[The carotid chemodectoma. Presentation of 4 clinical cases and review of the literature]. / Il chemodectoma carotideo. Presentazione di quattro casi clinici e revisione della letteratura.

After a brief introduction about carotid body tumor's etiopathogenesis and clinical presentation, four clinical cases observed between January 1996 and December 1998 are described. Three of them have been classified as I and the last as III type according to Shamblin's classification. The diagnostic trial and surgical option needed by each patient are presented. The surgical treatment and the possibility of alternative or complementary techniques such as endovascular embolization and/or irradiation are discussed. The conclusion is drawn that surgical option for carotid body tumor is the best choice. Embolization, some hours before surgical treatment, can be a very useful procedure in order to reduce intraoperative risks and bleeding. Nevertheless surgery of carotid body tumor must be performed by surgical teams experienced in supra-aortic vessel treatment.

[Surgical treatment of post-mastectomy lymphedema of the upper limb]. / Il trattamento chirurgico del linfedema dell'arto superiore secondario a mastectomia.

The authors analyze their experience of surgical treatment of post-mastectomy lympho-edemas of the upper arm. They have performed 14 operations, each upon patients with praecox or later oedema, following Cariati's classification, and with median age of 56.5 years. Seven patients were present at the follow-up in 6 has been performed microsurgical lympho-venous anastomosis, in 1 a fasciotomy of the forearm and in 1 patient some silastic tubes were positioned in her subcutaneous tissue. An improvement of the subjective symptoms has been recorded in 57.14% of the patients, while the objective ones have improved in 50% of the patients. The authors think that the microsurgical treatment of the lymphedema post-mastectomy of the upper arm is the first choice nowadays.

Alpha 1-antitrypsin activity in subarachnoid hemorrhage.

An altered equilibrium of protease/protease-inhibitor factors may be involved in the pathogenesis of aneurysm rupture: alpha 1-antitrypsin (alpha 1-AT) represents the most relevant inhibitor of elastase, a proteolytic enzyme enhancing catabolic processes of collagen metabolism. In the present study we test the hypothesis whether the activity of alpha 1-AT is altered in SAH patients; 5 cases with unruptured intracranial aneurysm and 27 patients with diagnosis of aneurysm SAH were included in the study. Blood samples were obtained immediately at admission. As control samples we consider the 5 cases of unruptured aneurysm, 15 cases of unruptured aortic aneurysms and 10 patients with non-vascular CNS diseases. Measurement of alpha 1-AT level was determined by immunoturbidimetric method. Serum levels of alpha 1-AT are significantly lower in patients admitted within 72 hours after SAH, if compared to patients admitted in a delayed phase. The linear relationship between alpha 1-AT and collagenase inhibitory percentage capacity (CIC) was shown to be different in the 4 subgroups considered, and so were the mean % CIC values in the between-groups comparison, except for unruptured aneurysm vs controls. The alpha 1-AT CIC in patients with SAH is shown to be the lowest when compared to controls and unruptured aneurysms (p = 0.0001).

Aortic wall structural strengthening by intraluminal net prosthesis to arrest aneurysm progression and to prevent dissection and rupture.

The major limitation implicit in the endovascular procedures for aortic prosthetic substitution is that they cannot be used in those tracts of the aorta where important collateral branches originate (aortic arch, thoraco-abdominal tract, upper abdominal), that would be occluded by the prosthesis. In order to overcome this limitation we hypothesized the endovascular positioning of a prosthesis in the form of a wide mesh network that would be gradually and spontaneously covered by new intima and included in the aortic wall. The fabric framework linked to the aortic wall would then condition its significant, regular and uniform mechanical strengthening that fractionates and partially absorbs the centrifuge pulsatile stress of the bloodstream. The purpose of this paper is to report the results of the insertion of a braided Prolene net prosthesis in the first 7 cm of the descending aorta of ten swine. The animals were killed after 6 weeks, the substituted segment removed and aortic wall compliance measured under standardized conditions. The prosthesis was found entirely covered by new intima, well embodied in the aortic wall. The intercostal collateral included in the substituted segment was patent, as proved by bubble formation during underwater insufflation. Compliance of the prosthesis segment was significantly lower than that of the adjacent descending aorta. Histology showed a regular net prosthesis inclusion deep in the neo-intima layer. Present results indicate the technical feasibility of the procedure, achieving significant aortic wall strengthening without affecting the collateral (intercostal) circulation.

[Choledochocele: a rare cause of chronic pancreatitis of the head of the pancreas]. / Coledococele: rara causa di cefalo-pancreatite cronica.

The authors critically review the literature in order to ascertain the current state of knowledge regarding the anatomopathological, clinical and therapeutic characteristics of choledochocele, or cystic dilation of the terminal portion of the biliary tract. In particular, the Authors examine the etiopathogenetic aspects to explain how the presence of a choledochocele may lead to the onset of chronic pancreatitis. A clinical case which was recently brought to their attention is examined in detail. It concerns a 27-year-old patient in whom the presence of a large choledochocele had led to the onset of severe cephalopancreatitis which resisted all forms of treatment. In the case in question, ERCP played a decisive role in the diagnosis of the choledochocele, whereas ultrasonography, CT and selective arteriography were useful above all in relation to pancreatitis. In the case described ultraradical surgery, namely duodenocephalopancreatectomy, allowed the severe pancreatopathy and its etiological cause (choledochocele) to be efficaciously treated, confirming that this type of surgery currently plays an important role in the treatment of chronic pancreatitis.

[A comparative study among different therapeutic approaches to portal hypertension and bleeding esophageal varices]. / Studio comparativo tra diversi approcci terapeutici all'ipertensione portale ed alle varici esofagee sanguinanti.

Recurrence of haemorrhage in patients with portal hypertension is the most feared life-threatening complication and the one which most often conditions patient survival. The present study compares the results obtained in two groups of patients treated by surgery and endoscopic sclerotherapy, respectively, and a control group treated with traditional medical therapy during bleeding episodes and subsequently given no further treatment. The patients in each group were subdivided into three different risk classes on the basis of the Child classification. Patients treated surgically mainly belonged to Child classes A and B, whereas those treated by endoscopic sclerotherapy belonged to Child class C. The long-term survival results show no significant differences between the two groups. On the other hand, both groups show better survival data than the untreated patients. On the basis of the results obtained, the authors believe that surgical treatment appears to most indicated in patients belonging to the lower risk classes (Child A and B), whereas endoscopic sclerotherapy is better suited to patients belonging to the higher risk class (Child C).