MDCT evaluation of the cardiac venous system.

PURPOSE: This study was undertaken to evaluate the usefulness of electrocardiographically (ECG)-gated multidetector-row computed tomography (MDCT) for the assessment of the coronary venous system and detection of its anatomical variants, in order to identify those suitable for lead placement in cardiac resynchronisation therapy (CRT). MATERIALS AND METHODS: We retrospectively examined the coronary MDCT studies of 89 patients (73 males, 16 females, average age 62.5 years, range 31-79) referred for suspected coronary artery disease. The cardiac venous system was assessed in all patients using three-dimensional (3D) postprocessing on a dedicated Vitrea workstation (five patients were excluded from the analysis). RESULTS: The coronary sinus, the great cardiac vein, the anterior interventricular vein and the middle cardiac vein were visualised in all cases. The lateral cardiac vein was visualised in 56/84 patients (67%) and the posterior cardiac vein in 63/84 patients (75%), never both missing. Along the postero-lateral wall of the left ventricle, only one branch was present in 44 cases, two branches in 21 cases and three or more branches in 19/84 cases (22%). Evaluation of the maximum diameter revealed that the lateral vein was dominant over the posterior vein in 20/40 cases. The small cardiac vein was visualised in 11/84 cases. CONCLUSIONS: MDCT provides good depiction of the cardiac venous system, enabling the study of the vessel course and the identification of anatomical variants. Hence, this imaging technique could be proposed for the preoperative planning of CRT in selected patients.

[Cardiac rhythm disturbances in hypertensive cardiopathy]. / Le alterazioni del ritmo cardiaco nella cardiopatia ipertensiva.

Patients with hypertensive heart disease are at a significantly increased risk for cardiovascular morbidity and mortality. Ultrastructural and gross anatomical cardiac changes, combined with hemodynamic and neurovegetative balance fluctuations, are frequently responsible for cardiac arrhythmias of atrial and/or ventricular origin. The prevalence, the pathophysiologic mechanism and the prognostic significance of cardiac rhythm disturbances occurring in hypertensive heart disease are discussed in this review.

[Incidence and treatment of local recurrences after conservative surgical treatment for cancer of the breast]. / Incidence et traitement des récidives locales après traitement chirurgical conservateur pour cancer du sein.

Long-term survival is comparable after total mastectomy or conservative surgery for early breast cancer. Our purpose was to evaluate the rate and therapy of breast relapse at the Regional Hospital of Varese (Italy) in a 10 years period. From 1/1/1980 to 31/12/1990 a total of 606 patients with early breast cancer (Stage I or II early) were evaluated. They all were submitted to quadrantectomy, axillary dissection and radiotherapy. In case of metastases to the axillary lymph nodes, hormono or chiotherapy were performed. 425 patients were regularly followed for a period of 2.5-13 years. In 15 patients (3.2%) a local recurrence was discovered. They were treated as follows, 8 patients: mastectomy, 4 patients: conservative surgery, 4 patients: no therapy. The surgical approach of the local recurrence, mastectomy or conservative surgery, does not influence long-term survival of patients treated with conservative surgery and radiotherapy for early stage breast cancer. Conservative surgery is often possible in treating local recurrence without interfering with complete removal of the tumor and long-term survival.

Effects of surgical trauma of laparoscopic vs. open cholecystectomy.

The effects of surgical trauma resulting from laparoscopic cholecystectomy and open cholecystectomy, were compared by assessing the postoperative acute phase alterations of selected plasma proteins, hormones and lymphocyte subpopulations in fifty-seven patients prior to elective cholecystectomy. Patients were prospectively randomized to undergo either laparoscopic cholecystectomy (n = 30) or open cholecystectomy (n = 27). Duration of operation and general anesthesia was similar in the two patient groups. The laparoscopic cholecystectomy patients had a shorter postoperative stay in hospital (3.1 (0.5) days vs. 7.1 (1.6) days; p < 0.001). In open cholecystectomy patients a significantly greater postoperative acute phase increase in plasma C-reactive protein (p < 0.001), cortisol (p < 0.05), and prolactin blood level (p < 0.001) was recorded. The postoperative acute phase decrease in the blood total-T-lymphocyte count (CD3 cells) and in the activated-lymphocyte count (OKDR cells) was significantly greater after open cholecystectomy (p < 0.05). These results, showing that acute phase responses are less marked after laparoscopic cholecystectomy than after open cholecystectomy, support the concept that the laparoscopic procedure is less traumatic.

[Acute postintervention cholecystitis]. / La colecistite acuta post-aggressiva.

A case of postoperative cholecystitis in a 64 years old man is reported. This is a nosological entity characterized by gallbladder distension without any patent obstacle in the cystic duct and constancy of necrosis involving all the parietal layers. Clinical signs and symptoms are aspecific. Mortality rate is high and diagnosis has to be done quickly because the gallbladder necrosis makes cholecystectomy compulsory on such patients.