Update on distal deep venous thrombosis. Reports of a multicenter study.

AIM: No study of strong methodology could be found to resolve the controversy of optimal treatment of distal deep venous thrombosis (DDVT). Some inconclusive evidence exists on two approaches to care: anticoagulants and compression therapy or compression therapy and Duplex scanning monitoring. Different studies report propagation to popliteal vein in 8% of patients without anticoagulant treatment, while a complete thrombus resolution within 4 weeks occurred in 20% of patients. We report data of a study conducted in patients affected by DDVT and treated with nadroparin administered once daily in association with compression therapy. METHODS: One hundred and ten patients with DDVT of the gastrocnemius or tibial veins, assessed by Duplex scanning, were enrolled in 8 clinical centres of the Lazio Region. At baseline, patient demographics, medical history (including risk factors for DDVT), circumferences of both calves and ankles, and a VAS-pain scale were recorded. At 7 and 28 days from baseline, patients were re-assessed by Duplex scanning, calves and ankles circumferences and VAS-pain were measured, and the patients were asked about possible side effects. RESULTS: At the end of the study period, no propagation to the popliteal vein was observed, and no side effects were reported. Overall, the calf circumference in the affected leg significantly decreased from baseline (38.1 cm) to week 1 (37.1 cm), and to week 4 (35.7 cm). Also the VAS-pain scores significantly decreased during the study - the observed means were 58.4, 30.7, and 12.7 at the three visits, respectively. The percentage of partial recanalization of tibial DVT at 7 days was lower than gastrocnemius DVT (31.6% vs. 59.8%) whereas the percentage of total recanalization at 28 days was comparable (52.6% vs. 59.8%). Complete recanalization occurred in 56.4% of all patients. CONCLUSION: Our study suggests that anticoagulant treatment, associated with compression therapy, is safe and causes clinical improvement (as assessed by calf measurements) and pain relief. Overall complete resolution (56.4%) is significantly higher than in untreated patients (20%). Such results, together with the already reported higher satisfaction of patients for the once-daily administration regimen, should be considered as a viable option for the treatment of DDVT.

[Recurrence of varicose veins after treatment. Multicenter study by the Italian Doppler Club, Clinical and Technological Society]. / La comparsa di varici dopo loro trattamento. Studio multicentrico del Doppler Club Italiano Società di Clinica e Tecnologia.

BACKGROUND: The first results of a multicentric study dealing with recurrent varicose veins after surgery are presented. The aims of the study are: identifying the type of varicose vein, specifying the most frequent complaints (esthetical or functional), locating the causes of recurrence, establishing the causes and the most frequent seat of recurrence, clarifying whether it is enough to call recurrent all the varicose veins which appear after surgery or whether it is necessary to distinguish various typologies. METHODS: 194 patients (139 women and 55 men) aged 51.6 average (range 28-87), have been studied up to now with duplex and color scanner following a precise protocol which consisted of three stages: before treatment, within 2 months from treatment and after recurrence of varicose veins or venous insufficiency symptoms. RESULTS: Recurrent varicose veins represented 65.7%, residual ones 14.3%, new ones 2.5%. It has not been possible to identify the type of varicose vein in 8.3% of cases. Stripping of the great saphenous veins was carried out in 88% of cases, short stripping in 4.1%, stripping of the short saphenous veins in 6.9%. Recurrent varicose veins were due to technical error in 78.7% of cases, to diagnostic error in 9.2%, to unidentifiable causes in 12% of cases. CONCLUSIONS: Data relating to the prospective study of the research will be published in subsequent papers.

[Rare tumor of the stomach: leiomyoblastoma]. / In tema di tumori rari dello stomaco: il leiomioblastoma.

The Authors report a case of gastric leiomyoblastoma presenting a dyspeptic and painful symptomatology and microcytic hyposideremic anaemia. The patient underwent elsewhere gastric resection and was discharged with the diagnosis of "gastric leiomyoma characterized by bizarre cells". After a review of the literature, the Authors emphasize the anatomo-pathological and clinical aspects pointing out the diagnostic difficulties in this malignancy. The correct treatment is based on predicted factors of malignancy.

[Surgical treatment of obesity: our experience]. / Trattamento chirurgico dell' obesità: nostra esperienza.

The surgical treatment of morbid obesity is reserved to patients non responding to medical and dietetical therapy. The Authors suggest for these patients a sequential surgical treatment: a vertical gastroplasty, followed by an abdominoplasty. In the Authors experience, this approach offers good results in terms of weight loss and aesthetics. In this paper, the results obtained in 19 patients, operated for morbid obesity in the past three years, are reported.

[Physical training and low-dose heparin-calcium in patients suffering from chronic obliterating arteriopathy of the lower limbs with intermittent claudication]. / Training fisico ed eparina calcica a basse dosi in pazienti affetti da arteriopatia obliterante cronica degli arti inferiori con claudicatio intermittens.

In the treatment of peripheral obliterating arteriopathy (POA) physical training provides clear results in terms of increased walking autonomy; it is still not fully clear whether the positive effects of physical training can be further improved by concomitant back-up drug therapy. For this purpose 374 patients of both sexes, with a mean age of 64 years, suffering from chronic peripheral obliterating arteriopathy of the lower limbs were enrolled in a controlled open clinical trial, instructed to follow a programme of physical training and randomly allocated to low dose treatment with heparin calcium (12,500 IU/day) for 6 months. An improvement in the claudicometric parameters (free gait interval, absolute gait interval and recovery time) measured at constant speed and in the resting Winsor ankle/arm index of the most severely damaged limb were observed in both groups. These improvements were significantly greater in the group receiving pharmacological treatment (p < 0.01) and efficacy increased in line with basal deambulatory impairment. The results obtained and the good tolerance of the drug underline the clinical efficacy of heparin calcium at low doses in association with a physical training programme in patients suffering from Fontaine's stage II peripheral obliterating arteriopathy.

[Spontaneous rupture of the esophagus]. / La rottura spontanea dell'esofago.

Spontaneous rupture of the esophagus is a rare emergency that requires immediate diagnosis and superior surgical treatment. Delay in diagnosis is common and is caused mostly by lack of consciousness of the disease and consequent tendency to diagnose a cases as perforated peptic ulcer, pancreatitis, acute coronary disease etc. Mortality and morbidity increase proportionally to the time between esophageal perforation and adequate treatment. In this paper the Authors present a case of Boerhaave's syndrome in a patient who underwent two surgical repairs followed by leakages of the esophageal sutures. The definitive successful treatment has been obtained with a third operation performed after complete sterilization of the mediastinum.

[Collagenous colitis: a disease difficult to define]. / La colite collagena: una patologia di difficile definizione.

The Authors report a case with watery chronic diarrhoea not related to malabsorption or to inflammatory bowel disease or to intestinal neoplasm. Colonic biopsy, performed during colonoscopy, with the histologic finding of collagenous material in the subepithelial space associated to epithelial alterations and to the presence of inflammatory cells, confirmed the diagnosis of this rare pathologic condition. The pathogenesis of the syndrome, however, is still unknown.