[Prevalence of atherosclerosis in renal transplant recipients]. / Prevalenza dell'aterosclerosi nei pazienti portatori di trapianto renale.

BACKGROUND: Cardiovascular diseases are a major cause of morbidity and mortality after kidney transplantation. Renal transplant recipients have in fact accelerated atherosclerosis because of prolonged hemodialysis, arterial hypertension, dyslipidemia and other vascular risk factors. Studies concerning carotid and lower limb atherosclerotic changes in renal transplanted patients are at present scant. METHODS: In the present study the prevalence of carotid and iliac-femoro-popliteal atherosclerosis was evaluated by color flow Doppler in 99 patients 64 +/- 41 DS months after renal transplantation. Statistical analysis was used to correlate the presence and grade of atherosclerotic lesions with vascular risk factors and other clinical-laboratoristic parameters of the patients. RESULTS: The overall incidence of atherosclerotic lesions in the population studied was 54.5%; 46.5% of patients presented atherosclerotic plaques at carotid district, 43.4% at lower limb arteries and 35.4% at both districts. Two of these patients were symptomatic; one patient affected by claudicatio intermittens was submitted to conservative therapy, whereas another patient with abdominal aortic aneurysm underwent to surgical treatment. Univariate analysis showed a significant difference between males and females for lower limb atherosclerotic lesions (p=0.0013), whereas no correlation was found between carotid lesions and sex, or between smoke and atherosclerosis. Significant correlations were found by multiple correlations analisys between: the grade of atherosclerotic lesions in both districts and the patient age (p<0.0001); the grade of carotid atherosclerotic plaques and duration of pretransplantation dialysis (p<0.01); the grade of lower limb atherosclerosis and respectively glicemic (p<0.01), hematocrit (p<0.01), potassium (p<0.002) values, systolic blood pressure (p<0.02). CONCLUSIONS: Relevant rates of renal transplant recipients have carotid and peripheral atherosclerotic lesions. The study of aorto-iliac and lower extremity vascular atherosclerosis have important implications for the transplanted kidney functionality. Color flow Doppler represents a sensitive method for the follow-up examination of these patients.

[Uninodular bronchioalveolar carcinoma. Apropos of 10 operated cases]. / Osservazioni sul carcinoma bronchiolo-alveolare uninodulare. A proposito di 10 casi operatori.

BACKGROUND: This study reports 10 cases of uninodular bronchiolo-alveolar carcinoma (BAC) operated on in the General Surgery and Organ Transplantation Institute of the University of Parma between January 1st 1981 and December 31st 1995. METHODS: Seven patients were males and three females, mean age was 65 (DS 11, range 37-75) and globally accounted for 6.4% of all surgically treated lung malignant tumors. RESULTS: Hospital mortality was null; one patient was treated with assisted ventilation four days after surgery for respiratory insufficiency. Actuarial survival at 36 and 60 months was 48% and 36% respectively; survival rates were not significantly different at log-rank test from squamous carcinoma (46.2% at 36 months, 35% at 60 months) and adenocarcinoma (50.5% at 36 months, 34.3% at 60 months). The analysis of other series of literature shows significantly higher survival rates at 5 years for BAC than for adenocarcinoma (55.6% vs 40%). CONCLUSIONS: Broader series are needed for statistical confrontation with other histological types by stage and grade. There is no evidence of peculiar prognostic or clinical features in this histological type of pulmonary malignancy, prognosis so far is in fact conditioned by the same factors of other non small cell lung carcinomas.

[Lp(a) and the cardiovascular risk in dyslipidemia subjects]. / Lp(a) e rischio cardiovascolare in soggetti dislipidemici.

In this paper the presence of a correlation between plasma Lp(a) levels and peripheral vascular disease (PVD) and/or coronary heart disease (CHD) was investigated in 20 dyslipidaemic patients (10 males and 10 females, well matched for age, type of hyperlydaemia and other CVD risk factors). Lp(a) plasma levels, ECG and carotid and femoral arteries duplex ultrasonography were performed in all the patients. No difference in plasma Lp(a) levels between patients without and with carotid and femoral arteries stenotic lesions was observed. On the contrary Lp(a) was significantly higher in patients with ECG signs of coronary ischaemic heart diseases than in patients with normal ECG. These observations confirm the importance of Lp(a) as a risk factor for coronary heart disease in dyslipidaemic patients.

[Clinical suspicion and instrumental diagnosis of ruptured aneurysm of the abdominal aorta. Analysis of our experience]. / Sospetto clinico e diagnosi strumentale di rottura di aneurisma dell'aorta addominale. Analisi della nostra esperienza.

The authors report their experience in the management of 54 patients who underwent emergency surgery for rupture of an abdominal aortic aneurysm, correlating results to time of diagnosis. The overall mortality rate was 55.5%. The extent and the site of bleeding, free blood in peritoneal cavity or retroperitoneal hematoma alone, were critical factors influencing survival and were correlated to early of diagnosis. Patients with small hematomas had no mortality; cases with more extensive hematomas had a mortality rate of 53%; in case of intraperitoneal bleeding the mortality rose to 73% (p = 0.001). The median times between symptoms' onset and surgical intervention was correlated with a significant value to extent of retroperitoneal hematoma (p = 0.003). This time is also significantly different in dead patients compared to survivors (p < 0.001). In patients with incorrect admitting diagnosis the mean times between onset of symptoms and surgical treatment was significantly different from time of correctly diagnosed patients (p < 0.001). Our findings emphasize the need for rapid recognition of prodromal symptoms of rupture and the earlier referral of patients with known abdominal aneurysm; we suggest that in an unstable patient with a suspected ruptured aneurysm immediate surgery should be performed without delay for confirmatory tests or full resuscitation.

[Acute acalculous cholecystitis in patients submitted to severe surgical stress]. / Colecistite acuta alitiasica in pazienti sottoposti a stress chirurgico grave.

Acute acalculous cholecystitis in critically ill surgical patients is a clinical entity whose features are more and more clearly identified. Numerous conditions have been correlated with its onset (multiple transfusions, narcotic analgesics, total parenteral nutrition, mechanical ventilation with positive end pressure, major traumas and burns, dehydration and many more). The Authors reporting their experience in five cases envisage the multifactoriality of etiology, emphasize the significance of a timely suspicion and the role of ultrasonography as the most useful implements in the assessment of this disease.

[Recanalization with laser and angioplasty of atherosclerotic lesions of the legs. Personal experience with 31 treated lesions]. / Ricanalizzazione mediante laser ed angioplastica nelle lesioni aterosclerotiche degli arti inferiori. Esperienza personale su 31 lesioni trattate.

From January to November 1989, 31 iliac and femoro-popliteal atherosclerotic lesions were treated in 29 patients (age range: 33-80 years) by means of percutaneous laser-assisted angioplasty. The lesions were 6 iliac tubular stenoses, 6 iliac occlusions and 19 femoro-popliteal occlusions, 2-20 cm long. The laser equipment employed was in 10 cases a Cardiolase 4000 Nd:YAG "hot tip" unit, and in 21 cases a Nd:YAG "sapphire contact probe" unit. Initial success was achieved in 23/31 lesions (74%); the follow-up, by clinical examination, Doppler US, and ankle-arm pressure index performed every 4th month, showed 1-year actuarial patency of 80% for femoro-popliteal occlusion and 100% for iliac lesion, with 87% cumulative patency. Overall complication rate was 22.5%. There were 6 local complications, 4 of which were hematomas at the arterial puncture site, and 2 were performation of the superficial femoral artery, all without any clinical sequelae; one patient developed rethrombosis within 72 hours from treatment, which needed amputation after an emergency bypass. Our preliminary results show no significant improvement when compared with conventional balloon angioplasty results both in immediate success rate and in short-to-midterm patency; furthermore, laser therapy was burdened by a higher complication rate. We believe that laser angioplasty should be employed only in arterial occlusion uncrossable with angiographic guidance alone.

[Chylous ascites: a rare and awesome complication of aortic surgery]. / Ascite chilosa: complicanza rara e temibile in chirurgia aortica.

Chylous ascites is a rare complication in abdominal aortic surgery, there have been thirteen previously reported cases of chylous ascites after aortic surgery, both for aneurysmectomy or revascularization. This complication always represents a difficult problem in patient management because of the serious failures of the nutritional balance, the potentially dangerous immunological deficit and the frequent respiratory function impairment overcoming with various mechanisms. Analysis of ascitic liquid, which shows the aspect and chemical composition of chyle, is required to make the diagnosis. Several therapeutic pathways are possible for the treatment of this complication (paracentesis, reinfusion of chyle, diuretics, total parenteral hyperalimentation, medium-chain triglyceride diet, peritoneovenous shunt, operative closure) and the choice results in an association which is specific for each patient. This article describes a further case of postoperative chylous ascites after aortic surgery and envisages the main lines of the treatment of this iatrogenic pathology.

[Surgery of the saphenous-popliteal junction in the treatment of initial insufficiency of the small saphenous vein]. / La crossectomia dell'ostio safeno-popliteo nel trattamento dell'insufficienza iniziale della piccola safena.

Insufficiency of the sapheno-popliteal junction may be the first sign of varicose disease, and represents one of several ways that lower limb-venous insufficiency uses to present itself. Doppler ultrasound is particularly helpful in diagnosing this often subclinical insufficiency. Based on satisfactory results in a series of 18 patients treated between 1985 and 1988 (mean follow-up 1.5 years), the authors suggest treating sapheno-popliteal junction insufficiency by means of crossectomy, under local anesthesia, and on an out-patient basis. When surgical treatment is performed during the first stages of the disease, the consequent irreversible damages to the lesser saphenous vein due to stasis are avoided, and thereby, a true varicose state is avoided.