Rectal bleeding by Dieulafoy-like lesion: successful endoscopic treatment.

A 81-year old woman affected by chronic renal failure, non insulin-dependent diabetes mellitus (NIDM) and hypertension, had an severe anemia massive hematochezia. The colonoscopy could not localize the bleeding site except some blood spots in the rectum. The patient was readmitted after 1 month with hypovolemic shock by massive hematochezia and required several blood transfusions. The endoscopic examination showed an important arterial bleeding treated successfully with epinephrine and bipolar elettro-coagulation (BICAP). We suggested that the patient presented a Dieulafoy-like lesion; this is an uncommon gastrointestinal cause of bleeding due to a defect of a submucosal artery without evidence of atherosclerosis or vasculitis. Both chronic renal failure and age could be considered as predisponent factors in this patient. Hematochezia is the most important sign and is often complicated by haemorrhagic shock. The diagnosis was delayed due to the difficulty in localizing the bleeding site; moreover, the patient needed several blood transfusions. The arteriographic diagnosis associated to endoscopic treatment by epinephrine and BICAP enabled a successful therapy.

Esophageal involvement as an uncommon modality of relapse of Hodgkin lymphoma.

We present a case of systemic Hodgkin's lymphoma, relapsed with esophageal involvement after 3 years of complete remission. The importance of an accurate diagnostic work-up is emphasized. Esophagectomy and chemotherapy followed by bone marrow transplantation allowed a complete response and the long-term survival of the patient.

Black esophagus: should it be considered an unfavorable prognostic factor?

Black esophagus is a rare condition, reported for the first time in 1990. It is always noted in severely compromised patients. The diagnosis is possible using endoscopy. An esophageal ischemic injury should be considered. It is important that a differential diagnosis is made with consideration of other necrotic conditions of the esophagus. Only supportive treatment and the improvement of the associated disease appear possible.

Complete regression of primary gastric MALT-lymphoma after double eradication Helicobacter pylori therapy: role and importance of endoscopic ultrasonography.

The authors report on a case of complete regression of primary gastric Mucosa Associated Lymphoid Tissue MALT-lymphoma after double eradication Helicobacter pylori therapy. They analyze the diagnostic role of endoscopic ultrasonography and the therapeutic aspects, on the grounds of literature data and personal experience are analyzed.

Cutaneous seeding after ultrasound-guided percutaneous ethanol injection for treatment of hepatocellular carcinoma.

Cutaneous seeding is a rare complication of interventional ultrasound procedures. We describe a case of needle-track cutaneous seeding of hepatocellular carcinoma (HCC) after sonographically guided percutaneous ethanol injection (PEI). In our case, the seeding might have been related to the type of needle used and the multiple passes required to treat the liver lesion. Despite the risk of needle-track seeding, PEI remains useful in the treatment of HCC.

Immunohistochemical telomeric-repeat binding factor-1 expression in gastrointestinal tumors.

The maintenance of telomere length has been hypothesized to be involved in the early steps of cancerogenesis. A physiologic modulation of telomere maintenance is exerted by TRF1 (telomeric-repeat binding factor-1), which deletion permits telomere elongation. Gastrointestinal neoplastic (n=19) and non-neoplastic tissues (six inflammatory disease and six normal mucosa distant from tumor at least 5 cm) were studied, by immunohistochemistry, for TRF1 expression, by using a polyclonal antibody anti-TRF1. Differentiated and not proliferating epithelial secretory cells (Ki67 and p53 negative cells) were stained by anti-TRF1, which did not stain tumor cells in all cases but one (p<0.0001). p53 was expressed by 26% of tumor cases. Inflammatory gastrointestinal non-tumor tissues showed lower expression of TRF1 in epithelial secreting cells compared to normal tissues (p=0.008). These preliminary data suggest that down-regulation of the TRF1 expression in tumor cells may be involved in cell immortalization as an initial step in gastrointestinal carcinogenesis (before p53 alteration), and may open new perspectives, when confirmed, in gastrointestinal tumor prognosis.

Diagnosis and survey of abnormal/atypical squamous cells of undetermined significance and low-grade squamous intraepithelial lesions: a retrospective study.

The new Bethesda System (BS) terminology has opened a series of problems about the Abnormal/Atypical Squamous Cells of Undetermined Significance (ASCUS) and Low-Grade Squamous Intraepithelial Lesion (L-SIL) categories, particularly on their treatment and follow-up. Moreover in these field a non negligible portion of lesions progress to High-Grade Lesion (H-SIL). With the aim of comparing the data, we examined samples observed in our Ambulatories with 6-12 months follow-up. We observed retrospectively 11.197 Pap test from January 1995 to June 1997, mostly first visits. All received a Pap test, colposcopy and gynaecological examination. Biopsy and histological standard examinations were performed when necessary. Alterations classified as mild epithelial abnormalities, of both ASCUS and L-SIL categories, were observed in 146 cases: 78 ASCUS and 68 L-SIL. Of these 48 were CIN 1/mild dysplasia (25 HPV associated) and 20 were HPV lesions, according to BS. All the cases with persistent ASCUS and L-SIL underwent a second control. In these 45 cases we observed 2 new cases of H-SIL and one of L-SIL; so 82.3% and 30.7% of ASCUS and L-SIL regressed to negatives. In the stable group 11.8% and 60.4% were ASCUS and L-SIL. Moreover 5.9% of ASCUS and 4.8% of L-SIL progressed to H-SIL. No cases of invasive cancer were observed. Our data show that ASCUS and L-SIL diagnosis can identify 6% and 4.8% of H-SIL respectively. In addition 17-18% of ASCUS were stable or progressed. These two categories, as already demonstrated in other studies, are mostly at risk.

Isolated rectal relapse in non Hodgkin lymphoma patient.

The authors report on case of isolated rectal relapse of non Hodgkin lymphoma after complete remission with chemotherapy. They analyse diagnostic and therapeutic aspects, on the grounds of literature data and personal experience.

[Endoscopic treatment of a gastric phytobezoar using electrohydraulic lithotripsy: a case report]. / Trattamento endoscopico di un fitobezoario gastrico mediante litotrissia elettroidraulica intracorporea (LEI): descrizione di un caso.

The Authors report a case of spontaneous large gastric phytobezoar in an unoperated stomach and describe this pathology especially with regards to pathogenesis, diagnosis and endoscopic treatment.

[Stenosing esophagitis caused by Trichosporon beigelii: presentation of a rare case]. / Esofagite stenosante da Trichosporon beigelii: presentazione di un raro caso clinico.

The Authors describe a rare case of esophageal stenosis complicated by gastroesophageal reflux due to Trichosporon beigelii in the absence of a pathologic predisposition or immunodeficiency. The diagnosis was drawn by embedding membrane fragments obtained endoscopically in Sabouraud and blood-Agar cultures. The patient was treated with antimicotics, immunostimulants, inhibitors of the gastric protonic pump, prokinetics and later underwent endoscopic dilatation combined with Savary-Guillard and pneumatic dilatators of growing diameter, until complete "restitutio ad integrum" of the esophageal lumen.

[Esophageal leiomyoma: ultrasonographic endoscopic diagnosis]. / Leiomioma dell'esofago: diagnosi ecoendoscopica.

Leiomyoma is the most frequent benign neoplasia of the esophagus. It is generally diagnosed, accidentally during a radiologic examination (filling defect with clear and regular margins) or endoscopically (sessile, hemispheric, covered by pink mucosa). Recently, to the above conventional exams, endoscopic ultrasonography has been added allowing to identify the single layers of the esophageal wall, thus furnishing useful informations on the morpho-structural characteristics of the leiomyoma. From October '94 to May '96, at the Endoscopy Service of the Institute of Oncology of the University of Messina, 12 patients, 8 males and 4 females, ranging from 39 to 69 years of age (median age 55.4) underwent EUS for suspect leiomyoma. An Olympus EU-M20 echoendoscope was used with a radial scan transducer of 12 Mhz. In 8 patients the leiomyoma was located in the III mid-esophagus, while in 4 patients the III inferior portion was interested. The Authors observed lesions ranging in size from 0.5 to 2.5 cm. In their experience, a suspect of leiomyoma represents a good indication for an endoscopic ultrasonography, which shows high sensitivity and specificity.

[Sedation in endoscopic diagnosis: rationale of the use of specific benzodiazepine antagonists]. / Sedazione in diagnostica endoscopica: rationale d'uso degli antagonisti specifici delle benzodiazepine.

The aim of this study was to evaluate the best clinical use of Flumazenil, a specific antagonist of benzodiazepines, during endoscopic exams. Two-hundred patients were studied: 120 were treated with Flumazenil and 80 with placebo. The patients were prepared for the endoscopic exam with local anaesthesia and i.v. Diazepam administration. Controls performed at the end of the exam and at 5, 30, 120 e 240 minutes from the administration of Flumazenil and placebo, allowed to evaluate the state of awakeness, the level of conscience and the capacity of time-space orientation. Significantly statistical differences between the two groups were obtained at 5, 30 and 120 minutes after Flumazenil administration, while both groups had retrograde amnesia. The drug was well tolerated and there were no undesiderable side effects or reactions. The Authors therefore affirm that Flumazenil, in virtue of its competitive action toward benzodiazepine receptors, interrupts sedation with immediate awakening and improvement of the state of consciousness. Such drug, thus, permits the Day Hospital performance of endoscopic procedures which otherwise would require hospitalization, at the same time allowing the surgeon to use benzodiazepines at doses more adequate for surgical necessities.

[Use of endoscopic ultrasonography in the staging of esophageal tumors]. / L'impiego dell'ecoendoscopia nello staging dei tumori esofagei.

Endoscopic Ultrasound (EUS) was performed in 15 patients with esophageal and cardial carcinoma with the aim to evaluate intramural or extraesophageal invasion and regional lymph node metastases. In 10 patients the Authors correctly evaluated the tumoral depth invasion. In 5 patients mediastinal lymph node metastases were observed. It is concluded that EUS is a useful diagnostic method in the staging of esophageal carcinoma.