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Background: It has been suggested that the variation of biochemical and microbiological parameters in the gastric juice may play a role in the development of gastric cancer. In the present study we concurrently assessed the presence of N-Nitroso compounds (NOC) and their precursors, bacteria and carcinoembryonic antigen (CEA) in the gastric juice of normal controls, patients with gastric resection, and advanced gastric cancer. Methods: Detailed analyses of biochemical and microbiological parameters such as pH, nitrite (NO 2 ) concentration, N-nitroso compounds (NOC) concentration, carcino-embryonic antigen (CEA) level, total viable counts (TVC), nitrate-reductase positive bacterial counts (NRPBC), and identification of micro-organisms were carried out. Results: Significantly higher mean pH values, NO 2 , NOC and CEA concentrations, TVC, and NRPBC were found in partial gastrectomies compared with normal controls, and all these intragastric parameters were significantly higher in patients with gastric cancer than in those with partial gastrectomies. As far as surgical methods are concerned, higher mean pH values, NO 2 and NOC concentrations, TVC, NRPBC, and anaerobic bacterial counts were observed in the juice of patients with Billroth II compared with Billroth I gastrectomies. Apart from the type of surgical reconstruction, higher mean NOC levels were recorded in patients with more severe histological changes and H. pylori infection. Conclusions: All these data suggest that the presence of high levels of NOC in the gastric juice of gastroresected patients can be considered a risk factor of gastric stump cancer.

Pulmonary function, pain and endocrine-metabolic response to surgical stress were compared in 50 patients with elective cholelithiasis who were randomly treated by laparoscopic cholecystectomy (LC) (group 1 = 29 patients) and by open cholecystectomy (OC) (group 2 = 21 patients). Data were stored in Dbse III and analysed using SPSS software. We compared the two groups using the unpaired t-test and by two-tailed chi-square test. No respiratory dysfunction was present after LC whilst in the OC group, pulmonary impairment lasted 5–7 days post-operatively. Pain evaluation by visual analogue scale confirmed that LC is less invasive and less harmful than OC. During surgery, hormonal response did not significantly differ in either group. In the post-operative period, an increase in prolactin and cortisol levels resulted in the OC group, which suggested stress. The findings of this study suggest that LC has more advantages than OC in the elective treatment of gallstones.

Current organ shortage is estimated to keep outpacing demand for years to come. Among the advocated strategies, artificial and bioartificial devices may prove beneficial to a wide category of patients on transplant waiting lists. Bionic organ science allows to reproduce organ architecture and function through a complex interplay of cellular and mechanical elements. Some bioartificial organs may well be used to replace anatomical defects, while others allow to compensate for failing organ functions and to bridge patients to transplantation. Among these latter, bioartificial liver (BAL) systems bear the highest potential for clinical application, even if their use is raising several controversial issues. These latter regard the identification and stratification of patients fit for transplantation, timing and type of transplantation after recovery, appropriateness of double-blind, randomized clinical trials and safety of animal and/or human cell lines. Nonetheless, bionic organ science needs to be regarded as a useful adjunct in the armamentarium of organ replacement therapies for the third millennium.

Acute pancreatitis and leakage of pancreaticojejunal anastomosis are the most important causes of operative morbidity and mortality after pancreatoduodenectomy. We have introduced a modified technique for reconstruction that provides a functional exclusion of the pancreatic-jejunostomy in respect of the transit of gastric and biliary secretions. The immediate advantages of this technique are the reduction in the risk of leakage and the possibility of undertaking conservative treatment, in the case that leakage occurs. The preservation of the antral-pyloric unit, according to Traverso and Longmire,1 increases the functional features of the procedure, by reducing entero-gastric refluxes, and assuring a regulated gastric emptying. We herein present our series of 11 pancreatoduodenectomies (PD) for periampullary neoplasms and chronic pancreatitis. Throughout our series we experienced no cases of operative mortality. However, there was one specific instance of morbidity, consisting of one case of external biliary fistula by micro-dehiscence of the hepaticjejunostomy and which was later resolved by conservative treatment. Our most recent results have produced almost normal findings in terms of gastric secretion, gastric emptying and an absence of dumping syndrome, ulcers and refluxes.

We read with interest the recent article in the Journal about the use of a circular stapler to create the duodenoenterostomy for enteric drainage of a pancreas transplant. Congratulations to the authors for their report of 14 patients with only a 7% complication rate (1 anastomotic leak in 14 anastomoses).This technique has already been used not only for duodenocystostomy for bladder drainage but also for duodenum-jejunum or duodenum-ileal anastomosis in pancreas transplantation. In a survey of the International Pancreas Transplant Registry conducted in 1998 to report on various surgical techniques around the world, it was found that the anastomosis of donor duodenum to either the recipient ileum or jejunum with or without the use of a Rouxen-Y limb was performed with a circular stapler by five different institutions. In this survey, 40 centers were performing enteric drainage and 5 (12.5%) used a circular stapler to anastomose the donor duodenum to the recipient small bowel. Techniques were as follows: pancreatic tail facing up in the abdomen, four centers; facing down, one center; use of recipient jejunum for the anastomosis, three centers; use of the recipient ileum, two centers; direct anastomosis to recipient small bowel, four centers; use of the Roux-en-Y loop, one center; systemic venous drainage, four centers; and portal venous drainage, one center. Obviously, the portal drainage required the tail of the pancreas to be positioned facing down the pelvis. Unfortunately, no data are available in the survey about the rate of complications with the use of circular stapler versus the hand-sewn technique. It would be interesting to know the complication rate of different institutions using a stapling device, because intestinal leak still represents one of the most troublesome complications of enteric drainage in pancreas transplantation. The use of an end-to-end circular stapler to create a side-to-side anastomosis between two intestinal loops makes sense, because such an anastomosis needs to drain only the pancreatic exocrine secretions. Currently, enteric drainage represents the drainage of choice of many centers, and it is likely that the fast and safe stapling technique will be used more often. REFERENCES

A case of juvenile polyposis is reported and 271 cases are collected from the literature. The risk for neoplasia is analyzed and the endoscopic or surgical therapy is discussed. The authors conclude that juvenile polyposis should be considered as a challenge to the surgeon with regard to familial adenomatous syndromes, and strongly recommend a close follow-up of patients with juvenile polyposis.

The aim of this study was to determine the impact of two reperfusion techniques on the peri-operative hemodynamic changes and early post-operative graft function of adult patients undergoing orthotopic liver transplantation. Material and methods: From June 2003 to May 2004, 50 consecutive liver transplants were performed and divided into two groups: group A, 25 patients, portal vein flush with 500 cm3 of Ringer's lactate without vena caval venting. Group B, 25 patients, vena caval venting with no portal vein flush. Donor and recipient characteristics were similar in both groups. Sixty-four different parameters were analyzed, and Pearson's χ2 test and t-test were used for statistical analysis, p0.05. Results: One patient (4%) in group B experienced a post-reperfusion syndrome (PRS). Pearson's χ2 test found a significant relationship between the analyzed parameters and the two different reperfusion techniques for 10 parameters (t-test analysis showed a significant difference between the two groups in favor of group A). Conclusions: In our transplant center, portal vein flush without vena caval venting provided a lower incidence of hemodynamic changes in the peri-operative period after liver transplantation and earlier recovery of the graft function.