P. Rispoli - Academia.edu (original) (raw)
Papers by P. Rispoli
Annals of Vascular Surgery, 2017
Aneurysms of the inferior thyroid artery (ITA) are extremely rare and potentially determine sever... more Aneurysms of the inferior thyroid artery (ITA) are extremely rare and potentially determine severe sequelae. We report a case of true ITA aneurysm in a 45-year old Caucasian woman treated with endovascular embolization; postoperative course was uneventful and, at 6-month follow-up, the aneurysm is completely thrombized. A systematic review of the literature has been also performed to identify the epidemiologic and clinical characteristics and diagnostic and operative options of this disease. Size alone is not able to predict the fate of the aneurysm and an aggressive treatment seems to be justified because of the high risk of complications in case of rupture. In an emergency setting the endovascular procedures associated to hematoma evacuation or open surgery should be rapidly performed to save patient life.
Minerva cardioangiologica, 1977
Chirurgia italiana, 1985
The authors studied the inter- and postoperative complications arising in a series of 690 consecu... more The authors studied the inter- and postoperative complications arising in a series of 690 consecutive interventions on thyroid. The results showed a cipher mortality and a 3% aggregate morbidity. In 0.9% of cases, compressive hematomata in the thyroid loggia, collapse of the tracheal wall due to tracheomalacia or bilateral paralysis of the vocal cords determined an acute respiratory stoppage. 1.4% of the treated patients suffered from alterations in the motility of the vocal cords, ascribable to damage of the recurrent nerves. 0.9% of cases showed a postoperative parathyroid insufficiency, the nature of which, however, was always temporary. The incidence of complications, in the whole, resulted significantly higher in the patients undergoing iterative surgery, in respect of those operated on the first time.
Angiología
The Authors report their preliminary experiences concerning the use of transcranial Doppler (TCD)... more The Authors report their preliminary experiences concerning the use of transcranial Doppler (TCD) in the pre- and postoperative monitoring of extracranial carotid surgery. TCD is a non invasive method of investigation able to give informations about the distribution of cerebral blood flow and about the mechanisms of compensation of Willis' circle. Furthermore, TCD showed itself to be very useful in the postoperative qualitative evaluation of surgery, pointing out, as a general rule, an increased flow in the middle cerebral artery after thromboendarterectomy of internal carotid artery. This haemodynamic modification, if present, is perceptible since the immediate postoperative period and becomes more evident and definitely stable at a distance of 20-30 days after operation, likewise the definitive stabilization of Willis' circle's haemodynamics.
International angiology : a journal of the International Union of Angiology, 2012
Guidelines for the assessment of the visceral arteries and veins and of the renal artery .
International angiology : a journal of the International Union of Angiology, 2012
The traditional morphological parameters for the description of a carotid atherosclerotic plaque ... more The traditional morphological parameters for the description of a carotid atherosclerotic plaque (degree of stenosis, echogenicity, systolic peak velocity etc.) are insufficient for the prediction of the risk of embolization. Contrast enhanced ultrasound (CEUS), based on the theory of inflammation and neoangiogenesis, seems to have a great potential for the detection of unstable plaques. The purpose of our work was to compare echogenicity of the plaque (evaluated with the Grey Scale Median; GSM), the degree of stenosis and CEUS with the histopathological findings. Patients with indication for internal carotid endarterectomy (CEA) underwent a preoperative imaging study with B-mode echo Doppler Ultrasound and with CEUS. The contrast enhancement of the plaque was described with two parameters: the maximum and mean signal intensity (SImax, SImean). After the surgical operation the removed plaque is sent to the pathology laboratory for the measurement of the neoangiogenesis (vessel densi...
Minerva cardioangiologica, 2001
Two cases of left-sided inferior vena cava observed in a patient affected by Leriche syndrome and... more Two cases of left-sided inferior vena cava observed in a patient affected by Leriche syndrome and the other affected by aortic abdominal aneurysm (AAA) are presented. This very rare congenital malformation (0.2-0.5) was not recognized by the duplex scanner performed preoperatively probably because of the low level of suspicion carried on by an experienced operator. Angio-CT e angio-MR which would have surely showed the anomaly, were not done because in the absence of an aneurysmal disease or other abdominal situations, these investigations were not required before operation. An angio-CT was performed routinely to the patient affected by AAA and so the left-sided vena cava was observed before operation; and then an abdominal arteriography and an ilio-caval venography were required which documented the vena cava anomaly. Surgical interventions didn t have complications. In the case of Leriche syndrome an aorto-bifemoral bypass was performed, and in the case of abdominal AAA an aortic ...
The Journal of cardiovascular surgery, 2000
The authors report a case of acute superior mesenteric and right renal artery embolism that occur... more The authors report a case of acute superior mesenteric and right renal artery embolism that occurred during an interventional radiological procedure on the abdominal aorta of a young diabetic woman. The onset of a severe abdominal pain during the procedure evoked the clinical suspicion of intestinal ischemia related to the dislodgement of atheroembolic material into the mesenteric artery; the event was correctly diagnosed, but the surgical therapy was delayed by many hours because of the fact that the patient was in a peripheral hospital of the region and had to be transferred to our institution. Fortunately in spite of the considerable delay, the operation was fully successful, probably because of the favourable location of the embolus, which allowed collateral splanchnic circulation to maintain a good metabolic balance.
The Journal of cardiovascular surgery, 1997
We present a case of left-sided inferior vena cava unexpectedly observed during an operation of a... more We present a case of left-sided inferior vena cava unexpectedly observed during an operation of aorto bifemoral bypass in a patient with severe Leriche syndrome and almost complete obstruction of the infrarenal aorta. This very rare congenital malformation (0.2-0.5%) was not recognized by the duplex scanner performed preoperatively, probably because of the low level of suspicion carried on by an experienced operator. AngioCT or angioMR, which would have surely shown us the anomaly, were not done because, in the lack of an aneurysmal disease or other abdominal pathological situations, these investigations were not required before operation. The possible hazards of such an unrecognized malformation are great, mostly in terms of incontrollable intraoperative hemorrhages, but the final outcome of this case was positive.
The Journal of cardiovascular surgery, 1993
The Authors report their experience in the treatment of venous and arteriovenous malformations, w... more The Authors report their experience in the treatment of venous and arteriovenous malformations, which in this paper are divided into two subgroups, pure venous malformations (VMs) and arteriovenous malformations (AVMs). A pure surgical indication was evident in less than 50% of cases (48.1%), while more conservative treatments were performed in remaining patients. Considering the particular characteristics of the disease, a complete surgical radicality isn't always possible, so surgery must be considered in selected cases.
Minerva cardioangiologica, 1976
Minerva cardioangiologica, 1978
Journal of Vascular Diagnostics, 2014
Background: Endovenous laser ablation is a minimally invasive procedure in the treatment of great... more Background: Endovenous laser ablation is a minimally invasive procedure in the treatment of great saphenous vein insufficiency. Procedural criteria (energy delivered according to the selected fluence) could affect outcome after treatment, potentially improving the success rate and reducing complications. However, the optimal values of the required energy per unit volume are not known, but on the basis of clinical experience, a range of optimal speed of retraction of the laser fiber catheter should exist and strictly depend on the actual vein dimensions. Methods: The study population included 21 patients. The equipment was a Diomed 30W ® laser, wavelength 810 nm. Before treatment, three segments of the great saphenous vein were mapped and their diameter measured and recorded. The energy delivered to each segment was recorded as well as its relationship with vein diameter being evaluated for each vein segment. Results: A 100% success rate was observed at 12-month follow-up assessment, the discomfort complaint 1 week after endovenous laser ablation by 19% of patients was always low (2 or 3 on a scale of pain of 10). On the basis of the actual result, which greatly improves our previous clinical experience, a range of effective values of speed of retraction of the laser fiber catheter (and of the energy per unit volume) is assessed, which strictly depends on the diameter of each segment of the vein. Conclusion: The speed of retraction of the laser fiber catheter should be properly tailored, in order to deliver the right energy dose depending on the actual vein diameter. A real-time procedure can be easily performed using a simple mathematical nomogram.
Interactive Cardiovascular and Thoracic Surgery, 2008
Pseudoaneurysms of the sovra-aortic trunks are uncommon lesions that usually have a post-traumati... more Pseudoaneurysms of the sovra-aortic trunks are uncommon lesions that usually have a post-traumatic etiology. The singular case of a patient who developed an innominate artery pseudoaneurysm (IAP) where a stent had been inserted 12 years earlier to manage severe innominate trunk stenosis is described. A chronic and large (8 cm in diameter) IAP was successfully treated in extracorporeal circulation and deep hypothermic circulatory arrest. The distal tract of the ascending aorta and the proximal aortic arch were substituted; total replacement of the innominate trunk with a singular 8-mm Dacron graft was necessary. We reviewed the literature about the reports of IAPs and the management of this singular lesion.
Background: Seminomatous and non-seminomatous Germ Cell Tumors (GCT) of the testis are a rare can... more Background: Seminomatous and non-seminomatous Germ Cell Tumors (GCT) of the testis are a rare cancer, with an estimated incidence of 56.3 per million white males and 10 per million black males in the United States. The association between non-seminomatous GCT and horseshoe kidney is a rare event and is seen in about 1.3% of patients requiring retroperitoneal lymph node dissection. To our knowledge, no cases have been reported in which replacement of the IVC was also necessary. Case presentation: We report the case of a 22-year-old man with horseshoe kidney and metastatic non-seminomatous germ cell tumor involving the wall of the inferior vena cava. Following post-chemotherapy retroperitonal lymph node dissection, the inferior vena cava was replaced with an expanded polytetrafluoroethylene graft. At 2-years follow-up, the patient was in good health and the graft was patent. No clinical or diagnostic signs of renal impairment or recurrence of neoplastic disease were noted. Conclusion: Radical surgery is warranted in patients with non-seminomatous germ cell tumor metastasizing to the retroperitoneal lymph nodes. When vena cava replacement is required, and the situation is further complicated by horseshoe kidney, as in this case, surgical technique will rely on multidisciplinary surgical treatment planning by a team composed of urologists, vascular surgeons and oncologists.
Journal of Vascular Surgery, 2009
After the incidental intraoperative discovery of a paraganglioma of cranial nerve XII, we searche... more After the incidental intraoperative discovery of a paraganglioma of cranial nerve XII, we searched our hospital database and literature for similar cases to determine whether evidence exists to support the existence of paraganglioma of the hypoglossal nerve. We describe a case of cranial nerve XII paraganglioma, recognized only during surgery, without any indicative preoperative sign or symptom nor diagnostic imaging studies. In light of published findings, only four cases described since 1966, and our experience, the report discusses diagnostic criteria that could aid in establishing a diagnosis of hypoglossal nerve paraganglioma based on a reasonable degree of medical certainty.
Journal of Vascular Surgery, 2013
Objective: To test the hypothesis that the size of a juxtaluminal black (hypoechoic) area (JBA) i... more Objective: To test the hypothesis that the size of a juxtaluminal black (hypoechoic) area (JBA) in ultrasound images of asymptomatic carotid artery plaques predicts future ipsilateral ischemic stroke. Methods: A JBA was defined as an area of pixels with a grayscale value <25 adjacent to the lumen without a visible echogenic cap after image normalization. The size of a JBA was measured in the carotid plaque images of 1121 patients with asymptomatic carotid stenosis 50% to 99% in relation to the bulb (Asymptomatic Carotid Stenosis and Risk of Stroke study); the patients were followed for up to 8 years. Results: The JBA had a linear association with future stroke rate. The area under the receiver-operating characteristic curve was 0.816. Using Kaplan-Meier curves, the mean annual stroke rate was 0.4% in 706 patients with a JBA <4 mm 2 , 1.4% in 171 patients with a JBA 4 to 8 mm 2 , 3.2% in 46 patients with a JBA 8 to 10 mm 2 , and 5% in 198 patients with a JBA >10 mm 2 (P < .001). In a Cox model with ipsilateral ischemic events (amaurosis fugax, transient ischemic attack [TIA], or stroke) as the dependent variable, the JBA (<4 mm 2 , 4-8 mm 2 , >8 mm 2) was still significant after adjusting for other plaque features known to be associated with increased risk, including stenosis, grayscale median, presence of discrete white areas without acoustic shadowing indicating neovascularization, plaque area, and history of contralateral TIA or stroke. Plaque area and grayscale median were not significant. Using the significant variables (stenosis, discrete white areas without acoustic shadowing, JBA, and history of contralateral TIA or stroke), this model predicted the annual risk of stroke for each patient (range, 0.1%-10.0%). The average annual stroke risk was <1% in 734 patients, 1% to 1.9% in 94 patients, 2% to 3.9% in 134 patients, 4% to 5.9% in 125 patients, and 6% to 10% in 34 patients. Conclusions: The size of a JBA is linearly related to the risk of stroke and can be used in risk stratification models. These findings need to be confirmed in future prospective studies or in the medical arm of randomized controlled studies in the presence of optimal medical therapy. In the meantime, the JBA may be used to select asymptomatic patients at high stroke risk for carotid endarterectomy and spare patients at low risk from an unnecessary operation.
The Journal of cardiovascular surgery, 2012
Secondary aortoesophageal fistula is a relatively rare but very often lethal complication that ma... more Secondary aortoesophageal fistula is a relatively rare but very often lethal complication that may develop after thoracic endovascular aneurysm repair (TEVAR). The clinical syndrome is well explained by the Chiari triad: midthoracic pain and/or dysphagia, and sentinel minor hematemesis followed by massive hematemesis. The incidence of this serious complication has increased with the growing number of patients undergoing TEVAR. This case report describes a patient who was seen in the emergency department at this hospital because of fever, sepsis and thoracic pain radiating to the back and unresponsive to drug therapy, diagnosed with a secondary aortoesophageal fistula and subsequently treated with a two stage surgical procedure.
Journal of Vascular Surgery, 2010
This report describes the case of a 60-year-old woman with a history of hysterectomy for myomas, ... more This report describes the case of a 60-year-old woman with a history of hysterectomy for myomas, totally asymptomatic, with incidental evidence of a pelvic intracaval mass extending to the right atrium. She underwent a staged procedure (sternothomic and abdominal) through a thoracolaparotomic approach in circulatory arrest and deep hypothermia. Using a one-stage surgical approach, we were able to withdraw one portion of the mass from the right atrium and another from the abdominal inferior vena cava, thus minimizing the risk of unexpected venous or atrial wall injury during surgical manipulation.
Liver Transplantation, 2014
Stefano Salizzoni followed the patient, helped to write the manuscript, and contributed to the im... more Stefano Salizzoni followed the patient, helped to write the manuscript, and contributed to the image process. Renato Romagnoli performed the surgery and critically reviewed the manuscript. Pietro Rispoli critically reviewed the manuscript and contributed to the image process. Paolo Strignano followed the patient and helped to write the manuscript. Roberta Suita helped to write the manuscript and contributed to the image process. Ezio David prepared and analyzed the histopathological specimens and critically reviewed the manuscript. Michele La Torre performed the surgery and critically reviewed the manuscript. Mauro Rinaldi performed the surgery and critically reviewed the manuscript.
Annals of Vascular Surgery, 2017
Aneurysms of the inferior thyroid artery (ITA) are extremely rare and potentially determine sever... more Aneurysms of the inferior thyroid artery (ITA) are extremely rare and potentially determine severe sequelae. We report a case of true ITA aneurysm in a 45-year old Caucasian woman treated with endovascular embolization; postoperative course was uneventful and, at 6-month follow-up, the aneurysm is completely thrombized. A systematic review of the literature has been also performed to identify the epidemiologic and clinical characteristics and diagnostic and operative options of this disease. Size alone is not able to predict the fate of the aneurysm and an aggressive treatment seems to be justified because of the high risk of complications in case of rupture. In an emergency setting the endovascular procedures associated to hematoma evacuation or open surgery should be rapidly performed to save patient life.
Minerva cardioangiologica, 1977
Chirurgia italiana, 1985
The authors studied the inter- and postoperative complications arising in a series of 690 consecu... more The authors studied the inter- and postoperative complications arising in a series of 690 consecutive interventions on thyroid. The results showed a cipher mortality and a 3% aggregate morbidity. In 0.9% of cases, compressive hematomata in the thyroid loggia, collapse of the tracheal wall due to tracheomalacia or bilateral paralysis of the vocal cords determined an acute respiratory stoppage. 1.4% of the treated patients suffered from alterations in the motility of the vocal cords, ascribable to damage of the recurrent nerves. 0.9% of cases showed a postoperative parathyroid insufficiency, the nature of which, however, was always temporary. The incidence of complications, in the whole, resulted significantly higher in the patients undergoing iterative surgery, in respect of those operated on the first time.
Angiología
The Authors report their preliminary experiences concerning the use of transcranial Doppler (TCD)... more The Authors report their preliminary experiences concerning the use of transcranial Doppler (TCD) in the pre- and postoperative monitoring of extracranial carotid surgery. TCD is a non invasive method of investigation able to give informations about the distribution of cerebral blood flow and about the mechanisms of compensation of Willis' circle. Furthermore, TCD showed itself to be very useful in the postoperative qualitative evaluation of surgery, pointing out, as a general rule, an increased flow in the middle cerebral artery after thromboendarterectomy of internal carotid artery. This haemodynamic modification, if present, is perceptible since the immediate postoperative period and becomes more evident and definitely stable at a distance of 20-30 days after operation, likewise the definitive stabilization of Willis' circle's haemodynamics.
International angiology : a journal of the International Union of Angiology, 2012
Guidelines for the assessment of the visceral arteries and veins and of the renal artery .
International angiology : a journal of the International Union of Angiology, 2012
The traditional morphological parameters for the description of a carotid atherosclerotic plaque ... more The traditional morphological parameters for the description of a carotid atherosclerotic plaque (degree of stenosis, echogenicity, systolic peak velocity etc.) are insufficient for the prediction of the risk of embolization. Contrast enhanced ultrasound (CEUS), based on the theory of inflammation and neoangiogenesis, seems to have a great potential for the detection of unstable plaques. The purpose of our work was to compare echogenicity of the plaque (evaluated with the Grey Scale Median; GSM), the degree of stenosis and CEUS with the histopathological findings. Patients with indication for internal carotid endarterectomy (CEA) underwent a preoperative imaging study with B-mode echo Doppler Ultrasound and with CEUS. The contrast enhancement of the plaque was described with two parameters: the maximum and mean signal intensity (SImax, SImean). After the surgical operation the removed plaque is sent to the pathology laboratory for the measurement of the neoangiogenesis (vessel densi...
Minerva cardioangiologica, 2001
Two cases of left-sided inferior vena cava observed in a patient affected by Leriche syndrome and... more Two cases of left-sided inferior vena cava observed in a patient affected by Leriche syndrome and the other affected by aortic abdominal aneurysm (AAA) are presented. This very rare congenital malformation (0.2-0.5) was not recognized by the duplex scanner performed preoperatively probably because of the low level of suspicion carried on by an experienced operator. Angio-CT e angio-MR which would have surely showed the anomaly, were not done because in the absence of an aneurysmal disease or other abdominal situations, these investigations were not required before operation. An angio-CT was performed routinely to the patient affected by AAA and so the left-sided vena cava was observed before operation; and then an abdominal arteriography and an ilio-caval venography were required which documented the vena cava anomaly. Surgical interventions didn t have complications. In the case of Leriche syndrome an aorto-bifemoral bypass was performed, and in the case of abdominal AAA an aortic ...
The Journal of cardiovascular surgery, 2000
The authors report a case of acute superior mesenteric and right renal artery embolism that occur... more The authors report a case of acute superior mesenteric and right renal artery embolism that occurred during an interventional radiological procedure on the abdominal aorta of a young diabetic woman. The onset of a severe abdominal pain during the procedure evoked the clinical suspicion of intestinal ischemia related to the dislodgement of atheroembolic material into the mesenteric artery; the event was correctly diagnosed, but the surgical therapy was delayed by many hours because of the fact that the patient was in a peripheral hospital of the region and had to be transferred to our institution. Fortunately in spite of the considerable delay, the operation was fully successful, probably because of the favourable location of the embolus, which allowed collateral splanchnic circulation to maintain a good metabolic balance.
The Journal of cardiovascular surgery, 1997
We present a case of left-sided inferior vena cava unexpectedly observed during an operation of a... more We present a case of left-sided inferior vena cava unexpectedly observed during an operation of aorto bifemoral bypass in a patient with severe Leriche syndrome and almost complete obstruction of the infrarenal aorta. This very rare congenital malformation (0.2-0.5%) was not recognized by the duplex scanner performed preoperatively, probably because of the low level of suspicion carried on by an experienced operator. AngioCT or angioMR, which would have surely shown us the anomaly, were not done because, in the lack of an aneurysmal disease or other abdominal pathological situations, these investigations were not required before operation. The possible hazards of such an unrecognized malformation are great, mostly in terms of incontrollable intraoperative hemorrhages, but the final outcome of this case was positive.
The Journal of cardiovascular surgery, 1993
The Authors report their experience in the treatment of venous and arteriovenous malformations, w... more The Authors report their experience in the treatment of venous and arteriovenous malformations, which in this paper are divided into two subgroups, pure venous malformations (VMs) and arteriovenous malformations (AVMs). A pure surgical indication was evident in less than 50% of cases (48.1%), while more conservative treatments were performed in remaining patients. Considering the particular characteristics of the disease, a complete surgical radicality isn't always possible, so surgery must be considered in selected cases.
Minerva cardioangiologica, 1976
Minerva cardioangiologica, 1978
Journal of Vascular Diagnostics, 2014
Background: Endovenous laser ablation is a minimally invasive procedure in the treatment of great... more Background: Endovenous laser ablation is a minimally invasive procedure in the treatment of great saphenous vein insufficiency. Procedural criteria (energy delivered according to the selected fluence) could affect outcome after treatment, potentially improving the success rate and reducing complications. However, the optimal values of the required energy per unit volume are not known, but on the basis of clinical experience, a range of optimal speed of retraction of the laser fiber catheter should exist and strictly depend on the actual vein dimensions. Methods: The study population included 21 patients. The equipment was a Diomed 30W ® laser, wavelength 810 nm. Before treatment, three segments of the great saphenous vein were mapped and their diameter measured and recorded. The energy delivered to each segment was recorded as well as its relationship with vein diameter being evaluated for each vein segment. Results: A 100% success rate was observed at 12-month follow-up assessment, the discomfort complaint 1 week after endovenous laser ablation by 19% of patients was always low (2 or 3 on a scale of pain of 10). On the basis of the actual result, which greatly improves our previous clinical experience, a range of effective values of speed of retraction of the laser fiber catheter (and of the energy per unit volume) is assessed, which strictly depends on the diameter of each segment of the vein. Conclusion: The speed of retraction of the laser fiber catheter should be properly tailored, in order to deliver the right energy dose depending on the actual vein diameter. A real-time procedure can be easily performed using a simple mathematical nomogram.
Interactive Cardiovascular and Thoracic Surgery, 2008
Pseudoaneurysms of the sovra-aortic trunks are uncommon lesions that usually have a post-traumati... more Pseudoaneurysms of the sovra-aortic trunks are uncommon lesions that usually have a post-traumatic etiology. The singular case of a patient who developed an innominate artery pseudoaneurysm (IAP) where a stent had been inserted 12 years earlier to manage severe innominate trunk stenosis is described. A chronic and large (8 cm in diameter) IAP was successfully treated in extracorporeal circulation and deep hypothermic circulatory arrest. The distal tract of the ascending aorta and the proximal aortic arch were substituted; total replacement of the innominate trunk with a singular 8-mm Dacron graft was necessary. We reviewed the literature about the reports of IAPs and the management of this singular lesion.
Background: Seminomatous and non-seminomatous Germ Cell Tumors (GCT) of the testis are a rare can... more Background: Seminomatous and non-seminomatous Germ Cell Tumors (GCT) of the testis are a rare cancer, with an estimated incidence of 56.3 per million white males and 10 per million black males in the United States. The association between non-seminomatous GCT and horseshoe kidney is a rare event and is seen in about 1.3% of patients requiring retroperitoneal lymph node dissection. To our knowledge, no cases have been reported in which replacement of the IVC was also necessary. Case presentation: We report the case of a 22-year-old man with horseshoe kidney and metastatic non-seminomatous germ cell tumor involving the wall of the inferior vena cava. Following post-chemotherapy retroperitonal lymph node dissection, the inferior vena cava was replaced with an expanded polytetrafluoroethylene graft. At 2-years follow-up, the patient was in good health and the graft was patent. No clinical or diagnostic signs of renal impairment or recurrence of neoplastic disease were noted. Conclusion: Radical surgery is warranted in patients with non-seminomatous germ cell tumor metastasizing to the retroperitoneal lymph nodes. When vena cava replacement is required, and the situation is further complicated by horseshoe kidney, as in this case, surgical technique will rely on multidisciplinary surgical treatment planning by a team composed of urologists, vascular surgeons and oncologists.
Journal of Vascular Surgery, 2009
After the incidental intraoperative discovery of a paraganglioma of cranial nerve XII, we searche... more After the incidental intraoperative discovery of a paraganglioma of cranial nerve XII, we searched our hospital database and literature for similar cases to determine whether evidence exists to support the existence of paraganglioma of the hypoglossal nerve. We describe a case of cranial nerve XII paraganglioma, recognized only during surgery, without any indicative preoperative sign or symptom nor diagnostic imaging studies. In light of published findings, only four cases described since 1966, and our experience, the report discusses diagnostic criteria that could aid in establishing a diagnosis of hypoglossal nerve paraganglioma based on a reasonable degree of medical certainty.
Journal of Vascular Surgery, 2013
Objective: To test the hypothesis that the size of a juxtaluminal black (hypoechoic) area (JBA) i... more Objective: To test the hypothesis that the size of a juxtaluminal black (hypoechoic) area (JBA) in ultrasound images of asymptomatic carotid artery plaques predicts future ipsilateral ischemic stroke. Methods: A JBA was defined as an area of pixels with a grayscale value <25 adjacent to the lumen without a visible echogenic cap after image normalization. The size of a JBA was measured in the carotid plaque images of 1121 patients with asymptomatic carotid stenosis 50% to 99% in relation to the bulb (Asymptomatic Carotid Stenosis and Risk of Stroke study); the patients were followed for up to 8 years. Results: The JBA had a linear association with future stroke rate. The area under the receiver-operating characteristic curve was 0.816. Using Kaplan-Meier curves, the mean annual stroke rate was 0.4% in 706 patients with a JBA <4 mm 2 , 1.4% in 171 patients with a JBA 4 to 8 mm 2 , 3.2% in 46 patients with a JBA 8 to 10 mm 2 , and 5% in 198 patients with a JBA >10 mm 2 (P < .001). In a Cox model with ipsilateral ischemic events (amaurosis fugax, transient ischemic attack [TIA], or stroke) as the dependent variable, the JBA (<4 mm 2 , 4-8 mm 2 , >8 mm 2) was still significant after adjusting for other plaque features known to be associated with increased risk, including stenosis, grayscale median, presence of discrete white areas without acoustic shadowing indicating neovascularization, plaque area, and history of contralateral TIA or stroke. Plaque area and grayscale median were not significant. Using the significant variables (stenosis, discrete white areas without acoustic shadowing, JBA, and history of contralateral TIA or stroke), this model predicted the annual risk of stroke for each patient (range, 0.1%-10.0%). The average annual stroke risk was <1% in 734 patients, 1% to 1.9% in 94 patients, 2% to 3.9% in 134 patients, 4% to 5.9% in 125 patients, and 6% to 10% in 34 patients. Conclusions: The size of a JBA is linearly related to the risk of stroke and can be used in risk stratification models. These findings need to be confirmed in future prospective studies or in the medical arm of randomized controlled studies in the presence of optimal medical therapy. In the meantime, the JBA may be used to select asymptomatic patients at high stroke risk for carotid endarterectomy and spare patients at low risk from an unnecessary operation.
The Journal of cardiovascular surgery, 2012
Secondary aortoesophageal fistula is a relatively rare but very often lethal complication that ma... more Secondary aortoesophageal fistula is a relatively rare but very often lethal complication that may develop after thoracic endovascular aneurysm repair (TEVAR). The clinical syndrome is well explained by the Chiari triad: midthoracic pain and/or dysphagia, and sentinel minor hematemesis followed by massive hematemesis. The incidence of this serious complication has increased with the growing number of patients undergoing TEVAR. This case report describes a patient who was seen in the emergency department at this hospital because of fever, sepsis and thoracic pain radiating to the back and unresponsive to drug therapy, diagnosed with a secondary aortoesophageal fistula and subsequently treated with a two stage surgical procedure.
Journal of Vascular Surgery, 2010
This report describes the case of a 60-year-old woman with a history of hysterectomy for myomas, ... more This report describes the case of a 60-year-old woman with a history of hysterectomy for myomas, totally asymptomatic, with incidental evidence of a pelvic intracaval mass extending to the right atrium. She underwent a staged procedure (sternothomic and abdominal) through a thoracolaparotomic approach in circulatory arrest and deep hypothermia. Using a one-stage surgical approach, we were able to withdraw one portion of the mass from the right atrium and another from the abdominal inferior vena cava, thus minimizing the risk of unexpected venous or atrial wall injury during surgical manipulation.
Liver Transplantation, 2014
Stefano Salizzoni followed the patient, helped to write the manuscript, and contributed to the im... more Stefano Salizzoni followed the patient, helped to write the manuscript, and contributed to the image process. Renato Romagnoli performed the surgery and critically reviewed the manuscript. Pietro Rispoli critically reviewed the manuscript and contributed to the image process. Paolo Strignano followed the patient and helped to write the manuscript. Roberta Suita helped to write the manuscript and contributed to the image process. Ezio David prepared and analyzed the histopathological specimens and critically reviewed the manuscript. Michele La Torre performed the surgery and critically reviewed the manuscript. Mauro Rinaldi performed the surgery and critically reviewed the manuscript.