[An assessment of neuronal regeneration in neural anastomoses by synthetic guide and biological systems and insulin administration: an experimental study in the rat]. / Valutazione della rigenerazione neuronale nelle anastomosi nervose mediante sistemi tutoriali sintetici, biologici e somministrazione di insulina: studio sperimentale sul ratto.

The synthetic and biological nerve guide regeneration gives interesting perspective of use in making artificial conduits for peripheral nerve reconstruction. In sixty Wistar rats, under general anesthesia and with microsurgical technique, the ischiatic nerve was isolated. On the right side a segment of the nerve was removed in order to create a 10 mm gap. The defect then repaired using the conduit. Control were performed at 20, 90, 180 days and consisted in histological microscopy and electromyography investigation. The regeneration of the nerve fibers in the lumen of the conduit was not significantly different on the contralateral nerve limb.

[Heterotopic heart transplantation in the rat: a preliminary study]. / Il trapianto eterotopico di cuore nel ratto: studio preliminare.

The aims of this study are to settle and verify how trustful is the heterotopic transplantation of the heart in an experimental model utilizing the original technique of Abbott modified by Ono and Lindsey distinguishing from it for the administration of the anaesthesia and the preservation of the organ. In this type of operation is necessary to realize only two micro-surgical vascular anastomosis that represent the basis of any other micro-surgical operation of organ's transplantation in the rat. There have been used 30 rats of the Wistar stock of male sex and weighing about 200-300 grs. both as donor and as receiving. The anaesthesia consisted in the administration of methoxyflourane by inhalation during the operation. The heart is kept in a container with Stanford solution on ice. The 77% of the cases (23 on 30) have been successful, even considering the ischaemic damage that has been evaluated examining the cardiac beat and the color of the organ. The study of Ono and Lindsey gave as result the success of the operation on 91% of cases (147 on 161 operated), compared to the result obtained by us, on a smaller number of cases (77% of success on 30 operated rats) permits to consider this experimental model to be utilizable even for further more complex studies.

An experimental animal model of intestinal obstruction to simulate in utero therapy for jejunoileal atresia.

OBJECTIVE: To obtain 'intestinal atresia-like' conditions in the fetal lamb model to subsequently allow in utero surgical repair. METHODS: Six time-dated pregnant sheep underwent general anesthesia at 75 days of gestation (term 145 +/- 5 days). After maternal laparotomy and hysterotomy, the fetal abdomen was opened. Once the jejunoileal intestinal loop was identified, the mesenteric vessels were isolated, ligated, and sectioned in 2 fetuses, and in the remaining 5 fetuses the bowel loop was ligated. Two further fetuses were used as controls and underwent sole laparotomy. Of the group of 7 fetuses 2 were reoperated at 100-105 days of gestational age and underwent intestinal recanalization. Eight fetuses were delivered at term by cesarean section and the remaining 1 by spontaneous delivery. One newborn underwent neonatal entero-enteric anastomosis. RESULTS: 4 out of 6 fetuses survived, in utero intestinal or vascular ligation having provoked an 'intestinal atresia-like' picture. The animal operated at birth died. The 2 control fetuses and the 2 fetuses with in utero intestinal recanalization survived until term. CONCLUSION: The present study shows that in utero treatment of intestinal obstruction is possible in an experimental model.

[Cervical neurinomas. (Considerations in five cases operated in Day-Surgery)]. / I neurinomi cervicali. (Considerazioni su 5 casi operati in Day-Surgery).

We report the experiment of five cases of neurinoma observed in the division of Day Surgery of the Third Surgery Clinic, operating in the Hematology Institute of University of Studies "La Sapienza" in Rome. The problems of the diagnosis of this neoplasia has been faced, though it is commonly unknown or confused with other cervical especially lymphonodules tumefactions, from which it is almost impossible to distinguish before the operation. In the period of six years on 775 cases of cervical neoformations have been operated only 5 patients bearers of neuromi; two originated from vago cervicale (right and left), one from simpatico cervicale on the left, another from the left spinal accessory and the last from the secondary medial trunk of the left brachial plexus. All the patients have been operated in Day-Surgery anaesthesia, locoregional and with calming of spontaneous breath. One case, that originated from the secondary medial trunk of the left brachial plexus, has been operated with microsurgical technique. On all the cases has been done a subcapsular exeresis to preserve nervous continuity. No post operating complications have been recorded; all the patients discharged in the evening. The diagnosis about the nature is left to the final histological test on the operating piece. The surgical removal remains even today the elective treatment able to exclude probable relapses and potential malignant transformation of these tumours.

Hepatic echinococcus disease: our experience over 22 years.

BACKGROUND/AIMS: It is important to single out the indications for surgery of hydatid disease of the liver at an early stage. For this, a fully comprehensive diagnostic work up of the patient is required. Surgery represents the most effective therapy and involves resection of the cysts and their outer capsule. This must be as complete as possible. MATERIAL AND METHODS: Between 1970 and June 1992, 95 patients received this combined treatment for hydatid disease although only those presenting from 1985 were followed up. RESULTS: No serious complications were noted apart from pyrexia due to secondary cholangitis or reactive pleuritis. This responded quickly to antibiotics and there was no mortality. No cases of relapse occurred although one case did show evidence of reappearance of the disease on serological testing alone, all other tests being negative. CONCLUSION: The most effective treatment for echinococcus cystic disease of the liver is radical surgery. Results are best when surgery is combined with medical therapy of benzoimidazole drugs given pre- and post-operatively. From our experience, we are now confident that surgical treatment must always be preceded and then followed by treatment with benzoimidazole antihelminthics.

[The treatment of benign lesions of the liver. Indications and surgical approach]. / Il trattamento delle formazioni benigne del fegato. Indicazioni e strategia chirurgica.

Benign formations in the liver constitute a heterogeneous group of pathology lesions that are rarely found clinically. In the period between January 1985 and June 1992, 81 patients, affected by benign formations of the liver, were observed at the Institute of the III Surgical Clinic of Rome "La Sapienza". Most of these lesions are asymptomatic and their diagnosis is mostly casual. Among these we found 48 cases of echinococcus cystis, 13 cases of congenital cystic formations, 2 amoebiasis cases, and 1 case the ecografic exam, which shows an hepatic formation to the fifth segment, was not in conformity with the cytologic exam which proved negative because of cellular abnormalities of any nature, therefore it's constituted by normal parenchyma. Consequently the patient was discharged. We operated on 65 patients. The complications found in the patient operated on were not important and we had the death of only 1 patient affected by hepatic abscess on the 3rd day after surgery because of septicemia and cardio-circulatory problems. The follow-up made after a certain time has resulted negative because of relapses if we exclude 1 case of echinococcus cystis wherein we found a serological relapsing. In our experience and according to most of the authors, the operation must take place always in cases such as: adenoma, cystoadenoma, hemangiomas having a diameter higher than 3 cm, echinococcus cysts, syntomatic formations and when we have complications. For all other cases we must limit ourselves to observation over a certain period both the dimensions and morphological modification of the lesions.

[Preoperative diagnosis of thyroid nodule. Ultrasonography-guided fine-needle aspiration]. / In tema di diagnosi di natura preoperatoria del nodulo tiroideo. L'FNA ecoguidata.

Nodular thyroid pathology weighs heavily for 4-5% of the general population, being the most common among the endocrinopathies. Because of this these diagnostic methods have gained more and more importance as FNA able to select already in the pre-operation phase the malignant nodules from the benign ones and to decide on the most suitable surgical intervention. In the period of time between January 1989 and June 1992 in the Institute of the III Surgical Clinic in Rome there have been performed 403 FNA. From the whole total we have extrapolated 221 patients. In this study we stressed how the FNA method has a sensibility of 80%, a specificity of 93% and afterwards an accurate diagnosis of 92%. Besides we have verified that sonography and radionuclide scanning have a truth worthiness respectively of 64% and 52%. The FNA in our opinion allows us to have in the pre-operation phase a much more accurate diagnosis as regards that obtained with only sonography and radionuclide scanning therefore the latter methods must be considered complementary to FNA.

[Autotransfusion in general surgery]. / L'autotrasfusione in chirurgia generale.

Self-transfusion represents a clinical method used for the restoration of haematic losses that, in recent years has been employed more and more widely in the surgical ambit. The utilisation of this method has become increasingly frequent because of the high diffusion of haemotransmitted diseases, and of the incidences, not negligible, of complications relative to the transfusions of homologous blood. The techniques that are currently used are: self-donation with predeposit; inter-surgery recovery; hemodilution normal blood volume. From 1989 until now 260 patients have been performed, in the Institute of III Surgical Clinic of University of Rome, to self-transfusional method with predeposit and intersurgery recovery. In practice this technique did not present any complications.

Thymectomy as treatment of autoimmune diseases other than myasthenia gravis.

This paper reviews the different series of thymectomies performed in patients with autoimmune diseases other than myasthenia gravis. It is possible that thymectomy can decrease the activity of T-helper lymphocytes or, alternatively, it may enhance the activity of T-suppressor lymphocytes, whose function is depressed in autoimmune diseases. Thymectomy was performed empirically for systemic lupus erythematosus and rheumatoid arthritis. The therapeutic benefits were questionable. Conflicting results were reported for thymectomy against autoimmune hemolytic anemia. Several trials were conducted to assess the therapeutic value of thymectomy in multiple sclerosis. Benefits were achieved only in relapsing-remitting but not in chronic-progressive multiple sclerosis. The effect of thymectomy in autoimmune diseases associated with myasthenia gravis were also reported. The authors conclude that thymectomy as treatment for autoimmune diseases other than myasthenia gravis is not elective therapeutic choice and it is acceptable only in selected cases.