Transcatheter thrombin embolization of a giant visceral artery aneurysm.

A 9.5-cm visceral artery aneurysm was found during a computed tomography (CT) scan performed for abdominal pain. Subsequent selective angiography showed the aneurysm arising from the second branch of the superior mesenteric artery (SMA). The celiac trunk was occluded at its origin and blood supply to the splenic artery was provided through the pancreatic-duodenal arcade. Two injections of 5.000 U of thrombin were delivered transcatheter to produce complete thrombosis. No major complications occurred. After 32 months the aneurysm decreased to 3.7 cm in diameter. Transcatheter thrombin injection seems to be a safe and durable option in the treatment of visceral aneurysms.

Distribution of GAP-43 mRNA in the adult rat brain.

Regional distribution of gene expression of the axonal growth-associated protein, GAP-43, was studied in adult rat brains by in situ hybridization autoradiography to determine the features of mature neuronal populations that synthesize GAP-43 protein. Such synthesis appears to correlate with axonal growth during maturation and regrowth after axotomy. In most adult neurons, the sharp decline in GAP-43 gene expression implies a reduced capacity for axonal growth. Neurons capable of extending axonal knobs in the absence of injury may indicate a "plasticity" underlying dynamic processes of interaction between neurons and their synaptic targets. Antisense and sense (control) riboprobes were used on serial sections in the three principal axes, and the magnitude of hybridization signal was examined to determine regional patterns. GAP-43 mRNA levels are pronounced in diverse neuronal groups including the locus coeruleus, raphé nn., dopaminergic nigral and ventral tegmental nn., mitral cells, hippocampal CA3, inferior olivary n., vagal motor n. and other parasympathetic preganglionic neurons, select thalamic midline and intralaminar nn., several specific nn. of the hypothalamus and basal forebrain, the granular layer of cerebellar cortex, the infragranular neocortex, and the granular olfactory paleocortex; there is a substantial range in the magnitude of expression. Regions revealing minimal signal include most thalamic sensory relay nuclei, the granule neurons of the olfactory bulb and dentate gyrus, and the caudate and putamen. Possible concomitants of GAP-43 expression include regulation of ion flux and neurotransmitter release. Those neurons with long, extensively dispersed and numerous synaptic connections display the strongest signals and may possess the greatest propensity for continuous growth and turnover of their axon terminals, in contrast to short-axon and specific projection neurons exhibiting minimal levels. These data may enable inferring which populations display normal or experimentally induced axonal growth.

GAP-43 mRNA localization in the rat hippocampus CA3 field.

Gene expression of the axonal growth-associated protein, GAP-43, has been studied in the adult rat brain by in situ hybridization histochemistry. This protein is synthesized at high levels in neuronal somata in immature and regenerating neurons, but after establishment of mature synaptic relations its synthesis generally declines sharply, thus providing a marker denoting propensity for exhibiting synaptic plasticity. Detailed examination of the distribution of mRNA for GAP-43 in rat hippocampus is selectively and robustly expressed in the pyramidal neurons of field CA3 and, to a lesser extent, the polymorph neurons of the hilus of the dentate gyrus. Additional hippocampal regions of moderate expression include the tenia tecta and the subicular and entorhinal fields, but CA1 and CA2 are strikingly lower in signal. The significance of this pattern of localization is considered in the context of the phosphorylation of GAP-43 and its role in influencing synaptic events underlying the establishment and maintenance of long-term potentiation and plasticity in the hippocampus.

Increased preproneuropeptide Y mRNA in the rat hippocampus during the development of hippocampal kindling: comparison with the expression of preprosomatostatin mRNA.

The levels of preproneuropeptide Y (ppNPY) mRNA and preprosomatostatin (ppSOM) mRNA were analyzed in different brain regions during the development of hippocampal kindling in rats. ppNPY mRNA levels were markedly elevated in the dorsal hippocampus bilaterally, two days after stage 2 (preconvulsive stage) and stage 5 (full seizure expression). The contents of ppSOM mRNA were slightly, although not significantly, increased in the dorsal hippocampus at stage 2 whereas a significant increase was observed in the ipsilateral hippocampus of fully kindled rats. ppNPY and ppSOM mRNA levels were unchanged in the cortex and striatum at both stages of kindling. These results show that an increased synthesis of somatostatin and neuropeptide Y, with a greater effect for the latter, occurs during hippocampal kindling in rats. The relative role of the two peptides in the development and expression of kindling phenomenon remains to be elucidated.

Resolution of hyperthyroidism in a pregnant woman with toxic thyroid nodule by percutaneous ethanol injection.

Overt hyperthyroidism was found in a 35-year-old pregnant woman at the 13th week of gestation who was referred to us for tachycardia, tremors, and weight loss. Clinical signs, symptoms, and laboratory findings led to the diagnosis of toxic thyroid nodule. She was treated with ultrasound guided percutaneous ethanol injection (PEI) and, after 2 weeks of treatment, the woman was completely euthyroid. These findings suggest that during pregnancy PEI appears to be a rapid and safe therapy for toxic nodular goiter and an effective alternative to the administration of antithyroid drugs.

Thyroid vascularization by color doppler ultrasonography in Graves' disease. Changes related to different phases and to the long-term outcome of the disease.

To investigate possible correlations between thyroid vascularization and activity of Graves' disease, we measured blood flow (TBF) at the inferior thyroid artery and intraparenchymal vascularization (number of vessels per square centimeter) by color Doppler ultrasonography (CDU) on Graves' patients at different phases of the disease. We studied 88 patients cross sectionally: 22 untreated; 17 euthyroid after 6 months of methimazole; 49 euthyroid at drug withdrawal after 12 to 24 months of treatment. The patients of the latter group were followed up for 29.1 +/- 6.3 months after discontinuation of treatment. On the day of CDU examination, free triiodothyronine (FT3), free thyroxine (FT4), thyrotropin (TSH), antiperoxidase and anti-TSH receptor (TRAb) antibodies were measured. Vascularization indices were significantly higher in the Graves' patients than in controls. In the patients euthyroid under treatment, vascularization was not significantly lower than in the untreated group, but TBF and vessel number both appeared clearly reduced in the patients tested at drug withdrawal. The vascularization indices at drug withdrawal were significantly higher in the patients who relapsed than in those in stable remission: TBF (mL/min) 50.6 +/- 36.8 vs. 23.8 +/- 17.5, p = 0.001; vessel number/cm2 1.8 +/- 0.8 vs. 0.8 +/- 0.5, p = 0.002. A multivariate analysis, evaluating the predictive value of vascularization, hormonal and immunological parameters for relapse, demonstrated a significant predictive value for TRAb (RR 8.2; p = 0.001) and a weak predictive value for TBF (RR 1.1; p = 0.02). In conclusion, CDU examination confirms that thyroid hypervascularization in Graves' disease is not related to thyroid hormone circulating levels. The association of increased TBF and high levels of TRAb in the relapsing forms of disease suggests that thyroid hypervascularization is probably related to the activity of the underlying autoimmune processes.

Frequency and clinical evolution of indeterminate colitis: a retrospective multi-centre study in northern Italy. GSMII (Gruppo di Studio per le Malattie Infiammatorie Intestinali).

OBJECTIVE: To evaluate the prevalence and the clinical evolution of patients with an initial diagnosis of indeterminate colitis. DESIGN: Retrospective, observational study. SETTING: Fifteen gastrointestinal units in northern Italy. PARTICIPANTS: Patients with an initial diagnosis of indeterminate colitis seen between 1988 and 1993. INTERVENTIONS: Patients were traced through a common database and centres were requested to update their clinical follow-up. MAIN OUTCOME MEASURES: Frequency of patients with an initial diagnosis of indeterminate colitis among those with IBD; rate of patients who subsequently had a definite diagnosis of either Crohn's disease or ulcerative colitis. RESULTS: Fifty out of 1113 IBD patients (4.6%) had been diagnosed as having indeterminate colitis. During follow-up, 37 patients (72.5%) had a definite diagnosis of either Crohn's disease or ulcerative colitis. The cumulative probability of having a definite diagnosis of either ulcerative colitis or Crohn's disease was 80% 8 years after the first one (i.e. the first diagnosis). The probability of having a diagnosis of Crohn's disease was increased in patients with fever at onset, segmental endoscopic lesions or extra-intestinal complications and in current smokers. The probability of having a diagnosis of ulcerative colitis was increased in patients who had not undergone appendectomy before diagnosis. CONCLUSIONS: In our area, indeterminate colitis accounts for about 5% of initial diagnoses of IBD. In about 80% of patients, a diagnosis of either ulcerative colitis or Crohn's disease is made within 8 years. Several clinical and demographic features can help in identifying those patients more likely to have a subsequent diagnosis of Crohn's disease and those more likely to have a subsequent diagnosis of ulcerative colitis.

Variability of renal echo-Doppler measurements in healthy adults.

BACKGROUND: We examined the most widely used echo-Doppler variables in healthy adults to define their normal distribution and variability in relation to age, sex, body surface area and the right and left kidney. METHODS: Ninety healthy subjects were selected, stratified for sex and age (range 20-65 years). We also examined 8 subjects with a congenital solitary kidney and 15 surgically nephrectomized patients. Variables studied were the diameters and volume of the kidneys, renal blood flow (RBF) and resistive index (RI) measured on the renal, interlobar and cortical arteries. RESULTS: The mean length was greater in the left kidney (p<0.01) and width in the right one (p<0.02). Volume was no different on the two sides. RBF showed an age-dependent reduction (p<0.0001), while interlobar (p<0.0001) and cortical (p<0.0001) RI showed a selective age-dependent increase. RI were higher in females and diameters, volume and RBF, after correction for body surface area, were not different in the two sexes. Cortical RI was lower than the interlobar and renal RI (p<0.0001). In the group with congenital single kidney, length, volume and RBF were all greater. In the mononephrectomized patients, length and volume were greater but RBF was the same as in a normal single kidney. CONCLUSIONS: The ultrasonographic and Doppler variables studied did not show any differences from normal distribution but they were influenced differently by some demographic parameters; however, the integrated use of these measurements offers precision and repeatibility, and could help evaluating diffuse or localized abnormalities.

Dimensional and hemodynamic differences between native and transplanted kidneys, evaluated by color Doppler ultrasonography.

Aim of the study was to asses the differences in size and hemodynamics in the normal kidney and well-functioning renal graft by color Doppler ultrasonography (CDU). Sixty healthy subjects, 75 well-functioning cadaver renal transplant recipients, 15 couples of living donors and related graft recipients were compared by CDU. Renal diameters, volume, renal blood flow (RBF) and renal resistance index (RI) were the variables studied. Cadaveric transplants, living donors and related recipients had a longer kidney (p<0.00001) and greater volume (p<0.001) than normal native kidneys. This was not associated with any significant increase in RBF. RI was lower in healthy subjects and in kidney donors than in transplant recipients (p<0.00001). Transplanted kidneys had a higher arterial RI but apparently normal function.

Histopathological findings in a case of systemic lupus erythematosus-associated anti-phospholipid syndrome.

The vessel anatomopathological lesions in a patient with systemic lupus erythematosus associated anti-phospholipid syndrome are described. Vasculitic lesions were nearly absent but small vessels showed hyalin thrombosis or substenosis due to subendothelial deposition of amorphous PAS-positive material in different anatomical districts. These findings can be related to the patient's clinical manifestations, particularly the central nervous system involvement and can be discussed regarding the possible pathogenetic mechanisms.

Nasal formulations of ketorolac tromethamine: technological evaluation--bioavailability and tolerability in rabbits.

This paper describes the development of a novel formulation of the powerful non narcotic analgesic ketorolac tromethamine. This drug is given orally three to four times/day to deliver a total of 30 to 60 mg of drug. Higher doses cannot be given orally because of gastrointestinal side effects and intramuscular injections, three times/day must then be used. The need for injections limits the drug to a clinical setting. Nasal delivery offers a method of achieving the high blood levels of repeated intramuscular injections in a formulation that can be easily applied by the patients. Four formulations were evaluated in "in vitro" and "in vivo" rabbit tests. The best formulation consisted of a 5% solution of ketorolac tromethamine containing 0.3% sodium glycocolate as a known mucosal drug absorption enhancer. Ketorolac applied in this way had a bioavailability greater than 80%. The controlled release nature of nasal delivery also doubled the drug's apparent half life. The drug formulation was stable in three-months stability tests and produced minimal nasal irritation.

[Color Doppler ultrasonography in the diagnosis of solid breast lesions]. / L'eco-color-Doppler nella diagnosi delle lesioni solide mammarie.

The color-Doppler signals in 50 patients with breast lumps were assessed subjectively. Number and location of vessels within the masses were recorded and compared with histologic diagnosis and lesion size. All the malignancies were vascularized but only 16/37 of the benign ones showed vessels. All malignancies but one displayed > or = 2 vessels, which on the other hand occurred in only 4/16 vascularized benignancies. There was a relation between size of the lesion and number of the observed vessels, and color-Doppler proved more reliable in the differential diagnosis of breast masses when lesions less than 2 cm were considered.

Interventional radiology in the treatment of urological vascular complications.

Urological vascular complications (UVC) are largely secondary to percutaneous procedures that are nowadays extensevely used by the urologists and the nephrologists. The major frequency of UVC is observed after the renal biopsy, in a percentage varying from 7 to 17% in different series; UVC are less frequent after a nephrostomic procedure (near 1-3%). UVC consist of artero-venous fistulas (AVF) and pseudoaneurysms (PA), that generally cause haemorrhage, particularly macroscopic hematuria. In the vast majority of cases hematuria resolves spontaneously or with conservative therapy but, in the 4 to 9% of patients persists and requires an adequate therapy, often in emergency. Interventional radiology permits an effective and timely treatment of the lesions, using the techniques of transcatheter embolization that are greatly improved in the last 20 years and that present rate of technical success greater than 80%. Moreover radiological embolization shows a low incidence of complications and lower hospitalization cost with respect to surgical treatment. Herein we describe the different techniques of embolization, the indications and the results as appears from the literature and the personal experience. The latter is based on a series of 31 procedures performed in 26 patients, with a rate of technical and clinical success of 93.5%.

Interventional radiology in the treatment of renal artery stenosis.

Percutaneous transluminal renal angioplasty (PTRA) alone or in combination with stent implantation, is increasingly used as an alternative technique to surgical revascularization for treatment of renal artery stenosis (RAS) wich may cause hypertension or jeopardize renal function. Herein we report the results obtained with 305 PTRAs performed in 242 hypertensive patients, 144 of whom had atherosclerotic RAS, 69 fibromuscolar dysplasia, 15 Ras in transplanted kidneys, 6 restenosis in surgically revascularized kidneys, 4 Takayasu arteritis and 4 neurofibromatosis. Stents were implanted in 68 cases, mostly in atherosclerotic stenoses. The technical success was achieved in 261 arteries (85.6%), with 33 failures (10.8%) and 11 (3.6%) procedures not completed for anatomical reasons. PTRA related complications were observed in 23 cases (7.5%), but no fatalities occurred. An overall benefit on blood pressure control was observed in 41% of patients with atherosclerotic RAS and in 68% of those with fibromuscolar dysplasia. It appears that independently from the ethiology PTRA is technically effective in correcting RAS; yet the position of PTRA with respect to that of medical or surgical treatment needs to be better delineated through randomized, controlled studies aimed at comparing the clinical efficacies of these different approaches.

[Abdominal approach to the treatment of the vestigial retrorectal tumors: our experience]. / L'approccio addominale per i tumori vestigiali retrorettali: nostra esperienza.

Although the vestigial retrorectal cysts are still rare, the number of the observed ones is destined to increase, as methods by imaging become routinely used in the clinical practice. Once diagnosed, the removal of retrorectal lesions should be mandatory. Therefore, by reporting three clinical cases, the Authors propose notes of technique above the abdominal approach used for the surgical treatment of these retrorectal congenital neoformations. In their experience, the anterior route had no postoperative complications, short stay, no neurological consequences and good long-term results.

[Principles of surgical technique of the anterior access to the thoraco-lumbar spine]. / Principi di tecnica chirurgica per l'accesso anteriore alla colonna vertebrale toraco-lombare.

General surgeons are more and more frequently requested to prepare an operative exposure of the spine, in order to perform anterior maneuvers of removal and stabilization of the vertebral bodies. Since 1989 to date, in collaboration with the neurosurgical équipe of Prof. G. Cantore, Neurological Sciences Department, La Sapienza University of Rome, the Authors have collected 116 cases of vertebral diseases: among them, 48 involved the thoraco-lumbar junction of the spine (D12-L2). In this paper, Authors' aim is to state precisely the surgical technique of the anterior access to the thoraco-lumbar junction: attention has been focused on this tract of the column stating its anatomical complexity and the high invasivity of the procedures requested for its exposure. Therefore, such notes of technique have been elaborated to make safer the neurosurgical demolitive and reconstructive procedures and, most of all, to reduce the surgical trauma whenever it is possible.

[Current role of traditional endoscopy and prospects for virtual colonoscopy in the management of colorectal neoplastic lesions]. / Ruolo attuale dell'endoscopia tradizionale e prospettive della colonscopia virtuale nel management delle lesioni neoplastiche del colon-retto.

The Authors, reviewing their surgical experience with colo-rectal cancer in the last 13 years, conclude that, in the management of this condition, the routine use of traditional endoscopy will continue to have a crucial role in terms of prevention, cure and/or survival. It is possible that in the future present limits of endoscopic techniques will be seperated by routine use of endoscopic ultrasounds and virtual colonoscopy.

[Current role of endoscopic ultrasonography in the treatment of colorectal neoplastic lesions]. / Ruolo attuale dell'ecografia endoscopica nel trattamento delle lesioni neoplastiche colo-rettali.

The Authors examined the value of endoscopic ultrasounds in the tmanagement of colo-rectal lesions, particularly neoplastic ones, on the basis of their surgical experience, concluding that to date such technique cannot substitute traditional endoscopy, but surely can be a valid complementary tool for imaging diagnostics, expecially to study wall tumoral infiltration or extra-parietal relapses.

[Abdominal aortic aneurysm and rectal cancer: what surgical strategy?]. / Aneurisma dell'aorta addominale e cancro del retto: quale strategia operatoria?

The incidence of abdominal aortic aneurysm and colorectal cancer association is 0.5-1%. This concomitance of two potentially lethal diseases creates a decision making problem regarding priority of treatment. The Authors report a case in which colorectal cancer and abdominal aortic aneurysm were present. This patient first underwent surgery for colorectal cancer, then for aortic aneurysm. Moreover, the Authors review the Literature and discuss their decisional principles about treatment priorities.

[Small bowel lymphomas: a case report]. / Considerazioni diagnostiche e chirurgiche su un caso di linfoma del tenue.

The Authors, reporting a recent case of small bowel lymphoma, review progress in diagnosis, methodology and therapeutical approach. They also stress the crucial role of surgery as diagnostic and therapeutic tool, sometimes curative in early stages, and however necessary for a proper staging and definition of these rare neoplasms of intestinal tube.