Biologic liver support: optimal cell source and mass.

Hepatic support is indicated in acute liver failure (ALF) patients to foster liver regeneration, or until a liver becomes available for orthotopic liver transplantation (OLT), in primary non function of the transplanted liver, and hopefully in chronic liver disease patients affected by ALF episodes, in whom OLT is not a therapeutic option. The concept of bioartificial liver (BAL) is based on the assumption that only the hepatocytes can perform the whole spectrum of biotransformation functions, which are needed to prevent hepatic encephalopathy, coma and cerebral edema. Among others, two important issues are related to BAL development: 1) the choice of the cellular component; 2) the cell mass needed to perform an adequate BAL treatment. Primary hepatocytes, of human or animal origin, should be considered the first choice because they express highly differentiated functions. Accordingly, a minimal cell mass corresponding to 10% of a human adult liver, i.e. 150 grams of freshly isolated, > or = 90% viable hepatocytes should be used. When 4 degrees C cold-stored or cryopreserved hepatocytes are used, the cellular mass should be increased because of a drop in cell viability and function. In case of hepatoma-derived cells, cultured cell lines or engineered cells, an adequate functional cell mass should be used, expressing metabolic and biotransformation activities comparable to those of primary hepatocytes. Finally, the use of porcine hepatocytes or other animal cells in BAL devices should be presently directed only to ALF patients as a bridge treatment to OLT, because of potential transmission of animal retrovirus and prions which may potentially cause major pandemics.

[Laser-assisted angioplasty in the treatment of obliterations of the iliac-femoral axis]. / L'angioplastica laser-assistita nel trattamento delle obliterazioni dell'asse iliaco-femorale.

In the last years, intraluminal techniques and instrumentations grown from the primitive concept of balloon angioplasty, have made an incredible leap among these techniques, Laser assisted balloon angioplasty plays, in selected cases, an important role in the treatment of vascular occlusive disease. The focus of this report will be to present the preliminary experience of the authors about the use of this technique, in the treatment of 18 patients with atherosclerotic occlusive iliac-femoro-popliteal disease. In spite of short number of cases; they try to focalize indications, limits and principal complications of the technique.

Abdominal aortic aneurysmectomy associated with a native iliac kidney. Case report.

Abdominal aortic aneurysm (AAA) repair associated with a pelvic kidney is extremely rare. To date only 14 cases have been reported in the literature. The main problem during aortic cross clamping is kidney preservation. The purpose of this article is to record and additional case of AAA repair associated with a native pelvic kidney. The preservation has been successfully achieved by a distal aortic double clamping.

[Traumatic duodenal lesions]. / Lesioni duodenali traumatiche.

The authors refer their experience about five cases of traumatic duodenal lesions. They confirm the casual relationship between delayed diagnosis, often due to inaccurate clinical-radiological evaluation, and prognosis. They emphasize the opportunity to perform a simple suture and decompression by nasogastric tube, to selected cases.

[Intra-operative manometry and hiatal hernia]. / Manometria intraoperatoria ed ernia iatale.

Personal experience of the intra-operative use of oesophageal manometry in cases of hiatus hernia is presented. Using this system the pressure in the air cushion surrounding the L.E.S. can be adjusted to avoid any complications due to overtight or overlax surgery. Various types of post-operative tests confirm the value of the technique.

[Papillo-sphinctero-plasty in benign obstruction of the terminal choledochus]. / La papillo-sfintero-plastica nell'ostruzione benigna del coledoco terminale.

The indications for papillosphincteroplasty in benign obstruction of the terminal choledochus are explained. This technique is certainly preferable to drainage via a T tube--a method no longer applied in a personal series. Lastly, it is stated that the primary transduodenal approach is better than that via choledochotomy. Excellent results were obtained in 62% of cases, good results in 31%, and poor results due to recurrent cholangitis in 3%. Acute pancreatitis is the most dangerous complication, but was very rarely observed.

[Modified Thal operation in the treatment of achalasia of the esophagus]. / L'intervento di Thal modificato nel trattamento della acalasia dell'esofago.

The results of modified Thal (cardioplasty with gastric patch) in the surgical treatment of oesophageal achalasia are reported. Clinical, endoscopic, radiological, pHmetric and manometric findings offer evidence of the value of the technique.

[Interposition of a jejunal loop, using the Mouchet-Camey method, in gastric cancer surgery]. / L'interposizione di ansa digiunale secondo Mouchet-Camey nella chirurgia del cancro gastrico.

A series of 80 patients subjected to total gastrectomy for neoplasia is presented. Interposition of the jejunal loop according to Mouchet-Camey was employed as the reconstruction technique. The advantages of this method are highlighted, with particular reference to the results of a study of the absorption of 125I-oleic acid. The complications associated with the operation and the way in which they can be corrected are described.