IN SYSTEMIC LUPUS ERYTHEMATOSUS AND ANTIPHOSPHOLIPID ANTIBODY SYNDROME.

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1 1. Minerva Chir Apr;67(2): CRITICAL LOWER LIMB ISCHEMIA IN A PATIENT WITH ATHEROEMBOLISM FROM AORTIC SOURCE IN SYSTEMIC LUPUS ERYTHEMATOSUS AND ANTIPHOSPHOLIPID ANTIBODY SYNDROME. Mirenda F, Stilo F, Benedetto F, De Caridi G, Modafferi A, Spinelli F. PMID: [PubMed - indexed for MEDLINE] 1. Chir Ital Jul-Aug;59(4): 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 after elective operation for bone lengthening or correction of a deformity are very rare situations. We describe 3 cases. Case 1: male, aged 22, undergoing corticotomy for bone lengthening; immediately presented acute limb ischaemia due to a partial lesion of the popliteal artery, documented by U.S. After 7 h, direct reconstruction 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 of the infra-genicular popliteal artery and a voluminous false aneurysm. Direct correction of the artery and fasciotomies were performed. Case 3: male, aged 22, undergoing corticotomy for leg lengthening; immediately presented leg pain with decreased distal pulses. After 4h, there was an increase in leg volume, and arteriography showed a total lesion of the infragenicular popliteal artery and an arteriovenous fistula. Popliteo-tibial bypass with the contralateral greater saphenous vein and fasciotomies were performed. After 1 month endovascular closure of the fistula was obtained. All patients had recovered after two months with only minor leg insufficiency. Patency of the bypass and absence of infections or delayed false aneurysms were achieved. Vascular injuries after elective orthopaedic procedures are very rare situations. Such lesions are caused by an osteotomy via corticotomy performed percutaneously. The variety of clinical presentations accounts for the difficulty in diagnosing such lesions and for the delays in implementing treatment. It is very important to obtain an early diagnosis complete with an arteriography. PMID: [PubMed - indexed for MEDLINE] 2. Chir Ital Jan-Feb;58(1): [GUNSHOT INJURY OF SUPERFICIAL FEMORAL ARTERY. SURGICAL TREATMENT WITHOUT PREOPERATIVE ANGIOGRAPHY: A CASE REPORT] Mirenda F, Baccellieri D, Carmignani A, La Spada M, Benedetto F, Spinelli F. Unità Operativa Complessa di Chirurgia Vascolare, Cattedra e Scuola di Specializzazione in Chirurgia Vascolare, Università degli Studi di Messina.

2 The superficial femoral artery is the most frequently injured vessel in lower limb traumas. The traumatic agents responsible may be gunshot, blunt instrument and stab wounds. Preoperative angiography is often used to choose the most appropriate surgical approach for limb salvage. We report a case of a traumatic gunshot lesion of the superficial femoral artery surgically treated with a great saphenous vein bypass without preoperative angiography. PMID: [PubMed - indexed for MEDLINE] 3. Chir Ital Jan-Feb;58(1): [SYMPTOMATIC AORTO-ILIAC ANEURYSM AND SITUS VISCERUM INVERSUS: CASE REPORT] Baccellieri D, Mirenda F, Mandolfino T, La Spada M, Stilo F, Spinelli F. Unità Operativa Complessa di Chirurgia Vascolare Cattedra e Scuola di Specializzazione in Chirurgia Vascolare Università degli Studi di Messina. We report a case of infrarenal symptomatic aorto-iliac aneurysm in a patient with acute abdominal pain. The patient was admitted to the emergency care unit for abdominal pain and CT scans showing an infrarenal aorto-iliac aneurysm in a situs viscerum inversus (SVI) totalis syndrome. The patient underwent open aneurysm repair with an aorto-iliac bifurcated graft. This case shows that situs viscerum inversus cannot be considered a technical problem for the surgical treatment of abdominal aortic aneurysm. PMID: [PubMed - indexed for MEDLINE] 4. Chir Ital Nov-Dec;57(6): ILOPROST INFUSION IN DIABETIC PATIENTS WITH PERIPHERAL ARTERIAL OCCLUSIVE DISEASE AND 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 e Cardiovascolari, 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 a support measure in conjunction with endovascular procedures. We studied 244 patients with critical ischaemia of the lower limbs, 146 of whom (59.8%) affected by diabetes. A femoro-distal bypass was performed in 175 patients. In the 69 nonsurgical diabetic patients (47.3% of the diabetics) an iloprost infusion was started. These diabetics presented foot ulcers, a palpable or slightly hypo-sphygmic popliteal pulse and high distal arterial flow at the ankle. In 55 of these patients (79.7% of those not operated on and 37.6% of the diabetics) who were non-responders to medical therapy, an endovascular procedure was also performed. The results of the iloprost infusion (69 pts.) were evaluated after one 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 course of therapy. No severe ischaemia recurrences were reported in the follow-up of these 69 patients. In the 47.3% of subjects with diabetic arteriopathy presenting foot ulcers and high distal flow, it proved possible to avoid an open surgical revascularisation procedure and to resort to medical therapy with iloprost, completed in 79.7% of

3 cases with endovascular procedures. Iloprost infusion improves limb perfusion and, in selected cases may be an important therapeutic tool for the care of ulcerative lesions of the diabetic foot, also as a support measure in conjunction with endovascular procedures. PMID: [PubMed - indexed for MEDLINE] 5. Chir Ital May-Jun;57(3): [ANEURYSM OF THE ABDOMINAL AORTA ASSOCIATED WITH AN ECTOPIC PELVIC KIDNEY AND ABNORMAL VASCULARISATION: A CASE REPORT] 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 are a rare occurrence that can create technical problems during the operation in terms of preservation of renal parenchyma and vascularisation. A case of abdominal aortic aneurysmectomy associated with an ectopic pelvic kidney is presented. Preoperative diagnosis is necessary in order to plan the surgical technique to be employed in each anatomical variant encountered. PMID: [PubMed - indexed for MEDLINE] 6. Anesthesiology Jan;102(1): 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. vfodale@unime.it PMID: [PubMed - indexed for MEDLINE] 7. Chir Ital Nov-Dec;55(6): [VARICOSE VEIN RECURRENCE AFTER SURGERY OF THE SAPHENO-FEMORAL JUNCTION: COLOR DOPPLER ULTRASONOGRAPHY STUDY] Roscitano G, Mirenda F, Mandolfino T, De Caridi G, Stilo F, Benedetto F, Spinelli F. Cattedra e Scuola di Specializzazione in Chirurgia Vascolare Università degli Studi di Messina. The aim of this study was to evaluate the accuracy and sensitivity of colour Doppler ultrasonography for the diagnosis of postoperative recurrent varicose veins in patients submitted to surgical ligation of the saphenofemoral junction with a view to classifying the recurrences according to the causes. We studied 401 lower limbs in the orthostatic position with colour Doppler

4 ultrasonography in 318 patients (64 M and 254 F) presenting postoperative varicose vein recurrence during the follow-up (12-60 months). We evaluated the type of reflux at 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; an incontinent 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 diagnosis and classification of postoperative varicose vein recurrences in patients submitted to surgical obliteration of the saphenofemoral junction. It is decisive in the preoperative evaluation and followup of patients. In our experience, more than one half of the cases of recurrence were not due to an error of surgical technique. PMID: [PubMed - indexed for MEDLINE] 8. Chir Ital Sep-Oct;55(5): [ABDOMINAL ARTERY ANEURYSM AND ASSOCIATED SURGICAL ABDOMINAL DISEASES: TOWARDS OPTIMAL TIMING] Stilo F, Mirenda F, Mandolfino T, La Spada M, D'Alfonso M, Carmignani A, De Caridi G, Benedetto F, Spinelli F. Unità Operativa, Cattedra e Scuola di Specializzazione in Chirurgia Vascolare Università 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 abdominal surgical diseases. From January 1984 to December 2002, 372 patients underwent surgery for abdominal aortic aneurysms, 350 men (94%) and 22 women (6%), mean age 72 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 were treated during the same operation in 34 cases (85%). We had three deaths in the 34 cases treated in the same operation (9%). In the remaining cases no perioperative mortality was registered. There were no cases of prosthesis infection. 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 surgical procedure. The advent of the endovascular method allows us to postpone the treatment of the associated disease without increasing the technical difficulty of the second operation. PMID: [PubMed - indexed for MEDLINE] 9. Chir Ital Sep-Oct;55(5): [INTRAOPERATIVE RECOVERY OF BLOOD IN SURGERY OF INFRARENAL ABDOMINAL AORTIC ANEURYSM]

5 La Spada M, De Caridi G, Mandolfino T, Mirenda F, D'Alfonso M, Spinelli F. Unità Operativa di Chirurgia Vascolare, Cattedra di Chirurgia Vascolare Azienda Ospedaliera Universitaria Policlinico Gaetano Martino, Messina. The aim of the study was to evaluate the possibility of reducing the blood loss during elective surgery for abdominal aortic aneurysms using particular intraoperative surgical expedients. From 1993 to 1999, 200 patients were recruited into the study. We performed 90 aorto-aortic, 84 aortobisiliac, 4 aorto-iliac-femoral, 12 aorto-bisiliac-hypogastric, and 10 aorto-bifemoral reconstructions. Several surgical techniques were used and are described in detail. The mortality rate was 3.5%. Haemoglobinaemia 24 hours after the operation 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, and autologous transfusions in 17%. The average estimated blood loss was 350 ml, with mean reinfusion of 0.98 blood units. Our study suggests the possibility (44%) of avoiding the use of blood transfusions thanks to intraoperative blood saving by means of particular surgical techniques. PMID: [PubMed - indexed for MEDLINE] 10. J Cardiovasc Surg (Torino) Oct;43(5): PRIMARY AORTODUODENAL FISTULA INCLUDING THE AFFERENT LOOP OF A BILLROTH II ANASTOMOSIS. A CASE REPORT. Spinelli F, Mirenda F, Mandolfino T, La Spada M, Mondello B, D'Alfonso M, De Caridi 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 an abdominal aortic aneurysm (AAA). The 3rd and 4th portion of the duodenum are involved in up to 80% of all cases. Frequently, gastrointestinal bleeding represents the first symptom, and diagnosis is difficult because of the aspecific clinical presentation and course, characterized by alternating remission and relapse; this is the reason why surgical treatment is usually delayed and therefore such events are managed as emergencies with a preoperative and intraoperative high death rate. We report the case of a 76- year-old man with a primary aortoduodenal fistula, who was submitted to gastric resection according to Billroth II 20 years before. This case could be interesting for its anatomical peculiarities favourable to the formation of the fistula. PMID: [PubMed - indexed for MEDLINE] 11. Chir Ital Jun-Aug;44(3-4): [A RARE COMPLICATION DUE TO DIVERTICULITIS] Di Bernardo N, D'Ambrosio B, Mirenda F, Cittadino L, Vena M. Istituto di Fisiopatologia Chirurgica e Propedeutica Clinica, Università di Messina. The AA. report about a case of hepatic abscess found in a operated patient for perforation of a sigmoid diverticulum. The AA. made some consideration on the rarity of the hepatic abscess as complication of diverticulum perforation.

6 PMID: [PubMed - indexed for MEDLINE] 12. Chir Ital Jun;38(3): [A CASE OF PRIMARY INTESTINAL LYMPHOMA] Mandolfino T, Parisi A, Parisi S, Dattola A, Muscolino R, Mirenda F. The authors examine primary small bowel tumours, dealing at some length with problems 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 of thorough evaluation of those vague symptoms which may be the only manifestation of this disease. PMID: [PubMed - indexed for MEDLINE]