Biomedical subjects
Publications and source records attributed to P Negro.
Although breast metastases are not frequent, the most common ones are from cutaneous melanoma. In this paper two cases of breast metastases from malignant melanoma are reported. The literature is reviewed and the diagnostic and therapeutic problems related to metastatic mammary neoplasms are analyzed.
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Rates of fixation of mutations during the evolution of the foot-and-mouth disease virus (FMDV) C1 in nature have been estimated by hybridization of viral RNA to cloned cDNAs representing defined FMDV genome segments, and comparison of the selected RNAs by T1 RNase oligonucleotide fingerprinting. Values ranged from less than 0.04 X 10(-2) to 4.5 X 10(-2) substitutions per nucleotide per year (s/nt/yr), depending on the time period and the genomic segment considered. Rates for viral structural protein genes were up to sixfold higher than for nonstructural protein genes. Values in excess of 10(-2) s/nt/yr have been measured for the RNA region that encodes VP1-VP3. The nucleotide sequences of the major immunogenic region of capsid protein VP1 have been determined for six new FMDV C1 isolates, and they are compared with the two previously known sequences of FMDV C1 (C-S8 and C1-O). Both oligonucleotide fingerprinting of selected RNA fragments and direct nucleotide sequencing demonstrate that genetic heterogeneity exists among three viruses isolated on the same day, introducing a significant indetermination in the evaluation of fixation rates of mutations. During the FMDV C1 outbreak, amino acid substitutions did occur that are known to affect the immunological properties of the virus. The proportion of mutations between two viral RNAs does not increase significantly with the time elapsed between the two isolations, suggesting a cocirculation of multiple, related, nonidentical FMDVs ('evolving quasispecies') as the mode of evolution of this agent.
Detailed analyses of biochemical and microbiological variables such as pH, nitrite concentration, total viable counts (TVC), nitrate reductase-positive bacterial counts (NRPBC), and identification of microorganisms were carried out on 76 fasting gastric juice samples obtained at endoscopy from 64 patients previously submitted to partial gastrectomy (22 end-to-end Billroth I, 42 Billroth II/Reichel-Polya) and from 12 normal controls. Samples from normal controls were sterile, but bacteria were detected in the juice from all the operated patients. Significantly higher mean pH values and nitrite levels (p less than 0.001) were found in partial gastrectomies than in normal controls. In relation to surgical methods, higher mean pH values (p less than 0.005), nitrite levels (p less than 0.01), TVC (p less than 0.01), and NRPBC (p less than 0.005) were observed in the juice of patients with Billroth II as compared with Billroth I gastrectomies. Anaerobic bacteria, typical of faecal flora, and particularly Escherichia coli (p less than 0.05) characterized Billroth II samples. All these data suggest that the presence of bacteria in the gastric juice of gastroresected patients can be considered a risk factor of gastric neoplasia and that the type of operation used for the reconstruction of digestive continuity may influence the magnitude of this risk.
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The experience with 24 intussusceptions observed in a Department of General Surgery has been reviewed. The delay between onset of symptoms and hospitalization was less than 24 hours in 58% of cases, from 24 to 48 hours in 28%, and more than 48 hours in 14% of children. 23 patients were submitted to barium enema. Hydrostatic reduction was obtained in 19 cases. Laparotomy was performed in 13 patients after failure of hydrostatic reduction and in 5 emergency cases while only 4 underwent resection. The controversies about the management of intussusception are discussed, based on a review of literature (6,542 cases). A safe diagnostic and therapeutic approach to the disease is proposed.
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A method for portal stump pressure monitorization following arterialization is presented. Both intra and postoperative pressure determinations were performed and a significant difference between intra and postoperative values was observed. The pressure of the arterialized portal stump either using the left gastric artery or one of its branches, when compared to the free portal pressure did not reveal significant differences. According to these data, the proposed method of arterialization seems to create a "physiologic" arterialized stump pressure. This information while contributing to a better understanding of the complex hemodynamics of the arterialized liver represents essential guidelines for further studies on liver trophism and experimental portal hypertension.
Gallbladder microlithiasis may be a cause of acute recurrent pancreatitis. When this process cannot be detected with routine investigative procedures, a precise etiologic diagnosis cannot be formulated. In such circumstances, endoscopic collection of bile followed by microscopic examination for presence of cholesterol crystals constitutes a valid diagnostic tool. Three cases of acute recurrent pancreatitis are presented in which cholesterol crystals were found in the bile. The technique and advantages of the method are described and a useful diagnostic approach is proposed.
Acute acalculous cholecystitis is rather unusual, but it is considered an increasing entity. Particularly interesting are the post-traumatic or post-operative forms of acute acalculous cholecystitis. Ischemia of the gallbladder and biliary stasis are the most likely pathogenetic factors. A case of acute acalculous cholecystitis after total gastrectomy for cancer is presented. Particular emphasis is put on the significance of cholesterol and calcium bilirubinate crystals findings in the bile of the gallbladder. The pathogenetic role of this microscopic form of lithiasis in post-operative acalculous cholecystitis is discussed. It is concluded that all surgeons should be aware of this pathology since it is becoming much more common to be faced with elderly patients having life-threatening post-operative gallbladder complications unrelated to macroscopic lithiasis.
Operative risks of transduodenal sphincterotomy (T.D.S.) are the principal subject of discussion between those surgeons who practice the operation and those that condemn it. An international survey of 25, 541 cases treated by 130 surgeons showed that the incidence of specific complications such as acute pancreatitis (0.6 p. 100), hemorrhage (0,65 p. 100), and early cholangitis (0,5 p. 100), and relative mortality were lower than those usually reported by surgeons attributing an excessive operative risk to the procedure. Data was also obtained indicating that certain "risk factors" due to teh surgical technique were statistically significant (X2 test) and that knowledge of these enabled complications to be avoided. Morbidity and mortality of TDS could then be reduced to the level of those common to biliary tract surgery.
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