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1.
Endoscopy ; 49(1): 83-91, 2017 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-27617420

RESUMO

This Executive summary of the Guideline on pediatric gastrointestinal endoscopy from the European Society of Gastrointestinal Endoscopy (ESGE) and the European Society for Paediatric Gastroenterology Hepatology and Nutrition (ESPGHAN) refers to infants, children, and adolescents aged 0 - 18 years. The areas covered include: indications for diagnostic and therapeutic esophagogastroduodenoscopy and ileocolonoscopy; endoscopy for foreign body ingestion; endoscopic management of corrosive ingestion and stricture/stenosis; upper and lower gastrointestinal bleeding; endoscopic retrograde cholangiopancreatography, and endoscopic ultrasonography. Percutaneous endoscopic gastrostomy and endoscopy specific to inflammatory bowel disease (IBD) have been dealt with in other Guidelines and are therefore not mentioned in this Guideline. Training and ongoing skill maintenance will be addressed in an imminent sister publication.


Assuntos
Doenças do Sistema Digestório/terapia , Endoscopia Gastrointestinal/métodos , Endoscopia Gastrointestinal/normas , Corpos Estranhos/terapia , Adolescente , Queimaduras Químicas/etiologia , Queimaduras Químicas/terapia , Cáusticos/toxicidade , Criança , Pré-Escolar , Colangiopancreatografia Retrógrada Endoscópica/normas , Endossonografia/normas , Trato Gastrointestinal/lesões , Humanos , Lactente , Recém-Nascido
2.
J Pediatr Gastroenterol Nutr ; 64(1): 133-153, 2017 01.
Artigo em Inglês | MEDLINE | ID: mdl-27622898

RESUMO

This guideline refers to infants, children, and adolescents ages 0 to 18 years. The areas covered include indications for diagnostic and therapeutic esophagogastroduodenoscopy and ileocolonoscopy; endoscopy for foreign body ingestion; corrosive ingestion and stricture/stenosis endoscopic management; upper and lower gastrointestinal bleeding; endoscopic retrograde cholangiopancreatography; and endoscopic ultrasonography. Percutaneous endoscopic gastrostomy and endoscopy specific to inflammatory bowel disease has been dealt with in other guidelines and are therefore not mentioned in this guideline. Training and ongoing skill maintenance are to be dealt with in an imminent sister publication to this.


Assuntos
Endoscopia Gastrointestinal/normas , Gastroenteropatias/terapia , Adolescente , Cáusticos , Criança , Pré-Escolar , Colangiopancreatografia Retrógrada Endoscópica , Colonoscopia , Endoscopia do Sistema Digestório , Endossonografia , Europa (Continente) , Feminino , Corpos Estranhos , Gastroenterologia , Gastroenteropatias/diagnóstico , Hemorragia Gastrointestinal , Humanos , Lactente , Recém-Nascido , Masculino , Pediatria , Sociedades
3.
J Clin Gastroenterol ; 47(4): e33-7, 2013 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-22914349

RESUMO

GOALS: To implement an online, prospective collection of clinical data and outcome of patients with acute nonvariceal upper gastrointestinal bleeding (UGIB) in Italy ("Prometeo" study). BACKGROUND: Epidemiology, clinical features, and outcomes of nonvariceal UGIB are mainly known by retrospective studies and are probably changing. STUDY: Data were collected by 13 Gastrointestinal Units in Italy from June 2006 to June 2007 (phase 1) and from December 2008 to December 2009 (phase 2): an interim analysis of data was performed between the 2 phases to optimize the online database. All the patients consecutively admitted for acute nonvariceal UGIB were enrolled. Demographic and clinical data were collected, a diagnostic endoscopy performed, with endoscopic hemostasis if indicated. RESULTS: One thousand four hundred thirteen patients (M=932, mean age±SD=66.5±15.8; F=481, mean age±SD=74.2±14.6) were enrolled. Comorbidities were present in 83%. 52.4% were treated with acetyl salicylic acid or other nonsteroidal anti-inflammatory drugs (NSAIDs): only 13.9% had an effective gastroprotection. Previous episodes of UGIB were present in 13.3%. Transfusion were needed in 43.9%. Shock was present in 9.3%. Endoscopic diagnosis was made in 93.2%: peptic lesions were the main cause of bleeding (duodenal ulcer 36.2%, gastric ulcer 29.6%, gastric/duodenal erosions 10.9%). At endoscopy, Helicobacter pylori was searched in 37.2%, and found positive in 51.3% of tested cases. Early rebleeding was observed in 5.4%: surgery was required in 14.3% of them. Bleeding-related death occurred in 4.0%: at multivariate analysis, the risk of death was correlated with female sex [odds ratio (OR=2.19, P=0.0089)], presence of neoplasia (OR=2.70, P=0.0057) or multiple comorbidities (OR=5.04, P=0.0280), shock at admission (OR=4.55, P=0.0001), and early rebleeding (OR=1.47, P=0.004). CONCLUSIONS: Prometeo database has provided an up-to-date picture of acute nonvariceal UGIB in Italy: patients are elderly, predominantly males, and with important comorbidities. Gastroprotection is underutilized during NSAIDs treatment. With respect to previous studies, Prometeo shows a higher incidence of low-dose acetyl salicylic acid use and comorbidities, whereas no significant difference were found in other items (etiology of bleeding, NSAIDs use, need for endoscopic hemostasis, incidence of rebleeding, and overall mortality).


Assuntos
Hemorragia Gastrointestinal/epidemiologia , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Anti-Inflamatórios não Esteroides/efeitos adversos , Transfusão de Sangue , Comorbidade , Endoscopia Gastrointestinal , Feminino , Hemorragia Gastrointestinal/diagnóstico , Hemorragia Gastrointestinal/mortalidade , Hemorragia Gastrointestinal/terapia , Infecções por Helicobacter/epidemiologia , Hemostase Endoscópica , Humanos , Incidência , Itália/epidemiologia , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Neoplasias/epidemiologia , Razão de Chances , Úlcera Péptica Hemorrágica/epidemiologia , Estudos Prospectivos , Recidiva , Medição de Risco , Fatores de Risco , Fatores Sexuais , Choque/epidemiologia , Úlcera Gástrica/epidemiologia , Fatores de Tempo , Resultado do Tratamento
4.
Cancers (Basel) ; 15(12)2023 Jun 14.
Artigo em Inglês | MEDLINE | ID: mdl-37370797

RESUMO

This study assessed the incidence, mortality, and survival of lung cancer subtypes of NSCSLC (non-small-cell lung cancer), SCLC (small-cell lung cancer), and other morphologies. It is an observational epidemiological study using 7197 cases from the Reggio Emilia Cancer Registry recorded between 2001 and 2020 in males and females. The incidence of NSCLC in 5104 males indicates a significant 3% annual increase until 2013 and then a decline of -3.2% that is not statistically significant; until 2014, mortality increased significantly (3.2%), but it then decreased non-significantly (-12.1%), especially squamous cell cancer. In 2093 females, the incidence and mortality trends continued to rise significantly through 2012, and then they began to slightly decline (not statistically significant). The two-year relative survival of NSCLC increased from 32% to 38% in males and from 42% to 56% in females. SCLC in males decreased significantly both in incidence and mortality, while in women, it showed a slight increase (significantly for incidence but not for mortality). This study is important because it analyzes the decrease in lung cancer in males and the increase in females in relation to the different histotypes. Our study's findings confirmed a decline in male incidence and death beginning in 2013. We were unable to determine if the drop in cigarette smoking and the introduction of new drugs such as EGFR in first-line therapy were responsible for the lower incidence.

5.
Gastrointest Endosc ; 75(2): 263-72, 272.e1, 2012 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-22000792

RESUMO

BACKGROUND: Nonulcer causes of bleeding are often regarded as minor, ie, associated with a lower risk of mortality. OBJECTIVE: To assess the risk of death from nonulcer causes of upper GI bleeding (UGIB). DESIGN: Secondary analysis of prospectively collected data from 3 national databases. SETTINGS: Community and teaching hospitals. PATIENTS: Consecutive patients admitted for acute nonvariceal UGIB. INTERVENTIONS: Early endoscopy, medical and endoscopic treatment as appropriate. MAIN OUTCOME MEASUREMENTS: Thirty-day mortality, recurrent bleeding, and need for surgery. RESULTS: A total of 3207 patients (65.8% male), mean (standard deviation) age 68.3 (16.4) years, were analyzed. Overall mortality was 4.45% (143 patients). According to the source of bleeding, mortality was 9.8% for neoplasia, 4.8% for Mallory-Weiss tears, 4.8% for vascular lesions, 4.4% for gastroduodenal erosions, 4.4% for duodenal ulcer, and 3.1% for gastric ulcer. Frequency of death was not different among benign endoscopic diagnoses (overall P = .567). Risk of death was significantly higher in patients with neoplasia compared with benign conditions (odds ratio 2.50; 95% CI, 1.32-4.46; P < .0001). Gastric or duodenal ulcer significantly increased the risk of death, but this was not related to the presence of high-risk stigmata (P = .368). The strongest predictor of mortality for all causes of nonvariceal UGIB was the overall physical status of the patient measured with the American Society of Anesthesiologists score (1-2 vs 3-4, P < .001). LIMITATIONS: No data on the American Society of Anesthesiologists class score in the Prometeo study. CONCLUSIONS: Nonulcer causes of nonvariceal UGIB have a risk of death, similar to bleeding peptic ulcers in the clinical context of a high-risk patient.


Assuntos
Úlcera Duodenal/mortalidade , Hemorragia Gastrointestinal/mortalidade , Neoplasias Gastrointestinais/mortalidade , Trato Gastrointestinal/irrigação sanguínea , Úlcera Péptica Hemorrágica/mortalidade , Úlcera Gástrica/mortalidade , Idoso , Idoso de 80 Anos ou mais , Artérias/patologia , Intervalos de Confiança , Úlcera Duodenal/complicações , Úlcera Duodenal/cirurgia , Endoscopia do Sistema Digestório , Esofagite/complicações , Esofagite/mortalidade , Feminino , Hemorragia Gastrointestinal/etiologia , Hemorragia Gastrointestinal/cirurgia , Neoplasias Gastrointestinais/complicações , Neoplasias Gastrointestinais/cirurgia , Nível de Saúde , Humanos , Itália/epidemiologia , Masculino , Síndrome de Mallory-Weiss/complicações , Síndrome de Mallory-Weiss/mortalidade , Síndrome de Mallory-Weiss/cirurgia , Pessoa de Meia-Idade , Razão de Chances , Úlcera Péptica Hemorrágica/cirurgia , Recidiva , Fatores de Risco , Úlcera Gástrica/complicações , Úlcera Gástrica/cirurgia
6.
Cancers (Basel) ; 15(1)2022 Dec 31.
Artigo em Inglês | MEDLINE | ID: mdl-36612295

RESUMO

Ovarian cancer represents one of the most aggressive female cancers in the world, remaining a tumor with high lethality. This study aims to present how a multidisciplinary team (MDT) approach can improve the prognosis in terms of recurrence and death of patients. In total, 448 ovarian cancer cases registered in an Italian Cancer Registry between 2012 and 2020 were included. Information on age, morphology, stage, and treatment was collected. Recurrence and death rates were reported 1 and 2 years after diagnosis, comparing MDT vs. non-MDT approaches. Ninety-three percent had microscopic confirmation, and most showed cystic-mucinous morphology. In total, 50% were older than 65 years old. The distribution by stage was 17.6%, 4%, 44.9%, and 32.6% for stages I, II, III, and IV, respectively. The women followed by the MDT were 24.1%. Disease-free survival 1-year post-diagnosis, recurrences, recurrences-deaths, and deaths were 67.5%, 14.5%, 8.4%, and 9.6%, respectively, better than the non-MDT group (46.2%, 13.2%, 20.8 %, and 19.8%, respectively) (p < 0.01). The same positive results were confirmed two years after diagnosis, particularly for stages III and IV. Albeit small numbers, the study confirms a better prognosis for women managed by MDT with fewer recurrences and deaths, especially within the first 24 months of diagnosis.

7.
Dig Dis Sci ; 56(7): 2166-78, 2011 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-21290179

RESUMO

BACKGROUND: Hereditary hemorrhagic telangiectasia is a genetic disease characterized by teleangiectasias involving virtually every organ. There are limited data in the literature regarding the natural history of liver vascular malformations in hemorrhagic telangiectasia and their associated morbidity and mortality. AIM: This prospective cohort study sought to assess the outcome of liver involvement in hereditary hemorrhagic telangiectasia patients. METHODS: We analyzed 16 years of surveillance data from a tertiary hereditary hemorrhagic telangiectasia referral center in Italy. We considered for inclusion in this study 502 consecutive Italian patients at risk of hereditary hemorrhagic telangiectasia who presented at the hereditary hemorrhagic telangiectasia referral center and underwent a multidisciplinary screening protocol for the diagnosis of hereditary hemorrhagic telangiectasia. Of the 502 individuals assessed in the center, 154 had hepatic vascular malformations and were the subject of the study; 198 patients with hereditary hemorrhagic telangiectasia and without hepatic vascular malformations were the controls. Additionally, we report the response to treatment of patients with complicated hepatic vascular malformations. RESULTS: The 154 patients were included and followed for a median period of 44 months (range 12-181); of these, eight (5.2%) died from VM-related complications and 39 (25.3%) experienced complications. The average incidence rates of death and complications were 1.1 and 3.6 per 100 person-years, respectively. The median overall survival and event-free survival after diagnosis were 175 and 90 months, respectively. The rate of complete response to therapy was 63%. CONCLUSIONS: This study shows that substantial morbidity and mortality are associated with liver vascular malformations in hereditary hemorrhagic telangiectasia patients.


Assuntos
Malformações Arteriovenosas/mortalidade , Artéria Hepática/anormalidades , Veias Hepáticas/anormalidades , Fígado/irrigação sanguínea , Telangiectasia Hemorrágica Hereditária/mortalidade , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Malformações Arteriovenosas/complicações , Malformações Arteriovenosas/diagnóstico , Malformações Arteriovenosas/terapia , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Telangiectasia Hemorrágica Hereditária/complicações , Telangiectasia Hemorrágica Hereditária/diagnóstico , Telangiectasia Hemorrágica Hereditária/terapia , Resultado do Tratamento , Adulto Jovem
8.
Am J Gastroenterol ; 105(6): 1327-37, 2010 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-20029414

RESUMO

OBJECTIVES: Selecting patients appropriately for upper endoscopy (EGD) is crucial for efficient use of endoscopy. The objective of this study was to compare different clinical strategies and statistical methods to select patients for EGD, namely appropriateness guidelines, age and/or alarm features, and multivariate and artificial neural network (ANN) models. METHODS: A nationwide, multicenter, prospective study was undertaken in which consecutive patients referred for EGD during a 1-month period were enrolled. Before EGD, the endoscopist assessed referral appropriateness according to the American Society for Gastrointestinal Endoscopy (ASGE) guidelines, also collecting clinical and demographic variables. Outcomes of the study were detection of relevant findings and new diagnosis of malignancy at EGD. The accuracy of the following clinical strategies and predictive rules was compared: (i) ASGE appropriateness guidelines (indicated vs. not indicated), (ii) simplified rule (>or=45 years or alarm features vs. <45 years without alarm features), (iii) logistic regression model, and (iv) ANN models. RESULTS: A total of 8,252 patients were enrolled in 57 centers. Overall, 3,803 (46%) relevant findings and 132 (1.6%) new malignancies were detected. Sensitivity, specificity, and area under the receiver-operating characteristic curve (AUC) of the simplified rule were similar to that of the ASGE guidelines for both relevant findings (82%/26%/0.55 vs. 88%/27%/0.52) and cancer (97%/22%/0.58 vs. 98%/20%/0.58). Both logistic regression and ANN models seemed to be substantially more accurate in predicting new cases of malignancy, with an AUC of 0.82 and 0.87, respectively. CONCLUSIONS: A simple predictive rule based on age and alarm features is similarly effective to the more complex ASGE guidelines in selecting patients for EGD. Regression and ANN models may be useful in identifying a relatively small subgroup of patients at higher risk of cancer.


Assuntos
Doenças do Sistema Digestório/diagnóstico , Endoscopia do Sistema Digestório , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Humanos , Itália , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Redes Neurais de Computação , Seleção de Pacientes , Guias de Prática Clínica como Assunto , Estudos Prospectivos , Curva ROC , Adulto Jovem
9.
JOP ; 11(1): 78-84, 2010 Jan 08.
Artigo em Inglês | MEDLINE | ID: mdl-20065561

RESUMO

Autoimmune pancreatitis is a form of chronic pancreatitis caused by an autoimmune process. The classical appearance of autoimmune pancreatitis in abdominal imaging is diffuse pancreatic enlargement, but the focal form appears as a mass and often involves the pancreatic head; this scenario represents a challenging diagnostic problem because these features also resemble pancreatic cancer. We present the endoscopic ultrasound findings of seven patients with autoimmune pancreatitis in order to highlight the ambiguous features and the features pivotal for the diagnosis.


Assuntos
Doenças Autoimunes/diagnóstico por imagem , Endossonografia/métodos , Pancreatite/diagnóstico por imagem , Adulto , Doenças Autoimunes/complicações , Conscientização , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pancreatite/complicações , Adulto Jovem
10.
J Gastroenterol Hepatol ; 24(9): 1510-5, 2009 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-19743996

RESUMO

AIMS: To measure patients' satisfaction after endoscopic retrograde cholangiopancreatography (ERCP) for biliary stones in a large number of unselected endoscopy units. METHODS: A prospective study using a questionnaire (Group Health Association of America-9 [GHAA-9], modified) was administered 24 h and 30 days after the procedure. Patients undergoing endoscopy for biliary stones for the first time were enrolled in a large number of endoscopy units, regardless of their size and workload. RESULTS: In all, 700 patients were enrolled in 15 units. A high proportion of patients expressed satisfaction (80%). Satisfaction was less extensive for pain control and the quality of information provided before the procedure. There were no differences in the replies to questionnaires at 24 h and 30 days. CONCLUSION: It is feasible to record patients' satisfaction and in this series most patients were very satisfied. Criticisms concerned pain control and explanations provided before the procedure.


Assuntos
Colangiopancreatografia Retrógrada Endoscópica , Colelitíase/cirurgia , Satisfação do Paciente , Idoso , Idoso de 80 Anos ou mais , Analgésicos/uso terapêutico , Atitude do Pessoal de Saúde , Colangiopancreatografia Retrógrada Endoscópica/efeitos adversos , Colelitíase/diagnóstico por imagem , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Itália , Masculino , Pessoa de Meia-Idade , Dor Pós-Operatória/etiologia , Dor Pós-Operatória/prevenção & controle , Educação de Pacientes como Assunto , Estudos Prospectivos , Inquéritos e Questionários , Fatores de Tempo , Resultado do Tratamento
11.
J Sci Med Sport ; 22(2): 206-211, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30017464

RESUMO

OBJECTIVES: To compare the effects of local-vibration and active warm-up on knee extensors muscle stiffness and neuromuscular performance. DESIGN: Experimental crossover study. METHODS: Thirteen participants performed three 15-min warm-up protocols of control (CON), active (ACT) and local-vibration (LV) in separate testing session. Passive stiffness of vastus lateralis (VL) and vastus medialis (VM) by shear wave elastography and neuromuscular performance were assessed before and 2-min after each condition. RESULTS: A decrease in muscle stiffness was reported after ACT for VL (-16.0±6.6%; p<0.001) and VM (-10.2±8.7%; p=0.03) while no changes were reported after CON (p=0.46 and p=0.34 for VL and VM, respectively) and LV (p=0.07 and p=0.46 for VL and VM, respectively). Maximal jump performances increased during squat (+8.5±6.6%; p<0.001) and countermovement jump (+5.2±5.8%; p<0.001) after ACT while no changes were reported after CON and LV during squat (p=0.16 and p=0.81, respectively) and countermovement jump (p=0.18 and p=0.31, respectively). We further report that each condition was ineffective to inducing changes in maximal voluntary isometric contraction force (p=0.18), rate of force development (p=0.92), twitch parameters (p>0.05) as well as central modulations as reported by the unchanged voluntary activation level (p=0.24) and maximal electromyography (EMG) recorded from the VL (p=0.44). CONCLUSIONS: The active warm-up acutely reduced muscle stiffness and increased muscle performance during maximal dynamic tasks. With regard to LV, further studies are required to determine optimal parameters (frequency, amplitude, duration) to significantly increase muscle performance.


Assuntos
Desempenho Atlético/fisiologia , Músculo Quadríceps/fisiologia , Vibração , Exercício de Aquecimento , Adulto , Estudos Cross-Over , Elasticidade , Eletromiografia , Humanos , Contração Isométrica , Masculino , Adulto Jovem
12.
Ultrasound Med Biol ; 34(5): 718-25, 2008 May.
Artigo em Inglês | MEDLINE | ID: mdl-18207308

RESUMO

The purpose was to evaluate interobserver agreement on Doppler ultrasonographic (US) diagnosis of liver vascular malformations (VMs) in hereditary hemorrhagic teleangiectasia (HHT) and on their severity grading. During the interobserver agreement study, three observers with at least seven years of specific experience using Doppler US for the diagnosis of liver VMs, judged about the presence/absence of liver VMs and their severity on a set of images and videoclips. Interobserver agreement was estimated with kappa statistics. One-hundred ten cases were reviewed during interobserver study (80 cases with liver VMs, 30 without). Very good kappa values of the interobserver agreement were found for all pairs concerning the distinction between presence and absence of hepatic VMs. All observers demonstrated excellent sensitivity and specificity in identifying hepatic VMs, with their respective areas under the curve ranging from 0.97 to 0.99. Interobserver agreement among the three investigators in staging the hepatic VMs in HHT patients was moderate (Kendall's coefficient of concordance = 0.26). Study results indicate that Doppler US diagnosis of liver VMs in HHT has a high degree of agreement among ultrasonographers; a moderate agreement was found regarding severity staging.


Assuntos
Fígado/diagnóstico por imagem , Telangiectasia Hemorrágica Hereditária/diagnóstico por imagem , Ultrassonografia Doppler , Artéria Hepática/diagnóstico por imagem , Veias Hepáticas/diagnóstico por imagem , Humanos , Variações Dependentes do Observador , Curva ROC , Sensibilidade e Especificidade , Ultrassonografia Doppler em Cores , Gravação em Vídeo
13.
Ultrasound Med Biol ; 30(9): 1089-97, 2004 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-15550313

RESUMO

A vascular pathogenesis of hepatic focal nodular hyperplasia (FNH) has been suggested; this study was aimed to evaluate in families with hereditary hemorrhagic telangiectasia (HHT) the prevalence of FNH, relating it to presence and stage of hepatic vascular malformations (VMs). Fifty-two HHT families underwent a screening program including abdominal Doppler sonography (US) searching for hepatic VMs; we classified them as minimal, moderate and severe, depending on the number and degree of abnormalities found by Doppler US. Presence of focal liver lesions was recorded. Diagnosis of FNH was made if at least two examinations, whether color Doppler US, liver scintigraphy, dynamic computed tomography (CT) or magnetic resonance (MR), showed suggestive findings. FNH was found in five out of 274 subjects (1.8%). All five were affected by HHT. Thus, percentage related to the group of affected patients increased to 2.9; 4/5 presented severe liver VMs. Female-to-male ratio was 4:1. FNH was single in three cases; tumor size ranged between 20 and 90 mm. During follow-up, no lesion showed a reduction in size, three showed an increase. Prevalence of FNH in patients with HHT is far greater than that reported in the general population; Doppler US role in its diagnosis and follow-up is highlighted.


Assuntos
Hiperplasia Nodular Focal do Fígado/diagnóstico por imagem , Telangiectasia Hemorrágica Hereditária/diagnóstico por imagem , Adolescente , Adulto , Malformações Arteriovenosas/diagnóstico por imagem , Malformações Arteriovenosas/epidemiologia , Saúde da Família , Feminino , Hiperplasia Nodular Focal do Fígado/epidemiologia , Hemangioma/complicações , Hemangioma/diagnóstico por imagem , Artéria Hepática/anormalidades , Humanos , Fígado/diagnóstico por imagem , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/epidemiologia , Masculino , Pessoa de Meia-Idade , Distribuição por Sexo , Telangiectasia Hemorrágica Hereditária/epidemiologia , Ultrassonografia Doppler
16.
Dig Liver Dis ; 45(3): 207-10, 2013 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-23107488

RESUMO

BACKGROUND AND AIMS: Advances in colonoscopy, such as the Pentax i-Scan electronic technique, have the potential to improve the early detection of colorectal cancer. The aim of this multicentre study was to assess the interobserver agreement in the visualization of the surface and margins of colorectal polyps and in distinguishing neoplastic from non-neoplastic polyps. PATIENTS AND METHODS: Eight expert endoscopists examined 400 mixed previously recorded images of polyps taken with different Pentax i-Scan settings in order to give an evaluation of the surface of the polyp and regular colonic mucosa, the pit-pattern and the nature of the lesion. RESULTS: A total of 400 mixed images of polyps with a diameter >5mm and <10mm were stored for analysis. Overall, there was a Kf agreement of 0.370 (p<0.001) and 0.306 (p<0.001) regarding pit-pattern and margins, respectively. The Kf agreement for the difference between neoplastic and non-neoplastic lesions was of 0.446 (p<0.001). CONCLUSIONS: We observed good interobserver agreement in the evaluation of neoplastic and non-neoplastic lesions and poor agreement in the evaluation of pit-pattern and margins. Adequate training is required in order to interpret images acquired with the i-Scan technique.


Assuntos
Pólipos do Colo/patologia , Colonoscopia/estatística & dados numéricos , Neoplasias Colorretais/patologia , Mucosa Intestinal/patologia , Idoso , Colonoscopia/métodos , Feminino , Humanos , Aumento da Imagem , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador
17.
Intern Emerg Med ; 8(2): 141-6, 2013 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-21538157

RESUMO

Elderly patients are at increased risk for peptic ulcer and cancer. Predictive factors of relevant endoscopic findings at upper endoscopy in the elderly are unknown. This was a post hoc analysis of a nationwide, endoscopic study. A total of 3,147 elderly patients were selected. Demographic, clinical, and endoscopic data were systematically collected. Relevant findings and new diagnoses of peptic ulcer and malignancy were computed. Both univariate and multivariate analyses were performed. A total of 1,559 (49.5%), 213 (6.8%), 93 (3%) relevant findings, peptic ulcers, and malignancies were detected. Peptic ulcers and malignancies were more frequent in >85-year-old patients (OR 3.1, 95% CI = 2.0-4.7, p = 0.001). The presence of dysphagia (OR = 5.15), weight loss (OR = 4.77), persistent vomiting (OR = 3.68), anaemia (OR = 1.83), and male gender (OR = 1.9) were significantly associated with a malignancy, whilst overt bleeding (OR = 6.66), NSAIDs use (OR = 2.23), and epigastric pain (OR = 1.90) were associated with the presence of peptic ulcer. Peptic ulcer or malignancies were detected in 10% of elderly patients, supporting the use of endoscopy in this age group. Very elderly patients appear to be at higher risk of such lesions.


Assuntos
Endoscopia Gastrointestinal , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Neoplasias Gastrointestinais/diagnóstico , Neoplasias Gastrointestinais/epidemiologia , Humanos , Itália/epidemiologia , Masculino , Úlcera Péptica/diagnóstico , Úlcera Péptica/epidemiologia , Estudos Prospectivos
18.
Am J Gastroenterol ; 101(11): 2655-8, 2006 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-16952288

RESUMO

BACKGROUND: Von Hippel-Lindau (VHL) disease is an autosomal dominant multicancer syndrome caused by the germline mutation of a tumor suppressor gene. Affected individuals develop benign and malignant tumors of the central nervous system, kidneys, adrenal glands, pancreas, and reproductive system. Although VHL disease is mainly diagnosed after the detection of central nervous system tumors, they may not always be the first presentation. CASE REPORT: We report the case of a patient presenting with pancreatic cysts for whom the final genetic diagnosis of VHL disease was formulated. During management, the use of endoscopic ultrasonography (EUS) proved to be valid in the characterization of the pancreatic lesions. Family screening also revealed the genetic mutation in the patient's son and imaging investigations showed the presence of multiple tumors. The diagnosis allowed us to plan appropriate follow-up for both, thus improving their life expectancy. CONCLUSIONS: Gastroenterologists should be aware of the frequent pancreatic involvement in VHL disease and EUS can be useful in this setting.


Assuntos
Cisto Pancreático/complicações , Doença de von Hippel-Lindau/complicações , Adulto , Endossonografia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cisto Pancreático/diagnóstico por imagem , Doença de von Hippel-Lindau/genética
20.
Eur Radiol ; 15(5): 884-94, 2005 May.
Artigo em Inglês | MEDLINE | ID: mdl-15754165

RESUMO

Radiofrequency ablation (RFA) of liver tumors was first proposed in 1990. New technologies enable us to produce liver thermal lesions of approximately 3-3.5 cm in diameter; RFA has consequently become an emerging percutaneous therapeutic option both for small hepatocellular carcinoma (HCC) and for non-resectable liver metastases, mainly from colorectal cancer. New devices (for example, triplet of cooled needles, wet needles) and combined therapies (tumor ischemia and RFA) have made it possible to treat large tumors. RFA can be carried out by a percutaneous, laparoscopic or laparotomic approach. Percutaneous RFA can be performed with local anaesthesia and mild sedation; deep sedation or general anaesthesia are also used. The guidance system is generally represented by ultrasound. CT or MR examinations are the more sensitive tests for assessing therapeutic results. The series of patients treated with RFA allow the technique to be considered as effective and safe, achieving a relatively high rate of cure in properly selected cases; it should be classified as curative/effective treatment for HCC, replacing percutaneous ethanol injection. The complication rate of RFA is low but not negligible; key elements in a strategy to minimize them are identified.


Assuntos
Carcinoma Hepatocelular/cirurgia , Ablação por Cateter/métodos , Neoplasias Hepáticas/cirurgia , Ablação por Cateter/instrumentação , Desenho de Equipamento , Humanos , Seleção de Pacientes
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