Biomedical subjects

S M Giulini

Publications and source records attributed to S M Giulini.

At least 37 records · Page 2Linked to original sources

PubMed1998

Relations between cardiac and vascular structure in patients with primary and secondary hypertension.

BACKGROUND: Data on cardiac and vascular structure in secondary hypertension are generally scarce, and no data on the interrelations between cardiac mass and structural characteristics of the vessel wall, both in large and in small resistance arteries, are presently available. OBJECTIVES: The aim of this study was to investigate the relation between structural changes in subcutaneous small arteries, left ventricular mass and wall thickness of the common carotid artery in patients with primary and secondary hypertension. METHODS: Seventy-four subjects were included in the study: 11 patients with pheochromocytoma, 14 with primary aldosteronism (PA), 19 with renovascular hypertension (RVH), 18 with essential hypertension (EH) and 12 normotensive (NT) control subjects. All subjects were submitted to a biopsy of subcutaneous fat. Morphologic characteristics of subcutaneous small resistance arteries (relaxed diameter <300 microm) were directly evaluated using a micromyographic technique. All subjects were submitted to calculation of left ventricular mass index (LVMI) and common carotid artery intima-media thickness (CCIMT), using ultrasound technique. RESULTS: The correlation coefficients between the media to lumen ratio in subcutaneous small arteries (M/L) and LVMI or between M/L and CCIMT were closer in RVH than in pheochromocytoma, EH or NT; in PA the correlation coefficients were slightly less close than those in RVH. An excess prevalence of carotid plaques in RVH was observed. CONCLUSIONS: A close relation between small resistance artery morphology and cardiac or carotid artery structure may be observed in those hypertensive patients in whom the renin-angiotensin-aldosterone system is activated. In constrast, in NT, EH and pheochromocytoma no significant correlation between M/L and LVMI or CCIMT was observed.

Arterioles↗

PubMed1998

Endothelial dysfunction in hypertension is independent from the etiology and from vascular structure.

The aim of our study was to evaluate the relationships between endothelial function, small resistance artery structure, and blood pressure in patients with primary or secondary hypertension. Sixty subjects were included in the study: 9 patients with pheochromocytoma, 10 with primary aldosteronism, 17 with renovascular hypertension, and 13 with essential hypertension with 11 normotensive subjects who served as controls. Clinic and 24-hour ambulatory blood pressure (ABPM) were evaluated. All subjects were submitted to a biopsy of subcutaneous fat. Small resistance arteries were dissected and mounted on a micromyograph and the media/lumen ratio was calculated. A dose-response curve to acetylcholine was performed at cumulative concentrations from 10(-9) to 10(-5) mol/L. The vasodilator response to acetylcholine was similarly impaired in the four groups of hypertensive patients (ANOVA P<.05 versus normotensive controls), without any significant difference among them. In subcutaneous small arteries of patients with either primary aldosteronism or renovascular hypertension, a marked increase in media:lumen ratio was observed, while in patients with pheochromocytoma, the extent of vascular structural alterations was similar to that observed in essential hypertension. No significant correlation between media-lumen ratio or clinic blood pressure and maximum acetylcholine-induced vasodilatation was observed. On the contrary, a significant, albeit not very close, correlation between ABPM values and maximum acetylcholine-induced vasodilatation was observed (r=34, P<.05 with 24-hour systolic blood pressure, r=0.36, P<.05 with 24-hour diastolic blood pressure). In conclusion, endothelial dysfunction seems to be independent from the degree of vascular structural alterations and from the etiology of hypertension, and it is probably more linked to the hemodynamic load.

Acetylcholine↗

PubMed1998

[Carotid endarterectomy in patients with neurological non-side related (NSRS) symptoms].

Out of 970 carotid endarterectomies (CE) performed for high-grade (> 80%) stenosis of the internal carotid artery (ICA) until 1995, 147 patients with neurological non side-related symptoms (NSRS) and without any cardiac, ocular or vestibular significant pathology have been evaluated, analyzing the medium and long-term functional results (mean follow-up 37.6 months) related to the morphological status of the ICA contralateral and the vertebral arteries. NSRS disappeared in 126 pts (85.71%): contralateral ICA was non-stenotic in 32 cases (25.39%), stenotic < 75% in 68 cases (53.96%), stenotic > 75% in 7 cases (5.55%) and occluded in 19 cases (15.09%); vertebral arteries were pathological in only 6 cases (4.75%), among which 4 were on the same side and 2 on the opposite side of CE. NSRS persisted in 20 pts (13.6%): contralateral ICA was non-stenotic in 5 cases (25%), with a stenosis < 75% in 11 cases (55%) and with stenosis > 75% in 4 cases (20%); vertebral obliterative lesions were 3 (15.78%), among which 1 on the same and 2 on the opposite side of CE. No one statistical comparison among the groups of cases obtained on the ground of the status of ICA and vertebral arteries were significant (p always > 0.05 at chi-square analysis). Authors' data confirmed that high grade stenoses of ICA can cause NSRS and that CE--always performed at the aim to prevent major neurological attacks--can relieve also these functional disorders in the most of cases, independently from the status of the contralateral ICA and the vertebral arteries.

Aged↗

PubMed1997

[Smooth-muscle-cell tumors of the gastroenteric tract. A review of cases].

Smooth muscle tumors of the gastrointestinal tract are difficult to evaluate and to stage. Twenty-four patients surgically treated during the last ten years have been evaluated using a TGM staging to identify the more rational criteria for the therapeutic choice. Six gastric leiomyomas, 1 ileal leiomyoma, 4 gastric leiomyosarcomas, 1 esophageal leiomyosarcoma, 4 ileal leiomyosarcomas, 2 rectal leiomyosarcomas and 6 gastric leiomyoblastomas were included. 62.5% of cases presented acute clinical features. Preoperative histological diagnosis was adequate in 29% of cases. We performed 7 excisions, 6 gastric subtotal resections, 3 total gastrectomies, 1 esophageal resection, 5 ileal resections, 2 rectal low anterior resection. Fourteen patients were staged I/II, 8 staged III and 2 staged IV. The overall median survival time was 27.5 months (56, 20 and 5 months concerning stage I/II, III and IV respectively; p < 0.01). In relation to T and G factors overall survival was statistically significant. TGM staging was highly significant to predict long-term survival. Radical surgical procedure was highly effective to guarantee long-term survival. Extended follow up is requested because recurrences after many years seem to be possible also with low histologic grade at first presentation.

Aged↗

PubMed1996

Vascular hypertrophy and remodeling in secondary hypertension.

It has been proposed that several neurohumoral factors may be involved in the genesis of vascular structural changes (remodeling or hypertrophy) frequently observed in essential hypertension. Therefore, in this study we investigated vascular structural alterations of subcutaneous small resistance arteries in patients with secondary forms of hypertension. The study included 70 participants: 11 with pheochromocytoma, 13 with primary aldosteronism, and 17 with renovascular hypertension; 13 normotensive subjects and 16 patients with essential hypertension served as controls. All subjects were submitted to a biopsy of subcutaneous fat. Small resistance arteries were dissected and mounted on a micromyograph, and media-lumen ratio, media thickness, remodeling index, and growth index were evaluated. Endothelial function was evaluated according to the dose-response curve to acetylcholine. In patients with either primary aldosteronism or renovascular hypertension, a marked increase in media-lumen ratio was observed, whereas in patients with pheochromocytoma, the extent of vascular structural alterations was similar to that observed in patients with essential hypertension. The increase in media-lumen ratio in patients with essential hypertension and with pheochromocytoma was mainly due to vascular remodeling (remodeling index, 93% to 94%), whereas in patients with renovascular hypertension, there was vascular growth (remodeling index, 70%; growth index, 53%). Patients with primary aldosteronism had an intermediate pattern compared with the other two forms of secondary hypertension. An evident impairment of endothelial function was observed in all four hypertensive groups. In conclusion, the renin-angiotensin-aldosterone system seems to be more powerful than the adrenergic system in inducing vascular growth.

Acetylcholine↗

PubMed1996

Temporary axillo-femoral bypass graft for renal transplant protection during aortic aneurysm repair.

Aortic surgery in renal transplant recipients requires a method of maintaining intraoperative graft perfusion. Here we present a case in which temporary axillo-femoral bypass was used to perfuse a renal transplant during the aortic aneurysm repair; the rationale of inserting the temporary axillo-femoral bypass on transverse arteriotomies is pointed out. Other methods of renal graft perfusion are discussed.

Aortic Aneurysm, Abdominal↗

PubMed1995

Arterial spontaneous rhythmic contractile activity in humans and rats: spectral analysis and regulatory mechanisms.

OBJECTIVE: Many experimental observations have demonstrated the presence of spontaneous cyclic vasomotor activity (CVA) in large and small arteries. This study aimed to evaluate the characteristics of spontaneous CVA in rat and human resistance arteries, and to investigate its possible interference with the evaluation of sympathetic activity by means of spectral analysis of blood pressure in vivo. DESIGN AND RESULTS: In study 1 we examined small mesenteric arteries of spontaneously hypertensive rats and Wistar-Kyoto rats, as well as small omental arteries of normotensive subjects and hypertensive patients (Mulvany and Halpern technique). CVA was enhanced by the agonists of nitric oxide release, and was abolished by the inhibitors of nitric oxide or cyclic GMP synthesis. A potassium channel, which is barium- and zinc-sensitive and tetraethylammonium-insensitive, seems to play a crucial role in the genesis of CVA. In rats and in humans the frequency of CVA fell exactly in the frequency band ('low frequencies') of power spectral analysis of blood pressure usually considered to be an 'index of sympathetic activity'. In study 2, a power spectral analysis of blood pressure variability before and after intra-arterial infusion of noradrenaline or acetylcholine was performed in 18 patients with mild-to-moderate hypertension. The absolute and normalized spectral power of the low-frequency systolic blood pressure peak increased remarkably after noradrenaline and acetylcholine infusion, while its central frequency shifted from 0.10 Hz to approximately 0.06 Hz, exactly the frequency of CVA observed in vitro. CONCLUSIONS: A potassium channel appears to be involved in the genesis of CVA. Also, CVA might contribute to the blood pressure variability independently of the autonomic nervous system activity, and thus probably plays a role in the genesis of the low-frequency peak in the rat and in humans.

Acetylcholine↗

PubMed1995

Surgery for obstructive lesions of the main trunk of the renal artery. A review of the literature and personal experience of 41 operated patients.

Today, surgical revascularization of the renal artery seems to maintain interest in the therapy of renovascular hypertension and chronic ischemic nephropathy because both medical therapy and angioplasty show limits and inconveniences. The authors present here their experience of 45 revascularized renal arteries in 41 patients and they discuss early and late morphological and functional results related to isolated arterial renal pathology (Group 1 of 23 patients) and associated to aorto-iliac pathology (Group 2 of 18 patients). Mortality related to arterial renal reconstruction was nil. There were 3/45 arteries (6.6%) with early thromboses and 4/32 (9.3%) with late thromboses. Early functional results, with respect to renovascular hypertension and/or chronic ischaemic renal insufficiency, showed 16/41 (39%) healed patients, 16/41 (39%) improved patients and 9/41 (22%) unvariated patients. Late results among 28 observed patients (average follow up at 49 months, range from 18 to 144 months) showed 14/28 (50%) healed patients, 11/28 (39%) improved patients and 3/28 (11%) unvariated patients. Results of the Group I were significantly better than results of Group 2 with regards to healed patients (p < 0.01) but not summarizing healed and improved cases. These data have been discussed in comparison with the Literature review of 46 references.

Adult↗

PubMed1995

Media: lumen ratio in human small resistance arteries is related to forearm minimal vascular resistance.

BACKGROUND: For the evaluation in humans of structural alterations in resistance arteries, most studies have used an indirect index, the measurement of minimal vascular resistance (mean blood pressure divided by maximal postischaemic blood flow) in suitable vascular beds. A sensitive and specific micromyographic technique was recently made available for the study of human small resistance arteries. Whether a correlation really exists between results obtained with the two techniques has not yet been investigated. OBJECTIVE: To evaluate both forearm minimal vascular resistance and media:lumen ratio of omental or subcutaneous small arteries in normotensive subjects and hypertensive patients. DESIGN AND METHODS: Thirty-four individuals were included in the study (age range 35-74 years; 24 hypertensive, 10 normotensive). Twenty-five had elective abdominal surgery and nine hypertensive patients had a gluteal biopsy. Omental and subcutaneous small arteries were dissected and mounted on a wire micromyograph (Mulvany's technique), and media:lumen ratio and media thickness were measured. The dose-response curve to noradrenaline was constructed at cumulative concentrations from 3 x 10(-9) to 3 x 10(-5) mol/l. Venous occlusion plethysmography was used to measure blood flow in the forearm, and minimal vascular resistance was calculated from mean blood pressure and postischaemic maximal blood flow (13 min ischaemia plus exercise). RESULTS: A statistically significant correlation was found between media:lumen ratio and minimal vascular resistance (r = 0.74, P < 0.001) as well as between media:lumen ratio and systolic (r = 0.44, P < 0.01) and diastolic (r = 0.38, P < 0.05) blood pressures. Similar correlations were observed between media thickness and systolic and diastolic blood pressures. Small arteries from hypertensive patients had a significantly increased reactivity to noradrenaline (by analysis of variance) compared with those from normotensive subjects, in terms of wall tension but not of active media stress. CONCLUSIONS: The present study demonstrated that the media:lumen ratio of small resistance vessels is significantly related to forearm minimal vascular resistance, suggesting that direct and indirect evaluations of vascular morphology will give similar results.

Adult↗

PubMed1995

[Hepatic injuries: diagnostic and therapeutic features].

Sixty-four consecutive patients with hepatic trauma were examined. Five (7.8%) patients were managed nonoperatively and 59 (92.2%) underwent immediate laparotomy. Nonoperative management is appropriate in hemodinamically stable patients. It requires increasing use of computed tomography instead of peritoneal lavage to evaluate stable patients with blunt abdominal trauma. Patients with complicated associated injuries must be excluded. Analysis of patients who underwent immediate abdominal exploration showed that grade I through grade III injuries of AAST classification are the most common in blunt hepatic trauma (84.75%). Associated intra-abdominal injuries requiring operation for ongoing hemorrhage were observed in 50% of these patients. In the management of grade I through grade III hepatic injuries a simple suture was a safe and highly effective treatment. More complex injuries actively bleeding were controlled by finger fracture technique to achieve intrahepatic hemostasis with selective vascular ligation. Hepatic resection was exceptionally required (2%). On the contrary, resection was required in grade IV injuries with extensive parenchymal destruction and in grade V lesions for a better vascular control of the ruptured suprahepatic veins.

Adolescent↗

PubMed1994

RT-PCR detection of fibronectin EDA+ and EDB+ mRNA isoforms: molecular markers for hepatocellular carcinoma.

Alternative splicing of fibronectin pre-mRNA has been shown to be independently regulated at the EDA and EDB regions in a tissue and developmental stage-specific manner. In this study, RT-PCR approaches were developed for the detection of EDA and EDB FN mRNA isoforms in hepatocarcinoma cells (SK-Hep-I) grown in vitro and in human liver biopsies. While EDA+ and EDB+ isoforms were not present in control adult liver, they were detectable in the hepatocarcinoma cells and in fetal liver. The RT-PCR analysis, extended to biopsies of malignant and non-malignant hepatic tissues, showed that FN mRNAs containing the EDA and EDB sequences were present in the 14 hepatocellular carcinomas (HCCs) tested but absent in the non-tumorous liver tissues (i.e., normal parenchyma, non-specific reactive and chronic hepatitis, steatosis). The EDB+ FN mRNA isoforms were also detected in 3 cases of benign neoplasm (hepatocellular adenoma, HCA, I; nodular focal hyperplasia, NFH, 2), while the EDA+ was only detectable in I of the 2 cases of NFH. In addition, both EDA+ and EDB+ isoforms were expressed in 5 out of 9 cirrhotic livers surrounding the tumors. This molecular analysis, which can also be performed on small liver biopsies (2 mg), may therefore be a useful additional tool in the diagnosis of HCC.

Alternative Splicing↗

PubMed1994

Unusual localizations of hydatid disease: a 18 year experience.

The Authors report their experience with rare localizations of hydatid cysts during a period of 18 years. In 8 patients (14%) other organs than liver or lungs were involved: in particular one case of hydatid cyst of the spleen, one of the pancreatic area and one of the soft tissue of the back presented as primary locations. In 5 patients the disease of the liver was associated to hydatid cysts in other sites: 3 multiple peritoneal localizations, one in the abdominal rectus muscle and one of the gallbladder. Four cases (10% of the patients with liver disease) of cyst ruptures in the biliary tree were reported. In all cases differential diagnosis was more challenging than usual, but imaging devices combined with immunobiological tests could solve the diagnostic problem. Surgical treatment was as radical as possible considering the benign character of the disease. Postoperative results were satisfying: no recurrence but one was found at follow up.

Adolescent↗

PubMed1994

Superior mesenteric artery emboli during renal PTA: successful surgical treatment after fibrinolysis failure.

The paper presents a rare case of iatrogenic embolization of the superior mesenteric artery which required an emergency operation after an unsuccessful fibrinolytic treatment. An old woman, who had undergone renal percutaneous angioplasty (r-PTA), presented sudden but transient abdominal pain. Angiographic control of the angioplasty showed the goal of r-PTA but also an embolic occlusion of the main trunk of the superior mesenteric artery that did not respond to a selective fibrinolytic treatment. Within a few hours, the abdominal pain appeared again and induced an exploratory laparotomy which showed an extensive ischaemia of the whole jejunum. A successful embolectomy was performed associated with the resection of about 20 cm of necrotic jejunum. The postoperative period was uncomplicated. The case underlines several topics: close collaboration is necessary between interventional radiologists and surgeons in order to get a surgical "stand-by" during PTA procedures; the embolic occlusion of the superior mesenteric artery can produce irreversible, even if segmentary intestinal damage, also within a very short time after onset and, therefore, it seems to be at high risk for a fibrinolytic approach.

Aged↗

PubMed1991

Monitoring of somatosensory evoked potentials during carotid endarterectomy: relationship with different haemodynamic parameters and clinical outcome.

The authors studied the changes of Somatosensory Evoked Potentials (SEPs) performed in 241 anaesthetised patients during 264 carotid endarterectomies (CEs). SEP responses were considered significantly modified when the central conduction time was greater than 1 ms and/or when the amplitude of the complex N20-P25 decreased by at least 50%. Both CCT and N20-P25 have been correlated with different parameters, including the presence or absence of preoperative neurological deficits, the type of general anaesthesia, the status of the contralateral and the ipsilateral carotid artery, stump pressure, the use of an intraluminal shunt and the perioperative results. After carotid cross-clamping SEP responses were within the normal range in 236 CEs (89%), and abnormal in 28 (11%). A shunt was inserted 23 times in 264 (9%) cases. None of the patients operated on in this series experienced a permanent neurological deficit; there were three (1.1%) transient deficits (two Rinds and one TIA) and two deaths from non-neurological causes. Only one of the transient deficits was present when the patient woke from the anaesthetic and this event was predicted by significant modification of the SEP which did not reverse after removal of the clamps (a shunt was not used). None of the patients in our series who did not present significant modifications of SEPs during the operation had any postoperative neurological deficit. The authors conclude that SEP recording is a highly reliable and objective method for continuous monitoring of brain function during CE.

Brain Ischemia↗

PubMed1991

Hydatid disease of the liver: long term results of surgical treatment.

Many surgical techniques have been used in the management of the hydatid disease of the liver. The aim of the treatment should be to minimize the high risks of complication and recurrence. The Authors reviewed the records of 33 consecutive cases of hydatid disease of the liver surgically treated during a 6 year period (1974-1979) to determine complications and long term results (10 years) of the different surgical procedures applied. Partial pericystectomy with tube drainage was the most common treatment (30/49 cysts) followed by total pericystectomy (15/49) and partial liver resection (4 cases). Complication rates were 13.3%, 6.6% and 0% respectively. There was no perioperative mortality. In 1989 all patients were investigated for cystic recurrence: it was possible to study by CT scan or abdominal US 23 patients. Only three of them showed an asymptomatic recurrent disease. They had undergone partial pericystectomy in 1974 (2 cases) and 1977 (1 case) for recurrent hydatid disease of the right hepatic lobe and, in one case, even of the rectus muscle. Complication and recurrence rates seem to be higher with conservative surgical procedures compared to more radical treatment, but indiscriminate application of total pericystectomy or major liver resection may be followed by a higher incidence of major postoperative complications and mortality. Therefore, total pericystectomy or wedge resection were performed only for peripheral cysts since we believe liver resection for hydatid cyst is a very radical approach taking into account the type of disease.

Adolescent↗

PubMed1990

Immediate detection of postreconstructive ischaemia by intra-operative Doppler ankle pressure index monitoring during aortic reconstructions.

From March 1980 to February 1988, 368 aorto-iliac or aorto-femoral bilateral reconstructions were performed for aneurysmal or occlusive disease. In order to demonstrate early postreconstructive ischaemic complications, the intra-operative Doppler Ankle Pressure Index (API) was measured immediately before reconstruction (PRE), just after declamping (DEC) and 5, 15, 30 and 45 min thereafter. Each limb of the reconstruction (736) was considered individually and subdivided as follows: Group (A) 705 immediately successful (96% of limbs and 92% of patients); Group (B) 22 (3% of limbs and 5% of patients) in which, on the grounds of API data, an ischaemic complication was regarded as imminent and treated by graft revision or a peripheral thromboembolectomy (intra-operative corrections); Group (C) 9 (1% of limbs and 2% of patients) in which the diagnosis of ischaemic complications was made postoperatively when the patients underwent successful reoperation. All 736 reconstructions were patent and functional at discharge of the patient. By a retrospective analysis the intra-operative APIs were studied and the features (single or associated) suggesting an ischaemic complication examined. These were: (1) no flow at the time of declamping or its disappearance during the operation (10 cases, 1.25% of limbs) all detected and successfully corrected intra-operatively.(ABSTRACT TRUNCATED AT 250 WORDS)

Ankle↗

PubMed1990

[Carotid thromboendarterectomy in old age].

Data obtained in 323 carotid bifurcation endarterectomies and in 77 patients affected by extracranial internal carotid artery stenosis not operated, have been analyzed in relation to patients' age: Group 1 less than or equal to 69 years old (268 cases operated on and 59 not operated), and Group 2 greater than or equal to 70 years old (55 cases operated on and 18 not operated). Among the operated patients, the most important anaesthetic risk factors, the type of neurological symptoms, and the diameter of the lesion did not turn out significantly different between the two age groups, except for the patients operated on because of stenoses less than or equal to 50% of carotid lumen reduction (42 cases in Group 1 and 1 case in Group 2, p less than 0.001). The overall operative mortality rate was 1.8% (6/323 carotid endarterectomies): 1.5% in Group 1 (4/268 cases, 2 due to stroke and 2 to heart disease), and 3.6% in Group 2 (2/55 cases, both due to stroke) (N.S.). The overall neurological morbidity was 0.6%, owing to 2 strokes both found in Group 2 (3.6% of patients greater than or equal to 70 years). Therefore, the overall incidence of fatal and non fatal stroke was 1.8% (6/323 carotid endarterectomies): 0.7% (2 cases) in Group 1, and 7.3% (4 cases) in Group 2 (p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Age Factors↗

PubMed1989

Predictive value of cervical bruit for the detection of obstructive lesions of the internal carotid artery. Data from 2000 patients.

Between January 1982 and June 1985, 2000 patients with either symptoms of cerebrovascular insufficiency (1873) or asymptomatic cervical bruits (127) were studied at the Surgical Department of the University of Brescia (Italy). Of these, 441 presented a mono- or bilateral cervical bruit. The value of the bruit as indicator of an obstructive pathology of the extracranial carotid artery was evaluated in comparison with the findings of Doppler spectrum analysis. A stenosis or occlusion of the internal carotid artery was present in 51% of the patients with a bruit (homolateral to the bruit in 91% of the cases) and in 9% of those without a bruit. Stenoses of a medium-high degree were those more often associated with the bruit. Both in patients with bruit and in those without bruit the age and the severity of the presenting symptoms significantly influenced the rate of association with lesions of the internal carotid artery was present in 51% of the patients with a bruit (homolateral to the bruit in 91% of the cases) and in 9% of those without a bruit. Stenoses of a medium-high degree were those more often associated with the bruit. Both in patients with bruit and in those without bruit the age and the severity of the presenting symptoms significantly influenced the rate of association with lesions of the internal carotid artery.

Adult↗