Endovenous thermal ablation. Standardization of laser energy: literature review and personal experience.

Endovenous laser treatment is a new, minimally invasive technique for ablation of the incompetent great and small saphenous vein and their tributaries. Although the satisfactory safety/efficacy results of this technique, literature is poor regarding standardization of the energy needed to ablate the incompetent vein in order to have success and durability of the procedure. The aim of this paper is a review of the literature to find out if authors with large experience on endovenous laser treatment achieved a standardization of the delivered energy at the incompetent vein wall and if new concepts proposed by the authors, like cold saline anesthesia, echogenic vein occlusion and regular distribution of laser energy to the vein wall, can improve the technique in order to have optimum results.

[Benign monoclonal gammopathies: probable antibody specificity of monoclonal immunoglobulins]. / Gammopatie monoclonali benigne: probabile specificità anticorpale delle immunoglobuline monoclonali.

40 patients with benign paraproteinemia have been studied in relation to their age and associated diseases. Significantly high frequency of liver diseases (CALD, cirrhosis, hepatoma, metastases) has been found (12 over 40 people) and increased incidence of idiopathic paraproteinaemia in the old age has been confirmed. 9 patients have been followed for 5 years, so that one could be sure that they had really benign paraproteinaemia: these patients have been then studied from an immunological point of view, in vivo by means of skin tests (PPD, Candida, Trichophyton, DNCB) and in vitro by searching for circulating immune complexes (using a new highly specific immuno-enzymatic method), and compared to controls without paraproteinaemia. Highly positive skin tests have been found only in 7 over 9 patients (even in old subjects) and 6 of them had circulating immune complexes (C.I.C.) in their sera; all the controls were negative both for skin tests and for C.I.C. Immune complexes have been found also in some cases of idiopathic paraproteinaemia, so that they do not seem to be in relation to the associated diseases. The Authors suggest that a genetically determined defect in regulator/suppressor T lymphocyte activity may cause the growth of a benign B cell neoplasm; and that monoclonal immunoglobulins most probably have antibody specificity and are directed against target antigens.