Antonio Nocito

Characterization of time‐related changes after experimental bile duct ligation

Although bile duct ligation (BDL) in mice is used to study cholestasis, a detailed description of this animal model is lacking. The aim of this study was to define specific phases of acute and chronic injury and repair in the different cellular compartments of the liver.

Platelets and platelet-derived serotonin promote tissue repair after normothermic hepatic ischemia in mice

Hepatic ischemia and reperfusion (I/R) leads to the formation of leukocyte–platelet aggregates. Upon activation, platelets generate reactive oxygen species and release proapoptotic and proinflammatory mediators as well as growth factors. In cold hepatic ischemia, adhesion of platelets to endothelial cells mediates sinusoidal endothelial cell apoptosis. Furthermore, platelet‐derived serotonin mediates liver regeneration. We hypothesized that platelets may contribute to reperfusion injury and repair after normothermic hepatic ischemia. The aim of this study was to assess the impact of platelets in normothermic hepatic I/R injury using models of impaired platelet function and immune thrombocytopenia. Inhibition of platelet function in mice was achieved via clopidogrel feeding. Immune thrombocytopenia was induced via intraperitoneal injection of anti‐CD41 antibody. Platelet‐derived serotonin was investigated using mice lacking tryptophan hydroxylase 1. Mice were subjected to 60 minutes of partial hepatic ischemia and various time points of reperfusion. Hepatic injury was determined via AST and histological analysis of the necrotic area as well as leukocyte infiltration. Liver regeneration was determined via proliferating cell nuclear antigen and Ki67 immunohistochemistry. Neither inhibition of platelet function nor platelet depletion led to a reduction of I/R injury. Liver regeneration and repair were significantly impaired in platelet‐depleted animals. Mice lacking peripheral serotonin were deficient in hepatocyte proliferation, but otherwise displayed normal tissue remodeling. Conclusion: Platelets have no direct impact on the pathogenesis of normothermic I/R injury. However, they mediate tissue repair and liver regeneration. Furthermore, platelet‐derived serotonin is a mediator of hepatocyte proliferation in the postischemic liver, but has no impact on tissue remodeling. (HEPATOLOGY 2007;45:369–376.)

Robotic-assisted versus laparoscopic cholecystectomy: outcome and cost analyses of a case-matched control study.

Objective:To compare safety and costs of robotic-assisted and laparoscopic cholecystectomy in patients with symptomatic cholecystolithiasis. Background:Technical benefits of robotic-assisted surgery are well documented. However, pressure is currently applied to decrease costs, leading to restriction of development, and implementation of new technologies. So far, no convincing data are available comparing outcome or costs between computer assisted and conventional laparoscopic cholecystectomy. Methods:A prospective case-matched study was conducted on 50 consecutive patients, who underwent robotic-assisted cholecystectomy (Da Vinci Robot, Intuitive Surgical) between December 2004 and February 2006. These patients were matched 1:1 to 50 patients with conventional laparoscopic cholecystectomy, according to age, gender, American Society of Anesthesiologists score, histology, and surgical experience. Endpoints were complications after surgery (mean follow-up of 12.3 months [SD 1.2]), conversion rates, operative time, and hospital costs (ClinicalTrial.gov ID: NCT00562900). Results:No minor, but 1 major complication occurred in each group (2%). No conversion to open surgery was needed in either group. Operation time (skin-to-skin, 55 minutes vs. 50 minutes, P < 0.85) and hospital stay (2.6 days vs. 2.8 days) were similar. Overall hospital costs were significantly higher for robotic-assisted cholecystectomy

Serotonin Regulates Macrophage-Mediated Angiogenesis in a Mouse Model of Colon Cancer Allografts

7985.4 (SD 1760.9) versus

Atraumatic Chylous Ascites: Systematic Review on Symptoms and Causes

6255.3 (SD 1956.4), P < 0.001, with a raw difference of

Randomized clinical trial comparing venous cutdown with the Seldinger technique for placement of implantable venous access ports.

1730.1(95% CI 991.4–2468.7) and a difference adjusted for confounders of

Cholestasis protects the liver from ischaemic injury and post-ischaemic inflammation in the mouse

1606.4 (95% CI 1076.7–2136.2). This difference was mainly related to the amortization and consumables of the robotic system. Conclusions:Robotic-assisted cholecystectomy is safe and, therefore, a valuable approach. Costs of robots, however, are high and do not justify the use of this technology considering the lack of benefits for patients. A reduction of acquisition and maintenance costs for the robotic system is a prerequisite for large-scale adoption and implementation.

Laparoscopic gastric pouch and remnant resection: a novel approach to refractory anastomotic ulcers after Roux-en-Y Gastric Bypass: Case report

Serotonin, a neurotransmitter with numerous functions in the central nervous system (CNS), is emerging as an important signaling molecule in biological processes outside of the CNS. Recent advances have implicated serotonin as a regulator of inflammation, proliferation, regeneration, and repair. The role of serotonin in tumor biology in vivo has not been elucidated. Using a genetic model of serotonin deficiency (Tph1(-/-)) in mice, we show serotonin to be crucial for the growth of s.c. colon cancer allografts in vivo. Serotonin does not enhance tumor cell proliferation but acts as a regulator of angiogenesis by reducing the expression of matrix metalloproteinase 12 (MMP-12) in tumor-infiltrating macrophages, entailing lower levels of angiostatin-an endogenous inhibitor of angiogenesis. Accordingly, serotonin deficiency causes slower growth of s.c. tumors by reducing vascularity, thus increasing hypoxia and spontaneous necrosis. The biological relevance of these effects is underscored by the reconstitution of serotonin synthesis in Tph1(-/-) mice, which restores allograft phenotype in all aspects. In conclusion, we show how serotonin regulates angiogenesis in s.c. colon cancer allografts by influencing MMP-12 expression in tumor-infiltrating macrophages, thereby affecting the production of circulating angiostatin.

What should we do about anal condyloma and anal intraepithelial neoplasia? Results of a survey.

Chylous ascites, or chylaskos, is a rare form of ascites characterized by a milky-appearing fluid containing high levels of triglycerides. Its incidence ranges from 1 in 20,000 to 1 in 187,000 admissions at large tertiary referral hospitals. Therapeutic interventions and trauma are well-known causes of chylous ascites. In a cohort of 1,103 patients undergoing abdominal surgery, the incidence of postoperative chylous ascites was reported to be 1.1%. When retroperitoneal, esophageal, gastric, or cytoreductive surgeries were performed, the postoperative incidence was even higher, amounting to 7.4%. Apart from oncologic thoacic and abdominal surgery, chylous ascites can also occur fter abdominal aortic surgery and very rarely after donor nephrectomy. In contrast to the direct injury of lymphatic vessels during surgery, the hyperextension and hyperflexion of the body during a blunt abdominal trauma entail a rupture of lymphatic vessels, thus causing chylous ascites. An additional cause of indirect injury leading to the development of chylous ascites is radiotherapy. Abdominal radiation is thought to induce fibrosis of the lymphatic vessels within the small bowel and the mesentery, causing obstruction and subsequent extravasation of chylous. In patients fter radiation of the whole abdomen for gynecologic maignancies, the incidence was reported to be as high as 3%. The most common clinical presentation of chylous ascites is supposed to be increasing painless abdominal distension. Less frequently, postinterventional and posttraumatic chylous ascites can induce an acute abdomen. Although the clinical features and causes of chylous ascites secondary to surgery or trauma are familiar to most clinicians, little is known about the incidence, etiology, and distribution of different clinical symptoms of atraumatic chylous ascites. The incidental finding of a few milliliters of chylous ascites during a routine inguinal hernia repair in a 28-year-old man finally leading to the diagnosis of non-

An outcome and cost analysis of anal fistula plug insertion vs endorectal advancement flap for complex anal fistulae

The aim of this randomized controlled study was to compare the primary success rate between venous cutdown and the Seldinger technique for placement of the totally implantable venous access port (TIVAP).