Impairment of chemical clearance is a primary pathophysiological mechanism specific to GERD: it is unaffected by medical/surgical therapy, is not found in FH, and is more pronounced in ERD than in NERD. Using the PSPW index could improve the diagnostic efficacy of impedance-pH monitoring.
At on-therapy impedance-pH monitoring, PSPW index and MNBI efficiently distinguish PPI-refractory NERD from FH. The PSPW index represents an independent predictor of PPI-refractory GERD.
O rthotopic liver transplantation (OLT) is the ideal treatment for hepatocellular carcinoma (HCC) emerging in liver cirrhosis since both the tumor and the underlying cirrhosis can be cured. 1 According to Mazzaferro et al., 2 OLT should be restricted to patients with single HCC lower than 5 cm or with no more than 3 nodules, each smaller than 3 cm, in order to achieve an acceptable rate of tumor recurrence. Several studies confirmed a 5-year survival of 57 to 74% if these selection criteria are taken into account. 3 -8 However, progressive tumor enlargement, occurrence of new nodules or of vascular invasion may take place precluding transplantation in HCC patients awaiting for OLT. Adjuvant treatments such as transarterial chemoembolization (TACE), percutaneous ethanol injection (PEI), and radiofrequency ablation (RFA) have been used to prevent tumor progression in HCC patients listed for OLT, but a clear confirmation of their usefulness is still lacking. 1 The efficacy evaluation of percutaneous ablation techniques is usually made using imaging techniques such as multiphasic computed tomography (CT) and magnetic resonance imaging, assessing the presence of residual arterial vascularization within the nodule. Based upon imaging techniques, the rate of short-term complete necrosis of small HCCs lower than 3 cm has been shown to be 70 to 80% after PEI 9,10 and 90 to 93% after RFA. 10,11 The model of the explanted liver provides an unique opportunity to validate the ablation techniques allowing to evaluate their efficacy result from a pathological point of view. However, there are
Gastrointestinal perforations and post-surgical fistulas are dreaded complications that dramatically increase morbidity and mortality. A new endoscopic over-the-scope clip (OTSC) system may be potentially useful for sealing visceral perforations in several clinical settings. We evaluated the advantages and clinical impact of the placement of OTSCs on the management of non-malignant gut leaks in 12 consecutive patients. OTSCs of 9.5 or 10.5 mm were used, according to the diameter of the defect within the wall. The indications for treatment were mainly related to post-surgical fistulas. Healing of the fistula was assessed by endoscopic or radiological means, and failed only once. No OTSC-related complications occurred. Endoscopic closure of perforations and post-surgical fistulas with the OTSC system is a simple and minimally invasive technique. This approach, when feasible, may be less expensive and more advantageous than a surgical approach.
SUMMARY
BackgroundIn short-segment Barrett's oesophagus (SSBO) heartburn may be absent and oesophageal acid exposure time (OAET) assessed with pH-only monitoring may be normal. By detecting reflux episodes independently of their acidity, multichannel intraluminal impedance-pH (MII-pH) monitoring allows a comprehensive characterization of reflux events, either off or on proton pump inhibitor (PPI) therapy.
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