Biomedical subjects

R Totaro

Publications and source records attributed to R Totaro.

21 records · Page 2Linked to original sources

PubMedDate not supplied

Contrast-enhanced transcranial Doppler sonography in patients with acute cerebrovascular diseases.

The aim of the study was to evaluate the diagnostic potential of galactose-based microbubble suspension (Levovist) in patients with acute cerebrovascular disease and inadequate transtemporal acoustic window, when examined by transcranial Doppler (TCD). We studied 10 patients with either transient ischemic attack (no. = 3) or stroke (no. = 7). Inadequate transtemporal acoustic window was unilateral in 3 patients and bilateral in the remaining 7 patients. Signals from middle, anterior, and posterior cerebral arteries (MCA, ACA, PCA) were recorded after injecting Levovist 300 mg/ml. Six patients needed 3 injections of Levovist, 1 patient two, and 3 patients one. Mean +/- SD duration of optimal signal enhancement was 175.2 +/- 53.2 s, range 70-290 s. Doppler waveform analysis was possible in 14 (82.3%) MCA, 11 (65%) ACA, and 9 (53%) PCA. Levovist improved the reliability of TCD in patients with acute cerebrovascular disease and insufficient transtemporal insonation.

Aged↗

PubMedDate not supplied

[Physiopathology of cerebral circulation].

Autoregulation of the cerebral circulation is the key mechanism that keeps CBF constant within wide limits of arterial pressure. The mechanism for autoregulation and the influence of arterial hypertension and extracranial carotid stenosis are discussed. Brain function and metabolism are critically dependent on sufficient CBF and oxygen supply. Cerebral ischemia occurs when flow drops below about 10-15 ml/100 g/min. Metabolic and therapeutic aspects of acute cerebral ischemia are discussed.

Acute Disease↗

PubMedDate not supplied

[Transcranial Doppler sonography in the pre- intra- and post-operative evaluation of 85 patients undergoing carotid endarterectomy].

PURPOSE: To evaluate the usefulness of transcranial Doppler sonography during carotid endarterectomy. PATIENTS AND METHODS: Pre-, intra-, and postoperative transcranial Doppler was performed in 85 patients who underwent carotid endarterectomy. Intracranial collateral pathways were evaluated preoperatively and continuous monitoring of middle cerebral artery flow velocity was performed during carotid surgery. Transcranial Doppler was repeated in each patient 1 and 7 days thereafter. RESULTS: Values of residual middle cerebral artery flow velocity during preoperative digital compression of the common carotid artery were significantly correlated (r = 0.56; P < 0.001) with those obtained during cross-clamping. Middle cerebral artery flow velocity was significantly lower during cross-clamping with respect to pre-clamping (P = 0.006), in patients with neurologic symptoms (P = 0.001), EEG alterations (P = 0.001), or defective collateral blood supply through the anterior communicating artery (P = 0.01). Postoperative flow velocity values of the MCA were significantly higher at day-1 examinations (P < 0.0001) with respect to preoperative values, and were no more significantly different at day-7. CONCLUSIONS: Transcranial Doppler is a useful method to evaluate the risk of cerebral ischemia during carotid endarterectomy cross-clamping, to identify those patients in which shunt insertion is mandatory, and to evaluate the postoperative effect of carotid endarterectomy on cerebral hemodynamics.

Blood Flow Velocity↗