Thoracoscopic truncal vagotomy.

BACKGROUND: Nowadays the only indications to truncal vagotomy is recurrent ulceration after previous gastric surgery. Truncal vagotomy allows us to obtain a reduction in acid production and to promote ulcer healing, but this technique causes pylorospasm in about 20% of cases and this requires further synchronous or metachronous pyloric drainage procedure. For this reason, videothoracoscopic truncal vagotomy is reserved to patients with gastroresection. METHODS: The authors describe 15 patients treated with videothoracoscopic truncal vagotomy. In 12 patients, a gastrojejunostomy was done according to Roux technique in 2 patients, a reconstruction according Billroth II technique and in 1 patient, a gastroduodenostomy according to Billroth I technique. RESULTS: Videothoracoscopic bilateral truncal vagotomy was done in all patients; operation time was 45 minutes. During the postoperative period there were no complications. No patients underwent medical therapy for peptic ulcer. Only in 12 patients was it possible to execute an endoscopic follow-up in a period of 3 to 4 years. In all patients the ulcer was completely healed. CONCLUSIONS: Complete vagotomy in patients who present with recurrent gastrointestinal bleeding after previous gastroresection, is associated with significant risks. Videothoracoscopic bilateral truncal vagotomy as a simple and efficient procedure seems to be an alternative treatment for the management of recurrent ulceration after previous gastric surgery for peptic disease.

[Colo-anal anastomosis in tumors of the lower rectum]. / L'anastomosi colo-anale nei tumori del retto basso.

The Authors report their experience about totally mechanical coloanal anastomoses. Seven patients affected by rectal cancer and submitted to proctosigmoidectomy and, following totally mechanical coloanal anastomoses as described by Goligher are taken in consideration. The distance of the neoplasm from the anal verge goes from 5 to 7 cm. Using Dukes classification 6 patients were classified in B stage, only 1 in A stage and nobody in C stage. No patient received adjuvant radiotherapy. In the patients in B stage has been performed an extended ilio-pelvic lynfoadenectomy. Particular attention was put on the complete remotion of the mesorectum. In no case has been provided with a creation of a diverting colostomy. No mortality in the post-operative period nor anastomotic leakages haven't been recorded. The follow-up goes from a minimum of 8 months to a maximum of 7 years. Have been reported 2 cases of recurrence, at pelvic level after 18 months and at empathic level after 8 months from intervention. In 6 of the 7 patients have been valued the functional results that have put in evidence a satisfying gas and fecal continence. Only during the first months following the intervention has been recorded an increasing of the number of defecation that have reduced in the long term.

Identification of the Serum Complex Which Induces Cerebellar Granule Cell In Vitro Differentiation and Resistance to Excitatory Amino Acids.

The protein complex promoting in vitro terminal differentiation of cerebellar granule cells has been isolated from rabbit serum. We designate the complex the neurite outgrowth and adhesion complex (NOAC). The apparent molecular weight, evaluated by gel filtration, is 80 - 100 kDa. Rat cerebellar granule cells cultured in NOAC exhibit much lower glial cell contamination and survive, in their differentiated state, much longer than in 10% foetal calf serum. While they bind tetanus toxin, express specific antigens such as synapsin I, synaptophisin and A2B5, and release [3H]d-aspartate in a fashion similar to that shown by cells cultured in foetal calf serum, they show a 60% reduction in the total number of kainate binding sites. Excitatory amino acid (EAA)-triggered and depolarization-stimulated calcium influx, measured in the presence of different agonists, is 50 - 80% lower in NOAC-cultured cells. NOAC cells are resistant to excitotoxic stimuli carried by EAAs or by depolarizing treatments with 50 mM KCl or 6 microM veratridine. The marked resistance of NOAC-cultured neurons to EAAs can be attributed to decreased calcium entry through EAA-coupled and voltage-gated calcium channels and possibly to other, as yet unidentified, phenotypic properties of these cells. These findings demonstrate that rabbit serum contains one or more polypeptide(s) endowed with the properties of promoting in vitro survival and differentiation of rat cerebellar granule cells and of conferring an EAA-resistant phenotype.

Manometric evaluation of jejunal limb after total gastrectomy and Roux-Orr anastomosis for gastric cancer.

Total gastrectomy with Roux-Orr anastomosis is frequently performed for gastric cancer. Since intestinal motility of the Roux limb has never been evaluated after this operation, pressure activity was investigated in the Roux limb of ten patients (aged 51-77 years) who had undergone total gastrectomy and Roux-Orr reconstruction. Investigations were carried out during a 6-h fast and 3 h after a 605 kcal mixed meal. During fasting only two patients had activity fronts and these were abnormal. All ten patients displayed non-propagating bursts of contractions and three had discrete clustered contractions and high amplitude jejunal contractions. The fed state was characterized by a severely reduced motor activity pattern and other abnormalities. Total gastrectomy with Roux-Orr anastomoses provokes a relatively severe disturbance in intestinal activity.

In vitro interactions of opioid peptides with phospholipids. IV. Methionine enkephalin versus leucine enkephalin.

The interaction of methionine and leucine enkephalin with phosphatidylserine and phosphatidylcholine was studied by optical spectroscopy techniques. The data reported indicate that with both peptides the binding is controlled by ionic parameters. They also indicate that the differences in the binding behavior of the two peptides induced by changing these parameters are minor. Non-ionic interactions are also important in the binding phenomena, but the above observations hold in this case as well. Finally, the tridimensional structure of both enkephalins appears to be modified in the presence of phospholipids. Moreover, the changes induced by these lipids appear to differ from one peptide to the other.

[Use of diverse prosthetic materials in preparation of sequential bypasses in combined lesions of the aorto-iliac-femoral axis]. / Uso di materiali protesici diversi nella confezione dei by-pass sequenziali nelle lesioni combinate dell'asse aorto-iliaco-femorale.

A series regarding three years of surgery is analysed with regard to the preparation of four sequential by-passes out of 23 aorto-bifemoral revascularisations. Indications and the eminently technical aspects are discussed, the latter consisting of the adoption of two types of different prostheses sutured one to the other, such as the Dacron and the PTFE prostheses, which proved to be very compatible and long-lasting. The results were excellent as is testified by the follow-up.

[Stapler reconstruction after total gastrectomy contrasted with manual anastomosis]. / La ricostruzione con Stapler dopo gastrectomia totale a confronto con l'anastomosi manuale.

A personal series (1985-1987) of 22 cases of total gastrectomy for cancer is analysed, a comparison being made between 11 cases treated with manual anastomosis and 11 reconstructed using a stapler. The advantages and disadvantages of the various techniques are examined and although no substantial difference is noted between the two reconstructive modalities, at least as regards morbidity and mortality, stress is laid on the unquestionable advantages of mechanical staplers. These are essentially speed of execution, suture perfection and excellent long-term results.

[Follow-up of revascularization. Our echotomographic experience with 20 aorto-femoral by-pass patients]. / Follow-up delle rivascolarizzazioni. Nostra esperienza ecotomografica su 20 pazienti operati di by-pass aorto-bifemorale.

Twenty patients submitted to aortobifemoral bypass and controlled every six months with echotomography, echoflow and digitalised angiography were followed up and the results reported. The value of the technique emerges clearly. It is risk-free and possesses high sensitivity for the analysis of peripheral vascular anastomosis. The limitations of the technique would appear to be connected solely to poor evaluation of the aortic anastomosis.

[Methods for preparing patients to vascular surgery. Our experience]. / Metodiche di preparazione dei pazienti vascolari all'intervento. Nostra esperienza.

A personal series covering two years of vascular surgery involving 58 cases without problems of sepsis has been examined. The modalities employed for preventing wound infections and prosthesis suppuration when it occurred and consisting of showers, antibiotic prophylaxis and shaving are reported. In conclusion it is maintained that a specific, disciplined protocol must be followed in all candidates for prosthesis.

Enkephalin activity on antigen-induced proliferation of human peripheral blood mononucleate cells.

The effect of the two opioid pentapeptides met- and leu-enkephalin and of the tetrapeptide TYR-GLY-GLY-PHE on the stimulated proliferation of human peripheral blood mononucleate cells (PBMC) is described. Cell populations obtained from different donors were induced to proliferate with a Candida antigen. In the presence of the antigen, met-enkephalin and TYR-GLY-GLY-PHE had a concentration-dependent diphasic effect. The proliferation of PBMC was stimulated at high peptide concentration, while it was inhibited at the lower concentrations used. The effect of leu-enkephalin appears to be rather ambiguous, and directed towards the inhibition rather than the stimulation of PBMC proliferation.