Giorgio Minoli

The influence of carbon dioxide and nitrous oxide on pain during laparoscopy: a double-blind, controlled trial

A prospective and controlled trial in 92 patients was done to determine the influence on the onset of pain during laparoscopy under local anesthesia by age, sex, perlaparoscopic guided liver biopsy, the presence of adhesions and of ascites, and the type of gas (CO2 or N2O) used in the abdominal cavity. N2O was found less pain provoking, while other factors had no influence on the onset of pain.

Irritable bowel syndrome: Still far from a positive diagnosis

The diagnosis of irritable bowel syndrome requires the exclusion of any associated organic disease: a positive diagnosis would avoid expensive and potentially dangerous diagnostic procedures. A scoring system has been proposed for positive diagnosis where more than 44 points excluded organic digestive disease. The aim of this study was to determine the usefulness of this scoring system in a different setting. Patients (1257) consecutively referred to our medical division were admitted to the study and 270 of these, complaining of abdominal symptoms, were scored on the Kruis system method. The positive predictive value (53.8% for men and 81.5% for women) and the sensitivity (46.7% and 59.5%) did not appear to be adequate. The negative predictive value (91.6% and 87.3%) and the specificity (93.5 and 95.4%) gave higher results, but two cases of neoplasia and nine cases of other organic digestive diseases were not identified or suggested. We believe that this scoring system may be useful only as a first step in a diagnostic flow chart.

Gastric candidiasis: an endoscopic and histological study in 26 patients

The endoscopic and histological characteristics of gastric candidiasis are described in 26 patients. Gastric candidiasis was seen endoscopically as thrush in 42% of the cases, as a nodular form with tissue invasion in 31%, and as an ulcerated form with histologically confirmed mycosis in 27%. The histological picture was characterized by pseudomycelial infiltration, granulation (more often in a nodular form), or microabscesses with hyphae, which are frequently associated with ulcers.

Invasive candidiasis does not complicate short-term cimetidine treatment of duodenal ulcer

The purpose of this study was to record the frequency of invasive candidiasis of duodenal ulcer and to determine whether or not it is enhanced by cimetidine treatment. Our multicenter prospective trial involved 99 patients with endoscopically proven duodenal ulcer who were undergoing a 4- or 8-week cimetidine (800 mg/day) treatment program. At the endoscopic examination, performed before and after the 4- or 8-week treatment, three biopsy samples were taken from the ulcer edge or from the healed tissue. Ulcer infiltration by Candida was presumed by the presence of mycetes in stained tissue samples. Healing rate was 76% at 4 weeks and 89.9% at 8 weeks. Candida infiltration was not seen in any biopsy specimen. Short-term treatment with cimetidine does not promote invasion of mycetes into the duodenal ulcer lesion.