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Biomedical subjects

L Selvetella

Publications and source records attributed to L Selvetella.

At least 19 recordsLinked to original sources
PubMed1997

Late arteriovenous fistulas and pseudoaneurysms of the extremity secondary to civilian firearms.

To evaluate the treatment of late sequelae of penetrating arterial injuries associated with civilian firearms, such as false aneurysms and arteriovenous fistulas (AV-Fs) of the extremities, a retrospective clinical study was carried out. Whenever diagnosis or operative management is delayed because of local fibrosis or morphological and structural vessel changes, primary repair is not feasible and segmental resection is required. Twenty-four patients presenting late false aneurysms (14) and AV-Fs (11) of the extremities, caused by firearms (6 rifle wounds, and 18 pistol wounds), were identified between 1983 and 1995. Twenty-three patients were submitted to resection of pseudoaneurysms (13) or AV-Fs (8), while arterial patch angioplasty was applied in two patients. The venous lesions were repaired by an interposition graft (7) or lateral venorraphy (3). Saphenous vein (15) or PTFE (6) grafts were placed in injured arteries. Percutaneous embolization by coils was performed in two patients. Twenty-three out of 24 patients (95.8%) recovered; one patient (4.1%), affected by aneurysmal AV-Fs of a lower limb dating from 12 years, with enlarged and weakened artery, bled to death. No limb loss occurred. A better evaluation of minimal vascular injuries is required to avoid late sequelae of civilian firearms lesions, with significant blood loss, which need segmental excision of the injured vessels.

Adolescent↗
PubMed1997

Popliteal artery entrapment syndrome: diagnosis and management.

A variety of anatomical abnormalities may product an external compression of the popliteal artery, resulting in a thrombotic occlusion. Between 1983 and 1995, 9 patients presented a popliteal artery entrapment syndrome, bilateral in two cases. Ultrasonography, Angio-CT scan and MRI showed the abnormal structures and position of the popliteal artery on popliteal fossa. Arteriography detected an arterial compression in 6 limbs and occlusion in 4 limbs as well as an associated popliteal aneurysm in one patient and distal embolism in four. The abnormal medial head of the gastrocnemius muscle was resected in 8 limbs, while fibrous membranes were resected in 3 limbs. Autogenous vein replacement was performed in 4 cases of popliteal artery occlusion and following resection of a popliteal artery aneurysm in one case. All patients recovered. In the followup period, the occlusion of the arterial reconstruction occurred after 28 months in one patient, with a mild claudication. Noninvasive vascular imaging techniques may allow early diagnosis and management of PAES, avoiding popliteal arterial wall lesions and its occlusion, with a better outcome.

Adolescent↗
PubMed1996

Popliteal-to-tibial bypass for acute leg ischemia complicating aortic reconstruction.

Between 1983 and 1995, elective aortic surgery was performed on 1018 patients for aneurysmal (417 cases) or occlusive disease (489 cases), or both (112 cases). Intraoperative acute popliteal occlusion, despite of aortic graft patency, developed in 2 patients due to distal embolization (0.19%) and in 5 patients secondary to acute popliteal trifurcation thrombosis (0.49%). Preoperative ankle index was 0.46 +/- 0.12, but intraoperatively it went down to zero; distal popliteal occlusion was confirmed by intraoperative arteriography. A balloon catheter embolectomy was performed in two patients. Distal bypass from popliteal artery above knee (1) and below knee (3) to the posterior tibial artery was implanted in four patients using reversed autogenous saphenous vein. In one patient, revascularization was not feasible because of diffuse calcified obstructive disease of leg arteries. Reoperations resulted in a satisfactory outcome in 6 out of 7 patients (85.7%). The patient, in which revascularization was not possible, was submitted to major amputation. In the four popliteal-to-tibial bypasses evaluated through a follow up period of 43 months, graft patency was 75% and limb salvage rate was 100%. Instead of amputation, popliteal-to-tibial bypass is a useful treatment for acute in situ thrombosis of popliteal trifurcation following aorto-iliac reconstruction.

Acute Disease↗
PubMed1996

[Aneurysms of the external jugular vein].

External jugular vein aneurysms are rare and appear as a soft, compressible mass in the neck. Three cases are herein reported. Ultrasonography is the investigation of choice. Surgical excision is indicated, specially in case of giant and thrombosed venous aneurysm.

Adult↗
PubMed1996

[Arteriosclerotic aneurysms of the subclavian artery].

OBJECTIVE: To evaluate diagnostic investigations, operative management and long-term outcome of atherosclerotic aneurysms of the subclavian artery. DESIGN: A retrospective clinical study through a follow-up period of 68 months (8 months to 11 years). SETTING: Department of Vascular Surgery, University Hospital. PATIENTS: Between 1983 and 1995, 5 patients with atherosclerotic aneurysms of the extrathoracic subclavian artery were reviewed. All patients presented a pulsatile supraclavicular mass. Ultrasonography and angiography confirmed the diagnosis and were useful in planning the operation. INTERVENTIONS: Four patients were submitted, through a supraclavicular incision, to resection of the aneurysm and replacement of a prosthetic graft (dacron in 2 cases, PTFE in the remaining 2 cases). In one patient, with a small saccular aneurysm, a tangential aneurysmectomy with a patch angioplasty (PTFE) was performed. RESULTS: All patients recovered after a mean hospital-stay of 9 days and had a valid radial pulsation. During the follow-up period, a dacron graft failure occurred 38 months later in one patient: she remains today asymptomatic. CONCLUSIONS: Resection is today recommended for all patients with diagnosed subclavian artery aneurysms. Because of unknown natural history of asymptomatic aneurysms, with an unpredictable risk of complications, more accurate evaluations are required for optimal clinical decision making (early surgery vs watchful waiting?).

Adult↗
PubMed1996

[Clinical study of the efficacy of and tolerance to seaprose S in inflammatory venous disease. Controlled study versus serratio-peptidase].

This study was designed to compare the efficacy and safety of seaprose S and serratio-peptidase in the treatment of venous inflammatory disease. Forty patients entered the study (11 males, 29 females), mean age 54.3 years (range 30-77), mean weight 74.8 kg (range 51-96), with superficial thrombophlebitis. The trial was conducted following a controlled, between patients, randomized experimental design. Seaprose S was administered as 30 mg tablets at a daily dosage of 90 mg (one tab t.i.d.), and serratio-peptidase as 5 mg tablets, at a dose of 30 mg per day (two tabs t.i.d.), both orally, for 14 days. Twenty patients received seaprose S and 20 serratio-peptidase. The findings indicate that seaprose S was more effective and better tolerated than serratio-peptidase. Although the group of patients assigned to seaprose S had considerably more severe initial symptoms, by the end of treatment spontaneous pain was reduced 68.7% from the baseline mean score (from 3.2 to 1.0), as compared with a 63.3% reduction in the serratio-peptidase group (from 3.0 to 1.1). Pain on pressure was reduced 61.1% with seaprose S (from 3.6 to 1.4), compared to 57.6% with the reference treatment (from 3.3 to 1.4). Edema was reduced respectively 75% (from 1.6 to 0.4) and 56.2% (from 1.6 to 0.7); erythema diminished 72.4% (from 2.9 to 0.8) and 58.3% (from 2.4 to 1.0); nighttime cramps were 61.1% less (from 1.8 to 0.7) compared with 52.9% (from 1.7 to 0.8); hemorrhagic suffusion was 53.3% less (from 1.5 to 0.7) compared with 41.7% (from 1.2 to 0.7); cutaneous dystrophy was reduced by 11.1% (from 1.8 to 1.6) and 7.7% (from 1.3 to 1.2). At the end of the treatment with seaprose S efficacy was assessed as good or excellent in 85% of the cases, compared with 65% for serratio-peptidase. Seaprose S caused no adverse reactions. During serratio-peptidase treatment one patient reported diarrhea, requiring temporary dosage reduction and specific treatment. It can thus be confirmed that seaprose S was effective and well tolerated in patients with inflammatory venous diseases.

Adult↗
PubMed1991

Pseudo velocity profiles in carotid artery through Doppler US signal processing.

In this paper a new method of obtaining hemodynamic information from spectral analysis of continuous wave Doppler ultrasound signals is presented. Some considerations of the evaluation of maximum and mean frequencies of the signal arising from scattering in the insonated volume are proposed. A new algorithm to compute the maximum frequency has been applied. Maximum and mean frequency are, respectively, proportional to the maximum and mean velocity in the insonated volume. Their application to mathematical models enables an estimate of velocity profiles into the vessels. The proposed method offers the possibility of matching an accurate evaluation of spectral broadening. In vitro tests and some clinical results involving healthy young people, arteriopathic and stenotic patients show the potential of the method in evaluating different hemodynamic conditions.

Blood Flow Velocity↗
PubMed1989

Our experience with spinal cord stimulation (SCS) in peripheral vascular disease.

Spinal cord stimulation (SCS) by epidural electrodes is being used more often in the treatment of patients with severe intractable ischemic pain. The promising clinical results and the objective increase in lower extremity blood flow (plethysmography, thelethermography, etc.), suggests that spinal cord stimulation may have an important role in the management of advanced arterial disease when other forms of treatment have failed. The selection criteria for implantation of SCS are very important. Our indications in patients with peripheral vascular disease are: 1. Peripheral vascular disease with severe, intractable symptoms that are untreatable by medical or surgical therapy. 2. Inflammatory or diabetic arterial disease resistant to medical treatment and/or sympathectomy. 3. Persistent and severe ischemic pain and/or ulcers in patients with patent grafts. 4. Patients for lumbar sympathectomy who have a high myocardial risk. Contraindications to implantation of SCS are claudication intermittent, large necrotic lesions (gangrene) and patients who have undergone prolonged narcotic therapy.

Adult↗
PubMed1985

[Hemorheologic and blood coagulation studies in 94 patients with chronic obstructive peripheral arterial disease].

During the last three years we have analyzed, in 94 patients with chronic arterial occlusive disease, in order to assess the hemorheological and hemocoagulative balance, the following parameters: prothrombin time, partial thromboplastin time, antithrombin III, antiplasmin, fibrinogen, factor VIII, erythrocyte sedimentation rate, platelet aggregation, erythrocyte filterability and hematocrit values. The main findings were: in 56 patients the hematocrit value was higher than 44%; Katz index was above normal values in 61.7% of the cases; ATIII showed a trend to lower values; platelet aggregation was increased; no significant variations in comparison to normal values were found in FVIII, antiplasmin levels, prothrombin time and partial thromboplastin time. Erythrocyte filterability values were decreased at a level as lower as more advanced was the clinical stage of the disease. These findings show, in agreement with those of other authors, the presence of hyperviscosity and hypercoagulative state in patients with chronic arterial occlusive disease.

Aged↗
PubMedDate not supplied

Intestinal ischemia after aortic surgery.

Intestinal ischemia after abdominal aortic surgery is a highly lethal complication. In order to evaluate the pathogenesis, the diagnostic modalities and the best management, in a retrospective review, 12 patients undergoing postoperative small bowel or colonic ischemic lesions were identified between 1983 and 1995. Preoperative occlusion of IMA was present in nine patients, while a selective angiography of SMA demonstrated occlusive disease of peripheral branches in two asymptomatic diabetic patients. No patent IMA was ligated. When possible, hypogastric circulation was preserved by distal anastomosis into iliac bifurcation (4 cases). Postoperative leukocytosis or elevated LDH values were present. Colonscopy showed a suspected ischemic colitis in two patients and necrotic lesions in three cases. One patient died and diagnosis was made at autopsy. Nine patients were submitted to reoperation and a bowel resection with a proximal stoma was performed in seven of them. In two patients, the aorta or iliac artery below the proximal anastomosis and hypogastric artery suffered acute thrombosis, while prosthetic grafts were patent. A coagulation disorder caused thrombosis of intramural arterioles of the small bowel while peripheral branches of SMA were pulsatile. Eight of the patients submitted to relaparotomy died; non-operative management resulted in a left colon late stricture, while the remaining patient survived without sequelae. Overall mortality rate was 66.6%. Symptoms of this complication are not specific and diagnosis is delayed; consequently surgical repair is often unsuccessful. One patient with small bowel necrosis after elective AAA resection survived, which is extremely rare.

Adult↗
PubMedDate not supplied

[Carotid endarterectomy: what postoperative care is needed?].

With the introduction of the diagnosis-related groups system (DRGs), hospital cost containment without compromising quality of care is recommended. Carotid endarterectomy is an effective stroke prevention treatment; the need for routine postoperative intensive care unit (ICU) admission is questionable and is herein evaluated. Between January 1994 and November 1995, 68 patients underwent 79 carotid endarterectomies (CEAs), under general anesthesia, and were postoperatively monitored in a post-anesthesia care unit. 13 patients presented postoperative hypertension and 3 arrhythmia, while 5 patients (7.3%) experienced postoperative complications. Only 8 patients (11.7%) were admitted in ICU for treatment of persistent hypertension (3 cases) with continuous vasoactive drug infusion or because of postoperative complications. One patient (1.4%) died of post-CEA hyperperfusion syndrome. The use of a step down unit for monitoring patients undergoing CEAs is safe and cost-effective and also may identify patients requiring ICU admission.

Aged↗