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The success of every intestinal surgical procedure primarily depends on correct technical execution of the intestinal sutures. Despite the continuing improvements in intestinal synthesis techniques and the introduction of mechanical staplers, the risk of anastomotic dehiscence remains a major concern. For high-risk anastomoses, defined as those performed under critical conditions, n-butyl-2-cyanoacrylate tissue adhesive allows for quick sealing of the two stumps and supports the physiological wound-healing process. Furthermore, no experimental or clinical studies have shown that this glue has any carcinogenic or mutagenic properties. Thus, we believe that n-butyl-2-cyanoacrylate will be extremely useful for intestinal anastomoses with a high risk of dehiscence.

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Authors reports the results of an experimental study on the usefulness of n-butyl-2-cyanoacrylate in abdominal surgery. The research, performed on Wistar rats and Landrace pigs, is constituted by an early phase, to verify the tissue reaction to the n-butyl-2-cyano-acrylate and its adhesive properties, and a main phase, in which it was evaluated the efficacy of n-butyl-2-cyano-acrylate as the only support or as an adjunct to the usual methods in intestinal synthesis. histological and angiographic examination of the surgical specimens demonstrated the tissue autotoxicity and the good adhesive effect of the tissue glue. Because of these characteristic, authors propose its employment to reinforce intestinal sutures performed with the usual methods in high risk condition.

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Results of cultured islet transplantation in the management of insulin-dependent diabetes are still unsatisfactory. The main problem preventing success is the swift and resolute host immune rejection. To obviate this we designed and experimented a model of bioartificial pancreas, made of polymeric hollow fibers, put into the blood circulation as an artero-venous bypass to immunoisolate endocrine tissue from leucocytes and immunoglobulins. We tested four different membrane bioreactors (BR1-4). BR1 and 2 had seven hollow fibers, the others more than 6,000 smaller fibers. In BR4 a connecting tube with a high-permeability membrane was inserted between the islet compartment and the bioreactor outlet to improve the ultrafiltration flow. In vitro, the islets inside the bioreactor perfused with glucose solutions (300 mg%) showed a rapid, high insulin secretory response, related to the glucose stimulation. The use of the outside connection allowed a twofold increase of insulin production.

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The use of pancreatic islet transplantation in membrane bioreactors put in vascular circuits aims at resetting the glucose homeostasis in diabetic or pancreatectomized patients, avoiding immune host rejection. Our experience was carried out at following stages: porcine pancreas explantation and enzymatic separation of endocrine tissue from exocrine fraction by collagenase; evaluation of islet functionality (culture tests); in vitro tests of the islets-bioreactor system, to assess the metabolic response to the glucose; in vivo evaluation to assay the haemodynamic behaviour. The trials showed a good metabolic bioreactor functionality and a decreasing incidence of coagulative problems.

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The aim of the present study was to compare the efficacy of a single dose of ceftriaxone with a triple dose of gentamicin as prophylactic agents in patients undergoing open urologic surgery. Fifty-two patients were allocated into two groups which were well matched with respect to sex, age and surgical procedure: --24 were given single-dose ceftriaxone (2 g i.v.) at the time of anesthesia (ceftriaxone group); --28 received gentamicin (80 mg i.v.) at the time of anesthesia and two additional doses of the same antibiotic were subsequently administrated every 8 hours (gentamicin group). The incidence of urinary tract infection (UTI) was 3.5% in the gentamicin group and 0% in the ceftriaxone group (p = n.s.); postoperative fever (greater than 38 degrees C) occurred in 28.3% and 8.3% in the gentamicin and ceftriaxone groups respectively (p = n.s.). There was no clinical or hematological evidence of drug side effects in any patient. Results of the study show that short-term antibiotic regimens can improve UTI rates after open urologic surgery; moreover a single preoperative dose of ceftriaxone resulted to be as effective as three doses of gentamicin.

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The authors describe their experience of surgery in long term dialysis patients. 47 major surgical operations are presented. Chronic renal failure doesn't increase risk in current surgery operations. On the other hand, daily variations of water, salts, weight and hematologic parameters increase risk in emergency surgery, performed on hemodialyzed patients.

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The treatment of a high risk case of an advanced thyroid cancer is reported. The patient had a thyroid cancer with metastatic lesions of the frontal bone, left temporal bone, left sacroiliac joint, lytic destruction of C6 and lytic lesion of C7. A pre-operative immobilization of the cervical spine was performed by a halo cast set on a corset of gypsum. After this, the patient underwent a thyroidectomy and, at the same time, a metallic plate was applied to immobilize C5-C7. A month after he underwent reoperative surgery to stabilize definitively the cervical spine. Subsequently he was treated by TCT and 131I subdivided in several cycles. The latest total body scan demonstrated a complete regression of secondary lesions.

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The Authors examine the behavior of P.A.N. membranes hemoperfusion combined with district hemodialysis in the prevention of tardy revascularization syndrome. Their experience "in vitro" seems to confirm the use of P.A.N. membrane is advisable whenever an increase of the myoglobin concentration occurs and they also envisage the use of the P.A.N. membrane in the prevention of T.R.S.

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A case of post-traumatic haemobilia in a 15-yr-old boy is presented. The clinical picture is described, together with the treatment adopted (selective ligation of the right hepatic artery). A brief account is given of the reasons underlying the choice of this approach. Stress is laid on the essential and soundness of selective angiography in the evaluation of such cases.

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