[Surgical treatment of epiphrenic diverticulum based on associated functional changes: report of a case]. / Trattamento chirurgico di diverticolo epifrenico modulato sulle alterazioni funzionali associate: presentazione di un caso.

OBJECTIVE: The authors report their experience about the surgical treatment of a epiphrenic diverticulum (ED) associated with motor disfunctions and gastroesophageal reflux. DESIGN: Report of 1 case; evaluation of effectiveness of the treatment. SETTING: Operative Unit of General and Thoracic Surgery, Department of Surgical, Anatomical and Oncological Disciplines. Policlinico, University of Palermo. INTERVENTIONS: Thoracotomic diverticulectomy + esophageal extramucosal myotomy + antireflux procedure. RESULTS: Resolution of syntomatology. Negative the follow up. CONCLUSIONS: ED is the epiphenomenon of esophageal motor disfunctions. The surgical procedure is based on their comprehension and on the study of this factors.

[Intra-arterial chemotherapy in the treatment of liver metastases of colorectal cancer]. / La chemioterapia intrarteriosa nel trattamento delle metastasi epatiche da cancro del colon-retto.

AIM: The authors evaluate the value of hepatic intrarterial chemotherapy (HAC) as an alternative treatment for hepatic metastases from colo-rectum cancer unsuited to radical surgery. METHODS: This study evaluates the physiopathological and pharmacodynamic bases for this type of treatment, the correct procedure for patient staging and selection, the surgical technique used to insert the infusional system, surgical complications and those linked to endoarterial treatment, the evaluation of response and the results. Complications correlated to the infusional system were evaluated in a total of 1223 patients in 10 non-randomised studies and 7 randomised studies taken from the literature. Complications correlated to chemotherapy were analysed in a total of 777 patients from 8 randomised studies and 7 randomised using FUDR. Special emphasis was placed on the possible association of locoregional and systemic treatment in order to prevent extrahepatic progression, the main cause of death in patients undergoing a single cycle of HAC. RESULTS: By comparing locoregional and systemic treatment taken from a number of randomised and non-randomised studies, the results were evaluated in terms of objective response and survival. CONCLUSIONS: There was no proportional increase in survival rates compared to systemic treatment only, in spite of the large proportion of objective responses achieved using locoregional treatment alone.

[Intra- and postoperative anesthesiologic management in cerebral arteriovenous malformations]. / Management anestesiologico intra- e post-operatorio nelle malformazioni artero-venose cerebrali.

The authors analyze the anesthetic management of 59 cases of "large" arteriovenous malformation (more than 20 cm3), all completely removed by microsurgical technique. The discussion is focused on immediate pre-operative, intra-operative and post-operative pharmacological treatments in order to reduce the hemodynamic effects in the surrounding brain after excision of angiomas.

Effect of nicotinamide therapy upon B-cell function in newly diagnosed type 1 (insulin-dependent) diabetic patients.

This study describes the effects of nicotinamide therapy on B-cell function in Type 1 (insulin-dependent) diabetes. C-peptide secretion was studied in 20 patients newly diagnosed with Type 1 diabetes at basal state and also after an i.v. glucagon stimulus. Patients were randomly allocated according to a single-blind schedule, to one of the following treatments over a 45-day period: Group 1: 10 patients, nicotinamide 1 g/day; Group 2: 10 patients, placebo. The C-peptide secretion tests were performed before treatment and on days 15, 45, 180, 365 of the follow-up. The clinical and metabolic data were similar in the two groups of patients. Basal and stimulated C-peptide levels increased by 45 days in both groups, but the increase in stimulated C-peptide response was greater in the nicotinamide group (p less than 0.01). However, the B-cell function decreased after the period of nicotinamide administration. No difference in the number of clinical remissions or insulin requirement and HbA1 between the groups was observed. These data suggest that treatment of Type 1 diabetes with nicotinamide at diagnosis is associated with a moderate increase of C-peptide secretion recovery.