[Gastric metastasis of cutaneous melanoma. Apropos of a case letter]. / Métastase gastrique d'un mélanome cutané. A propos d'un cas.

We report a case operated for gastric metastasis of a cutaneous melanoma. Although such localizations are frequent, symptomatology is nonspecific. Diagnostic fibroscopy is effective if the lesion is blackened by melanin. Immediate surgery is required to avoid acute complications. The indication for elective surgery can be raised if there is a solitary metastasis. In case of recurrence, subtotal gastrectomy appears to be possible. Although the prognosis is poor, surgery offers important palliative relief.

[Surgical therapy of diaphragmatic eventration in adults: indications, technique and choice of approach]. / Terapia chirurgica dell'eventratio diaframmatica nell'adulto: indicazioni, tecnica e scelta della via di accesso.

The Authors report their experience in the surgical treatment of eventration of the diaphragm in the adult. Symptoms and indications for surgery are evaluated and compared with data reported in the literature.

Crohn's disease of the esophagus.

Esophageal involvement in patients with Crohn's disease is uncommon. Histologic proof is rarely obtained by means of endoscopic biopsies. Moreover, the natural history of this condition and its response to therapy are largely unknown. We report a case of biopsy-proven esophageal Crohn's disease, which presented with a stricture of the distal third of the esophagus and was successfully treated by progressive endoscopic dilatation.

Cerebral amino acid levels and transport after portocaval shunt in the rat: effects of liver arterialization.

Altered plasmatic and cerebral amino acid patterns have been observed after portocaval shunt in the rat. Similar alterations have been found in plasma and in cerebrospinal fluid of cirrhotic patients and are likely to play an important role in the pathogenesis of hepatic encephalopathy. Impaired liver blood flow could contribute to these biochemical abnormalities. Therefore we wondered whether liver arterialization, by improving liver perfusion, could have any beneficial effects on the altered amino acid levels occurring in the rat after portocaval shunt. Amino acid concentrations were determined in four cerebral regions and in the plasma of shunted rats with or without liver arterialization, 4 weeks after surgery. Blood-brain barrier transport was studied with the Oldendorf's technique. After portocaval shunt, we observed lower plasma levels of the branched chain amino acids valine, isoleucine, leucine, and net higher levels of the aromatic tyrosine and phenylalanine and of glutamine. In the cerebral regions, we observed a slight increase of branched chain amino acids and an enormous increase of tyrosine, phenylalanine, tryptophan, histidine, and glutamine. Arterialization of the liver made no difference to the postportocaval shunt plasma levels of branched chain amino acids, while it almost normalized those of aromatics. In the cerebral regions, we observed a marked improvement in the level of tyrosine, phenylalanine, tryptophan, and histidine. The enhancement of blood-brain barrier transport for the neutral amino acid class, observed after portocaval shunt, was not influenced by liver arterialization. We conclude that, in our model, liver arterialization improves the pathologic amino acid levels following portocaval shunt. This would be in agreement with clinical reports suggesting that hepatic encephalopathy is less frequent after portocaval shunt when associated with arterialization of the liver.

Effect of L-dopa treatment on cerebral amino acid levels in rats after portocaval anastomosis.

L-Dopa therapy has been suggested as effective in the reversal of hepatic coma both in humans and in animals. Beneficial effects have been reported also in chronic hepatic encephalopathy. There are many possible mechanisms through which L-dopa could ameliorate this pathological state. The present study was carried out to clarify whether the L-dopa effect could be mediated through an improvement of the brain neutral amino acid patterns, since it competes for the same transport carrier at the blood-brain barrier. A first group of rats was orally administered L-dopa (10 mg/100 g body weight daily) for 1 month following portocaval anastomosis. A second group was intraperitoneally injected (1.5 mg/100 g body weight daily) for 1 week, a month after portocaval shunt. Amino acid levels were determined in plasma and in four cerebral regions. No beneficial effects were observed clinically (in general condition, body weight, or hypertonic posture) in rats receiving L-dopa compared to controls. The large increase of tyrosine, phenylalanine, tryptophan, histidine, and glutamine that occurs in the cerebral tissue after portocaval shunt was also not affected by L-dopa administration. In conclusion, in this experimental condition we had no clinical improvement in shunted animals receiving L-dopa. Moreover, this compound did not seem to influence the pathological increase of aromatic amino acids in the brain, which is considered to play an important role in hepatic encephalopathy.

Does liver arterialization improve the altered cerebral amino acid pattern in the rat after portacaval shunt?

Altered plasma and brain amino acid patterns have been observed in the rat after portacaval shunt. Similar alterations are likely to play an important role in hepatic encephalopathy in humans. In our model, liver arterialization remarkably improves the pathologic amino acid levels following portacaval shunt.

Cerebral amino acid levels and uptake in rats after portocaval anastomosis: I. Regional studies in vitro.

Uptake of various amino acids was studied in slices from brain regions of rats four weeks after portocaval anastomosis. No differences of the inulin compartment were observed between control and experimental animals. After 60-minutes incubation, uptake showed an overall pattern of diminution. This was more evident for some amino acids: valine, methionine, and lysine exhibited a lowering of about 30%, which was fairly uniform in the four tested regions; others showed a regional decrease-- alanine in pons-medulla, phenylalanine in cerebellum, histidine and GABA in mesodiencephalon. This decrease did not seen to be related to transport classes. The restricted entry of amino acids into brain cells in portocaval encephalopathy is somewhat difficult to explain; a decreased rate of protein synthesis may be of some importance, but other factors, such as a "carrier" impairment, effects on release and on amino acid metabolism, may also be involved.

[In vivo aminoacid transport in the brain of the rat with porto-caval anastomosis (author's transl)]. / Trasporto di alcuni aminoacidi in vivo nel cervello del ratto sottoposto ad anastomosi porto-cava.

Cerebral capillary permeability to L-amino acids was studied in rats submitted to porto-caval anastomosis 4 weeks before. The short-term intracarotidal injection technique described by Oldendorf was used throughout. Neutral amino acid permeability appeared to be greatly increased, the most important enhancement being for the tryptophan. On the opposite, basic amino acids showed a net decrease in their rate of passage from blood to the brain. No changes were observed for GABA and glutamic acid. These data suggest a marked modification of the permeability of the cerebral capillary membranes in the rat with chronic portocaval anastomosis. Moreover, such alterations are selective for the different amino acid transport classes. Competitive inhibition decreased the permeability of methionine at the same level in both control and experimental animals: therefore, the neutral amino acid increased entry into the rat brain after porto-caval shunt is due to an enhancement of the transport processes.