Thrombolysis with i.v. recombinant human tissue-type plasminogen activator in patients with bypass graft occlusion: a good adjunctive therapeutic mode (preliminary and case reports).

BACKGROUND AND METHODS: The authors report their experience with thrombolytic therapy in seven cases of graft thrombosis managed successfully with low-dose i.v. rt-TPA. In six patients the cause was an anatomical one and so, after the successful lysis, there was enough time to confirm a correct diagnosis and plan the "right" and "less extensive" surgical procedure, obviating it in one case with a "functional" cause of thrombosis. RESULTS: No complication directly attributable to rt-TPA infusion occurred, and no systemic fibrinogenolysis was registered in any cases. Judging from this experience, i.v. rt-TPA appears safe and effective in patients with graft thrombosis, proving to be a good adjunctive therapeutic mode. CONCLUSIONS: Further studies are needed do delineate more clearly safe indication and the validity of this method.

[Femoro-distal bypasses with the saphenous vein in situ. Our experience]. / I bypass femoro-distali con safena in situ. Nostra esperienza.

The authors report their experience with the femoral-to-distal in situ saphenous vein bypass. Evaluation of the distal circulation, the adequacy of the saphenous vein, and routine follow-up after bypass, along with the operative procedure and technical problems (A-V fistulas, valvulectomy, etc.) are described. Overall the in situ saphenous vein bypass provides a natural, compliant endothelial-lined conduit that allows an optimal revascularization to below-knee arteries.

[Pathophysiology of pancreatico-duodenectomy according to Traverso-Longmire. Clinical and instrumental study]. / Fisiopatologia della duodenocefalopancreasectomia sec. Traverso-Longmire. Studio clinico e strumentale.

The authors report their experience with 9 patients, affected by pancreatic and periampullary carcinoma, treated using pancreaticoduodenectomy with pyloric preservation. They analyse the physiopathology of this technique, by the light of the international reports, and note the advantages that this technique allows about the nutritional status and the quality of life of the patients operated on.

Finger-assisted laparoscopic surgery.

Advances in laparoscopic surgical procedures will facilitate the solution of specific problems, especially in emergency surgery. A simple technique of intracorporeal finger assistance, which permits a fast and safe solution in selected cases involving right and left lower abdominal quadrants, is described. The forefinger, introduced like a cannula, can be used to complete laparoscopic procedures in which there is potential risk for bowel injury or failure in using laparoscopic instruments.

Near velocity field downstream prosthetic valves in aortic position.

Using a cardiovascular simulator to duplicate in vitro the flow conditions through valves in aortic position, bidimensional velocity maps very near the valve are reconstructed, from an ultrasonic 8 Mhz doppler system, in an elastic model of the ascending aortic arch. Three mechanical heart valves representative of the different types of commercial models (a tilting disc, a ball in cage and a two-leaflet valve) and a new bileaflet prototype were investigated. From examination of the velocity field, it is possible to define the main characteristics of the valve wake and to observe the development of negative velocities associated with regurgitant flows. From a comparison with tests in rigid tubes, the role played by the arch elasticity is analysed.

[Pancreatoduodenectomy using the Traverso-Longmire technique in the surgical treatment of carcinoma of the pancreas and periampullary region. Our experience]. / La duodenocefalopancreasectomia sec. Traverso-Longmire nella terapia chirurgica del carcinoma pancreatico e della regione periampollare. Nostra esperienza.

The paper reports the study of 35 patients affected by pancreatic and periampullary carcinoma. The authors analyse the results of six patients treated using pancreaticoduodenectomy with pyloric preservation and compare the results to those achieved using Whipple's operation.

[Prognostic factors in thromboembolectomy with the Fogarty catheter for acute ischemia of the limbs]. / Fattori prognostici nella tromboembolectomia con catetere di Fogarty per ischemia acuta degli arti.

The Authors describe the results obtained in 181 patients treated with thromboembolectomy by Fogarty catheter for acute limb ischaemia. Data were analyzed with the help of a set of computer programs for statistical computations, and some highly significant prognostic factors were determined: ischaemia duration and severity cause a substantial increase of both death and amputation probability; associate diseases or thrombosis are significant factors for amputation; occlusion level for death. The patients whose limb was saved without the pulse being present were characterized by ASO or thrombosis.