Clinical course of severe colitis: a comparison between Crohn’s Disease and ulcerative colitis.

Few data are available about the clinical course of severe colonic Crohn’s disease (CD). The aim of this study is to describe the clinical course of severe Crohn’s colitis in a patient cohort with isolated colonic or ileocolonic CD, and to compare it with the clinical course of patients with severe ulcerative colitis (UC). Thirty-four patients with severe Crohn’s colitis were prospectively identified in our cohort of 593 consecutive hospitalized patients through evaluation of the Crohn’s Disease Activity Index score and the Harvey-Bradshaw Index. One hundred sixty-nine patients with severe ulcerative colitis were prospectively identified in our cohort of 449 consecutive hospitalized patients through evaluation of the Lichtiger score and the Truelove-Witts score. We evaluated the following data/aspects: response to steroids, response to biologics, colectomy rate in acute, colectomy rate during follow-up, megacolon and cytomegalovirus infection rate. We did not find significant differences in the response to steroids and to biologics, in the percentage of cytomegalovirus infection and of megacolon, while the rate of colectomy in acute turned out to be greater in patients with severe Crohn’s colitis compared to patients with severe UC, and this difference appeared to be the limit of statistical significance (Chi-squared 3.31, p = 0.069, OR 0.39); the difference between the colectomy rates at the end of the follow-up was also not significant. In the whole population, by univariate analysis, according to the linear regression model, a young age at diagnosis is associated with a higher overall colectomy rate (p = 0.024) and a higher elective colectomy rate (p = 0.022), but not with a higher acute colectomy rate, and an elevated ESR is correlated with a higher overall colectomy rate (p = 0.014) and a higher acute colectomy rate (p = 0.032), but not with a higher elective colectomy rate. This correlation was significant on multivariate analysis. The overall rate of colectomy in the cohort of patients with severe Crohn’s colitis was greater than that of the cohort of patients with severe UC, but this figure is not supported by a different clinical response to steroid therapy or rescue therapy with biologics. The clinical course of severe Crohn’s colitis requires to be clarified by prospective studies that include a larger number of patients in this subgroup of disease.

Focal active colitis as a predictor of inflammatory bowel disease: results from a single-center experience.

The term focal active colitis (FAC) is conventionally used to describe the presence of isolated cryptitis, characterized by an inflammatory infiltrate consisting of intraepithelial neutrophils and/or neutrophils invading the lumen of the criptae, with no other microscopic alteration of the colonic mucosa and, in particular, without the presence of signs of chronic inflammation. To date, only four studies, including one conducted in a pediatric population, have been performed to evaluate the clinical significance of this disease. The aim of this retrospective study on prospectively-collected data is to evaluate the clinical implications of the focal active colitis, since there still remains a marked uncertainty regarding this topic and about how often such a diagnosis will presage a diagnosis of inflammatory bowel disease (IBD). Clinical, endoscopic, and pathological data were retrospectively reviewed from 30 patients with focal active colitis, who had no other diagnostic findings on colorectal biopsy and no history of chronic inflammatory bowel disease. The histological findings were correlated with clinical diagnoses. Thirty patients (11 males, 19 females; age 24-80 years, median 56 years) (0.5%) out of 5,600 undergoing colonoscopy between January 2012 and December 2016 presented a definitive diagnosis of FAC. Follow-up ranged from 6 to 60 months (median 24 months). At endoscopy, 19 patients (63%) had mild and non-specific changes, such as mild mucosal erythema, while 11 (37%) had normal findings. Eight patients were documented as having irritable bowel syndrome, while nine cases could be attributed to the effects of drugs, five presented FAC as incidental finding, one a diagnosis of infectious colitis, and seven a diagnosis of IBD (4 with Crohn’s disease). FAC was confirmed to be a more significant predictor of IBD than the previous literature would indicate, even if larger prospective studies, targeted to study this relationship, are needed to understand more clearly its clinical significance.

Liver trauma--operative management.

Civilian liver trauma is generally sustained by blunt injury, with management strategies increasingly focusing on selective non-operative strategies and endovascular intervention. Military liver trauma is more often ballistic in nature and almost always requiring operative intervention. This article reviews established and evolving surgical techniques in the operative management of liver trauma.

[Acute neoplastic colic obstructions: therapy and postoperative complications. Our experience]. / Le occlusioni acute neoplastiche del colon: terapia e risoluzione di complicanze postoperatorie. Nostra esperienza.

Authors report their experience about neoplastic large bowel obstructions and present two cases of anastomotic leakage resolution by means of transtomy wash-out. They observe that the most important problem in this surgery is anastomotic leakage which, if small, can be solved in a non operative way. According with literature, they also point out anastomotic leakage is commonly due to the impossibility of a correct preparation of colon to operation in emergency. They conclude it is possible, in case of little leakages, to perform trans-stomy wash out which permits a good toilette and sterilization of the colon.

[Our experience in inguinal hernia recurrences treatment]. / Il trattamento delle ernie inguinali recidive: nostra esperienza.

Reporting their personal experience, the authors focus on characteristics and causes of recurrence, either after traditional surgery or with tension-free technique. They describe difficulties and advantages in open interventions and laparoscopic ones. Facing a relapse it's convenient to assume an "eclectic" behaviour, thinking both of general and specific single patient anatomo-pathologic features.

[GIST of the jejuno-ileal tract]. / I GIST del tratto digiuno-ileale.

Jejunum-ileum stromal tumors give diagnostic and therapeutical problems, especially with regard to histopathological identification and biological behavior. These tumors are very rare in all case report. After gastric stromal tumors these ones are the most frequent of all alimentary tract. They are often incidentally found; because of their potential transformation, they have to be treated by respecting oncologic eradication standards and observing prognostic criteria based on a correct histopathological evaluation (neoplasm localization and dimension, its structure, presence of cytological atypisms, mitotic index, ploidia, surgical resection). Then there has to be a good follow-up program.

Microvascular assessment of burn depth conversion during varying resuscitation conditions.

Conversion of partial- to full-thickness injuries, even after the burning has stopped, remains a significant clinical problem. We developed a rat model with a wide range of burn depths to study this phenomenon by microvascular assessment. Fifty-four male Sprague-Dawley rats weighing 460 g on average were studied. Real-time tissue monitoring of pH, paCO2, and paO2 was achieved by placement of a continuous blood gas monitor transducer in the aorta. Ten, 2-cm x 2-cm burns were created on each animal with milled aluminum templates (100 degrees C) with varying contact times. Conversion of burn depth in these wounds was documented by serial laser Doppler imager scanning over a 5-hour period. Animals received Ringer's lactate resuscitation at 0, 2, 4, 6, and 8 ml/kg/%burn. Serial laser Doppler scanning directly demonstrated progressive loss of perfusion to partial-thickness burns dependent upon the amount of fluid resuscitation. Conversion of partial- to full-thickness burns in this rat model (documented by laser Doppler microvascular assessment) was dependent upon how the animals were resuscitated.

The 2003 Carl A Moyer Award: real-time metabolic monitors, ischemia-reperfusion, titration endpoints, and ultraprecise burn resuscitation.

Real-time metabolic monitoring of varied vascular beds provides the raw data necessary to conduct ultraprecise burn shock resuscitation based on second-by-second assessment of regional tissue perfusion. It also illustrates shortcomings of current clinical practices. Arterial base deficit was continuously monitored during 11 clinical resuscitations of patients suffering burn shock using a Paratrend monitor. Separately, in a 30% TBSA rat burn model (N = 70), three Paratrend monitors simultaneously recorded arterial blood gas and tissue pCO2 of the burn wound and colonic mucosa during resuscitation at 0, 2, 4, 6, and 8 ml/kg/%TBSA. Paratrend data were analyzed in conjunction with previously reported laser Doppler images of actual burn wound capillary perfusion. With current clinical therapy, continuous monitoring of arterial base deficit revealed repetitive cycles of resolution/worsening/resolution during burn shock resuscitation. In the rat model, tissue pCO2 in both burn wounds and splanchnic circulation differed depending on the rate of fluid resuscitation (P <.01 between sham and 0 ml/kg/%TBSA and between 2 ml/kg/%TBSA and 4 ml/kg/%TBSA). Burn wound pCO2 values correlated well with laser Doppler determination of actual capillary perfusion (rho = -.48, P <.01). The following conclusions were reached: 1). Gratuitous and repetitive ischemia-reperfusion-ischemia cycles plague current clinical therapy as demonstrated by numerous "false starts" in the resolution of arterial base deficit; 2). in a rat model, real-time monitoring of burn wound and splanchnic pCO2 demonstrate a dose-response relationship with rate of fluid administration; and 3). burn wound and splanchnic pCO2 are highly correlated with direct measurement of burn wound capillary perfusion by laser Doppler imager. Either technique can serve as a resuscitation endpoint for real-time feedback-controlled ultraprecise resuscitation.

[The usefulness of cytodiagnosis in nonpalpable breast lesions]. / Utilità della citodiagnostica nelle lesioni non palpabili della mammella.

The paper underlines the importance of early diagnosis in the treatment of breast tumours and emphasises the value of cytodiagnosis as a very sensitive and specific predictive method for detecting impalpable lesions. In conclusion, the Authors affirm that cytodiagnosis, together with the introduction of new diagnostic instruments such as the TRC Mammotest, allows the diagnostic and therapeutical approach to impalpable breast tumours to be improved. It adds to the already high sensitivity of mammography and to the high predictive specificity of cytology, thus contributing to the reduction of the so-called "bioptic cost".

[Tumor markers in colorectal cancer]. / I markers tumorali nel cancro del colon-retto.

Over the past ten years numerous studies have been carried out to identify tumour markers able to diagnose cancer of the digestive tract. The paper reports the combined use of some markers (CEA, TPA, GICA, CA 125) in patients with carcinoma of the colon-rectum. The Authors conclude that although these markers are of little use, especially in association, in the early diagnosis of disease, it is very important to utilise these markers to monitor patients following surgical, chemotherapeutic or radiotherapeutic treatment.

[ Tissue and blood CEA levels in stomach cancer]. / I dosaggi del CEA tissutale e sierico nel carcinoma dello stomaco.

The assays of serum CEA is a useful prognostic marker in patients with stomach cancer. In this study pre-operative serum CEA and tissue CEA in tumour or biopsy were assayed in a group of patients with gastric carcinoma in order to assess their prognostic roles. Based on an analysis of the results the authors affirm that high serum CEA levels in patients with advanced stages of stomach cancer indicate a fatal prognosis, and likewise the finding of tissue CEA in loco-regional lymph nodes at the same concentration as that in the primary tumour is also the sign of a severe prognosis.

[Minimal breast carcinoma (the authors' experience)]. / Il carcinoma minimo della mammella (nostra esperienza).

The authors relate their experience about twenty-one cases of impalpable lesions of the breast come to their observation during the years 84-88. After expanding therapeutical tactics carried out by them, the promoters infer asserting that a wide diffusion of screening programmes allowed a more verifications of the minute lesions of the breast, addressing the surgeon towards operations more and more conservatives.

[Miles operation in rectal carcinoma: history and current status]. / L'intervento di Miles nella chirurgia del carcinoma del retto: la sua storia, il suo presente.

The Authors confirm how the advent of mechanical suture has directed the management of rectal carcinoma to an increasingly conservative attitude. In reporting their experience--which consists of about twenty years (222 patients) they specify how not only an increased incidence of recurrence has not appeared, but they have also observed a reduction of theirs (-5.2%). They then attempt to outline basic moments which have characterized the history of rectal carcinoma surgery and they state how today, 80 years since it was conceived, Miles' intervention maintains its validity, even if with more restrictive indications.

[Evaluation of the use of calcitonin in rheumatoid arthritis by bone densitometry and the study of of phospho-calcium metabolism]. / Valutazione dell'impiego della calcitonina nell'artrite reumatoide mediante densitometria ossea e studio del metabolismo fosfo-calcico.

Forty-eight patients were subdivided into three groups according to the stage of their rheumatoid arthritis and to whether or not they received glucocorticoids; they were compared to healthy volunteers of similar sex, age, and body weight. Before calcitonin treatment, bone mineral content (BMC) of RA patients was significantly lowered, especially in patients with 3rd and 4th Steinbroker degree and in those taking glucocorticoids. Synthetic eel calcitonin was administered in three 60-day cycles separated by 40-day intervals with daily dosage 40 U.M.R.C. (1 vial). This treatment did not result in a increase of BMC compared to baseline. A further decrease of BMC observed at the end of treatment was not statistically significant. No appreciable variation was found in parameters of phospho-calcic metabolism.

[Our experience with early gastric cancer]. / L'early gastric cancer nella nostra esperienza.

Authors assert that, in Early gastric cancer diagnosis, anatomicomedical characteristics expressed on the basis of canons formulated by Endoscopy Japanese Society and by Lauren's unexipered classification are of particular interest. After having referred on characteristics observed on a group of patients, in the light of data given from medical Literature, they try to extrapolate aetiopathogenetic factors. These, together with anatomicopathological characteristics of the lesion, are the premises for a wise radical therapeutic choice.

[Anatomo-clinical considerations on early gastric cancer]. / Considerazioni anatomo-cliniche sull'early gastric cancer.

After having asserted the still rising interest for an as early as possible diagnosis of gastric cancer, authors refer on a group of patients who are carriers of Early gastric cancer. After having touched upon localization and histological characteristics of neoplasms, linger on the rules that leaded their therapeutic choice and they report the results of a follow-up dragged ten years long. They terminate affirming only a timeliness diagnosis can consent a really decisive therapeutic approach.

[A rare salivary gland neoplasm: cystadenolymphoma]. / Una rara neoformazione delle ghiandole salivari: il cistoadenolinfoma.

The authors, after having examined three recent cases, explain some basic concepts about diagnostics and therapy in cystadenolymphoma of salivary glands. As a matter of fact this neoplasia, in spite of its low frequency, is very important because of its still controversial etiopathology and recent tendency in increasing its incidence in females. Today the diagnostic protocol, undertaken after clinical examination, which is necessary, consists of ultrasonography or computerized tomography. But only postoperative histological examination gives a sure diagnosis and can point out main histomorphological characteristics of tumour. Therapeutic approach can be limited to conservative treatment, which is able to respect the parotid gland, its vascularization and innervation.

[Intrahepatic biliary lithiasis: experience in 20 years]. / La litiasi biliare intraepatica: esperienza di 20 anni.

In confirming that intrahepatic gallstones don't represent a frequent disease in western countries, Authors specify how this incidence is going to grow up slowly, but in a progressive way. In reporting their experience since 1980 to nowadays they point out how different diagnostic procedures and therapy way of acting were in the first and in the second deca. After having explained actual therapeutic direction that is described in literature, they finish by stating how this is often conditioned by complex anatomicopathological picture and by seriousness of hepatic damage that often comes with intrahepatic lithiasis.

[Reflections on mesenteric infarct]. / Riflessioni sull'infarto mesenterico.

The authors relate their statistic about mesenteric infarction in the last five years and they get out the starting point in order to check the characteristics of a disease, which is today distinguished by an infaust prognosis. After few mentions about etiopathology and pathologic anatomy they keep their attention on clinic manifestations of disease and on diagnostic research. After dealing with medical and surgical therapy they declare how more refined diagnostic technique could help early diagnosis and consequently decrease morbidity and morbidity, which are completely unacceptable.

[Spontaneous retroperitoneal hematoma from ileopsoas muscle bleeding. A case report]. / L'ematoma retroperitoneale spontaneo da sanguinamento del muscolo ileopsoas. Considerazioni su un caso clinico.

The Authors report a case of spontaneous retroperitoneal hematoma due to iliopsoas muscle bleeding. The different causes responsible of such hematomas are taken into account as well as clinical, therapeutical and pathophysiologic aspects connected with the spontaneous bleeding of the iliopsoas muscle. As in the case observed, the Authors suggest that often a careful wait-and-see approach represents the most appropriate therapeutical choice.