Bilateral ureteroarterial fistula: a case report and review of literature.

Ureteral arterial fistula (UAF) is an uncommon condition characterized by a direct fistulous communication between a ureter and an iliac artery resulting in bleeding into the ureter, which can be massive and life-threatening because of hemodynamic instability, as confirmed by the high mortality rate (7-23% overall).This condition is actually increasing in frequency because of its relation to predisposing factors such as vascular pathology, previous radiation therapy, previous surgery, and necessity of ureteral stenting. Diagnosis is often challenging, as in most patients, the only symptom is hematuria and the treatment may require a multidisciplinary approach, including the expertise of the urologist, vascular surgeon, and interventional radiologist. Endovascular approach offers advantages over open surgery decreasing morbidity (reduced risk of injury to adjacent structure) and shortening hospital staying. There is no consensus regarding the safety of intentional occlusion of the hypogastric artery: proximal occlusion of a hypogastric artery typically produces little or no clinical symptoms due to well-collateralized pelvic arterial networks. On the contrary, significant complications, such as colonic ischemia, spinal cord paralysis, buttock claudication, or erectile dysfunction, are well-recognized adverse events after hypogastric artery embolization, especially in bilateral cases. We describe our experience of a bilateral UAF treated with bilateral endvascular approach.

Cerebellar pathology and micturitional disorders: anatomotopographic and functional correlations.

Cerebellar diseases represent about 2-3% of neurologic pathologies; they usually are classified as:--heredodegeneratives--pure cerebellar syndromes. Such diseases--aside from their aetiology--lead, through several evolutive stages, to different micturitional disorders, in most cases represented by hyperreflexic non dyssynergic bladder and urinary incontinence. On the basis of anatomopathological studies, also considering our 16 years long personal series (1992-2008), we were able to establish a relationship between such disorders and specific cerebellum anomalies, mostly of Purkinje network.

Gastrointestinal stromal tumor presenting as a large abdominal mass.

OBJECTIVE: We report on a male patient operated on for a mesenchymal tumor of the digestive tract presenting a mega cyst-like abdominal mass. MATERIAL AND METHODS: The size of the lesion was magnum, the mass presented as unilocular, the wall thickness was not uniform (0.1 to 1 cm) with hemorragic areas, the lesions were multiple measuring 3x2 cm and less, the mitotic index was borderline. The diagnosis was histologically defined as GIST borderline (low mitotic count and tumor size < 5 cm). The ultrasonography and TAC were unable to diagnostic information. CONCLUSION: The GIST presents no specific signs and the most frequent symptoms are abdominal pain and abdominal mass, the CT scan and ultrasonography are sensitive in the evaluation of location, size, invasion of adjacent organs but not for diagnosis. Prognostic predictions are on the basis of mitotic index and tumor size (1). The precise cellular origin of GIST (2) has recently been proposed to be the interstitial cell of Cajal, an intestinal pacemaker cell. The gain-of function mutation of c-kit (receptor tyrosine kinase--KIT positive tumor) proto-oncogene has been detected in GIST and its role in molecular pathogenesis has been established. The treatment of unresectable and metastatic lesion is Imatinib mesylate, inhibitor of tyrosine-kinase activity (Gleevec, Novartis).