Introduction and Establishment of Pissodes castaneus (Coleoptera: Curculionidae) in the Andean Patagonia of Argentina.

The pine weevils that occur in plantations of Pinus spp. in Andean Patagonia of Argentina belong to the species Pissodes castaneus (De Geer), a Eurasian endemic species, according to the identification based on molecular and morphological characters. Sequences of the mitochondrial Cytochrome oxidase subunit I and nuclear genes (28 S rDNA and ITS2) were obtained for individuals of 13 afforestations, covering the entire distribution area of the established populations in the Andean Patagonia of Argentina. Sequence comparison with representative species of the genus (European, North American, and Chinese species) shows that Patagonian specimens are conspecific to those of P. castaneus sequenced from Europe. Phylogenetic analyses indicate that all terminals from Patagonia form a monophyletic unit without evident subclades, eliminating the possibility of existence of more than one species of Pissodes Germar in this area, including cryptic ones. Moreover, the very low genetic divergence between the Patagonian populations suggests that it is plausible that P. castaneus was introduced into Patagonia from just one location. Mitochondrial DNA analysis shows that Patagonian terminals group together with a French haplotype and are clearly separated from other P. castaneus individuals represented in our sample, and reveal that established populations in Andean Patagonia originated via a limited introduction.

Necessity of therapy for post-thyroidectomy hypocalcaemia: a multi-centre experience.

PURPOSE: Hypoparathyroidism is one of the most common and most feared complications of total thyroidectomy (TT). The aim of this study is to detect possible markers that may facilitate early tracing of hypocalcaemia-prone patients in order to reduce clinical cost by optimizing patient discharge and to avoid unnecessary treatment. METHODS: Over an 18-month period, 995 patients, 23 % male and 77 % female, aged 52.9 ± 13.4 years, underwent TT in ten Lombardy hospitals. The following parameters were analyzed: calcaemia before and 12-24 and 48 h after surgery, pre- and post-operative parathyroid hormone (PTH) at 24 h and pre-operative 25OH vitamin D. RESULTS: Mortality was nil and morbidity was 22.4 %. Mean 24-h calcaemia and PTH were 2.17 ± 0.15 mmol/l and 31.81 ± 20.35 pg/ml, respectively; mean 24-h PTH decay was 36.7 ± 34.12 %. Four hundred seventy-three (47.5 %) patients were hypocalcaemic at discharge; 142 of whom had transient hypoparathyroidism that became permanent in 27. Patients developing hypocalcaemia had significantly higher values of PTH and calcium decay. At multiple logistic regression, only 24-h calcium decay, PTH drop and the presence of symptoms and parathyroid auto-grafting were significantly related to hypoparathyroidism. The association of these factors had a 99.2 % negative predictive value (NPV) for the development of hypoparathyroidism. A 70 % PTH drop had a 93.75 NPV for transient hypoparathyroidism. A 12 % calcaemia decay had a 95.7 NPV for hypoparathyroidism. CONCLUSIONS: Hypocalcaemic asymptomatic patients with less than 70 % PTH and 12 % calcaemia decay may be safely discharged without treatment. Symptomatic patients and those with parathyroid grafting should receive calcium and vitamin D.

Occurrence of medullary thyroid carcinoma, bronchial carcinoid tumor, and papillary thyroid carcinoma in a family bearing the RET G691S polymorphism.

RET mutations play an important role in the development of human neuroendocrine tumors. The prevalence of the RET polymorphism G691S of exon 11 is higher in patients with medullary thyroid carcinoma (MTC) as compared to the general population. A weak association between RET polymorphisms and sporadic papillary thyroid carcinoma (PTC) has also been described. We hereby describe the association of MTC, bronchial carcinoid tumor, and PTC in a familial setting. A 75-yr-old woman developed MTC 7 yr after successful treatment of a bronchial carcinoid. Serum calcitonin was 12.9 pg/ml with a peak response to pentagastrin (151.0 pg/ml). The patient underwent total thyroidectomy and a genetic mutational analysis of the RET gene. Histological evaluation confirmed MTC with no evidence of lymph nodes involvement. After thyroidectomy serum calcitonin was <2.0 pg/ml. A germline missense mutation at codon 691 in exon 11 of the RET gene was found. The mutational analysis was extended to the patient's offspring, and her daughter was found to bear the G691S polymorphism of RET. Wild type RET gene was found in the son. The daughter, who showed a nodular goiter, autoimmune thyroiditis and normal serum calcitonin, also underwent thyroidectomy. Histologic examination of the thyroid revealed an incidental PTC. This is the first description of a bronchial carcinoid tumor occurring in association with MTC. The occurrence of apparently unrelated NET in the same subject, or within a family, should be regarded as a challenge for deeper investigations into the possible oncogenic role of this genetic alteration.

The Swedish Adjustable Gastric Band: laparoscopic technique and preliminary results.

BACKGROUND: The laparoscopic technique for the Swedish Adjustable Gastric Band (SAGB) has been developed based on the previously established open technique. METHODS: From March 1996-June 1997, laparoscopic SAGB was attempted in 85 consecutive obese patients (77 women and 8 men). The average preoperative BMI was 44 (34-59). RESULTS: All operations except one were completed by laparoscopy. One patient had to be converted because of unfavorable anatomic conditions. The average operating time was 40 minutes. There were no immediate perioperative complications. All patients were followed for 1 year. During this period 2 patients developed esophagitis and 3 patients experienced repeated vomiting. There were no other complications. At 1 year follow-up the average BMI was 33 (21-46). The excess weight loss was 54% (17-100%). CONCLUSION: Early results are encouraging. No significant complications related to the technique were registered. One-year weight loss was equal to what was achieved by open surgery. Laparoscopic SAGB will be established as an attractive alternative for surgical treatment of morbid obesity.

Swedish adjustable gastric banding: a preliminary experience.

BACKGROUND: The authors have been performing bariatric surgery for 15 years; since February 1992 they have carried out laparoscopic gastric banding (LGB) with a silastic band. Good experience with the LGB combined with everyday laparoscopic activity in their institution persuaded them to try laparoscopic placement of the Swedish adjustable gastric band (SAGB). METHODS: The surgical procedure is the same as that for laparoscopic gastric banding except for the use of a 15 mm trocar that is required to introduce the band, and the need to place a port that is connected to the band via a wide loop tube; the port is place subcutaneously and is supported by the lower part of the sternum. The authors do not use any abdominal drain nor a naso-gastric tube. At surgery the band is left empty, and filling is usually not started until 4 weeks after surgery. The patient is immediately mobilized and begins a liquid diet the evening after the operation. The patients are usually discharged from hospital on the first postoperative day. RESULTS: Over 8 months, 24 patients underwent SAGB, with mean BMI 44.69 and mean operating time 45 minutes (range 30-75). No early complications occurred. Preliminary results in this small series show BMIs of 38.65 and 34.60 at 3 and 6 months postoperation. CONCLUSION: SAGB appears for be a good method for obesity surgery. It is easy to perform and is associated with a low operative risk. Provided that the band is put in the right place, weight loss can be adjusted to patient comfort.

[Hepatocellular carcinoma. Our experience]. / Il carcinoma epatocellulare. Nostra esperienza.

From June 1991 to february 1993, 29 patients with hepatocarcinoma in cirrhosis were admitted to our department. After a careful preoperative assay, 17 patients underwent hepatic resection. These patients were suffering from unifocal or superficial tumours with Child A or Child B hepatic function. In the other 12 patients, with multifocal hepatocarcinoma or with Child C hepatic function, a Port-a-cath was implanted in the hepatic artery for chemotherapy. The hepatic resection, performed after clampage of the hepatic hilum, was always restricted to exeresis of the tumor at 1 cm, of its border, avoiding damage to the poor hepatic function because of cirrhosis. The average time in performing such an important procedure was 20 minutes. There was no postoperative death and all patients still alive. Postoperative complications were ascites, always treated with diuretic therapy and albumin, and moderate pleuritis. Our good results depend on accurate preoperative assay and especially on the restricted hepatic resection that didn't reduce the hepatic functional reserve further. The implantation of a Port-a-cath in the hepatic artery, performed in patients not suitable for surgical procedures, allows us to carry ut the right chemotherapy in the other patients, eliminating the risk of postoperative deaths.

Psychological Effects of Vertical Banded Gastroplasty on Pathologically Obese Patients.

For a period of 2 years the authors have examined on 16 pathologically obese patients the psychological effects of the weight loss resulting from vertical banded gastroplasty. At the time of surgery the patients' average age was 41 years. The patients' average weight of 125.9 kg (range 110-150 kg) decreased after surgery to 89 kg, showing a decrease of 36.9 kg (range 20-69 kg). The postoperative compliance has been good despite the fact that the remaining gastric capacity allows for the ingestion of only 50-70 ml of food. Psychological results, obtained through consultations, semi-structured interviews and a series of tests, brought to light remarkable changes directly proportional to the weight loss achieved. Psychic well-being, self-esteem, and improvements in the interpersonal relations within the family and work environments represent in summary the positive results of the weight loss achieved by patients with no other possibility (voluntary) to keep their food intake under control (which we termed 'food addiction'). The patients abandon their depressive traits and achieve a degree of confidence that preserves them from stress and anxiety. Patients improve their social mobility, and for many the sexual relations with the partner become more frequent and intense. The weight loss plays an indispensable role within itself but additionally is associated with a general normalization of all physical parameters. Also, it starts an avalanche of positive events which break the vicious cycle: aesthetic inadequacy-anxiety/depression-food-excess weight.

Videolaparoscopic Vertical Banded Gastroplasty.

BACKGROUND: In June 1993, the authors started performing the Vertical Banded Gastroplasty (VBG) via laparoscopy. METHODS: Since June 1993, 25 patients have undergone laparoscopic VBG. RESULTS: Weight loss did not differ from the traditional open VBG. CONCLUSIONS: The laparoscopic procedure, which can be performed simply, permits minimal trauma compared to the traditional open operation, with a reduction in hospitalization and in short-term as well as long-term complications.