Enhanced beta-adrenergic response in rat papillary muscle by inhibition of inducible nitric oxide synthase after myocardial infarction.

AIM: Myocardial infarction (MI) induces a progressive ventricular remodelling leading to a contractility depression. During the acute phase of MI inducible nitric oxide synthase (iNOS) expression and nitric oxide (NO) production increases in the heart. The aim of this study was to investigate the role of iNOS in the left ventricular contractility at 3 days after MI. METHODS: Wistar rats were divided into: sham operated (SHAM, n = 23), infarction (INF, n = 18); sham operated plus the iNOS inhibitor, S-methylisothiourea (SMT) 5 mg kg(-1) day(-1), i.p. treatment (SHAM-SMT, n = 26) and infarction plus SMT (INF-SMT, n = 22). Concentration-response curves for isoprenaline, Ca(2+) and frequency-force curve were studied in isolated papillary muscle from left ventricle. RESULTS: After 3 days infarct area was similar between groups. SMT treatment reduced the time to peak tension during frequency-force curve in the infarct group (SHAM = 63 +/- 3; SHAM-SMT = 71 +/- 3; INF = 90 +/- 4; INF-SMT = 79 +/- 4 ms, P < 0.05) and increased the maximal response to isoprenaline (SHAM = 0.93 +/- 0.11; SHAM-SMT = 1.13 +/- 0.1; INF =0.84 +/- 0.16; INF-SMT = 1.49 +/- 0.15 g mm(-2), P < 0.05). The response to Ca(2+) was equally reduced in the INF and INF-SMT groups. SMT treatment did not change the reduced post-rest potentiation performed by INF group, but attenuated the plasma nitrite and nitrate (NOx) levels in the INF group without any haemodynamic effect. CONCLUSION: These finding suggest that at 3 days after MI the iNOS modulates the isolated papillary muscle response to isoprenaline and its inhibition improves the beta-adrenergic inotropic responses.

Total anorectal reconstruction with an artificial bowel sphincter: Report of five cases with a minimum follow-up of 6 months.

BACKGROUND: The artificial bowel sphincter (Acticon ABS - American Medical Systems, Minneapolis, MN, USA) has been proposed as a treatment for patients with faecal incontinence. The good results achieved with this procedure encouraged us to utilize this device for reconstruction of patients who previously underwent an abdominoperineal resection (APR). METHOD: Between 1999 and 2000 we implanted the ABS in five patients undergoing an APR. One patient was male and four female, the mean age was 51.3 years. Three patients had been operated on for rectal cancer, one for rectal agenesia and one for a giant benign tumour of the pelvis. RESULTS: The length of follow up ranged from 6 to 22 months. Manometry assessed a basal pressure with the ABS cuff inflated between 58 and 62.2 mmHg. All but one achieved a good grade of continence with a Wexner score range between 3 and 9. A certain degree of impaired evacuation occurred in two patients but, with adequate training, this improved and did not affect patient satisfaction. CONCLUSION: The ABS is a good option for reconstruction of patients previously treated with an APR. As compared to electrostimulated graciloplasty the ABS technique seems to be easier to perform and more acceptable for the patients, although the cost of the device is still high.

The role of lymphoscintigraphy in rectal laparoscopic surgery: can the sentinel node concept be applied to rectal carcinoma?

BACKGROUND: Lymphadenectomy for rectal cancer, whether by open surgery or laparoscopy, is still a controversial subject. If we consider that approximately 20% of patients have nodal obturator metastases, then we must concede that extended lymphadenectomy is useless in the other 80% of patients. We set out to determine whether lymphoscintigraphy could show the lymphatic drainage from the cancer toward the obturator lymph nodes and thus help us to select the patients who would benefit by their removal. We also analyzed the possibility of applying the concept of the sentinel node to the treatment of rectal cancer. METHODS: Among 42 people who underwent laparoscopy for rectal cancer 11 patients with TNM stages T2-T3N0M0 were studied by CT & MRI, rectal ultrasonography, and lymphoscintigraphy with a colloidal injection of human albumin labeled with 99mTc at the base of the neoplasm. Afterward, the 11 patients underwent a lymphadenectomy that extended to the obturator nodes. RESULTS: In two patients, lymphoscintigraphy showed lymphatic drainage toward the obturator nodes. In one case, there were metastases. Lymphoscintigraphy did not show lymphatic drainage toward the obturator nodes in any of the other patients, and there were no metastases among them. It was not possible to identify a sentinel node. CONCLUSION: Lymphoscintigraphy can be used to select patients with rectal cancer who will be helped by a lymphadenectomy extended to the obturator nodes. However, the concept of the sentinel node cannot be applied to rectal cancer.

[Original reconstruction technique after duodenopancreatectomy]. / Tecnica originale di ricostruzione dopo duodenocefalopancreasectomia.

The authors present an original reconstruction technique after pancreaticoduodenectomy, with anastomosis between the pancreatic stump and the posterior wall of the stomach, using two Roux-en-Y loops to separate the hepaticojejunostomy from the pancreaticogastrostomy and gastrojejunostomy in order to reduce postoperative complications and mortality. Eighteen consecutive patients underwent the procedure. There was no mortality and no pancreaticogastrostomy leaks occurred. Two (11.1%) gastric bleeds occurred in the first two cases. Twelve cases (66.6%) presented alimentary emesis on postoperative day 5 or 6 after food intake. Three patients (16.6%) had postoperative diarrhea. There were no complications calling for reoperation. The mean hospital stay was 14.4 days. No significant late complications were observed. The procedure is easy and safe with no mortality and with one of the lowest complication rates in the literature.

[Primary lymphomas of the gastro-intestinal tract]. / I linfomi primitivi del tratto gastro-intestinale.

The authors considered a series of 13 patients undergone surgical operation for primary malignant lymphoma of digestive system, with gastric, gastro-jejunal, jejunal, ileal and colic localization. They examined diagnostic and therapeutic features and the follow-up data. According to literature, the authors remark the importance of roentgenology and endoscopy, that together with bioptic data may reach a definite and early diagnosis; an elective and wide surgical exeresis seems useful in early stages, showing a better prognosis and epithelial malignancies. IV stage patients, however, had a very poor survival; a quick management appears today the only factor affecting long-term results in these patients.

[Non-parasitic cysts of the liver (considerations on 10 surgically treated cases)]. / Le cisti non parassitarie del fegato (considerazioni su 10 casi operati).

The Authors report their experience concerning 10 cases operated on for non-parasitic cysts of liver, among which a case of multicystic liver and a biliary pseudocyst. They emphasize the necessity, in symptomatic patients, for a selective treatment, but, where possible, with complete removal of cystic wall. The interventions performed also include six typical hepatic resections (two right hepatectomies, one of which extended to the fourth segment, and four minor resections), which revealed to be an effective therapeutical means, exempt from significant postoperative complications.

[Carotid paragangliomas]. / I paragangliomi carotidei.

Three cases of carotid body paragangliomas are reported. The authors underline the critical diagnostic role of carotid arteriogram whenever such disease is suspected. Surgical treatment can lead to good results even in malignant forms. In the latter, treatment should be completed with radiotherapy.

[Intrahepatic calculosis]. / La calcolosi intraepatica.

After a short synthesis of the elements characterising intrahepatic calculosis, and evaluation of the five cases considered, the value of cholangiography (both intravenous and instrumental) and of radio-scintiscanning with Bengal Rose marked with I131 in pre-operative diagnosis is stressed. The intra-operative use of choledochoscopy in conjunction with cholangiography is recommended. With regard to treatment, it must ensure removal of the calculi and create an ample biliodigestive communication (papillectomy or, even better, hepaticojejunostomy on excluded Roux loop) in order to prevent recurrences. In order to visualise the intrahepatic branches of the bile ducts, the removal of the hilar plaque is advised, possibly combined with sagittal scissurectomy or mobilisation of the 4th segment. In conclusion it is asserted that correctly performed surgical treatment is the only means of offering permanent cure.