[Treatment of short bowel syndrome]

On the basis of personal experience and the latest reports in the literature on the treatment of short bowel syndrome, the clinical and therapeutic aspects of the malabsorption syndrome arising after removal of long segments of the small intestine are analysed with emphasis on the salient features and particularly the critical phase constituted by the transfer from parenteral to enteral and oral nutrition whose importance for the maintenance of life is objectively confirmed by the adaptive response of the remaining small bowel (compensatory hypertrophy).

[A case of leiomyoblastoma of the stomach. Clinical and anatomopathologic considerations]

Gastric leiomyoblastoma or Martin's myoid tumour or Stout's smooth muscle cell bizarre tumour is a rare benign mesenchymal neoplasia that may become malignant. A personal clinical case is reported and the most important anatomopathological and clinical aspects are reviewed, stress being laid on the importance of identifying the macroscopic and histological features that can point with certainty to malignity and so influence the choice of surgery. This, depending on the situation, may tumorectomy, gastric resection or gastrectomy with exeresis of any metastases.

[Conservative treatment of simple, uncomplicated diverticulitis. Preliminary study for evaluating the effectiveness of a method of topical therapy: rectal perfusion]

Transit times and distribution modalities of an oily mixture used as a vehicle for drugs administered by rectal perfusion in topical therapy in patients with uncomplicated diverticulitis of the colon have been examined. X-ray study makes it possible to state that the technique is mainly indicated in descending colon and sigmoid localisations, segments in which the oily mixture distributes homogeneously and massively in all patients treated.

[Treatment of perforated duodenal ulcer. Our experience]

Personal experience in the treatment of perforated duodenal ulcers is reported. The 78 patients concerned were divided into two groups (operated on before or after the introduction of anti-HZ antihistamines) and were encountered between 1-1-1972 and 30-12-1986. The results were generally satisfactory: mortality (operative and postoperative) 5.1%; postoperative complications 6.4%; recurring ulceration 1-5 years after surgery 6.4%. The most successful operations (lowest death and complication rates, shortest hospital stay) were simple suturing and suturing combined with superselective vagotomy. Analysis of the results show that the success of the operation was significantly influenced by the following factors: patient's age and general condition, associated diseases, time of onset of the ulceration prior to perforation and above all the length of time between the perforation and the operation i.e. the presence or absence of peritonitis. Simple suturing should always be used where possible, particularly now we have the anti-H2 drugs. Superselective vagotomy combined with suturing is the definitive surgical treatment of choice and produced no deaths or complications in the 13 patients given this treatment.

[Crohn disease of the colon with acute onset at the 17th week of pregnancy. Description of a clinical case]

A case of Crohn's disease of the colon onsetting at 17 weeks gestation and observed at the 22 weeks when the disease presented severely and concomitant to serious maternal malnutrition, is reported. The patient was treated with NPT for 4 weeks in association with corticosteroids and sulphasalazine therapy continued to term (36 weeks). The newborn (weight 2480 g, Apgar of 9 at 5') developed moderately serious postnatal icterus resolved with phototherapy; at twelve months he presented normal growth and neurological development conditions. Stress is laid on the fortunate outcome of this gestation and the role of NPT in the correction of maternal malnutrition and the maintenance of foetal growth.

Complications of uterine cervix carcinoma treatments: the problem of a uniform classification

Ninety-six articles published in English, French and Italian between 1938 and 1986 have been examined in order to analyze the classifications and reporting methods used by different researchers. Specialty and nationality of authors, classifications used, organs, systems and anatomic sites considered, weight given to the most frequently encountered complications are studied. Fifty-nine papers make no use of classification of complications of any kind, neither by onset time, nor by severity, but simply describe the observed events. The remaining 37 papers use a classification based on varying criteria. Thirty-four authors use a classification by severity according to different criteria; four authors classify complications according to the treatment required. In the remaining 30 papers a true scale is used. A total of 22 classifications emerges from these papers; in eight cases a previously published classification is used. The weight assigned by different authors to specific complications has been compared. The following main points emerge from the analysis: about two authors out of three simply describe the observed complications; 30 rely on a true scale of severity, but 22 different grading systems are used. Most classifications do not cover all possible complications, both surgical and radiotherapeutic, but concentrate on those complications which are typically generated by author's therapeutic approach. Only three take into account complications related to different treatment modalities. The observation period is not standardized: published data derive from follow-up times spanning from some months to many years. Authors mainly focus their interest on gastrointestinal and/or urinary complications; other organs and systems are rarely considered.(ABSTRACT TRUNCATED AT 250 WORDS)

Kinetics for the synthetic bile acid 75selenohomocholic acid-taurine in humans: comparison with [14C]taurocholate

The "apparent" fractional turnover rate of the gamma-labeled bile acid analogue 75selenohomocholic acid-taurine (75SeHCAT) was assessed from decline in radioactivity over the gallbladder area on 4 successive days using a gamma-camera, and was compared in the same subjects with the fractional turnover rate of the corresponding natural bile acid, cholic acid-taurine, labeled with 14C ([14C]CAT) using the classical Lindstedt technique. Very similar results were obtained in 5 healthy individuals (coefficient of variation 4.8%, medians 0.35 and 0.34, respectively). By contrast, the fractional deconjugation rate assessed from zonal scanning of glycine- and taurine-conjugated bile acids on thin-layer chromatography was much less for 75SeHCAT than for [14C]CAT (0.02 and 0.13, respectively; p less than 0.05). The fractional rate for deconjugation plus dehydroxylation was also determined by zonal scanning, and gave lower values for 75SeHCAT than for [14C]CAT (0.02 and 0.12, respectively; p less than 0.05). There was a striking similarity between the fractional rate for deconjugation alone and that for deconjugation plus dehydroxylation for both bile acids in individual samples (r = 0.999, p less than 0.001), suggesting that these two processes might occur simultaneously and probably involve the same bacteria. We conclude that our scintiscanning technique provides an accurate, noninvasive method of measuring fractional turnover rate of a bile acid in humans, and that the finding that 75SeHCAT remains conjugated with taurine during enterohepatic recycling means that absorption should be specific for the ileal active transport site, thus rendering it an ideal substance for assessing ileal function.

Diagnostic value of serum immunoreactive conjugated cholic or chenodeoxycholic acids in detecting hepatobiliary diseases. Comparison with levels of 3 alpha-hydroxy bile acids determined enzymatically and with routine liver tests

The diagnostic value of the enzymatic fluorometric method for total serum bile acids (TSBA) and for radioimmunoassay measurement for conjugated cholic acid (CCA) or chenodeoxycholic acid was compared with that of routine liver function tests in 223 patients with liver disease, 88 healthy subjects, and 118 patients affected by other diseases. The value of the tests for screening in the general population was assessed by simulation, using estimates of disease prevalence. TSBA was significantly more sensitive (78%) but less specific (94%) than CCA (sensitivity of 69%, specificity of 98%). Aspartate aminotransferase was nearly as sensitive (74%) as TSBA, but significantly less specific (93%) than CCA. CCA provided the highest positive predictivity (98%), even in a screening simulation (32%). With the use of sequential aspartate aminotransferase measurement followed by CCA, this value rose to 100%. This test procedure appears to be the best screening method for liver diseases available at present.

Physiology of ileoanal anastomosis with ileal reservoir for ulcerative colitis and adenomatosis coli

A physiologic and metabolic assessment was carried out on eight patients six months after total proctocolectomy with ileal reservoir for ulcerative colitis and familial adenomatosis coli. All patients were continent and able to defecate spontaneously, stool frequency ranging from two to five per 24 hours. Anal sphincter resting pressures (35 +/- 14 mmHg) and squeeze pressures (88 +/- 24.2 mmHg) were similar to those of a healthy population, with the exception of one patient's complaint of nocturnal mucous leakage per anus. Biopsies of the ileal mucosa of the reservoirs showed a mild inflammation in seven patients; in one a subtotal villous atrophy (plus glandular pattern) was found. Anthropometric measurements, lymphocyte counts, hemoglobin, albumin, transferrin, iron, B12, and folate were normal in all. In the majority of patients there was no evidence of bacterial overgrowth. Vitamin B12 absorption was reduced slightly in only one patient. Lipid absorption (as judged by the 14C-Triolein breath test) was abnormal in three patients. Fecal clearance of alpha 1 antitrypsin as protein losses index was abnormal in three patients. Bile acid malabsorption was the most important ileal dysfunction observed in the patients.

Use of a gamma-labeled bile acid (75SeHCAT) as a test of ileal function. Methods of improving accuracy

The object of the present study was to improve the accuracy of measurements of ileal function obtained by abdominal scanning and fecal counting after oral administration of the gamma-labeled bile acid 75seleno-homocholic acid-taurine (75SeHCAT), as current techniques do not distinguish between retention of the bile acid within the enterohepatic circulation from retention within the colon, and are also affected by incomplete stool collection when using the fecal method. We have therefore introduced the following modifications: (a) simultaneous ingestion of 51CrCl3 as a nonabsorbable correction marker for both the abdominal scanning and fecal counting methods; and (b) the use of 75SeHCAT counts over the gallbladder area on abdominal scanning, because these counts should be independent of colonic retention. We have studied 42 subjects, including 6 healthy controls, 6 ileal resection subjects, 15 ulcerative colitis patients, and 15 patients with unresected ileal Crohn's disease. Colonic retention (0%-68% per day) caused a variable overestimate of 75SeHCAT absorption. Corrected measurements of the fecal absorption index determined by a gamma-counter and of the abdominal absorption coefficient determined by a gamma-camera correlated well with each other (r = 0.92, p less than 0.0001), providing an internal validation of the 51CrCl3 modification. The fecal absorption index could also be determined from the carmine-rich stool collection of a single day, and this also correlated well with the abdominal absorption coefficient (r = 0.81, p less than 0.0001). Gallbladder scanning alone was simpler, involving only one isotope, but it correlated less well with the fecal absorption index than did the abdominal absorption coefficient (r = -0.64, p less than 0.001).

[A case of splenic abscess in a drug addict with acquired immunodeficiency syndrome]

The complex diagnostic procedure involved in a case of splenic abscess in a young drug addict as a result of septicaemia caused by streptococcus fascalis is described and discussed with an examination of the criteria in support of a more aggressive approach to the removal of septic foci in such patients with AIDS. It is concluded that such criteria are valid even when, as in the case described, splenectomy further depresses the immune system.

A comparative analysis of the growth of sweet and forage sorghum crops. I. Dry matter production, phenology and morphology

A sweet sorghum (cv. Wray) and a forage sorghum (cv. Silk) were grown in south-east Queensland without water deficit at two densities in 0.75 m rows on four occasions between late September and mid January. Tiller and branch numbers, and dry matter production, were recorded at appearance of the third leaf ligule, panicle initiation, anthesis, soft-dough stage, maturity and 3 weeks after maturity. Light interception was measured every 2 weeks. The time between all the studied phenological events up to anthesis was shortened with delay in sowing date except for that between appearance of the third ligule and initiation in cv. Silk. The time between anthesis and maturity lengthened with the delay in sowing date of both cultivars. Rate of development was a function of ambient temperature to the third ligule stage and again during maturation. Tiller and branch production were greatest in cv. Silk, decreased with delay in sowing date for both sorghums and was increased by the high density. The estimated assimilate flux required to sustain basal tillers was substantially lower in cv. Silk than in cv. Wray. This flux increased with temperature. In early sown crops, dry matter yields of cv. Wray were greater than those of cv. Silk. Close spacing increased dry matter yields up to anthesis, but by maturity the effect of spacing had been reduced. Cv. Wray produced a larger leaf canopy more rapidly than cv. Silk, although the partitioning of dry matter to leaf tissue only differed between cultivars after canopy closure. The efficiency with which crops used intercepted light energy to produce new above-ground dry matter changed during their ontogeny. It is suggested that early changes in efficiency were a consequence of altered partitioning to roots. The effect of sowing date and spacing on efficiency of light use was slight until the maturation phase, when efficiency decreased with delay in sowing date and at high density. Water use efficiency differed in a similar way to light use efficiency. The relationships found in this study indicate that sorghum growth models need to recognise differences in the morphological development of sorghum types.

A comparative analysis of the growth of sweet and forage sorghum crops. II. Accumulation of soluble carbohydrates and nitrogen

Well-watered crops of sweet sorghum (cv. Wray) and forage sorghum (cv. Silk) were grown in south-eastern Queensland. Treatments consisted of four sowing dates, two intra-row spacings and harvests taken at six physiological growth stages from the third ligule to 3 weeks after grain maturity. Plant density effects on the concentration of sugars and nitrogen were slight, and changes in yields of these components were a function of density effects on dry matter yields. At any growth stage, the concentration of sugars in both cultivars was decreased with delay in sowing date. The delay in sowing date led to an increased nitrogen concentration in cv. Wray, but in cv. Silk the nitrogen concentration was highest in early and late sowings. At maturity, the concentration of sugars in cv. Wray averaged 40'70, 10 times the level in cv. Silk. In both cultivars, accumulation was a near linear function of either time or radiation sum. The partitioning of carbohydrate differed little between cultivars but altered with their ontogeny. The efficiency of light use for sugars production was greater in cv. Wray and altered with ontogeny. In contrast, concentration of nitrogen was similar for both cultivars and decreased curvilinearly with time or degree days. The partitioning of nitrogen altered with ontogeny and the amount partitioned to leaf material was greater in cv. Silk pre-anthesis but was less post-anthesis. Yield of stem sugars in cv. Wray exceeded 10 t ha-1 when the crops were sown early in the season, but was only 3 t ha-1 with late-sown crops.

[Use of vasopressin in the treatment of acute hemorrhagic lesions of the stomach. Our experience]

Since bleeding from acute lesions of the gastric mucosa can cease spontaneously and the mortality rate of emergency surgery is high, conservative treatment is always preferable. Satisfactory results were obtained with continuous infusions of vasopressin in low doses (0.2 U/kg/hr for 8 hours) so that this treatment appears a valid alternative to more recent techniques (somatostatin).

[Use of vasopressin in the treatment of bleeding esophageal varices. Our experiences]

Results obtained in the control of oesophageal varix rupture haemorrhage by intravenous vasopressin perfusion or selective intraarterial administration are reported. This comparative study shows intravenous administration to be the best method since it produces the same therapeutic effects with fewer undesirable side-effects than when administered arterially. In view of the high level of complications caused by selective arterial catheters, this administration method would only appear justified in cases where selective arterial catheterisation is to be carried out in any case.

[Diagnostic and therapeutic problems in angiodysplasias of the digestive tract]

After a review of recent literature on angiodysplasias of the digestive system, a diagnostic procedure based on personal experience is proposed for haemorrhagic patients. Criteria for the selection of treatment protocols are then proposed for cases where angiodysplasia is recognised as the cause of the bleeding.

[Alcoholic beri-beri: a not yet clearly understood pathogenesis. Problems presented by a particularly clinical complex case]

A detailed clinical and autoptic study of a case of alcoholic beri-beri is presented. In the light of recent experimental literature, the symptoms support the as yet tentative new hypothesis that pathogenesis may relate to the parasympathetic system, in which case there may be a concrete possibility of immediate medical cure.

[Use of vancomycin in the treatment of severe Staphylococcus aureus infection. Description of 3 cases]

In recent years, the diffusion of antibiotic multiresistant staphylococcus strains in hospitals (especially aureus and epidermis) has created serious drawbacks as regards the treatment of severe septic forms and the systemic spread of these bacteria. The results of endovenous vancomycin treatment in three cases of sepsis with secondary localisations (endocarditis, osteomyelitis, pneumonia) caused by gram positive staphylococcus aureus are examined. The pharmaceutical was found to be effective in all cases and free from significant side effects.

Diagnostic value of serum bile acids and routine liver function tests in hepatobiliary diseases. Sensitivity, specificity, and predictive value

Total serum bile acids measured by enzymatic fluorometry and routine liver function tests were determined in a large population including 97 healthy subjects, 138 patients free of hepatobiliary diseases but affected by other diseases, and 344 patients with mild or severe hepatobiliary diseases. In order to define the diagnostic value and some operational characteristics of serum bile acids, sensitivity, specificity, and several predictive value tables for increasing cutoff levels of serum bile acids were calculated by means of a computer program. Serum bile acids and aspartate aminotransferase were found to be similar in sensitivity, specificity, and predictive value. Serum aspartate aminotransferase was found to be more suitable than serum bile acids in detecting mild hepatobiliary diseases, whereas serum bile acids were more sensitive than routine liver tests in the evaluation of severe hepatobiliary diseases. In view of its ability to detect severe hepatobiliary diseases, serum bile acids test may play a decisive role in clinical practice (eg, decision to perform a liver biopsy).

[Medical management of reflux esophagitis]

When the cause of oesophagitis has been discovered, patients for whom surgical management is impossible may be successfully treated by improving oesophageal peristalsis, increasing the tone of the LES, and speeding up the emptying of the stomach. The best results are obtained in peptic oesophagitis, since the latest secretion-inhibiting drugs ensure constant reduction of the acidity of the gastric juice, as has been demonstrated by continuous pH monitoring.

[The dosimetry of gynecological curietherapy by means of computed tomography]

The dosimetry of endocavitary curietherapy by means of CT in 15 patients, affected by cancer of the uterine cervix was studied. The results were compared with those obtained by the method of the European Group of Curietherapy. The authors measured the dimensions of the treated volume and the dose at critical points. The good relationship between the 2 methods is demonstrated, and the great possibilities opened by the new method are emphasized.

[Notes on the use of the Angelchik-Cohen ring]

Results obtained by using Angelchik and Cohen's ring prosthesis in 10 patients with hernia due to sliding through the oesophageal hiatus of the diaphragm are reported. In 8 patients, the ring was perfectly tolerated and performed its antireflux and hernia containment functions. In the 2 other patients, however, the prosthesis rose to the mediastinum, causing hernia to recur in one case and leading to recurrence of symptomatology in the other.

Meal stimulated response of serum bile acids levels in normal and altered bile acids enterohepatic circulation

Sequential measurement of postprandial serum levels of bile acids was carried out in ten healthy controls and in four patients with different impairment of bile acids enterohepatic circulation. An enzymathic fluormetric method was used for SBA analysis. The peak of increase above fasting baseline in normal subjects was 11.8 +/- 1.2 microM/1 (mean +/- SD). In a cholecystectomized subject no SBA peak was observed. Two patients with mild and severe liver impairment (i.e. alcoholic steatosis and Summerskill-Walshe disease during an acute attack of jaundice) had postprandial SBA increase of 20 microM/1 and 70 microM/1 respectively. In a patient affected by Crohn's disease, with proved bile acids malabsorption, a negligible postprandial SBA increase was noted (6.65 microM/1). It is concluded that meal stimulated response of SBA levels might be useful index of altered hepatobiliary and intestinal function.

Early assessment of sweet sorghum as an agro-industrial crop. 2. Maturity factors

Two experiments were carried out at Ayr, north Queensland, to examine maturity factors on sweet sorghum (Sorghum bicolor) juice characteristics and yields. In experiment 1, four commercially available forage cultivars were harvested at anthesis, milk dough and mature grain stage, and 10 days after maturity. Sucrose and soluble solids concentration and yields in stems were highest at or near grain maturity. In experiment 2, harvests of the cv. Rio were taken at milk dough or mature grain stages on plants that had been left intact, had the panicle removed at anthesis, or had the panicle and subsequent shoots removed. Induced barrenness resulted in a higher concentration of soluble solids and sucrose in the stem over that in intact plants. The sucrose yield of stems of barren plants (up to 3.2 t ha-1) equalled the carbohydrate yield as stem sucrose and grain starch in intact plants. In barren plants, leaves remained greener for longer and stems were less prone to lodging.