Updated management of malignant biliary tract tumors: an illustrative review

The management of malignant biliary tumors (MBTs) is complex and requires a multidisciplinary approach. Guidelines and methods of staging for biliary tumors have recently been released by main international societies, altering the clinical and radiologic approach to this pathologic condition. The aim of the present review is to detail the updated role of imaging in preoperative staging and follow-up and to illustrate clinical/therapeutic pathways. In addition, future perspectives on imaging and targeted/embolization therapies are outlined

Tumore desmoide della parete addominale in una donna in età fertile: cosa possiamo fare?

Il tumore desmoide (TD) è una neoplasia dei tessuti molli loca - lizzata più frequentemente nella parete addominale anteriore in gio - vani donne in età fertile. Inoltre a causa della sua frequente inciden - za in donne con recente gravidanza, la stimolazione alla proliferazio - ne dei tessuti muscolo-aponeurotici è stata messa in relazione col trau - ma del parto. L’intervento chirurgico radicale è il trattamento di scelta per pre - venire recidive locali. Molti autori sottolineano il ruolo della radioterapia nella regres - sione del tumore e nel controllo delle recidive locali in pazienti che hanno ricevuto una resezione incompleta. Molti altri invece racco - mandano l’uso della chemioterapia o della terapia antiestrogenica anche in presenza di tumori con recettori per gli estrogeni negativi. Il TD, d’altra parte, pur essendo un tumore con un’altissima incidenza di recidiva locale, non dà mai metastasi, per tale motivo in una giovane donna appare razionale, qualora realizzabile, un tratta - mento chirurgico che, senza lasciare residuo macroscopico di malattia, miri a preservare le strutture e la funzione. Inoltre i dati in letteratu - ra evidenziano che la positività istologica dei margini di resezione non è correlata con la comparsa di recidiva locale e che la gravidanza non rappresenta di per sé un fattore di rischio. In una donna in età fertile, dopo un’exeresi primaria di un TD, anche in presenza di margini microscopici positivi, potrebbero per - tanto essere evitate la radioterapia, la chemioterapia o la terapia antiestrogenica e può essere ragionevolmente presa in considerazione la sola osservazione clinica

Posterior tibial artery false aneurysm as an early complication after fogarty embolectomy

Abstract: Pseudoaneurysm is a possible complication after Fogarty balloon catheter thrombectomy because of intimal linear or full-thickness tears or disruption of the vessel wall. A 50-year-old woman was admitted with acute severe ischaemia of the lower extremities due to bilateral embolic common femoral artery occlusion so an embolectomy was performed under local anaesthetics. On the third post-operative day the patient complained of increasingly severe pain in her left calf with reduced dorsiflexion. A pseudoaneurysm was diagnosed and through a medial approach it was opened and the posterior tibial artery was reconstructed by a great saphenous vein autograft interposition

Spontaneous Rupture of Superficial Femoral Artery Repaired with Endovascular Stent-Grafting with use of Rendez-Vous Technique, Followed by Delayed Infection

This is the case of a 72-year-old man with lower limb ischemia due to spontaneous rupture of nonaneurysmal superficial femoral artery that developed into thigh hematoma. After failure of a Fogarty revascularization, an emergency endovascular procedure was performed to restore the arterial continuity. A rendezvous procedure was performed with a double femoral and popliteal approach and two covered stent-grafts were deployed. Patient's clinical conditions immediately improved, but 4 months later the stent-grafts were surgically removed for infection and exteriorization. A femoropopliteal bypass was performed. After 1 year follow-up, the patient is in good clinical condition

Octogenarians submitted to elective infrarenal abdominal aortic aneurysm repair: can they currently be considered "high-risk" for open repair?

Aim. The aim of this paper was to report our experience in octogenarian patients affected by infrarenal abdominal aortic aneurysm (AAA) and to compare the outcomes between patients electively treated by open repair (OR) or endovascular aneurysm repair (EVAR). Methods. Among 576 patients treated for elective infrarenal AAA repair between January 2002 and July 2009 we identified 82 >= 80 years in our prospectively collected departmental database. We compared results between the two groups of patients according to: perioperative (30-days) and late mortality related or nor to AAA, perioperative morbidity, length of in-hospital stay, other complications prolonging length of in-hospital stay (LHS). A P<0.05 was considered statistically significant. Results. Fifty-three patients underwent OR and twenty-nine EVAR. Mean follow-up time was 38.2 months (range 6-96). Technical success was achieved in all patients. One perioperative death was recorded in the EVAR group while 3 OR patients died within 30 days (P=0.55). Overall survival estimates at 60 months were 77% and 55% in OR and EVAR groups respectively. No late aneurysm-related deaths were recorded in OR group while 1 death occurred in the EVAR group (P=0.35). Analysis of late mortality rates unrelated to aneurysm showed a mild statistical significance in favour of OR (22.6% vs. 41.3%; P=0.042). Total late death rates revealed a significant difference between the two groups in fayour of OR (EVAR 44.8%, OR 22.6%, P=0.02). Analysis of total perioperative complications between groups proved no significant differences but subgroup analysis of systemic and local complications displayed worst results for OR and EVAR respectively (20.7% and 24.1%). Both types of complications caused a significant longer in-hospital stay in the two groups (P=NS). Conclusion. Elective EVAR and OR for infrarenal AAA seem safe and effective in patients older than 80 years at early and late results. Age alone should not prevent clinicians from treating those patients by OR

Endovascular repair of acute and chronic aortic type b dissections

The aim of this study was to assess factors influencing the clinical outcome and morphological changes of acute and chronic type B aortic dissection after thoracic endovascular aortic repair (TEVAR)

Comparative study on carotid revascularization (endarterectomy vs stenting) using markers of cellular brain injury, neuropsychometric tests, and diffusion-weighted magnetic resonance imaging

OBJECTIVE: Subclinical alterations of cerebral function can occur during or after carotid revascularization and can be detected by a variety of standard tests. This comparative study assessed the relationship among serum levels for two biochemical markers of cerebral injury, postoperative diffusion-weighted magnetic resonance imaging (DW-MRI), and neuropsychometric testing in patients undergoing carotid endarterectomy (CEA) or carotid artery stenting (CAS) for high-grade asymptomatic carotid stenosis. METHODS: Forty-three consecutive asymptomatic patients underwent carotid revascularization by endarterectomy (CEA, 20) or stenting (CAS, 23). They were evaluated with DW-MRI and the Mini-Mental State Examination (MMSE) test preoperatively and <or=24 hours after carotid revascularization. Venous blood samples to assess serum levels of neuron-specific enolase (NSE) and S100beta protein were collected for each patient preoperatively and five times in a 24-hour period postoperatively and assayed using automated commercial equipment. The MMSE test was repeated at 6 months. The relationship between serum marker levels and neuropsychometric and imaging tests and differences between the two groups of patients were analyzed by chi(2) test, with significance at P < .05. RESULTS: No transient ischemic attacks or strokes were clinically observed. CAS caused more new subcortical lesions at postoperative DW-MRI and a significant decline in the MMSE postoperative score compared with CEA (P = .03). In CAS patients, new lesions at DW-MRI were significantly associated with a postoperative MMSE score decline >5 points (P = .001). Analysis of S100beta and NSE levels showed a significant increase at 24 hours in CAS patients compared with CEA patients (P = .02). The MMSE score at 6 months showed a nonsignificant increase vs the postoperative score in both groups. CONCLUSIONS: Biochemical markers measurements of brain damage combined with neuropsychometric tests and DW-MRI can be used to evaluate silent injuries after CAS. The mechanisms of rise in S100beta and NSE levels at 24 hours after CAS may be due to increased perioperative microembolization rather than to hypoperfusion. Further studies are required to assess the clinical significance of those tests in carotid revascularization