Biomedical subjects

G Ghilardi

Publications and source records attributed to G Ghilardi.

At least 55 records · Page 3Linked to original sources

PubMed1993

[Aortoenteric fistulae. Diagnosis, therapy, results].

A series of 26 aortoenteric fistulas, 8 primary (PAEF) communications between abdominal aorta and gastrointestinal tract and 18 secondary (SAEF) communications between aortic graft and intestine, is reported. PAEF is commonly due to aneurysmal rupture into the intestine, while SAEF is an uncommon complication of abdominal aortic reconstructive surgery. Male to female ratio was 3:1 among the PAEF group and 8:1 among the SAEF one. Seven of the PAEF subjects underwent urgent surgical operation: 6 enteral defect closure and prosthetic aortic replacement. One patient underwent ileal resection and hypogastric artery ligation. Survival rate in this group was 42% (3/7). Among the 18 subjects affected with SAEF after intestinal repair, vascular procedures were 8 aortic graft removal and extra-anatomic bypass grafting, 4 aortic graft removal and aortic stump ligation, 5 anastomotic repairs and 1 prosthetic branch substitution. Survival rate among this group was 39% (7/18). No differences in outcome were noted in this series depending on type of operation, according to the literature. The authors conclude that surgical outcome is affected by the presence of severe infection not dominated by antibiotics rather than by surgical technique. In this series survival rate among the patients with negative bacterial culture of the surgical specimen raised up to 80%, while it decreased to 20% among subjects harboring septic retroperitoneal collection and graft infection.

Adult↗

PubMed1993

[Prevalence of carotid kinking in a resident population. Partial results of the OPI (Objective Prevention of Ictus)].

This paper reports partial results on carotid kinking prevalence from the ongoing program Obiettivo Prevenzione Ictus, whose main target is to detect atherosclerotic carotid lesions in a resident population. Over a period of 23 months, 13.936 subjects, aged 45 to 75, were screened by physical vascular and carotid CW Doppler ultrasound examinations; 1.386 (9.9%) subjects underwent color coded echoflow imaging, according to the design of the screening program (suspected carotid atherosclerotic lesion at first level screening): 185 among this subgroup, 40 males and 145 females, were affected with 266 carotid kinkings. In 81 cases (43.8%) the lesions were bilateral. Sensibility and specificity of carotid bruit (25% and 73%, respectively) and CW Doppler ultrasound (48.5% and 55.8%, respectively) proved inadequate for routine diagnosis of carotid kinking. Hypertension was recorded in 146 cases (78.9%). No cerebral ischemic attack was recorded in these 185 subjects over the period considered.

Aged↗

PubMed1993

Rupture of abdominal aortic aneurysms into the major abdominal veins.

Over the period January 1965-July 1992 26 spontaneous fistulas between an abdominal aortic aneurysm (AAA) and the major abdominal veins were observed and surgically treated. Twenty-two were aorto-caval, one iliaco-iliac and 3 aorto-iliac; since clinical features, pathophysiology, principles of surgical treatment and postoperative care are similar, both the conditions are considered as a single disease (aorto-caval fistula: ACF). The incidence among 373 ruptured AAA operated in emergency conditions in the same period was 6.97%, with an operative mortality rate of 34.61% compared to an overall mortality for ruptured AAA of 34.85%. All subjects were males with a mean age of 67.3 years. Twelve subjects showed shock at admission (46.1%): the mortality rate in this subgroup was 50% compared to 21.4% among the non-shocked patients. Pain was always present, oedema of one or both of the lower limbs in 9 cases (34.6%) and abdominal bruit or murmur and thrill in 16 (61.5%). One patient died at laparotomy for irreversible cardiac arrest; the 25 completed procedures consisted of endoaneurysmal repair of the fistula under venous bleeding control by digital compression and prosthetic replacement of the abdominal aorta (7 straight and 18 bifurcated grafts). Intraoperative mean blood losses exceeded 4,000 ml, but autotransfusion, available only in 12 procedures, allowed significant sparing of heterologous blood units. The mortality rate was not clearly improved by autotransfusion, but among these 12 patients shock was present in 7 instances (58.3%), compared to 5 out of 14 subjects (35.7%) operated on before autotransfusion devices were available.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗

PubMed1993

[Objective prevention of ictus. Data informatics from a mass screening program].

The main technical and functional abilities of the computer supply to the epidemiologic program Obiettivo Prevenzione Ictus are described. The aim of the program is to investigate the epidemiology of carotid occlusive disease in subjects aged 45 to 75 by following a diagnostic and therapeutic protocol, designed to discover and treat internal carotid artery stenosis. The magnitude of the population involved is 23,140 subjects. The data from the population are collected in a three level archive whose configuration makes it possible to obtain information either from within each level and from all of them. Thus, the software adopted provides specific tools for elaboration of epidemiologic data as well as for clinical management of carriers of carotid lesion and for follow-up of treated patients.

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

[Surgery of the carotid: the morphology of plaque and the clinical correlations].

A consecutive series of 256 patients operated on of carotid endarterectomy for cerebrovascular atherosclerotic disease from January 1987 through December 1990 is presented. The following parameters were considered: clinical presentation, morphology of the carotid atherosclerotic plaque and topographic distribution of other concomitant atherosclerotic lesions of epiaortic arteries. 422 carotid lesions and 154 lesions of other epiaortic vessels were investigated by means of echo and color flow imaging, digital subtraction angiography and macroscopic observation of the specimen: 143 plaques proved grossly ulcerated. Unilateral lesions were 90 (35.2%) while bilateral disease was present in 166 cases (64.8%): 38.8% of subjects out of the first group and 30.2% out of the second were asymptomatic. Anterior and posterior neurological symptoms were equally distributed among both the 116 (69.8%) symptomatic subjects harboring bilateral lesions and the 55 (61.1%) symptomatic subjects with unilateral lesion (anterior 78.4% and posterior 21.6% for bilateral and 78.2% and 21.8% respectively for unilateral lesions). According to the degree of stenosis, the lesions were divided into three main groups: < 50%; 50-70%; > 70%. As the degree of stenosis increased, the incidence of focal symptoms increased too; moreover, the presence of ulceration of the stenosing plaque carried an increase in the incidence of focal symptoms within each group: respectively from 7.8% to 30% (< 50%), from 18.6% to 53.8% (50-70%), from 27.7% to 55.6% (> 70%). This study supports the relationship of morphological characteristics of the stenosing atherosclerotic plaques of the internal carotid artery to neurological symptomatology.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1992

[The clinical picture and surgery of pheochromocytomas. Our experience over 25 years].

The pheochromocytoma syndrome, caused by an abnormal secretion of catecholamines, is a rare pathology responsible for 0.1-2% cases of hypertension in the overall population considered. Although in the past we deemed the pheochromocytoma could cause prevalently the typical syndrome characterized by paroxysmal hypertensive crises, now we think that the usual clinical presentation is a continue or subcontinue hypertensive state (65%). In this paper the authors refer the clinical experience acquired in 25 years in the General and Cardiovascular Institute of the University of Milan (head: Prof. Ugo Ruberti), analyzing epidemiological aspects and pathogenesis of pheochromocytoma, with particular care to diagnostic methodologies and referring the therapeutic choices. From 1965 until today 40 patients have been surgically treated for pheochromocytoma mono or bilateral. 43 operations have been done, carrying out 46 adrenalectomy. Two complication must be referred: an ictus cerebri consequent upon an hypertensive crisis and one death caused by intraoperative ventricular fibrillation. Normalization of arterial pressure has been obtained in all patients.

Adrenal Gland Neoplasms↗

PubMed1991

[Paraganglioma of the neck. Analysis of 32 operated cases].

Between january 1965 and november 1990, 32 operations for neck paraganglioma were performed: 29 chemodectomas (carotid body tumors) and 3 paragangliomas of the vagus nerve. Seven subjects were affected with bilateral chemodectomas and one of them showed concurrent unilateral vagal paraganglioma. Two paragangliomas were malignant, with invasion of the latero-cervical lymphnodes revealed at operation. Four individuals came to observation from two different families, suggesting familiarity. Preoperative diagnosis was correctly made in 12 of 18 asymptomatic chemodectomas (66.6%), ten of whom observed during the last decade: angiography is the gold standard for diagnosis but CT scan, ultrasound and NMR imaging are going to earn the confidence of physicians for precise evaluation of latero-cervical masses. Surgery is to date the treatment of choice, and the results are dependent on the size of the tumor and the involvement of the neighbouring vascular, nervous and visceral structures. According to the majority of the literature, the 29 chemodectomas were classified in the three groups of Shamblin: I: 4 cases; II: 10; III: 15. Twenty out of the 24 transient or permanent postoperative complications took place in the third group: in five instances some procedures of internal carotid artery reconstruction were needed. Fourteen complications for chemodectomas and 2 for vagal paragangliomas affected the cranial nerves; three transient and one permanent ischemic central neurological deficits occurred in the group III chemodectomas. Not any operative mortality was registered in this series.

Adult↗

PubMed1991

[Association of pheochromocytoma and renovascular hypertension].

The case of a 47-year-old woman affected with right adrenal pheochromocytoma and right renal artery stenosis is presented. The concurrence of these two diseases is rarely reported in the literature, as shown by the review presented. Nevertheless, this association carries some problems as far as diagnosis is concerned, because missing renal artery lesion can lead to the maintenance of the hypertensive disease after surgical excision of the adrenal pheochromocytoma. Anyway, the extensive use of angiography is not justified for pheochromocytoma alone, because an excellent imaging of the mass can be achieved by means of non-invasive technologies, such as CT, echo B-mode, NMR. A careful evaluation of clinical features and non-invasive imaging and the presence of elevated plasma renin activity, although not determinant in surgical decision making, can support the suspicion of renovascular hypertension in the presence of pheochromocytoma and suggest to carry out renal angiogram and selective renal veins reninemia.

Adrenal Gland Neoplasms↗

PubMed1991

[Arterial diseases of surgical importance. Long-term control of diet-related risk factors].

From 1980 to 1990 a yearly medical-surgical control was carried out on 950 arteriopathic patients hospitalised in the General and Cardiovascular Surgery Institute, Milan University, during the above mentioned period. The operations for surgical reconstruction were mainly for arteriosclerotic lesions involving the abdominal-peripheral district (750 patients, 79%) and the supra aortic trunks (200 patients, 21%). 84% of the patients were males. Among the patients on follow-up, a relatively modest number (100 patients) did not attend the prescribed diet therapies for several reasons, consequently these patients have been considered as a control group. The comparison, between the patients who attended and those who did not attend the diet, has been made on the basis of the following parameters: cholesterolemia (COL), LDL, HDL, triglyceridemia (TG), VLDL, glycemia (GLI), body mass index (BMI) and arterial pressure (PA). The results have shown a decrease in the absolute normal values of cholesterol, LDL and triglycerides, while they have not shown the same significant variations regarding glycemia and body weight. In accordance with the literature, the diet seems to have obtained satisfactory results, especially regarding the values of lipidemia, with a reduction in the atherogenic risk index. Regarding smoke as a risk factor it has been shown that it is present in 80% of the patients at the beginning: 60% of the patients stop smoking at the moment they are hospitalised and the remaining 20% continue smoking. The hygienic-dietetic intervention is confirmed, also in our experience, as a curative, or even more, a preventive tool against the worsening of an already overt arteriosclerosis as well as a necessary support for drug therapies.

Arteriosclerosis↗

PubMed1990

[Latero-lateral choledochoduodenostomy in benign pathology of the common bile duct. A prospective study].

Biliodigestive derivations for benign diseases of the biliary tract are currently accepted in case of extended to recurrent choledochal stenosis, excessive dilation of the choledochus, impacted ampullary stones. This paper concerns 19 subjects that underwent laterolateral choledochoduodenostomy (CDS) according to the Roesner technique over the period January 1986 through December 1987 in order to evaluate long-term functional results of this operation. Hepatic serum enzymes and bilirubin were determined at intervals of two weeks during the first three months and of four weeks until the sixth month postoperatively. At this time a battery of controls was performed, namely standard plain X-ray of the abdomen, hepatobiliary sequential scintigraphy with HIDA, endoscopic examination of the anastomosis. The level of serum enzymes was then determined at 18 months postoperatively and scintigraphy was repeated as well. Based on the results of this study and the review of the recent literature, our opinion is that CDS has shown as a safe procedure with good long-term results in the treatment of benign disease of the biliary tract, mostly if high-risk aged subjects are concerned.

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↗

PubMed1990

[Volvulus of the gallbladder. Presentation of a case and review of the literature].

A case of acute torsion of the gallbladder in a 83-year old woman is presented. According to the literature, the pathogenetic mechanism, the anatomical bases and the clinical presentation of this disease are discussed. The age intervals more often affected are the pediatric and teen-ager and, mostly, the elderly over the 70's. The basic anatomical defect is the gallbladder flotation, congenital or acquired. The clinical feature is that of right acute abdomen, and emergency cholecystectomy is the treatment of choice.

Acute Disease↗

PubMed1990

[Functioning extra-adrenal paragangliomas].

The diagnosis of extra-adrenal paraganglioma requires the recognition of catecholamine hypertension and the site of the lesion. I-131-MIBG scintigraphy, CAT scan and angiography may localize primitive and metastatic lesions. Six cases of extra-adrenal paraganglioma (5 abdominal, 1 thoracic) surgically treated with complete resolution of the hypertensive state are presented here.

Abdominal Neoplasms↗

PubMed1990

[Primary carcinoma of the gallbladder].

Primary carcinoma of the gallbladder, while infrequent, is the most representative among the malignant neoplasms of the biliary tract. The diagnosis of carcinoma of the gallbladder was made in 22 out of 1252 operations performed for gallbladder disease (1.8%) since January 1980 through June 1988: only in 9% of the subjects a malignant tumor of the gallbladder was suspected preoperatively. In 21 cases the carcinoma was associated with chronic lithiasic cholecystitis. The 22 cases were assessed according to the classification proposed by Nevin. The operations performed were: 4 routine cholecystectomies (stages I and II) 4 cholecystectomies with lymphadenectomy (stages I and II); 4 cholecystectomies with lymphadenectomy and liver wedge resection of the bed of the gallbladder (stages II, III, IV, V); 7 explorative laparotomies and 3 gastrojejunal anastomoses (stage V). A complete follow-up was available for each of the 22 subjects: cumulative survival rates were calculated according to Kaplan-Meyer. The overall 5-year cumulative survival rate after operation was 19% for the whole group, whereas it reached 76% for the subgroup of 9 patients classified in stages I and II. This analysis reinforces the statement that surgical therapy can achieve excellent results if brought about before cancer overwhelms the muscular layer of the gallbladder wall. Thus, as the preoperative diagnosis of gallbladder carcinoma is extremely difficult and uncertain, any delay in performing cholecystectomy seems to be unwise in all those cases of chronic benign disease of the gallbladder (whether lithiasic in nature or not) that are suspected to be a major risk factor for cancer degeneration because of their frequent association with the carcinoma of the gallbladder.

Adult↗

PubMed1990

Medical management of acromegaly: effects of SMS 201-995 in 30 patients.

The effect of chronic administration of SMS 201-995, a long acting analogue of somatostatin, has been studied in 30 acromegalic patients (pts). CT-scan showed pituitary adenoma in 20/30 pts, empty sella in 9/30 pts and no sign of pituitary tumor in one case. SMS 201-995 was administered subcutaneously every 8 hours at the daily dose of 150-900 micrograms. Blood samples for GH, insulin and blood glucose were taken hourly from 04:00 to 20:00 h before treatment, after 15 days and then monthly or fortnightly. IGF-I plasma levels were assayed at 08:00 h in the same day as GH determinations. CT-scan controls were carried out after 12-24 months of treatment in 16/20 pts. GH plasma levels were normalized in 16/30 pts after 0.5-9 months of SMS treatment, whereas in 14/30 pts they were reduced by about 50%. In 10/16 pts the CT-scan examination showed a shrinkage of the tumor size of 20-55%, while no variation of the tumor mass was observed in the 2 pts. In conclusion our data show that SMS 201-995 is a very effective medical treatment in acromegalic patients.

Acromegaly↗

PubMed1990

[Malignant cutaneous lymphoma in a case of Wiskott-Aldrich syndrome with long-term survival].

The case of a 24 year old man affected with Wiskott-Aldrich syndrome (WAS) is reported. The review of the charts of previous hospital admissions revealed the presence of an inherited trait and a long history of recurrent infections and hemorrhages. This young man was referred to our surgical department with the diagnosis of right lower limb gangrene, but the biopsy showed the lesion being due to cutaneous malignant lymphoma characterized by large polymorphic cells. All clinical and immunological elements typical of WAS were present: they are discussed with regard to the recent literature.

Adult↗

PubMed1989

[Current indications for percutaneous transhepatic cholangiography (PTC)].

Percutaneous transhepatic cholangiography (PTC) showed its widest diffusion during the late '70s while since the early '80s it was gradually replaced by endoscopic retrograde cholangiopancreatography (ERCP). Anyway, a well definite role for PTC still exists. PTC was performed in 60 of 131 cases of obstructive disease of the biliary tree: the indications are illustrated in detail. The statistical indicators utilized to choose this examination were: echographic determination of the diameter of the biliary tree, bilirubinemia, alkaline phosphatase (ALP) and serum gamma-GT. Data collected during this study showed that biliary dilation has a significant correlation to serum levels of ALP, while bilirubin has not. Biliary dilation is currently well established by echography: in some instances, however, biliary obstruction is earlier suggested by elevated serum enzymes of biliary stasis, while it is clearly demonstrated that biliary dilation is a precursor of jaundice, better defined as an expression of biliary hypertension. Based on these observations and on the review of the literature, the Authors believe that PTC still remains a second choice examination as compared to ERCP: when the latter be not effective for diagnosis or decompression of the biliary tree, then PTC can be resolutive.

Alkaline Phosphatase↗