Endoscopic polypectomy: techniques, complications and follow-up.

Colorectal cancer is one of the most common cancers in developed countries. Increasing numbers of early stage colorectal cancers and precancerous adenomatous lesions, polypoidal type lesions, and flat and depressed type lesions can be visualised and treated endoscopically thanks to endoscopic ultrasonography, high magnification chromoendoscopy and other technical advances. Polypectomy is generally considered for protuberant lesions, with both sessile and pedunculate morphology, and endoscopic mucosal resection (EMR) is indicated for superficial, flat or depressed types of lesions. Endoscopic therapy for colonic adenoma with dysplasia and early colorectal cancer is more advantageous than the conventional operative treatment, in that it is a relatively non-invasive and less costly method. However, endoscopic therapy is completely ineffective in lesions with lymph node or distant metastasis. Therefore, it is becoming more and more important to understand the correct indications and limitations of endoscopic polypectomy/mucosectomy as well as complication rates and the correct follow-up schedule.

Intraluminal high dose rate brachytherapy combined with external radiotherapy in the treatment of oesophageal cancer.

Twenty eight patients with previously untreated oesophageal carcinoma without distant metastases were divided into two groups: Group A consisted of 18 pts. treated with conventional external radiotherapy only. Another group of 10 pts. (Group B) received treatment with external beam irradiation with further high dose rate intraluminal brachytherapy up to a dose of 4-12 Gy delivered in 2-3 sessions of 4 Gy (one session a week). All pts. were evaluated clinically, radiologically and endoscopically every 3 months. At the end of treatment there was a marked difference in relief of dysphagia (39% in Group A vs. 90% in Group B), local control (56.7% in Group A vs. 100% in Group B) and time to progression of dysphagia (20.8 weeks in Group A vs. 67.7 weeks in Group B). No marked difference was observed in overall survival. The complication rate was low in both groups and major complications were observed in pts. treated with external radiotherapy alone (two fistulas). The association of external beam and intraluminal radiotherapy can give a better local control of the disease, improving the quality of life.

[Adenocarcinoma of the distal esophagus treated with external and intracavitary radiotherapy. Description of a clinical case and review of the literature]. / Adenocarcinoma dell'esofago distale trattato con radioterapia esterna ed endocavitaria. Descrizione di un caso clinico e revisione della letteratura.

The prognosis of esophageal adenocarcinoma is extremely poor. Despite recent improvements in diagnostic and therapeutic techniques, the 5-years survival rate remains below 10%. Management is primarily surgical or radiotherapeutical, although pre- or postoperative radiation or chemotherapy are often employed. Chemotherapy alone, however, has not demonstrated great therapeutic efficacy in the management of this neoplasm. As most patients with cancer of the lower esophagus have an advanced stage of the disease and a very poor prognosis, the main aim of treatment should be to improve the quality of life. Intracavitary radiation (high dose rate) is a well recognised method of treatment alone or in combination with external radiotherapy. Its simplicity, the convenience of short treatment time and radiation safety provided by the remote after loading system make this the ideal palliative treatment in esophageal cancer. Endoscopic techniques, like dilation and endoprosthesis placement, laser therapy or BI-CAP probe, provide good palliation for dysphagia, with a low morbidity rate. The paper describes a case of lower esophageal adenocarcinoma treated with combined external and intracavitary radiation and endoscopic palliative techniques. Good control of the disease was achieved and the patient is alive 26 months after treatment with a good quality of life.

A single-blind pilot study comparing standard and half bedtime doses of ranitidine in the short-term healing of duodenal ulcer.

In this two-center, pilot trial we assessed the efficacy of single bedtime does of 150 mg ranitidine (half dose) and 300 mg ranitidine (full dose) in promoting duodenal ulcer healing by comparing the proportions of healed ulcers after 4 and 8 weeks of treatment. One hundred thirty-nine patients (106 men) were randomly allocated according to a prearranged treatment schedule to either dose and were treated single-blind (endoscopist). One hundred twenty-six patients (63 given 150 mg ranitidine and 63 given 300 mg) completed the trial. In the per-protocol analysis, 55 patients given full doses (81%) and 47 given half doses (70%) of ranitidine had healed ulcers at 4 weeks. Sixty full-dose and 55 half-dose patients (95% and 87%, respectively), had healed ulcers at 8 weeks. The difference was not significant using the chi 2 test (two-tailed), but the 95% confidence limits were in favor of the 300-mg dose. This study had a 75% power to detect a 25% difference in healing rates between the two groups.

[Esophageal ulcer caused by Geotrichum candidum in a case of AIDS]. / Ulcera esofagea da Geotrichum candidum in un caso di AIDS.

Isolate esophageal ulcer caused by Geotrichum candidum in a case of AIDS. We report the case of a 29-year-old white man, AIDS affected, presented with odynophagia, dysphagia and chest pain. X-ray and endoscopic study revealed an isolated esophageal ulcer whose culture demonstrated to be caused by Geotrichum candidum. This etiologic agent was not previously described in this kind of lesion.