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PubMedDate not supplied

[Morphologic study of the microcirculation in connective tissue diseases].

Capillaroscopy is a non-invasive diagnostic test used to study microvascular abnormalities which are present in many disorders, particularly some rheumatic pathologies, such as connective tissue diseases. In systemic sclerosis, capillaroscopy allows detection of pathognomonic microvascular alterations. In other connective tissue diseases, including systemic lupus erythematosus, dermatopolymyositis, undifferentiated connective tissue diseases, and mixed connective tissue disease, the capillaroscopic patterns, although non-specific, can provide a valid support for the diagnosis. In Raynaud's phenomenon, capillaroscopy enables detection of early microvascular abnormalities that are useful for preclinical diagnosis of secondary Raynaud's phenomenon.

Connective Tissue Diseases↗
PubMed2001

[New coronary imaging modality. I. Digital angiography (cineless) and low-energy digital fluoroangioscopy systems].

The advent of digital medical imaging offered unique new possibilities of analyzing, visualizing and communicating medical images. This article reviews the impact of the digital technology in the cardiac catheterization laboratory and covers a range of topics such as the standard DICOM, the transition to cineless angiography, the digital cardiac archive, the network system for imaging exchange and the role of the cardiac digital mobile imaging systems.

Angiography, Digital Subtraction↗
PubMed2001

Relevance of diffusion and perfusion weighted mri for endovascular treatment of vasospasm in subarachnoid hemorrhage.

The endovascular treatment of vasospasm is effective when implemented rapidly. However its indication often proves difficult on account of the lack of diagnostic arguments or the difficulties in obtaining them in daily practice. We report a case that highlights the relevance of MRI in the decision-making process. A 37-year-old patient presented with symptomatic vasospasm of the middle cerebral artery and was subjected to morphological, diffusion- and perfusion-weighted MRI. These investigations confirmed the presence of significant oligemia in the MCA territory and revealed onsetting diffusion disorders. Angioplasty was immediately performed, resulting in normal diffusion and hemodynamic parameters and complete regression of clinical signs. This case highlights the relevance of MRI when assessing vasospasm before treatment. Coupled with transcranial Doppler, it should help teams quickly select patients most likely to benefit from angioplasty.

Adult↗
PubMedDate not supplied

[Endovascular treatment of dissecting aneurysms of the posterior cerebral artery].

In the literature, there are few reports of posterior cerebral artery aneurysms resulting from isolated dissections. In these cases the treatment is still a matter of discussion and includes anticoagulation, surgical intervention, endovascular techniques and conservative management. We present five cases of Posterior Cerebral Artery (PCA) aneurysms, with angiographic criteria of dissection (double lumen, proximal narrowing), all being situated at the P2 segment, three being close to the P1/P2 junction. In one case, a large aneurysm ruptured during the attempted catheterization with subsequent death of the patient. In three patients occlusion of the parent vessel was performed with Guglielmi detachable coils located proximal to the aneurysm, with no new neurological deficits. In the other case there was spontaneous thrombosis of the aneurysm. Occlusion of the parent vessel by endovascular techniques in dissecting PCA aneurysms has a low probability of neurological deficits and seems to be an appropriate approach for these aneurysms.

Adult↗
PubMed2001

[Endoscopic perforating vein surgery. Review of the literature and personal experience].

The endoscopic treatment of perforating veins incompetence of the legs has been recently introduced as an effective surgical therapy in serious cases of chronic venous insufficiency. According to CEAP classification, the primary indication is set on the class 5 or 6 patients, affected by active ulcers or relapsing ulcerative lesions. During the last two years, 53 operations of SEPS have been performed at the Vascular Surgery Unit of G. Salvini Hospital in Garbagnate Milanese. Here we present A perspective study of 24 cases with a 6 to 18 months follow-up is presented. In 8 patients (33%) an active ulcer was present, while in 16 cases history of relapsing ulcers was described. After the first month, all the lesions were healed and a subjective clinical improvement of the hypodermosclerosis was observed. At 12 months follow-up new ulcerations appeared only in four patients. On the basis the experiences of many authors and the results obtained in this study, following conclusions are made: the best results are achieved in case of sole perforating veins incompetence; the insufficiency of superficial venous circulation must be treated simultaneously or better previously, considering later the operation on the perforators veins; the sclerotherapy is introduced to cure the ectasic superficial veins in order to avoid a sponge effect with a precocious reappearance of the ulcers.

Adult↗
PubMed2001

[Role of the subfascial endoscopic perforating veins surgery in the treatment of venous ulceration: physiopathology and diagnosis].

Chronic venous insufficiency is a recurrent pathology, but affected patients often undergo clinical observation at a most severe and clearly symptomatic stage of the disease. In this late stage, therapy can only relieve symptoms of the disease which often lead to disability. In the clinical course of chronic venous insufficiency, phlebostatic ulceration constitutes a recurrent finding and it is responsible of compromising patients quality of life. The role of perforating veins, made refluxive by various pathogenic noxa, in the genesis of ulcerative lesions has been known since long time. For many years the interest in perforating veins surgery has been limited because of the several negative consequences of the operations. The possibility of modifying the hemodynamics of perforating veins compartment without causing post-operation complications by video-supported surgery, led to the debate on the role of these vessels in the chronic venous insufficiency. The phlebostasis non-invasive diagnosis uses imaging techniques consisting in tests which mostly are cheap, simple and easy to perform, thus representing the best early approach to the patient. It is widely thought that even though complex examinations are available, most precious information can be obtained by only two examinations: color-Doppler ultrasonography and, limitedly, plethysmography. By these diagnostic directions it is possible to better identify the site and the hemodynamic origin of the venous insufficiency.

Angioscopy↗
PubMed2001

[Uretero-iliac artery fistula: endovascular treatment. Complications of prolonged use of double J endoprosthesis].

The authors report a case of fistula between the external iliac artery and the left ureter, in a patient with a double J stent for several years to treat iatrogenic ureteric stenosis. The diagnosis was suggested by the patient's history and the presence of bright haematuria from the left ureteric meatus. Interventional radiology established the positive diagnosis and allowed treatment by placement of a covered prosthesis in the external iliac artery. This is the fourth published case of endovascular treatment of an iliac uretero-arterial fistula.

Aged↗
PubMed2001

[Multivariate analysis as a method of determination of anthropogenic load on the course of Raynaud's disease in patients with systemic scleroderma and systemic lupus erythematosus].

AIM: To determine the effect of high industrial pollution on development of Raynaud's syndrome and impairment of pulmonary hemodynamics in patients with scleroderma systematica (SS) and systemic lupus erythematosus (SLE). Two groups of patients were examined: 20 SS and 33 SLE patients living in highly polluted territories, 15 SS and 27 SLE patients living in moderately contaminated territories. The tests included capillaroscopy, thermography, rheovasography of the fingers, zonal rheopulmonography. Semiquantitative spectral analysis measured content of 3 trace elements (Ti, Ba, Li) and 16 heavy metals (Cu, Zn, Pb, Ni, Mn, Sn, Cr, Y, Ga, Ag, Mo, Bi, Co, Cd, Fe, Zr) in the patients' hair. RESULTS: Patients living in highly polluted areas had a severe course of Raynaud's syndrome. Metal accumulation is decisive in patients of group 1; in development of staging of Raynaud's syndrome the key role belongs to lead, nickel, tin and iron; realization of the factor of the disease activity is related to lowering of zinc, copper concentrations and growing concentration of nickel. CONCLUSION: Vascular disorders in SS and SLE in patients living in heavily contaminated areas aggravate due to direct damage from heavy metals.

Environmental Pollutants↗
PubMed2001

Endoscopic radial artery harvest: a new approach.

BACKGROUND: Although early attempts to use the radial artery (RA) as a conduit for cardiac revascularization met with disappointing results, recent data have shown the RA to achieve very good short-term patency as well as promising mid-term patency results. The recent increase in the frequency of coronary reoperations, with their limited options for vascular conduits, has also stimulated an interest in the RA graft. The success of minimally invasive vein harvesting techniques encouraged us to develop a minimally invasive technique for harvesting the RA from the forearm, which is reviewed in this article. METHODS: The endoscopic harvest technique was employed on more than 120 nonselected patients at our facility over a 12-month period. The procedure involved exposure of the RA under direct visualization and without direct manipulation, using an endoscopic dissector and harmonic shears. Side branches of the RA were isolated and divided, and the vessel was removed and side branch occlusion verified. The harvested RA was then prepared for the revascularization surgery. RESULTS: The patients who underwent the procedure showed no evidence of graft spasm or occlusion in the immediate postoperative period. Patients also preferred the small endoscopic incision to the full forearm incision of the "open" technique. CONCLUSIONS: Our experience indicates that endoscopic radial artery harvesting is a safe technique that achieves good short-term patency results and improved patient satisfaction. Evaluation of long-term vessel integrity is needed, and a comparison of the minimally invasive and the open technique has been initiated.

Angioscopy↗
PubMedDate not supplied

Nailfold capillary abnormalities in patients with familial Mediterranean fever.

OBJECTIVE: To determine the frequency and the degree of the nailfold capillary abnormalities in patients with familial Mediterranean fever (FMF). METHODS: We studied 67 (M/F: 28/39) patients with FMF. Thirty-seven healthy subjects (16/21), 19 patients (0/19) with systemic lupus erythematosus (SLE), and 8 patients (0/8) with scleroderma (PSS) were also studied. All participants were questioned for the presence of Raynaud's phenomenon (RP). Capillary loops of eight fingers were evaluated and scored with respect to avascular areas, tortuosity, enlargement and extravasations by the conventional capillary microscopy. Both FMF patients and healthy controls were examined in a blind manner. RESULTS: FMF patients differed from healthy controls by the presence of increased tortuosity and enlargement of capillary loops, but not by microhemorrhages. Being female and the presence of RP were the factors that correlated with the capillaroscopic findings. CONCLUSION: Capillary abnormalities are seen in patients with FMF.

Adolescent↗
PubMed2002

[Indications and short term results of subfascial endoscopic perforator surgery (SEPS)].

BACKGROUND: The aim of this study is to evaluate diagnostic methods, indications and surgical technique in SEPS procedure and to analyze short term results. METHODS: Eighteen patients affected by chronic venous insufficiency (CVI) have been analyzed. According to NAVS (North American Vascular Society) classification three patients were included in class 6 (C6), 3 (C5), 6 (C4), 2 (C3) and 4 (C2). From 2 to 5 selective subfascial endoscopic ligation of perforator veins, especially I and II Cockett perforator veins' were performed. In 7 cases, total stripping of the great (6) or less (1) saphenous vein was associated with SEPS procedure. After the operation, an elastic bandage of the lower limbs was performed and a medical treatment with LMVH was started. RESULTS: In 6 patients of the C2 and C3 groups, neither recurrence or pathological reflux were observed at clinical examination and at color duplex. In 12 patients of C4, C5 and C6 groups a reduction of the perimalleolar oedema was observed. In the last 3 patients, with leg ulceration, a resolution of the lesion in 2 cases, and a reduction in diameter in the last one, were observed. CONCLUSIONS: SEPS is particularly advised in those patients belonging to C5 and C6 groups, especially in presence of leg ulceration. This operations is suggested also in patients with CVI and incontinence of perforator veins detected by at color duplex. This diagnostic investigation seems to be adequate in the diagnosis of CVI and in the mapping of perforator veins of the leg.

Adult↗
PubMed2001

[Endovascular treatment using endoprosthesis and metallic stents for aneurysmal dissection of the intracranial vertebral artery].

Dissecting aneurysms of the intracranial vertebral artery represent a more frequently recognized cause of subarachnoid hemorrhage. The poor natural history of the ruptured dissecting aneurysms indicate a surgical or endovascular treatment. Endovascular treatment usually consists of balloon occlusion of the vertebral artery. This treatment however can lead to hemodynamic complications especially when the treated artery is unique or dominant. We report two cases of ruptured dissecting aneurysms of the intracranial vertebral artery treated by intravascular stent and endosaccular GDC coils. The first patient suffered from bilateral dissection with spontaneous occlusion of the right vertebral artery and development of a pouch on the left side. The second patient suffered from a dissection of the left vertebral artery which was dominant. The stenting-coiling technique was efficient in the two cases. The patients are free of symptoms with a respective follow up of 24 and 8 months. The stenting-coiling association seems to be an interesting therapeutic option in case of intracranial dissecting aneurysms which allows a preservation of the arterial flow and selective occlusion of the aneurysmal pouch.

Adult↗