[The "malic enzyme" activity in the cirrhotic human liver].
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Humans↗
Biomedical subjects
A Notarbartolo
Publications and source records attributed to A Notarbartolo.
[Increase of catecholamines in the arterial and venous blood in cirrhotic subjects].
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Adult↗
Apolipoprotein profile in type II diabetic patients with and without coronary heart disease.
Diabetes mellitus is frequently associated with lipid metabolism abnormalities. In the present study the lipid and apolipoprotein profiles have been compared in type II diabetic subjects with (n = 30) and without (n = 30) coronary heart disease (CHD). All subjects were studied after good metabolic control had been achieved. Significant differences in plasma lipids and apolipoproteins were seen in diabetic patients with CHD in comparison with diabetics without CHD. Patients with CHD presented higher total cholesterol, triglyceride, LDL-cholesterol, apo B, apo CII and apo CIII levels and total cholesterol/HDL-cholesterol and LDL-cholesterol HDL-cholesterol ratios and lower HDL-cholesterol values and apo A1/apo B ratio than the patients without CHD. The same findings were found in females; while male subjects with CHD had significantly increased total cholesterol, LDL-cholesterol and apo B levels and total cholesterol/HDL-cholesterol and LDL-cholesterol/HDL-cholesterol ratios and significantly decreased apo A1/apo B ratio compared with males without CHD. These findings support the concept that the apolipoprotein profile plays a remarkable role as risk factor for CHD in type II diabetes mellitus.
Aged↗
Prevalence of diabetes mellitus and impaired glucose tolerance in cystic fibrosis.
The aim of this study was to evaluate the prevalence of impaired glucose tolerance or diabetes mellitus in 99 patients (53 M, 46 F; mean age 10.5 +/- 6.9 years), with cystic fibrosis. Glucose tolerance was evaluated in all patients without overt diabetes using the oral glucose tolerance test (OGTT). Six patients showed a pathological OGTT and 2 patients had insulin-requiring diabetes mellitus. The mean age of the patients with impaired glucose tolerance was significantly higher than that of the subjects with normal glucose metabolism (p less than 0.0001). Patients with overt diabetes mellitus were the oldest subjects in the study group.
Adolescent↗
Correlation between different degree and duration of metabolic control and thyroid hormone levels in type 1 and type 2 diabetics.
Thyroxine (T4), triiodothyronine (T3), reverse T3 (rT3) and HbA1c were assayed in 21 insulin-dependent (type 1) diabetics and in 45 non-insulin-dependent (type 2) diabetics with normal thyroid function and different levels of control, and were compared to values found in apparently healthy controls. rT3 and rT3/T3 ratio were significantly increased both in type 1 and type 2 diabetics. T3 and T4 were significantly lower in type 2 diabetics than in the controls. Significant positive correlations of HbA1c to rT3 (r = 0.63) and to rT3/T3 ratio (r = 0.53) were found in type 1, and in type 2 diabetics (HbA1c, rT3-r = 0.50), (HbA1c, rT3/T3-r = 0.37). There was no correlation between glycemia (BG), relative body weight (RBW) and thyroid hormones. These data suggest that the alterations of thyroid hormones in type 1 and type 2 diabetes mellitus reflect the degree of control better than the hyperglycemia and the duration of metabolic unbalance.
Adolescent↗
Diagnostic use of fructosamine assay in the control of type II diabetes mellitus.
In an attempt to evaluate the usefulness of fructosamine assay in monitoring type II diabetes, 142 diabetic patients were investigated. Fructosamine values were found to be higher in patients on insulin treatment than on oral hypoglycemic agents. In order to evaluate the metabolic control by using the correlated variations of F, Gm and HbA1c, the patients were subdivided into many control classes: mean values of fructosamine were higher in poorly controlled patients. Fructosamine however correlated better with glycemia in patients with recent variations in metabolic state than HbA1c. It was concluded that fructosamine is a good index for short-term metabolic control, and if used in an integrated fashion with glycemia and HbA1c, can provide further information on the metabolic state of diabetes.
Adult↗
Comparison of BT-PABA test and fecal chymotrypsin measurements in normal subjects and diabetic patients.
A N-benzoil-L-tyrosil-PABA test on 6h urine collection, a plasma PABA assay 2 h after administration and a fecal chymotrypsin assay were performed on 66 patients (36 controls and 30 type 2 diabetic patients on insulin therapy). All patients were hospitalized and without gastrointestinal and renal disease. The mean values of plasmatic PABA and fecal chymotrypsin were significantly lower in the diabetic group than in the controls (p less than 0.025 and p less than 0.01, respectively), although they remained within normal range. But this was not the case for PABA urinary excretion values. This may indicate a slower but more protracted PABA absorption during the third or fourth hour with the result that urinary excretion over 6h is not greatly affected. There was good correlation between fecal chymotrypsin values and both PABA urinary excretion values and serum PABA values, a trend observed both in diabetics (p less than 0.005 and p less than 0.001, respectively) and in controls (p less than 0.001 and p less than 0.005, respectively). This could indicate that even at lower mean levels, the diabetic patients show the same behavior pattern and therefore maintain the same indexes of correlation as the control population. Our results suggest that these indirect, but simple, economical and well-tolerated tests could be considered a valid alternative for investigating pancreatic function especially in those patients that cannot be tested by a Secretin-Cerulein test.
4-Aminobenzoic Acid↗
Prospective study on thyroid autoimmunity and dysfunction related to chronic hepatitis C and interferon therapy.
This study was designed to assess patients with chronic hepatitis C (CHC) for the presence of thyroid autoimmunity and dysfunction, to evaluate the risk of thyroid disorders associated with interferon (IFN) therapy, and to survey the outcome of possible treatment-related thyroid injury. Out of 104 consecutive untreated patients (30 women and 74 men; mean age, 52.7 years), 8 (7.7%) were found seropositive for thyroid autoantibodies (ThyAb), whereas seropositivity in healthy controls was 1/98 (1.3%). The relative increase in risk of developing thyroid autoimmunity associated with CHC was 760% (95% CI, 220-1300%). No patients had abnormalities of thyroid function tests, but on IFN treatment, 3/3 patients showed a rapid over-range rise in circulating thyrotropin, which returned to normal after therapy discontinuation. In the other 5 seropositive patients who refused treatment, thyroid function remained normal. Out of the 58 initially seronegative patients who consented to IFN treatment, 9 (15.5%) developed thyroid autoimmunity. Seven of them (77.7%) had thyroid dysfunction: hypothyroidism in 4 cases, transient thyrotoxicosis in 2 cases. The last patient developed TSH-receptor antibodies and Graves' disease, requiring methimazole therapy. Thyroid function recovered in the former 6 cases following IFN discontinuation. In the 28 initially seronegative patients who refused IFN and participated in a preliminary tauroursodeoxycholic acid trial, antithyroglobulin antibodies alone appeared in one case, but no thyroid dysfunction was observed. The relative risk of thyroid autoimmune disorder associated with IFN therapy was 342% (28-636%). The patients with CHC were unlikely to develop thyroid dysfunction in the absence of IFN therapy, in spite of being ThyAb seropositive. Moreover, a considerable proportion of seronegative patients, when IFN-treated, developed thyroid autoimmunity and then thyroid dysfunction. Both in seropositive and seronegative patients immediate IFN discontinuation normalized thyroid function and hormone replacement therapy was not necessary.
Adult↗
Thrombin-antithrombin III complexes in type II diabetes mellitus.
Several studies suggest that diabetes is associated with a hypercoagulable state. Therefore determination of thrombin-antithrombin complex (TAT) could represent a sensitive parameter for specific detection of a latent activation of the clotting system. The present study documents increased plasma TAT in a heterogeneous group of non-insulin-dependent diabetic patients. The finding of increased TAT levels both in diabetic patients with vascular complications and in vascular disease patients without diabetes suggests a relationship between existing vascular disease and the hemostatic mechanism that produces augmented thrombin activity. In acute vascular occlusions the presence of diabetes seems to increase activation of the coagulative system.
Adult↗
Evidence of transient IgA anti-endomysial antibody positivity in a patient with Graves' disease.
BACKGROUND: Anti-endomysial antibodies (EmA) have been shown to have a high specificity and sensitivity in celiac disease (CD) diagnosis, and their use is considered effective in improving the diagnostic accuracy of CD screening. AIMS: To report the clinical details of transient IgA EmA positivity in a patient with Graves' disease. METHODS: We screened 48 patients (7 males, age range 19-79, median 58.3 years) for CD. They were hospitalized for thyroid disorders (30 patients had autoimmune hypothyroidism and 18 had Graves' disease with clinical hyperthyroidism associated with diffuse goitre). CD screening was carried out on all patients by assaying serum anti-gliadin antibodies (AGA) and EmA. RESULTS: None of the 48 patients in our study were positive for IgA and/or IgG-class AGA and none showed IgA deficiency. Only 1 patient was positive for EmA; however, intestinal biopsy in this subject was normal both when thyroiditis was first diagnosed and subsequently after 2 and 3 years. Furthermore, EmA became negative after 2 years. New gastroenterological investigations performed 3 years after the diagnosis confirmed the normal intestinal histology and absorption capacity. Moreover, AGA, EmA and tissue transglutaminase antibodies were negative. CONCLUSIONS: This study underlines the possibility of transient EmA positivity without any signs of CD in patients with autoimmune thyroid disorders.
Aged↗
Thyroid function and release of thyroid-stimulating hormone and prolactin from the pituitary in human obesity.
Thyroid function, basal serum thyroid-stimulating hormone (TSH) and prolactin concentrations, and the effects of 200 micrograms TSH-releasing hormone (TRH) given intravenously on TSH (delta TSH) and prolactin (delta prolactin) were investigated in 25 euthyroid obese subjects and 20 lean controls. No significant differences in serum thyroid hormone concentrations, glucose metabolism parameters, or basal TSH and prolactin concentrations were detected between groups, but a significant (P less than 0.01) increase in delta TSH and a significant (P less than 0.01) decrease in delta prolactin were observed in obese subjects. No significant differences in basal TSH and prolactin were observed in obese men and women compared with corresponding lean controls, but delta prolactin decreased significantly (P less than 0.01) in obese men and women compared with lean controls and TSH increased significantly (P less than 0.01) in obese men and women. No correlation was found between delta TSH or delta prolactin and body mass index. The study suggests that hyper-responsiveness of TSH and hyporesponsiveness of prolactin to TRH in obese subjects can be related to changes in the central serotoninergic system.
Adult↗
Rapid improvement of symptomatology with pantoprazole, amoxycillin and metronidazole in Helicobacter pylori-positive duodenal ulcer patients.
BACKGROUND/AIMS: To evaluate the efficacy and tolerability of a new 1-week triple therapy regimen consisting of pantoprazole, amoxycillin and metronidazole. METHODOLOGY: The study involved 51 Helicobacter pylori (H. pylori) positive patients (M:30, F:21, mean age: 52.5 years, range: 24-75) affected with duodenal ulcer in active phase. At baseline and 6 weeks after the completion of treatment, clinical assessment, endoscopy with gastric biopsies, rapid urease test, 13C urea breath test, and serum laboratory analyses were performed. All patients were treated with pantoprazole 40 mg once daily, plus amoxycillin 1 gram tid and metronidazole 250 mg tid for 1 week, and pantoprazole 40 mg once daily for a second week. A clinical diary for daily assessment of symptoms and side effects was completed by patients during the treatment period. RESULTS: Three patients were discontinued from the study. Six weeks after therapy, the ulcer was healed in 47 of 48 patients (97.9%, 95% CI = 93.9-100). The cure rates of H. pylori infection, expressed using both the intention-to-treat and per protocol analyses, were 80.4% (95% CI = 69.5-91.3) and 85.4% (95% CI = 75.4-95.4), respectively. The therapy led to a significant, rapid disappearance or reduction in daytime epigastric pain, from 68.8% on day 1 to 82.2% on day 3 (p < 0.001) and in nocturnal epigastric pain, from 80.6% on day 1 to 93.3% on day 3 (p < 0.001). After 2 weeks of treatment, the percentage of patients completely free of pain was 82.2% for daytime pain and 90.3% for nocturnal pain. A rapid improvement in acid regurgitation, heartburn, nausea and vomiting was also observed with a median value of symptom disappearance of 2 days. The percentages of patients completely symptom-free were 37.5% after 1 day, 54.1% after 3 days, 75% after 2 weeks, and 83.3% after 2 months. H. pylori-cured patients showed a significant decrease in the histological activity of both antral (p = 0.0001) and body (p < 0.008) gastritis. Mild to moderate adverse events were reported by 15 patients. CONCLUSIONS: One week triple therapy with pantoprazole in combination with amoxycillin and metronidazole, followed by a second week of pantoprazole, was well tolerated and highly effective for the 1) rapid improvement or resolution of symptoms; 2) healing of the DU; 3) eradication of H. pylori infection; and, 4) reduction of histological signs of chronic gastritis activity.
2-Pyridinylmethylsulfinylbenzimidazoles↗
Lipoprotein(A) levels and apoprotein(a) phenotypes in a Sicilian population.
The aim of this study was to evaluate the influence of lipoprotein(a) levels and apoprotein(a) isoform size in determining the low cardiovascular risk of a rural, inland Sicilian population. Plasma levels of total cholesterol, LDL-cholesterol, HDL-cholesterol, triglycerides, lipoprotein(a) and apoprotein B and AI were measured in a sample of 278 subjects (141 males, 137 females) representative of a population of 1351 subjects (622 males, 729 females). The apoprotein(a) isoforms were also identified. Results indicated that the levels of the common lipo-apoliproprotein parameters were lower than those of other populations, while lipoprotein(a) plasmatic levels and apoprotein(a) isoform distribution were similar to those of other Caucasian populations. The distribution of lipoprotein(a) levels was skewed to the right, with a higher prevalence of low levels, the apoprotein(a) isoforms most strongly represented in our sample were of intermediate size (25-27 kringles IV). Univariate analysis showed that lipoprotein(a) levels were correlated to apoprotein(a) isoform size (R = -0.48, p < 0.001) and to the age of the subjects (R = +0.13, p < 0.01). In a multiple regression analysis, lipoprotein(a) levels were correlated to the apoprotein(a) isoform size of the homozygous isoforms or smaller heterozygous isoforms, while larger heterozygous forms were not correlated. In conclusion, our study showed that in our population, lipoprotein(a) levels and apoprotein(a) isoforms are similar to those of other Caucasian populations. Other factors, such as the physical activity of a rural population or the Mediterranean diet, must be considered in order to explain the lower cardiovascular risk of this population.
Adult↗
[Clinical and etiologic features of hepatocarcinoma in Sicily].
Hepatocellular carcinoma is a neoplasia with a high degree of malignancy and a quite unfavorable prognosis, and its frequency has tripled over the last 30 years. The aim of this study was to shed further light on some epidemiological and clinical aspects of hepatocellular carcinoma, on the basis of experience with a wide ranging patient population. We included 179 patients (127 males, 52 females, age range 31-86 years), diagnosed with hepatocellular carcinoma between January 1993 and December 1998. For each patient we recorded age, sex, coexistence and cause of cirrhosis, severity of cirrhosis, stage of hepatocellular carcinoma, serum markers of viral hepatitis (hepatitis B surface antigen and hepatitis C virus antibodies) and serum levels of alpha-fetoprotein. Hepatocellular carcinoma was associated with hepatitis C virus in 72% of patients, with hepatitis B virus in 10%, with combined infection in 3% and with negative viral markers in 15%. Mean age at diagnosis was significantly higher in the hepatitis C virus infection patients than in the combined infection patients (p < 0.04); the male/female ratio was 2.1:1 in the hepatitis C virus and 8:1 in the hepatitis B virus subjects. At hepatocellular carcinoma diagnosis, 175 out of 179 patients had liver cirrhosis with a significantly higher severity in patients with negative viral markers than in those with positive viral markers (p < 0.02). The stage of hepatocellular carcinoma at diagnosis was very advanced: in 103 out of 179 cases (58%) neoplasia was stage IV, with a stage I diagnosis in only 14 out of 179 (8%) cases. All the combined (hepatitis B and C virus) cases were diagnosed at stage IV, while hepatocellular carcinoma cases in patients with negative viral markers were diagnosed at earlier stages (66% stages I-II). Serum alpha-fetoprotein levels were above the normal limit (20 ng/mL) in 72% of patients; however, only 30% (54/179) had alpha-fetoprotein values > 400 ng/mL. These data confirm some previous epidemiological and clinical evidence concerning hepatocellular carcinoma (mean age at diagnosis, male/female ratio, severity of pre-existing liver disease, frequency of an associated hepatitis C and/or hepatitis B virus infection). Data based on such a large population, moreover, aid clarification of some still unresolved points such as the utilization of alpha-fetoprotein values in diagnosing hepatocellular carcinoma.
Adult↗
[Fecal chymotrypsin and steatorrhea in chronic pancreatitis].
The aim of the present study was to evaluate in 56 patients (48 M, 8 F) with chronic pancreatitis: a) the diagnostic validity of fecal chymotrypsin (FCT) assay, performed both on random samples and from previously homogenized samples collected over 3 days; b) the correlation between chymotrypsin and fecal fat excretion. CTF was measured using Kaspar's colorimetric method and fecal fats using the Van de Kamer method. Mean values of chymotrypsin measured on random samples were very similar to those measured on previously homogenized feces, 17.9 +/- 16.7 U/g vs 17.1 +/- 15.3 U/g respectively. There was a highly significant correlation between these values (r = 0.77 p less than 0.0003) and a highly significant inverse correlation between fecal fat and chymotrypsin excretion, both when the latter was measured on random and on previously homogenized samples (p less than 0.0001). FCT assay was fairly good sensitive (54%) for the whole group of patients with chronic pancreatitis, but very good (91%) for the group of patients with steatorrhea. The results show that the fecal chymotrypsin assay on random fecal samples is as valid as that carried out on homogenized feces and that there is a good correlation between fecal chymotrypsin values and steatorrhea of pancreatic origin.
Adult↗
Prospective study on thyroid function anomalies in severely ill patients.
Patients with severe non-thyroidal illness (NTI) often evidence concomitant anomalies in thyroid function (TF). In order to shed light on the implications of these anomalies and/or changes and disease course, we monitored TF changes in a selected cohort of 45 patients with serious NTI (21 with liver cirrhosis, 15 with renal failure and 9 with malignancy) from April 1985 to October 1989. TF test results on admission were as follows: all patients had normal thyroid stimulating hormone (TSH) levels; 16 patients had no TF abnormalities; 28 had decreased serum triiodothyronine (T3) and increased serum reverse triiodothyronine (rT3) levels, (8 of them had low serum free T3 values as well); 1 patient had subnormal level of both T3 and thyroxine (T4). Fifteen (53.5%) of the 28 subjects with initial low T3 sustained a subsequent decline in total and free serum T4 to subnormal levels; in 13 of these patients the drop occurred shortly before death. Patients in critical condition with below normal serum T4 also had decreased serum TSH concentrations: the so-called "low T3 and low T4 syndrome" might thus result from decreased TSH concentrations: due to failure of the usual feedback mechanism. Eighteen patients (40%) had died by the end of the study period. The mortality rate was 89% in patients with initial T3 level less than 0.40 nmol/L. This finding leads us to the hypothesis that initial low T3 levels in NTI patients are indicative of a poor prognosis.
Aged↗
[Serum pancreatic enzymes and fecal chymotrypsin before and after glyco-metabolic control in diabetic patients].
The aim of the present study was to ascertain whether secretory capacity of the pancreas, evaluated by assaying serum total amylase (TA) and pancreatic amylase activity (PA) and fecal chymotrypsin excretion (FCT), is impaired in diabetic and to what extent it is influenced by the degree of glyco-metabolic control. TA, PA and FCT were assayed in 40 patients affected with type II diabetes mellitus in secondary insufficiency, both at hospitalization and after metabolic control assessment; 43 hospitalized patients constituted the control group. A statistically significant difference was found between the metabolic failure phase values of diabetics patients and those of the control group for TA (p less than 0.0005), PA (p less than 0.025) and FCT (p less than 0.0005); between metabolic control phase values and control group fo TA (p less than 0.0005), and FCT (p less than 0.005) but not for PA values. PA values were statistically significant, within diabetic group, before and after metabolic control assessment. A statistically significant result was obtained by correlating C-peptide and FCT values (p less than 0.01), C-peptide and PA values (p less than 0.001); glycaemia and PA values (p less than 0.05). Our data suggest that in diabetic patients there is an impairment in secretory capacity of the pancreas and that the the PA is the more sensitive enzyme to the local levels of insulin.
Amylases↗
Lipid and apoprotein behaviour after oral fat load in hypertriglyceridaemia.
Post-prandial profiles of plasma lipids and apoproteins have been studied in 13 hypertriglyceridaemic patients and in 24 normolipidaemic subjects who acted as controls. Triglyceride curves were different in the two groups: type IV patients reached the peak later than the controls (7-h vs 4 1/2-h) and cleared plasma triglycerides more slowly. The magnitude of post-prandial response was found to be higher in hypertriglyceridaemic patients. Positive correlations were also found between triglycerides response and fasting levels of triglycerides, apo B, apo C-II, apo C-III and apo E levels and negative correlations (not significant) with HDL-C levels in both hypertriglyceridemics and controls. In normolipidaemic subjects the triglyceride increase area was also correlated with age, BMI and total cholesterol, while in type IV patients with apo A-I and apo A-II levels. These data confirm that the magnitude of post-prandial phase is influenced by fasting levels of triglycerides-rich lipoproteins and that HDL are important determinants in the control of the post-prandial response. The most relevant finding in this study was the difference of the post-prandial profile of apoproteins C-II, C-III and E. These apoproteins significantly decreased nine hours after meal in the controls, while in hypertriglyceridaemics these apoproteins showed a rise over time. On the contrary apo A-I, apo A-II and apo B curves presented a similar profile in both groups. Possible mechanisms have been discussed, but further studies are necessary to understand the metabolic defects responsible for this behaviour in hypertriglyceridaemia.
Adult↗