[Effect of circulating insulin on liver damage by CCl4 in the rat. I. Biochemical studies]. / Effetti dell'insulina circolante sull'azione epatolesiva da CCl4 nel ratto. I. Aspetti bioumorali.

The authors have studied the damaging effects of CCl4 (0.05ml/Kg) in healthy rats, in alloxan-diabetic rats, and in rats treated with tolbutamide per os (100mg/Kg) for twenty days. Biochemical studies in these animals demonstrated that actually hyperinsulinemia has a preventive effect in relation to the damage produced by CCl4 as demonstrated by a decrease in bilirubinemia and transaminasemia.

[Effect of circulating insulin on liver damage by CCl4 in the rat. II. Histological aspects]. / Effetti dell'insulina circolante sull'azione epatolesiva da CCl4 nel ratto. II. Aspetti istologici.

The authors have studied the damaging effects of CCl4 (0.05ml/Kg) in healthy rats, in alloxan diabetic rats and in rats treated with tolbutamide per os (100mg/Kg) for twenty days. Histological studies in these animals demonstrated that actually hyperinsulinemia has a slight protective action on damage produced by CCl4 on rat liver.

Incidence and immunochemical features of serum cryoglobulin in chronic liver disease.

Essential cryoglobulinaemia was detected in 44 out of 150 patients (29%) screened on the basis of histological confirmation of chronic inflammatory liver disease (chronic persistent or aggressive hepatitis, or cirrhosis). Cryoglobulinemia prevailed in the patients whose hepatic tissue showed more features of active inflammation; also, a female prevalence was observed. There were no correlations between cryoglobulinaemia and either HBsAg positivity or alcoholic liver disease. Mixed cryoglobulins made of heterogeneous immunoglobulins without monotypic components were mostly associated with established cirrhosis, whereas monotypic cryoglobulins were exclusively found in patients with either persistent or aggressive chronic hepatitis. Mixed cryoglobulins with a monotypic component were associated with all histological grades of liver damage. This study affords an objective evaluation of both the frequency and immunochemical features of cryoglobulins associated with chronic inflammatory liver disease.

Laparoscopy in endocrine and genetic disorders of the gonads.

The guideline of this work is to examine the diagnostic value of laparoscopy in some endocrine and genetic syndromes connected with gonadal pathology or abnormal sexual development in relation to the various hormonal and cytogenetic techniques usually utilized by the endocrinologist. After a brief introduction, Chapter 1 stresses our purpose to examine the advantages and limits of laparoscopy by investigating the most significant cases that came to our observation. Attention is drawn in Chapter 2 to the application of laparoscopy in a particular form of amenorrhea (uterus absence), admittedly of great endocrinologic interest. In particular, the results obtained by the application of this technique are reported in cases of uterus agenesis and the testicular feminization syndrome. The clinical, cytogenetic and hormonologic study of one case of uterus agenesis is reported together with that of four cases of the testicular feminization syndrome with the view to discussing the differential diagnosis between these two syndromes and the particular diagnostic problems connected with the latter. Our conclusion is that laparoscopy, although usually having only a confirmatory value in these syndromes, may assume in certain cases major diagnostic importance (the post-puberal testicular feminization syndrome without palpable gonads, the pre-puberal testicular feminization syndrome, rare cases of the testicular feminization syndrome associated with chromosome aberrations). Chapter 3 discusses the application of laparoscopy in female gonadal dysgenesis on the basis of three cases of Turner's syndrome with different diagnostic problems and one of pure gonadal dysgenesis. It is stressed that, although in the majority of cases of Turner's syndrome the laparoscopic findings are quite characteristic (streak gonads), in some cases the gonads may also present the aspect of hypoplastic ovaries. This finding is observed in two cases of Turner's syndrome with XO/XX mosaicism, of which one case with spontaneous menarche. The diagnostic value of laparoscopy is discussed in the cases of pure gonadal dysgenesis and in variants of Turner's syndrome chromatin-positive with X chromosome partial monosomy and chromatin-negative with a Y chromosome. Our conclusion is that laparoscopy assumes particular diagnostic value in cases of pure gonadal dysgenesis without chromosome aberrations, because chromosome aberrations may be absent in this syndrome, as well as in chromatin-negative variants with a Y chromosome because the gonads and gonaducts differentiation may be variable.

Chronic hepatitis and cirrhosis of the liver in cryoglobulinaemia.

Hepatic biopsy showed either persistent or aggressive chronic hepatitis in 11 patients with cryoglobulinaemia not attributable to known disease entities, whereas liver impairment was not in every case suggested by either physical examination or functional abnormalities. The incidence was predominantly in women and cryoglobulin behaviour was similar in these patients and in five subjects with cirrhosis-associated cryoglobulinaemia. It is concluded that liver disease should be included among the constant features of the cryoglobulin-associated syndrome, and the speculation is advanced that in cryoglobulinaemic patients both cirrhosis and chronic hepatitis may be caused by the same pathogenic mechanism(s).

Peritoneoscopic features of intraabdominal vessels in cirrhosis of the liver.

Peritoneoscopy was carried out in 57 cirrhotic patients in order to evaluate the morphological features of intraabdominal veins. These were described either as normal or characterized by minimal, moderate, or marked alterations: accordingly, the patients were classified into four groups. Intrahepatic and intrasplenic pressures were measured in most patients; abnormally elevated values were found in every case, and the higher figures belonged to the subjects with minor involvement of the intraabdominal veins. Superficial collateralization and oesophageal varices appeared unrelated to changes in these veins, whereas splenomegaly was mostly found in patients with normal or slightly altered intraabdominal veins. Percutaneous splenoportography was performed in 16 patients, and venographic appearances did not correlate with peritoneoscopic features of the intraabdominal veins. Ascites, on the other hand, was exclusively present in patients with alterations in these veins. It is suggested that some pathogenetic relationship might exist between changes in intraabdominal veins seen by peritoneoscopy and ascites.