Massive hemobilia and papillomatosis of the gallbladder in metachromatic leukodystrophy: a life-threatening condition.

Polyposis of the gallbladder is rare during childhood. This condition can be associated with three other conditions: metachromatic leukodystrophy, Peutz-Jeghers' syndrome, and pancreaticobiliary maljunction. We report the case of a child with hemobilia in metachromatic leukodystrophy, which rendered cholecystectomy necessary. Macroscopically, the gallbladder measured 4.6 cm in length and showed an opaque serous surface and focal brown petechiae. Moreover, a yellow polypoid lesion of 2 cm in diameter and a diffuse thickening of the fundus wall were observed. Many reports describe the importance of the association of gallbladder papillomatosis with metachromatic leukodystrophy, but only three cases presented with massive intestinal bleeding, such as our young patient had. It is thus imperative that this life-threatening condition should be well known.

The effects of parachlorophenylalanine and naloxone on acupuncture and electroacupuncture modulation of capsaicin-induced neurogenic edema in the rat hind paw. A controlled blind study.

OBJECTIVE: The aim of this work was to study the effect of pre-treatment with parachlorophenylalanine (PCPA) and posttreatment with naloxone on the modulating action on neurogenic inflammation of manual acupuncture and low intensity (5 mAmp), low frequency (5 Hz) electroacupuncture (EA). METHODS: Edema was induced by the subcutaneous administration of 50 micrograms capsaicin in rat paws. Pre-treatment with intraperitoneal PCPA was given for 3 days: 200 mg/Kg on the first day and 100 mg/Kg on the second and third days. Naloxone (1 mg/Kg) was administered at the end of the stimulation. RESULTS: The results show that naloxone and PCPA reduce the anti-edema effect of both manual acupuncture and EA. Combined administration of the two drugs completely eliminated the effect of manual acupuncture, and decreased but did not abolish the effect of electroacupuncture. CONCLUSION: These results indicate that both the opioid and the serotonergic inhibitory control systems are involved in the modulating action of acupunctural stimulation on neurogenic inflammation.

[Monophasic sarcomatoid carcinoma of the ileum. Description of a case and review of the literature]. / Carcinoma sarcomatoide monofasico dell'ileo. Descrizione di un caso e revisione della letteratura.

INTRODUCTION: A case of monophasic sarcomatoid carcinoma of the ileum is described. RESULTS: The patient was a 76 year old woman, presenting with a 5 cm perforated mass of the ileum. The tumor was constituted by epithelioid and spindle atypical cells, arranged in fascicles and in solid sheets; no clear-cut carcinomatous component was evident. Immunohistochemically, the neoplastic cells were positive for cytokeratin and, focally, for vimentin. The patient died of disease 2 months after surgery. DISCUSSION: The literature on small intestine sarcomatoid carcinoma is reviewed and the differential diagnosis is discussed. In the Author's opinion, the term sarcomatoid carcinoma (monophasic or biphasic) should be used in the small intestine for those neoplasms previously described as enteroblastoma, carcinosarcoma or pleomorphic carcinoma.

Aneurysm of right retroesophageal subclavian artery.

A case of aneurysm involving an anomalous right subclavian artery arising from the aortic arch and passing posteriorly to the esophagus is reported. Ischemic syndrome and neurological impairment of the right arm were the symptoms at onset. The diagnostic and operative approach is discussed underlining the technical problems of this type of surgery. The case was successfully treated by resection of the retroesophageal arterial segment and the aneurysm through left thoracotomy and right supraclavicular incision.

Aneurysms of the thoracoabdominal aorta.

Five cases of thoracoabdominal aneurysms are reviewed. These cases were observed during the last 10 years and their incidence was 4% of all aortic aneurysms admitted in the same period. In all the patients the Crawford's technique by graft inclusion with visceral vessel reattachment by direct suture, without by-pass, was adopted. Of the five patients, two underwent elective surgery and three emergency surgery. While the mortality rate in the patients operated on election was 0%, on emergency it was 66,6%.

[Influence of lymphostasis on healing processes of intestinal anastomoses. Experimental research]. / Influenza della linfostasi sui processi riparativi delle anastomosi intestinali. Ricerca sperimentale.

The Authors studied the healing of the intestinal anastomoses in rats with mesenteric and celiac lymph-vessels coagulated and cut. The experiment was realized utilizing 104 rats, divided in fours groups: after the induction of the lymphostasis, in the first group an end-to-end ileal anastomosis was made by polyglycolic acid suture, 6/0 in diameter. The control groups consisted of rats with ileal anastomoses, with lymphostasis solely and sham operated. The macroscopic observation and the histological findings were studied 7 and 14 days after the anastomoses' performance. Only in the animals with lymphostasis was observed an anastomosal leakage of 19% at 7th day control. In the same period the histologic sections showed a modified anastomosal healing, related to the significant reduction of the granulomatous tissue formation in presence of the lymphostasis.

[The treatment of acute cholecystitis (author's transl)]. / "Il trattamento delle colecistiti acute".

Authors report own experience on 384 patients operated for acute cholecystitis, from 1970 to 1979, among over 2.100 operations for cholelithiasis performed in that period. Operations have been divided in 3 groups: 1) deferred after 2 months (196 cases); 2) deferred, but during hospitalization, between 8th and 25th day from the onset of acute symptomatology (133 cases); 3) early, within 72 degrees hour from beginning of the disease (55 cases). Many clinical features have been considered and among these bacteriological investigations. Diagnostic acids, especially echotomography in last years, surgical procedures, pathological findings and different rates of mortality and morbidity, for each group of patients, have been studied. The conclusion is that acute cholecystitis have to be operated early, not after degrees day from onset of symptoms, especially if there is no tendency to remission of symptomatology.

[Vascular and histological changes in rat liver after porta-systemic shunt]. / Alterazioni vascolari ed istologiche nel fegato di ratto dopo derivazione porto-sistemica.

The authors analyze vascular liver modifications after porta-caval shunt in the rat. The examination of the portal vascular bed obtained by neoprene latex injection allows the definition of different morphologic phases, throughout these liver reaches new structural balance, with an efficacious lobular perfusion. In the same periods histological findings show a cell damage, without necrosis, followed by a recovery after 8 months. In distance, in normal rat porta-caval shunts induce a reduction of the liver volume, both the lobular structures have normal functions and morphology.

[Comparison between lymphangiovenous and adeno-lymphovenous anastomoses in the rat with mesenteric lymphostasis]. / Confronto tra anastomosi linfangiovenose ed adeno-linfo-venose nel ratto con linfostasi mesenterica.

A comparison between lymphangiovenous and lymphadeno-venous anastomoses has been realized in rats with mesenteric lymphostasis. The lymphangiovenous anastomoses have showed a better patency than lymphonode-venous shunt owing to technics and biologic problems. Their function was verified until 15th p.o. day, while all lymphonode venous shunt were closed at 10 th p.o.. The shunt occlusion may be related with lymphatic newborn vessels, which exclude the anastomoses from lymph flow.