Pulmonary transit time as a marker of diastolic dysfunction in Takotsubo syndrome.

AIM: To evaluate the pulmonary transit time (PTT) and its derived parameters using cardiac magnetic resonance imaging (CMRI) as markers of diastolic dysfunction in Takotsubo syndrome (TS) and its relationship with transthoracic echocardiography and CMRI parameters. MATERIALS AND METHODS: Twenty-two patients with TS, who exhibited diastolic dysfunction as assessed by transthoracic echocardiography, were enrolled retrospectively and the PTT, pulmonary transit time index (PTTI), and pulmonary blood volume index (PBVI) were evaluated using first-pass CMRI. PTT was calculated as the number of cardiac cycles required for a bolus of contrast agent to move from the right ventricle (RV) to the left ventricle (LV), whereas PTTI represents the PTT interval corrected for the heart rate. Finally, PBVI was calculated as the product of PTTI, and RV stroke volume indexed for body surface area. Normal references of PTT, PTTI, and PBVI were evaluated in a cohort of 20 age- and sex-matched healthy controls. RESULTS: Compared with healthy subjects, TS patients showed significantly higher PTT, PTTI, and PBVI (p=0.0001, p=0.0001, and p=0.002, respectively). Using multivariable logistic regression, PBVI provided the best differentiation between TS and controls (AUC 0.84). PBVI was significantly associated with the index of diastolic dysfunction and left atrial strain parameters. In addition, PBVI demonstrated a significant correlation with global T2 mapping (r=0,520, p=0,019). CONCLUSION: PTT and the derived parameters, as assessed using first-pass CMRI, are potential tools for assessing LV diastolic dysfunction in patients with TS.

Complete substitution of the left ureter with vermicular appendix during hemicolectomy for cancer in an adult patient.

We demonstrated that a complete left ureteral substitution with appendix is a feasible and safe technique. To our knowledge, this is the first case of a successful complete substitution of the left ureter with vermicular appendix in an adult patient reported in the literature.

Indigo Thrombectomy System for Hepatic Artery Thrombosis After Liver Transplantation: A Case Report.

INTRODUCTION: Hepatic artery thrombosis still represents a major complication after liver transplantation responsible for graft failure, possibly resulting in the need for retransplantation. CASE REPORT: We describe a case of a patient undergoing liver transplant complicated by hepatic artery thrombosis, successfully treated with an endovascular approach using the Indigo System. This new system allows mechanical fragmentation and aspiration of the thrombus, with no injection of any thrombolytic agents, thereby reducing the risk of bleeding. Hepatic artery flow was immediately restored, with no complications for the patient and the graft. DISCUSSION: The Indigo System appears to be a safe, affordable, and manageable technique for endovascular management of late hepatic artery thrombosis after liver transplant.

A Particular Use of Endobag®: Extraction of Rectal Foreign Bodies.

INTRODUCTION: The incidence of foreign bodies (FBs) in the rectum has recently increased. FB removal by the transanal way or by colonoscopy is generally feasible and only in few cases surgery is strictly necessary. Due to FB dimensions or rectum and colon anatomy, sometimes it may represent a challenge. MATERIALS AND METHODS: Two cases of FB inserted in the rectum were treated in our institute. They underwent surgery using Endobag, a laparoscopic surgical device. The device was inserted through the anus in order to catch and remove the FB. RESULTS: Both the procedures were easily performed, without any complication. CONCLUSIONS: The use of Endobag seems to be a good and effective way to remove FB from rectum.

Splenic Artery Syndrome as a Possible Cause of Late Onset Refractory Ascites After Liver Transplantation: Management With Proximal Splenic Artery Embolization.

BACKGROUND: Portal hyperperfusion (PHP) is a hemodynamic condition which may develop after liver transplantation and cause refractory ascites (RA). The diagnosis is established by exclusion of other causes of increased sinusoidal pressure/resistance such as cellular rejection or toxicity and outflow obstruction. PHP as part of the pathogenesis of the splenic artery syndrome (SAS) can be treated with splenic artery embolization (SAE). METHODS: This is a retrospective study on a cohort of first-time whole-size liver transplant recipients diagnosed with RA due to PHP and treated by proximal SAE (pSAE) at the Liver Transplant Unit of the University Hospital of Udine between 2004 and 2014. RESULTS: For this study, 23 patients were identified (prevalence 8%) and treated. Preliminary clinical workup to diagnose SAS was based on exclusion of other possible causes of RA with graft biopsy, cavogram with hepatic venous pressure measurement, computed tomography scan, and angiography. The pSAE was performed 110 ± 61 days after transplantation, and no procedure-related complications occurred. pSAE resulted in a significant decrease of portal vein velocity (P = .01) and wedge hepatic venous pressure (P = .03). The diameter of the spleen showed a slightly significant reduction (P = .047); no modification of hepatic artery resistive index were encountered (P = .34). Moreover, pSAE determined the resolution of RA in all cases. CONCLUSIONS: pSAE is a safe and effective procedure to modulate the hepatic inflow and thus to treat RA secondary to SAS, with a low incidence of complications and a high rate of clinical response.

[Surgical treatment of extraoesophageal symptoms of GERD. Critical points in the diagnostic-therapeutic pathway]. / Trattamento chirurgico dei sintomi extraesofagei da MRGE. Punti critici nel percorso diagnostico-terapeutico.

Patients with GERD and atypical symptoms represent a particular category with a less clear definition of the physiopatological mechanisms and thereby need a precise attention toward the indication to surgery. The less good response to surgery therefore requires a careful evaluation and selection of patients with atypical symptoms.

Increased pulmonary epithelial permeability in systemic sclerosis is associated with enhanced cutaneous nerve growth factor expression.

Background: Nerve growth factor (NGF), a neurotrophic factor that indirectly induces fibroblast proliferation and collagen production, has been found to be increased in the affected dermis of patients with systemic sclerosis (SSc). To investigate the possibility of a relationship between cutaneous NGF production and pulmonary damage in SSc, we studied seven non-smoking scleroderma patients. Methods: Abnormalities in lung structure were assessed by radiological lung examination, and pulmonary epithelial permeability (PEP) was determined by ventilation lung scintigraphy. All patients underwent skin punch biopsy with NGF immunohistological staining. Results: A statistically significant correlation was found between the PEP values and the cutaneous NGF staining scores, which were markedly increased in all of the patients examined, irrespective of the age, disease duration, or radiologically defined lung abnormalities. Conclusion: These results support the hypothesis that functional and anatomical changes in SSc target organs may be determined by a local tissue hyperproduction of NGF.

In vitro effect of Pt and Pd mercaptopyridine complexes.

In previous research we studied the cytotoxic effect of new Pt mercaptopyridine (MP) complexes on several tumoral cell lines (F10, Föhn, LoVo and HeLa) as well as on the fibroblast cell line (3T3). The more interesting Pt compounds are compared here to Pd mercaptopyridine analogs, in order to evaluate the metals influence on activity. Earlier, the complexes C/2 = [Pt(MP)3Cl]Cl; C/5 = [Pt(MP)3Br]Br; C/8 = [Pd(MP)3Cl]Cl and C/11 = [Pd(MP)3Br]Br and cis-DDP as reference were tested on 3T3 and LoVo cells, by Sauter's multiwells technique and neutral red uptake. The results obtained using lysosomal neutral red uptake to confirm those by the Sauter's multiwells techniques, showing that C/2 and C/11 are the most active complexes. In particular, C/2 shows a significantly higher cytotoxic activity than cis-DDP on LoVo cells, and equivalent on 3T3. C/5 complex also induces an interesting cell growth reduction, but only on LoVo, while C/8 is completely inactive on all cell lines. Because the major limitation to the successful treatment of platinum-based chemotherapeutic regimens is the emergence of drug resistance, the activity of the four complexes on cis-DDP sensitive (M5076) and cis-DDP resistant cancer cells (M5/DDPc) has been tested. The data reported in this work make devident that the presence of ligands with sulfur donor atoms may be of particular importance in confirming the antitumor properties of Pt complexes. In fact, Pt mercaptopyridine C/2 is also more active than cis-DDP against cells made resistant to cis-DDP. Moreover, the results obtained with Pd complex C/11, especially on LoVo cells, showed that this metal could be considered interesting in the design of potential new antitumor drugs.

The effect of cis-DDP and Pt mercaptopyridine complexes on cell lines in vitro.

The effect of Platinum (II) complexes with mercaptopyridines on cell lines (fibroblasts 3T3 and the tumour ones F10, Föhn, Lovo) were studied. Synthesis and characterization of the compounds are reported together with the preliminary in vitro tests. Data obtained on cytopathogenic effect (CPE), cell growth and colony forming ability demonstrated that all the platinum mercaptopyridines tested are more active than cisplatin in the same conditions.

In vitro studies on tin-dithiocarbamates.

Organotin compounds have been studied for their biological properties, whereas very little is known about the effects of tin-inorganic derivatives on biological systems. Owing to our interest in the dithiocarbamate moiety in relation to metal redistribution in the body and to its biological import, we performed in vitro cytotoxicity experiments on dithiocarbamates. Preliminary results obtained with five tin-dithiocarbamates, where DDTC is the diethyldithiocarbamate anion, indicate some very promising compounds.