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Biomedical subjects

A Morelli

Publications and source records attributed to A Morelli.

At least 217 records · Page 12Linked to original sources
PubMed1989

Gastric and esophageal acidity during continuous treatment with H2-antagonists in uncomplicated esophagitis.

Twenty-four-hour gastric and esophageal pH were monitored simultaneously in 19 patients with moderate esophagitis before and after a randomized crossover treatment with 40 mg famotidine or 300 mg ranitidine. Gastroesophageal reflux in patients with esophagitis was compared with that in 22 healthy controls. Patients with esophagitis had more esophageal acidity than controls; the percentage of time with esophageal pH less than 4 was significantly greater during a 24-h period (p less than 0.01) both in the upright (p less than 0.01) and in the supine (p less than 0.01) position. In esophagitis patients the percentage of time with pH less than 4 during the total 24-h period correlated closely with acid reflux in the upright (p less than 0.001) and supine (p less than 0.01) position. This indicates that daytime reflux is probably as injurious to the esophagus as nighttime reflux. Famotidine and ranitidine decreased gastric acidity during the entire 24-h period (p less than 0.001) but not during the daytime or early evening. The inhibitory effect lasted slightly longer with famotidine (12 h) than with ranitidine (10 h). Famotidine and ranitidine reduced esophageal acidity during the entire 24-h period (p less than 0.001) and particularly during the nighttime (p less than 0.001) but not during the daytime. Famotidine and ranitidine also did not modify the esophageal acid clearance. Nightly doses of famotidine or ranitidine were ineffective in reducing GER during daytime hours.

Adult↗
PubMed1989

[Carcinoma and fibroadenoma of the breast].

Eight cases of breast carcinoma coexisting with fibroadenoma were retrieved from the files of the Division of Pathology from 1957 to 1987. In 3 patients (Group I) the lesion was within the fibroadenoma and in the remaining 5 patients, adjacent to it (Group II: synchronic carcinomas). All patients were females. During the same period, 987 fibroadenomas and 2004 carcinomas were diagnosed: 0.30% of the fibroadenomas developed carcinoma within the epithelial component and 0.15% of the carcinomas originated in the fibroadenoma's epithelium. The mean age was 39 years for in situ lesions and 45.5 years for infiltrating carcinoma with a general mean age of 43.3 years, 20 years older than the peak age of fibroadenoma. In Group I, there were 3 in situ lesions, 1 lobular and 3 ductal (Table 1). Two of the three patients had another coexisting gynecologic malignancy. In Group II all cases had infiltrating carcinomas, one lobular, 3 ductal and 1 mixed lobular and ductal (Table 1). The adjacent breast tissue showed associated pathology in all cases: multiple fibroadenomas, fibrocystic diseases, sclerosing adenosis, infiltrating ductal carcinoma and/or lobular hyperplasia. Different hypotheses from the literature were analysed concerning an association between carcinoma and fibroadenoma. A casual association is suggested by the low percentage of carcinomas developing in fibroadenomas as well as the low percentage of carcinomas originating from fibroadenomas.

Adenofibroma↗
PubMed1989

Functional gut disorders and health care seeking behavior in an Italian non-patient population.

We conducted a survey on functional gut disorders and health care seeking behavior in a large non-patient population of an Italian region (Umbria). 533 subjects were interviewed by means of a specific questionnaire. 44 (8.5%) reported symptoms compatible with the irritable bowel syndrome, 30 (5.8%) had non-colonic pain, 48 (9.2%) chronic constipation, and 20 (3.8%) dyspepsia. It is concluded that in our region there is a relatively high percentage of subjects that do not commonly seek health care, although affected by functional gut disorders.

Adult↗
PubMed1989

Effect of omeprazole on gastroesophageal reflux in Barrett's esophagus.

Pattern of gastric and esophageal acidity were evaluated in 14 patients with endoscopically and histologically proven Barrett's esophagus, in 46 with slight-to-moderate esophagitis, and in 22 healthy subjects. In patients with Barrett's esophagus, LES pressure was considerably lower and percentage exposure to acid was considerably higher than in either patients with esophagitis or controls (p less than 0.001). Percentage of time with esophageal pH below 4 was 33.2% in patients with Barrett's esophagus, 14% in patients with slight-to-moderate esophagitis (p less than 0.001), and 3.4% in controls (p less than 0.001). In patients with Barrett's esophagus, the esophageal exposure to acid was similar in upright and supine positions, and the number of refluxes that lasted longer than 5 min was also greater in these patients than in uncomplicated esophagitis or controls (p less than 0.001). Accordingly, their acid-clearing capacity was markedly reduced (p less than 0.001 vs. control). Omeprazole 20 mg, given once daily, reduced both percentage of time with pH below 4 (p less than 0.001) and the number of episodes longer than 5 min (p less than 0.001), but had no effect on acid clearance. In patients with Barrett's esophagus, omeprazole lowered intragastric acidity by 77.8% (p less than 0.001). Median intragastric pH was 1.9 (1.7-2.1) pretreatment, and 4.5 (4.2-5) during omeprazole (p less than 0.001).

Barrett Esophagus↗
PubMed1989

Oxidative metabolism of human peripheral blood eosinophils and neutrophils: H2O2 production after stimulation with phorbol myristate acetate and immune complexes.

Eosinophils like neutrophils possess an oxidative metabolism which is activated by phagocytosis and cell membrane activation. Since eosinophils may take part in inflammatory reactions by releasing oxygen species and have membrane receptors for immunoglobulins, immune complexes may activate their respiratory burst. We compared the ability of phorbol myristate acetate (PMA) and immunoglobulin G (IgG) and immunoglobulin E (IgE) immune complexes to stimulate hydrogen peroxide (H2O2) release from circulating eosinophils and neutrophils. PMA was able to stimulate a significant respiratory burst in both cell types, PMA-induced H2O2 production being higher in eosinophils than in neutrophils (p less than 0.05). Similar results were obtained when the cells were stimulated by IgG (p less than 0.05). In contrast, aggregated human myeloma IgE induced a detectable H2O2 release only from peripheral blood eosinophils. We conclude that H2O2 release from eosinophils may play a role in parenchymal injury associated with hypereosinophilic disorders and the presence of immune complexes at sites of disease activity.

Adult↗
PubMed1989

Intragastric pH monitoring during antisecretory therapy in patient with gastrointestinal bleeding.

This study was undertaken to evaluate the effect of various cimetidine and ranitidine administration schedules on intragastric pH in patients with recent episodes of hematemesis. The investigation was performed on 10 subjects whose hemorrhage had ceased either spontaneously or after pharmacological treatment for at least 24-36 h. The following therapeutic regimens were randomly evaluated: bolus infusions of ranitidine (100 mg/6 h and 50 mg/4 h) and cimetidine (400 mg/6 h and 200 mg/4 h) and continuous infusions of ranitidine (0.2 and 0.4 mg/kg/h) and cimetidine (100 mg/h). Each study evaluated at least two consecutive boli or an 8-h continuous infusion. All treatments produced significant elevations in the basal intragastric pH (p less than 0.001). With bolus administrations, however, the pH displayed consistent oscillations. The pH fell below 4 approximately 6 h after the administration in all the patients treated with 400 mg of cimetidine and in three treated with 50 mg of ranitidine. The administration of histamine H2-receptor antagonists every 4 h allowed better control of intragastric acidity. The pH dropped below 4 in seven of the 10 patients in the 4-h period after the administration of 200 mg cimetidine, and in one of the 10 patients treated with 50 mg of ranitidine/4 h. Increasing bolus dose did not reduce the time lapse or increase the inhibition of intragastric acidity. Continuous infusions were efficacious in maintaining pH values constantly above 6. Ranitidine (0.2 mg/kg/h) achieved the same inhibitory efficiency as cimetidine (100 mg/h). These data indicate that continuous venous infusion of both ranitidine and cimetidine is significantly more efficacious than repeated single bolus administrations.

Adult↗
PubMed1989

Colonic motor response to eating: a manometric investigation in proximal and distal portions of the viscus in man.

The motor response of the human colon to a meal is still poorly characterized. Such data as are available were obtained chiefly for the distal colonic portions with myoelectrical techniques. For these reasons, we investigated proximal and distal colonic motor responses to food ingestion in a rather large group of healthy subjects. Twenty-nine healthy volunteers were studied with a colonoscopically positioned multilumen manometric probe and low-compliance infusion system. Recordings were obtained for 2 h during fasting and for 3 h after the subjects had eaten a 1000-kcal standard mixed meal. During fasting, motility was quite low, and no significant differences between proximal and distal portions were seen. After eating, each portion significantly increased its motor activity throughout the subsequent recording period, but there were differences in the time course in the response to eating for different colonic segments. Proximal portions (especially the transverse colon) had first a sudden maximal increase and then a decrease, whereas the distal ones had a slower and more sustained increase in activity. These findings are of interest, especially for comparison with those of patients with suspected motor dysfunction of the large bowel.

Adult↗
PubMed1988

Colonic mass movements in idiopathic chronic constipation.

As relatively little is known of human colonic motor activity either in health, or in pathological conditions, we investigated mass movements in 14 chronically constipated patients and 18 healthy volunteers. Mass movements were recorded from proximal and distal colon during 24 h (12 noon-12 noon) by a colonoscopically positioned multilumen manometric probe and low compliance infusion system. Patients and controls differed significantly in the number (mean 2.6 (0.7) v 6.1 (0.9) (SE), p = 0.02) and duration (mean 8.2 (1.6) v 14.1 (0.8) s, p = 0.04) of mass movements. The data suggest that one pathophysiological mechanism of constipation may be decreased propulsive activity. A circadian pattern, with a significant difference between day and night distribution, was documented in both groups. The patients reported decreased defecatory stimulus concomitant with the mass movements.

Adult↗
PubMed1988

Oesophageal motor activity in rheumatoid arthritis: a clinical and manometric study.

Oesophageal motor function was clinically and manometrically investigated by means of a low-compliance system in 24 nonselected rheumatoid arthritis (RA) patients and 15 healthy controls. Dysphagia was referred by 37.5% of RA patients. Oesophageal motor abnormalities were discovered to be significantly present in a high percentage (62.5%) of patients with RA. However, there was no correlation between oesophageal motor abnormalities and any disease characteristic. It is concluded that a high percentage of RA patients have an oesophageal motor dysfunction, even in the absence of dysphagic symptoms.

Arthritis, Rheumatoid↗
PubMed1988

Human peripheral blood and pleural fluid eosinophils can be induced by immune complexes to release IgG immune complexes and aggregated IgE.

The ability of IgG and IgE immune complexes and of phorbol myristate acetate (PMA), a soluble membrane activator, to stimulate hydrogen peroxide (H2O2) release and to induce oxygen radical-mediated cytotoxic activity by human peripheral blood (PBL) eosinophils and by PBL neutrophils was evaluated in normal volunteers and patients with hypereosinophilic malignant pleural effusions due to lung cancer. PMA stimulated a significant respiratory burst. Similar results were obtained with IgG IC stimulation, although the levels of H2O2 were lower. Agg IgE induced H2O2 release only by PBL and PE eosinophils and not by neutrophils. PMA stimulation resulted in detectable cytotoxic activity. IgG IC generated both PBL and PE eosinophil and PBL neutrophil cytotoxicity. Agg IgE induced significant cellular cytotoxicity in both PBL and PE eosinophils. This study suggests that eosinophil oxidative metabolic burst and cytotoxic activity stimulated by IgG and IgE immune complexes could represent a possible mechanism of parenchymal injury in eosinophilic disorders.

Adult↗
PubMed1988

Manometric evaluation of cimetropium bromide activity in patients with the nutcracker oesophagus.

There are at present few therapeutic alternatives to calcium channel blockers for the medical treatment of patients with nutcracker oesophagus. For this reason, we evaluated by means of a low-compliance manometric system the effect of a new anticholinergic compound, cimetropium bromide (10 mg intravenously), on oesophageal variables of eight patients with nutcracker oesophagus, in a single-blind study. Eight age-matched healthy volunteers served as controls. In both patients and controls, cimetropium bromide significantly decreased lower oesophageal sphincter pressure and the distal and proximal mean contraction amplitude of the oesophageal body. Apart from an increase in pulse rate, no noteworthy side effects were observed. It is concluded that cimetropium bromide may be an effective therapeutic option in patients with nutcracker oesophagus.

Adult↗
PubMed1988

Do anticholinergics interact with histamine H2 receptor antagonists on night intragastric acidity in active duodenal ulcer patients?

The effect of administering low doses of famotidine or ranitidine alone or in combination with an M1-receptor-selective antagonist, pirenzepine, on night intragastric acidity was evaluated in 16 active duodenal ulcer patients to verify 1) whether anticholinergics and H2-antagonists have a synergic effect on inhibition of night gastric acidity, and 2) whether patients with vagal hypertone are more sensitive to anticholinergics than the remainder of the duodenal ulcer population. The endogastric pH was continuously recorded for 12 h (8 PM-8 AM) after random, single-blind administration of one of the following drug regimens: 20 mg famotidine, 150 mg ranitidine, 50 mg pirenzepine, 20 mg famotidine plus 50 mg pirenzepine, and 150 mg ranitidine plus 50 mg pirenzepine. Six patients with a basal acid output:peak acid output BAO:PAO greater than 0.3 were considered "vagal hypertone" subjects. Night gastric acidity inhibition was -39.6% with pirenzepine (p less than 0.001) and -73.7% and -71.5% with famotidine or ranitidine (p less than 0.001 vs. pirenzepine). The simultaneous administration of pirenzepine with famotidine or ranitidine provoked only a slight, insignificant increase in percent suppression, 5.1% and 6.3%, respectively, and did not modify either the time lag to onset of anti-H2 action or the duration of action. Patients with a BAO:PAO greater than 0.3 were not more sensitive to anticholinergic treatment than other duodenal ulcer patients. Our study furnishes evidence that combined administration of anti-H2 and anticholinergics is not significantly better than anti-H2 alone, in active duodenal ulcer patients.

Adult↗
PubMed1987

Twenty four hour manometric recording of colonic motor activity in healthy man.

The motor activity of the transverse, descending, and sigmoid colon was recorded for 24 hours in 14 healthy volunteers with a colonoscope positioned catheter. During the study the patients ate two 1000 kcal mixed meals and one continental breakfast. Colonic motor activity was low before meals and minimal during sleep; the motility index increased significantly after meals and at morning awakening. Most of the motor activity was represented by low amplitude contractions present singly or in bursts, which showed no recognisable pattern. All but two subjects also showed isolated high amplitude (up to 200 mmHg) contractions that propagated peristaltically over long distances at approximately 1 cm/sec. Most of these contractions occurred after morning awakening, and some in the late postprandial period, with a mean of 4.4/subject/24 h. The peristaltic contractions were often felt as an urge to defecate or preceded defecation, and could represent the manometric equivalent of the mass movements.

Adult↗
PubMed1987

Transverse and sigmoid colon motility in healthy humans: effects of eating and of cimetropium bromide.

There have been few studies of the motility of the colon proximal to the rectosigmoid area. For this purpose we evaluated (1) fasting and postprandial transverse and sigmoid colon motor activity and (2) the effects of a new nonselective anticholinergic drug, cimetropium bromide, on transverse and sigmoid motor responses to eating. Two paired studies were carried out in 11 healthy volunteers by means of a colonscopically positioned manometric probe. After placebo, eating significantly increased transverse and sigmoid motility indices throughout the recording period. Cimetropium significantly reduced the motor responses to eating in both the transverse and the sigmoid colon.

Adult↗