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Background Catastrophic events have been correlated to increased incidence of cardio-vascular events, but no correlation between RAA and seismic activities have ever been investigated. Methods Hospital admissions related to RAA between January 2014 and December 2016 were retrospectively assessed in nine vascular centers of central Italy and correlated with date-matched seismic events. Correlation between RAA presentation and seismic event was first evaluated by Linear Regression analysis. Incidence of RAA events, mortality rate, and type of intervention were analyzed during seismic days (SD) and compared to outcomes during non-seismic days (nSD). Results A total of 376 patients were admitted with a diagnosis of RAA, and a total of 783 seismic events were reviewed. Twenty patients died before intervention (untreated). Open surgery was performed in 72.8%, endovascular treatment in 27.2%. General mortality at 30 days was 26.6% (30.5% for open surgery; 21.6% for endovascular treatment; P=0.24). Linear regression analysis between RAA and seismic periods revealed a significant correlation (slope=0.11±0.04, equation: y = 0.1143 x + 3.034, P=0.02). Incidence of RAA was 0.34 event per day during the entire period, 0.32 during nSD and 0.44 during SD (P=0.006). During seismic days, patients with RAA were older (80.5 years during SD vs. 77 years during nSD, P=0.12), were in poorer general condition at admission and remained untreated more frequently (8% SD vs. 4.7% nSD, P=0.3), and had a higher mortality rate at 30 days (46.2% SD vs. 27.2% nSD, P=0.012). Conclusions During seismic days, the incidence of RAA is higher in comparison to non-seismic days. Patients with rupture during seismic days have a higher risk of death.

Objective: to evaluate early and long term results of thrombolysis and surgery in acutely thrombosed popliteal artery aneurysms. Setting: retrospective study; teaching hospital. Materials: between 1990 and 2000, 109 popliteal artery aneurysms were operated on. In 24 patients acute leg ischaemia due to thrombosis of aneurysm was present. Methods: ten patients underwent urgent surgical intervention (group 1); and 14 thrombolysis with urokinase, until patency of popliteal and tibial vessels was achieved or for a maximum of 3 days (group 2). Ultrasonographic follow-up was performed at 1, 3, 6 and 12 months and then annually. Early results and follow-up data were analysed by chi-square test and life-table analysis (Kaplan–Meier curve) and late results were compared by mean of log rank test. Results: in group 1 early limb salvage was 70%; in group 2 it was 86% ( p =n.s.). When thrombolysis was successful, patency and limb salvage were 100%. There was no local or systemic complications during thrombolysis nor worsening of ischaemia. Follow-up was completed in 91 cases, with a mean duration of 26 months. Forty-eight months primary patency rate was better, even if not statistically significant, in group 2 than in group 1. Conclusions: in patients with acute leg ischaemia due to thrombosis of popliteal artery aneurysms, preoperative thrombolysis can be considered a safe and effective alternative to urgent surgery.

La ristenosi rappresenta una complicanza a medio-lungo termine della tromboendoarteriectomia (TEA) carotidea. La sua incidenza è piuttosto variabile e va da un minimo del 2% fino al 20–30%. Particolari problematiche pone l'eventuale trattamento della ristenosi ed il tipo di trattamento da adottare risulta senz'altro l'argomento più dibattuto. In 21 casi delle 1886 TEA eseguite (pari all'1,1%) è stato eseguito un trattamento della ristenosi. In 4 casi è stata eseguita un'angioplastica transluminale intraoperatoria. Non si sono verificate complicanze intra o perioperatorie. Tutti i pazienti sono stati reinseriti nel programma di follow-up clinico e strumentale come dopo la prima procedura terapeutica. In tutti i casi il buon risultato precoce si è mantenuto a distanza di 24 mesi.

An important element in the evaluation of biomaterials is quantification of the relationships and the sequence of events between blood elements, blood flow, and the foreign surface. We adapted a qualitative two-dimensional 111In-labeled platelet imaging method to a quantitative noninvasive analysis of platelet uptake/release kinetics for infusion catheters in a canine model. Bilateral femoral vein 6 Fr. Groshong catheters (one treated with a hydroxylated siloxane to improve albumin affinity) were monitored at femoral vein sites with a GE 400T gamma camera, interfaced with a Technicare 560 image acquisition computer. The field of view was sufficiently large that all events below the diaphragm were recorded without having to move the camera. Image acquisition time was 2.5 min; images were obtained every 5-15 min for 3 hrs. Continuous recordings were obtained from bilateral ultrasonic velocity probes, attached distal to the catheter implant sites. A 5 ml blood sample was placed in the field to permit calibration of gamma emissions per pixel in terms of labeled platelet density. Signal compensation for near field capillary perfusion was performed. The two-dimensional platelet distribution was computed and displayed. Local, time dependent platelet accumulation on the catheters and adjacent vessel walls was observed. Platelet accumulation proceeded in irregular steps during the implant period. Loss of local platelet deposits was observed. Downstream reattachment of platelet emboli was inferred from simultaneous reductions and increases in local platelet densities at two catheter positions. Platelet attachment was inversely related to vein blood velocity.(ABSTRACT TRUNCATED AT 250 WORDS)

Introduction Pancreatic cancer is still predominantly diagnosed in advanced stages, and 85%–90% of patients are not eligible for surgery at diagnosis. This is mainly due to the great difficulty in detecting the tumour at an early stage and presently no satisfactory results have been obtained to overcome this problem. Studies on molecular genetic profile of pancreatic cancer may represent an important approach. This study was focused on the mutations of p53 and DPC4 detectable in the bile of patients with histologically proven pancreatic cancers. Materials and Patients We analysed specimens of bile collected through percutaneous transhepatic biliary catheters, placed to treat malignant biliary obstruction in 25 patients with pancreatic adenocarcinoma. A percentage of mutation was obtained of 43 % for the microsatellite D17S945 (p53), 54% and 50 % for D18S46 and D18S474 (DPC4), respectively. The percentage of amplification was 67%, 93,6%, and 80%. Conclusion We consider the results encouraging enough to decide to enlarge the number of patients examined. The aim is to determine if a test for DPC4 and p53 mutations is eligible for introduction in clinical routine use. More sets of samples are required to satisfactorily answer this question. J. Surg. Oncol. 2004;88:210–216. © 2004 Wiley-Liss, Inc.

An important element in the evaluation of biomaterials is quantification of the relationships and the sequence of events between blood elements, blood flow, and the foreign surface. We adapted a qualitative two-dimensional 111In-labeled platelet imaging method to a quantitative noninvasive analysis of platelet uptake/release kinetics for infusion catheters in a canine model. Bilateral femoral vein 6 Fr. Groshong catheters (one treated with a hydroxylated siloxane to improve albumin affinity) were monitored at femoral vein sites with a GE 400T gamma camera, interfaced with a Technicare 560 image acquisition computer. The field of view was sufficiently large that all events below the diaphragm were recorded without having to move the camera. Image acquisition time was 2.5 min; images were obtained every 5-15 min for 3 hrs. Continuous recordings were obtained from bilateral ultrasonic velocity probes, attached distal to the catheter implant sites. A 5 ml blood sample was placed in the field to permit calibration of gamma emissions per pixel in terms of labeled platelet density. Signal compensation for near field capillary perfusion was performed. The two-dimensional platelet distribution was computed and displayed. Local, time dependent platelet accumulation on the catheters and adjacent vessel walls was observed. Platelet accumulation proceeded in irregular steps during the implant period. Loss of local platelet deposits was observed. Downstream reattachment of platelet emboli was inferred from simultaneous reductions and increases in local platelet densities at two catheter positions. Platelet attachment was inversely related to vein blood velocity.(ABSTRACT TRUNCATED AT 250 WORDS)

The symptoms of thoracic outlet syndrome (TOS) may be improved or cured either by physiotherapy or by a surgical operation. The choice of patients to be submitted to surgery must be performed on the basis of clinical picture and of non invasive and invasive assessment. Moreover the surgeon must choose the best procedure to relieve symptoms. The Authors on the basis of their experience and of a literature review refer to the various surgical approaches used in the treatment of TOS.

A 25 year old women presented an incidental adrenal mass which was diagnosed to be a pheochromocytoma before surgery by means of a positive 131-I-MIBG scintigraphy. Urinary vanilmandelic acid resulted repeatedly normal as well as basal plasma norepinephrine (NE), epinephrine (E) and dopamine (DA). Urinary homovannilic acid resulted in the normal range. Stimulation tests with iv glucagone, tyramine and metoclopramide evoked normal NE and E responses while a slight increase in plasma DA was observed after metoclopramide. Oral clonidine suppressed plasma catecholamines (CA) normally. Histologic and immunohistochemical studies confirmed that the tumor was a pheochromocytoma showing positivity for tyrosine hydroxylase but not for dopamine-beta-hydroxylase activity. This case is the first report on a completely asymptomatic pheochromocytoma presenting as an incidental adrenal mass which was investigated with repeated biochemical tests before surgery and demonstrates that, among the extremely variable functional attitudes of pheochromocytomas, a defect in CA synthesis and secretion is also to be included.

The frequency of acute ischemic graft thrombosis is increasing owing to the larger number of graft implantations. The possibility of success depends on detection of the reasons for the thrombosis and the ability to repair it. In addition lytic therapy must be considered during diagnosis followed usually by an adjunctive procedure like surgery or percutaneous transluminal angioplasty. With this kind of approach physicians are able to delay the surgery, to get more information about the vascular bed, and so to choose the most proper surgical procedure. At present the authors are using this protocol: 100,000 U bolus of urokinase and then 35,000 U/hour. During the application of this protocol certain laboratory parameters are monitored (fibrinogen, activated partial thromboplastin time, thrombin time, fibrinogen degradation products) in order to evaluate the coagulation system during therapy. Their protocol also includes serial controls by means of clinical examination, Doppler examination, and angiography. Angiography can be considered at the end of the therapy as a means of final evaluation and can detect those cases that need adjunctive therapy. Their experience is based on treatment of 47 graft occlusions in 44 men and 3 women, in whom they used urokinase. They divided the patients with late graft occlusions into two subgroups according to the occlusion level. The clinical results were good in 88.6°10 of cases in proximal and 75 ~Io of cases in distal occlusion. The overall lysis as determined by angiography was 85.707o in proximal and 41.7% in distal grafts. The authors found a significant difference in the time limit for starting efficient therapy of a thrombosed graft versus an atherosclerotic artery. In therapy of an occluded graft they were able to achieve patency by starting the thrombolytic infusion within nine hundred sixty hours after the occlusion. In terms of the Winsor index before and after therapy they noticed that the improvement was less evident than could be imagined from looking at the arteriographic results because of the pathologic status of the artery below the graft. In conclusion they recommend the technique of "low dose" catheter-directed therapy for its good results and its lack of significant systemic effects.

Purpose: To report the immediate and long-term outcome of intraoperative balloon angioplasty for the treatment of recurrent disease in the internal carotid arteries (ICAs). Methods: Three patients (2 males, 1 female; ages 53 to 70 years) presented with > 80% restenotic lesions (bilateral in one patient) at the distal aspect of a previous carotid endarterectomy. Two patients exhibited hemianopia, while the third was asymptomatic but had a contralateral ICA occlusion. All four lesions appeared smooth and fibrous on ultrasonography and were located high in the ICA. The location and morphology of the lesions made balloon angioplasty a more potentially successful treatment option. Results: Through open access to the common carotid artery, the lesions were approached and dilated under fluoroscopic guidance with monitoring of evoked potentials. The lesions were successfully dilated as determined by control arteriography, and no complications were encountered. Over a follow-up period extending to 18 months in one patient and 24 months in the other two, ultrasound imaging and arteriography have shown no restenosis at any treatment site. Conclusions: Although caution is prudent when dealing with lesions in the cervical arteries, balloon angioplasty may have a role in treating surgically in accessible restenotic carotid lesions that demonstrate a low potential for embolic complications. More experience with this technique will be required before widespread application of balloon angioplasty in the cervical vessels can occur.