Blocking both type A and B endothelin receptors in the kidney attenuates renal injury and prolongs survival in rats with remnant kidney.

Renal disease progression in the rat is associated with a time-dependent upregulation of renal endothelin-1 (ET-1) gene expression and synthesis. We have previously demonstrated that endothelin A receptor subtype (ETA) blockade in rats with remnant kidney reduced signs of disease activity, suggesting that ET-1 exerts part of its deleterious effects on the kidney through ETA. No data are available so far on the role of ETB receptor in progressive renal injury. We first studied renal ETA and ETB receptor gene expression in rats with remnant kidney on days 7, 30, and 120 after the surgical procedure. While renal expression of ETA was unaffected, ETB receptor gene was significantly upregulated with time in rats with remnant kidney, being 3.5-fold and sixfold higher than shamoperated rats at days 30 and 120. We also evaluated whether bosentan, a nonpeptidic ETA and ETB receptor antagonist, offered better protection against renal disease progression than reported for ETA-selective blockers and whether it improved survival in animals with renal ablation. Two groups of rats with renal mass reduction (n = 11 each) were given bosentan 100 mg/kg/d orally or its vehicle (carboxymethyl cellulose) beginning day 7 after the surgical procedure and were followed until the death of the vehicle-treated animals. Sham-operated animals comprised the control group. Bosentan partially prevented increases in blood pressure and proteinuria, but had a remarkable protective effect on renal function and significantly prolonged animal survival. These data suggest that blocking both renal ETA and ETB receptors might have major implications in the treatment of human progressive nephropathies.

[Popliteal aneurysm]. / Aneurismi poplitei.

The authors describe their experience of the aneurysm popliteal artery. They analyze the symptomatology, the diagnostic way and the therapy of such disease.

Abdominal aortic coarctation inducing aortic occlusion and renovascular hypertension.

Abdominal aortic coarctation is a rare, non-atherosclerotic disease. It is a functionally significant at an early age when associated with aortic branch stenosis and renovascular hypertension. The pathogenesis of aortic constrictive lesions remains unknown, but may be related to developmental error or aortic growth arrest and various hypotheses have been reported. When the renal arteries are involved by the coarctation, severe hypertension is common at an early age and in untreated patients, life-threatening complications commonly occur. Patients who reach the age of 40 years generally have the coarctation below the renal arteries but even when the renal arteries are not involved by the coarctation, renovascular disease may still occur due to secondary atherosclerosis. Aortic thrombosis secondary to abdominal aortic coarctation with renovascular disease and lower limb ischemia, occurring in a 63-year old woman, is reported.

[Diverticulitis of the cecum]. / La diverticolite del ceco.

Cecal diverticulitis, is not a common disease, frequently congenital, becoming clinically evident between the second and the fourth decade. The diagnosis of cecal diverticulitis is often controversial since the signs and symptoms simulate an acute appendicitis or an appendicular abscess. Moreover, during surgery, sometimes it appears like carcinoma of the cecum. Barium enema is the only clinical test useful for a correct diagnosis before surgical procedure, but in the case of an acute appendicitis this test is normally not performed. The surgical treatment is, when possible, diverticular resection associated with cecal appendix resection. In doubtable or technically hazardous cases it is sometimes necessary a right hemicolectomy. Mortality and morbidity for minor procedures are negligible, whereas for right hemicolectomy they range between 3,7% and 11% according to different Authors.

[Malignant neoplasms of the extrahepatic bile ducts and Vater's papilla: clinico-therapeutic study]. / Le neoplasie maligne delle vie biliari extraepatiche e della papilla di Vater: inquadramento clinico-terapeutico.

No changes in prognosis of extrahepatic bile ducts malignant tumors was observed in the last years, in spite of modern tomographic procedures: only occasionally an early diagnosis resulting possible. Jaundice is the presentation sign of the disease, allowing in most cases when the site of tumor is the papilla of Vater or distal common bile duct a radical surgery but only palliative procedures when the tumor arises in the gallbladder or at the hepatic duct junction. Survival data from literature and personal experience indicate limited late results for radical surgery together with high operatory mortality. In the field of palliative surgery transtumoral drains appear to offer better results.

[Computerized management of a surgical department: preliminary report]. / La computerizzazione gestionale di un reparto chirurgico: rapporto preliminare.

The authors deal with the problem of the computerized management of the Department, using a TRS 80 microprocessor, with a RAM memory of 48 Kbyte. They are working for the creation of a data bank which will store the basic information of the patient hospital record in variable format, together with some specific files for a number of diseases in fixed format. The main advantages in the use of the so-called "department's microprocessor" are the great saving of time in the management of the patient's data and the more accurate analysis of the same which allows a prompt diagnostic and therapeutic feedback.

[Traumatic perforations of the esophagus]. / Le perforazioni traumatiche dell'esofago.

The Authors describe 6 patients with esophageal jatrogenic of foreign body perforation treatment during the last 5 years. The early recognition and immediate direct suture of the lesion proved a simple and efficient treatment. At the contrary a delayed diagnosis represent the cause of morbidity and mortality (one case on the six described) being impossible a direct suture of the lesion as consequence of local and general infective complication leading to very long postoperative causes with possible iterative surgery. The use of T.P.N. and of antibiotic therapy gascromatografich testing guides for anaerobic infection provide today a much improved prognosis for these patients.

[Cancer of the kidney. Natural history and therapeutic problems]. / Il cancro del rene. Storia naturale e problemi di terapia.

Radical nephrectomy with initial ligation of the renal artery and removal en bloc of the perirenal fat and lumboaortic lymphadenectomy was carried out according to the technique of Robson (1969) in 10 cases at the University of Parma 1st Surgical Clinic between 1976 and 1978. The usefulness and superiority of the technique were demonstrated in this albeit small series, which included four stage I, two stage II, one stage III, and four stage IV patients, according to the classification of Flocks et al. Supplementary antiblastic and/or hormonal treatment was given, except in stage I cases. 1.4 mg/m2 Velbe i.v. (1st day) followed by 80 mg/m2 BCNU i.v. (2nd, 3rd, 4th days) was of no avail, whereas progesterone (Depot-provera 200-500 mg/day for 1-3 months) and testosterone propionate (300 mg/week) still seem to be effective. Improvements in this oncological sector, however, are geared to the outcome of radical nephrectomy.

[The use of selective amino acid solutions in the pre- and post-operative treatment of cirrhotics. Preliminary observations]. / L'impiego delle soluzioni selettive di aminoacidi nel trattamento pre- e post-operatorio dei cirrotici. Osservazioni preliminari.

The use in cirrhosis of so-called selective amino acid solutions, i.e. solutions rich in branched and poor in aromatic acids, is readily explained by the proven alteration of the basal amino acid picture in this disease. It is also known that marked haemorrhage, stress, surgery and massive dehydration exacerbate the position and open the way to encephalopathy. A study was therefore made of the clinical, biochemical, and body fluid picture of cirrhosis patients subjected to portal surgery, and treated pre-, intra- and post-operatively with these special solutions. The treatment proved effective. It is felt that a study could usefully be made of more patients, with account being taken of features indicative of the behaviour of the nitrogen balance.

[Primary carcinoma of the gallbladder: report of 41 cases (author's transl)]. / Il cancro primitivo della colecisti: studio su 41 osservazioni.

The Authors described their experience in 41 patients operated on because of gallbladder cancer. The overall mortality was 20%. Four cases suitables for a "radical" wide resection showed an average survival of 8 months, while 2 on 3 patients with in "situ" carcinoma treated by simple cholecystectomy are still alive at more than 3 years, the other dying after five years because of disease not related to the gallbladder cancer. The bad general prognosis of the disease is mainly related to the delayed diagnosis together with the anatomical relations of the gallbladder as demonstrated by the discouraging survival in the "radically" widely resected patients. It must be considered consequently categorical to realize an early cholecystectomy, the only possible preventive procedure, in the height risk patients.

[Surgical treatment of cancer of the pancreas]. / La terapia chirurgica del cancro del pancreas.

A series of 145 patients with cancer of the pancreas is presented. Radical surgery was performed in 23 cases. An assessment is made of anatomical and clinical factors likely to interfere with the results of surgery, particularly radical surgery. The mean survival after palliative operations was 5.5 months and after duodenocephalopancreatectomy 16.1 months. After resection, operative mortality as a whole was 21.6%, though in the last 5 years it had fallen to 8.8%. Actuarial survival after 1 yr was 56.3% and after 2 yr 18.8%. The average duration of the symptom picture was long due to the difficulty of making an early diagnosis. This has an adverse influence on the operability of cancer of the pancreas. On average, survival after resection was less in cases with infiltration of the lymph nodes, but not in those with extension of the neoplasia to neighbouring organs, such as the duodenum. The results of radical management were much the same as those reported in the literature and are regarded as unsatisfactory, even though better than those achieved with palliative surgery. Their improvement is discussed in the light of the technical features of duodenocephalopancreatectomy. It is felt that extensive lymphadenectomy is required and that this should be planned and performed in accordance with strict anatomical and surgical criteria.

[Transduodenal papillosphincterotomy in treatment of biliary lithiasis]. / La papillosfinterotomia transduodenale nel trattamento della litiasi biliare.

The Authors report 180 cases of transdudenal papillosphincterotomy. Medium follow-up at 5 years revealed a complete recovery in 87 of 100 controlled patients. Nine cases revealed persistence of some degree of dyspepsia, while a second operation was necessary for the remaining patients to remove recurrent calculi in 2 cases and because of Oddi's stenosis in other two cases. A 4,4% mortality operative was observed, following postoperative pancreatitis in 1,1%, duodenal fistula or haemorrhage in 1,6%, and 1,6% from other causes. On the basis of their results the Authors conclude that transduodenal papillosphincterotomy is an effective procedure in treating complicated lithiasic biliary disease when respecting the reported indications.

[Dedo and Fishman technique for laryngeal release in cervical tracheal reconstruction (author's transl)]. / L'abbassamento laringo-tracheale secondo Dedo e Fishman nelle ricostruzioni della trachea cervicale.

The Authors report two cases of tracheal tumor operated with laryngeal release and tracheal mobilization following Dedo and Fishman. They discuss the indications and describe this technical procedure which has proved successful in obtaining a suture without traction also for 4 cm sleeve resection of trachea.

[Emergency colectomy in ulcerative colitis (author's transl)]. / La colectomia totale d'urgenza nella colite ulcerosa.

During the last 12 years 7 patients with ulcerative colitis were treated because of an acute complication consisting in 2 cases of colonic perforation, 3 cases of toxic megacolon (two of them perforated) and 2 cases of massive enterorragia. In all patients an emergency total colectomy was performed resulting a mortality of 3 cases, two of which had required the removal in a second time of the rectal stump. In 3 or 4 recovered patients we performed in a period of 7-15 months an ileo-proctostomy once confirmed the healing of the ulcerative lesions in the residual rectum. The problems concerning the indications and surgical procedures involved in such cases are discussed on the base of the personal experience, with particular consideration on advantages and limits of preserving a rectal stump. The authors agree on an eclectic behavior considering each case on the base of pathological findings, the age and the general and psychic conditions of the single patient.