Superior vena cava thrombosis secondary to thoracic outlet syndrome. Case report.

A case of superior vena cava thrombosis secondary to the thoracic outlet syndrome is reported. The diagnosis was revealed by CT-scan and confirmed by phlebography performed to insert a catheter for intrathrombotic infusion of urokinase. The thrombolytic treatment was followed by complete clot lysis. A hyperabduction manoeuvre confirmed costoclavicular compression as the cause of the subclavian-axillary vein thrombosis for which the patient underwent first rib resection. Axillary-subclavian vein thrombosis (or Paget-von Schroetter syndrome) is a relatively frequent complication of the thoracic outlet syndrome often treated with anticoagulants on the basis of a duplex examination. Involvement of the superior vena cava is not readily detected by duplex ultrasound so a partial thrombosis, with a possible fatal outcome could remain undiagnosed. Full investigation by phlebography or CT-scan is therefore recommended. In addition, transcatheter thrombolytic therapy has a lower incidence of follow-up complications than heparin.

[Chemoembolization of hepatocarcinoma. Six years' experience]. / La chemioembolizzazione dell'epatocarcinoma. Sei anni di esperienza.

This study was aimed at retrospectively assessing the effectiveness of transarterial chemoembolization by reviewing our six years' experience. From January, 1988, to December, 1993, chemoembolization was performed in more than 400 patients. Of them, 321 patients with complete follow-up were selected. The treatment was retrospectively analyzed according to survival rates. The average survival of chemoembolized patients is 12 months after the first treatment session. Average survival rates in Child A, B and C patients were, respectively, 13.79, 11.2 and 6.01 months. The patients were also divided according to tumor spread and the results follow: patients with single localizations had 15.19 months' survival, those with multiple localization 12.06 and those with tumor spread had 9.51 months' survival. The patients were divided into two groups: complete chemoembolization (group A) and incomplete chemoembolization (group B). The average survival was 15.95 months for 160 group A patients and 10.11 months for 161 group B patients. As for the number of chemoembolization sessions, 123 patients underwent only one session, 112 patients two sessions, 70 patients three, 12 patient four and 4 patients five sessions--625 sessions in all. Chemoembolization was performed every 3-4 months and was always preceded by a CT exam. Our patients were compared with an untreated group where average survival was 6.32 months. The value of CT after the first treatment in predicting survival was also studied. Finally, the methods used in all treatment are reported on, together with the general results and those in the different classes of patients.

[The usefulness of angiographic studies in the vascular complications of liver transplantation. The authors' own experience]. / Utilità delle indagini angiografiche nelle complicanze vascolari del trapianto del fegato. Esperienza personale.

The authors report their experience with angiographic techniques in the diagnosis of vascular complications after liver transplantation. From 1986 to 1990, 78 patients were transplanted in our Hospital; of them, 8 underwent angiographic investigations for vascular complications. Angiography is very important when vascular complications are suspected, in the patients with a rise in cytolytic enzymes and in bilirubine levels, with hyperpyrexia, and with bioptic confirmation of no rejection. Duplex US is useful in the evaluation of portal canalization; if there are any doubts, angiography is performed also in the preoperative phase.