Detachable snare versus epinephrine injection in the prevention of postpolypectomy bleeding: a randomized and controlled study.

BACKGROUND AND STUDY AIMS: Several endoscopic techniques have been developed to prevent bleeding after the removal of large pedunculated polyps. PATIENTS AND METHODS: From January 1995 to December 2002, 488 consecutive patients with pedunculated colorectal polyps, the heads of which were larger than 10 mm in diameter, were randomly assigned to three groups. In group A (163 patients), detachable snares were placed at the base of the stalk and standard snares were then used for polypectomy. In group B (161 patients), the polyp stalk was injected with a 0.01 % epinephrine solution before conventional snare polypectomy. Group C (a control group including 164 patients) underwent conventional snare polypectomy without preventive measures. Early (< 24 h) and late (> 24 h - 30 days) bleeding complications were assessed. Each group was divided into two subgroups relative to the polyp size (polyps 1.0 - 1.9 cm and polyps > or = 2 cm). RESULTS: Overall bleeding complications occurred after 4.3 % of the polypectomies. Bleeding was successfully controlled in all patients, and no blood transfusions were required. There were three cases of bleeding in group A (1.8 %), five in group B (3.1 %), and 13 in group C (7.9 %). Early bleeding was more frequent than late bleeding (15 vs. six patients). In polyps > or = 2 cm (207 patients), postpolypectomy bleeding occurred in 14 patients (6.7 %): two (2.7 %) in the detachable snare group, two (2.9 %) in the epinephrine injection group, and 10 (15.1 %) in the control group. CONCLUSIONS: These results show that polypectomy of large pedunculated polyps is associated with a higher incidence of bleeding. Particularly in polyps larger than 2 cm, preventive measures can significantly reduce bleeding complications after polypectomy. This can be achieved with similar efficacy either by placing Endoloops or by injecting epinephrine.

Prevalence of HNPCC in a series of consecutive patients on the first endoscopic diagnosis of colorectal cancer: a multicenter study. The Italian Collaborative Group.

BACKGROUND AND STUDY AIMS: It is difficult to measure the prevalence of hereditary non-polyposis colorectal cancer (HNPCC) in geographical areas that do not have tumor registers, as is the case in the present study, and it was therefore decided to assess the prevalence in Italy using different methods. PATIENTS AND METHODS: The pedigree was established for 485 of 501 colorectal cancer patients diagnosed with colorectal carcinomas. Patients were included consecutively in 13 gastroenterology centers; they had not taken part in prevention examinations. Information was collected regarding the neoplastic pathology observed in the families, confirmed in 90% of cases among 3515 first-degree relatives and in 79.5% of cases among 7068 second-degree relatives. RESULTS: In the 3515 first-degree relatives (1002 parents, 1560 siblings and 953 children), 61 colorectal carcinomas, 29 carcinomas in the digestive tract outside the colon, and 99 carcinomas in other locations were reported. Only five of the 485 patients (1%) satisfied the Amsterdam criteria (three cancers, two of which were in first-degree relatives in different generations and one in a relative younger than 50). When broadening the criteria that we are proposing (satisfying only two of the three Amsterdam criteria), the prevalence would increase to 3% (15 cases). CONCLUSIONS: Modifying the criteria makes it easier to identify new mutations or confirm the existence of those already known, as well as allowing preventative treatment in relatives who are apparently healthy.

[Clinical suggestions on the use of calcium hydroxide in therapy of pulp necrosis]. / Suggerimenti clinici sull'impiego dell'ossido di calcio nella terapia della necrosi pulpare.

The Aa. discuss the Bernard's method for therapy of pulpar necrosis, based on using of calcium oxide, know as "ocalexic method". They report clinical procedure and results of their experience.

[Morphology of the cranial base in a group of Campania school children]. / La morfologia della base cranica in un campione della popolazione scolastica della Campania.

The A.A. analysed the cranial base morphology on 14 school-children in the eastern part of Naples, to establish if the most used cephalometric values were useful for Campanian people. The values found out resulted superimposed to those referred in the considered analysis.

The influence of high blood levels of urea on the presence of Campylobacter pylori in the stomach: a clinical study.

In order to determine whether urea influences the presence of Campylobacter pylori (Cp) in the stomach, the incidence of this infection was determined in patients with chronic renal failure who received no treatment (group A) or underwent regular hemodialysis (group B). A third group was examined as control. Biopsies from the gastric antrum were taken for histological investigation and for Cp detection. No significant differences among the 3 groups of patients were found with regards to the incidence of Campylobacter pylori. Urea can be considered as a preferred metabolite but no proof that high levels influence the occurrence of the organism in the stomach was found.

[Congenital dilatation of the extrahepatic biliary tract]. / La dilatazione congenita della via biliare extraepatica.

Congenital dilatations of the extrahepatic bile duct are examined with special regard for the operating techniques proposed for their correction. After pointing out that the terminology adopted in the literature does not reflect the real morphology of the malformation, and lends itself to erroneous interpretations, a modification is proposed. The basis for the paper was provided by a case of complex malformation of the extrahepatic bile duct (dilatation of the whole duct, with a dividing wall along nearly its whole length) observed in a girl of 15. The case was successfully treated with choledocho-cysto-jejunostomy.