Preclinical Safety Evaluation in Rats of a Polymeric Matrix Containing an siRNA Drug Used as a Local and Prolonged Delivery System for Pancreatic Cancer Therapy.

Conventional chemotherapy treatments for pancreatic cancer are mainly palliative. RNA interference (RNAi)-based drugs present the potential for a new targeted treatment. LOcal Drug EluteR (LODER(TM)) is a novel biodegradable polymeric matrix that shields drugs against enzymatic degradation and releases small interfering RNA (siRNA) against G12D-mutated KRAS (siG12D).

Assessment of splanchnic tissue oxygenation by gastric tonometry in patients undergoing laparoscopic and open cholecystectomy.

This experimental study compared the effects of laparoscopic (n = 31) and open (n = 32) cholecystectomy on gastric intramucosal pH (pHi). For this purpose, pHi was measured tonometrically before induction of anaesthesia, at 30-min intervals during surgery, and 1, 2 and 4 h after operation in otherwise healthy patients undergoing elective cholecystectomy. Additionally, perioperative arterial pH (pHa), arterial carbon dioxide tension (PaCO2), intramucosal carbon dioxide tension, arterial bicarbonate concentration, end-tidal carbon dioxide pressure (PECO2), levels of serum lactate, lactate dehydrogenase (LDH) and gamma-glutamyl transferase (GGT), haematocrit and arterial blood pressure were recorded.

Preoperative staging of rectal cancer by endoluminal ultrasound vs. magnetic resonance imaging. Preliminary results of a prospective, comparative study.

Purpose: The aim of this study was to compare the value of endoluminal ultrasonography (ELUS) with magnetic resonance imaging (MRI) for preoperative staging of rectal carcinoma.

Methods: Thirty-seven consecutive patients were examined by ELUS and MRI. Imaging results were compared with pathohistologic studies.

[Local excision of rectal tumors: Y. Mason's operation].

Twenty-nine patients with cancer of the low rectum were treated by local excision performed by a transsphincteric approach (Mason's operation). Patient's selection requires a careful digital examination, biopsy, CT or MR and intraluminal ultrasound. In our series an accurate and strictly selection provides low recurrence rates with no mortality and low postoperative complications.

[Portal circulation following the Warren operation--computerized tomography study of portal hemodynamics 5 to 11 years following distal splenorenal anastomosis].

18 patients underwent CT-investigation with bolus injection of contrast medium 5 to 11 years after splenorenal Warren shunt. According to this investigation all patients were found to have developed hepatofugal collaterals in consequence of distal splenorenal anastomotic suction. In most cases the portal liver perfusion was maintained.

[Portal circulation following Warren's operation. Long-term control using computerized tomography].

Computed tomography with contrast injection was carried out in 18 patients who had undergone a Warren procedure for portal hypertension due to cirrhosis of the liver more than five years previously. The results show that it is not possible to drain only a part of the venous portal territory. The portal circulation does not consist of two portions, with different pressure relationships.

Long-term outcome of acute necrohemorrhagic pancreatitis. A 4-year follow-up.

This long-term follow-up of 27 patients treated with conservative surgery for necrohemorrhagic pancreatitis (NHP) showed that an almost complete recovery of the exocrine function is achieved within 4 years after discharge, while about half of the patients presented still abnormal endocrine function. The morphological sequelae, pointed out by endoscopic retrograde pancreatography in almost 50% of the cases, remained unchanged during the follow-up period. Therefore, these data seem to exclude an evolution of NHP towards chronic pancreatitis.

Evolution of pain in chronic relapsing pancreatitis: a study of operated and nonoperated patients.

A group of 191 patients with chronic relapsing pancreatitis was followed for about 10 years. Ninety-three of them were selected for surgery because of incapacitating painful relapses or persistent pain and were submitted to side-to-side pancreaticojejunostomy. Ninety-eight were selected for medical management.

[Bilemia. Considerations apropos of a case].

The Authors report a case of bilemia, a complication of hepatic biopsy. They analyse the physiopathogenetic problems and those of surgical tactics, and emphasize the importance of retrograde and/or interoperative cholangiography ii the diagnostics of such disease.

[Our experience with selective proximal vagotomy].

The authors show a casuistry of 125 operations of SPV, and comment on the clinical and physiopathologic presuppositions justifying the indications to SPV in the field of gastroduodenal peptic pathology. They report the results of the gastric probings, both basal and after stimulation with pentagastrin in the pre- and postoperative phase, and after a year. They face the problem of pyloroplastics, and appraise the elements indicating and contra-indicating it in association to SPV.

[Supervision of the postoperative period in biliary shunt operations: validity of sequential hepato-biliary scintiphotography with 99mTc-HIDA].

The Authors' aim was to assess the effectiveness of Sequential Scintiphotography of the Liver with 99mTc-HIDA (SSFH) in the evaluation of post operative jaundice, in operations of biliary derivation (43 observations in 28 patients). SSFH proved to be highly reliable even in comparison with more laborious procedures (such as Transhepatic Cholangiography), and superior to equally simple procedures such as Echo Tomography and Computerised Tomography, evidencing itself as the investigation of choice for the study of this pathology, especially in long-term follow-ups.

[Transhepatic embolization of oesophageal varices (author's transl)].

Personal experience (12 cases) and a literature review (165 cases) of trans-hepatic embolization of oesophageal varices are evaluated; indications, contra-indications, complications and results are discussed. Results are analyzed in term of: history of past bleeding, bleeding at the moment of the procedure, successive surgical or medical treatment. Moreover portal haemodynamics variations induced by the procedure are evaluated.

[The distal spleno-renal anastomosis of Warren (author's transl)].

This is a report on 28 Warren-Shunts, 17 of these patients had undergone clinical, hematological and angiographic controls 2--46 (mean 10) months after the operation. The critical evaluation of the results shows that the Warren derivation, which is selective at the moment of operation, develops in the following time some hepatofugal circulation. This is a more radical effect than the intended drainage of the gastro-esophageal venous bed alone.

[Complications of lung surgery in the aged: relapsing postresection atelectasis (author's transl)].

The authors describe one case of relapsing postoperative atelectasis occurring with considerable severity after an upper left lobectomy for malignancy in a man of 68. Said complication recurred no fewer than six times during a hospital stay of 44 days and constituted a major threat to the good outcome of surgery. The patient was finally discharged in good conditions, and a later recheck revealed no important alterations in the surviving lower left lobe.

[Percutaneous transhepatic biliary drainage].

The authors describe their experience in 23 cases of biliary tract drainage by the transhepatic-percutaneous approach in the course of obstructive jaundice of diversified origin. This can be done for essentially three reasons, namely to alleviate jaundice preoperatively, to provide permanent bile drainage in patients not amenable to surgery, and to relieve excess pressure in surgical anastomoses of the biliary passages. On the basis of biological considerations (relationship between severity and duration of cholestasis on the one hand and postoperative mortality and morbidity on the other), and in light of their own results, the authors argue in favor of this procedure, explaining that it is only mildly traumatic to the patient, easy to perform, attended by a low quota of complications, and above all effective as a drainage; also, it does not unduly prolong the preoperative period for patients scheduled for further and major surgery.

[Distal termino-lateral spleno-renal anastomosis, using the Warren technic].

The authors describe 23 cases of distal splenorenal derivation after Warren. Of these patients, 17 received a complete followup clinical hematological and angiographic examination at an average remove of 10 months after surgery. The authors discuss their results and submit that the Warren operation, while really selcetive in most cases when performed, in the long run tends to shung rather too much blood away from the liver; in other words, the effectiveness of the shunt tends to exceed the intended drainage,which should be restricted to the gastro-esophageal vascular bed.

Computed tomography in surgical pancreatic emergencies.

The findings observed with computed tomography (CT) in such pancreatic emergencies as necrotic-hemorrhagic pancreatitis, pancreatic abscess, broken pseudocyst, and pancreatic ascites with mediastinitis are presented. The value of CT in these conditions, which often require surgical intervention, is discussed. Computed tomography appears to be the ideal diagnostic procedure, especially for surgical treatment planning in pancreatic abscess.

[The problems of surgical tactics in the treatment of pancreatic pseudocysts and related complications].

On the basis of 45 cases of operated pseudocyst, the Authors tackle the problem of surgical tactis in treatment of these lesions and any complications. The paper outline the contribution that recent diagnostic methods--such as endoscopic retrograde cholangiopancreatography, computed tomography and ultrasonography--have made to solution of the problem and establishes the criteria for emergency or elective operation. In the first condition, consisting in cases of complications (haemorrhagic, suppurative, perforative etc.

[Surgical treatment of gastric carcinoma in the elderly. Clinical considerations on a group of patients undergoing major surgical destruction].

A group of 24 patients in senile age was subjected to major demolition operations, for purposes of radical removal of gastric carcinoma (total gastrectomy, subtotal resection, oesophago-gastric resection). In six patients the major operation was widened by partial demolition of neighbouring organs (liver, colon, pancreas). The flattering results (both immediate and long-term) obtained from this operation and the progress reached in the knowledge and correction of the senile physiopathological alterations allow encouraging developments to be forecast for this surgery, the success of which is subject to careful tactical selections and to close multidisciplinary cooperation directed to strengthening vital reserves, assistance of main functions and prompt recognitions and treatment of any complications.