[Vascular access for hemodialysis. Clinical experience]. / Accesso vascolare per emodialisi. Una esperienza clinica.

Seventy-nine arteriovenous fistulas for periodic hemodialysis were created in 62 uremic patients: 64 primary vascular accesses and 15 salvage operations for malfunctioning fistulas. Sixty-three distal and 1 proximal arteriovenous fistulas between the radial artery and the cephalic vein, were created as primary vascular access. The utilization time of the primary arteriovenous fistulas was longer than 5 years in 34%, 3-4 years in 25% and 0-2 years in 41% of cases. Eleven fistulas evidenced thrombosis: a salvage operation (resection-anastomosis) was possible for 9 (89%). A salvage operation was possible for 100% of poor flow fistulas. The utilization's time of the salvage fistulas is longer than 5 years in 15%, 3-4 years in 15% and 0-2 years in 70% of cases.

[A difficult diagnosis: retroperitoneal rupture of the duodenum caused by closed trauma of the abdomen]. / Una diagnosi difficile: la rottura retroperitoneale del duodeno da trauma chiuso nell'addome.

The Authors report two cases of sub-peritoneal rupture of the duodenum following blunt abdominal trauma. The diagnostic difficulties are explained in detail. Emphasis is placed on the importance of prompt recognition of the duodenal injury and early surgical treatment to ensure a successful outcome.

[The incidence of 1,2-dimethylhydrazine-induced colonic neoplasms in the rat: the effect of constipation]. / Incidenza delle neoplasie coliche indotte da 1,2-dimetilidrazina nel ratto: influenza della stipsi.

The authors studied the role of slow bowel transit in the development of colonic neoplasias in rats treated with 1,2-dimethylhydrazine (DMH). Forty Sprague-Dawley male rats, weighing 400 g, were used in the experiment and were divided into 4 groups of 10 rats each. The first and the second group were given, weekly, subcutaneous injections of DMH at a dose of 25 mg/kg for 25 and 27 weeks respectively; in these groups constipation was obtained by reducing water intake throughout the period of the experiment. The third and the fourth group (control groups) received DMH at the dose of 25 mg/kg for 25 and 27 weeks respectively and water "ad libitum". The rats were weighed once a week and stool output, weight, and number of scybala/day were recorded once every four weeks. Rats were sacrificed one week after the final injection of DMH and every intestinal lesion macroscopically identified was histologically examined. All rats showed weight loss from the 22nd week to the sacrifice. The mean stool weight/day was 21.2 g +/- 1.47 in the groups A and B; while for the groups C and D it was 23.6 g +/- 1.81 (p = 0.019). The number of scybala/day was 26 +/- 3 in the groups A and B, whereas in the groups C and D was 34 +/- 4 (p = 0.05). An increased number of cancers per rat was recorded in the groups A and B compared to control groups, respectively from 0.66 to 1.4 at 25 weeks (p = 0.02) and from 0.9 to 2.44 at 27 weeks (p = 0.07). A corresponding increase in the number of polyps after 25 weeks was demonstrated, taking into account the possible polyp-cancer sequence. Our study suggests that the slow bowel transit induced an increased number of colonic neoplasia in relation to the prolonged contact of the carcinogen with the mucosa or to its greater concentration in the colonic lumen due to the fecal output reduction.

[Embolism of the superior mesenteric artery. A clinical experience]. / L'embolia dell'arteria mesenterica superiore. Un'esperienza clinica.

The Authors report their clinical experience in superior mesenteric artery embolism: 10 arterial embolisms (71%) collected from a series of 14 obstructions of the superior mesenteric artery. The main interval from the beginning of the symptomatology to hospital admission was 48 h. Laparotomy was performed in all ten patients; gangrenous bowel was resected in 2 and 2 had an embolectomy of the superior mesenteric artery without intestinal resection. The remaining 6 patients had laparotomy alone and died. The Authors emphasize the difficulty in recognizing the disease at an early stage and suggest to contemplate in patients at risk with a persistent abdominal pain, the possibility of a superior mesenteric artery embolism.

[Recovery after amputation for arteriosclerosis. Follow-up study]. / Il recupero dell'arteriopatico amputato. Studio a distanza.

Clinical follow-up of 71 patients subjected to major amputation of the lower extremities for atherosclerotic arteriopathy has been analysed for the purpose of ascertaining real possibilities of functional recovery and quality of life. Research results show that only a small number of patients (38%) can achieve an acceptable quality of life. The reasons have been identified in the objective difficulty of adequate physical and psychotherapeutic rehabilitation owing to structural shortcomings or the presence of associated pathology or the advance in the basic condition which does not permit application or frustrates results.

The "ultraperipheral" revascularization in arteriosclerotic obstruction of tibial vessels. Experimental study.

In arteriosclerotic obstruction of the main tibial arteries, the tibial collateral vessels are usually patent, and about 70% of these arteries are potentially suitable for surgical revascularization. The present study aimed at investigating the practical feasibility of a selective revascularization procedure on these tibial muscular arteries (ultraperipheral revascularization). Six lower limbs amputated at thigh level for arteriosclerotic gangrene with complete obstruction of the main tibial arteries, were studied: the tibial collateral muscular vessels showed patency in 65% of cases. The authors propose a surgical technique for the revascularization of these peripheral vessels with the use of a vascular prosthesis. The "post-operative" angiographic studies showed that revascularization of these peripheral muscular arteries was possible.

[Endarterectomy of the internal carotid. Clinical experience]. / La disostruzione della carotide interna. Esperienza clinica.

The authors report a clinical experience on 37 internal carotid endarterectomies of 33 patients classified as: group A (asymptomatic patients); 4 patients (13%), group B (RIA); 9 patients (27%), group C (stabilized neurological lesions); 19 patients (56%), group D (acute cerebral ischemia): 1 patient (3%). Sixteen thromboendarterectomies (43%) were carried on for the prophylaxis of neurological lesions, 20 (54%) to increase and balance the cerebral blood flow in patients with stable neurological lesions, 1 (3%) for acute cerebral ischemia. The overall operative mortality was 6%, the operative morbidity was 22%. The clinical follow-up concerned 26 patients: the overall mortality was 19%: in survivors the late results were excellent. The rate of postoperative stenosis was 18%: 80% of these arteries had been treated without a patch angioplasty.

[Complementary profundoplasty. Clinical experience]. / Profundoplastica "complementare". Esperienza clinica.

The Authors report a 68% overall success rate in a three years follow-up study of 45 "complementary" profundoplasties. The key factors with a significant prognostic effect on the clinical surgical results are the early postoperative increase of the resting ankle pressure index (I.W.) and the angiographic preoperative patency of the tibial arteries. An early postoperative increase of I.W. has been always associated with good results whereas an unchanged postoperative I.W. has always been associated with poor results; an angiographic tibial run-off (one or two or three patient tibial arteries) has been associated with significant better clinical results (p less than 0.001).

[Acute stress ulcer and elective surgery. Do indications for anti-H2 prophylaxis exist?]. / Ulcera acuta da stress e chirurgia d'elezione. Esiste indicazione alla profilassi con anti-H2?

One hundred-eighty-one patients who underwent major surgical procedures were retrospectively considered to value the incidence of gastrointestinal bleeding. Upper-gastrointestinal-tract bleeding occurred in only one patient (0.5%). The Authors suggest that only critically ill patients require prophylactic use of cimetidine.

Patent muscular vessels in atheromatous obstruction of tibial arteries: a support of more peripheral revascularization procedures?

A considerable number of patients having aorto-femoral surgery for chronic obliterative atherosclerosis show evidence of obstructed run-off vessels. In this condition poorer long-term results were documented in many series. The present study was aimed at investigating the state of 33 small muscular arteries of 8 limbs amputated for atherosclerotic gangrene. Histological studies showed that 11 muscular arteries were completely free from atheromatous lesions and that another 11 with minor abnormal features could be considered susceptible of revascularization. The conclusive data from this study in a small series suggest that in generalized atherosclerotic obstruction of lower limbs, nearly 70 per cent of the muscular vessels distal to the obstruction are potentially suitable for revascularization.

Hemobilia from ruptured hepatic artery aneurysm: angiographic demonstration of arteriobiliary fistula in a successfully treated case.

Rupture of a hepatic artery aneurysm into the biliary tree is a rare cause of hemobilia. The dramatic nature of the disease and the difficulties in obtaining a preoperative diagnosis are the main causes of its high mortality rate. Progress in vascular radiology and surgery seems to be an important factor in improving the survival rates in patients with this type of hemobilia. A case of a patient with an aneurysm of the common hepatic artery ruptured into the common bile duct is reported. Preoperative arteriography revealed the aneurysm and the arteriobiliary fistula causing massive hemobilia. The patient was successfully treated by arterial ligation and is symptom free after 2 years.