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Purpose Hemolysis is a frequent adverse effect of ribavirin (RBV). Oxidative stress has been suggested to play a role, but mechanisms and predictive risk factors are unknown. Methods: Markers of redox status were determined in erythrocytes from hepatitis C infected patients with and without G6PD-deficiency before and during RBV treatment, and erythrocytes were incubated with RBV and dipyridamole, diethylmaleate or glutathione ester. Results: 5 out of 30 patients developed major RBV-induced hemolysis, which was associated with a more pronounced increase in thiobarbituric acid reactive substances (+22.5 vs. +9.4 nmol/gHb, p

With the usual echographic technics, the Wirsung duct, when dilated can be only episodically seen: the seesaw motion of the transducer produces some undesirable echoes, which rub out the lumen of the Wirsung duct. In order to obtain steadily pictures of the dilated Wirsung duct, the transducer must be used with a sweep motion in only one direction, while a positive pressure is exerted on the epigastrium. When transversally intersected, the Wirsung duct appears spindle shaped; it can be displayed on a rather good length. When sagittaly intersected, it presents, itself like a curved shaped picture, 4 mm to 2 cm in diameter, empty of echoes, in the center of the pancreatic section. The Wirsung duct, with the former technics, had been displayed 20 times in 140 cases of chronic pancreatitis; whe have found it in 4 cases in our 10 last cases of chronic pancreatitis. These case have been verified by endoscopic Wirsungography.

The contribution of echotomography in the surgical approach to intra-abdominal masses is illustrated through description of several clinical observations. In order to effect frontal reconstruction of ultrasonic seriography, the authors used a manual-scanning B echotomograph probe working in the range of grays. This technic afforded detection of the intraperitoneal and extraperitoneal abdominal masses under investigation as well as precise definition of their location, size, and nature. Because of its rapidity and painlessness, echotomography should be adopted as firstchoice procedure for the diagnostic exploration of intraabdominal masses. Frontal reconstruction enables the surgeon to verify the topography of said masses with remarkable precision, and hence to plan surgery more intelligently.

Calcitonin (CT) is a 32 amino acidic polypeptide hormone which has been found in almost all species and whose effects are mainly concerned with calcium and phosphorous homeostasis. Three preparations are employed for therapeutic uses: salmon (sCT), porcine (pCT) and human CT (hCT). The sCT is the most powerful one and in human volunteers a strong relaxing effect has been shown on gallbladder (GB) basal volume and emptying in response to a meal, intraduodenal instillation of a liquid meal and i.v. cholecystokinin (CCK) infusion. Our study was aimed at investigating if a direct sCT effect could be demonstrated on smooth muscle strips from guinea pig GBs "in vitro" (organ bath). Isometric contractions were measured in response to maximal doses of acetylcholine (ACh: 10(-4) M), KCl (80 mM) and cholecystokinin octapeptide (CCK-OP: 10(-6) M), in absence and in presence of four doses of sCT (1 x 10(-9), 1 x 10(-8), 1 x 10(-7) and 1 x 10(-6) M). sCT did not affect the initial strip basal tone. ACh, CCK-OP and KCl caused, as expected, a powerful contraction of the strips, but no effect was shown when each of the sCT doses was administered before ACh (1.28+ 0.69 SEM without sCT vs 1.28g+ 0.69 with sCT; n = 6) and CCK-OP (1.46g+ 0.19 without sCT vs 1.46g+ 0.19 with sCT; n = 8) or 5 min after the induced KCl contraction. On the basis of these preliminary results, we conclude that no evidence of a direct sCT effect was found on guinea pig GBs when considering either basal smooth muscle tone or isometric contraction in response to ACh, KCl and CCK-OP. Further studies are therefore required to clarify the influence of CT on GB dynamics in vivo and to elucidate its the physiological significance.

In order to verify the influence of the adrenergic system on the gallbladder contraction the Authors studied the effect of isometeptene, a sympathomimetic drug active on beta receptors, on gallbladder emptying. The gallbladder was studied on 6 subjects using a real-time (linear array) equipment with a 3,5 MHz transducer. In fasting subjects the gallbladder emptying was obtained by a fatty meal. In the next day the fatty meal stimulation was associated with the administration of isometeptene. The mean values +/- S.D. of the follow parameters were evaluated: -gallbladder basal volume -gallbladder residual volume both after fatty meal and after the association with isometeptene -gallbladder maximum emptying percentage in two experiences. The results show that the isometeptene doesn't inhibit significantly the gallbladder emptying induced by a fatty meal.

The use of inert plastic (Prolene mesh, 0,027 inches in thickness fournited by Ethicon) as preperitoneal prosthesis in repair of incisional hernias and inguinal hernia recurrencies has been investigated in 28 patients operated upon then 1977 to 1984. In 9 patients the inguinal approach was used with one recurrence (11%). In 9 patients the posterior approach through a midline incision has been used with two recurrences (22%). In 10 patients with incisional hernias there was only one recurrence (10%). Total recurrences rate was 14%. Most recurrences occur in patients operated from 1977 to 1980 (40%). Patients operated in the last period from 1980 to 1984 had no recurrences.

The investigation methods of gallbladder physiology in normal man are usually limited because often they are invasives and hazardous (radiations). The gallbladder size was accurately evaluated by US with study "in vitro". The variations in gallbladder-size measurements in the same observer and among many observers by US, demonstrate that Real-Time ul-ultrasonography is a simple, accurate, non-invasive and potentially valuable mean in the study of gallbladder motility.

The simultaneous effects of acute i.v. ethanol administration (1.3 gm./kg.) on pancreatic and gastric acid secretion was studied on dogs provided with chronic pancreatic and gastric fistulas (Thomas cannula) and subjected to a continuous i.v. injection of GIH secretin (0.5 CU./kg./hr.) and gastrin (Eurorga hog gastrin I-II, 6 gamma/kg./hr.). Acute i.v. ethanol inhibits the pancreatic secretion of protein (concentration and output) and stimulates gastric acid secretion. Experiments were repeated: 1. Superimposing an atropine infusion (1.0 mg./hr.) on the continuous hormonal perfusion. 2. After reserpine administration for 48 hours (0.10 mg./kg./24 hr.) Atropine abolished the ethanol-mediated inhibition of pancreatic protein secretion but did not prevent the alcohol-mediated gastric acid stimulation. Reserpine did not change the ethanol-mediated pancreatic inhibition. It is assumed that in nonalcoholic dogs, i.v. ethanol inhibits pancreatic secretion by an intermediate nervous mechanism and enhances gastric acid secretion by acting directly on the oxyntic cells. Reserpine induces a high plateau level of HCl secretion which obscures the ethanol-mediated excitatory influences on the oxyntic cells.

10 esophagojejunostomies by EEA Stapler were performed on adult patients (8 males and 2 females, mean age 54 years), after total gastrectomy for gastric cancer. No postoperative bleeding or stricture were observed. 2 anastomotic leaks occurred (20%). The major cause of anastomotic failure is probably technical (incorrect assembly or lubrication of the instrument). According to the our experience and to literary data, the use of stapling devices for performance of esophagojejunostomies is recommended.

In 4 patients who under went low anterior resection for cancer of mid and lower 1/3 of the rectum, with colo-rectal anastomosis by posterior transphinteric approach, anorectal pressure profiles have been studied by open tip technique 30 d. 6 months following operation. Bowel movements, gas and feces discrimination and anal continence were also controlled. Resting pressure, delta % pressure changes during recto-anal reflex, pressure in voluntary contraction, altered in the first post-operative period, become normal in 6 months. Although volume and pressure at urgent rectal sensation, volume and rectal sensation and compliance altered after surgery did not change after 6 months, suggesting that the reservoir function of the rectum is lost, patients achieved a good control of bowel movements, and a good gas and feces discrimination and anal continence within the first 6 months of operation.

To assess the prevalence of gallstone disease and the behavior of gallbladder (GB) volume in childhood and adolescence, an ultrasonographic survey was carried out on 1570 subjects (age range 6-19 yr). Entered in the study were 750 males and 752 females (attendance rate, 95.7%). Gallstones were detected in two females aged 13 and 18 yr, respectively. None of the subjects in the study population had undergone cholecystectomy. The overall prevalence of gallstone disease was equal to 0.13% (0.27% in the female sex). A positive family history for biliary calculous disease was present in one of the two lithiasic girls. A progressive increase of GB volume with age was observed in both sexes, and figures were greater in males, than in age-matched females. A positive and statistically significant relationship was found between GB volume and body mass index (BMI) in both sexes. Obesity was recognized in 188 males (25.3%) and 167 females (25.0%). Obese subjects exhibited larger GB volumes than the nonobese age- and sex-matched controls. The study supports the view of a very low prevalence of gallstone disease in people younger than 20. It also provides information on GB size in relation to age, sex, and BMI.

The gallbladder volume has been evaluated in 22 normal volunteer subjects (12 men and 10 women) by the real time ultrasound B scanning, using the formula V = 1/6 abc (a = length; b = width, c = antero-posterior diameter). The fasting GB volume, the residual GB volume after Bronner's meal (every 15 min. for 90 min.) and the maximum emptying (%) were evaluated in each subject. It was not observed any statistically significative difference between the two groups (fasting volume: 18.5 +/- 6.0 ml in men and 15.2 +/- 5.1 ml in women; residual volume: 4.3 +/- 1.5 ml in men and 3.5 +/- 1.3 ml in women). The maximum GB emptying in women occurs later. In order to verify its reproducibility, the experience has been repeated in two different days in seven men without any statistically significative difference.

Sequential changes in pancreatic secretion were evaluated during a 2- to 3-year follow-up study in 8 dogs provided with Thomas gastric and duodenal fistulas. Four animals were given intragastric ethanol (2 g kg-1) daily for 3 years; 4 others served as controls. In alcohol-fed animals: (1) Flow rate and bicarbonate output in response to 1 clinical unit kg-1 hr-1 of secretin were increased at the end of 2 years but not after 1 year of alcohol feeding. (2) At the end of 2 years, the dose-response curve of pancreatic secretion to cholecystokinin was unchanged but the maximal bicarbonate and water secretion in response to high doses of secretin were increased. Modifications (1) and (2) are explained by reduplication of pancreatic ducts secondary to the development of chronic pancreatitis, verified by biopsy. (3) The previous report by our group of an increased cholecystokinin release in the course of chronic alcohol consumption in dogs seems to be attributable to an artefact. This work shows that the pancreatic response to intraduodenal oleic acid is not significantly modifed by 3 years of alcohol feeding.

Two groups of men, nonalcoholics (mean daily alcohol consumption less than 40 g) and alcoholics (mean daily alcohol consumption greater than 100 g) were compared with respect to the effects of intravenous ethanol on hormonally (secretin + CCK) submaximally stimulated pancreatic and bile secretion and chymotrypsin secretion during the basal state and after a Lundh test meal. Intravenous ethanol injection (600 mg/kg) significantly decreased pancreatic secretion of lipase (-74%), chymotrypsin (-78%), volume (-53%), and bicarbonate (-58%) in nonalcoholic but not in alcoholic men: The secretory pattern of the exocrine pancreatic response to an intravenous infusion of ethanol was therefore changes by the regular consumption of ethanol. The chymotrypsin concentration during the basal state was higher in alcoholic than in nonalcoholic men. This difference progressively disappeared after a test meal showing that chronic alcohol consumption modifies more basal than meal-stimulated pancreatic secretion.

In five dogs, provided with chronic pancreatic and gastric fistulas (Thomas' cannula), the effects on exocrine pancreatic secretion of an intravenous continuous perfusion of gastrin (Eurorga, hog gastrin I-II, 6 mug./kg./hr.) and secretin (GIH, 0.5 C.U./kg.hr.) was studied before and after 48 hours of reserpine treatment (0.1 mg./kg./24 hr.). When compared with the pretreated plateau levels, reserpine induced a significant pancreatic secretion dissociation, a depressive of the alkaline and a rising of the protein component. The former phenomenon suggests a participation of a catecholamines in the secretin-elicited pancreatic electrolyte secretion. The latter, an enhanced sensitivity of intranpancreatic and/or acinar cells of the "pancreon" to gastrin stimulation.

In 14 duodenal Thomas fistula dogs, four of them alcohol-fed for two years, lidocaine, applied topically to the duodenal pancreatic papilla, inhibited secretin-induced pancreatic secretion probably by interrupting duodenopancreatic reflexes that contribute to the "pancreon's" cholinergic tone. Opposite effects were observed with lidocaine administered against a CCK plus secretin background stimulation of the pancreas. The significant rising of volume and protein output above plateau levels were enhanced by chronic alcohol feeding. Lidocaine infused intravenously did not change secretin-induced pancreatic secretion but raised CCK and secretin evoked plateau secretion levels. Chronic alcoholism enhanced these latter effects. Atropine perfusion superimposed on CCK and secretin stimulation did not prevent but raised the intravenous lidocaine-induced pancreatic secretion changes. It is postulated that the modifications elicited by lidocaine sprayed topically and infused intravenously on CCK plus secretin evoked pancreatic secretion plateau levels are due to depression of an anti-CCK factor secreted by the small intestine mucosa.

In conscious dogs, provided with gastric and duodenal fistulas (Thomas cannula), the effect of an acute i.v. calcium infusion (10 mg./kg./hr.) on the plateau levels of secretin-induced (GIH, 1 CU./kg./hr.) pancreatic juice parameters were analyzed without or with previous cholingergic blockade by a continuous atropine perfusion (1.5 mg./hr.). In the former condition, i.v. calcium raised all pancreatic juice parameters, mainly protein concentration (148%) and output (173%). During atropine blockade, i.v. calcium changed neither flow rate nor bicarbonate output of secretin-induced pancreatic secretion. On the other hand, i.v. calcium exerted a reduced but still evident effect on protein concentration (85%) and output (40%). Intravenous calcium enhances secretin-induced pancreatic secretion plateau values through two mechanisms, mainly by raising the cholinergic tone of the whole "pancreon" and, partially, through a direct stimulus-secretion coupling effect on the acinar cells. Acute hypercalcemia induces the formation of protein plugs in the pancreatic secretion. They are excreted in the course of many days in both basal and secretin-stimulated pancreatic juice.

Previous research has shown that MVO (Maximum Venous Outflow), VR (Venous Reflux), VE (Venous Emptying) and the respiratory waves recording are useful in differentiating occlusion and recanalization in postphlebitic syndrome. In the present work strain-gauge plethysmography was employed to quantitate the venous function after deep venous thrombosis of the legs. The studies were performed in a vascular laboratory with controlled temperature (23 to 25 C); records were obtained by a plethysmograph Parks mod. 270 connected to a Hewlett-Packard multi-channel mod. 7700. 17 patients (12 males, 5 females), mean age 55 years (range 24-75) that presented femoropopliteal thrombophlebitis documented by phlebography at the admission to the hospital were examined. MVO with and without superficial veins occlusion was measured by a mercury in silastic strain-gauge placed circumferentially about the calf. A pneumatic cuff thigh was inflated to 60 mm Hg. VE was measured in patients lying in inclined bed with the lower extremities 100 cm below the heart level compressing the calf with a pneumatic cuff 10 times for 5 seconds; the strain-gauge was placed on the foot level. VR after Valsalva's maneuver and the respiratory waves were recorded by a strain-gauge positioned at the maximum girth about the calf in patients lying on inclinated bed with the lower extremities 50 cm below the heart level. The result are here indicated: (Table: see text) There was differences in the evolution of venous function after deep venous thrombosis of the legs for each patient. Strain-gauge plethysmography may become evaluable non invasive technique in the evaluation of deep venous thrombosis evolution in the legs. The therapeutic assessment of postphlebitic syndrome.

The tensiometric properties of smooth muscle strips from 10 male guinea pig gallbladders were evaluated following acetylcholine (ACH), cholecystokinin octapeptide (CCK-OP), cerulein (CRL) and histamine (HIS) administration. All agonists induced dose-dependent tonic contractions with the maximum effect caused by the octapeptide. CRL showed a 9-folds higher relative potency when compared to CCK-OP. ED50s of agonists were: ACH 1.36 +/- 0.28 SEM microM (n = 14; range 0.20-3.60); HIST, 5.7 +/- 1.9 microM (n = 12; range 1-23); CRL 0.72 +/- 0.15 nM (n = 8; range 0.35-1.07); CCK-OP, 6.77 +/- 1.80 nM (n = 12; range 0.44-20.32); For the same strips, max tension (g), was: 1.97 (SEM 0.12) for ACH; 1.5 (0.18) for HIST; 1.81 (0.18) for CRL; 2.44 (0.14) for CCK-OP. Pretreatment of the strips with atropine (1 microM) completely abolished ACh-induced contractions, without affecting either CCK-OP or CRL responses. The model represents a valid "in vitro" study of different molecules whose action might stimulate, enhance or inhibit the physiological hormonal and non-hormonal effect of the agonists at the level of animal and human gallbladder smooth muscle.

In 16 patients affected by cancer of the mild or lower 3 of the rectum, has been performed a colorectal anastomosis by EEA Stapler, with abdomino-transanal approach. In the postoperative period no case of anastomotic bleeding or stenosis has been observed. 3 patients (18%) presented minor anastomotic dehiscence detected by radiologic examination, without clinical symptomatology. The EEA Stapler anastomosis seem sure almost as the traditional hand sutures, and allow the execution of anterior resection instead of abdominal perineal amputation of rectum.

The secretion of lipase, chymotrypsin and total protein secretion was measured on the pancreatic juice collected from the cannulated pancreatic duct of four dogs. The results suggest that the lipase and chymotrypsin can be secreted independently of each other.

In dogs provided with chroinic pancreatic and gastric fistulas (Thomas canula), one of them vagotomized and alcohol-fed for 17 months with 50% (v/v) intragastric ethanol (0.2gm./kg.), an atropine perfusion (1.0 mg./hr.) superimposed on a continuous i.v. injection of secretion (GIH, 1.0 CU./kg./hr.) and CCK (GIH, Crick, Harper 3.0 U./kg./hr) prevents the excitatory effects on pancreatic secretion of an acute i.v. ethanol infusion (1.3 gm./kg.). In alcohol-fed dogs, the i.v. ehtanol-induced excitatory effect on 'pancreon' is exerted through a cholinergic mechanism, elicited at the hypothalamic bulbar centers and/or the intrapancreatic ganglia.

Gastirn blood levels after the ingestion of a meat meal, either alone or associated with ethanol (1.0 gm./kg.), are higher and better sustained in dogs treated chronically with alcohol than in control animals. This greater gastrin-releasing capacity of the dog gastric antrum would be responsible for the increased parietal cell mass and gastric acid secretion shown by animals subjected to chronic alcohol intoxication.

L'agire politico tra determinismo e creatività. Cenni di una teoria postmoderna.