Combined radiological and surgical treatment of arteriovenous malformations of the head and neck.

Arteriovenous malformations (AVMs) are high-flow lesions. More than 50% of all AVMs are located in the head and neck region. They represent a therapeutic challenge because of their hemodynamic characteristics and their modality of growth. AVMs have a tendency to recur and often require radical resection, making surgical ablation and reconstruction difficult. AVMs require angiography not only for diagnostic purposes but as an initial therapeutic step in the form of embolization. Surgical ablation, which follows a few days after embolization, is facilitated by the reduction in vascularity and shrinkage of the lesion, both of which are afforded by the embolization. These benefits allow for less blood loss at the time of ablation, and less extensive resection. The authors report their experience with 16 patients with extracranial AVMs of the head and neck examined over the last decade.

[Thromboendarterectomy of the superficial femoral artery with a femoro-popliteal endoprosthesis. Technical note on a preliminary experience]. / La Tromboendoarteriectomia (TEA) dell'arteria femorale superficiale (SFA) con posizionamento di endoprotesi femoro-poplitea. Note di tecnica su una esperienza preliminare.

BACKGROUND: The authors report an early experience with a new endovascular approach in the treatment of occlusive superficial femoral artery disease to evaluate the efficacy and the feasibility of the new technique. METHODS AND RESULTS: Four patients with disabling claudication or leg rest pain were treated for long segment occlusion of superficial femoral artery (SFA). A remote endarterectomy (EA) of SFAs has been performed using a single groin incision and a conventional Vollmar ring stripper to remove the entire atheroma core for a length of 20, 10, 9 and 8 cm. In 3 cases following complete extraction of intimal core and a guidewire placement across from the distal endpoint, the endarterectomized segment was lined endoluminally by implanting one or more Self-Expanding Coated Stent (Meadox Passager 6-10 mm); the stent was positioned under fluoroscopic guidance to prevent dissection without any further balloon-dilation. In 1 case a 5 mm diameter thin-walled PTFE endoluminal graft was positioned using a Strecker stent for distal fixation. One patient had an immediate post-operative occlusion of distal stent which required a femoro-popliteal autologous vein bypass. In the remaining 3 cases no postoperative complications were observed and the patients are asymptomatic with normal flow through the stent and the endoluminal PTFE graft at 6 months. CONCLUSIONS: In this report a combined surgical and endovascular procedure has been proposed. A prospective randomized study is carrying on at our Institute to verify if EA+ endovascular grafting of SFA represents an alternative to traditional femoro-popliteal vein bypass.

[Gastric lymphoma: diagnostic radiology in the staging of the disease]. / Il linfoma gastrico: la diagnostica radiologica nello staging della malattia.

In the staging of gastric lymphoma, the radiologist has very important role, because he has many means to define correctly the stage. Conventional radiology is useful for detection of the lesion. Moreover, Ultrasound, Computed Tomography, and Magnetic Resonance are useful to define parietal extension and eventual nodal involvement. Lymphography remains a study kept to negative or doubt cases. In the future, the Magnetic Resonance will have a bigger role than now, in the definition of abdominal and pelvis nodal involvement.

[The origin of the arteria sigmoidea ima]. / Sull'insorgenza dell'a. sigmoidea ima.

The authors report the results of their observations on the lowest sigmoid artery, carried out on 92 anatomical specimens coming from surgical operations on the sigmoid and rectum. The specimens were injected and radiographed immediately after their removal . The observations were often preceded by pre-operative angiographies performed for diagnostic reasons. The AA. document all the variational patterns of this artery. They confirm the poor functional value of this artery more known by the old surgeons than by the anatomists.

[Connections between the phrenic arteries and various visceral arteries]. / Sulle connessioni fra le arterie freniche ed alcune arterie viscerali.

During an angiographic research carried out over more than 1100 cases, some connections between the phrenic arteries and the arteries of the hepatic, superior mesenteric and renal districts were observed. The AA. point out the presence of these connections even of thin calibre, their right prevalence (71%), and their uncertain embryologic origin.

Arterial thrombosis as clinical manifestation of congenital protein C deficiency.

A 49-year-old man was hospitalized for slight paresis of the upper left limb. Thrombosis of the right internal carotid artery was documented by arteriography and digital angiography, which showed evidence of an anastomotic blood flow. He went on anticoagulation treatment. Five years later, after an uneventful period, he was referred to our center for the occurrence of a superficial thrombophlebitis: diagnosis of congenital protein C deficiency was possible in the patient as well as in two of his relatives. Two other subjects with congenital protein C deficiency belonging to two different kindreds, whose illness was diagnosed in our center, suffered from myocardial infarction and TIA, respectively, as the only clinical manifestation; a fourth case, previously described, with recurrent superficial thrombophlebitis, suffered from a TIA when on treatment with stanozolol. These cases indicate that arterial thrombosis or TIA is not an uncommon event in congenital protein C deficiency, even in patients without other risk factors for arterial thrombosis.

[The termination of the superior hemorrhoidal artery. An anatomicoradiological study]. / Sulla terminazione della a. emorroidale superiore. Studio anatomo-radiologico.

The author report the observations carried out on the distal part of the hemorrhoidal artery, obtained with a research on the vascularization of the large intestine, studied by the angiographic method and injection of the c.m. in the anatomical specimen immediately after surgical extirpation. The study was based on 92 anatomical specimens and reveals a variability of the terminal arterial distribution which can be summarized in few more frequent models, but cannot be given an absolute rule.

Respiratory syncytial virus infection in bone marrow transplantation: a case report (syncytial virus infection).

The authors describe the case of a patient receiving a second bone marrow transplantation for acute lymphoblastic leukemia who developed, in the early post transplant period, an interstitial pneumonia caused by respiratory syncytial virus. The patient promptly recovered, but radiological findings of interstitial pneumonia lasted for three months.

[Embolization of the splenic artery in cirrhotic patients with portal hypertension. Ultrasound results and follow-up]. / L'embolizzazione dell'arteria splenica nei pazienti cirrotici con ipertensione portale. Risultati e controlli ecografici.

Over the last four years the authors performed transcatheter embolization of the splenic artery by Gianturco coils in 32 consecutive cirrhotic patients with portal hypertension, splenomegaly, cytopenia and gastro-esophageal varices endoscopically proved. This procedure was especially useful for treatment of splenomegaly and cytopenia because a constant reduction of spleen dimensions and increase in platelet count were registered. The effectiveness of transcatheter embolization and follow-up are based on clinic, hematologic and sonographic findings. We believe sonographic monitoring to be very useful both to evaluate splenomegaly and signs of portal hypertension and to reveal splenic complications (abscesses). We never registered severe complications.

[Hemobilia: comparison of diagnostic technics. Considerations on 14 patients]. / Emobilia: tecniche diagnostiche a confronto. Considerazioni su 14 pazienti.

Fourteen cases of hemobilia of traumatic (six), vascular (six) or neoplastic (two) origin were reviewed. Eleven patients obtained correct diagnosis only be integration of at least two diagnostic procedures out of Ultrasonography, Computed Tomography, arteriography and cholangiography. Although US and CT are extremely useful as screening procedures, correct diagnosis should be only possible by integration of more diagnostic technics. Arterial embolization represents a successful alternative to surgical intervention; moreover US may also be helpful for follow-up of treated patients.

Melorheostosis: presentation of a case followed up for 24 years.

The case of a woman affected by Melorheostosis of the left arm, who was followed for 24 years, is presented. After a brief review of the main clinico-radiological features and the most likely pathogenetic theory, the authors point out the slow but inexorable progression of the alterations and their localization, which is strictly limited to the dermatome supplied by a spinal nerve.

Premature epiphyseal fusion and extramedullary hematopoiesis in thalassemia.

The main skeletal abnormalities in beta-thalassemia are widening of medullary spaces, rarefaction of bone trabeculae, thinning of cortical bone, and perpendicular periosteal spiculation. Premature epiphyseal fusion (PEF) and extramedullary hematopoiesis (EH) are found, though more rarely. The incidence of PEF and EH in 64 patients affected by beta-thalassemia is reported. The different incidence of such complications in thalassemia major and intermedia is reported, and a possible correlation with transfusion regimen is also considered.

[Percutaneous treatment of varicocele]. / Trattamento percutaneo del varicocele.

Percutaneous occlusion of the spermatic vein has been performed in 104 patients with varicocele in the last five years. We report our long-term results on the first 87 cases with a follow-up of at least six months. The occlusion of the gonadal vein is generally induced by selective transcatheter injection of sclerosing agent. Our patients are always evaluated before and after sclerotherapy by telethermography and/or doppler examination. Furthermore spermiogram is obtained before and six months after therapy. We registered only four recurrences with no major complications.