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Endoscopic submucosal dissection (ESD) is gaining popularity worldwide in the treatment of neoplastic lesions of the gastrointestinal tract. However, the experience in Western countries is quite limited and restricted to large or academic centers. Besides, this approach requires an optimal pathological assessment. The aim of this study was to report our experience with colonic ESD using a new device that allows complete handling of the resected specimens and especially of lateral margins, for pathological analysis. In a 1-year period, 14 patients (6 men, 8 women, age range 50-82 years) underwent colonic ESD in a non-academic hospital. The endoscopic procedure was carried out successfully en bloc in more than 90 % of cases. Perforation requiring surgery occurred in one patient (7 %). Pathological assessment with the new device allowed entire and complete examination of both the deep and lateral margins of the excised specimens. Colonic ESD is a viable option for non-surgical treatment of large bowel lesions even in relatively small centers and in non-academic settings. The new device allows good handling of the specimens, and it seems to be useful for the entire examination of the resection margins.

Chronic intestinal pseudo-obstruction (CIPO) is a syndrome characterized by signs and symptoms of intestinal obstruction without a mechanical cause. In children, two main subtypes, the neuropathic and myopathic forms, are found [1]. A variety of pathological findings of the smooth muscle can result in clinical syndromes involving a motility disorder of the small or large intestine. Moreover, abnormalities of enteric innervation or intestinal muscle defects may be diffuse or involve limited tracts [1]. Deficiency of one of the isoforms of the cytoskeletal smooth muscle protein actin, aactin, involving the circular muscle of the jejunum, is known to induce CIPO both in adults and in children [2]. We report a unique case of a-actin deficiency associated with Ehlers– Danlos syndrome. A 14-year-old girl was urgently admitted because of shock with abdominal distension and severe dehydration. On plain abdominal X-rays, severe small and large bowel dilatation was noted. The patient’s history was negative for any previous medical or surgical condition. She had mandibular prognathism causing aerophagia and affecting speech and mastication. An urgent exploratory laparoscopy was carried out; dilatation of the ascending colon and terminal ileum were found. No perforation or necrosis was detected on inspection of the whole intestine. Two weeks later, persistent bowel dilatation necessitated ileostomy. The patient developed intestinal obstruction following ileostomy closure. Subsequently, several surgical intestinal deviation procedures were performed and after every attempt at reversal immediate reoperation was required. Ten months later, a definitive end ileostomy had to be fashioned 10 months later. Full-thickness biopsies of the ileum and colon were obtained. Histological examination with conventional (hematoxylin and eosin, H&E) staining appeared basically normal (Fig. 1a). Immunohistochemical assessment (NSE, S100, CD117) showed normal features of the enteric nervous system in both the small intestine and the colon, whereas immunohistochemistry for a-actin revealed decreased expression in the circular layer of the small bowel (Fig. 1b– d) and normal features in the colon. Skin biopsy performed after abdominal surgery, revealed hallmarks of disturbed fibrillogenesis and led to the diagnosis of Ehlers–Danlos syndrome, classical type (old type I) [3]. Abnormal intestinal findings often leading to intestinal perforation, especially in the colon, are observed in Ehlers– Danlos syndrome, although almost exclusively in patients with subtype IV [4]. As far as we know, no previous association has been described between Ehlers–Danlos syndrome and a-actin deficiency. The latter was probably the cause of CIPO in our patient (since the enteric nervous system appeared normal), causing impaired propulsion in the small bowel and pseudo-obstructive symptoms. The diagnosis of CIPO, in both adults and children, is often delayed, due a low index of suspicion and the fact G. Pelizzo ! G. Nakib ! V. Calcaterra Pediatric Surgery Unit, Department of Mother and Child Health, IRCSS Polyclinic S. Matteo Foundation, University of Pavia, Pavia, Italy

This work reports on the application of Raman spectroscopy for the analysis of Xenopus laevis oocytes (stage-I). A two-color home-made microscope has been used for this investigation. In particular, a 785nm Raman probe has been used to acquire the spontaneous Raman scattering from the oocyte cytoplasm, while a 532nm probe has been employed to detect carotenoids through Resonant Raman Scattering. Finally, the distribution of beta-carotene along a diameter of a single oocyte has been investigated.