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DeDonato G, Benedetto F, Stilo F, Chiesa R, Palombo D, Pasqui E. Evaluation of Clinical Outcomes After Revascularization in Patients With Chronic Limb-Threatening Ischemia: Results From a Prospective National Cohort Study (RIVALUTANDO). J Vasc Surg 2021. [DOI: 10.1016/j.jvs.2021.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Cavalcante Silva J, Grasseli E, Canesi L, Palombo D, Abdalla D. P310A new dual-PPAR agonist (GQ-11), prevents ischemia-reperfusion damage in rats after supraceliac aorta clamping. Eur Heart J Cardiovasc Imaging 2019. [DOI: 10.1093/ehjci/jez148.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- J Cavalcante Silva
- University of São Paulo, Faculty of Pharmaceutical Sciences, SÃO PAULO, Brazil
| | | | - L Canesi
- University of Genoa, Genova, Italy
| | | | - D Abdalla
- University of São Paulo, Faculty of Pharmaceutical Sciences, SÃO PAULO, Brazil
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Cavo A, Rubagotti A, Bellodi A, Zanardi E, Zinoli L, Spallarossa P, Bagnato P, Pane B, Favorini S, Barra S, Arboscello C, Arboscello E, Palombo D, Boccardo F. Cardiovascular disease (CVD) markers in patients(pts) with prostate cancer(PCa) treated with GN-RH agonists(AG) or antagonist(AN): a prospective cohort study. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx423.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Verzola D, Milanesi S, Bertolotto M, Garibaldi S, Villaggio B, Brunelli C, Balbi M, Ameri P, Montecucco F, Palombo D, Ghigliotti G, Garibotto G, Lindeman JH, Barisione C. Myostatin mediates abdominal aortic atherosclerosis progression by inducing vascular smooth muscle cell dysfunction and monocyte recruitment. Sci Rep 2017; 7:46362. [PMID: 28406165 PMCID: PMC5390310 DOI: 10.1038/srep46362] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 03/20/2017] [Indexed: 12/30/2022] Open
Abstract
Myostatin (Mstn) is a skeletal muscle growth inhibitor involved in metabolic disorders and heart fibrosis. In this study we sought to verify whether Mstn is also operative in atherosclerosis of abdominal aorta. In human specimens, Mstn expression was almost absent in normal vessels, became detectable in the media of non-progressive lesions and increased with the severity of the damage. In progressive atherosclerotic lesions, Mstn was present in the media, neointima, plaque shoulder and in infiltrating macrophages. Mstn co-localized with α-smooth muscle actin (α-SMA) staining and with some CD45+ cells, indicating Mstn expression in VSMCs and bloodstream-derived leukocytes. In vitro, Mstn was tested in VSMCs and monocytes. In A7r5 VSMCs, Mstn downregulated proliferation and Smoothelin mRNA, induced cytoskeletal rearrangement, increased migratory rate and MCP-1/CCR2 expression. In monocytes (THP-1 cells and human monocytes), Mstn acted as a chemoattractant and increased the MCP-1-dependent chemotaxis, F-actin, α-SMA, MCP-1 and CCR2 expression; in turn, MCP-1 increased Mstn mRNA. Mstn induced JNK phosphorylation both in VSMCs and monocytes. Our results indicate that Mstn is overexpressed in abdominal aortic wall deterioration, affects VSMCs and monocyte biology and sustains a chronic inflammatory milieu. These findings propose to consider Mstn as a new playmaker in atherosclerosis progression.
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Affiliation(s)
- D Verzola
- Nephrology Division, Department of Internal Medicine, IRCCS University Hospital San Martino, University of Genova, Genova, Italy
| | - S Milanesi
- Nephrology Division, Department of Internal Medicine, IRCCS University Hospital San Martino, University of Genova, Genova, Italy
| | - M Bertolotto
- First Clinic of Internal Medicine, Department of Internal Medicine, University of Genova, viale Benedetto XV, 6, 16132 Genova, Italy
| | - S Garibaldi
- Division of Cardiology, IRCCS University Hospital San Martino, Research Centre of Cardiovascular Biology, University of Genova, Genova, Italy
| | - B Villaggio
- Nephrology Division, Department of Internal Medicine, IRCCS University Hospital San Martino, University of Genova, Genova, Italy
| | - C Brunelli
- Division of Cardiology, IRCCS University Hospital San Martino, Research Centre of Cardiovascular Biology, University of Genova, Genova, Italy
| | - M Balbi
- Division of Cardiology, IRCCS University Hospital San Martino, Research Centre of Cardiovascular Biology, University of Genova, Genova, Italy
| | - P Ameri
- Division of Cardiology, IRCCS University Hospital San Martino, Research Centre of Cardiovascular Biology, University of Genova, Genova, Italy
| | - F Montecucco
- First Clinic of Internal Medicine, Department of Internal Medicine, University of Genova, viale Benedetto XV, 6, 16132 Genova, Italy.,IRCCS AOU San Martino-IST, Genova, largo Benzi 10 16143 Genova, Italy
| | - D Palombo
- Unit of Vascular and Endovascular Surgery, University of Genova, Genova, Italy
| | - G Ghigliotti
- Division of Cardiology, IRCCS University Hospital San Martino, Research Centre of Cardiovascular Biology, University of Genova, Genova, Italy
| | - G Garibotto
- Nephrology Division, Department of Internal Medicine, IRCCS University Hospital San Martino, University of Genova, Genova, Italy
| | - J H Lindeman
- Department of Vascular Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - C Barisione
- Division of Cardiology, IRCCS University Hospital San Martino, Research Centre of Cardiovascular Biology, University of Genova, Genova, Italy
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Rossi A, Palombo D, Capilupi V, Chiapasco M. Pancreatite acuta secondaria a somministrazione di paracetamolo e codeina dopo trattamento odontoiatrico. Analisi della letteratura e caso clinico. Dental Cadmos 2016. [DOI: 10.1016/s0011-8524(16)30065-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Rossi A, Moneghini L, Capilupi V, Anello T, Corsi E, Tregambi A, Palombo D, Chiapasco M. Displasia odontomascellare segmentale: revisione della letteratura e descrizione del primo caso italiano. Dental Cadmos 2016. [DOI: 10.1016/s0011-8524(16)30046-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Barisione C, Milanesi S, Bertolotto M, Palombo D, Villaggio B, Lindeman J, Ghigliotti G, Brunelli C, Ameri P, Garibotto G, Verzola D. Myostatin participate to abdominal aortic atherosclerosis and aneurysm development through VSMCs dysfunction and monocyte activation. Vascul Pharmacol 2015. [DOI: 10.1016/j.vph.2015.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Blondeaux E, Lambertini M, Musio D, Vecchio S, Poggio F, Gazzola V, Palmieri D, Bruzzi P, Rossi G, Pastorino S, Perfumo M, Pronzato P, Palombo D, Bighin C, Del Mastro L. Correlation between treatment with aromatase inhibitors and carotid intima-media thickness, carotid stenosis and abdominal aortic diameter. A prospective cohort study. Ann Oncol 2015. [DOI: 10.1093/annonc/mdv336.23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Fontana I, Bertocchi M, Centanaro M, Varotti G, Santori G, Mondello R, Tagliamacco A, Cupo P, Barabani C, Palombo D. Abdominal compartment syndrome: an underrated complication in pediatric kidney transplantation. Transplant Proc 2015; 46:2251-3. [PMID: 25242763 DOI: 10.1016/j.transproceed.2014.07.045] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The transplantation of a large kidney in small children can lead to many complications, including an underrated complication known as abdominal compartment syndrome (ACS), which is defined as intra-abdominal pressure (IAP)≥20 mm Hg with dysfunction of at least one thoracoabdominal organ. Presenting signs of ACS include firm tense abdomen, increased peak inspiratory pressures, oliguria, and hypotension. Between June 1, 1985, and September 30, 2013, our center performed 420 kidney transplants (deceased/living related donors: 381/39) in 314 pediatric recipients (female/male: 147/167). ACS occurred in 9 pediatric patients (weight<15 kg) who received a large kidney from adult donors. In 1 case, the patient underwent abdominal decompression with re-exploration and closure with mesh in the immediate postoperative period. In a second case, the patient developed a significant respiratory compromise with hemodynamic instability necessitating catecholamines, sedation, and assisted ventilation. For small children transplanted with a large kidney, an early diagnosis of ACS represents a critical step. From 2005 we have measured IAP during transplantation via urinary bladder pressure, and immediately after wound closure we use intraoperative and postoperative duplex sonography to value flow dynamics changes. We recommend that bladder pressure should be routinely checked in small pediatric kidney recipients who are transplanted with a large graft.
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Affiliation(s)
- I Fontana
- General Surgery and Kidney Transplantation Unit, IRCCS San Martino University Hospital - IST National Institute for Cancer Research, Genoa, Italy.
| | - M Bertocchi
- General Surgery and Kidney Transplantation Unit, IRCCS San Martino University Hospital - IST National Institute for Cancer Research, Genoa, Italy
| | - M Centanaro
- Anesthesiology and Intensive Care Unit, IRCCS San Martino University Hospital - IST National Institute for Cancer Research, Genoa, Italy
| | - G Varotti
- General Surgery and Kidney Transplantation Unit, IRCCS San Martino University Hospital - IST National Institute for Cancer Research, Genoa, Italy
| | - G Santori
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
| | - R Mondello
- General Surgery and Kidney Transplantation Unit, IRCCS San Martino University Hospital - IST National Institute for Cancer Research, Genoa, Italy
| | - A Tagliamacco
- Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - P Cupo
- General Surgery and Kidney Transplantation Unit, IRCCS San Martino University Hospital - IST National Institute for Cancer Research, Genoa, Italy
| | - C Barabani
- General Surgery and Kidney Transplantation Unit, IRCCS San Martino University Hospital - IST National Institute for Cancer Research, Genoa, Italy
| | - D Palombo
- Department of Surgery, IRCCS San Martino University Hospital - IST National Institute for Cancer Research, Genoa, Italy
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Chiapasco M, Palombo D. Sinus grafting and simultaneous removal of large antral pseudocysts of the maxillary sinus with a micro-invasive intraoral access. Int J Oral Maxillofac Surg 2015; 44:1499-505. [PMID: 26265064 DOI: 10.1016/j.ijom.2015.07.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Revised: 03/22/2015] [Accepted: 07/13/2015] [Indexed: 11/19/2022]
Abstract
Large antral pseudocysts of the maxillary sinus (APCs) may hamper the elevation of the Schneiderian membrane during sinus grafting and may impair osteo-meatal complex patency after sinus augmentation. Therefore, these should be removed prior to or at the time of sinus grafting. This study presents a new technique that combines enucleation of large APCs during sinus grafting via a lateral approach with preservation of the Schneiderian membrane periosteal layer. Twelve patients underwent a sinus graft via lateral approach during the years 2004-2012. Simultaneous APC removal was achieved through a small additional bony access, preserving the integrity of the periosteal layer of the Schneiderian membrane. Nineteen implants were inserted at the time of sinus augmentation or during a second stage. Prosthetic rehabilitation was started at 4-6 months after implant placement. No patient developed surgical complications or APC recurrence. The survival rate of implants and related prostheses was 100% over a mean follow-up of 50 months (range 12-96 months) after completion of the prosthetic restorations. This technique may represent an effective procedure to achieve APC removal at the time of sinus grafting, preserving the integrity of the Schneiderian membrane periosteal layer.
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Affiliation(s)
- M Chiapasco
- Unit of Oral Surgery, Department of Health Sciences, San Paolo Hospital, University of Milan, Milan, Italy.
| | - D Palombo
- Unit of Oral Surgery, Department of Health Sciences, San Paolo Hospital, University of Milan, Milan, Italy
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Morbelli S, Ghigliotti G, Spinella G, Marini C, Bossert I, Cimmino M, Pane B, Rousas N, Cittadini G, Massollo M, Camellino D, Riondato M, Palombo D, Barisione C, Sambuceti G. Systemic vascular inflammation in abdominal aortic aneurysm patients: a contrast-enhanced PET/CT study. Q J Nucl Med Mol Imaging 2014; 58:299-309. [PMID: 24658166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
AIM The aim of this paper was to investigate the presence of systemic vascular inflammation and its relationship with risk factors and biomarkers of systemic inflammation related to atherosclerosis in asymptomatic abdominal aortic aneurysm (AAA) patients. METHODS Thirty AAA patients and 30 age-matched controls underwent contrast-enhanced 2-deoxy-2-[18F]fluoro-D-glucose (FDG) PET/CT. C-reactive protein, erythrocyte sedimentation rate, white blood cell count and differential, serum fibrinogen, D-dimer and full lipid panel were also evaluated. Region of interest analyses were performed to obtain target-to-background (TBR) metabolism of aorta, subclavian, carotid, iliac arteries and AAA. CT-based arterial calcium load (CL) was evaluated. Arterial Metabolism and CL intergroup differences were tested (unpaired t-test). Linear regression analysis was performed only between blood biomarkers on one side and both TBR and ACL of the arterial districts that resulted significantly different between patients and controls on the other. In all the analyses P values <0.05 were considered significant. RESULT FDG-uptake was higher with respect to controls in aorta, carotid and iliac arteries (P<0.01, P<0.007, P<0.04 respectively). AAA and aorta metabolism showed an inverse correlation with HDL-chol (P<0.02 and P<0.01, respectively) while only aorta showed a direct correlation with lymphocytes' count (P<0.02). Carotid metabolism was directly correlated with monocytes' count and C-reactive protein concentration (P<0.02 and P<0.004, respectively). CONCLUSION The present findings support the relevance of systemic vascular inflammation in all phases of atherosclerosis-related disorders. Moreover they confirm the concept that acute ischemic syndromes might represent the local result of a systemic inflammation rather than the focal involvement of a single arterial lesion.
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Affiliation(s)
- S Morbelli
- Nuclear Medicine Unit IRCCS San Martino University Hospital, IST Dept of Health Sciences, University of Genoa, Genoa, Italy -
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Pane B, Spinella G, Signori A, Musio D, Perfumo MG, Lucertini G, Rousas N, Palombo D. Early and long-term outcomes after open or endovascular repair for abdominal aortic aneurysms in high-risk patients. J Cardiovasc Surg (Torino) 2014; 55:257-263. [PMID: 24670832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
AIM The aim of our study was to evaluate the earlier and long term survival as well the postoperative complications in high-risk patients who received endovascular aortic repair (EVAR) as first choice, or open repair when anatomical requirements for EVAR were not met. METHODS Between January 2005 and January 2010, 593 patients underwent procedures for elective abdominal aortic aneurysm (AAA) repair; 172 of these were considered at high risk according to the American Society of Anesthesiology (ASA) score (ASA III and IV): 150 high-risk patients were males (mean age 72.7, range 53-93 years) and 22 females (mean age 72.9 years, range 60-90 years). The median AAA diameter was 64 (53-75) mm in the open repair group and 62 (55-70) mm in the EVAR group. 121 patients underwent open repair and 51 EVAR, respectively. RESULTS The 30-day mortality rate was 0% in the EVAR group and 2.4% (3/121) in the open repair group (P=0.26). Long-term results showed: no EVAR-related mortality, no late conversion to open repair in the EVAR group was required during follow-up. No aneurysmal expansion was observed. In the open repair group, no graft-related events were observed during follow-up. The mean follow-up for survival analysis was 1542 days. Overall 5-year survival was 71.7% (SE=4.2%). Survival during follow-up was 92.2%, 86.1%, 76.2%, 65.9% and 61.8% at 12, 24,36,48,60 months respectively in EVAR Group. Open Group present long term survival of 95%, 88.9%, 83.9%, 79.7%, 76% at 12, 24, 36, 48, 60 months respectively. CONCLUSION Our results in open repair surgery show a perioperative low mortality rate with high survival rate in long term. This result could be successfully achieved even in high-risk patients unsuitable for EVAR.
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Affiliation(s)
- B Pane
- Vascular and Endovascular Surgery Unit University Hospital IRCCS San Martino‑IST University of Genoa, Genoa, Italy -
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Scalone L, Cortesi PA, Spinella G, Pane B, Cesana G, Mantovani LG, Palombo D. Use of health-related quality-of-life measurements to estimate individuals' health on screening. Acta Chir Belg 2013; 113:406-414. [PMID: 24494467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVES to investigate the utility of assessing Health-Related Quality of Life (HRQoL) in a large group of subjects participating in a screening program for aneurysm and the relationship between HRQoL, diagnosis of aneurysm and related risk factors. METHODS subjects involved in this screening program were submitted the EQ-5D questionnaire to report their own HRQoL. HRQoL was reported also a second time by the subjects who were diagnosed with aneurysm during screening and who returned for a monitoring follow up visit a few months later. We evaluated compliance with HRQoL data collection and performed multiple regression analyses in order to investigate the possible relationship between demographic and clinical data with HRQoL. RESULTS 1,633 subjects screened (6.1% diagnosed with aneurysm) and 125 subjects diagnosed with aneurysm and attending a follow-up visit reported their HRQoL. Completion of the EQ-5D questionnaire was well accepted by both physicians and subjects undergoing screening. HRQoL was not significantly different between the screening and followup visits, on adjusting for age and sex. At the screening visit, HRQoL was associated with ASA class, heart condition, BMI and respiratory diseases. No associations were found at the follow-up visit. CONCLUSION Assessing HRQoL in screening programs is feasible and well accepted and add useful information on health of large numbers of subjects from general population. This could be considered as a routine approach to optimizing the informative role of screening programs in guiding other investigations or interventions.
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Affiliation(s)
- L Scalone
- Research Centre on Public Health (CESP), University of Milan-Bicocca, Monza, Italy
| | - P A Cortesi
- Research Centre on Public Health (CESP), University of Milan-Bicocca, Monza, Italy
| | - G Spinella
- Division of Vascular and Endovascular Surgery, IRCCS San Martino University Hospital-IST, University of Genoa, Genoa, Italy
| | - B Pane
- Division of Vascular and Endovascular Surgery, IRCCS San Martino University Hospital-IST, University of Genoa, Genoa, Italy
| | - G Cesana
- Research Centre on Public Health (CESP), University of Milan-Bicocca, Monza, Italy
| | - L G Mantovani
- Department of Clinical Medicine and Surgery, University Federico II of Naples, Naples, Italy
| | - D Palombo
- Division of Vascular and Endovascular Surgery, IRCCS San Martino University Hospital-IST, University of Genoa, Genoa, Italy
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Pane B, Spinella G, Salcuni M, Palombo D. Stent-graft and multilayer stent for treatment of type II thoracoabdominal aortic aneurysm in a high-risk patient. J Cardiovasc Surg (Torino) 2013; 54:505-509. [PMID: 24013540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
The aim of the present article was to present an alternative endovascular treatment for type II thoracoabdominal aortic aneurysm that would have the advantage of limiting the duration of the procedure and the use of contrast. A high-risk patient was admitted to our Vascular Unit for type II thoracoabdominal aneurysm according to Crawford's classification. Two thoracic stent-grafts (Valiant Captivia, Medtronic, Pewaukee, WI, USA), a bifurcated stent-graft (Endurant Medtronic) and two multilayer stents (Cardiatis SA, Isnes, Belgium) were deployed. No postoperative major complications were observed. Operative time and use of contrast material were 45 min and 80 mL, respectively. Computed angiography tomography at 1 and 6 months showed patency of visceral and renal arteries and progressive thrombosis of the aneurysmal sac. This stent-graft treatment in combination with multilayer stent could be an alternative treatment for thoracoabdominal aneurysm in high-risk patients.
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Affiliation(s)
- B Pane
- Vascular and Endovascular Unit, University of Genoa IRCCS San Martino University Hospital IST, Genoa, Italy2 Interventional Radiology Unit, Casa di Cura Pierangeli Pescara, Italy -
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Bertoglio S, Rezzo R, Merlo F, Solari N, Palombo D, Vassallo F, Beltramini S, DeMaria A. Pre-filled normal saline syringes to reduce totally implantable venous access device-associated bloodstream infection: a single institution pilot study. J Hosp Infect 2013; 84:85-8. [DOI: 10.1016/j.jhin.2013.02.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2012] [Accepted: 02/10/2013] [Indexed: 11/24/2022]
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Lees T, Troëng T, Thomson I, Menyhei G, Simo G, Beiles B, Jensen L, Palombo D, Venermo M, Mitchell D, Halbakken E, Wigger P, Heller G, Björck M. International Variations in Infrainguinal Bypass Surgery – A VASCUNET Report. Eur J Vasc Endovasc Surg 2012; 44:185-92. [DOI: 10.1016/j.ejvs.2012.05.006] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2011] [Accepted: 05/07/2012] [Indexed: 10/28/2022]
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Lees T, Troëng T, Thomson I, Menyhei G, Simo G, Beiles B, Jensen L, Palombo D, Venermo M, Mitchell D, Halbakken E, Wigger P, Heller G, Björck M. International Variations in Infrainguinal Bypass Surgery – A VASCUNET Report. J Vasc Surg 2012. [DOI: 10.1016/j.jvs.2012.06.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Vikatmaa P, Mitchell D, Jensen L, Beiles B, Björck M, Halbakken E, Lees T, Menyhei G, Palombo D, Troëng T, Wigger P, Venermo M. Variation in Clinical Practice in Carotid Surgery in Nine Countries 2005–2010. Lessons from VASCUNET and Recommendations for the Future of National Clinical Audit. Eur J Vasc Endovasc Surg 2012; 44:11-7. [DOI: 10.1016/j.ejvs.2012.04.013] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2011] [Accepted: 04/16/2012] [Indexed: 11/24/2022]
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Palombo D, Lucertini G, Robaldo A, Pane B, Spinella G. Treatment of penetrating aortic ulcer by endoprosthesis: a single center experience. INT ANGIOL 2012; 31:54-61. [PMID: 22330625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
AIM This is a retrospective study of a single center experience in the endovascular treatment of penetrating aortic ulcer (PAU). METHODS Sixteen consecutive patients aged 69.1±9.6 years presenting PAU (in the aortic arch in 2, the descending thoracic aorta in 11, and in the abdominal aorta in 3) undergone therapy. Nine patients presented symptomatic, while 7 were asymptomatic. All patients underwent computer tomography angiography (CTA) of the thoracic and the abdominal aorta. Endovascular therapy alone was carried out in 12 patients, while 4 received hybrid therapy. RESULTS One patient died of multiorgan failure after hybrid procedure. Complications consisted of type II endoleak from lumbar arteries in 1 case of endovascular procedure, and acute respiratory insufficiency in 1 patient treated by endovascular technique on the emergency basis for aortic rupture. CONCLUSION PAU involves more frequently the descending thoracic aorta. Endovascular treatment (alone or in hybrid therapy) can give good results in patients with severe concomitant diseases. Prognosis of these patients is not favourable in most cases (48-month survival rate 47.9%) due to severe concomitant diseases.
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Affiliation(s)
- D Palombo
- Unit of Vascular and Endovascular Surgery, University Hospital San Martino, University of Genoa, largo Rosanna Benzi 10, Genoa, Italy
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Palombo D, Lucertini G, Robaldo A, Pane B, Spinella G. Treatment of penetrating aortic ulcer by endoprosthesis: a single center experience. INT ANGIOL 2011:R34112586. [PMID: 21796090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
AIM: This is a retrospective study of a single center experience in the endovascular treatment of penetrating aortic ulcer (PAU). METHODS:Sixteen consecutive patients aged 69.1±9.6 years presenting PAU (in the aortic arch in 2, the descending thoracic aorta in 11, and in the abdominal aorta in 3) undergone therapy. Nine patients presented symptomatic, while 7 were asymptomatic. All patients underwent computer tomography angiography (CTA) of the thoracic and the abdominal aorta. Endovascular therapy alone was carried out in 12 patients, while 4 received hybrid therapy. RESULTS:One patient died of multiorgan failure after hybrid procedure. Complications consisted of type II endoleak from lumbar arteries in 1 case of endovascular procedure, and acute respiratory insufficiency in 1 patient treated by endovascular technique on the emergency basis for aortic rupture. CONCLUSION:PAU involves more frequently the descending thoracic aorta. Endovascular treatment (alone or in hybrid therapy) can give good results in patients with severe concomitant diseases. Prognosis of these patients is not favourable in most cases (48-month survival rate 47.9%) due to severe concomitant diseases.
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Affiliation(s)
- D Palombo
- Unit of Vascular and Endovascular Surgery, University Hospital San Martino, University of Genoa, Genoa, Italy -
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Menyhei G, Björck M, Beiles B, Halbakken E, Jensen L, Lees T, Palombo D, Thomson I, Venermo M, Wigger P. Outcome Following Carotid Endarterectomy: Lessons Learned From a Large International Vascular Registry. Eur J Vasc Endovasc Surg 2011; 41:735-40. [DOI: 10.1016/j.ejvs.2011.02.028] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2010] [Accepted: 02/19/2011] [Indexed: 11/29/2022]
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Affiliation(s)
- D. Palombo
- Unit of Vascular and Endovascular Surgery, University Hospital San Martino, Genova, Italy
| | - G. Lucertini
- Unit of Vascular and Endovascular Surgery, University Hospital San Martino, Genova, Italy
| | - B. Pane
- Unit of Vascular and Endovascular Surgery, University Hospital San Martino, Genova, Italy
| | - G. Spinella
- Unit of Vascular and Endovascular Surgery, University Hospital San Martino, Genova, Italy
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Palombo D, Lucertini G, Pane B, Mazzei R, Spinella G, Brasesco PC. District-based abdominal aortic aneurysm screening in population aged 65 years and older. J Cardiovasc Surg (Torino) 2010; 51:777-782. [PMID: 21124273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
AIM Screening for abdominal aortic aneurysms (AAAs) has been carried out in an area of Genoa (Italy) for subjects aged 65 years or more to evaluate prevalence of this disease. METHODS Between March 2007 and September 2009 8234 subjects were screened. Ultrasound examination of the abdominal aorta and the iliac arterial segments was carried out on each subject and all data related to risk factors were collected. RESULTS Five hundreds-twelve (6.2%) subjects were found to have an AAA: 469 (10.8%) males and 43 (1.1%) females (significant difference, P < 0.01). Based on the aortic diameter, 403 (4.9%), 80 (1.0%) and 29 (0.3%) had an AAA of 3.0-3.9 cm, 4.0-4.9 cm and ≥ 5.0 cm diameter, respectively. With regards to risk factors, family history of cardiovascular disease only resulted more frequent in subjects with AAA than in those without AAA. CONCLUSION The prevalence of patients with AAA (6.2%) was similar to previously published estimates. Nevertheless, AAA resulted very high in males. This observation is likely due to screening in a city with a very high percentage of elderly subjects. Family predisposition to cardiovascular disease resulted significant risk factor for AAA. Results of our epidemiological study provide evidence of the usefulness of AAA screening thanks to early diagnosis and appropriate treatment of AAA.
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Affiliation(s)
- D Palombo
- Vascular and Endovascular Surgery Unit, San Martino University Hospital, Genoa, Italy.
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Palombo D, Lucertini G, Mambrini S, Spinella G, Pane B. Carotid endarterectomy: results of the Italian Vascular Registry. J Cardiovasc Surg (Torino) 2009; 50:183-187. [PMID: 19282808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
AIM The aim of this study was to evaluate the results of carotid endarterectomy (CEA) carried out in centers dedicated to vascular surgery. METHODS The study was supported by the Italian Registry for Vascular Activity, which collected the data of 89 centers of vascular surgery (almost all of the existing centers in Italy) during 2007. Data were collected for 5962 CEAs. A total of 5,809 patients (153 were operated bilaterally in two staged procedures), 3990 (68.7%) males and 1,819 (31.3%) females, whose ages ranged from 33 to 100 years (mean 72.7+/-7.78) underwent the surgery procedure. Several surgical techniques were used: i.e., standard CEA with direct suture (1477 cases, 24.8%), standard CEA with patch (2242 cases, 37.6%), and eversion technique (2243 cases, 37.6%). RESULTS Combined perioperative mortality and stroke rate were also evaluated (1.1% [stroke 0.9%, mortality 0.2%]). CONCLUSIONS These results are very good and are comparable to what has been reported in the literature during the last few years. This observation provides further proof of the effectiveness of CEA in the management of extracranial carotid disease. Moreover, these results have to be taken into account when evaluating any new therapeutic options, such as carotid stenting, before accepting them as valid alternatives.
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Affiliation(s)
- D Palombo
- Unit of Vascular and Endovascular Surgery, San Martino University Hospital, Genoa, Italy
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Lombardo L, Ruggia O, Crocellà L, Masoero G, Foti M, Mambrini S, Palombo D, Melchiorri C, Lupo M, Pera A. Epidural plus general anesthesia vs general anesthesia alone for elective aortic surgery: effects on gastric electrical activity and serum gastrin secretion. Minerva Anestesiol 2009; 75:109-115. [PMID: 19221543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
BACKGROUND The aim of this study was to evaluate differences in electrogastrographic activity and serum gastrin secretion in patients subjected to general anesthesia (GA) vs blended anesthesia (BA = GA plus epidural analgesia) for abdominal aortic surgery. METHODS Thirty-four patients (all males: 28 with abdominal aorta aneurysm, 6 with obstructive aorto-iliac disease; mean age: 68+/-7 years) were randomly assigned either to GA (N.=17) or to BA (N.=17) for abdominal aortic surgery. Each patient was evaluated for serum gastrin secretion at the time of electrogastrography (EGG) 24 h before and after surgery, using ambulatory equipment. Gastrin levels were tested under fasting conditions and after a standard meal. EGG shows gastric electrical activity that parallels gastric motor activity. RESULTS Before surgery, no significant difference was found for any of the EGG parameters or the serum gastrin integrated value (area under the curve [AUC]) between the two groups of patients. After surgery, an increased frequency of electrical waves (tachygastria) was observed in 22% of those undergoing GA and in 5% of patients undergoing BA. The power ratio (postprandial/fasting total power) was exceedingly high (>4) in 53% of the GA patients and in 11% of the BA patients (P<0.05). The gastrin AUC was 263+/-58 pg/mL in the GA group and 179+/-92 pg/mL in the BA group (P<0.01). CONCLUSIONS An excess of EGG activity and serum gastrin secretion was observed in patients undergoing GA vs those submitted to BA. Thus, the latter procedure seems to affect gastric function less than GA alone.
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Affiliation(s)
- L Lombardo
- Department of Gastroenterology, Mauriziano U.I. Hospital, Turin, Italy.
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Palombo D, Mambrini S, Lucertini G. Aneurysmal expansion of the aortic patch after thoracoabdominal aortic aneurysm repair. J Cardiovasc Surg (Torino) 2008; 49:305. [PMID: 18431354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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Liapis CD, Bellos JK, Bergqvist D, Van Bockel JH, Palombo D, Wolfe JHN. European continuing medical education in vascular surgery: 5-year results of congresses approved by the Union Européenne des Médecins Spécialistes Section of Vascular Surgery. INT ANGIOL 2007; 26:361-366. [PMID: 18091704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
AIM Continuing medical education (CME) can be defined as ''educational activities that serve to maintain, develop, or increase the knowledge, skills and professional performance of a physician to provide services for patients, the public, or the profession''. CME is a major professional responsibility. The European Board of Vascular Surgery of the Union Européenne des Médecins Spécialistes (UEMS) Section of Vascular Surgery has, through its European Vascular CME (EVCME) Committee, accredited 74 congresses during the 5-year period from 2000-2004. METHODS Official evaluation forms were completed by the congress participants for a personal appraisal of the quality of the activities. The data in this manuscript focused on questions that were the most relevant and of the greatest interest to the participants. A statistical analysis of the results was performed utilizing ANOVA and Robust tests of equality of means as well as a posthoc analysis for further investigation, and non parametric Wilcoxon signed ranks test. RESULTS The educational needs of participants regarding new diagnostic and therapeutic modes were stated as ''important'' and ''extremely important'' in the responses at over 80% in total. Over 75% of the participants answered ''extremely important'' and ''important'' to the question ''how important is evidence-based practice to your practice''. CONCLUSION This survey indicates that the EVCME approved congresses had a positive impact for the vascular surgeon by updating overall knowledge on vascular surgery; the majority of comments by the participants also indicates that EVCME is fulfilling its aim to bring as much evidence-based practice as possible into the daily work schedule of the surgeon by turning knowledge acquired by CME into performance of the participants.
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Affiliation(s)
- C D Liapis
- Department of Vascular Surgery, Athens University Medical School, Athens, Greece.
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Palombo D, Lucertini G, Mambrini S, Zettin M. Subtle Cerebral Damage after Shunting vs Non Shunting during Carotid Endarterectomy. Eur J Vasc Endovasc Surg 2007; 34:546-51. [PMID: 17681825 DOI: 10.1016/j.ejvs.2007.05.028] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2007] [Accepted: 05/05/2007] [Indexed: 01/18/2023]
Abstract
OBJECTIVE To compare the extent of subtle cerebral damage (SCD) in patients undergoing carotid endarterectomy with or without shunt placement. DESIGN Prospective, randomised study. PATIENTS AND METHODS We assessed a consecutive series of 96 patients undergoing endarterectomy for severe unilateral left carotid stenosis who had been randomly assigned to receive a shunt (48) or not (48). Eligibility criteria included age up to 80 years and Mini-Mental State Examination score >24 points. Patients underwent neuropsychological testing before surgery. Serum concentrations of S100 protein, neuron-specific enolase (NSE) and interleukin-6 (IL-6) were measured intraoperatively before and after carotid clamping. Finally, each patient underwent neuropsychological testing 3 weeks after surgery. RESULTS Patients with and without shunt had similar serum concentrations of S100 protein, NSE and IL-6 as well as similar neuropsychological test scores, all p>0.05. CONCLUSIONS There was no difference in subtle cerebral damage between patients randomized to receive a shunt or not.
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Affiliation(s)
- D Palombo
- Unit of Vascular and Endovascular Surgery, Azienda Ospedaliera Universitaria San Martino, Genova, Italy
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de Donato G, Gussoni G, de Donato G, Cao P, Setacci C, Pratesi C, Mazzone A, Ferrari M, Veglia F, Bonizzoni E, Settembrini P, Ebner H, Martino A, Palombo D. Acute limb ischemia in elderly patients: can iloprost be useful as an adjuvant to surgery? Results from the ILAILL study. Eur J Vasc Endovasc Surg 2007; 34:194-8. [PMID: 17433732 DOI: 10.1016/j.ejvs.2007.02.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2006] [Accepted: 02/08/2007] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To evaluate the effects of iloprost, in addition to surgery, on the outcome of acute lower limb ischemia (ALLI). DESIGN Post-hoc analysis of a randomized, double-blind, placebo-controlled study. METHODS In the context of the ILAILL (ILoprost in Acute Ischemia of Lower Limbs) study, 192 elderly patients (>70 years old) undergoing surgery for ALLI were assigned to receive perioperative iloprost (intra-arterial, intra-operative bolus of 3000 ng, plus intravenous infusion of 0.5-2.0 ng/kg/min for six hours/day for 4-7 days following surgery), or placebo (iloprost: n=100; placebo: n=92). Patients were followed-up for three-months following surgical revascularization. RESULTS The combined incidence of death and amputation (primary study end-point) was significantly reduced in patients treated with iloprost (16.0% vs 27.2% in the placebo group; hazard ratio 1.99, 95% confidence interval 1.05-3.75, p=0.03). A statistically significant lower mortality (6.0%) was reported in patients receiving iloprost, compared to controls (15.2%) (hazard ratio 2.93, 1.11-7.71, p=0.03). The overall incidence of death and major cardiovascular events was lower in patients receiving iloprost compared to those assigned placebo (24.0% and 35.9%, respectively), at the limits of statistical significance (relative risk 1.64, 0.97-2.79, p=0.06). CONCLUSIONS These results confirm the poor outcome in elderly patients with ALLI. Based on a subgroup analysis iloprost, as an adjuvant to surgery, appears to reduce the combined end-point of death and amputation.
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Affiliation(s)
- G de Donato
- Department of Vascular Surgery, San Giovanni Bosco Hospital, II University of Naples, Italy.
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Palombo D, Vola M, Lucertini G, Mazzei R, Ferrero E, Grana A, Castagnola M. Cardiac risk assessment of asymptomatic patients by stress echocardiography before infrarenal aortic aneurysm surgery. J Cardiovasc Surg (Torino) 2005; 46:31-6. [PMID: 15758874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
AIM Aggressive cardiac assessment before aortic abdominal aneurysm (AAA) surgery is indicated for patients with symptomatic coronary artery disease (CAD). Assessment of intermediate and moderate risk patients is still under debate. The purpose of the study was to prospectively evaluate the effectiveness of stress echocardiography (SE) in the detection of CAD in patients undergoing AAA surgery who have no symptoms and/or signs of CAD, but who have risk factors for it. METHODS Patients with 1 or more risk factors for CAD underwent SE. All patients with positive SE underwent coronary arteriography, and, when indicated, treatment. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were calculated for SE by comparing results to coronary arteriography. Moreover, major perioperative cardiac events were recorded. RESULTS Ninety-one patients with AAA and risk factors for CAD were studied. SE was positive in 9 cases, including 7 presenting critical CAD on the basis of coronary arteriography. One major cardiac event (1.1%), a nonfatal myocardial infarction, occurred in 1 patient with positive SE and non-critical, single-vessel CAD. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of SE proved to be 100%, 98%, 78%, 100%, and 92%, respectively. CONCLUSIONS Positive SE should be considered a valid method for testing high-risk patients for CAD. The low rate of major cardiac events in this series suggests that cardiac assessment by SE and selective coronary arteriography prior to AAA surgery is effective in asymptomatic patients with one or more risk factors.
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Affiliation(s)
- D Palombo
- Division of Vascular and Endovascular Surgery, San Martino Hospital, 16132 Genova, Italy
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Palombo D, Liapis CD, Tzortzis EA, Wolfe JHN, Bergqvist D. The value of a logbook for young vascular surgeons in training The UEMS experience. INT ANGIOL 2004; 23:95-9. [PMID: 15507884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
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Affiliation(s)
- J H van Bockel
- The Committee for Continuing Medical Education, of the European Board of Vascular Surgery (EBVS), of the Union Européenne des Médicins Spécialistes (UEMS), The Netherlands
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Palombo D, Valenti D, Gaggiano A, Lupo M, Borin P. Early experience with the minimal extracorporeal circulation system (MECC) during thoracoabdominal aortic aneurysm repair. Eur J Vasc Endovasc Surg 2004; 27:324-6. [PMID: 14760604 DOI: 10.1016/j.ejvs.2003.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
AIM The purpose of this report is to describe our early experience with a minimal extracorporeal circulation system (MECC), a compact closed heparin coated system consisting of a centrifugal pump and a membrane oxygenator, during thoracoabdominal aortic aneurysm (TAAA) repair. METHODS Between January and December 2002 the MECC system was employed in seven consecutive patients (four TAAA type II, two TAAA type I and one TAAA type III according to the Crawford classification). In all patients distal aortic, selective renal and visceral perfusion was performed with this compact closed heparin coated system consisting of a centrifugal pump and a membrane oxygenator. RESULTS The MECC system was used in all cases with no technical malfunctions. Six out seven patients were discharged from the unit. One patient developed paraplegia after TAAA repair and died on the third post-operative day from multi-organ failure. In this case the total spinal ischaemic time was 120 min and the distal aortic perfusion pressure was <50 mmHg. No cardiac, cerebral, renal, hepatic or bleeding complications were recorded in the remaining six patients. CONCLUSION Our early experience with MECC during TAAA repair showed that it is feasible for distal aortic spinal and visceral selective perfusion. Further large clinical trials are required to determine the efficacy of this technique.
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Affiliation(s)
- D Palombo
- Department of Cardiac and Vascular Diseases, Vascular Surgery Unit, Mauriziano Hospital, Largo Turati, 62, Turin I-10128, Italy
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Palombo D, Valenti D, Mazzei R, Gaggiano A. Colour Duplex Scan Guided Endovascular Aortic Saccular Aneurysm Repair in a Patient with Chronic Renal Failure. ACTA ACUST UNITED AC 2003. [DOI: 10.1016/s1533-3167(03)00098-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Valenti D, Gaggiano A, Berardi G, Ferri M, Mazzei R, Roda G, Palombo D. Intra-operative assessment of technical defects after carotid endarterectomy: a comparison between angiography and colour duplex scan. Cardiovasc Surg 2003; 11:26-9. [PMID: 12543568 DOI: 10.1016/s0967-2109(02)00112-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We compared the intra-operative diagnostic value of CDS vs IA-DSA in identifying major and minor technical defects after CEA. Between August 1997 and December 1998, 138 consecutive patients undergoing 141 carotid endarterectomies were intra-operatively investigated with colour duplex scan and intra-arterial digital subtraction angiography. Thirty-six (25.5%) technical defects were identified. Four (11.1%) major defects were detected by both methods and they were immediately corrected. Fifteen (41.6%) minor defects were detected by both methods, thirteen (36.1%) minor defects were detected by colour duplex but ignored by angiography. Angiography detected four (11.1%) kinkings missed with the colour duplex. The overall sensitivity of both methods for major defect was 100%. The sensitivity of colour duplex for minor defects was 87% vs 59% for angiography. On the basis of our study, colour duplex could be considered the choice method for quality control after carotid endarterectomy.
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Affiliation(s)
- D Valenti
- Department of Cardiac and Vascular Diseases, Vascular Surgery Unit, Mauriziano Hospital, Corso Turati 62, 10128 Turin, Italy
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Cao P, Giordano G, De Rango P, Zannetti S, Chiesa R, Coppi G, Palombo D, Peinetti F, Spartera C, Stancanelli V, Vecchiati E. Eversion versus conventional carotid endarterectomy: late results of a prospective multicenter randomized trial. J Vasc Surg 2000; 31:19-30. [PMID: 10642705 DOI: 10.1016/s0741-5214(00)70064-4] [Citation(s) in RCA: 126] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The durability of carotid endarterectomy (CEA) may be affected by carotid restenosis. The data from randomized trials show that the highest incidence of restenosis after CEA occurs from 12 to 18 months after surgery. The optimal CEA technique to reduce perioperative complications and restenosis rates is still undefined. This study examines the long-term clinical outcome and incidence of recurrent stenosis in patients who undergo eversion CEA. Previously published perioperative results of this study did not show statistically significant differences in study endpoints between the eversion and standard techniques. METHODS From October 1994 to March 1997, 1353 patients with surgical indications for carotid stenosis were randomly assigned to undergo eversion (n = 678) or standard CEA (n = 675; primary closure, 419; patch, 256). Withdrawal from the assigned treatment occurred in 1.6% of the patients (in 13 assigned to eversion CEA, and in nine assigned to standard CEA). The clinical and duplex scan follow-up examination was 99% complete, and the mean follow-up interval was 33 months (range, 12 to 55 months). The primary outcomes were perioperative and late major stroke and death, carotid restenosis (stenosis >/= 50% of the lumen diameter detected at duplex scanning), and carotid occlusion. The primary evaluation of study outcomes was conducted on the basis of an intention-to-treat analysis. RESULTS Restenosis was found at duplex scanning in 56 patients (19 in the eversion group, and 37 in the standard group). Within the standard group, the restenosis rates were 7.9% in the primary closure population and 1.5% in the patched population. Of the patients with restenosis, 36% underwent cerebral angiography that confirmed restenosis in all cases. The cumulative restenosis risk at 4 years was significantly lower in the group that underwent treatment with eversion CEA as compared with the standard group (3.6% vs 9.2%; P =.01), with an absolute risk reduction of 5. 6% and a relative risk reduction of 62%. Eighteen patients would have had to undergo treatment with eversion CEA to prevent one restenosis during the 4-year period. The incidence rate of ipsilateral stroke was 3.3% in the eversion population and 2.2% in the standard group. There were no significant differences in the cumulative risks of ipsilateral stroke (3.9% for eversion, and 2.2% for standard; P =.2) and death (13.1% for eversion, and 12.7% for standard; P =.7)) in the two groups. Of the 18 variables that were examined for their influence on restenosis, eversion CEA (hazard ratio, 0.3; 95% confidence interval, 0.2 to 0.6; P =.0004) and patch CEA (hazard ratio, 0.2; 95% confidence interval, 0.07 to 0.6; P =. 002) were negative independent predictors of restenosis with multivariate Cox proportional hazards regression analysis. CONCLUSION The EVEREST (EVERsion carotid Endarterectomy versus Standard Trial) showed that eversion CEA is safe, effective, and durable. No statistically significant differences were found in late outcome between the eversion and standard techniques at the available follow-up examination.
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Affiliation(s)
- P Cao
- Division of Vascular Surgery, Policlinico Monteluce, Perugia, Italy
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Palombo D, Maione M, Cifiello BI, Udini M, Maggio D, Lupo M. Matrix metalloproteinases. Their role in degenerative chronic diseases of abdominal aorta. J Cardiovasc Surg (Torino) 1999; 40:257-60. [PMID: 10350113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
BACKGROUND The main chronic degenerative diseases of the abdominal aorta, namely aneurysmatic and steno-obstructive pathologies, have a common denominator: atherosclerosis. Both pathologies are characterised by the destruction of the structural integrity of the extracellular protein matrix (ME). A number of studies have shown the presence and involvement of a group of enzymes with proteolytic activity towards one or more ME components, the matrix metalloproteinases (MMPs), in the pathogenesis of aneurysms of the abdominal aorta. Other authors have underlined the role of MMPs in the proliferation and migration process of smooth muscle cells into the intima in the pathogenesis of atheromasic plaque. The aim of this study was to evaluate the possible role of these enzymes in the pathogenesis of chronic degenerative diseases of the aorta. METHODS Fragments of aortic wall were removed from patients undergoing elective aortic surgery for aneurysms (14 patients) or aortic steno-obstruction (4 patients). The samples obtained were treated appropriately and then subject to immunohistochemical analysis. The preparations were incubated with specific anti-MMP antibodies and were also incubated with substrate and chromogen, forming a pigmented precipitate on the site of the antigen, before being observed using an optic microscopic at an enlargement of 250x. Nuclear positivity linked to the presence of the antigen testified the validity of staining. Lastly, the MMP INDEX, or in other words the number of positive cells out of 100, was stained in the adventitia and in the tunica media in each preparation. RESULTS MMPs were divided into three main groups: interstitial collagenase (MMP1) which degrade type I and III native collagen; gelatinases (MMP9, MMP2) which act on elastin and type IV collagen; stromelysins (MMP3) with specific proteolytic action towards proteoglycans, fibronectin and laminine. In our experience, those preparations obtained from aorta affected by steno-obstructive pathologies (4 patients) revealed the presence of MMPs with a preferential localisation on the intimal side of the tunica media. In particular, the increased activity of gelatinases MMP9 in atherosclerotic aorta might be responsible for destroying the internal elastic lamina and fostering the proliferation and migration of smooth muscle cells and the formation of atheromasic plaque. On the other hand, preparations obtained from aneurysmatic aorta (14 patients) showed an opposite situation with a preferential localisation within the adventitia and on the adventitial side of the media. Above all, the loss of elastin represents an essential stage in the formation of aortic aneurysms. CONCLUSIONS This study concords with numerous authors who have demonstrated the involvement of proteinase MMPs in the development of aortic aneurysms and their possible role in the pathogenesis of atheromasic plaque. The different origin of these enzymes (inflammatory cells and macrophages or endothelial cells) may be the result of different pathogenetic mechanisms. Although they present different pathogenetic features, aortic aneurysms and steno-obstructions have a common denominator in atherosclerosis. The mechanisms responsible for their evolution towards one or other form are not known. The different expression of MMPs in the context of the aortic wall represents a field for future research.
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Affiliation(s)
- D Palombo
- Department of Cardiac and Vascular Diseases, Mauriziano Umberto I Hospital, Turin, Italy
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Cao P, Giordano G, De Rango P, Zannetti S, Chiesa R, Coppi G, Palombo D, Spartera C, Stancanelli V, Vecchiati E. A randomized study on eversion versus standard carotid endarterectomy: study design and preliminary results: the Everest Trial. J Vasc Surg 1998; 27:595-605. [PMID: 9576071 DOI: 10.1016/s0741-5214(98)70223-x] [Citation(s) in RCA: 98] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE The EVEREST Trial was designed to determine whether the surgical technique influences the durability and complications of carotid endarterectomy (CEA). The current report focuses on the study design and preliminary results. METHODS EVEREST is a randomized multicenter trial. A total of 1353 patients with carotid stenosis requiring surgical treatment were randomly assigned to received standard (n = 675) or eversion (n = 678) CEA. Primary end points included carotid occlusion, major stroke, death, and restenosis rate. RESULTS The rate of perioperative major stroke and death (1.3 for each study group) and the incidence of early carotid occlusion (0.6% for eversion vs 0.4% for standard) were similar. No significant differences were found between eversion and standard CEA with respect to incidence of perioperative transient ischemic accident, minor stroke, cranial nerve injuries, neck hematoma, myocardial infarction, or surgical defects as detected with intraoperative quality controls. Clamping time was significantly shorter for eversion CEA compared with patch standard procedures (31.7 +/- 15.9 vs 34.5 +/- 14.4 minutes, p = 0.02). A shunt was inserted in 11% of patients undergoing eversion CEAs and in 16% of patients undergoing standard procedures. Overall 30-day events occurred in 13.3% of the eversion group and in 11.4% of the standard group (p = 0.3). At a mean follow-up of 14.9 months (range, 1 to 38 months), 16 (2.4%) restenoses occurred in the eversion group and 28 (4.1%) occurred in the standard group (odds ratio, 0.56; 95% confidence interval, 0.3 to 1.1; p = 0.08). CONCLUSION The preliminary results of the EVEREST Trial suggest that eversion CEA is a safe and rapid procedure with low major complication rates. No significant differences in restenosis rates were observed between eversion and standard CEA at the available follow-up. Longer-term results are necessary to assess whether the eversion technique influences the durability of CEA.
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Affiliation(s)
- P Cao
- Unit of Vascular Surgery, Policlinico Monteluce, Perugia, Italy
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Palombo D, Porta C, Brustia P, Peinetti F, Udini M, Antico A, Meloni T, Carbonatto P. [Limb salvage in critical ischemia. Our experience]. MINERVA CHIR 1995; 50:263-8. [PMID: 7659262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The aim of this paper is to present our six-year experience in the treatment of critical limb ischaemia, even if in the period (1987-1993) considered the definition of critical ischaemia had been partly reviewed in the publication of the "European Consensus Document on Critical Limb Ischaemia" (March 1989). Two hundred thirty-nine patients have been treated in our Unit for critical limb ischaemia: reconstructive surgery was used in 34% of cases, lumbar sympathectomy or spinal cord stimulation in 17% of cases and pharmacotherapy in 14% of cases. Taking into account arterial and graft patency as well as the percentage of limb salvage, our results were similar to those presented in the literature.
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Affiliation(s)
- D Palombo
- Unità di Chirurgia Vascolare ed Angiologia, Ospedale Regionale della Valle d'Aosta
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Palombo D, Porta C, Peinetti F, Brustia P, Udini M, Antico A, Cantalupi D, Varetto T. Cerebral reserve and indications for shunting in carotid surgery. Cardiovasc Surg 1994; 2:32-6. [PMID: 7914143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The aim of this study was to establish whether a preoperative evaluation of cerebral haemodynamic reserve, carried out by means of transcranial Doppler and single photoemission computed tomography with a provocative test (acetazolamide) is able to select those patients who require carotid shunting to avoid cerebral ischaemia during clamping. All patients were monitored during operation by means of somatosensitive evoked potentials. Those patients who required shunting because of abnormal evoked potentials were also those who had a poor cerebral reserve with a perfusion and velocity increase below 15%. Only one neurological deficit developed in patients who were not shunted.
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Affiliation(s)
- D Palombo
- Vascular Surgery Unit, Regional Hospital, Aosta, Italy
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Meloni T, Carbonatto P, Mistretta L, Palombo D, Peinetti F, Porta C. [Arterial recanalization with the Kensey catheter. Preliminary results]. Radiol Med 1993; 86:509-12. [PMID: 8248590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Fifteen patients with chronic obstruction of leg arteries (mean length: 6 cm) were treated with the Kensey catheter and then with PTA. In 11 cases the procedure was successful (74%) and in 2 it was interrupted--in one case for dissection and in the other for vessel perforation. Two maneuvers, after dissection, were ended with PTA and stent placement (overall success rate: 87%). Emergency surgery was never needed. In the cases solved with the Kensey catheter, the cumulative patency rate was 51% at 6, 12 and 24 months. The Kensey catheter did not improve the results of conventional PTA, which means its role is complementary to that of PTA and an alternative to more expensive laser systems, if PTA fails.
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Affiliation(s)
- T Meloni
- Unità Operativa di Radiologia, Ospedale Regionale Valle d'Aosta
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Palombo D. Council of Vascular Surgeons in the European Community. Cardiovasc Surg 1993; 1:203-6. [PMID: 8076030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Palombo D, Porta C, Brustia P, Peinetti F, Udini M, Antico A, Maione M, Meloni T, Carbonato P. [Loco-regional thrombolysis in deep venous thrombosis]. Phlebologie 1993; 46:293-302. [PMID: 8362012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Anticoagulation, by means of heparin and warfarin is, till now, the most common treatment in deep venous thrombosis. Although thrombolytic agents have been available for over 10 years, their use remains quite low, ranging from 15 to 20% of deep venous thromboses. This is due to the relatively high incidence of contraindications as well as to the fact that the potential advantages versus heparin are diminished by the increased bleeding risk and by the potential risk of pulmonary embolism (migration of partially lysed thrombi). Following the example of the "triple armed therapy" proposed by Rosenthal for the treatment of pulmonary embolism, we will evaluate if loco-regional thrombolysis, with the catheter wedged against the thrombus, associated with a temporary vena cava interruption by means of an intraluminal filter, can achieve a better lysis of the thrombus without pulmonary embolism. In our Unit 18 patients affected by proximal deep venous thrombosis were submitted to thrombolytic therapy, 6 to systemic treatment, 3 to local treatment and the last 9 to loco-regional thrombolysis, using recombinant tissue-type Plasminogen Activator. We obtained 10 complete lyses, 1 with systemic and 9 with loco-regional treatment. There were no major complications. Thus, we think that venous loco-regional thrombolysis with rt-PA at lower doses, associated with temporary caval interruption, can probably achieve a better lysis than systemic treatment without risk of pulmonary embolism and with a very low haemorrhagic risk, as in arterial loco-regional thrombolysis. Furthermore, loco-regional thrombolysis, by means of a faster thrombus dissolution, could better prevent post-phlebitic syndrome.
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Affiliation(s)
- D Palombo
- Unité de chirurgie vasculaire et angéiologie, Hôpital Régional du Val-d' Aoste, Italie
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Palombo D, Porta C, Ferrero C, Peinetti F, Brustia P, Udini M, Majone M, Meloni T. [Arterial embolism, venous thrombosis, pulmonary embolism: a suggestive triad]. MINERVA CHIR 1992; 47:1671-4. [PMID: 1480299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The aim of this study is to present a relatively rare case of paradoxical arterial embolism, found in a patient who was sent to us for serious pulmonary embolism. Taking into account that the foramen ovale, despite being functionally competent, remains anatomically patent in 30% of the adult population, we cannot neglect the possibility of a paradoxical embolism, in the presence of a sudden embolic limb ischemia unless heart pathology or aortic lesions can be held responsible. Furthermore it must not be forgotten that deep venous thrombosis in the lower limbs or in the pelvic plexus may go unobserved on a purely clinical evaluation.
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Affiliation(s)
- D Palombo
- Unità di Chirurgia Vascolare ed Angiologia, Ospedale Regionale della Valle d'Aosta, Aosta
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Palombo D, Porta C, Peinetti F, Brustia P, Udini M, Antico A, Carmonini A, Cantalupi D, Varetto T. [Hemodynamic reserve in carotid surgery and the use of "superselective" shunt]. MINERVA CHIR 1992; 47:1589-94. [PMID: 1480283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The aim of this study is to establish whether a preoperative evaluation of the Cerebral Hemodynamic Reserve, carried out by means of transcranial Doppler and SPECT with provocative test (acetazolamide) can single out those patients who, because they are supplied with a poor cerebral reserve, are truly in need of intraoperative shunting after carotid clamping. All patients were intraoperatively monitored by means of Somato Sensitive Evoked Potentials (SSEPs). Those patients who were shunted due to abnormalities in SSEPs were also those who showed a perfusion and velocity increase below 15%, and therefore supplied, in our opinion, with a scanty cerebral reserve. No, but one, neurological deficit appeared on awakening in patients who were not shunted.
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Affiliation(s)
- D Palombo
- Unità di Chirurgia Vascolare ed Angiologia, Ospedale Regionale della Valle d'Aosta, Aosta
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Palombo D, Ferrero C, Peinetti F, Porta C, Brustia P, Udini M. [Deep phlebothrombosis disclosing aortoiliac aneurysms]. MINERVA CHIR 1992; 47:55-8. [PMID: 1553054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The purpose of the present study is to underline the importance of the systematic search for iliocaval venous compression on the part of an aortoiliac aneurysm in the face of a clinical picture of suspected deep venous thrombosis. Early diagnosis of this syndrome, although rare in everyday experience, is of decisive importance, as is every other clinical sign of aneurysmal pathology prior to rupture. Correct, systematic diagnostic exclusion procedure, which is capable of leading to certain diagnosis in all cases is therefore necessary.
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Affiliation(s)
- D Palombo
- Unità Operativa di Chirurgia Vascolare ed Angiologia, Ospedale Regionale della Valle d'Aosta
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Meloni T, Rossi G, Carbonatto P, Palombo D, Mirelli M, Peinetti F, Porta C. [Embolization of popliteal artery aneurysm with Gianturco coils and angiographic guide wires]. Radiol Med 1991; 82:528-30. [PMID: 1767064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- T Meloni
- Unità Operativa di Radiologia, Ospedale Regionale della Valle d'Aosta
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Palombo D, Mirelli M, Peinetti F, Porta C, Brustia P, Udini M. Spasm of arm arteries due to ergotamine tartrate. A case report. INT ANGIOL 1991; 10:51-3. [PMID: 2071975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Ergotamine tartrate and caffeine has been widely prescribed for the prevention and treatment of migraine headaches. Rarely the ergotamine can cause symptoms of peripheral vascular insufficiency, often concerning the lower extremities. A case report of bilateral severe ischemia to the upper limbs, caused by a chronic assumption of ergotamine tartrate is presented.
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Affiliation(s)
- D Palombo
- Unità Operativa di Chirurgia Vascolare e Angiologia, Ospedale Regionale della Valle d'Aosta, Italy
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Meloni T, Rossi G, Palombo D, Peinetti F, Porta C. [Bilateral persistence of the sciatic artery]. Radiol Med 1989; 78:656-8. [PMID: 2626560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- T Meloni
- Unità Operativa di Radiologia, Ospedale Regionale della Valle d'Aosta
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50
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Spagliardi E, Palombo D. [A case of isolated rupture of the azygos vein]. Minerva Cardioangiol 1978; 26:637-9. [PMID: 703965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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