[Aneurysms of the splanchnic arteries]. / Aneurismi delle arterie splancniche.

Although visceral aneurysms usually have an asymptomatic course, ruptures associated with high mortality do occur. When an asymptomatic lesion is found, the physician must decide whether it should be treated surgically and which surgical technique should be used. Because this type of aneurysm is relatively rare, the answer to these questions have not been determined previously. The outcome in 16 patients treated by surgical or embolization procedures was evaluated. A group of 16 patients with visceral aneurysms were observed in our institution between 1987 and 1993. Localization of aneurysms was on the splenic artery in 8 cases, renal artery in 4 cases, hepatic artery in 3 patients and superior mesenteric artery in one patient. Hypertension was related to renal aneurysms and angina abdominis to the patient with superior mesenteric artery aneurysm. Of the 16 patients, 8 (6 splenic and 2 hepatic aneurysms) were asymptomatic, 3 (2 splenic and 1 hepatic) were treated as an emergency because they presented with shock. In the splenic group (8 cases), 2 patients underwent embolization procedures with Gianturco's coils, and 6 surgical procedures; in the hepatic group 1 embolization and 1 surgical procedure were performed; and finally in the renal and mesenteric group surgical reconstruction was performed during aortic prosthetic surgery. Because of well documented natural history of progressive enlargement and eventual rupture, the aneurysms of visceral arteries should be corrected surgically when the diagnosis is confirmed by vascular imaging (ultrasounds, CT, RM, angiography). Ruptures are treated with emergency operations, when possible. In high-risk patients, non operative management by selective embolization (in case of splenic and hepatic aneurysms) may be suitable alternative.

[Recent developments in the medical treatment of emergency cirrhotic hemorrhage. Vasopressin and glipressin, prostaglandins, somatostatin, propranolol, cimetidine and ranitidine]. / Recenti acquisizioni in tema di trattamento medico nelle urgenze emorragiche da cirrosi. Vasopressina e glipressina, prostaglandine, somatostatina, propanololo, cimetidina e ranitidina.

Haemorrhages in the course of cirrhosis and portal hypertension are surgical emergencies. Nevertheless medical treatment may be necessary both to revive the patient and temporarily to check the haemorrhaging itself. Some views are presented on the use of drugs, both those already in clinical use and others at the experimental stage, which appear to be effective in the treatment of haemorrhaging in portal hypertension (Vasopressin, glypressin, prostaglandin, somatostatin, propranolol, cimetidine and ranitidine).

Percutaneous splenic artery occlusion for portal hypertension. A new mechanical technique for hypersplenism.

We studied 16 patients with hypersplenism, splenomegaly, and moderate nonbleeding portal hypertension with the purpose of discovering a hyperdynamic component associated with splenomegaly. We treated the patients' splenic hyperdynamic component and hypersplenism with a splenectomy. We measured wedge hepatic vein pressure (WHVP) before and after superior mesenteric artery occlusion by a balloon catheter, and after splenic artery (SA) occlusion by a balloon catheter. In 11 patients, following SA temporary occlusion an average WHVP reduction of 10.4 cm saline was obtained, and SA occlusion by Gianturco's coils was performed to obtain a gradual and segmentary occlusion. No colliquative phenomena were observed, and a stable decrease of WHVP with a marked improvement of peripheral cytopenia was obtained.

Prehepatic portal hypertension: experience with 88 cases.

Although prehepatic portal hypertension (PHPH) is less common than intrahepatic portal hypertension, it gives rise to more serious diagnostic and therapeutic problems than the latter. From their experience of 88 cases, the authors feel that it is necessary for a correct approach to PHPH to derive a classification useful throughout the clinical course of these patients. They distinguish PHPH due to extrinsic obstruction from PHPH due to intrinsic obstruction, and subdivide these two classes according to etiologic, pathologic and hemodynamic criteria. A series of principles has been developed, in answer to the problems related to each of these classes, as an aid in the prevention of portal hypertension relapse.

[Endoscopic sclerosing therapy in esophageal varices. Indications and personal technics]. / Sclerosi endoscopica delle varici esofagee.

Variceal bleeding in cirrhotic patients with poor liver function is associated with a high mortality. A non-operative treatment, endoscopic sclerotherapy, was employed in 16 patients. The preliminary results have been encouraging. It has been possible to eradicate esophageal varices in the cronic injection group. A longer follow-up period will be required to assess both the quantitative and the qualitative aspects of survival and to determine how long esophageal varices will remain eradicated as well as how frequently repeated injections will be required.

[Hemorrhage of esophageal varices: conservative or emergency treatment?]. / Le emorragie da varici esofagee: trattamento conservativo o intervento d'urgenza?

The emergency treatment of bleeding esophageal varices still remain a very difficult problem. In this report results obtained with conservative and operative procedures will be compared. In particular 32 patients underwent transhepatic occlusion of the gastric vessels feeding varices, and 8 patients (total experience 27 cases) to emergency esophageal transection with the EEA stapler instrument. The conclusion is that both methods represent useful alternatives, in selected cases, rather than being antagonists.

[Splenoportography: still important technic. New prospects (author's transl)]. / Splénoportographie: une technique toujours actuelle. Nouvelles perspectives.

Splenoportography still plays today an important role among angiographic examinations used in the study of portal hypertension. The authors arrived at these conclusions after studying the results obtained in more than 500 examinations carried out. In the text, they give a few details of the technic used to improve the photographic result and to reduce the risk of the examination.

[Glucose tolerance and insulinemia in patients with hepatic cirrhosis and portal hypertension treated by portacaval anastomosis]. / Tolleranza al glucosio ed insulinemia in pazienti con cirrosi e patica ed ipertensione portale trattati con anastomosi porta cava.

Development of diabetes mellitus is a common complication of side to side porta-caval anastomosis (PCA). Five patients with liver cirrhosis and portal hypertension have been studied with intravehous (IVGTT, 0,5 g/Kg B.W.) and oral (OGTT, 1 g/Kg B.W.) glucose tolerance tests before and three weeks after PCA. Fasting plasma glucose was 84 +/- 7 before and 87 +/- 3 mg/dl after PCA. Fasting IRI increased from 17 +/- 3 to 31 +/- 6 microU/ml. The pattern of plasma glucose and IRI response to IVGTT did not change after PCA. Plasma glucose resonse to OGTT after PCA showed only an earlier rise at 60 instead of 90 minutes, whereas IRI resonse (area under the insulin curve) was significantly enhanced (from 12.4 to 19.8 U/l, p < 0.05). These data suggest a role of gut polipeptides in determining hyperinsulinemia and insulin resistence in PCA patients.