[Spinal cord electric stimulation. Treatment of serious chronic ischemic syndromes of the limbs]. / La stimolazione elettrica del midollo spinale. Trattamento delle sindromi ischemiche croniche severe degli arti.

BACKGROUND: Aim of this study is to estimate the effectiveness of epidural electric stimulation of spinal cord for the treatment of patients with severe peripheral chronic arteriopathy who can't be surgically treated or when surgical therapy failed. METHODS: A retrospective study was carried out on 18 patients with peripheral chronic arteriopathy at clinical stage I of Fontaine classification; average age was of 60.08 years an they had rest pain and dystrophic lesions. Five patients couldn't be surgically treated. Stimulator catheter was placed in the epidural space and its action was evaluated studying lesion demarcation and pain resolution. RESULTS: In 16 cases there was a good pain control and in 14 patients lesion demarcation, while in 4 cases there was cases no improvement and amputation was necessary. CONCLUSIONS: Epidural electric stimulation of spinal cord is a valid treatment in selected patients for ischemia pain control and limb savage.

[Present-day role of vena cava filters]. / Ruolo attuale dei filtri cavali.

BACKGROUND: The purpose of the present is to assess the effectiveness of pulmonary embolism prevention using temporary or permanent vena cava filters in deep venous thromboses of the lower extremities with a discussion of indications and complications. METHODS: In the period between 1989 and 1998 we observed 46 patients (33 m, 13 f) suffering from deep venous thrombosis of the lower extremities. RESULTS: The cases treated with cava filter showed an improvement in clinical conditions in 15-19 cases with 4/19 cases of complications: filter ascent, lipothymia, one case of pneumothorax and one case of filter ascent with thrombosis of the contralateral venous axis. All complications were solved without further sequelae. After catheterisation of the femoral vein, the thrombosis of the contralateral venous axis in patients with caval filter was a frequently observed event (in 75% of cases). In the cases without filter, an evident improvement was observed in 22/27 cases, a slight improvement in 2/27 cases, with 3/27 cases of complications: two cases of cardiocirculatory arrest and one case of severe dyspnea with suspected pulmonary embolism which survived the event. CONCLUSIONS: From our experience, the use of caval filters is unquestionably useful for the prevention of pulmonary embolism, but is not wholly free from complications.

Possibilities at present for the application of lumbar sympathectomy in chronic occlusive arterial disease of the lower limbs.

BACKGROUND: Research on the limitations of the validity of lumbar sympathectomy in surgical treatment of lower limb occlusive arterial disease is still of great interest today. METHODS: Our study deals with 385 patients who underwent the surgical removal of a segment which includes the 2nd and the 3rd ganglion of the lumbar sympathetic chain in the period between the month of January 1989 and the month of December 1998. RESULTS: Results were good in 63.6% of patients and stationary in 10.53% of cases; in 26% of cases lumbar sympathectomy was not valid. CONCLUSIONS: Satisfactory results were recorded, as will be shown in this text, on patients experiencing a period of rest pain, patients with ischaemic dystrophic lesions and those with very advanced intermittent claudication equally favourable results were seen in diabetic patients.

Prosthetic infections.

BACKGROUND: The authors report the up to date trends regarding the etiopathology, diagnosis and treatment of vascular-graft infections. This paper concerns the responsible micro-organisms; the reference to the formation of anastomotic pseudo-aneurysm for the infections involving the lines of suture and the reference to the aortoenteric fistula. METHODS: A case study which refers to the period between 1990 and 1999 presents 19 cases of prosthetic infections out of 520 operations of implants of prosthetic materials. RESULTS: 11 successful, 7 amputations, 1 decrease. CONCLUSIONS: In the past years the results of the treatment have improved thanks to a more refined and codified therapeutical conduct and to the employment of prosthetic materials which are more resistant to infection, or to a greater attention paid to asepsis, before, during and after surgery to antibiotic prophylaxis before, during and after the operation. But, nevertheless graft infection still remains a dreadful complication for vascular surgery operations. The therapeutical approach is substantially aggressive and the removal of the infected prosthesis is essential. Nevertheless we believe that we should not underestimate open local treatment, which in localized and superficial infections and infections not involving anastomosis allows us to preserve prosthesis and make it root.

[Popliteal aneurysms. Personal experience]. / Gli aneurismi poplitei. Nostra esperienza.

BACKGROUND: The 70% of peripheral aneurysms are localized at the popliteal artery; approximately one third of patients are asymptomatic, but the occurrence of complications (acute ischemia, rupture) endangers the survival of the leg. The purpose of this paper is to demonstrate the validity of elective surgery for popliteal aneurysms, also for asymptomatic lesions. METHODS: Twenty-seven popliteal aneurysms were observed in 20 patients; only 7 of these were affected by a unilateral lesion, other 7 patients by a bilateral lesion and the remainder 6 patients by a polydistrict association; 3 patients refused the surgical therapy which was proposed. Prosthetic grafting with exclusion or resection of the aneurysm has been practiced in 16 cases; one time only a Dacron graft was employed, while the autologous saphenous vein was employed in 15 cases. A locoregional thrombolysis has been performed in 3 patients, in presence of an acute peripheral ischemia. In 5 cases a conservative approach has been chosen; these were asymptomatic aneurysms with a <2 cm diameter. RESULTS: In 87,5% of patients operated (14/16) a good immediate result was obtained. In a mean 2 years follow-up the 75% of these patients maintained the clinical result. The fibrinolytic therapy was resolutive in 2 cases of acute peripheral ischemia; a lumbar sympathectomy was necessary in one case. CONCLUSIONS: In consideration of the complications that the aneurysmatic disease can give, among which the acute peripheral ischemia is the most dreadful, a surgical approach is widely justified, also in the light of the good results described.

Thromboembolism in pregnancy: a new temporary caval filter.

BACKGROUND: Our aim was to check out the advantages of temporary caval filtration in pregnancy with a retrievable filter: Tempofilter (tCF). METHODS: During a period of 2 years we implanted tCF in four patients at the third pregnancy trimester with serious acute deep venous thrombosis (DVT) of the lower limbs for prophylaxis of pulmonary thromboembolic disease (TED) in the pre-partum, during Caesarian section (CS), and in the post-partum period. tCF has been placed percutaneously in local anaesthesia using the Seldinger technique and under image intensifier control. All procedures were performed in a polyvalent ICU. RESULTS: tCF positioning was always easy. No complications linked to the adopted technique occurred. No incidence of pulmonary embolism was reported (PE). The permanence period of tCF in situ was 14 to 29 days (mean+/-SD: 21+/-6). The CS always took place without complications either for the patient or for the foetus. CONCLUSIONS: The combined use of tCF and an anti-coagulating therapy resulted in an effective prophylaxis of TED for the pregnant woman without any interferences with CS and with no consequence as for permanent endovascular prosthesis for the young patient herself.

[A comparative evaluation of the efficacy of the excisional new attachment procedure (ENAP) relative to root planing in the etiological phase of periodontal therapy]. / Valutazione comparativa dell'efficacia della excisional new attachment procedure (ENAP) nei confronti della levigatura radicolare nella fase etiologica della terapia parodontale.

BACKGROUND: In the present study, the effectiveness of root planing has been compared to the excisional new attachment procedure (ENAP) during the etiological phase of periodontal therapy, after the supragingival scaling, in order to establish if a technique offering an easy access to the subgingival areas could reduce the need for a surgical phase in the periodontal treatment. METHODS: Twenty-seven patients, affected by moderate periodontitis, participated in this study; in each of them root planing was performed in a half of the oral cavity (control site) and the ENAP in the other half (test site). The main clinical parameters of periodontal health (probing depth--PD-, attachment loss--AL-, plaque index--PlI- and gingival index--GI-) were evaluated before and 1, 2 and 6 months after the periodontal treatment. RESULTS: The results of the study showed that the parameters related with the amount of plaque and with the conditions of the marginal gingival tissue were not influenced by the different treatments used. Better improvements were found in PD and AL values in teeth treated by ENAP compared to those treated by root planing; this result is explained by a better access to the roots offered by the ENAP. CONCLUSIONS: We can conclude that, within the limits of the present study, the ENAP can reduce the need for a further surgical treatment of the periodontal patient.

Expanded polytetrafluoroethylene and dental rubber dam barrier membranes in the treatment of periodontal intrabony defects. A comparative clinical trial.

As observed in previous case reports, dental rubber dam (DRD) can be utilized as a barrier membrane in the guided tissue regeneration (GTR) technique for the treatment of periodontal intrabony defects. The purpose of the present study was (1) to confirm the validity of DRD as a suitable material in regenerative procedures and (2) to compare, in a split-mouth clinical trial, the effectiveness of DRD-made membranes in the treatment of periodontal intrabony defects versus that of expanded polytetrafluoroethylene (e-PTFE) barriers. 22 systemically healthy non-smoker adult periodontitis patients (7 male, 15 female) aged between 35 to 58 years were selected for the study. In each patient, a couple of 2-3 wall intrabony defects, located in different quadrants, were treated by a GTR technique using DRD (test sites) and e-PTFE (control sites), respectively. Performing a strict control of the oral hygiene level and of the marginal gingival health during the whole period of study, clinical (pocket probing depth, PPD; probing attachment level, PAL; gingival recession, GR) and intrasurgical (depth of the defect's intraosseous component, IOC; level of the alveolar crest, ACL) parameters were recorded at baseline and at the 1-year re-entry procedure in each experimental site. Furthermore, the coronal level of the newly formed tissue from the base of the defect (NFTL) and the vertical bone gain (VBG) were calculated at the time of membrane removal and after the re-entry procedure respectively. Membranes were removed from both test and control sites after 5 weeks; however, exposure of the membrane always occurred in test sites whereas it was observed in only 6 out of 22 control sites, this fact leading to an incomplete coverage of the regenerated tissue by the gingival flap in 18 out of 22 test sites. In both test and control sites, a statistically significant improvement of clinical and intrasurgical parameters occurred at the end of the study period; however, a significantly greater improvement was observed in control sites for PAL (+4.0 mm versus +3.0 mm; p<0.05) and VBG (3.9 mm versus 2.9 mm; p<0.05) although at the time of membrane removal, NFTL was similar between the experimental sites (test: 5.8; control: 5.6; p>0.05). Conversely, test sites exhibited a statistically significant greater increase in gingival recession (+1.9 versus +1.2; p<0.05) and alveolar crest resorption (-1.1 versus -0.3, p<0.01) in comparison to controls. It was concluded that (1) DRD is a suitable material to be used as a barrier membrane in GTR procedures although (2) e-PTFE membranes can provide a greater improvement in PAL and VBG, probably because of the difficulty in completely covering the regenerated tissue due to the fact that the gingival tissues have undergone a consistent recession in DRD-treated sites. Further studies are needed to demonstrate if an adequate coverage of the regenerated tissue in DRD-treated sites can eliminate these differences.

[Hyperplastic gingival lesions in pregnancy. I. Epidemiology, pathology and clinical aspects]. / Lesioni gengivali iperplastiche in gravidanza. Nota I. Epidemiologia, patologia e clinica.

The principal aspects of the hyperplastic pathology which frequently appears during pregnancy and its epidemiological and clinical aspects are discussed. The existence of a particular kind of gingivitis, typical in pregnancy, not different from that appearing in not-pregnant women, let to hypothesize the existence of a relationship between the gingival lesion and the particular hormonal condition observed in pregnancy. Sometimes pregnancy gingivitis can show a tendency towards localized hyperplasia, this condition is defined pregnancy granuloma. Clinically a mass of variable size is observed; generally it appears in the 2 degrees-3 degrees month of pregnancy, with a tendency to bleeding and a possible interference with mastication. From a histological point of view, the pregnancy granuloma presents an inflammatory component characterized by lynphocytes, plasmacells and neutrophiles, an abundant vascular component with newly formed capillars and a great proliferation of fibroblasts. The differential diagnosis of pregnancy granuloma must be done with some forms of gingival hyperplasia, with pyogenic granuloma and with fibrous epulis (or hyperplasia). As to therapy, it is better to perform the surgical removal after delivery, considering that sometimes the lesions can spontaneously disappear. These lesions can reappear in a subsequent pregnancy.

Reconsiderations about the clinical importance of the sympathetic skin response.

Over the last few years, neurologists have been showing increasing interest in the study of the sympathetic skin response (SSR). In the present report we describe a simple method that permitted us to determine a wide variation of SSR in response to different stimuli such as respiration, deglutition, blinking, skeletal movements, biting, auditory or light stimuli, vocalization, and sphincter contraction. These results raise doubts about the role of SSR as a complementary diagnostic method.

Muscle carnitine deficiency in patients with severe peripheral vascular disease.

BACKGROUND: This study was designed to evaluate the effect of severe peripheral arterial insufficiency on carnitine concentrations and carnitine acetyltransferase and palmitoyltransferase activities in the ischemic skeletal muscles of patients with severe peripheral vascular disease. METHODS AND RESULTS: Nine biopsy specimens of ischemic muscles were obtained from five patients undergoing reconstructive vascular surgery. Biopsies from 35 normal subjects served as controls. Ischemic muscles showed a significant reduction in total carnitine from the control value of 20.9 +/- 5.2 to 11.6 +/- 6.2 nmol/mg noncollagen protein (p less than 0.01). A significantly lower free carnitine and acylcarnitine content contributed to this reduction. Similarly, carnitine acetyltransferase activity was reduced in the ischemic muscles from the control value of 102.1 +/- 41.2 to 52.9 +/- 22.1 nmol/min/mg noncollagen protein (p less than 0.01). On the contrary, carnitine palmitoyltransferase activity did not show any change (0.29 +/- 0.05 nmol/min/mg noncollagen protein in the ischemic muscles and 0.28 +/- 0.07 nmol/min/mg noncollagen protein in controls). Carnitine, acylcarnitines, and enzyme activities were also measured in the ischemic muscles in four additional patients 2 days after intravenous administration of L-propionylcarnitine (1.5 g as a single bolus followed by an infusion of 1 mg/kg/min for 30 minutes). Treatment restored normal levels of carnitine and its esters in the ischemic muscles but did not affect enzyme activities. CONCLUSIONS: Demonstration of carnitine deficiency in severe peripheral vascular disease substantiates previous findings showing the efficacy of carnitine supplementation to ischemic muscles. Furthermore, the feasibility of restoring carnitine homeostasis with L-propionylcarnitine provides the basis for clinical trials aimed at assessing the efficacy of this carnitine ester in the treatment of peripheral vascular disease.

[Measurement of cutaneous evaporation. 5. Cutaneous water loss in peripheral vascular disease]. / L'evaporimetria cutanea. Nota V. La coutaneous water loss (CWL) nelle angiopatie periferiche.

The purpose of this research is the measurement of the cutaneous water loss in 19 angiopathie patients by the Evaporimeter. Ep I in order to compare it with the values of normal people. We found a statistical significant increase of the CWL without difference between the normal and pathologic limb.

[Lipid-metabolic and blood coagulation factors in chronic peripheral arteriopathies]. / Su alcuni fattori lipido-metabolici ed emocoagulativi nelle arteriopatie croniche periferiche.

The authors have tested serum levels of cholesterol, triglycerides, HDL-cholesterol and LDL-cholesterol, with the plasmatic levels of Antithrombin III and other parameters (Quick time, PTT, fibrinogenaemia and platelets) in patients affected by chronic obstructive arterious diseases in various stages including a group of patients affected by diabetes mellitus. The results show that there is a correlation between the behaviour of the parameter tested and the follow-up of the diseases, particularly for HDL and LDL cholesterol and Antithrombin III. The authors suggest the use of these tests for monitoring this kind of vascular peripheral diseases.