[Five-years experience of Emergency Endoscopic Unit at Policlinico "Umberto I" University "La Sapienza" of Rome]. / Analisi dell'attività quinquennale del Servizio di Pronta Reperibilità Endoscopica dell' Azienda Policlinico "Umberto I" dell'Università degli Studi di Roma "La Sapienza"

A second level hospital must assure to the patients a 24 hours service of emergency endoscopy. Since 1989 in the Policlinico 'Umberto I' University 'La Sapienza' of Rome, a dedicated operative unit is active. The Authors present their experience of last five years (2001-2005). The endoscopic diagnosis for appropriate therapeutics reduced time and costs of the hospitalization. The Endoscopic Operative Unit resolved the emergency in two/four hours. Neverthless, in some cases, the referall to Unit was not appropriated.

[Endoscopic endoprosthesis insertion in the treatment of digestive diseases]. / L'utilizzo delle protesi endoscopiche nella patologia dell'apparato digerente.

Over the last few years the use of endoscopically placed endoprostheses for benign and malignant digestive diseases has considerably developed. The endoscopic placement of prostheses is usually well tolerated by patients; it does not require anaesthesia and it is a relatively low-risk procedure. New self-expandable metallic prostheses allow to treat even very tight stenoses; they do not usually require dilatation, therefore reducing the risks involved in dilatation procedure. This study presents a review of experience with prostheses placement in digestive diseases. Indications, limits and complications will be discussed according to data reported in the international literature.

[Modern indications on the medical treatment of symptomatic diverticular disease]. / Moderni orientamenti nel trattamento medico della malattia diverticolare sintomatica.

Authors refer about their experience on treatment of symptomatic diverticular disease both with antibiotic and anti-inflammatory drugs. They confirm the observation of other Authors on effectiveness of this new therapeutic approach versus traditional antibiotic therapy.

Endoscopic findings and psychometric abnormalities: what is the relationship in upper endoscopic outpatients?

BACKGROUND: Psychological disorders are often associated with diseases of the upper digestive tract. Although emotions can influence gastrointestinal function in healthy individuals, psychological setting in upper gastrointestinal patients are unclear. We evaluate the psychological alterations prevalence in outpatients submitted to upper endoscopy. MATERIALS AND METHODS: A total of 130 patients (50 males and 80 females; mean age 54±17 years) submitted to upper gastrointestinal endoscopy, were enrolled over the period May 2009 - September 2010. Subjects were asked to complete questionnaires before endoscopic examination. Alexithymia, anxiety, depression and coping style were assessed using the Toronto Alexithymia Scale, Spielberger Trait Anxiety Inventory, Beck Depression Inventory and Coping Inventory for Stressful Situations, respectively. RESULTS: Coping impairment, Alexithymia, Anxiety and Depression were found respectively in 80.3%, 25.4%, 24.6% and 17.2%, often in association. Task-oriented, emotion-oriented and avoidance-oriented alterations were found in 41.8%, 40% and 30.6%, respectively. No correlations were demonstrated between diagnosis of upper gastrointestinal disease and psychometric results. CONCLUSIONS: In our study, a high prevalence of psychometric alterations in gastrointestinal outpatients was unconnected with endoscopic findings, especially considering coping style alterations. This aspect should be taken into account in patients management and a long-term follow-up should clarify a possible role of these factors in patients prognosis and compliance.

[Carotid body tumors. Observation of an unusual case associated with thyroid disease]. / In tema di tumori del glomo carotideo. Osservazione di un raro caso associato a tireopatia.

A case of tumour of the carotid glomus associated with diffuse cystic colloid struma of the thyroid is examined. Classification, symptomatological, diagnostic and therapeutic problems are reassessed on the basis of the case in question and the literature. Stress is laid on the importance of carotidography as a decisive examination for preoperative diagnosis of the nature of the case. Some basic problems of surgical treatment are examined and the operating techniques that have proved most valid are proposed.

[Bizarre gastric leiomyoblastoma. A case report and review of the literature]. / Leiomioblastoma gastrico bizzarro. Analisi di un caso e revisione della letteratura.

Gastric leiomyoblastoma of Martin's myoid tumour or Stout's smooth muscle cell bizarre tumour is a rare benign mesenchymal neoplasia, that may become malignant. A personal clinical case is reported and the most important clinical and anatomopathological aspects are reviewed, stress being laid on the importance of identifying the macroscopic and histological features that can point with certainty to malignity and so influence the choice of surgery.

[Malignant peritoneal mesothelioma: apropos a new case]. / Il mesotelioma peritoneale maligno: a proposito di una nuova osservazione.

Prognosis for patients with malignant peritoneal mesothelioma is very poor, and most patients are beyond cure by the time the diagnosis has been made. The pathogenesis of this uncommon neoplasm seems to be related to asbestos and radiation exposure. The authors report a case of diffuse peritoneal mesothelioma in a 33-year-old man. Since the patient complained of aspecific symptoms and both biochemical and "imaging" studies did not provide useful informations for a definitive diagnosis, an exploratory laparotomy was performed. Intraoperative histological findings demonstrated the presence of a malignant peritoneal mesothelioma which had spread all over the omentum; considering the inoperability assessment of this case, the operation was completed and the patient was dismissed with an adjuvant chemo-therapy. Five weeks later the patient died.

[The emergency management of foreign bodies: our own experience in 46 cases]. / Il management dei corpi estranei in urgenza: la nostra esperienza in 46 casi.

Foreign bodies ingestion is a common cause of emergency endoscopic therapy. Usually ingestion is accidental for children and elderly patients, instead is voluntary in some others as psychopathic people or prisoners. The authors report their experience with 46 cases from January 1992 to December 1998: this technique is safe, with low rate of complications and hospitalization.

[Polyethylene glycol versus sodium phosphate: comparison of 2 preparations for colonoscopy]. / Polietilenglicole "versus" fosfato sodico: confronto tra due preparazioni per la colonscopia.

The intention of this study is to compare the efficacy and tolerability of an electrolytic solution containing polyethylene glycol (PEG) with a saline solution containing sodium phosphate in the preparation of colon for an endoscopic examination. 80 patients were subdivided at random into two groups: Group 1; PEG 4 liters - Group 2; sodium phosphate 3 packets plus one microenema. The efficacy of the two preparations was decided on the basis of: presence or absence of liquid/solid faecal residues observed by the endoscopist during the exploration of the large intestine, and classified as follows: perfect, good, mediocre and bad. Acceptability was established on the basis of patient tolerability in completing or not the preparation as well as presence of any side effect. The PEG solution was observed to be more efficient than sodium phosphate solution while both preparations had comparable tolerability. The cost of the PEG preparation was higher compared to the sodium phosphate preparation.

[Percutaneous endoscopic gastrostomy (PEG)]. / La gastrostomia percutanea endoscopica (PEG).

When gastric decompression or enteral feeding are needed for patients affected by neurological problems or neoplasias with a long life expectancy (months), PEG represents the method of choice because it has a lesser number of complications, needs a mild sedation, and has a lower cost compared to surgical techniques.

[Comparison between virtual and conventional colonoscopy in the screening of colorectal polyps]. / Confronto tra colonscopia virtuale e convenzionale nello screening dei polipi del colon-retto.

Aim of this study was to compare virtual and conventional colonoscopy for the detection of colon-rectal polyps. The authors studied 20 patients with these two methods and it was found that virtual colonoscopy is dependent on the size of lesions regarding sensitivity and specificity, is expensive and the learning process with reading images is very long.

[Current status of the use of the endoscopic cholangiography technique]. / Attualità sull'uso della tecnica colangiografica per via endoscopica.

The endoscopic retrograde cholangiopancreatography as a diagnostic technique employed to obtain an accurate radiological study of the biliary path, and the biliary duct-pancreatic-duodenal junction. However, during the initial diagnostic studies, both echography and nuclear magnetic resonance have taken a priority. Currently, their importance is as a preliminary diagnostic method during endoscopic intervention.

[Endoscopic prosthesis in colonic malignant pathology]. / Le protesi endoscopiche nella patologia maligna del colon.

The utilization of stents in neoplastic colon pathology finds a correct location in the therapeutic panorama. Authors report the use of enteric stents as definitive treatment in acute intestinal occlusion with inoperable malignant neoplasia as well as palliative treatment in intestinal occlusion with non-surgically resectable neoplasia.

[Breath test as non-invasive assessment for the initial screening of non-ulcerous dyspepsia]. / Il Breath Test come indagine non invasiva di scelta per lo screening iniziale della dispepsia non ulcerosa.

Considering the important role of Helicobacter Pylori (Hp) in the most common gastro-intestinal pathologies, the Authors want to test the effectiveness of a non-invasive diagnostic technique for detection of the Hp in the gastric mucosa. At the end of experience they think, like the most of Literature, that the Breath Test, concerning sensibility and specificity, represent the gold standard for detection of the Hp.

[Endoscopic treatment of benign esophageal stenosis]. / Il trattamento endoscopico delle stenosi esofagee benigne.

Benign esophageal stenosis is the most frequent type of stenosis of the digestive tract. Surgical treatment is still affected by a high percentage of morbidity and mortality. This is not acceptable for a condition which is not neoplastic in nature. The introduction of modern endoscopic instruments has significantly simplified the technique also reducing the complications, therefore oesophageal dilatation has a fundamental role. The main indications to endoscopic treatment are represented by postoperative stenosis, and those caused by caustics, peptic acid, actinic lesions and achalasia. During the past 15 years, the Authors performed 205 endoscopic dilatation including 26 cases affected by esophageal achalasia. In the experience of the Authors, olivarian metallic probes were gradually abandoned in favour of Celestin & Savary polimetric dilators while pneumatic dilators were preferred only in achalasic cases. Endoscopic therapy was resolutive in 24 patients affected by achalasia (92.3%). In 158 patients, mechanic dilatation was employed (88.2%) and among them, 4 cases (2.19%) of esophageal perforation were observed. Overall, mortality rate was zero. As far as the average number of dilatation employed, the highest number was registered among caustic lesions (5), followed by peptic (4), and post-operative stenosis (1). The results obtained confirm the validity and efficacy of the endoscopic treatment for benign esophageal stenosis also considering the good compliance of the patients and the fact that no general anaesthesia is required.

[Endoscopic ligation and sclerotherapy in the treatment of esophageal varices]. / La legatura endoscopica e la scleroterapia nel trattamento delle varici esofagee.

Endoscopic variceal ligation (EVL) and esophageal variceal sclerotherapy (EVS) are both used in the treatment of esophageal varices. Sclerotherapy is widely used with success, however it is associated with multiple local and systemic complications. To overwhelm the complications of sclerosis, Stiegmann in 1986 proposed the elastic band variceal ligation which demonstrated to be efficient as sclerotherapy though with minor side effects. Therefore, the Authors decided to apply a therapeutical protocol with EVL for the primary prevention of variceal esophageal bleeding. Preliminary results are herein reported.

[Pneumatic dilatation in the treatment of esophageal achalasia]. / La dilatazione pneumatica nel trattamento dell'acalasia esofagea.

The purpose of therapy in esophageal achalasia is to reduce the pressure at the level of the lower esophageal sphincter. In this study 26 patients (16 males and 10 females) between 30 and 50 years of age, affected by esophageal achalasia underwent esophageal dilatation with Rigiflex pneumatic dilators. A total of 40 dilatations were performed. A complete success using the Rigiflex pneumatic dilators, was achieved in 24 out of 26 patients (92.3%).

[Study of fecal antigens against Helicobacter pylori as non-invasive test compared with the 13C-urea breath-test. Personal experience]. / La ricerca dell'antigene fecale dell'Helicobacter Pylori come test non invasivo in confronto al 13C-urea Breath-Test. Esperienza personale.

The target of this study is the evaluation of two different noninvasive tests: 13C-urea Breath-Test, as gold standard, versus the HpSA test, as new method to research the faecal antigen of Helicobacter Pylori (HP). Thirty patients, affected by dyspeptic symptomatology and never treated before by antibiotic therapy to eradicate the HP, was subjected, by Authors, to this evaluation. This study say that the 13C-urea Breath-test represent the gold standard in the pre-endoscopic research of HP presence concerning specificity and sensibility. However, the HpSA test need more improvement.

[The role of endoscopic sphincterotomy in the therapy of choledocholithiasis: a review of our experience]. / Il ruolo della sfinterotomia endoscopica nella terapia della calcolosi coledocica: revisione della nostra esperienza.

The treatment of common bile duct stones is nowadays endoscopic sphincterotomy. The authors reviewed their series from 1992 to 1999 and confirm that this is a safe, definitive, with low complication rate treatment if is performed in specialized centers and reduces the duration of hospitalization. Operative ERCP is successful is about 96-97% of the cases. There was no mortality related to the technique.

[Endoscopic treatment of polyps of the large intestine: authors' experience with 250 cases of polypectomy]. / Il trattamento endoscopico dei polipi del grosso intestino: nostra esperienza su 250 polipectomie.

The Authors report their experience of endoscopic polipectomy. This technique represents a gold standard treatment for polyps of the colon-rectum because it is safe and effective, being correlated with low-risk of complications as perforation and hemorrhage. Hospitality stay was only 24-48 hours. The polyps were histologically examined and grade of dysplasia was determined. The patients underwent surgical resection of the colon when an invasive carcinoma was found.