A multi-centre North Italian prospective survey on some quality parameters in lower gastrointestinal endoscopy.

BACKGROUND AND AIM: To record prospectively, in a multi-centre survey, the adherence to some quality parameters of lower digestive endoscopy in everyday practice, focusing in particular on sedation and monitoring; choice of extension of endoscopic examination by the operator and relative performance in intubation of the caecum; behaviour, in some particular clinical circumstances, such as fresh haematochezia, screening and surveillance situations, functional symptoms, management of polyps. PATIENTS AND METHODS: Twenty-five centres located in Lombardia, Italy took part in the study; the duration of the survey was 2 weeks. 1,406 consecutive cases were recorded. RESULTS: The main indications to colonoscopy were fresh haematochezia (21%). abdominal pain (11.7%) and surveillance after surgery for tumours or endoscopic polyp removal (24.3%). Screening examinations accounted for 7.1% of all examinations. Conscious sedation was administered in 63.9% of patients; pulse oxymetry and cardiac frequency monitoring was used in 44.2% of cases. Total colonoscopy was planned in 84.2% of cases; the actual rate of intubation of the caecum in the cases submitted to the procedure was 84.1%. Normal results were obtained in 24.3%. In 24.3% of patients, one or more polyps were identified; 84.2% of these were removed during the first examination. Four complications (accounting for 0.28% of cases) were recorded, all after polypectomy and all successfully treated conservetively. CONCLUSIONS: The present study has shown that some attitudes in lower digestive endoscopy are sub-optimal: in particular, screening examinations are still infrequent; conscious sedation and monitoring have probably been used too rarely; intubation of the caecum was achieved in <90% of cases; the endoscopic removal of many polyps has been delayed for unexplained reasons. On the other hand, timing of surveillance after surgery for tumours or endoscopic removal of polyps has, overall, been adequate; the rate of normal examinations and the rate of complications have been satisfactorily low.

A 10% mannitol solution effective for colonic preparation for X-ray.

Hydroelectrolytic changes, the time of action and complications induced by oral administration of 10 per cent mannitol solution in the colonic preparation for X-ray examination were examined. Twenty-six patients were examined using two different solution volumes: one liter in 15 patients and two liters in 11 patients. No significant biochemical changes were noted. X-ray study of the colon revealed an insufficient evacuation in 3.8 per cent, sufficient in 7.6 per cent, and good in 88.6 per cent of cases. In 6 per cent nausea and vomiting occurred, in 11.7 per cent abdominal distention, and in 7.6 per cent hypotension. This approach was well tolerated, particularly when one liter of the solution was used.

[Current trends in drug therapy of cerebral ictus]. / Orientamenti attuali nella farmacoterapia dell'ictus cerebrale.

The following protocol was used in the management of 25 hospitalised patients with acute cerebrovascular episodes: 4 vials Hydergine per day (slow venous drip) during the entire stay in hospital, with glycerol, diuretics, papaverine, cituridine, etc., during the initial period. Good results were noted in 18 cases (72%), including complete or nearly complete recovery of mobility and marked improvement of the entire clinical picture. A modest result was obtained in 4 cases and a fair result in one. Two subjects died, one from cardiographic shock and the other from supravening deep coma. It is considered that the protocol described is definitely useful in the medical treatment of cerebral ictus.