Stenosis of the carotid artery and thrombosis of the internal contralateral carotid. Analysis of surgical results in thirty patients.

Carotid thrombosis and stenosis of the contralateral axis is a hemodynamic situation which results in reduced blood supply to the brain, and consequently in risk of transitory or permanent ischemic episodes. In fact, 40% of patients are symptomatic for TIA or Little Stroke and 50% of them will develop a complete stroke. Of the 255 patients who underwent TEA, over a period of 5 years, only 30 presented the above mentioned bilateral feature. A continuous electroencephalographic recording (EEG) was intraoperatively carried on for cerebral monitoring, as well as mean residual arterial pressure (MRAP), and according to variations in these parameters Javid's shunt was used in 50% of cases. No death was recorded either during surgery or hospitalization, while 2 transitory post-operative neurological deficits (6.6%) in correspondence to the stenotic vessel, and a late permanent deficit contralateral to the stenosis were reported. We believe TEA of the stenotic carotid artery to be a rational choice considering the great incidence of strokes on the stenotic side (Grillo, 1975) and the greater benefit for patients with symptoms resulting from the occluded carotid (Riles, 1980), who account for 46.6% of our case histories. We are convinced that surgery is an absolute indication in this particular category of patients, even at the cost greater intraoperative risks, provided it is carried out by an experienced surgical team well aware of problems involved in intraoperative cerebral monitoring.

Breast cancer in pregnancy.

Breast cancer in pregnancy involves a psychosocial, religious, multidisciplinary medical decision. From 1991 the Authors have surgically treated six patients affected by breast cancer in pregnancy. The Authors, in this papers, review analysing current therapeutic approach for this disease.

[Femoral neuropathy due to a spontaneous hematoma of the iliopsoas muscle during therapy with heparin-calcium]. / Neuropatia femorale da ematoma spontaneo del muscolo ileo-psoas in corso di terapia con eparina calcica.

With increased use of anticoagulant agents, femoral neuropathy subsequent to spontaneous hemorrhage within the ileo-psoas muscle has become a serious and more frequent clinical problem. The authors describe one case of femoral neuropathy from iliac muscle hematoma during heparin administration. The successful surgical treatment by decompression and drainage is reported. The anatomical and CT scanning features with the suspected pathogenesis are emphasized, as well as the role of early diagnosis in the assessment of prognosis and for successful operative decompression.

[Intraoperative blood autotransfusion in general surgery]. / Il recupero intraoperatorio del sangue in chirurgia generale.

The use of intraoperative autotransfusion is progressively increasing both in emergency and in elective surgery. Intraoperative autotransfusion reduces the risk of infection and alloimmunization and allows a considerable saving of homologous blood. The authors describe their experience in the field of intraoperative autotransfusion by means of Dideco Autotrans BT 597. This equipment was employed in 172 patients submitted to general and vascular surgery. It is stressed the safety of this device particularly in trauma and vascular surgery where the quick availability of blood is essential.