Anastomotic pseudoaneurysm complicating renal transplantation: treatment options.

INTRODUCTION: Anastomotic pseudoaneurysm following renal transplantation is uncommon. Indications for repair, treatment options and outcomes remain controversial. REPORT: We present 6 renal transplant recipients with large anastomotic pseudoaneurysms. Five of the patients underwent open repair while one had a stent-grafting and delayed transplant nephrectomy for a ruptured pseudoaneurysm. A transplant nephrectomy was needed in all cases but one. Arterial reconstruction enabled limb salvage in all cases. One patient died of sepsis postoperatively. No patient presented late infection, failure of vascular reconstruction, nor pseudoaneurysm recurrence. CONCLUSIONS: Surgical excision of anastomotic pseudoaneurysms results in high rates of allograft loss. Less invasive techniques have a place in selected cases.

Health tourism: an opportunity for sustainable development.

In February 2017, the "Programma Mattone Internazionale Salute" (ProMis), that is the Italian Program for Internationalization of Regional Health Systems of the Ministry of Health (MoH), presented the first version of its Position Paper on Health Tourism, which embeds a first shared approach to the recommendations expressed by the European Committee of Regions (CoR) on "Age-Friendly" tourism. The CoR stresses the importance of local and regional authorities in the coordination of multi-sectoral policies such as healthcare, social assistance, transport, urban planning and rural development in relation to the promotion of mobility, security, accessibility of services, including health care and social services. "Age-friendly" tourism is an example of an innovative tourist offer that strives to meet the health needs of the entire "traveling" population, with an integrated and cross-sector approach that involves various organizations operating in sectors such as healthcare, accessibility and transport. The aim of the workshop was to explore the interest of the stakeholders to participate in a systemic action in the field of "health" tourism, and to identify priority implementation areas that offer opportunities to take advantage of validated, innovative experiences that strengthen the accessibility to health and social services in regional, national and international contexts. This effort provides the opportunity to take advantage of aligning the European Structural and Investment Funds (ESIF) to the development of tourism, coherently with the needs and resources of local and regional health authorities.

Intramural hematoma of the thoracic aorta in octogenarians: is non operation justified?

OBJECTIVE: The prognostic factors and treatment options for thoracic aortic intramural hematoma are controversial. The purpose of this study was to determine the most suitable treatment of this condition in very elderly patients. METHODS: In a review of the world literature, eight octogenarians with thoracic aortic intramural hematoma were found; to these the three cases reported here must be added. The descending thoracic aorta was involved in eight cases and the ascending/arch in three. RESULTS: In spite of patients' poor general conditions, the medical treatment group showed survival rates of 85.7% (descending) and 66.6% (ascending/arch), respectively. CONCLUSION: Extensive atherosclerotic changes of the aortic wall in the elderly, combined with control of hypertension, may probably prevent thoracic aortic intramural hematoma from progressing to dissection, with a favourable outcome. An earlier and more accurate preoperative diagnosis by modern diagnostic techniques, including spiral computed tomography (CT), as were performed in our own patients, will allow optimal treatment and increased patient survival.

Inferior pancreaticoduodenal artery aneurysm associated with common hepatic artery occlusion.

A unique case of true inferior pancreaticoduodenal artery aneurysm (IPDA) associated with occlusion of common hepatic artery is reported. Radiological and MRI findings are described. Because of high risk of visceral ischemia that contraindicated a percutaneous transluminal embolization, a successful tangential resection of aneurysm was performed.

Arterial homografts in the management of infected axillofemoral prosthetic grafts.

Two lower limb amputees with infected contralateral axillofemoral prosthetic grafts received preserved human arteries after removal of the infected materials. Both grafts grew organisms (Enterococcus species, plus Staphylococcus species in one). Long length arterial conduits were fashioned from freshly harvested (in one patient) and cryopreserved (in another one) cadaveric iliac and femoral arteries. One arterial homograft had ABO-compatibility with the recipient. No immunosuppressive drugs were administered after repeat arterial reconstructions. After 12 and 15 months both grafts are still patent, without parietal changes at ultrasonography; the patients have a viable remaining lower extremity and are free of symptoms or re-infection.

Spontaneous rupture of the iliac vein.

Two unusual cases of iliac vein spontaneous rupture into the retroperitoneum are presented together with 18 cases reported by the literature. In one patient of ours, entrapment of clots in an IVC filter and proximal iliac vein involvement into the scar tissue surrounding the left limb of an aortoiliac bifurcation graft might have caused flow disturbances and subsequent predisposition to rupture of the thrombosed external iliac vein. Inflammatory parietal changes, including infiltration of macrophages, T and B lymphocytes producing elastin degradation by means of cytokines, may have led ultimately to vein disruption. Despite clinical features and CT scan findings, the physician's awareness of this disease remains the most important factor for the early treatment.

Postoperative gastric complications in vascular patients.

Although there is no etiopathogenetic correlation between arterial diseases and gastroduodenal ulcer, a chronic gastric disease can increase postoperative morbidity and mortality, in patients with arterial diseases. Furthermore, postoperative complications due to the development of acute hemorrhagic gastritis are frequent and dangerous, even in patients without any pre-existing gastric pathology. The experience of our Department in this field is reported here, and the risk and severity of hemorrhagic complications after administration of prophylaxis in patients with arterial diseases and gastroduodenal ulcer are evaluated.

[Clinical study of the efficacy of and tolerance to seaprose S in inflammatory venous disease. Controlled study versus serratio-peptidase]. / Studio clinico sull'efficacia e la tollerabilità del seaprose S nelle flebopatie infiammatorie. Studio controllato verso serratio-peptidasi.

This study was designed to compare the efficacy and safety of seaprose S and serratio-peptidase in the treatment of venous inflammatory disease. Forty patients entered the study (11 males, 29 females), mean age 54.3 years (range 30-77), mean weight 74.8 kg (range 51-96), with superficial thrombophlebitis. The trial was conducted following a controlled, between patients, randomized experimental design. Seaprose S was administered as 30 mg tablets at a daily dosage of 90 mg (one tab t.i.d.), and serratio-peptidase as 5 mg tablets, at a dose of 30 mg per day (two tabs t.i.d.), both orally, for 14 days. Twenty patients received seaprose S and 20 serratio-peptidase. The findings indicate that seaprose S was more effective and better tolerated than serratio-peptidase. Although the group of patients assigned to seaprose S had considerably more severe initial symptoms, by the end of treatment spontaneous pain was reduced 68.7% from the baseline mean score (from 3.2 to 1.0), as compared with a 63.3% reduction in the serratio-peptidase group (from 3.0 to 1.1). Pain on pressure was reduced 61.1% with seaprose S (from 3.6 to 1.4), compared to 57.6% with the reference treatment (from 3.3 to 1.4). Edema was reduced respectively 75% (from 1.6 to 0.4) and 56.2% (from 1.6 to 0.7); erythema diminished 72.4% (from 2.9 to 0.8) and 58.3% (from 2.4 to 1.0); nighttime cramps were 61.1% less (from 1.8 to 0.7) compared with 52.9% (from 1.7 to 0.8); hemorrhagic suffusion was 53.3% less (from 1.5 to 0.7) compared with 41.7% (from 1.2 to 0.7); cutaneous dystrophy was reduced by 11.1% (from 1.8 to 1.6) and 7.7% (from 1.3 to 1.2). At the end of the treatment with seaprose S efficacy was assessed as good or excellent in 85% of the cases, compared with 65% for serratio-peptidase. Seaprose S caused no adverse reactions. During serratio-peptidase treatment one patient reported diarrhea, requiring temporary dosage reduction and specific treatment. It can thus be confirmed that seaprose S was effective and well tolerated in patients with inflammatory venous diseases.

[Ischemic phlebitis and venous gangrene]. / Flebiti ischemizzanti e gangrene venose

Seventeen cases of ischaemising phlebitis and 5 of venous gangrene are reported. Attention is given to the aetiopathogenetic factors that lead to massive thrombosis and dramatic progression of the disease: depression of vascular heparin, polyglobulia, serious dysproteinaemia, marked involvement of the arterial district, etc. Treatment may be medical or surgical, based on large doses of anticoagulants, low-weight dextrane and thrombolytic drugs, though the results expected are not always obtained. At present, early venous disobstruction with a Fogarty catheter, coupled with prolonged anticoagulant management is the best course. Prognosis is certainly better in ischaemia. When gangrene sets in, prognosis is particularly poor, even as far as survival is concerned, due to serious concomitant shock.

[Hypocobaltemia in chronic obstructive arteriopathy. Physiopathologic and therapeutic importance]. / L'ipocobaltemia nelle arteriopatie croniche ostruttive. Suo significato fisiopatologico e terapeutico.

The role of some so-called primary and secondary (or oligo-elements) elements in the physiopathology of the cardiocirculatory system has been well known from a number of years and they have been regularly included in the treatment protocols. Some, including K, Ca, Mg and Zn, are extremely well known and widely used in clinical practice. Recently, however, a growing number of studies have focused on the biological importance of other oligo-elements in the pathogenetic mechanisms of atherogenesis and its clinical manifestations. This study aimed to verify the exact role of free cobalt in the physiopathology of the chronic obstructive arterial diseases (COAD). A total of 80 patients affected by 2nd stage COAD were examined and the levels of some oligo-elements, including Co, were assayed. Constantly low levels were found (85% of cases) in relation to other oligo-elements studied (Cu, Zn, Mg, Ca). This findings is particularly interesting since it confirms the biochemical hypothesis of atherosclerosis according to which parietal damage plays a central role in the pathogenetic mechanism. Some enzymatic deficiencies, which lead to changes in membrane stability at the level of the endothelial cells, are closely related to the presence of tissutal and humoral peroxidation products. These peroxides (lipid peroxides), which are formed following the interaction of fatty acids with oxygen free radicals, have been identified by a number of studies as being responsible for endothelial damage. Several authors have shown that lipid peroxidation is involved in the atherogenic process through several mechanisms entailing monocytic activity and reduced prostacyclin (PG2) synthesis.(ABSTRACT TRUNCATED AT 250 WORDS)