Self-expanding metal stents for treatment of anastomotic complications after colorectal resection.

Self-expanding metal stents (SEMS) can be used to treat patients with symptomatic anastomotic complications after colorectal resection. In the present case series, 16 patients with symptomatic anastomotic stricture after colorectal resection were treated with endoscopic placement of SEMS. Seven patients had a "simple" anastomotic stricture and nine patients had a fistula associated with the stricture. The anastomotic fistula healed without evidence of residual stricture or major fecal incontinence in seven of the nine patients. Overall the anastomotic stricture was resolved in 10 of the 16 patients. SEMS placement represents a valid adjunctive to treatment in patients with symptomatic anastomotic complications after colorectal resection for cancer.

Spatiotemporal dynamics of the electrical network activity in the root apex.

The study of electrical network systems, integrated with chemical signaling networks, is becoming a common trend in contemporary biology. Classical techniques are limited to the assessment of signals from doublets or triplets of cells at a fixed temporal bin width. At present, full characteristics of the electrical network distribution and dynamics in plant cells and tissues has not been established. Here, a 60-channels multielectrode array (MEA) is applied to study spatiotemporal characteristics of the electrical network activity of the root apex. Both intense spontaneous electrical activities and stimulation-elicited bursts of locally propagating electrical signals have been observed. Propagation of the spikes indicates the existence of excitable traveling waves in plants, similar to those observed in non-nerve electrogenic tissues of animals. Obtained data reveal synchronous electric activities of root cells emerging in a specific root apex region. The dynamic electrochemical activity of root apex cells is proposed to continuously integrate internal and external signaling for developmental adaptations in a changing environment.

PTR-TOF-MS and HPLC analysis in the characterization of saffron (Crocus sativus L.) from Italy and Iran.

Saffron samples from Italy and Iran were analyzed for their content in aroma and bioactive compounds with different analytical techniques. HPLC was used for the identification and quantification of crocins, picrocrocin, safranal and flavonoids content, while the novel proton transfer reaction time-of-flight mass spectrometer was employed for the aroma compounds analysis. Italian saffron turned out to be richer in total crocins and safranal contents. Sample characterization was performed with an unsupervised statistical approach; tests involving different numbers of parameters deriving from the two analytical techniques were performed. The results achieved showed that the best samples classification was obtained by joining the information acquired from both techniques; following such an approach, a sharper separation between Iranian and Italian samples was achieved. Finally, among the variables that most contribute to the description of variability, isophorone, safranal and picrocrocin were identified to be the most significant.

Management of benign biliary strictures: biliary enteric anastomosis vs endoscopic stenting.

HYPOTHESIS: Although advances in endoscopic procedures have provided alternative options for relieving biliary obstructions, the overall chance of cure for patients with benign biliary stricture is the same using surgical or endoscopic treatment. DESIGN: Case-control study. SETTING: Tertiary care university hospital. PATIENTS: Of 163 patients referred for treatment with diagnoses of benign strictures of the common bile duct between January 1, 1975, and July 1, 1998, we studied 42 patients with postcholecystectomy stricture and a follow-up longer than 60 months. Twenty of these patients were treated with endoscopic stenting and 22 with surgery (hepaticojejunostomy, choledochojejunostomy, or intrahepatic cholangiojejunostomy). MAIN OUTCOME MEASURES: Postoperative mortality and morbidity and long-term outcome. The rate of restenosis was also determined. RESULTS: Morbidity occurred more frequently in patients treated with endoscopic procedures than with surgical ones (9 vs 2; P = .34). Hospital mortality was 0%. Surgery achieved excellent or good long-term outcome in 17 of 22 patients. Endoscopic biliary stenting was successful in 16 of 20 patients. Overall, excellent or good outcomes were achieved in 34 patients (81%). CONCLUSION: The ability to achieve steady, long-term results confirms hepaticojejunostomy as the best procedure in the treatment of benign biliary strictures, even if endoscopic procedures are gaining a new role in the treatment of a greater number of patients.

Effects of pinaverium bromide in the premedication of endoscopic retrograde cholangio-pancreatography and on motor activity of the sphincter of Oddi.

A double-blind study was carried out in 18 patients with biliary and pancreatic disease to assess the use of pinaverium bromide in premedication for endoscopic retrograde cholangio-pancreatography and its effects on motor activity of the sphincter of Oddi. Patients were divided at random into three groups. One group received 100 mg pinaverium bromide twice daily for 3 days before and then 100 mg 1 hour before the examination, the second group received placebo, and the third had no medication. All patients received 10 to 20 mg diazepam intravenously 10 minutes before endoscopy. Assessments were made of the transit time of various endoscopic phases and patients' tolerance of the procedure. The effects of treatment on the sphincter of Oddi were estimated by means of endoscopic manometry. The results showed that pinaverium bromide allowed transit time reduction in endoscopic procedure, a greater tolerance on the part of the patient and marked reduction in the amplitude and duration of the phasic activity of the sphincter.

Relationship between pancreatic and serum amylase in basal conditions and during stimulation in man. Report of a new intraoperative technique.

The correlation between serum amylase and pancreatic amylase secretion was studied in two patients. Both patients underwent sphincterotomy, and the pancreatic duct was cannulated with a polyethylene tube. The tube was left in place for 15 to 21 days. The rate of amylase secretion over 7 days was studied in response to (1) a standard meal, (2) duodenal acidification, (3) scalar doses of cholecystokinin, (4) scalar doses of secretin, and (5) scalar doses of secretin with simultaneous infusion of cholecystokinin. Blood samples were collected during the tests to measure serum amylase. No significant correlation was shown between blood concentration and output of amylase in any of the tests. Our findings show that under normal conditions serum amylase levels are not influenced by pancreatic secretion and suggest that serum amylase concentration is not related to pancreatic exocrine secretion.

The usefulness of biliary drainage for restoring liver function in obstructive jaundice.

In eighty patients with obstructive jaundice treated with percutaneous or endoscopic drainage, the results of biochemical liver-function tests (serum bilirubin, transaminase, gamma-glutamyl transferase, alkaline phosphatase, and albumin) were analyzed to evaluate the return of liver function after biliary decompression. Before decompression all the patients had increased serum concentrations of all the liver-function indicators measured. Conjugated bilirubin normalized within 7 days in 67.5% of the patients and within 14 days in 94.5%. The other serum responses normalized as follows: glutamic oxaloacetic transaminase (7 days in 45%, 14 days in 100%); glutamic pyruvic transaminase (7 days in 46.2%, 14 days in 100%); gamma-glutamyl transferase (7 days in 56.2%, 14 days in 89.1%); alkaline phosphatase (7 days in 52.5%, 14 days in 90.4%); and albumin (7 days in 100%, 14 days in 90.4%). The low mortality and morbidity rates in this series of patients with obstructive jaundice: 0% and 7% after endoscopic and 2.1% and 10.4% after percutaneous drainage suggest that biliary drainage has a valuable place in the preparation of jaundiced patients for surgery and in some cases provides a definitive intervention.

[Tiropramide hydrochloride in the premedication of diagnostic and therapeutic proctosigmoidocolonoscopy (endoscopic polypectomy) and the treatment of colonic diverticulosis]. / La tiropramide cloridrato nella premedicazione della rettosigmoidocolonscopia diagnostica e terapeutica (polipectomia endoscopica) e nel trattamento della malattia diverticolare del colon.

This study was undertaken with a view to assessing the effectiveness and tolerance of tiropramide hydrochloride in the premedication of endoscopic rectosigmoidoscopy. The following were considered for this purpose: 1) speed of execution of the procedure; 2) its tolerance; 3) possible complications. The effectiveness of tiropramide was also examined in uncomplicated diverticular disease: 1) comparison of execution times for rectosigmoidoscopy before and after therapy; 2) the evaluation of the reduction in symptomatology. The patients were subdivided into three groups: 1st group submitted to diagnostic rectosigmoidoscopy; 2nd group submitted to therapeutic rectosigmoidoscopy; 3rd group with diverticular disease. In the first group, execution times were less than 20 minutes in all cases bar 1 and tolerance was good in 27 cases, average in 3. In the second group, times were less than 15 minutes in 6 cases and higher in 4, and tolerance was good in 7 cases and average in 3. In the third group (10 patients), examination execution time was reduced after therapy in 9 cases and in the same number pain symptomatology regressed. Tiropramide proved to be the antispastic of choice in premedication for rectosigmoidoscopy and an effective drug in the treatment of uncomplicated diverticular disease.

[Tiropramide chlorhydrate in premedication for endoscopic retrograde cholangiopancreatography and its effects on the motor activity of Oddi's sphincter]. / La tiropramide cloridrato nella premedicazione della colangiopancreatografia retrograda endoscopica e suoi effetti sulla attività motoria dello sfintere di Oddi.

The activity of tiropramide chlorhydrate in the pre-medication for the endoscopical examinations has been evaluated. In particular ERCP has been studied considering as parameters the timing of the different stages of the examination and the activity of Oddi's sphincter. At the end of endoscopy the pressure of the sphincterial region was measured a 3-way miniature catheter. Patients included in the study were divided into two different groups: group A treated with tiropramide chlorhydrate and diazepam vs group B treated only with diazepam. The group with patients pre-medicated with tiropramide chlorhydrate presented a significant reduction in the timing of the different stages of endoscopy. Endoscopy was better tolerated. Manometry showed an antispastic action of the drug without side effects. An important reduction of the degree and duration of the sphincterial phase activity, with a possible improvement of biliary defluxion into the duodenum, was observed.

Screening and treatment for cervical intraepithelial neoplasia (CIN) in HIV-infected women.

BACKGROUND: To determine: 1) whether the pathology correlates with the degree of immunosuppression, 2) whether there is a relation between pathology and antiretroviral therapies, 3) whether Papanicolau (Pap) smears correlate with colposcopic and histologic findings, 4) whether there is rapid genital disease progression after standard gynaecologic care. METHODS: Retrospective study. Immunologic, gynaecologic and virologic data were extracted either from patients charts or from laboratory testing. RESULTS: At first visit Pap smears resulted normal in 43.7% of the women, 8.4% of the patients had reactive and reparative changes, 2.8% atypical cells of undetermined significance, 33.8% low-grade squamous intraepithelial lesions and 11.3% high-grade squamous intraepithelial lesions. Patients with a normal PAP smear had higher CD4 cell count (318+/-191 cells/mL) compared to patients with squamous intraepithelial lesions (297+/-116 cells/mL) but the difference was not statistically significant (Mann-Whitney test). The distribution of cervical dysplasia was found to be similar regardless of antiretroviral therapy (chi(2) test). The sensitivity and specificity of Pap tests for detecting CIN were 94 and 80%. Twenty-two per cent of surgically treated women had persistent or recurrent disease. CONCLUSIONS: Lower CD4+ cell counts are not predictive of the presence of cervical dysplasia. All HIV-infected women, independently from their immunological and clinical conditions, need regular Pap smears with appropriate follow-up for abnormal cervicovaginal cytology, this could prevent nearly all deaths from cervical cancer.

[Electrohydraulic intracorporeal lithotripsy in the treatment of "difficult" calculi of the common bile duct. Report of a caseload]. / La litotrissia intracorporea elettroidraulica nel trattamento della calcolosi "difficile" della via biliare principale. Presentazione della casistica.

The Authors report their experience in 38 cases (January 1990-Septembre 1994) of "difficult" gallstone disease of the main bile duct treated with electrohydraulic intracorporeal lithotripsy. Nineteen patients were affected with giant stones of the biliary tree, 6 with multiple stones of the main bile duct, 13 with stones of one or both hepatic ducts. The approach to the biliary tree was peroral transpapillary in 16 patients and transhepatic in the remaining 22. Twenty-five patients were previously submitted to surgery of the biliary tree (13 hepaticojejunostomy, 8 choledochoduodenostony, 4 papillostomy), while 5 had required a cholecystectomy, and 6 a gastroresection according to Billroth II. In 80% of the cases two lithotripsy sessions were enough to achieve the complete clearing of the bile duct. There was no mortality and morbidity was 5.3%. Total clearing was obtained in 97.4% of the cases. 6-48 months after treatment 37 patients still do not show clinical, laboratory or echographic signs of gallstone stasis or disease relapse.