Minerva dietologica e gastroenterologica最新文献

The diagnosis of lower intestinal hemorrhage usually follows the successive sequence: a) digital rectal examination, b) rectosigmoidoscopy, c) barium enema, d) colonoscopy. This latter method has proven to be the most sensitive. This study is a retrospective examination of the results obtained by emergency colonoscopy on the diagnosis and treatment of lower intestinal hemorrhage. Out of 1258 colonoscopy procedures performed between January 1983 and June 1988 in the Digestive Endoscopy Unit of our Institute, 44 (3.5%) were emergency procedures (within 48 hrs. after recovery) due to lower intestinal hemorrhage. The most frequent causes of hemorrhage found were the following: 1) hemorrhagic colitis (20.5%), 2) polyps (13.6%), 3) hemorrhoids (13.6%), 4) carcinoma (9.0%). The hemorrhagic source was not established in 9 cases (20.5%). The sensitivity of this method was therefore 97.2%. In 6 cases of hemorrhagic polyps treatment to stop bleeding was also possible by means of the colonoscopy (endoscopic polypectomy). In our experience, the emergency colonoscopy was found to be a highly sensitive diagnostic procedure for lower intestinal hemorrhages, permitting even definitive treatment of the lesion in 13.6% of cases with no complications associated with the technique. We feel therefore that, when available, it should be considered the first and foremost exam to be performed for emergency diagnosis of colo-rectal hemorrhages.

The paper reports a case of a 45-year-old female with long-standing anemia, recurrent abdominal pain and subocclusive crises. Following a negative endoscopy of the upper tract of the large intestine, barium enema and angiography, the patient underwent total colonoscopy. Massive bleeding from the ileal valve suggested an ileal pathology: a small intestine enema confirmed a polypoid proliferation 60 cm above the Bahuino valve with related ileal invagination 25 cm long. The patient underwent surgery and pathological findings revealed a 7 cm-wide ileal lipoma near a small angiodysplasia. The latter seemed to be the cause of bleeding. The diagnosis of small intestine tumours is made difficult by the fact that the only important signs are abdominal pain, intestinal bleeding and subocclusive crises, which are common symptoms in many pathologies. The authors stress the importance of a thorough endoscopic examination and selective angiography.

Infection and sepsis remain major causes of death in medical and surgical services, despite the availability of potent antibiotics, aggressive surgery and close monitoring of patients in intensive-care units. Actually the terminology to define this type of events in multiple organ failure: we considered the role of intestine in its pathogenesis and its management.

The rate of the irritable bowel syndrome (IBS) and the follow-up of its symptoms on diet and in therapy with disodium cromoglycate have been studied in a group of patients suffering from mainly extra-digestive symptoms related to food intolerance. Following our observation, we can draw the conclusion that food additives intolerance may be a major factor in the pathogenesis of IBS.

The Authors report on their experience in endoscopic laser photoablation (Nd-YAG laser) of advanced, non surgical rectosigmoid tumors, large sessile adenomas and their recurrence after polypectomy. 37 patients have been studied: 21 out of them had an advanced rectosigmoid tumor, 10 out a large sessile adenoma, and the remaining 6 had a recurrence of adenoma after polypectomy. All the rectosigmoid tumors improved either clinically or symptomatically after 2-4 laser treatments. In 2 cases stenosis occur after laser therapy but no dilatation was necessary. Large adenomas and recurrence were all cured by the laser treatment, with a recurrence rate of about 30% at six months. In conclusion, endoscopic laser treatment is a safe and effective technique for the treatment of benign sessile rectosigmoid tumors and for palliation of symptoms from malignant ones in selected non surgical patients.

The response of 20 patients with oesophageal varices randomly assigned to treatment by endoscopic sclerotherapy with or without adjuvant Glipressina was assessed on the basis of the following parameters: mean eradication time for oesophageal varices and frequency of bleeding during that period. The preliminary results suggest that the drug may have a favourable influence on both eradication time and bleeding in sclerotherapy.

The effect of early protein restriction (0.6 g:kg/p.i./die) in patients suffering from initial kidney failure for a period of two years has been studied. The hypoprotein diet proved effective in slowing development of kidney damage in so far as a stabilization was observed in renal function parameters during the hypoprotein diet period compared to the non-diet period.

The influence of coffee on plasma lipids has been largely investigated during the last twenty years, but still many doubts remain about this subject. For this reason the influence of the assumption of coffee on plasma lipids, in healthy people, during six weeks has been studied. The coffee was prepared with an Italian coffee-machine (moka). No relationship was found between coffee assumption and increase of hematic cholesterol.

One hundred-eighty-one patients who underwent major surgical procedures were retrospectively considered to value the incidence of gastrointestinal bleeding. Upper-gastrointestinal-tract bleeding occurred in only one patient (0.5%). The Authors suggest that only critically ill patients require prophylactic use of cimetidine.

In order to assess the antiemetic properties of alizapride in the specific context of premedication for endoscopy, a double blind test was conducted on 100 patients against both metoclopramide and a placebo. Efficacy was assessed on the basis of the following parameters: technical judgement of the endoscopist; assessment of evident signs of "discomfort" by an outside observer; comparative judgement (better, worse, same) of the patient's condition after the two endoscopies performed. In the case of the first two parameters, alizapride proved significantly more effective than the control substances. The patients themselves only expressed a significant preference for alizapride vis-à-vis the placebo. It is concluded that given its efficacy and the absence of side effects, alizapride is of value in premedication for endoscopy.