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Biomedical subjects

P Castelli

Publications and source records attributed to P Castelli.

At least 55 records · Page 3Linked to original sources
PubMed1985

[Myocardial protection in valvular surgery by retroperfusion of the coronary sinus with cardioplegic solution in valve surgery. Immediate results and technical considerations].

Retrograde coronary sinus perfusion as a means of delivering cardioplegia was evaluated in 20 patients undergoing cardiac valve surgery. Other 10 patients, undergoing similar operation with antegrade coronary cardioplegic perfusion served as a control. Results showed no significant differences between the two groups of patients in terms of: myocardial cooling; pre-ischemic and post-perfusion myocardial lactate extraction; post-operative clinical findings (myocardial infarction occurrence, need for inotropic support, mortality). We conclude that retroperfusion through the coronary sinus is a safe and effective alternative of cardioplegic delivery. Since it simplifies the operative procedure (it allows the cardioplegia delivery at any desired time of the operation, without discontinuing the procedure), we recommended its use during valvular cardiac operations, especially on aortic valve replacement.

Heart Arrest, Induced↗
PubMedDate not supplied

Ruptured abdominal aortic aneurysm: endovascular treatment.

BACKGROUND: This report describes our preliminary experience in endovascular management of 25 ruptured abdominal aortic aneurysms (rAAAs). METHODS: In the past 3 years we treated 46 patients who had rAAA, and 25 (54.3%) were treated with an endovascular approach. Patients' mean age was 76 +/- 9 years. The diagnosis was confirmed by computed tomographic angiography in 23 patients (92%). Mean aneurysm diameter was 73 +/- 17 mm. We used an infrarenal bifurcated device in 17 patients (68%), a suprarenal bifurcated in four patients (16%), and an aortomonoiliac graft in four patients (16%). Overall, nine patients (36%) required intensive care. Every patient underwent radiologic follow-up according to the Eurostar register, with concomitant evaluation of the D-dimer level (cut-off <200 microg/L) as a biological marker for endoleaks. RESULTS: The primary technical success rate was 100%. Overall in-hospital mortality rate was 20%. Mean hospitalization was 7 days (range, 3-30), and mean follow-up was 7 months. One occlusion (4%) of the iliac limb and two type II endoleaks (8%) occurred. The mean D-dimer level in type I endoleak was 1045 microg/L (range, 459-2021). CONCLUSIONS: In our experience, endovascular management of rAAA is feasible and safe and produces better results than conventional surgery, provided the morphology is suitable and the procedure is carried out by an experienced endovascular team.

Aged↗
PubMedDate not supplied

Hybrid treatment for thoracic and thoracoabdominal aortic aneurysms in patients unfit for open conventional repair.

PURPOSE: To describe a technique combining endovascular and conventional surgery for the treatment of distal aortic arch and thoracoabdominal aortic aneurysms. MATERIAL AND METHODS: In the last two years, we used hybrid approach to treat six patients with distal aortic arch or thoracoabdominal aortic aneurysms unfit for open conventional repair owing poor cardio-respiratory function. RESULTS: The primary technical success rate was 100%. Intraoperative mortality rate was 0; conversion to open conventional repair was never required. Mean operation time and blood loss averaged 256 minutes and 1233 ml, respectively. Neurological complications were not observed. Overall, two patients died postoperatively. During a mean 17-month follow-up, two minor type II endoleak occurred and were successfully managed with coil embolization. All stent-grafts and conventional bypasses were patent, and no stent-graft-related complication was observed. CONCLUSION: Our initial experience attests the feasibility and potential attractive alternative of hybrid treatment for distal arch and thoracoabdominal aortic aneurysms.

Aged↗
PubMedDate not supplied

Left ventricular volume reduction for end-stage heart disease.

Partial left ventriculectomy (PLV) was recently introduced for end-stage dilated cardiomyopathy to improve ventricular function. Since November 1996 we have performed PLV in 14 patients; preoperatively 4 patients had idiopathic dilated cardiomyopathy and 10 had ischemic dilated cardiomyopathy. 57.1% of patients were in New York Heart Association functional Class IV. The mitral valve was replaced in 11 patients. Postoperative echocardiography showed a reduction of left end-diastolic diameter (55.4 +/- 5.4 mm) and an increase in forward ejection (cardiac index from 2.19 +/- 0.571 min/m2 to 2.67 +/- 0.931/min/m2). The 30-day mortality was 28.6% and 20-month survival was 57.2%. Only one patient was not in NYHA functional class due to postoperative progressive mitral incompetence. Prognostic factors should be identified to avoid early failure. However, even if the mortality rate for PLV high, this operation is a valid choice for the treatment of end-stage dilated cardiomyopathy.

Actuarial Analysis↗
PubMedDate not supplied

Clonal expansion of sequence type (ST-)5 and emergence of ST-7 in serogroup A meningococci, Africa.

One hundred four serogroup A meningococci in our collection, isolated in Africa from 1988 to 1999, were characterized by multilocus sequence typing (MLST). Our results and data from the Internet indicate that sequence type 5 (ST-5) strains were responsible for most of African outbreaks and sporadic cases during this period. In 1995, a new clone, characterized by ST-7 sequence, emerged and was responsible for severe outbreaks in Chad (1998) and Sudan (1999). MLST and epidemiologic data indicate that ST-5 and ST-7 represent two virulent clones. These two STs, which belong to subgroup III, differ only in the pgm locus: allele pgm3 is characteristic for ST-5 and allele pgm19 for ST-7. Subgroup III strains were responsible for two pandemics in the 1960s and 1980s. Our data show that the third subgroup III pandemic has now reached Africa.

Africa↗
PubMedDate not supplied

[Differential diagnosis of hematoma, pulsating hematoma and pseudoaneurysm of the femoral artery using color Doppler].

Color Doppler and Duplex Doppler US were employed on 4 patients with clinically suspected pseudoaneurysms as a complication of femoral artery puncture after cardiac catheterization. Pseudoaneurysms were identified with Color Doppler US and their typical appearance was confirmed. The grey-scale findings did not allow an adequate differentiation between hematoma and pulsed hematoma without fibrous encapsulation: only Color Doppler US easily detected the track between damaged artery and blood collection and allowed a sample to be obtained for pulsed Doppler examination. Color Doppler US allowed an accurate and non-invasive diagnosis of groin masses after femoral artery catheterization.

Aneurysm↗
PubMedDate not supplied

Thrombosis prevention with ticlopidine after femoropopliteal thromboendarterectomy.

Fifty patients submitted to thromboendarterectomy in the femoropopliteal district for obstructive arterial disease of the lower limbs, documented angiographically, were randomly allocated to treatment with ticlopidine (500 mg/day) (T) or a placebo (P) in double-blind conditions. The treatment was started as soon as possible after the surgical intervention and was continued for six months or until a clinically evident reocclusion occurred. There were 46 patients available for assessment, 23 in each treatment group both of which were comparable in preoperative characteristics and type of surgery. Doppler ultrasonography at the end of treatment showed three cases of reocclusion of the operated segment in the T group versus six occlusions and seven significant stenoses in the P group (p = 0.003). Clinically, the active treatment significantly reduced the incidence of both acute ischemia during the treatment (four cases, all in the P group) and residual claudication at the end of treatment: in the T group five patients presented persistent or recurrent symptoms versus 16 in the P group (p = 0.001). Hemostatic function tests showed a marked inhibition of platelet activation in the T group. The treatment was well tolerated.

Aged↗
PubMedDate not supplied

Semiclosed thromboendoarterectomy on femoro-popliteal tract revisited after a fourteen years experience on 595 cases.

In the seventies atherosclerotic femoropopliteal lesions were extensively treated by means of retrograde semiclosed thromboendarterectomy (FP-TEA) an analytic follow-up of cases, until 1980, induced the modification of the indications to FP-TEA. Currently the FP-TEA technique is only employed for patients at the 2nd Fontaine's stage with disabling claudication (generally less than 100 mt) with a good distal run-off (at least 2 tibial vessels patent). The report deals with a series of 595 cases operated in the period January 1971-December 1984. In 45% of cases FP-TEA was associated with a proximal revascularization. In an attempt to focus on the factors that may influence the outcome, the patients operated in 1976, 1980, 1984, were assessed and the results related to clinical stage, angiographic pattern and postoperative treatment.

Arterial Occlusive Diseases↗