Biomedical subjects

G Ghilardi

Publications and source records attributed to G Ghilardi.

At least 37 records · Page 2Linked to original sources

PubMed1998

Hypothyroid myopathy as a complication of interferon alpha therapy for chronic hepatitis C virus infection.

Interferon alpha (IFN-alpha) therapy is associated with a number of immunological side-effects, including autoimmune diseases and a 10% prevalence of thyroiditis. Hepatitis C virus (HCV) infection itself predisposes to autoimmune phenomena including hypothyroidism and myositis. The development of clinical hypothyroidism in the presence of positive thyroid antibodies in patients infected with HCV and treated with IFN-alpha suggests a possible association between the viral disease and the therapy. HCV infection may predispose to autoimmune thyroid disease and IFN-alpha therapy may secondarily lead to the development of thyroid dysfunctions. We report the single case of a female patient who developed a severe proximal myopathy in conjunction with primary hypothyroidism (Hoffmann's syndrome) secondarily to IFN-alpha therapy for HCV infection. This case highlights the need for careful clinical and biological monitoring for potential side-effects in such patients.

Adult↗

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↗

PubMed1996

Non occlusive ileocaecocolic intussusception caused by caecum cancer--case report.

A case of ileocaecocolic intussusception caused by a caecum carcinoma is presented. The authors stress the peculiarity of clinical manifestation, without intestinal obstruction despite the presence of a big abdominal mass involving vessels and bowel, revealed by CT scanning and angiography. Endoscopy was not able to identify the nature of the lesion. Laparotomy performed with the idea to find a mesenchymal neoplasia, permitted to achieve the diagnosis.

Adenocarcinoma, Mucinous↗

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↗

PubMed1995

Indications and role of isolated profundaplasty in patients affected by limb ischemia.

The deep femoral artery is the primary source of blood supply to the lower extremity in presence of superficial and/or popliteal occlusion. The atherosclerotic involvement of the profunda femoris artery is relatively less frequent and generally is localized in the initial segment of the artery. The profundaplasty employed to relieve limb threatening ischemia is infrequently used as an isolated procedure. However many authors demonstrated that restoration of flow through this vessel alone, in patients without significative lesions of the aorto-femoral district, will effectively relieve ischemia when the superficial femoral artery is also occluded. Our experience gained in the last eight years concerns 24 patients (21 male, 3 female). All the patients had severe ischemia of the lower limb with invalidating claudication (13), rest pain (9) and gangrene (2). On the basis of our results, we think that the operation is recommended, whenever possible, in patients with critical ischemia when the possibilities of more extensive revascularizing procedures are absent.

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

[Stenotic-obliterative carotid lesions and arterial hypertension. An analysis of 16,379 subjects from the OPI program. Obiettivo Prevenzione Ictus].

BACKGROUND: A positive correlation of arterial hypertension (AH) to atherosclerosis and of AH to cerebral stroke is widely accepted, while the relationship between AH and carotid occlusive disease (COD) is not yet clear. PURPOSE: To assess the correlation of AH to COD in a resident population screened during the OPI (Obiettivo Prevenzione Ictus) program. METHODS: The goals of OPI program are to assess prevalence of COD among the population resident in the USSL (Sanitary District) n. 69 Lombardia (Parabiago-Italy), aged 45 to 75; to administer a therapeutic protocol; and to carry on a long-term follow-up of people treated for risk of stroke from COD. Data reported herein were recorded from the first 16,379 subjects out of 24,436 enrolled in the OPI program and classified according to blood pressure and degree of COD (preliminary report). All were investigated by physical examination and CW Doppler ultrasound; subjects suspected to harbor COD of any entity underwent a second physical examination and color coded echoflow imaging of extracranial carotid arteries, to assess the degree of COD. Statistical analysis has been performed through Fisher's exact test and chi 2 test, and results were assumed as significant for a p value of less than 5 x 10(-2). RESULTS: Among 7,800 males and 8,779 females, some 8,428 (51.45%) people were shown to be hypertensive: 2,800 of them were classified as borderline (e.g.: systolic pressure of 141-160 mmHg and diastolic < 90 mmHg). As many as 538 COD were observed in 404 subjects. Among the 7,951 normotensive people as many as 109 COD (20.3%) were identified in 90 subjects (1.12%); among hypertensive people, 314 (3.72%) were affected with 429 (79.7%) COD (p < 10(-6)): COD prevalence among borderline hypertensive subjects was double than among normotensive (p = 1.3 x 10(-6)). Unilateral as well as bilateral CODs were more frequent among hypertensive people (p between 3.1 x 10(-2) and < 10(-6) according to the degree of stenosis). Forty-five (50%) among 90 normotensive people affected with COD showed unilateral stenosis < 50%, but only 19 (14.2%) among 134 affected with bilateral lesions were normotensive, and 81.6% of these lesions were < 50%. Among 230 lesions in 115 hypertensive people with bilateral COD, 137 (59.5%) were < 50%, 63 (27.4%) between 50-70%, 19 (8.3%) > 70%, and 11 (4.8%) occlusions. CONCLUSIONS: COD is more frequent among hypertensive than normotensive people (odds ratio = 3.38; p < 10(-6)). Severity of COD is higher in hypertensive subjects (odds ratio = 3.79; p < 10(-6)). Isolated systolic hypertension is more frequently associated to COD than systolic-diastolic hypertension (odds ratio = 2.26; p < 10(-6)). Among people with isolated systolic hypertension, diastolic values of less than 75 mmHg do not increase the risk of COD. As COD prevalence is concerned, the 1,494 subjects with effective drug control of hypertension behaved as like as people with isolated systolic hypertension: in particular, the risk of COD was 7.59 times as high as for normotensive people.

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

[The significance of a carotid bruit. The preliminary experience of the OPI program. The Obiettivo prevenzione ictus (Stroke Prevention Objective)].

BACKGROUND: Carotid bruit has been correlated to occlusive atherosclerotic carotid disease and cerebrovascular ischemic disease, based on selected series or small population cohorts. The OPI programme has been accomplished to investigate the prevalence of carotid lesions in a population aged 45 to 75 and resident in the USSL (Sanitary District) n. 69, Lombardia. OBJECTIVE: To establish the frequency of carotid bruit in an unselected population and the correlation of this sign to the internal carotid lesion. METHODS: In this paper 16,379 people of both sexes are considered: all underwent physical examination, oriented to vascular problems, and C.W. Doppler ultrasound examination, from 1990 to March, 31st 1992. A further examination completed with color flow imaging was carried out for subjects showing either carotid bruit, or C.W. Doppler alterations, history of cerebrovascular disorders, previous vascular operations, concomitant extracarotid vascular occlusive diseases. Carotid kinking has been considered as "carotid lesion", for its attitude to cause flow alterations fitting to carotid bruit. RESULTS: The prevalence of carotid bruit in the considered population was 3.7%, a total of 806 carotid bruits in 612 subjects. Male to female ratio was 0.69. A strong correlation of bruit to age was recorded (p < 10(-6)): subjects over 70 years old have a five-fold probability to harbor carotid bruit than younger people (45 to 50 years old). Likewise hypertensive people have a two-fold probability of carotid bruit than normotensive (p < 10(-6)). Only 302 carotid lesions (36%) of the 864 found showed bruit, while 539 (64%) did not. Among the 31,917 unaffected carotids 504 (1.6%) had bruit and 31,413 had not (98.4%); sensitivity of bruit to carotid lesion was 35.9%, and specificity 98.4%. The probability for carotids with bruit to be affected with lesion (stenosis, occlusion or kinking) is approximately 35 times as high as for carotids without bruit (odds ratio = 34.9). CONCLUSIONS: Notwithstanding its low sensitivity, that prevents its use as a simple screening test for carotid lesion, the high specificity of carotid bruit makes it possible to separate a group at elevated risk of harboring carotid lesion. The absence of bruit does not rule out the presence of carotid lesion. A strong correlation to age and hypertension has been proved. Carotid bruit must be considered as a risk factor for carotid lesion, not a means to make diagnosis.

Age Distribution↗

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

[The value of CW Doppler and Doppler-color-echocardiography in the mass screening for atherosclerotic carotid lesions].

BACKGROUND: The availability of non invasive ultrasound technologies for the diagnosis of extracranial carotid atherosclerotic disease allowed designing and applying mass screening programmes devoted to uncover and study unknown carotid stenosis in resident populations. OBJECTIVE: To evaluate usefulness and correct application of Continuous Wave Doppler (CWD) and Color Coded Echo Flow Imaging (CCEF) examinations during different levels of the screening programme OPI (Obiettivo Prevenzione Ictus). METHODS: Between January 29th 1990 and March 31st 1992 the screening programme OPI has been applied to 16.379 subjects of both sexes, aged 45 to 75, enrolled in a sanitary district of Lombardia. They underwent first level screening (anamnesis, physical examination, CWD of carotid arteries). 1.661 (10.1%) were suspected of harboring carotid lesions and invited to second level screening (physical examination, biohumoral sampling, CCEF): 1.587 attended. The results of CWD and CCEF examination of 3.174 carotid arteries are discussed. RESULTS: An overall sensitivity and specificity of 63.6% and 66%, respectively, was found as CWD and CCEF were compared for lesions detectable by CWD (i.e. excluding kinkings and aneurysms). Of 1.815 carotid arteries classified as negative at CWD the absence of lesions was confirmed by CCEF for 1.450 (79.9%); CWD failed to reveal 146 (8%) stenosis < 50% and 52 (2.9%) severe lesions, of which only 5 (0.3%) could possibly undergo surgical treatment. CONCLUSIONS: Despite low accuracy, CWD has proven to be useful for the purpose of a mass screening of carotid occlusive disease, that is selection of a contained group of subjects (10.1%), with increased risk for carotid stenosis, for further non invasive examination, with low cost (hardware cost: 1.430 lire per exam v/s 24.000 lire per exam for CCEF) and low risk of missing severe stenosis with possible surgical indication (0.3%).

Aged↗

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

[The surgical treatment of renovascular hypertension in subjects with a single kidney].

Renovascular hypertension in subjects with a solitary kidney, though an infrequent condition, requires surgical direct revascularization procedures either to reduce the hypertensive state and, more important, to preserve renal function. This paper reports a series of six surgically treated cases between 1982 and 1990, with at least two years follow-up. Preoperative renal function, as evaluated by BUN and blood creatinine, was reduced in 5 cases, the remaining one being normal. All subjects were hypertensive at admission: in four cases drug therapy was ineffective for restoring normal pressure values. All subjects had previously undergone surgical nephrectomy: in 3 cases for shrunk kidney, in 2 for failure of a previous attempt of renal revascularization, and one for renal tuberculosis. 3 subjects were concomitantly affected with abdominal aortic aneurysm, and one had previously undergone aortobifemoral bypass. Treatment of the concomitant aortic lesion and renal artery revascularization were carried out at the same operation. Operations performed were TEA of residual renal artery in 3 cases, prosthetic reconstruction in 2 and intraoperative transluminal angioplasty by Gruentzig balloon catheter in one. Over a two-year follow-up renal function remained good in 4 cases, while one subject required a second surgical revascularization due to late acute thrombosis of a previous aortorenal saphenous vein graft. Acute early postoperative renal failure occurred in one case and permanent haemodialysis was instituted. No deaths were recorded in this series.

Adult↗