Biomedical subjects

S Miani

Publications and source records attributed to S Miani.

At least 37 records · Page 2Linked to original sources

PubMed1993

[The physiopathology and therapy of esophageal diverticula].

The authors report their experience in the management of 14 patients affected by esophageal diverticula and surgically treated (9 had cervical diverticula, 2 had epibronchial diverticula and 3 had epiphrenic diverticula). All these patients underwent a diverticulectomy: in 3 cases the diverticulectomy was associated with a subdiverticular myotomy. In the last three cases the resection of the diverticulum was performed using an automatic stapler. The follow-up of these patients was prolonged for a period of 5 years with clinical, radiographic and endoscopic evaluations performed at 6 monthly intervals. The most recently operated patient has a minimum follow-up of 22 months. There were no operative deaths and none of the patients complained of recurrence of the diverticulum or of the preoperative symptomatology. No significant complications were observed in the postoperative period in the patients who underwent a simple diverticulectomy or in the cases in which a subdiverticular myotomy was associated. The scant number of observed patients does not allow us to draw any conclusion about the necessity maintained by most authors of an associated myotomy. It is however evident that this adjunctive procedure doesn't cause any further difficulty and is not loaded with an increased risk of complications. Finally the authors believe in the usefulness of performing the diverticulectomy with an automatic stapler, these devices allow in fact a considerable reduction of the surgical time and prevent dangerous contaminations of the operative field.

Adult↗

PubMed1993

[Prosthetic separation in the retroperitoneum in reconstructive arterial surgery].

In this assay we take into consideration 3410 retroperitoneal prosthetic reconstructions in aorto-iliac pathology performed in the last 25 years at the General and Cardiovascular Institute of Milan. Thirty-nine retroperitoneal prosthetic dehiscences were observed; 35 of them had been subjected to their first operation in our Institute (1.03%). The incidence of vasculo-enteric fistula and pseudoaneurysm seem to decrease in the last 8 years up to 0.9 (0.9%). Authors consider etiologic factors, diagnostic procedures and technical approaches to this severe complication of vascular surgery.

Adult↗

PubMed1993

[Primary lymphoma of the gastrointestinal tract].

Lymphomas of the gastrointestinal tract are rare tumors with unusual features and few characteristics. Clinical, radiological and endoscopic diagnosis is difficult, because they may be confused with inflammatory or neoplastic forms, especially in primary involvement of the gastrointestinal tract. From 1965 we observed 4 patients with primitive gastrointestinal tract lymphomas. Prognostically important features for GI lymphomas were: stage, site of the primary disease, histological type. Authors report on the clinical findings, diagnostic procedures, surgical treatment and results.

Adolescent↗

PubMed1993

[Functioning paraganglioma].

Pheochromocytomas and functioning paragangliomas are rare tumors arising from indifferent cells of the primitive neural crest. These tumors produce clinical symptoms (pheochromocytoma syndrome) related to catecholamine production. The pheochromocytoma syndrome, constituted by arterial hypertension, headache and sweating, is due in 80% of cases to adrenal pheochromocytomas and only in 20% of cases is due to extra-adrenal secreting paragangliomas. The diffused localization of the Paraganglion System and the common embryologic origin, can explain the occasional identification of multicentric tumors (10%), and the association with multiple endocrine neoplasms (MEN), especially in familial occurrence. Careful follow-up of patients, in order to detect the later development of multicentric or metachronous neoplasms is necessary. The Authors present their experience with 80 patients affected by neoplasms involving the adrenal medulla and the multicentric paraganglion system, surgically treated during the last 25 years. Eight patients (10%) were affected by functioning extra-adrenal paragangliomas: 7 patients (87.5%) had solitary extra-adrenal tumors (6 abdominal and 1 thoracic) with a classic pheochromocytoma syndrome, and 1 patient (12.5%) had a double asymptomatic abdominal paraganglioma.

Adult↗

PubMed1993

[Vagal paraganglioma].

Vagal paragangliomas are rare tumors of neural crest origin. This neoplasm is generally located at various points along the peripheral distribution of the vagus nerve, in the region of the jugular and nodose ganglia, just beneath the perineurium of the nerve, but may arise anywhere along the course of the vagus nerve. Histologically, vagal paragangliomas are similar to carotid body tumors, and occasionally can undergo malignant transformation and metastasize (10-19%) or infiltrate the base of the skull. Selective arteriography can distinguish vagal paraganglioma from carotid body tumor, because the first lies above carotid bifurcation without widening of the vessels. CT scanning and MR are useful for preoperative evaluation of the jugular foramen for neoplastic involvement. Surgical resection is the treatment of choice, but usually it isn't possible to exercise these lesions without sacrifice of the vagus nerve. A careful follow-up examination for the development of metastases and multicentric paragangliomas is necessary. Two cases of vagal paragangliomas one of them with cervical node metastases, are reported. Diagnostic and surgical features of these rare neoplasms are outlined.

Adult↗

PubMed1993

[Mediastinal functioning paraganglioma. A case report].

Functioning paraganglioma of the mediastinum is an uncommon tumor of the paraganglion system. We report a case of a 26 year-old woman with a 6 month history of hypertension refractory to therapy. Urinary catecholamine excretion and plasma noradrenaline concentration were elevated. Chest radiograph and computed tomography (CT) scan revealed high-density mass located on the posterior mediastinum. An mIBG scan showed uptake by the mediastinal tumor. At thoracotomy a 5 cm lesion was resected. Histological examination confirmed that it was a paraganglioma. Authors refer on the clinical finding and diagnostic procedures of this rare disease.

Adult↗

PubMed1993

[Pancreatic insulinomas].

Neuroendocrine pancreatic tumors are neoplasms derived from APUD cells, characterized by hyperincretion of several peptides of hormonal activity. The incidence of these tumor is low. They are usually classified according to the predominant secreted peptide: gastrinoma, insulinoma, VIPoma, glucagonoma. Insulinoma is the most frequent endocrine pancreatic tumor, characterized by a peculiar clinical picture due to insulin action. This neoplasm is prevalently benign (90%), and may cause symptoms due to hypo-glycemia such as epilepsy, asthenia, deep coma, dizziness, hunger and epigastric pain. Surgery still constitutes the principal therapy for insulinoma treatment, but an accurate tumor identification is necessary. Selective arteriography of the pancreas and new diagnostic investigations as intraoperative US, selective sampling of pancreatic veins with insulin Quick-RIA, aid the diagnosis and more precise localization of the tumor. When surgical therapy is not practicable, for diffuse metastases, octreotide has an inhibitory effect upon hormone release, and may be combined with chemotherapy for controlling clinical symptoms. We review the clinical records of 2 patients from our Institute, who had hyper-insulinism due to benign insulinomas of the tail of the pancreas. Surgical treatment was performed with enucleation of the neoplasms.

Aged↗

PubMed1993

[Primary malignant tumors of the small intestine].

The clinical records of 10 patients with small intestinal tumors during a 27 years period were reviewed. The patients, 5 men and 5 women ranged from 17 to 79 years old. There were 6 carcinomas (60%), 3 lymphomas (30%), and 1 sarcoma (10%). Tumors were most frequent in the distal part of the small intestine (70%). The most common complaints were pain (70%) and obstruction (40%). All patients had surgical treatment; curative resection was attempted in 70% of the cases. Prognosis is poor, the mean survival time was 20.4 months.

Adolescent↗

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

[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

[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

[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 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

[Thrombectomy of the infra- and suprarenal cava to prevent pulmonary embolism in the presence of deep venous thrombosis. Personal experience with 11 surgically-treated cases].

DVT is a fairly frequent event and often fails to be recognised. Its main complication, pulmonary embolism, is the third cause of death in Italy with more than 70,000 deaths per annum. In the presence of infra- and suprarenal floating thrombi, cases in which the application of neither intraluminal nor extraluminal filters is indicated, the treatment of choice is thrombectomy with direct surgical access to the cava. Personal experience of 11 patients operated in the past 16 months with excellent surgical success is analysed. The indications and surgical techniques adopted are described.

Adult↗

PubMed1991

[Association of pheochromocytoma and phakomatosis. Apropos of a clinical case].

Of the multiple endocrine syndromes, the association between pheocromochytoma, medullary thyroid carcinoma (MTC) and parathyroid-hyperplasia (Sipple's syndrome, MEN IIa), and the association of MTC, with multiple monocutaneous neuromas and with a characteristic facial appearance (MEN IIb syndrome) are well known. Furthermore in about 10% of the patients affected by Von Recklinghausen's disease (neurofibromatosis) a pheocromochytoma is present. A new classification of this important (even though rare) chapter of endocrine pathology was developed by Pears in 1968 when he hypothesized a common neuroectodermic origin for groups of cells diffused throughout the body and nested in different organs. The association of such different pathological conditions could be justified by a faulty development of these primitive neuroectodermic cells. This study aim to analyse a recently observed case of pheocromochytoma associated with Von Recklinghausen's disease. The Pathogenetic hypotheses of this rare pathological association, the diagnostic methods and the therapeutic procedures will be review.

Adrenal Gland Neoplasms↗

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↗