50 research outputs found
Che fare se è assente la transilluminazione al posizionamento della PEG?
No full textPercutaneous endoscopic gastrostomy (PEG) was described for the first time in 1980 by Gauderer and Ponsky. It became the procedure of choice in most patients that are unable to eat owing due to neoplastic or neurological diseases or cerebrovascular accidents. In some cases, however, the transillumination of the gastric wall is missing and therefore another therapeutic option is required
Direct cholangioscopy supporting diagnosis and conservative surgery of a biliary rhabdomyosarcoma in a child
No full textAccuracy of visual on-site evaluation (Vose) In predicting the adequacy of Eus-guided fine needle biopsy: a single center prospective study
No full textObjective: Endoscopic ultrasound is the standard procedure for the diagnosis of pancreatic lesions and new needles have been developed to improve tissue acquisition (FNB). Rapid onset evaluation (ROSE) decreases the number of needle passes but is not always available. We introduced an easy and rapid method of direct classification of EUS-FNB sample namely Visual on-site evaluation (VOSE).
Aims: To assess the accuracy of VOSE in predicting the histological adequacy of specimens. To evaluate the diagnostic power of FNB and the rate of core tissue obtained.
Methods: Prospective single center study on patients with pancreatic lesions that underwent EUS-FNB. VOSE parameters were presence of blood, macroscopic visible core (MVC), number, color and length of specimen. The association between VOSE tool and histological adequacy was assessed. Fisher's exact test and Student's t-test used to compare categorical and continuous variables. Logistic regression analysis was used to assess association between variables.
Results: 99 patients (58.6% male; mean age 68.4 ± 10) enrolled, including 102 lesions. Total number of passes was 358 with median number of 4 (range, 2-4). The 92.7% of samples were adequate and it was higher with the 22-G needle than with 25G (96.5% vs 89.2% p 0.01). VOSE "red-mixed specimen" was associated with a higher probability of histological adequacy (OR 2.39 95% CI 1.03-5.42 p = 0.04).
Conclusions: The VOSE tool "red-mixed specimen" can be used to predict the histological adequacy and guide the number of needle passes. Overall, FNB provides a high rate of adequate and diagnostic specimen and high rate of core tissue especially with the 22G needle
Intestinal pseudo-obstruction in patient affected by multiple sclerosis: case report
No full textNo abstrac
Erratum to: Bowel perforations in a patient affected by Churg–Strauss syndrome under high-dose steroid treatment: will alternative drugs reduce risk of surgery? (Rheumatol Int, (2011), 31, (1239-1241) DOI 10.1007/s00296-009-1289-5)
No full textErratum in
Erratum to: Bowel perforations in a patient affected by Churg-Strauss syndrome under high-dose steroid treatment: will alternative drugs reduce risk of surgery? [Rheumatol Int. 2016]
Abstract
Churg-Strauss syndrome is a relapsing-remitting vasculitis that frequently involves digestive system. Ischemic perforation of the large bowel is relatively rare and potentially life threatening. We report a case treated with high dose of steroids for a relapsing of Churg-Strauss vasculopathy that underwent emergency surgery for multiple large-bowel perforations. Massive use of steroids is common for controlling relapse of this disease, but this increases the risk of intestinal perforation. A prompt switching to alternative drugs when intestinal tract is involved should be considered in order to prevent surger
Proctalgia as a late complication of stapled hemorrhoidectomy. Report of our case series.
No full textINTRODUCTION:
Incidence and etiology of persistent pain after stapled hemorrhoidectomy remain uncertain. Characteristics, clinical course and management of this complication have not yet been assessed. Purpose of this essay is to describe our experience with persistent pain in our series of patients with this technique.
METHODS:
This retrospective study evaluated 126 cases of stapled hemorrhoidectomy treated from 2006 to 2009. We gathered information on each patient regarding type of prolapsed hemorrhoids, number of haemostatic suture placed, histology of each doughnut and post operative complications. A close follow up was done in those patients complaining about pain.
RESULTS:
Early and late complications occurred in 11.9% and 16.7% of patients respectively. At two weeks from surgery 18 patients (14.3%) were complaining of persistent pain. The average number of haemostatic sutured placed in this group and in all series is 4.5 and 2.5 respectively. Eight patients (6.34%), 3 (2.4%) and 2 (1.6%) patients were still complaining of persistent pain at 1 month, 4 months and 6 months of follow up, respectively. In these patients, endoanal manometry was normal at 4 months from surgery, while endoanal ultrasound showed retained staples in 3 of them. At 7 months from surgery a staples removal was performed in 2 patients that were still complaining of pain.
CONCLUSIONS:
Incidence of pain at 2 weeks after surgery resulted in 14.3% of patients. In most patients its etiology remains unclear but we reckon it might be related to the high number of haemostatic sutures placed. Staples removal resulted successfully
A pilot study assessing tolerance safety and feasibility of diagnostic transnasal esophagogastroduodenoscopy using an improved larger caliber endoscope and an adapted topical anesthesia
No full textBackground: Transnasal esophagogastroduodenoscopy (TN-EGDS) is well tolerated by patients and the examination is perceived comfortable without the need of a sedative drug. Conversely, mainly in Western literature, some authors report limitations in illumination, image quality, and working channel as affecting TN-EGDS diffusion. To overcome these disadvantages, a new transnasal endoscope (TNE) was tested but, due to its larger diameter, we have no evidence of its clinical safety and tolerability. A new adapted nasal anesthesia could be useful to improve TNE tolerance. In an independent, not sponsored, pilot prospective study we enrolled, in a busy clinical hospital setting, 30 adult patients receiving nasal atomized Lidocaine and Xylometazoline (XAL) to undergo a diagnostic TN-EGDS with TNE to evaluate its tolerance, safety, and feasibility. Methods: Three physicians enrolled inpatients and outpatients with indication to diagnostic EGDS during a 6-month period. Main outcome measures were cardio-pulmonary monitoring data and patients’ answers to an adapted questionnaire investigating pain, anxiety level, willingness to repeat the examination, operators’ scores about endoscopy quality, examination conduction and anesthesia-related complications. Results: The examination was completed by the transnasal route in 100 % of the enrolled patients, endoscopy satisfaction and feasibility were scored to nearly the highest levels by the three different physicians. A total of 29/30 patients (96.6 %) declared the willingness to repeat the same examination if needed. The mean patients’ score for overall pain was 3.7 ± 1 SD (range 1–10 by Visual Analog Scale). Mean endoscopy duration was 11.1 ± 2.6 min (range 5.0–19.0). In a total of 17/30 TN-EGDS that lasted more than 11 min, higher heart frequency variations and worse tolerance scores were found (p < 0.05). Conclusion: Our pilot study demonstrates that TN-EGDS with TNE and NA is safe, well tolerated, and feasible. The best clinical tolerance is reached when TN-EGDS lasts <11 min
Feasibility of EUS-guided Nd:YAG laser ablation of unresectable pancreatic adenocarcinoma
No full textBackground and Aims: EUS has become an interventional technique in which a needle may be used as a vehicle to deliver therapeutic agents. Laser ablation (LA) has been used to treat many primary and secondary neoplasms. This study aimed to assess the feasibility of EUS-guided LA for unresectable (UR) pancreatic cancer. Methods: Patients with stage IIb-III pancreatic cancer underwent EUS-guided LA. All patients were unresponsive to previous chemoradiotherapy. LA was performed by using a 300-μm flexible fiber preloaded onto a 22-gauge fine needle. A 1064-nm wavelength neodymium-yttrium aluminum garnet (Nd:YAG) laser light with different power settings of 2 W for 800 J, 1000 J, and 1200 J; 3 W for 800 J, 1000 J, and 1200 J; and 4 W for 800 J, 1000 J, and 1200 J was used. Each patient was treated with a single application of 1 of these settings. The application time of the power settings ranged from 200 to 600 seconds. Results: Nine patients (median age, 74.7; range 55-85) underwent Nd:Yag LA. The mean size of the focal lesion was 35.4 mm (range, 21-45). The ablation area, demonstrated by 24-hour CT, ranged from.4 cm3(for the lower power setting of 2 W/800 J) to a maximum of 6.4 cm3(for 4 W/1000 J). The procedure was completed in all 9 patients without adverse events. Conclusion: In our human experience, EUS-guided LA was feasible and well tolerated in patients with UR pancreatic cancer
Complications in pediatric endoscopy
No full textThe experience of the “endoscopic community” in pediatric patients is limited, but during recent years increased skills of the endoscopists and technological improvements lead to a standardization of pediatric endoscopy and the development of specialized pediatric endoscopy unit. Adverse events related to diagnostic and therapeutic endoscopy in children are usually rare. Diagnosis, prevention and treatment of complications in pediatric endoscopy is crucial when dealing with benign diseases in children. The complication rate of diagnostic EGD and colonoscopy in children are extremely low. Therapeutic procedures have obviously an increased rate of adverse events. Esophageal dilations are the most common indication for endoscopic therapy in children and can lead to perforations which requires prompt diagnosis and management. Complications of ERCP in pediatric age are similar to those reported in adults. The experience in pediatric emergency endoscopy (mainly foreign body removal) is consolidated and related adverse events extremely rare. Sedation of children during endoscopy maybe needs further evaluation and standardization, to reduce the rate of specific complications
