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Biomedical subjects

F Longhi

Publications and source records attributed to F Longhi.

26 records · Page 2Linked to original sources
PubMed1991

[Association of pheochromocytoma and renovascular hypertension].

The case of a 47-year-old woman affected with right adrenal pheochromocytoma and right renal artery stenosis is presented. The concurrence of these two diseases is rarely reported in the literature, as shown by the review presented. Nevertheless, this association carries some problems as far as diagnosis is concerned, because missing renal artery lesion can lead to the maintenance of the hypertensive disease after surgical excision of the adrenal pheochromocytoma. Anyway, the extensive use of angiography is not justified for pheochromocytoma alone, because an excellent imaging of the mass can be achieved by means of non-invasive technologies, such as CT, echo B-mode, NMR. A careful evaluation of clinical features and non-invasive imaging and the presence of elevated plasma renin activity, although not determinant in surgical decision making, can support the suspicion of renovascular hypertension in the presence of pheochromocytoma and suggest to carry out renal angiogram and selective renal veins reninemia.

Adrenal Gland Neoplasms↗
PubMedDate not supplied

Surgical approach to combined abdominal aortic aneurysm and renal artery stenosis.

Thirty-four cases of combined abdominal aortic aneurysm (AAA) and renal artery stenosis (RAS) are reported. Hypertension was found at admission in 32 subjects, the other two being well responsive to drug therapy. Angiography and selective renal vein renin assay were always performed: renal artery stenosis was unilateral in 21 (61.7%) subjects and bilateral in 13 (38.3%). In 9 cases renal artery stenosis was not correlated to the hypertensive state. Mild chronic renal insufficiency was demonstrated preoperatively in 20 patients (58.8%). Simultaneous surgical treatment was carried out in 25 cases (73.5%). Mortality was 4% (one subject), severe renal insufficiency 8% (two subjects) and permanent renal failure 4% (one subject) All complications occurred among the group with bilateral RAS. While surgical repair of AAA is always mandatory, simultaneous surgical treatment of AAA and RAS should be carried out in carefully selected cases, due to elevated mortality rates reported in the literature, in order to cure renovascular hypertension, when it is demonstrated as related to RAS, or to preserve renal functionality, when RAS is contralateral to a functionally excluded or hypotrophic kidney or it exceeds 80% of the diameter of the artery.

Aged↗
PubMedDate not supplied

The concomitance of renal artery stenosis and Conn's adenoma in a hypertensive woman.

A case of adrenal aldosterone-secreting adenoma concomitant with active renal artery stenosis in a hypertensive middle-aged woman is reported. The concomitance of the two lesions was previously reported in the literature only in five more reports, that are mentioned and commented here. This association is thought to be almost anecdotal, but some remarks must be done in order to rule out the risk of leaving an ignored lesion at the time of the definitive treatment. The widespread use of noninvasive imaging techniques is effective to find unsuspected adrenal adenoma in the presence of renovascular hypertensive disease, whereas unknown renal artery stenosis can be revealed by more aggressive diagnostic attitude, that is justified only in well selected cases of Conn's disease.

Adenoma↗
PubMedDate not supplied

[Complementary echo flow imaging and digital angiography in the supra-aortic area for indication and intervention of carotid revascularization in 1587 subjects in the OPI (Stroke Prevention) program].

The availability of non invasive carotid ultrasound imaging techniques actually allows planning and carrying on of large screening programs for detection of atherosclerotic carotid occlusive disease. The aim of non invasive ultrasound patient selection is to limit the practice of invasive carotid angiography only to patients for whom carotid endarterectomy is likely to be a therapeutic choice. PURPOSE. Testing the efficacy of sequential use of color coded echo flow imaging (echo color Doppler: ECD) and arterial digital angiography (ADA) respectively in the second and third phases of a screening program for detection and treatment of carotid occlusive disease in a resident population (OPI program). METHODS. From January 29th 1990 through March 31st 1992, 1,587 subjects underwent ECD out of 16,379 subjects that participated in the first level investigations. 404 of these (25.5%) were affected with carotid occlusive disease, 271 (17%) had inframural non stenosing carotid lesions and 228 (14.3%) carotid kinkings. At ECD, 71 showed lesions as severe as to be susceptible of surgical operation and underwent ADA. The percentage of carotid stenosis was calculated on the ADA imagins, applying the method suggested by the North American Symptomatic Carotid Endarterectomy Trial. RESULTS. Overall sensitivity and specificity of ECD versus ADA were 94% and 95.2% respectively. Cases in which ECD overestimated the lesion as compared to ADA results were recorded as false positive, while cases in which ECD underestimated the lesion were recorded as false negative. CONCLUSIONS. Both ultrasound imaging and ADA are useful in screening programs for carotid occlusive disease: informations different and complementary to the definition of the lesions can be obtained from each procedures in subsequent phases. Morphologic findings of carotid ECD are essentially consistent with ADA, thus allowing to carry on safely non invasive long-term follow-up programs for operated subjects as well as for people bearing carotid lesions originally not susceptible of surgical treatment.

Aged↗
PubMedDate not supplied

[Surgery of the kinking carotid artery].

Forty-three kinkings of the epiarotic vessels were observed at the Istituto di Chirurgia Generale e Cardiovascolare dell'Università di Milano from January 1st 1971 through July 31st 1992. Six subjects were admitted for a history of one or more transient ischemic attacks. In four cases surgical resection of the kinked tract of the internal carotid and end-to-end direct reconstruction was carried out, completed by carotid bifurcation endarterectomy in three, where atherosclerotic carotid disease was severe. All the reconstructions are currently patent and no neurological symptoms were recorded at follow-up; 39 cases were treated conservatively by antiplatelet therapy and controlled each six months: to date no worsening of the echocolordoppler imaging of the lesion was noted, and all these subjects remained completely asymptomatic. The authors point out that correct clinical approach to carotid kinking is a conservative one: surgical operation must be performed only in those subjects affected with cerebral ischemic attacks not justified by other diseases.

Aged↗
PubMedDate not supplied

[Carotid kinking and arterial hypertension. Preliminary results of the OPI program].

The relationship between carotid kinking and arterial hypertension is stressed, based on the results of the first two years of an epidemiological research on prevalence of carotid lesions capable of producing cerebral ischemia in a population, aged 45 to 75, resident within the district USSL no. 69 (Parabiago), Lombardia. Reported data are referred to 13,936 subjects that underwent the first level of screening between January 29th 1990 and December 31st 1991. 1,386 subjects underwent further examination by color coded echo flow (second level of screening) due to suspected carotid lesion; they were divided into two groups according to the presence or absence of arterial hypertension. The distribution of these groups does not repeat that of the general population (p < 1 x 10(-6)). 158 subjects were affected with carotid kinking. Within the normotension group (439; 31.67%), 39 (8.88%) were demonstrated to harbor kinkings, while in the hypertension group (947; 68.33%) 141 (14.88%). Thus, the difference between the two groups remains largely below the limits of statistical significance (p > 1). The association between kinking and hypertension is not affected by sex (p > 1 x 10(-1)), regardless of a significant difference of distribution between the sexes (145 women and 40 men: p < 1 x 10(-6)). The conclusions point out that the evidence of this study strongly stresses that the association between carotid kinking and arterial hypertension is incidental.

Aged↗
PubMedDate not supplied

[Risk factors for arteriosclerosis and diet of surgical patients. 10 years of outpatient activity].

The follow-up of arteriopathic subjects who have already been hospitalized (abdominal-peripheral vascular district 79% of patient and supra-aortic branch district 21%) has been carried out for around 10 years using an out-patient regime at the Institute of General and Cardiovascular Surgery of Milan. During outpatient visit the main risk factors for arteriosclerosis are routinely checked and treated if required; among the various therapies for metabolic control particular emphasis is placed on diet since its influence on the metabolism is well known, above all in the long term. The efficacy of this treatment has been evaluated by evaluating blood chemical changes (total cholesterol, LDL cholesterol, HDL cholesterol, triglycerides, VLDL and glycemia) in a group of patients who followed the diet in comparison to a group which did not. The results obtained show that in dieting patients there was a statistically significant decrease in blood values for total cholesterol, LDL cholesterol, triglycerides and VLDL, together with a decrement, which failed to reach statistical significance, in glycemia and HDL cholesterol. In non-dieting patients it was found that all parameters increased but that this was only statistically significant for total cholesterol and HDL cholesterol. The control of risk factors for arteriosclerosis through diet therapy therefore appears to be satisfactory even for secondary prevention in surgical arteriopathic subjects. It is important to underline that these results were not obtained under conditions of clinical research but in the reality of day-to-day clinical and therapeutic activity whose efficacy is vitally important for scientific health.

Ambulatory Care↗