[Percutaneous endoscopic gastrostomy]. / Gastrostomia endoscopica percutanea.

Surgical gastrostomies were first performed in the middle of the 19th century and modified during the following years, but the most important technical improvement was percutaneous endoscopic placement (PEG), in 1980 by Ponsky and Gauderer. This technique doesn't require anesthesia and it in possible also in patients with contraindications to surgical gastrostomy. The simple procedure involves a shorter hospitalization, lower risks and reduced costs. Many authors already reported the good results of this new technique, that can be performed on a day-hospital regimen as well. The main indications are head and neck cancers, neurologic diseases involving food intake capacity, cancer cachexia, obstruction of the GI tract when there is enough space for an endoscopic procedure. Every disease that can compromise food intake for a period longer than 60 days can find an indication in placing a percutaneous gastrostomy. The advantage for the patient is a much better psychological tolerance compared with a naso-gastric tube. Also the incidence of mechanical complications of a PEG is much lower. In our experience from October '90 to July '92 we followed 34 patients with PEG, 22 males and 12 females, with mean age of 69 years (range 41-88). We used 9-French tube placed using the pull-method technique. All patients received antibiotic therapy for 5 days. About 12 hours after PEG placement all patients began using the gastrostomy, initially with the administration of electrolyte solutions and later with enteral polymeric formulas. The constant increase led all patients to a 1500 non protein calories daily intake in 3-4 days.(ABSTRACT TRUNCATED AT 250 WORDS)

[Dietetic and pharmacologic treatment of hypercholesterolemia. Study of 32 patients over 14 months]. / Trattamento dietetico e farmacologico delle ipercolesterolemie. Studio su 32 pazienti della durata di 14 mesi.

The aim of the study was to evaluate the effectiveness of dietetic-behavioural and pharmacological treatment on 32 patients with high level hypercholesterolemia (LDL-c greater than 160 mg/dl) over 14 months. Clinical and laboratory tests were performed at time 0 (enrollment), at time 1 (after 2 months dietetic-behavioural treatment only), at time 2 and time 3 (after 6 and 12 months respectively of combined dietetic-behavioural and pharmacological treatment). The dietetic-behavioural treatment consist of reduced intake of saturated fatty acids, cholesterol and rapidly absorbed glycid; increased intake of omega-3 fatty acids and fiber; reduced overall calorie intake. The patients were also advised to take light daily exercise. The pharmacological treatment (sinivastatin 20 mg/die) was given to patients whose total cholesterol levels were over 250 mg/dl after 60 days of dietetic-behavioural only treatment and then continued for the whole study. The result showed an average reduction of 20% (p less than 0.01) in LDL-c in all patients after dietetic-behavioural only treatment and a further 20% (p less than 0.01) reduction after 12 months of combined treatment. There was therefore confirmation of the validity of dietetic-behavioural and pharmacological treatment during our study.