Medicine today strongly aims at prevention and optimization of diagnosis and therapy Studies tried staging and standardization of clinical trials in diseases and made search of markers for early diagnosis, prognosis and therapy. Moreover, risk factors and other variables such as predictors are now investigated more often in groups or populations of apparently healthy subjects, especially for such diseases as atherosclerosis and neoplasia. This new aspect of increasing interest may be defined as medical prolepsis (from the Greek pi rho ómicron lambda eta psi iota zeta = anticipated idea). It includes early signals of disease (protopathology) as well as other signals the host shows as defence or alarm reaction. Hence, we suggest a chronobiological approach in this field, which allows to quantify health and reveals more subtle differences in many physiological variables. According to these views, we reported studies concerning humoral markers and other parameters considered as risk factors both in atherosclerosis and in some endocrine tumors.

Arteriosclerosis↗

PubMedDate not supplied

[Acute ischemia of the lower limbs].

One hundred nineteen patients operated upon for acute ischemia of the lower limbs have been retrospectively reviewed, in order to evaluate the influence of the condition on outcome, and the patterns of treatment. Fifty six per cent of the patients were males and 42% females, 68.4% had an history of aorto-iliac obstructive disease; 51.2% of the ischemias were due to arterial thrombosis and 48.8% to embolism, in 12.5% of the cases etiology was unknown. Thrombosis were more frequent in younger patients' population (mean age 59.8 years) compared to embolism (mean age 69 years), even if the mean age of patients bearing an ischemia of embolic type has risen, in the last 10 years: 62.1% were due to atrial fibrillation and 50% occurred on pathologic arteries, patients with arterial obstructive disease presented a higher incidence of arrest of embolic material at the common femoral artery bifurcation. Women's mean age was significantly higher then that of men (70.9 vs. 59 yrs.). Embolism was more frequent in women than in men (64 vs 42.2), whereas thrombosis was more frequent in men than women (57.8 vs 36%). There were more deaths in women than men (30.8 vs 20.8%), but more amputations in men than women (37.3 vs 17.3%). Embolism of arterial origin include 15.2% of all acute ischemias and 31% of all embolisms, and their site of origin is often unknown, particularly when it is located in the thoracic aorta, which mandate a complete arteriography and eventually a CT-Scan of the thorax and the abdomen. A lower limb phlebitis, associated with an acute ischemia mandates the search of a patent foramen ovale, and an heparin induced thrombocytopenia. Surgical treatment is directed towards obstruction removal (embolectomy, by-pass) and towards the treatment of the causative agent (aortic endarterectomy, caval filter, anticoagulants). Post-operative thrombolysis may be beneficial in case of distal residual thrombus after embolectomy. An higher mortality rate has been observed in acute ischemias due to embolism rather than thrombosis (31 vs 19.6%) and more major amputations in thrombosis than in embolism (37.7 vs 17.2%). Overall mortality rate has been of 25%, with an amputation rate of 28%. Present results have been compared with those of the literature, both agree on some changes over the last 20 years, concerning the incidence of different mechanisms of acute ischemias and their prognosis.

Acute Disease↗

PubMedDate not supplied

Transcranial Doppler validation of hemodynamic vertebrobasilar insufficiency diagnosis.

Transcranial Doppler (TCD) can be useful in the diagnosis and validation of surgical treatment of vertebrobasilar insufficiency (VBI). A case is reported in which TCD confirmed the diagnosis of vertebrobasilar insufficiency and validated the indication of surgery by detecting a bidirectional flow in a stenotic and compressed vertebral artery. In the postoperative period and at late follow-up TCD demonstrated a restored antegrade flow, as a consequence of a well functioning revascularization. Surgical indication of VBI is rare and TCD can be proposed as part of routine patients' study before a surgical decision is taken.

Aged↗

PubMedDate not supplied

Surgical treatment of digestive arteries aneurysms.

Eight patients of a mean age of 56.4 years, have been operated on for 9 digestive arteries aneurysms in a 7-years-period. Sites of aneurysmal disease included 3 splenic, 3 superior mesenteric, 2 hepatic, and 1 left gastric arteries. Five patients (62.5%) were asymptomatic, while 3 (37.5%) presented with symptoms. Three patients (37.5%) presented associated aortic lesions consisting in 2 infrarenal aneurysms and 1 aorto-iliac stenosis. Of the 9 arteries treated, 5 were revascularized. Restaurative operations included 1 reconstructive endoaneurysmorraphy, 3 retrograde by-pass grafts (2 Dacron and 1 PTFE), and 1 antegrade by-pass graft (Dacron) from the coeliac aorta. There were no post-operative deaths. Mean length of follow-up was 47.8 months. No patient presented with late intestinal or operation related problems.

Adolescent↗