Biomedical subjects

F Pezzolla

Publications and source records attributed to F Pezzolla.

At least 19 recordsLinked to original sources

PubMed2004

Colonic smooth muscle responses in patients with diverticular disease of the colon: effect of the NK2 receptor antagonist SR48968.

BACKGROUND: Little is known about the pathophysiology of diverticular disease. AIM: To compare passive and active stress and the response to carbachol of colonic smooth muscle specimens from patients with diverticular disease and patients with colon cancer. The effect of the NK2 receptor antagonist, SR48968, on electrically evoked contractions of circular muscle was also investigated. PATIENTS: Sigmoid colon segments were obtained from 16 patients (51-83 years) undergoing elective sigmoid resection for diverticular disease and 39 patients (50-88 years) undergoing left hemicolectomy for non-obstructive sigmoid colon cancer. METHODS: Isometric tension was measured on circular or longitudinal taenial muscle. Strips were stretched gradually to Lo (length allowing the development of optimal active tension with carbachol) and were also exposed to increasing carbachol concentrations. The effects of atropine, tetrodotoxin and SR48968 on electrically evoked (supramaximal strength, 0.3 ms, 0.1-10 Hz) contractions of circular strips from 8 patients with diverticular disease and 19 patients with colon cancer were also studied. RESULTS: Both passive and active stress in circular muscle strips obtained from patients with diverticular disease was higher than in patients with colon cancer (P < 0.05). Electrically evoked contractions were significantly reduced by atropine in all preparations and were virtually suppressed by combined SR48968 and atropine. Tetrodotoxin suppressed electrically evoked contractions only in patients with colon cancer, whereas a tetrodotoxin-resistant component was identified in patients with diverticular disease. CONCLUSIONS: The changes in both passive and active stress in specimens from patients with diverticular disease may reflect circular smooth muscle dysfunction. Acetylcholine and tachykinins are the main excitatory neurotransmitters mediating electrically evoked contractions in human sigmoid colon circular muscle.

Aged↗

PubMed2003

Persistent dyspepsia after laparoscopic cholecystectomy. The influence of psychological factors.

BACKGROUND: Many patients with gallstone disease continue to report gastrointestinal symptoms after cholecystectomy, but the predictive value of preoperative factors is not well understood. We aimed to investigate whether psychological symptoms can be associated with poor outcome after cholecystectomy in patients with gallstones and dyspepsia. METHODS: A sample of 52 consecutive patients with uncomplicated gallstone disease and dyspepsia (conceived in a broader sense to include symptoms of the whole digestive tract) were assessed for psychological (revised 90-item Hopkins Symptom Checklist) and gastrointestinal symptoms (Gastrointestinal Symptom Rating Scale). One year after laparoscopic cholecystectomy, patients rated their gastrointestinal symptoms and were divided into improved and unimproved on the basis of the change in symptoms. RESULTS: Twenty-one (40.4%) patients did not improve after surgery. Improved and unimproved patients did not differ in terms of sex, age, education or illness duration. Unimproved patients showed significantly higher psychological and dyspeptic symptoms than improved patients before surgery. Logistic regression showed that psychological factors were significantly associated with unimprovement after surgery. CONCLUSIONS: Patients with gallstone disease and dyspeptic symptoms are unlikely to improve 1 year after surgery if they show psychological distress before surgery. Psychological symptoms were strongly associated with poor post-cholecystectomy outcome, thus highlighting the clinical relevance of joint assessment of psychological and gastrointestinal symptoms before surgery.

Adult↗

PubMed2001

Effect of three nonpeptide cholecystokinin antagonists on human isolated gallbladder.

Cholecystokinin is the most important stimulant of postprandial gallbladder contraction, and a regulator of gallbladder fasting tone. The aim of this study was to evaluate the effect of dexloxiglumide on isolated human gallbladder contraction induced by cholecystokinin-octapeptide and to compare this effect to that of lorglumide and amiglumide, two glutaramic acid analogs of dexloxiglumide. The negative logarithms of the antagonist dissociation constant (pK(B)) values were 7.00 +/- 0.14, 6.95 +/- 0.11, and 6.71 +/- 0.10 for lorglumide, dexloxiglumide, and amiglumide, respectively. Dexloxiglumide produced a concentration-dependent rightward shift of the cholecystokinin-octapeptide curve, without affecting its maximal response. A similar effect was obtained both with lorglumide and amiglumide. Moreover, the slopes for the three antagonists did not differ significantly from unity. These data show that the three molecules have a potent antagonistic effect, of a competitive nature, on gallbladder cholecystokinin type 1 receptors. It may be concluded that dexloxiglumide, lorglumide, and amiglumide exhibit a promising therapeutic profile for biliary colic and other gastrointestinal disorders in which CCK1 receptors play important physiological roles.

Cholecystokinin↗

PubMed2000

K-ras and p53 mutations in DNA extracted from colonic epithelial cells exfoliated in faeces of patients with colorectal cancer.

BACKGROUND: Exfoliated colonic epithelial cells in faeces provide a source of human DNA which may be analysed for the presence of tumour-induced modification. AIM: In the present study we investigated K-ras and p53 mutations in faeces of patients with colorectal carcinoma, to verify whether analysis of these mutations might identify a high percentage of patients with colorectal cancer. PATIENTS AND METHODS: Faeces, tumour and normal mucosa samples were taken from 26 patients. Polymerase chain reaction amplification and restriction enzyme analysis were performed to detect K-ras mutations; p53 gene mutations were identified by using polymerase chain reaction amplification and single strand conformation polymorphism. RESULTS: We were able to amplify the K-ras gene and exons 5-9 of the p53 gene in 100% of the faecal samples studied. K-ras and p53 gene mutations were detected in faeces in 26.9% and 50% of the cases, respectively. The two mutations were present together in 5 out of 26 patients. There was full agreement between the K-ras and p53 pattern observed in faecal DNA and that in tumour tissue DNA. CONCLUSIONS: Application of K-ras and p53 mutation gene analysis in the faeces may have clinical applications in the future. Since this genetic analysis is able to detect only 57.7% of patients with colorectal cancer, the study of other genes involved in colorectal carcinogenesis is necessary.

Adenocarcinoma↗

PubMed1999

Effect of somatostatin on human gallbladder motility: an in vitro study.

In vivo studies have demonstrated that somatostatin induces human gallbladder relaxation. To determine whether this polypeptide acts directly on the gallbladder muscle, its effect on strips of human gallbladder was studied in vitro. Strips of gallbladder were set up isometrically in an organ bath containing oxygenated Krebs' solution. Dose-response curves to cholecystokinin-octapeptide and carbachol were first established. The ability of somatostatin to cause relaxation under basal conditions and during 50% maximal stimulation by cholecystokinin-octapeptide (7.2 x 10(-8) M) and carbachol (3.5 x 10(-6) M) was assessed in 32 strips at 4.3 x 10(-6) M concentration which mimics the plasma concentrations found in patients with somatostatinoma and in 12 additional strips at 4.3 x 10(-8) M concentration. Somatostatin action on the intrinsic innervation by using electrical field stimulation (EFS) (200 mA 5 msec in duration, 30 Hz; 400 mA, 1 msec in duration, 10 Hz) was also evaluated in 39 strips. Somatostatin had no effect on the basal or carbachol-generated tensions. On the contrary, somatostatin (4.3 x 10(-6) M) reduced cholecystokinin-octapeptide-generated tensions by 8% (P < 0.001) and reduced EFS-generated tensions at 30 Hz by 7.7% (P < 0.01) and those at 10 Hz by 41.2% (P < 0.01). All responses to cholecystokinin-octapeptide and carbachol were abolished by dibutyryl-guanosine 3', 5'-cyclic monophosphate (5 x 10(-3) M) and atropine (10(-5) M), respectively (P < 0.0002 and P < 0.0002). All responses to electrical field stimulation were reduced or abolished by tetrodotoxin (2 x 10(-6) M) (P < 0.001 and P < 0.0001, respectively). Our findings show that somatostatin exerts its inhibitory action on the response to cholecystokinin-octapeptide and on the intrinsic innervation of the gallbladder smooth muscle. The probable neurotransmitter is the acetylcholine.

Carbachol↗

PubMed1998

Motor responsiveness of proximal and distal human colonic muscle layers to carbachol and neurotensin.

A regional heterogeneity of the responsiveness to neurohumoral agents has been demonstrated in proximal and distal colon. The aim of this study was to compare the motor responsiveness of circular and longitudinal muscles from ascending and sigmoid colon to carbachol and neurotensin. Ascending colon circular muscle was more sensitive to carbachol than sigmoid colon circular muscle (P < 0.05). Moreover, the potency for the carbachol-stimulated contraction was greater in ascending colon circular than longitudinal muscle (P < 0.05). The potency for carbachol and neurotensin stimulations was similar in longitudinal and circular muscles of both sections, respectively. However, the ascending colon circular muscle had a greater potency to neurotensin than longitudinal muscle (P < 0.03). Longitudinal muscle was more sensitive to the effects of neurotensin in sigmoid than ascending colon (P < 0.01). On a molar basis, neurotensin was approximately fivefold more potent than carbachol in producing similar contractions. These data suggest that these agents stimulate human colon smooth muscle according to region and type of muscle layer.

Adult↗

PubMed1997

Effects of cholecystectomy on gastric emptying and myoelectrical activity in man.

To investigate the effects of cholecystectomy on gastric motor function, 13 patients with symptomatic gallstones were studied before and 8-12 months after surgery. Twelve healthy subjects entered the study as control group. The cutaneous electrogastrography and ultrasound examination of gastric emptying were simultaneously performed at pre- and post-prandial states. The dominant gastric frequency and its coefficient of variation were not affected by surgery. After cholecystectomy, an increase in normal 3 cpm wave percentage and a decrease in power ratio were found (P < 0.05 and P < 0.01, respectively). Gastric emptying recorded after cholecystectomy was faster than before surgery (306.9 +/- 15.9 min vs 336.9 +/- 11.8 min, respectively; P < 0.05). Such changes were associated with the relief of symptoms, and the comparison between patients and controls showed a normalization of the gastric electrical activity and gastric emptying after surgery. In conclusion, in symptomatic patients, gallstones are associated with motor dysfunctions, and cholecystectomy seems to induce a normalization of gastrointestinal motility.

Adult↗

PubMed1997

[Surgical therapy of the peptic ulcer in a hospital specializing in gastroenterology. Effects of therapy with h2 antagonists].

To evaluate how the introduction of H2-receptor antagonists has modified the epidemiology of surgical management of peptic ulcer, we examined data records of patients operated on for gastric or duodenal ulcer in our Institute. Patients were divided into two groups: a) patients operated from 1970 to 1979 and b) patients operated from 1980 to 1992. The comparison between the two groups showed the following variations: decrease in male/female ratio from 8 to 4.4:1 (p = 0.0009); decrease in duodenal/ gastric ulcer ratio from 5 to 3.5:1 (p = 0.02); decrease in elective/emergency surgery ratio from 16 to 6.4:1 (p = 0.00006); increase in mean age of patients undergoing emergency operations from 51 to 58 years (p = 0.05); decrease in elective/emergency surgery ratio for gastric ulcer from 17.5 to 5.3:1 (p = 0.03), above all for the increase in emergency operations for hemorrhage; decrease in the prevalence of operations for refractory duodenal ulcer from 49% to 36% (p = 0.00009). Our findings show that H2-receptor antagonists have greatly modified the epidemiology of surgical treatment of peptic ulcer with a clear decrease in elective surgery for refractory duodenal ulcer in men and an increase in emergency surgery for gastric ulcer.

Adolescent↗

PubMed1996

Electrical activity recorded from abdominal surface before and after gastric surgery in man.

To explain the role of the different portions of the stomach in the genesis of electrical signal obtained from abdominal surface (Electrogastrography, EGG), the EGG was recorded in 6 patients with gastric cancer and 7 with duodenal ulcer before and after total gastrectomy or Billroth II gastric resection, respectively. Eight patients undergoing cholecystectomy entered the study as controls. The spectral frequency components were subdivided into ranges, and the dominant frequency and power were calculated for each range before and after surgery. The power profile, expressed as difference in power percentages before and after surgery for each frequency range, was obtained. The power profile from total gastrectomy or gastric resection was clearly different from that resulting from cholecystectomy in the 2.6-3.5 cycles per minute range (cholecystectomy vs gastric resection, P = 0.009; cholecystectomy vs gastrectomy, P = 0.012). No difference in power profile between total gastrectomy and gastric resection was demonstrated. Since total and partial gastrectomized patients showed a similar power profile, EGG signal corresponded to the electrical activity of the distal two third of the stomach.

Abdomen↗

PubMed1996

Gallbladder motility in vitro in men with gallstones following Billroth II gastric resection.

Gastric surgery induces an increased incidence of gallstones. To investigate the changes in gallbladder kinetics after gastric resection, 20 male patients were studied: ten patients undergoing cholecystectomy for gallstones developed after Billroth II gastric resection and ten patients undergoing cholecystectomy for cholelithiasis without previous abdominal surgery. Longitudinal strips from the gallbladder wall were suspended in an organ bath and the isometric tension recorded. Dose-response curves to cholecystokinin-octapeptide and carbachol were obtained. Half the maximal response to cholecysto-kinin-octapeptide was 0.50 +/- 0.11 x 10(-7) M in the first group and 1.36 +/- 0.37 x 10(-7) M in the second group (P < 0.05). The ED50 to carbachol was 24.33 +/- 2.69 x 10(-7) M in the gastrectomy group and 40.39 +/- 5.01 x 10(-7) M in the control group (P < 0.01). There was no significant difference in the maximal contractile response either to cholecystokinin-octa-peptide or carbachol in the two groups. Our study shows an increased gallbladder sensitivity to cholecystokinin-octapeptide and carbachol in patients with gallstones developed after Billroth II gastric resection.

Aged↗

PubMed1995

Gallbladder motility before and after Billroth II gastric resection.

The aim of this study was to determine the effect of Billroth II gastric resection (BII) without vagotomy on gallbladder contraction in response to meal and CCK-OP infusion. Fourteen duodenal ulcer patients were studied before surgery and six months postoperatively. Gallbladder volume was measured by real-time ultrasonography. After surgery, there was a significant increase in fasting gallbladder volume (P < 0.05). Postprandial gallbladder emptying was not significantly affected by gastrectomy apart from a trend towards a shorter t1/2 and a larger ejection volume. In addition, postoperative gallbladder relaxation was more pronounced at time 120 min. In response to cholecystokinin-octapeptide (CCK-OP) infusion, there was a significant decrease of t1/2 after BII and a prolonged contraction with a significantly reduced gallbladder volume. Our data show that the gallbladder response both to meal and CCK-OP infusion is modified after BII and a larger postoperative gallbladder volume may play a role in the pathogenesis of gallstone disease after gastric surgery.

Adult↗

PubMed1995

[Effects of gastric resection by the Billroth II technic on reflux esophagitis associated with duodenal or pyloric ulcer].

Although duodenal ulcer and reflux esophagitis may frequently co-exist, it is not clear whether surgery for duodenal ulcer associated with reflux esophagitis should not be associated with anti-reflux plastic surgery. The authors make a retrospective evaluation of the prevalence of reflux esophagitis (endoscopic diagnosis) in a consecutive series of 633 patients undergoing elective gastric resection according to Billroth II for duodenal or pyloric ulcer during the period 1974-1992 and assess the effects of surgery on co-existent esophagitis. The prevalence of reflux esophagitis associated with duodenal or pyloric ulcer was 12.3%. In patients in whom stenosis represented the indication for ulcer surgery, the prevalence of esophagitis was 20%, whereas it was 5% in those operated because of failure to respond to medical therapy of hemorrhage (p = 0.000001). In 95% of patients, controlled endoscopically 6 months after surgery, Billroth II gastric resection led to the resolution or improvement of associated esophagitis. The authors conclude that by eliminating the main pathological factors of reflux esophagitis associated with duodenal ulcer (hypersecretion of gastric acid, impeded gastric emptying) gastric resection is sufficient to achieve the resolution of esophagitis.

Adult↗

PubMed1995

Surgical management of reflux esophagitis associated with duodenal ulcer.

The prevalence of associated reflex esophagitis and the effects of surgery for ulcer on coexistent esophagitis were assessed in 687 patients operated on for duodenal or pyloric ulcer. Eighty-one patients (12%) had a preoperative endoscopic diagnosis of reflux esophagitis. The association resulted to be more frequent in patients with pyloric or bulbar stenosis than in patients without stenosis (20% vs 5%, p = 0.000001). Billroth II gastric resection, performed in most cases, caused the healing or the improvement of esophagitis in 95% of cases as demonstrated at endoscopy 6 months after surgery, particularly in 98% of patients with pyloric or bulbar stenosis and in 80% of patients without stenosis (p = 0.05). Therefore, gastric resection, eliminating the main pathogenetic factors of reflux esophagitis associated with pyloric or bulbar stenosis (gastric acid hypersecretion, impaired gastric emptying), assures the healing of esophagitis in most cases. However, anomalies in Lower Esophageal Sphincter function might play an important role in the pathogenesis of reflux esophagitis in duodenal ulcer patients without stenosis. In these patients, on the basis of manometric and pH monitoring data, it may be useful to associate an anti-reflux procedure or a duodenal diversion with a gastric resection in presence of Lower Esophageal Sphincter hypotonia.

Adult↗

PubMed1994

Electrical activity recorded from abdominal surface before and after right hemicolectomy in man.

To explain the origin of the electrical signals obtained from the abdominal cutaneous surface (electrosplanchnogram, ESG), the ESG was recorded in 6 patients with carcinoma of the right colon without obstruction before and after right hemicolectomy. The analysis of colonic electrical activity was performed by means of spectral analysis that utilized fast Fourier transform method. Since the colonic electrical signal is highly complex and it may contain several frequencies concurrently the spectral frequency components were subdivided in ranges and the dominant frequency and power were calculated for each range before and after surgery. The pattern obtained from power profile, expressed as differences in power percentages before and after surgery, demonstrated that there were significant differences in power data from right hemicolectomized patients compared to cholecystectomized ones (p = 0.00001 and p = 0.001 in 2.5-3.5 and 3.6-7.5 cpm range, respectively). In particular, hemicolectomized patients showed a slight increase of power percentage in the 2.6-3.5 cpm range and a clear reduction in the 3.6-7.5 cpm range. These data suggest that there are several components of colonic origin in the cutaneous ESG signal which, in the right colon, are identifiable in the 3.6-7.5 cpm range.

Abdomen↗

PubMed1994

[The palliative surgery of periampullary neoplasms. Our experience].

The increased incidence of peri-ampullar neoplasia and the low percentage of cases in which radical surgery is possible fuel interest in the use of palliative treatment for this pathology. The authors report their 10-year experience of palliative surgery for peri-ampullar cancer and evaluate immediate and long-term results. Between January 1980 and December 1990 the authors operated 91 patients with peri-ampullar carcinoma (head of the pancreas, Vater's ampulla, terminal choledochus). Eight (9%) underwent radical surgery and 83 (91%) underwent palliative surgery. The distribution of cases according to tumour origin in the latter group was as follows: head of the pancreas 60 cases (72%); intra-pancreatic choledochus 13 (16%); Vater's ampulla 10 (12%). The most frequent symptoms were pain (70%) and jaundice (63%). The mean interval between the appearance of symptoms and diagnosis was 1 month (range: 5 days-12 months). The most frequently performed biliodigestive derivative surgery was cholecystojejunostomy (72% of cases). Complications were observed in 18% of cases. Mortality was 12%. Mean survival was 5 months (range: 2-43 months). The recent use of endoscopic techniques for the treatment of jaundice in patients with inoperable peri-ampullar carcinoma now requires prospective studies to compare these techniques with surgery.

Adult↗

PubMed1994

Duodenogastric reflux and gastric mucosal cell proliferation after cholecystectomy or Billroth II gastric resection.

OBJECTIVES AND METHODS: Twelve patients to be undergone cholecystectomy and 4 patients to be undergone Billroth II gastric resection were examined before and after surgery in order to evaluate the association between duodenogastric reflux and gastric mucosal cell proliferation. Duodenogastric reflux was assessed by measuring the concentration of bile acids in gastric juice and expressed as fasting bile reflux in mumol/h. Gastric mucosal cell proliferation was assessed by measuring the concentration of polyamines (putrescine, spermidine and spermine) in biopsy specimens and expressed in mumol/g of tissue. RESULTS: The median increase in fasting bile reflux was 34 mumol/h after cholecystectomy and 238 mumol/h after Billroth II gastric resection (P = 0.008). After cholecystectomy the median value of putrescine levels in antrum was 39 mumol/g, whereas after Billroth II gastric resection putrescine levels in pre-anastomotic area was 79.5 mumol/g (P = 0.008). There was a positive correlation between fasting bile reflux and putrescine levels either in antrum (r = 0.37, P = 0.04) or body (r = 0.48, P = 0.006). CONCLUSIONS: The increase in cell proliferation activity of gastric mucosa after Billroth II gastric resection might explain the increased risk for cancer of gastric remnant.

Adult↗

PubMed1994

[The clinical aspects of 49 cases of early gastric cancer].

Forty-nine consecutive patients with early gastric cancer (EGC), observed from January 1978 to December 1992 in the Surgery Department of our Institute, were included in a retrospective study. The EGC prevalence in the overall cases of gastric cancer was 11%. This frequency was 8% in the period 1978-1985 and 15% in the period 1986-1992. All patients underwent gastroscopy with gastric biopsy, but only in 35 cases (72%) was a preoperative diagnosis of gastric cancer possible. In the remaining 14 cases only the histological examination of surgical specimens made possible a definitive diagnosis. A subtotal gastrectomy was carried out in 36 cases (73%), a total gastrectomy in 12 cases (25%) while only in one case (2%) was a superior polar resection carried out. The postoperative morbidity was 5% and mortality was 2%. The median survival was 61 months and, at the moment, 41 patients are alive and free from disease. Our data confirm the favourable prognosis of EGC compared to the advanced gastric cancer. We think it useful to carry out a routine gastroscopy when there are symptoms related to the upper abdomen in order to make an early diagnosis of gastric cancer.

Adult↗

PubMed1993

Influence of the method of digestive tract reconstruction on gallstone development after total gastrectomy for gastric cancer.

The aim of this study was to evaluate whether total gastrectomy performed for gastric cancer leads to an increased risk of cholelithiasis and whether the method of reconstruction of the digestive tract influences that risk. A total of 102 patients who had undergone total gastrectomy for gastric cancer between 1980 and 1990 were studied. The preoperative prevalence of cholelithiasis was 4% in men and 12% in women. Eighty-seven patients (85%) without gallstones before surgery were reexamined after gastrectomy. The postoperative prevalence of cholelithiasis in this group was 36% in men and 19% in women. Before surgery, the difference between the expected frequency of cholelithiasis (calculated on the basis of the data of a community survey) and the observed frequency was not statistically significant (p > 0.05) either in men or women. After surgery, the observed frequency of gallstones was significantly higher than the expected frequency in men (p < 0.0001) but not in women (p = 0.06). The risk of cholelithiasis was significantly higher in patients with Roux-en-Y reconstruction (n = 55) than in those with jejunal interposition (n = 32) (log-rank test, p = 0.03), and that risk was independent of age, sex, and body mass index.

Adult↗