[Cell transplantation: current treatments and future prospects]. / Transplantation cellulaire: traitements actuels et perspectives d'avenir.

Regenerative medicine aims to replace a body function or specific cell loss. It includes therapies at the forefront of modem medicine, issuing from translational biomedical research. Transplantation of organs and cells has revolutionized the management of patients for whom medical treatment is a failure. Unfortunately, organ shortage is limiting treatment possibility. As an example, among the 15,000 patients with type I diabetes in Switzerland, only approximately 30 can receive a pancreas or an islet transplant per year. Second example, 500 patients die each year in Switzerland from alcoholic cirrhosis because no treatment is available. Transplantation of islet cells, hepatocytes, mesenchymal stem cells or dopaminergic neurons represents hope fora therapy available for large populations of patients.

[Xenotransplantation: recent developments and futur clinical applications]. / Xénotransplantation: nouveaux développements et applications cliniques à l'horizon.

The aim of xenotransplantation is to allow the transplantation of animal organs or cells to humans. This approach would immediately eliminate the human organ shortage that is responsible for a significant mortality of patients on the waiting list for transplantation of organs. The immune differences between pig and human induce an immediate rejection of porcine tissues by humans. This rejection has recently been partially controlled by genetic engineering of pigs, the use of new immunosuppressive drugs and encapsulation of isolated cells. However, due to the risk of transmission of animal infectious agents to humans, the WHO recommends that clinical application of xenotransplantation only takes place if adequate regulations are in place.

Porcine orthotopic liver autotransplantation: facilitated technique.

The technique of a liver autograft in the pig has three advantages: (1) It provides an excellent training model of liver transplantation, (2) it provides an experimental model for cancer research, and (3) it is more economical than liver allotransplant. We describe a facilitated technique of liver autograft, which can be employed to develop experimental models without the use of a biopump. Mean blood arterial pressure, heart rate, pH, and lactates were tested during the liver grafting and at the end of the procedure in pigs that underwent autografting of the liver and compared with pigs that underwent an orthotopic liver allotransplantation. The cell damage was assessed in the same two groups of animals by monitoring aspartate aminotransferase (AST) and alanine aminotransferase (ALT) blood levels and with the MEGX test, 15 min after the beginning of reperfusion. The surgical procedure may be divided into three parts: hepatectomy, side-to-side portocaval shunt with passive caval-jugular shunt, and reimplantation. This procedure could have a clinical indication for otherwise unresectable liver tumors.

[Urethral ultrasonography: a new diagnostic approach in the evaluation of stenosis of the male urethra]. / Ultrasonografia uretrale: un nuovo approccio diagnostico nella valutazione della stenosi dell'uretra maschile.

Endoscopy and radiological investigations, using contrast medium, have been the only available methods in the study of urethral pathology. In this article we have suggested using the technique of urethral ultrasound to visual the urethra before using ultrasound. Our study included 16 patients ranging in age from 23 to 82 years with urethral stenosis already diagnosed or suspected on the basis of symptomatology at referral. When the urethra is distended by the gel it appears to be a black tube with a smooth surface which does not produce echoes. The gel determines the compression of the corpus spongiosa which is normally a rigid, inelastic tissue because of the prevalence of collagen fibres. The possibility of adding further gel inside the urethra to confirm the echo results even after the introduction of a standard quantity at the start of the procedure we feel is the second definitive advantage with this method. In fact it was possible in our survey by increasing the quantity of gel to currently differentiate between complete and partial stenosis. No patient suffered from a temperature or using retention after this test. No-one complained of discomfort during the procedure. The anterior and posterior urethra are separated by the external sphincter. Radiological images are better obtained from the anterior urethra than the posterior urethra. We have found that ultrasound is a reliable and possibly superior method. With this method it is possible to obtain more information about the peri-urethral scar tissue, the length of the stenosis, the degree of spongy fibrosis therefore allowing more precise urethrotomies to be performed. The test is comfortable for the patient, simple and reduces the risk of radiation. The disadvantages of this method are that the posterior urethra is poorly visualized. Examination of the posterior urethra using a trans-scrotal approach have given poor results. It is necessary to avoid excessive pressure on the probe which could give false positive results. To eliminate this problem it is necessary to scan longitudinally and transversally within the lumen at various stages of filling. It is important to note that air present within the gel could simulate urethral calculi, if the image has been frozen. During the test the presence of air helps to evaluate the degree of flow through the stenosis.

Secondary carcinoma of the liver from parotid gland tumor.

Secondary tumors of the liver from primary tumors arising in organs of the head and neck are rarely diagnosed during the patient's lifetime, though they should be suspected. A case of parotid mucoepidermoid carcinoma with liver metastases, treated by liver resection, is described. The clinical features and biological behavior of this secondary tumor are similar to those of the rare primary mucoepidermoid carcinoma of the liver. This case is unique because it is such a very rare occurrence.

Laparoscopic robot-assisted right adrenalectomy and left ovariectomy (case reports).

BACKGROUND: Laparoscopic robot-assisted surgery has been created to reduce the patient risk of inappropriate scope movements by an assistant and to perform operations quicker and with greater ease. The Authors report their experience in laparoscopic robot-assisted right adrenalectomy for Conn's syndrome and right ovariectomy for benign ovarian mass. MATERIAL AND METHODS: Case 1. CT scan: solid right adrenal mass (diam. 2 cm). An anterior transperitoneal approach was used to perform the right adrenalectomy. The surgeon was placed at the ventral side of the patient and robotic-device was placed at the backside. HISTOLOGY: adrenocortical adenoma (diam. 3 x 2.5 x 1.5 cm). Case 2. CT scan: left iliac mass (diam. 3.5 cm) with origin in the left ovary. The patient was positioned in the gynecological position. The surgeon was positioned on right side of the patient and robot-device on left side. Left ovariectomy was performed. HISTOLOGY: ovarian serous cyst. RESULTS: Operating time was 180 min. for the adrenalectomy and 25 min. for the ovariectomy. No blood loss or complications for both operations were encountered. Image was steady and lens cleaning was unnecessary. CONCLUSIONS: The robot device (AESOP 2000) facilitated the procedures by enhancing stability of the image and reducing the need for lens cleaning. We believe that this method is feasible and could be advantageous especially for cholecystectomy, Nissen funduplication or ovariectomy but at the moment there are no comparative studies to establish the real value of this device.

Development in diagnosis and treatment of hepatic echinococcosis in a surgical department of a Mediterranean centre over a 20-years period.

Liver echinococcosis is an endemic disease in some areas of the world like Middle East and is a serious problem both from social-economic and clinical-therapeutical stand-points in other areas like Mediterranean regions. We report our experience on hepatic echinococcosis diagnosis and treatment over a 20-year period. In this retrospective study we have reviewed 89 patients affected by hepatic hydatidosis who underwent surgery in our Unit (between November 1975 and October 1995). Patients were divided into two groups: group A including 65 patients (30 males and 35 females) operated on between 1975 and 1988 and group B including 24 patients (11 males and 13 females) operated on between 1989 and 1995. Main outcome measures reported were recurrence of echinococcosis, association with surgical procedure, complications, diagnostic trial. In group A we performed 41 marsupializations, 20 subtotal pericystectomies and 4 total pericystectomies; while 14 total pericystectomies and 10 liver resections were performed in group B. Postoperative hospital stay was of 30 days for group A patients and of 18 days for group B. A single death occurred in group A. Recurrences occurred in group A only (11 cases equal to 17%) and were treated with total pericystectomies (8 cases) and liver resections (3 cases). Our study shows the development of diagnostic procedures trial during the 20-year period and the different surgical approaches between the two groups. Nevertheless we believe that surgical procedures should be tailored to each patient avoid H high surgical risk due to the benign nature of the disease.

Correlation between cytochrome P-450 system and liver function tests during experimental liver transplantation.

The aims of this investigation are: 1) to assess the function of the hepatocyte in transplanted porcine liver, immediately after reperfusion, by monitoring both LFTs and the MEGX levels; 2) to search for correlation between MEGX and LFTS, in an effort to evaluate the metabolic mechanisms occurring in the early liver transplantation revascularization phase. The MEGX test was found to be less than 50 micrograms/ml in all the recipients and all the LFTS tested have been reported to be out the normal range. Furthermore our data has shown a statistically significant correlationship between the MEGX values and those of alkaline phosphatase and prothrombin and a highly significant correlationship with cholinesterase.

[Unreliability of the lidocaine test as a prognostic indicator of acute liver failure: an experimental study in swine]. / L'inattendibilità del test alla lidocaina come indice prognostico nell'insufficienza epatica acuta: studio sperimentale nel suino.

It has been reported, in the recent literature, that fifteen minutes lidocaine-MEGX (monoethylglycinexylidide) test can also be used in case of acute hepatic failure because in these conditions the test allows a rapid evaluation of the hepatic damage, uneffected by te infusion of liquid or fresh plasma which can alter conventional laboratory parameters. The Authors have demonstrated, in a experimental model, the unreliability of the lidocaine-MEGX test as measure of functional hepatic damage in the early stages of an acute liver failure. The slight decrease of the rate of the MEGX test in these animals submitted to one-stage hepatic devascularization suggests that the hepatic failure is not so early detected by this specific liver function test. Accordingly, the 15' MEGX test should not be used as isolated discriminatory measure to detect an early hepatic failure following fulminant hepatitis or an early hepatic insufficiency as a result of extensive liver resection.

[Rare malignant tumors of the thyroid]. / I tumori maligni rari della tiroide.

The incidence of rare malignant tumors of the thyroid is about 4 cases/100,000 people and represent only 1.8% of all the thyroid cancers. When we talk about "rare" tumors, obviously, we do not refer to the most frequent cancers (papillary, follicular), or less frequent tumors (medullary, anaplastic), but to some types of thyroid tumors that have been almost always sporadically observed. Mucoepidermoid carcinoma and squamous carcinoma have been described in the literature. They present occasional papillary formation so that, according to some authors, could be considered as variants of the papillary carcinoma. Teratoma is another rare tumor which in the paediatric age is benign, but its prognosis could be unfavourable because it causes an important respiratory distress, while in the adult it presents a very aggressive clinical course like the anaplastic carcinoma. Lymphoma is the most frequent of the "rare" tumors of the thyroid (1-5% of all the thyroid cancers). It arises often in a setting of a long history of goitre and Hashimoto thyroiditis. Fine-needle aspirate is important to make diagnosis and to start a correct treatment which allows a 5-year survival up to 85% in the favourable cases.

[Doppler echography in the intraoperative assessment of the liver circulation: an experimental study in swine]. / L'eco-Doppler nella valutazione intraoperatoria del circolo epatico: studio sperimentale nel suino.

In this experimental study the authors report an experience in the evaluation of hepatic blood flow with intraoperative echo-Doppler during orthotopic liver transplantation and side-to-side or end-to-side portacaval shunt. Doppler ultrasonography studied the flow of portal vein, hepatic artery and inferior vena cava before the recipient hepatectomy, and after reperfusion during liver grafting. Furthermore echo-Doppler of the portal system was performed to confirm portacaval shunt efficacy. Usually intraoperative Doppler ultrasonography may give informations about the patency of the shunt and regarding the development of early hepatic artery thrombosis during liver transplantation, but often unclear is the exact evaluation of the velocity of the blood flow through the liver. Further experimental studies and clinical evaluations need to find safe parameters and markers of vascular alteration using this superior diagnostic procedure.

[Identification of an experimental model of partial portocaval shunt]. / Identificazione di un modello sperimentale di derivazione porto-cava parziale.

Portacaval shunt with interposition of 6 mm H-graft of PTFE is a real partial shunt. In this experimental study, the operation has been well tolerated and has been compared with 8 mm H-graft and direct "vein to vein" portacaval shunt. Intraoperative data show that 6 mm is the ideal diameter for a portacaval shunt to prompt an experimental model based on partial decompression of portal bed in animals in this size.

[A facilitated technique for donor hepatectomy: experimental study in the pig]. / Proposta di una tecnica facilitata per il prelievo di fegato: studio sperimentale nel suino.

A facilitated technique of porcine donor hepatectomy is reported underlying the possibility to make an easy procedure without in situ portal perfusion, so other abdominal organs supplied by superior mesenteric system can be harvested at the same time. The viability of those grafts procured without in situ portal perfusion has been compared with an other group of livers harvested with in situ aortic and portal flushing. The evaluation of the histology and early graft function two hours after riperfusion has shown no differences between both groups.

cDNA sequence analysis and expression of the expression of the ribosomal protein S24 during oogenesis and embryonic development of the sea urchin Paracentrotus lividus.

A gene for the Paracentrotus lividus ribosomal protein S24, called P1-S24, has been isolated and sequenced. Ribosomal protein P1-S24 consists 130 amino acids and has a molecular weight of 14869 Da. Sequence analysis shows a high percentage (90%) identity with the corresponding gene of Strongylocentrotus purpuratus. Hybridization of the cDNA to digested sperm DNA suggests that P1-S24 is represented in no more than two copies. Studies of the temporal expression of P1-S24 gene indicate a good correlation between this and the expression of the rRNA genes both during oogenesis and embryonic development.