TRANSLUMINAL RECANALIZATION AND DILATATION IN ATHEROSCLEROTIC OBSTRUCTION OF FEMORAL POPLITEAL SYSTEM.
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A case of pulmonary atresia with ventricular septal defect is reported where continuity between the right ventricle and the hypoplastic pulmonary artery was established interventionally. The atretic valve was perforated using a special "perforation needle" with a sharp and stiff distal and a flexible proximal part. Perforation of the bifurcation was well tolerated without later sequelae. After perforation of the atresia, dilation was successfully performed using 2, 4, and 7.2 mm balloons with a pressure of 10 atm; the arterial oxygen saturation increased from 72% to 84%. Four weeks later repeated "valvuloplasty" was performed (balloon diameters 8 mm, 9.5 mm, and 12 mm) and the "valve" ring was dilated to a diameter of 10.5 mm. Although no general conclusions can be drawn from this single application, mechanical perforation of the atresia could become an attractive interventional approach for the treatment of pulmonary atresia.
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The utility of coronary intervention in the treatment of multivessel coronary disease with complex morphology and damage to the myocardium remains controversial. What is certain is that drug treatment is often not adequate and surgical revascularization not always possible. A patient with occlusion of all coronary vessels who underwent a multivessel intervention is presented. Multivessel intervention can improve the left ventricular function and appreciably increase the performance of the patient. In similar cases, consideration should be given to percutaneous coronary intervention as an alternative to bypass surgery.
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BACKGROUND: Detorsion and cystectomy of twisted adnexa have been performed in young women. However, identification was incomplete, and the function of the affected tube was not investigated. CASE: A 23-year-old, nulligravid woman with an acute abdomen was diagnosed with adnexal torsion. An emergency laparotomy revealed that both ovaries were 12x9x9 cm. the right adnexa were twisted and bluish black. Detorsion of the twisted lesion and ipsilateral fallopian tube was performed, with subsequent cystectomy of both lesions. Hysterosalpingography on the 14th postoperative day showed right tubal obstruction; 6 months postoperatively, repeat hysterosalpingography revealed patency of the right tube. CONCLUSION: At least several months may be required for functional recovery of an untwisted tube. For that reason, postoperative repeat hysterosalpingography is a useful method for follow-up of function in an untwisted tube.
AIM: Restoration of colorectal continuity is the second step of the procedure originally described by H. Hartmann for the treatment of sigmoid colon cancers. It is a safe, but complex procedure, that needs a meticulous surgical technique and is associated with a significant morbidity in as many as 40% of cases. For this reason, many patients are not submitted to reversal of the colostomy. METHODS: The authors report their experience: 32 patients underwent colostomy closure after Hartmann's procedure during the last 8 years. RESULTS: The mortality rate was nil, but post-operative complications occurred in 12 patients (37.5%), namely: wound infection (11 patients) and anastomotic leak (2 patients). CONCLUSION: In light of this, it could be wiser to perform, in the patients affected with benign pathology, and in those affected with limited malignant pathology (T3), resection of the diseased segment of colon and primary anastomosis with temporary ileostomy, reserving Hartmann's procedure to patients unsuitable to one step treatment because of their poor general and local conditions.
A 47-year-old man was diagnosed with primary antiphospholipid syndrome and Budd-Chiari syndrome (membranous complete obstruction of the intrahepatic inferior vena cava), with edema and ascites refractory to medical treatment. The inferior vena cava membrane was punctured with a Brockenbrough needle under multidirectional fluoroscopic guidance via a transfemoral approach. The occlusion was dilated with balloons of increasing size and was subsequently stented successfully. At 1-year follow-up venography showed patency of the stent, and the patient remains asymptomatic 2 years after the procedure.
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