Minerva dietologica e gastroenterologica最新文献

The frequency of peptic ulcer and the role of ulcerogenic risk factors in cirrhotic patients were evaluated in a retrospective study. Peptic disease was observed in 18.2% of the cirrhotic patients examined. When compared to the prevalence of ulcerative lesions in the general population, this finding suggests that cirrhotic patients have the same probability of being affected by peptic ulcer as non-cirrhotic subjects. The analysis of ulcerogenic risk factors highlighted the importance of alcohol and smoking. The etiology of cirrhosis and portal hypertension were not found to be important. In conclusion, peptic disease is not more frequent in cirrhotic patients than in the general population.

The Authors examine retrospectively 93 CT exams performed on 60 patients submitted to hepatic surgery both for malignant and benign lesions. It is concluded that CT, if performed correctly, is helpful in recognizing both complications and recurrences.

We studied antipyrine clearance (APC1) in 19 healthy controls, 10 cirrhotic patients, 20 patients undergoing partial hepatectomy for liver tumors (14 with cirrhosis and 6 without cirrhosis). The aim of the study was to evaluate if the test represents a measure of the residual hepatic function and a useful index of surgical risk in cirrhotic patients following partial hepatectomy. The APC1 was significantly reduced in cirrhotic patients ws healthy controls. It is reduced following partial hepatectomy in cirrhotic patients (p less than 0.001) and in non cirrhotic patients (n.s.). The APC1 was found to be related with the plasma level of albumin and pseudocholinesterase; it also was related with the Pugh's score for hepatic function. The APC1 is a satisfactory index of residual hepatic function. On the other hand it does not provide more useful information than the Pugh's score for surgical risk in liver resection.

The Authors have assessed the incidence of ulcer recidivation in patients with cicatrized bulbar ulcers following anti H2 treatment using two maintenance therapy protocols: 1) 400 mg/day of cimetidine in a single evening dose for 1 year (continuous therapy); 2) the same dose of cimetidine administered at the same time but only for 4 months a year (February-March and September-October) (seasonal therapy). Ninety patients with cicatrized ulcers which had been diagnosed using endoscopy were randomly assigned to the two treatment protocols. Protocols were followed for a least one year with endoscopic controls every 6 months. There were no significant differences between continuous and seasonal therapy in relation to the recurrence of duodenal ulcers (Log Rank test p less than 0.05). Cox's proportional hazard model was used to assess the effect of the two treatment protocols on ulcer recurrence eliminating the influence of sex, age and smoking; it was seen that only smoking influenced the incidence of recidivation (p less than 0.05). These results suggest that seasonal maintenance therapy with anti H2 is as efficacious as continuous therapy in preventing the recurrence of ulcers.

The paper gives a short critical bibliographic review of colonic preparation for endoscopy, focusing on the out-patient use of gastrointestinal endoscopy. A method of preparation based on dietary restrictions plus cathartics is proposed that allows the number of enemas used to be reduced to a minimum. The results obtained in 265 out-patients undergoing colonoscopy confirm the efficacy, practicality and tolerability of the method.

The presence of latent encephalopathy was assessed by means of various psychodiagnostic tests in 24 non-alcoholic cirrhotics. Twenty-four subjects hospitalized for chronic extrahepatic conditions served as the control group. The following tests were utilized: 1) semistructured individual clinical interviews; 2) Rorschach test; 3) Minnesota Multiphasic Personality Inventory; 4) Reitan's test; 5) spatial capability test (hand test); 6) reaction times to sound and light stimulation. Mood and behavioural modifications were frequently found in cirrhotics, probably as a consequence of the reaction to a chronic disease. Such abnormalities could, however, be differentiated from the early impairment of superior psychomotor functions which were present in nearly 50% of cirrhotics as latent encephalopathy. Results indicate that the use of the Reitan's test, can allow for a better management of cirrhotics even at non advanced stages of the disease and that more sophisticated tests failed to add further clues to diagnosis of latent encephalopathy.

Chemical litholysis of biliary stones is currently performed using monooctanoin (Mo) and methyl tert-butyl ether (MTBE). These two solvents dissolve cholesterol gallstones at different speeds due to their viscosity, high for Mo (47 cps) and low for MTBE (0.2 cps). A third compound was recently used which was produced by combining the previous two agents, Mo and MTBE, at a ratio of 2:1 v/v. The mixture has an intermediate viscosity (2.8 cps) and has shown good tolerability, management and efficacy with a 90% success rate in the treatment of post-surgical gallstones in 28 patients.

The paper reports a series of 236 patients who underwent emergency esophagogastroduodenoscopy (EGDS) (within 48 hours of hospitalisation) due to hemorrhage of the upper digestive tract. A definitive diagnosis of the of bleeding was made in 233 (98.7%) cases. In 1.3% of cases, endoscopic tests proved negative. The most frequent cause of bleeding was duodenal ulcer, followed by esophageal varices. Hemorrhage was caused in only 46.2% of 80 cirrhotic patients by the rupture of esophageal varices, whereas in the remaining 53.8% of cases the source of hemorrhage was a lesion associated to esophageal varices. Surgery was necessary in 15 patients (6.4%). The death rate within 30 days was 5.5%. In conclusion, emergency EGDS performed within 24 hours of hospitalisation is the most precise diagnostic technique for upper gastrointestinal bleeding.