[The diagnostic procedure in deep venous thrombosis. The authors' experience]. / Iter diagnostico nella trombosi venosa profonda. Esperienza personale.

Diagnostic flow chart of 101 patients admitted with suspected TVP between 1987 and 1991 is discussed. In all of them Doppler cw and radionuclide venography with pulmonary scanning with albumin Tc 99 were performed. Since the 90's a triplex scanner was employed, usually after Doppler cw examination. Phlebography was considered as a golden backup. Pulmonary embolism was detected in 15% of patients and 2/3 were completely asymptomatic.

[Surgery of the carotid: the morphology of plaque and the clinical correlations]. / Chirurgia della carotide: morfologia della placca e correlazioni cliniche.

A consecutive series of 256 patients operated on of carotid endarterectomy for cerebrovascular atherosclerotic disease from January 1987 through December 1990 is presented. The following parameters were considered: clinical presentation, morphology of the carotid atherosclerotic plaque and topographic distribution of other concomitant atherosclerotic lesions of epiaortic arteries. 422 carotid lesions and 154 lesions of other epiaortic vessels were investigated by means of echo and color flow imaging, digital subtraction angiography and macroscopic observation of the specimen: 143 plaques proved grossly ulcerated. Unilateral lesions were 90 (35.2%) while bilateral disease was present in 166 cases (64.8%): 38.8% of subjects out of the first group and 30.2% out of the second were asymptomatic. Anterior and posterior neurological symptoms were equally distributed among both the 116 (69.8%) symptomatic subjects harboring bilateral lesions and the 55 (61.1%) symptomatic subjects with unilateral lesion (anterior 78.4% and posterior 21.6% for bilateral and 78.2% and 21.8% respectively for unilateral lesions). According to the degree of stenosis, the lesions were divided into three main groups: < 50%; 50-70%; > 70%. As the degree of stenosis increased, the incidence of focal symptoms increased too; moreover, the presence of ulceration of the stenosing plaque carried an increase in the incidence of focal symptoms within each group: respectively from 7.8% to 30% (< 50%), from 18.6% to 53.8% (50-70%), from 27.7% to 55.6% (> 70%). This study supports the relationship of morphological characteristics of the stenosing atherosclerotic plaques of the internal carotid artery to neurological symptomatology.(ABSTRACT TRUNCATED AT 250 WORDS)

[Femoral non-infected anastomotic pseudoaneurysm. Clinical contribution]. / Gli pseudoaneurismi anastomotici non infetti a sede femorale. Contributo clinico.

The femoral region is the most common site of development of anastomotic pseudoaneurysms that represent a relatively frequent complication of reconstructive vascular surgery. Clinical examination alone generally is sufficient to diagnose these lesions because they usually appear as a pulsatile inguinal mass not accompanied by pain. Echography and angiodynography permit a better evaluation of size and blood flow. CT is useful to evaluate proximal aortic anastomosis specially in pseudoaneurysms with septic pathogenesis. Rupture or thrombosis are rare clinical presentations. Vascular reconstructive surgery is always suggested in this sort of pathology. In this paper the Authors report the clinical experience acquired from 1980 to 1990 in the General and Cardiovascular Surgery Department of the University of Milan (Head: Prof. Ugo Ruberti) is 34 cases of femoral anastomotic aseptic pseudoaneurysms, analyzing the pathogenesis of this sort of lesion, describing the surgical solutions adopted and reporting the immediate and late results.

[The clinical picture and surgery of pheochromocytomas. Our experience over 25 years]. / Clinica e chirurgia dei feocromocitomi. Nostra esperienza in 25 anni.

The pheochromocytoma syndrome, caused by an abnormal secretion of catecholamines, is a rare pathology responsible for 0.1-2% cases of hypertension in the overall population considered. Although in the past we deemed the pheochromocytoma could cause prevalently the typical syndrome characterized by paroxysmal hypertensive crises, now we think that the usual clinical presentation is a continue or subcontinue hypertensive state (65%). In this paper the authors refer the clinical experience acquired in 25 years in the General and Cardiovascular Institute of the University of Milan (head: Prof. Ugo Ruberti), analyzing epidemiological aspects and pathogenesis of pheochromocytoma, with particular care to diagnostic methodologies and referring the therapeutic choices. From 1965 until today 40 patients have been surgically treated for pheochromocytoma mono or bilateral. 43 operations have been done, carrying out 46 adrenalectomy. Two complication must be referred: an ictus cerebri consequent upon an hypertensive crisis and one death caused by intraoperative ventricular fibrillation. Normalization of arterial pressure has been obtained in all patients.

[Paraganglioma of the neck. Analysis of 32 operated cases]. / Paragangliomi del collo. Analisi di 32 casi operati.

Between january 1965 and november 1990, 32 operations for neck paraganglioma were performed: 29 chemodectomas (carotid body tumors) and 3 paragangliomas of the vagus nerve. Seven subjects were affected with bilateral chemodectomas and one of them showed concurrent unilateral vagal paraganglioma. Two paragangliomas were malignant, with invasion of the latero-cervical lymphnodes revealed at operation. Four individuals came to observation from two different families, suggesting familiarity. Preoperative diagnosis was correctly made in 12 of 18 asymptomatic chemodectomas (66.6%), ten of whom observed during the last decade: angiography is the gold standard for diagnosis but CT scan, ultrasound and NMR imaging are going to earn the confidence of physicians for precise evaluation of latero-cervical masses. Surgery is to date the treatment of choice, and the results are dependent on the size of the tumor and the involvement of the neighbouring vascular, nervous and visceral structures. According to the majority of the literature, the 29 chemodectomas were classified in the three groups of Shamblin: I: 4 cases; II: 10; III: 15. Twenty out of the 24 transient or permanent postoperative complications took place in the third group: in five instances some procedures of internal carotid artery reconstruction were needed. Fourteen complications for chemodectomas and 2 for vagal paragangliomas affected the cranial nerves; three transient and one permanent ischemic central neurological deficits occurred in the group III chemodectomas. Not any operative mortality was registered in this series.

[Association of pheochromocytoma and renovascular hypertension]. / Associazione tra feocromocitoma e ipertensione nefrovascolare.

The case of a 47-year-old woman affected with right adrenal pheochromocytoma and right renal artery stenosis is presented. The concurrence of these two diseases is rarely reported in the literature, as shown by the review presented. Nevertheless, this association carries some problems as far as diagnosis is concerned, because missing renal artery lesion can lead to the maintenance of the hypertensive disease after surgical excision of the adrenal pheochromocytoma. Anyway, the extensive use of angiography is not justified for pheochromocytoma alone, because an excellent imaging of the mass can be achieved by means of non-invasive technologies, such as CT, echo B-mode, NMR. A careful evaluation of clinical features and non-invasive imaging and the presence of elevated plasma renin activity, although not determinant in surgical decision making, can support the suspicion of renovascular hypertension in the presence of pheochromocytoma and suggest to carry out renal angiogram and selective renal veins reninemia.

[Association of pheochromocytoma and phakomatosis. Apropos of a clinical case]. / Associazione di feocromocitoma e facomatosi. A proposito di un caso clinico.

Of the multiple endocrine syndromes, the association between pheocromochytoma, medullary thyroid carcinoma (MTC) and parathyroid-hyperplasia (Sipple's syndrome, MEN IIa), and the association of MTC, with multiple monocutaneous neuromas and with a characteristic facial appearance (MEN IIb syndrome) are well known. Furthermore in about 10% of the patients affected by Von Recklinghausen's disease (neurofibromatosis) a pheocromochytoma is present. A new classification of this important (even though rare) chapter of endocrine pathology was developed by Pears in 1968 when he hypothesized a common neuroectodermic origin for groups of cells diffused throughout the body and nested in different organs. The association of such different pathological conditions could be justified by a faulty development of these primitive neuroectodermic cells. This study aim to analyse a recently observed case of pheocromochytoma associated with Von Recklinghausen's disease. The Pathogenetic hypotheses of this rare pathological association, the diagnostic methods and the therapeutic procedures will be review.

[Abdominal aortic aneurysm and horseshoe kidney. Clinical cases]. / Aneurisma dell'aorta addominale e rene a ferro di cavallo. Contributo clinico.

The concomitance of horseshoe kidney and abdominal aortic aneurysm is rare but represents an interesting challenge for vascular surgeons. The trouble is greater if the diagnosis is formulated intraoperatively and specially if it is an emergency operation for aortic rupture or fissuration. The surgeon's aim is to get to the aneurysm collar without damaging the kidney, the renal arteries or the urinary tract that often have an anomalous development. The authors make a review of the literature and describe three cases occurred out of 2558 prosthetic reconstructions due to abdominal aortic aneurysm.

The concomitance of renal artery stenosis and Conn's adenoma in a hypertensive woman.

A case of adrenal aldosterone-secreting adenoma concomitant with active renal artery stenosis in a hypertensive middle-aged woman is reported. The concomitance of the two lesions was previously reported in the literature only in five more reports, that are mentioned and commented here. This association is thought to be almost anecdotal, but some remarks must be done in order to rule out the risk of leaving an ignored lesion at the time of the definitive treatment. The widespread use of noninvasive imaging techniques is effective to find unsuspected adrenal adenoma in the presence of renovascular hypertensive disease, whereas unknown renal artery stenosis can be revealed by more aggressive diagnostic attitude, that is justified only in well selected cases of Conn's disease.

[Functioning extra-adrenal paragangliomas]. / Paragangliomi extrasurrenalici funzionanti.

The diagnosis of extra-adrenal paraganglioma requires the recognition of catecholamine hypertension and the site of the lesion. I-131-MIBG scintigraphy, CAT scan and angiography may localize primitive and metastatic lesions. Six cases of extra-adrenal paraganglioma (5 abdominal, 1 thoracic) surgically treated with complete resolution of the hypertensive state are presented here.

[Primary mediastinal masses of benign nature. Clinical classification and criteria of therapy]. / Masse primitive del mediastino di natura benigna. Inquadramento clinico e criteri di terapia.

A consecutive series of 34 primary mediastinal masses of benign origin was operated on since 1970 through 1988. Many diagnostic techniques were performed, including traditional x-ray of the chest, scintigraphy, angiography; in the more recent years CT and NMR took the place of traditional tomography. In selected cases hormonal dosages were of value in clarifying the endocrine activity of the masses. The various diagnostic techniques performed are discussed as well as their effectiveness in the preoperative diagnosis of nature, benign or malignant, of the masses. This cannot be reached with precision without opening the thorax. The detail of the 34 cases is reported. In the light of the recent literature, the absolute need for surgical treatment of any mediastinal masses, even if asymptomatic, is debated. This aggressive surgical approach is the only effective way to establish the histological nature of the mass and, at the same time, to obtain the radical cure of the lesion.

[Loco-regional complications in the surgery of the subclavian artery]. / Complicanze loco-regionali nella chirurgia della succlavia.

Surgical treatment of subclavian artery atherosclerotic lesions has prophylactic significance in the evolution of cerebrovascular insufficiency. Local complications during interventions on subclavian artery are incidentally more significant than cerebral ischemic complications. Among local complications we reported 2 cases of phrenic nerve involvement and 1 case of thoracic duct lesion in a series of 86 operated patients. We never found cerebral ischemic complications in the surgery of subclavian artery atherosclerotic lesions.

[Prognostic evaluation of malignant tumors of the lower third of the rectum]. / Valutazione prognostica nei tumori maligni del terzo inferiore del retto.

Authors took into consideration 44 cases of neoplasm located in the lower third of the rectum. This site represents one of the most affected by the large bowel cancer and is also distressed by the highest frequency of late recurrences after curative resection. A careful follow-up of these patients has been made in order to define the survival rate in relation to different prognostic factors. To this purpose staging, grading and other morphologic features of the neoplasm turned out to be especially significant.