[The complications of lumbotomies]

After having described the surgical anatomy of the lumbar region, with particular regard to the relationships with pleura and peritoneum, as well as to the course of the nervous structures of the region (12th intercostal, ileohypogastric and ileoinguinal), the authors describe the possible complications related with the surgical approaches to the lumbar region. Pathogenesis of post-operatory pains and parietal hypotonies is especially evaluated; these complications may be caused by section, ligature or compression of one or more nervous trunks. The authors conclude that the respect of the anatomic structures located in the lumbar region represents the best way in order to prevent most complications related to lumbotomies.

[Transitory postoperative anuria after transvesical prostatic adenomectomy: review of the literature, description of new clinical cases and physiopathological considerations]

Anuria is a rare complication after prostate adenomectomy. Three cases of complete bilateral anuria and one case of monolateral anuria are reported following transvesical prostate adenomectomy, characterized by immediate onset without any apparent cause and by spontaneous resolution within 48 hours. After a thorough review of the literature, the authors analyze the pathophysiological and clinical aspects of post-prostate-adenomectomy anuria and postulate an "obstructive" aetiology for the anuria cases observed in their series.

Hemorrhagic pseudocysts of the adrenal gland: Case description

Cysts of the suprarenal gland, classified as parasitical cysts, epithelial cysts, endothelial cysts and pseudocysts are uncommon. We report a case of pseudocysts of the suprarenal gland. Clinical signs consisted of flank pain and palpable mass. Urography, ultrasonography and computed tomography were essential for diagnosis. Treatment consisted of surgical extirpation, as percutaneous needle aspiration entails high rate of recurrences.

[Study on the activity of a therapeutic bacterial combination in intestinal motility disorders in the aged]

The possible beneficial effects and changes in the histology of the duodenojejunal and colonic mucosa brought about by oral bacterial therapy were studied in 60 elderly patients (mean age +/- SD: 76.6 +/- 5.3 years) with bowel disorders mainly represented by diarrhea accompanied by abdominal pain and meteorism. All patients were submitted to a 7-day washout followed by treatment with 6 capsules daily, each capsule containing live, lyophilized Lactobacillus acidophilus (10(9) CFU/ml). The clinical course was observed in 50 patients while the remaining 10 were hospitalized and submitted to esophago-gastro-duodenoscopy and colonoscopy both before and after treatment for withdrawal of duodenal secretion and fragments of duodenojejunal and colonic mucosa biopsies. Duodenal secretion was examined bacteriologically, and after treatment an increase of the anaerobic flora at the expense of the aerobic one was found together with improved quality of the former. Histologic examination showed reduction of the inflammatory infiltration by lymphocytes and plasma cells and increased muciparous activity of the glands. Clinically, a marked improvement of the symptoms was observed in all 60 patients.

Expression of cell cycle-dependent genes and proliferative state of lymphocytes in aging

The authors analyzed the expression of some genes involved in the control of T lymphocyte proliferation in a group of healthy elderly subjects. They focused their attention on genes involved in the G(0)/G(1) transition (TK, PCNA, H3, IL2-R) and showed decreased expression in the TK, H3 and IL2-R genes. Using flow cytofluorimetry, delayed transition from the G(0)/G(1) to the S stage was observed.

Continuous subcutaneous insulin infusion: a long-term study

The authors report data obtained from a 3-year study of CSII and humanized insulin (semi-synthetic human insulin) administered to 18 insulin-dependent subjects in the outpatient clinic. The aim of this study was to evaluate the validity of insulin pumps in long-term treatment. Metabolic parameters were significantly improved (p less than 0.001) in the first month and remained so with only slight alterations throughout treatment. The authors underline some metabolic problems (ketosis) caused by malfunctioning of the insulin pumps, by the difficulties with the infusion system or by nodular skin lesions at the infusion site. Only these lesions called for treatment to be discontinued in 4 patients. The highest incidence of nodular skin lesions was seen after one year's uninterrupted treatment and they seem connected to the duration of treatment rather than to the patients' negligence (inadequate hygiene, delayed needle substitution). The authors conclude that CSII treatment is valid over short-term periods, whereas it presents drawbacks over long-term administration.

Triiodothyronine and thyrotropin-releasing hormone interaction on TSH release in man

In order to study thyrotropin releasing hormone (TRH)-thyroid hormone interaction, we examined thyrotropin (TSH) behaviour after synthetic TRH administration in 24 euthyroid subjects, 3 patients with primary hypothyroidism and 10 hyper thyroids. 8 normal subjects were studied before and after triiodothyronine (T₃) treatment with increasíng TRH dosage. Our results suggest that (1) TRH-thyroid hormone interaction is dose-related: this means that TSH response to TRH depends on both thyroid hormone and TRH concentration; (2) T₃-TRH interaction on TSH release is only roughly quantitative since it is suggested that other extrathyroidal factors interfere with this mechanism controlling TSH secretion.