Biomedical subjects

S Miani

Publications and source records attributed to S Miani.

80 records · Page 5Linked to original sources

PubMedDate not supplied

[Inflammatory aneurysms of the subrenal aorta. Histopathological, diagnostic and therapeutic aspects].

Inflammatory abdominal aneurysms (AIAA) represent a clearly defined clinical entity with an incidence ranging between 1.2% and 15%. In spite of the increasing number of observations reported in recent years, the etiopatholgenesis and natural history have not been defined. The lesion can present in an acute, subacute or chronic manner and the histopathological studies reveal prevalently two components: an inflammatory infiltrate and a diffuse fibrosis, in varying degree. This study aimed to analyze the more recent imaging procedures in order to correctly diagnose this lesion. In our experience the incidence of AIAA is about 2.5%. On the basis of macro microscopic pictures the authors divided patients into two groups: one constituted by the acute or subacute inflammatory forms, the other by chronic clear inflammatory aneurysms. All patients underwent on operative treatment. The surgical adopted techniques and the obtained results are reported.

Aged↗

PubMedDate not supplied

[Natural history and course of aneurysmal disease in patients operated on for abdominal aortic aneurysms].

This study is aimed at analyzing our experience in the evolution of aneurysmatic disease after surgical treatment of the typical subrenal abdominal aortic aneurysm. In fact in some cases we reobserved these patients for the onset of a new important dilatation involving the proximal tract of the abdominal aorta or the common iliac arteries. From 1980 to December 1992, 24 patients out of a group of 1508 patients previously submitted to an aorto-aortic or aorto-iliac reconstructive procedure using dacron prosthetic grafts were reoperated for relapsing aneurysmatic disease. In six cases the dangerous ectasia was located above the proximal aortic anastomosis; in four patients the re-reconstructive procedure was performed clamping the subdiaphragmatic abdominal aorta and performing the proximal anastomosis just below the ostia of the renal arteries. In two cases the aneurysmatic process involved the origins of the visceral vessels and a left thoracophrenolaparotomic access was necessary in order to perform a thoracoabdominal reconstruction reimplanting the visceral arteries on the prosthetic graft. In 18 cases the progressive aneurysmatic process involved the common iliac axis provoking, in some cases, a kinking or a shortening of the aortic prosthetic graft. The results of these reintervention are good with no mortality at operation and a satisfactory middle term (average 3 years) follow-up. Our investigation demonstrates that in a small, but significant (1.6%) percentage of patients the aneurysmatic disease spreads upward and downward involving arterial segments formerly non affected.

Aged↗

PubMedDate not supplied

[The physiopathology, clinical picture and therapy of chronic intestinal ischemia].

Between January 1982 and April 1993, 8 patients suffering from a typical clinical picture of chronic intestinal ischemia, have been observed. All these patients were symptomatic and 7 cases presented stenosing or occlusive lesions of at least 2 of the 3 splanchnic trunks. 5 of these 7 patients underwent a corrective surgical procedure. 2 patients underwent percutaneous transluminal angioplasty. One patient affected by stenosis of the coeliac trunk due to external compression caused by the median arcuate ligament of the diaphragm was not operated because the symptomatology was atypical and the other 2 splanchnic trunks were perfectly patent. Three patients died following the therapeutic procedure: a woman in whom an aorto-mesenteric bypass graft was inserted, underwent, 4 months after, an intestinal infarction due to thrombosis of the graft; another woman, whose coeliac trunk and superior mesenteric artery were thrombosed and whose inferior mesenteric artery was reimplanted on the common iliac artery, died for acute hepatic failure, after 12 months of total parenteral nourishment; a third patient, successfully submitted to PTA of the superior mesenteric artery, died after 4 months due to the occurrence of acute renal insufficiency.

Adult↗

PubMedDate not supplied

[Aneurysm of the popliteal artery. Prognostic and therapeutic criteria].

Experience of the management of 45 patients affected by popliteal artery aneurysms is reported. All patients, but one, underwent operative treatment. The importance of immediate surgical reconstruction whenever a popliteal artery aneurysm has been detected is stressed. In fact the most frequent complication represented by sudden thrombosis of the aneurysmatic sac and/or by peripheral embolization is generally followed by an irreversible closure of the vascular run off, determining the high rate of failures (28% in our experience) in spite of a prompt surgical reconstructive procedure.

Aged↗

PubMedDate not supplied

[Reconstructive surgery of the abdominal aorta in a case of left-positioned inferior vena cava. Clinical case and review of the literature].

An unsuspected left-sided inferior vena cava (IVC) can present a formidable challenge for the surgeon attempting abdominal aortic surgery. The incidence of congenital anomalies of the post-renal (infrarenal) vena cava is approximately 3%, with double inferior vena cava most frequently occurring. The authors refer to a case of isolated left-sided vena cava in a 53 year old man who underwent an aorto-femoral bypass graft for aorto-iliac occlusive disease. On the basis of a literature review the authors recall the incidence and the embryology of this anomaly, and analyze its surgical implications, with particular reference to abdominal aortic surgery.

Anastomosis, Surgical↗

PubMedDate not supplied

[Atherosclerotic aneurysm of a branch of the deep femoral artery].

Peripheral arterial aneurysms present characteristic locations. In the lower limbs, atherosclerotic aneurysms of the deep femoral artery are very rare. Authors report an interesting case of arteriosclerotic aneurysm of a branch of the profunda femoris artery observed in a 80 year-old man, and associated with an abdominal aortic aneurysm. Endo-aneurysmectomy was performed with a dacron patch interposition. Surgical treatment of this rate disease is discussed.

Aged↗

PubMedDate not supplied

[Critical evaluation of the reconstruction of the intestinal continuity after total gastrectomy by the Moricca technique].

The authors analyze a series of 48 total gastrectomies for gastric carcinomas performed between 1987 and 1994. Seven out of these 48 gastrectomies were performed adopting the double circuit esophagojejunoduodenal plasty according the procedure described in 1976 by Francesco Moricca. The double jejunal loop represents a sort of "digestive reservior" allowing to avoid the sensation of epigastric fullness after eating. Moreover, this technique permits a better absorption of the liquids and the partial mixing of the bolus with the bilio-pancreatic secretion stimulates the duodenal secretin and cholecystochinin release. The possibility of a "dumping syndrome" is diminished by the presence of the double possibility of diversion of the alimentary bolus. On the contrary the segment of jejunum transposed between the esophagus and duodenum is antiperistaltic and this fact can cause sometimes an esophagitis at the lower third of the esophagus due to the prolonged alkaline reflux. This study is aimed at verifying the entity and frequency of the esophagitic complication in patients who underwent a total gastrectomy and at analyzing the procedures adopted to cure this severe complication that seriously affects the wellness and the nutritional status of the gastrectomized patients.

Adult↗

PubMedDate not supplied

[Secondary aorto-enteric fistula].

Aortic graft fistula is a rare and life-threatening complication after aortic reconstruction. The incidence ranges from 0.5 to 4%, and even if the diagnosis and treatment is appropriate, the results of surgery are poor: mortality rate ranges from 14 to 70%. The optimal method of treatment is still controversial; prosthetic removal and extra-anatomic bypass has been advocated as the standard method, but more recently, because the high mortality rate associated with this procedure, some have prompted to recommend in situ aortic graft replacement as a more successful treatment. Personal experience with incidence (0.7%) outcome and mortality (57%) in 7 patients treated over a period of 6 years (1990-1996) is reported. Results from this group are compared with another group (6 patients) previously treated (1975-1982) for the same pathology. Our results after 10 years, show the same incidence (0.7 vs 0.6%) and an elevated and unchanged mortality (57 vs 66%). Better results in the management of aorto-enteric fistulas could be achieved with the removal of infected infrarenal aortic prosthetic grafts and in situ homografts replacement.

Aorta, Abdominal↗