Ultrasonographic detection and assessment of the severity of Crohn's disease recurrence after ileal resection

<p>Abstract</p> <p>Background</p> <p>Recurrence and severity of Crohn's disease mucosal lesions after "curative" ileal resection is assessed at endoscopy. Intramural lesions can be detected as increased wall thickness at Small Intestine Contrast Ultrasonography (SICUS).</p> <p>Aims. To assess after ileal resection whether: 1) SICUS detects recurrence of Crohn's disease lesions, 2) the intestinal wall thickness measured at the level of ileo-colonic anastomosis predicts the severity of endoscopic lesions, 3) the extension of intramural lesions of the neo-terminal ileum is useful for grading severity of the recurrence, 4) the combined measures of wall thickness of the ileo-colonic anastomosis and of the extension of intramural lesions at level of the neo-terminal ileum may predict the endoscopic Rutgeerts score</p> <p>Methods</p> <p>Fifty eight Crohn's disease patients (M 37, age range 19-75 yrs) were prospectively submitted at 6-12 months intervals after surgery to endoscopy and SICUS for a total of 111 observations.</p> <p>Results</p> <p>Six months or more after surgery wall thickness of ileo-colonic anastomosis > 3.5 mm identified 100% of patients with endoscopic lesions (p < 0.0001). ROC curve analysis, combining wall thickness of ileo-colonic anastomosis and the extension of intramural lesions of neo-terminal ileum, discriminated (0.95) patients with, from those without, endoscopic lesions. Performing two multiple logistic regression analyses only wall thickness of ileo-colonic anastomosis and extension of neo-terminal ileum intramural lesions were significantly associated with absence or presence of endoscopic lesions. An ordinal polychotomus logistic model, considering all investigated variables, confirmed that only SICUS variables were associated with endoscopic grading of severity.</p> <p>Conclusions</p> <p>In patients submitted to ileal resection for Crohn's disease non-invasive Small Intestine Contrast Ultrasonography 1) by assessing thickness of ileo-colonic anastomosis accurately detects initial, minimal Crohn's disease recurrence, and 2) by assessing both thickness of ileo-colonic anastomosis and extension of intramural lesions of neo-terminal ileum grades the severity of the post-surgical recurrence.</p

Gastric xanthomatosis in a patient with severe lipid metabolic disorder

Gastric xanthomas are rare in routine endoscopy, generally ranging from to 2 to 5 mm in diameter, mostly isolated, but in some cases multiple. Their nature has not yet been cleared. In fact, even if they have histochemical characteristics similar to cutaneous xanthelasmas, they are not generally considered closely related to lipid metabolism disorders. The Authors report a case with some peculiarities regarding number, location and dimension of the gastric xanthomas, and point out the possibility of a metabolic disorder in their aetiopathogenesis

Surgical treatment of isolated lung and adrenal metastasis from colorectal cancer. Case report.

INTRODUCTION: Up to 30% of stage I and II colorectal cancers (CRCs) treated with surgical resection alone show disease recurrence, indicating that lymph node (LN) involvement was probably underestimated. Lung is a common site of CRC metastasis, whereas adrenal glands are rarely involved. CASE REPORT: On July 2004 a 56-year old woman underwent left hemicolectomy for a stage I sigmoid cancer. Four years later a lobectomy was performed for an isolated lung metastasis; thirteen months thereafter she underwent left adrenalectomy for adrenal metastasis. No lymph node involvement has ever been demonstrated either histopathologically or radiologically. At present, the patient is alive and apparently disease-free. DISCUSSION: The presence of LN occult metastasis, that might explain recurrence in stage I and II CRCs, has recently been investigated by means of immunohistochemistry and polymerase chain reaction; evidence of LN metastasis obtained with the latter technique is associated to a worse outcome. There have been very few cases that resemble our patient's neoplastic progression and they were either stage III neoplasms or rectal cancers. Our patient's primitive localization in the sigmoid colon makes it difficult to imagine why the liver has not been a site of metastasis. Finally, surgery has an important role in treating isolated metastasis in both lungs and adrenal glands. KEY WORDS: Colorectal cancer, Lung metastasis, Solitary adrenal metastasis

[Large cystic polyps of the stomach].

The Authors report the case of a 83 year old woman with large cystic polyps of the stomach. Gastric cystic polyps are polypoid lesions which may develop following functional disorders such as increased mucosal stimulation by gastrin, or excessive retention of gastric secretions. The incidence of these polyps is variable, depending on their being underestimated since they are not always macroscopically visible. The case here reported is very interesting not only for the number of lesions (over 50), but also for their size (5-25 mm in diameter)

Conventional (CH) vs stapled hemorrhoidectomy (SH) in surgical treatment of hemorrhoids. Ten years experience

Abstract Introduction: Interest about hemorrhoids is related to its high incidence and elevated social costs that derive from its treatment. Several comparative studies are reported in Literature to define a standard for ideal treatment of hemorrhoidal disease. Radical surgery is the only therapeutic option in case of III and IV stage haemorrhoids. Hemorrhoids surgical techniques are classified as Open, Closed and Stapled ones. Objective: We report our decennial experience on surgical treatment focusing on early, middle and late complications, indications and contraindications, satisfaction level of each surgical procedure for hemorrhoids. Methods: Four hundred forty-eight patients have been hospitalized in our department fom 1st January to 31st December 2008. Of these 241 underwent surgery with traditional open or closed technique and 207 with the SH technique according to Longo. This retrospective study includes only patients with symptomatic hemorrhoids at III or IV stage. Results: There were no differences between CH and SH about both pre and post surgery hospitalization and intraoperative length. Pain is the most frequently observed early complication with a statistically significant difference in favour of SH. We obtain good results in CH group using anoderma sparing and perianal anaesthetic infiltration at the end of the surgery. In all cases, pain relief was obtained only with standard analgesic drugs (NSAIDs). We also observed that pain level influences the outcome after surgical treatment. No chronic pain cases were observed in both groups. Bleeding is another relevant early complication in particular after SH: we reported 2 cases of immediate surgical reintenvention and 2 cases treated with blood transfusion. Only in SH group we report also 5 cases of thrombosis of external haemorrhoids and 7 perianal hematoma both solved with medical therapy There were no statistical significant differences between two groups about fever, incontinence to flatus, urinary retention, fecal incontinence, substenosis and anal burning. No cases of anal stenosis were observed. About late complications, most frequently observed were rectal prolapse and hemorrhoidal recurrence, especially after SH. Discussion and conclusion: Our experience confirms the validity of both CH and SH. Failure may be related to wrong surgical indication or technical execution. Certainly CH procedure is more invasive and slightly more painfull in immediate postoperative period than SH surgery, which is slightly more expensive and has more complications. In our opinion the high risk of possible early and immediate complications after surgery requires at least a 24 hours hospitalization length. SH is the gold standard for III grade haemorrhoids with mucous prolapse while CH is suggested in IV grade cases. Hemorrhoidal arterial ligation operation (HALO) technique in III and IV degree needs further validations

Resezione endoscopica di un emangioma dello stomaco: a proposito di un caso clinico

Gli emangiomi gastrici rappresentano una infrequente varietà istologica di neoplasie benigne del tratto gastrointestinale. La diagnosi si avvale di diverse metodiche d’imaging ma la certezza si ottiene solo con l’esame istologico definitivo. La resezione per via endoscopica, rispettando alcuni criteri, rappresenta il trattamento di scelta per queste lesioni. Gli Autori presentano un caso di emangioma cavernoso della piccola curva gastrica, diagnosticato e trattato mediante approccio endoscopic

[Evaluation of the effect of H2-histamine antagonists in the natural history of stomach cancer].

On a study population of 131 patients the Authors evaluate possible differences related to the use of H2 blockers. Patients were divided in 2 groups: one (70 cases) studied before the introduction of H2 blockers and the other (61 cases) treated with H2 blockers. The influence of endoscopy for the early diagnosis of gastric cancer was also considered. The Authors conclude that H2 blockers do not have a negative influence from a surgical point of view, however the correct diagnosis may often be delayed and this is not acceptable for an era in which early diagnosis is feasible

Dalla biologia molecolare ai nuovi approcci terapeutici del cancro colorettale: ricerca di base, sperimentazione clinica ed implicazioni chirurgiche

Gli Autori analizzano, attraverso una ampia disamina della let - teratura, le moderne conoscenze circa la storia naturale del cancro colorettale nell’ottica biologico-molecolare e genetica. Vengono passati in rassegna la patogenesi delle cripte aberranti e delle poliposi familiari adenomatose e la oncogenesi dei cancri colo - rettali di tipo sporadico, anche sulla scorta di esperienze personali circa lo studio e l’applicazione clinica dei geni del sistema di ripara - zione del DNA. Pur se dal punto di vista chirurgico non si è ancora in grado di proporre significative variazioni alle tecniche di trattamento fin qui consolidate e coadiuvate, nelle forme più avanzate, da trattamenti radio e chemioterapici di tipo adiuvante o neoadiuvante che non hanno fin qui consentito significativi miglioramenti per ciò che attie - ne periodo libero da malattia e sopravvivenza, al momento non è ancora affidabile una terapia genica radicale che possa portare alla reintroduzione nelle cellule di un gene difettoso reso funzionale. Sono comunque allo studio farmaci apparentemente in grado di agire in maniera preventiva e sulla evoluzione dei cancri colorettali di tipo sporadico e sui precursor

Is it possible to consider Intranuclear DNA Imaging as a new parameter for colo-rectal cancer prognostic evaluation?

San Diego, C