Aneurysm of the extrahepatic portal vein associated with segmental portal hypertension and spontaneous porto-caval shunting through the inferior mesenteric vein.

A case of a congenital aneurysm of the extrahepatic portal vein is reported. It was complicated by segmental portal hypertension of the territory of the inferior mesenteric vein, which was a pathway for spontaneous porto-caval shunting.

Aortography in the diagnosis of traumatic aortic rupture due to blunt chest trauma. Report of thirty-six cases.

Thirty-six patients were evaluated by aortography after blunt chest trauma with a suspicion of traumatic aortic rupture (TAR). There were 16 isolated TARs at isthmus, 2 multiple injuries both of the thoracic aorta and brachiocephalic arteries and no false negative aortographies. Seventeen aortographic examinations were negative, as confirmed by clinical and radiological follow up one false positive aortography was due to a ductus diverticulum. Aortography had a sensitivity of 100%, specificity of 94.4%, and accuracy of 97.2%. No complications or deaths resulted from angiography. Aortography is a safe, accurate and rapid technique to evaluate patients with suspicion of TAR; aortography is superior to other non-invasive techniques in depicting vascular anatomy and pathology, knowledge of which is essential for surgical planning.

[Chemoembolization in the therapy of hepatocarcinoma. A 3-year experience]. / La chemioembolizzazione nella terapia dell'epatocarcinoma. Esperienza di 3 anni.

This study was aimed at evaluating the efficacy of chemoembolization (CE) to improve survival in patients with hepatocellular carcinoma (HCC). Our results were compared with the natural history of HCC. Sixty-two consecutive patients with HCC in Okuda's stages I and II underwent CE. Forty-seven patients were treated with CE alone; 9 patients had CE prior to surgery, and 6 patients had it after surgery because of recurrent HCC. One hundred and nine CEs (mean: 1.8 CEs/patient) were performed with Lipiodol UF, epirubicin and gelatin sponge. Actuarial survival was calculated considering Okuda's stage, neoplasm size, and evidence of pseudocapsule. The mean cumulative survival of the 47 patients treated with CE alone was 13.2 months; survival (+/- SE) at 12, 24 and 36 months was 0.75 (+/- 0.07), 0.46 (+/- 0.10) and 0.28 (+/- 0.12). Survival was not affected by Okuda's stage, neoplasm size, evidence of pseudocapsule (p > 0.05). Nevertheless, the patients with early HCC had better prognosis. Eighteen patients (42.9%) died during follow-up, 12 of whom (66.7%) from hepatic failure. The mean survival of patients with recurrence of HCC after surgery was 41 months (range: 24.8-74.9 months) since initial diagnosis of HCC, and 14.8 months (range: 7.1-29.6 months) since diagnosis of recurrence. Two of these patients died from hepatic failure. All the patients who underwent also surgery after CE are still alive (mean survival: 14.7 months). Histologic findings of resected specimens revealed viable neoplastic cells in all cases. Twenty-one major complications (20.2%) occurred in 18 patients (29%); the outcome of complications was favorable in all but one patient who died from sepsis. CE is a reliable and safe treatment for unresectable HCC. Small HCCs should be preferably treated with surgery or, alternatively, with percutaneous alcohol injection.