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Biomedical subjects

S Bonardelli

Publications and source records attributed to S Bonardelli.

At least 37 records · Page 2Linked to original sources
PubMed1989

Influence of contralateral carotid artery on neurologic outcome after carotid endarterectomy.

The discrepancy in the literature about the immediate results after carotid endarterectomy in the presence of occluded or seriously stenotic contralateral carotid artery, has encouraged a retrospective study on 230 patients subjected to 255 carotid endarterectomies. 63 operations (group 1) were carried out in the presence of occluded contralateral carotid artery (40 operations) or of seriously stenotic contralateral carotid artery (23 operations). In the remaining 192 operations (group 2) the contralateral carotid artery was normal or not significantly stenotic (less than 60% of diameter reduction). The indication for surgery and age and sex distribution were similar in the two groups. No operations were performed during acute stroke. Patients with previous stroke underwent surgery only after at least 1 month from the onset of symptoms, in stable neurological conditions. All the patients were operated on under general anesthesia and with systemic heparinization; the indication for intraluminal shunt was made on the basis of clinical evaluation, of back pressure value and, in 106 operated cases of somatosensory cortical evoked potentials. At the end of every operation, ultrasonographic and/or angiographic instrumental controls were carried out. No statistically significant difference was evidenced in the incidence in groups 1 and 2 of postoperative transitory neurological insufficiency (both 3.2%, P greater than 0.8), of permanent neurological insufficiency (0% and 1%, P greater than 0.9), of mortality because of neurological (3.2% and 1%, P greater than 0.5) and non neurological causes (1.6% and 0%, P greater than 0.1).(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1988

Value and limits of "critical auscultation" of neck bruits.

Within a group of 2,000 patients evaluated, most of them with symptoms of cerebrovascular insufficiency, 441 had a monolateral or bilateral cervical bruit. The 627 sides with an audible bruit were divided into main groups (A) symptomatic (TIA and/or stroke homolateral to the bruit), (B) possibly symptomatic (non-side-related symptoms), (C) asymptomatic (C1, in totally asymptomatic patients; C2, in patients with symptoms dependent on the hemisphere contralateral to the cervical bruit). Each patient was studied by means of clinical (history, blood pressure in both upper limbs, phonoendoscopic auscultation at various levels) and noninvasive instrumental examinations (CW Doppler spectrum analysis). An apparently primitive cervical bruit corresponded to a lesion of the carotid bifurcation in 61% of the cases (positive predictive value) whereas a normal bifurcation was detected in 70% of the cases in which the cervical bruit was considered as secondary (negative predictive value); the diagnostic accuracy of the "critical auscultation" has a value therefore of 63%, with a sensitivity of 84% and a specificity of 40%. The results obtained in the different groups of patients (symptomatic or asymptomatic) were not significantly different (chi-square). Even though maintaining the value of a cervical bruit as a sign of carotid stenosis or occlusion and consequently confirming the importance of neck auscultation, the authors conclude that the critical auscultation as commonly performed is not capable of excluding the presence of a carotid lesion with sufficient reliability, even in totally asymptomatic patients.

Auscultation↗
PubMed1984

Value of Doppler multi-level segmental pressure index in the diagnosis and hemodynamic characterization of totally occlusive aorto-iliac-femoro-popliteal lesions.

Four-level lower limb Doppler S.P.I. (upper thigh; above knee; below knee; above ankle) were evaluated in 275 limbs, 110 of which showed totally occlusive lesions at one or more levels of the aorto-iliac-femoro-popliteal axis on angiographic examination, 65 showed stenosis less than 50% (sclerotic controls) and 100 did not undergo arteriographic examination since they apparently had no lesions (healthy controls). Analysis of the results-carried out using the Student's t statistical method-showed a drop in the S.P.I. close to or over 0.30 between two adjacent levels and was indicative of the presence of an occlusion in the intermediate area. This method therefore allowed the presence and the position of an isolated lesion to be detected. In the case of multiple lesions in series, the proximal one is detected with certainty, whereas the more distal ones can be recognized but not their exact position and extension. Multiple lesions in series are more hemodynamically significant than isolated ones, and proximal lesions more than distal ones.

Aorta↗
PubMedDate not supplied

Complete in vitro prosthesis endothelialization induced by artificial extracellular matrix.

This report presents our research on the conditions necessary to substain optimal in vitro prosthetic endothelialization using human endothelium cultures. Human vein endothelial cells were seeded at a concentration of 3 x 10(5)/cm2 in a gelatinized Dacron patch graft coated with a commercial collagen film, using a solution of fibrin glue. Endothelium adhesion, proliferation, and survival were measured by [3H]thymidine incorporation, after 7 days of incubation. Finally, the morphology of prosthetic endothelialization was analyzed by scanning electron microscopy. We observed that the Dacron patch grafts coated with collagen film were able to promote endothelialization better than the prostheses coated with highly concentrated collagen solution or gelatin. We therefore concluded that the collagen film that supports endothelial cell adhesion and proliferation uniformly covers the entire synthetic endoluminal surface of the Dacron graft, thus preventing endothelial cell alterations induced by direct contact with the synthetic prosthetic surface.

Adhesives↗
PubMedDate not supplied

Is there an association between Helicobacter pylori cytotoxin Cag A seropositivity and risk for gastric cancer?

BACKGROUND: Since discovered in 1990, Cag A, a protein expressed by specific strains of Helicobacter pylori, was thought able to explain why only a few Helicobacter infected patients develop peptic diseases and gastric cancer. However, clinical trials provide discordant results. MATERIALS AND METHODS: In this study we evaluate Helicobacter pylori and Cag A seropositivity in 35 cancer affected patients, in 36 gastritis affected patients and in 40 healthy blood donors by means of two commercially available fluorescence enzyme-immunoessay (ELISA). RESULTS: Odds ratios determination strongly suggests that Cag A bearer Helicobacter strains play a pathogenetic role in gastric diseases (OR 4.23, 95% CI 3.22-5.24 for cancer versus healthy volunteers, OR 3.2, 95% CI 2.19-4.21 for gastritis versus asymptomatic patients), but is unable to demonstrate a direct carcinogenic activity (cancer-gastritis difference is not significant: OR 1.32, 95% CI 0.39-1.25). CONCLUSIONS: Cag A seropositivity can be considered a risk factor for peptic disease, and only indirectly for gastric carcinoma. The paper also discuss some sampling, laboratory and statistical bias that can explain a wide eterogenity of the results reported in the literature.

Adult↗
PubMedDate not supplied

[Distal pancreatic resection with splenic preservation for metastasis of renal carcinoma diagnosed 24 years later from the nephrectomy].

Renal cell carcinoma is a malignant tumor with a singular biological behaviour, presenting in some reported cases very late metastases. This report describes a case of solitary pancreatic metastasis from kidney carcinoma, operated on 24 years before, that appears exceptional because of the long disease-free period after nephrectomy and the unusual metastatic site. The 73-year-old woman concluded the follow-up several years before; she presented aspecific abdominal pain and ultrasonographic examination and CT-scan revealed the presence of a mass in the pancreatic istmus. The mass was excised with splenic preservation and was diagnosed to be a pancreatic metastasis from clear cell renal carcinoma. We discuss the diagnostic and therapeutic features of this tumors. It appears important to obtain the diagnosis preoperatively, because good results may be obtained with surgery, justifying an aggressive surgical approach.

Aged↗
PubMedDate not supplied

[The role of magnetic resonance in the follow-up of aortofemoral prosthetic reconstructions].

The authors report their experience with the use of Magnetic Resonance (MR) in the follow-up of patients undergone aortofemoral bypass or substitution procedures for aneurysmal and/or steno-occlusive lesions of the aortoiliofemoral vascular bed. Twenty-eight patients, at least 2 years from aorto-bifemoral revascularization were evaluated by means of coronal and parasagittal MR planes (mean follow up 78.9 months). One exam over 28 was found to be not diagnostic; whereas the technique showed great usefulness in the morphological and haemodynamic evaluation of each of the graft sites explored (proximal anastomosis, graft body and limbs, femoral anastomosis and periprosthetic tissues) in the remaining 27 cases. The use of this method, in spite of some setting up problems peculiar to the type of examination, according to the authors is very promising because of the chance to obtain morphological and functional data at once and because of the interesting current and future developments of this diagnostic device.

Anastomosis, Surgical↗
PubMedDate not supplied

[Results of elective open surgery for juxtarenal aortic aneurysms].

Review of the most significant surveys (data base: Pub Med on September 2003) of elective open surgery for Juxtarenal aneurysms and personal results of 106 cases (9.3% of AAA consecutively operated in the last 11 yrs.) are reported. Mortality and morbidity are discussed related to: technique of aortic cross-clamping; protective measures on splanchnic and renal perfusion; risks from previous CAD and chronic renal failure. Over all, the main predictive factor is the accuracy of the selected technique, without any difference among different approaches, and the same results of infrarenal aneurysms can be obtained.

Adult↗
PubMedDate not supplied

Surgical treatment of lesions obstructing the external carotid artery.

Atherosclerotic lesions obstructing the external carotid artery are generally disregarded in the evaluation of patients with symptoms of cerebral ischemia; nevertheless, in the presence of occlusion of the ipsilateral or of both the internal carotid arteries, external carotid artery endarterectomy may be indicated, in order to increase the flow to the brain through collaterals. A lesion of the external carotid artery may be the source of retinal emboli; patients may benefit from surgical treatment of the lesion. The Authors of the present paper operated on 6 such patients, from a total of 230 carotid bifurcation endarterectomies performed in the period between January 1982 and March 1988. Morbidity and mortality were nil and 5 of the 6 patients are free of symptoms after a mean follow-up period of 23 months. One patient died 2 months after surgery due to a myocardial infarction. On the basis of this experience, the Authors discuss indications, surgical techniques and results of the surgical treatment of lesions obstructing the external carotid artery.

Aged↗
PubMedDate not supplied

[Doppler spectrum analysis and traditional angiography in the study of the extracranial tract of the internal carotid artery].

Examination of 88 extracranial carotid arteries using CW Doppler spectrum analysis is compared with the findings of transfemoral conventional arteriography. There is no significant difference (P greater than 0.05) between CWD and angiographic results, although sensitivity, specificity and accuracy are superior for the latter technique. CWD spectrum analysis can underestimate complete occlusion and misinterpret the degree of stenosis, however it is a cheap and rapid procedure that can be used to judge whether particular symptoms are due to identifiable disease and whether selective carotid arteriography is advisable.

Carotid Artery Diseases↗
PubMedDate not supplied

Direct and indirect evaluation of lesions obstructing the carotid bifurcation. A comparison of Doppler spectrum analysis with angiography.

The diagnostic accuracy of real-time continuous wave (c.w.) Doppler spectrum analysis and of indirect periorbital Doppler examination for detecting carotid bifurcation disease was evaluated. The results of non-invasive studies were compared with contrast arteriograms of patients studied for symptomatic cerebrovascular disease (91%) or for asymptomatic bruits (9%). Periorbital examination was insensitive to less than 75% carotid stenoses and sensitivity to severe stenoses or occlusions was respectively 56% and 85% (mean 73%). Mean sensitivity of real-time C.W. Doppler spectrum was 93% and sensitivity to stenoses of less than 45% diameter reduction was equal to 76%, while specificity in identifying normal carotid arteries was 89% for an accuracy of the method of 91%. Positive and negative predicting values were respectively 89% and 93%. Direct Doppler interrogation of the carotid arteries with real-time C.W. Doppler spectrum analysis was able to distinguish operable stenoses from inoperable occlusions in 87% of the cases.

Angiography↗
PubMedDate not supplied

Factors affecting prognosis in acute intestinal ischemia.

The anamnestic, clinical, laboratory, radiological and intraoperative data on 34 consecutive patients affected by acute intestinal ischemia or infarction, caused by superior mesenteric obstructive and nonocclusive pathology were collected and assessed. The aim of this study is the identification of the factors influencing the prognosis which in this disease is still really displeasing, with a mortality of over 90% in many surveys, and 73.5% in this report. The mean age of the 34 patients was 73. Cardiac ischemic disease and or arrhythmias were present in 83.8% of the patients. The most significant prognostic factors were those related to the evolutive stages of the intestinal ischemia. Among the anamnestic ones, the interval between the onset of the symptoms and diagnosis (mortality of 50% if less than or equal to 24 hrs., 86.4% if greater than 24 hrs.). Among the clinical factors, the presence of peritoneal signs was followed by a mortality of 82.3%, in contrast with the 33.3% when the same signs were absent. Also significant was the presence of shock (100% mortality), in contrast with 50% in patients presenting systemic systolic pressure greater than 100 mmHg. Extensive intestinal infarction caused a 100% mortality rate, while early revascularization allowed the survival of 81.8% of the patients treated in the absence of infarction or when irreversible ischemic damage was limited to less than 1 meter of bowel.

Acute Disease↗
PubMedDate not supplied

Intra-operative control of carotid thromboendoarterectomy by Doppler spectrum analysis.

The authors report their experience with intraoperative Doppler spectrum analysis of carotid flow after thromboendoarterectomy. The method seems to be useful in the early localisation of technical defects potentially responsible for postoperative stroke. In 22 patients operated on consecutively, three major abnormalities were detected, one of the internal and two of the external carotid. This enabled immediate reexploration of the involved artery with restoration of normal flow. This kind of examination is also safe, quick and highly accurate. The authors propose it as a substitute to intraoperative arteriography which is routinely performed by some surgeons after carotid thromboendoarterectomy.

Carotid Arteries↗
PubMedDate not supplied

[Indications and short and medium time results of crossover bypasses in the treatment of obstructive arteriopathies of the lower limbs].

The authors evaluate the indications, the hemodynamical aspects, the short and medium term results over their track record of 49 crossover bypass (44 dacron and 5 PTFE grafts) performed between 1981 and 1993. Crossover bypass grafts were mainly inserted for unilateral iliac arterial disease in order to avoid aortic manipulation. This procedure was particularly selected when in presence of: young patients (< 60 years old), high surgical risk, poor run-off, high risk of prosthetic infection, thrombosis and/or infection of orthotopic grafts. 3 ilio-iliac, 27 iliofemoral, 18 femorofemoral and 1 femoropopliteal bypass have been performed. The postoperative resting pressure Index increase was highly significant in recipient limbs. There wasn't perioperative mortality; during the follow up (mean 24.4 months) no amputation of recipient limb was observed. 4 patients died of A.M.I. and 1 of neoplastic disease. Late cumulative patency rate was 81% at 2 years and 67.3% at 3 years. These values rise to 97.2% and 86.1% respectively when considering patients with "ideal" indication (excluding 7 patients operated on for complications of previous bypass grafts and 6 with extremely poor run-off). An accurate evaluation of the lesion topography and haemodynamic pattern of donor and recipient iliofemoral districts are stressed as key points for a correct surgical indication.

Adult↗