ABSTRACT
The clinical importance of Barrett's esophagus is related to its correlation to adenocarcinoma. The diagnosis is based on histologic demonstration of specialized intestinal metaplasia in the distal esophagus. The aim of this study was to assess the prevalence of intestinal metaplasia of the distal esophagus in a population submitted to gastroscopy not selected for reflux disease, and with columnar lined distal esophagus between 0.5 and 2 cm. Four biopsies in the distal esophagus were done in 224 patients undergoing routine gastroscopy. Patients were not selected for gastroesophageal reflux. Other clinical parameters were recorded to assess any possible association. In four Centers 224 patients received endoscopy with biopsies demonstrating specialized intestinal metaplasia in 21% of cases. No association was present among the patients with esophagitis or hiatal hernia, as well as with reflux symptoms. A significant association was present in over 70 (females), as well as with the presence of antral intestinal metaplasia demonstrated in 45 patients by gastric biopsies. No other significant associations were present. Biopsy samplings can diagnose the presence of intestinal metaplasia during endoscopy in patients endoscopically suspected for Barrett's esophagus: at present there is not clear evidence to promote this screening to achieve mortality reduction of esophageal adenocarcinoma.
Subject(s)
Barrett Esophagus/diagnosis , Endoscopy, Gastrointestinal , Esophagus/pathology , Intestinal Mucosa/pathology , Aged , Aged, 80 and over , Female , Humans , Male , Metaplasia/epidemiology , Middle Aged , PrevalenceABSTRACT
BACKGROUND: The surgical approach in chronic anal fissures (CAF) may, occasionally result in anal incontinence. The aim of this investigation was to study feasibility, effectiveness, and safety of hydropneumatic anal dilation (HAD) in conservative treatment of CAF and to compare it with local nitroglycerin (GTN) treatment. METHODS: Efficacy of HAD was evaluated in 109 patients (65 male, 44 female; mean age, 53.3 years), following anal dilation using Microvasive Rigiflex instrument (Otw 40 mm). Thereafter, 36 patients were randomly divided into two groups to undergo treatment with 0.25% GTN or HAD. RESULTS: Recovery rate with HAD was 79.8% after 10 days and 94.5% after 30 days. An immediate (within 24 hours) drop was observed in the level of pain; no significant complications or recurrence were reported within 2 years. Healing rate was 94.5% following HAD vs. 38.9% after GTN. CONCLUSION: HAD should be considered a new safe option in CAF treatment.
Subject(s)
Catheterization/methods , Fissure in Ano/therapy , Nitroglycerin/administration & dosage , Vasodilator Agents/administration & dosage , Administration, Topical , Chronic Disease , Feasibility Studies , Female , Humans , Male , Middle Aged , Treatment OutcomeABSTRACT
Free flaps are used to reconstruct defects that cannot be repaired by traditional methods using local adjacent tissue. Advantages include a single operation, decreased immobility, increased vascular supply to tissues for healing, minimal risk of flap loss, and primary closure of the donor site. Disadvantages are a long operation, two surgical sites, need for surgery if vascular compromise occurs, donor site morbidity, and expense. Preoperative care focuses on readiness for surgery and avoidance of medications (nicotine, caffeine) and situations (cold exposure) that cause vasospasm. Intraoperative nursing care includes positioning, range of motion, and pneumatic compression devices for the long case. The operating microscope requires special care and instruments. After surgery, blood flow to the flap is closely monitored. Laser flow Doppler can be used with data recorded on a flow sheet. Common postoperative problems include temperature instability, pain, blood pressure fluctuations, and oliguria. Dismissal teaching includes avoidance of vasoconstrictive medications and dressing changes.
