1. Chir Ital. 2007 Jul-Aug;59(4):575-9.
Vascular lesions secondary to osteotomy by corticotomy.
Spinelli F, Spinelli R, Stilo F, De Caridi G, Mirenda F.
UOC e Cattedra di Chirurgia Vascolare, Azienda Ospedaliera Universitaria,Messina.
Management of vascular traumas is frequently delayed. Vascular injuries afterelective operation for bone lengthening or correction of a deformity arevery'rare situations. We describe 3 cases. Case 1: male, aged 22, undergoingcorticotomy for bone lengthening; immediately presented acute limb ischaemia due to a partial lesion of the popliteal artery, documented by U.S. After 7 h, directreconstruction of the artery and fasciotomies were performed. Case 2: male, aged 27, undergoing directional osteotomy for genu varus correction. For 30 days,constant increase in leg volume and decrease in function. US showed an important haematoma at the popliteal level; arteriography documented a partial lesion ofthe infra-genicular popliteal artery and a voluminous false aneurysm. Directcorrection of the artery and fasciotomies were performed. Case 3: male, aged 22, undergoing corticotomy for leg lengthening; immediately presented leg pain withdecreased distal pulses. After 4h, there was an increase in leg volume, andarteriography showed a total lesion of the infra-genicular popliteal artery andan arteriovenous fistula. Popliteo-tibial bypass with the contralateral greatersaphenous vein and fasciotomies were performed. After 1 month endovascularclosure of the fistula was obtained. All patients had recovered after two months with only minor leg insufficiency. Patency of the bypass and absence ofinfections or delayed false aneurysms were achieved. Vascular injuries afterelective orthopaedic procedures are very rare situations. Such lesions are causedby an osteotomy via corticotomy performed percutaneously. The variety of clinicalpresentations accounts for the difficulty in diagnosing such lesions and for the delays in implementing treatment. It is very important to obtain an earlydiagnosis complete with an arteriography.
PMID: 17966782 [PubMed - indexed for MEDLINE]
2. Chir Ital. 2006 Jan-Feb;58(1):117-20.
[Gunshot injury of superficial femoral artery. Surgical treatment withoutpreoperative angiography: a case report]
[Article in Italian]
Mirenda F, Baccellieri D, Carmignani A, La Spada M, Benedetto F, Spinelli F.
Unità Operativa Complessa di Chirurgia Vascolare, Cattedra e Scuola diSpecializzazione in Chirurgia Vascolare, Università degli Studi di Messina.
The superficial femoral artery is the most frequently injured vessel in lowerlimb traumas. The traumatic agents responsible may be gunshot, blunt instrumentand stab wounds. Preoperative angiography is often used to choose the mostappropriate surgical approach for limb salvage. We report a case of a traumaticgunshot lesion of the superficial femoral artery surgically treated with a great saphenous vein bypass without preoperative angiography.
PMID: 16729619 [PubMed - indexed for MEDLINE]
3. Chir Ital. 2006 Jan-Feb;58(1):113-6.
[Symptomatic aorto-iliac aneurysm and situs viscerum inversus: case report]
[Article in Italian]
Baccellieri D, Mirenda F, Mandolfino T, La Spada M, Stilo F, Spinelli F.
Unità Operativa Complessa di Chirurgia Vascolare Cattedra e Scuola diSpecializzazione in Chirurgia Vascolare Università degli Studi di Messina.
We report a case of infrarenal symptomatic aorto-iliac aneurysm in a patient withacute abdominal pain. The patient was admitted to the emergency care unit forabdominal pain and CT scans showing an infrarenal aorto-iliac aneurysm in a situsviscerum inversus (SVI) totalis syndrome. The patient underwent open aneurysmrepair with an aorto-iliac bifurcated graft. This case shows that situs viscerum inversus cannot be considered a technical problem for the surgical treatment ofabdominal aortic aneurysm.
PMID: 16729618 [PubMed - indexed for MEDLINE]
4. Chir Ital. 2005 Nov-Dec;57(6):731-5.
Iloprost infusion in diabetic patients with peripheral arterial occlusive diseaseand foot ulcers.
Mirenda F, La Spada M, Baccellieri D, Stilo F, Benedetto F, Spinelli F.
Cattedra e UOC di Chirurgia Vascolare, Dipartimento di Scienze Toraciche eCardiovascolari, Policlinico Universitario di Messina.
The aim of the study was to evaluate iloprost infusion as an alternative to open surgical revascularisation in diabetic patients with foot ulcers, also as asupport measure in conjunction with endovascular procedures. We studied 244patients with critical ischaemia of the lower limbs, 146 of whom (59.8%) affectedby diabetes. A femoro-distal bypass was performed in 175 patients. In the 69nonsurgical diabetic patients (47.3% of the diabetics) an iloprost infusion wasstarted. These diabetics presented foot ulcers, a palpable or slightlyhypo-sphygmic popliteal pulse and high distal arterial flow at the ankle. In 55of these patients (79.7% of those not operated on and 37.6% of the diabetics) whowere non-responders to medical therapy, an endovascular procedure was alsoperformed. The results of the iloprost infusion (69 pts.) were evaluated afterone week. In 14 responders treated only with iloprost infusion, complete healing of the lesions occurred during the 3 weeks following the end of the 4-week courseof therapy. No severe ischaemia recurrences were reported in the follow-up ofthese 69 patients. In the 47.3% of subjects with diabetic arteriopathy presentingfoot ulcers and high distal flow, it proved possible to avoid an open surgicalrevascularisation procedure and to resort to medical therapy with iloprost,completed in 79.7% of cases with endovascular procedures. Iloprost infusionimproves limb perfusion and, in selected cases may be an important therapeutictool for the care of ulcerative lesions of the diabetic foot, also as a supportmeasure in conjunction with endovascular procedures.
PMID: 16400768 [PubMed - indexed for MEDLINE]
5. Chir Ital. 2005 May-Jun;57(3):361-4.
[Aneurysm of the abdominal aorta associated with an ectopic pelvic kidney andabnormal vascularisation: a case report]
[Article in Italian]
Mandolfino T, Canciglia A, D'Alfonso M, Mirenda F.
UOC di Chirurgia Vascolare, Scuola di Specializzazione in Chirurgia Vascolare,Università degli Studi di Messina.
Renal malformations during surgery for repair of an abdominal aortic aneurysm area rare occurrence that can create technical problems during the operation interms of preservation of renal parenchyma and vascularisation. A case ofabdominal aortic aneurysmectomy associated with an ectopic pelvic kidney ispresented. Preoperative diagnosis is necessary in order to plan the surgicaltechnique to be employed in each anatomical variant encountered.
PMID: 16231826 [PubMed - indexed for MEDLINE]
6. Anesthesiology. 2005 Jan;102(1):227-9.
Tramadol and vocal cord closure.
Fodale V, Mondello B, Mirenda F, Spinelli F, Santamaria LB.
Department of Neuroscience, Psychiatric and Anesthesiological Sciences,University of Messina, School of Medicine, Policlinico Universitario G. Martino, Italy.
PMID: 15618808 [PubMed - indexed for MEDLINE]
7. Chir Ital. 2003 Nov-Dec;55(6):893-6.
[Varicose vein recurrence after surgery of the sapheno-femoral junction: color doppler ultrasonography study]
[Article in Italian]
Roscitano G, Mirenda F, Mandolfino T, De Caridi G, Stilo F, Benedetto F, SpinelliF.
Cattedra e Scuola di Specializzazione in Chirurgia Vascolare Università degliStudi di Messina.
The aim of this study was to evaluate the accuracy and sensitivity of colourDoppler ultrasonography for the diagnosis of postoperative recurrent varicoseveins in patients submitted to surgical ligation of the saphenofemoral junctionwith a view to classifying the recurrences according to the causes. We studied401 lower limbs in the orthostatic position with colour Doppler ultrasonographyin 318 patients (64 M and 254 F) presenting postoperative varicose veinrecurrence during the follow-up (12-60 months). We evaluated the type of refluxat the inguinal level under the Valsalva manoeuvre and divided them into 5 types.We observed an incomplete crossectomy (type 1) in 23.2% of the cases; anincontinent saphenofemoral junction, intact and in an anatomical site in 12.5%(type 2); a major tributary (double saphena) originating from the common femoral vein near to the crossectomy site in 10.2% (type 3); neovascularization in 9.7%(type 4) and the presence of a number of major tributaries from the veins of the perineal and pudendal region or from the abdominal parietal veins in 44.4% (type 5). In all cases it was possible to note and classify the type of recurrence.Colour Doppler ultrasonography is an accurate, reliable tool for the diagnosisand classification of postoperative varicose vein recurrences in patientssubmitted to surgical obliteration of the saphenofemoral junction. It is decisivein the preoperative evaluation and follow-up of patients. In our experience, morethan one half of the cases of recurrence were not due to an error of surgicaltechnique.
PMID: 14725231 [PubMed - indexed for MEDLINE]
8. Chir Ital. 2003 Sep-Oct;55(5):643-8.
[Abdominal artery aneurysm and associated surgical abdominal diseases: towardsoptimal timing]
[Article in Italian]
Stilo F, Mirenda F, Mandolfino T, La Spada M, D'Alfonso M, Carmignani A, DeCaridi G, Benedetto F, Spinelli F.
Unità Operativa, Cattedra e Scuola di Specializzazione in Chirurgia VascolareUniversità degli Studi di Messina.
The purpose of this study was to assess which modalities offered the best timing in the treatment of abdominal aortic aneurysms associated with other abdominalsurgical diseases. From January 1984 to December 2002, 372 patients underwentsurgery for abdominal aortic aneurysms, 350 men (94%) and 22 women (6%), mean age72 years. Of these 10% were operated on urgently. The traditional open technique was used in 307 patients, and the endovascular method in the remaining 65 cases. In 40 patients (11%) we observed other associated abdominal diseases which weretreated during the same operation in 34 cases (85%). We had three deaths in the34 cases treated in the same operation (9%). In the remaining cases noperioperative mortality was registered. There were no cases of prosthesisinfection. The mean hospital stay was 9 days. Simultaneous treatment appears, on the one hand, to carry an increased operative risk and increased mortality and,on the other, to present the advantage of having to perform only one surgicalprocedure. The advent of the endovascular method allows us to postpone thetreatment of the associated disease without increasing the technical difficultyof the second operation.
PMID: 14587107 [PubMed - indexed for MEDLINE]
9. Chir Ital. 2003 Sep-Oct;55(5):637-42.
[Intraoperative recovery of blood in surgery of infrarenal abdominal aorticaneurysm]
[Article in Italian]
La Spada M, De Caridi G, Mandolfino T, Mirenda F, D'Alfonso M, Spinelli F.
Unità Operativa di Chirurgia Vascolare, Cattedra di Chirurgia Vascolare AziendaOspedaliera Universitaria Policlinico Gaetano Martino, Messina.
The aim of the study was to evaluate the possibility of reducing the blood lossduring elective surgery for abdominal aortic aneurysms using particularintraoperative surgical expedients. From 1993 to 1999, 200 patients wererecruited into the study. We performed 90 aorto-aortic, 84 aorto-bisiliac, 4aorto-iliac-femoral, 12 aorto-bisiliac-hypogastric, and 10 aorto-bifemoralreconstructions. Several surgical techniques were used and are described indetail. The mortality rate was 3.5%. Haemoglobinaemia 24 hours after theoperation had decreased by 2.5 +/- 0.9 g/dl. In 67% of cases the estimated blood loss was lower than 300 ml. There were no transfusions in 44% of cases, andautologous transfusions in 17%. The average estimated blood loss was 350 ml, withmean reinfusion of 0.98 blood units. Our study suggests the possibility (44%) of avoiding the use of blood transfusions thanks to intraoperative blood saving bymeans of particular surgical techniques.
PMID: 14587106 [PubMed - indexed for MEDLINE]
10. J Cardiovasc Surg (Torino). 2002 Oct;43(5):711-4.
Primary aortoduodenal fistula including the afferent loop of a Billroth IIanastomosis. A case report.
Spinelli F, Mirenda F, Mandolfino T, La Spada M, Mondello B, D'Alfonso M, DeCaridi G, Stilo F.
Department of Thoracic and Cardiovascular Surgery, University of Messina,Messina, Italy.
Primary aortoenteric fistula is a very rare consequence of the evolution of anabdominal aortic aneurysm (AAA). The 3rd and 4th portion of the duodenum areinvolved in up to 80% of all cases. Frequently, gastrointestinal bleedingrepresents the first symptom, and diagnosis is difficult because of the aspecificclinical presentation and course, characterized by alternating remission andrelapse; this is the reason why surgical treatment is usually delayed andtherefore such events are managed as emergencies with a preoperative andintraoperative high death rate. We report the case of a 76-year-old man with aprimary aortoduodenal fistula, who was submitted to gastric resection accordingto Billroth II 20 years before. This case could be interesting for its anatomicalpeculiarities favourable to the formation of the fistula.
PMID: 12386590 [PubMed - indexed for MEDLINE]
11. Chir Ital. 1992 Jun-Aug;44(3-4):131-6.
[A rare complication due to diverticulitis]
[Article in Italian]
Di Bernardo N, D'Ambrosio B, Mirenda F, Cittadino L, Vena M.
Istituto di Fisiopatologia Chirurgica e Propedeutica Clinica, Università diMessina.
The AA. report about a case of hepatic abscess found in a operated patient forperforation of a sigmoid diverticulum. The AA. made some consideration on therarity of the hepatic abscess as complication of diverticulum perforation.
PMID: 1306139 [PubMed - indexed for MEDLINE]
12. Chir Ital. 1986 Jun;38(3):282-7.
[A case of primary intestinal lymphoma]
[Article in Italian]
Mandolfino T, Parisi A, Parisi S, Dattola A, Muscolino R, Mirenda F.
The authors examine primary small bowel tumours, dealing at some length withproblems of a diagnostic and clinical nature. The difficulties often encountered in reaching an early diagnosis and the feasibility of radical surgery frequently prove to be factors conditioning prognosis. The importance is then stressed ofthorough evaluation of those vague symptoms which may be the only manifestationof this disease.
PMID: 3791530 [PubMed - indexed for MEDLINE]