[Splenic embolization and hepatic chemoembolization: combined transcatheter treatment of hepatocellular carcinoma in cirrhosis with hypersplenism]. / Embolizzazione splenica e chemioembolizzazione epatica: trattamento combinato transcatetere del carcinoma epatocellulare su cirrosi con ipersplenismo.

Liver cirrhosis with hypersplenism is often associated with HCC. In many such cases, chemoembolization (TACE) may be very difficult because of the high incidence of hemorrhagic complications due to treatment and/or following portal hypertension, as well as for poor hematologic tolerance to antiblastic drugs in cirrhotic patients. Six patients with nodular HCC and cirrhosis (Child B) with hypersplenism were treated by combined TACE and partial splenic embolization (PSE) to reduce splenic size and to improve hematologic and hepatic function rates. Actual and long-lasting (up to 6 months since TACE/PSE) positive results were observed in splenic size and in hepatic function synthesis, as well as on hematologic and hemocoagulation factors. The clinical-laboratory improvement following TACE/PSE allowed TACE to be completed in all cases, following the usual protocol based on 3 procedures. Therefore, in the patients with advanced/decompensated cirrhosis and hypersplenism associated with HCC, the combined one-step TACE/PSE treatment can be said to improve patients' tolerance to antiblastic drugs and to reduce the risk of hemorrhagic complications due to invasive radiologic procedures and/or to portal hypertension.

[Bone metastasis of hepatocellular carcinoma: observations in patients treated with transcatheter arterial chemoembolization]. / Metastasi ossee da carcinoma epatocellulare: osservazioni nei pazienti trattati con chemioembolizzazione arteriosa transcatetere.

Bone metastases from hepatocellular carcinoma (HCC) are fairly rare, their average occurrence rate being 7.3%. Seven cases of secondary bone lesions (2%) were observed in a series of 347 consecutive cases treated with transcatheter arterial chemoembolization (TACE). The conventional X-ray and the CT patterns of secondary bone involvement were studied, together with histologic features, tumor and cirrhosis stage, and follow-up results. Bone metastases were detected in the early stages of cirrhosis and HCC, which suggested that patients might experience long survival if adequately treated. On the other hand, due to the lower rate of bone metastases in our series than in untreated cases, TACE cannot be said to be of even partial value in the treatment of distant HCC metastases. At any rate, bone metastasis alone is not necessarily a sign of poor prognosis, if it is adequately treated with radio-chemotherapy.

Congenital absence of pericardium as unusual cause of T wave abnormalities in a young athlete.

The congenital absence of pericardium is a rare condition which may determine electrocardiographic ST-T abnormalities. The case of a 16-year-old athlete who presented T-wave abnormalities at standard electrocardiogram performed during a physical checkup is reported. Ventricular repolarization tended to normalize during exercise and in right lateral decubitus. Chest x-ray and echocardiography showed typical signs of complete absence of the left pericardium. The definite diagnosis was made by computer tomography (CT) scan. The importance of a complete investigation of athletes with T-wave abnormalities is emphasized. Diagnostic and therapeutic features of the congenital absence of pericardium are discussed.

Benign solitary nerve sheath tumors of the spinal accessory nerve in the posterior triangle of the neck. Report of two cases.

A case of solitary schwannoma and one of solitary neurofibroma originating from the spinal accessory nerve in the posterior triangle of the neck are described. Location of such neoplasms in this region is exceptional. The authors emphasize the importance of accurately enucleating the mass; when it is impossible to preserve the continuity of the neural pathway, nerve repair should be considered.

Ganglionic cysts of the peroneal nerve at the knee: CT and surgical correlation.

The CT appearance of two cases of ganglionic cysts of the common peroneal nerve at the knee is reported. In both cases the ganglion appeared as a cystic unenhanced lesion of mucoid density. The radiological findings were confirmed by surgery. The differences in the appearance of intraneural and extraneural ganglia are discussed.

A hazard of craniotomy in the sitting position: the posterior compartment syndrome of the thigh. Case report.

A bilateral posterior compartment syndrome of the thigh with a sciatic neuropathy in a patient following a craniotomy in the sitting position is described. The pathophysiology of the sciatic nerve dysfunction is discussed and the diagnostic value of computerized tomography is emphasized. Prompt decompression of the nerve is suggested.