Fat absorption and gastroenteric pH profile in postsurgical pancreatic insufficiency: role of the association of H2-receptor antagonists with pancreatic enzymes.

The complete control of steatorrhea in post-surgical exocrine pancreatic insufficiency is difficult. The aim of this study was to evaluate the effect of the association of ranitidine with pancrelipase om fecal fat excretion in patients who had undergone a pancreatoduodenectomy with suppression of the exocrine pancreatic secretion by Neoprene injection. Ten patients were studied 1 year after surgery. Steatorrhea was measured as an integrated test of 3-day stools, while patients were kept on a diet of 100 g lipid/day, with their usual enzyme supplementation therapy (16,050 USP units of lipase/meal). A basal 24-h gastroenteric pH profile was also obtained. In the following month, patients had ranitidine (150 mg twice a day) in addition to pancrelipase. Then steatorrhea and gastroenteric pH were reassessed. Mean fecal fat was 26.9 (SD 13.7) g/day without ranitidine and 30.5 (SD 13.9) g/day during combined treatment. Body weight and nutritional parameters did not show any significant variation after ranitidine administration. Even in the absence of ranitidine, postprandial gastroenteric pH values were always > 4; the H2-receptor antagonist only reduced fasting gastric acidity. In conclusion, the gastroenteric pH and fecal fat determinations showed that ranitidine is not useful in patients with total postsurgical exocrine pancreatic insufficiency.

[Symptomatic efficacy of clotrimazole combined with surgery in the treatment of recurring anal and genital condylomatosis in seropositive and AIDS patients]. / Efficacia sintomatica del clotrimazolo associato alla terapia chirurgica nel trattamento delle condilomatosi anali e genitali plurirecidivanti in pazienti sieropositivi ed affetti da AIDS. Comunicazione preliminare.

During their daily surgical activity in Hiv-positive and AIDS patients the authors have seen in surgical treatment of anogenital recurring acuminate condylomata (treated with diatermocoagulation) in 1995 that prescribing elotrimazole ointment in Candida albicans infection of the same regions there was and amelioration or the healing of the mycotic infection but also a net lowering of the condylomata and persistent latency (disease-free time) till to the next local recurrence. So they have hypothesized and antiviral and antiblastic effect of elotrimazole. Under this heading they have done a literature research discovering that in 1995, only some months ago, two fundamental works have been published on this intriguing topic. They demonstrate at an experimental level in mice a strong antiviral and antiblastic activity of clotrimazole. This new fascinating field is completely open to future research and the consequences at a therapeutic level will be of utmost importance.

[Does post-cholecystectomy syndrome exist? Epidemiologic features and therapeutic effects of ursodeoxycholic acid]. / Esiste la "sindrome post-colecistectomia"? Rilievi epidemiologici ed effetti terapeutici dell'UDCA.

140 cholecystectomized patients were subjected to out-patient clinical follow-up (follow-up range 15.5 +/- 7.1 months) as were 45 patients given various operations on the digestive tract. The controlled study was divided into two phases: epidemiology and therapy. The results of the epidemiological trial clearly showed that in about half the cases treated cholecystectomy leaves certain problems of digestive dysfunction (dyspeptic-pain syndrome) unresolved but does not cause new symptoms. Hence there is no justification for the term "post-cholecystectomy syndrome". A double blind therapeutic trial confirmed the efficacy of UDCA in the treatment of dyspepsia in cholecystectomized patients (p = 0.03) but showed that it has little influence on the pain factor (p = 1.00).

[Muscle and nerve biopsy in ambulatory surgical practice]. / La biopsia muscolare e nervosa nella pratica ambulatoriale chirurgica.

The diagnostic value of nerve and muscle biopsy in detecting several neurological diseases is discussed. A bioptic technique for current surgical practice is proposed.

[Continuous 24-hour intragastric pH monitoring. A new model of interpretation]. / La pHmetria endogastrica continua sulle 24 ore. Nuovo modello d'interpretazione.

Using the study as a basis for a novel interpretation of the pH-metric curve, the paper reports the results of a study carried out in a sample group of 11 normo-secretory subjects (students from the Faculty of Medicine and Surgery). The pH-metric curve was assessed over 24 hours using a portable pH measuring device.

[Comparative study of 24-hour continuous gastric pH-measurements in healthy people and in patients with pancreatic neoplasms treated with duodeno-pancreatic head resection]. / Studio comparativo delle pHmetrie endogastriche continue nelle 24 ore tra soggetti sani e patologici, sottoposti a cefaloduodenopancreasectomia per neoplasia pancreatica.

The Authors compare pH measurements taken over a 24-h period to monitor, using an original method, a sample group of 11 healthy subject and a series of patients suffering from gastroenteropancreatic diseases. The data obtained confirm the utility of the functional study of gastrointestinal secretion.

[Anatomical and surgical considerations on the internal spermatic venous system]. / Considerazioni anatomiche e chirurgiche sul sistema venoso spermatico interno.

The surgical anatomy of the spermatic venous system is described. Thereafter an experimental evaluation performed on cadavers by the vascular mould technique using plastic materials is reported. The resulting data point out the complex variability of the spermatic venous circulation, stressing the value of preoperative phlebography in the surgical approach to varicocele.

A new ligament: the "gastro-pancreatic".

The authors wish to draw attention to the gastro-pancreatic ligament (gastropancreaticus), no description of which is to be found in the usual anatomy text-books or in literature. The presence of this anatomic element can suggest new interpretations of the embryological development of the pancreas.

[Liver transplant in children: comments and legislative proposal]. / Trapianto di fegato nel bambino: considerazioni e proposta legislativa.

Having examined the literature on this subject, the authors raise the problem of segmentary liver transplant from a liver donor to a pediatric patient. They evaluate the current Italian legislation regarding the donation of organs and on the basis of foreign experience they draft a possible amendment to the law currently in force.

[Current diagnostic-therapeutic trends in treatment of pediatric appendicitis]. / Attuali atteggiamenti diagnostici-terapeutici nel trattamento della appendicite in età infantile.

Acute appendicitis is the first cause of emergency surgery in children. Actually, emergency abdominal sonography has evolved in differential diagnosis of acute appendicitis in children to differentiate it from other causes of acute abdomen as mesenteric lymphoadenitis, acute right pyelonephritis, acute diverticulitis in Meckel's diverticulum, intestinal intussusception, regional enterits, primary peritonitis, anaphylactoid purpura of Henoch-Schonlein. The aim of this study is the evaluation of the usefulness of abdominal sonography in diagnosing acute appendicitis in our current series of pediatric patients. We have operated 102 patients afflicted by appendicitis admitted to the pediatric department of Ospedale San Raffaele, Milano in a period of 5 years and operated on for appendectomy. In the last 2 years 36 patients were evaluated with abdominal sonography. This diagnostic tool showed in 34 (94.4%) a liquid effusion, sometimes thick of the right iliac fossa. In 2 patients the appendix had thickened layers, was edematous and the lumen was clearly filled with debris. Abdominal sonography has given a clear cut picture of the acute inflammatory process of the appendix. None of these patients has suffered from septic or obstructive complications. Mean duration of hospital stay was 6.35 days (3-15 days). Differential diagnosis of acute appendicitis can be extremely variable, from simple, paradigmatic situations to the most intriguing ones. This concept is well emphasized by William Silen when he says that "differential diagnosis of acute appendicits is an encyclopedic compendium of every abdominal disease that causes pain" in the 11th edition of Harrison's Principles of Internal Medicine.(ABSTRACT TRUNCATED AT 250 WORDS)

Polyneuropathy in hypothyroidism: clinical, electrophysiological and morphological findings in four cases.

Clinical, neurophysiological and morphological studies of four patients with polyneuropathy and secondary hypothyroidism are reported. Neurophysiological studies revealed signs of muscle denervation and reduction of conduction velocity in all the patients. Sural nerve biopsies showed axonal degeneration in all cases but one. All the patients were treated with replacement therapy and clinical symptomatology and neurophysiological parameters improved in all patients.