Use of the Given Patency System for the screening of patients at high risk for capsule retention.

BACKGROUND: Capsule enteroscopy is a non-invasive diagnostic tool for the study of the small bowel. Due to the risk of capsule retention, capsule enteroscopy is contraindicated in patients with suspected small bowel strictures. The Given Patency Capsule is a disintegration time-controlled capsule developed to identify patients with strictures that may cause capsule enteroscopy retention. The presence of the patency capsule within the patient's body can be detected by a radio-frequency scanner. AIM OF THE STUDY: To evaluate safety and usefulness of the patency capsule in preventing capsule retention in patients at high risk. PATIENTS AND METHODS: Thirty-two patients were studied. Indications for patency capsule were: (A) Crohn's disease (18), (B) previous intestinal surgery (7), (C) previous obstruction (1), A+B (3), A+C (1), B+C (2). Patients were evaluated with the scanner at 72 h from ingestion. RESULTS: At 72 h, 24 patients had already excreted the intact capsule in the stool. Of these, two experienced abdominal pain during capsule passage. In the other eight patients, the scanner detected the presence of the patency capsule. Four of them excreted the capsule intact in the stool after 72-96 h, the remaining four never found the capsule in the stool. The 26 patients who excreted the patency capsule intact without experiencing abdominal pain were deemed eligible for the capsule enteroscopy procedure, which was performed uneventfully in the 25 who agreed to undergo the examination. CONCLUSIONS: The patency capsule is useful to identify, among patients at high risk, those who can be submitted to capsule enteroscopy without risks of capsule retention.

Primary lymphoma of the liver - a case-report and a review of the literature.

A case of primary lymphoma of the liver in a 72-year-old man is reported. The patient showed a three to four month history of abdominal ache, low grade fever, and weight loss. The presence of a large mass occupying the V and VT hepatic segments was demonstrated; no other organs were involved and no evidence of lymphoadenopathy was found. Laboratory tests showed a remarkable increase in ESR, LDH and alkaline phosphatase while CEA and alpha-1 fetoprotein were within the normal values. Two ultrasound-guided needle biopsies on the hepatic lesion did not produce any significant tissue for diagnosis. Therefore the V and VI hepatic segments were excised; a hard, greyish mass with the largest diameter of 6.5 cm, was found at laparatomy. Histology of the surgical specimen showed the presence of a malignant non-Hodgking's B-cell lymphoma, centroblastic-centrocytic, diffuse type (working formulation: G) of intermediate grade of malignancy. Staging was completed with lymphography, and bone marrow biopsy; both proved normal. After the operation adjuvant chemotherapy was commenced (COP for six cycles). Follow-up has so far shown no signs of recurrence after 24 months. In conclusion, the diagnosis of primary lymphoma of the liver is very difficult and is often reached only after histologic evaluation of the surgical specimen. Moreover, this disease has a much more favourable prognosis than the hepatocellular carcinoma and other primary or secondary liver cancers; therefore accurate investigations are important to reach the correct diagnosis.

Capsule enteroscopy in small bowel transplantation.

BACKGROUND: Enteroscopy plays a key role in the post-operative monitoring of patients with small bowel transplantation for the early detection of post-transplant complications and for the assessment of the graft's integrity. Routine surveillance enteroscopies (trans-stomal terminal ileoscopy or jejunoscopy) are invasive, may be unsafe in frail patients, and only allow incomplete exploration of the transplanted graft, which may be unsatisfactory. since the distribution of the lesions is often patchy or segmental. AIMS. To evaluate the potential of capsule enteroscopy, a new, minimally invasive technique which allows complete exploration of the small bowel. in small bowel transplant recipients. METHODS: Five small bowel transplanted patients underwent capsule enteroscopy with the GIVEN endoscopy system. The results of capsule enteroscopy were compared with those of trans-stomal ileoscopy. RESULTS: Capsule enteroscopy was better tolerated than ileoscopy and good quality images of the small bowel were obtained in four patients. The terminal ileum was normal both on ileoscopy and capsule enteroscopy. Mucosal changes in segments not reached by ileoscopy were detected by capsule enteroscopy in three of four patients. CONCLUSIONS: Capsule enteroscopy is better tolerated than ileoscopy, allows complete exploration of the transplanted graft and can detect mucosal changes in segments not reached by ileoscopy.

Inappropriate pemoline therapy leading to acute liver failure and liver transplantation.

A 36-year-old female, presenting with jaundice, developed acute liver failure requiring orthotopic liver transplantation. On admission, none of the known causative factors for acute hepatitis, including use of drugs, were found to be present. Several days after hospitalization, the patient admitted taking therapy prescribed by a "non-traditional" physician, that she had been using for several years due to overweight and which had recently been modified with the introduction of pemoline. A considerable body of evidence exists in the medical literature showing that pemoline, which is a central nervous system stimulant, has variable hepatotoxic effects, ranging from a mild transient increase of serum transaminases to liver failure, including some lethal cases.

Unsuspected ileal stenosis causing obscure GI bleeding in patients with previous abdominal surgery--diagnosis by capsule endoscopy: a report of two cases.

Peri-anastomotic ulcerations may occur in patients with previous abdominal surgery. They may present only with obscure GI bleeding. We report two cases in whom capsule endoscopy identified postsurgical stenoses with ulcers as the cause of obscure GI bleeding. Case 1. A 57-year-old male operated on in 1970 for a post-traumatic diaphragm hernia followed by displacement of the caecum in the upper left abdominal quadrant. Case 2. A 32-year-old female with a salpingectomy for tuberculosis (1978) followed by segmental ileal resection for intestinal obstruction. Both patients had undergone extensive work-up including bidirectional endoscopies and enteroclysis with negative results. Capsule endoscopy with the GIVEN diagnostic system was done. Ileal stenoses with mucosal ulcers in dilated prestenotic loops were observed in both cases. The capsule was retained at the stenosis site, requiring ileal resection and anastomosis. Pathology reports showed mucosal ulcers. In case 2, tuberculosis was ruled out by tissue and faecal polymerase chain reaction and culture. Ileal stenoses with prestenotic ulcerations causing GI bleeding may occur in patients with previous abdominal surgery. Capsule endoscopy may clarify the diagnosis and shorten the diagnostic work-up. However, these patients should be warned that capsule retention requiring surgery might occur.

[Rheumatoid arthritis with cervical localization. Description of a case with neurological symptomatology and review of the literature]. / L'artrite reumatoide a localizzazione cervicale. Descrizione di un caso con sintomatologia neurologica e revisione della letteratura.

A case of a patient with rheumatoid arthritis with a cranio-cervical junction involvement is presented. Medullary compression was present and was partially invalidating. Radiological and CT scan signs are explained and their relationship with a clinical symptomatology is discussed. The importance of radiological monitoring is emphasised in order to avoid dangerous neurological complications.

[The efficacy of echography in the diagnosis of gallbladder carcinoma]. / Utilità dell'ecografia nella diagnosi del carcinoma della colecisti.

The preoperative diagnosis of carcinoma of the gallbladder is very difficult because the clinical manifestations of this disease are nonspecific and often indistinguishable from those of cholecystitis. Radiography, including oral cholecystograms and i.v. cholangiograms, give aspecific findings. Ultrasound scans were performed on 13 gallbladder carcinomas: only "massive" cancer was diagnosed correctly, because sonography does not offer specific patterns for "infiltrating" and "fungating" carcinomas.

[Arterial hypertension with hypokalemia]. / Ipertensione arteriosa con ipopotassiemia.

After a careful review of the literature on physiopathological role of the renin-angiotensin-aldosterone system in cases of arterial hypertension with hypokalaemia, a simple diagnostic procedure is suggested to differentiate between this and secondary hypertensions which, though few, are often curable. Three clinical cases examined in the medical department of Casalpusterlengo Hospital are presented in which the study of the renin-angiotensin system proved decisive for a correct diagnosis of the hypertension.

[Gigantic liposarcoma of the retroperitoneum]. / Liposarcoma gigante del retroperitoneo.

A case of giant liposarcoma of the retroperitoneum (7.5 kg, diam. 39 x 30 x 18 cm) is reported. The most frequent sites of onset are discussed and stress is laid on the most useful diagnostic investigations. Surgical treatment, the only possibility of treatment for such large tumors, is often not radical and the recurrence rate is high.

[Solitary fibrous mesothelioma of the peritoneum. Considerations of a clinical case in our observation]. / Il mesotelioma fibroso solitario del peritoneo. Considerazioni su un caso clinico giunto alla nostra osservazione.

The authors report a case of so-called solitary fibrous peritoneal mesothelioma which was successfully operated on. Their case is compared with the few cases reported in the literature. Analysis of findings shows the fibrous peritoneal mesothelioma to be a solitary well defined tumor, generally of considerable size at the time of the diagnosis, very similar to the fibrous metothelioma of the pleura. It is believed to originate in the sub-mesothelial connective tissue. Surgery provides a definitive cure.

Evaluación de la producción de carne de ganado criollo patagónico / Evaluation of Criollo Patagónico (Native Patagonian breed) cattle meat production

Objetivo. Evaluar la producción de carne del ganado Criollo Patagónico respecto al Angus y cruzas entre ambas razas. Materiales y métodos. Se dispuso de una muestra de 42 animales de los genotipos Criollo Patagónico, Angus y cruza entre ambos, clasificados en novillitos o vaquillonas, terminados en feed lot durante un período de 114 y 156 días, a partir de los cuales se conformaron ocho grupos de análisis desbalanceados. Para la parte exploratoria se empleó análisis factorial. Se usaron modelos lineales mixtos para contemplar las correlaciones entre las mediciones sobre un mismo animal. Resultados. Se pudo constatar diferencias entre las medias de los pesos a faena de los dos períodos de engorde y que esta ganancia de peso se depositó en los cortes de menor valor comercial. Con relación al rendimiento de los cortes de alto valor económico, se detectó interacción entre éstos y los grupos, identificándose diferencias entre grupos para algunos de los cortes. Conclusiones. En virtud de los resultados obtenidos, se considera promisoria la producción de carne del ganado Criollo Patagónico con relación al rendimiento de los cortes de alto valor económico, pues sus rendimientos medios sólo se vieron superados en bife ancho por su cruza con Angus.

Objective. Evaluate the production of meat from the Criollo Patagónico cattle with resect to Angus and the cross breading between these two breeds. Materials and methods. A sample of 42 animals of the following cattle genotypes was used: Criollo Patagónico, Angus and the cross breed between these two breeds, classified in steers or heifers, finished in feedlot for a period of 114 and 156 days, after which eight groups of unbalanced analysis were formed. A factorial analysis was used during the exploratory stage. Linear mixed models were used to see the correlations between measurements on the same animal. Results. The findings suggest differences between the means of slaughter weights of the two fattening periods as well a the fact that this weight gain was deposited in the cuts of less commercial value. Regarding the productivity of cuts of high economic value, interaction was detected between them and the groups, allowing for an identification of differences amongst the groups in the case of some of the cuts. Conclusions. In virtue of the obtained results, the production of Criollo Patagónico cattle meat is considered promising in relation to the productivity of the high economic value cuts, as their average yields were only surpassed in "bife ancho" in its cross with Angus.

Microdureza del esmalte dental en incisivos centrales permanentes de dos genotipos bovinos / Dental enamel micro-hardness for permanent central incisors in two beef cattle genotypes

Objetivo. Evaluar la microdureza del esmalte dental de novillos criollos de origen patagónico y cruza índica criados en ambientes diferentes. Materiales y métodos. Se utilizaron dientes incisivos centrales derechos de novillos adultos: ocho Criollos Patagónicos (GCP) y siete Cruzas Índicas (GCI). Para cada diente se definió una transecta central recorriendo el diente desde el borde externo del esmalte hacia la dentina y se midió la dureza en tres profundidades equidistantes: a 30 μ del borde exterior (P1), a 30 μ previos a la conexión amelodentinaria (P3) y P2 equidistante entre P1 y P3. Las mediciones de microdureza se realizaron con un microdurómetro Shimadzu modelo HMV-2 y se expresaron en unidades Vickers. Para el análisis se utilizó un modelo de regresión aleatoria. Se empleó el criterio de información de Akaike para la elección de la estructura de las matrices asociadas a los efectos aleatorios. Para el análisis estadístico se empleó el procedimiento PROC MIXED de SAS, y un nivel de significación del 5%. Resultados. No se detectó falta de paralelismo entre los grupos (p>0.05), con lo cual se ajustaron rectas de igual pendiente en cada grupo. La dureza media del esmalte disminuyó al aumentar la profundidad de la medición para ambos genotipos. Se observó heterogeneidad en la variabilidad de los grupos. Conclusiones. El GCP presentó mayor dureza pero fue el de mayor variabilidad. Se confirma la disminución de la dureza media con el aumento de la profundidad en el esmalte independientemente del genotipo y el ambiente.

Sensitivity and specificity of the suspected blood identification system in video capsule enteroscopy.

BACKGROUND AND STUDY AIMS: Capsule enteroscopy has become a standard tool for the evaluation of obscure gastrointestinal bleeding. Reviewing the video recordings of capsule examinations is time-consuming and requires prolonged attention. Recently, software that can recognize the frames containing "red spots", the Suspected Blood Identification system (SBIS), has been developed with the aim of assisting in the analysis of video recordings. We assessed the sensitivity and specificity of the SBIS in patients undergoing capsule enteroscopy. PATIENTS AND METHODS: 100 consecutive patients underwent capsule enteroscopy at our tertiary referral center, for the following indications: obscure gastrointestinal bleeding (75 patients), metastatic carcinoid (7 patients) known or suspected Crohn's disease (5 patients), miscellaneous (13 patients). Capsule endoscopy was carried out by the standard method. Four gastroenterologists, experienced in capsule endoscopy, reviewed the recordings. RESULTS: Small-bowel visualization was obtained in 95 cases. The physicians identified 209 "red spots", 54 of which (25.8%) were also identified by the SBIS. The overall sensitivity, specificity, and positive and negative predictive values of the SBIS, calculated on the number of true-positive, true-negative, false-positive and false-negative results, were 40.9%, 70.7%, 69.2% and 42.6%, respectively. Sensitivity was higher for the identification of red blood (60.9%) than for nonbleeding "red" lesions such as arteriovenous malformations (25.8%). CONCLUSIONS: The SBIS has low sensitivity and specificity. It can be used as a complementary and rapid screening tool, but complete review of the recordings is still necessary.

General paresis: neuropsychological and SPECT study of five cases.

Although much less common than before the advent of the antibiotics, cognitive impairment due to general paresis can still be found in clinical practice. Five patients with general paresis underwent longitudinal neuropsychological assessment; on the occasion of the final evaluation, Single Photon Emission Tomography (SPECT) was also performed in four cases. The most frequent cognitive deficit at admission was long term spatial memory impairment, which was present in four patients. Only the two patients who received the highest dosage of intravenous penicillin therapy showed significant improvement at neuropsychological tests after treatment. SPECT findings included areas of cortical hypoperfusion and/or perfusion asymmetry in three out of four patients.

Prevalence and risk factors of Helicobacter pylori-negative peptic ulcer: a multicenter study.

Peptic ulcer disease (PUD) has been described in the absence of Helicobacter pylori (Hp) infection, suggesting that different factors are involved in its etiopathogenesis. We investigated prevalence and characteristics of Hp-negative (Hp-) PUD in an area of Northern Italy and calculated the rate of Hp-positive (Hp+) patients with PUD in whom Hp might be coincidental and not causal. Four hundred nine consecutive patients with endoscopically diagnosed PUD were enrolled in seven hospitals. Hp infection was assessed by rapid urease test and histologic examination. The attributable risk percentages in different age groups were calculated by appropriate formulas. Of 409 patients, 31 (7.6%) were Hp- (gastric, 8.3%; duodenal, 7.6%). Age, nonsteroidal antiinflammatory drug (NSAID) consumption, and complication rates were significantly higher in Hp-than Hp+ patients with duodenal ulcers (DUs). Of the Hp-patients with DU, 58% did not use NSAIDs. In patients with Hp+ DU, the attributable risk percentage for Hp infection in patients aged <40 years, 40-60 years, or >60 years was 98%, 88%, and 66%, respectively. The prevalence of Hp- PUD was about 8%, mainly unrelated to any known etiologic factor. In about one-third of Hp+ patients with PUD aged over 60 years, Hp infection might be coincidental and not causal.

[Care of skin infections in patients in peritoneal dialysis]. / Indagine descrittiva sulla cura dell'emergenza cutanea nel paziente in dialisi peritoneale.

The incidence of exit-site infections among peritoneal home-dialysis patients was quantified following for 1 year all home dialysis patients of 23 dialysis centres. The exit site conditions were observed and classified according to Twardowsky. When an infection occurred data on its treatment were collected. 393 patients were observed. The infection occurred in 40 patients (10.1%). 82.2% of patients wear a Tenckoff catheter, 3% do not protect the exit site with any kind of dressing. The strategies adopted by different centres vary for the choice of antiseptics, the suggested frequency of changes dressing and the routine use of nasal swabs. Due to the limited number of patients with infection no association was found between tunnel direction or frequency of dressing changes and infections occurrence. Discussion on controversial aspects and the definition of common guidelines for instance for frequency of dressing changes, use of antiseptics is warranted.