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BACKGROUND: Double-balloon enteroscopy is a newly developed endoscopic method allowing non-surgical full-length exploration of the small bowel, biopsies sample and endoscopic treatment of previously inaccessible lesions. AIM: To prospectively assess the diagnostic and therapeutical impact of double-balloon enteroscopy in patients with suspected or documented small bowel disease. PATIENTS AND METHODS: One hundred consecutive patients referring to our centre for suspected small bowel disease underwent double-balloon enteroscopy. Starting insertion route (anal or oral) of double-balloon enteroscopy was chosen according to the estimated location of the suspected lesions basing on the clinical presentation and on the findings, when available, of previous endoscopic or radiological investigations. Major indications for the procedures were acute recurrent or chronic mid-gastrointestinal bleeding (n=71), suspected gastrointestinal tumours (n=10), suspected Crohn's disease (n=6), chronic abdominal pain and/or chronic diarrhoea (n=8), refractory celiac disease (n=5). RESULTS: One hundred and eighteen double-balloon enteroscopy procedures were carried out. Oral and anal route double-balloon enteroscopies were performed in 54 and 28 patients, respectively, while 18 patients underwent a combination of both approaches. Overall diagnostic yield of double-balloon enteroscopy resulted 69%. Most common pathological findings included angiodysplasias (n=39), ulcerations and erosions of various aetiologies (n=21), tumours (n=7) and ileal stenosis in patients with Crohn's disease suspicion (n=2). In the 65% of the patients examined, double-balloon enteroscopy findings influenced the subsequent clinical management (endoscopic, medical or surgical treatment). No major complications related to the procedure occurred. CONCLUSIONS: Our prospective analysis shows that double-balloon enteroscopy is a useful, safe and well-tolerated new method with a high diagnostic and therapeutic impact for th

This study evaluated the anaesthetic management of 20 patients, undergoing intra-operative radiation therapy for pancreatic or rectal tumours. Patients with a re-approximated surgical incision were transferred from the operating room to the radiotherapy department while still under anaesthesia. The risks of such transport as well as guidelines for the patient's care during this phase are examined. The results of this study indicate that in order to transport anaesthetized patients safely it is necessary to ensure stable cardiovascular, respiratory and metabolic conditions prior to their transfer. It is also important to guarantee adequate analgesia and to establish appropriate monitoring during transport.

L'anestesia nella chirurgia addominale del paziente ultraottantenne

The purpose of this work was to verify the usefulness of somatosensory evoked potentials (SEPs)in detecting cerebral ischemia and the need for a shunt during carotid endarterectomy (CEA).

Gli autori hanno condotto uno studio su 356 pazienti sottoposti ad interventi di chirurgia maggiore per verificare la validità di tre differenti metodiche di analgesia postoperatoria : morfina per via peridurale, analgesici per via parenterale, blocco dei nervi intercostali.