[Percutaneous transhepatic biliary drainage. Complications and their treatment]. / Il drenaggio biliare transepatico percutaneo. Complicanze e loro trattamento.

In the present series of 296 PTBDs in 281 patients, 103 complications of different degree developed (34.7%). Early complications directly connected to the procedure (32/296 = 10.8%) and late complications generally due to malfunctioning of the catheter or progression of the disease (71/296 = 23.9%) are analyzed. Caveats to prevent complications, therapeutic procedures to resolve them, as well as obtained results are reported. On the whole, major complications directly related to the procedure are present in a small percentage and the procedure appears well tolerated also in patients with poor general conditions.

Double contrast barium enema combined with non-invasive imaging in peritoneal mesothelioma.

Mesotheliomas are rare tumors arising from serosal linings of the major serous cavities. Five patients with peritoneal mesothelioma underwent a double contrast barium enema (DCBE) and ultrasonography (US) (2 patients), computed tomography (CT) (3 patients) and/or magnetic resonance imaging (MRI) (3 patients). The diagnosis was confirmed at laparotomy. The radiologic pattern at DCBE is unspecific and consists of compression and dislocation of bowel loops by extrinsic masses. Mesenteric retraction and segmental stenosis may be present. In one patient DCBE was normal. US, CT and MRI findings are also unspecific but when combined with information obtained from DCBE the site and abdominal extension of the disease are well defined.

Esophageal carcinoma. Radiologic appearance of minimal lesions.

Twelve minimal lesions were found over a period of 18 months at the Istituto Nazionale Tumori of Milan at the end of the radiologic, endoscopic and histologic procedures. Eleven lesions were radiologically detected, and a radiologic diagnosis of malignancy was perspectively made in 10 of the identified lesions. The radiologic aspects of minimal lesions are described. Double contrast study of the esophagus allows excellent mucosal detail and good reproduction of lesions. Simplicity and minimal discomfort for the patient justify it as a first diagnostic step for detection of neoplastic pathology.

[Epigastric pain in patients with biliary drainage. A symptom not to be overlooked]. / Il dolore epigastrico nei pazienti con drenaggio biliare. Un sintomo da non sottovalutare.

Patients with longstanding percutaneous transhepatic biliary drainage often complain of epigastralgia. This symptom has occurred in 33% of the patients in our series. In all the patients complaining of these symptoms who underwent radiological or endoscopic examinations of Upper GI, there was evidence of gastric or duodenal ulcerative lesions which subsequently were cured by medical treatment. Administering anti-acids to those 13 patients who complained of epigastralgia, reduced the symptoms uniformly. The symptom has not been reported elsewhere in literature and is often not given enough importance by the medical practitioner who attributes the symptoms to the presence of the catheter and/or underlying disease. This symptom is more often a sign of a gastric of duodenal peptic lesion that needs to be actively investigated.