[Lipoma of the colon. Apropos of a case report]. / Il lipoma del colon. A proposito di un'osservazione.

Lipoma of the large intestine is a rare, benign tumor. The clinical findings and the diagnostic studies are analysed and a case of giant submucosal colonic lipoma removed by colonoscopy is reported. Colonoscopic removal of submucosal lipomas is recommended, while the necessity of a surgical treatment in presence of intussusception or subserosal lipomas is confirmed.

[Endoscopic insertion of a prosthesis in the palliative treatment of tumors of the head of the pancreas]. / L'apposizione di protesi per via endoscopica nel trattamento palliativo dei tumori della testa del pancreas.

The Authors report their experience of biliary endoscopic endoprosthesis placement in 42 patients for palliative treatment of carcinoma of the pancreatic head. The morbidity, the mortality and the duration of hospitalization are considerably less than with surgical biliodigestive anastomosis. The mean survival is almost the same in both cases.

[Intestinal polyposis in children. Description and differential diagnosis of 2 cases]. / Poliposi intestinale in età pediatrica. Descrizione e diagnosi differenziale di due casi.

The case of a 21-month-old girl with lymphoid nodular hyperplasia and the case of a 9-year-old girl with familial adenomatous polyposis are described. Both patients presented rectal bleeding. A defect of secretory IgA was found in the first patient. In both cases diagnosis was based on medical history, barium enema with aircontrast technique, colonscopy, and endoscopic biopsy. Differential diagnosis and diagnostic procedures in these two diseases are discussed.

Endoscopic manometry of the sphincter of Oddi in patients with and without juxtapapillary duodenal diverticula.

The motor activity of the sphincter of Oddi (SO) has been evaluated, by endoscopic manometry, in 48 subjects, 8 with and 40 without duodenal juxtapapillary diverticula. All values were expressed in mm Hg, taking duodenal pressure as zero reference. In subjects with diverticula the SO basal pressure was 14.1 +/- 4.3 mm Hg, peak pressure was 52.3 +/- 17.2 mm Hg, and wave height was 39.75 +/- 14.19 mm Hg; in subjects without diverticula these values were 31.2 +/- 8.9 mm Hg, 93.2 +/- 21.3 mm Hg, and 68.17 +/- 25.86, respectively. The difference was statistically significant (P less than 0.001 for basal and peak pressure; P less than 0.002 for wave height). Wave frequency was not significantly different in controls (4.99 +/- 1.17/min) and in subjects with diverticula (4.98 +/- 1.13/min). These findings seem to indicate that in patients with diverticula the SO is insufficient or dysfunctioning . The insufficiency of the SO and a reflux of bacteria from the duodenum into the bile duct could play a major role in the formation of stones in patients with diverticula. The same mechanism could be responsible for duodenopancreatic reflux and possible pancreatic lesion.

Endoscopic removal of foreign bodies in the large bowel.

Endoscopic removal of foreign bodies from the intestinal tract is an extremely useful method. In our series, foreign bodies passing down from the upper intestinal tract were removed endoscopically from the rectum and colon of 13 patients. No complications were observed. It can be concluded that endoscopy is a simple, safe and effective method which, in many cases, avoids surgical procedures.

Endoscopic sphincterotomy: indications and results.

Endoscopic sphincterotomy (ES) is a simple, effective and remarkably safe method of treatment of choledocholithiasis and papillary stenosis. In this series, ES was technically successful in 255 (86.1 per cent) of 296 patients in whom it was attempted. Forty-nine of the successful cases had papillary stenosis complicated by pain, cholangitis and/or jaundice in patients after cholecystectomy; 205 had choledocholithiasis, of whom 164 had a cholecystectomy and 41 were poor surgical risks and did not have cholecystectomy. One patient had a tumour of the ampulla of Vater. ES has been performed as an emergency in 16 subjects because of severe septic cholangitis in 11 and acute biliary pancreatitis in 5. Of the 205 patients with choledocholithiasis, spontaneous passage of calculi after ES occurred in 151 cases (73.6 per cent), and instrumental extraction of stones was possible in 44 (21.5 per cent); 10 patients (4.9 per cent) had residual stones and required surgery. In this series the overall success rate of ES in removing common bile duct stones was 82 per cent in 238 cases; in the patients with benign papillary stenosis ES was successful in relieving symptoms and biochemical cholestasis in 72 per cent of 57 cases. Complications occurred in 18 cases (7 per cent): cholangitis in 4 (1.6 per cent) and haemorrhage in 14 (5.4 per cent). Two patients (0.8 per cent) with acute bleeding following ES died; in one of these surgery had been performed to arrest the haemorrhage, but the patient died 3 days after operation of hepatorenal failure. The other complications were treated conservatively without mortality.

Neomycin and the combination of neomycin and bacitracin in the prevention of bacterial infection in surgery of the colon and/or rectum.

In two groups of patients submitted to surgery of the colon and/or rectum, treatment to prevent bacterial infections using a combination of 100 mg neomycin and 10,000 U bacitracin every 6 h for 48 h gave the same results as neomycin employed alone at a dosage of 500 mg every 6 h for 48 h. Results confirm the synergism of action between neomycin and bacitracin.

[Endoscopic papillotomy. Indications and limitations]. / La papillotomia per via endoscopica. Indicazioni e limiti.

Personal experience of 161 cases of endoscopic papillotomy (EP) is reported. Indications and contra-indications are considered in relation to the therapeutic effectiveness of the technique and to the lower percentage of morbidity and mortality connected to it with respect to that following on laparatomic surgery. On the basis of results obtained and of the data reported in the literature, it is pointed out that EP represents real progress in the treatment of calculosis of the hepatocholedochus and of stenosing papillitis.

[Transgastric lymphadenography]. / La linfoadenografia transgastrica.

The transgastric lymphadenography technique carried out by the endoscopic route in 52 patients at the Digestive Endoscopy Centre of the 3rd Surgical Clinic of Rome University is described. On the basis of personal results it is considered that transgastric lymphadenography represents an interesting technique for the study of perigastric lymphnodes in normal and pathologic conditions. It is thought that it could also be useful in the study of the abdominal lymphatics although further verification and a larger series are necessary.

ERCP and EPT: Italian experience.

The use of endoscopy has had a satisfactory development in Italy and today at least 70% of Italian hospitals have a fiberscope. Most of the examinations performed are in the diagnosis of diseases of the oesophagus, stomach or duodenum, whilst only a small percentage are represented by coloscopy which is usually carried out in specialized units. One of the examinations, that is most rarely performed, is ERCP, even if some hospitals have a duodenoscope suitable for catheterization of the papilla of Vater. Regardless of the fact that the usefulness of this method has been recognized and that positive results are being reported from various centers throughout the world, ERCP in Italy is performed by very few endoscopists and only in very highly specialized centres. In Rome, for example, ERCP is performed only in our Centre of Digestive Endoscopy which furthermore has the only important experience in Italy in endoscopic papillo-sphincterotomy (EPT); this type of operation has, in fact, so far been carried out only in a very limited number of patients, in a few other endoscopy units.