[Duodenal angiodysplasia and Turner's syndrome. Case report]

The Turner's syndrome is the most common chromosomic disease in the women and touches 1:2,500 women born live. The most important anomaly is the presence of short stature and ovarian failure. Others disorders are increasing in case reports: osteoporosis, hypothyroidism, renal diseases and gastroenteric diseases. The Authors, after careful review of the literature, that proves rarity of the disease, report a case of duodenal vascular anomaly associated with Turner's syndrome and describe surgical therapy, peculiar to this atypical localization.

CASE REPORT

A 31 years old woman, genotypic XO and female phenotypic, with diabetes mellitus type I, arterial hypertension and hypertransaminasemia. Since three days the patient reports epigastric pain discontinuous, not widespread, not nocturnal, with wretch, bowel open only to gas. The patient underwent Rx abdomen, Rx with gastrografin, TC abdomen. Diagnosed as a high digestive occlusion, the patient underwent explorative laparotomy. As laparotomy she had a necrotic-hemorrhagic lesion in duodenum D3-D4 and first jejunal loop, with stenosis of the jejunal lumen, perforation of serosa and blood in peritoneal cavity. Resection of necrotic loop and reconstruction with Y loop performing manual duodenum jejunal L-L anastomosis, mechanical gastroenterostomy and enteric-enteric L-L mechanical anastomosis. After operation hemorrhage from anastomosis was observed, treated with omeprazole therapy and total parenteral nutrition. The patient was discharged in 14th p. o. day. After two years she is in good health without gastrointestinal symptoms. In patients with Turner's syndrome gastrointestinal vascular anomalies have to be considered as diagnostic hypothesis in cause of abdominal pain.

[Surgical complications for gastric and small bowel metastases due to primary lung carcinoma]

Lung carcinoma is the first cause of death for tumors; in Italy there are from 35,000 to 40,000 new cases a year, with a global survival to 5 years from the diagnosis in 13% of cases. The gastric and small bowel metastases are rare, respectively 0.4% and 1.1% and the cases reported in the literature are rare. There is often a poor symptomatology and diagnosis is usually based on post-mortem examination. Yet, sometimes, the first and only demonstration of the secondary illness is a surgical complication, whether it be a haemorrhage, a perforation or an occlusion. The authors report their experience, from April 1999 to March 2003, of 3 cases of small bowel metastases, presented in 1 case with a perforation and in 2 cases with an occlusion and of 1 case of gastric metastasis, which presented with a haemorrhage. These patients were treated by emergency surgery, with 1 case only of postoperative mortality. The 1st patient died 6 months after surgery, and the 2nd patient 6 days after, the 3rd patient 4 months after the 1st operation and the 4th patient is still in follow-up after 6 months. The authors present a review of the literature and some considerations of diagnosis and surgical treatment.

[Extrauterine endometriosis: three new cases]

Extragonadal endometriosis is rarely diagnosed preoperatively due the variety of its localizations. Presentation to general surgeons may be atypical and pose diagnostic difficulties. The Authors report three cases surgically treated between 2000-2003. The Authors stress the peculiarity of one of these cases with endometrial tissue involvement of the intestinal mucosa. They also discuss about various aetiological hypothesis, symptomatology, differential diagnosis and need for multidisciplinary treatment.

[Monitoring of hepatocyte xenotransplantation. Usefulness of various laboratory parameters]

The authors report a study in which they evaluate the efficacy of some laboratory parameters for monitoring intrasplenic hepatocyte xenotransplantation (mouse to rat) as an alternative to 99Tc-HIDA dynamic scan and histologic exam. Swiss mouse and wistar rat hepatocytes were obtained with collagenase digestion. Wistar male rats were used as recipient and were allocated into three groups: A) omotransplanted rats; B) xenotransplanted rats; C) xenotransplanted and immunosuppressed (Cyclosporin A: 20 mg/kg/daily orally) rats. All rats underwent > 70% hepatectomy. Blood samples were obtained daily from a femoral vein and AST, ALT, ALP, bilirubin, albumin and urea were measured. No statistical differences were observed among groups and the laboratory parameters tested can't be considered a valid technique to xenotransplant rejection monitoring.

Technique of total hepatectomy in the rat

We report a novel one-stage technique of total hepatectomy in the rat, in which the liver is replaced by an autologous prosthesis. This prosthesis is obtained from a donor rat, and consists of the subhepatic vena cava and the left renal vein harvested en block. This graft is sutured with the subdiaphragmatic cava and linked with cuffs to the subhepatic vena cava and the portal vein in the donor rat. This procedure is associated with a very low operative mortality. Rats with glucose and plasma-expander infusions survived for a mean time of 23 +/- 9 hr. This technique of total hepatectomy can be considered a valid and reproducible model of true anhepaty for metabolic and survival studies with liver support systems.

[Anhepatic rat, technic for reconstruction of venous circulation]

Authors report an experimental model of total hepatectomy in the rat. In this model whole liver was replaced by an autologous vascular prosthesis. On the contrary as reported in other experiences, in this model is maintained the cavo-caval flow, with absence of cavo-caval and porta-caval shunts. Anhepatic rats survival not exceeded two hours from surgery.

Transglutaminase changes in intestinal mucosa after experimental small bowel resection in the rat

The low serum transglutaminase found in various intestinal disorders (celiac disease and IBD) suggested to us to study the serum and mucosal transglutaminase behaviour in an experimental model of small intestine resection in rats to reduce cellular mass and induce enterocyte hyperproliferation in the proximal part left in continuity. Transglutaminase activity in the intestinal mucosa was significantly higher in resected rats than in control and sham operated animals from days 4 (121 +/- 10 v basal 94 +/- 3 mU/g protein, p < 0.01) to 10 (165 +/- 37 mU/g protein, p < 0.05) after surgery; no significant difference was observed at days 12 and 15 (110 +/- 15 and 105 +/- 23 respectively). Both serum alkaline phosphatase activity (partly produced in enterocytes) and serum transglutaminase were significantly lower in resected rats at each time-point beginning at day 6 (208 +/- 34 v 557 +/- 125 UI and 1.55 +/- 0.11 v 3.78 +/- 0.70 mU/ml, p < 0.001 respectively). These data suggest an involvement of transglutaminase in enterocyte proliferation and confirm the association between reduced intestinal mass and low levels of the enzyme in serum.

Release of diamine oxidase into plasma by glycosaminoglycans in rats

Plasma diamine oxidase (DAO) values are enhanced by intravenous injection of heparin which releases the enzyme, synthesized in small bowel enterocytes, from binding sites located on endothelial cells of the intestinal microvasculature. Intestinal DAO, in analogy with lipoprotein lipase (another heparin-released enzyme), is believed to be electrostatically linked to endothelial binding sites composed of a glycosaminoglycan (GAG) which is presumably heparan sulphate, but the complete mechanism of enzyme release is not known. In this study we assayed in rats the DAO-releasing capability of heparan sulphate, dermatan sulphate, chondroitin sulphate A and hyaluronic acid, all heparin related compounds. Heparan sulphate, a compound with the same hexosamine as heparin but with a lower concentration of sulphated iduronic acid, induced a very high release of DAO (3-fold less than heparin), while the other tested GAGs, composed of higher proportions of non sulphated uronic acid and with galactosamine instead of glucosamine, induced a significantly lower release. In rats treated with 60 mg heparan sulphate the significant decrease in ileal mucosal DAO activity indicates that, in analogy with heparin, the high plasma enzymatic activity induced is of enterocytic origin. It is suggested that the high charge density of the compounds tested, due to the degree of sulphatation, is the decisive factor in promoting the release of intestinal DAO.

Human serum transglutaminase and coeliac disease: correlation between serum and mucosal activity in an experimental model of rat small bowel enteropathy

Transglutaminase (TG) activity is increased in the mucosa of patients with coeliac disease. Among 18 patients with untreated coeliac disease we have found a significant decrease (p less than 0.001) in serum levels of TG activity (0.72 (0.23) mU/ml). There was no significant differences between 16 treated coeliacs (1.24 (0.28) mU/ml) and 30 normal controls (1.63 (0.42) mU/ml). To evaluate the connection between serum and mucosal TG activity we used the experimental model of methotrexate induced acute hypoplastic enteropathy in the rat. Transglutaminase activity was unchanged in serum and mucosa 24 and 48 hours after MTX administration, but increased in mucosa (2.606 (0.95) v basal 0.207 (0.026) mU/mg protein, p less than 0.001) and significantly decreased in serum at 72 hours (2.08 (0.38) v basal 5.56 (1.50) mU/ml, p less than 0.001) during intestinal cell proliferation. Activity of the enzyme in the mucosa and serum returned to baseline levels within 120 hours. This experimental animal model helps to explain the data of TG activity in human intestinal mucosa and serum reported in this study. Results are mean (SD).