Risk factors for accelerated atherosclerosis in patients with systemic lupus erythematosus.
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Adult↗
Biomedical subjects
M De Monti
Publications and source records attributed to M De Monti.
Multidetector helical angio CT oblique reconstructions orthogonal to internal carotid artery for preoperative evaluation of stenosis. A prospective study of comparison with color Doppler US, digital subtraction angiography and intraoperative data.
AIM: The recent introduction to clinical practice of multidetector helical angio CT (MHACT) has generated a new interest in the diagnosis of carotid artery atherosclerosis. In recent years there has been a redefinition of the indications to carotid artery endarterectomy; there is a tendency to appraise plaque morphology and composition, and not only stenosis degree. The aim of this prospective study is to analyze the validity of MHACT in the diagnosis of atheromasic stenosis of the carotid bifurcation, in comparison with US color Doppler (USCD), digital subtraction angiography (DSA) and intraoperative evidence (OP). Special emphasis is given to the analysis of plaque composition and to precise evaluation of the stenosis percentage computed as an area rate on oblique reconstructions performed exactly orthogonal to the axis of the vessel at the point of maximal stenosis. METHODS: Twenty-seven carotid stenosis (in 24 patients) were preoperatively evaluated by USCD, MHACT, DSA. We calculated the stenosis degree with USCD, by the ECST method, both as a diameter rate and as a bidimensional value. By MHACT we computed the percentage of stenosis as an area rate, in an MPR oblique plane orthogonal to the vessel axis, at the point of maximal stenosis; by DSA we used NASCET and the common carotid artery method (CC). DSA measurements have been mathematically converted as area rate (NASCET2 and CC2). All the patients were operated on with the eversion technique (EEA); it was always possible to obtain an intact cylindrical specimen of the plaque and to perform a reliable and accurate evaluation of the degree of stenosis by sectioning and measuring it on the desk. We gave a score to the presence and amount of lipid and calcium components, and these data were compared to those obtained with the different diagnostic instruments. RESULTS: Statistical analysis of the 7 data sets showed an important underestimate of the angiographical method (DSA), even if the measurements were carried on by a precision caliper. The mathematical conversion of a linear stenosis rate into an area rate gives these values more reliability, indicating, as for NASCET2, non statistically significant differences when compared to surgical evidence, notwithstanding a high standard deviation. The rates obtained by USCD (area rate) and MHACT proved to be very accurate with respect to surgical evidence. In this study there was no significant difference in the detection of various components (lipid and calcium) of the atheromasic lesion, by MHACT and surgical evidence (OP). CONCLUSION: MHACT promises to be a very accurate instrument in the detection of plaque components and identification of the stenosis degree. It shows some limits in very calcific lesions and occasionally, in relevant cardiac failure, may be useless. Hence one feels the need to reassess the role of DSA, once considered the "gold standard", with more extensive prospective studies, including comparison with MHACT and USCD.
Angiography, Digital Subtraction↗
Brain involvement in extracranial internal carotid artery aneurysms.
BACKGROUND: No prospective study of extracranial internal carotid artery aneurysms (EICAA) has been reported to date. The aim of this study was to evaluate central nervous system complications associated with surgical intervention for EICAA. PATIENTS AND METHODS: A total of seven patients, representing all cases observed at our institution from December 1997 to December 1998, were entered in this prospective study. Three patients had bilateral involvement. The aneurysms were both atherosclerotic and dysplastic. All patients were males, with mean age of 70 years (range 65 to 74). Internal or common carotid artery to EICAAs diameter ratios were calculated on the angiograms. The transverse diameter as well as the craniocaudal extension of the lesions were accurately measured intraoperatively. Follow-up evaluations were performed at three, six and twelve months postoperatively, and consisted of a clinical evaluation by both a neurologist and a vascular surgeon who were not part of the primary surgical team. RESULTS: Six patients presented with neurological symptoms ranging from non-hemispheric TIAs to hemispheric stroke. One patient was asymptomatic. The severity of symptoms was correlated with the size of the aneurysm. Preoperative symptoms were more severe in EICAAs of > or = 3 cm in transverse diameter. One case had a postoperative stroke, no perioperative deaths occurred. All the internal carotid arteries operated on were patent during follow-up evaluations. No new neurologic event was observed during follow-up. CONCLUSIONS: The severity of central neurologic symptoms seems to depend on the size of the aneurysmatic lesion. Prompt surgical management of small EICAAs may reduce the occurrence of severe CNS complications, both preoperatively and postoperatively, due to the lower risk of embolization associated with small aneurysms compared to larger lesions.
Aged↗
Late rupture of an abdominal aortic aneurysm after Parodi's endoprosthesis replacement.
Endovascular surgery as a whole, and specifically in the context of aortic aneurysms, is a very interesting methodology the potential of which is increasingly being recognized. Follow up information on patients who underwent these procedures will be critical to validate the different techniques which have been developed and to identify the most appropriate situations for this type of surgical procedures. The authors present a case of aortic aneurysm rupture who had undergone Parodi's endoprosthesis placement two years before. CT angiographic evaluation showed a wide endoleak due to distal stent detachment, a complete dislodging of the endoprosthesis itself and retroperitoneal haematoma. Prosthesis replacement through a laparotomic approach was carried out and the patient was discharged 10 days postoperatively, surgically cured.
Aged↗
Steroid-independent activation of ER by GnRH in gonadotrope pituitary cells.
In the rat pituitary gland the mechanism responsible for ERalpha regulation has not been fully elucidated. Using transient transfection assays in alphaT3-1 cells, a cell line of gonadotrope origin, we show that GnRH stimulates estrogen response element-containing promoters in an estrogen-independent manner. This effect was strictly ER and GnRH receptor dependent, as no activation of the reporter gene was observed in presence of the anti-estrogen ICI 182,780 or a GnRH antagonist. These data suggest that the GnRH-triggered signaling pathway results in 17beta-estradiol-independent trans-activation of the ERalpha in alphaT3-1 cells. Furthermore, an additive activation was achieved when cells were treated with both GnRH and 17beta-estradiol. In primary pituitary cells, GnRH alone (100 nM) did not cause a significant stimulation of reporter gene activity, presumingly due to the low amount of gonadotropes. Interestingly, the combination of 17beta-estradiol and GnRH resulted in a significant increase in ERalpha trans-activation compared with that in cells treated with 17beta-estradiol alone. This enhancement was prevented by ICI 182,780, showing an ERalpha requirement. Moreover, we show that the effects of GnRH on ERalpha transcriptional activity in gonadotrope cell lines are mediated by the PKC/MAPK pathway. In conclusion, our data demonstrate that GnRH is an important signal in the regulation of ERalpha trans-activation in gonadotrope cells.
Animals↗
Endoscopy and surgery. A combined strategy for diagnosis and therapy of polyposis-cancer sequence in the colon.
BACKGROUND: The aim of the paper is to evaluate retrospectively the series of patients affected by colon polyps and colon cancer to purpose a planned follow-up for patients who underwent colon polypectomy. METHODS: Out of 198 patients affected by colon carcinoma, the authors describe 95 cases of previous, synchronous or metachronous polyps, with a global prevalence of 47.9%, and respectively of 13.6%, 16.6%, and 17.6%. RESULTS: The evolutive sequence between colon polyp and carcinoma is shown through both clinical experience and experimental tests. The epidemiologic curve of adenoma rate precedes by five years the curve of carcinoma, and such is the average period of time for the transformation of an adenoma into invasive carcinoma. In clinical practice, it is frequent to note synchronous or metachronous polyps with respect to colon carcinoma. It is also possible to note carcinoma in patients with previous polypectomies. CONCLUSIONS: On the basis of the retrospective evaluation of the clinical cases, and reviewing international literature, the authors suggest their diagnostic-therapeutic and endoscopic follow-up protocol for patients affected by colon neoformations (Fig. 1).
Adenomatous Polyposis Coli↗
Wall lesions of abdominal aortic aneurysms threatening an impending rupture: prognostic evaluations.
BACKGROUND: Final events preceding aneurysm rupture are not completely known. The current study relates to incomplete aortic aneurysm wall lesions (i.e. malacia, dark staining and blebs or blisters) as possible sites of aneurysm rupture. METHODS: 162 abdominal aortic aneurysms, resected between 1988 and 1996, have been reviewed and 27 cases of aneurysms presenting wall thickness lesions are reported. The lesions were scheduled by operative reports and compared to ultrasound and CT scans. RESULTS: The authors classify aortic aneurysms into three phases, depending on the degree of wall degeneration viz 1. Flawless wall aneurysms. 2. (a-b-c) Aneurysms with intraparietal lesions. 3. Ruptured aneurysms. CONCLUSIONS: It is concluded that stage 2 aortic aneurysms must be urgently operated on. They carry a high surgical risk and, consequently, higher morbidity and mortality compared with stage 1 aneurysms.
Abdominal Muscles↗
[Primary jejunal liposarcoma].
A case of primary jejunal liposarcoma is reported. Liposarcoma of the small intestine is very rare (four cases in the international literature). The early clinical symptoms of these malignancies are unclear non specific and for this reason the disease is often diagnosed at an advanced stage. The prognosis of these lesions is generally poor owing to the diffusion of the disease at the time of diagnosis. Usually small bowel neoplasms are preoperatively identified only in 27-72%. The percentage of surgical removal is from 65 to 80% according to the recent literature. Aim of this paper is to present a rare case of jejunal liposarcoma.
English Abstract↗
Non specific aorto-arteritis. Clinical picture, diagnosis and therapy.
This study is aimed at analyzing clinical features, angiographic findings and evolution of Takayasu's arteritis and the criteria adopted to establish the indication for non-surgical versus operative treatment. Eighteen patients affected by non specific aortarteritis were observed and treated at our Department between 1973 and 1996. All patients met the American College of Rheumatology 1990 criteria of classification of Takayasu's arteritis. Sixteen patients were young females. Two patients were males. Nine patients underwent surgical procedures. One young female underwent a PTA. All eight asymptomatic patients were only medically treated. One patient died some days after an aorto-bicarotid bypass graft due to acute myocardial infarction. Two other patients died two and four years after intervention for renal and cardiac failure respectively. One patient after an aorto bicarotid bypass underwent a left hemiplegia due to thrombosis of the right graft branch. All the other 14 patients either surgically or medically treated are well and are under strict surveillance through rigorous follow-up. The 10 patients who underwent surgical or interventional radiological treatment were certainly the most seriously affected patients and were symptomatic (presented neurological disturbances or a severe hypertensive state). This fact explains, to some extent, the mortality and morbidity rate observed in this group. The seven medically treated patients were completely asymptomatic in spite of a major involvement of various vascular districts.
Adolescent↗
Acute vascular abdomen. General outlook and algorithms.
Acute vascular abdomen is a severe and life-threatening pathology due to arterial degeneration, leading to hemorrhage or arterial occlusion leading to ischemia. Differential diagnosis of patients with severe abdominal pain and/or shock include several vascular and traumatic diseases, the most common being rupture of abdominal aortic aneurysm (AAA), or less frequently rupture of visceral artery aneurysm. Also acute aortic dissection, iatrogenic injury and acute mesenteric ischemia may lead to acute vascular abdomen. Clinical evaluation of the haemodynamic status of the patient may be very difficult, and may require airway maintenance and ventilation with a rapid treatment of hemorrhagic shock. In the stable patient with an uncertain diagnosis, CT scan, NMR and selective angiography may be helpful in diagnosis before vascular repair. On the contrary, the unstable patient, after hemodynamic resuscitation, must be operated on expeditiously. We present our vascular algorithms, to assess timing of diagnosis and treatment of this severe acute disease.
Abdomen, Acute↗
Recurrent aneurysms: late complication for patients previously submitted to graft replacement for abdominal aortic aneurysm.
BACKGROUND: The possibility to perform easy and cheap ultrasonographic examinations of the abdomen allows us to face the problem of possible development of new paraanastomotic aneurysms or aneurysms on native arteries in subjects already submitted to endoaneurysmectomy of the abdominal aorta. The idea of planning accurate programs of ultrasonographic follow-up of operated patients is sustained by the hypothesis that the aortic aneurysm is an expression of a systemic disease due to a connectival defect of genetic nature. METHODS: Two different follow-up experiences are described: the first was a simple follow-up based only on clinical evaluation of patients previously submitted to aortic surgery in the last ten years at the Department of General and Cardiovascular Surgery of the University of Milan, and the second experience a planned follow-up programme based on instrumental evaluation of the patients. RESULTS: Thirty-one cases of recurrent aneurysms of native arteries in 13 subjects already operated for AAA from 3 to 13 years before are described. Despite the patients were evenly inserted in a clinical follow-up, as a matter of fact, 25 of these lesions were detected during occasional investigations performed for other reasons or for rupture, while during the last two years, the planned ultrasonographic follow-up of 95 patients detected 6 new aneurysms. CONCLUSIONS: Incidental detections of new paraanastomotic true aneurysms or ectasia of native arteries far from the graft are more and more frequent in patients already submitted to aortic replacement for abdominal aneurysm. In the international literature only few papers have been published about perspective studies based on instrumental follow-up of operated patients. The planning of such controls is mandatory, at present, also in order to evaluate the clinical development of aneurysmatic disease.
Aged↗
[Malignant neoplasia of the small intestine. Apropos of 7 cases. Clinical discussion and review of the literature].
The authors report seven cases of primary malignancies of the small intestine observed and treated between 1989 and 1995 at the First Surgical Division of Treviglio Hospital. Three patients were affected by adenocarcinomas (two involving the duodenum and one the jejunum), two patients had non-endocrine carcinoid tumors of the ileum, one presented a jejunal liposarcoma and one a lymphoma of the ileum. Four patients died (respectively at three months, 15 months, 18 months and five years after surgical intervention). Three patients are still alive. The early clinical features of these malignancies are typically vague and non specific and for this reason the disease is often diagnosed at an advanced stage. The prognosis of these lesions is generally poor owing to the diffusion of the disease at the time of diagnosis. In fact these neoplasms are preoperatively identified only in 27-72%. The percentage of surgical removal ranges between 65 and 80% according to the recent literature. This study is aimed at analysing the clinical and pathologic characteristics of the observed cases and the difficulties of the diagnostic procedure. The adopted surgical techniques and the outcome of the operative treatment are also examined.
Adenocarcinoma↗
Immunohistochemical study of secretogranin II in 62 neuroendocrine tumours of the digestive tract and of the pancreas in comparison with other granins.
An immunohistochemical study on 62 cases of gastrointestinal and pancreatic neuroendocrine tumours was performed in order to test the interest and specificity of a new anti-human secretogranin II antibody and compared to the other granin markers (chromogranin A and chromogranin B). Specific immunoglobulins were purified by affinity chromatography from an antiserum raised against a recombinant secretogranin II. Gastric tumours did not express secretogranin II, and ileal and appendiceal tumours only rarely expressed it (1/10 and 1/7 respectively), unlike the other classic neuroendocrine members of the granin family. In duodenal and pancreatic tumours, secretogranin II was detected when the other granins were also expressed. On the other hand, all rectal tumours expressed secretogranin II (7/7), frequently in the absence of chromogranin A. Though the granins expressed in tumoral tissue and in adjoining non tumoral tissue are mostly related, strong secretogranin II positivity occurred in 4 tumours while mucosa was secretogranin II negative. These observations highlight the interest for associating another antigranin such as secretogranin II to the classical markers of neuroendocrine tumours.
Adolescent↗
[So-called "spontaneous" lesions of the popliteal artery].
The term "spontaneous", when attributed to a stenotic or obliterative arterial lesion, could seem ambiguous and doesn't completely explain the anatomical substrate that is the basis of this morbid condition. However, it is true that injuries can occur without the patient being aware of any traumatic event, and can cause a symptomatology arising suddenly and, apparently, "spontaneously". In this study, three cases of patients observed for acute or chronic lower limb ischemia are presented. All patients were male, young and underwent an angiographic examination that demonstrated, in an otherwise normal arterial tree, filling defects or obstruction involving the popliteal artery. Two patients underwent a reconstructive surgical procedure. The third was medically treated. CAT or MNR examinations were performed in order to exclude developmental defect such as an anomalous course of popliteal artery determined by a displacement due to medial head of the gastrocnemius muscle. Actually in these three cases, a definite etiology of the arterial damage was not demonstrated and therefore it is suggested that a physical effort could have injured an already weakened arterial structure.
Adult↗
[The role of ERCP in the diagnosis and therapy of Mirizzi's syndrome. Apropos a clinical case].
Mirizzi syndrome is a rare variant of obstructive jaundice due to compression of the hepatic duct caused by a stone inserted in the cystic duct or in the Hartmann recess and it is referred with a prevalence of 0.05-1% of patients with cholelithiasis. These percentages are, nevertheless, unreliable because only an accurate preoperative cholangiography allow to detect a Mirizzi syndrome and so, very often, the real cause of the jaundice remains unacknowledged. Early diagnosis of the syndrome is particularly important because it suggests an accurate and prudential surgical approach considering the frequent fibrotic adherences caused by chronic inflammation. In this paper the authors present a clinical case quickly and successfully cured operative endoscopy, followed by traditional surgery. The authors believe that the study of obstructive jaundices must include an ERCP either for the diagnosis or because operative endoscopy could ameliorate clinical feature and hepatic performance in order to allow a safer surgical operation.
Cholangiopancreatography, Endoscopic Retrograde↗
Non occlusive ileocaecocolic intussusception caused by caecum cancer--case report.
A case of ileocaecocolic intussusception caused by a caecum carcinoma is presented. The authors stress the peculiarity of clinical manifestation, without intestinal obstruction despite the presence of a big abdominal mass involving vessels and bowel, revealed by CT scanning and angiography. Endoscopy was not able to identify the nature of the lesion. Laparotomy performed with the idea to find a mesenchymal neoplasia, permitted to achieve the diagnosis.
Adenocarcinoma, Mucinous↗
[The "sump syndrome": a case treated by surgical endoscopy. A discussion about biliodigestive diversions and endoscopic sphincterotomies].
A case of "sump syndrome", occurred in our department, suggested the discussion about the opportunity of endoscopic operative procedures in choledocholithiasis and in biliary tract surgery complications. Improvement of endoscopic operative procedures allow extensive indication of ERCP sphincterotomy instead of traditional choledochoduodenostomy or transduodenal papillosphincterotomy. Additionally, operative endoscopic procedures are good alternative to reoperation for traditional biliary tract surgery complications.
Biliary Tract Surgical Procedures↗
[Choledochoduodenostomy in the treatment of benign disease of the common bile duct: evaluation of long-term results].
The Authors report their experience in the treatment of 36 patients managed by side-to-side choledochoduodenostomy for common bile duct disease and followed for a period of five years. The main indication to surgery was a choledochal dilatation more than 1.5 cm. The surgical technique consisted in a single layer side-to-side choledochoduodenostomy with absorbable suture according to Roessner. There was no operative mortality and few post surgical complications (six patients, 15.78%) were registered; 25 patients (69.45%) were completely asymptomatic at five years, while in six cases (16.66%) significant symptoms were observed. In one case a biliary gastropathy with no metaplasia was documented.
Aged↗