[Endovascular versus conventional vascular surgery--old-fashioned thinking? Part 2: carotid artery stenosis and peripheral arterial occlusive disease]. / Endovaskuläre vs. konventionelle Gefäßchirurgie--antiquiertes Denken? Teil 2: Karotisstenose und periphere arterielle Verschlusskrankheit.

Endovascular therapy has widely replaced conventional open vascular surgical reconstruction. For this reason, both techniques were widely considered to be competing approaches. Evidence-based data from randomized prospective trials, meta-analyses and clinical registries, however, demonstrated that both techniques should be used to complement each other. It became increasingly more evident that the use of either procedure depends on the underlying disease and the anatomical conditions, whereby a combination of both (hybrid approach) may be the preferred option in certain situations. This review focuses on the treatment of patients with carotid artery stenosis, intermittent claudication, critical limb ischemia and acute limb ischemia.

[Endovascular versus conventional vascular surgery - old-fashioned thinking? Part 1: interventions on the aorta]. / Endovaskuläre vs. konventionelle Gefäßchirurgie - antiquiertes Denken? Teil 1: Eingriffe an der Aorta.

Endovascular therapy has widely replaced conventional open vascular surgical reconstruction. For this reason both techniques were widely considered to be competing approaches. Evidence-based data from randomized prospective trials, meta-analyses and clinical registries, however, demonstrated that both techniques should be used to complement each other. It became increasingly more evident that the use of either procedure depends on the underlying disease and the anatomical conditions, whereby a combination of both (hybrid approach) may be the preferred option in certain situations. This review focuses on the treatment of complicated acute type B aortic dissection, descending thoracic aortic aneurysms, thoracoabdominal aortic aneurysms as well as asymptomatic and ruptured abdominal aortic aneurysms.

Transjugular Intrahepatic Portosystemic Shunt and Laparoscopic Colorectal Resection: the ideal minimally-invasive management for the treatment of colorectal cancer in severe cirrhotic patients. A case report and literature review.

Surgical interventions on gastrointestinal tract are often not well tolerated by patients with cirrhosis and severe portal hypertension, impairing their prognosis if suffering from malignant disease. Combining the benefits of two minimally invasive techniques such as Transjugular intrahepatic portosystemic shunt (TIPS) and Laparoscopic Colorectal Resection (LCR), the complications related to surgical intervention might be reduced and thus, it allows patients with liver disease, to undergo a curative intervention. One patient with cirrhosis and portal hypertension diagnosed with a rectal cancer underwent a meticulous preoperative preparation through placement of TIPS before laparoscopic surgery. TIPS placement was performed without intraprocedure complications. The patient was successfully operated by laparoscopic technique 36 days after TIPS placement without intraoperative bleeding or postoperative complications. Our experience, despite being based on one case, allows us to conclude that decompression of portal system by TIPS, already used in open surgery, may be applicable as a preoperative laparoscopic procedure with equally satisfactory results.

Influence of obesity-susceptibility loci (MC4R and INSIG2) on the outcome of weight loss and amelioration of co-morbidity in obese patients treated by a gastric-bypass.

BACKGROUND: Genome-wide association and linkage studies have identified multiple susceptibility loci for obesity. OBJECTIVE: We hypothesized that such loci may affect weight loss and comorbidity amelioration outcomes following a gastric-bypass. DESIGN: A total of 200 obese patients who underwent a gastric bypass surgery were genotyped for single-nucleotide polymorphisms (SNPs) in insulin induced gene 2 (INSIG2) and melanocortin 4 receptor (MC4R) obesity genes. RESULTS: After a follow-up of 18 month, the patients (192) data of weight excess loss (72%) and co-morbidities (Hypertension -62- and Diabetes -39-) were analyzed and compared. 26 Patients with SNP were found (9 MC4R and 17 INSIG2). No significant differences in weight excess loss and amelioration of comorbidities were revealed. CONCLUSIONS: The data suggest no influence of weight excess loss and amelioration of co-morbidities after gastric-bypass by genetic susceptibility.

High-dose chemotherapy in small-cell lung cancer.

Small cell lung cancer (SCLC) is highly sensitive both to radiotherapy and chemotherapy. Given its high chemo sensitivity, even two decades ago, SCLC was one of the first malignancies deemed suitable for maximising the dose and dose intensity with the support of autologous bone marrow (ABMT). On the whole, results were disappointing and the procedure was practically abandoned. Nowadays some interest is again emerging due to improvements in supportive care, such as the availability of hematopoietic growth factors and the peripheral blood progenitor cells (PBPC). Data of 505 patients included in 26 studies were reviewed. About two thirds of these patients had LD (limited disease). Late intensification protocols were used in 311 patients who, however, represented only the 30% of the population initially given conventional chemotherapy. Of the patients not achieving complete remission (CR) after induction, high-dose induced a CR in 39% of the cases. The use of early intensification was reported in 8 studies including 194 patients. The CR rate was 51.5%. Overall, the probability of achieving the CR was 2-3 times higher in LD than in ED (extensive disease). Relapses occurred at the site of the primary in more than half of the cases, showing that the course of the disease was not modified by the use of high-dose chemotherapy. Toxic deaths occurred in 7% of the treated patients, without difference in the two treatment methods. Though the schedules were too variable to draw firm conclusions, the ICE (ifosfamide, carboplatin, etoposide) and the CBP (cyclophosphamide, cisplatin, carmustine) regimens apparently provided better results, with a 2-year survival rate of 30-50% in the LD subset. An european multicenter randomized trial is ongoing. At the present time high-dose chemotherapy is still to be considered experimental treatment, since major problems such as the selection of the patients, doses and timing of chemotherapy and radiotherapy remain unsolved.

Nicotinic receptors in the cerebellar vermis modulate the gain of the vestibulospinal reflexes in decerebrate cats.

1. The possibility that the cholinergic afferent system terminating in the vermal cortex of the cerebellar anterior lobe acts on the target neurons by utilizing nicotinic receptors has been investigated in decerebrate cats by testing the effects of local microinjection of cholinergic nicotinic agonists and antagonists on posture as well as on the dynamic characteristics of the vestibulospinal (VS) reflexes. 2. Unilateral injection into the vermal cortex of the culmen of nicotine (0.25 microliter at the concentration of 0.05-0.5 microgram/microliter saline) decreased the extensor tonus in the ipsilateral forelimb, while the extensor tonus in the contralateral forelimb increased. The some agent significantly increased the gain of the first harmonic component of the EMG responses of the ipsilateral and more prominently also of the contralateral triceps brachii to animal tilt. However, the phase angle of the responses remained bilaterally unmodified. The effects described above were first observed 5-10 min after the injection, reached the peak after 40-60 min and persisted for at least 2-3 h before disappearing. 3. The effective area was located between the second and the fourth folium of the cerebellar vermis rostral to the fissura prima, at the laterality of 1.4-1.8 mm. This area, which upon cathodal stimulation suppressed the spontaneous EMG activity of the ipsilateral triceps brachii, actually corresponds to the zone B of the cerebellar cortex which exerts a direct inhibitory influence on the lateral vestibular nucleus. Moreover, the effects were dose-dependent. 4. Microinjection of nicotinic antagonists of both the ganglionic type (hexamethonium, 0.25 microliter at 4 micrograms/microliters saline) and the neuromuscular type (d-tubocurarine, 0.25 microliter at 7 micrograms/microliters saline) produced a postural asymmetry opposite in sign to that elicited by nicotine. The same agents also decreased the response gain of the triceps brachii of both sides to animal tilt recorded either under normal conditions or after previous injections of nicotine. 5. The experiments indicate that the cholinergic system is involved in the control of posture as well as in the gain regulation of the VS reflexes. Previous histochemical studies had shown that the cholinergic fibers terminate not only on Purkinje (P)-cells, but also and more prominently as mossy fibers ending on granular cells. This system may thus affect the discharge of P-cells and related inhibitory interneurons not only ipsilaterally but also contralaterally to the side of the injection.(ABSTRACT TRUNCATED AT 400 WORDS)

[Facial paralysis secondary to arachnoid cysts. Description of a case in a girl with precocious puberty]. / Paralisi del facciale secondaria a cisti aracnoidea. Descrizione di un caso in una ragazza affetta da pubertà precoce.

Arachnoid cysts are unusual in childhood. We describe a case of arachnoid cyst in a girl with precocious puberty. The cyst caused facial paralysis from compression. A link between arachnoid cyst and precocious puberty was excluded by cerebral TAC. We briefly discuss the aetiology and topography of arachnoid cysts.

[Spondylo-epiphyseal dysplasia. Description of a family]. / Displasia spondilo-epifisaria. Descrizione di una famiglia.

The authors describe a family, father and two sisters, suffering from spondylo-epiphyseal dysplasia. The disease is an autosomal dominant; genetic counseling depends on an exact diagnosis. The two sisters show some atypical features, which confirm the disease heterogeneity.

[Recurrent meningitis. Description of a case in a girl with dermal sinus]. / Meningite ricorrente. Descrizione di un caso in bambina affetta da seno dermico.

The authors describe a case of recurrent meningitis in a child with a dermal sinus. All the conditions causing this severe pathology are considered, particularly those in the pediatric age. The surgical treatment of the congenital malformation gave a complete resolution of the recurrent infections.