[Malignant tumors or the small intestine. Review of the literature and report of a clinical case]. / Tumori maligni del tenue. Revisione della letteratura e presentazione di un caso clinico.

The authors present one case of patients with adenocarcinoma of the small bowel. Primary malignant tumors of the small intestine are uncommon neoplasms accounting for 1-2 per cent of all gastrointestinal malignancies. Patients are usually seen late in the course of their illness when curative therapy is unlikely. The rarity of these neoplasms explains in part why the early signs and symptoms frequently go unrecognized and is undoubtedly a major factor contributing to their poor prognosis. Despite a fourfold greater length and a nearly tenfold greater mucosal surface area, the incidence of adenocarcinoma of the small intestine is about a fortieth that of the colon. This relative immunity of the small bowel to the development of the malignant tumors is unexplainable. Several theories have been suggested and include the following: a) the rapid transit time of the small intestine may reduce its exposure to dietary carcinogens; b) the relative sterility of the small intestine compared with the colon may lessen the formation of carcinogenic substances by the action of bacteria on components of bile or other substances within the intestinal lumen; c) certain mucosal enzymes such as benzopyrene hydroxylase that detoxify potential carcinogens are present in higher concentrations in the small intestine than in the colon; d) immunoglobulin A which is found in high concentrations in the small bowel, may protect it against carcinogenic viruses. Interestingly, patients deficient in IgA and those receiving immunosuppressive therapy have been found to have a higher incidence of small intestinal cancer. Adenocarcinoma is the most common primary malignant small bowel neoplasm.(ABSTRACT TRUNCATED AT 250 WORDS)

Through the nose gastroscopy for the placement of feeding tubes.

Following local anesthesia to the nose, through-the-nose (TTN) passage of a paediatric gastroscope was successful and well tolerated in 82 of 92 patients on whom it was attempted in order to place nasogastric feeding tubes. This technique allows for guidewire placement to be used for insertion tubes or dilators. The ten failures we observed occurred in patients with bilateral narrow turbinates. We conclude that the TTN approach is quicker and easier than conventional methods of feeding tube placement allowing for an additional endoscopic evaluation of the upper GI tract.

Balloon dilatation of anastomotic intestinal stenoses: long-term results.

Since 1983 we have treated 59 consecutive patients with anastomotic intestinal strictures. In 43 cases the stenosis was located in the esophagus, and in 16 cases in the colon. The balloon catheter was positioned under fluoroscopic and endoscopic control. The number of dilatations required by each patient ranged from one to five, with 47% of our patients receiving only one session, and 23% two sessions. We had no initial treatment failures. We observed stricture relapse in 10.1% of our cases, occurring within two to five months. In these patients repeat dilatation was 100% successful. We had no significant complications. All the patients with esophageal stricture were able to eat solid food after dilatation. Long-term results and relapse-free intervals have been assessed on a clinical basis with a mean follow-up of 26.5 months. Balloon dilatation would seem a safe and reliable method of treating anastomotic strictures, with special emphasis on stenosis with a small diameter, and tortuosity of the gut.

[Cytodiagnosis of suspect lesions of the esophagus and stomach. Histocytological correlations in 435 cases]. / La citodiagnosi di lesioni sospette dell'esofago e dello stomaco. Correlazioni cito-istologiche di 435 casi.

This report analyses the results obtained using endoscopic cytodiagnosis in upper gastrointestinal lesions. Cytological and bioptic samples were taken from 435 lesions, in 435 patients. Specificity was 0.99% and sensitivity 0.9%. The accuracy of the endoscopic sampling and in preparing the cytological slides had a decisive influence on the obtaining of these results. The time required for a good cytological sample is the same as required for a biopsy. As employed the cytodiagnosis of esophago-gastric lesions was really useful, and indeed essential in diffuse mucosal lesions.

Fournier's gangrene following a perianal abscess.

Fournier's disease is an uncommon form of gas gangrene involving the scrotum and perineum. Described by Fournier as an idiopathic condition, it must be recognized as a synergistic gangrene secondary, in most cases, to a focus of perianal infection. Urinary tract infection and local trauma follow as possible causal factors. Five cases complicating a perianal abscess observed in a period of 11 years have been treated with urgent aggressive surgical debridement and intensive care support. Full-thickness skin grafts were required in three patients. Hospital mortality occurred in one case. Although combination antibiotic therapy and correct postoperative wound management are potentially successful, the mainstay of treatment is complete excision of all necrotic tissue. Colostomy and urinary diversion are not mandatory. Treatment with hyperbaric oxygen is controversial.