[The colonoscoy in elderly patients]. / Il ruolo della coloscopia nella quarta età.

AIM: The increase in the average life led an increase of diseases, acute and chronic, not only cardiovascular and respiratory system, but also gastrointestinal. Likewise we see an increase in neoplastic lesions, sometimes diagnosed in advanced stage of disease, not susceptible to radical therapy. The purpose of this work is to evaluate the usefulness, reliability and security of colonoscopy in elderly patients, age 75 years or more. MATHERIALS END METHODS: We analysed 2407 colonoscopies, performed from January 2005 to December 2006 in Unit of Digestive Endoscopy of Gastrointestinal Surgery ("Federico II" University of Naples) and in Unit of Digestive Endoscopy of "Villa Maria Clinica" (Mirabella Eclano). Of these four hundred and sixty-nine patients (19.5%), 276 men and 139 women, were 75-years-old or more. Were considered indications to endoscopy completeness of the examination, findings, presence of any complications. In all patients were performed premedication with midazolam, 2,5-5 mg and floroglucina biidrata, 40-80 mg. The patients were constantly monitored with pulsiossimetro. RESULTS: The colonoscopy was completed in 432/469 patients (92%). In 19 cases (4%) there was a neoplastic stenosis; other reasons for the failure of cecal intubation were the poor intestinal preparation (2.5%) and intolerance of the patient (1.5%). Were excluded patients in follow-up to previous surgery or polypectomy (33.5%). Other indications in the investigation were, in descending order, abdominal pain (32.8%), presence of anaemia (22.4%), rectal bleeding (19.2%), diarrhea or constipation (18.4%), presence of abdominal mass (72%). There were no complications observed, or local (perforation/bleeding), or general (cardio-respiratory or neurological). Most frequent findings were: diverticoular disease (34.4%), polyps (22.4%), cancer (12.8%), find colitis also aspecific (10.4%), hemorrhoids (8.8%). In 11.2% of patients colonoscopy was negative. CONCLUSION: The endoscopic examination of the gastrointestinal tract is now practiced daily in almost all hospitals. The advanced age of patient, with the possible presence of diseases associated is not, in our opinion, a controindication. Although present in the literature trials that emphasize the possibility of a higher incidence of complications in elderly patients, our experience shows how this control is quite safe, if executed in appropriate and correct manner, thanks also to appropriate preparation/sedation and monitoring of the patient. Compared to other diagnostic methods, such as air contrast barium enema, the computed tomography and virtual colonoscopy, "traditional" colonoscopy has the undoubted and decisive advantage of being able to run biopsies, and complete removal of the lesion, as in the case of polypectomy. In our case we have seen a high number of elderly patients, well 469/2407, equivalent to 19.5%. A neoplastic lesion was found in 165 patients (35.2%) and of these over 80% has successfully received curative treatment (surgery or polipectomy).

Silent non-alcoholic fatty liver disease-a clinical-histological study.

BACKGROUND/AIMS: We studied the prevalence of non-alcoholic fatty liver disease and non-alcoholic-steatohepatitis in patients with metabolic-syndrome but normal liver enzymes. The histological findings of patients with normal liver enzymes and non-alcoholic-steatohepatitis were compared with those of a control-group with persistently abnormal liver enzymes. METHODS: Patients presenting with normal liver enzymes were enrolled in the study and underwent liver biopsy. Prevalence of non-alcoholic-steatohepatitis and risk factors for fibrosis and cirrhosis were evaluated. Data from a control-group with non-alcoholic-steatohepatitis and abnormal liver enzymes were used to compare the histological findings. RESULTS: Fifty-eight of the 80 patients enrolled had varying degrees of non-alcoholic steatohepatitis, of these 26 had fibrosis and 8 silent cirrhosis. The association of metabolic-syndrome, female-sex, a long-history of obesity and body mass index>45 were considered to be independent risk-factors for fibrosis. Comparing the histological findings of cases and controls we found a similar severity of steatosis and fibrosis, with a greater prevalence of ballooning degeneration and glycogenated-nuclei rather than lobular-inflammation. CONCLUSIONS: In the subjects selected according to our criteria, liver enzyme levels could not be used as surrogate markers of non-alcoholic-steatohepatitis. Histological hallmarks of patients with metabolic-syndrome, normal liver enzymes and non-alcoholic-steatohepatitis consist to a lesser degree of lobular-inflammation and a more severe ballooning and glycogenated-nuclei.

Randomized comparison of power Doppler ultrasound-directed excisional biopsy with standard excisional biopsy for the characterization of lymphadenopathies in patients with suspected lymphoma.

PURPOSE: The sensitivity of lymph node excisional biopsy requires validation. Power Doppler ultrasound (US) helps predict the malignant status of lymphadenopathies. We used power Doppler US to select for biopsy the lymph node most suspected of malignancy. PATIENTS AND METHODS: One hundred fifty-two patients having lymphadenopathies with clinical suspicion of lymphoma were divided into two well-matched groups and randomly assigned to undergo either standard or power Doppler US-directed lymph node excisional biopsy. RESULTS: Histology showed a malignancy in 64% of patients in the standard group (lymphoma, 49 patients; carcinoma, two patients) and in 87% of patients in the US-assisted group (lymphoma, 62 patients; carcinoma, one patient). There were significantly fewer biopsy-related complications in the assisted group than in the standard group. During the follow-up of the patients with lymph nodes reported as being reactive, 14 of 29 patients in the standard group were rebiopsied and were found to have lymphoma (13 patients) or carcinoma at the subsequent lymph node histology, whereas none of the patients in the assisted group (nine patients) required a second biopsy. Thus, biopsy provided false-negative results for malignancy in 21% of patients affected by lymphoma in the standard group and never in the assisted group (P <.01). CONCLUSION: Power Doppler US is an accurate tool for screening lymphadenopathies to be removed by excisional biopsy in patients with suspected lymphoma.