External banding valvuloplasty of the superficial femoral vein in the treatment of recurrent varicose veins.

OBJECTIVES: The aim of this study is to evaluate the efficacy of reconstructive surgery of primary deep venous insufficiency in preventing recurrent varicose veins. DESIGN: Retrospective analysis of patients affected by recurrent varicose veins submitted to external banding valvuloplasty of the superficial femoral vein. SETTING: A division of vascular surgery in a hospital/scientific institute. MATERIALS: Nineteen limbs (19 patients) with recurrent varicose veins, severe chronic venous insufficiency and 3rd or 4th grade reflux in the superficial femoral vein and competence of the profunda femoris vein were selected for surgical reconstructive treatment after a complete diagnostic study by continuous wave Doppler duplex scanning and descending phlebography. INTERVENTIONS: External banding valvuloplasty of the superficial femoral vein was performed in all cases: A Dacron sleeve was used in nine patients and Venocuff in 10. RESULTS: In one case a deep venous thrombosis of the calf occurred in the first postoperative period; in three cases the correction of the deep reflux was incomplete and a recurrence of the varices was observed. After a mean follow-up of 50 months, abolition of reflux and relief of symptomatology were obtained in 15 cases (78%). CONCLUSIONS: Primary deep venous insufficiency, unknown at the time of the initial operation, may be the cause of recurrent varicose veins. External banding valvuloplasty of the superficial femoral vein may abolish the reflux and correct venous hypertension, preventing recurrences.

[The role of spinal cord electric stimulation in critical ischemia of the extremity]. / Il ruolo dell'elettrostimolazione midollare nell'ischemia critica d'arto.

The aim of this study is to evaluate, through a retrospective analysis of our experience, the effectiveness of spinal cord stimulation (SCS) in conservative treatment of critical limb ischaemia. During a 7-year period, at our Institution, SCS has been performed in 35 patients affected by severe lower limb ischaemia with angiographic multilevel distal lesions; femoro-distal bypass was not advisable or had failed due to poor outflow conditions. Basing upon clinical criteria (regression of rest pain, claudicatio and ischaemic lesions, limb salvage and need of amputation) the results of therapy were distinguished in "good,", "satisfactory" and "poor". Mean follow-up was 25 months (range 2-80). A good result has been achieved in 17 patients (48.5%) satisfactory in 11 (28.8%) and poor in 7 (20%), with a 80% limb salvage rate. No significative differences were observed in subgroups of patients with diabetes, hypertension or both. Appropriate management of critical limb ischaemia depends on a well-thought-out plan. Although femoro-distal vein bypass has been widely advocated as the treatment of choice, the good result of revascularization is related to adequate outflow conditions (adequate run-off). SCS has been reported to reduce ischaemic pain and improve ulcer healing and microcirculation in ischaemic limbs. Our experience and recent studies have provided strong evidence that SCS reduces tissue loss and improves limb salvage rate in inoperable patients. A prospective randomised study will be helpful in defining if SCS should represent an efficacious and alternative procedure to bypass in the treatment planning of critical leg ischaemia.

[Spinal cord electric stimulation vs. femoro-distal bypass in critical ischemia of the legs. Preliminary results in a randomized prospective study]. / Elettrostimolazione midollare vs bypass femoro-distale nell'ischemia critica degli arti inferiori. Risultati preliminari di uno studio prospettico randomizzato.

In the last few years the development of new and improved surgical procedures caused a more aggressive approach, by femoro-distal bypass, to the limb affected by critical ischaemia. A good surgical result is related to the crural vessel patency, the presence of an adequate autologous vein and the possibility to visualize inframalleolar and foot arteries by selective angiograms. Should all these conditions not be present, an outflow procedure might be at high risk for failure. On the other hand, several studies show that SCS relieves rest pain and improves trophic lesion healing although there is no evident increase in peripheral blood flow, but these studies refer to heterogeneous non-randomized patients. In order to evaluate the effectiveness of SCS compared to distal arterial reconstruction, we started this prospective and randomized study. In a period of 15 months, 12 patients affected by critical limb ischaemia at 4th stage of Fontaine with angiographic multilevel distal lesions were randomised for SCS (7 cases: group A) and distal bypass (5 cases: group B). The result of the therapy was judged as good or fair when either complete or evident pain regression and trophic lesion healing were obtained; otherwise the result was considered as poor. Actually the study is in progress, the follow-up is partial (3-12 months), the results are preliminary. In the patients of group A the results were good or fair in 5 cases (72%) and poor in 2 (28%). In the patients of group B the results were good or fair in 2 cases (40%) and poor in 3 (60%).(ABSTRACT TRUNCATED AT 250 WORDS)

[Use of mechanical staplers in low anterior resection: functional findings]. / Impiego delle suturatrici meccaniche nella resezione anteriore bassa: rilievi funzionali.

Twenty-three patients submitted to low stapled anterior resection for rectal carcinoma were studied by clinical questionnaire and manometry in order to assess anorectal function. Results were compared with those obtained from 11 patients submitted to the same procedure by hand suture.

Effect of different fractions of alkaline reflux on the gastric stump and the esophagus: an experimental research on pigs.

An experimental study was conducted to evaluate the effect of different fractions (bile and pancreaticoduodenal secretions) on the gastric stump and esophageal mucosa. Twenty pigs underwent partial gastrectomy (two-third distal) and cardiomyotomy in order to induce free gastroesophageal reflux. Then, reconstruction of the alimentary tract was performed to assess the effects of different types of alkaline reflux. A combined (biliary and pancreaticoduodenal) reflux, an isolated biliary reflux, and an isolated pancreaticoduodenal reflux were induced, respectively, in three different groups of five pigs each. In a control group a Roux-en-Y gastrojejunostomy was performed. Nine months later, the animals were sacrificed, the esophagus and the gastric stump were removed for histologic examination. The results show that the most severe histopathological lesions are determined by combined alkaline reflux; on the other hand, separated fractions can induce only mild changes on the gastric stump and esophageal mucosa.

[Therapeutic and prognostic possibilities in primary lymphoma of the thyroid]. / Prospettive terapeutiche e prognostiche nel linfoma primitivo della tiroide.

Personal experience with small cell thyroid tumours is reviewed in the light of recent developments in diagnosis and treatment. All cases were examined by means of immunohistochemical investigation of the lymphocytic and epithelial antigens. In 7 cases in which the production of lymphocytic antigens was confirmed, a primary lymphoma of the thyroid was diagnosed. Immunohistochemical studies of the lymphocytic and epithelial antigens are essential in all small cell thyroid tumours, in order to differentiate between small cell anaplastic carcinomas and thyroid lymphomas. This differentiation is indispensable for the correct choice of treatment and an accurate prognostic assessment. In the case of lymphomas, combined surgical and radiation treatment adjusted to the clinical stage of the tumour is recommended.

[Advanced age and clinical staging in the prognostic evaluation of differentiated carcinoma of the thyroid gland]. / Età avanzata e stadio clinico nella valutazione prognostica del carcinoma differenziato della tiroide.

The prognostic significance of age in differentiated thyroid tumours is assessed via the analysis of 156 cases of differentiated thyroid carcinoma surgically treated in 1967-85. A statistical analysis was performed on a sample of 120 patients under observation since their operation. The results indicate that the negative influence of old age is due more to the higher incidence of advanced tumours among the elderly than to more aggressive behaviour by the tumour.