Solar Energy Conversion by Water Photodissociation: Transition metal complexes can provide low-energy cyclic systems for catalytic photodissociation of water.

The basic concepts for direct and catalyzed photodissociation of water have been summarized. Water dissociation in closed-cycle processes based on endothermic photochemical reactions offers a potential solution to the solar energy conversion problem. Transition metal complexes, whose excited state chemistry is extremely rich (23, 24) although mostly unexplored, are, in principle, suitable "catalysts" for cycles of this type. The most interesting cycles are those involving metal hydrido complexes or binuclear complexes in which the two metal atoms are bound into a macrocyclic ligand. Systematic investigations of the photochemistry of transition metal complexes with the aim of designing suitable systems for solar energy conversion have long-range promise and merit further consideration.

Restoration of luteinizing hormone response to naloxone in postmenopausal women by chronic administration of the antidopaminergic drug veralipride.

To determine whether antidopaminergic drug administration may modify endogenous opioid activity at the hypothalamic-pituitary level, the effects of naloxone infusion (1.6 mg/h for 4 h) on LH secretion were studied in six postmenopausal women before and after administration of the potent antidopaminergic drug veralipride for 20 days. Before veralipride administration, the naloxone infusion did not alter LH secretion. Chronic administration of veralipride resulted in a significant (P less than 0.01) decline in plasma LH levels. In addition, the naloxone infusion induced a significant (P less than 0.05) increase in plasma LH levels, which reached values similar to those before veralipride administration. These results demonstrate that in postmenopausal women the antidopaminergic drug veralipride can restore, at least in part, the activity of the endogenous opioid system. These findings suggest that endogenous opioid peptides may mediate the inhibitory effect exerted by chronic antidopaminergic drug administration on LH secretion in humans.

Hepatoid carcinoma of the stomach: is it still an unusual anatomo-clinical entity? Six cases-report.

Hepatoid carcinoma of the stomach is a rare neoplasm (especially in western countries) characterized by high levels of serum alpha-fetoprotein (AFP), the presence of "hepatoid foci" inside the gastric tumor and poor prognosis, due to the earlier onset of liver metastases. We treated six patients for hepatoid carcinoma of the stomach between 1990 and 1997. The female to male ratio was 1:1, the average age was 71 (54-81) and the average AFP-level was 1160 ng/ml (603-1531). We performed 2 total gastrectomies, 2 subtotal gastrectomies and 2 gastro-jejunostomies (due to presence of liver metastases): in one case, the patient underwent a splenectomy as well. All the tumors showed the presence of "hepatoid foci" (the morphological feature is close to the hepatocellular carcinoma) and a positive immunoreactivity to AFP. The mean survival was 3 months: only one patient is still alive and disease-free (with a 52 months follow-up). After radical surgery, she underwent a chemotherapic treatment with cisplatin, epirubicin, 5-fluorouracil and l-leucovorin. We conclude that our series (the widest in Italy and one of most impressive in Europe) confirm the poor prognosis of this neoplasm, but we also want to underline that this tumor is not so "unusual" any more and it requires new types of treatment, like postoperative chemotherapy, besides surgery, to be fighted properly.

Postoperative intraabdominal abscesses: percutaneous versus surgical treatment.

The optimal treatment of postoperative intraabdominal abscesses has not yet been defined and mortality and morbidity remain high. In this retrospective study 2.310 laparotomies were reviewed. The records of 39 patients with postoperative intraabdominal abscesses (1.6%) are reported and the results obtained in percutaneous drainage (PD, n = 27) versus surgical drainage (SD, n = 10) are compared. The choice of drainage was made after consultation with the interventional radiologist, and PD was preferred in single, well-defined abscesses. Two patients had prompt spontaneous resolution of the abscess. The two groups were homogeneous for age, sex and postoperative day of abscess diagnosis. There was no difference in severity of illness assessed by Acute Physiologic Score (APS) between PD and SD groups (7.9 vs 9.3). No significant difference was found in mortality (11% vs 20%), morbidity (11% vs 40%) and duration of drain tube (14 vs 15 days) between PD group and SD group. This study confirms the data of recent retrospective stratified series: PD and SD are equally efficacious to cure postoperative intraabdominal abscesses. However, PD should be the treatment of choice because of its lower invasiveness and cost.

[Indications and technics of the surgical treatment in iliaco-femoral thrombophlebitis in the acute phase]. / Indicazioni e tecnica nella terapia chirurgica delle flebotrombosi iliaco-femorali in fase acuta

A personal technique employed in the successful resolution of a case of iliacofemoral phlebothrombosis is described. Attention is drawn to the indications for this type of operation. The technique is not traumatic and can be easily performed, particularly with the aid of a Fogarty catheter. The results obtainable as far as the prevention of lung embolism and postphlebitic syndromes are concerned are also described.

[Revascularization of the deep femoral artery in arterial insufficiency of the lower limbs. Clinical aspects and immediate results]. / La rivascolarizzazione dell'arteria femorale profonda nella insufficienza arteriosa degli arti inferiori. Aspetti clinici e risultati immediati.

The main indications for revascularisation of the lower limb using the deep femoral artery are explained. In aorto-iliac disease with obstruction of the superficials, an aortofemoral by-pass is created, and the distal end of the prosthesis is sutured on the point of origin of the profunda in the form of a patch. In cases where the patients's local or general condition precludes the establishment of a femoro-popliteal by-pass in femoro-popliteal disease, endoarteriectomy is performed and a patch is applied from the CFA to the first segment of the profunda. Thirty-six cases in which the method described was applied are illustrated. These are culled from a total of 144 artery reconstructions performed in 1975--77. The results (33 asymptomatic cases 6 months after surgery, equal to 91.7%) are comparable with those obtained in by-passes with patent SFA in patients with aorto-iliac obstruction. In addition, the method often makes amputation unnecessary in patients with obstruction of the subinguinal trunks only, but unable to be treated by the establishment of a femoropopliteal by-pass.

[Lung surgery in patients over 70 years]. / La chirurgia polmonare nei pazienti sopra i 70 anni.

The Authors according to their previous experience, report on the possibility of thoracic surgery in patients older than 70 with lung cancer. Fourty-seven patients older than 70 have been operated in the period 1984-1988 for lung cancer. The Authors performed 34 lobectomy, 11 pneumonectomy, and 4 wedge resection. The mortality rate was 4.25% (2 patients). Thirty-four patients are still living (follow-up range 12-60 months). Ten patients died. The Authors report a diagnostic and therapeutic guideline for this kind of pathology.

["Hepatoid" gastric tumor]. / Il tumore gastrico "epatoide".

In this study the Authors describe two cases of hepatoid adenocarcinoma of the stomach: one is characterized by the presence of alpha-fetoprotein (AFP) high levels of the serum both pre and post-operating and by the very positive response to the adjuvant chemotherapy (how the return to the normality of such values demonstrates). The other is instead characterized by the presence of post operating hepatic metastasis, event which is very frequent in this kind of neoplasm, but presents many problems concerning the differential histological diagnostics with the primitive hepatocarcinoma (problems which are nowadays not completely solved). Moreover the Authors relate to this study the revision of the international literature of the main characteristics and of prognosis of this particular and rare neoplasm.

[Effect of octreotide on the hepatic metastasis of human colorectal cancer: an experimental model in athymic mice]. / Effetti dell'octreotide sulle metastasi epatiche da cancro del colonretto umano: modello sperimentale su topo atimico.

The aim of this randomized study was to determine the effects of octreotide therapy on the growth and development of experimental liver metastases from a human colonic cancer cell line (HT 29) in nude mice model. No important and significant difference could be found between mice, lungs and liver weights of both groups as well as lung metastatization; indeed, significant was the difference between groups concerning liver, metastases (the majority of them were in treated group): in spite of the small number of data collected, which does not allow to draw any conclusion on the efficacy of this drug on liver metastases, we believe that octreotide therapy does not affect dramatically the growth and development of liver metastases from a human colon cancer.

Adenocarcinoma arising from a recurrent fistula-in-ano.

Anal fistulas are frequent events which often recur after an inadequate surgical treatment. Nevertheless their evolution into malignant diseases is infrequently observed. The authors report one case of mucinous adenocarcinoma arising out of a recurrent, long-lasting fistula-in-ano. As reported, abdomino-perineal resection combined with radiotherapy can be the choice treatment. The difficulty is to obtain a reliable differential diagnosis. No imaging technique nor histologic examination can establish a definitive reliable diagnosis; nevertheless, as the risk of adenocarcinoma developing from a long-lasting recurrent fistula-in-ano, although small, is real, authors believe that operative exploration and biopsy of recurrent abscesses and fistulas should be recommended.

[Perioperative changes in the plasma levels of fibrinogen and D-dimer during laparoscopic cholecystectomy: the preliminary results of a prospective randomized clinical study]. / Modificazioni perioperatorie dei tassi plasmatici di fibrinogeno e D-dimero in corso di colecistectomia laparoscopica: risultati preliminari di uno studio clinico prospettico randomizzato.

AIM: Considering that laparoscopic procedure is associated with increased resistance to lower-limb venous return and subsequent stasis, with possible implications in terms of thromboembolic complications, the aim of our study was to investigate prospectively the coagulative-fibrinolytic profile, in laparoscopic and open cholecystectomy, in patients randomly alloted to receive or not preoperative heparin. METHODS: We prospectively analyzed 36 patients (20 laparoscopic and 16 open) and we randomly divided the patients in two groups: Group-A (28 patients--16 laparoscopic and 12 open) didn't take any preoperative thromboprophylaxis, Group-B (8 patients--4 laparoscopic and 4 open) took preoperative subcutaneous heparin. We took blood venous samples before surgery, at time 0 and + 30 min., at the end and 1 and 24 hours postoperatively. The following parameters were assessed: prothrombin time, partial thromboplastin time, fibrinogen and D-dimer. We statistically analyzed the differences by ANOVA test. RESULTS: In Group A, fibrinogen and D-dimer were significantly higher (p < 0.0001 and p = 0.0266) in open group as compared with laparoscopic one and we observed significant time-depending changes of fibrinogen's concentration (p = 0.0168). In Group B we obtained a higher fibrinogen's value in laparoscopic group than in conventional one, with a significant difference (p = 0.0283); also, the sampling-time affected the result in a very significant meaning (p = 0.0041). Comparing fibrinogen levels between Groups A and B, we observed lower values in heparin-treated group than in the other one (p < 0.0001), while in laparoscopic surgery there was not a significant difference between two groups of treatment. CONCLUSIONS: Our preliminary data suggest that, perioperatively (besides a smaller laparoscopic acute-phase response) the coagulative-fibrinolytic changes are lower in laparoscopic cholecystectomy than in open one and heparin treatment significantly reduces these changes in open surgery but doesn't seem to affect laparoscopic group. Our results seem to show another possible advantage of the laparoscopic surgical procedures over the traditional ones.

[The surgeon's role in the treatment of cholelithiasis]. / Il ruolo del chirurgo nel trattamento della colelitiasi.

From a surgeon's point of view, the management of biliary tract calculi can be simplified as follows: 1) In the asymptomatic patients a prophylactic surgery is not justified. 2) In the symptomatic patients the cholecystectomy is by far the best procedure as it eliminates the symptoms and it prevents the complications. 3) If performed in elective and good-risk patients, this surgical technique is without morbidity and mortality. 4) Such a statement which absolutely fits in case of laparotomic cholecystectomy, is not true in case of laparoscopic cholecystectomy which, on the contrary, presents with an higher mortality. 5) Laparoscopic cholecystectomy must be performed by surgeons with biliary tract management wide experience. 6) The management of complications is still almost surgical. 7) Common duct calculi are often treated by endoscopic techniques in association with surgery. 8) The surgeon must always be able to evaluate his patient and to suggest the best management with particular regard to the alternative not surgical procedures which sometimes are more favourable to the patient. 9) Actually, to left behind the statement "a chance to cut is a chance to cure" could sometimes involve much credit to the surgeon and more profit to the patient.

[Surgical staplers in thoracic surgery]. / Le suturatrici meccaniche in chirurgia toracica.

Since its introduction in our department, in 1987, stapling devices are used on routine basis for thoracic surgery. Overall, 133 operations were performed: 95 lobectomies, 30 pneumonectomies, and 8 bilobectomies. Stapled related complications consisting of bronchopleural fistula following right pneumonectomy were registered in 3 cases. The use of vascular staplers was never associated with complications, and no air leakages following stapled parenchymal sutures were observed. The advantages related to the use of stapling devices are represented by low air leakage and bleeding rates, reduced operative trauma, and reduced operating time. However, confidence with the techniques is needed to avoid regrettable consequences.