[Etiological hypothesis on five cases of elastofibroma dorsi]. / Ipotesi eziologica su cinque casi di elastofibroma dorsi.

Elastofibroma dorsi is a rare benign lesion of the soft tissue of the thoracic wall, usually located in the subscapular region. It occurs mostly in elderly women patients. This lesion usually arises in right region but it can also be bilateral. Even if the pathogenesis is still unknown, it is considered that "rubbing" of the scapula against the thorax wall could determine growth of the elastofibroma. The differential diagnosis from sarcoma is required but the typical localization and the MRI suggest the diagnosis which should be confirm with the histological exam. The Authors present their experience on five patients, with a median age of 64, affected by elastofibroma dorsi. In two cases, a builder and an obstetrician, the lesion was bilateral; in the other three cases, two teachers and a notary, the lesion are right-sided. A thorax computed tomography (CT) revealed a lesion with heterogeneous density, and the magnetic resonance imaging (MRI) , shows intralesional areas of medium and high intensity signals in the tissue with low intensity in both T12 and T2-sequences. The patient underwent surgery and diagnosis was confirmed by the histological exam. Prevalence of the right localization reported in literature, the correlation between the job of the patients and the lesion localization, more evident in the women, confirmed, according to the other Authors, the etiological hypothesis which considers the lesion as a proliferative response of the connective tissue to the repeated mechanical stress which excessive elastic fibrollogenesis probably due to genetic predisposition.

[Subfascial endoscopic perforating vein surgery in patients with advanced trophic lesions (lipodermatosclerosis or ulcers)]. / La legatura endoscopica delle vene perforanti nei pazienti con lesione trofiche avanzate(lipodermatosclerosi o ulcere).

AIM: Subfascial endoscopic perforating vein surgery (SEPS) is proposed in the treatment of chronic venous insufficiency stages C4-C6 of the CEAP classification. METHODS: SEPS was performed in 10 patients (4 men, 6 women), 3 of which were stage C4, 4 stage C5 and 3 stage C6. RESULTS: Full resolution of ulcers was achieved in the 12-month follow-up period; no post-operative sepsis complications were observed. CONCLUSIONS: SEPS is a safe procedure and a valuable therapeutic aid in the treatment of chronic venous insufficiency complicated by trophic skin ulcers. Compared with other techniques, it is less invasive, works directly on the healthy skin and significantly reduces skin wounds.

Biliary tract cancer: our experience with gemcitabine treatment.

Biliary tract cancers are uncommon tumors, with a poor prognosis because most patients present an invasive cancer at diagnosis that makes them inoperable. Chemotherapy is a palliative treatment, but single drugs or combination schedules have demonstrated a response rate of 14-18%, with a duration of response of 8.5 months. We report a single center experience with gemcitabine in the treatment of patients with advanced biliary tract cancers. We report on four cases of chemonaive patients with advanced biliary tract cancers treated with gemcitabine 1 g/m q days 1, 8 and 15. After three cycles of treatment we observed one partial response and three stable disease (according to WHO criteria), with an increase in performance status and a complete relief of pain in all patients. The median time to progression observed was 10.7 months. Although this experience is limited to a small number of patients, it shows that gemcitabine appears to be worthy of clinical research in this neoplastic pathology and makes the drug a particularly interesting agent for investigation in patients with biliary tract malignancies.

Can preoperative spiral CT scans alone determine the feasibility of endovascular AAA repair? A comparison to angiographic measurements.

PURPOSE: To determine whether computed tomography (CT) alone can be used for excluding patients from endovascular repair for abdominal aortic aneurysms (AAA). METHODS: Among 71 patients evaluated for endovascular AAA repair using spiral CT imaging and angiography, 31 were selected who had both studies performed within 6 months of each other using a graduated measuring catheter or guidewire. Measurements of aneurysm neck diameter, neck length, and infrarenal aortic length were made from the CT and angiographic images using handheld calipers with calibration markers as guides. Infrarenal aortic length and neck length were determined from CT images by multiplying the width of the cuts by the number of slices between the lowest renal artery and the aortic bifurcation or the top of the aneurysm, respectively. RESULTS: CT neck diameter measurements differed significantly from the angiographic dimensions (6.3 +/- 5.1-mm mean difference, p < 0.001). In the majority of patients (25, 81%), CT neck diameters were larger (mean 7.3 +/- 3.8 mm). The mean difference in neck length measurements was 0.5 +/- 15.9 mm (p = NS). Twenty-two (71%) patients had aortic length measurements that were longer on the angiogram (mean 15.4 +/- 17.2 mm, p = NS). Five patients who would have been excluded as candidates based on overestimated CT neck diameter measurements subsequently underwent successful endovascular aneurysm repair. CONCLUSIONS: Considerable discrepancies exist between preoperative neck diameter and infrarenal aortic length measurements obtained from CT scans and angiograms used to evaluate candidates for endovascular aortic aneurysm repair. CT alone may not be adequate for predicting the feasibility of endovascular AAA repair.

Endoluminal repair of aneurysms containing ostia of essential branch arteries: an experimental model.

PURPOSE: To examine experimentally the feasibility of transfemoral endoluminal repair of aneurysms containing the ostia of essential branch arteries. METHODS: In a canine model (n = 4), suprarenal aortic aneurysms were created by suturing an artificial patch onto an anterior arteriotomy. Following a 2-week recovery period, the dogs underwent endovascular exclusion of their aneurysms using an aortic stent-graft with separate renal artery branch grafts. Outcome was evaluated using angiography, intravascular ultrasound (IVUS), Doppler flow, invasive pressure monitoring, and autopsy, respectively. RESULTS: Successful creation and subsequent endovascular exclusion of the aneurysm using aortic stent-grafts and separate bilateral renal artery stent-grafts was achieved in all trials. Angiographically, all aneurysms were excluded from aortic flow and all renal arteries were patent at completion of the procedure. With IVUS, good graft apposition and absence of perigraft flow were demonstrated in all animals. Mean pressure in the aneurysmal sac at completion of the procedure was 40 +/- 7 mmHg, compared to a mean systemic blood pressure of 105 +/- 8 mmHg (p < 0.05). At autopsy, no gross intimal damage was seen in the aorta or the renal arteries, and intact aortic grafts and branch grafts without twisting, coiling, or kinking were found in all trials. CONCLUSIONS: In an acute animal model, suprarenal aortic aneurysms can be excluded from the circulation with preservation of renal flow using an endoluminally placed aortic stent-graft with separate branch grafts.