Chelating Surfaces for Oriented Human Serum Albumin Molecules.

Protein immobilization in a specific conformation or orientation at an interface is influenced by specific interactions with the outer layer of the surface. A strategy to build-up a complex construct which is able to orient protein molecules, based on metal-cation chelation processes, is reported. The proposed methodology implies the formation of a mercaptoundecanoic acid monolayer on a gold surface that is activated to attach covalently the tripeptide glycyl-l-histidyl-l-lysine (GHK) on the surface, whose sites are then employed to chelate copper ions, providing a selective platform for the orientation of human serum albumin (HSA) molecules. The protein adsorption process on GHK and GHK-Cu(II)-complex surfaces was monitored by the in situ quartz crystal microbalance with dissipation monitoring (QCM-D) and force spectroscopy technique. The changes in frequency and dissipation factor as well as the D- f plots from QCM-D measurements help to characterize the changes in the protein conformation and are confirmed by force curve spectroscopy results. An improved kinetic model, based on random sequential adsorption with variable protein footprints, has been developed to predict and simulate the experimentally found HSA average surface coverage onto the GHK and GHK-Cu(II)-complex surfaces.

Structure of a liquid/liquid interface during solvent extraction combining X-ray and neutron reflectivity measurements.

We have resolved the molecular structure of a bulk oil/water interface that contains amphiphilic ligand molecules using a combination of X-ray and neutron reflectivity measurements for the first time. This new capability can greatly impact future work in the field of ion separation by phase transfer, i.e. liquid/liquid extraction.

Combined duodenal and pancreatic major trauma in high risk patients: can a partial reconstruction be safe?

Pancreatic trauma is an uncommon injury, occurring in only about 0.2% of blunt abdominal injuries, while duodenal injuries represent approximately 4% of all blunt abdominal injuries. When trauma of the pancreas and duodenum do not permit reparation, pancreatoduodenectomy (PD) is mandatory. In the reconstructive phase, the use of ductal ligation as an alternative to standard pancreaticojejunostomy has been reported by some authors. We report a case of polytrauma with pancreatic and duodenal injury in which the initial diagnosis failed to recognize the catastrophic duodenal and pancreatic situation. The patient was submitted for PD and the pancreatic stump was abandoned in the abdominal cavity after main pancreatic ductal ligation. This technique can minimize the morbidity and mortality of PD in patients with other organs or apparatus involved severely and extensively in trauma.

Primary neuroendocrine lung tumor presenting with acute ileal obstruction. Case report.

The authors describe a clinical case of a patient with neuroendocrine carcinoma of the lung diagnosed after the onset of an intestinal obstruction from an ileal metastasis. A review of literature reveals that the incidence of symptomatic gastro-intestinal metastases from lung cancer has been estimated to be about 2-3% and is exceedingly rare that the intestinal symptoms may be the initial presentation of cancer of the lung. The authors emphasize the difficulty of preoperative diagnosis of gastro-intestinal metastases which is made, almost always, too late because of the lack of specific symptoms. In our case, on account of the computed tomography, we leaned towards the diagnosis of lymphoma because of the double mediastinal and abdominal localization. Furthermore, this diagnosis was supported by the fact that the pulmonary lesion did not have clear radiological features of a lung cancer. The prognosis is poor because once intestinal metastases occur, other metastatic sites, which would make surgery only a palliative measure, are already present. The review of the literature shows that the average survival rate of these patients is 136 days. In our case the patient survived 277 days.

Late cutaneous fistula after inguinal hernia repair without prosthesis.

Late onset of cutaneous fistulas associated with inguinal hernia repair represents an extremely rare complication that occurs especially after affixing a prosthesis. The authors report a case of a patient developing this complication after a hernia repair (Shouldice's technique), emphasize that the fistula appeared after more than 12 years (the longest interval reported in the literature), and explain how it resolved only with the surgical removal of the suture used for hernia repair. The authors emphasize the aetiology of this complication and stress that it can occur even after a hernia repair without prosthesis.

Mid-transverse colon cancer and extended versus transverse colectomy: Results of the Italian society of surgical oncology colorectal cancer network (SICO CCN) multicenter collaborative study.

INTRODUCTION: Transverse colon cancer (TCC) is poorly studied, and TCC cases are often excluded from large prospective randomized trials because of their complexity and their potentially high complication rate. The best surgical approach for TCC has yet to be established. The aim of this large retrospective multicenter Italian series is to investigate the advantages and disadvantages of both hemicolectomy and transverse colectomy in order to identify the best surgical approach. MATERIALS AND METHODS: This was a retrospective cohort study of patients with mid-transverse colon cancer treated with a segmental colon resection or an extended hemicolectomy (right or left) between 2006 and 2016 in 28 high-volume (more than 70 procedures/year) Italian referral centers for colorectal surgery. RESULTS: The study included 1529 patients, 388 of whom underwent a segmental resection while 1141 underwent an extended resection. A higher number of complications has been reported in the segmental group than in the extended group (30.1% versus 23.6%; p 0.010). In 42 cases the main complication was the anastomotic leak (4.4% versus 2.2%; p 0.020). Recovery outcomes also showed statistical differences: time to first flatus (p 0.014), time to first mobilization (p 0.040), and overall hospital stay (p < 0.001) were significantly shorter in the extended group. Even if overall survival were similar between the groups (95.1% versus 97%; p 0.384), 3-year disease-free survival worsened after segmental resection (78.1% versus 86.2%; p 0.001). CONCLUSIONS: According to our results, an extended right colon resection for TCC seems to be surgically safer and more oncologically valid.

A study about mechanisms of des-gamma-carboxy prothrombin's production in hepatocellular carcinoma.

AIM: Des-gamma-carboxy prothrombin (DCP) is an abnormal prothrombin, increased in serum of patients with hepatocellular carcinoma (HCC) as result of an acquired defect of post-translational carboxylation of prothrombin's precursor. It is unclear if the reduced activity of gamma-carboxylase is secondary to vitamin K deficiency or to an altered gene encoding this enzyme. The aim of this study was to evaluate the effect of vitamin K administration on DCP and alpha-fetoprotein (AFP) levels, to identify a relationship between vitamin K and DCP serum levels and to investigate mechanisms of serum elevation of DCP levels. METHODS: The authors determined DCP and AFP serum levels and vitamin K concentration in 64 cirrhotics with HCC and in 60 cirrhotic subjects without HCC. In HCC subjects DCP and AFP levels were measured before and after vitamin K administration. A t-test for unpaired data was applied (P values <0.05 statistically significant). RESULTS: Only HCC patients had detectable levels of DCP and significant AFP levels. Administration of vitamin K reduced DCP but not AFP levels in HCC patients. No correlation was observed between vitamin K concentration and DCP levels: vitamin K concentration was similar both in HCC patients and in control group without HCC; HCC patients had the same vitamin K concentration regardless of elevated o reduced DCP levels after vitamin K administration. CONCLUSION: DCP detectable serum levels are the result not only of vitamin K deficiency or selective defects of carboxylase, because probably alterations of membrane receptors or cytoplasmatic transfers, that are necessary for the function of vitamin K, are involved.

Usefullness of the ultrasonically activated scalpel in laparoscopic cholecystectomy: our experience and review of literature.

Laparoscopic cholecystectomy (LC) actually represents the most used and proper treatment for gallbladder lithiasis, because its many and known advantages in comparison with 'open' abdominal surgery. But there are some problems during and after LC due to the use of the electric scalpel and these have brought to the search of an alternative system of dissection and coagulation. The ultrasonically activated scalpel (Harmonic Scalpel, HS) allows to perform dissection and coagulation with a minimal thermal side effect for surrounding tissues, unlike the electrocoagulation. Furthermore, the use of the HS brings a series of advantages in comparison to the other electromagnetic forms of energy (electro-scalpel, laser). HS cuts and coagulates with the same effectiveness of the electro-scalpel but, unlike this, it doesn't introduce risks of wandering currents. Moreover, HS contributes to have a more clean and clear (smokes-free) field of operation and it reduces the operative time, the bleeding and the costs of the operation without an increase of the complications and of the percentages of 'open' conversion, and perhaps leads to a less negative influence on the postoperative systemic immune response. The Authors report their experience that confirm these observations, according also with results reported in a brief review of the recent scientific literature, and support wider diffusion and technical development of this ultrasonically-operating surgical team.

[Myasthenia gravis and intestinal resection: is dehiscence likely to occur?]. / Myasthenia gravis e resezione intestinale: deiscenza in agguato?

Experimental and clinical data have proved that anticholinesterase drugs are responsible for vigorous peristaltic contractions and for an increase of the intraluminal pressure, because they determine muscarinic effects on the smooth muscle of the intestine both in small and large intestine. Therefore, a greater incidence of intestinal anastomotic disruption has been supposed when anticholinesterases are used both in the early postoperative period, to reverse curarization, and in myasthenic patients. The authors report a case of a patient with myasthenia gravis who received maximal doses of pyridostigmine and underwent left hemicolectomy and small intestine resection and afterwards total colectomy in order to treat a sigmoid perforated diverticulitis. In the postoperative course an anastomotic leak developed after both surgical operations. The authors believe that pyridostigmine could have had an important role in the pathogenesis of the leak and assert that, when an intestinal resection has to be performed in a myasthenic patient, it could be useful to reduce in the preoperative period the administration of anticholinesterase drugs and always perform a protective ileostomy.

Laparoscopic cholecystectomy (LC): predictive role of preoperative ultrasounds.

AIM: We studied several ultrasounds patterns concerning gallbladder, biliary tract and gallstones to identify some predictive signs of difficulties during LC. PATIENTS & METHODS: 112 patients (24 females), 25-75 years old, upper abdomen operated patients not included. From 7 ultrasounds patterns 4 degrees of potential intra-operative difficulty (0-3) were obtained. During the operation 7 conditions of true intra-operative problems were also classified. RESULTS: Patients showing grade 0: regular gallbladder wall stones < 20 mm, regular Main Biliary Tract (MBT) = 62 LC and 2 open surgery conversion (OSC); grade 1: wall < 4 mm, stones > 20 mm= 24 LC and 7 OSC; grade 2: hydrops, wall > 4 mm, infundibular stone = 6 LC and 6 OSC, grade 3: wall > 4 mm, stones > 20 mm, empyema of gallbladder, MBT > or = 6 mm = 3 LC and 0 OSC. Inflammation near gallbladder and wall > 4 mm were mainly responsible for transition of LC in OSC. CONCLUSION: Several predictive conditions for intraoperative difficulties are often detectable by accurate preoperative ultrasounds examination, with the aim of best surgical planning and to select those patients to entrust to surgeons during their learning phase.

Misplacement of a jugular line in a facial vein.

We report an exceptional misplacement of a central venous catheter, from the right jugular vein where it was introduced, into the right thyro-lingual-facial trunk. A brief description of the clinical course and a literature review on catheter misplacement is presented. This case illustrates the importance of routine use of a chest X-ray, and when necessary contrast medium, to verify the correct location of the catheter tip.

Pancreas transplantation in the rat using Lee's technique: a reliable model in experimental microsurgery.

Numerous unresolved problems, both technical and immunological, in pancreas transplantation stimulate experimental studies. Dogs have been routinely used in experimental studies but today rats are more commonly used. However, pancreas transplantation in the rat presents complex technical problems and requires a good knowledge of microsurgical techniques. In 1983 Squifflet undertook an experimental study aimed at evaluating the technical aspects of pancreas transplantation in the rat and calculating the success rates using different methods. The comparison of four methods revealed to our surprise that 100% of the rats operated on using Lee's technique had complications, with a 0% survival rate. In our study we report our experience using Lee's technique which we had the opportunity of mastering directly under the supervision of Professor Lee. We performed 100 pancreas transplantations using Lee's technique and divided our study in two phases. In the first phase we performed 70 pancreas transplantations and overall survival, after 1 week, was 42 rats (60%). In the second phase on 30 rats diabetes was induced by administering 70 mg/kg of streptozotocin. These 30 diabetic rats underwent pancreas transplantation and overall survival, after 1 week, was 25 (83.3%). We believe that our successful survival rates could probably be explained by the close collaboration between Lee and our department. Moreover, we noted the importance of constant training in obtaining better results, and in our opinion Lee's technique of pancreas transplantation is a reliable experimental model which can be used to resolve problems linked to pancreas transplantation.

Multimodal therapy of hepatocarcinoma: personal experience on 90 cases.

BACKGROUND/AIMS: In recent years, surgical and non-surgical options have been developed in the treatment of hepatocellular carcinoma in cirrhotic patients. We review our personal series from 1995-1999, in order to assess the choice of treatment. METHODOLOGY: Of 90 cases of hepatocellular carcinoma observed in the years 1995-1999, 15 underwent curative resective surgery; in 42 cases TAE, PEI or RITA were utilized (9 of them as multimodal therapy). In the remaining 33 patients any kind of therapy was scheduled. RESULTS: The mean survival of the 15 resected patients was 18 months, non-statistically better than RITA survival, compared by Log-Rank test. Perioperative mortality calculated in all procedures was 5.2% (2 pts surgery, 1 pt TAE). CONCLUSIONS: The high percentage of not treated hepatocellular carcinomas in our series is generally due to large tumor size diagnosed in advanced Child's stage. PEI, TAE and RITA have to be considered effective and safe for palliation for HCCs. However, surgical resection represents the curative therapy in selected cirrhotic patients affected by HCC.

Evaluation of the prognostic accuracy of Astler-Coller's and Jass' classifications of colorectal cancer.

AIM: The study aim was to determine whether the Jass classification is superior to that of Astler-Coller (modification of Dukes' stage) in determining prognosis of patients treated for colorectal carcinoma. STUDY DESIGN: The authors used Jass' classification to restage 263 patients who had undergone radical colorectal surgery and classified according to Astler-Coller. RESULTS: The results revealed that: 1) Astler-Coller's classification enables more accurate selection of patient groups where life expectancy can be predicted; 2) Jass' classification enables statistically significant (P <0.05) improved prognostic discrimination of Astler-Coller's B2 patients, for which the probability of nonrecurrence of the disease is around 60%. CONCLUSIONS: Although Astler-Coller's classification is still valid, Jass' classification is useful for the prognostic discrimination of Astler-Coller's B2 patients.

Radio-hyperthermia for subcutaneous metastasis of hemangiopericytoma of the mediastinum: case report.

Hemangiopericytoma is a rare type of neoplasia originating from the Zimmermann pericytes and can arise in numerous sites. As it is difficult to correlate the histologic aspect with the prognosis, it was considered advisable to take account of other factors such as age and tumoral site. Aggressive surgery followed by irradiation therapy is suggested as the most suitable management. Hyperthermia also was adopted in treating subcutaneous metastasis, but its role has yet to be fully defined.

[Nutritional aspects in a case of short bowel syndrome complicated by acute renal failure]. / Aspetti nutrizionali in un caso di sindrome da intestino corto complicato da insufficienza renale acuta.

The short bowel syndrome is a multifactorial disease that requires an intensive treatment especially if complication develop. The authors report their experience in a patient who, affected by acute renal failure after extensive intestinal resection, underwent temporary jejunostomy. The treatment of choice in this patient was initially a careful hydroelectrolytic balance, as he was in good nutritional status but underwent a dialytic treatment and jejunostomy. Then we started the nutritional support and initially we adopted enteral nutrition in order to facilitate small bowel functional integrity, avoid gastric uremic lesions and bacterial translocation which could prelude to multiple organ failure. At surgery we tried to preserve the distal ileum which is very important in order to absorb biliary salts and nutritional mixtures. Cholecystectomy was associated due to gangrenous cholecystitis probably caused both by short bowel syndrome and prolonged artificial nutrition. Six months after surgery the patient underwent a decrease of the body weight and then authors verified the stabilization of the weight and general conditions.

Microsurgical treatment of varicocele.

The authors report their experience of the surgical treatment of varicocele. After having performed modified Palomo's method for many years, recent pathogenetic data have induced them to adopt a microsurgical technique. This technique involves vascular anastomoses which allow drainage of the testicular blood into an area with lower venous pressure. They used Fox's technique (anastomosis between 2-3 veins of the pampiniform plexus and saphena vein) and Belgrano's technique (anastomosis between internal spermatic vein and inferior hepigastric vein). The authors report their series of 30 patients treated with these techniques between 1984 and 1987. The results obtained from 20 who were followed-up one year after surgery demonstrated an improvement in the physical examination in 70% of cases and a decreases in hyperthermia in 75% of patients. A spermiogram improvement has been obtained in 66.6% of 18 patients, as two of them were of pediatric age.

[Splenic abscess]. / Absceso esplénico.

Splenic abscess is rare and may be present either as a localized area in the spleen or as part of a generalized sepsis. A 35 year old man presented with a two month history of anorexia, weight loss, fever, abdominal pain and arthralgia. Multiple abscesses localized in the spleen were diagnosed by CT and splenectomy was performed.

[Role of somatostatin and parenteral nutrition in the treatment of acute pancreatitis. Personal experience]. / Ruolo della somatostatina e della nutrizione parenterale nel trattamento della pancreatite acuta. Esperienze personali.

The aim of the study was to evaluate and control the therapeutic validity of Somatostatin administration and the clinical benefits of parenteral nutrition during acute pancreatitis. We selected 31 patients with 1st and 2nd degree pancreatitis according to Ranson's classification. Diagnosis was based on clinical and humoral data and confirmed by echography and CT examinations. The most common etiological cause was biliary++ lithiasis (74.2%). All the patients in the study were split into two groups and received conventional treatment. The therapeutic schedule administered to group 1 included somatostatin (250 micrograms/h for 72-96 h), while group 2 received total parenteral nutrition with 2,000-2,500 Kal/day trough a central vein. The data obtained from our study demonstrated that both somatostatin and parenteral nutrition are valid tools during the acute phase of the disease. It must be pointed out that the former significantly influences the clinical course and allows a precise control of the painful symptomatology, the objective picture and the curve of the main hematochemical parameters. Parenteral nutrition betters the anabolic response of the organism during the acute phase and carries out an indirect antienzymatic response, so favouring a quicker recovery than observed in the group treated with somatostatin.

[Morphologic and endocrine changes in the male reproductive system after porta-caval anastomosis in rats. Experimental research]. / Alterazioni morfologiche ed endocrine dell'apparato riproduttivo maschile dopo anastomosi porta-cava nel ratto. Ricerche sperimentali.

Quantitative alterations of the sexual hormones are present in cirrhotic patients whose testicular volumes are decreased with tubular atrophy in more than 50% of cases. The authors performed an experimental study utilizing end-to-side portacaval anastomosis in the rat in order to evaluate the consequences of the complete interruption of the portal blood to the liver in the male genital system, i.e. testicular alterations, due to the missing hepatic inactivation. Forty male Sprague-Dawley rats were used for this study. Twenty rats were subjected to end-to-side porta-caval anastomosis according to Lee, 10 rats underwent sham-operation while the remaining 10 rats were utilized as negative controls. The rats were weighed and necropsied three and six months after surgery and the liver and genital organs were weighed. In rats subjected to porta-caval anastomosis loss of weight was shown, about 20 g three months after surgery and 30 g six months after surgery, while other rats (sham-operated and negative controls) showed an increase of its weight, about 60 g after three months and 80 g after six months. In rats subjected to porta-caval anastomosis the liver was hypotrophic and its weight was decreased in comparison with the control group. In the same rats testicular volumes were decreased and hypotrophic in comparison with the control groups with average length 0.5 to 1 cm, while control groups showed values of 1.7 to 2.5 cm. Testosterone levels were 0.50 ng/ml in rats subjected to porta-caval anastomosis while in control groups the levels were 2.20 ng/ml.(ABSTRACT TRUNCATED AT 250 WORDS)