[Cholecystosis: anatomo-clinical profile and therapeutic considerations]. / Le colecistosi. Profilo anatomo-clinico e considerazioni terapeutiche.

In the last 5 years 16 patients with cholecystosis were observed. In this period the most recent diagnostic and therapeutic techniques were used including ultrasound which allowed to diagnose 60% of adenomyomatosis, 33.3% of cholecystosis and 6.7% of gallbladder polyposis. In 6 cases a traditional open surgery cholecystectomy was performed, while the videolaparascopic approach was used in other 6 cases. Histologic examination always confirmed the preoperative diagnosis, however in one case a gallbladder cancer was histologically found; this case had been clinically diagnosed 9 years previously as adenomyomatosis. Therefore, our experience suggest, in agreement with others, that cholecystosis should be considered as a precancerous lesion.

[Current trends in therapeutic indications in gallstones]. / Attuali orientamenti nelle indicazioni terapeutiche per la calcolosi della colecisti.

In the last 3 years, 300 consecutive patients (110 men, 190 women) were treated for gallstone disease using either traditional open surgery or the video laparoscopic approach. The relative clinical data and results were compared and analysed. The Authors conclude that video laparoscopy presents a number of advantages such as minor costs, reduced pain, quick return to work, compared to traditional surgery, especially when correctly indicated.

[Ampullary and periampullary tumors]. / Tumori ampollari e periampollari.

Ninety-eight consecutive patients with ampullary and periampullary carcinoma diagnosed between 1983-1993 were studied retrospectively. Among these patients, 66 had a carcinoma of the head of the pancreas, 10 a carcinoma of the papilla of Vater, 8 a carcinoma of the duodenum, and 14 a carcinoma of the distal common bile duct. Resectability rate ranged from 12% to 90% according to the tumor location and histologic type. Palliative procedures such as laparotomy, biopsy and bilio-digestive bypasses were performed in 27 patients. Curative resections were performed in 24 cases: 20 pancreatoduodenectomies, 2 total pancreatectomies, 1 duodenectomy, 1 common bile duct resection. The results of the surgical treatment as well as mortality and morbidity rates were compared with those of different and larger series.

[Our experience in the recurrence of rectal cancer operated with radical intention in light of a case load treated in a homogeneous manner]. / La nostra esperienza delle recidive di cancri rettali operati con intento radicale alla luce dei risultati di una casistica trattata in maniera omogenea.

A reappraisal of the results obtained after potentially curative resection for rectal cancer compared with "historical" results is reported. An increase of the overall survival rates was registered as well as a corresponding lowering of the pelvic recurrences: 4.54% in the group of patients with a-two-year follow up. As for relapse surgery, however, reviewing the series from January 1991 to December 1994, the results are still poor because relapses were not resectable in 85.7% of the cases.

[Carcinoma of the extrahepatic bile ducts]. / Il carcinoma delle vie biliari extraepatiche.

In the last 5 years 25 patients (11 men, 14 women) with carcinoma of the extrahepatic biliary duct were studied. The most frequent localization of the carcinoma was the hepatic hilum. D.C.P. according to Whipple was possible only in one patient, while in 20 patients a palliative approach with external and internal biliary derivations was the choice. In the remaining 4 patients an explorative laparotomy with biopsy was performed. It is concluded that palliative resection allows for a better quality of life.

[Cholecystectomy and colorectal cancer: a retrospective study of a sample of 285 operated patients]. / Colecistectomia e cancro colo-rettale: studio retrospettivo su un campione di 285 pazienti operati.

A review of 285 patients operated for colo-rectal cancer in order to evaluate cholecystectomy rate in their pathologic history is reported. A surprisingly high rate (9.47%) was registered also when compared with Literature data. Although not definitely conclusive for a positive correlation between cholecystectomy and colo-rectal cancer, the Authors believe that this study identifies a subgroup of patients potentially at risk for colo-rectal cancer. In these subjects a prophylactic, periodic colonoscopy could be useful.

Platelet aggregation and histamine release by immunological stimuli.

Platelet aggregation and histamine release were evaluated in normal and IgE pretreated human platelets exposed in vitro to IgE, anti-IgE and thrombin. The response of platelets from atopic donors directly stimulated with anti-IgE was also evaluated. Histamine release was measured by fluorimetric analysis of histamine content in platelets and in supernatants. The morphology of platelets exposed to immunological and non-immunological stimuli was recorded using an electron microscope. A detectable amount of histamine was measured in quiescent platelets. Their exposure to varying concentrations of thrombin produces a progressive aggregation which runs parallel to histamine release. The effects were significantly enhanced in platelets pretreated with IgE. Incubation of normal platelets with increasing concentrations of IgE myeloma protein, or with anti-human IgE antibody was ineffective on both aggregation and histamine release. However, incubation of platelets passively sensitized with IgE-myeloma protein with different concentrations of anti-human IgE antibody produces a concentration-dependent increase both in aggregation and histamine release. The same effects were obtained using platelets from atopic donors directly stimulated with anti-IgE. The electron microscopic pattern of platelet aggregation induced by thrombin was indistinguishable from that evoked by anti-IgE in IgE pretreated platelets. Loratadine, a non-sedative H1-receptor blocker, significantly abated platelet aggregation and histamine release induced by anti-IgE in IgE pretreated platelets.

Generation of nitric oxide from nitrovasodilators modulates the release of histamine from mast cells.

The effect of organic and inorganic nitrovasodilators (sodium nitroprusside; 3-morpholinosydnonimine; glyceryl trinitrate; isosorbide dinitrate; sodium nitrite, was studied on the release of histamine evoked by compound 48/80 and calcium ionophore A 23187 in isolated purified rat serosal mast cells. All the compounds tested were capable of significantly reducing the release of histamine in a concentration-dependent fashion, at different levels of potency. This effect was reverted by oxyhaemoglobin. The inhibitory effect of glyceryl trinitrate on the release of histamine was potentiated in cells taken from animals pretreated with Escherichia coli lipopolysaccharide, and decreased by NG-nitro-L-arginine methyl ester. Glyceryl trinitrate and isosorbide dinitrate concentration-dependently increase the generation of nitric oxide by rat serosal mast cells. The inhibitory effect of glyceryl trinitrate and isosorbide dinitrate on the release of histamine from mast cells was potentiated by N-acetylcysteine, which significantly increases the generation of nitric oxide by mast cells. It is concluded that nitrovasodilators inhibit the release of mast cell histamine through the generation of nitric oxide. The effect may be relevant in considering the perivascular location of mast cells and the role played by these cells in cardiovascular pathophysiology.

[Contribution of glutathione to detoxification in alcoholism. Biochemical-clinical studies]. / L'apporto di glutatione nella detossificazione dell'alcolismo. Indagini biochimico-cliniche.

The effects of reduced glutathione (GSH) administration (1.2 g/day and 2.4 g/day intravenously) on erythrocyte glutathione levels, serum gamma-glutamyl transpeptidase activity (GGTP) and urinary glucaric acid elimination were studied in a population of 24 chronic alcoholics voluntarily admitted to a 30 day detoxification protocol in comparison to a 12 patient control group treated only with chlordiazepoxide (initial dose 75-100 mg/day). Glutathione treatment increases dose-dependently and in a significant way erythrocyte glutathione levels and hastens the recovery of serum GGTP and urinary glucaric acid elimination. The relationship between glutathione, GGTP and glucaric acid is discussed, suggesting the possible role of GSH against the oxidative damage of alcohol.