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Biomedical subjects

C Di Somma

Publications and source records attributed to C Di Somma.

85 records · Page 5Linked to original sources
PubMed1986

Effects of pirenzepine and atropine on gastroduodenal motor patterns in duodenal ulcer patients.

The aim of this study was to compare the effects of pirenzepine with those of atropine a non-selective antimuscarinic agent, on gastroduodenal motor patterns in duodenal ulcer patients. Twenty patients were allocated at random to 2 groups of 10 subjects each. The drugs were administered by bolus intravenous injection as equiactive antisecretory doses of 10 mg pirenzepine and 1 mg atropine. Before and 15 min after drug administration all patients underwent a gastroduodenal manometric and reflexogenic study with a specially designed probe and three inflatable latex balloons. Both drugs significantly decreased antral and duodenal pressure, but atropine was much more effective than pirenzepine: 91 +/- 2% verus 54 +/- 9% decrease in the motility index for the antrum and 95 +/- 1% versus 49 +/- 7% for the duodenum (p less than 0.01). The antral motor threshold was not modified by either drug. The results of this study confirm the selectivity of action of pirenzepine on gastric function.

Adult↗
PubMed1984

Colon motility and colo-anal reflexes in chronic idiopathic constipation. Effects of a novel enterokinetic agent cisapride.

Motor activity of the colon and reflex behaviour of the anal sphincters in normal subjects and in patients with idiopathic constipation were studied using a novel probe with 5 open-end tips to measure pressures, and 3 balloons for stimulation of the distal colon. Constipation appeared to be associated with an increased threshold of the inhibitory relaxation reflex of the internal anal sphincter (41.7 in normals and 65.7 in patients), and in particular with a blunted sensation of the defaecation urge (51.0 in normals and 112.8 in patients). Single-blind comparison with a placebo showed that cisapride, a new gastrointestinal prokinetic substance, had a significant effect on the sensation threshold, which normalized or improved in 15 out of the 16 patients studied.

Adult↗
PubMed1983

Colorectal cancer: relationship of histologic grading to disease prognosis.

Ninety patients underwent curative surgery for colorectal adenocarcinoma and they were followed for a period of 3 years. The aim of this retrospective study was to relate the cell differentiation (grading) and TNM classification of the UICC (1978) with the disease evaluation and patient survival. The results showed a consistent relation between grading and lymph node metastasis in patients with moderately and poorly differentiated adenocarcinoma, whereas no relationship was found between grading and local invasion of the tumor. Therefore, histocytologic grading of colorectal cancer appears to significantly influence survival grading parameters, and it may be a good method for monitoring the disease and follow-up of the patients.

Adenocarcinoma↗
PubMed1983

[Evaluation of the functional modifications of the lower esophageal sphincter after use of the Angelchik prosthesis].

The manometric recording of Lower Esophageal Sphincter (LES) has been made in 8 patients who have undergone surgical apposition of Angelchik prosthesis for hiatal hernia. The patients underwent an esophageal manometric study in the preoperative period, one month and one year after the intervention. In the preoperative patients, the mean LES pressure was 10,3 +/- 0,5 mmHg and there was sphincterial incoordination to peristaltic waves after swallow. In one month postoperative patients the LESP was 20,1 +/- 1,0 mmHg (p less than 0,001), and one year after the LESP was 17,0 +/- 0,3 (p less than 0,001) with an ameliorated coordination of the LES activity in response to swallow. Therefore, during postoperative manometric controls the Authors identified a high pressure subdiaphragmatic zone unmodified by deglutitory acts which was not present in the preoperative investigation. Probably the presence of this zone would been explained as a consequence of mechanical action of the prosthesis and the postsurgical fibrino-reaction around the prosthesis. The Authors discussed the results obtained and their importance to Angelchik prosthesis employment for surgical correction of hiatal hernia.

Esophagogastric Junction↗
PubMedDate not supplied

Failure of long-term therapy with sodium valproate in Cushing's disease.

The aim of the current study was to evaluate the effectiveness of a long-term treatment with sodium valproate in 19 patients with Cushing's disease. Before therapy beginning, the patients were subjected to acute test with 600 mg sodium valproate. Then, they were subjected to a 3-month therapy with sodium valproate at the dose of 600 mg/day before surgery (presurgical study). The 7 patients not surgically cured were subjected again to a 3-month therapy with sodium valproate at the dose of 600 mg/day after surgery (postsurgical study). Circulating ACTH and cortisol and urinary free cortisol levels were evaluated before and monthly after the beginning of the therapy. A decrease of plasma ACTH and serum cortisol levels greater than 50% of baseline was considered as positive response to acute test whereas the normalization of plasma ACTH, serum cortisol and urinary free cortisol levels and the clinical remission were considered as positive response to the long-term treatment. At acute test, 8 patients were considered responders and 11 patients non-responders. In no patient plasma ACTH, serum cortisol and urinary free cortisol were normalized during the long-term treatment. Urinary free cortisol levels significantly decreased (483.2 +/- 33.8 vs 699.4 +/- 67.0 micrograms/24 h), whereas plasma ACTH (302.8 +/- 17.7 vs 183.3 +/- 25.0 ng/l) and serum cortisol (466.5 +/- 23.2 vs 356.7 +/- 19.6 micrograms/l) significantly increased during sodium valproate administration in the 19 patients enrolled in the presurgical study. Plasma ACTH (247.7 +/- 22.3 vs 168.6 +/- 15.0 ng/l), serum cortisol (387.4 +/- 35.8 vs 282.0 +/- 16.0 micrograms/l) and urinary free cortisol (370.9 +/- 70.6 vs 261.3 +/- 37.8 micrograms/24 h) levels significantly increased in the 7 patients enrolled in the postsurgical study. No patient had clinical remission of Cushing's disease. In conclusion, the current study showed that long-term therapy with sodium valproate is not useful in the therapeutic management of Cushing's disease neither as alternative nor as adjunctive therapy to surgery.

Adrenocorticotropic Hormone↗
PubMedDate not supplied

Occurrence of GH deficiency in adult patients who underwent neurosurgery in the hypothalamus-pituitary area for non-functioning tumour masses.

Hypothalamus-pituitary tumours and their treatments (neurosurgery and/or radiotherapy) are major causes of acquired hypopituitarism. Scientific and clinical evidences show the positive effect of GH replacement therapy in severe adult GH deficiency (GHD) pointed toward the need of diagnostic screening of conditions at high risk for GHD. We screened 152 adults (82 males, 70 females; age: 52.3+/-1.2 years, age-range: 20-80 years, BMI: 26.4+/-0.8 kg/m(2)) in order to disclose the presence of GHD after neurosurgery for hypothalamus-pituitary tumours. The whole group (studied at least 3 months after neurosurgery) included: 111 non-functioning pituitary adenomas and 41 peri-pituitary tumours (24 craniopharyngiomas, 7 meningiomas, 5 cysts, 2 chondrosarcomas, 1 colesteatoma, 1 germinoma and 1 hemangiopericitoma). In 14 patients who underwent both neurosurgery and radiotherapy due to a tumour remnant, the somatotroph function was evaluated again 6 months after the end of radiotherapy. GHD was assumed to be shown by GH peak <5 microg/L (severe <3 microg/L) after Insulin Tolerance Test (ITT) or <16.5 microg/L (severe <9 microg/L) after GH-releasing hormone+arginine test (GHRH+ARG) (3rd and 1st centile limits of normality, respectively), two widely accepted provocative tests. Before neurosurgery GHD was present in 97/152 (63.8%) and resulted severe in 66/152 (43.4%) patients. After neurosurgery GHD was present in 122/152 (80.2%) and severe in 106/152 (69.7%). While 26 patients developed severe GHD (GHD) as consequence of neurosurgery, only one patient who had been classified as GHD before neurosurgery showed normal GH response after surgery. After neurosurgery, 91.0% (81/89) of the pan-hypopituitaric patients showed severe GHD. Considering the 14 patients who underwent also radiotherapy after neurosurgery, 7/14 had GHD before neurosurgery while 12/14 became severe GHD after radiotherapy in a context of pan-hypopituitarism. IGF-I levels below the 3rd age-related normal limits were present in 39.0% of patients in whom severe GHD was showed by provocative tests. In conclusion, this study shows that the occurrence of acquired severe GHD is extremely common in adult patients bearing non-functioning tumour masses in the hypothalamus-pituitary area and further increases after neurosurgery. All patients bearing non-functioning hypothalamus-pituitary tumours should undergo evaluation of their somatotroph function before and after neurosurgery that represents a condition at obvious more than high risk for hypopituitarism.

Adenoma↗
PubMedDate not supplied

Localization of the sentinel lymph node in breast cancer by combined lymphoscintigraphy, blue dye and intraoperative gamma probe.

Axillary lymph node status represents the most important prognostic factor in patients with operable breast cancer. A severe limitation of this technique is the relatively high rate of false negative sentinel lymph nodes (>5%). We studied 284 patients suffering from breast cancer; 264 had T1 tumors (16 T1a, 37 T1b and 211 T1c), while 20 had T2 tumors. All patients underwent lymphoscintigraphy 18-h before surgery. At surgery, 0.5 mL of patent blue violet was injected subdermally, and the sentinel lymph node (SN) was searched by gamma probe and by the dye method. The surgically isolated SN was processed for intraoperative and delayed examinations. The SN was successfully identified by the combined radioisotopic procedure and patent blue dye technique in 278/284 cases (97.9%). Analysis of the predictive value of the SN in relation to the status of the axillary lymph nodes was limited to 191 patients undergoing standard axillary dissection irrespective of the SN status. Overall, 63/191 (33%) identified SNs were metastatic, the SN alone being involved in 37/63 (58.7%) patients; a positive axillary status with negative SN was found in 10/73 (13.7%) patients with metastatic involvement. In T1a-T1b patients the SN turned out to be metastatic in 9/53 patients (17.0%). In 7/9 patients the SN was the only site of metastasis, while in 2/9 patients other axillary lymph nodes were found to be metastatic in addition to the SN. None of the 44 patients in whom the SN proved to be non-metastatic showed any metastatic involvement of other axillary lymph nodes. Our results demonstrate a good predictive value of SN biopsy in patients with breast cancer; the predictive value was excellent in those subjects with nodules smaller than 1 cm.

Adult↗
PubMedDate not supplied

Cardiological aspects of growth hormone and insulin-like growth factor-I.

In recent years it has been demonstrated that both GH deficiency and excess include in their advanced clinical manifestations an impaired cardiovascular function, which may reduce life expectancy. This observation has allowed the investigation of the role played by the GH/IGF-I axis on cardiac structure and function. In particular, several recent experimental and clinical studies support the evidence implicating GH and/or IGF-I in the regulation of heart development. Acromegalic cardiomyopathy is characterized by myocardial hypertrophy with interstitial fibrosis, lymphomononuclear infiltration and areas of monocyte necrosis which often result in increased right and left ventricular mass and concentric hypertrophy. Conversely, patients with childhood or adulthood-onset GH deficiency (GHD) have a reduced left ventricular mass and ejection fraction and the indexes of left ventricular systolic function remained markedly depressed during exercise. In addition, a significant increase in the thickness of the vascular intima-media wall and a higher number of atheromatous plaques have been reported. These abnormalities of the cardiovascular system are partially reversed after normalization of GH and IGF-I levels, by octreotide in acromegaly or after GH replacement therapy in GHD patients. The evidence that GH is able to increase cardiac mass suggested its use in the treatment of idiopathic dilated cardiomyopathy. In a recent study on such patients, the administration of rhGH was demonstrated to increase myocardial mass and to reduce the size of the left ventricular chamber, resulting in an improvement in hemodynamics, myocardial energy metabolism and clinical status. These promising results might open a new field for GH treatment.

Acromegaly↗
PubMedDate not supplied

[The postoperative prevention of deep venous thrombosis and pulmonary embolism with defibrotide versus heparin-calcium: a randomized clinical multicenter study of 1296 patients undergoing major abdominal surgery].

Postoperative thromboembolic complications do present an underestimated problem whenever their detection simply relies upon individual clinical judgement. Major abdominal operations are at increased risk of pulmonary embolism (PE) and deep vein thrombosis (DVT), mostly in advanced age, overweight subject, and in patients with cardiac or malignant diseases, or with previous venous diseases. Such patients may benefit from a peri- and postoperative prophylaxis with chemical or mechanical procedures, as a recent meta-analysis seems to suggest. In our experience, a randomized, multicentric clinical trial with defibrotide (DF) versus calcium-heparin (CH) was realized with the aim of evaluating their effectiveness and side effects in the prophylaxis of PE and DVT after major abdominal surgery; 1296 patients were randomly assigned to i.v. DF (400 mg.) or subcutaneous CH (0.2 ml. = 5000 U.I.) given one hour prior to operation and twice daily for seven days postoperatively. Definitive evaluation was carried out on 1212 patients (610 patients in DF and 602 in CH group, respectively) who completed the prophylaxis and monitoring schedule acceptably. One PE (0.16%) and 38 DVT (6.2%) were detected in DF group while 2 PE (0.33%) and 40 DVT (6.6%) were reported in CH treated patients. Post-operative blood loss was 578 +/- 150 cc. (median +/- S.E.M.) in DF group and 604 +/- 123 in CH group (p = n.s.). Wound hematoma was observed in 69 patients (5.7%): 20 (3.2%) in DF and 49 (8.1%) in CH group of patients (CHI-Square = 12.44; p = 0.0005); a significant post-operative decrease of RBC, WBC, Platelet count, and Fibrinogen was computed in both groups (p less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Abdomen↗
PubMedDate not supplied

[Gastroduodenal kinetic activity. Possible role of the duodenal bulb in controlling gastric emptying].

The aim of the present study was to evaluate the gastro-duodenal motility coordination, both during the interdigestive phase and after antroduodenal volumetric stimulus. It has been proved that it is possible to evoke the peristaltic gastric activity by stretching the gastric walls. Thus, the Authors simulated the mechanical conditions of the meal by inflating air into the antrum. They studied 5 healthy volunteers, whose age averaged 43 +/- 22.85 years. A 120 cm probe provided with two balloons at 7 and 21 cm from the distal end, and with 7 open-tips for manometric recording, was positioned by endoscopic way. The Authors were able to evaluate the Motor Antral Threshold (i.e. minimum air volume able to evoke an antral motor reflex), obtained by means of the antral inflatable balloon. The average values of this threshold showed to be 35 +/- 5 ml of air. While keeping the duodenal balloon inflated, the repetition of volumetric antral stimulus did not show any Motor Antral Threshold. This threshold showed up again with similar volumes in every patient after deflating the duodenal balloon. The results obtained suggest the existence of a negative duodenal-antral feed-back control on gastric emptying.

Adult↗