Nurse-led renal cell carcinoma clinic: a single center review

BACKGROUND

In 2015 our centre introduced a nurse-led renal cell cancer follow-up protocol and clinic for patients who have undergone partial or radical nephrectomy for organ-confined kidney tumours. The main aims of this clinic were to improve healthcare efficiency and standardize follow-up processes.

OBJECTIVES

The primary objective was to assess the effectiveness of a nurse-led renal cell cancer follow up clinic in regard to surveillance protocol compliance and the timely identification and appropriate management of recurrences. A secondary objective was to evaluate this locally developed follow up protocol against the current European Association of Urology (EAU) guidelines surveillance protocol.

PATIENT AND METHODS

All patients who underwent a partial or radical nephrectomy between 2015 and 2021 at a single Western Australia institution for a primary renal malignancy were included. Data was collected from local clinical information systems and protocol adherence, recurrence characteristics and management were assessed. The current EAU guidelines were applied to the cohort to assess differences in risk-stratification and theoretical outcomes between the protocols.

RESULTS

After a mean follow up period of 31.2 months (range 0-77 months), 75.5% (185/245) of patients had all follow up imaging and reviews within 1 month of the timeframe scheduled on the protocol. 17.1% (42/245) had a delay in their follow up of more than a month at some stage, 5.7% (14/245) did not attend for follow up but had documented attempts to facilitate their compliance, and 0.4% (1/245) were lost to follow up with no evidence of attempted contact. 15.5% (38/245) of patients had recurrence of malignancy detected during follow up and these were all discussed in a multi-disciplinary team (MDT) meeting. The recurrence rate was 2.5% (3/119) for low risk, 17.7% (14/79) for intermediate risk, and 44.7% (21/47) for high risk patients when they were re-stratified according to EAU risk categories. No recurrences were detected through ultrasound (USS) or chest x-ray (CXR) in this cohort and our protocol tended to place patients in higher risk-stratification groups as compared to current EAU guidelines.

CONCLUSION

Nurse-led renal cell cancer follow up is a safe, reliable and effective clinical framework that has significant benefits in regard to resource utilization. USS and CXR are ineffective in detecting recurrence and Computerized tomography (CT) should be considered the imaging modality of choice for this purpose. The EAU surveillance protocol appears superior to our protocol, and we have therefore transitioned to the EAU guideline protocol going forward.

99m Tc sestamibi SPECT/CT in the prediction of malignant versus benign small renal masses

OBJECTIVES

To determine the effectiveness of ^99m Tc-sestamibi renal SPECT/CT in distinguishing between malignant and benign renal lesions.

PATIENTS AND METHODS

Between June 2018 and October 2020 all patients with new indeterminate small renal masses (SRMs) underwent ^99m Tc-sestamibi renal SPECT/CT prior to biopsy or surgery. The accuracy of ^99m Tc-sestamibi imaging diagnoses was assessed against histopathology. Receiver operating characteristic (ROC) analysis was used to determine the optimum cut-off for the tumour:normal uptake ratio. Logistic regression was used to determine if quantitative analysis significantly added to visual interpretation alone.

RESULTS

A total of 74 patients with SRMs were investigated with ^99m Tc-sestamibi SPECT/CT. SPECT/CT correctly identified 49 malignant tumours and 11 benign tumours, resulting in a sensitivity of 0.89 [95% CI: 0.77 - 0.95] and a specificity of 0.73 [95% CI: 0.45 - 0.91]. ROC analysis of uptake ratios demonstrated that a tumour:normal uptake ratio of 0.41 provided optimal diagnostic accuracy (sensitivity 0.81, specificity 0.88, area under the curve 0.883 [95% CI:0.794 - 0.971]). The uptake ratio was also highly significant in excluding malignancy on univariate logistic regression analysis whereby the higher the uptake ratio, the lower the chances were for malignancy (OR 0.009,95% CI: 0.001-0.118, p < 0.001. However, this did not improve diagnostic accuracy when compared to visual interpretation alone.

CONCLUSION

^99m Tc-sestamibi SPECT/CT is a non-invasive technique with good accuracy in determining if a SRM is benign or malignant.

Repeat transurethral resection is still an essential tool in treating non-muscle invasive bladder cancer: the Western Australian experience

OBJECTIVES

To determine the rate of residual disease and under-staging after primary transurethral resection (TUR) of bladder tumors (TURBT) in tertiary hospitals in Western Australia.

METHODS

A retrospective study was performed evaluating all patients with TaHG (stage Ta, high-grade), T1LG (stage T1, low-grade) or T1HG (stage T1, high-grade) bladder cancer on primary TURBT conducted between January 1, 2012 and December 31, 2017 at the four largest metropolitan public hospitals in Western Australia. Only patients who underwent repeat resection within 3 months from initial resection were included. Those with previous history of bladder cancer, incomplete follow-up data and visibly incomplete initial resection were excluded. Baseline patient demographics, macroscopic clearance at initial resection, and disease data at initial and repeat resections were recorded.

RESULTS

Sixty-seven patients with a median age of 71 years were included in this study. At initial resection, T1HG was the most common disease stage (64.2%) and detrusor muscle was present in 82.1% of initial resections. At repeat resection, 41.8% of cases had residual disease. The rate of upstaging to muscle-invasive bladder cancer was 3.0%. Patients treated by operators with five or less years of formal training did not have a significantly different rate of residual disease from patients treated by operators with more than five years of experience.

CONCLUSIONS

Repeat TUR should remain an essential practice due to high rates of residual disease and a small risk of tumor under-staging. The presence of detrusor muscle and macroscopic clearance should not be used as surrogates for adequacy of resection or consideration of avoiding a repeat TUR, even for TaHG disease.

Extended pelvic lymph node dissection for clinically localized prostate cancer: a West Australian experience

BACKGROUND

The role and type of pelvic lymph node dissection for clinically localized prostate cancer is controversial in Australia. Our study aims to determine the incidence of pelvic lymph node involvement and the complication rate of extended lymphadenectomy in a group of West Australian patients who underwent a robotic assisted radical prostatectomy plus extended pelvic lymph node dissection.

METHOD

Forty-nine patients underwent a robotic assisted radical prostatectomy with extended pelvic lymph node dissection between 2008 and 2012 by a single private urological surgeon. The inclusion criteria for the extended lymph node dissection were clinical localized, intermediate and high-risk prostate cancer based on preoperative D'Amico classification.

RESULTS

Of the 49 patients, eight patients had positive nodes giving a nodal positivity rate of 16.33%. Six patients had a complication giving a total complication rate of 12.24%. Three of these complications have been attributed to the nodal dissection, thus giving an extended pelvic lymph node dissection complication rate of 6.12%.

CONCLUSION

Rates of nodal involvement in our West Australian cohort are in keeping with those published in the literature. Extended pelvic lymph node dissection can be performed with an acceptable complication rate. Further research is required to investigate the therapeutic role of pelvic lymph node dissection.

En bloc kidney transplant from an 18-month-old donor to an adult recipient: Case report and literature review

INTRODUCTION

There is an ever-increasing need for organ donations globally. Paediatric kidney transplantation into adult recipients is a well-recognised technique to expand the donor pool. The transplantation can be done either via en bloc kidney transplant (EBKT) or as single kidney transplantation (SKT).

PRESENTATION OF CASE

An EKBT from a 18-month-old (15 kg) male patient was transplanted in a 35-year old, 85 kg male with end stage renal failure (ESRF), secondary to Focal Segmental Glomerulosclerosis (FSGS) on haemodialysis. Post-operative recovery was uneventful. Immuno-suppressant drugs used were tacrolimus, basiliximab and prednisolone. Doppler ultrasound scans performed post-operatively showed normal renal resistive indices in both kidneys. Serum creatinine decreased from 1200 to 170 μmol/L 57 with eGFR improving from 4 to 38 mL/min/1.73 m² at four weeks post-transplant.

DISCUSSION

Given the low incidence of paediatric donors, EBKTs are relatively uncommon and subsequently published series tend to be centre specific with small numbers. The graft survival rates tell us that paediatric kidney donors should not be considered as marginal transplants. The difficulty is in determining when it is more appropriate to perform a paediatric EBKT as opposed to splitting and performing two SKT. Unfortunately there are no widely accepted guidelines to direct clinicians.

CONCLUSION

This case report highlights the first EKBT performed at our institution. The current literature demonstrates that paediatric donors are excellent resources that should be procured whenever available.

Beneficial effects of fibrin glue (Quixil) versus Lichtenstein conventional technique in inguinal hernia repair: a randomized clinical trial

INTRODUCTION

In inguinal hernia repair, many complications are due to mesh fixation technique. Therefore, new types of atraumatic methods of fixation have been proposed. In this article, we present the results of a prospective multicentric parallel randomized controlled trial aiming to compare two mesh fixation techniques: fibrin sealant (QUIXIL(®), Omrix Biopharmaceuticals S.A., Belgium) and Lichtenstein technique.

METHOD

Adult patients with primary uncomplicated inguinal hernia were randomized in two groups: fibrin sealant group (FSG) and Lichtenstein group (LTG). The two groups underwent a follow-up of 15 months. Operative time is the primary outcome. Intraoperative and postoperative outcomes were analyzed. Moreover, a differential cost analysis was performed. Patients and evaluators (with exception of the surgeon who treated the patient) were blinded.

RESULTS

A total of 102 patients, 50 in FSG and 52 in LTG, were enrolled from January 2009 to June 2010, and two patients were lost to follow-up at the twelfth month. No significant differences in baseline and clinical characteristics were observed in the two groups. Operative time was longer in LTG (median/ interquartile range: 35 min/30-42.5 min vs. 31 min/28-35 min; effect size: 0.65/95% CI 0.50-0.91; p < 0.05). No differences in intraoperative complications were observed. No significant differences were observed in early complication rate (RR = 0.62; p > 0.05). Numbness rate was lower in the FSG at 1 week (RR = 0.43; p < 0.01) and at 1 month (RR = 0.17; p < 0.05). No significant differences were observed after 6 months. Postoperative pain was lower in the FSG at 1 week (0/0-1 vs. 1/0-2; p < 0.05) and at 1 month (0/0-0 vs. 0/0-1; p < 0.05). Pain disappeared in all patients after 6 months. Analgesic assumption rate was lower in the FSG (RR = 0.42; p < 0.05). Twenty per cent of FSG and 9.62% of LTG patients were discharged within 12 h; 78% of FSG and 90.38% of LTG patients were discharged within 24 h. The only one recurrence we observed was in FSG group. About costs, although fibrin sealant needed for one mesh fixation is about 10 times more costly than the needed sutures, the total costs of the two procedures did not change significantly. This was mainly due to reduction in operative time.

CONCLUSIONS

The use of fibrin sealant determined a significant reduction in short-term numbness rate and postoperative pain. There was no relevant difference in total costs per patient between the two procedures.

Nosocomial bacteremia and catheter infection by Bacillus cereus in an immunocompetent patient

We present a case of Bacillus cereus bacteremia and catheter infection in an immunocompetent patient subjected to abdominal surgery, who recovered following central catheter removal and treatment with piperacillin/tazobactam.

Stromal tumors of the stomach. Review of our experience and reclassification of a series of patients

OBJECTIVE

To retrospectively review a series of 12 patients operated on in our department for stromal tumor of the stomach. Clinical and morphological data, and the patients' postoperative course, were analyzed.

METHODS

Medical records for 12 patients (mean age 63.3 years) were retrospectively reviewed to obtain data on clinical presentation, diagnosis and treatment. Surgical morbidity and mortality were analyzed. A pathologist reviewed the resected specimens to determine the morphological factors of prognostic value. The biological nature of the tumor was reclassified based exclusively on mitotic index, and all tumors were staged according to the TGM system. Recurrence and survival rates were also calculated.

RESULTS

The most frequent clinical presentation was abdominal pain and gastrointestinal bleeding. The most sensitive diagnostic methods were computerized tomography and echographic endoscopy. Operability and resectability rates were 100% and 91.6% respectively. Local resection was done in 5 patients, partial gastrectomy in 5, and extended total gastrectomy in 1. Histologically, 6 cases were muscular tumors (2 leiomyomas, 3 low-grade leiomyosarcomas and 1 high-grade leiomyosarcoma), 2 were gastrointestinal autonomic nerve (GAN) tumors, and 4 were pure stomal tumors. The morbidity rate was 33.3% and the mortality rate was 8.3% (1 patient). All patients were followed up: 1 patient each died after 9 months and 4 years, 1 developed liver metastases after a disease-free interval of 14 months, and the other 9 patients were still alive and free of disease after intervals ranging from 4 months to 7 years.

CONCLUSIONS

Stromal tumors include a group of tumors which may present muscular differentiation (the most frequent type), neural differentiation (GAN tumors) or no differentiation at all (pure stromal tumors). The mitotic index is the most valid parameter to determine biological nature, considering that classification as a benign tumor requires the total absence of mitoses. Treatment was mostly surgical, and local resection with adequate safety margins was effective. Prognosis was relatively good, but long-term follow-up is needed to assess the malignant potential of these tumors.

Partial hepatectomy accelerates local tumor growth: potential roles of local cytokine activation

BACKGROUND

Surgical excision of liver tumors represents the only curative treatment for primary and metastatic liver malignancies. It has been suspected that hepatectomy may stimulate growth of microscopic tumors. To determine whether local or systemic factors after hepatectomy are responsible for enhancement of tumor growth, the effects of hepatectomy on the experimental growth of liver or pulmonary tumors were examined.

METHODS

One hour after injection of 10(6) Morris hepatoma cells into either the portal or femoral vein, which produces isolated liver and lung tumors, respectively, animals were randomized to undergo 0%, 30%, or 70% partial hepatectomy (PH).

RESULTS

Animals that underwent portal injection of tumor had significantly increased liver tumor burden after PH (sham, 25 +/- 7 vs PH, 94 +/- 17; p < 0.01), whereas animals that underwent femoral injection had no change in lung tumor burden after PH. PH was associated with significantly increased levels of transforming growth factor-alpha, transforming growth factor-beta, and basic fibroblast growth factor in the liver but not in the lung.

CONCLUSIONS

Changes in liver cytokine-growth factor activation may contribute to enhanced tumor growth in the liver after hepatectomy.

Hepatic resection for noncolorectal, nonneuroendocrine metastases: a fifteen-year experience with ninety-six patients

BACKGROUND

The role of liver resection for hepatic metastases from noncolorectal, nonneuroendocrine (NCNN) cancers is unknown. This study examines a large, single institutional experience of hepatic resection for NCNN metastases.

METHODS

Records of 96 patients who underwent liver resection for metastatic NCNN cancer from 1980 to 1995 at a single institution were reviewed. Survival after liver resection in this cohort of patients is reported, and factors predictive of survival are analyzed.

RESULTS

Resection was performed for liver metastases from genitourinary primary tumors (n = 34), soft tissue primary tumors (n = 41), and metastases from other primary cancers (n = 21). Extent of liver resection included wedge (n = 32), lobectomy (n = 44), and extended hepatic lobectomy (n = 20). No operative deaths occurred. Overall survival rate after resection at 1, 3, and 5 years was 80%, 45% and 37%, respectively (median survival, 32 months), with 12 actual 5-year survivors. There was no difference in survival according to the type of liver resection, bilateral versus unilateral disease, or resection of extrahepatic disease. Disease-free interval of less than 36 months before discovery of liver metastases, curative resection, and primary tumor group (genitourinary was greater than soft tissue, which was greater than gastrointestinal) were predictors of a significantly better survival by multivariate analysis.

CONCLUSIONS

Primary tumor type, disease-free interval, and curative resection predict those patients who benefit from hepatic resection. Hepatic resection for patients with NCNN metastasis has value in carefully selected patients.

Factors influencing hepatocyte trafficking during allogeneic hepatocyte transplantation: improved liver sequestration with isolated perfusion

Transplantation of normal or ex vivo modified hepatocytes holds promise in therapy of a variety of diseases. In order to investigate hepatocyte trafficking, and specifically to determine whether the route, method of delivery, or other host factors may affect hepatocyte sequestration in the liver, 51chromium- and 111indium-labeled hepatocytes were transplanted into allogeneic hosts. Systemic injection of hepatocytes into the femoral vein resulted in sequestration mainly in the lungs (30 +/- 4%) whereas sequestration in the liver amounted to only 5 +/- 1%. Portal injection resulted in a dramatic increase in the liver sequestration (52 +/- 4%) and a reduction in the lung (2 +/- 1%, P < 0.05 vs systemic injection). Nevertheless, nearly half of portally injected hepatocytes came to rest in other organ sites. Partial hepatectomy prior to transplantation did not change the total hepatocyte sequestration in the liver or the organ specific activity. A remote site of inflammation, in the form of a turpentine abscess, also did not alter the pattern of hepatocyte trafficking. Isolated perfusion of the liver with labeled hepatocyte, however, significantly increased the sequestration of hepatocytes at this organ (control, 52 +/- 4%; isolated perfusion, 71 +/- 9%; P < 0.05). In the delivery of potentially toxic gene products for therapy, isolated perfusion of the target organ appears to provide the greatest likelihood of restricting expression of potentially toxic gene products to the target organ.

Prediction of survival and recurrence by serum and cytosolic levels of CEA, CA125 and SCC antigens in resectable non-small-cell lung cancer

Risk of death and risk of recurrence in 108 potentially curable non-small-cell lung cancer patients were analysed with respect of TNM stage, histological type and carcinoembryonic antigen (CEA), CA125 antigen and squamous cell carcinoma antigen (SCC) levels in serum and cytosol. CA125 and CEA levels were closely related to outcome figures. Multivariate analyses indicated that TNM stage and histological type had the best predictive power, but serum and cytosolic CA125 and serum CEA contained additional, independent prognostic information. Predictive information drawn from serum and cytosolic levels proved mutually complementary. We conclude that CA125 and CEA complement TNM classification and histological type for the purpose of quantifying risk of death or recurrence.

[Epidermal growth factor receptor in non-small cell cancer of the lung]

In this study we determined the concentration of epidermic growth factor receptors (EGFr) in non-small cell carcinoma of the lung (NSCCL) and analyzed its relation to the anatomical, pathological and clinical factors of these neoplasms. The concentration of EGFr in 62 tumor tissue samples was 9.9 +/- 14 fmol/mg, higher than that found in 14 tissue samples from cases of spontaneous pneumothorax (3.9 +/- 3.6 fmol/mg) (p = 0.005). EGFr concentration in lung tissue with no signs of neoplasm was 6.5 +/- 10 fmol/mg. In 21 (33%) cases of NSCCL the concentration exceeded the normal threshold of 10 fmol/mg. EGFr concentration was higher in cases of epidermoid carcinoma than in other tissue samples (p = 0.042). No significant association was found between EGFr levels and status of tumor node metastasis, degree of differentiation and mitotic index. The probability of remaining free of tumor recurrence and of survival after 24 months among patients whose tumoral EGFr concentration was below 10 fmol/mg was 34 and 40%, respectively. The rates for patients with concentrations that exceeded the threshold were 20% (p = 0.32) and 25% (p = 0.26), respectively. The results seem to indicate that the study of EGFr concentration alone does not yield practically important information for the management of patients with NSCCL who have undergone surgery. The concentration of EGFr marks degree of differentiation in NSCCL and has prognostic implications derived from its association with other factors.

Tissue-specific modulation of insulin receptor mRNA levels in a patient with a phaeochromocytoma

We have observed that the expression of the insulin-receptor gene is regulated in a tissue-specific manner in a patient with a phaeochromocytoma. Our results indicate that insulin receptor mRNA levels are decreased in adipose tissue and increased in both liver and skeletal muscle as compared with the corresponding values in the same tissues of a control patient. These findings provide the first evidence that insulin receptor mRNA levels may be modulated in vivo by high levels of catecholamines.

[Peutz-Jeghers syndrome with malignization of hamartomatous polyp]

Peutz-Jeghers syndrome is characterized by hamartomatous polyps in the gastrointestinal tract associated with mucocutaneous melanin spots; the condition is inherited in an autosomic dominant fashion. Although the hamartomatous polyps are not regarded as malignant, there is an association between the Peutz-Jeghers syndrome and the development of carcinomas of the gastrointestinal tract. Similarly, there is an increasing evidence suggesting that hamartomas can give rise to adenocarcinomas. We present a patient with Peutz-Jeghers syndrome who developed an adenocarcinoma in an hamartomatous jejunal polyp.

Value of serum neuron-specific enolase in nonsmall cell lung cancer

To assess the prognostic value of pretreatment serum neuron-specific enolase (NSE) in nonsmall cell lung cancer (NSCLC), levels were measured in 84 NSCLC patients, 40 healthy controls, and 20 patients with benign pulmonary diseases. NSE concentration was higher in NSCLC (11.7 +/- 10.8 ng/ml) (mean +/- SD; median = 9.7 ng/ml) than in the two control groups (p < 0.001). Serum NSE was neither related with the tumor-node-metastasis (TNM) stage, nor with histologic subtype. At a cutoff value of 15 ng/ml, NSE had a sensitivity of 27.3% and a specificity of 96%. Patients with a preoperative NSE level < 15 ng/ml showed significantly longer 24-month survival than those whose initial levels were > 15 ng/ml (70 vs, 47%; p < 0.05), and this was confirmed after stratifying by TNM stage. Likelihood of tumor relapse in I, II, and IIIa TNM stages showed similar behavior. These findings suggest that NSE could be used as an adjunctive prognostic test in NSCLC patients.

Immunohistological study of grumose degeneration of the dentate nucleus in progressive supranuclear palsy

The grumose degeneration observed in the dentate nuclei of 7 cases of progressive supranuclear palsy (PSP) was studied with a panel of antibodies which included 2 neurofilaments, Tau and ubiquitin. Dentate nucleus neurons were negative with all antibodies except ubiquitin which showed a slightly positive homogeneous pattern of staining. The amorphous material surrounding swollen or normal neurons was strongly positive for neurofilament and subunits and numerous torpedoes were observed in the granular layer of the cerebellar cortex. Our results confirm that grumose degeneration consists in degeneration of terminal axons of Purkinje cells in the dentate nucleus. The positivity of dentate nucleus neurons for ubiquitin may support the concept of synaptic dysfunction between Purkinje cells and dentate nucleus neurons.

[Bacteremic pneumonia caused by Rhodococcus equi and HIV infection. Report of a new case and review of the literature]

Rhodococcus equi (Corynebacterium equi) is able to produce infections not only in animals but also in patients, usually immunosuppressed ones. We report a new case of bacteremic pneumonia in a drug addict who was also infected by HIV. X-ray film of the chest showed a cavitated infiltrate in right upper lobe. R. equi was recovered from blood, respiratory secretions and lung tissue. The patient was with a prolonged course of antibiotics and also surgical treatment. In spite of both therapies, the patient died. We believe that this infection has to be considered in HIV infected patients with cavitated pneumonia and that early surgical treatment, combined with a prolonged course of multiple antibiotics, is advisable. Finally, in view of the severity of this infection, and its relation with other opportunistic infections, we believe that could be included as AIDS diagnostic criteria.

Evaluation of serum CA 125 as a tumor marker in non-small cell lung cancer

Serum CA 125 levels were evaluated in 130 healthy subjects and 133 patients with untreated pulmonary lesions. These were 33 patients with benign pulmonary conditions and 100 with lung cancer. The mean concentration of CA 125 was higher in patients with lung cancer (37 +/- 81 U/ml) than in those with nonmalignant disease (4.2 +/- 5.7 U/ml) (P less than 0.01). In the healthy control group CA 125 concentrations were significantly lower (0.63 +/- 1.5 U/ml) (P less than 0.001). In patients with lung cancer the concentration of this tumor marker was related to the tumor-node-metastasis (TNM) stage. At a cut-off value of 15 U/ml, CA 125 had a sensitivity of 44%, specificity of 100%, positive predictive value of 100%, and negative predictive value of 65% with respect to healthy subjects; in patients with benign pulmonary conditions, these values were 44%, 94%, 94%, and 31%, respectively. At this cut-off value, a correlation between the respectability prognosis and the likelihood of survival 24 months posttreatment was observed. These findings suggest that CA 125 can be used as an adjunctive test in the management of patients with lung cancer patients.

Lack of anticonvulsant tolerance with RU 32698 and Ro 17-1812

Possible development of anticonvulsant tolerance to three benzodiazepine receptor ligands was assessed in mice using an i.v. infusion of pentylenetetrazol as the convulsive stimulus. Extensive tolerance developed rapidly in the case of diazepam (0.35 mg/kg b.d. or 1.5 mg/kg b.d.). No significant tolerance was seen with the imidazopyrimidine derivative RU 32698 (9 mg/kg b.d.) or the partial agonist benzodiazepine Ro 17-1812 (1 mg/kg b.d.) These results provide further support for the hypothesis that partial agonists at the benzodiazepine receptor induce less tolerance than full agonists.

Intestinal angiodysplasia: retrospective study of 18 cases

Eighteen patients operated on for intestinal angiodysplasia are reported. Visceral angiography was the diagnostic procedure of choice, providing evidence in most cases of lesions in the right colon. Right hemicolectomy was the surgical treatment normally provided. Mortality in our series was nil. This report looks at the main clinical features of these lesions, paying particular attention to their etiopathogenesis.