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Biomedical subjects

F Vicari

Publications and source records attributed to F Vicari.

At least 19 recordsLinked to original sources
PubMed1997

Ribavirin and interferon-alpha combination therapy vs interferon-alpha alone in the retreatment of chronic hepatitis C: a randomized clinical trial.

Interferon-alpha (IFN-alpha) induces sustained remission of chronic hepatitis C in approximately 25% of patients. In patients who are non-responders to the first course of therapy, retreatment with IFN-alpha is of limited efficacy. Ribavirin has also been used to treat chronic hepatitis C, but it induces only a transient response. In this study, we evaluated the efficacy of ribavirin and IFN-alpha combination therapy for IFN-alpha resistant chronic hepatitis C. Twenty-four IFN-alpha non-responders and 24 relapsers were randomized to receive either ribavirin (1000 mg per day) together with IFN-alpha (3-6 million units (MU) thrice weekly) or the same dose of IFN-alpha alone, for 6 months. Both at the end of treatment and 6 months later, normal transaminase levels were more common in the patients receiving combination therapy than in the group receiving IFN-alpha alone: 17 (70.8%) vs seven (29.2%) patients (P = 0.009) and six (25%) vs one (4.2%) patient (P = 0.034), respectively. At the end of treatment and 6 months later, serum HCV RNA was no longer detectable in eight (33.3%) and five (20.8%) patients in the combination therapy group and in six (25%) and one (4.2%) patient in the IFN-alpha therapy group, respectively. Three patients (12.5%) were withdrawn prematurely from combination therapy because of side-effects; ribavirin therapy was ceased or dosage reduced in six other patients (25%), again because of side-effects. In conclusion, this combination treatment was more effective than retreatment with IFN-alpha, alone, in inducing sustained biochemical remission of chronic hepatitis C that was resistant to a previous course of IFN-alpha. The combination treatment, however, was frequently associated with significant side-effects.

Adult↗
PubMed1994

[Effect of enprostil on the healing and the recurrence of duodenal ulcer. Comparison with ranitidine].

Enprostil, a synthetic prostaglandin E2, has been shown to exert both antisecretory and mucoprotective activity. It is effective in duodenal ulcer healing. OBJECTIVE--This study was performed to compare the frequency and the delay of spontaneous duodenal ulcer relapse during a two-year follow up period after initial healing by enprostil (35 micrograms, twice a day) or ranitidine (300 mg per day). METHODS--This multicentric, double-blind, randomized study included 642 patients (324 in the enprostil group and 318 in the ranitidine group). Patients included in the follow up period were evaluated by an endoscopy at 6 months, one and two years after healing. RESULTS--After a 6 weeks treatment period, healing rate was 85% for ranitidine and 70% for enprostil, respectively (P < 0.001). Adverse effects, especially digestive ones, occurred more often with enprostil than with ranitidine (P < 0.001). After initial healing, there was no significant difference between the 2 groups concerning the cumulative rate of relapse, despite a non significant trend for a milder rate of relapse in the enprostil group (P = 0.08). Twenty-seven % of the patients randomized to treatment (intend-to-treat analysis) in the enprostil group and 29% in the ranitidine group had no ulcer recurrence 6 months after ulcer healing, and respectively 12% and 13% at 2 years (difference not statistically significant). CONCLUSIONS--It is concluded that a) ranitidine is more effective and has less adverse effects than enprostil for duodenal ulcer healing, b) after duodenal ulcer healing by enprostil, there is a non significant trend for a lower rate of relapse than after healing with ranitidine, c) there is the same proportion of patients without ulcer in the 2 groups after 6 months and 2 years.

Adolescent↗
PubMed1994

[Variations of plasma gastrin (basal and postprandial) in ththtreatmentof duodenal ulcer with either enprostil or ranitidine. Correlations with rates of relapse].

Enprostil, a synthetic E2-prostaglandin efficacious for duodenal ulcer healing, presents both antisecretory and antigastrinic effects. This is at variance with the elevation of plasma gastrin observed with ranitidine. OBJECTIVE--This leads us to compare enprostil and ranitidine on the following points: a) variations of plasma gastrin (basal and postprandial) parameters over a 6-week conventional treatment; b) correlation studies between ulcer relapses (frequency and temporal evolution) after treatment discontinuation and various gastrinic criteria. METHODS--Among a group of 642 patients followed for ulcer relapse, 165 were considered for gastrin (78 of the "Enprostil" group and 87 of the "Ranitidine" group). RESULTS--Initially, both populations were comparable for clinical and plasma gastrin parameters. After 6 weeks of treatment, the increases in the various gastrin parameters (basal, postprandial, peak, integraded) were significantly greater and the absolute values higher (Wilcoxon, P < 0.001) with ranitidine than with enprostil. No correlation was found between relapse occurrence after drug discontinuation and these gastrin parameters. CONCLUSIONS--Ranitidine hypergastrinemia seems directly related to gastric hyposecretion whereas its absence with enprostil is likely more dependent upon a specific antigastrinic activity than on a reduced antisecretory activity. Those differences in mechanism of action have no consequence on the stability of ulcer obtained by either drug.

Adolescent↗
PubMed1989

Comparative study of sucralfate versus cimetidine in the treatment of acute gastroduodenal ulcer. Randomized trial with 667 patients.

Six-hundred sixty-seven patients with endoscopically proven peptic ulcer were included in a randomized, multicenter trial to assess the comparative efficacy of sucralfate and cimetidine. One hundred eighty-seven patients with gastric ulcer and 480 patients with duodenal ulcer completed the study. Ulcer healing was evaluated endoscopically at six weeks for duodenal ulcer and at eight weeks for gastric ulcer. Patients with unhealed ulcer at this time were assigned to the other therapy for a second period of six or eight weeks of treatment (crossover). In patients with duodenal gastric ulcer, pain relief and healing were not significantly different in the two groups. Eighty-eight percent of duodenal ulcers and 73 percent of gastric ulcers healed with six weeks of sucralfate treatment. Reported side effects and symptoms, pooled together for duodenal and gastric ulcer, were more significant in the sucralfate group (7.5 percent) than in the cimetidine group (3.7 percent). Constipation was the most frequent symptom recorded. In conclusion, sucralfate and cimetidine are both excellent healing agents for short-term treatment of duodenal and gastric ulcer. Both give rapid relief of symptoms without severe side effects.

Acute Disease↗
PubMed1989

[Efficacy and tolerability of enprostil in the treatment of duodenal ulcer. Comparison with cimetidine].

Enprostil, a synthetic PGE2, has been shown to have an inhibitory effect on gastric acid secretion, a mucoprotective effect and a postprandial lowering effect on gastrin. A double blind randomized study was performed in 80 patients, in order to evaluate the efficacy and safety enprostil (35 mu b.i.d) as compared to cimetidine (400 mg b.i.d) in duodenal ulcer. Healing rates after two, four and six weeks of treatment, as based on endoscopic evaluation, were 35, 72 and 83 p. 100 for enprostil and 45, 73 and 83 p. 100 for cimetidine, respectively. There were no significant differences between treatment groups. The time to relief of nighttime and daytime ulcer pain and antacid consumption were similar in the two groups. The patient's overall subjective assessment was better in the cimetidine group, but this was not confirmed by physicians' opinions. Diarrhea was observed in 7 p. 100 of patients treated by enprostil compared with 5 p. 100 for patients treated by cimetidine. One enprostil treated patient withdrew from the trial prematurely because of abdominal pain. This study demonstrates the efficacy and safety of enprostil in the treatment of active duodenal ulcer at the dosage of 35 micrograms twice daily.

Adult↗
PubMed1989

[Scanning electron microscopic study of Campylobacter pylori and associated gastroduodenal lesions].

The detection of Campylobacter pylori was carried out with scanning electron microscopy (SEM) on 4,590 biopsies taken from 1,714 adult patients (1,348 duodenal biopsies, 1,690 antral biopsies and 1,552 fundic biopsies). The mucus was removed and the fragments of mucosa were then fixed with glutaraldehyde, dehydrated, critical point-dried with CO2 or hexamethyldisilazane, mounted, coated with gold, and observed with SEM. Under SEM, C. pylori was characterized by its spiral-shape (long form 2.5 to 6 microns) or by its curved-shape (short form 1.5 microns) and by its relatively constant diameter (0.5 micron). C. pylori was present in 671 patients (40 p. 100) and was found mainly in the fundus and antrum, near the neck of the gastric glands and at the level of the intracellular spaces. It was never present on the surface of enterocytes but was found in the 26 duodenal biopsies in the gastric metaplasia areas and on the surface of adjacent muciparous cells. The main epithelial lesions associated with C. pylori were of an erosive or desquamative type. The high definition observed using SEM allowed C. pylori to be distinguished from other microorganisms observed on the surface of the gastroduodenal mucosa: bacilli and cocci contaminants, Candida albicans, Giardia lamblia, spirochetes and other Campylobacters. SEM is a specific and rapid technique (less than 2 hours) which determines the morphology, localisation of bacteria as well as the associated lesions of the mucous cells.

Biopsy↗
PubMed1984

[Comparative study of intravenous midazolam and diazepam used as sedative agents during gastroscopy].

Midazolam was compared with diazepam for the intravenous sedation of gastroscopy patients. 0.1 mg X kg-1 midazolam were given to patients less than 65 years old, and 0.085 mg X kg-1 after that age; diazepam doses were 0,2 mg X kg-1 and 0.15 mg X kg-1 respectively. The effect and duration of action of both drugs were similar. The main differences between them were as follows: the intravenous injection of midazolam was not painful, and virtually no venous complications were seen; amnesia and patient contentedness were more frequent with midazolam; gastric secretion was reduced with midazolam. Neither drug had clinically significant cardiovascular effects.

Benzodiazepines↗
PubMed1982

[Contribution of per- and trans-endoscopic pH measurements to the exploration of the upper digestive tract (author's transl)].

Per- and trans-endoscopic pH measurements in the upper digestive tract have provided new and interesting data. Performed by the authors on a series of 314 patients, they showed that the gastric pH is seldom acid, even in duodenal ulcer, and is always alkaline in gastric ulcer and gastric carcinoma. Gastritis may be divided into two groups, depending on whether the pH is normal or hypoacid (4.5 in the antrum, 2.5 in the fundus). Biopsies demonstrated the presence of intestinal metaplasia and epithelial dysplasia in 57.8% of 83 patients with hypoacid gastritis. The method therefore constitutes a simple and reliable means of determining markers of precancerous lesions.

Esophagoscopy↗