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Abstract: The classical orthotopic liver autotransplantation is a very challenging and time wasting technique; it includes the division of major hepatic vessels and choledocus, and subsequent reconnection by end to end anastomoses. The caval end to end anastomoses are the most difficult to be performed and the interposition of a prosthesis can be required. We adopted the classical orthotopic liver autotransplantation technique in 2 patients affected with diffused liver metastases from colorectal cancer, for extracorporeal neutron capture therapy (BNCT). The procedure required very long operating times and the extracorporeal circulation (ECC) set up; furthermore the vena cava reconstruction was performed by the interposition of a goretex-prosthesis. We propose a “modified orthotopic piggy-back technique” to simplify liver reconnection and shorten the operating time. Materials and methods: The technique was developed in the swine (25kg body weight), under general anaesthesia. We performed the resection of the retro-hepatic vena cava with preservation of the caval flow during the anhepatic phase, by interposing a goretex-prosthesis. The reconstruction of the vena cava was then performed by a side-to-side cava-prosthesis anastomosis with lateral clamping of the prosthesis. The procedure was then completed according to the classical technique of liver transplantation. Results: The mean time for VC reconstruction was 56 (±10)min. and the mean time for side-to-side VC-prosthesis anastomosis was 13(±4)min. Conclusions: The “modified orthotopic piggy-back technique” can simplify the reimplant of the liver during autotransplantation and shorten the operating time. Furthermore also the time of total extracorporeal circulation is reduced, as during the anhepatic phase and during the side-to-side cava-prosthesis anastomosis the flow in the inferior vena cava is uninterrupted. [Copyright &y& Elsevier]

The aim of this study was to assess the combination of tiletamine-zolazepam (Zoletil 20 ) with three different doses of clonidine for general anaesthesia induction in rats submitted to vascular microsurgery. The evaluation of anaesthetic and analgesic effects was performed in 30 Wistar rats randomly divided into three groups and induced with Zoletil 20 [90 mg/kg Intraperitoneal (IP)] associated with three different doses of clonidine (60-90-120 µg/kg IP). Four clinical parameters were evaluated after induction: loss of righting reflex, voluntary movement, the pedal withdrawal response, and pain sensitivity tested by pinching the tail. The combination of Zoletil with 90 and 120 µg/kg of clonidine provided a surgical anaesthesia; however, 90 µg/kg of clonidine provided the most rapid anaesthesia induction, as confirmed by data obtained by clinical evaluation of the loss of the pedal withdrawal response and the absence of the tail pinch response. The increase in dose of clonidine did not lead to a more rapid action of the a2 agonist, probably due to achievement of a dose-dependent plateau. [ABSTRACT FROM AUTHOR]

Abstract: The ability to selectively hit the tumour cells is an essential characteristic of an anti-tumour therapy. In boron neutron capture therapy (BNCT) this characteristic is based on the selective uptake of 10B in the tumour cells with respect to normal tissues. An important step in the BNCT planning is the measurement of the boron concentration in the tissue samples, both tumour and healthy. When the tumour is spread through the healthy tissue, as in the case of metastases, the knowledge of the different kinds of tissues in the sample being analysed is crucial. If the percentage of tumour and normal tissues cannot be evaluated, the obtained concentration is a mean value depending on the composition of the different samples being measured. In this case an imaging method that could give information both on the morphology and on the spatial distribution of boron concentration in the sample would be a fundamental support. In this paper, the results of the boron uptake analysis in the tumour and in the healthy samples taken from human livers after boron phenylalanine (BPA) infusion are shown; boron imaging was performed using neutron autoradiography. [Copyright &y& Elsevier]

Abstract: Almost eight years ago, in December 2001, we performed for the first time in the world thermal neutron irradiation on an isolated liver of a patient. The organ was affected by diffuse metastases of a colon carcinoma and had been previously loaded with a 10B compound. In July 2003, the same procedure was applied again on a patient for the treatment of unresectable and incurable hepatic metastases of a carcinoma of the rectum. Both patients are dead at present. Now we can analyze in depth the clinical history of these patients and evaluate the effectiveness of this therapy. From this exciting experience we learned much, and we also found out about complications till then unknown, which need to be studied and addressed experimentally. Unfortunately we can base our conclusions just on the experience we had with these two patients. We could have been much more detailed and firm in our statements if the number of clinical cases was larger. The BNCT Pavia project has been suspended, but it is more than likely to resume in a short time. Good findings were many. The procedure is feasible; the original concept of complete immersion of the diseased liver in a homogeneous neutron field proved effective and winning. The tumor masses resulted completely necrotic and unknown metastases too appeared radically treated; healthy hepatic tissue was preserved from both morphological and functional points of view; no symptoms of cirrhosis appeared even four years after treatment. For the long term surviving patient, quality of life was excellent. Other findings require to be tackled in depth. The “post-irradiation syndrome” we observed in both patients, with identical symptoms and biochemical derangements, creates a dramatic—even though totally reversible—clinical condition, that is the probable cause of death for our second patient, suffering from cardiomyopathy, 33 days after treatment. For the first patient, recurrences were a late yet fatal complication, for which even a further surgical revision was ineffective. We offer some hypotheses about their origin and possible prevention. [Copyright &y& Elsevier]