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Biomedical subjects

F Giordanengo

Publications and source records attributed to F Giordanengo.

At least 37 records · Page 2Linked to original sources
PubMed1993

Idiopathic varicocele: a comparison between types of surgery based on the results of spermiogenesis.

Varicocele must be regarded of the utmost importance in determinating male infertility. Surgical indications should be considered of primary interest in order to achieve a qualitative and quantitative improvement in spermiogram parameters in the majority of the cases. Recent reports showed that it is not the severity of the lesions to determine the alterations in seminal parameters but the length of time of the varicocele. In our report we consider the results achieved on the spermiogram parameters in two groups of 25 patients surgical treated with different techniques. The first group was treated, in others Centers, by means of the traditional technique of ligature of the spermatic vein (Ivanissevich, Palomo). We treated all the patients of the second group (53 patients) with microsurgical technique of anastomosis pampiniform plexus-saphenous vein, and we control the sepermiogram parameters in 25 patients. The first group showed an improvement of the spermiogram parameters after 6 months from the surgical treatment in the 64% of the cases, while in the second group the improvement was of the 92%. Moreover we registered the persistence of this improvement after 12/36 months from the operation time. On the basis of these observations we think that the microsurgical technique leads to the best and longest results on the most invalidating cause of this pathology.

Adolescent↗
PubMed1993

The association between abdominal aortic aneurysms and chronic leg ischaemia. Prevalence in 125 consecutive patients.

A study was carried out to see if in patients with atherosclerotic lesions of the lower limbs the percentage of abdominal aneurysms is higher than in the general population. One hundred twenty five consecutive patients were studied in two different hospitals and compared with a control group. In the two groups with peripheral vascular diseases the patients had a prevalence of aneurysms of 12%, while in the control group the prevalence was of 3%. All patients were operated on successfully except two of them who are now in follow up with regular ultrasound assessment, one with an aortic aneurysm of 3.2 cm and the other with an aortic diameter of 4 cm and moderate liver failure.

Aged↗
PubMed1993

Splanchnic artery aneurysms.

From 1970 to October 1991, 26 patients affected by splanchnic artery aneurysms were observed and treated at the Department of General and Cardiovascular Surgery, University of Milan, Italy. Three splanchnic artery aneurysms were operated on in emergency. Visceral artery aneurysms are often completely silent and are generally detected during diagnostic procedures performed in order to clarify some diagnostic questions. When symptomatic they present a characteristic clinical picture of the involved vascular district. Two patients affected by aneurysmal disease of the proper hepatic artery died after operation. All the other splanchnic aneurysms underwent a successful surgical procedure. This study is aimed at analyzing some characteristic clinical pictures, diagnostic methods, therapeutic procedures and postoperative results.

Adult↗
PubMed1993

[Critical ischemia of the lower limbs: pathogenesis, clinical course and therapy. Results of authors' experience in 337 cases].

The definition of an ischaemic condition at lower limb level, may imply any different degree of the pathology, starting from a simple chronic slight claudication up to a severe ischaemia. Critical Limb Ischaemia is the term defined to identify an ischaemic condition, which endangers the limb or part of a limb and requires a prompt and appropriate treatment. However the pathophysiology of this condition remains to be well established and depends on various vascular factors. For the European Working Group on Critical Limb Ischaemia (Berlin 1989, Rudesheim 1991) the definition is strictly restricted to Fontaine's stage III B and IV, while in our opinion the definition could be very simple in all the patients with a prognostic limb-threatening condition (for localization and wide extension of the lesions) independent of the Fontaine's stage, which are going towards a future amputation if radical improvement of blood flow cannot be achieved with an adequate revascularization. In our five year late experience, we observed and surgically treated 337 patients with CLI (74% males and 80% atherosclerotic lesions). We discuss the preoperative findings, diagnostic procedures, surgical techniques and relate results.

Aged↗
PubMed1993

[Current role of extra-anatomical revascularization of the lower limbs].

In vascular reconstructive surgery of the lower limbs for aorto-iliac disease the first choice procedure is TEA or aorto-femoral bypass. In "high risk patients" alternative procedures like extra-anatomical bypass (axillo-femoral or femoro-femoral bypass grafts) are available. In some cases, such us infection of a retroperitoneal prosthesis, an axillo-femoral bypass is mandatory in order to obtain revascularization of the lower limbs. In this article we report our late experience in this surgery and our opinion on the correct indication for the use of these procedures.

Aged↗
PubMed1993

[Vascular complications in drug addicts. Intermittent claudication in a HIV seropositive heroin addict].

The widespread use of heroin has revealed the growing life-threatening complications consequent on drug practice. The effects of heroin on the cardiovascular, pulmonary, renal and central nervous system have been well described in medical literature, but the vascular complication of chronic occlusive arterial disease of the lower limbs is rare. We report a case of a young female patient who was a chronic drug addict for over five years, with concomitant serum positiveness for HIV infection. The etiologic and pathogenetic mechanisms of such an uncommon vascular complication are discussed on the basis of the existing literature.

Adult↗
PubMed1992

[Femoral non-infected anastomotic pseudoaneurysm. Clinical contribution].

The femoral region is the most common site of development of anastomotic pseudoaneurysms that represent a relatively frequent complication of reconstructive vascular surgery. Clinical examination alone generally is sufficient to diagnose these lesions because they usually appear as a pulsatile inguinal mass not accompanied by pain. Echography and angiodynography permit a better evaluation of size and blood flow. CT is useful to evaluate proximal aortic anastomosis specially in pseudoaneurysms with septic pathogenesis. Rupture or thrombosis are rare clinical presentations. Vascular reconstructive surgery is always suggested in this sort of pathology. In this paper the Authors report the clinical experience acquired from 1980 to 1990 in the General and Cardiovascular Surgery Department of the University of Milan (Head: Prof. Ugo Ruberti) is 34 cases of femoral anastomotic aseptic pseudoaneurysms, analyzing the pathogenesis of this sort of lesion, describing the surgical solutions adopted and reporting the immediate and late results.

Aged↗
PubMed1992

[Physiopathology of venous stasis at the microcirculation level].

The division of the venous circulation in to two sectors, one constituted by the superficial and deep venous trunks (macrocirculation) and the other by the capillaries and precapillary venules (microcirculation), is surely schematical but aids the comprehension of many hemodynamic effects connected to hampered venous return and to the incompetence of the valvular devices. In fact many of the effects of stasis and venous hypertension (oedema, red cell diapedesis, skin dystrophies) cannot be explained merely by hydraulic mechanisms but require a primary alteration of the microvascular wall associated with structural changes of the perivascular connective tissue. The alterations that occur in microcirculation are of the utmost importance in the formation of the venules ulcerations. The passage of fibrinogen through large pores in the venules of the patients affected by venous hypertension derived from venous insufficiency creates a pericapillary fibrin deposition that cannot be removed because of inadequate blood and tissue fibrinolysis. This accumulation acts as a barrier to the diffusion of oxygen and other nutrients, determining a stasis dermatitis that may lead to tissue necrosis and ulceration. The more precise knowledge of the phenomena connected with the venous stasis at the level of microcirculation (pericapillary fibrin deposition, endothelial ischemia, blocked lymphatic drainage) will not only allow a deeper comprehension of the clinical signs but hopefully will lead to a more effective treatment of the postphlebitic syndrome.

Humans↗
PubMed1992

[Profundaplasty as the only revascularization procedure in ischemia of the leg. Clinical contribution].

The profunda femoris artery is the primary source of collateral flow to the lower extremity in the presence of superficial femoral and/or popliteal occlusion. The arteriosclerotic disease involvement of this segment is relatively less frequent and in the majority of the cases localized on the ostium and reaches to the first branch. Profundaplasty to relieve limb-threatening ischemia is infrequently employed as an isolated procedure. However many Authors reported their experience on this treatment, in case of critical limb ischemia in patients without significative lesions of the aortofemoral district. Our late four year experience concerns of 22 patients (18 male, 3 female). All the patients had severe ischemia of the lower limbs, with serious symptoms, such as invalidating claudicatio (13), rest pain (7) and gangrene (2). Twenty-two profundaplasty were performed as the only reconstructive procedure. There was no postoperative mortality. Two patients had above knee amputations (15 days and 14 months after the revascularization). All of the other patients improved and follow-up extended to 48 months shows a limb salvage rate of 90%. In conclusion, on the basis of our experience, we think that the operation is recommended, whenever possible, in patients with critical ischemia when the possibilities of more extensive revascularization procedures are considered to be poor.

Aged↗
PubMed1992

[Cerebrovascular insufficiency: diagnostic technics compared].

The ability of angiodynography (or Color Flow Imaging) to achieve accuracy in image resolution of thin details of venous as well as arterial vessels has made continuous wave Doppler and frequency analysis Doppler almost obsolete techniques. Some controversies exist about the effectiveness of color flow imaging versus duplex scanner imaging, but recent progress in ultrasound imaging technology seems to overcome the problem. Angiodynography can effectively substitute X-ray angiography in some specific instances and is able to limit the use of invasive techniques to cases in which surgical procedures are really foreseeable. The non-invasiveness of angiodynography makes it useful to follow-up the asymptomatic lesions, particularly those of the carotid artery, as well as operated patients. Moreover, people for whom contrast angiography is contraindicated can be operated safely on the bases of angiodynography alone. This paper reports the results of one-year activity of Ultrasound Vascular Laboratory with 1982 patients: 923 (48.7%) had their epiaortic arterial vessels examined, with 180 (19.5%) follow-up controls, 297 (39.9%) negative explorations, 234 (31.5%) hemodynamically not significant lesions, 135 (18.2%) subjects affected with moderate (50-70% stenosis) and non ulcerated carotid stenosis, and 77 (10.4%) patients with ulcerated plaques or > 70% stenosis.

Carotid Artery, Internal↗
PubMed1992

[Isolated aneurysms of the internal iliac artery. A clinical contribution].

Five patients with isolated aneurysms of the internal iliac artery were identified and submitted to surgical procedure. Two patients were operated on in election, three in emergency with aneurysmatic rupture. The natural course of this pathology is one of progressive expansion and rupture. This lesion is often asymptomatic, but sometimes we found associated, compression symptoms of genito-urinary, intestinal tract and venous and neurological structures. Echography, CT scan and angiography are the most common and useful diagnostic procedure. Endoaneurysmectomy with proximal and distal suture of the stumps is the appropriate treatment in the majority of the cases.

Aged↗
PubMed1992

[The rupture of an abdominal aortic aneurysm in a patient with a fused horseshoe kidney. A clinical case report].

An emergency operation for a ruptured aortic aneurysm can be very difficult in the presence of horseshoe kidney. This concomitance is rare but represents an interesting challenge for vascular surgeons. The authors report a case of 80 year old male patient who reached the operating theatre for ruptured aortic aneurysm. Unexpectedly a preaortic horseshoe kidney was found. The authors describe the surgical technique adopted to get rapidly to the aneurysm collar preserving kidney integrity.

Aged↗
PubMed1991

[The surgical prevention of pulmonary embolism. Comments on 100 patients treated by different methods].

A series of 100 patients suffering from deep venous thrombosis with prior episodes of pulmonary embolism or ilio-caval floating thrombi, submitted to surgery for the prevention of new embolic episodes, is analysed. Indications are discussed together with the various prevention techniques adopted over the past 5 years. Special attention is paid to the analysis of 11 patients operated on in the last 2 years by thrombectomy of the infra- and suprarenal vena cava.

Adolescent↗
PubMed1991

[Prosthetic infection in vascular surgery].

Infection is one of the most serious complications that can occur in a patient who had an arterial surgical procedure with implantation of synthetic prosthetic grafts. The incidence of this complication is higher when the prostheses are placed in superficial area than when inserted deeply. Generally the first manifestation of infection is the appearance of pseudoaneurysm at the site of the anastomosis. In our experience the overall of incidence is of 4.2%. In this report we analyzed the clinical manifestations, the diagnosis and the types of surgical approaches followed by us.

Aneurysm↗
PubMed1991

[Abdominal aortic aneurysm and horseshoe kidney. Clinical cases].

The concomitance of horseshoe kidney and abdominal aortic aneurysm is rare but represents an interesting challenge for vascular surgeons. The trouble is greater if the diagnosis is formulated intraoperatively and specially if it is an emergency operation for aortic rupture or fissuration. The surgeon's aim is to get to the aneurysm collar without damaging the kidney, the renal arteries or the urinary tract that often have an anomalous development. The authors make a review of the literature and describe three cases occurred out of 2558 prosthetic reconstructions due to abdominal aortic aneurysm.

Aged↗
PubMed1991

[Clinical observations on 38 cases of inflammatory aneurysm of the abdominal aorta out of a total of 2014 operated cases].

The paper reviews 2014 cases of aneurysm of the abdominal aorta treated over the past 10 years at the Institute of General and Cardiovascular Surgery of the University of Milan directed by Prof. Ugo Ruberti, and analyses 38 which showed inflammatory characteristics. In spite of the low frequency of this type of aneurysm (1.8%), preoperative diagnosis is important since surgery entails greater technical difficulties than surgery for an atherosclerotic aneurysm of the abdominal aorta. In this respect the study of preoperative ESR and white blood cell levels is important: the review showed an increased ESR in 71% of cases in which the aneurysm was clearly inflammatory (a percentage which was twice that found in patients with atherosclerotic aneurysms) and increased white blood cells in 32% of cases compared to 2.6% in atherosclerotic aneurysms. Contrary to previous reports, CAT and abdominal echography were not particularly important. However, in those cases where the aneurysm was thought to be inflammatory on the basis of these findings, the Authors chose to operate once the diagnosis had been made without waiting for steroid therapy to reduce the extent of inflammation due to the well-known risk of rupture and the controversial efficacy of medical therapy.

Aged↗
PubMed1990

[Use of a new anti-inflammatory drug in the treatment of varicophlebitis of the lower limbs].

The paper reports the results obtained in 20 patients affected by varicophlebitis of the lower limbs following the oral administration of an anti-inflammatory substance. Results were compared with findings in single-blind study performed in a group of 20 patients treated with placebo. The evaluation of residual signs and symptoms and the control of recanalization of venous collectors using Doppler tests revealed a difference between the two groups in favour of the patients treated with the anti-inflammatory agent, although this was not statistically significant. The use of the drug was considered useful as a support to conservative varicophlebitis therapy with the aim of accelerating the resolution of the inflamed condition and thus reducing the functional disability of the limb.

Administration, Oral↗