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L Tromba

Publications and source records attributed to L Tromba.

15 recordsLinked to original sources
PubMed2003

[Postural vertigo and basilar artery flow increment].

PURPOSE: Research was focused on cerebral arterial flow in normal individuals and in patients suffering from short-term vertigo when sitting up rapidly from a lying position. PATIENTS AND METHODS: The research was performed in normal subjects and 46 patients affected by short term vertigo who underwent transcranial Doppler 32. In normal subjects (16 with an average age of 25 and 16 with an average age of 61) cerebral artery flow was recorded in a sitting and lying position, in Trendelenburg position and during transition from one position to another. In subjects suffering from short-term vertigo, arterial flow was recorded at baseline and during short-term vertigo. RESULTS: In normal subjects the flow remained unchanged in all body positions as well as during transition from one position to another. In subjects with short-term vertigo basilar artery flow increased with the onset of dizziness and returned to normal when dizziness ceased. CONCLUSIONS: In normal subjects cerebral self-regulation maintains constant flow in any body position. Increased basilar artery flow during short term vertigo is probably either due to altered self-regulation or its reduction in the carotid area with compensatory basilar artery hyperflow, or else to over-response in vertebro-basilar territory.

Adult↗
PubMed1999

Control of the operated carotid with ultrasound. Anatomical and hemodynamical modifications, both local and intracranial.

BACKGROUND: A study has been done on the operated carotid monitoring the modifications of the wall and of the flow in the site of the operation and at the intracranial level. METHODS: 146 operated carotids were studied using transcranial Doppler, duplex and color. The pre-surgical data were confronted with the postsurgical ones on the 4th day, one month later, 3 months later and every 6 months. RESULTS: The cerebrovascular reactivity (CR) and the cerebral hemodynamic latency time (CHLT), improved in more than half of the patients with stenosis >80%. When the stenosis is of minor entity, the improvement appears in 10% of the cases. The VCR and CHLT modifications appear within 1 month following the operation. Kinkings are more frequent with the patch (6%) than with the direct suture (3%). The symptomatic restenosis is 2%, while the asymptomatic one is 11%. The restenosis is present in 8% of the cases with direct suture and in 3% of those with suture with patch. CONCLUSIONS: The local and intracranial modifications after carotid revascularization depend on new anatomical and hemodynamical situation due to surgery. The response of the wall which can be of four types: myointimal reaction, is a "physiological" response to the trauma and its thickness does not exceed 3 mm; myointimal hyperplasia, with thickness exceeding 3 mm; early restenosis (12 to 18 months); late restenosis (after 2 years). Substantial differences in velocity between systole and diastole and the systolic stress favor hyperplasia more than low velocities with smaller differences.

Carotid Arteries↗
PubMed1999

Surgical treatment of paragangliomas of the carotid body and other rare localisations.

BACKGROUND: Cervical paragangliomas are uncommon benign or malignant neoplasms, deriving from stem cells of the neural crest. Compared to all the tumors of the head and neck, they occur less frequently. They can be found in any part of the body where there are sympathetic ganglia including chemoreceptors, suprarenal medulla, retroperitoneal ganglia and the extreme branches of the vagus nerves. It is not easy nowadays to define properly their biological behaviour, the possible multicentric location and the association with Multiple Endocrine Neoplasms; this is considered particularly important and occurs in 42 per cent of the cases of familial neoplasms of the paraganglion system. METHODS: After a review of recent diagnostic, pathological and clinical findings, the authors report their experience, between 1970-1995, of 10 patients affected by sporadic paraganglioma and 1 by familial multicentric neoplasm localised in the carotid bodies of both sides, left vagus nerve and left hypoglossus nerve. All patients but one were treated by a curative resection of the neoplasm. In one case only an explorative laparatomy was possible because of visceral and vascular involvement. RESULTS: There is no mortality. There are no modifications in arterial blood pressure and catecholamine values in all patients. The complications were a recurrential palsy in a patient operated on for vagal paraganglioma; a recurrential palsy and temporary dysarthria in the patient affected by multiple familial paraganglioma; another patient operated on for carotid body paraganglioma showed a cerebral ischemic lesion which caused a slightly transitory facial-brachial motor deficit on the right side and speech impairment. CONCLUSIONS: We can venture to say that any type of cervical, mediastinal or retroperitoneal swelling in persons belonging to a genetically prone family must be first of all considered a possible paraganglioma. For this reason the patient with more than one growth of this type, whether synchronous or not, must undergo genetic investigation, along with the rest of his family.

Adult↗
PubMed1998

[Recurrence of varicose veins after treatment. Multicenter study by the Italian Doppler Club, Clinical and Technological Society].

BACKGROUND: The first results of a multicentric study dealing with recurrent varicose veins after surgery are presented. The aims of the study are: identifying the type of varicose vein, specifying the most frequent complaints (esthetical or functional), locating the causes of recurrence, establishing the causes and the most frequent seat of recurrence, clarifying whether it is enough to call recurrent all the varicose veins which appear after surgery or whether it is necessary to distinguish various typologies. METHODS: 194 patients (139 women and 55 men) aged 51.6 average (range 28-87), have been studied up to now with duplex and color scanner following a precise protocol which consisted of three stages: before treatment, within 2 months from treatment and after recurrence of varicose veins or venous insufficiency symptoms. RESULTS: Recurrent varicose veins represented 65.7%, residual ones 14.3%, new ones 2.5%. It has not been possible to identify the type of varicose vein in 8.3% of cases. Stripping of the great saphenous veins was carried out in 88% of cases, short stripping in 4.1%, stripping of the short saphenous veins in 6.9%. Recurrent varicose veins were due to technical error in 78.7% of cases, to diagnostic error in 9.2%, to unidentifiable causes in 12% of cases. CONCLUSIONS: Data relating to the prospective study of the research will be published in subsequent papers.

Adult↗
PubMed1998

[Observations on the vertebro-basilar system studied by ultrasound].

Vertebro-basilar circulation is complex because conditioned by several factors. Ultrasounds allow the study of many of its aspect, both hemodynamic and anatomical. Data were obtained from the examination of 50,000 patients over 25 years, of which the last 1,000 patients were examined by means of transcranial Doppler, duplex scanner color and power. 40% of these patients were found normal, 20% only had arterial thickening, 26% various types of stenosis, 10.6% subclavian steal, 14% short vertigo. The basilar artery (BA) flow (230 ml/min +/- 40) is similar to that of the internal carotid (245 ml/min +/- 50). In elderly patients, the absence of a posterior communicating artery (28%) or of both arteries (13%) is more frequent than the absence of the anterior communicating artery (7%). In normal patients decubitus variations do not modify the BA flow. In patients with vertigo due to decubitus variations, BA flow velocity increases from 20% to 40% during vertigo. Subclavian steal completely modifies the hemodynamics of vertebral arteries, while in the BA it can vary in part or completely. In conclusion, vertebral hemodynamics is different from BA hemodynamics. BA must be considered as one side of the Willis' polygon because it is an anastomosis between the vertebral arteries and is a "hemodynamic damper" between intracranial and extracranial circulation.

Adolescent↗
PubMed1997

Classification of the subclavian steal syndrome with transcranial Doppler.

Ultrasound has provided a highlight of the different types of subclavian steal. The authors report epidemiological and clinical data concerning 40,000 ultrasound examinations performed on epiaortic arteries and particularly the last 12,000 in which Doppler c.w., duplex scanner and transcranial Doppler were used. Various types of steal are described; five types of subclavian steal have been classified and patients stratified as being symptomatic and asymptomatic. The neurological symptoms are divided as follows: generalized cerebral ischemia, vertebro-basilar ischemia and hemispheric ischemia. Based on this clinical and haemodynamic outline, surgical therapy is indicated and type of surgery suggested.

Carotid Arteries↗
PubMed1996

[Ultrasonic quantification, value of color and contribution of transcranial Doppler sonography in carotid artery surgery].

The authors briefly report their experience regarding the opportunities offered by the use of current ultrasound methods in carotid surgery. They describe: a system for the quantification of athcromasic plaque used to monitor non-operated patients over time; ultrasound methods used to analyse the carotid wall to establish whether it can be utilised as an index of vascular aggression in hypertension, diabetes and atherosclerosis; the use of transcranial Doppler; criteria for the definition of high risk plaque; the applications of eco-color Doppler. The paper also illustrates a new pathology identified by the authors, defined as primary intimal fibrous hyperplasia, and the evolution of the carotid wall after endarterectomy. The structural characteristics of primary hyperplasia can only be shown using ultrasound given that arteriography cannot distinguish it from atheromatic stenosis. After endarterectomy the carotid wall is subject to hematic and hemodynamic stimuli which determine the type of evolution of the wall itself. The authors therefore examine the myointimal reaction, myointimal hyperplasia, early restenosis and late restenosis as different facets of the same phenomenon.

Carotid Artery Thrombosis↗
PubMedDate not supplied

Paragangliomas of the carotid body and other rare localisation.

Cervical paragangliomas are uncommon benign or malignant neoplasms, originated by stem cells of neural crest. It is not easy nowadays to define properly their biological behaviour, the possible multiple location and the association with Multiple Endocrine Neoplasms. After a wide review about recent diagnostic, pathological and clinical acquisition, authors report their caseload of 10 patients affected by sporadic paragangliomas and 1 by familial multiple neoplasm localised in carotid bodies of both sides, left vagus nerve and left hypoglossus nerve. All patients but one were treated by a curative resection of the neoplasm. In one case only an explorative laparatomy was possible because of the visceral and vascular involvement.

Adult↗
PubMedDate not supplied

[Surgical treatment of differentiated thyroid carcinomas: results in 440 cases operated between 1970 and 1994].

The authors report their experience and surgical treatment of 440 patients with differentiated carcinoma of the thyroid (DCT) from 1970 to 1990 in the III Surgical Dept. at the University of Rome "La Sapienza". Considering 305 cases of papillary carcinoma, 103 Total Thyroidectomy (TT), 118 TT with Functional Regional Lymphadenectomy (FRL), 32 TT with Node-Picking, 51 TT with curative FRL and one TT with Radical Neck dissection were performed. In 135 cases of follicular carcinoma TT associated with Node-picking were performed on two patients, TT associated with FRL on 8 patients and TT associated with RND on 2 patients. Overall survival to 10 years was 90%; 98% for N- papillary carcinoma and 66% for N+ follicular carcinoma. There were no permanent recurrence of disease. Out of the patients who did not undergo cervical lymphadenectomy 30% developed temporary hypocalcemia; 53% (mediastinal lymphadenectomy) to 87% (FRL) of the patients submitted to lymphadenectomy developed temporary hypocalcemia with permanent hypoparathyroidism in 0.9%-23% of the cases. On the base of what has been observed by Pasieka and Grant, the Authors believe TT as the absolute solution for patients with DCT because it allows the removal of both the original tumor and the possible neoplasms in the residual gland tissue, and enables early identification of other metastases which can be treated efficaciously with I131.

Adenocarcinoma, Follicular↗
PubMedDate not supplied

A new classification of varicose veins to compare various surgical strategies.

Considering the presupposition that chronic venous insufficiency (CVI) and varicose veins classifications are extremely difficult, and that none of those presently in use are sufficiently complete, the authors propose the classification of the haemodynamic venous disease (HVD) and of the varicose veins from the clinical, anatomotopographical, etiopathogenetical and haemodynamical point-of-view. This type of classification allows us to closely follow the disease's evolution, to distinguish the benign forms from the more aggressive ones, and to evaluate the results of the medical, surgical and schlerotherapical treatments, from the efficiently, functional, instrumental and aesthetically point-of-view.

Female↗