Upper limb secondary lymphedema ultrasound mapping and characterization.

BACKGROUND: Ultrasound investigation potentials in lymphedema are still to be fully used in everyday practice. Aim of the present study was to report the sonographic characterization of the dermo-epidermal complex (DEC) and of the subcutaneous (SUBC) tissue, assessing the feasibility of a related mapping, in upper limb secondary lymphedema. METHODS: In this retrospective study 287 patients affected by monolateral upper limb post-mastectomy lymphedema (M5/F282; mean age 64±4.24) were enrolled and scanned by ultrasound, considering the healthy contralateral limb as control. In order to standardize the assessment, the limb was divided in sectors: 4 anterior, 4 posterior below the elbow, 4 anterior and 4 posterior above the elbow, plus the hand. DEC and SUBC regions B-mode appearance were reported, both in the healthy and in the pathological arms. DEC thickness was measured and compared among the same sectors of the healthy and pathological limbs. RESULTS: DEC and SUBC sonographic appearance was differentiated in fluid and sclerotic. DEC included a third category characterized by differentiation loss. The different sectors showed significantly different lymphatic involvement in the affected limb. In the comparison with the contralateral unaffected segments a significantly thicker DEC was reported in the forearm affected by lymphedema (P<0.005), while no significant difference was reported at the arm level. CONCLUSIONS: Traditional ultrasonography can provide a secondary upper limb lymphedema characterization with related mapping and useful data for a better lymphatic physiopathology understanding and for a properly addressed therapeutic protocol.

Arteriovenous intracavernous post-traumatic fistula: clinical management and treatment by superselective embolization.

Arteriovenous intracavernous post-traumatic fistula (FAV) is a rare post-traumatic lesion for which the first choice of treatment is superselective embolization. We present a case of post-traumatic fistula in a 45-year-old patient. The patient underwent penile blood gas analysis and color Doppler ultrasonography and was treated with superselective embolization with an acrylic co-polymer. Postoperative arteriography showed obliteration of the fistula. Color Doppler ultrasonography 60 days after the procedure showed reacquired physiologic patency of the cavernous artery with normal flow parameters. The results of this case confirm superselective embolization as the reference standard treatment of FAV. We propose the use of an acrylic co-polymer as a new, effective embolizing medium.

Color Doppler ultrasound guidance during renal angioplasty and stenting.

PURPOSE: To investigate whether an imaging technique combining color Doppler ultrasonography and selective renal artery digital subtraction angiography reduces contrast requirements in patients with progressive renal insufficiency undergoing renal artery angioplasty and stenting. METHODS: Eight patients (5 men; mean age 58 years) with renal artery stenosis and renal insufficiency underwent percutaneous transluminal angioplasty and stenting under color Doppler ultrasound guidance. RESULTS: Color Doppler ultrasound imaging yielded the information necessary for verifying catheter position, stent placement and expansion, and hemodynamics after revascularization. The combined imaging technique considerably reduced contrast requirements to only 10 mL in each case. No worsening of renal function was seen in any patient. CONCLUSIONS: The combined imaging procedure uses low doses of contrast agent and is especially suited to patients with renal dysfunction undergoing percutaneous renal revascularization.

¿Es el envejecimiento un verdadero factor de riesgo en las patologias urologicas en hombres y en mujeres? / Is aging a real risk factor for urological pathologies in men and women?

OBJETIVO: Con el progresivo envejecimiento de la población en los países industrializados, las patologías urológicas aumentan en número y crean un problema socio sanitario a la comunidad. Para investigar estos problemas hemos analizado retrospectivamente una muestra heterogénea de 283 pacientes, 134 hombres y 149 mujeres que han sido estudiados con métodos urodinámicos. MÉTODOS: De la muestra, las mujeres fueron divididas en 6 categorías y los hombres en 7 categorías, de acuerdo con el diagnóstico urodinámico. La distribución por edad se comparó con las de la población de la región del Lázio en Italia para calcular la "tendencia al riesgo". RESULTADO Y CONCLUSIONES: La patología más frecuente en los hombres fue la obstrucción de el cuello vesical asociada o no a hiperactividad detrusoriana y en mujeres la patología mas frecuente fue el cistocele asociado o no o a obstrucción urinaria. Hay un aumento considerable y muy significativo de las patologías urológicas en pacientes de edad avanzada. El riesgo relativo de las mujeres aumenta de 20 a 29 años, se estabiliza alrededor de los 50-69 años y decrece posteriormente. El riesgo se dobla aproximadamente cada 10 años desde los 20 hasta los 50. A la edad de 50-69 el riesgo es alrededor de 8 a 9 veces superior que a la edad de 20-29 y el doble que en mujeres con mas de 70 años de edad. El riesgo de los hombres es aproximadamente el doble cada 10 años que avanza su edad, los hombres entre 60 y 69 años tienen 25 veces mas riesgo de presentar estas patologías que los hombres entre los 20 y los 29 años. Los varones con mas de 70 años tienen alrededor de 40 veces un riesgo mayor (AU)