The arterial blood supply of the pancreas: a review II. The posterior superior pancreaticoduodenal artery. An anatomical and radiological study

5noreservedThe present paper is the second part of a comprehensive review of the arterial blood supply of the pancreas and deals with the posterior superior pancreaticoduodenal artery. The aim of this review is to summarise the anatomical studies, starting from Haller's reports, and to supply as far as possible, with original material, angiographic evidences for the classic anatomical notions. For this purpose, the overall research was carried out by picking out and studying 1015 selective angiographies (celiac trunk and its branches, superior mesenteric a.) taken from the angiographic archives of the Institutes of Radiology of Siena, Rome (University of Sacro Cuore, Catholic University), and Perugia. Angiographically, many possible different sources of the posterior superior pancreaticoduodenal a. (superior pancreaticoduodenal a., proper hepatic a., right hepatic a., left hepatic a., superior mesenteric a., accessory and replaced right hepatic a. coming from the superior mesenteric a.) have been demonstrated, as have rare variations of the course and a small number of collateral branches (retroduodenal a. and ventral commissural a.). Moreover, the authors underline the discordant opinions still existing regarding the incidence of the different ways the posterior superior pancreaticoduodenal a. arises.mixedBERTELLI, Eugenio; DI GREGORIO, Flavio; BERTELLI, Luciano; CIVELI, Lucia.; MOSCA, Stefano.Bertelli, Eugenio; DI GREGORIO, Flavio; Bertelli, Luciano; Civeli, Lucia; Mosca, Stefan

Protected iliofemoral venous thrombectomy in a pregnant woman with pulmonary embolism and ischemic venous thrombosis

Although thromboembolism is uncommon during pregnancy and the postpartum period, physicians should be alert to the possibility because the complications, such as pulmonary embolism, are often life threatening. Pregnant women who present with thromboembolic occlusion are particularly difficult to treat because thrombolysis is hazardous to the fetus and surgical intervention by any of several approaches is controversial. A 22-year-old woman, in her 11th week of gestation, experienced an episode of pulmonary embolism and severe ischemic venous thrombosis of the left lower extremity. The cause was determined to be a severe protein S deficiency in combination with compression of the left iliac vein by the enlarged uterus. The patient underwent emergency insertion of a retrievable vena cava filter and surgical iliofemoral venous thrombectomy with concomitant creation of a temporary femoral arteriovenous fistula. The inferior vena cava filter was inserted before the venous thrombectomy to prevent pulmonary embolism from clots dislodged during thrombectomy. When the filter was removed, medium-sized clots were found trapped in its coils, indicating the effectiveness of this approach. The operation resolved the severe ischemic venous thrombosis of the left leg, and the patency of the iliac vein was maintained throughout the pregnancy without embolic recurrence. At full term, the woman spontaneously delivered an 8-lb, 6-oz, healthy male infant

Pharmacokinetics of intraarterial mitomycin C in hypoxic hepatic infusion with embolization in the treatment of liver metastases

1. The pharmacokinetics of mitomycin C (MMC) was evaluated during hypoxic hepatic infusion (HHMI) with arterial embolization for the treatment of unresectable liver metastases. 2. Ten patients with hepatic metastases from colorectal cancer were considered. Antiblastic infusion with MMC (20 mg/m2 at 30 ml/min) was initiated after 10 min of hepatic arterial occlusion. Peripheral venous blood samples were collected at different time intervals. MMC was assayed by high-pressure liquid chromatography (HPLC), and pharmacokinetic parameters were determined using an open, two-compartment model and linear kinetics. 3. Cmax of MMC during HHMI was 708 +/- 336.6 ng/ml, and tmax was 9.3 +/- 1.1 min. The plasma concentration-time curve showed a t1/2 alpha ranging from 1.5 to 9 min, followed by a t1/2 beta ranging from 31 to 93 min. The Cltot was 35.5 l/h/m2 with an area under the plasma concentration-time curve (AUC) ranging from 251 to 850 micrograms h/l. The same AUC parameter standardized for the amount of MMC was 15.5 mg-1. The HHMI model that we used revealed a significant increase in Cltot and a reduction in AUC when compared to the locoregional intraarterial and peripheral intravenous models (p < .001). 4. The reduction in AUC following HHMI explains the limited systemic toxicity in treated patients, with a greater total tumor exposure to the drug and improved drug activation