[Biliodigestive anastomosis: case series and technical notes]. / Anastomosi bilio-digestive. Casistica e note di tecnica.

AIM: Biliodigestive anastomoses are widely used in the treatment of biliary obstruction. METHODS: A survey is presented of the personal case series treated during the last 5 years. Thirty biliodigestive anastomose have been performed both for neoplastic disease and for benign lesions. RESULTS: The biliodigestive anastomosis has been performed with the Blumgart's technique both for benign and malignant tumors. CONCLUSIONS: The authors point out that experience is of the utmost importance for the operation success. Major attention is paid to the surgical technique used for the biliodigestive anastomosis and a retrospective analysis is made.

Neoadjuvant transjugular intrahepatic portosystemic shunt: a solution for extrahepatic abdominal operation in cirrhotic patients with severe portal hypertension.

BACKGROUND: Major abdominal surgery, although technically feasible per se, can be contraindicated in some cirrhotic patients because of severe portal hypertension. The present study reports our experience of seven such patients who were prepared for major abdominal surgery by transjugular intrahepatic portosystemic shunt (TIPS). STUDY DESIGN: There were seven cirrhotic patients (six men and one woman aged 47 to 69 years) with portal hypertension. Portal hypertension was considered severe because of the presence of at least one of the following: history of variceal bleeding (five of seven patients), varices at risk of bleeding (red signs or cardial location of varices; four of seven patients), or intractable ascites (three of seven patients). The planned operations included colon, gastroesophageal, kidney, and aortic procedures in three, two, one, and one patient, respectively. Because portal hypertension was the leading cause of surgical contraindication, the following "two-step strategy" was applied to the seven patients: first, TIPS to control portal hypertension, followed, after a delay of at least 1 month, by abdominal surgery. RESULTS: The TIPS procedure was successfully performed in all patients without complications. The hepatic venous pressure gradient decreased from 18+/-5 to 9+/-5 mm Hg (p<0.01). All patients were operated on with a delay ranging from 1 month to 5 months after TIPS (2.9+/-1.3 months; median 3 months). The planned operation was performed in six of the seven patients. One patient with cancer of the cardia did not have resection because of extensive abdominal spreading of the tumor. Intraoperative transfusion was necessary in only two patients. Operative mortality occurred in one patient, 36 days after resection of a left colon cancer. CONCLUSIONS: The minimally invasive nature of TIPS allows us to propose the following two-step management of cirrhotic patients with severe portal hypertension needing abdominal surgery: decompression of the portal system by TIPS followed by elective surgery.

[Upper gastrointestinal hemorrhage of unusual etiology: clinical case and technical note]. / Emorragia digestiva alta da causa rara: caso clinico e note di tecnica.

The Authors report a case of upper digestive tract haemorrhage at atypical side, the diagnosis being often difficult as well as therapeutical options, particularly referent to the surgical solutions adopted.

Beta1B integrin interferes with matrix assembly but not with confluent monolayer polarity, and alters some morphogenetic properties of FRT epithelial cells.

Beta1B is a beta1 integrin splice variant that differs from the ubiquitous beta1A in the terminal portion of the cytosolic tail. The expression of this variant in CHO cells results in reduced fibroblast adhesion and motility (Balzac, E et al., J. Cell Biol. 127, 557-565 (1994)). We have evaluated the phenotypic changes induced by the expression of beta1B in the FRT epithelial cell line. Stable transfectants of FRT cells expressing beta1B or beta1A human integrins were obtained. The transfected integrins associated with the endogenous alpha subunits and were delivered to the plasma membrane. Beta1B expressing cells attached less efficiently and spread less on fibronectin, laminin or type IV collagen coated dishes. A great reduction of fibronectin fibrils associated to the basal membrane of non-confluent beta1B transfected cells was observed. This was paralleled by the disappearance of microfilament bundles and loss of basally located focal adhesions. On the contrary, upon beta1A transfection, a higher amount of fibronectin fibrils, together with microfilament bundles and focal adhesions, was observed. Expression of beta1B did not significantly modify the ability to manifest the polarized phenotype when cells were grown to confluence on filters in two-chamber-systems. Beta1B-transfected cells showed reduced motile properties when embedded as aggregates in type I collagen gels. Moreover, formation of polarized cysts in suspension culture was impaired. The results show that beta1B, by interfering with focal adhesion organization, microfilament and fibronectin assembly, cell spreading and migration, affects some morphogenetic properties of FRT epithelial cells.