Radiofrequency minimally invasive endovascular treatment of lower limbs varicose veins: clinical experience and literature review.

AIM: Varicose veins of the legs are a common condition affecting 10-15% of men and 20-25% of women in the western world. This high prevalence is responsible of high medical and social costs. Most primary varices are associated with greater saphenous vein (GSV) incompetence. A new method, radiofrequency (RF) endovenous obliteration (VNUS-Closure'' procedure), recently has been described as a less invasive and cost-saving alternative to stripping for the treatment of refluxing GSV. METHODS: Twenty-four patients with varicose veins underwent endovenous obliteration of the above knee GSV by VNUS Closure'' procedure. The vein diameters were from 5 to 10 mm. The RF catheter was inserted via percutaneous puncture or through a small skin incision. All operations were performed in local, tumescent anesthesia, under ultrasound guidance. All patients were discharged 2 h after operation. Clinical and ultrasound follow-up was performed at 1 week, and at 1, 6, 12, 24 months. RESULTS: The complete or partial occlusion of the treated segment of the GSV has been achieved in 23 cases. In only one patient persisting patency of the GSV was immediately detected after the procedure. That was successfully treated by ultrasound guided foam sclerotherapy. All patients could resume all normal activities within 3-5 days. Every patient had reduction of varicosities, leg pain, fatigue and oedema. Adverse sequelae were minimal: 2 patients had transient thigh paresthesias. We didn't report deep venous thrombosis or pulmonary embolism (mean follow-up 26.7 months, range 15-33 months). CONCLUSION: A literature review and the authors'experience reveal that, in absence of significant complications, such as deep vein thrombosis and pulmonary embolism, there are significant advantages in the RF endovascular obliteration of the GSV. In effect, the Closure'' procedure, in selected patients, offers reduced postoperative pain, shorter sick leaves, faster return to normal activities compared with vein stripping, and it appears to be cost-saving for society. The mid-term (36 months) recurrence rates after RF obliteration seem to be similar to the results of the conventional surgical management.

Mode transition in high refractive index coated long period gratings.

In this work, the numerical and experimental investigation of the cladding modes re-organization in high refractive index (HRI) coated Long Period Gratings (LPGs) is reported. Moreover, the effects of the cladding modes re-organization on the sensitivity to the surrounding medium refractive index (SRI) have been outlined. When azimuthally symmetric nano-scale HRI coatings are deposited along LPGs devices, a significant modification of the cladding modes distribution occurs, depending on the layer features (refractive index and thickness) and on the SRI. In particular, if layer parameters are properly chosen, the transition of the lowest order cladding mode into an overlay mode occurs. As a consequence, a cladding modes re-organization can be observed leading to relevant improvements in the SRI sensitivity in terms of wavelength shift and amplitude variations of the LPGs attenuation bands.

[Prevention of ischemic colitis following aortic reconstruction: personal experience of the role of transmural oximetry in the decision for inferior mesenteric artery reimplantation]. / Prevenzione della colite ischemica successiva a ricostruzione aortica. Nostra esperienza sul ruolo della ossimetria transmurale nella decisione del reimpianto dell'arteria mesenterica inferiore (AMI).

BACKGROUND: The colonic ischemic necrosis is one of the most serious complication in the surgical reconstruction of abdominal aorta aneurysm (AAA) due to surgical inappropriate binding of the inferior mesenteric artery (IMA). METHODS: A retrospective analyzed of a group of 118 infrarenal AAA surgically treated is presented. RESULTS: The most common cause of ischemic colitis (75% of cases) is the surgical binding of an opened IMA or its failed reimplantation. CONCLUSIONS: In this paper according to their personal experience and the literature data, the authors outline a diagnostic behaviour to select the patients needing the reimplantation of IMA; they suggest to complete the pre operative information with an instrumental evaluation during the surgical treatment.

[Indications for the surgical treatment of abdominal aortic aneurysms]. / Indicazioni al trattamento chirurgico degli aneurismi dell'aorta addominale.

BACKGROUND: On the basis of a literature review and of personal experience, the authors analyze the main indications and the best strategy for elective surgical repair of infrarenal abdominal aortic aneurysm (AAA). METHODS: Personal experience concerning elective surgical treatment of 110 patients with infrarenal AAA, is presented. RESULTS: No operative deaths have been observed and the postoperative recovery was regular in 108 patients. Two early complications (colon ischemia) and ten late postoperative complications (5 pseudoaneurysms, 5 sexual dysfunctions) occurred. CONCLUSIONS: The main therapeutic guidelines concerning the management of AAA should follow specific indications (aneurysm dimensions and growth rates). Indications for operative repair of aneurysms obviously should be judged in relation to the presence or absence of associated risk factors or concomitant medical conditions. In most cases, aneurysm repair can be performed safely, despite associated medical risks, by careful preoperative evaluation and preparation.

[Adrenal synchronous metastasis from non small cell lung carcinoma (NSCLC): combined surgical treatment? Case report and review of the literature]. / Metastasi surrenalica sincrona da carcinoma del polmone non microcitoma (NSCLC): trattamento chirurgico combinato? Case report e revisione della Letteratura.

The adrenal gland is a frequent site for metastases from non small cell lung carcinoma (NSCLC). Surgical strategy in patients with operable NSCLC with adrenal synchronous metastases is yet unclear. On the basis of a literature survey and of a personal case report, the authors analyze the main indications and the best strategy for solitary synchronous metastases in the adrenal gland from NSCLC.

[Abdominal aortic aneurysm associated with non-neoplastic abdominal disease. Therapeutic approach]. / Aneurismi dell'aorta addominale associati a patologia addominale non neoplastica. Strategia terapeutica.

BACKGROUND: Personal experience concerning the treatment of 8 patients with infrarenal aortic aneurysms associated with extravascular non-neoplastic abdominal diseases is presented. METHODS AND RESULTS: In all 7 cases which underwent combined surgical procedures (aneury-smectomy + cholecystectomy in 4 patients and aneurysmectomy + groin hernia repair in 3 patients) early and late postoperative complications were not recorded. CONCLUSIONS: The main therapeutic guidelines concerning the pathologic association of infrarenal aortic aneurysms associated with extravascular non-neoplastic abdominal diseases are discussed on the basis of a literature review and of personal experience.

[Use of autotransfusion in prosthetic surgery of the abdominal aorta]. / Utilizzo dell'autotrasfusione nella chirurgia protesica dell'aorta addominale.

Self-transfusion represents a method used for the restoration of haematic losses that, in recent years, has been employed more and more widely in the surgical ambit. The utilisation of this method has become increasingly frequent because of the high diffusion of blood transmitted diseases and of the incidence, not negligible, of complications relative to the transfusions of homologous blood. The techniques that are currently used are: self-donation with predeposit; inter-surgery recovery; hemodilution normal blood volume. The authors report their experience relative to the use of self-transfusion, as self-donation with predeposit and as inter-surgery recovery, employed in the treatment of haemorrhagic complications, from 1990 until now in the Department of I Surgical Clinic of University of Turin, in a series of 48 patients in which were performed infrarenal abdominal aortic repair. In practice this technique did not present any complications.

[Prevention and treatment of early and late postoperative complications of prosthetic surgery of the arterial aorto-iliac area]. / Prevenzione e trattamento delle complicanze postoperatorie precoci e tardive della chirurgia protesica del distretto arterioso aorto-iliaco.

During a 5-year period, from 1990 to 1994, 61 patients underwent prosthetic reconstruction of aorto-iliac district for aneurysmal (53 cases) or obstructive (8 cases) disease. There was no postoperative mortality; 3 cases of early perianastomotic thrombosis, 2 cases of left colon necrosis, 4 cases of femoral pseudoaneurysm and 5 cases of sexual disfunction were recorded. If accurately performed, the surgery of this arterial district offers very good early and late results.

[Colorectal ischemic necrosis following reconstructive surgery of the abdominal aorta. Report of 2 clinical cases]. / Necrosi ischemica colorettale successiva a chirurgia ricostruttiva dell'aorta addominale. Relazione di due casi clinici.

The authors report two cases of colorectal ischemic necrosis following surgical reconstruction of abdominal aorta. An intestinal resection according to Hartmann was performed in both cases. The value of prevention based on a careful anamnesis, on a precise angiography study of the abdominal aorta and of splanchnic circle in addition to inferior mesenteric artery reimplantation, when advisable, is underlined as the most effective therapeutic instrument against colorectal ischemic necrosis following surgical reconstruction of the abdominal aorta.

[Diagnostic and therapeutic approach to incidentally detected adrenal tumors]. / L'approccio diagnostico e terapeutico agli incidentalomi surrenalici.

The authors report their experience relative to 12 cases of adrenal "incidentaloma" surgically treated. All masses removed had a main diameter larger than 3 cm. In all patients an anterior median transperitoneal incision was performed. They didn't record postoperative mortality and the postoperative morbidity rate was 15%. In 6 cases a nonfunctioning cortical adenoma was diagnosed. No malignant neoplasm was detected in their series.

[Splenic abscess after angiography. Considerations on a clinical case]. / Ascesso splenico successivo ad angiografia. Considerazioni su di un caso clinico.

A case of splenic abscess in a diabetic, cardiopathic and arteriopathic 49-year-old man is reported. The abscess developed on a previous splenic infarction caused by an embolus coming from an intraventricular thrombus. The angiographic procedure was the source of bacterial contamination (Staphylococcus aureus). The patient was successfully treated with splenectomy.

[Surgical treatment of hepatic hydatidosis. Current trends]. / Il trattamento chirurgico dell'idatidosi epatica. Attuali orientamenti.

The authors report their experience relative to 33 patients with hepatic hydatidosis surgically treated during the years 1987 through 1993. Various surgical techniques were employed: subtotal (21 cases) and total (5 cases) cystopericystectomy, partial pericystectomy (12 cases), hepatic resection (2 cases). The postoperative rate complication was 30% (4 cases of cholangitis, 4 biliary fistulas, 1 suppuration of residual cavity and 1 colonic fistula). The postoperative morbidity was higher in patients treated with partial pericystectomy. There was no postoperative mortality.

[Intrabiliary rupture of hydatid cysts of the liver. A clinical case]. / Rottura intrabiliare di cisti idatidea del fegato. Considerazioni su un caso clinico.

The authors report a case of intrabiliary rupture of some recurrent hepatic hydatid cysts. The biliary drainage was performed endoscopically during ERCP. The results of treatment were satisfactory. The value of total cystopericystectomy and external biliary drainage on prevention of cyst-biliary fistulas is underlined.

[Indications for reimplantation of the inferior mesenteric artery in the course of prosthetic substitution for the subrenal aorta]. / Le indicazioni al reimpianto dell'arteria mesenterica inferiore in corso di sostituzione protesica dell'aorta sottorenale.

The authors report their experience relative to 8 patients who underwent IMA revascularization during infrarenal AAA repair. The Carrel patch technique was employed in all cases operated. With this procedure no ischemic intestinal complication occurred. Two cases of ischemic colitis were observed in a second group of 40 patients operated for AAA in whom the IMA wasn't reimplanted into the aortic graft. The overall incidence of acute intestinal ischemia was 4%.

[Surgical treatment of aneurysms of the popliteal artery]. / Il trattamento chirurgico degli aneurismi dell'arteria poplitea.

The authors report their experience of two cases of popliteal artery aneurysm. Both patients were treated with aneurysm resection and inverse saphenous vein bypass. Early surgical intervention is the only effective therapeutic tool to avoid serious complications of this pathology.

[Predictive value of the echo-Doppler test in relation to the development of carotid arteriosclerotic plaques]. / Predittività dell'esame eco-Doppler in rapporto all'evoluzione della placca aterosclerotica carotidea.

The authors report their experience relative to 102 patients evaluated with carotid duplex-scanner. Ultrasonographic data of atherosclerotic carotid changes have been correlated with the outcome of the tested series. In fact, echographic images of vascular changes with high thromboembolic risk (ulcerated plaque) have been associated with cerebrovascular injuries in 25% of the cases. Furthermore, the duplex-scanner showed the need for surgical treatment (TEA) in 32 patients with asymptomatic carotid stenosis. Therefore, this noninvasive diagnostic tool seems to play an essential role in the prevention of cerebrovascular ischemia.

[Synchronous and metachronous carcinomas of the large intestine]. / Carcinomi sincroni e metacroni del grosso intestino.

The authors present their experience relative to 5 patients with multiple carcinomas (synchronous and metachronous) of the large bowel. They underline that full examination of the colon before operation in all patients with primary colorectal cancer is necessary, and they propose a lifelong follow-up program after resection for early detection of multiple carcinomas.

[Femoral anastomotic pseudoaneurysms. The etiopathogenetic hypotheses and the therapy]. / Pseudoaneurismi anastomotici femorali. Ipotesi eziopatogenetiche e terapia.

The authors present two cases of patients with femoral anastomotic aneurysm treated by surgical vascular reconstruction. They underline the role of etiologic factors changing the structure of the arterial wall. The protective action of end to end anastomosis is confirmed. Finally, they recommend an early intervention to avoid life-threatening complications such as rupture and thrombosis.

[Mesenteric fibromatosis in Gardner's syndrome]. / La fibromatosi mesenterica nella sindrome di Gardner.

The paper reports a case of mesenteric fibromatosis with familial polyposis, an association which was diagnosed as Gardner's syndrome, and highlights the complications connected to mesenterial desmoid tumours. In addition, the importance of radical surgical therapy of these neoplasias is underlined. Lastly, it is hypothesised that full screening of patients affected by familial polyposis might show a greater incidence of association between widespread polyposis and pathological changes attributable to Gardner's syndrome.