The ministransplant procedure in liver transplantation.

In order to ameliorate early recovery after liver transplantation a reduction of invasiveness of the abdominal incision has been tested and compared with more extended incisions. This approach named "minitransplant procedure" resulted in better early and late outcome results irrespective of preoperative patients' risk factors as previous upper abdominal surgery, Body Mass Index and Model of End Stage Liver Disease score.

Acute renal failure following intravenous administration of hepatitis B im-munoglobulin in liver transplantation.

Intravenous administration of immunoglobulin (IVIG), rarely, can be the cause of acute renal failure (ARF). Such adverse reaction can occur almost exclusively when using preparations containing saccharose. The use of anti-HBV immunoglobulin (HBIG) is an effective prophylactic strategy against graft infection following liver transplantation. We report a case of ARF following prophylactic intravenous administration of HBIG in a liver transplanted patient. Anti-HBV immunoglobulin containing saccharose should be avoided in the perioperative period, because of the concomitance with other risk factors for ARF.

[Gastric cancer. Which resection?]. / Il cancro gastrico. Quale resezione?

BACKGROUND: The choice of surgical technique in antral gastric cancer is still debated. Some authors support total gastrectomy in all cases. In recent years there is a trend to use total gastrectomy only if strictly necessary. Total gastrectomy allows a large lymph node excision, with better oncological results. The mortality rate and post-operative complications are quite similar today after gastric resection. Anyway, if exact histological diagnosis is possible and at least 6 cm unaffected tissue is preserved, oncological cure is possible by gastric resection. METHODS: Personal experience in 224 patients operated on from 1975 to 1994 is reported. RESULTS AND CONCLUSIONS: 54.3% had antral gastric cancer, 16.5% body cancer and 8.7% fundus gastric cancer. Subtotal gastric resection should be the surgery of choice in antral gastric cancer. Early subtotal gastrectomy with R2, Advanced (III and IV-TNM) only resection with R2, and Advanced (II-TNM) total gastrectomy with R3.

Prolactin receptors in human pituitary adenomas.

OBJECTIVE: In the rat, prolactin receptors (PRL-R) have been identified in normal pituitary cells and in anterior pituitary tumours induced by oestradiol. No published data are available concerning PRL-R in the human pituitary. The aim of our study was therefore to detect the presence of PRL-R in the normal human pituitary gland and human pituitary adenomas. DESIGN: Evaluation of free and total PRL-R in the normal pituitary gland and different pituitary tumours characterized by immunocytochemical analysis. PATIENTS: Twenty-six unselected patients (14 M, 12 F) who underwent surgery for pituitary adenoma (3 prolactinomas, 4 GH-PRL adenomas, 5 GH adenomas, 1 ACTH adenoma, 9 glycoprotein and/or alpha-subunit adenomas, 4 null cells adenomas) were studied. Nine pituitaries from subjects whose death was unrelated to brain and endocrine diseases, were also studied as a control group in the PRL binding studies. MEASUREMENTS: Free PRL-R in microsomal membranes were determined by in-vitro radioreceptor assay using 125I-labelled human PRL as ligand. Total PRL-R were also measured in the same membrane fractions by removing endogenous PRL bound to its receptors using 4 M MgCl2. Serum PRL levels were also evaluated in all patients before surgery using an IRMA method. RESULTS: Specific binding values for PRL (free PRL-R) were 0.39 +/- 0.03% (range 0-1.96%) in the pituitary adenomas. These binding values were identical to those observed in normal pituitaries (0.38 +/- 0.07%, range 0.1-0.78%). Elevated PRL binding (1.25% and 1.96%) was found in two patients with PRL secreting adenomas and very high serum PRL levels (5768 and 11240 mU/I. No PRL binding was shown in 4 patients. Treatment of membranes with 4 M MgCl2 increased the specific binding (total PRL-R) in both pituitary tumours (0.5 +/- 0.11%; P < 0.001) and normal pituitaries (0.47 +/- 0.07%; P < 0.02). CONCLUSIONS: Our data have demonstrated the presence of prolactin receptors in normal cadaveric pituitary and in most pituitary adenomas, irrespective of histological classification. In particular, elevated prolactin receptor levels were shown in PRL-secreting tumours from patients with markedly increased serum PRL levels. Our study may support several lines of experimental evidence for a specific functional role for PRL in the growth of some pituitary adenomas.

Linear accelerator and Greitz-Bergstrom's head fixation system in radiosurgery of single cerebral metastases. A report of 86 cases.

Between 1984 and 1991 86 patients with single cerebral metastases underwent linear accelerator radiosurgery using the atraumatic and reproducible Greitz-Bergström head-fixation device. Routine one-month follow-up documented disappearance of the tumour in 16 patients, with resolution of the oedema and ventricular shift. Shrinkage of the metastasis occurred in 51 patients. In 9 patients the tumour remained stable, in 7 there was progression of tumour size. Among the patients showing shrinkage of the tumour or unchanged tumour volume, repeated radiosurgery resulted in disappearance of the metastasis in 5 and further shrinkage in 28. In 14 patients routine stereotactic CT follow-up study led to the detection of a new metastasis, again treated with excellent results. Local recurrence occurred in 2 patients and radiation necrosis in the target area in 5 patients. Radiosurgery thus proves to be an appropriate alternative to surgery. The versatility of our non-invasive and painless method permits CT staging (which we consider essential) without hospitalization of the patient.

[Mechanical duodenopancreatectomy]. / La duodenocefalopancreatectomia meccanica.

Pancreaticoduodenectomy with stapler devices is presented. Three patients affected by pancreatic malignant neoplasm were successfully treated, and the technique used is here reported.

[Aneurysms of the gluteal artery (description of a clinical case and review of the literature)]. / Gli aneurismi dell'arteria glutea (Descrizione di un caso clinico e revisione della letteratura).

The authors show a case of superior gluteal artery aneurysm they operated successfully. Starting from this case the Authors review the literature about the etiology, the clinical characteristics, the diagnosis and the various methods of treatment of this lesion.

[Open-door decompressive cervical laminotomy. Technic and initial experiences]. / Laminotomie cervicale décompressive a "porte ouverte". Technique et premières expériences.

The cervical laminectomy is usually applied in the treatment of cervical myelopathy caused by cervical canal stenosis and multiple spondylosis. Nevertheless, late complications are often reported, especially scar formation, the so-called laminectomy membrane, between the dura and overlying paraspinal muscles, which, compressing the cord, reduces until to abolish the favourable effects of the previous laminectomy; moreover, malalignment of the cervical spine with secondary kyphosis may follow an expansive laminectomy. In order to avoid these complications, in 1977 Hirabayashi introduced a new surgical technique, the "expansive open-door laminoplasty", which permits the enlargement of the spinal canal over multiple segments by completely incising the laminae laterally on one side and partially on the opposite: elevation with tilting of the laminae upward in the incised side, allows enlargement of the canal. The Authors describe in detail the operative procedure and report their experience in 10 patients.

Cystic meningiomas--an update.

Eighteen unusual cases of intracranial meningioma associated with a cyst are considered. Three patients were operated upon before the introduction of computed tomography scanning, and the discovery of a peritumoral cyst was unexpected. Among 15 patients studied with computed tomography, 8 had a peritumoral cyst, 6 had an intratumoral cyst, and 1 had a totally cystic meningioma (hypodense on computed tomography). Computed tomography permitted a correct preoperative diagnosis only in four cases. In six additional cases diagnosis was reached by selective angiographic studies. In the remaining cases diagnosis was impossible or incorrect. Different pathogenetic mechanisms underlie different radiologic patterns. The authors comment on the complex processes that lead to cyst formation in meningiomas and stress the necessity of an accurate preoperative study to avoid misdiagnosis.

The significance of preoperative neurological disorders in predicting outcome of cervical spondylotic myelopathy after surgery.

The authors report the results of a large series of patients which underwent surgical treatment for cervical spondylotic myelopathy. In this retrospective study clinical findings before surgery are compared with results at the follow-up after two years; their significance as prognostic factors is investigated. Marked spasticity, prevalence of unilateral motor signs, presence of Brown-Sequard syndrome and of Lhermitte sign resulted valuable criteria in predicting outcome after surgery.

The influence of the administration of pyritinol on the clinical course of traumatic coma.

(1) In a total of 100 patients with traumatic coma who were admitted to the intensive care unit of our Department of Neurosurgery we examined the effect of Encephabol after intravenous administration. (2) Compared to patients with the same clinico-neurological conditions who were, however, not treated with Encephabol, the cases treated by the preparation did not show any significant clinical improvement. Moreover, in the Encephabol group mortality rate in patients with an unfavourable prognosis sank to 35.3% (mortality rate in the comparative group: 54.2%). (3) Untoward effects on the clinico-neurological condition, cortical electrogenesis, vegetative functions and body fluid parameters were not observed after administration of the preparation.

Computerized axial tomography (CAT) in cerebral ischemia.

The CAT shows the site, extension and evolution of cerebral ischemic lesions, and implies no risk or pain for the patient. Cerebral ischemic lesions appear as dark, hypodense areas on the brain section planes and are well differentiated from the white hyperdense areas of hemorrhagic lesions. In the territory of the middle cerebral artery the symptomatology is well related to the extension of the lesions, but not to their site when they are 'limited'. At present the CAT is essential for the treatment of cerebral ischemic lesions.