Identification of the Serum Complex Which Induces Cerebellar Granule Cell In Vitro Differentiation and Resistance to Excitatory Amino Acids

The protein complex promoting in vitro terminal differentiation of cerebellar granule cells has been isolated from rabbit serum. We designate the complex the neurite outgrowth and adhesion complex (NOAC). The apparent molecular weight, evaluated by gel filtration, is 80 - 100 kDa. Rat cerebellar granule cells cultured in NOAC exhibit much lower glial cell contamination and survive, in their differentiated state, much longer than in 10% foetal calf serum. While they bind tetanus toxin, express specific antigens such as synapsin I, synaptophisin and A2B5, and release [3H]d-aspartate in a fashion similar to that shown by cells cultured in foetal calf serum, they show a 60% reduction in the total number of kainate binding sites. Excitatory amino acid (EAA)-triggered and depolarization-stimulated calcium influx, measured in the presence of different agonists, is 50 - 80% lower in NOAC-cultured cells. NOAC cells are resistant to excitotoxic stimuli carried by EAAs or by depolarizing treatments with 50 mM KCl or 6 microM veratridine. The marked resistance of NOAC-cultured neurons to EAAs can be attributed to decreased calcium entry through EAA-coupled and voltage-gated calcium channels and possibly to other, as yet unidentified, phenotypic properties of these cells. These findings demonstrate that rabbit serum contains one or more polypeptide(s) endowed with the properties of promoting in vitro survival and differentiation of rat cerebellar granule cells and of conferring an EAA-resistant phenotype.

Thoracoscopic truncal vagotomy

BACKGROUND

Nowadays the only indications to truncal vagotomy is recurrent ulceration after previous gastric surgery. Truncal vagotomy allows us to obtain a reduction in acid production and to promote ulcer healing, but this technique causes pylorospasm in about 20% of cases and this requires further synchronous or metachronous pyloric drainage procedure. For this reason, videothoracoscopic truncal vagotomy is reserved to patients with gastroresection.

METHODS

The authors describe 15 patients treated with videothoracoscopic truncal vagotomy. In 12 patients, a gastrojejunostomy was done according to Roux technique in 2 patients, a reconstruction according Billroth II technique and in 1 patient, a gastroduodenostomy according to Billroth I technique.

RESULTS

Videothoracoscopic bilateral truncal vagotomy was done in all patients; operation time was 45 minutes. During the postoperative period there were no complications. No patients underwent medical therapy for peptic ulcer. Only in 12 patients was it possible to execute an endoscopic follow-up in a period of 3 to 4 years. In all patients the ulcer was completely healed.

CONCLUSIONS

Complete vagotomy in patients who present with recurrent gastrointestinal bleeding after previous gastroresection, is associated with significant risks. Videothoracoscopic bilateral truncal vagotomy as a simple and efficient procedure seems to be an alternative treatment for the management of recurrent ulceration after previous gastric surgery for peptic disease.

[Colo-anal anastomosis in tumors of the lower rectum]

The Authors report their experience about totally mechanical coloanal anastomoses. Seven patients affected by rectal cancer and submitted to proctosigmoidectomy and, following totally mechanical coloanal anastomoses as described by Goligher are taken in consideration. The distance of the neoplasm from the anal verge goes from 5 to 7 cm. Using Dukes classification 6 patients were classified in B stage, only 1 in A stage and nobody in C stage. No patient received adjuvant radiotherapy. In the patients in B stage has been performed an extended ilio-pelvic lynfoadenectomy. Particular attention was put on the complete remotion of the mesorectum. In no case has been provided with a creation of a diverting colostomy. No mortality in the post-operative period nor anastomotic leakages haven't been recorded. The follow-up goes from a minimum of 8 months to a maximum of 7 years. Have been reported 2 cases of recurrence, at pelvic level after 18 months and at empathic level after 8 months from intervention. In 6 of the 7 patients have been valued the functional results that have put in evidence a satisfying gas and fecal continence. Only during the first months following the intervention has been recorded an increasing of the number of defecation that have reduced in the long term.

Manometric evaluation of jejunal limb after total gastrectomy and Roux-Orr anastomosis for gastric cancer

Total gastrectomy with Roux-Orr anastomosis is frequently performed for gastric cancer. Since intestinal motility of the Roux limb has never been evaluated after this operation, pressure activity was investigated in the Roux limb of ten patients (aged 51-77 years) who had undergone total gastrectomy and Roux-Orr reconstruction. Investigations were carried out during a 6-h fast and 3 h after a 605 kcal mixed meal. During fasting only two patients had activity fronts and these were abnormal. All ten patients displayed non-propagating bursts of contractions and three had discrete clustered contractions and high amplitude jejunal contractions. The fed state was characterized by a severely reduced motor activity pattern and other abnormalities. Total gastrectomy with Roux-Orr anastomoses provokes a relatively severe disturbance in intestinal activity.

[Use of diverse prosthetic materials in preparation of sequential bypasses in combined lesions of the aorto-iliac-femoral axis]

A series regarding three years of surgery is analysed with regard to the preparation of four sequential by-passes out of 23 aorto-bifemoral revascularisations. Indications and the eminently technical aspects are discussed, the latter consisting of the adoption of two types of different prostheses sutured one to the other, such as the Dacron and the PTFE prostheses, which proved to be very compatible and long-lasting. The results were excellent as is testified by the follow-up.

[Stapler reconstruction after total gastrectomy contrasted with manual anastomosis]

A personal series (1985-1987) of 22 cases of total gastrectomy for cancer is analysed, a comparison being made between 11 cases treated with manual anastomosis and 11 reconstructed using a stapler. The advantages and disadvantages of the various techniques are examined and although no substantial difference is noted between the two reconstructive modalities, at least as regards morbidity and mortality, stress is laid on the unquestionable advantages of mechanical staplers. These are essentially speed of execution, suture perfection and excellent long-term results.

[Methods for preparing patients to vascular surgery. Our experience]

A personal series covering two years of vascular surgery involving 58 cases without problems of sepsis has been examined. The modalities employed for preventing wound infections and prosthesis suppuration when it occurred and consisting of showers, antibiotic prophylaxis and shaving are reported. In conclusion it is maintained that a specific, disciplined protocol must be followed in all candidates for prosthesis.

[Indications and technics of the surgical treatment in iliaco-femoral thrombophlebitis in the acute phase]

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.