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.

[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.

[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.

[Sarcoidosis and clear cell carcinoma of the kidney: the sixth case?]. / Sarcoidosi e carcinoma renale a cellule chiare: il sesto caso clinico?

The Authors report a very rare case of clear cell renal cancer associated with sarcoidosis, incidentally discovered in a 39 year-old man, admitted for a not correlated pathology (multiple left rib fractures due to automobile crash). Problems related to a proper assessment of sarcoidosis are discussed as well as potential arising of a neoplasm during the entire follow-up period: for that, it must always be complete and accurate.

[Non-parasitic splenic cysts]. / Le cisti spleniche non parassitarie.

The Authors report their experience matured during the last decade in the Institute of III Surgical Clinic of the University "La Sapienza" in Rome, relatively to 174 patients operated of splenectomy of which 8 for not parassitair benign cystic pathology. After the nosologic organization of the varied types of cystics splenopaty is examined the different symptomatology and is discussed the different treatment.

[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.

[Hereditary nonpolyposis colorectal cancer (Lynch syndrome): a review of the literature and case reports]. / Cancro colorettale ereditario non poliposico (sindrome di Lynch): revisione della letteratura e contributo casistico.

The recent observation of a new HNPCC patient case induced the Authors to review their experience with the syndrome as well as to make an up to date of the problems related to diagnosis, surgical management, surveillance and genetic counselling for such patients with a lifelong high cancer risk. Patients with HNPCC and their first-degree relatives, whose risk of early colorectal carcinoma (especially in the proximal colon) as well as a variety of extracolonic cancers (particularly endometrium, ovary, stomach, small bowel, ureter and renal pelvis) is significantly higher then that of patients with sporadic carcinoma, should be properly managed with surgery and then with endoscopic examination (ideally all life long) starting--in unaffected individuals--at early age (25 years old). Problems related to genetic counselling are considered as well.

[Gastric leiomyoma. Diagnostic and surgical problems]. / Il leiomioma gastrico. Problemi diagnostici e terapeutici.

The Authors report their three year experience with five patients suffering from gastric leiomyoma, each with different anatomical and clinical characteristics. The Authors have performed a research of the different diagnostics, clinical and therapeutic problems of these rare tumors that sometimes are asymptomatic in spite of the large size they reach, but more frequently they present with haemorrhagic symptoms which tend to point to other more frequent pathological conditions. Diagnosis can only be suspected, but cannot be reached without a histological examination, also if the classifications of these tumors have been argument of many changes, particularly by the light of the recent diagnostics possibilities offered by ultrastructural and immunohistochemical examination.

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.

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.

[Synchronous and metachronous colorectal cancers: a case series contribution]. / I cancri sincroni e metacroni del colon-retto: contributo casistico.

The Authors, on the basis of their experience with neoplastic colorectal pathology and after a review of the Literature, report a reappraisal of the problems related to colorectal multiple carcinomas. They emphasize the importance of routine preoperative pancolonoscopy for the identification of possible synchronous tumors (both benign and malignant) and periodic endoscopic follow-up (ideally a life-long one) for the detection and removal of all adenomatous polyps as well as early stage metachronous carcinomas, especially for patients with HNPCC. Besides, they stress the importance of sensibilization of the population about the heritability of colorectal carcinomas.

[Our experience in the recurrence of rectal cancer operated with radical intention in light of a case load treated in a homogeneous manner]. / La nostra esperienza delle recidive di cancri rettali operati con intento radicale alla luce dei risultati di una casistica trattata in maniera omogenea.

A reappraisal of the results obtained after potentially curative resection for rectal cancer compared with "historical" results is reported. An increase of the overall survival rates was registered as well as a corresponding lowering of the pelvic recurrences: 4.54% in the group of patients with a-two-year follow up. As for relapse surgery, however, reviewing the series from January 1991 to December 1994, the results are still poor because relapses were not resectable in 85.7% of the cases.

[The endoscopic treatment of postoperative stenoses of the upper digestive tract]. / Trattamento endoscopico delle stenosi post-operatorie del tratto digestivo superiore.

The authors compare their experience in dilatation of postoperative benign esophageal strictures. A total of 60 patients (37 males, 23 females: mean age 52), all with severe dysphagia, from January 1985 to September 1995, underwent endoscopic dilatation: 32 of these with Savary dilators and 28 with balloon dilators. Dilatation was effective in 93% in both groups. Two severe complications were recorded (1 heart attack and 1 perforation) in the group that underwent endoscopic dilatation with Savary dilators. During endoscopic management, pain recurred in 43% and 87% of cases after balloon or Savary dilatations, respectively. The authors believe balloon dilators are more effective, better tolerated and with less complications than Savary dilators. They reserve the management with Savary dilators to the extremely severe esophageal strictures.

[Cholecystectomy and colorectal cancer: a retrospective study of a sample of 285 operated patients]. / Colecistectomia e cancro colo-rettale: studio retrospettivo su un campione di 285 pazienti operati.

A review of 285 patients operated for colo-rectal cancer in order to evaluate cholecystectomy rate in their pathologic history is reported. A surprisingly high rate (9.47%) was registered also when compared with Literature data. Although not definitely conclusive for a positive correlation between cholecystectomy and colo-rectal cancer, the Authors believe that this study identifies a subgroup of patients potentially at risk for colo-rectal cancer. In these subjects a prophylactic, periodic colonoscopy could be useful.

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.

[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.