The Italian journal of gastroenterology最新文献

Inflammatory bowel disease, in addition to intestinal involvement, may be complicated also by other extra-intestinal manifestations. Moreover, drugs commonly employed in the treatment of ulcerative colitis and Crohn's disease may induce iatrogenic pancreatitis. Acute pancreatitis is described in two ulcerative colitis patients following azathioprine treatment.

Primary hepatic leiomyosarcoma is a very rare tumour only eighteen cases having been reported in the literature. A new case of this tumour is reported here, in which a complete diagnostic imaging work-up was performed, leading to the pathologic diagnosis, obtained with ultrasonically-guided coarse needle biopsy. Transarterial chemoembolisation, a new therapeutic option for this disease, was attempted without success.

Ductal pancreatic changes and functional exocrine assessment have been studied, in a group of 60 cirrhotic patients. In these patients the aetiology of cirrhosis was alcoholism in 35, hepatitis B virus-hepatitis C virus infection in 19, primary biliary cirrhosis in 2 and not determinable in 4. Eighteen patients (30%) showed an endoscopic retrograde pancreatography picture consistent with chronic pancreatitis (14 mild, 2 moderate and 2 severe). Mild pancreatographic changes were present in 7 alcoholic (20%) and in 7 non-alcoholic cirrhosis patients (28%). Moderate and severe abnormalities were present only in alcoholic cirrhosis (4 patients, 11.4%). No correlation was found between presence or pancreatopathy degree and Child-Pugh score or cirrhosis duration. Functional exocrine tests were abnormal only in severe endoscopic retrograde pancreatography picture. Mild type ductal lesions can mimic either age-dependent changes or chronic pancreatitis. The absence of impaired functional tests makes it impossible to discriminate between these two possibilities. These findings emphasize that in our cirrhotic group the prevalence of chronic pancreatitis (with a moderate or severe endoscopic retrograde pancreatography picture) is low (6.6%) and alcoholism is always present. Possibly, cirrhosis with secretion of high-volume low protein concentration juice confers a protective effect on the pancreas.

The case of an 84-year-old woman with evidence of continuous gastrointestinal bleeding is presented. A barium study and endoscopy showed a 25 x 20 mm sized semipedunculated polyp in the second portion of the duodenum. No other lesion was found throughout the entire gastrointestinal tract, and endoscopic resection of the duodenal polyp was performed. The resected polyp showed typical histologic features of a Peutz-Jeghers type hamartomatous polyp, although the patient lacked any familial history and signs related to the Peutz-Jeghers syndrome. A focus of adenocarcinoma was also found within the polyp. The present case would appear to be the first demonstration of a solitary Peutz-Jeghers type hamartomatous polyp of the duodenum containing a focus of adenocarcinoma.

In order to develop a practical and reproducible method to assess gallbladder function, gallbladder emptying was studied by ultrasound in 27 gallstone patients after i.m. administration of ceruletide (0.3 micrograms/kg), and the procedure was compared to oral cholecystography with fatty meal. Maximal percent gallbladder contraction was reached in all patients 30 min after ceruletide. Maximal percent contractions were 47.5 +/- 27.7 during ultrasound with ceruletide and 33.9 +/- 16.3 during oral cholecystography with fatty meal (p = 0.03). A significant linear relationship was found between the results obtained with the two different procedures (r = 0.57; p = 0.002). Serial ultrasound determinations of gallbladder emptying were performed in 16 patients. Day-to-day variation was below 20% in 11 subjects, and it ranged between 20 and 40% in 5 subjects. Minor side effects were observed in 9 patients. Ultrasound determination of gallbladder emptying after ceruletide appears to be a practical and reliable method to assess gallbladder function.

The object of this work was to test the efficacy of ornidazole in patients with active Crohn's disease. Twenty-five patients with active Crohn's disease (Crohn's disease activity index greater than 150 points) participated in this open study. The analysis of results was based on changes in the severity of the Crohn's disease activity index measured at entry and at the end of the first, second, and third and fourth week. Analysis of variance, correlation analysis, multiple regression analyses and chi-square test were used for statistical evaluation of results. The results showed that the Crohn's disease activity index fell gradually from week 0 to week 4 (p < 0.001), while the number of patients going into remission increased gradually from week 0 to week 4 (18/25 patients, 75%). Sex, location of disease, age at onset, first attack or recurrence and duration of disease were not statistically related to response to treatment. Presence and severity of abdominal pain both decreased and bowel movements were also reduced. General well-being improved significantly, the loss of weight stopped and an increase in body weight was noted at the end of the fourth week. Side effects were minimal. It is concluded that ornidazole is an effective and safe drug for the treatment of active Crohn's disease.

A case of hepatic epithelioid haemangio-endothelioma is described in a 42-year-old female who presented with abdominal pain and hepatomegaly. The radiographic finding showed multiple hepatic lesions in both lobes. Diagnosis was based on the liver biopsy. The tumour cells were immunoreactive with factor VIII related antigen and vimentine. A liver transplantation was performed. Although at the time of diagnosis there was no clinical evidence of metastasis, the intra-operatorive examination revealed multiple mesenteric and pulmonary neoplastic nodules. The patient is alive and well seven months after liver transplantation.

A prospective study was undertaken to evaluate the prevalence, incidence, clinical spectrum and prognostic value of mixed cryoglobulinaemia in HCV infection. Four-hundred and thirty-two consecutive patients with chronic liver disease, 303 HCV-related, 81 HBV-related, 14 nonB-nonC related, and 34 of non-viral aetiology were studied. Cryoglobulinaemia was detected in 139 (46%) of the HCV-related chronic hepatitis patients, in 4 (5%) of the HBV-related and in none of the chronic hepatitis patients of any other aetiology. Cryoglobulinaemia was associated with liver cirrhosis, the duration of liver disease and predominantly with the female sex. HCV and anti-HCV antibodies were present in all the cryoprecipitates. All the HCV genotypes were associated with cryoglobulinaemia. In a high percentage of patients, the amount of cryoglobulinaemic was low and about half of the cryoglobulinaemic patients showed a clinical syndrome. The incidence per year of cryoglobulinaemia (6%) and of related signs was low. A higher incidence of malignant lymphoproliferative diseases was observed in type II cryoglobulinaemia. The presence of a cryoglobulinaemia-related clinical syndrome plays a role in the prognosis of patients with chronic hepatitis C.

Thoracic varices are rare anomalies in patients with liver cirrhosis and portal hypertension. Gastro-oesophageal varices usually drain into the azygos or hemiazygos vein. The case is reported here of an unusual collateral pathway of gastro-oesophageal varices with drainage to the vena anonyma system presenting as lung masses on chest X-ray, which completely resolved after successful liver transplantation.