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Biomedical subjects

G Ghilardi

Publications and source records attributed to G Ghilardi.

At least 91 records · Page 5Linked to original sources
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Two incidental cases of abdominal aortic aneurysm and gallbladder cancer. Further data influencing the management of patients affected by aneurysm and gallbladder disease.

Abdominal aortic aneurysm and cholelithiasis are two common diseases in the elderly population. The prevalence of abdominal aortic aneurysms ranges between 1.8 and 6.6% in autoptic series and it's estimated that 2.5% of the over sixty year old population is affected. Carcinoma of the gallbladder is the most common malignant tumor of the biliary tract and in the United States is the fifth most frequent digestive tract malignancy; it's incidence ranges between 2 to 10 cases of 100,000 persons/year. No adequate guidelines are now available to assist the surgeon, in the case of concomitant gallbladder disease and abdominal aortic aneurysm. In this paper the management of abdominal aortic aneurysm in a patient with gallbladder disease is discussed in order to assist the surgeon deciding whether to perform concomitant aneurysm resection and cholecystectomy. In 162 aneurysmectomies (1987-1997) 18 (11.11%) patients underwent combined aneurysmectomy and cholecystectomy operation. The patients ranged in age from 49 to 88 years (average 69 years). In two cases the anatomo-histological specimen examinations (twelve sections) demonstrated a gallbladder carcinoma. The overall mortality rate was 5.56% either for aneurysmectomy alone or for combined therapy. In case of abdominal aortic aneurysm and concomitant gallbladder disease, in choosing simple endoaneurysmectomy, the surgeon has to consider the risk of early and late complications of leaving a diseased gallbladder in place. In case of concomitant performance of both operations, the risks of a possible septic graft contamination must be considered. We believe that the patient may be best served by performing the vascular and nonvascular procedures in the same operation. In this paper a new proof, till now never considered in the international literature, is presented to support our opinion: the possibility of concomitant unknown cancer or precancerous lesions in a lithiasic gallbladder. Diagnosis of these lesions is, indeed, not easy to perform in the preoperative phase and is often a postoperative anatomo-histological detection.

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Surgical approach to combined abdominal aortic aneurysm and renal artery stenosis.

Thirty-four cases of combined abdominal aortic aneurysm (AAA) and renal artery stenosis (RAS) are reported. Hypertension was found at admission in 32 subjects, the other two being well responsive to drug therapy. Angiography and selective renal vein renin assay were always performed: renal artery stenosis was unilateral in 21 (61.7%) subjects and bilateral in 13 (38.3%). In 9 cases renal artery stenosis was not correlated to the hypertensive state. Mild chronic renal insufficiency was demonstrated preoperatively in 20 patients (58.8%). Simultaneous surgical treatment was carried out in 25 cases (73.5%). Mortality was 4% (one subject), severe renal insufficiency 8% (two subjects) and permanent renal failure 4% (one subject) All complications occurred among the group with bilateral RAS. While surgical repair of AAA is always mandatory, simultaneous surgical treatment of AAA and RAS should be carried out in carefully selected cases, due to elevated mortality rates reported in the literature, in order to cure renovascular hypertension, when it is demonstrated as related to RAS, or to preserve renal functionality, when RAS is contralateral to a functionally excluded or hypotrophic kidney or it exceeds 80% of the diameter of the artery.

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Surgical treatment of abdominal aortic aneurysm. A ten-year experience (1980-1989) referred to 1725 patients operated on.

The authors' experience of surgical management of abdominal aortic aneurysms (AAA), in 1725 consecutive patients, operated on in a ten years period (1980-1989) is presented. Surgical indications, operative technique, and outcome of elective and emergency procedures are analyzed. A ten years follow-up period is also presented. This shows a significantly better survival rate in surgically treated patients than in nonoperated cases.

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Pulmonary embolism secondary to puerperal ovarian vein thrombophlebitis.

Four cases of pulmonary embolism (PE) secondary to puerperal ovarian vein thrombophlebitis (POVT) were treated surgically during the first semester 1990. Clinical features are described in detail. The diagnosis was made by echotomography in three cases, but the crucial examination was contrast phlebocavography in all the subjects. Ovarian vein ligation, caval thrombectomy and inferior vena cava interruption by DeWeese clip positioning was the operation performed in any cases. Postoperative courses were always uneventful and three to six months follow-up was available. The extensive practice of echotomography during the first week of puerperium could demonstrate that POVT is more frequent than previously thought.

Adult↗
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Abdominal aortic aneurysms surgery in over 75 years old patients. Experience in 142 cases treated between 1980-1989.

The paper describes the Authors' experience of abdominal aortic aneurysm surgery in over 75-year-old patients. One hundred and forty-two cases were operated over a 10-year period (1980-89). Seventy-two patients were treated electively and 70 underwent emergency surgery following rupture of the aneurysm. Operative mortality during elective surgery was comparable to that in younger patients, whereas the mortality rate during emergency surgery was notably higher than that in under 75-year-old patients. Follow-up confirmed that the life expectancy of operated patients is significantly better than that of patients with untreated abdominal aortic aneurysms.

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The concomitance of renal artery stenosis and Conn's adenoma in a hypertensive woman.

A case of adrenal aldosterone-secreting adenoma concomitant with active renal artery stenosis in a hypertensive middle-aged woman is reported. The concomitance of the two lesions was previously reported in the literature only in five more reports, that are mentioned and commented here. This association is thought to be almost anecdotal, but some remarks must be done in order to rule out the risk of leaving an ignored lesion at the time of the definitive treatment. The widespread use of noninvasive imaging techniques is effective to find unsuspected adrenal adenoma in the presence of renovascular hypertensive disease, whereas unknown renal artery stenosis can be revealed by more aggressive diagnostic attitude, that is justified only in well selected cases of Conn's disease.

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Posttraumatic aneurysm of splanchnic arteries. Report of two cases.

Two cases of posttraumatic aneurysms of splanchnic arteries were referred to Istituto di Chirurgia Generale e Cardiovascolare del-l'Università di Milano (Italy) during 1989, and are the subject of this report. In both the instances a history of blunt abdominal trauma was collected, and histology confirmed the characters of false aneurysms of the lesions. The arteries involved were the middle colic and the splenic, respectively, with a long lasting history of recurrent abdominal pain related with particular physiologic events (e.g. meals or effort) only in the first case. The physiopathology, clinical feature, and problems related to surgical treatment in each cases are discussed in detail.

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The femorofemoral bypass graft. Report of a 11-year experience.

A series of 62 femorofemoral bypass grafts (FFBG) is reported. The indication for this operation was unilateral iliofemoral occlusion with severe ischemia of the lower limb in poor-risk patients. Severe ischemia presented as rest pain and/or minor necrotic lesions to the foot fingers, while patients were defined poor-risk for aging and concomitant diseases advising major surgical procedures and general anaesthesia. Claudication was not considered as an indication for this operation, and this statement is discussed in detail reviewing the literature. Operative death rate was approximately 6.4% (4 subjects), due to acute renal failure, revascularization syndrome, cardiac arrest and pulmonary oedema. Twenty subjects had had a total of 33 previous vascular reconstructive procedures; this occurrence did not reveal any statistically significant consequences on long-term patency rate, although a difference was seen in favour of the patients who had not undergone previous vascular reconstructive procedures. In the group of patients who underwent FFBG as the first vascular procedure, five early occlusions occurred: three Fogarty catheter thrombectomies were successful. Cumulative patency rate was then 77% at 36 months in the series of 58 survivors. Rest pain was relieved in any instances and a satisfactory improvement of claudication was obtained.

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[Complementary echo flow imaging and digital angiography in the supra-aortic area for indication and intervention of carotid revascularization in 1587 subjects in the OPI (Stroke Prevention) program].

The availability of non invasive carotid ultrasound imaging techniques actually allows planning and carrying on of large screening programs for detection of atherosclerotic carotid occlusive disease. The aim of non invasive ultrasound patient selection is to limit the practice of invasive carotid angiography only to patients for whom carotid endarterectomy is likely to be a therapeutic choice. PURPOSE. Testing the efficacy of sequential use of color coded echo flow imaging (echo color Doppler: ECD) and arterial digital angiography (ADA) respectively in the second and third phases of a screening program for detection and treatment of carotid occlusive disease in a resident population (OPI program). METHODS. From January 29th 1990 through March 31st 1992, 1,587 subjects underwent ECD out of 16,379 subjects that participated in the first level investigations. 404 of these (25.5%) were affected with carotid occlusive disease, 271 (17%) had inframural non stenosing carotid lesions and 228 (14.3%) carotid kinkings. At ECD, 71 showed lesions as severe as to be susceptible of surgical operation and underwent ADA. The percentage of carotid stenosis was calculated on the ADA imagins, applying the method suggested by the North American Symptomatic Carotid Endarterectomy Trial. RESULTS. Overall sensitivity and specificity of ECD versus ADA were 94% and 95.2% respectively. Cases in which ECD overestimated the lesion as compared to ADA results were recorded as false positive, while cases in which ECD underestimated the lesion were recorded as false negative. CONCLUSIONS. Both ultrasound imaging and ADA are useful in screening programs for carotid occlusive disease: informations different and complementary to the definition of the lesions can be obtained from each procedures in subsequent phases. Morphologic findings of carotid ECD are essentially consistent with ADA, thus allowing to carry on safely non invasive long-term follow-up programs for operated subjects as well as for people bearing carotid lesions originally not susceptible of surgical treatment.

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[Carotid stenotic-obliterative lesions. Distribution in 16,379 subjects 45-75 years of age].

BACKGROUND: The epidemiology of carotid occlusive disease in a resident population is still unclear. Data of some interest are available only from cohort studies on prevalence and incidence of neck bruits, whose correlation to carotid stenosis is weak. PURPOSE: A large population study (O.P.I. programme) has been carried out in the USSL (sanitary district) n. 69 of Lombardia (Italy), consisting of a two staged screening based on physical examination and neck vascular ultrasound imaging of men and women aged 45 to 75. This paper reports preliminary results of the screening. MATERIALS AND METHODS: From 1/29/1990 to 3/31/1992, 16,379 people agreed to be enrolled in the O.P.I. programme and underwent physical examination and CW Doppler ultrasound carotid exploration. Some 1,734 (10.6%) were selected for second level non invasive screening: 1,587 attended, and underwent second physical examination and carotid echo-flow imaging, to confirm carotid lesions. Population was divided into 7 age groups by 5 year intervals. According to the degree of stenosis, people affected with carotid occlusive disease were classified into five groups: < 50%; 50-70%; > 70%; occlusion; bilateral lesions of any degree. RESULTS: Carotid echo-flow imaging confirmed that 404 people harbored carotid occlusive disease (2.5%); 270 (66.8%) had unilateral stenosis or occlusion and 134 (33.2%) bilateral lesions. The 538 affected carotid arteries were equally distributed on both sides. Male to female ratio was 1.7:1 (p < 10(-6). Prevalence of the lesions was 0.43% among the youngest subjects and gradually rose up to 8.14% among the oldest age group (p < 10(-6). Ninety-five percent of subjects affected with severe carotid lesions (occlusion, unilateral stenosis > 70% or bilateral lesions) were 56 or older. Echographic appearance was determined in 439 of 514 stenosis (85.4%): ulcerated plaque was evident in 13.3% of stenosis > 70%, but only in 0.7% of stenosis < 50% (p = 0.02). Otherwise plaque calcification was dominant in 32.5% of stenosis < 50% and in 13.3% of stenosis > 70% (p = 0.0006). CONCLUSIONS: The prevalence of atherosclerotic carotid occlusive disease in people resident in the USSL n. 69 aged 45 to 75 years was 2.5%. Males were more severely affected than females. Prevalence and severity of the disease increase with ageing.

Age Factors↗
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[Surgery of the kinking carotid artery].

Forty-three kinkings of the epiarotic vessels were observed at the Istituto di Chirurgia Generale e Cardiovascolare dell'Università di Milano from January 1st 1971 through July 31st 1992. Six subjects were admitted for a history of one or more transient ischemic attacks. In four cases surgical resection of the kinked tract of the internal carotid and end-to-end direct reconstruction was carried out, completed by carotid bifurcation endarterectomy in three, where atherosclerotic carotid disease was severe. All the reconstructions are currently patent and no neurological symptoms were recorded at follow-up; 39 cases were treated conservatively by antiplatelet therapy and controlled each six months: to date no worsening of the echocolordoppler imaging of the lesion was noted, and all these subjects remained completely asymptomatic. The authors point out that correct clinical approach to carotid kinking is a conservative one: surgical operation must be performed only in those subjects affected with cerebral ischemic attacks not justified by other diseases.

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[Carotid kinking and arterial hypertension. Preliminary results of the OPI program].

The relationship between carotid kinking and arterial hypertension is stressed, based on the results of the first two years of an epidemiological research on prevalence of carotid lesions capable of producing cerebral ischemia in a population, aged 45 to 75, resident within the district USSL no. 69 (Parabiago), Lombardia. Reported data are referred to 13,936 subjects that underwent the first level of screening between January 29th 1990 and December 31st 1991. 1,386 subjects underwent further examination by color coded echo flow (second level of screening) due to suspected carotid lesion; they were divided into two groups according to the presence or absence of arterial hypertension. The distribution of these groups does not repeat that of the general population (p < 1 x 10(-6)). 158 subjects were affected with carotid kinking. Within the normotension group (439; 31.67%), 39 (8.88%) were demonstrated to harbor kinkings, while in the hypertension group (947; 68.33%) 141 (14.88%). Thus, the difference between the two groups remains largely below the limits of statistical significance (p > 1). The association between kinking and hypertension is not affected by sex (p > 1 x 10(-1)), regardless of a significant difference of distribution between the sexes (145 women and 40 men: p < 1 x 10(-6)). The conclusions point out that the evidence of this study strongly stresses that the association between carotid kinking and arterial hypertension is incidental.

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