Low-volume plus ascorbic acid vs high-volume plus simethicone bowel preparation before colonoscopy

AIM:To investigate the effectiveness of low-volumeplus ascorbic acid [polyethylene glycol plus ascorbicacid(PEG + Asc) ] and high-volume plus simethicone[polyethylene glycol plus simethicone(PEG + Sim) ]bowel preparations.METHODS:A total of one hundred and forty-fourout patients(76 males) ,aged from 20 to 84 years(me-dian age 59.5 years) ,who attended our Department,were divided into two groups,age and sex matched,and underwent colonoscopy. Two questionnaires,onefor patients reporting acceptability and the other forendoscopists evaluating bowel cleansing effectivenes saccording to validated scales,were completed. Indications,timing of examination and endoscopical findings were recorded. Biopsy forceps were used as a measuring tool in order to determine polyp endoscopic sizeestimation. Difficulty in completing the preparation wasrated in a 5-point Likert scale(1 = easy to 5 = un-able) . Adverse experiences(fullness,cramps,nausea,vomiting,ab dominal pain,headache and insomnia) ,number of evacuations and types of activities performed during preparation(walking or resting in bed) were also investigated.RESULTS:Seventy-two patients were selected for eachgroup. The two groups were age and sex matched aswell as being comparable in terms of medical historyand drug therapies taken. Fourteen patients droppedout from the trial because they did not complete the preparation procedure. Ratings of global bowel cleansing examinations were considered to be adequate in91% of PEG + Asc and 88% of PEG + Sim patients.Residual Stool Score indicated similar levels of amountand consistency of residual stool;there was a significant difference in the percentage of bowel wall visuali-zation in favour of PEG + Sim patients. In the PEG +Sim group,12 adenomas ≤ 10 mm diameter(5/left co-lon + 7/right colon) vs 9(8/left colon + 1/right colon) in the PEG + Asc group were diagnosed. Visualization of small lesions seems to be one of the primary advantages of the PEG + Sim preparation.CONCLUSION:PEG + Asc is a good alternative solution as a bowel preparation but more improvements arenecessary in order to achieve the target of a perfect preparation.

Liver metastases:Contrast-enhanced ultrasound compared with computed tomography and magnetic resonance

The development of ultrasound contrast agents with excellent tolerance and safety profiles has notably improved liver evaluation with ultrasound(US)for several applications,especially for the detection of metastases.In particular,contrast enhanced ultrasonography(CEUS)allows the display of the parenchymal microvasculature,enabling the study and visualization of the enhancement patterns of liver lesions in real time and in a continuous manner in all vascular phases,which is similar to contrast-enhanced computed tomography(CT)and contrast-enhanced magnetic resonance imaging.Clinical studies have reported that the use of a contrast agent enables the visualization of more metastases with significantly improved sensitivity and specificity compared to baseline-US.Furthermore,studies have shown that CEUS yields sensitivities comparable to CT.In this review,we describe the state of the art of CEUS for detecting colorectal liver metastases,the imaging features,the literature reports of metastases in CEUS as well as its technique,its clinical role and its potential applications.Additionally,the updated international consensus panel guidelines are reported in this review with the inherent limitations of this technique and best practice experiences.

The Pyramidal Lobe of the Thyroid

Anatomy of the thyroid has been extensively studied but the presence of pyramidal lobe varies in percentages from 15% to 75% of cases according to different authors. We therefore investigated systematically this peculiar anatomical aspect. From January 2001 to December 2011, 1002 patients underwent total thyroidectomy in our Division of General Surgery. We analyzed the data collected on the latest 200 thyroidectomies: for all patients pyramidal lobe was measured at removal of the specimen then dimension of the pyramidal lobe after fixation was checked. We found the pyramidal lobe in all cases. In most cases, it was approximately 2 cm (range 1 - 8 cm on fresh specimen). At histology it was described in 72% of cases, after fixation size decreased by a third approximatively. This is the first systematic intraoperative study to verify the prevalence of the thyroid pyramidal lobe. In our experience, the pyramidal lobe is always present and the thyroglossal duct is identifiable.