Biomedical subjects

Amedeo Lonardo

Publications and source records attributed to Amedeo Lonardo.

21 records · Page 2Linked to original sources

PubMedDate not supplied

[Multifactorial hepatopathy in a patient with biliopancreatic diversion].

The Scopinaro surgical technique for obesity consists of a partial distal gastrectomy with biliopancreatic diversion and cholecystectomy. It is an effective procedure in the control of the body weight but disrupts the physiological gut-liver axis. We report the case of a patient who developed liver cirrhosis with a multifactorial pathogenesis following antiobesity surgery according to Scopinaro and discuss the pathogenesis of the liver damage on the basis of our present understanding of alcoholic and nonalcoholic steatohepatitis. A 41-year-old male patient presented with ascites due to cryptogenic liver cirrhosis. Owing to morbid obesity, he had undergone antiobesity surgery according to Scopinaro when he was 25 years old. The procedure was effective and the patient lost about 40 kg of weight but manifested chronic diarrhea in the postoperative course. During the following 15 years, the patient continued to assume 100 g alcohol/day and did not turn up for clinical evaluation. Signs and symptoms of liver failure appeared in May 2000. After surgical correction of biliopancreatic diversion and abstinence from alcohol the hepatocellular function partially recovered and the patient regained his subjective complete well-being. The multifactorial pathogenesis of the liver disease observed in our patient included obesity, antrectomy, heavy alcohol consumption, bacterial overgrowth, and protein malnutrition.

Adult↗

PubMedDate not supplied

[Bleeding gastrointestinal angiodysplasias: our experience and a review of the literature].

The aim of the present study was to draw an outline of the clinical epidemiology of bleeding gastrointestinal angiodysplasias. The study includes a report of a case and of our series of patients with bleeding gastrointestinal angiodysplasias admitted, between 1993 and 2003, to a ward of Internal Medicine where digestive endoscopy is also performed. A review of the literature is also provided. An 80-year-old cirrhotic woman with aortic stenosis, was referred to our Department because of anemia due to melena. In spite of 13 hospitalizations during which numerous diagnostic procedures including endoscopy, X-ray studies, arteriography, labeled red blood cells scanning and laparotomy with intraoperative ileoscopy, the site and nature of the bleeding lesion remained unidentified. Her red blood cell requirement progressively increased from 6 U in 1993 to 24 U in 1994 to 40 U as of September 1995. Enteroscopy disclosed duodeno-jejunal angiodysplasia. The patient subsequently received 35 additional red blood cell units during 7 new admissions. Between 1993 and 2003, 24 patients were identified. They were mainly women and their average age was 77 years. Angiodysplasias were localized in the large bowel in 92% of cases. Comorbidities included: heart disease (79%), chronic liver disease (29%) and chronic renal failure (21%). One fourth of patients were under anticoagulant drugs or had a hemostatic blood disorder. All patients received blood transfusions and endoscopic treatment was performed in approximately half of the cases. The most relevant updates are related to the pathogenic relationship between aortic stenosis, von Willebrand's disease and bleeding gastrointestinal angiodysplasias, the hemostatic alterations associated with liver cirrhosis or with chronic renal failure and the diagnosis and treatment of bleeding gastrointestinal angiodysplasias. A better understanding of the clinical epidemiology of bleeding gastrointestinal angiodysplasias may facilitate their diagnosis and contribute to an effective clinical management.

Age Factors↗

PubMedDate not supplied

[Hepatitis C virus-associated and metabolic steatosis. Different or overlapping diseases?].

Hepatic steatosis is the hallmark of nonalcoholic fatty liver disease (NAFLD), which is the consequence of multiple metabolic derangements among which insulin resistance plays a pivotal role. Steatosis is, also, a feature of hepatitis C virus (HCV) infection. However, in chronic hepatitis C, the prevalence of steatosis is 2.5-fold more elevated than that expected by a chance concurrence with NAFLD, suggesting that HCV may be implied in the development of steatosis. As observed in NAFLD, in patients infected with HCV genotype 1 steatosis is associated with an increased body mass index. On the other hand, in patients infected with genotype 3 the extent of steatosis strictly correlates with the viral load indicating that steatosis is mainly "virus-related". Regardless of the "metabolic" or "viral" etiology, hepatic steatosis in HCV contributes to the progression of liver fibrosis, to the development of hepatocellular carcinoma and to an impaired response to interferon treatment. Features such as obesity, insulin resistance and type 2 diabetes mellitus are shared by NAFLD and HCV-associated steatosis. In addition, HCV infection, directly or through steatosis, favors the development of type 2 diabetes mellitus. Hyperlipidemia is an independent predictor of the development of NAFLD, but not of HCV-associated steatosis. Arterial hypertension is common in nonalcoholic steatohepatitis patients, and HCV infection has recently been acknowledged as an independent risk factor for atherosclerosis. The role of iron in the progression of both NAFLD and HCV-associated steatosis remains controversial while lipoperoxidation and oxidative stress are pathogenic mechanisms shared by both. Some metabolic risk factors may be shared by both HCV-associated steatosis and NAFLD although the disease progression and pathophysiological background may be different. Preliminary data suggest that the therapeutic options for NAFLD may also be useful to improve HCV-associated steatosis.

Fatty Liver↗