Spontaneous regression of rectal polyps following abdominal colectomy and ileorectal anastomosis for familial adenomatous polyposis, without sulindac treatment: report of four cases.

The only curative treatment for familial adenomatous polyposis (FAP) is prophylactic surgery and the two most popular options are total colectomy with ileorectal anastomosis and restorative proctocolectomy with ileal pouch-anal anastomosis. Today, ileal pouch-anal anastomosis has gained wider acceptance as a safer procedure, but ileorectal anastomosis still remains an option, especially for young patients with a moderate phenotype of the disease and limited polyps in the rectum. Partial or complete regression of rectal polyps after total colectomy with ileorectal anastomosis and treatment with nonsteroidal anti-inflammatory drugs (NSAIDs) such as sulindac is reported in up to 80 % of patients. However, in some cases such regression can be spontaneous and long-lasting following total colectomy and ileorectal anastomosis, without further treatment with NSAIDs. We present the cases of four patients with FAP treated by colectomy and ileorectal anastomosis, who had immediate, complete spontaneous regression of multiple polyps in the rectal stump, with no further need for sulindac treatment.

[Blood endotoxin in acute pancreatitis using limulus amebocyte lysate test (LAL test)]. / Studio sull'endotossinemia nella pancreatite acuta con l'impiego del limulus amebocyte lysate test (LAL test).

Forty-five cases of acute pancreatitis observed during the period 1986-88 were included in this study. Four of the 45 patients were operated during the acute phase and of these, two died. The remaining 41 patients were treated with conservative therapy using the application of a nasogastric tube, analgesics, and the endovenous administration of various solutions and antibiotics. The severity of each attack of pancreatitis was assessed according to Ranson and Agarwal's criteria. In severe cases (more than 3 of Ranson's criteria) the presence of endotoxin in the systemic circulation was shown using the "limulus" method, together with contemporary low levels of C3 complement factor. As is evident from the results of the study, the presence of endotoxinemia and the low level of C3 in acute pancreatitis are related to the high percentage of complications.