[Hematoma of the rectus abdominis as a complication of anticoagulant therapy with subcutaneously administered heparin calcium]. / Ematoma del muscolo retto addominale quale complicanza della terapia anticoagulante con eparina calcica s.c.

The use of anticoagulant therapy with subcutaneous heparin calcium has long become an established routine for both arterial and venous pathologies. However, albeit with a lower percentage than in intravenous anticoagulant therapy, it is not free from complications. The authors report their experience regarding two cases of hematoma of the rectus abdominis muscle that occurred after anticoagulant treatment with full dose subcutaneous heparin calcium in patients suffering from severe chronic obliterating arterial disease of the lower limbs. From a diagnostic point of view, in addition to the clinical examination of the patient, which often does not results in the decisive confirmation of diagnosis, ultrasound and computerized tomography are essential not only to confirm the suspected diagnosis but also to monitor the evolution of the hematoma over time. In both cases the hematoma resolved spontaneously following gradual resorption, although treatment, especially in cases in which the hematoma is not blocked by the suspension of anticoagulant therapy, may include surgical draining. In view of the frequency with which this treatment is used in arteriopathic or phlebopathic subjects, including elderly patients who may present concauses for the formation of a hematoma of the rectus abdominis muscle (connectivitis, chronic or acute renal insufficiency, hemodyscrasia in terms of hypocoagulation), the authors suggest that high-risk patients should be identified for the possible use of an alternative route of administration.

[Thoracic outlet syndromes. Arteriographic aspects]. / Sindromi dello stretto superiore del torace. Quadri arteriografici.

Chest outlet syndromes are characterized by pain symptomatology caused by (congenital or acquired reasons) compression of the vasculo-nervous bundle. After a brief mention of the anatomy of the question, the indications and angiographic technique are reported, special reference being made to certain positions and dynamic tests which increase symptomatology and highlight arteriographic findings. These are clearly identifiable in the pictures and offer documentary evidence of the cervical rib syndrome, scalenus syndrome, small pectoral syndrome, the hyperabduction syndrome and the costoclavicular syndrome. Differential diagnosis should consider a number of painful syndromes of the upper extremity of purely neurological interest (involvement of the brachial plexus). Vascular diseases such as arteriosclerosis, Takayasu's disease, etc., osteo-myo-articular and ORL sector diseases should also be taken into account. Arteriography is able to identify with precision the causes of the clinical syndrome and to guide surgical exploration of the supraclavicular fossa with excellent chances of success.

[Peripheral arterial embolism. Considerations on 101 cases (121 emboli)]. / L'embolia arteriosa periferica. Considerazioni su 101 casi (121 embolie).

The treatment of 101 patients with peripheral arterial embolism between 1970 and 1976 is discussed. Embolectomy was performed 98 times in 78 cases, antigoagulant and fibrinolytic management was employed in 19 cases, and primary amputation was necessary in the remaining four subjects. The limb was saved in 70% of those operated, while secondary amputation proved necessary in 14%. Overall mortality (after embolectomy and amputation) was 22%. Lastly, the therapeutic protocol used is discussed, together with the various factors that still prejudice the results of embolectomy.

[Hyperlipemias and obliterating peripheral arteriopathies]. / Iperlipidemie ed arteriopatie obliteranti periferiche

160 patients suffering from radiologically confirmed peripheral obliterating arteriopathy have been studied with respect to frequency of lipid alterations. The resulting data were compared with those observed in a group of clinically healthy subjects. In the arteriopathic series, lipid alterations were encountered in 44% of patients, with a percentage of 12.5% for Fredrikson type II, 7.4% for III and 24% for IV. In women, incidence attained 50% and type classification was 25% for the 2nd, 12.5% for the 3rd and 14.5% for the 4th. An alteration of 18.7% was encountered in the control group. The high frequency of hyperlipidaemia in peripheral vascular diseases reported in the literature and confirmed by the above data, justifies the employement of appropriate dietetic and pharmacological measures for the prevention and treatment of this arteriosclerotic disease risk factor.