Biomedical subjects

R Scorza

Publications and source records attributed to R Scorza.

At least 19 recordsLinked to original sources

PubMed1996

Renal vascular damage in systemic sclerosis patients without clinical evidence of nephropathy.

OBJECTIVE: To evaluate the use of color-flow Doppler ultrasonography, a direct, noninvasive technique, for measurement of kidney blood flow in patients with systemic sclerosis (SSc). METHODS: Twenty-five normal volunteers and 25 SSc patients (median disease duration 8 years, range 2-21 years) were studied. All were free of clinical symptoms of renal damage. The resistance index (RI) was determined on main, interlobar, and cortical vessels. RESULTS: In SSc patients, the RI was significantly increased at every sampling site examined (P < 0.001). RI values were strongly correlated with disease duration (main artery r = 0.56, P < 0.04; interlobar artery r = 0.63, P < 0.02; cortical artery r = 0.75, P < 0.002). Regression analysis showed no relationship between RI and creatinine clearance values. CONCLUSION: Color-flow Doppler ultrasonography is a sensitive and noninvasive technique for evaluating vascular damage of the kidney in patients with SSc.

Adult↗

PubMed1996

Case report: successful treatment with cimetidine and zinc sulphate in chronic mucocutaneous candidiasis.

The authors evaluated the clinical efficacy of a treatment with cimetidine and zinc sulphate in a patient with chronic mucocutaneous candidiasis. Cimetidine was given at a dose of 400 mg three times daily; zinc sulphate at a dose of 200 mg daily, then adjusted to maintain blood zinc levels at the upper normal range. This treatment lasted 16 months. An impressive and significant reduction of the infectious events and an increased CD4 (helper/inducer) cell counts were observed. The authors conclude that this combined immunopotentiating treatment is safe and inexpensive to treat immunodeficiency disorders.

Adjuvants, Immunologic↗

PubMed1995

Functional analysis of a new polymorphism in the human TNF alpha gene promoter.

In this paper the functional relevance of a TNFA promoter polymorphism, a G/A polymorphic sequence at position -238, was tested by analysing its influence on TNF alpha production upon in vitro stimulation of monocytes from 78 healthy, unrelated individuals by lipopolysaccharide (LPS) or after allogenic stimulation in a panel of 32 healthy individuals. All TNFA-A positive individuals were either DR3 or DR7 positive, confirming the previously reported strong linkage disequilibrium of the TNFA-A allele with the two extended haplotypes (B18, F1C30, DR3) and (B57, SC61, DR7). No individuals homozygous for the TNFA-A allele were present in the panel. The mean level of TNF alpha production was not significantly different in TNFA-G/G homozygous and in TNFA-A/G heterozygous individuals after LPS stimulation of monocytes (P = 0.35) or after allogenic stimulation (P = 0.7). After LPS and allogenic stimulation DR3 positive individuals had a higher mean TNF production. This could not be further differentiated by typing for TNF -283.

Adolescent↗

PubMed1995

[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↗

PubMed1995

[Proximal anastomotic pseudoaneurysms].

Abdominal aortic pseudoaneurysms development in patients submitted to endoaneurysmectomy or bifurcated aorto-peripheral by pass was, for a long time, considered a rare complication of aortic surgery. In old papers it was referred prevalence of abdominal PSA which rambled on values less than 1%. The diagnosis was always reached in concomitance with fissurations, ruptures or aorto-digestive fistulas. Recent papers, in which were reported results of accurate instrumental (echo and TC) follow-up of patients with aortic prosthesis, demonstrated a really higher prevalence of abdominal aortic pseudoaneurysms (about 6%). A retrospective analysis of PSA admitted to the General and Cardiovascular Institute of the University of Milan and the First Surgical Division of the General Hospital of Treviglio-Caravaggio (BG), demonstrated a high morbidity and mortality of complicated aortic pseudoaneurysms surgery. Considering the data reported in the international literature and the results of the surgery of complicated aortic PSA, the Authors point out the necessity of accurate periodical instrumental follow-up of subjects with aortic prosthesis in order to identify anastomotic pseudoaneurysm and to evaluate incidental evolution of aneurysmatic disease.

Adult↗

PubMed1995

Aorto-iliac aneurysms rupturing into the iliac veins.

BACKGROUND: Rupture of aorto-iliac aneurysms into the iliac veins is seldom reported in distinct series, and represents only a fraction of ruptures into the abdominal cavity. MATERIAL AND METHODS: Four cases are reported: two aortic aneurysms ruptured into the right iliac vein, one right iliac aneurysm ruptured into the right iliac vein, one right iliac aneurysm ruptured into the cava at the bifurcation, one aortoiliac aneurysm ruptured into the right iliac vein. Two patients showed severe shock at admission. Central venous pressure at operation was 43.6 +/- 26.3 cmH2O, and rapidly decreased at aortic clamping. Venous bleeding was controlled by finger compression of the iliac and caval vein and aortic graft replacement followed direct suture repair of the venous breach. De Weese caval clip was implanted twice, to prevent pulmonary embolism in severely compromised iliac veins. This series represents 1% among 373 ruptured abdominal aortic aneurysms operated on as emergencies over the same period. RESULTS: Pulmonary embolism, either paradoxical or postoperative, never occurred. Mortality rate was 25%, compared to 35% overall mortality among the whole ruptured group. The role of the site of rupture is swelling of the lower limbs is suggested, and edema can be suggestive though statistical evidence has not been achieved. CONCLUSIONS: Three concepts are stressed: early diagnosis and operation (i.e. before cardiac high output failure and shock); accurate as well as simple surgical technique; careful post-operative intensive care.

Aged↗

PubMed1995

[Anastomotic pseudoaneurysm, true para-anastomotic aneurysm and recurrent aneurysm following surgery for abdominal aortic aneurysm. Is a unifying theory possible?].

BACKGROUND. Recurrent aneurysms (RA) and true para-anastomotic aneurysms (TPA) are currently reported as anecdotal findings during occasional follow-up of subjects previously operated for abdominal aortic aneurysm (AAA). In several instances concomitant false anastomotic aneurysms (FAA) are found, not attributable to infection nor to suture or graft degradation. PURPOSE. To discuss the possibility that RA of inborn arteries, TPA, and non infectious FAA, when concomitantly present in the same subject, may reflect a peculiar late presentation of multiarterial aneurysmal disease. MATERIAL. Three cases of occasionally discovered concomitant RA, TPA, and FAA in subjects previously operated for AAA are reported. The finding of new aneurysms and FAA in subjects previously operated for AAA may be theoretically justified by the currently recognized pathogenetic mechanisms, molecular, enzymatic or genetically determined, implicated in the formation of AAA. This points out the need for a correct surgical management of AAAs and for accurate accomplishment of follow-up programmes supported by ultrasound echography of graft-arterial anastomoses and of the arteries at risk of aneurysmal disease.

Aged↗

PubMed1994

[A rational approach to cholecystectomy in the patient with an abdominal aortic aneurysm].

A retrospective series of 30 (2.8%) cases of cholelithiasis out of 1064 abdominal aortic aneurysmectomies is presented. 21 subjects underwent aneurysmectomy and prosthetic grafting combined with cholecystectomy. Complications related to the combined operation, early or late (6 months to 8 years follow-up was available for the whole series), were not recorded in this subgroup. 9 (30%) patients with coincidental gallstones underwent simple aneurysmectomy: 2 (22%) patients complained of symptoms of biliary colic, eight and fifteen weeks after operation respectively, and successfully underwent medical treatment. A third patient (11%), operated on urgently for ruptured abdominal aortic aneurysm, developed acute cholecystitis, gallbladder perforation and biliary peritonitis on the 17th day of operation: he died of multiple organs failure on the 8th day of urgent cholecystectomy. Acute alithiasic cholecystitis was recorded only once (0.1%) among the 1034 abdominal aortic aneurysmectomies without gallstones: fatal outcome was ascribed to massive multiple organ cholesterol embolization. If careful asepsis and correct surgical tactics are observed, cholecystectomy can safely be performed in combination with abdominal aortic aneurysmectomy in subjects with a positive history of cholecystitis or in poor general conditions, but it cannot be considered as a prophylactic treatment towards postoperative acute cholecystitis in good-risk subjects with a negative history of cholecystitis.

Aged↗

PubMed1994

A case of asymptomatic giant aneurysm of the common hepatic artery.

The authors are presenting a case of asymptomatic giant aneurysm of the common hepatic artery in a 72 year-old woman. The patient came under our observation with a complete, recent diagnosis. However, two years earlier in another clinic, a para-hilar hepatic mass with partially calcified walls was incidentally found during an abdominal ultrasound. An abdominal TC without contrast medium showed the mass to be hepatic hydatid cysts. TC images after 2 years showed a growth in diameter from 7 to 12 cm. Having undergone an hysterectomy and a rectal prosthesis, technical difficulties occurred because of the aneurysm's characteristics. The authors would like to emphasize that the rarity of the lesion must not exclude it from the diagnostic protocol of abdominal masses: ultrasound must be accompanied by a Doppler and the TC must be made using a contrast medium. Furthermore, revascularization surgery may create difficulties that cannot be previously prevented.

Aged↗

PubMed1994

[Recurrent aneurysmal disease of the native arteries in subjects operated on for abdominal aortic aneurysm].

Abdominal aortic aneurysm repairs are presently increasing in number all over the western countries; long life expectancy and high quality of life, warranted to patients surviving operation, stressed the possibility that aneurysmal disease affects other arteries as well as the para-anastomotic aorta itself. OBJECTIVE. The observation that, in the last four years, five patients were operated on for recurrent aneurysms of native arteries, gives the opportunity to discuss the matter and review the literature on this topic. MATERIAL AND METHODS. Five cases of recurrent aneurysms of native arteries in patients that had undergone abdominal aortic aneurysmectomy 4 to 11 (mean: 8) years before are discussed. A total of 16 new aneurysms were found. Although all these patients regularly attended their clinical follow-up program, these observations have to be considered retrospective and incidental, because B-mode echography was not yet routinely requested by the followup protocol. RESULTS. Neither hypertension nor type of graft implanted in the first operation were correlated to the development of new aneurysms in these five subjects. Rupture as causative of the original aneurysmectomy was recorded in two cases (40%), that developed 8 recurrent aneurysms (50%), one of which ruptured. CONCLUSIONS. Although recurrent aneurysms are occasionally reported in the literature, the lack of prospective follow-up series, based on non invasive serial imaging of the arterial system, prevents clarifying whether these observations are isolated or recurrence is likely to be a long-term outcome of aneurysmal disease.

Aged↗

PubMed1994

Primary aortocaval fistula.

Twenty-two spontaneous aortocaval fistulas between an abdominal aortic aneurysm and the inferior vena cava were surgically treated in 27 years at one surgical unit. The incidence was 5.9% of ruptured abdominal aneurysms; the operative mortality rate of 36.4% compared with an overall mortality rate for ruptured abdominal aortic aneurysms of 34.9%. Among 10 subjects in shock on admission the mortality rate was 50% compared with 25% in non-shocked patients. Of the 22 patients one died at laparotomy from irreversible cardiac arrest; in the other 21 the procedure consisted of endoaneurysmal repair of the fistula which involved replacement of the aneurysm by a Dacron prosthesis after control of venous bleeding was achieved. No occurrence of paradoxical pulmonary embolism was reported. Multiple organ failure caused death in six cases; of these, four died as a result of acute renal failure. Severe preoperative anuric shock was recorded in five instances, with a mortality rate of 80%, compared to 25% for non-shocked subjects. Mortality was not improved by intraoperative autotransfusion; however, the incidence of severe shock was 55.5% in those patients treated by autotransfusion, compared with 38.5% in the standard blood replacement group.

Aged↗

PubMed1994

[Current knowledge and unresolved problems in the pathogenesis of abdominal aortic aneurysm].

This is a wide literature review on abdominal aortic aneurysm (81 references). The main branches in which research is in progress are presented, and new concepts in pathogenesis are illustrated. These come out of the development of knowledge in basic sciences and their interdisciplinary application to this disease. Biochemistry, pathology, immunology, genetics, mathematics, mechanics, fluidodynamics are the routes now followed in the effort to cast light on the inner mechanism of birth and growth of this disease, presently unpredictable and uncontrollable, but successfully treatable by vascular surgery.

Aortic Aneurysm, Abdominal↗

PubMed1994

[Primary aorto-enteric communication].

BACKGROUND: Primary aortoenteric communications are a rare and severe complication of abdominal aortic aneurysms or erosions by neoplastic diseases. Early diagnosis and surgical treatment are crucial. Postoperative morbidity and mortality are high. Diagnosis if often made intraoperatively, because the typical clinical feature (digestive haemorrhage, abdominal aneurysmal mass, abdominal pain) is often incomplete and critically ill patients require quick surgical decision and do not allow the use of sophisticated diagnostic tools. MATERIAL AND METHODS: Eight cases, observed through 13 years, are presented: six males and two females. Mean age was 61 years; male to female ratio was 3:1. In four cases (50%) a herald bleeding occurred during the days preceding hospital admission. Presenting symptoms were haematemesis (63%), melaena (87%), abdominal pain (63%); six subjects (75%) presented hemorrhagic shock. Only three patients (37%) were aware to be affected with abdominal aortic aneurysm before admission. Diagnosis was always made by clinical feature and urgent laparotomy: two preoperative duodenoscopies were not diagnostic. Aortoduodenal communication occurred in six cases: one of these was secondary to erosion of the aorta by a carcinoma of the pancreas. Aortogastric communication occurred once; the remainder case was a communication between a hypogastric artery aneurysm and the last ileal loop. RESULTS: Surgical operation was carried out in emergency in seven patients: the eight (tumour of the pancreas and aortoduodenal erosion) died before operation. Enteric defect repair, aneurysmectomy and aortic grafting was performed in six cases. In the last case (hypogastric-ileal communication) ligation of the hypogastric artery and ileal segmental resection was performed. Thirty days operative mortality was 58%. CONCLUSION: Despite early recognition and operation, primary aorto-enteric communication remains a severe life threatening disease, bringing high mortality rates. These are clearly affected by shock condition, but a correct surgical technique and prolonged postoperative antibiotic medication to avoid graft infection are mandatory to minimize mortality.

Adult↗

PubMed1993

Markers of procoagulant imbalance in patients with localized melanomas and autoimmune disorders.

Hypercoagulability can be defined as a condition of procoagulant imbalance due to heightened enzymatic activation of coagulation zymogens, but with no laboratory evidence of fibrin deposition nor clinical signs of thrombosis. The imbalance can be detected by measuring the plasma levels of prothrombin fragment 1 + 2 (F1 + 2), fibrinopeptide A (FPA) and thrombin-antithrombin III (TAT) complexes. The aims of this study were to establish the frequency of existence and biochemical pattern of hypercoagulability in patients with cancer and autoimmune disorders, clinical conditions associated with an increased risk of thrombosis, and to ascertain the most sensitive method for its diagnosis. In approximately one-fourth of the patients hypercoagulability was identified by finding high levels of FPA F1 + 2 or TAT unaccompanied by signs of fibrin deposition (expressed by normal levels of D-dimer). In a smaller proportion of patients (approximately 10%), the concomitant presence of high levels of D-dimer indicated that the activation of the coagulation cascade had gone beyond the stage of heightened enzymatic activity to the point of cross-linked fibrin deposition. Of the markers used to detect hypercoagulability. FPA seems to be the most sensitive, being significantly increased in all clinical conditions studied.

Adolescent↗

PubMed1993

[Aortoenteric fistulae. Diagnosis, therapy, results].

A series of 26 aortoenteric fistulas, 8 primary (PAEF) communications between abdominal aorta and gastrointestinal tract and 18 secondary (SAEF) communications between aortic graft and intestine, is reported. PAEF is commonly due to aneurysmal rupture into the intestine, while SAEF is an uncommon complication of abdominal aortic reconstructive surgery. Male to female ratio was 3:1 among the PAEF group and 8:1 among the SAEF one. Seven of the PAEF subjects underwent urgent surgical operation: 6 enteral defect closure and prosthetic aortic replacement. One patient underwent ileal resection and hypogastric artery ligation. Survival rate in this group was 42% (3/7). Among the 18 subjects affected with SAEF after intestinal repair, vascular procedures were 8 aortic graft removal and extra-anatomic bypass grafting, 4 aortic graft removal and aortic stump ligation, 5 anastomotic repairs and 1 prosthetic branch substitution. Survival rate among this group was 39% (7/18). No differences in outcome were noted in this series depending on type of operation, according to the literature. The authors conclude that surgical outcome is affected by the presence of severe infection not dominated by antibiotics rather than by surgical technique. In this series survival rate among the patients with negative bacterial culture of the surgical specimen raised up to 80%, while it decreased to 20% among subjects harboring septic retroperitoneal collection and graft infection.

Adult↗

PubMed1993

Rupture of abdominal aortic aneurysms into the major abdominal veins.

Over the period January 1965-July 1992 26 spontaneous fistulas between an abdominal aortic aneurysm (AAA) and the major abdominal veins were observed and surgically treated. Twenty-two were aorto-caval, one iliaco-iliac and 3 aorto-iliac; since clinical features, pathophysiology, principles of surgical treatment and postoperative care are similar, both the conditions are considered as a single disease (aorto-caval fistula: ACF). The incidence among 373 ruptured AAA operated in emergency conditions in the same period was 6.97%, with an operative mortality rate of 34.61% compared to an overall mortality for ruptured AAA of 34.85%. All subjects were males with a mean age of 67.3 years. Twelve subjects showed shock at admission (46.1%): the mortality rate in this subgroup was 50% compared to 21.4% among the non-shocked patients. Pain was always present, oedema of one or both of the lower limbs in 9 cases (34.6%) and abdominal bruit or murmur and thrill in 16 (61.5%). One patient died at laparotomy for irreversible cardiac arrest; the 25 completed procedures consisted of endoaneurysmal repair of the fistula under venous bleeding control by digital compression and prosthetic replacement of the abdominal aorta (7 straight and 18 bifurcated grafts). Intraoperative mean blood losses exceeded 4,000 ml, but autotransfusion, available only in 12 procedures, allowed significant sparing of heterologous blood units. The mortality rate was not clearly improved by autotransfusion, but among these 12 patients shock was present in 7 instances (58.3%), compared to 5 out of 14 subjects (35.7%) operated on before autotransfusion devices were available.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗

PubMed1992

Pectin microgels and their subunit structure.

High-performance size exclusion chromatography revealed that alkaline-extracted peach fruit pectin dissolved in 0.05 M NaNO3 comprised a hierarchy of at least four aggregated, macromolecular-sized species. Each of the three largest species was found to be comparable in length to the three smallest subunits of an interconnecting gel network visualized by transmission electron microscopy of pectin, rapidly dried from solution. The interconnecting subunits of the gel network were rods or segmented rods and the integrated network formed a circular gel about 1 micron in diameter. Shadowed samples prepared from 5 and 50 mM NaCl or aqueous glycerol solutions produced images of partially dissociated subunits.

Chromatography, High Pressure Liquid↗

PubMed1992

HLA-associated susceptibility to HIV-1 infection.

We studied HLA antigen distribution of 50 heterosexual partners of HIV+ drug abusers with more than 1 year of sexual exposure to HIV, 36 children born to seropositive mothers and 61 haemophiliac patients exposed to presumably infectious clotting factor concentrates. B52 and B44 antigens were associated with HIV resistance while B51 was associated with HIV susceptibility. Forty-nine HIV+ drug abusers, spouses of heterosexual partners studied and 25 HIV+ mothers of the children were also typed. DR11 phenotype was associated with infectiousness of HIV+ subjects. Our data suggest that the HLA region controls susceptibility to infection with HIV and infectiousness of HIV+ subjects in different risk groups.

Acquired Immunodeficiency Syndrome↗