Left partial anomalous pulmonary venous connection (PAPVC), a rare pulmonary venous variant.

A left partial anomalous vein connection and connection between left upper pulmonary vein and left internal thoracic vein was discovered in a 71-year-old man, with no history of previous cardiac surgery or an atrial septal defect, underwent a thorax HRCT scan without contrast media, following a chest x-ray, due to repeated bouts of smoking-related bronchitis. Left partial anomalous pulmonary vein connection is a rare venous variant, which more commonly affects the right side, resulting in a left to right shunt [9].

Self-expandable metal stents in the treatment of antro-pyloric and/or duodenal strictures.

PURPOSE: To assess the usefulness of self-expandable metal stents in the recanalization of antro-pyloric and/or duodenal strictures. MATERIAL AND METHODS: We report our experience of 15 patients with inoperable antro-pyloric and/or duodenal strictures treated by implantation of 21 self-expandable metal stents (18 uncovered and 3 covered) inserted perorally under fluoroscopic guidance. The patients were 11 men and 4 women, mean age 65.3 years. Fourteen of 15 patients were affected by a malignant stricture of the antro-pyloric region and/or duodenum either primary or secondary in 10 and 4 cases, respectively. Only in 1 case there was a benign stricture from postoperative scarring. Stricture length and diameter varied from 3 to 9 cm (mean 5.4 cm) and from 0 to 4 mm (mean 1.27 mm), respectively. RESULTS: Twenty-one stents were placed in 15 patients: Technical success was achieved in all cases while clinical improvement was obtained in 14 cases. No short-term complications were observed. A mean 4.3-month follow-up was obtained. Two patients had emesis secondary to peritoneal dissemination of the tumor after 1 and 2 months, respectively. Two other patients showed tumor overgrowth of the oral edge of the prosthesis after 3 and 2 months, respectively, and required another coaxial stent to bridge the new stenosis. The patient treated for a benign stricture had jaundice after 3 months and percutaneous internal-external biliary drainage was necessary. CONCLUSION: Self-expandable metal stents are a safe and effective treatment of antro-pyloric and duodenal strictures; therefore, they should be considered an alternative to palliative resection in cases of advanced stage disease or poor general physical condition.

The use of the Valtrac ring in the upper and lower gastrointestinal tract, for single, double, and triple anastomoses: a report of 50 cases.

The Valtrac biofragmentable anastomotic ring (V-BAR) technique has been widely used in clinical practice, particularly in anastomoses of the colon. The success of this method encouraged some surgeons to use it also in anastomosis of the small intestine. We are convinced that the method can be used successfully also in anastomosis of the small intestine and the upper gastrointestinal tract, particularly in cases of technically difficult and high-risk anastomoses. Between 1995 and 1998, we used the V-BAR in 35 patients, performing a total of 50 anastomoses. In 13 patients a double anastomosis was created in the same operation, and in one patient a triple anastomosis was created. In all we performed one end-to-end esophagojejunostomy, one gastrojejunostomy, six gastroileostomies, two duodenojejunal anastomoses, 13 end-to-end duodenoileostomies, one jejuno-jejunal anastomosis, 18 end-to-side ileoileal anastomoses, one ileocolic anastomosis, and seven colocolic anastomoses. Follow-up at between 2 and 36 months showed good overall results with regard to resumption of intestinal transit and canalization, even in those cases in which a double and triple suture was performed using the Valtrac ring. In our experience, the V-BAR can be used in upper gastrointestinal surgery with excellent results. Compared with manual sutures, the ring allows better and faster resumption of transit and canalization.

[Diagnostic imaging of gastrointestinal leiomyosarcoma. Experience with 12 cases]. / Diagnostica per immagini del leiomiosarcoma con localizzazione gastrointestinale. Esperienza in 12 casi.

PURPOSE: Gastrointestinal (GI) leiomyosarcoma is an uncommon malignant cancer arising in the smooth muscle of the alimentary tract. It is known for its widely variable patterns and aspecific symptoms and signs preventing correct clinical assessment in the majority of cases. We will illustrate the key role of diagnostic imaging in the detection and staging of this lesion, describing the most suggestive imaging findings for the correct diagnosis. MATERIAL AND METHODS: January, 1990, to June, 1998, we examined 12 patients with GI leiomyosarcoma; they were 10 men and 2 women whose age ranged 42 to 85 years (mean: 63.7 years). Four lesions were found in the stomach, 3 in the jejunum and ileum, and 2 in the rectum. Due to the difficult clinical assessment of this type of lesion and to the development of emergency conditions, we could plan no diagnostic protocol in advance; thus, the most suitable diagnostic imaging approach was decided on the spot for studying the supposedly involved GI portions. Double contrast studies, US, CT and endoscopy were performed and each patient underwent at least two examinations. RESULTS: Barium contrast studies were performed in 9 patients: the lesion was detected in 7 cases and tumor site and extent were defined in 5, while the double contrast study of the colon allowed to exclude large bowel involvement in 2 ileal tumors. In all 9 cases US and US-guided endoscopy permitted better assessment of extra-luminal spread and involvement of adjacent organs. CT, which is essential to staging, provided useful information suggesting the lesion nature: a round, inhomogeneous mass in continuity with the intestinal wall, with irregular margins, peripheral enhancement after i.v. injection of contrast material and a central necrotic area. Histology confirmed CT diagnosis in 7/9 cases while an aspecific diagnosis of large retroperitoneal and abdominal lesion was made in 2 cases. CT did not allow to define the origin of 2 large exophytic lesions in the stomach and jejunum and missed peritoneal metastases in 3 cases. CONCLUSIONS: Although the aspecific and quite variable clinical patterns make it extremely difficult to plan a correct diagnostic protocol, in our experience all diagnostic imaging techniques played a fundamental role in identifying and staging alimentary tract leiomyosarcoma. Particularly, CT showed high sensitivity and specificity in characterizing and staging this lesion but exhibited rather poor sensitivity in recognizing peritoneal spread.

[Dilatation of benign colo-colonic and colo-rectal anastomotic stenosis with radiology-guided balloon catheter]. / Dilatazione delle stenosi anastomotiche benigne colon-coliche e colon-rettali mediante catetere a palloncino sotto guida radiologica.

Eleven patients with benign postoperative colonic strictures were treated with balloon dilatation November, 1990, through November, 1995. The anastomosis was sigmoidrectal in 7 patients and colocolic in 4 patients. All patients were submitted to contrast enema and colonscopy to assess the site, shape, grade and length of the stenosis. Biopsy was performed in 7 patients whose strictures had developed 2 months or more postoperatively. The dilatation was performed with 20-mm balloon catheters in the strictures developed 30 days postoperatively, to avoid any complications, and with 30-mm balloon catheters in the other cases. Balloon dilatation was performed under fluoroscopic guidance, with no-drug treatment. The procedure was well tolerated by all patients. One or two dilatation sessions were performed in ten and one patients, respectively. No complications were observed. The results were satisfactory in all cases, with symptom resolution. Follow-up included clinical, endoscopic and radiologic assessment. At follow-up, the technical result was good in all patients and the symptoms were completely relieved. In our experience, radiologically-guided balloon catheter dilatation proved to be an easy, safe and effective tool to treat benign postoperative colonic strictures.

[The radiological study of afferent and efferent loop syndromes]. / Lo studio radiologico delle sindromi dell'ansa afferente ed efferente.

The authors report on the diagnostic role of radiological imaging in the study of the patients who underwent gastric surgery. This kind of intervention is often followed by postoperative complications, so that accurate clinical-instrumental investigations are required. Routine controls both in the immediate postoperative period and during follow-up are useful especially when a neoplastic lesion was the underlying condition leading to surgery. Radiological imaging plays a fundamental role especially in evaluating such postoperative conditions as afferent and efferent loop syndromes. Radiology is thought to be essential to demonstrate the syndrome and to identify the mechanical/functional nature of the factors causing the disease, all of which are essential to an appropriate and safe therapy. Both the duration of follow-up (early and late controls) and the choice of contrast (water-soluble contrast medium or double contrast enema) are very important factors depending on the time of surgery and the clinical indication.