Recurrent form of neurogenic stunned myocardium: is myocardial adrenergic receptor distribution a dynamic process?

Neurogenic stunned myocardium mediated by stress-induced catecholamine acute release is considered as the central causative mechanism of transient left ventricular dysfunction syndrome (TVLDS). Interindividual differences in both LV ß-adrenergic receptor density and sympathetic innervation were proposed to explain the atypical forms of TVLDS. Whether this distribution is independent of age or may vary during ageing still remains unclear. We report a recurrent form of TLVDS characterized by two different patterns. Whilst myocardial receptor distribution or sympathetic innervation appears to follow a dynamic process, the precise determinants of these variations remain largely unknown.

[Carcinogenic perianal fistula]. / Fistola perianale cancerizzata.

The paper reports a case of anal fistula which led to the formation of a muco-secreting adenocarcinoma. The case is described in the context of other published case reports.

[Use of somatostatin in the treatment of gastro-duodenal hemorrhage]. / L'uso della somatostatina nel trattamento delle emorragie gastro-duodenali.

The results obtained in the last 4 years in the treatment of superior digestive haemorrhage are reported. Of 71 patients examined, haemorrhage control with i.v. somatostatin was obtained in 95% of cases (68 patients). Arrest of haemorrhage was temporary in 2 patients, permitting surgery of choice. Three patients failed to respond to medical therapy and were operated in emergency. One of these patients died. No unwanted side-effects were observed.

[Treatment of pilonidal sinus. Our experience]. / Il trattamento del "sinus pilonidalis". Nostra esperienza.

The various types of surgical techniques adopted in a group of 167 patients suffering from pilonidal cysts and fistulas are examined: closed, semi-closed and open method. The results are assessed and the reasons for preferring the closed method are examined.

[Use of somatostatin in acute pancreatitis of biliary origin]. / L'uso della somatostatina nelle pancreatiti acute di origine biliare.

The aetiology of acute pancreatitis may be alcoholic, dyslipidaemic, post-operative, traumatic, cryptogenic or biliary and only the biliary form is considered here. Fifteen patients with biliary pancreatitis and blood amylase above 250 mg (n.v. less than 100) were encountered in 1984-85. Six patients were given traditional medical treatment and 9 somatostatin alone. Despite the limited number treated the results obtained in the second group appear to confirm the validity and efficacy of somatostatin. In fact given the rapid disappearance of pain and the normalisation of the altered blood parameters it was never necessary to administer somatostatin for more than 24-36 hours.

[Use of transhepatic drainage in neoplastic stenosis of the upper biliary tract]. / L'impiego del drenaggio transepatico nelle stenosis neoplastiche della via biliare alta

Rodney-Smith's technique (transtumoral transhepatic drainage) was used palliatively in 6 patients with cancer of the upper biliary tracts. Diagnosis from the symptomatology (essentially obstructive icterus) was not easy, though the picture can almost always be clarified by endovenous and endoscopic retrograde cholangiography and, more particularly, by preoperative and intrahepatic intraoperative cholangiography and choledochoscopy in connection with laparatomy. Two patients survived for 9 months and 2 yr respectively, whereas the remainder died within 30 days of surgery. Despite this high mortality, primarily due to very poor general condition, this type of palliative operation is still the best form of management.