[Harvesting vascular segments]. / Prelievo dei segmenti vascolari.

The authors report the importance of the use of vascular homografts in treatment of prosthetic infections. To have good results is very important to obtain vascular segments prelevated and preserved in the best conditions. The importance of the explant is fundamental. The authors report the right sequence of organs' explant and the technique to obtain good vascular segments; for this purpose is important the coordination of the surgical equips taking part in the explant.

Mid-term results of endovascular repair for abdominal aortic aneurysm, with loco-regional anesthesia, in high-risk patients.

BACKGROUND: Aim of this study was to evaluate the results of endovascular repair of abdominal aortic aneurysm (AAA) in patients considered not suitable for traditional open surgical repair because of the high anesthesiological risk. METHODS: We have retrospectively evaluated the result of the endovascular treatment of 11 patients with AAA of more than 6 cm diameter and high surgical risk due to cardiac hypokinesia and/or respiratory insufficiency. Patients were selected by a team composed of vascular surgeons and vascular radiologists who decided to implant the graft according to anatomical features of the AAA and of the iliac arteries. The treatment was performed in loco-regional anesthesia. The main end-points were: implantation success, mortality, morbidity, the absence of endoleak during the follow up that lasted two years. RESULTS: All the grafts were successfully implanted. There were no complications caused by anesthesiological manouvres. We had a minor intra-operative vascular complication and we performed three adjunctive endovascular procedures. A patient died of acute myocardial infarction, in the post operative period. Mean stay was six days. Pre-discharge scan showed 3 endoleaks (type I), two of these healed spontaneously and one sealed by percutaneous endovascular treatment. During follow-up (3-24 months) no patient died. One endoleak (type II) still persists. CONCLUSIONS The use of loco-regional anaesthesia allows us to treat high risk patients. Following strictly the criteria of patient selection, the surgical high risk seems not to influence significantly the mid term results that are almost equal to the ones obtained in low-risk patients.

Prospects of prostanoid therapy. Preliminary results.

BACKGROUND: To evaluate the efficacy of treatment with prostaglandins (Iloprost and Alprostadil) in patients with peripheral arterial disease in whom a surgical act or a redo operation is not proposable and to set the role of these drugs in the therapy of arterial diseases. METHODS: We analyzed the results of 96 treatments in patients with peripheral arterial diseases of different etiology, treated in the Day Hospital in the Division of Vascular Surgery from the 1/1/1993 to the 30/6/1998. The efficacy of the treatment has been evaluated on the basis of the clinical picture (healing or reduction of ulcers, reduction of rest-pain, improvement of the ability to walk). RESULTS: We had positive results in 60% of the patients who completed the treatment, a good outcome for patients with particularly severe arterial disease. Interruptions induced by the occurrence of uncontrolled side-effects are a few (6.25%). Better results have been found in a special category of disease (arterial diseases not associated with diabetes, not very advanced clinical picture, female gender). Iloprost proved to be superior to Alprostadil. CONCLUSIONS: Prostaglandins today represent an effective therapeutic solution to be considered. Further studies need to be done to find a category of patients who can have the best benefit from this kind of drug.

Reactogenicity and immunogenicity of a new combined measles-mumps-rubella vaccine: results of a multicentre trial. The Cooperative Group for the Study of MMR vaccines.

A large single blind, multi-centre study involving 1779 children was performed in Italy. Infants, aged between 12 and 27 months were divided between two groups: group A received a single dose of a new MMR vaccine, 'Priorix'(3), while group B received a widely used MMR vaccine, Triviraten(4). Solicited local and general symptoms were recorded using diary cards and antibody levels were measured, prior to and 60 days post-vaccination, using ELISA assays. The incidence of solicited symptoms (evaluated in 1754 subjects) was comparable between groups, with the exception of fever which was significantly lower in group B. Immunogenicity was evaluated in 686 subjects. Of note, was the significantly higher anti-mumps seroconversion rate (p<0.001) observed in group A (97.0%) compared to group B (35.4%). However the anti-measles and anti-rubella seroconversion rates were equivalent between groups. Significantly higher (p<0.001) post-vaccination GMTs were in group A vs group B for anti-measles (2830 vs 784 IU/ml) and anti-mumps (1640 vs 469 U/ml), however the anti-rubella GMTs were significantly higher (p<0.001) in group B (117.6 IU/ml) compared to group A (92.6 IU/ml). The persistence of antibodies in 35 subjects was assessed 1 year after vaccination and the results showed no appreciable decline in titres with either vaccine. The trial demonstrates 'Priorix' is well tolerated and highly immunogenic.

Donor and recipient postoperative complications in living related kidney transplantation. A multicentric study.

BACKGROUND: Living related kidney transplantation is considered a gold standard of renal transplantation in order to overcome end-stage renal disease within the same family members. Living donation, albeit decreasing cadaveric donor shortage, exposes donors to the risk of surgical complications. METHODS: In order to assess the postoperative complication rate in donors and recipients, we reviewed retrospectively 90 consecutive living related kidney transplants in a multicentric study. All nephrectomies were performed extraperitoneally through a left flank incision. RESULTS: Major perioperative complications (first 3 weeks after surgery) occurred in 12 subjects: these included bleeding (2.2%), symptomatic pneumothorax (1.1%), iliac thrombophlebitis (3.3%), iliac artery dissection (1.1%), laparotomic dehiscence (2.2%), perirenal hematoma (1.1%), renal artery stenosis (1.1%), urinary fistula (1.1%). Minor perioperative complications took place in 8 cases. One recipient died. Donor postoperative major complications occurred in 2 subjects. CONCLUSIONS: On the basis of these results we conclude that living related kidney transplantation is an important treatment of end stage renal disease, due to the associated low major complication rate and the high feasibility of this methodology.

Experience with the Stentor endograft at four Italian centers.

PURPOSE: To report the outcome of an Italian multicenter trial of endovascular abdominal aortic aneurysm (AAA) exclusion using the Stentor device. METHODS: Between April 1995 and July 1996, 66 patients (63 men; average age 69 years, range 53 to 84) with infrarenal AAAs meeting the inclusion criteria were enrolled. The average diameter of the aneurysm was 4.6 cm (range 4.2 to 7). Three (4.5%) of the 66 AAAs were anastomotic aneurysms. RESULTS: Sixteen (25%) tubular and 50 (76%) bifurcated endograft procedures were attempted; 4 (6.1%) were converted and 1 terminated owing to technical faults with the bifurcated graft's second limb. One tube graft was too short and failed to exclude an anastomotic aneurysm. Sixty (91%) endograft procedures were completed successfully. Six (9.1%) vascular complications occurred, three in one patient who subsequently died of pulmonary embolism 72 hours postoperatively (1.5% mortality). There were four (6.1%) proximal endoleaks; two sealed spontaneously in < 1 month, and a third was converted (7.6% conversion rate). The fourth is being observed. Clinical success (aneurysm exclusion with no death or endoleak) at 30 days was 86.3% (57/66). In the 23-month follow-up of 57 eligible patients, 2 patients died of unrelated causes and 1 graft limb thrombosed, requiring a crossover femoral bypass. One patient was converted to surgical repair at 5 months postoperatively when increasing aneurysm size signaled an undisclosed endoleak (1.8% late conversion rate). Five other secondary endoleaks were treated with endovascular techniques. CONCLUSIONS: The Stentor was technically feasible in 10% to 40% of AAA candidates in this study, although deployment of the second limb was problematic in the bifurcated device. Introduction of the second-generation Vanguard endograft brought this study to an end.

[Post-traumatic pseudoaneurysm of the common carotid artery]. / Pseudoaneurisma post-traumatico della carotide comune.

The authors report their experience of one single case of carotid pseudo-aneurysm consequent on cervical trauma. The treatment required the substitution of the interested carotid segment by PTFE no. 6. This case is a rare event but the surgeon must always keep it in mind in the presence of cervical trauma.

[Carotid-subclavian bypass. Our experience with locoregional anesthesia]. / Bypass carotido-succlavio. Esperienza in anestesia loco-regionale.

Carotid-subclavian bypass has been adopted since 1956. The commonest indication is to abolish arterial occlusion or stenosis in patients with subclavian steal syndrome. Ten patients were submitted to carotid-subclavian bypass under regional anaesthesia: block of anterior rami of spinal nerves C3-C4 and block of cervico-brachial plexus by injection into the continuous perineural connective tissue space at the level of C6. The surgical procedure required carotid occlusion and cerebral function monitoring. The advantages of regional anaesthesia are the ability to monitor the patient's cerebral perfusion and function, to detect intraoperative ischaemia and embolisation and minimal interference with the cardiovascular and respiratory function.

Oxiracetam prevents the hippocampal cholinergic hypofunction induced by the NMDA receptor blocker AP7.

The intracerebroventricular injection of the N-methyl-D-aspartate (NMDA) receptor antagonist D,L-2-amino-7-phosphonoheptanoic acid (AP7) induces an increase of the hippocampal levels of acetylcholine (ACh) which is dose-dependent in the range 1.5-10 micrograms. Similar doses of AP7 failed to affect the ACh content of the striatum. The effect of the i.c.v. administration of 3.5 micrograms AP7 on hippocampal ACh levels was prevented by pretreatment with oxiracetam 100 mg/kg i.p. In the passive avoidance test the i.c.v. administration of 3.5 micrograms of AP7 caused severe amnesia which was antagonized in a dose-dependent manner by the pretreatment with oxiracetam. These results show that oxiracetam prevents the imbalance of cholinergic activity and the amnesia caused by blockade of NMDA receptors. The present study suggests that the hippocampal cholinergic activity is modulated by glutamatergic neuronal pathways and that the functional integrity of both systems is essential for learning and memory processes.

[Loco-regional anesthesia vs general anesthesia in carotid endarterectomy. Response to the surgical stress]. / Anestesia loco-regionale vs anestesia generale nell'endoarterectomia della carotide. Risposta allo stress chirurgico.

The advantages of performing carotid endarterectomy in the awake patient, perioperative analgesia, circulatory parameters, plasma cortisol and PRL response to surgery have been evaluated. Ten patients were submitted to general anaesthesia and ten patients to superficial and deep cervical block. The Authors conclude that, although the number of patients studied is limited, there are no significant differences between the two groups for intraoperative analgesia, hemodynamic imbalance and plasma cortisol and PRL. This result support the belief that carotid endarterectomy in awake patients can be safely performed on patients with chronic obstructive pulmonary disease.

[Endocrine-metabolic response to 2 different techniques in surgery of the abdominal aorta]. / Risposta endocrino-metabolica a due diverse tecniche anestesiologiche nella chirurgia dell'aorta addominale.

Plasma cortisol and PRL were measured in two groups of patients undergoing reconstructive aortic surgery under either general anaesthesia and continuous epidural analgesia with supplemental general anaesthesia. The results confirmed that epidural analgesia with light general anaesthesia is much able than general anaesthesia to suppress the metabolic response associated with aortic surgery procedures.

[Atherosclerotic vascular nephropathy. Description of 2 clinical cases and review of the literature]. / La nefropatia vascolare aterosclerotica. Descrizione di due casi clinici e rassegna della letteratura.

Atheromatous nephropathy, due to a reduction of arterial blood flow caused by stenosis or thrombosis of renal arteries, is now recognized as an important cause of chronic renal failure in the elderly. It has been shown that renal revascularization may allow a recovery of renal function up to the withdrawal of dialytic treatment. Digital arteriography is the preferred diagnostic method, but doppler scan and renal scintigraphy after administration of captopril may also prove useful, specially in the follow-up of the patients. Therapeutic means include percutaneous transluminal angioplasty and surgical revascularization; both treatments may improve or stabilize renal function. Surgery may allow better results in the long term, but is loaded by a significant morbidity. Our experience confirms the possibility to obtain a significant long term improvement of renal function after bilateral surgical revascularization.

[Neurovascular syndrome of the arm caused by acquired luxation of the sternoclavicular articulation]. / Sindrome neurovascolare dell'arto superiore conseguente ad anomalia acquisita dello stretto costoclavicolare.

The Authors report on a case of neurovascular syndrome of the upper extremity caused by acquired luxation of the sternoclavicular articulation. The patient was treated by simple scalenotomy with a favourable long-term result.

[15 cases of femoro-popliteal bypass with PTFE graft]. / Considerazioni su 15 casi di by-pass femoro-popliteo in PTFEE.

The authors report their clinical experience of 15 cases of femoro-popliteal by-pass with PTFE; all patients underwent postoperative anti-platelet therapy, in 8 cases with ASA and dipyridamole, in 7 with indobufene in accordance with a double blind randomized work. The Authors report the results of a one year follow-up. They deal with patency duration results and tolerance of pharmacological treatment.

[Use of slowly resorbing mesh in the repair of kidney rupture due to rejection]. / Uso di rete a riassorbimento lento nel recupero di reni rotti per rigetto.

Personal experience about the use of Vicryl mesh in a case of kidney rupture following rejection is presented. The stopping of bleeding and recovery of diuresis were obtained almost immediately after intervention.

In-vivo radiolabelled oxiracetam binding to rat brain.

The in-vivo binding of [3H]oxiracetam has been studied in brain areas of rats examined 30 min after i.c.v. injection. Soluble radioactivity accounted for more than 90% of total radioactivity in all the structures considered and was not affected by co-injection with a 1000-fold excess of unlabelled oxiracetam. Both total and bound radioactivity showed a marked regional distribution, with highest concentrations in the septum, followed by the hippocampus; the cerebral cortex, striatum and cerebellum had the lower concentrations of radioactivity. Computer-assisted quantitative autoradiography with [14C]oxiracetam confirms these findings. Analysis of [3H]oxiracetam bound to membranes indicated that, after co-injection with a 1000-fold excess of unlabelled oxiracetam, there was a significant reduction of binding only in the septum, hippocampus and cerebral cortex. These results suggest that in those cerebral structures oxiracetam binds to saturable sites.