Papers by Francesco de Santis
Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association, Jan 19, 2015
The purpose of this study was to assess our experience of carotid surgery habitually performed un... more The purpose of this study was to assess our experience of carotid surgery habitually performed under general anesthesia without intraoperative intracerebral monitoring, and following a pre-established perioperative protocol, which includes extensive use of an intraoperative shunt (IOS). This study included 311 consecutive carotid operations performed over 32 months. This patient cohort represents 14% of our total experience in carotid surgery (2219 operations, major stroke/mortality rate: 1.4%). The IOS was inserted routinely in the presence of intraoperative blood pressure instability during cross-clamping and when the predictable clamping time might have exceeded 20 minutes. A moderate and stable hypertension was maintained throughout surgery without IOS. Overall, 120 (38.6%) endarterectomies were performed with primary closure, 73 (23.5%) with eversion technique, 113 (36.3%) with patch angioplasty, and 5 (1.6%) with other techniques. Out of 113 patch angioplasties, 111 (98.2%) we...
In the European Union (EU) as whole, 24% of abstracted water is used in agriculture and, in some ... more In the European Union (EU) as whole, 24% of abstracted water is used in agriculture and, in some regions of Southern Europe, agriculture water consumption rises to more than 80% of the total national abstraction. Therefore agriculture can be considered unquestionably the main driving force in the water management. Overexploitation of water resources along with conflicts among different water uses, due to water scarcity problems, are becoming a pressing issue for environmental stewardship in various areas. Moreover climate change is expected to intensify irrigation requirements and water scarcity in the Mediterranean region. Accurate estimation of irrigation demands as well as irrigation consumption is therefore, a key requirement for more precise water management and an overview on European water use can contribute to develop suitable policies and management strategies. The paper analyses a methodology for the estimation of the irrigation water consumption at farm level in Italy by ...
Progress in clinical and biological research
Annals of Vascular Surgery, 2015
A 57-year-old woman was admitted to our unit suffering from hemorrhagic shock and upper abdominal... more A 57-year-old woman was admitted to our unit suffering from hemorrhagic shock and upper abdominal pain. An enhanced computerized tomography (CT) scan evidenced a large retroperitoneal hematoma due to visceral arteries aneurysm rupture and a significant celiac axis root segmental stenosis due to median arcuate ligament compression. A selective splanchnic arteries angiography showed 3 saccular pancreaticoduodenal artery arcade aneurysm (PDAAs), 2 in the inferior posterior pancreaticoduodenal artery, and 1 smaller in the superior anterior pancreaticoduodenal artery. The largest aneurysm showed evident rupture signs. Both inferior PDAAs were successfully treated via endovascular coil embolization. The celiac trunk stenosis and small inferior PDAA did not require treatment. A CT scan control at 1-year follow-up did not reveal any new PDAAs. In cases of celiac artery trunk (CAT) steno-occlusive lesions, multiple aneurysms can develop in the pancreaticoduodenal arcade. PDAAs should be treated because of high rupture risk, regardless of diameter. Although endovascular treatment via coil embolization represents the treatment of choice nowadays, a simultaneous treatment of the associated CAT lesions is still debated. However, in cases of aneurysm embolization alone, one cannot exclude that other PDAAs might develop in these patients in the future. Close monitoring and accurate long-term follow-up is highly recommended in these cases.
Phlebology
OBJECTIVES: A case of delayed popliteal artery injury (PA-INJ) onset after total knee arthroplast... more OBJECTIVES: A case of delayed popliteal artery injury (PA-INJ) onset after total knee arthroplasty (TKA) in a patient under postoperative anticoagulation therapy is reported. The role of anticoagulation both in late PA-INJ presentation and in PA-INJ management is discussed.ReportAn obese 76-year-old woman was presented with a common femoral vein thrombosis coupled with pulmonary embolism five days after TKA. She was immediately placed under anticoagulation therapy. Four days later, during physiotherapy-supervised mobilization, she developed a calf haematoma and large retro-articular pseudoaneurysm. Angiography revealed a minor PA-INJ successively treated with a covered stent-graft. CONCLUSIONS: In cases of initially undetected and staunched TKA-related PA-INJs, postoperative anticoagulation therapy may act as a potential trigger for final arterial rupture during mobilization exercises, followed by acute bleeding; in these cases, endovascular management represents an excellent treatm...
Vascular and endovascular surgery, 2012
Cervicocephalic artery dissections occurring during dental care have exceptionally been reported.... more Cervicocephalic artery dissections occurring during dental care have exceptionally been reported. We describe a case of internal carotid artery dissection, presenting as hypoglossal nerve palsy, occurring immediately after difficult inferior alveolar nerve anesthetic block for third inferior molar dental care. Carotid dissection was successfully treated with anticoagulation therapy while hypoglossal nerve palsy recovered with carotid dissection shrinkage. The etiopathogenetic mechanisms of this singular form of internal carotid artery dissection are discussed. The possibility of internal carotid artery dissection development during oral or dental procedure, specifically in cases of possible trivial intraoperative internal carotid artery injury, severe local periodontal infection, or prolonged cervical hyperextension should be considered. Every possible prophylactic measure should be taken (eg, sedating the patient during oral or dental procedures, aggressive preoperative management ...
Annali italiani di chirurgia
Whether mediastinoscopy is indicated in the preoperative staging of bronchogenic carcinoma is sti... more Whether mediastinoscopy is indicated in the preoperative staging of bronchogenic carcinoma is still a controversial issue. It may be performed routinely (to exclude locally inoperable patients from surgery), selectively, or it may be regarded as superfluous (in centers which prefer an extended lympho adenectomy at the time of thoracotomy). We regard mediastinoscopy as indicated for the following purposes: 1) staging of NSCLC and SCLC; 2) diagnostic (mediastinal masses or lung tumors without previous histology); 3) restaging after primary chemotherapy; 4) assessment of prognosis in patients with borderline operability. The indication for 224 mediastinoscopies performed at our institution in the period from September 1991 through March 1999 was mainly for staging (59.2%) or diagnostic (30.6%). Eight (5.4%) patients underwent mediastinoscopy for the assessment of operability, and 7 (4.8%) after primary chemotherapy for the restaging of loco-regionally advanced lung cancer. Sensitivity ...
La stima dei volumi idrici utilizzati per l'irrigazione a livello comunitario (EU27) è ormai ... more La stima dei volumi idrici utilizzati per l'irrigazione a livello comunitario (EU27) è ormai una priorità necessaria per la definizione di opportune politiche mirate ad un uso sostenibile della risorsa idrica. In questo contesto si colloca il progetto MARSALa (Modelling Approach for irrigation wateR eStimation at fArm Level) finanziato da EUROSTAT e finalizzato alla definizione di un sistema di calcolo
Journal of Vascular Surgery, 2013
A 48-year-old woman with neurofibromatosis type 1 (NF1) experienced progressive forearm swelling ... more A 48-year-old woman with neurofibromatosis type 1 (NF1) experienced progressive forearm swelling coupled with impending compartment syndrome. Computed tomography angiography revealed a ruptured aneurysm of the proximal radial artery, multiple fusiform radial artery aneurysms, and a high independent ulnar artery origin. Compartment syndrome required prompt hematoma evacuation. Radial artery reconstruction, technically demanding due to vessel wall fragility, was deemed unnecessary because of satisfactory blood supply to the hand. Histologic findings indicated NF1-related vascular abnormalities also in the apparently normal radial artery as well as in a forearm vein, suggesting diffused vasculopathy. This case report is the first on ruptured radial artery aneurysm in NF1-related polianeurysmatic degeneration. (J Vasc
European Journal of Obstetrics & Gynecology and Reproductive Biology, 1992
In order to suggest a valid experimental model for correlated studies regarding the complex pheno... more In order to suggest a valid experimental model for correlated studies regarding the complex phenomena of reproductive biology in humans, light (LM), transmission (TEM) and scanning electron microscopic (SEM) observations were carried out on vaginae of sexually mature New-Zealand albino rabbits, both in estrus and at 5 h after mating. To avoid artifacts depending upon the operative times for specimen removal and, in particular, to well visualize the inner surface of this organ, vaginal irrigation with fixative was performed prior to the surgical removal. Our data demonstrate that the upper 2/3 of the vaginal duct form a kind of 'cervico-vaginal canal' which shares many histological features with the human endocervix. In fact, this portion is lined within by a monostratified epithelium provided with tall microvillous and ciliated cells and often invaginated in crypts. After mating, the microvillous cells showed evidence of secretory activity, exhibiting dome-like luminal surfaces. Secretory droplets often contacted cilia and spermatozoa present in the mucosal furrows and crypts. Because of these singular features and the morphofunctional interactions between vaginal epithelium and male gametes, we believe the rabbit to be a helpful model for comparative biology in humans, concerning sperm capacitation and the general reactivity of the female genital tract during the reproductive cycle.
EJVES Extra, 2011
Introduction: Repair of vascular lesions can be particularly difficult in complex post-traumatic ... more Introduction: Repair of vascular lesions can be particularly difficult in complex post-traumatic injuries of the extremities due to subversion of the anatomic planes and unexpected anatomical anomalies. Report: We wish to report a case of complex post-traumatic injury of the upper extremities, in the presence of early brachial artery branching. A thorough examination of the wound revealed two proximal vascular stumps at inferior third of the arm level. Arterial continuity was reconstructed using two segments of reversed GSV to restore the damaged arteries' length. Discussion: In complex extremity traumas awareness of anatomical vascular anomalies is fundamental in planning an appropriate and durable vascular reconstruction. ª
cabi.org
The paper reports the methodology used for the realisation of a GIS based model to estimate the v... more The paper reports the methodology used for the realisation of a GIS based model to estimate the value of water demand for irrigated agricultural areas in Italian southern regions. Aim of this study is to develop a GIS based system for supporting infrastructural works raising the improvement of water resources efficiency. The evaluation method requires different databases and their harmonization: land use, soil, climate, statistical data and crop coefficient used to calculate crop evapotranspiration. The land use map is based on the photo-interpretation, using ortophotos and satellite images, and testing field campaigns. The classification system is based on a modified CORINE Land Cover nomenclature in order to have more details about agricultural irrigated areas. Climatic database is organized on the basis of the spazialization of 375 climatic stations data, aggregated by monthly average minimum and maximum temperature, and cumulative rainfall values. The result of climatic station data spazialization is the creation of 11 homogeneous climatic zones in Southern Regions. GIS-data have been intersected with agricultural statistical data and the different crop coefficient Kc calculating during the different culture growing periods. Agricultural statistical data have been used to define the different crops percentage present in the province of south Italy in relation with land use map. The crop coefficients used to calculate crop evapotranspiration have been derived from field measurement during the different culture growing period, where available, and from scientific literature. The result is a validated calculation model able to quantify the water demand in the agricultural areas, assessing the economical and environmental sustainability of irrigation and providing useful tool to support water management activity.
The Italian journal of surgical sciences / sponsored by Società italiana di chirurgia, 1989
Midline and transverse incision are commonly used in upper abdominal surgery. A comparison of the... more Midline and transverse incision are commonly used in upper abdominal surgery. A comparison of the two procedures with respect to the respiratory function, assessed by spirometry, blood gas analysis, inspiratory and expiratory pressures, and thoraco-abdominal respiratory synchronism, was made in two groups of patients after surgery on the abdominal aorta. 32 patients affected by abdominal aortic obstructive or aneurysmatic disease, candidates for aortoiliac revascularization, were randomized into two groups of 17 (group A) and 15 (group B) patients respectively. Group A underwent midline laparotomy and group B supraumbilical transverse laparotomy. Ventilatory function and blood gas analysis were determined on the day before operation and on the second and eight postoperative day. All patients showed a depressed ventilatory function postoperatively, but the impairment was significantly minor after transverse laparotomy.
The Italian journal of surgical sciences / sponsored by Società italiana di chirurgia, 1988
Surgical repair of abdominal aortic aneurysm (AAA) is frequently associated with DIC. 15 patients... more Surgical repair of abdominal aortic aneurysm (AAA) is frequently associated with DIC. 15 patients affected by AAA were studied to evaluate the risk of consumption coagulopathy and the efficacy of daily low-dose calcium heparin prophylaxis. The coagulation parameters investigated showed a postoperative decrease of AT III activity levels and platelet count the other laboratory tests did not show any significant modifications. Low dose heparin was effective in preventing coagulation activity or thrombotic episodes. No thromboembolic complications were observed, except nonfatal myocardial infarction.
Il Giornale di chirurgia, 1988
Minerva chirurgica, Jan 15, 1989
Giornale italiano di cardiologia, 1992
Inflammatory aneurysms of the abdominal aorta constitute an anatomoclinical entity characterised ... more Inflammatory aneurysms of the abdominal aorta constitute an anatomoclinical entity characterised by prominent thickening and fibrosis of the aneurysmal wall, extending to the adjoining structures. Etiology, pathogenesis and relation with atherosclerosis still remain controversial. Sixteen consecutive patients undergoing surgery for inflammatory aneurysm of the abdominal aorta between March 1987 and December 1990 were studied (Group I); as a control, a series of 16 consecutive patients operated on in the same period for atherosclerotic aneurysm of the abdominal aorta was selected (Group II). As far as clinical history and symptoms are concerned, the comparison between the two groups revealed significant differences only for hydronephrosis (exclusively present in Group I, p < 0.05) and abdominal pain (more frequent in Group I, p < 0.01). The microscopic study of the aneurysmal wall was performed by scoring its histological features (atherosclerotic lesions, medial and adventitia...
Journal of Cardiovascular Medicine, 2006
To compare the efficacy and safety of transoesophageal (TOC) vs. transthoracic (TTC) electrical c... more To compare the efficacy and safety of transoesophageal (TOC) vs. transthoracic (TTC) electrical cardioversion, both with biphasic shocks, for sinus rhythm (SR) restoration in patients with persistent atrial fibrillation (AF). We randomised 210 patients (151 male, 59 female, mean age 66 +/- 9 years) with persistent AF into two groups: group 1 (n = 104) undergoing TOC with a step-up protocol of 30, 50, 70 and 100 J, and group 2 (n = 106) undergoing TTC with a step-up protocol of 70, 100, 120 and 150 J. The two groups were homogeneous as for clinical and instrumental characteristics, except for left ventricular ejection fraction (50.5 +/- 10% in group 1 vs. 53 +/- 8% in group 2, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05) and thoracic impedance (63 +/- 8 Omega in group 1 vs. 66 +/- 6 Omega in group 2, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.005). SR was restored in 98 (94%) group 1 patients vs. 99 (93%) group 2 patients (P = NS). First shock was effective in 48 (46%) group 1 patients vs. 54 (51%) group 2 patients (P = NS). Mean delivered energy was 50.4 +/- 23.6 and 95.1 +/- 29.6 J; mean effective energy was 47.3 +/- 20.7 and 91.2 +/- 26.6 J in group 1 and group 2, respectively. Cross-over to the highest energy level was never effective. TOC tolerability was optimal (mean discomfort score 1.2 on a 1-4 grading scale). Markers of myocardial necrosis did not increase and no procedure-related complications occurred. On logistic regression analysis, the most predictive variables of unsuccessful cardioversion were AF duration (P = 0.0001) and low left atrial appendage emptying velocity (P = 0.02). Both TOC and TTC with biphasic shocks are effective and safe for SR restoration in patients with persistent AF; however, the considerably lower levels of delivered and effective energies for SR restoration allow TOC to be performed during mild sedation with optimal tolerability, thus avoiding general anaesthesia.
World Journal of Surgery, 2006
Resection line involvement has been indicated as an important prognostic factor for gastric cance... more Resection line involvement has been indicated as an important prognostic factor for gastric cancer. Its late detection renders the choice of treatment difficult for surgeons. We describe the multicenter experience of a group of 11 patients with early gastric carcinoma (EGC) and positive resection confirmed at histological examination who did not undergo surgical retreatment for reasons of associated disease, surgical considerations on duodenal stump, or patient refusal. The gastric margin was involved in 4 patients, and 7 patients had duodenal resection line involvement. No surgical complications or postoperative deaths were observed. Five and 8-year survival was 100% and 86%, respectively. The only patient who relapsed did not have lymph node involvement and died from liver metastases, without local recurrence. It is sometimes difficult to accurately define the resection line in gastric cancer surgery, especially in the early stages of disease, but because of the strongly negative prognostic value of an infiltrated margin, frozen sections are recommended if neoplastic invasion is suspected and a new resection is always recommended if possible. Nevertheless, the good prognosis of resected EGC patients with resection line involvement must be considered before submitting patients with associated diseases to radical surgical retreatment.
Journal of Vascular Surgery, 1991
Inflammatory abdominal aortic aneurysms are characterized by dense perianeurysmal fibrosis involv... more Inflammatory abdominal aortic aneurysms are characterized by dense perianeurysmal fibrosis involving the adjacent organs. Attempts to isolate the aneurysm can lead to operative injuries of these structures, thus increasing the rates of complications and mortality. In the last 12 years 45 patients with inflammatory abdominal aortic aneurysms underwent aneurysm resection at the Department of Vascular Surgery of the University of Rome. The aneurysm was resected through a standard, midline transperitoneal approach in 39 patients, through a thoracophrenolaparotomy in two patients, and through a left-flank extraperitoneal approach in the last four patients. The extraperitoneal approach simplified aneurysm dissection and aortic damping with no cases of postoperative morbidity or death. In addition, we reviewed the CT scan findings of 12 patients surgically treated for inflammatory abdominal aortic aneurysm. The amount of fibrosis in the anterior wall of the aneurysm was greater than in the left posterolateral aspect (p = 0.008). We conclude that the left-flank extraperitoneal approach is the most anatomically advantageous route for repair of inflammatory abdominal aortic aneurysm. (J V^sc SuR6 1991;13:692-7.)
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Papers by Francesco de Santis