Biomedical subjects

F Giordanengo

Publications and source records attributed to F Giordanengo.

At least 19 recordsLinked to original sources

PubMed1999

Non specific aorto-arteritis. Clinical picture, diagnosis and therapy.

This study is aimed at analyzing clinical features, angiographic findings and evolution of Takayasu's arteritis and the criteria adopted to establish the indication for non-surgical versus operative treatment. Eighteen patients affected by non specific aortarteritis were observed and treated at our Department between 1973 and 1996. All patients met the American College of Rheumatology 1990 criteria of classification of Takayasu's arteritis. Sixteen patients were young females. Two patients were males. Nine patients underwent surgical procedures. One young female underwent a PTA. All eight asymptomatic patients were only medically treated. One patient died some days after an aorto-bicarotid bypass graft due to acute myocardial infarction. Two other patients died two and four years after intervention for renal and cardiac failure respectively. One patient after an aorto bicarotid bypass underwent a left hemiplegia due to thrombosis of the right graft branch. All the other 14 patients either surgically or medically treated are well and are under strict surveillance through rigorous follow-up. The 10 patients who underwent surgical or interventional radiological treatment were certainly the most seriously affected patients and were symptomatic (presented neurological disturbances or a severe hypertensive state). This fact explains, to some extent, the mortality and morbidity rate observed in this group. The seven medically treated patients were completely asymptomatic in spite of a major involvement of various vascular districts.

Adolescent↗

PubMed1999

Acute vascular abdomen. General outlook and algorithms.

Acute vascular abdomen is a severe and life-threatening pathology due to arterial degeneration, leading to hemorrhage or arterial occlusion leading to ischemia. Differential diagnosis of patients with severe abdominal pain and/or shock include several vascular and traumatic diseases, the most common being rupture of abdominal aortic aneurysm (AAA), or less frequently rupture of visceral artery aneurysm. Also acute aortic dissection, iatrogenic injury and acute mesenteric ischemia may lead to acute vascular abdomen. Clinical evaluation of the haemodynamic status of the patient may be very difficult, and may require airway maintenance and ventilation with a rapid treatment of hemorrhagic shock. In the stable patient with an uncertain diagnosis, CT scan, NMR and selective angiography may be helpful in diagnosis before vascular repair. On the contrary, the unstable patient, after hemodynamic resuscitation, must be operated on expeditiously. We present our vascular algorithms, to assess timing of diagnosis and treatment of this severe acute disease.

Abdomen, Acute↗

PubMed1998

[Intestinal anastomosis with a biofragmentable rind (BAR). Results in comparison with mechanical and manual anastomosis].

METHODS: The use of the biofragmentable anastomosis ring (Valtrac-BAR) was attempted in 25 selected patients (group I) undergoing elective colonic resection for primary colon cancer, at the General and Cardiovascular Institute of the University of Milan. The results were compared with those of 30 selected patients who underwent elective colonic resection for the same pathology during the same period, and had their bowel anastomosis stapled (group II) or hand-sutured (group III). RESULTS: In group I there were 2 complications requiring reoperation: a little tear of the bowel near the BAR, and a postoperative ileus, compared with none in group II, that developed only 3 cases of abdominal wall infections. In group III, 2 patients developed a leakage of the anastomosis, one of them required reoperation. In the perioperative course there were 2 deaths (3.6%), in group II and III due to cardiovascular diseases. The results obtained showed no significant difference in the clinical course of the patients, or time of return of bowel function, and hospital stay. CONCLUSIONS: The conclusions is drawn that Valtrac-BAR device is a safe and reliable alternative to conventional suture anastomosis in all areas of the intestinal tract, except the low rectum.

Adult↗

PubMed1998

Ruptured abdominal aortic aneurysms: factors affecting the early postoperative outcome.

BACKGROUND: In spite of the progress in diagnosis and treatment of ruptured abdominal aortic aneurysms (RAAA) the mortality rate still remains very high (varying from 15% to 50% according to various experiences). This study is aimed at analyzing the relative contribution of preoperative hemodynamic conditions and of operative and postoperative factors to outcome of patients operated on for ruptured abdominal aortic aneurysms. METHODS: For this purpose a retrospective case series involving 152 patients operated on in emergency for RAAA, during the period 1990-1994, has been reviewed. In this group we examined the site of rupture, the size of the aneurysms, the presence or not of a shock condition at admission, the existence of inflammatory aspects, the adopted type of prosthesis. RESULTS: The mortality rate was 24.3% (37 patients). In 10 patients (27%) the cause of death was an irreversible hemorrhagic shock. Eight patients (21.6%) died for an intestinal infarction. In 7 patients the fatal outcome was due to the development of an acute renal failure. Five patients (13.5%) underwent an acute myocardial infarction and other five a multiorgan failure. Two patients (5.5%) eventually died for respiratory insufficiency. CONCLUSIONS: The results of our study seem to confirm that the outcome of patients affected by rupture of abdominal aortic aneurysms depends not only on the preoperative hemodynamic condition but also on the expertise of the surgical team.

Aged↗

PubMed1997

[Traumatic lesion of the subclavian and axillary arteries].

This study comprises 11 patients with traumatic vascular injuries of the subclavian and axillary vessels treated in the last 13 years at the Institute of General and Cardiovascular Surgery of Milan. Nine patients were male and two were female. In two patients the cause of injury was a penetrating trauma; blunt trauma occurred in nine patients. The majority of injuries were caused by motor vehicle accidents. Two patients suffered complete brachial plexus palsies with complete transection of the median nerve. Seven patients were affected by multiple bone injuries, while major venous injury was present in one case. Diagnosis was established by angiography performed in all stable patients. Vascular repair was performed in 10 patients; 4 patients were treated by primary repair, and 6 patients by interposition grafts. In one case we performed a transluminal percutaneous angioplasty (PTA) during angiographic examination, with a good result. There were no postoperative vascular complications and no patient died.

Adult↗

PubMed1997

[So-called "spontaneous" lesions of the popliteal artery].

The term "spontaneous", when attributed to a stenotic or obliterative arterial lesion, could seem ambiguous and doesn't completely explain the anatomical substrate that is the basis of this morbid condition. However, it is true that injuries can occur without the patient being aware of any traumatic event, and can cause a symptomatology arising suddenly and, apparently, "spontaneously". In this study, three cases of patients observed for acute or chronic lower limb ischemia are presented. All patients were male, young and underwent an angiographic examination that demonstrated, in an otherwise normal arterial tree, filling defects or obstruction involving the popliteal artery. Two patients underwent a reconstructive surgical procedure. The third was medically treated. CAT or MNR examinations were performed in order to exclude developmental defect such as an anomalous course of popliteal artery determined by a displacement due to medial head of the gastrocnemius muscle. Actually in these three cases, a definite etiology of the arterial damage was not demonstrated and therefore it is suggested that a physical effort could have injured an already weakened arterial structure.

Adult↗

PubMed1996

[Percutaneous angioplasty (PTA) in the treatment of non-penetrating injuries to the subclavian artery. A clinical case].

Non penetrating injuries to the subclavian vessels are uncommon. We present a case of a young patient with an isolated blunt trauma of the right subclavian artery. The patient, a 25 year-old woman, was admitted to our Institute after a motor-vehicle accident, with a physical findings of absent peripheral pulses and right clavicular fracture, confirmed by non-invasive vascular evaluation and X-ray of the chest. Diagnosis was established by an urgent selective angiography that showed a subintimal hematoma with occlusion of the vessel and peripheral ischemia of the arm. The patient clinical status (hemodynamically stable) permitted a conservative management and a transluminal percutaneous angioplasty (PTA) with a trans-femoral catheter balloon. After radiologic treatment, the patient showed good palpable peripheral pulses. Clavicular fracture was treated by esternal stabilization. We believe that in selected patients, without other serious life-threatening injures, the intimal artery injury can be treated by a conservative and now also radiologic Therapy; PTA treatment avoids morbidity and mortality associated with surgical intervention.

Accidents, Traffic↗

PubMed1995

[Malignant neoplasms invading into the inferior vena cava. Surgical indications].

Clinical conditions requiring resection and replacement of the inferior vena cava (IVC) are rare and have included tumors, traumatic or iatrogenic injuries. Intraluminal extension or direct mural involvement of the IVC is seen with a variety of tumors: renal cell carcinomas, adrenal cortical tumors, leiomyosarcomas and pheochromocytomas. Surgical treatment requires tumor resection with simultaneous en bloc resection of the involved IVC. Resection of the lower and middle segments of IVC is possible in nearly all cases and surgical reconstruction is generally made with a polytetrafluoroethylene (PTFE) tube graft. Resection at suprahepatic vein level is indicated only rarely: tumor invasion of the suprahepatic veins require liver transplantation. Venous bypasses have lower patency rates than prosthetic replacement because of the low pressure and lower-flow of the venous system.

Adrenal Gland Neoplasms↗

PubMed1995

Indications and role of isolated profundaplasty in patients affected by limb ischemia.

The deep femoral artery is the primary source of blood supply to the lower extremity in presence of superficial and/or popliteal occlusion. The atherosclerotic involvement of the profunda femoris artery is relatively less frequent and generally is localized in the initial segment of the artery. The profundaplasty employed to relieve limb threatening ischemia is infrequently used as an isolated procedure. However many authors demonstrated that restoration of flow through this vessel alone, in patients without significative lesions of the aorto-femoral district, will effectively relieve ischemia when the superficial femoral artery is also occluded. Our experience gained in the last eight years concerns 24 patients (21 male, 3 female). All the patients had severe ischemia of the lower limb with invalidating claudication (13), rest pain (9) and gangrene (2). On the basis of our results, we think that the operation is recommended, whenever possible, in patients with critical ischemia when the possibilities of more extensive revascularizing procedures are absent.

Aged↗

PubMed1995

[Intestinal infarction after ruptured aneurysm of the abdominal aorta. Clinical contribution].

Acute mesenteric ischemia is a severe complication after aortic reconstructive surgery for AAA repair. This ischemic event, due to a poor intestinal perfusion especially in ruptured AAA in consequence of the hypotension and the hypovolemic shock, shows different clinical manifestations such as delayed canalization, ischemic colitis or more serious like intestinal infarction. Between 1989 and 1994, 965 cases of abdominal aortic aneurysms have been surgically treated in General and Cardiovascular Surgery Institute of University of Milan. Rupture had occurred in 150 patients, and intestinal infarction was observed in 6 cases (3.9%). Mortality rate of 33% was observed. Etiology and technical procedures to avoid this complication are discussed.

Acute Disease↗

PubMed1995

Ruptured aneurysm of the internal iliac artery.

The aneurysms of the internal iliac artery are rare and very often asymptomatic. Because of the anatomic location of this artery, it can be difficult to diagnose this kind of aneurysm, when isolated. Frequently it is diagnosed in consequence of aneurysmatic complication, such as rupture and/or impending rupture. In this work we report our experience concerning 6 cases of ruptured aneurysm of the internal iliac artery, observed in 5 patients. In three of these cases the lesion was isolated. In two cases the patients had already been operated on for abdominal aortic aneurysm, 4 and 6 years before. All the five patients were operated on. In 5 cases we ligated the aneurysm, without using any vascular graft. In one case where the external iliac artery was involved, we used a vascular graft between the common iliac and common femoral artery, in order to repair the vascular axis. One case of mortality was observed and a rare complication occurred in one case. An 83-year-old man treated in emergency for ruptured aneurysm of the left internal iliac artery, with regular post-operative course, was hospitalized again 24 days later with sepsis and pain in the left lower abdomen. A CT scan and a following urography showed a urinary fistula probably due to an ischemic necrosis of a segment of the ureter. A percutaneous nephrostomy has been performed and the patient successfully discharged.

Aged↗

PubMed1994

[Renal arteriovenous fistulae].

Arteriovenous fistulas (AVFs) involving the kidney are rare. They are generally classified as congenital, idiopathic or acquired. The authors present 5 cases of renal arterio-venous communications observed in recent years. These cases don't include the congenital type and represent the forms of AVFs that are more frequently observed (1 idiopathic, 3 iatrogenic, 1 associated with malignancy). This study is aimed at examining the clinical picture and the procedures of detection and monitoring of renal AVFs. The various adopted therapeutic procedures (nephrectomy, surgical ablation, radiological embolization) are analyzed.

Adult↗

PubMed1993

[Primary lymphoma of the small intestine].

Lymphomas of the small bowel are rare tumors with few characteristics. Clinical and radiological diagnosis is difficult, because they may be confused by inflammatory or neoplastic forms, especially in primary involvement of the small intestine. Observation of three cases of primary extranodal lymphomas of the small bowel prompted a review of problems relating to the histology, clinical manifestations and the staging classification. This system is an important aid in the evaluation of the treatment and prognosis of these forms.

Adolescent↗

PubMed1993

[The physiopathology and therapy of esophageal diverticula].

The authors report their experience in the management of 14 patients affected by esophageal diverticula and surgically treated (9 had cervical diverticula, 2 had epibronchial diverticula and 3 had epiphrenic diverticula). All these patients underwent a diverticulectomy: in 3 cases the diverticulectomy was associated with a subdiverticular myotomy. In the last three cases the resection of the diverticulum was performed using an automatic stapler. The follow-up of these patients was prolonged for a period of 5 years with clinical, radiographic and endoscopic evaluations performed at 6 monthly intervals. The most recently operated patient has a minimum follow-up of 22 months. There were no operative deaths and none of the patients complained of recurrence of the diverticulum or of the preoperative symptomatology. No significant complications were observed in the postoperative period in the patients who underwent a simple diverticulectomy or in the cases in which a subdiverticular myotomy was associated. The scant number of observed patients does not allow us to draw any conclusion about the necessity maintained by most authors of an associated myotomy. It is however evident that this adjunctive procedure doesn't cause any further difficulty and is not loaded with an increased risk of complications. Finally the authors believe in the usefulness of performing the diverticulectomy with an automatic stapler, these devices allow in fact a considerable reduction of the surgical time and prevent dangerous contaminations of the operative field.

Adult↗

PubMed1993

[Prosthetic separation in the retroperitoneum in reconstructive arterial surgery].

In this assay we take into consideration 3410 retroperitoneal prosthetic reconstructions in aorto-iliac pathology performed in the last 25 years at the General and Cardiovascular Institute of Milan. Thirty-nine retroperitoneal prosthetic dehiscences were observed; 35 of them had been subjected to their first operation in our Institute (1.03%). The incidence of vasculo-enteric fistula and pseudoaneurysm seem to decrease in the last 8 years up to 0.9 (0.9%). Authors consider etiologic factors, diagnostic procedures and technical approaches to this severe complication of vascular surgery.

Adult↗

PubMed1993

[Vagal paraganglioma].

Vagal paragangliomas are rare tumors of neural crest origin. This neoplasm is generally located at various points along the peripheral distribution of the vagus nerve, in the region of the jugular and nodose ganglia, just beneath the perineurium of the nerve, but may arise anywhere along the course of the vagus nerve. Histologically, vagal paragangliomas are similar to carotid body tumors, and occasionally can undergo malignant transformation and metastasize (10-19%) or infiltrate the base of the skull. Selective arteriography can distinguish vagal paraganglioma from carotid body tumor, because the first lies above carotid bifurcation without widening of the vessels. CT scanning and MR are useful for preoperative evaluation of the jugular foramen for neoplastic involvement. Surgical resection is the treatment of choice, but usually it isn't possible to exercise these lesions without sacrifice of the vagus nerve. A careful follow-up examination for the development of metastases and multicentric paragangliomas is necessary. Two cases of vagal paragangliomas one of them with cervical node metastases, are reported. Diagnostic and surgical features of these rare neoplasms are outlined.

Adult↗

PubMed1993

[Pancreatic insulinomas].

Neuroendocrine pancreatic tumors are neoplasms derived from APUD cells, characterized by hyperincretion of several peptides of hormonal activity. The incidence of these tumor is low. They are usually classified according to the predominant secreted peptide: gastrinoma, insulinoma, VIPoma, glucagonoma. Insulinoma is the most frequent endocrine pancreatic tumor, characterized by a peculiar clinical picture due to insulin action. This neoplasm is prevalently benign (90%), and may cause symptoms due to hypo-glycemia such as epilepsy, asthenia, deep coma, dizziness, hunger and epigastric pain. Surgery still constitutes the principal therapy for insulinoma treatment, but an accurate tumor identification is necessary. Selective arteriography of the pancreas and new diagnostic investigations as intraoperative US, selective sampling of pancreatic veins with insulin Quick-RIA, aid the diagnosis and more precise localization of the tumor. When surgical therapy is not practicable, for diffuse metastases, octreotide has an inhibitory effect upon hormone release, and may be combined with chemotherapy for controlling clinical symptoms. We review the clinical records of 2 patients from our Institute, who had hyper-insulinism due to benign insulinomas of the tail of the pancreas. Surgical treatment was performed with enucleation of the neoplasms.

Aged↗

PubMed1993

[Primary malignant tumors of the small intestine].

The clinical records of 10 patients with small intestinal tumors during a 27 years period were reviewed. The patients, 5 men and 5 women ranged from 17 to 79 years old. There were 6 carcinomas (60%), 3 lymphomas (30%), and 1 sarcoma (10%). Tumors were most frequent in the distal part of the small intestine (70%). The most common complaints were pain (70%) and obstruction (40%). All patients had surgical treatment; curative resection was attempted in 70% of the cases. Prognosis is poor, the mean survival time was 20.4 months.

Adolescent↗