PubMed Health⌕ Search

Biomedical subjects

V Sciacca

Publications and source records attributed to V Sciacca.

At least 55 records · Page 3Linked to original sources
PubMed1986

An uncommon systemic arteritis--a case report.

A 26-year-old male shortly after an acute respiratory disease was affected by a thrombophlebitis of the left leg. After a few days he had two syncopal attacks. Later on, a myocardial ischemia was diagnosed. Subsequently the patient began to complain of a bilateral claudication of the calves; after an attack of fever, the ischemia of the lower limbs worsened with recurring pain at rest. At the same time, in absence of any symptom, a myocardial ischemia occurred again and the presence of a thrombus was observed in the right atrium. After surgical removal of it, the ischemic troubles of the lower limbs once again began to worsen with the occurrence of bilateral gangrene of the feet. An amputation of both the legs was promptly performed at the level of the thighs. The histological examination of the arteries of the amputated legs showed segmental arteritis with partially recanalized thrombi of the popliteal, left femoral and tibioperoneal arteries. In the meantime, the titres for Coxsackie virus B2 and B6 were found slightly increased. One month later, the left radial pulse disappeared for a few days. The histopathological findings may relate this arteritis to a form of Buerger's disease even if a systemic thromboangiitis obliterans is not commonly accepted. In case that the acute respiratory infection represented the true onset of the sickness, it seems conceivable that the hypothesis of a viral infection gave raise to arteritis with morphological features recalling those of Buerger's disease.

Adult↗
PubMed1986

Modifications of transcutaneous oxygen tension in lower limb peripheral arterial occlusive disease patients treated with spinal cord stimulation.

The current noninvasive techniques for investigating the response to epidural spinal cord stimulation in peripheral arterial occlusive disease patients are far from optimal. Transcutaneous oxygen tension measurements in these patients treated with spinal cord stimulation demonstrated a statistically significant increase during the stimulation and 30 min after the pacemaker has been switched off, suggesting the effectiveness of the spinal cord stimulation on cutaneous oxygenation. The transcutaneous oxygen tension measurements would represent in the future a reliable parameter to predict the effect and to modulate the pacemaker setting in peripheral arterial occlusive disease patients.

Aged↗
PubMed1985

Takayasu's disease in middle-aged women. A clinicopathologic study.

Of ten patients with Takayasu's disease (TD), all women, hospitalized in our Service in the last 5 years, seven were more than 38 years old. In these subjects the mean age at diagnosis was 41.2 years. These findings confirm that, in Italy as in other Western countries, including the United States, the diagnosis of TD is usually made later than in Asia and Latin America. This circumstance is probably related to actual later onset of the disease. In most of our cases both the anamnestic data and the angiographic findings demonstrated an evolution of the disease with further involvement of other arteries. Several arterial biopsies consistently showed, within a diffuse sclerosis, more or less extensive inflammatory aggregates characterized by a lymphoplasmacellular infiltration often associated with giant cells. Such a pattern testifies to the persistence of an active arteritis even a long time after the onset of the disease - "persistent active arteritis" instead of "residual arteritis." Pointing out such an evolution of the TD in every stage, our clinicopathologic study emphasizes the importance of a careful followup of the patients; it also advises continuous treatment with corticosteroid drugs, sometimes associated with immunosuppressors, to attain a reduction of the inflammatory process.

Adult↗
PubMed1985

Buerger's disease in women. A case report with critical approach to the literature.

The Authors describe a case of arteritis of the lower limbs in a woman, in which the clinico-angiographical features were suggestive for Buerger's disease, and this was confirmed by histological examination of the left posterior tibial artery. A bilateral lumbar sympathectomy was effective at least in slowing the course of the disease.

Adult↗
PubMed1985

In vivo study of Dacron aortic grafts through B-mode ultrasonography.

Real-time B-mode ultrasonography was used to study in vivo the behavior of bifurcated aortic grafts (Dacron knitted) implanted over a period of 1 to 88 months previously in 67 patients, 28 of whom (42 per cent) were hypertensive. Most grafts showed an increase in size, when compared with the original one, which appeared to be closely related to arterial pressure (P less than 0.05). This increase was not dependent on the time elapsed from implant.

Aorta, Abdominal↗
PubMed1985

Renal vein thrombosis with involvement of the vena cava: report of a case.

A case of bilateral renal vein thrombosis with involvement of the vena cava in a nephrotic patient, treated by thrombectomy and anticoagulation, is reported. A iatrogenic lesion of the right renal vein during thrombectomy forced to perform a nephrectomy; the patient died four months later from renal failure. The rationale for the different treatments of renal vein thrombosis, as a complication of the nephrotic syndrome, is shortly discussed.

Adult↗
PubMed1984

Biogenic grafts in arterial surgery--long-term results (I. The homologous vein--II. The modified heterologous bovine carotid artery--III. The human umbilical vein).

This report summarizes the authors' experience with homologous vein grafts, modified heterologous bovine carotid artery grafts and human umbilical vein grafts in reconstructive vascular surgery. The homologous saphenous vein, taken from living donors, was implanted in 21 patients. The high percentage of early and late complications (28% and 38%, respectively), the difficult availability and the development of modern materials appear to suggest that these grafts, at least the type used in this study, should no longer be employed. The experience with 102 femoro-popliteal and femoro-tibial bypasses in 140 revascularization operations carried out with modified heterologous bovine carotid artery grafts (Solcograft) is presented. The cumulative patency rate was 43% after 5 years for the above-knee and 33% for the below-knee femoro-popliteal bypasses. The high early and late complication rates (37% and 35%) lead us to believe that this graft should also no longer be employed. The human umbilical cord vein (Meadox-Dardik-Biograft) was used in performing 68 femoro-popliteal and 15 femoro-crural bypasses in 60 limbs of 57 patients. The patency rates calculated according to the standard life table method was 36% for the above-knee (after 5 years) and 32% for the below-knee femoro-popliteal bypass (after 4 years) and 31% (after 3 years) for the femoro-tibial bypass, respectively. On the understanding that other materials should be preferred in the individual case, this material still seems to be recommendable as a graft of second or third choice.

Adolescent↗
PubMed1983

[Polymyalgia rheumatica and giant cell arteritis, clinical and histopathological study of three cases].

We report three patients with giant cell arteritis but no clear clinical signs of temporal artery involvement, during an episode of polymyalgia rheumatica. In the first case a biopsy performed upon an apparently normal temporal artery showed a typical hortonian arteritis. The same finding was obtained from a pulseless right temporal artery in the second patient, who suffered a sudden blindness of right eye after a trigeminal neuralgia. In the third case the polymyalgic symptoms developed together with a syndrome of the aortic arc. The histologic findings of the temporal artery were normal, whereas the biopsy performed on both the subclavian arteries during surgical revascularization demonstrated a typical giant-cell arteritis in the acute stage. The cases mentioned above confirm that there is a close relation between polymyalgia rheumatica and Horton arteritis. In the latter the temporal localization could be inconstant.

Aged↗
PubMed1980

[Syphilitic aneurysms of the abdominal aorta. Considerations on 2 cases].

Abdominal aortic aneurysm have been considered in the modern literature only arteriosclerotic, apart from any possibility of superimposed bacterial infections. In 2 cases, after the hystological study on the aneurysmatic wall the Authors have found typical syphilitic lesions. both didn't have positive historical data and in one only serological tests were positive. This observation calls the attention on the importance of such an insidious pathology which is still present in spite of the decrease of the luetic epidemiology. It happens mainly in patients ignoring to be carriers of a remote infection or in those inadequately treated for it. Even it anamnestical and serological data are negative not only in presence of a thoracic aortic aneurysm but also in presence of an abdominal one, physicians must take syphilis into account in their diagnosis. The mistake comes often from an associated arteriosclerotic process present in elderly patients developing the aortitis a long time after infection. Therefore it is necessary to perform a careful hystological test of the aneurysmatic wall even if macroscopical examination suggests only arteriosclerotic lesions. An hystological evidence of syphilitic aortitis advises a long-term treatment aimed to avoid other localizations.

Aged↗
PubMedDate not supplied

Epidural spinal cord electrical stimulation in diabetic critical lower limb ischemia.

Spinal cord stimulation (SCS) has been suggested to improve microcirculatory blood flow to relieve ischemic pain and to reduce amputation rate in patients with peripheral arterial occlusive disease (PAOD). The aim of this study was to evaluate the specific prognostic parameters in the prediction of successful SCS, in diabetic patients, performing a retrospective data analysis. To perform this evaluation, 64 diabetic patients (39 men, 25 women; mean age, 69 years) classified as Fontaine's stage III and IV, with PAOD, were treated with SCS for rest pain and trophic lesions with dry gangrene, after failed conservative or surgical treatment. In clinical controls, pedal transcutaneous oxygen tension (TcPO(2)), ankle/brachial blood pressure index (ABI), and toe pressure Doppler measurements were utilized to select and follow-up the patients. After 58 months of follow-up (range, 20-128 months), pain relief greater than 75% and limb salvage were achieved in 38 diabetic patients. A partial success was obtained in nine patients with pain relief greater than 50% and limb salvage for at least 6 months. The method failed in 17 patients or the device was removed due to technical problems, and the limb was amputated in these patients. TcPO(2) was assessed on the dorsum of the foot. Clinical improvement and SCS success were associated with increase of TcPO(2), before and after implantation. Limb salvage was achieved in the patients who had significant TcPO(2) increase within the 2 weeks of the testing period, independently of the stage of the disease. A TcPO(2) increase of more than 50% in the first 2 months after implantation was predictive of success, and was related to the presence of adequate paresthesias in the painful area during the trial period. TcPO(2) significantly increased after long-term follow-up in all patients with limb salvage (from 22.1 to 43.1 mm Hg in the rest pain patients, from 15.8 to 36.4 mm Hg in those with trophic lesions of less than 3 cm(2), and from 12.1 to 28.1 in those with trophic lesions of greater than 3 cm(2), (p < 0.01). ABI did not changed under stimulation. In diabetic patients with PAOD, the SCS increases the skin blood flow, is associated with significant pain relief, and could be proven an excellent alternative therapy, improving the life quality. Significant TcPO(2) increase within the 2-week test period, is a predictive index of therapy success and should be considered before the final decision in terms of cost effectiveness, before the permanent implantation.

Aged↗
PubMedDate not supplied

Transcutaneous oxygen tension (TcPO2) in the testing period of spinal cord stimulation (SCS) in critical limb ischemia of the lower extremities.

BACKGROUND: Spinal cord stimulation (SCS) improves microcirculatory blood flow, relieves ischemic pain and reduces amputation rate in patients with severe peripheral arterial occlusive disease. AIM: To evaluate the transcutaneous oxygen tension (TcPO2) measurements as a specific prognostic parameter in the prediction for permanent device implantation in a prospective controlled study in patients with lower limb ischemia. METHODS: 45 patients (35 men, 10 women; mean age 65 years, range: 46-70 years) were submitted to implantation of a spinal cord electrical generator for rest pain, trophic lesions dry gangrene in severe lower limb ischemia, after failed conservative or surgical treatment. The clinical status was classified as Fontaine's stages III and IV and the main pathology was essentially due to atherosclerosis and diabetic vascular disease. Pedal transcutaneous oxygen tension (TcPO2), ankle and toe pressure Doppler measurements were performed before, 2 weeks and 4 weeks after implantation. RESULTS: After 18 months follow-up, pain relief was > 75% and limb salvage was achieved in 26 patients. In 9 patients, a partial success with pain relief > 50% and limb salvage was obtained for at least 6 months. In 10 patients, the method failed, and the patients' limbs were amputated. TcPO2 was assessed on the dorsum of the foot. Clinical improvement and SCS success was associated with an increase of TcPO2, within the first 2 weeks after implantation (temporary period). Limb salvage was achieved in those patients who presented significant TcPO2 increase within the first 2 weeks of the testing period (from 21.6 mmHg to 29.5 mmHg in the patients with rest pain, P = 0.035, from 15.2 mmHg to 21.1 mmHg, P = 0.035 in those with trophic lesions < 3 cm2, and in those with trophic lesions > 3 cm2, from 12.4 mmHg to 17.3 mmHg) independently of the stage of the disease and of the initial TcPO2 value. TcPO2 changes were related to the presence of adequate paresthesias and warmth in the painful area during the trial period. The systolic ankle/brachial blood pressure index did not change under stimulation. CONCLUSIONS: In patients with failed conservative and surgical treatment for severe critical lower limb ischemia, the SCS increases the skin blood flow, is associated with a significant pain relief and could prove an excellent alternative therapy that improves the quality of life. We also demonstrate that TcPO2 increase within a test period of 2 weeks, is a predictive index of SCS therapy success and should be considered in terms of cost effect before the final decision for permanent implantation.

Aged↗
PubMedDate not supplied

Diagnosis and treatment of Barrett's oesophagus. A general survey.

Barrett's oesophagus is an acquired condition with columnar metaplasia of the distal oesophagus. This condition represents the most serious consequence of chronic gastro-oesophageal reflux as it is associated with an increased incidence of oesophageal adenocarcinoma. Since the exact pathophysiology is not known, prevention is not possible. The diagnosis of Barrett's oesophagus requires the presence of intestinal metaplasia in at least one biopsy specimen from the lower oesophagus. Barrett's oesophagus is considered a premalignant condition and some cases progress from dysplasia to invasive adenocarcinoma. Medical or surgical antireflux treatment controls symptoms and oesophagitis, but Barrett's oesophagus remains. Patients are usually followed up by endoscopy for detection of dysplasia or early cancer. Several reports in the literature have assessed the effects of H2-blocker and proton pump inhibitors treatment on Barrett's epithelium, but none has clearly documented a significant and consistent regression of the metaplastic epithelium. Even with high doses of proton pump inhibitors given for a prolonged period of time, it does not appear that a significant regression of Barrett's epithelium can be achieved. Various studies have assessed the effects of antireflux surgery on the regression of columnar epithelium and dysplasia and its potential protective effect on the subsequent development of carcinoma. Overall, it appears from these reports that antireflux surgery, despite adequate symptomatic results, does not significantly and consistently lead to a reduction in length or disappearance of the Barrett's mucosa, and does not prevent the development of dysplasia and its progression to carcinoma. Recently, numerous reports have documented the regression of Barrett's mucosa by using various experimental techniques: these thermal therapies focus on the removal of the columnar epithelium with restoration of the squamous epithelium. Technological advances including laser and especially photodynamic therapy have allowed for endoscopic mucosal ablation. Long-term results are more encouraging when this mucosal ablation is associated with antireflux medical or surgical therapy. Currently, none of these approaches can obviate the need for continued endoscopic surveillance; however the photodynamic therapy seems to be a promising alternative in the future.

Aftercare↗
PubMedDate not supplied

The effect of body weight compression on axillo-femoral by-pass patency.

The influence of external compression on extra-anatomic bypass patency is still debated. The specific purpose of this study is the evaluation of ankle Pressure Index (P.I.) and Pulse Volume Recorder (P.V.R.) wave amplitude changes after 5 and 10 minutes of external bypass compression by body weight, lying on the side of the reconstruction. Eight patients with axillo-femoral bypass (mean follow-up 15.5 months) have been evaluated. The external body weight compression caused important changes of graft haemodynamics: (1) decrease in ankle Pressure Index at 5 min (p less than 0.005) or 10 min (p less than 0.0005); (2) decrease in P.V.R. wave amplitude at 5 min (p less than 0.005) and 10 min (p less than 0.025).

Aged↗
PubMedDate not supplied

Cross-over axillary by-pass. Treatment of subclavian or innominate artery obstructive lesions.

A 13-year experience consisting on 16 consecutive patients submitted to axillary-to-contralateral artery by-pass in the treatment of obstructive lesions of the subclavian or innominate artery is reported. Nine patients complained of typical subclavian steal syndrome. Extended patency with very satisfactory functional result was achieved in twelve patients. An extensive survey is made of the results of such procedure, as reported in the literature. The theoretical advantages in comparison with other kinds of extrathoracic procedures aiming at the same goal are briefly outlined.

Adult↗