Fibrosclerotic lymphedema: pathophysiology and therapy.

We describe our experience with 12 patients with severe fibrotic lymphedema treated between 1979 and 1987. Each patient initially underwent nonoperative treatment (postural drainage and pneumatic compression) and in 10 patients who required operation, these measures were continued postoperatively. Operation included excision of subcutaneous tissue (debulking), which was extensive in 8 and limited in 2 patients. Only 2 patients were satisfactorily managed by nonoperative treatment alone. Based on the extensive pathophysiologic changes that occur in the tissue microenvironment with lymph stasis, it is unlikely that at this advanced stage of lymphedema that nonoperative treatment alone or "physiologic" operations such as lymphatic-venous shunt or lymphatic collector reconstruction is satisfactory. Rather, nearly all such patients require limited or extensive excision of the fibrotic-edematous subcutaneous tissue.

Atherothrombotic microembolism of the lower extremities (the blue toe syndrome) from atherosclerotic non-aneurysmal aortic plaques.

Six patients with no hemodynamically significant atherosclerotic lesions of the lower limb arteries but with ischemic changes of the feet or toes were studied and diagnosed as having atherothrombotic microembolism. All patients were non claudicators and had peripheral Doppler examinations on admission. Five patients experienced more than one separate episode of microembolization involving both extremities. None presented with a history of heart disease or diabetes. Biplanar arteriograms revealed in every case atherosclerotic degeneration of the aorta without any obstructing lesions and anatomical arterial continuity between the aorta and the site of distal embolization. Three patients who refused operation, were treated conservatively, with a combination of dipyridamole plus aspirin. Three other patients had surgical repair of their atheromatous infrarenal aorta: in two cases thromboendarterectomy was performed, and in the other a Dacron bifurcated graft interposition. No amputations resulted in the patients treated medically, but one of the surgical group lost one toe. This study confirms that atherothrombotic microembolism from an ulcerated atherosclerotic aorta is a potential threat to the extremities and indicates that the optimal therapy for this syndrome has yet to be found.

[Clinico-morphologic correlations of lesions induced by adriamycin administered in the thoracic aorta]. / Correlazione clinico-morfologica della lesione indotta dalla somministrazione di adriamicina sull'aorta toracica.

The Authors, on the basis of 9 casual radiographic observations of thoracic aortic ectasy in subjects affected of neoplasms and previously treated with antitumoral drugs, hypothesize a possible correlation between the use of adriamycin and the appearance of the aortic lesion. So, they suggest an experimental study on 12 rabbits. They administered adriamycin 2 mg/kg twice weekly for 5 weeks to 8 rabbits. The other 4 rabbits are considered as control group. After 24 hours from the end of treatment the Authors sacrifice 4 treated rabbits and 2 controls, and they examine the heart and the thoracoabdominal aorta. This procedure is repeated at 21th day in the other 4 treated rabbits and in the controls. The histopathological examinations show in the treated group the appearance of lesions especially in the media. These lesions are the elastic fragmentation, the medionecrosis and the cystic necrosis, they can be responsible of aortic ectasy.