Clinical assessment and management of severe acute pancreatitis: a multi-disciplinary approach in the XXI century.

Acute pancreatitis (AP) is the most common gastrointestinal disorder requiring hospitalization, with a high rate of morbidity and mortality. Severe AP is characterized by the presence of persistent organ failure involving single or multiple organs. Clinical evolution, laboratory and radiological assessment are necessary to evaluate the prognosis and inform the management of AP. The onset of severe AP may be classified in two principal phases. The early phase, during the first week, is characterized by the activation of the auto-inflammatory cascade, gut dysbiosis, bacterial translocation, and the down-regulation of immune responses. The late phase is characterized by the development of local and systemic complications. Several old paradigms have been amended in the management of AP patients, such as the indication of nutrition, the use of antibiotic therapy, pain control strategies, and even the use of surgery. Real world evidence has shown that in the majority of cases a step-up approach is most effective. In this review, we discuss the clinical assessment and improvements to the management of patients with severe AP in a high volume center where a multi-disciplinary approach is performed.

[Primary lymphoma of the small intestine: clinico-radiological correlations]. / Linfomi primitivi dell'intestino tenue: integrazione clinico-radiologica.

From 1987 to 1989, 7 patients were diagnosed as having a primary lymphoma of the small bowel. The patients, 5 men and 2 women aged 14-66 years (average: 45), were studied by means of small bowel enema and CT. Using small bowel enema, our findings were: masses related to a loop, stenosis, mucosal patterns with thick, irregular, and nodular folds, and bowel walls thickening. In nearly all cases CT showed not only small bowel lesions but also mesenteric lymphadenopathy. Five of seven patients had lymphomas, 1 had IP-SID lymphoma (immunoproliferative small intestinal disease related lymphoma), and 1 had IPSID associated with a late prelymphomatous stage. The diagnosis of IPSID is very important in patients with malabsorption syndrome, which may or may not be related to alpha heavy chain disease, because IPSID may evolve into lymphoma but its prelymphomatous stage can be treated and cured. We have therefore reported the different features seen with enteroclysis and CT, comparing the results obtained in the various forms of lymphoma of the small bowel. The importance is stressed of an accurate diagnosis of IPSID forms, however uncommon in our Country.

[Critical review of 222 cases of neoplastic pathology of the colon. Our experience using a computer]. / Revisione critica di 222 casi con patologia neoplastica del colon. Nostra esperienza mediante computer.

From August 1983 to December 1985, 2352 radiological examinations of the colon were performed in the Radiology Department of Università Cattolica del Sacro Cuore of Rome. From this group a sample of 222 patients was analyzed. They included 111 patients with colonic polyps and 111 with cancer. These cases were carefully examined, in terms of age, frequency of this pathology according to sex, symptom-illness rate, and the radiological data were compared with the endoscopic and histological findings. The data were processed using a computerized program. A critical correlation of the data obtained revealed that: 1) The surest symptom of colon carcinoma is blood in faeces with or without changes in defaecation frequency. Nor should isolated bowel disorders be ignored ("irritated" colon due to organic injuries). 2) The diagnostic accuracy of double contrast enema is very close to that of endoscopy, provided that intestinal cleaning is adequate (this in fact is an important aspect of the examination). 3) The mean age of patients in this group is high and cancer is more common than polyps. This seems to be due to the back of a complete diagnostic sequence, in which radiology has a specific and important role.