Minerva dietologica e gastroenterologica最新文献

Primary esophageal motility disorders consist of a complex group of motor disturbances, affecting the characteristics of esophageal contractions, occurrence of peristalsis and lower esophageal sphincter function. The medical treatment is still challenging because of the absence, except for Achalasia, of generally agreed criteria for diagnosis and the still unresolved relationship between esophageal symptoms and some motor abnormalities. In Achalasia, the medical therapy does not constitute a main role and should be reserved to selected conditions. Current medical therapies for Diffuse Esophageal Spasm and Esophageal Chest Pain are often considered less than satisfactory, however, a better physiopathological knowledge of these conditions might produce a more appropriate therapeutic management of the patients with continual and disabling symptoms.

A retrospective study was carried out in 110 patients who underwent colon resection for cancer of the colon-rectum. Polypoid formation reappeared in 10 (21.5%) patients in whom synchronous polyps were found around carcinoma during initial staging; during the follow-up polyps were only found in 3% of patients in whom synchronous polyps had not been documented. A similar ratio was found in the incidence of neoplastic recurrences which was greater (14%) in patients with synchronous polyps. This incidence was higher in cases with multiple polyps and/or polyps larger than 2 cm in size, and in relation to their histological type. The authors suggest that a more comprehensive operation, for example subtotal colectomy, should be performed in patients at greater risk to develop a second primary carcinoma, and/or that a particularly careful post-operative follow-up should be carried out in these patients.

Meckel's diverticulum (MD) is a well-known cause of lower gastrointestinal hemorrhage, particularly in the pediatric age group. The radionuclide 99mTc-pertechnetate has been found useful in visualizing MD which contain gastric mucosa. This test is predicated of the affinity of the isotope for the parietal cells of the gastric glands. In an attempt to evaluate the sensibility and specificity of pertechnetate, the clinical data and scintigrams of 27 patients with suspected MD were reviewed. The scintigram correctly identified MD before operation in 6 of 7 patients. The false negative study occurred in a MD without gastric mucosa.

A group of 11 patients received somatostatin for a minimum period of 30 days. Patients affected by pancreatic fistulae following either chronic and acute pancreatitis of surgery were admitted to the study. Other published reports are not explicit about the possible side-effects of such a long period of full-dose therapy (lasting at least twice the recommended cycle). In this case, having been forced to continue therapy, no significant side-effects were observed and the therapy retained its effectiveness and tolerability up to the end of the study.

A group of patients with a patch-test positive to nickel sulphate, was selected within a population suffering from pseudo-allergic chronic cutaneous manifestations. On the ground of the results of dietary restriction and oral challenge, the Authors reach the conclusion that the intolerance to nickel salts is to be considered in these patients the mayor factor in the development of skin disorders.

Correct diagnostic evaluation of chronic pancreatitis pictures must of necessity be directed to recognition of recurrent and stable forms and identification of the pathogenetic cause of the clinical forms. This objective seems to be achieved more than satisfactions by the diagnostic protocol employed personally, the first stages of which include X-ray of the abdomen for the identification of possible pancreatic calcification, ultrasonography and computed axial tomography for the analysis of organ's morphology and structure, intestinal absorption and pharmacodynamic tests of the papillary excretory complex for the evaluation of functional state of the pancreas. At a second time, this diagnostic protocol includes endoscopic pancreatography for the analysis of the excretory duct and identification of possible calcareous concretions in its lumen, and district angiography, for information on the extreme viscero-vascular implications and the possibility of coexistence of district portal hypertension pictures. The resulting information dominates therapeutic choices by indicating the usefulness of performing a papillo-sphincteroplasty to handle the biliary aetiology in recurrent forms and Wirsung septoplasty for ductal ostial stenoses. The choice of shunts and resections is confirmed to the stable forms, with the use of the former in the event of ductal dilatation and of the latter in the absence of this and in the presence of more or less marked gland fibrosis. Derivative procedures also control treatment of chronic post-pancreatitis pseudocyst, with a clear-cut prevalence of cysto-gastric shunts over all the other possibilities.(ABSTRACT TRUNCATED AT 250 WORDS)

The detection of CP in the mucosa of the gastric antrum had led to the supposition of this bacterium's potential pathogenetic role in the onset and continuation of peptic ulcer and/or inflammatory gastroduodenal disease. After reviewing the literature, the Authors report the incidence rate of the presence of C.P. in the mucosa of the gastric antrum in 110 symptomatic patients. Endoscopic examination revealed a negative diagnosis, or the presence of gastric and/or duodenal ulcer, or aspecific inflammatory disease. C.P. was detected using the quick urea test and histomorphological analysis after modified Giemsa staining on bioptic endoscopic specimens. C.P. were present in 86.6% of duodenal ulcers, 94.8% of gastro-duodenal inflammation, and 29.4% of endoscopical normal patients. These results confirm that C.P. should not be considered an occasional finding but almost a constant factors. The importance of performing the quick urea test during endoscopic examination is underlined, since if positive an appropriate therapeutic protocol can be started as soon as possible.

Gallbladder carcinoma is difficult to diagnose in its early stage due to the nonspecificity of various characteristics. The authors describe 3 cases of gallbladder carcinoma. Diagnostic utility of ultrasonography in primary carcinoma of the gallbladder and diagnostic problems in the differentiation from inflammatory diseases are reported.

On the basis of the results obtained in a previous perspective comparative study aimed to compare the diagnostic accuracy of a computerized diagnostic decisional support in gastroenterology with that of non-specialist physicians, the Authors have carried out a retrospective study, based on the same series and on the same results, but disaggregating the global comparisons according to the feature of the clinical presentations. The latter were therefore classified by independent gastroenterologists as "typical", "atypical", or "borderline", and for each group the difference of diagnostic accuracy between program and physicians was again evaluated. Even if the program proved more accurate in all groups, the greatest difference was observed in the "borderline" group which the Authors claim to include the kind of presentation which more than any other needs a decisional aid. This should suggest a possible useful implementation of the system in daily clinical practice.

The authors describe a large gastric leiomyoma with prevailing subserous growth. Conventional X-ray examination and endoscopy failed to diagnose the lesion properly. On the contrary, with CT it was possible to hypothesize the existence of leiomyoma with the correct definition of the outline of the lesion.