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Introduction: Endovascular aortic repair (EVAR) has significantly altered the therapeutic strategy for abdominal aortic aneurysm (AAA), due to less invasiveness and lower perioperative morbi-mortality. However, specific complications such as persistent type 2 endoleak (pT2E, present > 6 months after EVAR) have been associated with adverse outcomes. However conflicting results from heterogeneous studies, failed to support an optimal threshold for intervention. The purpose of this study was to identify predictive factors associated with pT2E., Methods: The clinical data of the last 100 patients admitted for EVAR in our hospital until April 2016 were retrospec- tively reviewed. Statistical analysis was performed using SPSS V.22., Results: We analyzed 100 cases of EVAR, performed with a branched stentgraft for AAA or aorto-iliac aneurysms. Most cases (n=83) were performed electively but 17 were performed for ruptured AAA. No pre-operative inferior mesen- teric artery (IMA) coil embolization was performed. A pT2E was observed by Computed Tomography Angiography (CTA) in 21 cases (21%). Univariate analysis of risk factors for pT2E revealed that the number of patent lumbar arteries, patent IMA, platelet antiaggregants, absence of thoracic aortic aneurysm, and ruptured AAA were risk factors for pT2E (p<0.05). Binary logistic regression concluded platelet antiaggregants and increasing number of patent lumbars were independent risk factors for pT2E (p<0.05)., Discussion: Recently, pT2E that persists over a long period of time following EVAR has been reported to be involved in aneurysm sac growth, open conversion and rupture. Identification of pT2E predictive factors is crucial to prevent compli- cations and to consider measures such as pre-operative IMA coil embolization. We identified the number of patent lumbar arteries, the presence of patent IMA, platelet antiaggregants, absence of thoracic aortic aneurysm and ruptured AAA as sta- tistically significant risk factors for pT2E (p<0.05).

Introduction: Coronary spasm can cause myocardial ischemia and angina in both patients with and without obstructive coronary artery disease. However, provocation tests using intracoronary acetylcholine (ACh) have been rarely performed in the Western world., Case Report: We report a case of a 75-year-old woman with a history of hypertension and a mechanical aortic prosthesis who presented in the emergency room with acute-onset chest pain, widespread ST-segment depression and severe left ventricular systolic dysfunction, with no signs of prosthesis dysfunction. Emergent coronary angiography excluded obstructive coronary artery disease. Pain relief and normalization of ST segment and systolic function occurred within six hours. The patient was treated for a possible thromboembolic myocardial infarction and was discharged home asymptomatic. Two weeks later, cardiac magnetic resonance was performed showing inferoseptal transmural infarct scar, inferior and inferolateral subendocardial infarct and mid-basal ischemia in the anterior and anterolateral walls. She was readmitted with recurrence of chest pain and it was decided to perform a provocation test with ACh. After injection of ACh into the left anterior descending artery, chest pain, ST-segment depression, blood flow impairment (TIMI 1) and transient grade 3 atrioventricular (AV) block occurred. Intracoronary administration of nitrates reversed the coronary spasm and AV conduction disturbances. Twenty minutes later, chest pain and ischemic ST changes recurred; there was no response to vasodilators and the patient developed cardiac arrest with pulseless electrical activity. Advanced life support was maintained for 32 minutes without return of spontaneous circulation., Conclusions: Provocation tests have a high sensitivity and specificity for the diagnosis of vasospastic angina. Although it is rare, these tests have the potential risk of irreversible spasm leading to arrhythmia and death., (Crown Copyright © 2015. Published by Elsevier España. All rights reserved.)

Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA or Bland-White-Garland Syndrome) is a rare congenital heart abnormality with a high mortality in the first year of life. It's manifestation in adulthood is even rarer and it may be an important cause of sudden cardiac death. We report a case of a young female who survived from a cardiac arrest, with overweight and an asymptomatic cardiac murmur without any structural abnormality, having been diagnosed ALCAPA syndrome that was subsequently surgically corrected.

Patient: Female, 58., Final Diagnosis: Acute hear failure., Symptoms: Dispnoea • edema • fatigue., Medication: —, Clinical Procedure: Bone marrow biopsy • endomyocardial biopsy • abdominal subcutaneous fat biopsy under ECMO support., Specialty: Cardiology., Objective: Rare disease., Background: Cardiac amyloidosis results from the amyloid deposition in heart tissue, either in the context of a systemic disease or as a localized form. Several pro-amyloid proteins can produce amyloid deposits in the heart. Each of these amyloidoses has characteristic clinical (cardiac and extracardiac) features, and a specific diagnosis and treatment., Case Report: A 58-year-old woman who presented with acute heart failure and echocardiographic findings strongly suggestive of infiltrative cardiomyopathy needed percutaneous veno-arterial extracorporeal membrane oxygenation (ECMO) as bridge-to-decision. Amyloid deposition was found on endomyocardial and bone marrow biopsies. Bone marrow plasma cell infiltrate with acute renal lesion and hypercalcemia confirmed the diagnosis of multiple myeloma-associated systemic light-chain amyloidosis (AL). Refractory shock with multi-organic failure syndrome persisted and no improvements in left ventricular function and structure were seen. After extensive discussion by a multidisciplinary team, and with the patients' family, she was not considered eligible for high-dose chemotherapy and/or autologous stem cell transplantation, heart transplantation, or sequential heart with autologous stem cell transplantation. The patient died a few hours after ECMO withdrawal. During the 14 days of ECMO support no major bleeding or thrombotic complications occurred., Conclusions: The clinician must consider a diagnosis of cardiac amyloidosis in patients with heart failure, a restrictive type of cardiomyopathy with ventricular hypertrophy in the absence of valve abnormalities, or uncontrolled arterial hypertension. Although developments in chemotherapy have greatly improved the outcomes in AL amyloidosis, the prognosis of patients with severe cardiac involvement remains very poor. ECMO is potentially a reliable bridge-to-diagnosis and bridge-to-decision in these patients. An experienced ECMO team, careful patient selection, and rigorous management protocols with objective criteria to wean or stop ECMO are needed.

The clinical and autopsy findings of a 66-year-old man with myocardial infarction complicated by reperfusion injury are described, highlighting the presence of large myocardium calcium deposits., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Serotonin syndrome is a potentially life-threatening drug effect. It may be misdiagnosed because it has mostly been reported in adults. Case Report. An 8-year-old girl with behavioral problems and medicated with risperidone and sertraline was admitted in the emergency department after she had taken voluntarily 1500 mg of sertraline (50 mg/kg). At admission, she had marked agitation, visual hallucinations, diaphoresis, flushing, and tremor. She had fever and periods of hypertension. She also showed generalized rigidity and involuntary movements. She was treated with fluids and iv diazepam, midazolam, clemastine, and biperiden. As the patient presented a severe insomnia and a progressive rhabdomyolysis, she was transferred to pediatric intensive care unit (ICU), where she was under treatment with cyproheptadine, mechanical ventilation, and muscular paralysis for 11 days. She was discharged from hospital a few days later with no neurological sequelae. Conclusions. Serotonin syndrome is still not well recognized by physicians. In our patient, the diagnosis was made early due to the history of overdose with serotonin reuptake inhibitors and the triad of mental, neurological, and autonomic signs. Parents must be educated to prevent children from having free access to drugs, avoiding self-medication or overdose.

Syphilitic aortic aneurysm is a rare occurrence in the antibiotic era, making the diagnose assumption even more infrequent. Nonetheless, this pathology can appear and should be suspected in patients with aortic aneurysm. We report a case of a 57-year old patient who presents with neurosyphilis and, in the following study, a large ascending aorta aneurysm is identified. The authors discuss the diagnostic challenge, the epidemiologic concerns, surgical indication and treatment and subsequent follow-up.

The Abdominal Compartment Syndrome (ACS) is a clinical entity recognized for over a century, but only recently its risk criteria, monitorization and treatment have been defined by the World Society of the Abdominal Compartment Syndrome (WSACS). The general surgeon's involvement is vital since this syndrome is common in surgical patients and because its treatment may culminate in a laparostomy. 250 questionnaires of 17 questions were distributed among general surgeons attending the XXVIII Portuguese Congress of Surgery. The data were analyzed using SPSS® v16. We received 36,4% (91) of the delivered questionnaires, most of which from male surgeons (63,7%), from central hospitals (75,8%), working 42 h per week (70.3%), whose average of age was 38 years. About half of the respondents received training in Intensive Care Units. All surgeons had already heard about measuring the Intra- abdominal Pressure (IAP), which was being performed at 89% of their hospitals. About 40% of surgeons only admitted intra-abdominal hypertension above 20 mmHg (only 22% indicated the correct value of 12 mmHg). 36,3% of surgeons suggested that a decompressive laparostomy must be carried out for primary ACS if IAP greater then 20 mmHg with new organ failure; 36.3% favoured the "Vacuum-pack"-like system, and 56% only re-operate the patients "as needed". 48,4% of surgeons had already performed decompressive laparostomy, 66% of which had residence training in a ICU (p = 0,005). Respondents also pointed an average mortality related to ACS of 81% without laparostomy, and a reduction to 38,5% after performing that procedure. Only 26% of the surgeons were aware of the WSACS consensus definitions and recommendations, of those, 83% had already performed a laparostomy (P<0,001). It can be concluded that, in spite of recognizing the ACS as a clinical entity, portuguese general surgeons are quite unaware of the WSACS definitions and treatment guidelines, urging the need for its divulgation.

The etiopathogenesis of Crohn's disease (CD) is still controversial: several genetic, immunologic, and environmental factors, including some bacteria, have been implicated. This study has been devised to assess the involvement of Escherichia coli in CD. Seven E. coli strains were isolated from 14 biopsies obtained from ileocolic ulcers of patients affected by inflammatory bowel disease (IBD), including six with ulcerative colitis and eight with CD. Five strains, exclusively isolated from CD patients, were found inside mucosal cells. Different PCR techniques (for chuA, yjaA, TspE4.C2, escV, and bfpB genes) were performed and PFGE was carried out to characterize these bacteria in comparison with other E. coli strains isolated from non-IBD specimens. The correlation of these characters with bacterial invasiveness on intestinal (Caco-2) and phagocytic (U937) cells was assessed. Overall our pilot data suggest that five among eight strains isolated from CD patients belonged to the adherent-invasive E. coli (AIEC) group, and were invasive on Caco-2 cells and resistant to phagocytosis. These findings suggest that these bacteria could be considered target organisms whose elimination could reduce the intestinal inflammatory process and CD progression.

This paper gives practical guidelines for diagnosis and treatment of chronic pancreatitis. Statements have been elaborated by working teams of experts, by searching for and analysing the literature, and submitted to a consensus process by using a Delphi modified procedure. The statements report recommendations on clinical and nutritional approach, assessment of pancreatic function, treatment of exocrine pancreatic failure and of secondary diabetes, treatment of pain and prevention of painful relapses. Moreover, the role of endoscopy in approaching pancreatic pain, pancreatic stones, duct narrowing and dilation, and complications was considered. Recommendations for most appropriate use of various imaging techniques and of ultrasound endoscopy are reported. Finally, a group of recommendations are addressed to the surgical treatment, with definition of right indications, timing, most appropriate procedures and techniques in different clinical conditions and targets, and clinical and functional outcomes following surgery., (Copyright © 2010 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd.. All rights reserved.)

Pancreatic ductal adenocarcinoma (PDAC) is a highly aggressive malignancy characterized by rapid progression, invasiveness, and resistance to treatment. It is the fourth leading cause of cancer death with a 2% 5-year survival rate. Biomarkers for its early detection are lacking. This study was designed to use a proteomics-based approach as a means of identifying antigens that elicit a humoral response in PDAC patients. Antibodies against PDAC-associated antigens are useful for early cancer diagnosis and therapy. Proteins from PDAC cell lines were separated by 2-DE, and the serum IgG reactivity of 70 PDAC patients, 40 healthy subjects (HS), 30 non-PDAC tumor patients, and 15 chronic pancreatitis (CP) patients was tested by Western blot analysis. Spots specifically recognized by PDAC sera and revealed by mass spectrometry corresponded to metabolic enzymes or cytoskeletal proteins. Most were up-regulated in PDAC tissues. Thus, it seems that metabolic enzymes and cytoskeletal proteins are specific targets of the humoral response during PDAC. The results of further studies of these serological-defined antigens could be of diagnostic and therapeutic significance in PDAC.

The sequelae of pancreas surgery are determined by the type of procedure, the extent of the parenchymal resection and the underlying disorder. In ductal carcinoma, the outcome is heavily influenced by the disease itself. Mortality rates are lower in centers which perform the most operations. In chronic pancreatitis, surgical management is essentially therapeutic for complications and palliative for the disease whose progress is closely correlated with the sequelae. Elective surgery does not appear to increase the risk of diabetes whereas distal pancreatectomy is an independent risk factor. Parenchymal resection aggravates nutritional deficiencies, such as low selenium, linoleic acid, LDL and apolipoprotein B levels, and thus increases the risk of atherogenesis. Abstinence from alcohol is an indispensable step towards the disappearance of postoperative pain.

Background: Eleven liver biopsies from six male patients who received a liver transplant (LT) from female donors were examined in order to determine whether male host-derived hepatic cells were present in female grafts that exhibited minimal or important inflammatory damage., Methods: Immunohistochemistry for epithelial cell type differentiation (anticytokeratin monoclonal antibody) and fluorescence in situ hybridization for XY chromosomes identification were performed on each slide., Results: Host-derived hepatic cells were found in all except one transplant, with a frequency ranging from 2.3 to 25 per thousand of the total hepatocytes in the biopsy specimen. They were usually found as isolated cells scattered throughout the hepatic lobule; in one patient they were grouped into little clusters. Host-derived hepatic cells persisted throughout the histological follow up (up to 535 days after LT). Polyploidy for XY chromosome was observed., Conclusion: Hepatocytes derived from extra-hepatic stem cells are frequently found in small numbers in human liver grafts and persist over time.

Cells of colonic mucosa are sensitive to the Smad-mediated growth-inhibitory effect of transforming growth factor-beta1 (TGF-beta1). Another important cell growth inhibitor is the polyunsaturated lipid peroxidation end product, 4-hydroxynonenal (HNE), which triggers apoptosis through c-Jun N-terminal kinase (JNK) activation. Interestingly, a close association between TGF-beta1 and HNE was found in the progression of human colon cancer, with concentration of both molecules inversely related to the malignancy. We investigated the cross talk between Smads and JNK signal transduction pathways in inducing apoptosis. To this purpose TGF-beta1 and HNE were added singly or in combination to CaCo-2 human colon adenocarcinoma cells. The cotreatment induced a marked enhancement of apoptosis and of JNK and Smad4 activities much more than either individual molecule. Cell preincubation with the JNK inhibitor SP600125 significantly prevented JNK and Smad4 enhancement and, subsequently, the cooperative proapoptotic effect was abolished. The primary role of JNK activity in TGF-beta1/HNE cooperative signaling was fully confirmed in a second set of experiments by using JNKi I, a more selective kinase inhibitor. Hence, in tumor cells becoming resistant to TGF-beta1-mediated growth inhibition, increased induction of the remaining TGF-beta1 pathways by interaction with other antiproliferative molecules, such as HNE, could help in inhibiting tumor growth.

Acromegaly is an infrequent disease attributable to endogenous excess of GH and IGF-I. Human studies have associated the GH-IGF-I axis with the development of colorectal cancer; however, the question of whether colorectal cancer is a problem in acromegaly is currently unresolved. We performed a cross-sectional study to assess the risk of colonic neoplasia in patients with acromegaly. Colonoscopic screening was performed in 235 patients with acromegaly at five tertiary care hospitals in Italy between January 1, 1996, and December 31, 2001. A repeat colonoscopy was performed in 121 patients after a mean interval of 32.1 months. Colonoscopic findings in patients with acromegaly were compared with those of 233 patients with nonspecific abdominal complaints who were referred for endoscopy during the study period. A total of 65 patients (27.7%) and 36 controls (15.5%) had colonic neoplasia. In 55 patients (23.4%) and 34 control subjects (14.6%), the most important findings were adenomas (odds ratio, 1.7; range, 1.1-2.5), whereas 10 patients (4.3%) and two control subjects (0.9%) had carcinoma (odds ratio, 4.9; range, 1.1-22.4). The risk of colonic neoplasia was higher for younger patients with acromegaly compared with age-matched controls. Patients with acromegaly with or without colonic neoplasia did not differ significantly for IGF-I levels or duration of disease. A neoplastic recurrence was found in 16.5% of patients who underwent follow-up; 90% of them had had a neoplasm removed at the first colonoscopy. Acromegaly carries with it a moderate, but definitive, increase in the risk of colonic neoplasia that occurs at a younger age than in the general population. Patients who are found to harbor a colonic neoplasia are at risk for recurrence.

As weightlessness is not completely reproducible on Earth, usability evaluation of space systems is often simulated through tests in an aquatic environment. A Neutral Buoyancy Facility test programme was organized in a special pool to simulate Extra-Vehicular Activities on the Columbus module of the future International Space Station with the aim of assessing various aspects of crew interface design. This study was designed to evaluate workload using visibility, accessibility and operability tests. Diving workload was determined through basic physiological measurements, such as pulmonary ventilation and heart rate during underwater operations. As anxiety can influence physiological processes, and consequently also the workload evaluation determined through these parameters, we developed an evaluation methodology to investigate the anxiety level based on a specific questionnaire submitted to all subjects before and after the dives. Heart rate increased in underwater work to a value approximately 50% larger than the value obtained in the resting condition while sitting outside the pool. This increase in heart rate was accompanied by an increase in pulmonary ventilation of 200% larger than the value recorded in the rest condition while sitting outside the water. The extent of these increases was notable in all the test subjects, who varied in age and stature. Recorded values of workload, heart rate and pulmonary ventilation were evaluated on the basis of Christensen's (Arbeitsphysiol. 14 (1950) 251) and Wells' (J. Appl. Physiol. 10 (1957) 51) classifications. Through this analysis it was possible to determine that the workload, indicated by performance on our neutral buoyancy tests, corresponds to moderate physiological work. For test subjects, anxiety related to underwater performance was light. Among the causes of anxiety all the subjects indicated the lack of confidence with neutral buoyancy tests and a feeling of lack of safety, typical of aquatic environments. We can conclude that context did not produce considerable psychological effects, and consequently that the psychological load did not influence heart rate and pulmonary ventilation values that can therefore be directly related to task workload., (Copyright 2004 Elsevier Ltd.)

CARD15 on chromosome 16 is the only IBD susceptibility gene identified among several mapped loci. Its recurrent variants R702W, G908R and L1007fs have shown significant association with Crohn's disease (CD), but not with ulcerative colitis (UC), in different Caucasian populations. We analysed these three variants in 184 CD and 92 UC Italian patients and in 177 healthy controls. L1007fs and G908R were independently associated with CD, while R702W showed a nonsignificant increase. After combining the three variants together, 32.6% of CD patients were positive vs 18.6% of the controls. The association was stronger for homozygotes and compound heterozygotes, OR 13.9 (1.8-108), and weaker but still significant for simple heterozygotes, OR 1.7 (1.0-2.9). An excess of homozygotes/compound heterozygotes also resulted from the comparison with Hardy-Weinberg expectations. Phenotype-genotype correlations were analysed first by univariate logistic regression and then by multivariate analysis, the effect of CARD15 positivity being adjusted according to the status of smoking, familiarity and sex, so as to focus on the predictivity of genetic and environmental risk factors on the clinical phenotype. Significant risk estimates of the CARD15 genotype were obtained for stricturing vs inflammatory behaviour, OR 2.76 (1.2-6.3), and for penetrating behaviour, 2.59 (1.0-6.6), and marginally significant for ileal vs colic location, OR 3.0 (0.9-9.8). Our findings indicate that the association of the CARD15 genotype with behaviour and location of disease holds also for the Italian population.

Mutations in the cationic trypsinogen, cystic fibrosis transmembrane conductance regulator (CFTR) and pancreatic secretory trypsinogen inhibitor (PSTI) genes have recently been associated with chronic pancreatitis. This paper investigates the frequency of CFTR and PSTI gene mutation in patients with idiopathic and alcoholic chronic pancreatitis, the clinical course of patients with these two kinds of disease, and examines the clinical differences between carriers and noncarriers of mutation. In idiopathic pancreatitis a significant increase was found in mutation frequency both in the CFTR gene (13%) and N34S mutation in the PSTI gene (3.9%), as well as an increase in familial disposition to pancreatic disorders. In alcohol-induced pancreatitis an increase in calcification, exocrine insufficiency, and diabetes mellitus was observed. In conclusions, mutations in the genes investigated are involved in causing idiopathic pancreatitis. Such mutations have no connection either with the age at onset or the clinical course of the disease.

Background: Mesalazine enemas are of well proven efficacy for the topical treatment of distal ulcerative colitis. Although new rectal formulations of mesalazine are not expected to be superior in efficacy and tolerability to standard formulations, they may offer secondary advantages in terms of overall acceptability., Aim: To compare the efficacy, tolerability and overall acceptability of a new mesalazine rectal foam (Salofalk foam) with mesalazine enema in the treatment of active distal ulcerative colitis., Patients and Methods: A multicentre study was carried out in patients with active proctitis, proctosigmoiditis and left-sided ulcerative colitis as evaluated by the Clinical Activity Index (CAI > or =4) and Endoscopic Index (EI > or =6). Patients were randomly assigned to receive, in open-label fashion, either mesalazine foam 2 g twice a day or mesalazine enema (2 g/60 ml twice a day) for 3 weeks. Patients who did not achieve remission (defined as CAI <4 and EI <6) after 3 weeks continued the study receiving the alternative galenic formulation for a further 3 weeks., Results: A total of 195 patients were enrolled. Characteristics at baseline were similar except for concomitant therapy with oral 5-ASA products: during the 1st treatment phase, 41% of patients on enema received such treatment vs only 29% of those on foam. Patients with at least one post-treatment efficacy evaluation were included in the intent-to-treat analysis (n=89 foam, n=96 enema). After 3 weeks of treatment, 112 patients were in remission and only 59 patients entered the 2nd treatment phase thus providing data on acceptability. Remission was achieved after 3 weeks in 54% of patients treated with foam and in 67% of those treated with enema. The 90% confidence interval for the difference in remission rates was 0 to 24 and thus within the clinically acceptable range of therapeutic equivalence. At the end of the 2nd phase, 70% of patients switched to foam were in remission vs 65% to the enema. Two patients discontinued treatment with foam prematurely due to anal burning. No clinically important changes were seen in the laboratory tests., Conclusions: Salofalk foam and enema are equally effective for the treatment of proctitis, proctosigmoiditis and left-sided ulcerative colitis. The new foam preparation is as well tolerated and accepted as enemas and can be used as a therapeutic alternative to conventional mesalazine enema formulations.

Although no therapeutic breakthrough has taken place, the life expectancy of patients with cystic fibrosis (CF) has dramatically increased in the last 20 yrs. Nowadays, more than 80% of the patients outlive 18 yrs of age, with a mean survival age approaching 28 yrs. These favourable results are due mainly to early diagnosis and continuous treatment in specialized centres. The main therapeutic items are: prevention and early treatment of lung infections, mainly due to Pseudomonas aeruginosa, drainage of bronchial secretions (postural drainage, forced expiratory techniques, positive-expiratory-pressure mask, autogenic drainage,...), substitutive therapy with pancreatic enzymes and hypercaloric diet. Thus cystic fibrosis is increasingly a disease which involves adults, with many related problems, which span from the difficulties of prescribing an effective antibiotic therapy in cases with multiple resistances, to combining the need for a long daily physiotherapy schedule with school or a working life. Sexual problems and related psychological troubles are an important issue in the management of cystic fibrosis in adult patients, and are accordingly treated.

This study describes a new technique for excision of small colorectal polyps in a series of 210 consecutive patients, who had total colonoscopy, and in whom any clotting problems had been excluded. A total of 288 small polyps of 5 mm or less in diameter were transected by mechanical strangulation with a polypectomy snare, but without applying any electrical energy. All polyps were recovered whole and sent for histologic examination. No case of perforation, serious bleeding, or mortality was recorded, nor was there any need for blood transfusion because of sudden or delayed bleeding. Of the small polyps, 56% were adenomas, 43% hyperplastic, and 1% were other types. No invasive cancer was found, but in seven small adenomas severe dysplasia was observed. No correlation between the macroscopic appearance of small polyps at endoscopy and their nature at histology was found. Our data confirm that all visible polypoid lesions of the colon should be removed, and that cold snare excision of small polyps is a safe and effective alternative method of treatment in patients without clotting problems.

Lactoferrin is a protein present in many fluids of the human organism and in the secondary granules of polymorphonuclear cells (PMN). In the blood stream lactoferrin favours the segregation of PMN by mediating and amplifying the immune response, and realizes a negative feedback control on the Colony Forming Unit Granulocyte/Macrophage (CFU-GM) proliferation. At intestinal level it promotes iron absorption and prevents bacterial overgrowth. The antibacterial effect of lactoferrin is used clinically to prevent bacterial infections in neutropenic patients submitted to chemotherapy for leukemic diseases type M1, M2, M4 and M5, according to FAB criteria. In patients affected by chronic pancreatitis the lactoferrin concentration, in duodenal juice, is found to be significantly higher than in normal subjects. This finding suggests a pathogenetic role of the protein in chronic pancreatitis.

We report a case of primary sclerosing cholangitis associated with Crohn disease of the large intestine and marked eosinophilia in a 64 year old woman. Clinical features, histologic findings at biopsy of the intestine and liver and the endoscopic retrograde cholangiopancreatography are described. The case report is discussed, particularly as regards treatment with biliary salts and aminosalicilic acid.

Lactoferrin is a nonenzymatic secretory protein of human pancreas specifically increased in the external pancreatic secretion of patients with chronic calcifying pancreatitis. The possibility of an elevated concentration of plasma lactoferrin level in these patients needed to be explored even if the low pancreatic concentration of the protein did not favor this hypothesis. As expected, no increase could be observed between the plasma lactoferrin level of 16 patients with chronic calcifying pancreatitis (131 +/- 15 micrograms/l), compared to 17 controls (166 +/- 11 micrograms/l) and 15 patients with different organic diseases (187 +/- 18 micrograms/l).

This study indicates that a single injection of platelet activating factor (PAF, 50-500 ng) into the superior pancreaticoduodenal artery of rabbits induces dose-dependent morphologic alterations of pancreatic tissue and increases serum amylase levels, both consistent with the development of an acute pancreatitis. The main histologic findings observed by light microscopy 24-72 hours after the injection of PAF were edema, polymorphonuclear neutrophil infiltration, cell vacuolization, and acinar cell necrosis. Fat cell necrosis was present in 30% of animals. By electron microscopy an increase of the number of zymogen granules in the apical region of acinar cells was observed 3 hours after PAF challenge. At 24-72 hours, many acinar cells showed vacuoles containing myelinlike figures, zymogen granules, and cellular debris. Pancreatic lesions developed in the area supplied by the artery injected with PAF and they were completely antagonized by the pretreatment of rabbits with CV 3988, a specific antagonist of PAF. In addition, the significant protective effect of atropine suggests a potential role for cholinergic mechanisms in the pancreatic alterations induced by PAF.

On the basis of some experimental observations of hypergastrinemia in animals chronically intoxicated with ethanol, both fasting and after meals serum gastrin were determined in patients affected by chronic alcoholic pancreatitis. A significant increase in serum gastrin levels was observed in patients with chronic pancreatitis compared with controls, both in basal conditions and following food stimulation. The physiopathological hypotheses and possible aetiopathogenetic implications suggested by such gastrin behaviour are discussed.

Slow, progressive constriction with cellophane tape was experimented on the proximal segment of the rabbit pancreas. Histological examination of the distal segment over a period of 10-30 days showed the appearance of morphological changes reminiscent of chronic pancreatopathy in man. Stress is laid on the need for an experimental model suitable for the provocation of chronic forms, particularly if similar results can be obtained on animals of larger size.

To assess the relation between circulating cathodic trypsinogen (CT) levels and exocrine pancreatic function, and to compare the radioimmunological with the enzymatic measurement of duodenal trypsin, we evaluated exocrine pancreatic function in 34 controls and in 32 patients with proven chronic pancreatitis (CP). There was no relation between CT and the volume rate of pancreatic secretion, nor did serum CT levels correlate with the concentration output of duodenal bicarbonate in controls. However, in CP patients, there was a low value of the correlation coefficient. A good relationship between serum CT levels and duodenal trypsin secretion was detected when the trypsin content was expressed as the mean value of both concentration and output. The enzymatic estimation of duodenal trypsin was related closely to its radioimmunological measurement, but there was better correlation of serum CT to duodenal immunoreactive than to enzymatic trypsin. In patients with CP, low levels were observed in 29% of cases with serum CT estimation, in 75% with duodenal bicarbonate, and in 63% and 79% with enzymatic and immunoreactive trypsin outputs, respectively. We conclude that serum CT levels may reflect the functioning mass of pancreatic acinar cells and that in assessing pancreatic secretory capacity, the immunoreactive measurement of trypsin excretion is more sensitive than the enzymatic measurement and as accurate as bicarbonate output.