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.

Surgical approach to combined abdominal aortic aneurysm and renal artery stenosis.

Thirty-four cases of combined abdominal aortic aneurysm (AAA) and renal artery stenosis (RAS) are reported. Hypertension was found at admission in 32 subjects, the other two being well responsive to drug therapy. Angiography and selective renal vein renin assay were always performed: renal artery stenosis was unilateral in 21 (61.7%) subjects and bilateral in 13 (38.3%). In 9 cases renal artery stenosis was not correlated to the hypertensive state. Mild chronic renal insufficiency was demonstrated preoperatively in 20 patients (58.8%). Simultaneous surgical treatment was carried out in 25 cases (73.5%). Mortality was 4% (one subject), severe renal insufficiency 8% (two subjects) and permanent renal failure 4% (one subject) All complications occurred among the group with bilateral RAS. While surgical repair of AAA is always mandatory, simultaneous surgical treatment of AAA and RAS should be carried out in carefully selected cases, due to elevated mortality rates reported in the literature, in order to cure renovascular hypertension, when it is demonstrated as related to RAS, or to preserve renal functionality, when RAS is contralateral to a functionally excluded or hypotrophic kidney or it exceeds 80% of the diameter of the artery.

The concomitance of renal artery stenosis and Conn's adenoma in a hypertensive woman.

A case of adrenal aldosterone-secreting adenoma concomitant with active renal artery stenosis in a hypertensive middle-aged woman is reported. The concomitance of the two lesions was previously reported in the literature only in five more reports, that are mentioned and commented here. This association is thought to be almost anecdotal, but some remarks must be done in order to rule out the risk of leaving an ignored lesion at the time of the definitive treatment. The widespread use of noninvasive imaging techniques is effective to find unsuspected adrenal adenoma in the presence of renovascular hypertensive disease, whereas unknown renal artery stenosis can be revealed by more aggressive diagnostic attitude, that is justified only in well selected cases of Conn's disease.

Rupture of abdominal aortic aneurysms into the major abdominal veins.

Over the period January 1965-July 1992 26 spontaneous fistulas between an abdominal aortic aneurysm (AAA) and the major abdominal veins were observed and surgically treated. Twenty-two were aorto-caval, one iliaco-iliac and 3 aorto-iliac; since clinical features, pathophysiology, principles of surgical treatment and postoperative care are similar, both the conditions are considered as a single disease (aorto-caval fistula: ACF). The incidence among 373 ruptured AAA operated in emergency conditions in the same period was 6.97%, with an operative mortality rate of 34.61% compared to an overall mortality for ruptured AAA of 34.85%. All subjects were males with a mean age of 67.3 years. Twelve subjects showed shock at admission (46.1%): the mortality rate in this subgroup was 50% compared to 21.4% among the non-shocked patients. Pain was always present, oedema of one or both of the lower limbs in 9 cases (34.6%) and abdominal bruit or murmur and thrill in 16 (61.5%). One patient died at laparotomy for irreversible cardiac arrest; the 25 completed procedures consisted of endoaneurysmal repair of the fistula under venous bleeding control by digital compression and prosthetic replacement of the abdominal aorta (7 straight and 18 bifurcated grafts). Intraoperative mean blood losses exceeded 4,000 ml, but autotransfusion, available only in 12 procedures, allowed significant sparing of heterologous blood units. The mortality rate was not clearly improved by autotransfusion, but among these 12 patients shock was present in 7 instances (58.3%), compared to 5 out of 14 subjects (35.7%) operated on before autotransfusion devices were available.(ABSTRACT TRUNCATED AT 250 WORDS)

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.

[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%).

[Cerebrovascular insufficiency: diagnostic technics compared]. / Insufficienza cerebrovascolare: tecniche diagnostiche a confronto.

The ability of angiodynography (or Color Flow Imaging) to achieve accuracy in image resolution of thin details of venous as well as arterial vessels has made continuous wave Doppler and frequency analysis Doppler almost obsolete techniques. Some controversies exist about the effectiveness of color flow imaging versus duplex scanner imaging, but recent progress in ultrasound imaging technology seems to overcome the problem. Angiodynography can effectively substitute X-ray angiography in some specific instances and is able to limit the use of invasive techniques to cases in which surgical procedures are really foreseeable. The non-invasiveness of angiodynography makes it useful to follow-up the asymptomatic lesions, particularly those of the carotid artery, as well as operated patients. Moreover, people for whom contrast angiography is contraindicated can be operated safely on the bases of angiodynography alone. This paper reports the results of one-year activity of Ultrasound Vascular Laboratory with 1982 patients: 923 (48.7%) had their epiaortic arterial vessels examined, with 180 (19.5%) follow-up controls, 297 (39.9%) negative explorations, 234 (31.5%) hemodynamically not significant lesions, 135 (18.2%) subjects affected with moderate (50-70% stenosis) and non ulcerated carotid stenosis, and 77 (10.4%) patients with ulcerated plaques or > 70% stenosis.

[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.

[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.

[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.

[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.

[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.

[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.

[Surgery of the carotid: the morphology of plaque and the clinical correlations]. / Chirurgia della carotide: morfologia della placca e correlazioni cliniche.

A consecutive series of 256 patients operated on of carotid endarterectomy for cerebrovascular atherosclerotic disease from January 1987 through December 1990 is presented. The following parameters were considered: clinical presentation, morphology of the carotid atherosclerotic plaque and topographic distribution of other concomitant atherosclerotic lesions of epiaortic arteries. 422 carotid lesions and 154 lesions of other epiaortic vessels were investigated by means of echo and color flow imaging, digital subtraction angiography and macroscopic observation of the specimen: 143 plaques proved grossly ulcerated. Unilateral lesions were 90 (35.2%) while bilateral disease was present in 166 cases (64.8%): 38.8% of subjects out of the first group and 30.2% out of the second were asymptomatic. Anterior and posterior neurological symptoms were equally distributed among both the 116 (69.8%) symptomatic subjects harboring bilateral lesions and the 55 (61.1%) symptomatic subjects with unilateral lesion (anterior 78.4% and posterior 21.6% for bilateral and 78.2% and 21.8% respectively for unilateral lesions). According to the degree of stenosis, the lesions were divided into three main groups: < 50%; 50-70%; > 70%. As the degree of stenosis increased, the incidence of focal symptoms increased too; moreover, the presence of ulceration of the stenosing plaque carried an increase in the incidence of focal symptoms within each group: respectively from 7.8% to 30% (< 50%), from 18.6% to 53.8% (50-70%), from 27.7% to 55.6% (> 70%). This study supports the relationship of morphological characteristics of the stenosing atherosclerotic plaques of the internal carotid artery to neurological symptomatology.(ABSTRACT TRUNCATED AT 250 WORDS)

[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.

[Objective prevention of ictus. Data informatics from a mass screening program]. / OPI: obiettivo prevenzione ictus. Informatizzazione dei dati di uno screening di massa.

The main technical and functional abilities of the computer supply to the epidemiologic program Obiettivo Prevenzione Ictus are described. The aim of the program is to investigate the epidemiology of carotid occlusive disease in subjects aged 45 to 75 by following a diagnostic and therapeutic protocol, designed to discover and treat internal carotid artery stenosis. The magnitude of the population involved is 23,140 subjects. The data from the population are collected in a three level archive whose configuration makes it possible to obtain information either from within each level and from all of them. Thus, the software adopted provides specific tools for elaboration of epidemiologic data as well as for clinical management of carriers of carotid lesion and for follow-up of treated patients.

[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.

[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.

[Association of pheochromocytoma and renovascular hypertension]. / Associazione tra feocromocitoma e ipertensione nefrovascolare.

The case of a 47-year-old woman affected with right adrenal pheochromocytoma and right renal artery stenosis is presented. The concurrence of these two diseases is rarely reported in the literature, as shown by the review presented. Nevertheless, this association carries some problems as far as diagnosis is concerned, because missing renal artery lesion can lead to the maintenance of the hypertensive disease after surgical excision of the adrenal pheochromocytoma. Anyway, the extensive use of angiography is not justified for pheochromocytoma alone, because an excellent imaging of the mass can be achieved by means of non-invasive technologies, such as CT, echo B-mode, NMR. A careful evaluation of clinical features and non-invasive imaging and the presence of elevated plasma renin activity, although not determinant in surgical decision making, can support the suspicion of renovascular hypertension in the presence of pheochromocytoma and suggest to carry out renal angiogram and selective renal veins reninemia.