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S M Giulini

Publications and source records attributed to S M Giulini.

83 records · Page 5Linked to original sources
PubMedDate not supplied

[Results of elective open surgery for juxtarenal aortic aneurysms].

Review of the most significant surveys (data base: Pub Med on September 2003) of elective open surgery for Juxtarenal aneurysms and personal results of 106 cases (9.3% of AAA consecutively operated in the last 11 yrs.) are reported. Mortality and morbidity are discussed related to: technique of aortic cross-clamping; protective measures on splanchnic and renal perfusion; risks from previous CAD and chronic renal failure. Over all, the main predictive factor is the accuracy of the selected technique, without any difference among different approaches, and the same results of infrarenal aneurysms can be obtained.

Adult↗
PubMedDate not supplied

[Intra- and postoperative changes in blood viscosity].

Blood and plasma viscosity has been controlled in a group of patients undergone to aorto-iliac reconstruction and in a group of control after thyroidectomy, cholecystectomy, and hernioplasty. The hemodilution induced by intraoperative infusion in the vascular reconstruction produced an important decrease of hematic and plasmatic viscosity which lasted for several days after the operation. Removing the hemodilution effect by a mathematical correction of the viscosity measured values to a standard haematocrit, it has demonstrated as surgical operation, apart from its entity, promoted an increase of the viscosity which persisted long in the postoperative course. For what it concerns the risk of postoperative thrombosis from one side protective effect of hemodilution is confirmed, from the other, in absence of the hemodilution, it would be useful to continue the antithrombotic prophylaxis longer the perioperative time as usual.

Aged↗
PubMedDate not supplied

Surgical treatment of lesions obstructing the external carotid artery.

Atherosclerotic lesions obstructing the external carotid artery are generally disregarded in the evaluation of patients with symptoms of cerebral ischemia; nevertheless, in the presence of occlusion of the ipsilateral or of both the internal carotid arteries, external carotid artery endarterectomy may be indicated, in order to increase the flow to the brain through collaterals. A lesion of the external carotid artery may be the source of retinal emboli; patients may benefit from surgical treatment of the lesion. The Authors of the present paper operated on 6 such patients, from a total of 230 carotid bifurcation endarterectomies performed in the period between January 1982 and March 1988. Morbidity and mortality were nil and 5 of the 6 patients are free of symptoms after a mean follow-up period of 23 months. One patient died 2 months after surgery due to a myocardial infarction. On the basis of this experience, the Authors discuss indications, surgical techniques and results of the surgical treatment of lesions obstructing the external carotid artery.

Aged↗
PubMedDate not supplied

[Doppler spectrum analysis and traditional angiography in the study of the extracranial tract of the internal carotid artery].

Examination of 88 extracranial carotid arteries using CW Doppler spectrum analysis is compared with the findings of transfemoral conventional arteriography. There is no significant difference (P greater than 0.05) between CWD and angiographic results, although sensitivity, specificity and accuracy are superior for the latter technique. CWD spectrum analysis can underestimate complete occlusion and misinterpret the degree of stenosis, however it is a cheap and rapid procedure that can be used to judge whether particular symptoms are due to identifiable disease and whether selective carotid arteriography is advisable.

Carotid Artery Diseases↗
PubMedDate not supplied

Direct and indirect evaluation of lesions obstructing the carotid bifurcation. A comparison of Doppler spectrum analysis with angiography.

The diagnostic accuracy of real-time continuous wave (c.w.) Doppler spectrum analysis and of indirect periorbital Doppler examination for detecting carotid bifurcation disease was evaluated. The results of non-invasive studies were compared with contrast arteriograms of patients studied for symptomatic cerebrovascular disease (91%) or for asymptomatic bruits (9%). Periorbital examination was insensitive to less than 75% carotid stenoses and sensitivity to severe stenoses or occlusions was respectively 56% and 85% (mean 73%). Mean sensitivity of real-time C.W. Doppler spectrum was 93% and sensitivity to stenoses of less than 45% diameter reduction was equal to 76%, while specificity in identifying normal carotid arteries was 89% for an accuracy of the method of 91%. Positive and negative predicting values were respectively 89% and 93%. Direct Doppler interrogation of the carotid arteries with real-time C.W. Doppler spectrum analysis was able to distinguish operable stenoses from inoperable occlusions in 87% of the cases.

Angiography↗
PubMedDate not supplied

Intra-operative control of carotid thromboendoarterectomy by Doppler spectrum analysis.

The authors report their experience with intraoperative Doppler spectrum analysis of carotid flow after thromboendoarterectomy. The method seems to be useful in the early localisation of technical defects potentially responsible for postoperative stroke. In 22 patients operated on consecutively, three major abnormalities were detected, one of the internal and two of the external carotid. This enabled immediate reexploration of the involved artery with restoration of normal flow. This kind of examination is also safe, quick and highly accurate. The authors propose it as a substitute to intraoperative arteriography which is routinely performed by some surgeons after carotid thromboendoarterectomy.

Carotid Arteries↗
PubMedDate not supplied

[Indications and short and medium time results of crossover bypasses in the treatment of obstructive arteriopathies of the lower limbs].

The authors evaluate the indications, the hemodynamical aspects, the short and medium term results over their track record of 49 crossover bypass (44 dacron and 5 PTFE grafts) performed between 1981 and 1993. Crossover bypass grafts were mainly inserted for unilateral iliac arterial disease in order to avoid aortic manipulation. This procedure was particularly selected when in presence of: young patients (< 60 years old), high surgical risk, poor run-off, high risk of prosthetic infection, thrombosis and/or infection of orthotopic grafts. 3 ilio-iliac, 27 iliofemoral, 18 femorofemoral and 1 femoropopliteal bypass have been performed. The postoperative resting pressure Index increase was highly significant in recipient limbs. There wasn't perioperative mortality; during the follow up (mean 24.4 months) no amputation of recipient limb was observed. 4 patients died of A.M.I. and 1 of neoplastic disease. Late cumulative patency rate was 81% at 2 years and 67.3% at 3 years. These values rise to 97.2% and 86.1% respectively when considering patients with "ideal" indication (excluding 7 patients operated on for complications of previous bypass grafts and 6 with extremely poor run-off). An accurate evaluation of the lesion topography and haemodynamic pattern of donor and recipient iliofemoral districts are stressed as key points for a correct surgical indication.

Adult↗
PubMedDate not supplied

Arterial chemoembolization in hepatocellular carcinoma suitable for resective surgery.

BACKGROUND/AIMS: Authors examined transcatheter arterial embolization (TAE) reliability in modifying diagnosis, staging, choice of treatment after a common instrumental evaluation and in increasing results in patients with hepatocarcinoma(s) potentially suitable for surgery; this value was compared to TAE-related mortality and morbidity. MATERIALS AND METHODS: Thirty-nine patients underwent TAE. Diagnostic value, reduction in tumor size and necrosis' percentage after treatment were computed. Immediate and long term results were compared to those obtained by primary liver resection in 62 patients. RESULTS: TAE showed more lesions than any other diagnostic tool, thus excluding 4 patients (10.2%) from surgery. TAE-related mortality (1 patient) and severe morbidity (11 patients) excluded 4 more patients. Complications were correlated to Gelfoam embolization (p < 0.01). After TAE tumor size reduction was sporadic; tumor necrosis > 70% was present in 13/29 resected tumors. Intraoperatively 16/25 patients had TAE-related anatomical alterations; a choledochus' wall necrosis and a tumor' explosion must be mentioned. TAE and intraoperative echography had an equivalent diagnostic value. Immediate and long term results were comparable to those obtained by primary liver resection. CONCLUSIONS: TAE has a high diagnostic accuracy but the capacity in changing the final judgment after a good instrumental evaluation is low. The specific risk-benefit ratio is not favourable, in particular after mechanical embolization, and clinical benefit is not evident.

Aged↗
PubMedDate not supplied

[Total pancreatectomy. Which indications?].

This a review of the different topics held by literature for and against total pancreatectomy (TP) for adenocarcinoma of the pancreas. Technical and oncological aspects are discussed as are the metabolic effects of TP; metabolic data of our series of 6 TP are also referred. Postoperative mortality and morbidity decreased to less than 5% during the last decade both for TP and the Whipple procedure; long term survival is also similar for the two procedures. Even if the metabolic consequences of both exocrine and endocrine function deprivation are generally well compensated, they can still threaten the patient's life; furthermore their long term effects are only partially known. These are the reasons that force most authors to choose TP only in selected patients in which a multifocal neoplasia is demonstrated or whose pancreatic remnant is particularly soft and friable with high risk of pancreatojejunostomy complication. A pancreatic remnant in fact grants the hormonal milieu that makes easy the pharmacological control of any pancreatic function deficiency.

Carcinoma↗
PubMedDate not supplied

[Splanchnic aneurysms: 10 treated cases and review of the literature].

The splanchnic aneurysms, which are complicated by rupture in 25% of cases with a mortality of 25-70%, are usually a surprise during diagnostic tests for other abdominal pathologies or emergency laparotomies. 10 cases treated (8 in elective and 2 in emergency surgery) are presented here: the aneurysm was in celiac trunk (1 patient), common hepatic artery (1 pt.), hepatic artery (2 pts.), gastroduodenal artery (1 pt.), superior mesenteric artery (1 pt.), inferior pancreaticoduodenal artery (1 pt.), right colic artery (1 pt.) and inferior mesenteric artery (1 pt.). There were 1 case of Marfan syndrome and 9 cases of atherosclerosis, 4 of which arteries presenting hyperdynamic flow consequent to occlusions of the superior mesenteric artery and/or the celiac trunk. The 2 cases operated on for hemoperitoneum underwent aneurysmectomy and ligation of the inflow vessels (1 death from pulmonary embolism on 5th postoperative day), whereas the 8 cases electively treated (with no deaths and I case of transient diarrhoeal syndrome) underwent 4 aneurysmal resections with end-to-end arterial reconstruction, 3 PTFE-graft substitutions and 1 autologous saphenous vein substitution. At follow-up (12-74 months; mean 30.6) all the reconstructions resulted successful. These data confirm the consistent indications of the recent Literature suggesting the indication to the surgical treatment of the incidental aneurysms in the splanchnic area.

Aged↗