Prevalence of intestinal metaplasia in the distal oesophagus, oesophagogastric junction and gastric cardia in symptomatic patients in north-east Italy: a prospective, descriptive survey. The Italian Ulcer Study Group "GISU".

BACKGROUND: Incidence of adenocarcinoma of distal oesophagus and gastric cardia, probably arising from areas of intestinal metaplasia, has been increasing rapidly. AIMS: To define prevalence of intestinal metaplasia of distal oesophagus, oesophagogastric junction and gastric cardia and to evaluate potential associated factors, by means of a prospective multicentre study including University and teaching hospitals, and primary and tertiary care centres. PATIENTS: Each of 24 institutions involved in study enrolled 10 consecutive patients undergoing first-time routine endoscopy for dyspeptic symptoms. METHODS: Patients answered symptom questionnaires and underwent gastroscopy Three biopsies were taken from distal oesophagus, oesophago-gastric junction and gastric cardia, and were stained with haematoxylin and eosin. Specimens were also evaluated for Helicobacter pylori infection. RESULTS: A total of 240 patients (124 male, 116 female; median age 56 years, range 20-90) were enrolled in study. Intestinal metaplasia affected distal oesophagus in 5, oesophago-gastric junction in 19 and gastric cardia in 10 patients. Low-grade dysplasia was found at distal oesophagus and/or oesophago-gastric junction of 3/24 patients with intestinal metaplasia vs 2/216 without intestinal metaplasia (p<0.05). A significant association was found between symptoms and presence of intestinal metaplasia, regardless of location, and between Helicobacter pylori infection and intestinal metaplasia at oesophago-gastric junction. CONCLUSIONS: Intestinal metaplasia of distal oesophagus, oesophagogastric-junction and gastric cardia is found in a significant proportion of symptomatic patients undergoing gastroscopy and is associated with dysplasia in many cases. Although prevalence of dysplasia seems to decrease when specialized columnar epithelium is found in short segment, or even focally in oesophago-gastric junction, these small foci of intestinal metaplastic cells may represent source of most adenocarcinomas of cardia.

[Iopentol in varix radiography. Double blind comparison with iohexol]. / Iopentolo nella varicosografia. Confronto in doppio cieco con Iohexolo.

This trial was aimed at comparing the tolerance and the safety of Iopentol, a new nonionic monomeric contrast agent, with Iohexol, a reference compound already on the market and commonly used in similar trials. Sixty adult patients (41 women and 19 men, aged 23 to 76 years, mean age: 51.4 years) referred to our Department of Radiology for varicography 24 hours before surgery were examined; the trial was designed as a double-blind, parallel two-group comparison of Iopentol 300 mg/ml and Iohexol 300 mg/ml with 30 patients in each treatment group. No adverse reactions were observed in our series of patients. Only slight and not clinically significant changes were observed in heart rate and blood pressure values. The immunohistochemical parameters were studied for postvaricography anatomopathologic complications of the injected veins (A-Actin ML, Vimentin, Factor VIII, CD31, CD68, CK, Ulex Europaeus I, Lecitin, Desmin, Laminin) and no statistically significant differences were observed between the two groups. The histologic specimens showed only venous wall changes, as diagnosed on admission. All radiographs were classified as technically adequate and contrastographic efficacy was defined as "good" in all patients by two independent radiologists. To conclude, our trial on the efficacy and safety of the two nonionic monomeric radiographic contrast agents Iopentol and Iohexol proved the two contrast agents to be equally effective and well tolerated, which makes Iopentol a good alternative to Iohexol in varicography.

Personality, inner experience and compliance in advanced cancer patients treated with external pumps.

The presence of portable pumps for protracted infusional chemotherapy in metastatic solid tumors at an advanced stage determines the need to evaluate psychologically the inner experience of the patients in relation to this therapeutic modality. The objective of the study were to analyze personality variables (coping and awareness), inner experience variables (acceptance and expectations) and the compliance of the patients during repeated courses of therapy. In addition we evaluated the influence of sex, age, level of education and response to treatment in relation to these variables. From February 1992 to March 1994 we evaluated 50 metastatic patients with a psycho-dynamic interview at the 1st, 3rd, 6th and the 9th course of therapy. The data obtained showed a positive trend for all the variables examined and in all the subgroups (age, sex, level of education, response) up to the 6th course. After the 6th course, personality variables remained stable, yet a drop in variables related to inner experience and compliance was observed in the whole group. While the personality variables remain constant in all patients, a decrease of acceptance and expectation was observed in patients non responding to therapy for their tumor, a trend which becomes significative at the 9th course regards expectation. The use of a psycho-dynamic interview allowed us to evaluate the effect of treatment on psychological variables and compliance to therapy. The length of treatment and the response to treatment seem to influence the more profound inner experiences of the patients.

[Association of bronchogenic cyst of the pancreas and duplication cyst of the stomach]. / Association d'un kyste bronchogénique du pancréas à un kyste de duplication de l'estomac.

One case of bronchogenic cyst of the pancreas associated to a true gastric cyst produced by duplication is described. Such congenital neoformations are extremely rare. The symptoms are highly variable. The diagnosis can be established only through the histopathological study of the surgical specimen.

[Ultrasonic diagnosis of the central hyperechogenic area in lymph nodes. A sign of benign lymphadenopathy]. / Identificazione ecotomografica di area iperecogena centrale nei linfonodi. Segno di linfoadenopatia benigna.

When identifying superficial lymphadenopathies by means of echotomography, the only accepted criterium of evaluation is still dimension. Only lymph nodes with a diameter longer than 0.5 cm are considered as potentially pathological, irrespective of their morphological characteristics. In the past two years an echotomographic study of the surface regions was carried out on 300 patients. Some suffered from unspecific solitary lymphadenopathies; most of the others were affected by stationary neoplasias, mainly situated in the cervical region. In many cases it has been possible to correlate the echotomographic and the histological results. Sixty-nine out of the 300 examined patients had lymph nodes with a central hyperechogenic area. Histology showed these lymph nodes to be the site of reactive hyperplasia. This characteristic has never been found in neoplastic lymph nodes. It has been hypothesized that this spot corresponds to the hilus of the lymph node and that, through its identification, it may be possible to distinguish benign from neoplastic lymph nodes.