Preoperative risk stratification in patients undergoing elective infrarenal aortic aneurysm surgery: evaluation of five risk scoring methods.

OBJECTIVE: To evaluate five risk scoring methods in predicting the immediate postoperative outcome after elective open repair of abdominal aortic aneurysm (AAA). DESIGN: Retrospective evaluation of the Eagle score, Glasgow aneurysm score, Leiden score, modified Leiden score and Vanzetto score in a consecutive series of patients. PATIENTS: Two hundred and eighty-six consecutive patients undergoing elective infrarenal aortic aneurysm repair. RESULTS: Nine patients (3.1%) died in hospital and another 35 (12%) experienced severe postoperative complications. For the Glasgow aneurysm score, Leiden score, modified Leiden score and Vanzetto score receiver operating characteristics (ROC) curve analysis for prediction of in-hospital mortality showed area under the curve (AUC) of 0.749 (p=0.01), 0.777 (p=0.008), 0.788 (p=0.006) and 0.794 (p=0.005), respectively. The Eagle risk score was less accurate for predicting in-hospital mortality. The risk-scoring systems did not perform well in predicting post-operative complications, but multivariate analysis showed that the modified Leiden score was an independent predictor of postoperative complications. CONCLUSION: All scoring systems predict, with reasonable accuracy, the risk of in-hospital death in patients undergoing elective open repair of AAA, whereas the accuracy in predicting severe postoperative complications is less.

Stent graft repair for rupture of the subclavian artery secondary to infection of a subclavian-to-carotid bypass graft.

The case of anastomotic rupture of the subclavian artery following infection of a subclavian-to-carotid bypass grafting is reported. Emergency endoluminal stent graft repair was life saving and aided wound healing, but stent graft thrombosis occurred. Such a complication raises some concern about the safety of this procedure in an infected setting. The use of autologous saphenous vein-covered stent graft may provide some advantages in avoiding graft infection and thrombosis.

Carotid artery dissection. Correlation of different diagnostic techniques.

Dissection of the carotid artery is a rare entity, but a frequent cause of cerebrovascular accidents in young adults and can result in severe neurologic consequences that are often irreversible. Carotid dissection can be secondary to trauma, brisk rotation of hyperextension of the neck, as a complication in certain diseases. It may lead to distal embolization, complete occlusion of the vessel, extensive or limited stenosis, aneurysmal form which has the appearance of a berry aneurysm or resolution of the process with complete patency of the dissected vessel. The authors find color-Doppler sonography to be an invaluable tool in the evaluation of such a process, since it is non invasive, readily available, relatively inexpensive and can yield detailed information about the lumen of the vessel, blood flow, mural and intramural structures. Furthermore, in comparison to MRA, color-Doppler sonography is particularly suitable for the early detection of thrombus. Ultrasonographic investigation has some methodologic limitations: occlusion cannot always be demonstrated directly because of its high cervical location and detection of aneurysms localized in the retrostyloid++ space is usually not possible. The combination of ultrasonographic findings and MRA is the method of choice for follow-up on evaluation of carotid dissection and helps make the decision as to whether one should proceed to angiography in this young age group.

[Coarctation of he abdominal aorta]. / Coarctation of the abdominal aorta.

The Authors report a 49-year-old woman complaining of slight nocturnal lower limb pain in whom an uncommon type IV coarctation of the infrarenal aorta associated with multiple renal arteries, slight hypoplasia of iliac and femoral arteries bilaterally, and a retroaortic left vein were found. She underwent an aorto-aortic prosthetic repair. The correction of this vascular condition was followed by partial improvement of her symptoms. The suspicion of an associated ischaemic spinal origin of these painful symptoms may be suggested by the typical and often complex presence of multiple vascular malformations described in patients with coarctation of the abdominal aorta.

Five-centimeter superior mesenteric artery aneurysm. A case report.

An unusual large mesenteric artery aneurysm presented as "angina abdominis" and abdominal mass is described. Endoaneurismectomy with reverse end-to-end saphenous vein graft was performed. The incidence, pathogenesis and diagnosis are reviewed and the treatment is discussed.

Percutaneous embolization of an isolated hypogastric artery aneurysm. A case report.

We describe a case of an isolated aneurysm of the left hypogastric artery which came under our observation because of a syndrome of compression on the homolateral iliac vein. Having excluded the presence of aneurysms in other sites, it was decided to perform a percutaneous embolization of the hypogastric aneurysm. The follow-up revealed the disappearance of the compression on the ipsilateral iliac vein and a 30% reduction in the diameter of the thrombosed aneurysm. The method limited invasiveness, the reduction in volume of the aneurysmal mass, the disappearance of compression problems, and the shortened hospitalization time support the choice of embolization treatment.

Replacement of a prosthetic valve after the Bentall procedure.

Patients undergoing a composite graft replacement of the aortic root with reimplantation of the coronary ostia (Bentall procedure) are at risk for late prosthetic heart valve dysfunction: approximately 10% of the patients are expected to experience this complication at 10 years. Therefore, replacement of the prosthetic valve is indicated. This procedure involves technical problems related to the manipulation and the reconstruction of the composite graft without distortion of the coronary arteries. We describe a simple surgical approach to treat these particular patients.

[Medico-social aspects of AIDS]. / Aspetti medico-sociali dell'AIDS.

The AIDS crisis has brought us face to face with complex medical and social challenges unparalleled in this century. The magnitude of this tragic epidemic is measured not only in the cost in human lives, but also the enormous financial burdens of health care and lost productivity which each and every one of us, as well as future generations, will ultimately bear. This article presents an opportunity to explore a variety of health, social, economic, juridical and working issues of AIDS.

Clinical performance of low-profile bioprostheses: results at 10 years.

The purpose of this retrospective study is to evaluate the long-term performance of the Liotta minimally intrusive bioprosthesis (MIB) and to identify its most important risk factors. From January 1980 to March 1982, 73 patients (30 males and 43 females; mean age 45.5 years +/- 11.7 standard deviation; range 11 to 64) underwent operation for heart valve replacement with an MIB. Fifty-two mitral valve replacements (MVR), 16 aortic valve replacements (AVR), 4 mitral and aortic valve replacements (MAVR), and 1 mitral and tricuspid valve replacement (MTVR) have been performed (78 MIBs implanted). Global operative mortality has been 8.2% (6/73): 9.6% (5/52) for MVR and 6.2% (1/16) for AVR. The 10-year follow-up reaches 519 patient-years and 581 valve-years, and is 96.5% and 93.9% complete, respectively. Actuarial freedom from any patient- or valve-related event has been calculated at one time with its hazard function and its incidence normalized per 100 patient- and/or valve-years; statistical significance of difference between curves has been assessed. In this report, overall actuarial survival at 10 years is 79.4% +/- 5.3% SEM (standard error of the mean), including operative deaths (incidence = 2.6% per patient-year). Two patients experienced periprosthetic leakage (PL) at 4 and 9 years, respectively (incidence = 0.4% per valve-year). One patient underwent reoperation because of otherwise untreatable prosthetic valve endocarditis (PVE) at 5 years (0.2% per valve-year).(ABSTRACT TRUNCATED AT 250 WORDS)

[Hepatocellular carcinoma (HCC): the long-term response to tamoxifen. A clinical case report and review of the literature]. / Carcinoma epatocellulare (HCC): risposta prolungata al tamoxifen. Descrizione di un caso clinico e revisione della letteratura.

A 52 years old female with hepatocellular carcinoma (HCC) was treated successfully with Tamoxifen. The tumor involved IV hepatic segment with hilar extension and biliary obstruction, was unresectable, and had been pretreated with hormone-chemotherapy. Tamoxifen treatment induced a PR of 6 months, with normalization of serum bilirubin, reduction of alfa-fetoprotein level and improvement of PS, and was free of toxicity. At disease progression intra-arterial chemotherapy with Cis platinum (CDDP) and 5-FU gave a further 4 months PR, until disease progression and exitus in hepatic coma. Tamoxifen therapy, even in the absence of E.R. assay is a useful tool in the management of HCC patients. Further randomized studies are necessary to ascertain the role of Tamoxifen in the treatment of HCC.