[Intraoperative echography in biliopancreatic surgery]. / L'ecografia intraoperatoria nella chirurgia bilio-pancreatica.

Intraoperative sonography (I.O.S.) with the use of high-frequency probes placed in direct contact with structures in exploration assures a more diagnostic accuracy. I.O.S. is particularly useful in bilio-pancreatic surgery for a more precise diagnostic valuation and an excellent surgical approach. It is fundamental in the lithiasis of the biliary duct, especially hepatic lithiasis, microlithiasis, obstruction of common bile duct of uncertain cause and during laparocholecystectomy. In pancreatic surgery I.O.S. is of great usefulness in the study of acute and chronic pancreatitis and their complications, cysts, pseudocysts and cystic tumors. I.O.S. plays important role both in exocrine pancreatic carcinomas for a correct staging, and resectability decision, and in endocrine functioning tumors, permitting the location of some lesions of little dimension and eventual hormone secreting hepatic or lymph nodal metastases. In laparoscopic mini-invasive surgery, I.O.S. substitutes the palpatory sense of touch in the location and study of anatomic structures, reducing the risks of iatrogenic lesions and allowing, diagnostic accuracy even in some underestimated pathologies.

Morphological and biochemical effects of intrahepatic alcohol injection in the rabbit.

The local and systemic effects, as well as the repair mechanisms, of sterile absolute ethyl alcohol injection were evaluated at a range of doses (0.1-2.0 mL/kg body weight) in rabbit liver in order to confirm the feasibility and safety of local treatment of tumours in man. Saline injection was used in the control animals. The animals were killed at varying intervals (range: 1-30 days after injection), and the liver was studied by gross and microscopic examination. The ethyl alcohol injection was well tolerated and did not induce significant systemic side-effects. All doses could induce necrosis and none proved to be lethal. The alcohol injection produced an area of coagulation necrosis, the size of which appeared to be dose-related, and which was surrounded by granulation tissue, gradually repairing the necrotic lesion; the adjacent tissue was intact, or had signs of mild steatosis. However, at higher doses (1.0 and 2.0 mL/kg bodyweight), necrotic lesions were observed in the liver both near and remote from the site of injection. Fine needle percutaneous alcohol injection is effective in producing necrotic lesions which appear to be dose-related; at higher doses, however, an unpredictable intrahepatic diffusion may occur.

[Acute experimental hepatic insufficiency in pigs. Validity of a model with biohumoral and electroencephalographic monitoring]. / Insufficienza epatica acuta sperimentale nel suino. Validità di un modello attraverso monitoraggio bioumorale ed elettroencefalografico.

Effectiveness of surgically induced acute hepatic failure in pig and most suitable time to apply artificial support in hepatic coma are evaluated in this work. Five male pigs weighing about 30-35 kg are employed. Latero-lateral porto-caval shunt was performed; the vascular disconnection of liver was obtained by ligature of blood vessels. Ligature was also placed on main biliary way after cholecistectomy. Blood samples were obtained (at 0, 1, 2, 6, 12, 18, 24 hours) to essay serum bilirubin, alkaline phosphatase and GOT-GPT levels as index of cholestasis and necrosis. Porto-caval encephalopathy was evaluated by means of serum ammonium levels, aminoacid pattern and E.E.G. Serum aminoacid pattern was carefully determined; its changes were found similar in man during coma. All pigs died 24-36 hours after surgery with liver ischemic and necrosis. Clinical and laboratory data obtained in experimental conditions were found similar to picture of acute hepatic failure in man, confirming validity of our model.

Study of the hemocoagulative parameters in hemoperfusion on polymer coated resins.

A hemoperfusion column containing anionic exchange resin coated with a new polymer has been tested in vivo for blood compatibility. The hemocoagulative parameters, evaluated before and after the cartridge during hemoperfusion, did not show any significant alteration even as regards the number and the functionality of the platelets nor as regards a possible activation of the fibrinolysis process. On the basis of these results, the hemoperfusion system examined can be regarded as hemocompatible from the hemocoagulative standpoint.