Paolo Tonti

Argon plasma coagulation of hemorrhagic solitary rectal ulcer syndrome.

Solitary ulcer syndrome (SUS) is a rare disorder that may provoke hematochezia. Argon plasma coagulation (APC) is used in a wide range of gastrointestinal bleeding. We experienced APC in a patient with a bleeding gigantic SUS: a 64-year-old woman who developed a SUS at 60. After 3 years, recurrent hematochezia, secondary anemia, and rectal pain occurred. Endoscopy revealed a large rectal bleeding ulcer. Moreover, the pain led the patient to assume analgesics. These conditions stimulated us to treat this ulcer with APC within 4 sessions; each session spaced out at 30-day intervals. The patient experienced and maintained the following benefits: (1) resolution of bleeding and secondary anemia after the first session, (2) reduction of ulcer depth, disappearance of pain and analgesic withdrawal at the end of the cycle, (3) almost complete endoscopic healing of the ulcer after 9 months of follow-up. This experience suggests that APC may represent a therapeutic approach for bleeding SUS even if controlled studies are necessary before recommending it as acceptable treatment.

Pulsed Doppler US diagnosis of hepatocellular carcinoma and other liver focal lesions

Objective: To assess the role of pulsed Doppler ultrasound in the differential diagnosis of focal liver lesion, based upon the presence of a Doppler signal and its waveform. Methods: The presence of a Doppler signal was accurately investigated in 267 focal liver lesions which had subsequently a definitive diagnosis. Most representative groups included hepatocellular carcinomas (188 cases), metastases (34 cases) and haemangiomas (42 cases). Results: Doppler signals were detected with a significantly higher rate in hepatocellular carcinomas than in metastases (P = 0.001) and haemangiomas (P < 0.0001). The detection rate in metastases was significantly higher than in haemangiomas (P = 0.001). Assuming the detection of a Doppler signal allows to classify a liver lesion as malignant, we obtained sensitivity of 84.9%, specificity of 90.5%, diagnostic accuracy of 85.8%, positive predictive value of 97.9% and negative predictive value of 52.8%. Considering only the presence of a pulsatile wave as a diagnostic sign of malignancy, these figures resulted 80.8%, 100%, 84.2%, 100% and 52.8%, respectively. Conclusions: The detection of Doppler signals from within a liver lesion has a clinical relevance. The finding of a pulsatile waveform makes it possible to differentiate a malignant lesion from haemangioma with high sensitivity and absolute specificity.