Interactions between Lactobacillus sakei and CNC (Staphylococcus xylosus and Kocuria varians) and their influence on proteolytic activity.

AIMS: To evaluate interactions between Lactobacillus sakei and coagulase negative cocci (CNC) (Staphylococcus xylosus and Kocuria varians) and to investigate the influence of these interactions on their own proteolytic activity. METHODS AND RESULTS: Interactions occurring between strains of Lact. sakei and CNC were assessed by spectrophotometric analysis. The growth of 35 strains of Lact. sakei, used as indicators, was compared to that obtained combining the same strains with growing cells or cell-free supernatants of 20 CNC (18 Staph. xylosus and 2 K. varians). The proteolytic activity expressed by single strains or by their combinations was assessed on sarcoplasmic protein extracts by sodium dodecyl sulfate-polyacrylamide gel electrophoresis. The results evidenced that interactions are able to affect not only the growth but also the in vitro proteolytic activity of Lact. sakei and CNC used in combination. CONCLUSIONS: A relationship between the presence of interactions among useful strains and the strength of technological characteristics, such as proteolysis, was defined. SIGNIFICANCE AND IMPACT OF THE STUDY: The study highlighted that CNC are able to stimulate the growth of some Lact. sakei strains. At the same time, this interaction positively influences the proteolytic activity of strains used in combination. Given the importance of proteolysis during the ripening of fermented meats, this phenomenon should be taken into account to select meat starter cultures.

Superselective intra-arterial radiometabolic therapy with I-131 lipiodol in hepatocellular carcinoma.

Superselective transcatheter arterial radioembolization with radioiodinated lipiodol and gelatin sponges was evaluated in 11 patients with nodular hepatocellular carcinoma. Thirteen tumor nodules were treated using 3-5 ml of lipiodol labeled with 259 to 2220 MBq of I-131 followed by gelatin sponge with the following results: 1) there was elevated uptake in 12 tumor nodules with high tumor-to-background ratios: 2) there was excellent clinical tolerance to the treatment (stable cirrhosis in 5 patients and cirrhosis progression in 2 cases); 3) there was good disease control with size reduction in five tumor lesions (41%) and no increase in seven lesions (59%) followed for 2 years; 4) there was a 2-year survival rate of 70%; and 5) three deaths due to hepatic failure at 2, 3, and 20 months after therapy. Superselective arterial radioembolization with I-131 lipiodol is a useful palliative approach to inoperable hepatocarcinoma, providing long-term local control without severe complications in the progression of cirrhosis.

A simplified percutaneous hepatogastric drainage technique for malignant biliary obstruction.

We describe a technique to bypass a malignant biliary obstruction by creating a direct connection between the left biliary tree and the stomach. First, adherence between the left liver parenchyma and the stomach is achieved by a Cope anchor system. Then, the left biliary tree and stomach are connected by Colapinto needle puncture of the stomach from a left biliary duct with the needle inserted through a 9 Fr transhepatic sheath. Over a stiff guidewire, a Ring drainage catheter is placed. Later, the Ring catheter is replaced by a metallic stent. Four patients with malignant biliary obstruction underwent this procedure. The mean survival time was 77 days with maximum follow-up of 171 days. Neither obstruction nor dislocation of the metallic stents occurred.

[Percutaneous biliary drainage in obstructions due to malignant pathology]. / Drenaggio biliare percutaneo nelle ostruzioni da patologia maligna.

Experience with percutaneous transhepatic biliary drainage (PBD) in 68 cases of malignant biliary obstructions, is described. 78 procedures (11 external drains, 36 internal-external drains, 17 soft endoprosthesis and 14 self-expandable metallic stents), were performed between December 1989 and December 1991. No significant differences in terms of results were found between internal endoprosthesis and metallic stents. The mortality rate of the procedure was 1.47% (1 case). Complications for the internal prostheses were: obstructions 8 (25.8%), dislodgement 2 (6.5%), cholangitis 1 (3.2%) and metastases along the catheter tract 1 (3.2%). Considering this, the Authors prefer the endoprosthesis instead of external or internal-external drainages.

[Angiography with magnetic resonance in the study of portal hypertension. Clinical applications]. / Angiografia con risonanza magnetica nello studio della ipertensione portale. Applicazioni cliniche.

The role of MR angiography (MRA) was investigated in 31 patients with portal hypertension. The 2D time-of-flight (TOF) technique was used. All patients underwent CT first. MR angiograms were compared with DSA images in 15 cases and to duplex or color Doppler US scans in 16 cases. In 5 low-grade portal hypertension cases MRA showed splenoportal trunk enlargement and portal vein verticalization. In 26 patients with high-grade portal hypertension MRA allowed portosystemic shunts extent to be evaluated. Portal flow reduction or inversion and left gastric vein enlargement were always demonstrated by MRA in the patients with esophageal varices and azygos vein enlargement. MRA always correctly visualized cavernoma (5 cases) and portal vein thrombosis (9 cases). The diagnostic yield of MRA was greater than that of CT and SE MR sequences in 91% of cases. MRA provided the same information as (or more than) DSA and duplex US in 66% of cases.

[Stage I and II cervical carcinoma. Study with magnetic resonance and transrectal echography]. / Il cervicocarcinoma al I e II stadio. Studio con Risonanza Magnetica ed ecografia transrettale.

Twenty-five patients with histologically-proven cervical carcinoma (clinical stages I and II according to FIGO classification system) were studied by means of transrectal US (TRUS) and MR imaging (MRI) at 1.5 T, to evaluate the primary tumor and measure its size. Stage Ib cancers were divided into small 4 (less than 4 cm) and large (greater than 4 cm). The patients with large Ib and those with stage II lesions were administered preoperative radiation therapy. All the patients underwent TRUS, MRI, and clinical examination under sedation; they were subsequently operated. Stage Ia and small Ib patients underwent therapeutic surgery, while large Ib and stage II cases had surgical exploration for pathologic staging. The tumor was correctly identified and measured in 22 patients with MRI, and in 20 cases with TRUS. Tumoral involvement of parametria and uterine ligaments was demonstrated in 75% of cases by MRI and in 62.5% of patients by TRUS. Vaginal involvement was demonstrated by MRI in 77.8% of cases and by TRUS in 66.6% of patients. Tumor size could be evaluated more accurately than with clinical examination under sedation, while the results were poorer in the demonstration of tumor spread into uterus and parametria.

[Magnetic resonance angiography of the vessels of the neck. Study technique and normal anatomy]. / Angiografia con risonanza magnetica dei vasi del collo. Tecnica di studio ed anatomia normale.

Magnetic Resonance Angiography (MRA) is a new diagnostic technique which allows vascular structures to be studied atraumatically and without any contrast medium. Its basic principles are reported in the present paper, together with the results of a preliminary study of normal neck anatomy. Twenty healthy volunteers and 10 patients with no cerebral vascular diseases underwent this MRA study. Internal and common carotid arteries were always well visualized, while external carotid was demonstrated in 87% of cases. Among intracranial vessels, the middle cerebral artery was clearly depicted in 63% of cases, while the anterior cerebral artery was visible in 18% of the study population only.

CT demonstration of peritoneal metastases after intraperitoneal injection of contrast media.

Thirty-three patients with ovarian carcinoma who had no evidence of metastases or ascites demonstrated on computed tomography (CT) with and without contrast agent were examined with CT after injection of approximately 3000 cc of a 2.4% solution of nonionic contrast media into the peritoneum. After intraperitoneal injection with CT (IPC CT), 22 were diagnosed as having intraperitoneal metastases. Of these, 19 were found to be true positives and 3 false negatives. Three other patients diagnosed as normal were found to have metastases. In all patients the peritoneum was well outlined and generally any metastases smaller than 1 cm were demonstrated. It was possible to identify compartmentalization of the peritoneum and to determine the location of the lesion to be in the peritoneum or the extraperitoneal space. This information is necessary in the planning of chemotherapy, particularly endoperitoneal chemotherapy. Tiny metastases to the omentum or adherent loops of small bowel could not be seen well.

[Magnetic resonance in hepatic lesions. Experience with a 1.5-T magnetic field]. / La Risonanza Magnetica nelle lesioni epatiche. Esperienza con campo magnetico da 1,5 T.

Forty-one patients with histologically proven hepatic lesions (6 cysts, 6 hemangiomas, 8 hepatomas, 19 metastases and 2 negative cases) were studied with Magnetic Resonance (MR) imaging at 1.5 T, and with US and CT. This prospective study was aimed at evaluating: the comparative accuracy of MR, US and CT; the sensitivity and specificity of spin-echo (SE) vs FISP pulse sequences; the efficacy of T1 and T2 relaxation time values in differentiating hemangiomas from hepatomas and metastases. MR diagnostic accuracy was 94.7% vs 89.4% of CT and 84.2% of US. FISP sequences provided 60% sensitivity and 66% specificity. T2 relaxation time values were statistically significant (p less than 0.05) in differentiating hemangiomas (T2 range: 80.9-218.9 ms) from hepatomas (T2 range: 59.4-83.2 ms). The differences in mean T2 values between hemangiomas and metastases (T2 range 54.3-177.3 ms) were not statistically significant (p greater than 0.25).

High contrast enhancement of the liver in CT by repeated doses of contrast medium.

A technique consisting of repeated injections of contrast medium has been used in 530 cases of upper abdominal CT studies for evaluation of hepatic and pancreatic disease. Out of 530 cases, 105 patients had hepatic lesions, 62 metastatic, 3 adenomas, 4 haemangiomas and 6 hepatomas. The remaining 30 patients had cystic lesions involving the liver. Using a repeat dose technique and rapid scanning, the accuracy rate ranged about 90%. Th authors feel that this technique should be employed routinely for evaluation of hepatic problems and that other techniques should be abandoned.

[Abdominal angio-CT: technique of injection and scanning (author's transl)]. / L'angio-TC degli organi addominali: tecnica di iniezione e scansione.

Angio-CT consists in a rapid bolus intravenous injection of contrast medium followed by serial sequential fast scanning to include the arterial and the venous phases. Injection of contrast medium of 50 cm3 are made 3 or 4 times for a total of 150 divided by 200 cm3 of contrast medium at an iodine concentration of 29 g/100 cm3. At the beginning, scans are intercalated with injections, until the total amount of contrast medium is reached. Thereafter, the scans are rapidly continued to cover the whole organ under study. The scanning during the vascular enhancement has considerably helped our diagnostic accuracy and has a made the drip-infusion technique out-moded.

[Arterial transcatheter embolization in arterio-venous fistulae therapy (aithor's transl)]. / L'impiego dell'embolizzazione arteriosa transcatetere nella terapia delle fistole artero-venose.

In arterio-venous malformations, arterial trans-catheter embolization can be considered as a definitive treatment, a pre-operative devascularizing technique, and a palliative treatment of those not surgically operable malformations. A very important point is choosing the correct way where to introduce the catheter and the embolizing devices. The most known devices are: synthetic fibrin foam (Gelfoam, Spongostan), Gianturco coils, and among the non reabsorbable devices a polyvinylic alcohol foam (Ivalon), the isobutyl-2-cyanoacrylate and silicone. Furthermore detachable balloons and bristle-brushes can be used. Many parameters must be taken into consideration: hemodynamic fluxes of the lesion, type of vascularization, extension of the lesion, aim of the embolization, possible risks. When embolizing large territories, the protocol must foresee several performances for the control of the embolized vessels, the presence of collateral circulation, the extension of the embolization and other afferent arteries to the lesion. Regarding the permanent occlusions it is preferable to utilize fragments of Ivalon, small silicone spheres or liquid silicone; finally, reabsorbable device must be used in the distal embolizations and non reabsorptible in the proximal embolizations. The best results have been achieved in the traumatic lesions where a direct communication exists between an artery and a vein. Among the arterio-venous malformations the best results have been achieved in cranio-facial angiomas with low flux. The possible complications are consequences of ischemia: necrotic musculo-cutaneous, cerebral or troncular changes.

[Therapeutic embolization of the liver (author's transl)]. / L'embolizzazione terapeutica del fegato.

The authors present their experience with 18 cases of hepatic arterial embolization: 9 for neoplasm, 8 for hemorrhage and 1 for vascular malformation. Aside from contral of acute arterial bleeding, this angiographic technique has extended its indications to the preoperative or palliative treatment of hepatic primary and secondary tumors and also to non surgical treatment of arterovenous and malformations. Compared to surgical ligation, embolization, being highly selective, produces less damage to the normal parenchyma. In case of inoperable tumors embolization produces some improvement of general conditions and has analgesic effect; while when operation is possible it may act as a preoperative devascularization procedure. Finally with employment of non absorbable material embolization may substitute surgery in presence of arterovenous malformation. The procedure has no controindications but it is essential that hepatic function is preserved and that portal flow dynamics are not altered. Among laboratory data to be investigated blood glucose level is particularly important since it may reveal ischemic damage. Possible complications due to reflux of emboli can be avoided with a correct technique and with some simple acquirements.