Managing anomalous splenic artery aneurysm: a review of the literature and report of two cases.

The splenic artery originates from the superior mesenteric artery in approximately 1% of cases, which may explain the extreme rarity of aneurysms involving this anomalous branch, with only five cases reported in the international literature to date. We report our experience of managing two patients with aneurysms involving splenic arteries arising from the superior mesenteric artery, one treated surgically and the other percutaneously. From a diagnostic point of view, the first approach is ultrasound, while computed tomographic (CT) scan and angiography enable a better definition of the lesion and of the anatomical anomaly; CT angiography is currently the method of choice for the preoperative workup. Finding these two anomalies in association is so rare that it is impossible to draw any final conclusions as to the best type of treatment. In the authors' experience, both surgery and percutaneous treatment can prove useful.

Salivary gland involvement in patients with chronic pancreatitis.

The salivary glands are structurally similar to the exocrine pancreas and may be involved in the course of diseases of autoimmune origin (sclerosing cholangitis, ulcerative rectocolitis, primary biliary cirrhosis). For a not-yet-quantified proportion of chronic pancreatitis (CP) cases, a possible autoimmune pathogenesis has been postulated. The aim of the study was to assess the frequency of salivary ductal system abnormalities in patients with CP. Fifty-one patients with CP consecutively admitted to our center were studied (44 men, seven women; mean age, 48.2 +/- 10.8 years). The mean duration of disease was 11.7 years (range, 1-37 years); 44 (86%) of 51 patients had pancreatic calcifications, 25 (49%) of 51 diabetes, 25 (52%) of 48 steatorrhea, and 32 (63%) of 51 underwent pancreatic surgery. As a control group, we studied 10 patients of whom four with liver cirrhosis (three alcoholic and one posthepatitis; three men, one woman; mean age, 57 +/- 12.5 years), and six with temporomandibular pain (five men and one woman; mean age, 42 +/- 10.3 years). The patients were given parotid sialography, the findings being read by two independent observers. In two CP patients, parotid sialography was unsuccessful. Fifteen (31 %) of 49 patients and none of the 10 control patients exhibited abnormalities of the glandular ducts compatible with chronic inflammation of the salivary ducts (p = 0.039). None of the CP patients had salivary intraductal calcifications. Findings of parotid ductal abnormalities are frequent in the course of CP and may indicate a common pathogenetic mechanism, even of an immune type.

Role of chemoembolization in synchronous liver metastases from pancreatic endocrine tumours.

Endocrine tumours of the pancreas, even in case of liver involvement, are generally characterized by a slower evolution and a better prognosis, if compared with ductal carcinoma. This fact gives reason to a radical surgical approach, whenever possible, and to the research of any effective adjuvant treatment. For this purpose, hepatic transarterial chemoembolization (TACE) has been proposed in recent years for the treatment of metastatic endocrine tumours. Out of 80 patients suffering from endocrine tumours of the pancreas, observed between January 1985 and December 1996, 28 (35%) presented liver metastases at the time of diagnosis. Twelve of these patients were submitted to palliative resection of pancreatic tumour and one or more cycles of TACE. Overall survival was 50% (6/12); median survival was 35.4 months (range 4-75). These results suggest that chemoembolization, combined with surgical resection of primary malignancy, appears to be able to control the disease for a certain time and to increase the survival rate.

[Long-term results of the veno-occlusive percutaneous treatment of erectile disorders of venous origin]. / Risultati a lungo termine del trattamento percutaneo veno-occlusivo della disfunzione erettile di origine venosa.

The treatment of impotence due to venous leakage is remedied by creating an increase in the resistance of the venous outflow in order to trap arterial blood within the corpora cavernosa of the penis during erection. The percentage of success reported in Literature after resection of the deep dorsal vein and ligature of the cavernous veins varies from a minimum of 12.5% to a maximum of 75%. Interventional radiology represents a valid alternative to traditional surgery in the non-prosthesis treatment of erectile dysfunction of venous origin due to the absence of complications and lack of intrusiveness and for the encouraging short and mid term results obtained. From May 1991 to February 1997, seventeen patients (aged between 24-54, average age 36 years) affected by venous leakage underwent embolisation of the principal veins of drainage of the corpora cavernosa. All patients were previously strictly selected in order to exclude those affected by arterial, neurological, endocrine or ++psychological disease. Pathologic venous drainage was shown by pharmacocavernosometry and pharmacocavernosography. The technique employed consisted in isolation and catheterization of the deep dorsal vein of the penis with a cannula needle of 14 G and subsequent ligature and simple section of the vein; venous leakage fluoroscopic evaluation; coils placement under radiological control, in the distal tract of each vein chosen to be occluded; and then at last, embolization of the deep dorsal vein. A fluoroscopic control performed after these procedures showed the correct vascular occlusion. The operation has an average duration of 120 minutes and requires two-day hospitalisation. In 12% (2/17) of the selected cases a technical failure was recorded due to difficult catheterization of the periprostatic plexus, therefore only surgical ligature and section was carried out in the penile deep dorsal vein. Only in one case (6%) there was a slight and transitory oedema of the penis observed. The average follow-up is 34 months (range 3-72 months). Up to now, 11 patients over 15 (73.4%) refer a good improvement of erectile dysfunction together with a satisfactory sexual activity. In two cases (13.3%) only partial improvement have been referred. Only 2 cases (13.3%) did not obtain any benefit from treatment.

Spontaneous rupture of a pancreatic pseudocyst into the portal vein.

Spontaneous rupture of a pancreatic pseudocyst into the portal vein is described. This has been previously reported in only five cases. Diagnosis was made by computed tomography (CT) and was confirmed by CT-guided transhepatic portography.

[The treatment of hepatocellular carcinoma by chemoembolization]. / Il trattamento del carcinoma epatocellulare mediante chemoembolizzazione.

One hundred and fourteen consecutive patients with unresectable hepatocellular carcinoma were treated by chemoembolization using ethiodized oil (Lipiodol), anticancer agents. Ninety patients had concomitant chronic liver disease. Hepatocellular carcinoma (HCC) was diagnosed by US, contrast enhanced CT, fine needle biopsy and alpha-feto-protein level. Admission criteria were as follows: tumor confined to the liver with or without hilar nodal involvement, Child class A or B, white blood cell count above 2.000/mmc and platelet count above 75,000/mmc. All the patients underwent angiographic chemoembolization with Lipiodol and anticancer agents. In 98 patients we performed transcatheter hepatic arterial embolization (TAE) with Gelfoam or for Ivalon sponge. In 16 patients TAE was not performed because of portal thrombosis (7 cases) or technical reasons (9 cases). Mitomycin was used in 40 patients and dihydroxyanthracenedione (DADH) in 58 patients. In the TAE group 83 patients were Child A and 15 Child B. In 27 patients HCC was mononodular whereas in 71 it was multinodular. In 41 patients the tumor was more than 5 cm in diameter (in multinodular tumors only the larger lesion was taken into account). In 56 patients chemoembolization plus TAE was repeated. Seven patients died within one month after treatment: two from myocardial infarction, two from liver failure, two from digestive haemorrhage and one from necrotizing pancreatitis. Long-term survival rates were investigated in relation to prognostic factors: anti-cancer agent, number of nodes, tumor size and Child stage using Kaplan-Meier method. Survival rate at 12, 24 and 36 months are 64%, 38%, and 30% respectively.(ABSTRACT TRUNCATED AT 250 WORDS)