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Background: Injury of the ureter is a potential complication of any difficult abdominopelvic surgical procedure, with an incidence ranging between 0.5% and 10% in most series. The treatment depends on the severity and the place of the lesion. The severe mid and upper ureteral injuries usually require complex treatment procedures, which can be contraindicated in case of severe comorbidities with high anesthesiologic risk. We report our experience in the endoscopic treatment with Wallgraft stenting of complete iatrogenic iliac ureteral injury in a high-risk surgical patient., Methods: A 74-year-old female patient was admitted at our department due to a complete lesion of the right iliac ureter following right iliac artery aneurysm repair with iatrogenic ileal injury. The patient was in coma, affected by severe respiratory insufficiency, sepsis and uroperitoneum. These conditions contraindicated a general anesthesia encumbering the positioning of a nephrostomy, and influenced our indication of Wallgraft stent placement. The Wallgraft endoprosthesis (10 x 50 mm) is a self-expanding super-alloy metallic high flexible stent covered by PET, which can be placed at the level of the lesion using fluoroscopy after introducing an angiographic catheter and guidewire. This procedure is usually indicated in the treatment of vascular lesions., Results: After positioning the Wallgraft stent, pyelography showed a complete closure of the lesion. The patient's clinical condition improved quickly and remained stable at a follow-up of 45 months., Conclusions: Although the Wallgraft stent positioning cannot be considered as a standard treatment for all the complete ureteral lesions, it can be proposed in the management of some patients with severe comorbidities, which do not allow any other approach.

The use of intraoperative angioscopy, till now utilized exclusively in arterial surgery, is now used also in venous surgery. From January 1992 54 patients underwent to video-guided venous surgery: 23 cases of external valvuloplasty of the sapheno-femoral junction (EV-SFJ), 25 cases of hemodynamic correction of varicose veins (French acronyms CHIVA), 5 cases of high ligation plus long saphenous vein intraoperative sclerotherapy (HL-IS) 1 case of sub-fascial perforators interruption (SPI), the only extraluminal videoguided procedure. We have used 3 different video-angioscopes: a 1 mm monofibroscopy let in a 6 Fr Fogarty catheter, a disposable 2,8 mm colangioscope and a 2,2 mm operative angioscope. For the perforators interruption we have utilised the thoracoscope. EV-SFJ: the angioscopy has confirmed the presence of normal valvular cusps in a dilated vein wall in 21 cases, so excluding 2 patients from the planned treatment. At the end of the operation the angioscope has verified the reapproach of valvular cusps. CHIVA: the angioscopy has allowed to identify the exact points of the superficial venous system which should be interrupted, according to the Franceschi's theory. This procedure can avoid the technical errors due to intraoperatory misleadings of the duplex mapping. HL-IS: consists of a classic high ligation followed by long saphenous vein intraoperative sclerotherapy. The angioscopy has allowed a complete deconnection of the long saphenous vein from tributaries and perforators. Furthermore has facilitate the proportional distribution of the sclerosing agent along the long saphenous vein. SPI: the videoassistance have permitted the identification of the insufficient perforating veins reducing their surgical exposures.(ABSTRACT TRUNCATED AT 250 WORDS)

The study included a 5-year-follow-up. We noticed that our data did not agree with the data in literature as regards the distribution percentage of the various articular subsets. It was pointed out that the distribution percentage of some particular clinical subsets of the disease (for example the symmetrical polyarticular subset and the spondylitic and/or sacro-iliac subset) were linked to sex. The study of the bio-humoral parameters showed that the most significant data was the particular clinical and radiological severity of PA in the patients with high IgA levels. Radiological findings showed the involvement of the sterno-clavicular and manubriosternal joints by osteoproduction and/or erosive manifestations, which was associated with a particular clinical severity of the disease. Eventually, our study revealed a significant relationship between psycho-physical stress and articular and/or cutaneous manifestations of the disease. This data seems to confirm the recent neuro-immunological studies hypothesizing a likely role of stress and subsequent depression in the ethiopathogenesis of rheumatic diseases caused by an immune imbalance.

PTCA and new-device angioplasty have dramatically altered the management of patients with symptomatic coronary artery disease. Concurrent with the technical improvement in coronary angioplasty, the methods used to evaluate procedural outcome during and after revascularization have also become more sophisticated. Quantitative coronary angiography, angioscopy, and intravascular ultrasound are the most important methods for decision making, monitoring the procedure and document the final results. However despite their overall research value, these qualitative and quantitative techniques may be of limited value to the clinical interventional cardiologist and are often complementary or redundant. If a choice of these techniques is necessary, on-line quantitative coronary angiography, and intravascular ultrasound are certainly the most helpful methods in a Cath Lab to evaluate procedural outcome.