Biomedical subjects
Publications and source records attributed to F Romani.
Bilateral anorchia was diagnosed in a young boy with the apparently balanced de novo reciprocal translocation t(4;6)(q28;q14). Possible explanations for the association include coincidence of two unrelated events and position effect.
The surgical treatment of 87 hepatic cysts from Echinococcus granulosus in 42 patients has been presented. The importance of determining the features of the cysts in each patient (age, number, location, and relation with vasculobiliary structures) in order to carry out the most appropriate treatment was stressed. Radical surgery was preferred because marsupialization, a conservative technique still widely used, has a high complication rate (60 percent in this study) and a prolonged recovery time. Arguments for and against cystopericystectomy and hepatic resections have been discussed. It is noteworthy that excellent results have been observed after hepatic resection when it was performed in selected patients.
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In the last years, total bone scan has gained an important place in the staging of the neoplasms of the lung. Out of 271 patients with lung cancer who underwent a bone scan in the period october 1979-october 1980. 10 showed an increased fixation of the isotope with a linear pattern along the diaphysis of the limbs. These findings, clinically silent, suggested the diagnosis of hypertrophic osteoarthropathy, which has been subsequently confirmed radiologically. The different pathogenetic theories and the evolution of the scintigraphic picture after therapy of the primary disease are briefly discussed.
Chest outlet syndromes are characterized by pain symptomatology caused by (congenital or acquired reasons) compression of the vasculo-nervous bundle. After a brief mention of the anatomy of the question, the indications and angiographic technique are reported, special reference being made to certain positions and dynamic tests which increase symptomatology and highlight arteriographic findings. These are clearly identifiable in the pictures and offer documentary evidence of the cervical rib syndrome, scalenus syndrome, small pectoral syndrome, the hyperabduction syndrome and the costoclavicular syndrome. Differential diagnosis should consider a number of painful syndromes of the upper extremity of purely neurological interest (involvement of the brachial plexus). Vascular diseases such as arteriosclerosis, Takayasu's disease, etc., osteo-myo-articular and ORL sector diseases should also be taken into account. Arteriography is able to identify with precision the causes of the clinical syndrome and to guide surgical exploration of the supraclavicular fossa with excellent chances of success.
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The ultrastructure of a testicular biopsy was carried out in a man with 46 XX chromosomes who had a masculine phenotype and in whom the hormone levels showed that the interstitial tissue of the gland was functioning well. Observations showed that the exocrine appearance of the testis was comparable to that described in Klinefelter's syndrome, namely germinal aplasia with invasion by Sertoli cells. On the other hand the interstitial glandular tissue showed morphological characteristics associated with normal androgen activity, which is unusual to find in Klinefelter's syndrome. Lipid inclusions, pigmentation and Reinke cristalloids were found. The cytogenetic techniques that happened to be used did not manage to show up even a small fragment of the Y chromosome. Various theories have been considered to explain the constitution of such a phenotype with this chromosome abnormality.
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With a view of clarifying the mechanism whereby the beneficial effect of hepatocyte transplantation is obtained, an autologous transplant was made of hepatocytes in the peritoneum of a surgical model of acute hepatic insufficiency in the rat, highly reproducible to the detriment of its reversibility. The cells were prepared in accordance with the non-perfusional enzymatic method proposed by Fry. The cell yield from 3 g of liver tissue was 4 X 10(6), with an index of viability of over 70%. There was no difference in survival between the treated animals and the control group, though coma appeared significantly later in the former. The conclusion is therefore drawn that transplantation offers no metabolic support to the anhepatic animal. Further investigation is required of the biochemical and metabolic aspects of the function of the hepatocyte in the light of its induction of a significant delay in the appearance of coma.
At present, there is no ideal model for acute hepatic insufficiency that assists in the understanding of its numerous clinical and metabolic problems. Pharmacological models are reversible but biologically imprecise, whereas surgical models offer a homogeneous biological answer, but are irreversible and only suitable for brief experiments. An assessment is made here of a model in the rat involving complete devascularisation of the liver by portocava anastomosis and ligation of the liver peduncle, and total hepatectomy in a single stage. The following parameters were used to evaluate the experimental usefulness of the model: reproducibility of the response and death due to acute insufficiency after a period long enough to permit the efficacy of support management to be assessed. All the controls survived for indefinite periods after portocava anastomosis, whereas the mean survival of 20 animals subjected to total hepatectomy was 12.05 +/- 5.0 hr), and coma intervened 7.5 +/- 3.3 hr after resection. These results point to the usefulness of the model in studies on the treatment of hepatic insufficiency. It is open to further improvement through alteration of the post-operative glycidic control and reduction of the radicality of liver resection.
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A technique originally described by Okuda has been employed to study 78 patients suffering from cholestatic syndrome. Visualization of the biliary system was obtained in 70 (89.7%). Of these, 65 presented dilatation of the bile ways whereas in 5, the biliary tree was normal. The 8 cases in which no visualization was obtained were later examined with other techniques and 6 proved to be suffering from intrahepatic cholestasis. In patients with extrahepatic obstruction, the biliary system was visualized in 97%, while in intrahepatic cholestasis, the percentage was 45.5%. The main indication for PTC is the speed at which intrahepatic cholestasis can be distinguished from the extrahepatic type; in the second event, it always pinpoints the site of the impediment, though less frequently the nature of the lesion and its extent. No complications requiring emergency laparotomy were ever encountered. Percutaneous transhepatic cholangiography with Chiba needle is a simple, reliable inexpensive method which gives excellent results in the study of patients with cholestatic syndrome.
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