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Biomedical subjects

G Bassotti

Publications and source records attributed to G Bassotti.

At least 73 records · Page 4Linked to original sources

Biofeedback, relaxation training, and cognitive behaviour modification as treatments for lower functional gastrointestinal disorders.

Biofeedback, relaxation training, and cognitive behaviour modification are being increasingly proposed for the treatment of numerous functional disorders of the gastrointestinal tract. Among these, those related to the lower part of the gut seem to be more likely to benefit from this therapeutic approach. We examine and discuss the literature studies adopting such techniques.

Adult↗

Gastrointestinal motility disorders in patients with inactive Crohn's disease.

BACKGROUND: Although some symptoms of Crohn's disease may be related to gastrointestinal motility disorders, studies on gastrointestinal motility in inactive Crohn's disease are lacking. METHODS: Fasting and postprandial motor activity (1 h) was recorded in the gastric antrum and upper small intestine of 35 patients with inactive Crohn's disease and 18 controls, using conventional manometry. RESULTS: Motor disorders were observed in 26 of 35 patients. The number of phase-II contractions was reduced (1.3 +/- 0.7/min versus 1.8 +/- 0.6/min in controls; P < 0.02) (mean +/- standard deviation), whereas the incidence of propagated single (2.2 +/- 3.2/h versus 0.5 +/- 0.6/h; P < 0.03) and clustered contractions (3.8 +/- 7/h versus 1.1 +/- 1.4, P < 0.04) was markedly increased. Motor abnormalities were more frequent and severe in patients with Crohn's ileitis than in controls, and in patients with gastrointestinal symptoms than in asymptomatic patients. CONCLUSION: Most patients with inactive, uncomplicated Crohn's disease show marked gastrointestinal motor disorders, characterized either by reduced incidence of small-bowel contractions and increased incidence of single or clustered propagated contractions.

Adolescent↗

Increased allergen-specific, steroid-sensitive gamma delta T cells in bronchoalveolar lavage fluid from patients with asthma.

OBJECTIVE: To test the hypothesis that allergen-specific, steroid-sensitive gamma delta T lymphocytes are increased in bronchoalveolar lavage fluid of patients with asthma. DESIGN: Case series. SETTING: The outpatient allergy services at the University of Perugia, Perugia, Italy. PATIENTS: 12 untreated atopic patients (6 children and 6 adults) with mildly symptomatic chronic asthma were studied. Bronchoalveolar lavage fluid from 10 healthy non-smoking volunteers and age-matched children with cystic fibrosis (n = 5) or anatomic malformation of the airways (n = 4) served as control samples. INTERVENTION: Three patients received treatment with deflazacort, 60 mg twice daily, for 1 week. MEASUREMENTS: CD3+, CD4+, and CD8+ T cells from patients and controls were examined by two-color flow cytometry for coexpression of V delta 1 and V delta 2 isoforms of the gamma delta T-cell receptor. In vitro pulmonary gamma delta T-cell proliferation in response to a specific allergen, the apoptotic death of these cells after incubation with 10(-7) M dexamethasone, and bronchoalveolar lavage fluid T-lymphocyte composition before and after 1 week of deflazacort therapy were evaluated in 3 Dermatophagoides pteronyssinus-sensitive patients. RESULTS: The proportion of gamma delta T lymphocytes, primarily CD4+ or CD4- CD8- cells, was higher in asthmatic patients than in controls (P < 0.05 by one-way analysis of variance). Most lung gamma delta CD4+ lymphocytes expressed the gamma delta T-cell receptor V delta 1 chain. These cells proliferated in response to allergen stimulation, underwent steroid-induced apoptosis in vitro, and disappeared after systemic steroid treatment. CONCLUSIONS: Allergen-specific, steroid-sensitive gamma delta T cells may be one of the cellular components involved in the airway inflammation that characterizes allergic bronchial asthma.

Adult↗

Upper gastrointestinal motor activity in patients with slow-transit constipation. Further evidence for an enteric neuropathy.

Recent evidence indicates that patients complaining of severe chronic idiopathic constipation may have motor abnormalities not limited to the colon. We studied by manometric means gastric and small bowel motility in a homogeneous group of patients with chronic idiopathic constipation, ie, the slow transit type. Twenty-one patients were recruited for the study and compared to 33 healthy subjects. Manometric examination was carried out for about 5 hr fasting and 1 hr after a standard meal. Analysis of the manometric tracings revealed during fasting no abnormalities in number and configuration of migrating motor complex with respect to controls. However, in 70% of patients motor abnormalities were detected, represented by bursts of nonpropagated contractions and discrete clustered contractions. After feeding, the patient group displayed a significantly shorter antral motor response to the meal with respect to controls; moreover, intestinal bursts of nonpropagated contractions were found in 19% of patients, and 14% of them had an early return of the activity fronts. We conclude that patients with slow transit constipation frequently display motor abnormalities of the upper gut. These findings further strengthen the concept that this condition may represent a panenteric disorder.

Adult↗

Flatus-related colorectal and anal motor events.

Although complaints of excessive "gas" symptoms are frequently encountered in clinical practice, the physiologic and pathophysiologic grounds of flatus events are poorly understood, partly because of the social taboos associated with the topic and partly because of technical difficulties in measuring flatus. For these reasons, we studied the colorectal and anal motor events occurring during artificially evoked flatus events and compared them to those that occurred spontaneously. Five healthy male volunteers were studied by multilumen probes placed in the left colon and rectum and across the anal canal, to observe the flatus-related motor events that occurred after instillation of air into the colon. Flatus-related spontaneously occurring motor events were also checked in 24-hr motility tracings obtained in three patients with functional bowel disorders. Analysis of the tracings showed that both artificially induced and spontaneously occurring flatus-related motor phenomena were characterized by colonic propagated contractions associated with a rise in rectal pressure and early relaxation of the anal sphincter, in a sequence resembling that observed following swallowing. Spontaneous flatus events were associated with colonic waves of lesser amplitude than those following insufflation of air into the colon.

Adult↗

Chronic idiopathic constipation: pathophysiology and treatment.

Chronic constipation is common in the general population, especially in women, in its idiopathic form. However, confusion still surrounds its definition, despite recent efforts to standardize it. Constipation can be divided in two large subgroups-normal transit and slow transit. The have different pathophysiological bases still not completely understood. Most patients respond to simple therapeutic measures aimed at correcting dietary fiber intake and lifestyle. Others, however, need more aggressive treatment, including laxatives, psychological therapy, and biofeedback. In a few patients with intractable constipation, surgery might be indicated to give relief.

Chronic Disease↗

Human colonic motility: physiological aspects.

From the point of view of its motor activity, the human colon is probably the least understood of the abdominal hollow viscera. This is due to several facts: a) its proximal portions are relatively inaccessible due to anatomical reasons; b) there is no reliable animal model due to the considerable anatomic-physiological differences among mammals. For instance, most deductions about human colonic motor activity have been drawn from experiences in cats and dogs, in which the colon displays a cecum which is almost atrophic, and the viscus is featureless and C-shaped, without the haustrations and the sharp angulations seen in man, c) the wide fluctuations of motility in the daily time course of the same individual makes the interpretation of many studies difficult, especially considering the fact that, until recently, most of the studies on human colonic motility have been conducted for relatively short (30-180 min) recording periods. Recently, however, techniques that allow recording from the proximal portions of the human colon have been developed, and prolonged (24 h or more) observations of myoelectrical and contractile events have been achieved, thus improving our knowledge of the normal physiologic properties of the viscus. These informations have furthermore been integrated and confirmed by scintigraphic techniques (less invasive), that allow the measurement of intracolonic flow activity. The purpose of the present paper is to review the physiological aspects of colonic motility in man, quoting animal studies where human ones are lacking. We will briefly introduce some basic concepts, then a more detailed description of the main topic will follow.

Animals↗

Idiopathic megarectum in adults. An assessment of manometric and radiologic variables.

Outlet obstruction is thought to be one of the major factors responsible for idiopathic constipation. However, outlet obstruction itself may be due to several mechanisms. Among these, the presence of a megarectum is a leading one. Pathophysiological studies in adult patients with idiopathic megarectum are scarce. We studied by manometric and defecographic means 15 adult subjects with idiopathic megarectum and severe chronic constipation. Twenty-five healthy volunteers of both sexes acted as controls. Manometric variables showed significant differences between patients and controls with respect to internal anal sphincter pressure (P = 0.02), minimum relaxation volume (P < 0.001), defecatory sensory threshold (P < 0.001), mean rectal tolerable volume (P < 0.001), and rectal compliance (P < 0.001). An altered response to straining was observed in 46.6% of patients and in 12% of controls (P < 0.04); the ability to expel a 50-ml balloon per anum was 13.3% in patients and 100% in controls (P < 0.001). Although all patients opened the anorectal angle and had descent of the pelvic floor, thereby confirming an adequate expulsion effort, evacuation of contrast material appeared extremely difficult. In fact, no subject was able to expel more than 30% of the rectal contents during fluoroscopic screening. These results confirm previous hypotheses that idiopathic megarectum displays features of a neuropathic process as an underlying mechanism. Further studies are needed that also take into consideration the muscle tone component of the rectum in these patients.

Adolescent↗

Effect of some abdominal surgical operations on small bowel motility in humans: our experience.

Until recently, it was only possible to make inferences about small bowel motility from experimental animal models, but manometric techniques now allow prolonged recordings of small bowel motor activity in humans. We have studied the effect of abdominal surgery on motor behavior of the small intestine and here report our observations after various surgical procedures (total gastrectomy, Billroth I and II gastrectomy, ileoanal anastomosis). We discuss the data together with the experiences of others.

Adult↗

Gastric emptying of solids in patients with nonobstructive Crohn's disease is sometimes delayed.

To date, only a few studies of gastric emptying in Crohn's disease have been published in the literature. This might be clinically important because slow-release drug formulations are increasingly available for treatment. Studies in children with gastric involvement suggest that gastric emptying may be delayed in this condition. We studied the scintigraphic gastric emptying of 21 adult patients with nonobstructive Crohn's disease and without gastric or duodenal involvement by the disease, compared with that of 20 healthy volunteers. Overall, no significant differences were found, but subgroup analysis showed that symptomatic patients [half-time (t1/2) 133 +/- 75.9] and those with colonic involvement (t1/2 127.2 +/- 64) had a significantly (p < 0.01) delayed gastric emptying over controls (t1/2 85.5 +/- 15.4). Such a difference was also observed between symptomatic and asymptomatic patients (p < 0.05). We conclude that gastric emptying is slowed in symptomatic patients with nonobstructive Crohn's disease and in those with colonic involvement. This may have therapeutic implications.

Adult↗

Upper gastrointestinal motor abnormalities in children with active celiac disease.

Although from the clinical point of view a GI motor disorder can be suspected in celiac disease, objective evidence for this is still lacking. We therefore conducted a study on children with active celiac disease to detect possible GI motor abnormalities in this disease. Fourteen children (age range, 1-13 years) were studied; they underwent fasting and fed manometric recordings in the gastroduodenojejunal area. Four patients were restudied after a 6-month gluten-free diet. Data were compared with those obtained in eight control children. As compared with controls, celiac disease patients showed a shorter duration of activity fronts (p < 0.01) and a significant (p < 0.01) reduction of the postprandial antral motility index; furthermore, > 90% of the patients displayed marked fasting and/or fed motor abnormalities, suggesting a neuropathic disorder. Interestingly, gut dysmotilities disappeared in the four subjects reassessed after the gluten-free diet. It is concluded that celiac disease frequently affects the motor behavior of the gut and that its effects may be reversed by appropriate diet.

Adolescent↗

Oesophageal motility in adult coeliac disease.

Coeliac sprue is a relatively frequent disease with protean clinical manifestations. Recent studies suggest that gastrointestinal motor abnormalities may explain some symptoms complained of by such patients. We investigated whether coeliac patients have oesophageal motor abnormalities from both a clinical and a physiological point of view. Thirty-six consecutive adult sprue subjects (14 during the florid phase and 22 on gluten-free diet) were studied. A clinical questionnaire on gastrointestinal symptoms (with emphasis on those of oesophageal origin) was administered. Moreover, 18 patients (13 on free and five on gluten-free diet) gave their consent for oesophageal manometry and eight subjects for pH-metry also. Oesophageal clinical symptoms were compared with those of 144 age- and sex-matched controls from a general population sample, and manometry with that of 34 healthy volunteers. Of coeliac patients 50% complained of dysphagia (P < 0.001 vs. controls) and 14% noncardiac chest pain (P = NS vs. controls). Manometric examination showed motor abnormalities in 67% of the subjects examined, consisting of nutcracker oesophagus, hypotonic lower oesophageal sphincter associated with simultaneous contractions, and frequent repetitive (> 3 peaks) contractions. These abnormalities were equally distributed among free and gluten-free diet patients. pH-metry showed only one pathological reflux out of eight subjects studied. We conclude that patients with coeliac sprue may display abnormal oesophageal motility. This confirms previous studies suggesting that gastrointestinal motor abnormalities should probably be added to the clinical spectrum of the disease.

Adult↗

Costimulation of CD3/TcR complex with either integrin or nonintegrin ligands protects CD4+ allergen-specific T-cell clones from programmed cell death.

An optimal stimulation of CD4+ cells in an immune response requires not only signals transduced via the TcR/CD3 complex, but also costimulatory signals delivered as a consequence of interactions between T-cell surface-associated costimulatory receptors and their counterparts on antigen-presenting cells (APC). The intercellular adhesion molecule-1 (ICAM-1, CD54) efficiently costimulates proliferation of resting, but not antigen-specific, T cells. In contrast, CD28 and CD2 support interleukin (IL)-2 synthesis and proliferation of antigen-specific T cells more efficiently than those of resting T cells. The molecular basis for this differential costimulation of T cells is poorly understood. Cypress-specific T-cell clones (TCC) were generated from four allergic subjects during in vivo seasonal exposure to the allergen. Purified cypress extract was produced directly from fresh collected pollen and incubated with the patients' mononuclear cells. Repeated allergen stimulation was performed in T-cell cultures supplemented with purified extract and autologous APC. The limiting-dilution technique was then adopted to generate allergen-specific TCC, which were also characterized by their cytokine secretion pattern as Th0 (IL-4 plus interferon-gamma) or Th2 (IL-4). Costimulation-induced proliferation or apoptosis was measured by propidium iodide cytofluorometric assay. By cross-linking cypress-specific CD4+ and CD8+ T-cell clones with either anti-CD3 or anti-CD2, anti-CD28, and anti-CD54 monoclonal antibodies, we demonstrated that CD4+ clones (with Th0- or Th2-type cytokine production pattern) undergo programmed cell death only after anti-CD3 stimulation, whereas costimulation with either anti-CD54 or anti-CD28 protects target cells from apoptosis.(ABSTRACT TRUNCATED AT 250 WORDS)

Allergens↗

Gamma delta T-cell subset distribution in human semen from fertile donors.

PROBLEM: Gamma delta T-cell subset distribution has not been fully investigated in normal human semen. METHODS: We therefore carried out experiments by using a direct immunofluorescence staining technique followed by two-color cytofluorimetric analysis on mononuclear cell (MC) suspensions from ejaculates of ten healthy, fertile volunteers. Autologous peripheral blood MC were simultaneously analyzed and the results used for statistical comparison. RESULTS: The proportion of normal human semen lymphocytes bearing the gamma delta T-cell receptor for antigen was greatly increased compared with autologous circulating counterparts. Interestingly, the rise was mainly due to an overexpansion of cells expressing V delta 1 gene-encoded determinants on their surface. This contrasts with the normal blood picture, where most gamma delta T cells express V delta 2 conformational epitopes. CONCLUSIONS: The numerical and phenotypical differences in semen gamma delta T lymphocytes provide further evidence of a defined migrating lymphocyte subset balance in anatomically and physiologically distinct areas of the body. Their functional role, in terms of both helper and suppressor-cytotoxic activities in the nonsterile proximal portions of the male genital tract, now needs to be explored in detail.

Adult↗

Gamma delta T lymphocytes in mumps meningitis patients.

Flowcytometric analysis on T-cell subpopulations in the blood and cerebrospinal fluid (CSF) of 10 children with mumps meningitis (MM) revealed that the proportion of lymphocytes which bore the gamma delta T-cell receptor for antigen was significantly higher in CSF than in autologous and heterologous blood samples. gamma delta T-cell values in CSF of MM patients were also significantly higher than those calculated in CSF specimens from nine children with non-inflammatory neurological disorders. Whether and how the expanded CSF gamma delta T-lymphocyte subset, either CD8+ or double-negative (CD4-/CD8-), contributes to the eradication of mumps virus infection from the central nervous system represents a central focus of our ongoing research.

Antigens, CD↗

Peripheral blood gamma delta T cells in human listeriosis.

A phenotypical analysis carried out by direct immunofluorescence and two-colour cytofluorometry showed that the number of lymphocytes bearing the gamma delta T-cell receptor heterodimer was increased in the blood of eight children with Listeria monocytogenes infection, mainly due to an expansion of cells identified by monoclonal antibodies which recognize V delta 2 gene products. These findings are further evidence that gamma delta T cells are in some way involved in the immune response directed against human intracellular pathogens.

Female↗

CD26 and CD31 surface antigen expression on human colostral T cells.

The expression levels of CD26 and CD31 surface antigens, two adhesion/activation molecules with helper and suppressor activities, respectively, were found to be significantly higher on human colostral T cells (CD3+) than in autologous peripheral blood samples. These findings provide further phenotypical evidence that immune system T lymphocytes are compartmentalized in the mammary gland late in pregnancy and during lactation. The question of whether these overexpanded T lymphocyte populations in breast milk modulate in situ, either by enhancing or suppressing, the cellular and/or humoral immune response of the suckling infant remains to be answered. Additional studies are, therefore, needed to explore this intriguing field concerning the immunology of the colostrum.

Antibodies, Monoclonal↗