Intestinal artery aneurysms are a rare clinical condition, usually asymptomatic. However, sometimes they occur as vascular emergency, with a mortality rate of about 75%. Therefore, their occasional ...diagnosis should be carefully considered as an indication for elective surgery. The authors report their experience in the surgical management of 3 cases of intestinal artery aneurysms respectively involving the splenic, the gastroduodenal and the inferior mesenteric artery. A review of the literature is also presented.
The Longo technique using a circular stapler has changed haemorrhoid therapy. Thanks to the advent of this technique for treating haemorrhoids without excision, we can now successfully eliminate the ...mechanism responsible for their pathogenesis. The aims of circumferential stapled anoplasty are to correct the anodermal prolapse and restore the haemorrhoidal cushions to their anatomical position. Furthermore, with a few variants the technique can be utilised for other proctological problems, such as obstructed defecation in rectocele and incomplete internal prolapse (or rectal intussusception). The authors report on their experience in a consecutive series of 122 cases undergoing circular stapled anoplasty for haemorrhoids, associated in 10 cases with rectocele or rectal intussuscep-tion, analysing early and late complications after an accurate follow-up. The procedure can be performed with local or spinal anaesthesia. The operation lasted on average 19 minutes. There were few complications: early bleeding (4.9%), late bleeding (0.8%), mild stricture (2.5%) and thrombosis of external piles (8.2%). This new surgical technique is effective and rapid, causes only minimal postoperative pain and could be proposed as an alternative to traditional surgery also in the day surgery setting.
The authors review their experience in the surgical management of rectal cancer. They analyze rectal malignancies and their recurrences from natural history to surgical strategies and survival rates. ...In particular, the need to perform extended operations in order to offer patients a better prognosis is discussed.
A computer controlled mechanical arm for stereotaxy is presented. It has 5 free joints and can be attached to a stereotactic frame. High precision digital encoders register the angular position of ...each joint and the computer determines the position of the tip of the instrument in the stereotactic space. Accuracy and usefulness are discussed.
The chances of pregnancy for uremic women are usually very low, because of hormonal balance changes which determine a strong reduction in fertility. Epidemiological studies reveal that pregnancy in ...hemodialyzed women in fertile patients 4.6-6 months after a well functioning kidney transplant, one fertile transplanted woman over 50 can become pregnant. In the first transplant era, pregnancy after kidney transplant was considered "a big hazard", especially because of the possible side-effects of immunosuppression drugs on foetus development, and the risk of a worsening in the mother's renal function. Therefore, women were strongly recommended to avoid pregnancy. More recently, several reported papers have shown that pregnancy can be safely carried on also by transplanted women, under careful criteria and monitoring. Our experience too, even if limited in number (4 patients) reported in this article confirms this conviction.
The elevation of the uremic population age, the longer survival of dialysis, the increasing number of elderly donors, together with the safer surgical, anesthesiological and immunological procedures ...have led all over the word to an improvement of over 60s patients transplantation program, with very good results. The authors present their own experience of renal transplantation in elderly recipients and a review of what is reported in the literature on the question.
Natural history and outcome of percutaneous transluminal renal angioplasty (PTRA) in renovascular hypertension (RVH) were assessed retrospectively in 52 patients in whom 62 PTRAs were successfully ...performed. Complications were observed in 16 patients: prolonged and extensive arterial spasms in eight, severe intimal dissection of the main renal artery in five, arterial thrombosis at the site of PTRA in two and acute deterioration of renal function in one. All the complications cleared up with medical treatment except for one major dissection occluding the distal branches, which required surgery. According to the Co-operative Study, after 1-5 years of follow-up, 21 patients (40.4%) were cured, 27 (51.9%) improved and four (7.7%) did not improve. The long-term results on blood pressure in both uncomplicated and complicated cases were better in fibrodysplasia (61.5% cured, 34.6% improved and 3.8% not improved) than in atherosclerosis (17.4% cured, 69.6% improved and 13% not improved). In the last 21 PTRAs performed, in which verapamil (200-1500 micrograms) was given as a bolus injection into the stenotic artery before dilatation, the complication rate was significantly lower. It is concluded that PTRA is an effective treatment for RVH; complications occurred in 25.8% of PTRAs and resulted in poor control of blood pressure in atherosclerosis but not in fibrodysplasia; premedication with verapamil into the stenotic renal artery reduced the complication rate.
Hypertension is often associated to other risk factors, such as abnormal lipid and carbohydrate metabolism, which should be considered for the choice of antihypertensive drug treatment. Doxazosin is ...a postsynaptic alpha-1 adrenoceptor blocker suitable for once a day treatment regime. It seems to induce fewer side effects than older drugs of the same class and it may improve lipid and carbohydrate profile, thereby reducing the risk of coronary artery disease. To verify its effects on blood pressure, serum lipids and glucose tolerance, doxazosin (1-8 mg od) was given for 8 weeks to 32 patients suffering from essential hypertension, of whom 16 had fasting serum cholesterol higher than 6 mmol/l and/or fasting serum triglycerides higher than 1.9 mmol/l. Sitting and standing blood pressure were significantly reduced (from 163 +/- 18/101 +/- 6 mmHg to 147 +/- 19/94 +/- 8, p less than 0.001 and from 162 +/- 18/107 +/- 9 to 145 +/- 18/95 +/- 8, p less than 0.001, respectively) at a mean daily dose of 5 mg. Normotension or a good hypotensive response was achieved in 60% of the patients. The daily dose which turned out to be effective in 50% of the patients was 7 mg. The drug treatment was well tolerated and orthostatic hypotension was never observed either on starting treatment or on increasing dosage. Blood lipids and glucose tolerance were not significantly affected. Doxazosin is therefore an effective antihypertensive agent suitable for use in patients with essential hypertension alone or combined with hyperlipidemia.
Short term angiotensin converting enzyme inhibition may induce a transient salt and water retention in patients with hypertension or heart failure. To verify the glomerular and tubular effects of ...short term converting enzyme inhibition, thirteen patients with mild to moderate essential hypertension (WHO I-II) were treated orally either with perindopril (4 mg o.d.) or captopril (25 mg b.i.d.) for one week. Both drugs reduced supine mean blood pressure significantly (p less than 0.01) (perindopril from 126 +/- 11 to 108 +/- 7 mmHg, mean +/- SD, and captopril from 132 +/- 12 to 121 +/- 16). Plasma volume (radio-iodinated albumin space) was unchanged while mean extracellular fluid volume (inulin space) increased although not significantly (from 5.05 +/- 1.32 l/sqm to 5.71 +/- 2.21 with perindopril and from 4.96 +/- 2.6 to 5.6 +/- 1.7 with captopril). Sodium clearance decreased (from 1.4 +/- 0.6 to 1.1 +/- 0.5 ml/min 1.73 sqm with perindopril, p less than 0.05, and from 0.97 +/- 0.44 to 0.88 +/- 0.51 with captopril, n.s.). In 9 patients (6 on captopril and 3 on perindopril) extra-cellular fluid volume increased simultaneously with reduction in glomerular filtration rate and in proximal tubule sodium re-absorption as well as an increase in distal tubule sodium reabsorption. In these patients the changes in proximal and distal tubule sodium reabsorption were significantly (p = 0.05) different from those of the patients with no extra-cellular fluid expansion.
