Chlamydia pneumoniae DNA detection in peripheral blood mononuclear cells is predictive of vascular infection

Abdominal aortic aneurysm tissue and peripheral blood mononuclear cells (PBMC) of 41 consecutive subjects undergoing abdominal aortic aneurysm surgery were analyzed by polymerase chain reaction (PCR) for the presence of Chlamydia pneumoniae, Mycoplasma pneumoniae, and Helicobacter pylori DNA. Twenty patients (49%) were positive for C. pneumoniae DNA-16 (39%) in both PBMC and aneurysm tissue, 3 (7.3%) in PBMC only, and 1 (2.4%) in the artery specimen only. Previous exposure to C. pneumoniae was confirmed in 19 (95%) of the 20 PCR positive subjects by C. pneumoniae-specific serology, using the microimmunofluorescence test. None was positive for H. pylori or M. pneumoniae DNA, either in the PBMC or in the artery specimens. In conclusion, carriage of C. pneumoniae DNA is common both in PBMC and in abdominal aortic tissue from patients undergoing abdominal aneurysm surgery. Blood PCR may be a useful tool for identifying subjects carrying C. pneumoniae in the vascular wall.

HLA class-I-soluble antigen serum levels in liver transplantation. A predictor marker of acute rejection

The serum levels of sHLA-I have been determined in 16 patients following liver transplantation. sHLA-I levels did not show remarkable variations in six patients without evidence of transplant-related complications. sHLA-I levels strongly increased in 10 patients undergoing acute rejection episodes. In these patients, an average 20% daily increase of sHLA-I levels was detected on the 6 days preceding and on the 2 days following the rejection episode. A fast decrease of sHLA-I levels was observed in seven patients following treatment of acute rejection with anti-CD3 mAb. The serum level of sHLA-I antigens positively correlated with ALT serum level and inversely correlated with PT. The determination of sHLA-I in serum may therefore be proposed as a useful marker in the monitoring of patients following liver transplantation. The increase of sHLA-I antigens may predict the onset of acute rejection whereas their decrease may be related to a good response of acute rejection to immunosuppressive treatment.

[Chronic anemia due to Meckel's diverticulum. The diagnostic and therapeutic considerations]

Meckel's diverticulum is a frequent embryologic residual organ. The importance of considering this diagnosis in the young adult presenting chronic hypochromic [correction of hyperchromic] anemia, despite the difficulties of the same, is emphasized. The condition to be satisfied is the complete excision of Meckel's diverticulum, to avoid leaving ectopic mucosa residuals, so we think it useful to resect an ileal sleeve.

[Diverticulitis of the appendix: a rare cause of acute abdomen]

Diverticulosis of the vermiform appendix, either single or multiple, congenital or acquired, is rather infrequent and usually asymptomatic. However, it may be complicated by flogosis configuring an acute abdomen hardly recognizable from an acute appendicitis not related to the diverticular disease. The Authors report a case of acute appendicular diverticulitis surgically treated. A brief review of the literature is also reported.

[Extensive resections in rectal carcinoma. Our experiences]

The authors review their experience in the surgical management of rectal cancer. They analyze rectal malignancies and their recurrences from natural history to surgical strategies and survival rates. In particular, the need to perform extended operations in order to offer patients a better prognosis is discussed.

[Aneurysms of the visceral arteries: the diagnostic problems and therapeutic strategies]

Intestinal artery aneurysms are a rare clinical condition, usually asymptomatic. However, sometimes they occur as vascular emergency, with a mortality rate of about 75%. Therefore, their occasional diagnosis should be carefully considered as an indication for elective surgery. The authors report their experience in the surgical management of 3 cases of intestinal artery aneurysms respectively involving the splenic, the gastroduodenal and the inferior mesenteric artery. A review of the literature is also presented.

[Intrahepatic jejunostomy by trans-scission approach in neoplasms of the superior biliary confluent (SBC)]

The Authors consider the trans-scission approach as a quick and safe alternative approach for doing intrahepatic bilio-intestinal anastomoses for the surgical treatment of well confined cancers of hepatic hilus (type I and II of Bismuth e Corlette). This approach should be recommended particularly when the presence of anatomical variations makes the hilar approach hazardous.

[Pulmonary metastases. Their diagnosis and surgical therapy]

The Authors on the basis of their own experience and scientific literature, study the indications to the surgical treatment of pulmonary metastasis. Surgical treatment usually produces a palliative result, bettering the quality of life. For some other Authors, surgical treatment if there are no local recurrences and metastasis, could produce complete healing.

[Magnetic resonance in the study of the temporo-mandibular joint. I. Anatomo-functional findings]

Thirty-four temporomandibular joints (TMJ) were examined in 17 normal subjects with two superconductive MR units at 1T and 1.5T. TMJ evaluation was performed with both SE sequences in occlusal position and with "fast" sequences (flash) during the gradual opening of the mouth. Therefore, both the anatomic features of the TMJs and their dynamic behavior during mouth opening were analyzed. The information acquired allowed the complete and non-invasive evaluation of TMJ function. The knowledge of the normal anatomic and functional patterns is of paramount importance for the diagnostic approach to TMJ pathologic conditions.

[Primary intrahepatic calculosis: hepatic lithotomy or hepatectomy?]

The authors discuss about the different surgical approaches in the management of primary intrahepatic stones, conforming their experience to literature reports. In the future they hope for a more conservative treatment on the basis of the good results obtained with percutaneous transhepatic fiber cholangioscopy (P.T.C.S.) and ultrasonographic extra-body lithotripsy recently adopted in the clinical practice.

[Soft-tissue sarcomas of the limbs at high risk of malignity. Current role of surgery and conservative treatment]

The authors discuss the role of surgical treatment in patients with highly malignant soft tissue sarcomas in the limbs. A careful analysis is made of different therapies on the basis of the results obtained by the authors and those reported in the literature. The anatomic classification of lesions is based on functional anatomic compartments, defined as intra- or extracompartmental. If a lesion was within an intrafascial compartment, all the muscles with intact fascial sheaths have up till now been removed "en bloc" to obtain radical margins. Many authors now think that all manifest disease be removed with a generous soft tissue margin on all sides to ensure adequate local treatment. Amputation has commonly been performed for extracompartmental lesions, but a multinodal treatment programme, including limb-sparing resection and tumour-bed radiation, should now be considered if possible in the management of these tumours.

[Endometriosis of the distal ileal loop. A clinical case report]

Intestinal endometriosis is a rare lesion characterized by a difficult differential diagnosis with other intestinal diseases. The authors report the case of a woman suffering from endometriosis involving the distal ileal loop.

[Carcinoma of the distal choledochus: its differential diagnosis and surgical treatment. Our experience]

Carcinomas of the biliary tree present very difficult problems in diagnosis and treatment. Low common bile duct tumors, excluding papillary tumors, are rare but not easily detectable preoperatively and correctly treated. Authors report their clinical experience on the argument.

Isolation and functional characterization of rat pancreatic acini

The Authors describe an optimized procedure for the isolation of rat pancreatic acini and the preliminary results concerning the functional characterization of the cells. Isolation is carried out by two sequential digestive steps in a KREBS modified medium containing collagenase, separated by an intermediate step in which acini separation is fostered by incubation in a Ca++ free medium containing the Ca++ chelator EDTA. Final separation is obtained through the application of mechanical forces by aspirating the suspension in plastic pipettes. The choice of the collagenase, the duration and the entity of the mechanical dissociation strength are the main modifications to the classic procedure and allow to obtain a very high yield of cells maintaining their ability to secrete enzymes for a long period (6-7 hours). Functional characterization is completed mainly by the determination of the amylase release stimulated by increasing doses of cholecystokinin.

[Indications, value and limits of surgical therapy in the treatment of cancer of the gallbladder]

The authors analyze different therapeutic modalities for gallbladder can and discuss indications, value and limitations on the basis of the results obtained by their own experience on 13 cases as well as literature data.

[Primary tumors of the biliary hilum. Anatomical and therapeutic aspects]

The validity of a selective surgical attitude towards primary tumours of the hepatic hilus after accurate pre- and intra-operative staging is stressed. Moreover the active management for both radical and palliative purposes is justified by some personal observations of the specific anatomoclinical behaviour of these tumours.

[Synchronous hepatectomy and exeresis of primary tumor of the colorectum]

Personal experience of 6 hepatectomies at the some time as primary colorectal tumour excision is reported. Like most Italian and foreign Authors, the paper stresses the negligible mortality and morbidity after this double surgery. Moreover, in these particular patients, it was never necessary to postpone hepatectomy. Finally, emphasis is placed on the importance of intraoperative echography for the identification of micrometastasis in one or two lobes, for the correct staging of the primary tumour and for oncologically appropriate hepatectomy.