Smoking habit in parents and exposure to environmental tobacco smoke in elementary school children of Milan.

INTRODUCTION: Children with smoking parents are potentially exposed to Environmental Tobacco Smoke (ETS). The aims of this study were: 1) to assess ETS exposure in Milan schoolchildren, by measuring urinary cotinine (COT-U), 2) to compare the parents' perception of children ETS exposure, with the actual ETS exposure measured by COT-U, 3) to explore the factors influencing COT-U, including smoking bans at home, the season, and children characteristics. METHODS: One-hundred school children (7-11 years) and their parents were recruited for the study in Spring 2018 (n = 81) and in Winter 2019 (n = 94), 75 children participated to both campaigns, for a sum of 175 observations. A questionnaire was submitted to parents to collect information about smoking habits in the house. COT-U was measured by LC-MS/MS in spot urine sample collected in the morning from children. RESULTS: Detectable COT-U levels were found in 42% and 57% of children, in spring and winter, in contrast with 17% and 13% of parents acknowledging ETS exposure. Children living with smokers or e-cigarette users (vapers) (30% of the participants) had higher COT-U levels than children not living with smokers or vapers (median 0.67, 0.46, and <0.1 µg/L in spring, and 0.98, 0.85, and 0.11 µg/L in winter, respectively). Increasingly higher COT-U levels were observed in children living in homes where smoking was completely banned, allowed in the external parts of the home, or allowed in some rooms. The multiple regression analysis confirmed the positive significant effect of living with smokers, a partial smoking ban and absence of smoking ban at home, the winter season, and BMI as determinants of COT-U. CONCLUSION: ETS exposure resulted in measurable urinary cotinine in children. Smoking parents underestimate exposure to ETS of their children. Living with smokers is a determinant of COT-U, only slightly mitigated by adopting partial smoking ban.

[Celiac artery aneurysm: a case report]. / Aneurisma del tronco celaco: presentazione di un caso clinico.

The aneurysms of the celiac trunk are extremely rare. The authors describe a case of aneurysm of the celiac trunk dealt with aneu-rysmectomy and reconstruction by means of protesic graft made in Dacron. The patient was asymptomatic, and the aneurysm was discovered accidentally during abdominal computerized tomography (CT) for the stadiation of hepatic cirrhosis. The aneurysmectomy and the reconstruction have been executed by means of a prosthetic graft finish-terminal in Dacron, succeeding in preserving the three arteries originating from the celiac trunk (left gastric, hepatic, splenic). The histologic examination documented the degeneration of the medium trunk with loss of elastic fibers and atherosclerotic lesions. The postoperative course was complicated by hepatic ascites, and severe renal insufficiency. As a result of paracentesis and diuretic dose titration, the blood parameters and the conditions of the patient improved progressively until allowing the discharge on XL postoperative day in good conditions. Six months after, abdomen CT documented the integrity of the prosthetic graft and the absence of perianastomotic leak.

[Critical evaluation of the reconstruction of the intestinal continuity after total gastrectomy by the Moricca technique]. / Valutazione critica della ricostruzione della continuità intestinale dopo gastrectomia totale secondo Moricca.

The authors analyze a series of 48 total gastrectomies for gastric carcinomas performed between 1987 and 1994. Seven out of these 48 gastrectomies were performed adopting the double circuit esophagojejunoduodenal plasty according the procedure described in 1976 by Francesco Moricca. The double jejunal loop represents a sort of "digestive reservior" allowing to avoid the sensation of epigastric fullness after eating. Moreover, this technique permits a better absorption of the liquids and the partial mixing of the bolus with the bilio-pancreatic secretion stimulates the duodenal secretin and cholecystochinin release. The possibility of a "dumping syndrome" is diminished by the presence of the double possibility of diversion of the alimentary bolus. On the contrary the segment of jejunum transposed between the esophagus and duodenum is antiperistaltic and this fact can cause sometimes an esophagitis at the lower third of the esophagus due to the prolonged alkaline reflux. This study is aimed at verifying the entity and frequency of the esophagitic complication in patients who underwent a total gastrectomy and at analyzing the procedures adopted to cure this severe complication that seriously affects the wellness and the nutritional status of the gastrectomized patients.

Non occlusive ileocaecocolic intussusception caused by caecum cancer--case report.

A case of ileocaecocolic intussusception caused by a caecum carcinoma is presented. The authors stress the peculiarity of clinical manifestation, without intestinal obstruction despite the presence of a big abdominal mass involving vessels and bowel, revealed by CT scanning and angiography. Endoscopy was not able to identify the nature of the lesion. Laparotomy performed with the idea to find a mesenchymal neoplasia, permitted to achieve the diagnosis.

[Anastomotic pseudoaneurysm, true para-anastomotic aneurysm and recurrent aneurysm following surgery for abdominal aortic aneurysm. Is a unifying theory possible?]. / Pseudoaneurismi anastomotici, aneurismi veri para-anastomotici e aneurismi ricorrenti in soggetti operati per aneurisma dell'aorta addominale. E possibile una teoria unificante?

BACKGROUND. Recurrent aneurysms (RA) and true para-anastomotic aneurysms (TPA) are currently reported as anecdotal findings during occasional follow-up of subjects previously operated for abdominal aortic aneurysm (AAA). In several instances concomitant false anastomotic aneurysms (FAA) are found, not attributable to infection nor to suture or graft degradation. PURPOSE. To discuss the possibility that RA of inborn arteries, TPA, and non infectious FAA, when concomitantly present in the same subject, may reflect a peculiar late presentation of multiarterial aneurysmal disease. MATERIAL. Three cases of occasionally discovered concomitant RA, TPA, and FAA in subjects previously operated for AAA are reported. The finding of new aneurysms and FAA in subjects previously operated for AAA may be theoretically justified by the currently recognized pathogenetic mechanisms, molecular, enzymatic or genetically determined, implicated in the formation of AAA. This points out the need for a correct surgical management of AAAs and for accurate accomplishment of follow-up programmes supported by ultrasound echography of graft-arterial anastomoses and of the arteries at risk of aneurysmal disease.

[Choledochoduodenostomy in the treatment of benign disease of the common bile duct: evaluation of long-term results]. / La coledoco-duodenostomia nel trattamento della malattia benigna della via biliare principale: valutazione dei risultati a distanza.

The Authors report their experience in the treatment of 36 patients managed by side-to-side choledochoduodenostomy for common bile duct disease and followed for a period of five years. The main indication to surgery was a choledochal dilatation more than 1.5 cm. The surgical technique consisted in a single layer side-to-side choledochoduodenostomy with absorbable suture according to Roessner. There was no operative mortality and few post surgical complications (six patients, 15.78%) were registered; 25 patients (69.45%) were completely asymptomatic at five years, while in six cases (16.66%) significant symptoms were observed. In one case a biliary gastropathy with no metaplasia was documented.

[Complementary echo flow imaging and digital angiography in the supra-aortic area for indication and intervention of carotid revascularization in 1587 subjects in the OPI (Stroke Prevention) program]. / Complementarietà di angiodinografia e angiografia digitale del distretto sovraortico per la indicazione ad interventi di rivascolarizzazione carotidea in 1587 soggetti del programma OPI.

The availability of non invasive carotid ultrasound imaging techniques actually allows planning and carrying on of large screening programs for detection of atherosclerotic carotid occlusive disease. The aim of non invasive ultrasound patient selection is to limit the practice of invasive carotid angiography only to patients for whom carotid endarterectomy is likely to be a therapeutic choice. PURPOSE. Testing the efficacy of sequential use of color coded echo flow imaging (echo color Doppler: ECD) and arterial digital angiography (ADA) respectively in the second and third phases of a screening program for detection and treatment of carotid occlusive disease in a resident population (OPI program). METHODS. From January 29th 1990 through March 31st 1992, 1,587 subjects underwent ECD out of 16,379 subjects that participated in the first level investigations. 404 of these (25.5%) were affected with carotid occlusive disease, 271 (17%) had inframural non stenosing carotid lesions and 228 (14.3%) carotid kinkings. At ECD, 71 showed lesions as severe as to be susceptible of surgical operation and underwent ADA. The percentage of carotid stenosis was calculated on the ADA imagins, applying the method suggested by the North American Symptomatic Carotid Endarterectomy Trial. RESULTS. Overall sensitivity and specificity of ECD versus ADA were 94% and 95.2% respectively. Cases in which ECD overestimated the lesion as compared to ADA results were recorded as false positive, while cases in which ECD underestimated the lesion were recorded as false negative. CONCLUSIONS. Both ultrasound imaging and ADA are useful in screening programs for carotid occlusive disease: informations different and complementary to the definition of the lesions can be obtained from each procedures in subsequent phases. Morphologic findings of carotid ECD are essentially consistent with ADA, thus allowing to carry on safely non invasive long-term follow-up programs for operated subjects as well as for people bearing carotid lesions originally not susceptible of surgical treatment.

Aorto-iliac aneurysms rupturing into the iliac veins.

BACKGROUND: Rupture of aorto-iliac aneurysms into the iliac veins is seldom reported in distinct series, and represents only a fraction of ruptures into the abdominal cavity. MATERIAL AND METHODS: Four cases are reported: two aortic aneurysms ruptured into the right iliac vein, one right iliac aneurysm ruptured into the right iliac vein, one right iliac aneurysm ruptured into the cava at the bifurcation, one aortoiliac aneurysm ruptured into the right iliac vein. Two patients showed severe shock at admission. Central venous pressure at operation was 43.6 +/- 26.3 cmH2O, and rapidly decreased at aortic clamping. Venous bleeding was controlled by finger compression of the iliac and caval vein and aortic graft replacement followed direct suture repair of the venous breach. De Weese caval clip was implanted twice, to prevent pulmonary embolism in severely compromised iliac veins. This series represents 1% among 373 ruptured abdominal aortic aneurysms operated on as emergencies over the same period. RESULTS: Pulmonary embolism, either paradoxical or postoperative, never occurred. Mortality rate was 25%, compared to 35% overall mortality among the whole ruptured group. The role of the site of rupture is swelling of the lower limbs is suggested, and edema can be suggestive though statistical evidence has not been achieved. CONCLUSIONS: Three concepts are stressed: early diagnosis and operation (i.e. before cardiac high output failure and shock); accurate as well as simple surgical technique; careful post-operative intensive care.

[A rational approach to cholecystectomy in the patient with an abdominal aortic aneurysm]. / Approccio razionale alla colecistectomia nel portatore di aneurisma dell'aorta addominale.

A retrospective series of 30 (2.8%) cases of cholelithiasis out of 1064 abdominal aortic aneurysmectomies is presented. 21 subjects underwent aneurysmectomy and prosthetic grafting combined with cholecystectomy. Complications related to the combined operation, early or late (6 months to 8 years follow-up was available for the whole series), were not recorded in this subgroup. 9 (30%) patients with coincidental gallstones underwent simple aneurysmectomy: 2 (22%) patients complained of symptoms of biliary colic, eight and fifteen weeks after operation respectively, and successfully underwent medical treatment. A third patient (11%), operated on urgently for ruptured abdominal aortic aneurysm, developed acute cholecystitis, gallbladder perforation and biliary peritonitis on the 17th day of operation: he died of multiple organs failure on the 8th day of urgent cholecystectomy. Acute alithiasic cholecystitis was recorded only once (0.1%) among the 1034 abdominal aortic aneurysmectomies without gallstones: fatal outcome was ascribed to massive multiple organ cholesterol embolization. If careful asepsis and correct surgical tactics are observed, cholecystectomy can safely be performed in combination with abdominal aortic aneurysmectomy in subjects with a positive history of cholecystitis or in poor general conditions, but it cannot be considered as a prophylactic treatment towards postoperative acute cholecystitis in good-risk subjects with a negative history of cholecystitis.

Primary aortocaval fistula.

Twenty-two spontaneous aortocaval fistulas between an abdominal aortic aneurysm and the inferior vena cava were surgically treated in 27 years at one surgical unit. The incidence was 5.9% of ruptured abdominal aneurysms; the operative mortality rate of 36.4% compared with an overall mortality rate for ruptured abdominal aortic aneurysms of 34.9%. Among 10 subjects in shock on admission the mortality rate was 50% compared with 25% in non-shocked patients. Of the 22 patients one died at laparotomy from irreversible cardiac arrest; in the other 21 the procedure consisted of endoaneurysmal repair of the fistula which involved replacement of the aneurysm by a Dacron prosthesis after control of venous bleeding was achieved. No occurrence of paradoxical pulmonary embolism was reported. Multiple organ failure caused death in six cases; of these, four died as a result of acute renal failure. Severe preoperative anuric shock was recorded in five instances, with a mortality rate of 80%, compared to 25% for non-shocked subjects. Mortality was not improved by intraoperative autotransfusion; however, the incidence of severe shock was 55.5% in those patients treated by autotransfusion, compared with 38.5% in the standard blood replacement group.

[Surgery of the kinking carotid artery]. / Chirurgia del kinking carotideo.

Forty-three kinkings of the epiarotic vessels were observed at the Istituto di Chirurgia Generale e Cardiovascolare dell'Università di Milano from January 1st 1971 through July 31st 1992. Six subjects were admitted for a history of one or more transient ischemic attacks. In four cases surgical resection of the kinked tract of the internal carotid and end-to-end direct reconstruction was carried out, completed by carotid bifurcation endarterectomy in three, where atherosclerotic carotid disease was severe. All the reconstructions are currently patent and no neurological symptoms were recorded at follow-up; 39 cases were treated conservatively by antiplatelet therapy and controlled each six months: to date no worsening of the echocolordoppler imaging of the lesion was noted, and all these subjects remained completely asymptomatic. The authors point out that correct clinical approach to carotid kinking is a conservative one: surgical operation must be performed only in those subjects affected with cerebral ischemic attacks not justified by other diseases.

[Recurrent aneurysmal disease of the native arteries in subjects operated on for abdominal aortic aneurysm]. / Reaneurismizzazione di arterie native in soggetti operati per aneurisma dell'aorta addominale.

Abdominal aortic aneurysm repairs are presently increasing in number all over the western countries; long life expectancy and high quality of life, warranted to patients surviving operation, stressed the possibility that aneurysmal disease affects other arteries as well as the para-anastomotic aorta itself. OBJECTIVE. The observation that, in the last four years, five patients were operated on for recurrent aneurysms of native arteries, gives the opportunity to discuss the matter and review the literature on this topic. MATERIAL AND METHODS. Five cases of recurrent aneurysms of native arteries in patients that had undergone abdominal aortic aneurysmectomy 4 to 11 (mean: 8) years before are discussed. A total of 16 new aneurysms were found. Although all these patients regularly attended their clinical follow-up program, these observations have to be considered retrospective and incidental, because B-mode echography was not yet routinely requested by the followup protocol. RESULTS. Neither hypertension nor type of graft implanted in the first operation were correlated to the development of new aneurysms in these five subjects. Rupture as causative of the original aneurysmectomy was recorded in two cases (40%), that developed 8 recurrent aneurysms (50%), one of which ruptured. CONCLUSIONS. Although recurrent aneurysms are occasionally reported in the literature, the lack of prospective follow-up series, based on non invasive serial imaging of the arterial system, prevents clarifying whether these observations are isolated or recurrence is likely to be a long-term outcome of aneurysmal disease.

[Primary aorto-enteric communication]. / Comunicazioni aorto-enteriche primitive.

BACKGROUND: Primary aortoenteric communications are a rare and severe complication of abdominal aortic aneurysms or erosions by neoplastic diseases. Early diagnosis and surgical treatment are crucial. Postoperative morbidity and mortality are high. Diagnosis if often made intraoperatively, because the typical clinical feature (digestive haemorrhage, abdominal aneurysmal mass, abdominal pain) is often incomplete and critically ill patients require quick surgical decision and do not allow the use of sophisticated diagnostic tools. MATERIAL AND METHODS: Eight cases, observed through 13 years, are presented: six males and two females. Mean age was 61 years; male to female ratio was 3:1. In four cases (50%) a herald bleeding occurred during the days preceding hospital admission. Presenting symptoms were haematemesis (63%), melaena (87%), abdominal pain (63%); six subjects (75%) presented hemorrhagic shock. Only three patients (37%) were aware to be affected with abdominal aortic aneurysm before admission. Diagnosis was always made by clinical feature and urgent laparotomy: two preoperative duodenoscopies were not diagnostic. Aortoduodenal communication occurred in six cases: one of these was secondary to erosion of the aorta by a carcinoma of the pancreas. Aortogastric communication occurred once; the remainder case was a communication between a hypogastric artery aneurysm and the last ileal loop. RESULTS: Surgical operation was carried out in emergency in seven patients: the eight (tumour of the pancreas and aortoduodenal erosion) died before operation. Enteric defect repair, aneurysmectomy and aortic grafting was performed in six cases. In the last case (hypogastric-ileal communication) ligation of the hypogastric artery and ileal segmental resection was performed. Thirty days operative mortality was 58%. CONCLUSION: Despite early recognition and operation, primary aorto-enteric communication remains a severe life threatening disease, bringing high mortality rates. These are clearly affected by shock condition, but a correct surgical technique and prolonged postoperative antibiotic medication to avoid graft infection are mandatory to minimize mortality.

[The value of CW Doppler and Doppler-color-echocardiography in the mass screening for atherosclerotic carotid lesions]. / Apporto del Doppler CW e dell'eco-color-Doppler nello screening di massa della lesione aterosclerotica carotidea.

BACKGROUND: The availability of non invasive ultrasound technologies for the diagnosis of extracranial carotid atherosclerotic disease allowed designing and applying mass screening programmes devoted to uncover and study unknown carotid stenosis in resident populations. OBJECTIVE: To evaluate usefulness and correct application of Continuous Wave Doppler (CWD) and Color Coded Echo Flow Imaging (CCEF) examinations during different levels of the screening programme OPI (Obiettivo Prevenzione Ictus). METHODS: Between January 29th 1990 and March 31st 1992 the screening programme OPI has been applied to 16.379 subjects of both sexes, aged 45 to 75, enrolled in a sanitary district of Lombardia. They underwent first level screening (anamnesis, physical examination, CWD of carotid arteries). 1.661 (10.1%) were suspected of harboring carotid lesions and invited to second level screening (physical examination, biohumoral sampling, CCEF): 1.587 attended. The results of CWD and CCEF examination of 3.174 carotid arteries are discussed. RESULTS: An overall sensitivity and specificity of 63.6% and 66%, respectively, was found as CWD and CCEF were compared for lesions detectable by CWD (i.e. excluding kinkings and aneurysms). Of 1.815 carotid arteries classified as negative at CWD the absence of lesions was confirmed by CCEF for 1.450 (79.9%); CWD failed to reveal 146 (8%) stenosis < 50% and 52 (2.9%) severe lesions, of which only 5 (0.3%) could possibly undergo surgical treatment. CONCLUSIONS: Despite low accuracy, CWD has proven to be useful for the purpose of a mass screening of carotid occlusive disease, that is selection of a contained group of subjects (10.1%), with increased risk for carotid stenosis, for further non invasive examination, with low cost (hardware cost: 1.430 lire per exam v/s 24.000 lire per exam for CCEF) and low risk of missing severe stenosis with possible surgical indication (0.3%).

[Aortoenteric fistulae. Diagnosis, therapy, results]. / Le fistole aorto-enteriche. Diagnosi, terapia, risultati.

A series of 26 aortoenteric fistulas, 8 primary (PAEF) communications between abdominal aorta and gastrointestinal tract and 18 secondary (SAEF) communications between aortic graft and intestine, is reported. PAEF is commonly due to aneurysmal rupture into the intestine, while SAEF is an uncommon complication of abdominal aortic reconstructive surgery. Male to female ratio was 3:1 among the PAEF group and 8:1 among the SAEF one. Seven of the PAEF subjects underwent urgent surgical operation: 6 enteral defect closure and prosthetic aortic replacement. One patient underwent ileal resection and hypogastric artery ligation. Survival rate in this group was 42% (3/7). Among the 18 subjects affected with SAEF after intestinal repair, vascular procedures were 8 aortic graft removal and extra-anatomic bypass grafting, 4 aortic graft removal and aortic stump ligation, 5 anastomotic repairs and 1 prosthetic branch substitution. Survival rate among this group was 39% (7/18). No differences in outcome were noted in this series depending on type of operation, according to the literature. The authors conclude that surgical outcome is affected by the presence of severe infection not dominated by antibiotics rather than by surgical technique. In this series survival rate among the patients with negative bacterial culture of the surgical specimen raised up to 80%, while it decreased to 20% among subjects harboring septic retroperitoneal collection and graft infection.

[Risk factors for arteriosclerosis and diet of surgical patients. 10 years of outpatient activity]. / Fattori di rischio per arteriosclerosi e dieta in pazienti di interesse chirurgico. Attività ambulatoriale di 10 anni.

The follow-up of arteriopathic subjects who have already been hospitalized (abdominal-peripheral vascular district 79% of patient and supra-aortic branch district 21%) has been carried out for around 10 years using an out-patient regime at the Institute of General and Cardiovascular Surgery of Milan. During outpatient visit the main risk factors for arteriosclerosis are routinely checked and treated if required; among the various therapies for metabolic control particular emphasis is placed on diet since its influence on the metabolism is well known, above all in the long term. The efficacy of this treatment has been evaluated by evaluating blood chemical changes (total cholesterol, LDL cholesterol, HDL cholesterol, triglycerides, VLDL and glycemia) in a group of patients who followed the diet in comparison to a group which did not. The results obtained show that in dieting patients there was a statistically significant decrease in blood values for total cholesterol, LDL cholesterol, triglycerides and VLDL, together with a decrement, which failed to reach statistical significance, in glycemia and HDL cholesterol. In non-dieting patients it was found that all parameters increased but that this was only statistically significant for total cholesterol and HDL cholesterol. The control of risk factors for arteriosclerosis through diet therapy therefore appears to be satisfactory even for secondary prevention in surgical arteriopathic subjects. It is important to underline that these results were not obtained under conditions of clinical research but in the reality of day-to-day clinical and therapeutic activity whose efficacy is vitally important for scientific health.

[Carotid kinking and arterial hypertension. Preliminary results of the OPI program]. / Kinking carotideo ed ipertensione arteriosa. Risultati preliminari del programma OPI.

The relationship between carotid kinking and arterial hypertension is stressed, based on the results of the first two years of an epidemiological research on prevalence of carotid lesions capable of producing cerebral ischemia in a population, aged 45 to 75, resident within the district USSL no. 69 (Parabiago), Lombardia. Reported data are referred to 13,936 subjects that underwent the first level of screening between January 29th 1990 and December 31st 1991. 1,386 subjects underwent further examination by color coded echo flow (second level of screening) due to suspected carotid lesion; they were divided into two groups according to the presence or absence of arterial hypertension. The distribution of these groups does not repeat that of the general population (p < 1 x 10(-6)). 158 subjects were affected with carotid kinking. Within the normotension group (439; 31.67%), 39 (8.88%) were demonstrated to harbor kinkings, while in the hypertension group (947; 68.33%) 141 (14.88%). Thus, the difference between the two groups remains largely below the limits of statistical significance (p > 1). The association between kinking and hypertension is not affected by sex (p > 1 x 10(-1)), regardless of a significant difference of distribution between the sexes (145 women and 40 men: p < 1 x 10(-6)). The conclusions point out that the evidence of this study strongly stresses that the association between carotid kinking and arterial hypertension is incidental.

[Critical ischemia of the lower limbs: pathogenesis, clinical course and therapy. Results of authors' experience in 337 cases]. / Ischemia critica agli arti inferiori: patogenesi, clinica e terapia. Risultati della nostra esperienza su 337 casi.

The definition of an ischaemic condition at lower limb level, may imply any different degree of the pathology, starting from a simple chronic slight claudication up to a severe ischaemia. Critical Limb Ischaemia is the term defined to identify an ischaemic condition, which endangers the limb or part of a limb and requires a prompt and appropriate treatment. However the pathophysiology of this condition remains to be well established and depends on various vascular factors. For the European Working Group on Critical Limb Ischaemia (Berlin 1989, Rudesheim 1991) the definition is strictly restricted to Fontaine's stage III B and IV, while in our opinion the definition could be very simple in all the patients with a prognostic limb-threatening condition (for localization and wide extension of the lesions) independent of the Fontaine's stage, which are going towards a future amputation if radical improvement of blood flow cannot be achieved with an adequate revascularization. In our five year late experience, we observed and surgically treated 337 patients with CLI (74% males and 80% atherosclerotic lesions). We discuss the preoperative findings, diagnostic procedures, surgical techniques and relate results.

[The surgical treatment of renovascular hypertension in subjects with a single kidney]. / Il trattamento chirurgico dell'ipertensione nefrovascolare in soggetti mononefri.

Renovascular hypertension in subjects with a solitary kidney, though an infrequent condition, requires surgical direct revascularization procedures either to reduce the hypertensive state and, more important, to preserve renal function. This paper reports a series of six surgically treated cases between 1982 and 1990, with at least two years follow-up. Preoperative renal function, as evaluated by BUN and blood creatinine, was reduced in 5 cases, the remaining one being normal. All subjects were hypertensive at admission: in four cases drug therapy was ineffective for restoring normal pressure values. All subjects had previously undergone surgical nephrectomy: in 3 cases for shrunk kidney, in 2 for failure of a previous attempt of renal revascularization, and one for renal tuberculosis. 3 subjects were concomitantly affected with abdominal aortic aneurysm, and one had previously undergone aortobifemoral bypass. Treatment of the concomitant aortic lesion and renal artery revascularization were carried out at the same operation. Operations performed were TEA of residual renal artery in 3 cases, prosthetic reconstruction in 2 and intraoperative transluminal angioplasty by Gruentzig balloon catheter in one. Over a two-year follow-up renal function remained good in 4 cases, while one subject required a second surgical revascularization due to late acute thrombosis of a previous aortorenal saphenous vein graft. Acute early postoperative renal failure occurred in one case and permanent haemodialysis was instituted. No deaths were recorded in this series.

[Prevalence of carotid kinking in a resident population. Partial results of the OPI (Objective Prevention of Ictus)]. / Prevalenza del kinking carotideo in una popolazione residente. Risultati parziali del programma OPI (Obiettivo Prevenzione Ictus).

This paper reports partial results on carotid kinking prevalence from the ongoing program Obiettivo Prevenzione Ictus, whose main target is to detect atherosclerotic carotid lesions in a resident population. Over a period of 23 months, 13.936 subjects, aged 45 to 75, were screened by physical vascular and carotid CW Doppler ultrasound examinations; 1.386 (9.9%) subjects underwent color coded echoflow imaging, according to the design of the screening program (suspected carotid atherosclerotic lesion at first level screening): 185 among this subgroup, 40 males and 145 females, were affected with 266 carotid kinkings. In 81 cases (43.8%) the lesions were bilateral. Sensibility and specificity of carotid bruit (25% and 73%, respectively) and CW Doppler ultrasound (48.5% and 55.8%, respectively) proved inadequate for routine diagnosis of carotid kinking. Hypertension was recorded in 146 cases (78.9%). No cerebral ischemic attack was recorded in these 185 subjects over the period considered.