with total body bone scintigraphy].

OBJECTIVES: To analyze the correlation between PSA values, bony symptoms and total body bone scintiscanning in order to determine the utility of the latter technique in patients with adenocarcinoma of the prostate. METHODS: We analyzed the correlation between the PSA values, bony symptoms and total body bone scintiscan findings of 191 patients with adenocarcinoma of the prostate; of these, 129 patients met the criteria for inclusion into the study. RESULTS: Of the 128 patients, 32 (25%) had PSA value < 20 ng/ml, 48 (37.5%) had values ranging from 20-50 ng/ml and 48 (37.5%) had values > 50 ng/ml. The bone scintiscan was positive in only one of the 32 patients with PSA < 20 ng/ml, 45.8% of those with PSA values between 20-50 ng/ml and 70.8% of those with PSA values > 50 ng/ml. All of the patients with PSA < 20 ng/ml and no bony symptoms had a negative bone scintiscan. All patients with PSA > 20 ng/ml and bony symptoms had a positive bone scintiscan. CONCLUSIONS: PSA is a biological marker that can effectively predict the scintiscan findings. The bone scintiscan was negative in 96.9% of the patients with PSA < 20 ng/ml. Total body bone scintiscanning can therefore be obviated in patients with PSA < 20 ng/ml and no bony symptoms, thereby reducing health costs without altering the benefits.

Adenocarcinoma↗

PubMedDate not supplied

[Correlation between prostate specific antigen and histopathologic findings in ileum-obturator node dissection].

OBJECTIVE: To determine the correlation between PSA values and the histopathological findings of ileo-obturator node dissection in prostatic cancer. METHODS: We reviewed the data of 51 patients with clinically localized prostatic carcinoma, submitted to ileo-obturator node dissection before definitive treatment of the tumor. The patients were classified into 4 groups according to their previous PSA values: A < 10 ng/ml, B > 10 and < 20 ng/ml, C > 20 and < 50 ng/ml and D < 50 ng/ml. RESULTS: Overall 17.6% of the patients had positive lymph nodes; 9.9% of the patients in group A, 15.4% of the patients in group B, 11.1% of those in group C and 41.7% of those in group D had positive nodes. Using 50 ng/ml as the cut-off point, 10% of those with PSA < 50 ng/ml had positive nodes vs 42.3% of those with PSA > 50 ng/ml, which was statistically significant with the Fischer test. CONCLUSION: Preoperative PSA has a statistically significant correlation with positive nodes, considering 50 ng/ml as the cut-off point. PSA determination in patients that have received no treatment is essential in the diagnosis and evaluation of therapy in prostate cancer.

Adenocarcinoma↗