Graded pneumatic dilation in subtype I and II achalasia: long-term experience in a single center.

Background: The efficacy of pneumatic dilation (PD) in the management of achalasia has yielded variable results. The availability of high-resolution manometry led to the identification of 3 clinically relevant subtypes of achalasia, revealing the poor efficacy of PD in subtype III. Furthermore, PD showed a lower response rate in patients with subtype III compared to laparoscopic Heller myotomy and peroral endoscopic myotomy.

Chronic non-allergic rhinitis with neutrophils is associated with higher acid exposure time: A pH-impedance monitoring study.

Background & Aim: Chronic rhinitis, a diffuse disease with a prevalence of 40%, can be classified in allergic (AR) and non-allergic rhinitis (NAR). Nasal cytology allows for the identification of different NAR sub-types according to the inflammatory cell infiltrate. NAR etiopathogenesis is not well clarified and, for NARNE (non-allergic rhinitis with neutrophils) subtype, gastroesophageal reflux disease (GERD) has been suggested as one of the etiopathogenetic factors.

Echocolor Doppler morpho-functional study of the jugulo-subclavian confluence in chronic cerebro-spinal venous insufficiency and multiple sclerosis patients.

Objectives: The aim of this work is to measure the mean diameter of the confluence jugulo- subclavian, the impact of different types of jugular confluences and the correlation between the types of confluences and the Valsalva maneuver (jugular reflux) in subjects with Chronic Cerebro-Spinal Venous Insufficiency (CCSVI) and Multiple Sclerosis.

Method: We investigated by Echo-Color-Doppler (ECD) 103 subjects (67 F 36M) of mean age 45 ± 12 years (a minimum of 22 to a maximum of 79 years, with a median of 44 and a modal value 42 years), mean EDSS of 4.7 and average disease duration of 12 years.

Why attempt en bloc resection of non-pedunculated colorectal adenomas? A systematic review of the prevalence of superficial submucosal invasive cancer after endoscopic submucosal dissection.

Objective: Endoscopic submucosal dissection (ESD) aims to achieve en bloc resection of non-pedunculated colorectal adenomas which might be indicated in cases with superficial submucosal invasive cancers (SMIC), but the procedure is time consuming and complex. The prevalence of such cancers is not known but may determine the clinical necessity for ESD as opposed to the commonly used piecemeal mucosal resection (endoscopic mucosal resection) of colorectal adenomas. The main aim was to assess the prevalence of SMIC SM1 (ie, invasion ≤1000 µm or less than one-third of the submucosa) on colorectal lesions removed by ESD.

GERD after per-oral endoscopic myotomy as compared with Heller's myotomy with fundoplication: a systematic review with meta-analysis.

Background And Aims: Per-oral endoscopic myotomy (POEM) represents a less invasive alternative to conventional laparoscopic Heller's myotomy (LHM) for patients with achalasia. It cannot be excluded, however, that the lack of fundoplication after POEM may result in a higher incidence of reflux disease, as compared with LHM. The aim of our study was to conduct a systematic review of prospective studies reporting the incidence of reflux disease developed after POEM and LHM.

Ductal stones recurrence after extracorporeal shock wave lithotripsy for difficult common bile duct stones: Predictive factors.

Background & Purpose: Extra-corporeal shock wave lithotripsy (ESWL) can be considered in difficult common bile duct stones (DCBDS), with a success rate greater than 90% but data on stone recurrence after ESWL are limited. We performed a retrospective analysis to evaluate long-term outcomes in patients who underwent ESWL for DCBDS.

Methods: From May 1992 to October 2012, patients who underwent ESWL treatment for DCBDS, not amenable to endoscopic extraction, were included.

Successful extracorporeal shock wave lithotripsy (ESWL) treatment of a symptomatic massive biliary stone proximal to an anastomotic biliary stricture.

Postoperative benign biliary stricture in the anastomotic site is one of the most common complications of biliary-enteric anastomosis, with a rate of 6.87% after 2-13 years of follow-up. If untreated, biliary strictures can induce other complications such as recurrent cholangitis, intrahepatic stones, pancreatitis and secondary biliary cirrhosis.

The management of 'hard-to-prepare' colonoscopy patients.

Effective bowel cleansing is crucial for high quality colonoscopy. A notable portion of patients still present with low quality bowel preparation prior to their colonoscopy, compromising the overall quality of their colonoscopy. Areas covered: This review focuses on the main strategies that can improve the cleansing quality with a special interest on those clinical conditions that have been associated with a poor bowel preparation quality, such as patients with chronic constipation, history of bowel resection, liver cirrhosis, diabetes mellitus and chronic kidney disease.

Clinical outcomes after endoscopic submucosal dissection for colorectal neoplasia: a systematic review and meta-analysis.

Background And Aims: Endoscopic submucosal dissection (ESD) is an endoscopic resection technique for lesions suspicious of superficial malignancy. It is performed using an ESD knife on its own (standard technique) or by the sequential use of a knife and a snare (hybrid technique). The experience with these techniques is different in Asian and non-Asian countries.

Brachytherapy for the palliation of dysphagia owing to esophageal cancer: A systematic review and meta-analysis of prospective studies.

Background: The management of dysphagia owing to esophageal cancer is challenging. Brachytherapy has been proposed as an alternative option to stent placement. We performed a systematic review to examine its efficacy and safety in the resolution of dysphagia.

Job stress: an in-depth investigation based on the HSE questionnaire and a multistep approach in order to identify the most appropriate corrective actions.

Background: Psychosocial hazards and work-related stress have reached epidemic proportions in Europe. The Italia law introduced in 2008 the obligation for Italian companies to assess work related stress risk in order to protect their workers' safety and health. The purpose of our study was to propose an accurate measurement tool, using the HSE indicator tool, for more appropriate and significant work-related stress' prevention measures.

Ionizing radiation and stress: the analysis of the medical ray technician.

Background: The present study aims to analyzing the relation between the work-related distress with the exposition to ionizing radiations in the radiology technicians, in the hospital environment.

Materials And Methods: Our present study has been conducted on a group of 36 sanitary technicians (14 women and 22 man, with an average age of 48±10,1 years) working in the Hospital Radiology Pavilion; 28 of them were less-exposed to radio-active emissions (B Category) and 8 were more exposed to radio-active emissions (A Category). The HSE questionnaire has been administered to all the 36 sanitary technicians.

Venous compression syndrome of internal jugular veins prevalence in patients with multiple sclerosis and chronic cerebro-spinal venous insufficiency.

Objectives: Analysis of the incidence of Venous Compression Syndrome (VCS) with full block of the flow of the internal jugular veins (IJVs) in patients with Multiple Sclerosis and Chronic cerebro-spinal venous insufficiency.

Methods: We included 769 patients with MS and CCSVI (299 males, 470 females) and 210 controls without ms and ccsvi (92 males, 118 females). each subject was investigated by echo-color-doppler (ecd).

A new mechanism of gastroesophageal reflux in hiatal hernia documented by high-resolution impedance manometry: a case report.

Gastroesophageal reflux disease (GERD) is recognized to be a multifactorial disease and several mechanisms leading to reflux have been described, nevertheless its pathophysiology has not been fully clarified. Hiatus hernia is a known risk factor for GERD since it impairs the esophagogastric junction, leading to: reduction in lower esophageal sphincter pressure; increase in the frequency of the transient lower esophageal sphincter relaxation; and impairment of esophageal clearance. Last generation diagnostic techniques have improved the understanding of these mechanisms.

Underuse of brachytherapy for the treatment of dysphagia owing to esophageal cancer. An Italian survey.

Background: International guidelines strongly recommend brachytherapy as valid alternative or in addition to stenting in patients with dysphagia owing to esophageal cancer. However, for not well understood reasons, brachytherapy is definitively underused for the palliative treatment of malignant dysphagia. Aim of the current survey was to investigate the use of brachytherapy for the treatment of malignant dysphagia in Italy.

Working over 5,000 m: medical check-up.

Any work activity performed at elevations over 3,000 m above sea level is considered as work at high altitude. The changing environmental conditions result in an adaptation of the human organism, mainly due to a reduced partial pressure of oxygen in the air and a proportional decrease in barometric pressure. We carried out a systematic review of the scientific literature in this field so as to develop a health and risk protocol as well as a procedure of ascent for researchers and staff expected to work in a science research lab at an altitude of 5,100 m asl.

Jugular diameter and venous reflux.

Objectives: Aims of this study were to investigate the prevalence of reflux on internal jugular veins(IJV) by Valsalva maneuver and to define the association between reflux of IJV in subjects with both CCSVI and MS.

Methods: We recruited 393 patients with MS and CCSVI. Study participants underwent EchoColor Doppler exam in order to define IJV diameter at confluence in subclavian (JSd).

C1-C2 X-Ray assessment of misalignment parameters in patients with Chronic Cerebra-spinal Venous Insufficiency and Multiple Sclerosis versus patients with other pathologies.

Purpose: The complete compression of the internal jugular veins, in front position, shows a prevalence of 48% and it is equally distributed in the various segments of these veins in patients with Chronic Cerebro-Spinal Venous Insufficiency (CCSVI) and Multiple Sclerosis (MS). The aim of this search is to identify radiological dislocation of C1-C2 as specific markers in patients with CCSVI and Multiple Sclerosis (MS).

Method: We investigated 386 patients suffering from CCSVI and Multiple Sclerosis and a control group of 156 patients without MS.

New acoustic wave therapy improves quality of life in patients with multiple sclerosis and chronic cerebrospinal venous insufficiency.

A Multiple Sclerosis patient with chronic cerebrospinal venous insufficiency (CCSVI) treated by acoustic waves, modulated in frequency and power of the Dreno-MAM® device, showed a progressive improvement in motor coordination, resistance to work, muscular power and rigidity, and distal microcirculation. Life quality, chronic fatigue, and clinical severity questionnaires EDSS show marked improvements with a follow-up of two years. We suggest that the method could be also used in the chronic fatigue syndrome and other neurological diseases such as Parkinson or Meniere syndrome.

Preliminary results after upper cervical chiropractic care in patients with chronic cerebro-spinal venous insufficiency and multiple sclerosis.

Purpose: The aim of the study is to evaluate the clinical and X-ray results of the Upper Cervical Chiropractic care through the specific adjustments (corrections) of C1-C2 on patients with chronic venous cerebral-spinal insufficiency (CCSVI) and multiple sclerosis (MS).

Method: We studied a sample of 77 patients before and after the Upper Cervical Chiropractic care, and we analyzed: A) The change of the X-ray parameters; B) The clinical results using a new set of questions. The protocol of the C1- C2 upper Cervical Chiropractic treatment, specific for these patients, lasts four months.

Liver and spleen stiffness and other noninvasive methods to assess portal hypertension in cirrhotic patients: a review of the literature.

Portal hypertension (PH) is one of the most important causes of morbidity and mortality in patients with chronic liver disease. PH measurement is crucial to stage and predict the clinical outcome of liver cirrhosis. Measurement of hepatic vein pressure gradient is considered the gold standard for assessment of the degree of PH; however, it is an invasive method and has not been used widely.

Spleen stiffness measurement can predict clinical complications in compensated HCV-related cirrhosis: a prospective study.

Background & Aims: Hepatic venous pressure gradient (HVPG) measurement represents the best predictor of clinical decompensation (CD) in cirrhotic patients. Recently data show that measurement of spleen stiffness (SS) has an excellent correlation with HVPG levels. Aim of the present prospective study was to assess SS predictive value for CD compared to HVPG, liver stiffness (LS), and other non-invasive tests for portal hypertension in a cohort of patients with HCV-related compensated cirrhosis.