Displacement of the inferior vena cava as a factor limiting catheter performance in long-term hemodialysis patients.

We report a case of a lady affected by autosomal dominant polycystic kidney disease who had been on hemodialyis for 24 years. She has exhausted all options for arterious-venous fistula. The presence of an acquired anatomical abnormality was an obstacle in order to get appropriate blood flow from standard tunnelled femoral catheters. The enlarged right kidney was pushing the inferior vena cava to the left side of the abdomen, and the abnormality was demonstrated by phlebography. Only after placing a cuffed catheter 53 cm long in her left femoral vein we could dialyze efficiently. Venography is mandatory before placing a cuffed catheter especially in uremic patients with long history of access failure, because it saves costs.

[Effectiveness of the combination of alpha tocopherol, rutin, melilotus, and centella asiatica in the treatment of patients with chronic venous insufficiency]. / Efficacia clinica di un'asociazione di alfatocoferoli, rutina, meliloto e centella asiatica nel trattamento di pazienti con insufficienza venosa cronica.

BACKGROUND: The aim of this comparative clinical study was to evaluate the efficacy of the association of alphatocopherol, rutin, melilotus officinalis, and centella asiatica with oral administration in patients with chronic venous insufficiency. METHODS: Thirty patients with chronic venous insufficiency have been randomized in two groups of fifteen subjects (control and treatment group). During the period of treatment the patients didn't wear elastocompressive stockings. The therapeutic efficacy and the clinical tolerability of this association have been valued with clinical-instrumental evaluations and by a control after 15 and 30 days. Functional bothers, cramps and the edema have been valued in function presence and of their gravity with a clinical-score between 0 and 4. RESULTS: At the end of the observation period, a significant improvement of the clinical simptomatology was obtained, characterised by a diminution of the sovrafascial edema. CONCLUSIONS: The present study confirms previous clinical experiences regarding the described treatment and suggests its application in chronic venous insufficiency.

[Duplex scanner diagnosis of complete extracranial carotid artery obstruction: possibilities and limitations]. / La diagnosi duplex scanner delle ostruzioni complete delle carotidi extracraniche: possibilità e limiti.

The authors enhance the current importance of the hemodynamic evaluation of the vascular carotid territory by means of Doppler-CV although the great development of the "real time" ultra sonographic imaging. Combined US/Doppler-CV technique is really useful in differential diagnosis of the severe obstructive disease of extracranial carotid arteries. The authors report the possibilities of pitfalls in diagnosis due to the limitation of devices employed or to the frequent anatomical variability featured by examination of severe obstruction of vascular carotid territory.

[Aplasia of the internal carotid. A clinical case report]. / Aplasia della carotide interna. Descrizione di un caso clinico.

Among the anomalies of internal carotid artery, agenesis and aplasia recur with a low rate: only about sixty cases are reported in literature. We observed a case of aplasia of the left internal carotid in a 49 year old male suffering from hypertension and showing cerebro-vascular symptoms due to TSA pathology: it was studied with arterial angiography and duplex scanner. The angiographic examination raised a suspicion of left internal carotid thrombosis; on the contrary the duplex scanner revealed a correct diagnosis of carotid aplasia.

[Qualitative ultrasound analysis as a preliminary step in revascularization of the femoro-popliteal axis]. / L'analisi qualitativa ultrasonografica come momento preliminare alla rivascolarizzazione dell'asse femoro-popliteo.

The Authors report on the use of non-invasive techniques in the preliminary evaluation of revascularization of the femoral-popliteal axis. The study of this pathology, for which surgery has become less and less frequent, being limited to the more serious cases, has greatly benefited by the use of H/R echography and of Doppler. These techniques, which remain complementary to angiography, have proved very important and reliable for their capacity to visualize the arterial lumen, an important element for the pre- and post surgical evaluation of vascular recanalization and of the relationship of continuity and continuity with the nearby structures.

[Importance of intraoperative H/R ultrasonography in the immediate evaluation of the results of thromboendarterectomy of the carotid bifurcation]. / Importanza dell'ecografia H/R intraoperatoria nella valutazione immediata del risultato degli interventi di TEA della biforcazione carotidea.

Personal experience on the intraoperative use of HR echography for the evaluation of the immediate surgical results in carotid bifurcation T.E.A. is reported. It is already assessed that early failure in vascular surgery is due to technically incorrect procedures.