Biomedical subjects

G F Giuffrida

Publications and source records attributed to G F Giuffrida.

At least 19 recordsLinked to original sources

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↗

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

[Surgery of abdominal aortic aneurysm and concomitant disease of the digestive tract].

The incidence of intra-abdominal diseases associated with abdominal aortic aneurysm is increasing, and it is difficult to decide whether to operate the abdominal disease first, the aneurysm first or both simultaneously. Variables used in decision analysis include type, stage and life expectancy of the cancer, rupture rate of abdominal aortic aneurysm. Symptomatic lesion should be treated first. Absolute indication for operation initially on the aneurysm is the presence of symptoms of rupture. Aortic abdominal aneurysmectomy combined with surgical removal of an intestinal disease may present severe risks as infection of the graft and anastomotic leakage, especially during lower abdominal surgery. In this paper authors present four cases of AAA which had intra-abdominal surgical disease. They were treated by one-stage operation with no complications. Criteria to assess timing of surgical treatment of abdominal surgical diseases concomitant to AAA are discussed.

Aged↗

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↗

PubMed1994

Spontaneous aorto-caval fistulas from ruptured abdominal aortic aneurysms.

Thirty-six cases of abdominal aortic aneurysms rupturing into the vena cava and two iliac aneurysms rupturing into iliac veins are reported. This group represents 10% of the total number of observed ruptured abdominal aortic aneurysms (388). Such a condition is therefore quite rare but should be considered positively because the reported mortality rate is less than with ruptured aneurysms in general. Nevertheless, a spontaneous aorto-caval fistula is responsible for a critical haemodynamic deterioration and sudden worsening of the general condition of the patient and therefore prompt surgical repair is mandatory. The overall mortality rate in our series was 21% (8 cases).

Aged↗

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 surgical treatment of renovascular hypertension in subjects with a single kidney].

Renovascular hypertension in subjects with a solitary kidney, though an infrequent condition, requires surgical direct revascularization procedures either to reduce the hypertensive state and, more important, to preserve renal function. This paper reports a series of six surgically treated cases between 1982 and 1990, with at least two years follow-up. Preoperative renal function, as evaluated by BUN and blood creatinine, was reduced in 5 cases, the remaining one being normal. All subjects were hypertensive at admission: in four cases drug therapy was ineffective for restoring normal pressure values. All subjects had previously undergone surgical nephrectomy: in 3 cases for shrunk kidney, in 2 for failure of a previous attempt of renal revascularization, and one for renal tuberculosis. 3 subjects were concomitantly affected with abdominal aortic aneurysm, and one had previously undergone aortobifemoral bypass. Treatment of the concomitant aortic lesion and renal artery revascularization were carried out at the same operation. Operations performed were TEA of residual renal artery in 3 cases, prosthetic reconstruction in 2 and intraoperative transluminal angioplasty by Gruentzig balloon catheter in one. Over a two-year follow-up renal function remained good in 4 cases, while one subject required a second surgical revascularization due to late acute thrombosis of a previous aortorenal saphenous vein graft. Acute early postoperative renal failure occurred in one case and permanent haemodialysis was instituted. No deaths were recorded in this series.

Adult↗

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

[Primary lymphoma of the gastrointestinal tract].

Lymphomas of the gastrointestinal tract are rare tumors with unusual features and few characteristics. Clinical, radiological and endoscopic diagnosis is difficult, because they may be confused with inflammatory or neoplastic forms, especially in primary involvement of the gastrointestinal tract. From 1965 we observed 4 patients with primitive gastrointestinal tract lymphomas. Prognostically important features for GI lymphomas were: stage, site of the primary disease, histological type. Authors report on the clinical findings, diagnostic procedures, surgical treatment and results.

Adolescent↗

PubMed1993

[Functioning paraganglioma].

Pheochromocytomas and functioning paragangliomas are rare tumors arising from indifferent cells of the primitive neural crest. These tumors produce clinical symptoms (pheochromocytoma syndrome) related to catecholamine production. The pheochromocytoma syndrome, constituted by arterial hypertension, headache and sweating, is due in 80% of cases to adrenal pheochromocytomas and only in 20% of cases is due to extra-adrenal secreting paragangliomas. The diffused localization of the Paraganglion System and the common embryologic origin, can explain the occasional identification of multicentric tumors (10%), and the association with multiple endocrine neoplasms (MEN), especially in familial occurrence. Careful follow-up of patients, in order to detect the later development of multicentric or metachronous neoplasms is necessary. The Authors present their experience with 80 patients affected by neoplasms involving the adrenal medulla and the multicentric paraganglion system, surgically treated during the last 25 years. Eight patients (10%) were affected by functioning extra-adrenal paragangliomas: 7 patients (87.5%) had solitary extra-adrenal tumors (6 abdominal and 1 thoracic) with a classic pheochromocytoma syndrome, and 1 patient (12.5%) had a double asymptomatic abdominal paraganglioma.

Adult↗

PubMed1993

[Mediastinal functioning paraganglioma. A case report].

Functioning paraganglioma of the mediastinum is an uncommon tumor of the paraganglion system. We report a case of a 26 year-old woman with a 6 month history of hypertension refractory to therapy. Urinary catecholamine excretion and plasma noradrenaline concentration were elevated. Chest radiograph and computed tomography (CT) scan revealed high-density mass located on the posterior mediastinum. An mIBG scan showed uptake by the mediastinal tumor. At thoracotomy a 5 cm lesion was resected. Histological examination confirmed that it was a paraganglioma. Authors refer on the clinical finding and diagnostic procedures of this rare disease.

Adult↗

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↗

PubMed1993

Idiopathic varicocele: a comparison between types of surgery based on the results of spermiogenesis.

Varicocele must be regarded of the utmost importance in determinating male infertility. Surgical indications should be considered of primary interest in order to achieve a qualitative and quantitative improvement in spermiogram parameters in the majority of the cases. Recent reports showed that it is not the severity of the lesions to determine the alterations in seminal parameters but the length of time of the varicocele. In our report we consider the results achieved on the spermiogram parameters in two groups of 25 patients surgical treated with different techniques. The first group was treated, in others Centers, by means of the traditional technique of ligature of the spermatic vein (Ivanissevich, Palomo). We treated all the patients of the second group (53 patients) with microsurgical technique of anastomosis pampiniform plexus-saphenous vein, and we control the sepermiogram parameters in 25 patients. The first group showed an improvement of the spermiogram parameters after 6 months from the surgical treatment in the 64% of the cases, while in the second group the improvement was of the 92%. Moreover we registered the persistence of this improvement after 12/36 months from the operation time. On the basis of these observations we think that the microsurgical technique leads to the best and longest results on the most invalidating cause of this pathology.

Adolescent↗

PubMed1993

[Critical ischemia of the lower limbs: pathogenesis, clinical course and therapy. Results of authors' experience in 337 cases].

The definition of an ischaemic condition at lower limb level, may imply any different degree of the pathology, starting from a simple chronic slight claudication up to a severe ischaemia. Critical Limb Ischaemia is the term defined to identify an ischaemic condition, which endangers the limb or part of a limb and requires a prompt and appropriate treatment. However the pathophysiology of this condition remains to be well established and depends on various vascular factors. For the European Working Group on Critical Limb Ischaemia (Berlin 1989, Rudesheim 1991) the definition is strictly restricted to Fontaine's stage III B and IV, while in our opinion the definition could be very simple in all the patients with a prognostic limb-threatening condition (for localization and wide extension of the lesions) independent of the Fontaine's stage, which are going towards a future amputation if radical improvement of blood flow cannot be achieved with an adequate revascularization. In our five year late experience, we observed and surgically treated 337 patients with CLI (74% males and 80% atherosclerotic lesions). We discuss the preoperative findings, diagnostic procedures, surgical techniques and relate results.

Aged↗

PubMed1993

[Current role of extra-anatomical revascularization of the lower limbs].

In vascular reconstructive surgery of the lower limbs for aorto-iliac disease the first choice procedure is TEA or aorto-femoral bypass. In "high risk patients" alternative procedures like extra-anatomical bypass (axillo-femoral or femoro-femoral bypass grafts) are available. In some cases, such us infection of a retroperitoneal prosthesis, an axillo-femoral bypass is mandatory in order to obtain revascularization of the lower limbs. In this article we report our late experience in this surgery and our opinion on the correct indication for the use of these procedures.

Aged↗

PubMed1993

[Vascular complications in drug addicts. Intermittent claudication in a HIV seropositive heroin addict].

The widespread use of heroin has revealed the growing life-threatening complications consequent on drug practice. The effects of heroin on the cardiovascular, pulmonary, renal and central nervous system have been well described in medical literature, but the vascular complication of chronic occlusive arterial disease of the lower limbs is rare. We report a case of a young female patient who was a chronic drug addict for over five years, with concomitant serum positiveness for HIV infection. The etiologic and pathogenetic mechanisms of such an uncommon vascular complication are discussed on the basis of the existing literature.

Adult↗

PubMed1992

[Femoral non-infected anastomotic pseudoaneurysm. Clinical contribution].

The femoral region is the most common site of development of anastomotic pseudoaneurysms that represent a relatively frequent complication of reconstructive vascular surgery. Clinical examination alone generally is sufficient to diagnose these lesions because they usually appear as a pulsatile inguinal mass not accompanied by pain. Echography and angiodynography permit a better evaluation of size and blood flow. CT is useful to evaluate proximal aortic anastomosis specially in pseudoaneurysms with septic pathogenesis. Rupture or thrombosis are rare clinical presentations. Vascular reconstructive surgery is always suggested in this sort of pathology. In this paper the Authors report the clinical experience acquired from 1980 to 1990 in the General and Cardiovascular Surgery Department of the University of Milan (Head: Prof. Ugo Ruberti) is 34 cases of femoral anastomotic aseptic pseudoaneurysms, analyzing the pathogenesis of this sort of lesion, describing the surgical solutions adopted and reporting the immediate and late results.

Aged↗

PubMed1992

[Profundaplasty as the only revascularization procedure in ischemia of the leg. Clinical contribution].

The profunda femoris artery is the primary source of collateral flow to the lower extremity in the presence of superficial femoral and/or popliteal occlusion. The arteriosclerotic disease involvement of this segment is relatively less frequent and in the majority of the cases localized on the ostium and reaches to the first branch. Profundaplasty to relieve limb-threatening ischemia is infrequently employed as an isolated procedure. However many Authors reported their experience on this treatment, in case of critical limb ischemia in patients without significative lesions of the aortofemoral district. Our late four year experience concerns of 22 patients (18 male, 3 female). All the patients had severe ischemia of the lower limbs, with serious symptoms, such as invalidating claudicatio (13), rest pain (7) and gangrene (2). Twenty-two profundaplasty were performed as the only reconstructive procedure. There was no postoperative mortality. Two patients had above knee amputations (15 days and 14 months after the revascularization). All of the other patients improved and follow-up extended to 48 months shows a limb salvage rate of 90%. In conclusion, on the basis of our experience, we think that the operation is recommended, whenever possible, in patients with critical ischemia when the possibilities of more extensive revascularization procedures are considered to be poor.

Aged↗