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The effect of bombesin on insulin and gastrin response to a standard labelled meal was studied in eight healthy male volunteers. The gastric emptying of solids was simultaneously evaluated. During intravenous infusion of the peptide (5 ng/kg/min) the insulin release after eating was greatly reduced whereas food stimulated gastrin release was significantly enhanced. Both effects of bombesin are likely to be connected with the marked inhibition of gastric emptying induced by the peptide. [ABSTRACT FROM PUBLISHER]

The clinical performance of composite resins is greatly influenced by the quality of the light-curing unit used. The aim of this study was to compare the efficiency of a commercial light-emitting diode (LED) with that of a halogen-based light-curing unit by means of dye penetration of a micro hybrid composite resin. The composite resin evaluated was Filtek Z250 (3M Dental). The composite was filled into acrylic moulds that were randomly polymerized for 40 seconds by each of the light-emitting systems: light-emitting diode Ultraled (Dabi Atlante) or halogen light Degulux (Degussa Hülls) curing units. Immediately after polymerization, each specimen was individually immersed in 1 ml of 2% methylene blue solution at 37 degrees C +/- 2 degrees C. After 24 hours, the specimens were rinsed under running distilled water for 1 minute and stored at 37 degrees C +/- 2 degrees C at relative humidity for 24 hours. The composite resins were removed from the moulds and individually triturated before being immersed in new test tubes containing 1 ml of absolute alcohol for 24 hours. The solutions were filtered and centrifuged for 3 minutes at 4,000 rpm and the supernatant was used to determine absorbance in a spectrophotometer at 590 nm. To verify the differences between groups polymerized by LED or halogen light t-test was applied. No significant differences were found between composite resins light-cured by LED or halogen light-curing unit (p > 0.05). The commercially LED-based light-curing unit is as effective to polymerize hybrid composite resins as the halogen-based unit.

Laparoscopic cholecystectomy is the suitable treatment for symptomatic cholelithiasis, even if the incidence of biliary lesions following this procedure may be up to threefold higher than that of open cholecystectomy. We report our experience concerning the incidence, aetiopathogenesis, diagnosis and treatment of complications in a homogeneous group of laparoscopic cholecystectomies. In a total of 492 laparoscopic cholecystectomies only three bile duct lesions were observed (0.6%); they were classified according to Bismuth and re-assessed according to Strasberg. They consisted in two biliary leakages and one bile duct stricture. All patients were evaluated by full blood test, ultrasonography and endoscopic retrograde cholangiopancreatography. Endoscopic treatment was successful in the two patients with biliary leakage, while the patient with a stricture required surgical therapy. In conclusion, we suggest that a correct knowledge of the aetiopathogenesis together with a multidisciplinary approach to the diagnosis appear to be the best method for the detection, complete classification and most suitable treatment of symptomatic cholelithiasis.

Background: Even though many types of reconstruction after total gastrectomy have been proposed to reduce postgastrectomy syndromes, choosing a method that would further improve the quality of life and nutrition of the gastrectomized patient is controversial. Hunt-Lawrence single pouch reconstruction seems to obtain better results compared with the more common Roux-en-Y technique, but both of these reconstructive approaches are associated with some reduction in food intake and some problems in achievement of ideal body weight., Methods: In this prospective, randomized trial, after total gastrectomy 18 patients had reconstruction according to the Hunt-Lawrence or single pouch technique (SP group), whereas for 23 patients, the technique was modified with construction of a second pouch in the distal portion of the jejunal loop (DP group). Patients in the two groups were compared at 12 months after surgery for problems in gastrointestinal function, quality of life, improvement in body weight and nutritional parameters, serum albumin, hemoglobin level, and serum protein., Results: The DP group demonstrated fewer symptom problems, better weight maintenance, and better laboratory values when compared with patients undergoing standard single jejunal pouch reconstruction., Conclusions: Reconstruction with use of a double pouch as a gastric substitute leads to better outcome assessments than with a single pouch reconstruction. Our double pouch technique has demonstrated significant improvement in quality of life and nutritional recovery in terms of functional results as well as patient satisfaction.

Background and Objectives: The actual relationship between malignancy and secreting breast has not yet been extensively verified, mainly in patients with nipple discharge but without evidence of a breast lump. This study was carried out in 1,251 consecutive patients to evaluate the reliability of cytology combined with galactography in order to assess the relationship of malignant and premalignant lesions with discharge without the presence of a breast lump., Methods: Those patients with bilateral discharge were approached endocrinologically, whereas the patients (433) with unilateral secretion were evaluated by cytology, mammography, fine needle biopsy, and galactography. Of 194 patients without a breast lump, 94 with positive cytology were surgically treated after mammogalactography. Surgical treatment included ductgalactophorectomy in 53, segmentectomy in 23, microdochectomy in 13, and mastectomy in 5 patients., Results: Pathologic findings showed a solitary papilloma in 49 cases, minimal breast cancer in 20, fibrocystic disease in 11, papillomatosis in 7, lobular cancer in 5, and, finally, a duct ectasia in 2., Conclusions: In the patients with secreting breast but without lump, cytological analysis in addition to galactography seems to be useful in identifying minimal breast cancer and in detecting premalignant lesions like papillomatosis., (Copyright 1999 Wiley-Liss, Inc.)

Intraabdominal structures may be damaged during blind introduction of the first trocar for laparoscopic operations. In this study, 150 patients with gallbladder lithiasis who underwent laparoscopy were randomly assigned to two groups, a blind (V group) or an open (H group), in order to compare the results and the rate of complications. No mortality was observed. Major complications occurred in 3/75 (4%) patients of the V group and in 1/75 (1.3%) patient of the H group (p < 0.05). Minor complications occurred in 5/75 (6.7%) patients of either group. The achievement of pneumoperitoneum required 4.5+/-0.4 min in the V group and 3.2+/-0.2 min in the H group (p < 0.05). The open laparoscopic technique is safer and faster than the blind approach; therefore, it is proposed that this approach be routinely used in all laparoscopic procedures.

All the epithelia lining the gastrointestinal (GI) tract, including that of the esophagus, exhibit a transmucosal electrical potential difference (PD). The luminal surface of the GI mucosa is indeed electrically negative when compared with the serosal one. Although it was initially felt that the body of the esophagus exhibits a PD near 0 or slightly positive, recent studies, using parenteral reference electrodes, have shown a negative PD of around -15 mV. Measurement of esophageal PD has been mainly used to locate both the lower and the upper esophageal sphincters but very rarely to evaluate esophageal mucosal integrity in clinical settings, most probably due to the difficulties encountered during measurement of mucosal PD. Reliable techniques to measure esophageal PD simultaneously with esophageal pressure or mucosal pH are now available. Application of these recently developed methodologies showed that measurement of esophageal PD during either manometry or endoscopy provides meaningful information about mucosal integrity. Indeed, tissue injury, either neoplastic of inflammatory, usually results in a less negative PD. In contrast, an abnormally high negative PD is very often observed in patients with columnar-lined lower esophagus. In patients with microscopic reflux esophagitis, PD exhibits less negative values which are significantly correlated with the degree of the mucosal damage. Normalization of the altered PD after either medical or surgical treatment makes it an additional parameter to evaluate the effect of a given therapy.

Acute necrotizing pancreatitis involves high mortality. When diagnosed, the disease implies a choice of suitable timing and proper technique of surgical approach. The experience on 16 patients with acute necrotizing pancreatitis, 9 males and 7 females, mean age of 54.7 +/- 3.3 years, is presented in this study. Necrosectomy and continuous local lavage of abdominal collections and pancreatic necrotic surfaces was the most appropriate surgical treatment. The method seems able to remove necrosis and active biological compounds and would appear to achieve a limited mortality and morbidity. Necrosectomy and postoperative local lavage represent a therapeutic effective procedure.

Seventeen consecutive patients with rectal cancer underwent surgery at our institution between January 1988 and December 1990. The aim of this study was to assess the urogenital symptoms after radical resection of the rectum. Ten of these patients were suitable for the study, 9 of whom had an Anterior Resection (with colorectal anastomosis in 7 cases and with coloanal anastomosis in 2) and 1 a Miles operation. We observed urogenital disturbances in 2 patients (20%), 1 male with urinary tract dysfunction and 1 female with difficulties of sexual activity. The disease-free interval, at 36 months, was 100%. We suggest that curative surgery for rectal cancer can be associated, in overall cases, with a low incidence of urogenital disturbances. This allows the improvement of quality of life without evidence of loco-regional recurrence. A resective approach of rectal cancer, able to preserve nervous fiber of pelvic plexus but providing at the same time a radical excision of the tumor, seems to be a determining factor.