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Biomedical subjects

A Gasbarrini

Publications and source records attributed to A Gasbarrini.

At least 235 records · Page 13Linked to original sources
PubMedDate not supplied

Symptomatic vertebral hemangioma: the treatment of 23 cases and a review of the literature.

It is the purpose of this study to analyze a group of 23 patients affected with hemangioma in one or more metameres of the vertebral column. On the basis of clinical examination and instrumental testing in time (minimum follow-up 12 months, maximum 217 months) the following treatment options are discussed: medical treatment and clinical monitoring closer in time; palliative surgical treatment whether or not associated with embolization of vascular afferences of the lesion and adjuvant treatment; intralesional surgical treatment whether or not associated with embolization of the vascular afferences of the lesion and adjuvant treatment. Skeletal hemangioma is a hamartomatous proliferation of vascular tissue, more precisely of endothelial tissue. This is demonstrated by its anatomical identity with other tissues and the existence of exceptional skeletal and multiple tissue hemangiomatosis that begin during childhood. Hemangioma is the benign tumor that is most frequently localized in the spine, involving about 10% of the world population, as reported in the literature on autoptic studies. It is often a solitary lesion, usually localized in the vertebral body, although it may extend to the posterior arch. There is predilection for the thoracic region of the spine, while it less frequently occurs in the cervical and lumbar spines. Generally, it remains asymptomatic throughout the entire life of the subject, so much so that it is often difficult to establish the onset of the lesion. Symptomatic hemangiomas (less than 1% of all hemangiomas) are those that are accidentally discovered via radiograms; they are most often observed during adult age. The most common treatment used for vertebral hemangioma associated with pain is radiotherapy, even if clinical observation represents a reasonable choice. Surgical treatment, preceded when possible by embolization of the vascular afferences of the lesion, is often associated with radiation therapy in cases where there is neurologic compression in addition to pain. It was the purpose of this study to analyze the long-term results obtained in a group of 23 patients affected with symptomatic vertebral hemangioma.

Adolescent↗
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Osteoid osteoma of L4: excision by videoendoscopy.

It is the purpose of this study to demonstrate how in the surgical treatment of vertebral osteoid osteoma a video-aided mini-invasive method may be used as an alternative to modern percutaneous X-ray-CT-guided mini-invasive methods such as radiocoagulation, interstitial photocoagulation with laser injection. Reported here is the case of a female aged 13 years where instrumental testing showed the presence of an osteoid osteoma involving the internal surface of the lamina of L3 and spreading in the lumen of the vertebral canal. Once we established that it was impossible to carry out the aforementioned mini-invasive percutaneous treatment because of the closeness of the osteoid osteoma to the nervous structures, thus risking complications, the only procedure that could guarantee complete removal of the tumor was open aminarthrectomy. But to reduce surgical aggressiveness to a minimum, we decided to proceed by means of a video-aided mini-invasive method with the purpose of limiting hospitalization and recovery time in order to obtain economically favorable results.

Adolescent↗
PubMedDate not supplied

Antibodies to Saccharomyces cerevisiae: are they useful in clinical practice?

BACKGROUND/AIMS: Antibodies to Saccharomyces cerevisiae are associated with Crohn's disease. The aim of this study was to assess the sensitivity and specificity of antibodies to Saccharomyces cerevisiae for Crohn's disease in an Italian population and to evaluate their clinical role. METHODOLOGY: Antibodies to Saccharomyces cerevisiae serum levels were assessed in 72 inflammatory bowel disease patients (30 Crohn's disease; 42 ulcerative colitis) and 35 age-matched controls. Patients were divided into subgroups on the basis of disease behavior and clinical feature were evaluated. RESULTS: Antibodies to Saccharomyces cerevisiae sensitivity and specificity for Crohn's disease patients were 50% (31-68) and 91% (77-98), for IgG and 56% (37-64) and 94% (80-99), respectively, for IgA. No correlation was observed between the presence of antibodies to Saccharomyces cerevisiae and clinical features. Antibodies to Saccharomyces cerevisiae were more prevalent in Crohn's disease than in ulcerative colitis patients (IgA: 57% vs. 26%; IgG: 50% vs. 17%; p < 0.05). Interestingly, in Crohn's disease patients, the prevalence of antibodies to Saccharomyces cerevisiae was higher in patients with small bowel involvement than in patients with pure colonic disease (IgA: 66% vs. 17%; IgG: 58% vs. 17%). No difference in antibodies to Saccharomyces cerevisiae prevalence was observed between ulcerative colitis and pure colonic Crohn's disease patients. CONCLUSIONS: Our data show an association between Crohn's disease and antibodies to Saccharomyces cerevisiae. However, it does not seem useful in discriminating between ulcerative colitis and colic Crohn's disease.

Adult↗
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Cell-based therapy for liver diseases.

Although liver transplantation has become standard therapy in the treatment of patients with liver failure, several problems should be considered in the management of these patients. Other approaches have been proposed, in particular cellular-based procedures. Isolated hepatocytes may be used instead of whole organ transplantation or integrated within the bioartificial devices, in order to replace the missing synthetic and metabolic liver functions. Moreover patient's own hepatocytes may be ex vivo genetically modified to provide the function of a mutant gene. However, new cell sources alternative to adult hepatocytes are actually under investigation, on the basis of recent advances in the field of liver repopulation. Xenogenic primary cells, human hepatoma cells, immortalized hepatocytes and stem cells have been testing in several experiments, even if up to now none of them represent a "gold-standard" for cell-based treatment of liver diseases. In the next future, it is possible that different clinical situations will require different therapeutic approaches, that will be finally defined from the concomitant advances in the development of artificial devices and liver cell biology.

Cell Transplantation↗
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13C-breath tests in the study of mitochondrial liver function.

Breath tests for "dynamic" liver function evaluation have been proposed several years ago. A variety of carbon-labelled breath tests for the assessment of mitochondrial, microsomal and cytosolic liver function have been described with the aim to increase data on liver disease staging, prognosis, and response to therapy. In the last years a great interest is developed about the use of breath test for liver mitochondrial function evaluation since it results impaired in a wide range of liver diseases either of genetic or acquired origin. In these cases mitochondrial oxidative metabolism of some substrates, as far as recovery of the hepatic energy state after a metabolic insult, results impaired because of the disfunction of the electron transport chain and/or ATP synthesis. Ketoisocaproic acid and methionine are the best studied carbon-labelled substrates for the investigation of mitochondrial functional damages related to structural alterations that occur in many liver diseases. Although these tests are simple, cost-effective and safe, to date there is still not general approval for their usefulness in clinical settings since they should fulfill several requirements to overcome the drawbacks of traditional quantitative tests. On the other hand, this field is relatively young and further studies are needed in order to assess the suitable substrate for the evaluation of the complex mitochondrial metabolism both in healthy subjects and in patients with liver disease.

Breath Tests↗
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13C-breath tests in the study of microsomal liver function.

Conventional liver tests can be used to estimate a mixture of injury and function but none of these may be regarded as a reliable marker either to quantify functional hepatic reserve or to reflect life-threatening complications of acute and chronic liver diseases. To overcome this limit, many dynamic tests have been developed in order to evaluate the "hepatic functional mass". Among these tests we can include breath tests with 13C-labeled substrates undergoing different metabolic pathways. As concerning the evaluation of microsomal function, two main categories of breath tests have been developed based on the limiting step in the different substrates metabolism. The first group include aminopyrine, caffeine and diazepam, all substrates with a metabolism independent from hepatic blood flow and dependent almost exclusively from the enzymatic activity of different cytochromes P450. The other group is composed of substrates with flow dependent metabolism like methacetin, phenacetin, erythromycin. The aim of this review is to describe the clinical applications of microsomal liver breath tests in different hepatic diseases.

Acetamides↗
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Fractures and dislocations of the lower cervical spine: surgical treatment. A review of 83 cases.

The authors examine 83 consecutive cases of fracture and dislocation of the lower cervical spine submitted to surgery over a period of 5 years. Sixty-five patients were monitored with minimum 5-months follow-up, 5 died, 13 could not be traced. Lesions were classified based on the method proposed by Argenson3 with the purpose of identifying guidelines for surgical treatment. Thus, different methods are proposed based on the type of lesion and on any neurologic deficit. Intersomatic fusion with anterior approach is the method of choice in most lesions. The exception to this is monoarticular dislocations that cannot be reduced, so that reduction by posterior approach associated with discectomy and anterior fusion are recommended. Circumferential fusion is proposed for traumatic spondylolistheses, complete dislocations with unsatisfactory anterior reduction, in lesions in flexion-extension and rotation associated with complete spinal cord injury, in order to favor functional rehabilitation free from ortheses. The need to review many cases of traumatic lesions of the lower cervical spine (LCS) collected over a relatively short period of time derives from the need to identify guidelines that will help the surgeon in his or her choice of the type of surgery to perform on the patient with emergency injury. The basic premise, as for other sites of traumatic injury, resides in an efficient classification (corresponding to the anatomic injury and of immediate and intuitive application) to which options for treatment may be related. In particular, an evaluation of the type of approach (anterior, posterior, combined) and of the sequence of surgical stages is essential to obtaining effective results with an acceptable complication rate. Finally, treatment must be definitive, and in cases of severe spinal cord injury it must allow for rapid rehabilitation and freedom from the use of ortheses.

Adult↗
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Intercellular adhesion molecule 1 gene polymorphisms in inflammatory bowel disease.

Intercellular adhesion molecule (ICAM)-1 is a single-chain cell surface glycoprotein that plays an important role in the recruitment of leukocytes at sites of inflammation and is up-regulated in intestinal mucosa of inflammatory bowel disease (IBD). ICAM-1 gene lies on chromosome 19p13, implicated in determining susceptibility to IBD. The human ICAM-1 gene contains two polymorphic sites in codon 241 (G241R) and 469 (K469E) which have been implicated in the susceptibility to a range of degenerative and inflammatory diseases. Recently, several reports have shown discordant data regarding the association of these polymorphisms with IBD. In particular, we found an association of IBD with the E/E genotype while allele E469 was associated with a subgroup of patients with more extensive location of Crohn's disease and penetrating behaviour. However, other studies reached different conclusions. A possible explanation for the discrepancy of results is probably the influence of the different geographic distribution of the genetic mutations.

Gene Frequency↗
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Platelets: new players in the mucosal scenario of inflammatory bowel disease.

Besides their classical haemostatic task, platelets are now recognized as novel cells deeply involved in inflammation. Compelling evidence support their role as active player in mucosal tissue injury that occurs in Crohn's disease and ulcerative colitis. In both forms of inflammatory bowel disease platelets contribute to microvascular endothelial activation and recruitment of inflammatory cells, thus fostering and amplifying mucosal inflammation.

Blood Platelets↗
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Infliximab in the treatment of steroid-dependent ulcerative colitis.

BACKGROUND AND OBJECTIVES: Infliximab has proven efficacious in the treatment of Crohn's disease. Limited and contrasting data are available on effectiveness of anti-TNF alpha therapy in ulcerative colitis. We evaluated the efficacy of infliximab in the management of steroid-dependent ulcerative colitis. METHODS: We report preliminary data from a randomized, open-label, methylprednisolone-controlled trial of infliximab in the induction and maintenance of remission of patients with moderate to severe steroid-dependent ulcerative colitis. Twenty patients received either three infusion of infliximab (5 mg/kg) at 0, 2 and 6 weeks and thereafter every 8 weeks (group A) or methylprednisolone (0,7-1 mg/kg) daily for one week followed by a tapering regimen up to the minimal dose to maintain a symptom-free condition (group B). Clinical remission was defined as a DAI score less than 3. RESULTS: Ten patients in group A (DAI: 8.9+/-1.4) achieved remission after the first infusion (DAI: 1.6+/-0,7; p = 0.005) and steroids were progressively discontinued. At present (mean follow-up: 9.8+/-1.1 months), 9 out of 10 patients maintain clinical remission, while one patient relapsed at 3 months. Ten patients in group B (DAI: 8.7+/-1.4) reached clinical remission at one week (DAI: 1.9+/-0.3; p = 0.005). Eight out of 10 patients were maintained at a minimal steroid dosage without any relapse at 9.7+/-1.0 months follow-up. Two patients relapsed at 6 and 8 months, respectively. CONCLUSIONS: Infliximab seems to be as effective as steroids in the management of moderate to severe steroid-dependent ulcerative colitis. These preliminary data suggest the potential efficacy of repeated treatment with infliximab for short-term maintenance of remission and steroid withdrawal in glucocorticoid-dependent ulcerative colitis.

Adult↗
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Spinal metastases: treatment evaluation algorithm.

Spinal metastases are only apparently similar lesions, considering the large varieties of istotypes and the spread of the primary tumor. These metastases develop early and are not terminal events, they have to be considered as severe complications because, when possible, surgical treatment can improve the history of the patient in terms of life expectancy and quality of life. The approach to these lesions should be multidisciplinary in collaboration with oncologists and radiotherapists, in fact the average of survival of these patients has increased in recent years. The evolution of anesthaesiological techniques that permit surgical treatments that were once considered prohibitive. The application of new adjuvant therapy increases the effectiveness for surgical treatment. Controversy exist over the most appropriate treatment for patients with metastatic disease of the vertebral column. The purpose of this article was to determine the best sequential process to arrive at the most appropriate treatment considering the individual general conditions and the parameters of the metastases. We review 269 cases in 182 patients suffering from spinal metastases from a solid tumour treated between 1996 and 2002. As the number of treatment options for metastatic spinal disease has grown, it has become clear that effective implementation of these treatments can only be achieved by multidisciplinary approach.

Adolescent↗
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Clinical features, diagnostic and therapeutic approaches to haematogenous vertebral osteomyelitis.

This article review the clinical features and the diagnostic approach to haematogenous vertebral osteomyelitis in order to optimise treatment strategies and follow-up assessment. Haematogenous spread is considered to be the most important route: the lumbar spine is the most common site of involvement for pyogenic infection and the thoracic spine for tuberculosis infection. The risk factors for developing haematogenous vertebral osteomyelitis are different among old people, adults and children: the literature reports that the incidence seems to be increasing in older patients. The source of infection in the elderly has been related to the use of intravenous access devices and the asymptomatic urinary infections. In young patients the increase has been correlated with the growing number of intravenous drug abusers, with endocarditis and with immigrants from areas where tuberculosis is still endemic. The onset of symptoms is typically insidious with neck or back pain often underestimated by the patient. Fever is present in 10-45% of patients. Spinal infections may cause severe neurological compromise in few cases, but mild neurological deficit, limited to one or two nerve roots, was detected in 28-35% of patients. The diagnosis of haematogenous vertebral osteomyelitis may be very difficult, as the symptoms can be sometimes not specific, vague or almost absent. The usual delay in diagnosis has been reported to be two to four months, despite the use of imaging techniques: in the early diagnosis of vertebral ostemyelitis is important the role of bone scintigraphy. The general principles for the management of spine infections are non operative, consisting of external immobilization and intravenous antibiotics, followed by oral antibiotics. Indications for surgery should be given in case of absence of clinical improvement after 2-3 weeks of intravenous antibiotics, persistent back pain and systemic effects of chronic infection and with presence or progression of neurological deficit in elderly or in cervical infection. Chronic ostemyelitis may require surgery in case of a development of biomechanical instability and/or a vertebral collapse with progressive deformity.

Anti-Bacterial Agents↗
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Giant cell tumor of the upper cervical spine: transmandibular-translingual access. Clinical case.

The authors describe the clinical case of a patient aged 18 years affected with giant cell tumor (GCT) at C3 who came to the surgical unit of Orthopaedics and Traumatology at the Ospedale Maggiore in Bologna after being treated by surgery elsewhere. Particular attention is paid to surgical access by means of median transmandibuloglossotomy used in order to obtain a sufficiently wide surgical field that can adequately expose the vertebral segment affected by neoplastic disease. In particular, possible complications that may be observed postsurgery can be compared to other surgical approaches to the upper cervical spine and above all that there are no permanent clinical sequelae.

Adolescent↗
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Nonalcoholic fatty liver disease: defining a common problem.

Non Alcoholic Fatty Liver Disease (NAFLD), with prevalence of 10-51% in general population involving all ages, is the major cause of elevation of ALT and a common finding by ultrasound screening and may range from simple steatosis, to Non Alcoholic Steatohepatitis (NASH) and its clinical consequences as cirrhosis and hepatocellular carcinoma. In this review will be analyse factors influencing the onset of the disease. NAFLD, primarly associated with insulin resistance, is in fact considered the hepatic manifestation of the metabolic syndrome: a cluster of disorder that includes obesity, diabetes mellitus, dyslipidaemia, arteriosclerosis and hypertension. The increased incidence and prevalence of obesity and diabetes may explain growing interest in NAFLD. Racial, ethnic, enviromental and behaviour models are also reviewed.

Alanine Transaminase↗
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Hepatic steatosis and vascular disease.

Nonalcoholic fatty liver disease (NAFLD) refers to a wide picture of liver damage, ranging from steatosis to steatohepatitis, fibrosis and cirrhosis. The epidemiological studies demonstrated an association of NAFLD with obesity, type 2 diabetes and hyperlipidemia. Under this light the metabolic syndrome (MS), including NAFLD, obesity, central fat distribution, diabetes, dyslipidemia, hypertension and atherosclerotic cardiovascular disease (CVD) can be considered the link to explain the presence of vascular diseases in patients with NAFLD. In NHANES III, the authors demonstrated that the presence of MS was associated with increased risk of myocardial infarction, stroke or both. In a prospective study on 1209 Finnish middle-aged men without CVD or diabetes at baseline, Lakka showed that MS per se is associated with an increased risk of CVD and all-cause mortality. Finally the Atherosclerosis Risk in Communities (ARIC) confirmed that subjects with MS were 2 times more likely to have prevalent coronary heart disease. From a pathophysiological point of view, growing evidences implicate the oxidative stress as the unifying mechanism for many CVD risk factors. Under this light there is emerging evidence suggesting that there is a significant increase in vascular oxidative stress in patients with MS, with the presence of endothelial dysfunction in the early stage of the syndrome. Indeed, the inflammation process evidentiated in these patients is initiated at the endothelial level, stressing the key role of this active and dynamic tissue in the pathophysiological pathways. Under this light the endothelium can be considered as the last effector of a multi-syndrome and the main target of all the future studies focused on the underlying mechamisms of this complex network. Because of the potential serious public health impact, the comprehension of these patophysiological pathways will be crucial to design new preventive measures and therapeutic strategies.

Animals↗
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The natural history and risk factors for progression of non-alcoholic fatty liver disease and steatohepatitis.

Nonalcoholic fatty liver disease (NAFLD) is a condition of increasing incidence in western Countries seldom associated to other diseases of high prevalence in general population (i.e. diabetes and obesity). NAFLD ranges from simple fatty liver to steatohepatitis (NASH), which may lead to cryptogenic cirrhosis and in some cases hepatocellular carcinoma (HCC). Natural history of NAFLD in humans is poorly understood and progression of liver disease seems to be due to interaction between hosting (i.e. genetic, gut flora, insulin resistance) and environmental factors (social and eating behaviours) that should be responsible of increased oxidative stress within hepatocytes. Even if we need non-invasive markers able to describe the progression of liver disease, only meaning of liver biopsy is useful to characterize the stigmata of worsening such as inflammation and fibrosis.

Animals↗