0000000000071126
AUTHOR
Geraci G.
Rectal Diclofenac administration for prevention of post-Endoscopic Retrograde Cholangio-Pancreatography (ERCP) acute pancreatitis. Randomized prospective study.
Introduction. Post-Endoscopic Retrograde Cholangio-Pancreatography pancreatitis (PEP) is a relevant (1-4%) complication of biliopancreatic operative endoscopy. Rectal nonsteroidal anti-inflammatory drugs (specifically, 100 mg of diclofenac) have shown promising prophylactic activity in PEP. The aim of our prospective study is to report whether prophylactic oral versus rectal suppository versus intramuscular diclofenac versus placebo are able to reduce the incidence and the severity of ERCP-induced pancreatitis.Materials and Methods. in this randomized, double-blinded, prospective study, 100 patients (49 male, 51 female), similar with regard to indication for ERCP, were enrolled between Janu…
PERCUTANEOUS US (ULTRA SOUND) GUIDED FINE NEEDLE ASPIRATION (FNA) OF ENDOTHORACIC NEOPLASM
Introduction: Ultrasound (US)-guided fine needle aspiration (FNA) of percutaneous, transparietal endothoracic lesions, is a useful method in the diagnostic process for anatomopathological characterization. This sampling is a minimally invasive procedure, with a low complication rate and can be performed under loco-regional anesthesia Material and methods: We retrospectively studied (2009 to 2019) the utility of US guided transthoracic FNA in the diagnosis of suspected endothoracic lesions on 54 patients (34 men and 20 women), aged between 44 and 79 years, with pleural, pulmonary or mediastinal neoplasm viewable with an US examination. Results: The definitive diagnosis of malignant or benign…
A rare clinical entity: stump appendicitis. Case report and complete review of literature.
BACKGROUND: Stump appendicitis is a rare delayed complication post-appendectomy and it represents a diagnostic problem as clinicians are often not very familiar with this pathology. MATERIALS AND METHODS: One case of stump appendicitis has been reported in a 54 year old woman, whose acute phase was conservatively treated in our Department. A review of Medline literature was also carried out, from 1945 to 2015, showing 111 cases of stump appendicitis. RESULTS: Stump appendicitis has been reported after either open or laparoscopic appendectomy, in a range between days to several years from the first procedure. Nowadays, it is not considered yet as a possible differential diagnosis in patients…
Retropharyngeal abscess from fishbone in adult immunocompetent host presenting as acute thyroiditis
Retropharyngeal abscesses (RPA) are rare in adults. We report a case of a healthy adult with RPA presenting with clinical symptoms of acute thyroiditis. A 37-yr-old female presented with a painful mass in the anterior region of the neck, sore throat, mild fever and dysphagy for liquids and solids. Neck emergency US dis-closed normal thyroid ventrally displaced by a huge retropharyngeal hypoechoic mass. Direct laryngoscopy revealed erythema of the posterior pharyngeal wall with bulges (8 cm) preventing the correct visualization of the glottic plane. CT confirmed the pres-ence of retropharyngeal abscess and laryngoscopic drainage was performed. The pa-tient was discharged on 11th post-operati…
Premedication with oral solution of simethicone plus N-acetylcysteine to improve the quality upper GI endoscopy: Initial experience
Introduction: To assess the efficacy and safety of simethicone with or without N-acetylcysteine (NAC) as premedications before gastroscopy. Materials and methods: Patients were randomized into 5 groups. Endoscopic visibility was evaluated in 4 districts (esophagus, gastric body, fundus and antrum) using a visual scale, graduating from 1 to 4 points. Results: There was no significant difference on the rate of positive findings when comparing simethicone with simethicone plus NAC and with water, respectively. Simethicone plus NAC showed better total mucosal visibility score than simethicone alone. Both simethicone plus NAC and simethicone alone offer more benefit than water. The procedure tim…
Spontaneous rupture of umbilical hernia in end stage liver disease patient: injection of fibrin glue as a temporary solution.
Background. Umbilical hernia is a common disease, which occurs in 20% of cirrhotic patients in the presence of persistent ascites. A rare but dangerous complication of this disease in end stage liver patient is a spontaneous rupture of umbilical hernia with ascitic fluid leaking. Up to date there is no general consensus on its most appropriate treatment. Case report. A 60 years-old male patient, with Child Pugh C and Meld score of 18 end stage liver disease, came to our observation for a spontaneous minimal rupture of his long lasting 5 cm umbilical hernia with ascitic fluid leaking. A medical therapy was undertaken aiming to manage the ascites and a temporary conservative therapy, with fib…
Rectal mucosa inflammation in non-celiac wheat sensitivity: comparison with duodenal histology.
Background and Aims: In recent years an increasing number of studies on Non-Celiac Gluten/Wheat Sensitivity (NCG/WS) have been published but no markers of this condition have as yet been found. Although the NCG/WS clinical presentation often overlaps with IBS, no previous study evacuate colon or rectal histology in NCG/WS patients. Patients and Methods: We performed a prospective study on 78 patients (66 females, 12 males, mean age 36. 4 years) diagnosed with NCG/WS by double-blind wheat challenge, presenting at two tertiary care centers in Italy from January 2015 through September 2016. Data were also collected from 55 control patients either with celiac disease (CD) or with self-reported …
Anxiety, depression, chronic inflammation and aortic stiffness in Crohn's disease: the brain--gut--vascular axis.
Background Patients with Crohn's disease have an increased aortic stiffness, a known cardiovascular risk factor. Anxiety, a key factor of the brain--gut axis in patients with Crohn's disease, is implicated in the pathogenesis and progression of the disease, and is linked with aortic stiffening in other clinical settings. Objectives Considering that depression is frequently linked to anxiety in Crohn's disease, we performed a mediation analysis to reveal the potential link between anxiety, depression and aortic stiffness in these patients. Methods Multicentre observational cross-sectional study of 86 consecutive patients with Crohn's disease and 86 matched control individuals. The connection…
The treatment of inguinal hernia in 'one day surgery'. Personal experience
Background. Personal experience in the treatment of inguinal hernia in 'One day Surgery' is reported. Methods. Design: Retrospective evaluation of cases treated in a twelve months period. The follow-up has been programmed at 1, 3, 6 and 12 months after the treatment. Setting: General, thoracic and oncological surgery, Department of Surgical and Anatomical Disciplines. Polyclinic, University of Palermo. Subjects: 54 patients aged between 17 and 86 years (middle age 51.9), 48 male have been treated; in 3 cases recurrent hernias were found. Interventions: In every case Trabucco's procedure with local anaesthesia has been performed. Premedication with Midazolam 10 mg i.v. has been associated. M…
ULTRASOUND (US) GUIDED DIAGNOSTIC PROCEDURES AND MALIGNANT PLEURAL EFFUSIONS
Introduction: Malignant pleural effusion (PE) is a rather frequent complication of several intrathoracic and extrathoracic tumors and has an incidence of about 660 patients per million inhabitants per year. Materials and methods: We retrospectively studied (2000 to 2018) the utility of US guided percutaneous puncture (PP) of PE, in the diagnosis/therapy of 121 patients (67 women and 54 men) with PE and suspected malignant neoplasm, mean age 52 years (39-78 years), Results: The diagnostic accuracy of the US guided PP fluid examination, (diagnoses of malignant PE), was 91.7% (111/121), with sensitivity of 89.5% (86/96) and specificity of 100%. (25/25). 10 patients did not have confirmation of…