The aim of this article was to carry out a retrospective analysis of the feasibility of using virtual endoscopy in the field of gastrointestinal diseases. After a retrospective review of the international literature the authors analyse the most controversial aspects of virtual endoscopy such as its effective diagnostic reliability and potential clinical employment with specific reference to diagnosing colon diseases. The international literature shows that virtual endoscopy is currently poorly sensitivity in detecting lesions measuring less than 10 mm in diameter and that the radiologist's experience can negatively condition the trustworthiness of this procedure. Virtual endoscopy is likely to be the future gold standard in the field of diagnostic imaging. Furthermore, it eliminates all the compliance-related problems and any risk of iatrogenic lesions such as perforations and bleedings which are typical of traditional endoscopy. Its current sensitivity, however, is poor and it is unable to detect lesions smaller than 10 mm. Its reliability therefore needs to be improved.
Tomography, X-Ray Computed/trends , Feasibility Studies , Forecasting , Humans , Retrospective Studies , Sensitivity and Specificity
Generalised acute peritonitis is a relatively frequently pathology which has always been extremely difficult to treat owing to the large number of complications. Considerable progress has been made over the past few years in the surgical treatment of these pathologies following the introduction of new materials accompanied by new techniques: continuous peritoneal lavage (CPL) and laparostomy are the best known. These techniques must be used in carefully selected patients. They allow a marked improvement in results: fewer cases of redo surgery; fewer local and general complications; shorter hospitalisation stay; fewer deaths. These results are possible because these techniques ensure a better cleansing of the peritoneal cavity, with easier removal of necrotic and purulent materials, the main cause of local and general complications.
Peritonitis/surgery , Acute Disease , Humans , Peritoneal Lavage
Over the past 20 years public health expenditure has progressively increased for various reasons. With the aim of reducing public health expenditure and hospital stays, alternative models of public health care have been more widely adopted over the past two decades: Day Hospital, day surgery and ambulatory surgery. What is meant by ambulatory surgery is the clinical, organisational and administrative possibility of performing surgical operations and/or invasive and semi-invasive diagnostic procedures without hospitalisation of patients, in doctors' surgeries, outpatient departments or protected outpatient facilities. For both the patients and the centres providing the service to be able to exploit all the advantages stemming from this kind of health care provision, careful patient selection is mandatory, including assessment of the impact of any potential concomitant pathologies. Starting from their own personal experience and existing reports in the international literature, the authors analyse the impact that concomitant pathologies may have on patient selection for ambulatory surgery. The authors conclude that thorough preoperative evaluation of all the possible variables involved is the only way of ensuring the success of ambulatory surgery.
Ambulatory Surgical Procedures , Preoperative Care , Humans
Gastro-intestinal stromal tumors (GISTs), as currently defined, represent the largest category of primary non epithelial neoplasms of the gastrointestinal tract. They arise from mesenchymal cells located in the wall of the organ and show a remarkable variability in their differentiation pathways. For this reason there is relevant degree of confusion in their interpretation. On the basis of immunohistochemical and ultrastructural studies these neoplasms are divided into several categories: leiomyomas, schwannomas and less differentiated tumors referred as GIST. In the small bowel GIST are uncommon. Usually asymptomatic, they could be the cause of surgical emergencies like massive bleeding, obstruction, intussusception or perforation. Generally benign, an higher percentage of malignant cases are described in the small bowel. The Authors report a case of malignant GIST of the small intestine presented with bowel obstruction by ileal invagination. In this case, as usually it happens in malignant GIST, the final diagnosis was obtained by an abdominal surgical exploration.
Ileal Neoplasms/pathology , Aged , Female , Humans , Ileal Neoplasms/surgery
Gastric antral vascular ectasia (GAVE), recently described in literature, is an important cause of gastric bleeding. A case of great gastrectasia with vascular ectasia in an elderly male patient is reported. The lesion was characterized by great linear and brush folds along the antrum and body of the stomach, Endoscopically, this folds seems like the watermelon streakings. It could be an acquired lesion probably linked to traumatism on gastric mucosa.
Gastric Antral Vascular Ectasia/pathology , Aged , Fatal Outcome , Gastric Antral Vascular Ectasia/complications , Humans , Male , Myocardial Infarction/complications
