Extreme endovascular revascularization for limb salvage in critical limb ischemia.

AIM: Distal bypass has been considered as a primary choice for the treatment of critical limb ischemia (CLI). When bypass failed with limb threatening ischemia, the amputation rate is high in patients with increased surgical risks and lack of conduit. Percutaneous transluminal angioplasty (PTA) has been shown to be effective and safe in the setting of CLI even in patients with failed bypass graft. The aim of this study was to review our experience and results of extreme endovascular revascularization in patients with CLI following occluded lower limb bypass graft. METHODS: Retrospective review from January 2005 to June 2008 of patients with CLI following occluded bypass graft who underwent PTA was performed. All patients were studied by Duplex scanning and dual-energy computed tomographic angiography (DE-CTA) bone removal technique. Stents were used in cases of residual stenosis or dissection. Technical success was defined as a residual stenosis less than 30%. Demographics, comorbidities, functional status, details of the procedure information were recorded. Descriptive, logistic regression and life-table analyses performed. RESULTS: Thirty-six patients with occluded bypass grafts were treated. The mean age was 69 years (range 56-89), 44% were older than 80 years, 83% had diabetes mellitus, 88% of limbs treated had multiple lesions included Tasc C and D lesions. Technical success was achieved in 91%. Mean follow-up was 24 months. At follow-up, there were 19 PTA failures which were followed by subsequent procedures: redo PTA in 16 limbs, redo bypass in 2, amputation in 5. Cumulative primary patency was 60% (±0.08 SE) and 24% (±0.07 SE). Secondary patency was 96% (±0.03 SE) and 83% (±0.08 SE). Limb salvage was 84% (±0.06 SE) and 70% (±0.10 SE). Freedom from surgical revision was 78% (±0.07 SE) and 54% (±0.11 SE). Overall survival was 89% (±0.05 SE) and 58% (±0.11 SE) at 12 and 24 months, respectively. CONCLUSION: Endovascular revascularization of patients with CLI and occluded bypass graft is a safe and feasible procedure with reasonable technical and clinical success and limb salvage. PTA may be the only alternative to amputation in these patients with extensive comorbidities and limited life expectancy.

Massive bleeding from a Dieulafoy's lesion of the duodenum successfully treated with "adjuvant" transarterial embolization and endoscopic laser coagulation.

Dieulafoy's lesions, very rare in the duodenum, are considered uncommon causes of gastrointestinal bleeding and occur from pinpoint non-ulcerated arterial lesions. We report a case of Dieulafoy's lesion of the duodenum, in which a first diagnostic approach by using endoscopy and angiography was not successful; then, due to a high operative risk, we performed an "adjuvant" embolization of the gastroduodenal artery with the aim of reduce the flow through the artery, allowing the endoscopic localization of the site of bleeding and subsequent effective treatment. To our knowledge, this is the first case reported in the literature, in which, without aetiological diagnosis, an "adjuvant" embolization of the gastroduodenal artery was performed with the aim of reduce the blood flow in the duodenal wall, permitting an easier endoscopic diagnosis of Dieulafoy's duodenal lesion and successful treatment with laser coagulation.

Embryologic and acquired anomalies of the inferior vena cava with recurrent deep vein thrombosis.

Anomalies of the inferior vena cava theoretically favor venous stasis and development of deep vein thrombosis. We report two cases of repeated deep vein thrombosis in patients with embryologic and acquired anomalies of the inferior vena cava, in which hypercoagulability syndrome was ruled out.

Hepatic artery aneurysm, an unusual cause of obstructive jaundice: MR cholangiography findings.

Hepatic artery aneurysms are rare vascular lesions, often with a nonspecific clinical presentation, and difficult to diagnose before rupture. We report the case of a patient with obstructive jaundice caused by a compression on the right biliary duct by a right hepatic artery aneurysm in which the diagnosis was suggested by magnetic resonance cholangiography and confirmed by Doppler sonography and preoperative digital subtraction angiography.

Unusual pleural involvement after exposure to amorphous silicates (Liparitosis): report of two cases.

Liparitosis is a rare pneumoconiosis determined by inhalation of pumice, an amorphous complex silicate extracted in the quarries of Lipari (Aeolian Archipelago, Italy). We describe two cases of subjects occupationally exposed to pumice dust in which high-resolution computed tomography (HRCT) revealed the presence of pleural lesions without parenchymal involvement.

Contrast-enhanced power Doppler US in the diagnosis of renal pseudotumors.

The term "pseudotumor" is used to refer to several anatomic variants that can simulate a renal mass, the most frequent of which are hypertrophied column of Bertin, persistence of fetal lobation, and the dromedary or splenic hump. We describe the findings of power Doppler US after the ultrasound contrast agent (Levovist, Schering, Berlin, Germany) administration in 4 patients with a renal focal lesion in whom gray-scale and baseline power Doppler US was not able to certainly differentiate pseudotumor from neoplasm.

Intrahepatic portal vein aneurysm: three-dimensional power Doppler demonstration in four cases.

We describe four cases of portal vein aneurysm that were studied with ultrasonography, color Doppler, computed tomography, and magnetic resonance imaging as well as three-dimensional power Doppler. Three-dimensional ultrasonography showed the portal aneurysm and its relationship to its portal branches in all patients and showed the portosystemic communication in three. In all cases, computed tomography or magnetic resonance imaging confirmed the three-dimensional ultrasonographic findings.

[Endovascular repair of abdominal aortic aneurysm: helical CT findings]. / Follow up post-procedura delle endoprotesi aorticho. Rilievi ocn TC spirale.

Endovascular repair of infrarenal abdominal aortic aneurysms is currently widely diffuse. Imaging plays a major role in the preprocedural patient evaluation, implantation of stent-graft, and patient follow-up. The aim of this paper is to describe the more frequent findings that can be seen in CT examinations after endovascular repair of infrarenal abdominal aortic aneurysm. We discuss CT findings related to the aneurysm (size, exclusion with complete perigraft thrombosis, back-filling of aneurysm sac via branch vessels) and to the device (dislocation, rotation, kinking, device expansion, patency/thrombosis, device disruption). We also show some examples of incorrect assembly of the modular components of the stent-graft.

[Clinical and etiopathogenetic evaluation of a rare cause of spontaneous pneumoperitoneum and volvulus of the ileum: pneumatosis cystoides intestinalis. Report of a case]. / Valutazioni cliniche ed etiopatogenetiche su una rara causa di pneumoperitoneo spontaneo e volvolo dell'ileo: la pneumatosi cistica intestinale. A proposito di un caso.

A case of pneumatosis cystoides intestinalis with pneumoperitoneum and volvulus complications is reported. After careful examination of the literature, etiopathogenic, pathophysiological and clinical features of the disease are analyzed by the Authors, also in the light of recent findings. Major diagnostic and therapeutic implications are discussed regarding possible complications requiring a different therapeutic approach. PCI, a lesion which can be benign, primary or secondary in many conditions, may be characterized by the presence of spontaneous pneumoperitoneum which only requires a careful, but not aggressive therapy, unlike other complications such as volvulus or intestinal occlusion which, instead, require timely surgical action. The Authors describing the therapy adopted, highlight the positive role of the enteral nutrition (NE) and oxygen therapy in the clinical course of the disease.

[The role of computed tomography after functional surgery on the paranasal sinuses. Normal findings and an assessment of the surgical failures]. / Ruolo della tomografia computerizzata dopo chirurgia funzionale dei seni paranasali. Rilievi normali e valutazione degli insuccessi chirurgici.

INTRODUCTION: Functional endoscopic sinus surgery has become the technique of choice to treat benign or inflammatory diseases of paranasal sinuses resistant to medical therapy. The goal of this type of surgery is to open the obstructed sinus ostia and restore normal aeration and mucociliary clearance. Messerklinger's is the most widely used technique. PURPOSE: We investigated the role of CT after functional endoscopic sinus surgery and describe CT findings of postoperative anatomical changes together with frequent complications and surgical failures. METHODS AND MATERIALS: Twenty-seven patients with relapsing symptoms were examined with CT of paranasal sinuses 8-32 weeks after functional endoscopic sinus surgery. In all cases both preoperative CT and surgical reports were available: CT and surgical results were compared. RESULTS: In 21/27 patients nasosinusal changes were demonstrated with CT. Recurrent disease secondary to inflammation and/or fibrosis was observed in 14 cases. Residual disease was seen in 5 patients. A major orbital complication was found in 1 patient with diplopia. One patient exhibited a large interruption of cribriform plate with CSF fistula. CONCLUSION: CT permitted an accurate assessment of extension and results of functional endoscopic sinus surgery. CT is indicated in the postoperative study of the patients who a) present symptoms of cerebral and ocular complications (early after functional endoscopic sinus surgery); and b) do not respond to medical treatments 8-32 weeks after unsuccessful functional endoscopic sinus surgery. In these patients CT can demonstrate recurrent and/or residual nasosinusal disease and bony defects unintentionally caused by the surgeon during the procedure.

Polinosis en la región de Bahía Blanca / Pollinosis in the region of Bahía Blanca

El presente trabajo pretende mostrar una descripción actualizada de las polinosis en nuestra zona. Se efectuó el relevamiento profesional de las plantas conocidas y/o sospechadas como alergógenas en la región de Bahía Blanca. Se estudió el polen absoluto en el aire durante 3 años. Se realizó un calendario floral de 30 especies, controlando sus inflorescencias durante el mismo lapso. Fueron preparados extractos con los pólenes antecitadas y posteriormente testificados en cien pacientes afectados por polinosis. Ochenta y seis enfermos mostraron pruebas positivas a gramíneas compuestas y quenopodiáceas; sólo catorce fueron positivos a gramíneas únicamente. Los síntomas por estos últimos pólenes fueron particularmente frecuentes e intensos en el mes de noviembre, correspondiendose con la floración de aquella familia. Sin embargo, a pesar de las reacciones positivas - marcadas y frecuentes - para quenopodiáceas, las consultas durante el verano disminuyeron ostensiblemente. No fue demostrada una correlación clínica significativa entre la floración de las compuestas y la signosintomatología del grupo estudiado. Consideramos imprescindible el acabado conocimiento de la flora alergógena y su calendario floral para el diagnóstico y tratamiento de la polinosis (AU)

Polinosis en la región de Bahía Blanca / Pollinosis in the region of Bahía Blanca

El presente trabajo pretende mostrar una descripción actualizada de las polinosis en nuestra zona. Se efectuó el relevamiento profesional de las plantas conocidas y/o sospechadas como alergógenas en la región de Bahía Blanca. Se estudió el polen absoluto en el aire durante 3 años. Se realizó un calendario floral de 30 especies, controlando sus inflorescencias durante el mismo lapso. Fueron preparados extractos con los pólenes antecitadas y posteriormente testificados en cien pacientes afectados por polinosis. Ochenta y seis enfermos mostraron pruebas positivas a gramíneas compuestas y quenopodiáceas; sólo catorce fueron positivos a gramíneas únicamente. Los síntomas por estos últimos pólenes fueron particularmente frecuentes e intensos en el mes de noviembre, correspondiendose con la floración de aquella familia. Sin embargo, a pesar de las reacciones positivas - marcadas y frecuentes - para quenopodiáceas, las consultas durante el verano disminuyeron ostensiblemente. No fue demostrada una correlación clínica significativa entre la floración de las compuestas y la signosintomatología del grupo estudiado. Consideramos imprescindible el acabado conocimiento de la flora alergógena y su calendario floral para el diagnóstico y tratamiento de la polinosis