Isolated aneurysm of the inferior thyroid artery repair with coil embolization.

A 68-year-old female patient with a suspected aneurysm of the inferior thyroid artery was admitted to the authors' Unit of emergency after an accident. The echography of the thyroid revealed a ''suspected'' aneurismal dilation of the inferior thyroid artery (max. diameter 30 mm.). The patient underwent an angiograph of the supra-aortic trunk, which detected a small round formation at the base of the left inferior thyroid artery (found to be unaffected by aneurismal pathologies), the aneurysm was excluded by coil embolization. The postoperative course was uneventful and the patient was discharged in one day without complications. The follow-up with colour Duplex, at 4-8 months, showed the normal vascularization of the neck arterial vessels and was confirmed the absence of aneurysmal dilations. Aneurysms of the inferior thyroid artery are extremely rare, in scientific literature only 28 cases have been reported of which 32.9% regard ruptured aneurysms in the thyroid artery and 10.7% led to mortality. They may cause dysphagia and/or respiratory difficulties. Therefore, treatment is always recommended, even in asymptomatic cases, by surgical exclusion or coil embolization.

Prevention of intrahepatic recurrence by adjuvant (131)iodine-labeled lipiodol after resection for hepatocellular carcinoma in HCV-related cirrhosis.

AIM: To evaluate the impact of postoperative injection into the hepatic artery of 131-iodine-labeled lipiodol on disease-free and overall survival rates in patients who underwent liver surgical resection for hepatocellular carcinoma. METHODS: Ten consecutive patients with HCV (hepatitis C virus)-related cirrhosis who underwent liver surgical resection for hepatocellular carcinoma were treated with adjuvant injection of 131-iodine-labeled lipiodol. They were matched with 20 HCV-positive cirrhotic controls who underwent liver resection alone; patients were paired in terms of age, Child-Pugh class, tumor size, microscopic vascular invasion, tumor histological pattern, presence of satellite nodules and type of surgical resection. Recurrence was defined as the development of a new hypervascularizated nodule in the liver. RESULTS: No significant differences were found between the two groups in clinical, biologic and histologic characteristics, except a lower platelet count in the control group. None of the treated patients developed an intrahepatic recurrence until the 15th month from liver resection, whereas recurrences occurred in nine of the 20 patients in the control group (p=0.01). From 18 months onwards, recurrences appeared also in the treated patients, and after 36 months of follow-up both recurrence rate and overall survival were not significantly different between the two groups. CONCLUSIONS: Intrahepatic injection of 131-iodine-labeled lipiodol improves the disease-free survival rate following liver resection of hepatocellular carcinoma in the short term up to 15 months; this advantage fades, however, away after 36 months.

[Limb salvage in critical ischemia. Our experience]. / Salvataggio d'arto nell'ischemia critica. Nostra esperienza.

The aim of this paper is to present our six-year experience in the treatment of critical limb ischaemia, even if in the period (1987-1993) considered the definition of critical ischaemia had been partly reviewed in the publication of the "European Consensus Document on Critical Limb Ischaemia" (March 1989). Two hundred thirty-nine patients have been treated in our Unit for critical limb ischaemia: reconstructive surgery was used in 34% of cases, lumbar sympathectomy or spinal cord stimulation in 17% of cases and pharmacotherapy in 14% of cases. Taking into account arterial and graft patency as well as the percentage of limb salvage, our results were similar to those presented in the literature.

[Arterial recanalization with the Kensey catheter. Preliminary results]. / Ricanalizzazione arteriosa con catetere di Kensey. Risultati preliminari.

Fifteen patients with chronic obstruction of leg arteries (mean length: 6 cm) were treated with the Kensey catheter and then with PTA. In 11 cases the procedure was successful (74%) and in 2 it was interrupted--in one case for dissection and in the other for vessel perforation. Two maneuvers, after dissection, were ended with PTA and stent placement (overall success rate: 87%). Emergency surgery was never needed. In the cases solved with the Kensey catheter, the cumulative patency rate was 51% at 6, 12 and 24 months. The Kensey catheter did not improve the results of conventional PTA, which means its role is complementary to that of PTA and an alternative to more expensive laser systems, if PTA fails.

Percutaneous embolization of subclavian pseudoaneurysmatic arteriovenous iatrogenic fistula by steel coils.

A case of iatrogenic subclavian arterio-venous fistula with pseudoaneurysm formation is described. Treatment by means of percutaneous embolization, on the venous side, with steel coils has been successful; in order to avoid complications, the arterial side was blocked by an angioplasty balloon. After discussing the more common complications of subclavian vein puncture, the Authors conclude that percutaneous embolization is a valuable alternative to surgery even in such a lesion, especially when the surgical risk is high.

[Percutaneous needle biopsy of the lung. Critical review of 496 cases]. / Agobiopsia percutanea polmonare. Revisione critica di 496 casi.

Between February 1979 and December 1986, 618 lung biopsies were performed on 496 patients (122 with double puncture, using Tru-cut and 19-20 G needles). Overall diagnostic accuracy was 84.5%; the 77 patients examined in the past 18 months only underwent thin needle (19-20 G) biopsies--which were carried out by an experienced radiologist--and more sophisticated cyto-histological techniques were employed. Such a procedure gave better results (sensitivity 94.1%, accuracy 94.8%) than did the use of larger caliber needles in the past years; moreover, no complications occurred in these patients. In conclusion, 19-20 G needles are to be preferred to bigger ones, provided that the operator be experienced and cyto-histology be correctly performed.

[Percutaneous treatment of ureteral obstructions with an internal double-J prosthesis. Initial long-term results]. / Trattamento percutaneo delle ostruzioni ureterali con endoprotesi a doppio J. Primi risultati a distanza.

Percutaneous insertion of ureteral stents is a widely accepted method for ureteral obstructions treatment. From 1981 to february 1986, we introduced 78 endoprostheses in 60 patients. Fifty-six with malignant tumours and 4 with benign stenoses. In 48 of those 60 patients follow-up is complete. In the patients with malignant obstructions the mean time of survival was 198 days. Twelve patients were still alive in february 1986, with a mean time of survival over 300 days. In 12 patients (25%) the stent became obstructed in a mean time of 96.8 days. The placement of ureteral stents offers an alternative treatment to the palliative urologic surgery.

[Effect of mescaline on cerebral cholinesterases and on exploratory behavior in rats]. / Azione della mescalina sulle colinesterasi cerebrali e sul comportamento esplorativo del ratto.

In this study the Authors had the purpose to evaluate the action of a psychotomimetic substance (mescaline) on behavior (exploring behaviour and spontaneous motility) and on cerebral biochemistry (cholinesterase activity) of rat. The mescaline has shown to be active both on behaviour (increasing the spontaneous motility) and on biochemistry (decreasing the total cholinesterase activity). From the examination of the results of this work it could be cautiously assumed the hypothesis that the behavioural effects of mescaline are related (at least partially) to modifications of the cholinergic system at the cerebral level.