[Clinical results of selective distal splenorenal and latero-lateral portacaval anastomoses. Comparative prospective study of 93 patients].

The distal splenorenal shunt (DSRS) was compared with the side-t-side portacaval shunt (PCS) in 93 prospectively matched cirrhotic patients with portal hypertension. After a mean follow-up of 38 months, no differences were observed in operative mortality, long term survival and variceal rebleeding between the two groups. There was no significant difference in terms of acute encephalopathy (22% in PCS group and 33% in DSRS group) and chronic encephalopathy (35% in PCS and 17% in DSRS).

[Cancer of the hypopharynx and cervical esophagus].

Between 1975 and 1988 we observed 169 patients with carcinoma of the cervical esophagus, 85 with a carcinoma involving the hypopharynx and the cervical esophagus, and 27 patients with a carcinoma of the cervical esophageal region arising after laryngectomy for laryngeal cancer. The mean age was 57.5 years (range 41-73).

[Tumor markers. II. Their significance in the follow-up of patients after radical resection of lung neoplasms].

The clinical field in which tumor markers proved to be most useful is the monitoring of cancer patients. The present study was carried out in order to evaluate the role of tumor markers in the prognostic assessment, and pre-clinical identification of disease recurrence in patients with completely resectable non-small cell bronchial carcinoma. Tumor markers have been measured: a) pre-operatively, in 109 patients with resectable lung cancer and b) post-operatively, in 61 patients who underwent complete resections and were followed for at least one year after surgery.

[Tumor markers. I. Their significance in the preoperative assessment of lung neoplasms].

The present study has been carried out in order to evaluate the role of tumor markers in the presurgical assessment of patients with bronchial carcinoma. The carcinoembryonic antigen (CEA), the neuron specific enolase (NSE), the tissue polypeptide antigen (TPA), the carbohydrate antigen 19-9 (CA 19-9) and the carbohydrate antigen 50 (CA 50) have been preoperatively measured in 133 subjects with potentially resectable lung cancers, and in 75 healthy smokers. Sixty-one patients had squamous cell carcinoma, 55 adenocarcinoma and 17 small cell carcinoma.

[A case of leiomyosarcoma of the small intestine. Clinical and anatomopathologic considerations].

Leiomyosarcoma of the small intestine is a malignant mesenchymal tumour composed of smooth muscle cells from the muscular coat or, rarely, from muscularis mucosae, which in the majority of cases is characterised by a clinically silent development and by an unfavorable prognosis. The considerable difficulty of obtaining a histological definition of the degree of malignancy of the leiomyosarcoma is also typical. The paper reports a clinical case and summarises its main clinical and anatomopathological aspects.

[Lung transplantation: a clinical reality].

Lung transplant has now become a viable clinical option for the treatment of irreversible end-stage respiratory failures. The first successful single lung transplant was performed by Cooper and coworkers in Canada in 1983, and the first successful double lung transplant was performed by the same group in 1986. The history of lung transplantation is followed by a discussion of the current surgical indications for single and double lung transplants.

[The Fitz-Hugh-Curtis syndrome. Postgonococcal perihepatitis].

A case of Fitz-Hugh-Curtis syndrome (post gonococcal perihepatitis) is reported. The patient proved to be affected by a typical case of the syndrome and the approach used concentrated on an accurate diagnosis and immediate therapy carried out during laparoscopic examination. A control examination after approximately one month confirmed the resolution of both perihepatitis and symptoms.

[Pharmacologic effects and safety profile of bethanechol in the differential diagnosis of pseudo-anginal thoracic pain].

The use of bethanecol has recently been proposed to improve the diagnostic accuracy of esophageal manometry in identifying the origin of symptoms in patients with non cardiac chest pain. In this study we report our experience in 30 patients who underwent esophageal functional studies. Despite its low diagnostic value, bethanecol test (two subsequential doses of 50 micrograms/kg) demonstrated an excellent safety profile, there were few side effects, and patients tolerance was good.

[Critical analysis of the new TNM staging (UICC, 1987) of cancer of the cervical esophagus in relation to therapeutic decisions].

66 consecutive patients with a tumor confined to the cervical esophagus underwent surgical resection. The comparison between clinical and pathological TNM stage showed a clinical understaging in 30 patients. 25 of the 56 patients who had undergone curative resection had lymph node metastases: positive mediastinal and abdominal nodes were found in 8 (32%) and 0 cases, respectively.

[Metachronous tumors of the large intestine. The anatomicoclinical considerations].

The paper analyses the results of a large number of patients operated for large intestine carcinoma who then underwent a postoperative endoscopic follow-up to assess the number of metachronous tumours. The anatomicoclinical characteristics of the latter are discussed.

[Treatment of recurrent or residual calculosis of the choledochus. A comparison of the technics].

The results of treating residual or recurrent calculosis of the choledochus for the purpose of obtaining elements for deciding whether or not to carry out a given operation in a particular group of patients are reported. Although they do not offer elements of certainty, the results still make it possible to arrive at an indication for endoscopic papillotomy in elderly patients in poor general condition with one or a few calculi and non-dilated choledochus, for choledochotomy in patients with choledochus of normal diameter and with multiple calculi, or for an intervention of biliodigestive drainage (particularly choledochojejunostomy) in patients with multiple calculosis and with dilated choledochus. In cases in which the apparatus of Oddi is the site of an irreversible inflammatory process and has lost its function, transduodenal papillosphincterotomy is justified.

[Transection of the popliteal artery caused by exostosis].

Two cases of post-traumatic transection of the popliteal artery in patients with exostosis of the lower extremities are reported. This complication does not seem to have been previously described in the literature. The pathogenetic, clinical, diagnostic and therapeutic aspects are analysed.

Substrate availability other than glucose in the brain during euglycemia and insulin-induced hypoglycemia in dogs.

Alternative substrates other than glucose could be used by the brain. In this study we hypothesized that lactate and ketone bodies can provide a significant portion of oxidative brain substrates in insulin-dependent diabetes mellitus (IDDM). Six control (C) and six insulin-treated streptozotocin diabetic (IDDM) dogs were studied during euglycemia (EU) and acute insulin induced hypoglycemia (HYPO).

Prognosis of nonpalpable infiltrating carcinoma of the breast.

A consecutive series of 185 instances of histologically confirmed nonpalpable infiltrating carcinoma of the breast is presented. Histologic nodal involvement was found in 12 per cent and was dependent on the size of the tumor. Conservative surgical treatment was the predominant method used during the study period.

[Surgical treatment of carcinoma of the hypopharynx and cervical esophagus].

Between 1975 and 1988 we observed 169 patients with carcinoma of the cervical esophagus, 85 a carcinoma involving the hypopharynx and the cervical esophagus, and 27 patients with a carcinoma of the cervical esophageal region arose after laryngectomy for laryngeal cancer. The mean age was 57.5 years (range 41-73).

[Treatment of short bowel syndrome].

On the basis of personal experience and the latest reports in the literature on the treatment of short bowel syndrome, the clinical and therapeutic aspects of the malabsorption syndrome arising after removal of long segments of the small intestine are analysed with emphasis on the salient features and particularly the critical phase constituted by the transfer from parenteral to enteral and oral nutrition whose importance for the maintenance of life is objectively confirmed by the adaptive response of the remaining small bowel (compensatory hypertrophy).

A simple device for prolapsing loop colostomies.

A simple device, applied to a conventional stomal appliance, prevents loop colostomy prolapse.

Brain cholecystokinin depletion in rats with acute liver failure.

A decrease of both hypothalamic and cortical CCK occurred in the brain of rats killed 8 hours after hepatic artery ligation following portocaval anastomosis. Brain CCK depletion was not reproduced by exogenously provoked hyperammonemia nor by insulin-induced hypoglycemia, thus suggesting a central mechanism for the derangement of the CCKergic system in the course of acute liver failure.