[Ectopic pheochromocytomas. Case reports].
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Biomedical subjects
Publications and source records attributed to F Giordanengo.
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The Authors describe the anatomopathological background of different types of renal artery lesion, causing renovascular hypertension. Various pathological aspects of dysplastic lesions are examined and compared with the aspects of arteriosclerotic disease. Finally correlations between angiographic and histological reports are considered, discussing when and how a surgical procedure should be advisable.
Penile systolic pressure has been evaluated by the Doppler-sonographic method in 15 diabetic patients suffering from erectile impotence. Urodynamic tests have also been carried out in some patients for a diagnosis of neurological impotence. The results obtained show the possibility of a double or sole origin (neurogenic or vascular, or both) in the pathogenesis of this symptom in diabetic subjects.
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Normal, potent arteriopathic and impotent arteriopathic subjects have been studied by means of the Doppler method for the determination of penile systolic pressure. A penile systolic pressure value less than 75 mmHg and a penisarm pressure index of than 0.55 were always associated with impotence. If present in the arteriopathic, impotence is not always caused by vascular factors.
Reference is made to a series of 620 cases of Raynaud's phenomenon observed at the University of Milan between 1951 and 1977. The following parameters are analysed: sex, age, aetiology (where known), incidence of involvement of the four limbs, presence or otherwise of a complete sign, percentage of trophic lesions, arteriographic picture, lab examinations performed. 534 thoracic sympathectomies were performed in 464 patients with Raynaud or Raynaud-like forms. The results are described.
Authors analyze some results obtained treating, with selective arterial perfusion (using antienzymes), experimental acute pancreatitis in dogs (fifteen). The first dogs' group was used to perform several experimental acute pancreatitis; the second group was treated by selective arterial perfusion and was related to group of dogs treated by i.v. antienzymes drugs. Histological and biochemical data are discussed. The results obtained with arterial perfusion are preliminary referred as better than classic i.v. antienzymes drugs therapy.
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5 cases of pulmonary embolism are reported. 3 of these were subjected to pulmonary embolectomy with complete success; repeated controls bear witness to the good long-term cardiorespiratory condition. Two patients died, one following angiography, the other at anaesthetic induction; this fact shows the desirability of submitting patients to partial support extracorporeal circulation prior to angiography and, in any cases, before submitting them to anaesthesia. This surgical success obtained in treatment of the three cases shows that embolectomy continues to play a decisive role.
A case of arterial hypertension due to suprarenal medulla hyperplasia is reported. Having accepted the existence of this form, the problem of its recognition is stressed, in the presence of catecholamine pathology, even though the type or site of its anatomo-pathological substrate cannot be identified, explorative surgery and possible removal of the suprarenal glands can be indicated.
The frequency of pulmonary embolization seems to be increasing. Venostasis, intimal damage and hypercoagulability of blood are the more recognized causes of pulmonary thromboembolism. It is especially threatening to the elderly, obese, immobilized (for an accident or an operation) patients. Pulmonary isotopic scans or angiograms are most often relied upon to establish the diagnosis. A properly performed pulmonary angiography is necessary to establish or refute the diagnosis in almost every case. With the exception of the patients suddenly dying for a massive pulmonary embolism, the period of time between onset of symptoms and death is usually adequate for substantiating a diagnosis and promptly beginning a fit anticoagulation therapy using continuous intravenous heparin or fibrinolytic agents infusion. Although it is not proper to separate surgical and medical treatment of thromboembolism, the Authors, on the ground of their experience on 5 patients affected by massive pulmonary embolism, in 3 of whom was performed a successful embolectomy, think that heparin anticoagulation treatment is at any rate to apply for treating pulmonary embolism, but in patients in whom the shock is unresponsive to vasopressors or in whom anticoagulation therapy is controindicated, the surgical removal of pulmonary emboly, with the support of a pump oxygenator, is the treatment of choice for the acute massive pulmonary thromboembolism.
As a result of the observation of oedemas of the lower extremities and lymphorrhoea in the immediate postoperative course of surgical reconstruction of the aorto-iliaco-femoro-popliteal arterial axis (and on the basis of similar cases in the literature), the participation of the lower extremity return circulation in this facet of vascular surgery has been documented. The venous system was never impaired whereas the local lymphatic system was always damaged by surgical aggression on the arterial vessels. However, the extensive anatomical lesions shown up by lymphography are not reflected in evident clinical signs; whenever oedema or lymphorrhoea of the surgical wounds are observed, these symptoms are always of slight importance and easily and quickly resolved. At long-term follow-up, no clinical evidence of impairment ot the venous and lymphatic venous return circulation was ever encountered. For prophylactic purposes the lymphatic structure encountered during the operation should be carefully ligated to counteract another dangerous complication: infection.
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