Multiple hypervascular pancreatic metastases from renal cell carcinoma: dynamic MR and spiral CT in three cases.

Pancreatic metastases are rare. Melanoma, lung cancer and breast carcinoma are the most common origin of pancreatic metastases, whereas renal cell carcinoma is counted in only 1-2%. Renal cell carcinoma usually leads to a solitary pancreatic metastasis, whereas multiple pancreatic metastases are uncommon. We present three cases of multiple hypervascular pancreatic metastases from renal cell carcinoma, studied with spiral CT and dynamic MR.

Nonoperative management of iatrogenic lesions of celiac branches by using transcatheter arterial embolization.

We present our experience in the nonoperative management of iatrogenic lesions of celiac branches by using transcatheter arterial embolization. We treated 6 pseudoaneurysms (5 intrahepatic and 1 of the gastroduodenal artery), 6 vessel lacerations (1 common hepatic artery, 1 right hepatic artery, 1 gastroduodenal artery, 2 pancreatoduodenal, 1 polar intrasplenic artery), 1 arterioportal fistula, and 1 arteriobiliary fistula; all the bleeding lesions were secondary to surgical, endoscopic, or interventional radiologic procedures.

Novel use of a T-tube access to perform an internal/external biliary drainage.

We report a case of post-surgical temporary functional stenosis of the sphincter of Oddi and biliary leak in a patient with a previous Billroth II reconstruction who had undergone cholecystectomy, surgical choledochotomy and sphincterotomy for biliary calculi. The patient was treated by creation of an internal/external biliary drainage using the T-tube access with an unreported technique.

Interventional radiology in the preoperative management of stromal tumors causing intestinal bleeding.

PURPOSE: Our experienee in the preoperative diagnostic and therapeutic management of small bowel gastrointestinal stromal tumors, cause of intestinal bleeding, by means of interventional radiological procedures is reported. MATERIALS AND METHODS: From October 1999 to October 2001 6 patients admitted for melena due to bleeding of a gastrointestinal stromal tumor were treated. In all cases the lower and/or upper gastrointestinal endoscopy were the first diagnostic approaches. In two cases a Te 99m pertechnetate-labeled autologous red blood cells (TRBC) scintigraphic examination was also performed. All the patients underwent an abdominal angiography that was followed in two cases by preoperative trans-catheter arterial embolization. All the patients had the surgical resection of the bleeding neoplasm. RESULTS: In all patients, the endoscopic examinations weren't able to localize the exact site of bleeding. The TRBC scintigraphic examination performed in 2 patients was negative in one case, instead gave an incorrect localization of the bleeding site in the other one. The localization of the bleeding tumors was provided by the selective abdominal angiography that also suggested the presumable nature of the neoplasm on the basis of angiographic characteristics. The embolization of the two tumors was technically successful and was followed by surgical resection. CONCLUSIONS: On the basis of our data, we emphasize and confirm the predominant role of interventional radiological procedures in the detection and in the preoperative management of bleeding gastrointestinal stromal tumors of the small bowel.

Epithelioid hemangioendothelioma of the stomach: clinical-pathological features, nosologic setting, and surgical therapy. Report of a case.

Vascular tumors of the stomach represent 0.9%-3.3% of all gastric neoplasms. A 41-year-old man was admitted to our department with a 3-month history of early postprandial epigastric pain, sluggish digestion, nausea, asthenia, and occasional alimentary emesis. Preoperative staging detected a submucosal neoformation in the prepyloric zone, which narrowed the lumen, without any infiltrative features; a wedge gastric resection was performed and the definitive diagnosis was an epithelioid hemangioendothelioma of stomach. An 8-month follow up did not show any relapse of the disease. The term hemangioendothelioma is controversial because of disagreements regarding the nosologic setting and treatment. As a result, the latest WHO classification calls such neoplasms "borderline." The correct diagnosis depends on the histological findings supported by immunohistochemistry. Surgery represents the treatment of choice; however, a conservative approach is preferred whenever possible. However, due to the borderline biological behavior of this neoplasm, it is important that detailed clinical evaluations be carried out for such patients along with a thorough follow-up.

Intrapleural fibrinolysis in the management of empyemas and haemothoraces. Our experience.

PURPOSE: We evaluate our experience in the management of empyemas and haemothoraces by means of intracavitary trans-catheter instillation of urokinase (UK). MATERIAL AND METHODS: We reviewed 54 patients (44 men and 10 women) ranging in age from 12 to 86 years (average 56.3) admitted between May 1999 and April 2001 with loculated pleural effusions (45 empyemas and 9 haemothoraces) and treated by percutaneous drainage and intrapleural urokinase instillation. The criteria for withdrawal of the catheter were: ceased drainage or the drainage of <80-100 ml of clear liquid per day. RESULTS: The duration of the drainage ranged from 2 to 15 days (average: 5.9). Total remission of symptoms occurred in 40 patients (74.07%); 7 patients presented a slight reduction in lung function tests (12.96%); 4 patients required surgery (7.4%); 3 displayed persistent pleural loculated effusions (5.55%) and 1 developed a bronchopleural fistula (1.85%); 2 patients were lost to our review (3.7%). CONCLUSIONS: In our experience percutaneous drainage with intrapleural UK instillation is an effective approach to the management of loculated pleural effusions (empyemas and haemothoraces), able to obviate the need for other more invasive pulmonary interventions.