Pulmonary embolism due to popliteal vein aneurysm: approach and surgical treatment - a case report.

Pulmonary embolism is the first presentation in 70-80% in patients with aneurysm of popliteal vein. We present a case of young man admitted in our hospital with respiratory distress, tachycardia and D-dimer >3000 mg/dL. The observation of pulmonary embolism required the placement of a caval temporary filter before the surgical treatment. The use of temporary filter is recommended in symptomatic patients for thromboembolic phenomena, and when ultrasound detects the presence of floating thrombus.

Anatomy and imaging of lumbar plexus.

Sensory and motor innervation of the whole lower limb is due to lumbo-sacral-plexus that arises from the spinal roots L1-S3. The whole lower limb can be blocked from its origin to the foot for surgical procedures or for postoperative analgesia. Single or continuous lumbar plexus blockade can be an alternative to general anesthesia and central block in elective and traumatic hip or femur repair, for knee surgery and for postoperative analgesia. To understand the relative plexus depth and the relationship between the plexus and the closer structure in order to avoid complicance, the aid of imaging technique such as CT-scan, MRI and ultrasounds can be considered.

[Role of ultrasonography in emergency surgery]. / Ruolo dell'ecografia in chirurgia d'urgenza.

A prospective study was carried out to compare the value of ultrasound examination with conventional management in patients presenting with emergency surgical problems. During an 4 years period the authors followed 301 patients referred to the Ist Institute of Surgery of the University of Rome "La Sapienza". After immediate clinical evaluation one or more US examinations were performed in each patient following a standard protocol of study. Abdominal emergencies were the most frequent conditions, found in 75% of the cases and the acute abdomen due to trauma in 17.6% of the cases. The overall sensibility, specificity and accuracy of clinical examinations and US examinations were respectively of 88%, 33%, 70% and 95%, 94%, 95%. In 38 patients (12.7%), a diagnosis was made up by sonographic examination which had not been clinically expected (group A). The principal condition in this group was gynaecological pathology, found in 17 patients. In 161 patients (53.3%) sonography confirmed the first diagnosis clinically suspected (group B) and in 23 cases the second or third differential diagnosis (group D). Sonography made no contribution to the diagnosis in 77 cases (25,5%) and only in 2 cases was considered misleading. The result of this study demonstrate the usefulness of emergency ultrasonography in gynecological, gall bladder, pancreatic and vascular diseases. Moreover sonography must be considered the principal diagnostic tool in patients with trauma. In order to recognize gynecological diseases which can simulate appendicitis US examination must be considered necessary in young female patients. When appendicitis is suspected US is useful in children and in older patients too.

[Ultrasound and color Doppler control of percutaneous angioplasty (PTA) of the renal artery]. / Controllo eco e color Doppler delle angioplastiche percutanee (PTA) dell'arteria renale.

The Authors report their experience about fifty patients affected with renovascular hypertension, treated by percutaneous transluminal angioplasty (PTA) for stenosis of main renal artery and now studied by Duplex-Scan and Color-doppler. Results, compared with arterial pressure measurements, renography and laboratory renal function evaluation, showed a sensibility of 84%, specificity of 90% and an accuracy of 87.5%. Advantages and limits of Duplex-scan in patients treated by PTA are briefly discussed.

[The echographic aspects of the splenoportal axis in patients with esophageal varices]. / Aspetti ecografici dell'asse spleno-portale in pazienti con varici esofagee.

In the present study the A. try to assess the usefulness of ultrasound in detecting blending risk in portal hypertension. Endoscopic and sonographic findings of 35 cirrhotic patients with esophageal varices were compared to a control group of 27 hepatopathy patients without portal hypertension, observed in the same department and in the same interval. The medium caliber of portal vein was 14.64 +/- 2.59 and 11.8 +/- 1.33 mm, respectively in the study and in the control group (p less than 0.01). Statistic correlations were also found in subgroups of patients with varices of different degrees. A portal vein greater than 16 mm was found in 10 of 11 patients with large varices; this pattern provides a sensitivity of 71.4% and a specificity of 94.1%. In our experience this echographic finding should represents a clear indication for close endoscopic follow-up, even in patients without previous bleeding from esophageal varices.

[Role of late laparotomy in Hodgkin's disease]. / Il ruolo della laparotomia tardiva nel morbo di Hodgkin.

Between 1976 and 1986 42 restaging laparotomies (RL) were performed in patients with Hodgkin's disease (HD). Eleven patients had received only radiotherapy, 25 chemotherapy and 6 patients had received radiotherapy plus chemotherapy. Thirty-seven patients underwent RL because of the uncertain answer to therapy. In 17 cases the persistence of abdominal disease was suspected; in 20 patients, on the contrary, the RL was performed to confirm the clinical evaluation of complete remission (CR). In the first group 6 RL (35%) were positive, in the latter group in one case only (5%) evidence of disease was found. In the last 5 patients RL was performed for abdominal recurrence after a Relapse free Survival (RFS) of 60 months (range 25-110 months). RFS of pathologically evaluated patients is significantly higher than that of those clinically evaluated. The great number of false positive (65%) suggests a role of RL in avoiding any further therapy in patients having no clear signs of disease after treatment completion; thus permitting a lower incidence of complications such as: induced leukaemia, neoplasia and infertility.