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Background: Duodenal diverticula are acquired lesions found more often in older patients; when located near the major duodenal papilla they are called juxtapapillary. The prevalence of juxtapapillary duodenal diverticula (JDD) in the general population is around 20%; they are often associated with biliary lithiasis. This study assessed the association between JDD and biliary stone disease, particularly choledocholithiasis. Methods: Four hundred fifty ERCPs were performed in 420 patients from 1995 through 1999. The results for 300 ERCPs that were performed in 285 patients for suspected biliary lithiasis were analyzed. Results: JDD were present in 21.42% of the 420 patients; most were found in patients in the eighth and ninth decades of life. Patients with JDD had bile duct stones alone more often than patients without JDD (44% vs. 24%). According to their features, these bile duct stones were characterized as mainly primary. The existence of JDD influences bile duct diameter irrespectively of the presence of bile duct stones. Conclusions: JDD are important causative factors in the formation of bile duct stones. (Gastrointest Endosc 2002;55:543-7.)

The action of the enzymic inhibitor Trasylol upon shock from occlusion of the superior mesenteric artery (SMA) in forty-six dogs, arranged in four groups, has been studied. In Group A of controls (thirteen dogs) an intestinal ischaemia of 31/2 hours duration was produced. After removal of the arterial occlusion, shock was produced in eleven dogs, which died within the first 24 hours. A frequent finding at autopsy was haemorrhagic infiltration of the intestinal mucosa and the occurrence of haemorrhagic contents in the intestinal lumen. Histologically, frequent findings were capillary distension and hyperaemia, perivascular haemorrhagic infiltration and superficial or total necrosis of the intestinal mucosa. In Group B (ten dogs), Group C (ten dogs) and Group D (thirteen dogs), the experimental arrangement was similar to that in Group A, except for Trasylol administration. An infusion of Trasylol, 30,000 units/kg body-weight intravenously 10 minutes before occlusion of the artery was given to the experimental animals of Group B, while a second infusion of 30,000 units/kg body-weight into the superior mesenteric artery or intravenously was given to the experimental animals of Group C and Group D, respectively, 10 minutes before the removal of arterial occlusion. The results in Group B were a little better in comparison with those of the controls, but the differences were not statistically significant. On the contrary, significant differences were seen with Group C and Group D. Shock was produced in a small number of experimental animals. Over 50% of the experimental animals survived. The intestinal alterations seen at autopsy and histologically were about the same as in the control group, but at a clearly lower frequency. It is concluded that the administration of enzymic inhibitors may eventually have a practical application in situations of re-establishment of mesenteric circulation after its acute interruption.

Abstract.: The aim of this experimental study was to investigate whether the intraperitoneal perioperative injection of 5-flurouracil (5-FU) – with or without the addition of interferon (INT) – influences colonic healing. We used 57 male Wistar rats which were subjected to anastomosis of the colon. Intraoperatively, the rats were randomised into one of three groups. The rats in the control group (group 1, n = 15) received a 0.9% NaCl solution; the rats in group 2 (n = 21), 5-FU (20 mg/Kg/day), and those in group 3 (n = 21), 5-FU (20 mg/Kg/day) plus INT (45.000 IU/Kg/day). These drugs were injected intraperitoneally during the operation and once daily for the next two days. The rats were sacrificed on post-operative days 3, 5 or 8. The rupture rate of the anastomoses was statistically significantly higher in groups 2 and 3, compared with the control group (P < 0.05); no differences were observed between groups 2 and 3. Abscess and adhesion formation were more marked in groups 2 and 3 than in the control group; however no differences were recorded between groups 2 and 3. The anastomotic bursting pressure was statistically significantly lower in groups 2 and 3 compared to the control group (P < 0.05), on post-operative days 5 and 8; however, no differences were measured between groups 2 and 3. Histologic evaluation also showed a more profound inflammatory response in groups 2 and 3, compared with group 1. In conclusion, the intraperitoneal, intraoperative administration of 5-FU hinders colonic healing in rats. The additional intraperitoneal injection of interferon does not seem to aggravate this adverse effect.

Abstract:: Rubber-band ligation is a widely performed method of treatment for second-degree haemorrhoids. Initial results of rubber-band ligation are satisfactory, but symptoms often recur in the long term. The aim of our prospective study was to present the long-term results of rubber-ring application in patients with second-degree haemorrhoids. From 1990 to 1996, 114 outpatients with second-degree haemorrhoids underwent rubber-band ligation according to the Barron technique. A single ligation was performed during one session. Most of the patients had three haemorrhoids being ligated. Three years after the initial treatment, 105 patients were re-examined and their symptoms were recorded. 16 patients underwent an additional rubber-band ligation 6–24 months after their initial treatment. After 3 years, 30 patients (28.5%) were symptom-free, 17 patients (16.2%) were improved, 32 patients (30.5%) were unchanged and 26 patients (24.8%) were worse. Bleeding and prolapse were the most frequent recurrent symptoms. Rubber-band ligation is a simple, safe and inexpensive method of treatment for second-degree haemorrhoids, although symptoms may recur in many patients in the future.

Abstract:: We present the results of combined, simultaneous application of sclerotherapy and rubber band ligation during one session in patients with symptomatic second-degree haemorrhoids. Between 1993 and 1996, 83 consecutive outpatients with second-degree haemorrhoids underwent simultaneous rubber band ligation of larger (primary) piles and sclerotherapy of smaller (secondary) piles. The treatment was successful, and the symptoms were controlled in 88% of the patients. The overall incidence of complications was 9.2%, but these were minor and transient. The simultaneous, combined sclerotherapy and rubber band ligation of second-degree haemorrhoids is a simple, safe, and effective method, with only minor and transient complications.