[Upper digestive hemorrhage as a rare manifestation of ectopic pancreas with gastric localization]. / L'emorragia digestiva superiore come manifestazione rara di pancreas ectopico a localizzazione gastrica.

The Authors report two cases of ectopic gastric pancreas, one of them causing a massive upper gastrointestinal hemorrhage, representing an infrequent complication of the disease. A literature review on the subject was then performed, and the importance of a differential diagnosis of the ectopy versus gastric malignancies, with relevant prognostical and management implications was assessed.

Ultrasonography in the management of acute appendicitis.

BACKGROUND: Ultrasonography (US) shows promise in the diagnosis of acute appendicitis. METHODS: The authors present their own experience in ultrasonography (US) employed in the diagnosis of appendicitis, based on 40 patients admitted to the Department of Surgery of the University of Perugia. RESULTS: US was found to be easily obtainable and reliable; it had good specificity and sensitivity, was not very time consuming, and had a good cost/benefit ratio. CONCLUSIONS: The authors believe US is an important diagnostic tool that can reduce useless laparotomies for false acute appendicitis, particularly in cases presenting with unclear clinical findings.

Acute appendicitis. How many uncorrect diagnosis? A clinical and histological evaluation of 124 cases treated with emergency procedure.

Acute appendicitis is a very common disease in western countries, affecting the entire population with higher prevalence in younger people. The diagnosis of the disease is still basically performed through the clinical evaluation of the patient, while peripheral White Cell Count or imaging techniques such as ultrasonography are poorly helpful. Therefore, a great number of patients is operated without finding a severe involvement of the appendix at intraoperative observation. To evaluate the rate of false acute appendicitis and to correlate the histological involvement with the clinical behavior of the disease the Authors carried a prospective study during a period of 28 months on 124 patients with a diagnosis of acute appendicitis treated on emergency basis.

[Intestinal lymphangiectasis in adults]. / La linfangectasia intestinale nell'adulto.

Although rarely, several conditions may cause malabsorption through lymphatic obstruction. Primary lymphangiectasia, a genetically determined disease characterized by diarrhoea, steatorrhoea and protein-losing enteropathy, is one of these conditions. The Authors report their experience in three cases of small bowel lymphangiectasia occurring in adults and discuss diagnostic and therapeutic problems of the disease.

[Primary choledocholithiasis after side-to-side choledochojejunostomy]. / La calcolosi primaria consecutiva a coledoco-digiunostomia latero-laterale.

Primary choledocholithiasis represents a quite unusual sequela of biliary tract surgery. Primary stones originate in the common bile duct and are soft, smooth, with a yellowish or brown-reddish colour, reproducing the shape of the duct in which arise. The Authors report a review of the cases observed in the division of General and Vascular Surgery-Department of Surgery and Surgical Emergencies of the University of Perugia. From January 1988 to December 1993, 577 laparotomic biliary tract operations were performed, and in 8 cases a re-operation was needed. Among the latter, particularly interesting were 2 cases of primary choledocholithiasis occurred in two patients with bilio-digestive anastomosis previously performed, i.e. two side-to-side Roux-en-Y or Braun loop choledochojejunostomies, respectively. Therefore, primary lithiasis following a choledochojejunostomy occurred when the bilio-digestive anastomoses were performed with the indication of a curative re-operation on the biliary tract. On the contrary, most choledochojejunostomies are performed as a palliative procedure in patients presenting a low survival rate not allowing to develop a Sump Syndrome and a consequent choledocholithiasis, which are long-term complications.

[Thoracic trauma]. / I traumi del torace.

From January 1989 to December 1992, in the Institute of Clinical Surgery of the University of Perugia, 102 patients were admitted for thoracic trauma. Two patients with an open thoracic trauma, both presenting multiple shot-wounds, underwent an explorative thoracotomy. One of them died on the operating-table from hemorrhage, while the other was saved by a wedge-resection. A 3rd explorative thoracotomy was successfully performed on a patient with internal thoracic trauma and severe hemothorax. Among the 100 patients with an internal thoracic trauma, mortality was 6%, but only one of the 6 deceased, had no lesions other than a fail chest. As a matter of fact 38 patients presented lesions in other parts of the body. Simple and complicated multiple costal fractures, found in 84 cases, were the most frequent lesions observed. Seventeen of the 38 patients with pneumothorax and/or pleural effusion had a chest tube applied. Three patients were operated for a diaphragmatic hernia with a positive outcome. Only 75 patients received medical treatment without surgery. Six of the patients with multiple costal fractures presented flail chest. One of them (mentioned above) died almost immediately after his admission and therefore received no more than the initial medical treatment. Four others, aged over 65, successfully underwent a costal osteosyntesis, while the 6th patient received medical therapy with a positive outcome. In the case of a critical flail chest with severe patho-physiological consequences, if the fractures are in technically favourable sites, the Authors believe it is better to immediately stabilize the thorax, since the operating trauma is minimum and in many cases the patient is already intubated and curarized.

[Neoplastic involvement of the inferior vena cava]. / L'interessamento neoplastico della vena cava inferiore.

Inferior caval vein invasion not infrequently complicates advanced neoplastic lesions. Primitive caval neoplasms (leiomyosarcomas) or other tumors such as renal carcinomas, pheochromocytoma, as well as liver, testis, and retroperitoneal tumors most likely cause caval invasion. In the past, caval invasion was a clear index of non operability, while today, a modern multidisciplinary approach allows to treat successfully even so advanced diseases. In the present report the Authors analyze the cases treated at the Dept. of Surgery of the University of Perugia, and review the most important international reports on this subject illustrating the new possibilities offered by IVC substitution with biological or artificial grafts.

[Diagnostic and therapeutic problems of "second look" in acute intestinal ischemia]. / Problematiche diagnostiche e terapeutiche nel "second look" delle ischemie intestinali acute.

The authors present their diagnostic approach to acute intestinal ischemia. They underline the need for early specific diagnosis because the therapeutic options vary widely in relation to different types of acute intestinal ischemia. Selective arteriography preceded by an aortogram is considered the diagnostic "gold standard". Although at present mesenteric ischemia is a serious, and often lethal, disease, an aggressive therapeutic approach can improve the outcome of this group of patients.

[Intestinal obstructions caused by colorectal carcinoma in the aged]. / Le occlusioni intestinali da carcinoma del colon-retto in età geriatrica.

Colorectal cancer is the second most common malignancy of the adult population in the United States. It is exceeded only by lung cancer among males and breast cancer among females. Malignancies of the colon and rectum are responsible for approximately 12 per cent of all adult cancer deaths. These tumors appear as surgical urgency by intestinal obstruction for 15-20 per cent and by perforation for 3-8 per cent of all cases. It often occurs in elderly patients; in fact, urgent surgical operations are especially performed in patients older than seventy. The mortality rate for urgent surgical operation in elderly patients is about 32-54 per cent. This high mortality is even due to concurrent pathologies and particular locoregional and/or general alterations induced by tumor. The authors studied all patients older than 75 years affected by colorectal cancer and treated by choice or by urgency at Dept. of Surgery of the University of Perugia from January 1987 to February 1993 to individualize some clinical, anatomo-pathological and therapeutical significant characteristics about colorectal cancer in geriatric age.

Effect of a new peptidyl-hypoxanthine derivative on natural killer cells and antitumor activity.

A new immunomodifier, [omega-(hypoxanthin-9-yl) pentoxy-carbonyl-leucyl-methionine] (RM06), was synthesized and its effect was evaluated on the activity of Natural Killer (NK) cells. Results indicate that RM06 is able to boost the NK activity of normal mice as well as to augment the regeneration of NK activity of lethally irradiated mice transplanted with syngeneic bone marrow (BM). This later effect also correlated with a significant increase in anti-tumor activity as evaluated by the resistance to metastasis in mice injected with syngeneic melanoma cells. These data indicate that RM06 is able to modulate the NK cell activity as well as the antitumor resistance.

[The role of Streptococcus mutans in human caries]. / Ruolo dello Streptococcus mutans nella carie umana.

Definite proof has been found that S. mutans, and probably S. sobrinus and lactobacilli, are responsible for caries in man. The aciduria of S. mutans encourages the selection inside the plaque and is directly responsible for its cariogenicity. Other aciduric species, as S. sobrinus, cause caries on the smooth surface of the tooth, where the principal causes of the rampant caries reside. If during the eruption of the tooth the fissures become colonized in depth by S. mutans, the development of caries becomes a highly probable event. Instead, if the colonization of the tooth by S. mutans takes place after the fissure depth have been occupied by other microbic species not cariogenic, it is probable that the caries will not manifest or will appear in a less severe form. In conclusion, the knowledge already acquired on the ecology of S. mutans and the mechanism of cariogenesis clearly indicate that all factors that interfere with the colonization of the tooth by S. mutans can greatly reduce the incidence of caries in man.

[Odontoma. A clinical case. Principles of diagnosis and therapy]. / Odontoma. Un caso clinico. Principi di diagnosi e terapia.

Odontoma is a typical tumor without eclatant symptoms and the case described from the Authors do not exception. This case is particular because the first time it is found in an adult age and in an unusual sit.

[Anticaries vaccination: present and future prospects]. / Vaccinazione anticarie: presente e prospettive future.

Despite the encouraging decline in dental caries observed in recent years in many populations, millions of children still risk tooth decay. Along with established methods of prevention, caries vaccines have the potential of making a highly valuable contribution to disease control. Compelling evidence has shown that Streptococcus mutans is the principal etiologic agent of dental caries, therefore a vaccine directed to this microorganism could significantly reduce the caries incidence. In experimental models with rodents, both peroral and parenteral immunization have provided protection against S. mutans infection and dental caries. In primates only parenteral immunization has given positive results, and there have been conflicting results in studies on human peroral immunization. Presently there is no conclusive evidence which shows that antibodies to S. mutans can protect against dental caries in humans. Among the S. mutans antigens that could be used as a vaccine, only some protein antigens have given protection in primates. One of these has been produced in large amounts and is ready for testing in humans. Another antigen, the enzyme complex glucosyltransferase, has shown protection in rodents and the effect of peroral administration of this antigen is now being tested in humans. While awaiting results of clinical trials with available vaccines, much additional experimental work is needed to understand the complex phenomenon of caries. New information will permit the development of more efficacious vaccines against the caries.

Inhibition of in vitro keratinization of chick embryo skin cultured with hepatectomized rat serum.

In the present study organ cultures of 6 day-old chick embryo matatarsal skin were used to determine the effect of hepatectomized rat serum in modulating epithelial differentiation. Six day-old chick embryo skin, maintained in organ culture for 6-7 days with a medium containing adult rat serum, was seem to undergo differentiation and keratinization faster then in vivo. Epidermis cultured for 6-7 days with a medium containing partially hepatectomized rat serum does not differentiate and the squamous layer is absent. Studies with 3H-cystine show a sharp decrease in the labelled amino-acids incorporation in the cultures added with serum obtained after partial hepatectomy.

Further researches on the action of hepatectomized rat serum on epithelial differentiation in chick embryo skin.

Skin explants obtained from 12-day old chick embryos, maintained in organ culture containing adult rat serum, show a lower epidermal growth in comparison with skin explants cultured with other adult animal serum; nevertheless the keratogeneous differentiation of the epidermal cell is evident. When the cultures are incubated with medium containing partially hepatectomized rat serum epidermal-cell differentiation and proliferation are absent.

[Incorporation of H3 uridine in chick embryo skin cultured in media containing histones]. / Incorporazione di urinina H3 in espianti di cute di embrione di pollo coltivati con istoni.

In this paper the authors have carried out further research on the differentiation of six-day limb skin from chick embryos cultured in vitro in mediam containing histones. When 3H-uridine is added to this modified medium, a decrease of 3H-uridine uptake and incorporation is observed. The authors conclude that in their system the histones not only interfere with the regulation of genetic transcription by inhibiting DNA-dependent RNA synthesis, but they also change cellular permeability.

[Differentiation in vitro of chick-embryo skin in presence of histones. Analysis of protein synthesis in toto and of keratin in particular, with the use of labeled precursors]. / Studio del differenziamento in vitro della pelle di embrione di pollo in presenza di istoni. Analisi della sintesi proteica in toto e della cheratina in par ticolare con l'uso di precursori marcati.

Six-day limb skin from a chick embryo was cultured in vitro for seven days in a complete medium either supplemented or not with histones. At the end of the incubation period, the chick embryo skin cultured in the absence of histones was found to undergo keratinization, the converse being true for the limbs cultured in the presence of histones. In the latter, when H3-leucine and C14-cystine were added to the medium, a sharp decrease in the labeled amino acid incorporation was found.