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R Castellano

Publications and source records attributed to R Castellano.

23 records · Page 2Linked to original sources
PubMed1993

Three dimensional time-of-flight magnetic resonance angiography in carotid artery surgery: a comparison with digital subtraction angiography.

Three dimensional time-of-flight magnetic resonance angiography (MRA) and intra-arterial digital subtraction angiography (DSA), considered the gold-standard technique, were compared for pre- and postoperative evaluation of the carotid bifurcation. Images of suitable quality of 194 bifurcations were available with both techniques. Percentage stenosis was graded into 5 groups: A = 0-29%, B = 30-59%, C = 60-89%, D = 90-99%, E = 100% (occlusion). Preoperative MRA (126 bifurcations) overgraded the stenosis in 14 cases and undergraded it in 11. The two techniques agreed in 101 cases and the extent of misgrading was never more than one category. Regression analysis showed a good correlation between the two methods. Severe ulceration was better identified by DSA. As far as the surgical indication was concerned, MRA had a sensitivity of 92.6% and a specificity of 98.3%. In 68 operated cases, postoperative MRA and intraoperative completion angiography showed a satisfactory endarterectomy with no residual stenosis in any of the cases. In conclusion, MRA seems an accurate modality for imaging of carotid bifurcations. Significant limitations still exist for an adequate demonstration of intracranial circulation.

Adult↗
PubMed1992

Antipyrine metabolism in patients with liver metastases from colorectal cancer.

BACKGROUND: The influence of cancer on antipyrine metabolism is under debate. METHODS: To assess the functional activity of a liver with solid metastases from primary colorectal cancer, antipyrine metabolism was studied after the drug was administered orally (18 mg/kg body weight) to 55 healthy volunteers, 62 patients with well-compensated cirrhosis, and 42 patients with small (Class A) or massive (Class B) metastatic liver involvement. RESULTS: In patients with cancer, antipyrine clearance (0.472 +/- 0.177 ml/min/kg) was similar to that in healthy volunteers (0.456 +/- 0.198 ml/min/kg) and significantly higher than in those with cirrhosis (0.259 +/- 0.17 ml/min/kg, P less than 0.001). There was no difference in antipyrine pharmacokinetics between Class A and B involvement. In the entire population, antipyrine clearance was correlated with serum albumin levels (r = 0.294, P = 0.0002) and prothrombin activity (r = 0.416, P = 0.001). This positive correlation was not present when only the neoplastic group was considered. No correlation was found between antipyrine clearance and alkaline phosphatase levels. In patients with cancer, no relationship was found between antipyrine clearance and carcinoembryonic antigen and lactic dehydrogenase levels. CONCLUSIONS: These results show that patients with livers largely replaced by solid metastases are able to metabolize antipyrine to the same extent as healthy subjects.

Adult↗
PubMedDate not supplied

Combined carotid endarterectomy and myocardial revascularization: personal experience.

A significant percentage of patients undergoing myocardial revascularization suffer from extracranial cerebrovascular disease; recognition of such combined lesions identifies patients at risk for cerebrovascular accidents during the cardiac procedure. Simultaneous or staged coronary artery bypass graft (CABG) and carotid endarterectomy operations have been performed for the last 20 years, however, the clinical indications and the timing of the procedures remain controversial issues. Between November 1988 and January 1994, 1122 patients underwent myocardial revascularization at our Institute and in 35 cases (3.7%) carotid endarterectomy was simultaneously performed; 502 isolated carotid endarterectomies were performed in the same period. Trivascular coronary artery disease was found in 27 cases and low ejection fraction in six. Each patient received an average of 3.7 coronary grafts. Hospital mortality was 5.7% and major neurologic morbidity 2.8%. We believe that a simultaneous approach is recommended in patients with unstable angina and symptomatic carotid artery disease; in patients with a critical but asymptomatic carotid artery stenosis the indication for operation is subject to individual clinical judgment.

Journal Article↗
PubMedDate not supplied

Results of carotid endarterectomy performed with preoperative duplex ultrasound assessment alone.

Contrast injection cerebral angiography has been considered for several decades the "gold-standard" technique for diagnosis and operative planning of carotid disease. More recently, however, an increasing number of institutions are using duplex ultrasound as the single independent preoperative test. The objective of this investigation was to evaluate the impact of the utilization of duplex ultrasonography as the only preoperative test on the outcome of the procedure. Between 1993 and 1996, the authors performed 1,149 carotid procedures. Duplex ultrasound as the only preoperative test was employed with increasing frequency in a total of 728 cases. In 1995 and 1996, a cerebral arteriogram was performed only if duplex ultrasound was technically inadequate or questionable or showed an atypical pattern of disease. During the 4 years analyzed in this study, the number of the procedures increased from 165 in 1993 to 412 in 1996. The thirty-day mortality rate was 0.43%, and neurologic morbidity was 1.65%. According to the year in which the procedure was performed, the mortality/morbidity rates were 1.2/2.4 in 1993, 0.52/2.08 in 1994, 0.26/1.57 in 1995, and 0.24/1.21 in 1996. Indication to perform an arteriogram became very selective in 1995. Regardless of these changes in the diagnostic work-up, some degree of reduction in both 30-day mortality and neurologic morbidity was recorded. Considering a cost of 724 European Currency Units (ECU) per arteriogram, 527,072 ECU were saved in this period. In the last 4 years, duplex ultrasound has replaced arteriography as the first-choice technique for preoperative assessment of carotid disease at the authors' institution. There was definitely no detrimental effect on the clinical results that, on the contrary, improved during the same period. This policy has allowed a significant reduction in the cost of the procedure and has most likely prevented several arteriography-related complications. The authors recommend this policy to all institutions in which accurate duplex ultrasound is available.

Aged↗