Hammerhead ribozyme specifically inhibits vascular endothelial growth factor gene expression in a human hepatocellular carcinoma cell line.

Hammerhead-type ribozymes are often utilized to suppress the expression of target genes. We evaluated the efficacy of an anti-vascular endothelial growth factor (VEGF) hammerhead-type ribozyme against GUC at exon 1 of the VEGF gene in a cell-free system (in vitro) as well as in the hepatocellular carcinoma cell line HLF (in vivo). The anti-VEGF ribozyme (alphaVRz) specifically cleaved synthetic VEGF RNA substrate, but not other triplet sequences of VEGF RNA substrate in vitro. When the alphaVRz was introduced into HLF cells, the ribozyme suppressed not only VEGF mRNA level but also that of VEGF protein. These results suggest that this ribozyme selectively inhibits VEGF gene expression in human hepatocellular carcinoma cells.

Interleukin 10 expression is correlated with thrombospondin expression and decreased vascular involvement in colon cancer.

Interleukin 10 (IL-10) is an immuno-suppressive cytokine produced by T-lymphocytes, and a regulatory molecule for angiogenesis in various cancers. We examined IL-10 gene expression in 53 colon cancer patients who underwent surgical resection. IL-10 gene expression was correlated with TSP1 and TSP2 gene expression (P=0.0049, P=0.0285). Colon cancer with IL-10 gene expression (19/53) showed significantly decreased venous involvement (P=0.0433). The mean vessel counts in the colon cancers with IL-10 gene expression were significantly lower than those without IL-10 gene expression (P<0.001). These results suggested that IL-10 stimulates angiostatic factor gene expression, and results in suppression of venous involvement.

The role of early radiological studies after gastric bariatric surgery.

BACKGROUND: The authors investigated early radiological findings after gastric surgery for morbid obesity to evaluate their usefulness in avoiding complications or facilitating treatment. MATERIAL AND METHODS: 413 patients underwent gastric bariatric surgery: 327 had vertical banded gastroplasty (VBG), 55 Roux-en-Y gastric bypass (RYGBP), 22 adjustable silicone gastric banding (ASGB), and 9 biliopancreatic diversion (BPD). A radiological upper gastrointestinal investigation employing water-soluble contrast medium was performed in each patient between the 2nd and 8th postoperative day. Several techniques were employed to assess different radiological findings related to the anatomic modifications after the bariatric surgery. RESULTS: In VBGs, delayed emptying was found in 10 patients (3%), gastric leak in 3 patients (0.9%), vertical suture breakdown in 1 patients (0.3%), and a wide pouch in 4 patients (1.2%). In RYGBP, a leak was detected in 2 patients (3.6%), delayed emptying in 2 (3.6%), and a wide pouch in 5 (9.1%). ASGB required band enlargement for stomal stenosis in 6 patients (27.2%). Temporary delayed emptying from stomal stenosis was also observed in 2 BPDs (22.2%). Overall complications were 35/413 (8.2%). Two cases of gastric leak after VBG were reoperated. Stomal stenosis after ASGB were treated by percutaneous band deflation; other cases were medically treated until complete healing. CONCLUSIONS: Early radiological study after gastric bariatric surgery is advisable, since it detected postoperative complications (gastric perforation, stomal stenosis, etc.) and modified the clinical approach. As the interpretation of these radiographs is often difficult, involving different projections or patient's positions or other technical managements, surgeons and radiologists must interact and be knowledgable.

[Treatment of locally advanced breast neoplasms]. / Il trattamento delle neoplasie mammarie localmente avanzate.

One particularly interesting problem in the treatment of breast carcinomas relates to the strategy to be adopted in locally advanced forms. In 10-25% of cases surgery in itself offers no guarantee of radicality and the prognosis is particularly poor. Once considered suitable only for radiation treatment, such cases now tend to be treated by mixed therapy adopting different modes and sequences. The present paper fully and carefully examines current concepts and treatment possibilities.

Long-term efficacy of oral microemulsion cyclosporin for refractory ulcerative colitis.

AIM: The 60% bioavailable oral microemulsion formulation of cyclosporin (NEORAL ), has replaced the intravenous route to treat both organ transplant and immune-based disease. Its use for steroid-refractory ulcerative colitis (a recognized indication for intravenous cyclosporin) has been scanty. METHODS: Twenty-three consecutive patients (14 male/9 female, universal colitis 14/23) entered a 3-month course of NEORAL (initially dosed at 5 mg/kg/day) because of steroid-refractoriness (14 cases) and steroid-dependence (9 cases). Responders (at least showing a 50% reduction of a clinical activity score) were continued on azathioprine. The initial steroid dose was tapered on commencing NEORAL; patients requiring steroid resumption or increase in the follow-up were defined as relapsers. RESULTS: The target trough concentration of 200 ng/ml of whole blood was achieved without major titration in all but 1 patient. There were 7 non-responders (30%). Of the 16 responders (70%), 2 have not relapsed; the remaining 14 relapsed at the median time of 9.5 months (1.5-60) with 10 (71%) showing only 1 relapse. Five patients were colectomized 12 months after NEORAL (1.5-24), leaving 11 of the initial 23 (47%) with their colon. Of the 16, all but 1 had azathioprine; the median daily steroid needs fell from 32 to 5 mg. CONCLUSION: The rates of acute and chronic response of 70% and 47% achieved by NEORAL in this indication duplicate the figures achieved by the traditional schedules of cyclosporin administration.

[Mitral valve substitution, using the Lillehei-Kaster prosthesis]. / La sostituzione valvolare mitralica con la protesi di Lillehei-Kaster.

Personal experience acquired in the course of 177 mitral valve replacements with a Lillehei-Kaster prosthesis up to June 1977 is discussed. Intraoperative mortality was 8.5%. Postoperative mortality (as at 31-12-1976) was 5.3%. The clinical, radiological, and ergometric findings were fully satisfactory. Haemodynamic examination at rest and during effort revealed improved pressure and heart capacity values. The mean transprosthetic gradient at rest was 5.61 and rose to 13.53 (after uncalibrated effort). Thromboembolism was noted in 5 patients (3.1%), as in the literature. The haemodynamic features and low thrombogenicity of the Lillehei-Kaster prosthesis would thus appear to make it a sound replacement for the mitral valve.

[Surgical treatment of endocrine tumors of the pancreas]. / Il trattamento chirurgico dei tumori endocrini del pancreas.

Following a brief review of the literature dealing with the rarity of this disease, and the diagnostic progress made to date, the surgical techniques applicable to the various locations of the neoplasia are described. Personal experience with 8 insuloma patients is reported.

[Management of obese patients: surgical therapy]. / Management del paziente obeso. Terapia chirurgica.

At present, the management of obesity includes integration of therapeutic strategies such as diet, physical training, behaviour therapy and pharmacologic therapy. An increased number of selected patients with morbid obesity, where medical therapy was ineffective, have been surgically treated in the last years due to less invasive surgical techniques, such as laparoscopic surgery. Main operations include gastroplasty, adjustable gastric banding, gastric bypass, bilio-pancreatic diversion. A less invasive procedure is intragastric balloon, i.e. a temporary device which is removed after few months. Surgery shows efficacy to induce weight loss and duration in time. All obese patients can't be treated by the same operation. Available surgical techniques are different and have to be chosen in each case according to the patient's clinical conditions.

[Extrahepatic gastrinoma. Report of a clinical case]. / Gastrinoma extrapancreatico. Descrizione di un caso clinico.

Gastrinoma is a rare neoplasia producing gastrina, the hormone responsible of the clinic manifestations related to Zollinger-Ellison syndrome. The localization of gastrinoma is pancreatic or extrapancreatic (usually in Stabile and Passaro triangle). We present a case report concerning an extra-pancreatic gastrinoma not localized in this area and included in a lymph node. This is an extremely infrequent localization (2.4%). There are two different opinions about this localization. Some authors think that this is always a secondary lesion of a small primary neoplasia usually asymptomatic. Other authors think that there are primary lymph nodal gastrinomas that could be safely removed with excision of lymph node. The infrequent localisation of this case induced us to report this experience in order to contribute to the comprehension of this pathology.

[Diagnosis of primary and secondary tumors of the liver]. / La diagnosi dei tumori primitivi e secondari del fegato

A brief epidemiological and clinical introduction is followed by an examination of the most useful methods for the diagnosis of primary and secondary tumours of the liver: alpha protein values, scintiscanning, arteriography of the coeliac artery, splenoportography, and laparotomy with directed biopsy. The diagnostic specificity and percent positivity of each method are illustrated.

[Use of the "flat mesh" T4r in the Trabucco inguinal hernioplasty. Technical note]. / Uso della "flat mesh" T4r nell'ernioplastica inguinale secondo Trabucco. Note di tecnica.

Many of the surgical techniques proposed over the years for inguinal hernia repair have been associated with a high number of recurrences due to the presence of great tension on the suture line and to a lack of consideration for the alteration of the collagen metabolism at the fascia trasversalis level. The advent of the new "tension-free" techniques, among which that described by Trabucco, has represented a turning point in inguinal hernia surgery. In this article, the characteristics, indications and use of the T4r "flat mesh" in this hernioplasty are described. The T4r is not a real "plug" but a "flat mesh", a 5 cm-diameter-round pre-shaped polypropylene mesh with an intermediate rigidity grade with a 1 cm diameter hole in an eccentric position for the passage of the elements of the spermatic funicle. To make its collocation inside the deep inguinal ring in the preperitoneal position easier, a Foley catheter (14 Ch) is used whose balloon is inflated with 20-30 cc of physiologic solution or air. One of the actual problems among the possible complications of prosthetic surgery of hernia is the "migration" of the plug and thus the use of "plugs" in the Trabucco inguinal hernioplasty has been reconsidered. The positioning of the T4r in place of a three-dimensional plug like T1 in particular is an elective choice to prevent the risk of compression of the loco-regional vascular structures.

[Gastric surgery in morbid obesity. Apropos of 101 cases]. / Chirurgie gastrique dans l'obésité morbide. A propos de 101 cas.

The authors analyze the complications and the results of gastric surgery for morbid obesity, on the basis of their personal experience. After abandoning up jejunoileal by-pass because of its severe complications, they started to perform gastric by-pass and vertical banded gastroplasty according to Mason. The number of severe complications was low and the results on the weight loss were good, without any disturbance of metabolic and nutritional tests. Gastric by-passes and gastroplasties had similar results. The authors suggest that gastroplasty could be the technique of choice as it is a simple and quick operation, without anastomosis, which ensures a better respect of gastroduodenal physiology and the possibility of exploration of the distal gastric pouch.

[Ketoprofen in the prevention of postoperative pain in abdominal surgery. A multicenter study]. / Il ketoprofene nella profilassi del dolore postoperatorio in chirurgia addominale. Studio multicentrico.

Two-hundred-forty-eight patients undergoing abdominal surgery were admitted to a multicentric clinical trial. The patients were randomly assigned to a single i.v. dose of ketoprofen or acetylsalicylic acid, 15 minutes after the end of operation. Ketoprofen showed a better analgesic activity with a statistically significant difference at 2 and 4 hours after administration. Two patients treated with ketoprofen reported vomiting and skin rash respectively. The results of this study confirm the efficacy of ketoprofen for the prophylaxis of postoperative pain in abdominal surgery.