Cyclase and phosphodiesterase activity on pre-T lymphoid human cells, treated with dimethyl sulfoxide (DMSO).

Our aim is to estimate the role of the DMSO on pre-T lymphoid human cells, we have searched the cyclase and phosphodiesterase activity. We have studied the GTPspecific cyclase (G-Case) and have observed an analogous course to that one of the cAMP-PDE, where, in both cases, the differences ratio is approximately 5. For the cyclase activity values it has been found that cAMP neo formed is undeterminable in these cells, for the controls and the treated samples.

Laparoscopic cholecystectomy (LC), intraoperative endoscopic sphincterotomy (ES), and common bile duct stones (CBDS) extraction for management of patients with cholecystocholedocholithiasis.

BACKGROUND: A combined method of endoscopic sphincterotomy (ES) with common bile duct stone (CBDS) extraction and laparoscopic cholecystectomy (LC) under general anesthesia for a single-session treatment of patients with colecysto-choledocholithiasis is described. METHODS: From June 1994 to January 1995, 15 consecutive cases considered for elective LC with preoperative diagnosis of CBDS underwent this procedure. Following orotracheal intubation, the patient is turned on the left lateral decubitus for ES and CBDS extraction. Nasobiliary drainage is positioned for per-laparoscopic cholangiogram. Routine LC is finally performed. RESULTS: These two interventions were successfully accomplished in all patients. Mean duration of the operative time for the combined procedure was 97.7 +/- 30.4 min, range 60-140 min. In four (26.6%) cases an accessory trocar with retracting instrument was used to obviate the bowel distension. CONCLUSIONS: No complications of ES or LC were observed. Mean hospital stay was 3 days (range 2-5 days). Routine follow-up (mean 3 +/- 2 months, range 1-12 months) did not reveal biliary-related problems in any of the observed patients.

Plastic prosthesis versus expandable metal stents for palliation of inoperable esophageal thoracic carcinoma: a controlled prospective study.

BACKGROUND: Rapid palliation of malignant dysphagia is usually possible with endoscopic implantation of a plastic prosthesis, but this device has a high rate of complications. Recently, expandable metal stents, a new class of endoprosthesis, have become available and may reduce complication rates. METHODS: Thirty nine patients affected by esophageal thoracic cancer were randomly assigned to treatment with either a plastic stent (20 patients) or expandable metal stent (19 patients). The degree of palliation (expressed as dysphagia score) and incidence of complications (short- and long-term) were compared in both treatment groups. RESULTS: Technical success, as a percentage of successful intubation, was similar in both treatment groups (90% vs 94.7%, p = NS) and dysphagia scores improved significantly and similarly in both treatment groups. Nevertheless, complications and mortality related to implantation were significantly less frequent with metal stents than with plastic prostheses (complications: 0% vs 21%, p < 0.001; mortality: 0% vs. 15.8%, p < 0.001). Late complications included obstruction by food in both treatment groups (four cases with plastic stents vs four cases with metal stents), tube migration only with plastic prostheses (two cases) and tumor ingrowth only with metal stents (two cases). CONCLUSIONS: Expandable metal stents can be considered an effective and safer alternative to conventional plastic prostheses in the treatment of esophageal obstruction caused by inoperable cancer.

[The current status of the perendoscopic treatment of biliary lithiasis]. / Lo stato attuale del trattamento perendoscopico della litiasi biliare.

The role of therapeutic biliary endoscopy, for management of bile duct stones, continues to be defined. Actually the endoscopic management should be considered the procedure of choice for treatment of retained or recurrent stones of the main bile duct, gallstone pancreatitis an acute cholangitis. It's role in the era of laparoscopic cholecystectomy is evolving. Actually new techniques and accessories continue to be developed for treatment of bile duct stones. The problem of the difficult bile duct stones has essentially been solved by the development of a variety of lithotripsy techniques. This work focuses on new developments in the therapeutic biliary endoscopy for treatment of main bile duct stones.

[Results of endoscopic Nd-Yag laser treatment of inoperable colorectal carcinoma]. / Risultati del trattamento perendoscopico con Nd-YAG laser del carcinoma del colon-retto non operabile.

Between November 1986 and December 1993, 94 patients underwent endoscopic laser therapy for inoperable colo-rectal cancers. According to the main clinical symptoms, tumors were divided into obstructing and bleeding; A Nd-YAG non contact laser was used at power setting of 70 to 100 watt. In 28 cases laser therapy was carried out after electrorection of the tumor and in 22 cases after dilation; in 41 cases it was associated with radiation therapy. In 90% of bleeding tumors and in 70% of obstructing tumors we achieved a good result in the short term. In 50% of bleeding tumors and in 65% of obstructing tumors the symptoms recurred after an interval of 8.2 and 6.1 weeks. The main survival period was 11.2 months for bleeding tumors and 7.4 months for obstructing tumors. Two patients with a small rectal cancer are free to neoplasia at 19 and 26 months after laser therapy.

Self-expanding metal stents for palliation of inoperable carcinoma of the esophagus and gastroesophageal junction.

OBJECTIVES: Rapid palliation of malignant dysphagia is usually possible with endoscopic implantation of plastic prosthesis, but this device has a high rate of complications. Recently expandable metal stents have become available that may have a reduced complications rate. METHODS: This report details our experience with 32 patients treated from September of 1992 through June of 1994. Twenty-three patients were treated primarily with the Ultraflex esophageal prosthesis, and five patients were treated with postoperative malignant stricture, three with failed laser therapy and one with postradiation therapy malignant stricturing. Implantation was successful in 30/32 patients (94%). No major bleeding or perforation followed placement. The dysphagia score improved dramatically from 3 to 0.5. Twenty-six patients had a follow-up of at least 30 days. No stent migration occurred. Food impaction was seen in three patients, tumor ingrowth in three, and overgrowth in one patient. The median survival was 6.2 months with a range of 1.8-11.3 months. CONCLUSIONS: Expandable metal stents are effective and safe for palliation of malignant obstruction of the esophagus and gastro-esophageal junction. However, long term problems remain to be addressed, such as ingrowth by tumor, food impaction, and limitation of stent expansion by tumor rigidity.

Endoscopic treatment of sessile rectal adenomas: comparison of Nd:YAG laser therapy and injection-assisted piecemeal polypectomy.

This prospective study was carried out in order to compare endoscopic laser therapy with injection-assisted piecemeal polypectomy for treatment of sessile rectal adenomas. We randomized 94 patients with rectal sessile adenomas to either of the two treatments. The adenomas were classified according to size as extensive or intermediate. Of the patients with extensive adenomas, a complete ablation was achieved in 63.6% with laser versus 33.3% with piecemeal snaring (p < .01). For the intermediate adenomas, the rates of permanent ablation were 81.2% with laser versus 86.6% with piecemeal snaring polypectomy (difference not statistically significant). The complication rates were acceptable in both the laser and piecemeal snaring groups. (One case of perforation and one case of stenosis were observed in the laser group, both probably related to prior electroresection.) Our study suggests that the specific indication for laser therapy should be extensive lesions; with intermediate adenomas, laser therapy and injection-assisted piecemeal polypectomy are equally efficacious for achieving complete ablation. However, the duration of initial treatment differs: 6.3 weeks for laser therapy versus 2.4 weeks for piecemeal polypectomy; moreover, about 70% of the intermediate adenomas were eradicated with a single session of piecemeal polypectomy.

[Comparison of Nd-Yag laser and strip biopsy in the treatment of extensive adenomas of the rectum]. / Confronto tra Nd-YAG laser e strip biopsy nel trattamento degli adenomi estesi del retto.

This prospective study was carried out in order to compare endoscopic laser therapy and strip biopsy for treatment of large sessile rectal adenomas. Between January 1990 and December 1991, 94 consecutive patients, referred to our Endoscopy Service because of extensive rectal adenoma have been allocated to laser therapy or strip biopsy. The effectiveness of the two techniques was statistically the same from many points of view: complete ablation (76.7% vs 71.4%), recurrence (35.4% vs 30.6%) need for surgical intervention (12% vs 16.6%) and complication rates. However, from our experience, the treatment period was significantly shorter for patients affected by an intermediate sized adenoma and treated with strip biopsy. In both groups, instead, complete, permanent ablation was difficult to obtain in the cases of extensive lesions and in particular if they were localized lower than 5 cm from the anus.

[Personal experience in the treatment of esophago-cardial stenosis with the Nd-YAG laser]. / Esperienza personale nel trattamento con Nd-YAG laser delle stenosi esofago-cardiali.

The authors analyze the results of treatment, by Nd-YAG laser. of benign and malignant esophageal and cardial stenoses. Particularly the personal technique, immediate and late complications and association with complementary techniques such as dilatation or intratumoral injection of polidocanol are evaluated.