P. Del Rio

Self-Expanding Metal Stents in the Treatment of Colonic Obstruction

Background: The use of self-expanding metal stents in the treatment of obstruction of esophageal tract, biliary tract, major vessel diseases and colonic obstruction has found favor in the last years. Patients and Methods: 13 patients (7 women and 6 men) with a mean age of 74.7 years were treated for an obstruction located at the descending colon-sigmoid tract in 9 cases, at the rectosigmoid tract in 2 cases, and at the transverse colon in 2 cases. Two cases had an obstruction post ischemic colitis. Results: The stents were conducted successfully in all patients. The mean hospital stay was 3.7 days versus 7.8 days for a colostomy (p < 0.001). Conclusions: The self-expanding stent for the treatment of colonic obstruction is a procedure that can be used not only in neoplastic and inoperable stenoses but also in all colonic stenoses where the surgical risk is bigger than that of the endoscopic procedure.

Can misdiagnosis in pre-operative FNAC of thyroid nodule influence surgical treatment?

Background: Pre-operative cytology in thyroid disease remains the most appropriate diagnostic test for defining the nature of a thyroid nodule before surgical excision. Materials and methods: We selected the most recent 825 surgical thyroid procedures performed in our institution from January 2004 to June 2007; 776 were total thyroidectomies, 23 were lobe-isthmectomies, and 26 were radical neck dissections. We distributed the data based on pre-operative cytology. Each cytological diagnosis was compared to results obtained by definitive histology. Tumors were called incidentalomas if they consisted of a neoplastic focus with a low grade of aggressiveness, as demonstrated by dimension <5 mm, non-aggressive histological subtype. Results: Of the 541 cases of benign disease, 417 were confirmed as benign. The other 124 cases are listed as follows: 29 follicular adenoma; 76 papillary carcinoma (35 found as incidentalomas), and 19 follicular carcinoma (3 incidentalomas). Cytology suggestive of papillary carcinoma was correct in 95.2% of cases (119/125). The 135 tumors termed “follicular neoplasm” were staged on pathology thus: 56 adenoma (41.4%), 26 carcinoma (19.2%), 13 (9.6%) absence of follicular proliferation, 38 (28.1%) papillary follicular variant, 2 (1.4%) undifferentiated cells. Medullary carcinomas were both confirmed. The “suspicious group” exhibited no malignancy on fine needle aspiration cytology (12 of 21; 57%). Conclusions: Cytology has good reliability in malignant lesions. Incidental tumors occurring in benign disease have little impact on clinical and surgical management; “follicular neoplasm” posed two problems — the impossibility of identifying the nature of the tumor, as well as the newer difficulty in distinguishing papillary follicular subtype.

Perkutane endoskopische Gastrostomie zur Magenfixierung bei einer kongenitalen Zwerchfellhernie

Percutaneous Endoscopic Gastrostomy for the Fixation of the Stomach in a Patient with Congenital Diaphragmatic Hernia Congenital diaphragmatic hernias at advanced age are rare and found mostly by accident. We present here the case old a 76-year-old female patient with a Morgagni hernia suffering from acute abdominal disturbances. Because of the high anesthesiological risk (ASA IV), a fixation of the stomach was carried out by means of percutaneous endoscopic gastrostomy.

Rôle de l’endoscopie dans le traitement de l’angiodysplasie du côlon

RésuméAu cours de ces 20 dernières années, les techniques endoscopiques n’ont pas seulement permis d’identifier les causes de l’hémorragie mais également de la traiter. De juillet 1999 à juin 2001, nous avons observé 17 patients atteints de rectorragies: 9 hommes et 8 femmes (moyenne d’âge: 78,1 ans).Nous avons réalisé 26 endoscopies chez 17 patients. Deux artériographies et 3 scintigraphies ont été réalisées également lorsque la coloscopie n’était pas suffisante pour localiser le siège de l’hémorragie.Le diagnostic a été posé chez 12 patients (70.6%); l’artériographie s’est avérée positive dans un des 2 cas et la scintigraphie dans 2 cas sur 3 seulement pour localiser le siège de l’hémorragie. 11 patients ont été soumis à une intervention chirurgicale.L’utilisation de l’endoscopie est une approche diagnostique satisfaisante permenttand d’identifier le siège des lésions angiodysplasiques.SummaryIn the last 20 years the endoscopic techniques have allowed not only to identify the cause of bleeding but also to cure the haemorrhage.From July 1999 to June 2001 we observed 17 patients affected by rectal bleeding; 9 males and 8 females with a median age of 78.1 years.We carried out 26 endoscopic examinations in 17 patients. Two selective arteriographies and 3 scintigraphies were carried out when the colonoscopy was not able to locate the seat of the bleeding.The diagnosis was obtained for 12 patients (70.6%); the arteriography was positive in one of the two cases and the scintigraphy in 2 out of 3 only to locate the seat of bleeding. In 11 cases we carried out surgery.The use of endoscopy is an efficient diagnostic approach which permits permits the identification of angiodysplastic lesions.