Catheter ablation of Wolff-Parkinson-White syndrome associated with congenital absence of inferior vena cava.

In the present report we describe a patient (a 36-year-old woman with 15 year history of supraventricular tachyarrhythmias) with congenital absence of inferior vena cava (IVC) revealed during radiofrequency (RF) catheter ablation procedure for right postero-septal Wolff-Parkinson-White syndrome (WPW). For the absence of IVC, the ablation procedure was more difficult, because we had to perform the ablation with the catheters (the ablator catheter and the coronary sinus catheter) introduced both through the superior vena cava. The application of RF energy (35 Watt for 60 seconds) at successful site abolished accessory pathway conduction. The following day was performed the venous angiography, showing the absence of the IVC and a venous return via paravertebral venous plexus to the azygous vein and superior vena cava into the right atrium. Computer tomography confirmed the absence of the IVC with azygous continuation. The drainage via the azygous system modified the radiological image on chest roentgenogram of the right mediastinal silhouette. During cardiogenesis fusion of the IVC and organisation of the heart occur between the 33rd to 40th embryonic days. It is therefore possible that some unknown teratogenic mechanism at this critical period might have caused, in the patient, both the developmental arrest of IVC and failure of regression of atrio-ventricular anatomical and electrical continuity in the right postero-septal region.

[Criteria for utilization and indications for use of permanent and short- and medium term temporary endocaval filters. Personal experience and review of the literature]. / Criteri dell'utilizzazione e indicazioni all'uso dei filtri endocavali definitivi e temporanei con durata breve e media. Esperienza personale e revisione della letteratura.

Screening and prophylaxis of the population at risk is the most correct approach to thromboembolic disease. Caval filters play a major role in the prevention of pulmonary embolism, but their use remains widely controversial, even if they are an alternative or additional method to medical therapy and not antithetical to it. July, 1990, to September, 1995, seventy-seven permanent vena cava filters (59 LGM, 13 Filcard and 5 titanium-Greenfield), 22 short-duration temporary vena cava filters (11 LGT, 6 Filcard, 3 Filcard-Emanuelli and 2 Lysofilter) and 10 mid-duration temporary vena cava filters (Tempofilter) were inserted in 109 patients (55 men and 54 women) aged 17-88 years. An inferior vena cavogram was always made before filter insertion to "map" the inferior vena cava and its tributaries (renal veins) and to assess caval size. This is a mandatory step to exclude or confirm the presence of endocaval thrombi. Sixty-eight filters were inserted percutaneously via a right internal transjugular approach, 40 via a common transfemoral approach (34 right and 6 left) using the same route as inferior cavography and digital pneumoangiography. One temporary filter was inserted via a right transhumeral approach. Sixty-three patients (57.8%) (44 with a permanent filter, 14 with a temporary filter and 5 with a Tempofilter) had medical diseases, 7 patients (6.4%) (4 with a permanent filter, one with a temporary filter and 2 with a Tempofilter) had surgical conditions; 10 patients (9.2%) (7 with a permanent filter and 3 with a Tempofilter) were surgical-orthopedic patients. Twenty-seven patients (24.8%) (22 with a permanent and 5 with a temporary filter) had cancer. Two patients (1.8%) with a temporary filter were breast feeding. All the patients had deep venous thrombosis of the lower limbs, including the inferior vena cava and the right renal vein in two patients. A proximal floating thrombus and a pulmonary thromboembolism was diagnosed in 41 (37.6%) and 34 (31.2%) cases, respectively. The temporary filters remained in situ 1-4 days and the Tempofilters 3-5 weeks. A pelvic hematoma developed (because of heparin?) after the insertion of a temporary filter and a Tempofilter branch detached and migrated into a lower branch of the left pulmonary artery were reported as immediate and short-term consequences. There were no early or late consequences for the patients. An axillary hemorrhage was observed in the site of previous surgery, during fibrinolysis with a Lysofilter, as well as the incomplete opening of a titanium-Greenfield filter and of two permanent LGM filters, partly trapped within endocaval thrombi. No further consequences to the patients due to permanent filters were observed, nor any case of symptomatic pulmonary thromboembolism, in patients with permanent or temporary filters. With reference to the relative literature and to their own experience, the Authors propose a detailed and rational synthesis of the diagnostic-instrumental approach protocol to thromboembolic disease.

[Sclerotherapy of varicocele. Efficacy of radiological, clinical and seminal treatment]. / Sclérose des varicocèles. Efficacité du traitement du point de vue radiologique, clinique et séminal.

Between december 1983 and april 1989, percutaneous retrograde sclerotherapy of varicocele was successfully performed on 364 patients. A 5% solution of sodium morrhuate and benzylic alcohol (Varicocid) was administered through a coaxial balloon catheter inserted into the spermatic vein. 10 of the patients had relapses after surgery. Long-term follow-up was available for 268 patients (73.6%). Three of them had incomplete relapses after sclerotherapy. In terms of spermatologic improvement, sclerotherapy appeared to be effective in the treatment of varicoceles. In our experience, sclerotherapy is a safe effective procedure to be preferred to surgery in the management of varicocele.

[Abdominal angina: percutaneous transluminal angioplasty of the superior mesenteric artery]. / Angina abdominalis: Transluminale perkutane Angioplastik der Arteria mesenterica superior.

Percutaneous transluminal angioplasty (PTA) of the superior mesenteric artery (SMA) was performed in a 65-year-old man with clinical and radiographic evidence of abdominal angina. The patient was relieved of abdominal pain immediately after the dilatation. At the angiographic follow-up (7 months later) the SMA was of normal caliber. At the last follow-up visit (14 months after intervention), the patient was still free of pain. PTA of SMA stenoses is an alternative to surgical revascularization, and can be repeated if symptoms recur.

[Varicocele: the effects of sclerotherapy on hemodynamics and spermatogenesis]. / Varicocele: effetti della scleroterapia sull'emodinamica e sulla spermatogenesi.

Between January 1984 and July 1988, percutaneous retrograde sclerotherapy of varicocele was successfully performed on 267 patients. A 5% solution of sodium morrhuate and benzylic alcohol (Varicocid) was administered through a coaxial balloon catheter inserted into the spermatic vein. Nine of the patients had relapses after surgery. Long-term follow up was available for 248 patients. Three of them had incomplete relapses after sclerotherapy. In terms of spermatologic improvement, sclerotherapy appeared to be effective in the treatment of varicoceles. In our experience, sclerotherapy is a safe and effective procedure to be preferred to surgery in the management of varicocele.

[Value of percutaneous sclerotherapy in the treatment of varicocele. Technic and results]. / L'intérêt de la sclérothérapie percutanée dans le traitement de la varicocèle. Technique et résultats.

Since December 1983, percutaneous transvenous retrograde sclerotherapy of the internal spermatic vein was performed successfully, without complications in 37 patients. The administration of the sclerosing agent through a coaxially balloon catheter specifically inserted into the spermatic vein caused therapeutic hardening. The effectiveness of the treatment was endorsed by subsequent checks by clinical and radiological examinations.

Accuracy of lymphography in staging of prostatic and bladder carcinoma: 88 cases with aspirative cytological and postlymphadenectomy histological verification.

Lymphography was performed in 88 patients with prostatic (n = 51) or bladder (n = 37) carcinoma. The lymphographic findings were correlated to the cytological and histological staging obtained by means of transcutaneous fine-needle aspiration biopsy and/or pelvic lymphadenectomy performed after lymphography on the most frequently involved glands. The lymphographic diagnosis was confirmed in 90.7% of the patients. In 16 cases (18.1%) histology was not in accordance with the positive lymphogram and in 5 cases (5.6%) lymphography was false negative. The authors emphasize the high rate (35.5%) of normal-sized nodes with evident but minimal metastatic changes, cytohistologically verified. These are, in fact, metastatic lymphonodal lesions which escape ultrasonography and computed tomography.

[Lymphography in staging prostatic cancer: correlations between the histo-pathological, anatomic and radiologic results in 30 patients. The role of transcutaneous lymph node biopsy]. / La linfografia nella stadiazione del carcinoma della prostata: correlazioni fra i risultati istopatologici, anatomici e radiologici in 30 pazienti. Il ruolo della biopsia linfonodale transcutanea.

Between September 1, 1978 and March 1, 1981, 35 patients with prostatic carcinoma, apparently localized (T0-3) and histologically proved, underwent pedal lymphography. 30 out of 35 underwent cytologic and/or histopathologic examination of pelvic lymph nodes, either by transcutaneous thin needle biopsy and/or pelvic lymphadenectomy. Prospective analysis demonstrated an overall lymphographic sensitivity of 84.2%, specificity of 73.7%, positive accuracy of 68.7% and negative accuracy of 78.5%. The authors herein underline the usefulness of lymphography and lymph node biopsy which, if cytologic positiveness occurs, allows to avoid pelvic lymphadenectomy.

[Pelvic lipomatosis and retroperitoneal fibrosis: 2 phases of the same disease? Report of 3 cases and review of the literature]. / Lipomatosi pelvica e fibrosi retroperitoneale: due fasi di una medesima malattia? Considerazioni su tre osservazioni personali e revisione della letteratura.

Three cases of pelvic lipomatosis and a review of the literature are presented. One patient with pelvic lipomatosis was found at radiographic exploration to have retroperitoneal fibrosis with obstruction of the inferior vena cava. The classic roentgen triad which includes 1) pelvic radiolucency, 2) elevation of an intact rectosigmoid, and 3) elevation of the urinary bladder (the radiologic features simulate, in the first case, a pelvic malignancy) is present in two patients; the case 3 suggested a theoretical possibility: the pelvic lipomatosis and retroperitoneal fibrosis may be a variant of the same disease.

[Lymph node staging in prostatic carcinoma Lymphography, pedal and intraprostatic lymphoscintigraphy, transcutaneous fine-needle lymph node biopsy and pelvic "guided" lymphadenectomy. Considerations on a series of 20 cases (1 September 1978-31 January 1980)]. / Lo staging linfonodale del carcinoma della prostata. Linfografia, linfoscintigrafia pedidia ed intraprostatica, biopsia linfonodale transcutanea con ago sottile e linfadenectomia pelvica "orientata". Considerazioni su una serie di 20 casi (1-9-1978/31-1-1980).

Evaluation of lymph node involvement in carcinoma of the prostate is an essential step in staging when radical management is still possible. For this purpose, lymphography, lymphoscintigraphy, thin-needle transcutaneous lymph node biopsy, and pelvic lymphadenectomy have been variously combined since 1978 in 20 new cases (T1-T2-T3/Mo). Pedal lymphography displayed a good correlation with the histological data offered by adenectomy, and proved indispensable for the execution of transcutaneous biopsy under fluoroscopic control. Pedal lymphoscintigraphy is less invasive than lymphography. It provided suggestive morphological pictures of the lymph node chains, including those outside the pelvis; these, however, were difficult to interpret and must be regarded as of great, but complementary utility. Intraprostatic lymphoscintigraphy by injecting the radionuclide into the gland capsule permitted visualisation of the periprostatic nodes and confirmed previous experimental and clinical data. Lymph node metastases were seen in 50% of cases. Their frequency was inversely proportional to the degree of histological differentiation. In all cases, the external iliac and "obturator" (internal chain of external iliac group) notes were involved. Voluminous metastases were observed in two cases of "incidental" (To) carcinoma. The lymphography contrast medium was always found in the "obturators". It is suggested that these findings underscore the need for careful lymph node examination, even in the earliest stages of prostate cancer. They also raise further queries with regard to the treatment of incidental carcinoma.

[Extramedullary erythropoiesis in the posterior mediastinum: clinical and radiological aspects of the authors' own case (Cooley's disease)]. / Eritropoiesi extramidollare nel mediastino posteriore: considerazioni clinico-radiologiche su di una osservazione personale (morbo di Cooley).

A case of intrathoracic extramedullary hematopoiesis, during Cooley's disease in a 38 year old male, is analysed, especially from the point of view of its radiological signs. The combination of radiological, clinical and laboratory findings makes the interpretation of the radiographs more precise. The radiologic diagnosis is essential because it makes it possible to avoid biopsy or surgery which can be harmful because of the extreme vascularity of this erythropoietic tissue. This avoids excision of these masses and thus avoids exacerbation the anemia.