Portohepatic gradient and portal hemodynamics in patients with cirrhosis due to hepatitis C virus infection.

We evaluated the agreement between wedged hepatic vein pressure (WHVP), portal vein pressure (PVP), and its relationship with portal hemodynamics in 21 patients with HCV-related cirrhosis with esophageal varices. Direct measurements of the portohepatic gradient (HVPG) were obtained by ultrasound-guided fine needle puncture of the right hepatic and the portal veins. In five cases PVP was 6.4-10.4 mm Hg higher than WHVP. In 12 cases measurements were similar (WHVP - PVP < or = 3 mm Hg). In the remaining four cases WHVP was 3.6-9.6 mm Hg higher than PVP. WHVP and PVP agreement was not related to HVPG mean value, Child-Pugh score, or grading of esophageal varices. By contrast, the difference between WHVP and PVP was inversely related to the portal flow velocity (P = 0.053) and directly related to the portal vascular resistance (P = 0.02). Whereas the portal branches were visualized in patients with WHVP lower or similar to PVP, a predominant left portosystemic collateral flow was observed in patients with WHVP > PVP. Our data point out that, in patients with cirrhosis due to hepatitis C virus infection, discrepant HVPG values reflect true hemodynamic differences.

[Role of arteriography and percutaneous transluminal angioplasty in the diagnosis and treatment of arterial vasculogenic impotence]. / Ruolo dell'arteriografia e dell'angioplastica percutanea transluminale nella diagnosi e nel trattamento dell'impotenza vasculogenica arteriosa.

High quality arteriographic studies of the iliopudendal vascular tree are mandatory for the correct examination of arteriogenic impotence patients before revascularization procedures. Twenty-three patients with chronic erectile dysfunctions due to stenosis or occlusive arteries diseases of the iliac arteries were treated with percutaneous transluminal angioplasty (PTA) in our Department. A positive clinical result was obtained in 15 of 23 cases (65.2%). The maneuver was successful in 8 of 14 patients with vascular lesions of the common and/or external iliac artery (57%). The erectile dysfunction was resolved in 4 of 6 patients with stenosis of the external iliac artery associated with a stenosis of the hypogastric artery (66.6%). The erectile dysfunction was also resolved in 3 patients with a single vascular lesion in the hypogastric artery. No major post-angioplasty complications were observed. PTA is a repeatable and not very invasive method with a low complication rate and could represent a valuable alternative to surgical revascularization in the patients with associated impotence and claudication of leg and hip. Moreover, it makes the treatment of choice in the patients with erectile dysfunctions due to isolated lesions of the hypogastric arteries.

A double-blind comparative study of the safety and efficacy of iomeprol in renal intra-arterial digital subtraction angiography.

This randomised, double-blind, parallel group study was to compare the safety, tolerance and diagnostic efficacy of iomeprol and iopamidol, both at an iodine concentration of 150 mgI/ml, in 40 patients with arterial hypertension who required renal intra-arterial digital subtraction angiography (IA-DSA) for suspected renovascular stenosis. All patients underwent extensive pre- and post-contrast clinical, instrumental and laboratory controls for safety assessments. The tolerance to the test contrast media was evaluated in terms of discomfort associated with the injection of the test compounds. Image quality was prospectively graded by two independent readers according to a five-point scale as follows: 1, insufficient; 2, sufficient; 3, good; 4, excellent; E, excessive. The quality of vascular opacification in the region of interest was rated as diagnostic in 87.8% of radiographs obtained in the iomeprol group and in 84.5% in the iopamidol group, without significant differences between the two study groups. The results of angiography were always useful for subsequent patient management. The procedure was always well tolerated. There were no clinically significant changes in vital signs, ECG and laboratory parameters during the study in both groups. The results of our study show that iomeprol 150 mgI/ml, and iopamidol 150 mgI/ml are equally effective, well tolerated and safe contrast agents when used for IA-DSA.

[Temporary caval filters. Indications, problems and results]. / Filtri cavali temporanei. Indicazioni, problemi e risultati.

The authors report their experience with the temporary placement of inferior vena caval filters to prevent pulmonary embolism in acute deep venous thrombosis patients. Twenty devices--6 Filcard and 4 Bruneau type--were positioned and left in situ over a time period ranging 4 to 14 days (mean: 9.8). In one patient the filter was positioned and no adjunctive medical therapy given to provide protection before nephrectomy; five patients were treated with i.v. heparin that provided no vein patency but prevented disease progression. Due to failure in positioning infusion guide catheters within the thrombus, four patients were submitted to fibrinolysis and heparin therapy: when the thrombus stabilized on angiographic images, heparin alone was administered and then followed by orally administered coumarin anticoagulants. In two cases partial thrombosis resolution was achieved, but with no significant improvement in patency rate. Ten patients underwent in situ fibrinolysis: six of them exhibited moderate improvement in femoroiliac axis patency and in three patients the inferior vena cava was successfully recanalized. No patient had any clinical evidence of pulmonary embolism. One case had cranial thrombus spread which was successfully treated with fibrinolysis. In our opinion, to control possible thrombotic involvement of the device, the patients candidate for temporary inferior vena caval filters must be easy to "manage" and exhibit no contraindications fibrinolysis and anticoagulant treatment.

[Role of phlebography in the study of recurrent leg varices]. / Ruolo della flebografia nello studio delle varici recidive degli arti inferiori.

In the last four years, 668 phlebographies of the lower limbs were performed in patients affected with varices. Recurrences were detected in 239 patients. Different phlebographic approaches were used, including ascending phlebography of the popliteal and femoral veins and varicography. Specific indications to different techniques are discussed and possible causes of recurrence are analyzed. In patients with recurrent varices, atypical venous drains were often observed, whose involvement could not be detected by either clinical examination or noninvasive instrumental evaluation. Therefore, phlebography represents a reliable and sensitive technique to recognize recurrent varices.

[Incompetence of the m. gemellus veins in varicose veins: its incidence and phlebographic study]. / L'incontinenza delle vene gemellari nella malattia varicosa: incidenza e studio flebografico.

The authors report on 466 venographies of the lower limbs performed over the past 2 years on 412 patients affected with varicose veins. Pathologic reflux of the gastrocnemius veins was observed in 15.7% of cases: 9.7% in the group of non-operated patients and 25.3% in the group with recurrent varicose disease. Ascending venography (and eventual popliteal venography) is the ideal diagnostic approach to show gastrocnemius veins incompetence, eventual anatomic variations, and isolated/associated incompetence of the short and/or long saphenous vein territory. Moreover, venography allows the hemodynamic evaluation, and shows reversed flow in the gastrocnemius veins in case of incompetence.

[Interventional radiology in the treatment of acute and chronic mesenteric ischemia]. / La radiologia interventistica nel trattamento dell'ischemia mesenterica acuta e cronica.

Radiologic revascularization procedures--i.e., percutaneous transluminal angioplasty (PTA) and fibrinolysis--are a valuable alternative to surgery in the treatment of stenoses and occlusions of the visceral vessels, that is the celiac tripod and the superior and inferior mesenteric arteries. We treated 32 patients, 10 of them with acute mesenteric ischemia and 22 with chronic mesenteric ischemia and clinical signs of angina abdominis. Grüntzig or pre-shaped Cobra or Simmons balloons were employed (diameter: 5-7 mm, with variable length) when PTA was performed. Urokinase or rtPA was employed for fibrinolysis. In 3 cases acute mesenteric ischemia was not occlusive and could be successfully treated with papaverine infusion. In 7 cases, acute mesenteric ischemia was occlusive: in 5 of these patients it was successfully treated by PTA and/or fibrinolysis. Our results were positive in 80% of the cases, with remission of clinical signs in 4 of 5 patients treated for acute mesenteric ischemia. In 22 patients with chronic mesenteric ischemia, 26 stenotic occlusions were observed at angiography and 22 were treated with PTA, which was technically successful in 21 instances (early success rate: 85-95%). At 24 months, 10% of restenosis was observed. In our experience, PTA of the visceral district, possibly preceded by loco-regional infusion of fibrinolytic drugs, can be widely applied and yields excellent therapeutic results.

[Selective arteriography in the study of arterial vasculogenic impotence]. / L'arteriografia selettiva nello studio dell'impotenza vasculogenica arteriosa.

According to the fundamental circulatory nature of penile erection, insufficiency of the arterial blood supply to the corpora cavernosa caused by an organic arterial disease is found in a large fraction of case, overall among the patients aged more than 40. It is possible to evaluate arterial origin of erectile dysfunction by using of noninvasive methods, but to obtain the necessary panoramicity and the characterization of the lesions it needs the use of angiography. Performance of standard arteriography leads to insufficient visualization of pudendal and penile vessels and risks false positive results. Because of penile hemodynamic variability in its different states is necessary the use of pharmacologic devices to perform a diagnostic arteriography. For the selective study of the pudenda and peniena vascularization we perform a selective arteriography bilaterally, with the catheter tip placed in the proximal part of the internal iliac artery. We use a contrast medium particularly diluted and mixed with xylocaine. We perform angiographic sequences after intracavernous injection of 8-10 mgr of papaverine to obtain the maximum blood flow and to prevent spasm of the terminal arterioles. Arteriography gives a complete study of the pudenda arterial tree and its terminal ramifications, and it is able to supply all the necessary informations regarding the planning of revascularization procedures. Treatment of arterial lesions is possible with surgical and radiologic methods. As in other arteries, percutaneous transluminal angioplasty (P.T.A.) can be applied in the therapy of impotence caused by arterial insufficiency. P.T.A. is the election treatment in the stenosis of the common iliac and internal iliac arteries.(ABSTRACT TRUNCATED AT 250 WORDS)

[Transluminal urethroplasty. Preliminary experience in 15 cases]. / Uretroplastica transluminale (TUP). Esperienze preliminari su 15 casi.

Thirteen patients with urethral stenoses of different etiopathology underwent TUP with an angioplasty balloon catheter. At follow-up, more than 10 months later, 8 out of 10 patients had normal urinary function. Excluding cases of urethral compression due to prostatic hyperplasia, 90% of the stenoses were successfully dilated. The gradualness of the dilatation, the application of a Foley catheter to maintain the dilatation obtained and the prevention of urinary infections are important factors for the success of this method.

[Diagnostic and therapeutic value of angiography of the mesenteric area]. / Valore diagnostico e terapeutico dell'angiografia nel distretto mesenterico.

The widespread diffusion of digital imaging progressively reduces the indications to conventional angiography in all vascular districts. On the contrary, angiography of mesenteric arteries still works as a valid complementary diagnostic tool in granulomatous and neoplastic lesions of ileum. Today, in selected patients, angiography is the first diagnostic approach to vascular ischemic and hemorrhagic pathology of ileum; timely resort to interventional angiography improve a dramatic prognosis.

[Transluminal esophagoplasty (TE)]. / Esofagoplastica transluminale (TE).

The authors analyze their experience on 9 cases of esophageal stenosis dilated by "Grüntzig" type balloon catheter under fluoroscopic examination (transluminal esophagus plastica: TE). This procedure also allows dilatation of severe narrowing, offering distinct advantages represented by: low risk, easy performance, good tolerance, reduction or disappearance of disphagia. Esophageal perforation is possible, though it never appeared in author's experience.

[Value of splenic embolization in patients with hypersplenism]. / Valore dell'embolizzazione splenica nei pazienti con ipersplenismo.

The authors describe the importance of embolization of the splenic artery by means of Gianturco coils in splenomegalic portal hypertension. They propose their first experience of six cases and the good results on the basis of clinical parameters, of bleeding of esophageal varices, of hematological values. They also show the influence of this method on hemodynamic, metabolic, and respiratory parameters, altered in cirrhotic patients.

[Angio-CT in the staging of renal carcinoma]. / L'angio-TC nello staging dei carcinomi renali.

The authors report the results about the staging of renal carcinoma using "angio-CT". The diagnostic accuracy, the sensibility, the specificity, in 42 patients, have been evaluated and compared with the subsequent operative or authoptic diagnosis. The meaning of this study is the comparison of the results obtained by this method in front of other examinations, especially artheriography.

[Splenic cavernous hemangioma. Presentation of a clinical case]. / L'emangioma cavernoso splenico. Presentazione di un caso clinico.

Cavernous haemangioma of the spleen is extremely rare both as a spleen condition and as a vascular malformation. The observation of a seven year old boy with this unusual pathology led to a review of the literature on the subject. Brief remarks on symptoms, diagnosis and therapy are also presented.

[Angioplasty of the renal arteries. Our experience with a 12-month follow-up]. / Angioplastica delle arterie renali. Nostra esperienza con un follow-up di 12 mesi.

We have treated 56 stenoses of renal arteries in 50 patients in which a renin assay indicated renovascular hypertension. In this paper we refer only to 40 cases of renal arteries angioplasty in 37 patients (3 cases of bilateral stenoses) with a clinical follow-up of 12 months. 25 lesions were of arteriosclerotic nature, while 15 were due to fibromuscular displasia. Results demonstrated that angioplasty resolved hypertensive conditions (either with or without medical therapy) in 82% of the cases of arteriosclerotic lesions and in 86% of the stenoses due to fibromuscular displasia. Although extremely rare, the complications that may occur with this procedure are very serious (arterial rupture, acute thrombosis, peripheral embolization). Out of utmost importance is a close collaboration with a vascular surgeon. Without doubt angioplasty will bring about radical changes in the preparation of therapeutical protocol and in some selected cases to improve renal function.