Molecular basis of autotrophic vs mixotrophic growth in Chlorella sorokiniana.

In this work, we investigated the molecular basis of autotrophic vs. mixotrophic growth of Chlorella sorokiniana, one of the most productive microalgae species with high potential to produce biofuels, food and high value compounds. To increase biomass accumulation, photosynthetic microalgae are commonly cultivated in mixotrophic conditions, adding reduced carbon sources to the growth media. In the case of C. sorokiniana, the presence of acetate enhanced biomass, proteins, lipids and starch productivity when compared to autotrophic conditions. Despite decreased chlorophyll content, photosynthetic properties were essentially unaffected while differential gene expression profile revealed transcriptional regulation of several genes mainly involved in control of carbon flux. Interestingly, acetate assimilation caused upregulation of phosphoenolpyruvate carboxylase enzyme, enabling potential recovery of carbon atoms lost by acetate oxidation. The obtained results allowed to associate the increased productivity observed in mixotrophy in C. sorokiniana with a different gene regulation leading to a fine regulation of cell metabolism.

[Low rectal cancer treatment in frail elderly patients. A personal series]. / Il trattamento del carcinoma del retto basso nel paziente anziano fragile. Contributo casistico.

Rectal cancer predominantly affects elderly people, who are however more likely to have concomitant medical diseases and, therefore, are at higer surgical risk. After a careful selection of the patients, some surgical procedures can be performed safely. We studied a series of 149 patients affected by low rectal cancer; of these, 46 were aged 75 or older and comprise the elderly group; 94 curative resections, 19 palliative surgical treatments, 31 local excisions were performed. This approach demonstrated to be safe and effective among older patients too; therefore we may conclude that it is associated with a good control of surgical risk and of cancer in selected patients.

[Fibrin sealant in tension free hernioplasty: our experience]. / La colla di fibrina nelle ernioplastiche tension-free: nostra esperienza.

The aim of this study was to prove that it is possible to fix mesh sutureless with Tissucol in the Lichtenstein procedure. The mesh fixation with Tissucol was done in 28 patients. Respect the traditional Lichtenstein technique, which was done in the remaining 28 patients, the advantages of using Tissucol are: no surgical trauma, total mesh fixation, no pain, reduced morbidity and reduced costs. Furthermore it is a safe and reproducible method. The results are promising, even if the verification goes more carried out with consisting casuistics and longer follow-up.

[Metachronous carcinoma of the colon: report of a clinical case]. / Carcinoma 'meta-metacrono' del colon: descrizione di un caso clinico.

The Authors deal with a rare case of 'meta-metachronous' carcinoma of the colon. A seventy years old man was admitted to ward after being diagnosed an adenocarcinoma of the transverse colon. The anamnestic data pointed out that the patient had already been operated twice for the colon carcinoma, which had been diagnosed in the left colon and in the cecum respectively seven and two years before. A colonoscopy performed sixteen months before did not show any lesion of the residual colon. It is likely that tiny lesions, which were still in the adenoma phase, were not diagnosed by the endoscopy; it is also possible that the adenoma-carcinoma sequence was extremely fast. On the basis of this experience the Authors recommend that patients with metachronus carcinoma undergo either frequent controls or a preventive subtotal colectomy.

[The use of drainage in the "per primam" treatment of recurrent pilonidal cysts]. / L'uso del drenaggio nel trattamento "per primam" delle cisti pilonidali recidive.

Recurrent pilonidal sinus treatment is still controversial, as more and more frequently methods used determine unpleasant discomforts to the patients ("open" method) or increase recurrences rate. According to this consideration, the Authors have made a review of their cases (27 patients with recurrences), selected by standardized criteria and treated by "en bloc" excision of all pathologic tissue and following closure "per primam" of the wound, previously placing an aspirative drainage, then removed after 2 or 3 days. Ordinary use of the drainage, antibiotic prophylaxis extended to postoperative sixth or seventh day and daily careful disinfection of the wound and surrounding skin until suture removal got them excellent results.

[Predictive factors and treatment of small bowel adhesive obstruction]. / Fattori predisponenti e trattamento dell'occlusione intestinale da sindrome aderenziale.

Our study is based on a retrospective analysis about a ten years' control on patients with a small bowel adhesive obstruction (SBAO) due to primitive abdominal surgical operations. From the valuation of the obtained data and through a literatures review we tried to better define the best treatment. On 297 admissions of 248 patients with a diagnosis of SBAO 196 operations were performed, which indication was based on every clinical data, haematologic and radiologic examinations. Moreover, it was analysed the responsive factor that caused adhesions with a careful valuation of the primitive surgical operation and the possibility of recurrences. From this study it is evicted that SBAO can be considered as a surgical differentiable urgency, where there aren't any signs of intestinal strangulation or peritonitis, and where the principal etiologic factor is represented by colorectal operations in the male and gynecologic operations in the female. Morbility and mortality in the surgical procedures for SBAO show greater percentages than the elderly patients.

[Recurrence after hernioplasty according to Lichtenstein: analysis of the cause]. / Le recidive dopo ernioplastica secondo Lichtenstein: analisi delle cause.

The performance of surgical interventions of tension-free hernia repair has certainly reduced the recurrence rate in comparison with the previous techniques; notwithstanding this it is not uncommon to observe some recurrences also after a Lichtenstein hernia repair. The aim of this study is that to analyse the causes. In the last 2 years, 42 patients (mean age of 68 years) with recurrent hernia have been operated by Lichtenstein technique; 11 of the 42 patients had been treated before with an useful mesh hernia repair. In 8 of these patients the recurrence was produced by an insufficient medial extension of the mesh; in the other 3 patients the cause was the presence of an unrecognized indirect hernia in patients operated for a direct inguinal hernia. All the patients treated have been submitted to a 18 months time of follow-up.

[Tension-free hernioplasty in the aged. A report of 94 cases]. / Ernioplastica secondo Lichtenstein nell'anziano. Contributo clinico.

BACKGROUND: Tension free inguinal hernioplasty has become the procedure of choice in the elderly. The operation of originally popularized by Lichtenstein and Shulman gives the best early result with low complication rates. METHODS: Between January 1991 and December 1996, 94 subjects over 70 with inguinal hernia were submitted to hernioplasty. The tension-free technique was adopted utilizing a polypropylene mesh. Peridural anesthesia was the method used in 67 procedures, local anesthesia in 27 procedures. RESULTS: The mean hospital stay was 48 hours (short stay surgery). Noteworthy general complications were not observed. Superficial wound infection occurred in 2 patients; superficial skin hematoma in 4 patients. No recurrences were observed (mean follow-up 60 months). The primary inguinal hernias in the aged is due to a progressive deterioration of the inguinal floor (collagenolylis, overpowers net collagen synthesis and deposition in the floor of the inguinal canal). CONCLUSIONS: Tension-free inguinal hernioplasty, originally popularized by Lichtenstein and Shulman, is simple to perform and gives excellent results with low complication rates. Current evidence suggests it as operation of choice in the elderly.

[Acute cholecystitis in patients over 80 years of age: indication for immediate surgical treatment]. / La colecistite acuta nei pazienti ultraottantenni: un'indicazione al trattamento chirurgico immediato.

The Authors analyse the results of very early surgical treatment in 43 patients over 80 years of age. The severity of morphological changes in the gallbladder and complicated course of the disease are the main factors causing an unfavorable effect on the results of a later treatment. Echography allows, in a high percentage of cases, to confirm the clinical doubt of acute cholecystitis. Cholecystectomy was carried out in all the patients within the first 6 hours (very early surgery-VES). The overall mortality rate was 7%; the morbility rate was 18%.

[Sarcoidosis with a prevalent splenic localization: surgical option (presentation of a case]. / Sarcoidosi a prevalente localizzazione splenica: opzione chirurgica (presentazione di un caso).

Sarcoidosis is a granulomatosis disease of unknown origin with a variable clinical presentation. The reported frequency of splenomegaly in sarcoidosis ranges from 1% to 40%. Splenomegaly has been associated with clinical evidence of more extensive thoracic and extrathoracic sarcoidosis. We describe an interesting case of sarcoidosis with giant splenomegaly and abdominal pain but no evidence of systemic involvement. Sarcoidosis must be considered in the differential diagnosis of splenomegaly. The main indication for splenectomy is splenomegaly with resulting discomfort and/or haematological abnormalities. Though the natural history of sarcoidosis is generally unchanged after splenectomy, in our patient the operation resolved the abdominal pain completely with no need for further therapy.

Conceptual problems of colon pathologies of surgical interest in the elderly.

Case reports of 151 patients above the age of 70 years, treated with colon diseases of surgical interest, have been compared to those of 220 patients treated with similar diagnoses, but in younger ages. The case reports were evaluated on the basis of the available literary data, and interpreted from the points of view of the geriatric pathology. It is concluded that a correct interpretation of surgical pathologies of the colon in the elderly cannot disregard the knowledge of the age-dependent involutive processes concerning particularly this part of the digestive tract, and also other organs and systems in global sense. Aging of the mucosa of colon, after all, represents a more or less expressed reduction of its barrier function against oncogenic factors and pathogenic microorganisms. The degenerative lesions involving continuously the micro- and macrocirculation of the splanchnic regions result in a more frequent occurrence of complications (ischemia, perforations). The instability of the bioimmunological equilibrium and the presence of accompanying diseases complicate further the clinical picture which displays usually a few symptoms even during the evolutive phases of the diseases. Once the diagnosis has been achieved, the therapeutic strategies should be modified individually without giving up the main principles, however, always considering the possible expectations as regards the quality of life of each patients for the remaining life.