Endoscopic palliative treatment of rectal cancer: our experiences with laser

Izhodišča. Paliativno zdravljenje bolnikov z neozdravljivim rakom je velik problem. Ko gre za bolnika z razširjenim rakom danke, je cilj zdravljenja preprečiti zaporo črevesa, krvavitev iz tumorja in bolečino in tako izboljšati kakovost preostalega življenja. Namen prikazane študije je bil oceniti vlogo laserja v paliativnem zdravljenju raka danke. Bolniki in metode. Od 1998 do 2005 smo z laserjem zdravili 44 bolnikov z rakom danke, ki ga ni bilo mogoče operativno zdraviti. Indikacija za zdravljenje je bila grozeča zapora, krvavitev in/ali bolečina. Rezultati. Rekanalizacijo in hemostazo smo dosegli pri 37 bolnikih, kar je v 84 %. Neuspešni smo bili pri 7 bolnikih, kar je 16 %. Opazovali smo 4 resne, vendar ne smrtne zaplete, perforacije danke z okolnim vnetjem. Vsi zapleti so bili zdravljeni konzervativno. Zaključki. Endoskopsko lasersko zdravljenje bolniki dobro prenašajo, metoda je učinkovita in varna. Je odlična metoda za paliativno zdravljenje raka danke, ki ga ni mogoče operativno zdraviti.Background. The palliative treatment of patients suffering from an incurable cancer is a common problem. In cases of advanced rectal cancer the therapeutic aims are elimination or prevention of obstruction, bleeding and pain and improvement in quality of life. The aim of our study was to evaluate the role of laser in the endoscopic palliative treatment of rectal cancer. Patients and methods. 44 patients with inoperable rectal cancer were treated with laser from 1998 to 2005. The indication for treatment included stenosis, bleeding and/or pain. Results. Recanalisation and haemostasis were achieved in 37 patients (84 %). In 7 patients (16 %) we were unsuccessful. We observed 4 serious but nonfatal complications in form of rectal perforations with inflammation. None of them needed surgical attention. Conclusions. Endoscopic laser therapy is an effective and well tolerated method in palliation of rectal cancer with low risk of complications

Foreign bodies in upper gastrointestinal tract and urgent endoscopic interventions - review of a ten-year period

Izhodišča. Tujki v zgornji prebavni cevi le redko povzročajo nujna stanja v gastroenterologiji. V prebavno cev zaidejo običajno ob hranjenju ali po pomoti. Nekatere skupine oseb, kaznjenci in psihiatrični bolniki, jih zaužijejo tudi namenoma. Avtorji so želeli ugotoviti delež bolnikov, pri katerih smo ob nujni endoskopski preiskavi ugotovili prave tujke v zgornji prebavni cevi, oceniti uspešnost endoskopskih posegov ter morebitne zaplete. Preiskovanci in metode. Raziskava zajema bolnike, pri katerih smo v desetletnem obdobju od 1. januarja 1994 do 31. decembra 2003 opravili nujne endoskopske preiskave zgornjih prebavil. Rezultati. Pregledali smo 6416 bolnikov, povprečne starosti 59,3 leta, SD +/- 17,2, v razponu od 1-106 let, 2452 žensk in 3964 moških. Pri 51 bolnikih, 0,8% vseh preiskovancev, smo ugotovili tujke v požiralniku ali želodcu. Skupaj smo opravili 65 endoskopskih posegov, v 94% smo tujke endoskopsko odstranili (48/51 bolnikov), pri treh pa endoskopski posegi niso bili uspešni. Med tujki smo odstranili najrazličnejše kovinske in plastične predmete: kovance, ključe, vijake, kljuke, baterije, britvice, igle, dele kuhinjskega, toaletnega ali pisalnega pribora, vžigalnike, gumbe, igrače, zobno ščetko, pa tudi zagozdene kosti. Pri bolnikih, ki so imeli uspešno endoskopsko odstranitev, nismo opazovali pomembnejših zapletov, le pri 3 bolnikih (3/48, 6,3%) smo opazovali blažje krvavitve iz predela ezofagogastrične stičnice. Zaključki. Tehnološki razvoj endoskopskih instrumentov je omogočil različne interventne posege. Metoda se je potrdila kot učinkovita pri odstranjevanju tujkov v zgornji prebavni cevi. Na uspeh posega vplivajo različni dejavniki, med pomembnejšimi so ustreznost opreme, izkušenost in potrpežljivost preiskovalca in endoskopske sestre ter seznanjenost in sodelovanje bolnika.Background. Foreign bodies in the upper digestive tube are rarely the cause of an urgent condition in gastroenterology. They usually enter the digestive tube during nutrition or by mistake. However, certain groups of the populationsuch as convicts or psychiatric patients tend to swallow them intentionally. The authors aim was to assess the percentage of patients in which urgent endoscopic investigation revealed true foreign bodies in the upper digestive tube, to evaluate the success of endoscopic preocedures and the resolution of eventual complications. Patients and methods. The study includes patients in which urgent endoscopic investigations of the upper digestive tract were performed in a 10-year period (1 January 1994 to 31 December 2003). Results. Altogether 6416 patients were investigated, mean age 59.3 years, SD +/- 17.2 years, range 1-106 years, 2452 females and 3964 males. In 51 patients, 0.8% of all subjects, foreign bodies were detected in the esophagus or stomach. In these patients a total of 65 endoscopic investigations were performed, in 94% the foreign bodies were removed endoscopically (48/51 patients), in three cases the endoscopic procedures were not successful. Among the foreign bodies removed were various metal or plastic objects: coins, keys, screws, hooks, batteries, razor blades, needles, parts of kitchen, toilet or writing utensils, lighters, buttons, toys, a toothbrush as well as impacted pieces of bone. In the patients with successful endoscopic removal of the objects, no significant complications were noted. In 3 patients (3/48, 6.3%) only mild hemorrhages from the region of the esophagogastric junction were observed. Conclusions. The technological development of endoscopic instruments made it possible to carry out different therapeutic procedures. The method has proved successful in removing foreign bodies from the upper digestive tube. Various factors affect the success of the procedure, the more important being adequate equipment, the experience and patience of the investigator and the assisting nurse, as well as the patient\u27s understanding of the procedure and his or her cooperation

Presentation of studies on the bacterium Helicobacter pylori at Maribor teaching hospital between 1988 and 2005

Izhodišča. Z odkritjem bakterije Helicobacter pylori (H. pylori) v bioptičnih vzorcih želodčne sluznice in s potrditvijo njene ključne vloge pri patogenezi ulkusne bolezni dvanajstnika, želodca, gastritisa, pomembne vloge pri limfomu MALT (angl. mucosa associated lymphoid tissue) in nastanku raka želodca se je pokazala tudi možnost vzročnega zdravljenja teh pri bolezni z antimikrobnimi zdravili. Cilj antimikrobnega zdravljenja je doseči odstranitev H. pylori, zmanjšanje recidivov bolezni in zmanjšati tveganje za razvoj želodčnega raka. Okužbo s H. pylori zdravimo s kombinacijami več antimikrobnih zdravil. Naravni rezervoar okužbe za H. pylori je človeški želodec. Pri prevalenci okužbe so pomembni tudi starost bolnikov, socialno ekonomski status in bivalne razmere. Določanje protiteles razredov IgG in IgA proti H. pylori v serumu in dokazovanje antigena v blatu pri asimptomatskih bolnikih je pomembno za epidemiološke raziskave. Bolniki in metode. V raziskave so bili vključeni bolniki, rutinsko napoteni v Splošno bolnišnico Maribor (SBM) s kroničnim gastritisom in z recidivi ulkusne bolezni dvanajstnika ali želodca, v študijo o dokazovanju protiteles proti H. pylori v serumu in antigena v blatu pa asimptomatski bolniki. H. pylori smo dokazovali v bioptičnih vzorcih želodčne sluznice s histološko preiskavo, kulturo, hitrim ureaznim testom in z ugnezdeno verižno reakcijo s polimerazo (angl. nested polymerase chain reaction - nested PCR), v brisih zobnega plaka prav tako metodo PCR nested. Protimikrobno zdravljenje za izkoreninjenje H. pylori smo izvajali v 3 študijah s primerjavo 2 skupin bolnikov. Prva skupina je redno prejemala ranitidin 2 x 150 mg dnevno, v prvi študiji 3 tedne, v naslednjih študijah 8 tednov in po potrebi antacid. Druga skupina bolnikov je v prvi študiji prejela ranitidin 2 x 150 mg + eritromicin 4 x 500 mg dnevno teden dni, v drugi študiji ranitidin 2 x 150 mg + koloidni bizmutov subcitrat (KBS) 2 x 240 mg dnevno 4 tedne, v tretji študiji pa KBS 4 x 120 mg + amoksicilin 4 x 500 mg + metronidazol 4 x 500 mg dnevno 2 tedna. Z latex aglutinacijskim testom (Orion) in z encimsko imunskim testom (Virion-Serion) smo dokazovali protitelesa razredov IgG in IgA proti H. pylori v serumu in antigen v blatu (HpSA-Meridian). V protokolih o epidemioloških značilnostih H. pylori okužbe smo zbirali in analizirali podatke o starosti in spolu bolnikov, njihovih bivalnih, sanitarnih, socialnoekonomskih razmerah in šolski izobrazbi. Rezultati. Raziskave so pokazale, da je bil H. pylori najpogosteje prisoten pri ulkusni bolezni dvanajstnika in želodca. Uspešnost antimikrobnega zdravljenja in odstranitev H. pylori z ranitidinom in eritromicinom teden dni dolgo je bila 11,1 %, s kombinacijo ranitidina in KBS 4 tedne dolgo 19,04 %, s trotirno kombinacijo KBS + amoksicilin + metronidazol 2 tedna pa 92 %. H. pylori v zobnem plaku smo dokazali v 16,6 %. Za možne dejavnike tveganja za nastanek okužbe smo ovrednotili srednjo starost, slabe do srednje dobre bivalne in ekonomske razmere ter nizko do srednješolsko izobrazbo bolnikov. Pri asimptomatskih bolnikih smo dokazali protitelesa IgG pri 26/34 bolnikih, pri 1/34 so bila mejno pozitivna in negativna pri 7/34. Protitelesa IgA so bila prisotna pri 17/34, pri 6/34 mejno pozitivna in negativna pri 11/34. Pozitiven antigen v blatu je imelo 10/33 bolnikov, 23/33 pa negativen. Protitelesa IgG in IgA v serumu in antigen v blatu so bila prisotna pri 8/33 bolnikih. Zaključki. Rezultat raziskav je bil začetek iskanja H. pylori pri bolnikih z gastritisom in ulkusno boleznijo v SBM ter ugotovitev, da je najpogosteje prisoten pri ulkusni bolezni dvanajstnika in želodca. Za dokaz H. pylori smo uvedli histološko metodo, kulturo in hitri ureazni test v rutinsko klinično prakso v SBM. Pričeli smo vzročno zdravljenje gastritisa in ulkusne bolezni z antimikrobnimi zdravili in spremljali uspešnost odstranitve H. pylori in s tem povezano ozdravitev ter znižanje recidivov bolezni. Ugotovili smo, da antimikrobna občutljivost in vitro ni porok za klinično uspešnost, kar nam je pokazal rezultat zdravljenja z eritromicinom. Tudi monoterapija ni bila dovolj učinkovita. Hipoteze, da je dentalni plak lahko pomemben rezervoar okuzbe s H. pylori, nismo potrdili. Metoda PCR nested za dokaz H. pylori v bioptičnih vzorcih želodčne sluznice in brisih zobnega plaka je primer hitre in zanesljive diagnostične metode. Z analizo epidemioloških značilnosti smo ugotovili, da so možni dejavniki tveganja za nastanek H. pylori okužbe srednja starost bolnikov, slabe do srednje dobre bivalne in ekonomske razmere ter nizka do srednješolska izobrazba. Pri asimptomatskih bolnikih smo dokazali prisotnost protiteles IgG in IgA proti H. pylori v serumu ter antigena v blatu.Background. The discovery of the bacterium Helicobacter (H) pylori in biopsy specimens from the gastric mucosa and the confirmation of its key role in the pathogenesis of duodenal and gastric ulcer disease, and gastritis, its significant role in mucosa associated lymphoid tissue (MALT) lymphoma and in the occurrence of gastric cancer also offered the possibility of causal treatment of these diseases with antimicrobial agents. The aim of antimicrobial treatment is the eradication of H. pylori, the decrease of recurrences and lessening the risk of gastric cancer diseases. H. pylori infection is treated with a combination of several antimicrobials. The human stomach is a natural reservoir of H. pylori. In the prevalence of H. pylori infection, patient age, socio-economic status, living and sanitary conditions can play an important role. Determination of serum IgG and IgA antibodies against H. pylori and detection of the antigen in the feces of asymptomatic patients is important for epidemiologic studies. Patients and methods. The study included patients with chronic gastritis and with recurrence of duodenal and gastric ulcer disease referred routinely to Maribor Teaching Hospital (MTH) while the study on the identification of serum antibodies against H. pylori and of antigen in feces included asymptomatic patients. For confirmation of H. pylori in biopsy specimens of the gastric mucosa we used the histologic method, culture, the urease test and the nested polymerase chain reaction (nested PCR) method. The latter was also used for dental plaque smears. Antimicrobial treatment with the aim of eradicating H. pylori was carried out in three studies comparing two groups of patients: The first group always received ranitidine - 2 x 150 mg over 3 weeks in the first study and over 8 weeks in the two further studies, with an addition of antacids if needed. The second group received ranitidine 2 x 150 mg + erythromycin 4 x 500 mg for one week in the first study, ranitidine 2 x 150 mg + colloidal bismuth subcitrate (CBS) 2 x 240 mg over 4 weeks in the second study, and CBS 4 x 120 mg + amoxycillin 4 x 500 mg + metronidazole 4 x 500 mg over two weeks in the third study. With the latex agglutination and with the enzyme immune system (Virion-Serion) we identified IgG and IgA antibodies against H. pylori in serum, and antigen in feces (HpSA - Meridian). In protocols of epidemiologic characteristics of H. pylori infection we collected and analyzed the data regarding patient age and gender, living and sanitary conditions, socio-economic status and the education level. Results. The studies showed that H. pylori was most frequently present in ulcer disease of duodenum and stomach. The success of antimicrobial treatment and eradication of H. pylori with ranitidine and erythromycin over one week was 11.1 %, with the combination of ranitidine and CBS over four weeks 19.04 %, with the triple combination therapy with CBS + amoxycillin + metronidazole over two weeks 92 %. In dental plaque, H. pylori was confirmed in 16.6 %. Middle age, poor or medium living conditions and economic status, and primary to secondary education were all identified as possible risk factors for H. pylori infection. In asymptomatic patients we confirmed IgG antibodies against H. pylori in serum in 26/34, in 1/34 they were borderline positive, and negative in 7/34 patients. IgA antibodies were present in 17/34, in 6/34 they were borderline positive, and negative in 11/34. Antigen in feces was positive in 10/33 patients, negative in 23/33. Serum IgG and IgA antibodies and antigen in feces were confirmed in 8/23 patients. Conclusions. Our studies resulted in the beginning of H. pylori detection in MTH patients with gastritis and ulcer disease, and in the ascertainment that H. pylori was most frequently present in ulcer disease of stomach and duodenum. For the confirmation of H. pylori, the histologic method, culture and the urease test were introduced into routine clinical practice of MTH. Causal treatment of gastritis and ulcer disease with antimicrobials was introduced, and the success of H. pylori eradication and the decrease of recurrences was followed. We found that antimicrobial sensitivity in vitro did not warrant clinical success - a statement proved by the results of treatment with erythromycin. The effect of monotherapy was also insufficient. The hypothesis that dental plaque could be a significant reservoir of H. pylori infection was not confirmed. The nested PCR method for proof of H. pylori in gastric mucosa biopsy specimens and dental plaque smears is a rapid and reliable diagnostic method. The analysis of epidemiologic characteristics showed that risk factors for the occurrence of H. pylori infection are middle age, poor or medium living conditions and socio-economic status, and primary to secondary education. In asymptomatic patients we proved the presence of IgG and IgA antibodies, and of antigen in feces