The role of splenectomy in myelofibrosis with myeloid metaplasia.

AIM: In this paper we retrospectively analyzed prospectively-collected data on our myelofibrosis with myeloid metaplasia (MMM) patients who underwent splenectomy. The aim was to ascertain the hematological response and any resolution of symptoms existing prior to splenectomy; redefining timing and role of splenectomy in the treatment of MMM. METHODS: This prospective study considered 31 patients with MMM who underwent splenectomy for transfusion-dependent anemia, thrombocytopenia, abdominal swelling and pain. Postoperative work-up consisting in laboratory tests and clinical evaluation performing a quality of life (QoL) test based on EORTC QLQ-C30 questionnaire. Follow-up data were collected for one year after surgery. Statistical analysis used Student's t-test, the Mann-Whitney rank sum, Fisher's exact test, the Friedman test and the Wilcoxon test. RESULTS: Mortality was 3.2%. Respiratory symptomatic complications occurred in 35.4%. In all patients the need for blood transfusions was significantly reduced (P=0.005). An improvement in the painful symptoms was reported and a significant improve of postoperative quality of life was observed at one year after surgery. CONCLUSION: In our experience splenectomy is associated with limited perioperative mortality and morbidity. Acute complications are almost exclusively limited to respiratory tract. The removal of spleen seems can be recommended to increase the QoL and to palliate hematological disorders in patients no more responder to chemotherapy.

[Internal carotid artery aneurisms: two cases]. / Anévrismes de l'artère carotide interne extra-crânienne: à propos de 2 cas.

INTRODUCTION: Aneurysms of the extracranial portion of the internal carotid artery (ICA) are rare (accounting for only 0.1-2% of all surgical procedures affecting the ICA, 0.4-1% of all arterial aneurysms, and 4% of all aneurysms involving peripheral arteries), but they are nonetheless clinically significant because of the high related risk of cerebral thromboembolism. Given the rarity of these lesions, it seems worthwhile to report on two extracranial ICA aneurysms, one of atherosclerotic, the other of fibrodysplastic etiology that came under our observation. PATIENTS AND METHODS: Our experience concerns just two cases, treated at the Department of Surgical and Gastroenterological Sciences of the Policlinico G.B. Rossi in Verona, presenting with very different clinical and instrumental findings, and requiring a different surgical treatment. The former underwent resection of the aneurysm and end-to-end reconstruction; in the latter, we performed a carotid transposition with internalization of the external carotid artery. RESULTS: Neither patient suffered from any major or minor neurological complications during or after surgery, and the follow-up confirmed a normal extracranial carotid patency. CONCLUSIONS: Based on our, albeit limited experience and an analysis of the literature, we make a few points concerning the diagnostic approach (which differs from the case of stenosing carotid lesions), the indications and type of treatment for extracranial ICA aneurysms.

[Treatment of celiac trunk aneurysms: personal experience and review of the literature]. / Traitement des anévrismes du tronc coeliaque: expérience personnelle et revue de la littérature.

INTRODUCTION: Celiac trunk aneurysms represent 4% of all splanchnic artery aneurysms. These lesions are thus extremely rare but yet have a significant clinical importance. Mortality, mainly related to site characteristics, is a significant risk (14%) in the event of rupture. PATIENTS AND METHODS: We put forward our experience in both diagnosis and treatment in three patients, two women and one man (average age 55.3 years, range 35-74), presenting aneurysms involving the celiac trunk. The preoperative diagnosis was established successively with ultrasonography, CT scan and angiography. Two patients were treated via an open surgical approach while endovascular percutaneous treatment was performed for the third patient. RESULTS: Mortality was null at 13 days on average from admission for the surgical patients and 4 days for the patient treated endovascularly. Postoperative complications were modest: pulmonary thickening with pleural effusion for the two surgical patients (spontaneous resolution), while for the third patient treated with an endovascular method, the stent migrated to a splanchnic arterial branch, with no consequence for the spleen. The average follow-up was 19 months (range 14-24). Full exclusion of the aneurysm was maintained at four months for the aneurysm treated percutaneously. A patent celiac was also maintained for the patients treated surgically. CONCLUSIONS: Considering the largely unforeseeable outcome and the high risk of rupture, we suggest that all the patients presenting this type of aneurysmal lesion should be treated. This attitude is widely advocated in the literature. Moreover, we noted null mortality in our small series, with only one percutaneous "re-do" case; resolutive at last control. With the present improvement in stent technology, endovascular treatment should be preferred. Patients should be treated surgically only if a percutaneous procedure would be risky or technically unfeasible due to the size of the aneurysm or its anatomic features.