[Therapy with L-thyroxine in thyroid struma. Study with ultrasonic evaluation]. / La terapia con L-tiroxina nello struma tiroideo. Studio con valutazione ecotomografica.

L-thyroxine therapy in thyroid goiter. Study with ultrasound imaging evaluation. The literature contains conflicting reports regarding the treatment of thyroid goiter. We evaluated the efficacy of thyrotropin-suppressive therapy with L-thyroxine to reduce the goiter. We studied two groups of 15 and 19 patients with euthyroid goiter for a period of six months: the former were untreated, the latter received L-thyroxine. Six patients represented the controls. All patients treated had suppressed thyrotropin secretion (as evaluated by immunoradiometric assay); sonography was used to measure the goiter. We found no statistically significant difference in size nodule between the two groups. Therapy was also unable to prevent the formation of new nodules.

Heterotopic liver allograft in acute hepatic failure in pigs.

Seven heterotopic liver allotransplantations were performed in pigs with total, acute hepatic necrosis, induced by arterial and portal vein devascularization. Six pigs survived for 4, 6, 7, 7, 23 and 90 days respectively. Good results can be obtained only with intensive perenteral postoperative support lasting the first three days. The viability of the graft is shown by the biochemical indices and the survival of the animals. These results confirm that a heterotopic liver transplantation provides a viable substitute when the host liver is affected by acute irreversible hepatic necrosis.

[Acute hepatic failure and renal damage. Experimental and clinical studies]. / Insufficienza epatica acuta e danno renale. Rilievi sperimentali e clinici.

Renal damage in acute hepatic failure induced in the pig by means of an hepatic state, temporary or permanent devascularisation Amanita phalloides poisoning or orthotopic liver transplant proved of slight degree, particularly in animals treated with replacement therapy. In the cases of animals that died in acute hepatic coma, on the other hand, renal cortex ischaemia and marked medullary congestion were constant. Histologically, the damage consisted of slight tubular nephrosis; this was more apparent in the proximal tubules. Evaluation of renal damage in 38 patients with acute hepatic failure was more complicated owing to the variety of clinical conditions (level of coma, hypovolaemia, intensive care and hepatic assistance). Nevertheless, a clear relation was established between the degree of liver damage and blood creatinine and creatinine clearance values. All patients who died presented liver cell necrosis of over 75%, blood creatinine values of more than 2 mg/100 ml, and less than 50 ml/min clearance. Tubular nephrosis was the predominant lesion. It appeared that renal damage was primarily pre-renal. No signs of a true hepatorenal syndrome could be made out.

Experience of treatment in the Amanita phalloides poisoning (clinical and experimental observations).

Intensive care was applied in 13 patients with acute liver insufficiency and different degrees of metabolic encephalopathy due to the ingestion of Amanita phalloides. Twelve of them were subjected to hepatic assist with E.T., in three cases this measure was repeated. Ten recoveries were obtained, which denote, on the basis of the necrosis enzymes and the hepatic histo-pathological aspects from bioptic samplings, the use of the E.T. method, when applied within the first 72 hours. In pigs poisoned with Amanita phalloides, the clinico-biochemical pattern and the histopathological findings are comparable to the observations in man. Electron microscopy demonstrates peculiar lesion in the cytoplasm. The anatomo-pathological findings in the three dead patients show a liver necrosis over the 90% and the presence of cerebral edema.