[Percutaneous angioplasty of arterio-venous fistulae with Zijlstra catheters]. / Angioplastica percutanea delle fistole artero-venose con catetere di Zijlstra.

Brescia-Cimino arteriovenous fistulas are the most common vascular accesses in hemodialysis patients. Arterial blood pressure inside the vein and repeated punctures cause progressive sclerosis of the vessel wall and stenosis or occlusion are the final outcome. Percutaneous dilatation is an effective method to preserve arteriovenous fistulas function. From January 1991 through December 1992, eleven dilatations were performed in 10 patients (7 women and 3 men, mean age: 55 years) using a Zijlstra dedicated catheter provided with multiple infusion holes, which allows long dilatation times and therefore progressive wall distention. A high-pressure balloon yields better results in case of stiff and diffuse stenosis. The immediate results of the maneuver were good in all patients. One acute thrombosis of the fistula was observed a few hours after the procedure, and a second dilatation was performed in a patient 8 months after the first one. Mean arteriovenous fistula patency time was 6 months. Finally, a critical review of the international literature on the subject is made and the value of dilatation in the treatment of fistula stenosis is reported; the necessity to use new dedicated catheters in also stressed.

[Differential diagnosis of hematoma, pulsating hematoma and pseudoaneurysm of the femoral artery using color Doppler]. / Diagnosi differenziale tra ematoma, ematoma pulsante e pseudoaneurisma dell'arteria femorale mediante color Doppler.

Color Doppler and Duplex Doppler US were employed on 4 patients with clinically suspected pseudoaneurysms as a complication of femoral artery puncture after cardiac catheterization. Pseudoaneurysms were identified with Color Doppler US and their typical appearance was confirmed. The grey-scale findings did not allow an adequate differentiation between hematoma and pulsed hematoma without fibrous encapsulation: only Color Doppler US easily detected the track between damaged artery and blood collection and allowed a sample to be obtained for pulsed Doppler examination. Color Doppler US allowed an accurate and non-invasive diagnosis of groin masses after femoral artery catheterization.

[Role of echography in the diagnosis of ovarian tumors]. / Ruolo dell'ecografia nella diagnosi dei tumori ovarici.

The role of sonography is evaluated in the diagnosis of ovarian tumors. Real-time US proves more sensitive than gynecological examination in the diagnosis of ovarian diseases. As yet, however, no correlation has been found between histological findings and US appearance. An accurate review of the relative literature and of our results lead us to the conclusion that sonography does not significantly affect the early diagnosis of ovarian tumors.

[Percutaneous transluminal angioplasty of supra-aortic vessels. Presentation of 16 cases]. / Angioplastica percutanea transluminale dei vasi sopra-aortici. Presentazione di 16 casi.

Sixteen cases are reported of dilatation of supra-aortic vessels; in 14/16 patients the vessel involved was either the subclavian artery or the brachiocephalich trunk. Special attention is paid to the choice of patients--the ideal one presenting with a single uncalcified lesion, with stenosis more than 50% of diameter; the symptoms have recently appeared, with a significant difference (more than 20 mmHg) in the pressure of the two arms. The technical aspects of the angioplastic procedure are discussed, especially in order to preserve the intracranial circulation and to limit possible complications. The presence of reversed blood flow in the vertebral artery is extremely important to preserve intracranial circulation from possible embolism; normal flow obtained at the end of the procedure is therefore an useful proof of successful dilatation. The advantages are stressed of dilatation over the surgical techniques used in the past. Finally, the importance is emphasized of a correct follow-up and doppler control of supra-aortic circulation.

[Urography with non-ionic contrast media. Multicenter experience on the optimization of the technic]. / Urografia con mezzi di contrasto non ionici. Esperienza multicentrica sulla ottimizzazione della tecnica.

The authors report the results of a multicentric experience based on 1200 urograms performed with nonionic contrast medium. The global diagnostic reliability is evaluated, together with the specific reliability for kidneys, ureters, and bladder, according to the various pathologies. The eventual need of radiographs of completion is showed. In searching for an optimization of the technique for nonionic contrast medium, a panoramic radiograph performed 10' after the end of the injection is pointed out as the key-moment of the test, being extremely rich in information, so as to help defining the most appropriate technique to continue the examination. For its excellent tolerability and high reliability, the nonionic contrast medium is recommended also in routine IVP, not only in risk patients.

[Five-minute urogram: is it sufficient for a diagnosis?]. / L'urogramma a cinque minuti: è sufficiente per la diagnosi?

It has been demonstrated, studying in retrospect a great number of urographies, that the most reliable urogram is the 5 minute urogram (5-U) after the end of the infusion of ionic contrast medium. The authors therefore, in order to save costs and dose to the population, suggest to simplify the urographical routine examination executing only 5-U. This is suggested especially in urographical evaluation of urolithiasis, urinary tract infections, prostate pathology, pelvic masses, pathologies in which 5-U is highly reliable. Very important is the immediate evaluation of 5-U, that allows to complete the urographical examination when necessary.

The role of embolization in the treatment of kidney carcinoma.

Although embolization is widely employed in kidney cancer patients, it is not yet clearly understood whether the procedure may influence the natural history of the disease. The writers' experience consists of 99 embolized patients, performed since 1976. The effects of the procedure were reduction of tumor bulk, creation of a good edematous cleavage plane, and shrinkage of venous thrombi. In stage I and II cases embolization seems to have prolonged the survival times of patients who died of tumor, but in stage III and IV cases no difference can be detected between the embolized and nonembolized groups, whereas in stage IV cases only palliative surgery allows better survival times.

Transcatheter embolization of hypogastric arteries as an aid or alternative to surgery in the management of life-threatening pelvic haemorrhage.

Transcatheter embolization for uncontrollable haemorrhage from pelvic organs was performed in 27 patients (12 women, 15 men) as an aid or alternative to surgery. The advantages and peculiarities of different embolic materials employed, and methods for managing intractable haemorrhage are discussed.

[Lumbar phlebography: methodological choice and reliability in the radiographic study of lumbar disk hernias]. / La flebografia lombare: scelta metodologica ed affidabilitá nello studio radiografico dell ernie discali lombari.

Lumbar epidural venography was used as the examination of choice in the investigation of suspected disc herniation in 270 patients. Compression or occlusion of an epidural and/or radicular vein at the disc level is the most significant venographic abnormality. In 110 patients operated on, the reliability of lumbar epidural venography was equal to 97.2%.

A case of renal oncocytoma.

A case of renal oncocytoma angiographically diagnosed and successfully treated by in situ tumorectomy under local hypothermia is presented.

[Lumbar phlebography: anatomy and technique (author's transl)]. / La flebografia lombare: anatomia e tecnica.

This article describes the normal radiological anatomy of the epidural veins whose understanding is necessary for the correct interpretation of venographic studies. Three ways of achieving adequate visualization of the epidural venous plexus are described. Experience with 80 cases is reported; a comparison has been made among the degree of visualization of the epidural venous plexus, the length of time, the cost and the amount of radiation received by the operator and patients during the performance of each technique. Preference is expressed for simultaneous injection of contrast media via two needles introduced into right and left femoral veins.

[Cholangiocarcinoma in a patient with hepatosplenic atrophy subsequent to thorotrast administration (author's transl)]. / Colangiocarcinoma in paziente con atrofia epato-splenica successiva a somministrazione di Thorotrast.

A case of cholangiocarcinoma observed in a woman of 38 following carotidographic examination with Thorotrast is described: the presence of radioactivity was also demonstrated by gamma spectrometry. The high mean dose absorbed by the liver (estimated at about 3,000 rad) together with the high relative biological effectiveness of the alpha contribution and the time lapse justify the hypothesis that the neoplasia was caused by irradiation.

[The intra-arterial use of lidocaine to reduce pain in aorto-femoral arteriography (author's transl)]. / L'impiego intra-arterioso della lidocaina per ridurre il dolore nell'arteriografia aorto-femorale.

In 50 patients subjected to aorto-femoral arteriography, the examination was carried out with and without the addition of 1 cm3 of 2% lidocaine per 10 cm3 of contrast medium; in 43/50 lidocaine led to a more or less notable reduction in pain without side-effects.

[Malignant insuloma. Evaluation of the response to treatment with streptozotocin, using selective arteriography of the celiac axis]. / Insuloma maligno. Valutazione della risposta alla terapia con streptozotocina mediante arteriografia selettiva del tripode celiaco.

A patients with metastatic insulin-producing islet-cell carcinoma has been treated with Streptozotocin intravenously and studied by selective celiac angiography during treatment. A 50% decrease of the tumor's size has been demonstrated by this technique after a total dose of 19 grams of the drug together with return to normal of the serum-insulin and blood-glucose values. The usefulness of angiography in evaluating the tumor response to Streptozotocin and in managing chemotherapy is discussed.