Randomised clinical trial: mesalazine and/or probiotics in maintaining remission of symptomatic uncomplicated diverticular disease--a double-blind, randomised, placebo-controlled study.

BACKGROUND: Placebo-controlled studies in maintaining remission of symptomatic uncomplicated diverticular disease (SUDD) of the colon are lacking. AIM: To assess the effectiveness of mesalazine and/or probiotics in maintaining remission in SUDD. METHODS: A multicentre, double-blind, placebo-controlled study was conducted. Two hundred and ten patients were randomly enrolled in a double-blind fashion in four groups: Group M (active mesalazine 1.6 g/day plus Lactobacillus casei subsp. DG placebo), Group L (active Lactobacillus casei subsp. DG 24 billion/day plus mesalazine placebo), Group LM (active Lactobacillus casei subsp. DG 24 billion/day plus active mesalazine), Group P (Lactobacillus casei subsp. DG placebo plus mesalazine placebo). Patients received treatment for 10 days/month for 12 months. Recurrence of SUDD was defined as the reappearance of abdominal pain during follow-up, scored as ≥5 (0: best; 10: worst) for at least 24 consecutive hours. RESULTS: Recurrence of SUDD occurred in no (0%) patient in group LM, in 7 (13.7%) patients in group M, in 8 (14.5%) patients in group L and in 23 (46.0%) patients in group P (LM group vs. M group, P = 0.015; LM group vs. L group, P = 0.011; LM group vs. P group, P = 0.000; M group vs. P group, P = 0.000; L group vs. P group, P = 0.000). Acute diverticulitis occurred in six group P cases and in one group L case (P = 0.003). CONCLUSION: Both cyclic mesalazine and Lactobacillus casei subsp. DG treatments, particularly when given in combination, appear to be better than placebo for maintaining remission of symptomatic uncomplicated diverticular disease. (ClinicalTrials.gov: NCT01534754).

[Endoscopic treatment of biliary fistulas after laparoscopic cholecystectomy]. / Trattamento endoscopico dello spandimento biliare dopo colecistectomia laparoscopica.

BACKGROUND: To evaluate the role of the endoscopic treatment of biliary fistulas after laparoscopic cholecystectomy. METHODS: From January 1993 to December 1997, 16 patients with biliary fistulas after laparoscopic cholecystectomy have been treated. All patients underwent endoscopic retrograde cholangio-pancreatography (ERCP) and endoscopic sphincterotomy (ES) and 12 biliary endoprosthesis were inserted, left in seat for 4-6 weeks, and a nasal-biliary drain, removed after 4 days. RESULTS: The seat of the leak was cystic duct in 12 cases, common hepatic duct in 2 cases and an intrahepatic duct in 2 cases. Eleven patients showed common bile duct stones, treated by endoscopic extraction, and two patients showed a biliary ascites, previously drained percutaneously. In all the patients a fast regression of the clinical signs and of the biohumoral index were observed, and at the time of stent removal the leak was always absent. CONCLUSIONS: The results obtained confirm the primary role of ERCP in the management of biliary duct injuries, as a definitive diagnosis and an immediate treatment, often resolutive, is guaranteed.

[Chronic idiopathic intestinal pseudo-obstruction associated with volvulus of the transverse colon. The identical mode of clinical presentation and of the intestinal manometric pattern in monozygotic twins]. / Pseudo-ostruzione intestinale cronica idiopatica, associata a volvolo del colon trasverso. Identica modalità di presentazione clinica e del pattern manometrico intestinale in gemelle monozigoti.

Two monozygotic female twins with chronic idiopathic intestinal pseudo-obstruction associated with transverse colon volvulus are described. Quite similar clinical events and temporal coincidences characterized the symptoms which has preceded and followed right colectomy undergone by both of them due to intestinal volvulus. The esophageal, gastroduodenal, colonic and anorectal manometric investigation revealed very similar alterations in both girls. Increased amplitude of distal contractions of the esophagus, a depressed fasting antro-duodenal motility, with absence into antrum and oro-aboral non-propagation in the duodenum of the phase III activity of the interdigestive motor complex were the main findings along with a state of pronounced colonic hypomotility and an hypoesthesia of the rectal ampulla to the volumetric stimulus. This report indicates the association between chronic intestinal pseudo-obstruction and transverse colon volvulus in monozygotic female twins, and it points out the rarity both of the specific symptomatic coincidences and the similar clinical events and of the almost absolute identity of the intestinal motor patterns.

[An anaphylactic reaction to succinylcholine. A clinical case]. / Reazione anafilattica da succinilcolina. Caso clinico.

A case of severe anaphylactic reaction provoked by suxamethonium during the induction of general anaesthesia is reported. Diagnosis of reaction and the trigger effect of suxamethonium was identified by intradermal testing. Diagnosis of anaphylactic reaction was confirmed on serial blood estimations of IgE and C3-C4 of complement fractions.