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Biomedical subjects

A Morbidelli

Publications and source records attributed to A Morbidelli.

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

[Role of anterior scalene muscle hypertrophy in thoracic outlet syndrome].

A case of hypertrophic anterior scalene muscle surgically treated is reported. The patient suffered from upper limb intermittent claudication at any sustained upper extremity activity such as lifting a weight or opening and closing the hand with the arm abducted. Doppler and angiographic study showed significant compression of subclavian artery with hyperabduction and Adson manoeuver. Simple anterior scalenotomy was followed by prompt recovery of symptoms. The results of scalenotomy and other surgical approaches to thoracic outlet syndrome are reviewed in the literature. The most common anomalies of anterior scalene muscle in the TOS are also described. Doppler and arteriographic study in different functional positions are necessary in the evaluation of subclavian artery compression by osseous or muscular structures. In the reported case scalenotomy was at least as effective as 1st rib resection.

Adolescent↗
PubMed1989

[Complete cervical rib. Possible neurovascular implications of the upper limb].

The thoracic outlet syndrome (TOS) is caused by compression of the brachial plexus or subclavian artery or vein in the region of the neck and shoulder girdle. The neurovascular bundle may be compressed at multiple sites: costoclavicular space, interscalene triangle, insertion of the pectoralis minor into the coracoid process. More than 90% of the patients present with neurologic symptoms: pain, paraesthesias or arm and hand weakness and 10% also have vascular problems. The diagnosis of TOS is always difficult and depends on careful clinical study of patients. For the neurological type of TOS, electromyograms, arteriograms and venograms are not helpful. The value of Doppler study and of arteriography is demonstrated in the present case of a woman with a five month history of pain and paraesthesias of the arm and hand, who shoved sudden occlusion of left humeral artery. Roentgenograms showed the presence of a well developed left cervical rib. Doppler study and arteriography showed the compression of subclavian artery with the arm abduction manoeuver. After first rib resection and humeral artery thrombectomy there was a complete return of humeral artery flow and of all neurologic functions. Thus the role of first cervical rib or other bone and muscular structures must be emphasyzed both in the brachial and in the subclavian artery or vein compression. Embolization of the axillary or humeral artery should be corrected as soon as possible when the cervical rib is corrected.

Adult↗
PubMed1989

[Pseudoaneurysm of the subclavian artery. Case reports].

Five patients suffering from subclavian artery false aneurysms underwent surgery in the last 6 years at the Institute of General and Cardiovascular Surgery University of Milan. The management was considerably different from the treatment of atherosclerotic lesions of this artery, because of the various nature of such traumatic lesion and the variable (stable or unstable) hemodynamic conditions of the patients. Arteriography was extremely useful in the evaluation of site and extension of pseudoaneurysms. When pseudoaneurysm was in the left side (in one case), supraclavicular incision and posterolateral thoracotomy were adopted to allow the control of both proximal and distal portion of subclavian artery. When the pseudoaneurysm was in the right side (in 3 cases) a median sternotomy with extension of the soft tissue incision into the right side of the neck provided the exposure of the proximal and distal right subclavian artery. In the last case, proximal infected false aneurysm (after right axillo-femoral bypass graft) was removed and substituted by contralateral axillo-bifemoral bypass.

Adult↗
PubMed1989

[Role of conservative therapy and surgical treatment in disease caused by gastroesophageal reflux].

A series of 82 subjects affected with reflux esophagitis is presented. Gastroesophageal reflux and peptic esophagitis were discovered and staged by contrast meal and endoscopy with biopsy. All patients underwent medical therapy based on drugs affecting gastroesophageal motility and acidity of gastric content: this therapy was administered for three months, then was performed a control endoscopic examination. Endoscopic recovery of esophagitis allowed a long term maintenance therapy, endoscopically controlled every year. When esophagitis persisted, cycles of medical attack therapy, were repeated. surgical operation was performed in 15 cases in which either three cycles of medical therapy failed to improve esophageal lesions, or when endoscopy showed worsening esophagitis.

Adult↗
PubMed1989

[Tumors of the upper excretory tract. Cases contribution and review of the literature].

Authors reviewed 11 cases of urothelial tumors of the upper urinary tract. Clinical history, diagnostic procedures and surgical treatment of 8 patients with tumor in the renal pelvis and of 3 patients with ureteral tumor are described. The aspecificity of clinical finding and the possibility of different urinary tract affections may be responsible of many difficulties in doing early diagnosis using routinary instrumental investigations. Nephroureterectomy is most frequently performed as surgical treatment. The results are correlated with the stage of infiltration of surrounding tissues by tumor. It is necessary an early clinical study of the patients with signs or symptoms referring to urinary tract (hematuria, abdominal pain) using excretory urogram, cystoscopy and urinary cytology in order to lower the delay of surgical procedure after the evidence of clinical finding.

Aged↗
PubMed1989

[Cervico-mediastinal goiter].

The descent of a cervical goiter below the plain of the thoracic inlet to become substernal in location, is fairly rare, but not exceptional, with an incidence, derived from several large series of operated patients, ranging from 1.7% to 13.1%. The importance of this particular location of the goiter is chiefly due to the fact that the thyroid is growing in a limited space with many surrounding structures, that unavoidably, sooner or later, will be compressed or strained. This provokes respiratory symptoms (such as cough, dyspnea, stridor) or difficulty in swallowing or determines a superior vena cava syndrome with venous stasis in the neck and in the upper thorax, and with facial oedema. The substernal location, that already constitutes a complication of the basic thyropathy, is further aggravated by the incidental malignant transformation of the substernal goiter or by the development of a thyrotoxicosis due to hyper-functioning intra-thoracic thyroid tissue. For all these reasons the presence of a substernal goiter represents in and of itself a precise indication for a surgical treatment. This study is aimed at examining the series of 19 substernal goiters observed at the Institution of General and Cardiovascular Surgery, University of Milan, from 1967 to 1987, particularly analyzing the progresses in the diagnostic procedures, the adopted surgical therapy and the observed complications.

Adult↗
PubMed1989

[Surgical tactics in the treatment of thyroid nodular pathology].

The thyroid nodules represent the most frequent endocrinopathy, because clinically palpable nodules are detectable in 4-5% of the general population. Such pathological condition includes adenomas, carcinoma, intraglandular haematomas or cysts, focal thyroiditis, etc. Fine-needle aspiration cytology allows a correct diagnosis in about 90% of the cases, distinguishing focal thyroiditis from nodular goiter or thyroid malignancies. The new instrumental and cytological studies make the choice for surgical interventions more selective. At the Institution of General and Cardiovascular Surgery, University of Milan, 597 patients underwent surgery from 1966 to January 1988. The observed nodular (toxic or non toxic) thyropathies were 498 (83.4%). Cold nodules represented about a third (34%) of the nodular thyropathies. Thyroid carcinomas were 33 (5.6%). This study is aimed to analyze our surgical attitude with respect to nodular thyropathies, the surgical procedures adopted and the observed complications.

Adenocarcinoma↗