[Retroperitoneal tumors. Clinical contribution].
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Biomedical subjects
Publications and source records attributed to E Morsiani.
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A 50% small bowel bypass was performed in diabetic rats (streptozotocin-treated) and in normal rats. Normal rats and diabetic rats were used as controls. Values of fasting blood glucose and oral glucose tolerance test showed a normalization and the disappearance of glycosuria, polyuria, polydipsia and hyperphagia in diabetic rats after surgery. Mean loss of weight 3 months after surgery was 9.1% in normal bypassed rats and 60.5% in the diabetic controls. After an initial postoperative weight loss of 33.4%, the diabetic bypassed rats gained subsequently their previous weight plus an increase of 7.2%. Improvement in carbohydrate metabolism appears to be independent of loss of weight and decrease in food intake in lean diabetic rats. Amelioration of diabetes after jejunoileal bypass is the result of several metabolic consequences, particularly the malabsorption of carbohydrates, fats and amino acids.
Three different dissociation techniques of rat liver were compared and yield, viability and morphology of the obtained cells were evaluated. The isolation methods used in this study were: 1. Enzymatic by immersion; 2. Mechanical; 3. Enzymatic by perfusion. The first method supplied 3.91 +/- 1.67 X 10(6) cells/g tissue (X +/- Standard Deviation) and a viability of 52.8 +/- 24.3%. The second method supplied 25.9 +/- 5.68 X 10(6) cells/g tissue and a viability of 62.3 +/- 18.6%. The third method supplied 50.5 +/- 26.6 X 10(6) cells/g tissue and a viability of 87 +/- 5.6%. The hepatocytes obtained according to the three methods were then transplanted into the spleen of allogeneic rats after partial hepatectomy. Allotransplantation of hepatocytes in partially hepatectomized rats proved to inhibit remaining liver regeneration in comparison to partially hepatectomized control rats using mechanically isolated hepatocytes (p less than 0.05), while the allotransplantation of hepatocytes obtained by the two enzymatic methods did not modify significantly liver regeneration.
An experimental study was carried out in young, growing rats submitted to total gastrectomy followed by Roux-en-Y esophagojejunostomy (RY) or jejunal loop interposition (JI) to test the role of rapid intestinal transit time in postgastrectomy malnutrition. One to two months postoperatively esophago-intestinal transit times were measured and nutrition evaluated by serial body weights. Small intestinal transit times were consistently rapid in the rats submitted to RY reconstruction, in comparison with JI (p less than 0.01). Four months after the operations the growth curves of the three groups (RY, JI and controls) were markedly different. After an initial fall in weight of 33% in the gastrectomized rats, a sizeable increase was observed in the rats with JI (p less than 0.05). This difference in growth may be due to malabsorption and accelerated intestinal transit as a result of bypassing the duodenum after RY.
Present knowledge of hepatic trophism and regeneration after partial resection of the parenchyma is reviewed. The importance of the various factors influencing hepatic regeneration (so-called hepatotrophic factors) is stressed by examining the most interesting data reported in the literature. In particular, an attempt is made to classify such factors according to their origin (e.g. hepatic or extra-hepatic) and specificity of action. A brief discussion of the clinical implications of this research and current treatment for acute and chronic hepatic insufficiency, with particular reference to the latest surgical techniques, closes the paper.
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Up to 50% of the neonates operated during the first hours of life for a congenital diaphragmatic hernia die. The presence of a severe lung hypoplasia, which is at the origin of hypoxia, acidosis, increased pulmonary vascular resistance and right to left shunt, explains the poor clinical results, in spite of surgical success and intensive therapy. A modern approach to the problem includes treatment with pulmonary vasodilator drugs, whose effects are still discussed. Perhaps the prenatal recognition of the defect could improve prognosis. Lots of experience are needed to know more on the subject. This could be obtained with an experimental approach on newborn animals with a CDH. The article relates authors experience in the creation of a CDH in a foetus of sheep, by means of a surgical intervention during its intrauterine life.
The intestine's ability to adapt following extensive resection is well known, and includes augmentation in calibre and the thickness of the wall, increased villus height, changes in motility, and qualitative and quantitative alterations in the flora. Positive identification of the mechanisms through which this morphological and functional adaptation takes place still forms the subject of research. An account is given of the latest views concerning the way in which compensation of the intestine takes place after resection and by-pass surgery.
A brief account is given of the current knowledge, experiments, and clinical findings concerning the surgical management of diabetes. The aim of all treatments, from conventional pancreas transplant to the sophisticated transplantation of islets and foetal pancreas, and a subject with its own special features, namely intestinal by-pass, is to relieve the patient from insulin management, which, while it increases his survival, does not defend him from possibly fatal vascular complications. Though far from providing a final solution, each of the topics dealt with provides an example of the way research and clinical practice continue to offer reasons for the experimentation of new therapeutic techniques.
Resection of about 50% of the small intestine was performed in rats diabetised with streptozotocin. The first results show that this operation leads to normalisation of sugar metabolism that is partly referable to partial malabsorption, but above all to loss of weight. Current knowledge with regard to the relation between diabetes and obesity is discussed and an account is given of the modern surgical approaches to the treatment of major obesity. Lastly, the suggestion is made that limited digestive bypass may be indicated in cases of insulin-independent diabetes where weight loss and control of blood sugar cannot readily be achieved by conventional medical management.
The latest findings support hypotheses that diabetes complications are secondary to metabolic control which current insulin therapy is unable to render constant. Surgical attempts to transplant the pancreas and Langerhans islets in the treatment of diabetes mellitus are reviewed and special attention paid to the use of the foetal pancreas which has proved particularly suitable in preventing microangiopathic complication. Comments are based on a careful review of the literature, made in the light of personal experience.
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The optimal site for implantation of isolated hepatocytes has not been established. We have developed a novel technique which allows repeated infusion of hepatocytes into the portal system via an indwelling catheter. Seven Nagase Analbuminemic rats (NAR) underwent single intraportal infusion of 2 x 10(7) isolated normal albumin-producing rat hepatocytes. Another seven NAR rats underwent placement of indwelling catheters into the portal venous system via the gastroduodenal vein. Each of them received six batches of 5 x 10(6) normal albumin producing hepatocytes. Seven control NAR rats were infused repeatedly (intraportally) with saline only. Plasma albumin (ELISA) showed significant increase in experimental animals and was more pronounced (p < 0.05) in rats transplanted repeatedly than in those given a single dose of cells. Immunohistochemical staining of the liver sections confirmed the presence of transplanted albumin producing hepatocytes. Rats transplanted with a single large batch of isolated hepatocytes showed liver tissue damage, whereas those subjected to repeated cell infusions had normal liver histology. We have developed a novel intraportal transplantation method which allows successful engraftment of a large number of isolated hepatocytes.
Poor engraftment and consequent loss of beta-cell mass could be one of the factors that are responsible for function loss after intraportal islet transplantation (Tx). Streptozotocin-diabetic rats were transplanted with syngeneic islets, which were injected into the portal vein via an indwelling catheter connected to a subcutaneous port. In Group I (n = 6), 1,000 islets were injected in a single dose into the liver. In Group II (n = 6), five doses of 200 islets were repeatedly injected over a period of 14 days, for a total of 1,000 islets. In Group III (n = 4), five decreasing doses of islets were injected over a period of 14 days, for a total of 750 islets. Nonfasting blood glucose (n-FBG) and body weight (b.wt.) were determined twice a week and an intravenous glucose tolerance test (IVGTT) was performed at 30 and 90 days. In Group I, n-FBG decreased in 2 wk from the time of first islet injection, averaging 110 +/- 21.9 mg/dl at 1 mo (p < 0.05 vs. normal controls); this value was maintained throughout the 3-mo duration of the study. In Group II, n-FBG was normalized in 2 wk averaging 90.2 +/- 25 mg/dL on day 12 (p = NS vs. normal controls) and 75.8 +/- 14.6 mg/dL at 1 month (p = NS vs. normal controls); this value was maintained throughout the 3-mo duration of the study. In Group III, n-FBG decreased to normal values in 2 wk, averaging 77 +/- 15.7 mg/dL at 1 mo (p = NS vs. normal controls), but normoglycemia was maintained for 40 days and then followed by a progressive increase. Only in Group II, KG (percent/min decline in glucose level) was not significantly different from that of normal controls (1.702 +/- 0.531 at 1 mo and 1.676 +/- 0.891 at 3 mo), while it was significantly lower than normal controls in both Group I and III animals. Body weight increase after Tx correlated with the number of transplanted islets and at 90 days, Group III rats showed less increase than Groups I and II (p < 0.05), while no significant differences in b.wt. were recorded between Group I and II. The findings indicate that intraportal islet Tx, injected repeatedly and in small doses, produced better metabolic effects than injection of the same total number of islets in a single dose.
Acute liver failure is very life-threatening since the conventional medical treatments have little effects on the clinical outcome. Artificial liver support systems based on blood detoxification alone have proven ineffective because they cannot correct the severe biochemical disorders. An effective liver support system should be capable of carrying out essential functions such as phase I reaction in which lipid-soluble toxic substance are rendered water-soluble by the enzyme system of the cytochrome P450 and NADPH-cytochrome reductase, and are therefore conjugated by the phase II reaction, before excretion. Liver support systems should be capable of sustaining patients with fulminant liver failure until an organ is available for liver transplantation (bridging treatment), or improving the survival in patients for whom liver transplantation is not a therapeutic option. Recent advances in cell biology and tissue culture techniques have led the way for potential clinical use of isolated hepatocytes so that they are now an important element of bioartificial liver support devices. Some of these systems are currently under clinical investigation in the USA and Europe, and the results of the prospective controlled trials will be soon available.
Fulminant hepatic failure (FHF) is a clinical syndrome characterized by the development of encephalopathy within eight weeks from the onset of the first symptoms, in the absence of previous hepatic disease. It is an uncommon but not rare disease, often fatal but potentially reversible. This article looks at the diverse aetiologies, clinical features, and current medical management, including orthotopic liver transplantation, and auxiliary orthotopic or eterotopic liver transplantation, that are the most recently adopted surgical procedures. Clinical experience with bio-artificial liver support systems of two of the most active research Groups in this field, concludes the paper.