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Biomedical subjects

G Cavallini

Publications and source records attributed to G Cavallini.

At least 91 records · Page 5Linked to original sources
PubMed1994

Common bile duct involvement in chronic pancreatitis.

The features of the common bile duct (CBD) have been checked in 78 chronic pancreatitis patients in order to evaluate the frequency of extrahepatic bile duct changes, possible associated factors and effects on the outcome of the disease. Fifty of the 78 patients had an intrapancreatic stricture of the CBD and 24 of them also showed an upstream dilatation. No relationship was found between the features of the CBD and the severity of the pancreatitis, the presence of calcifications and the length of the disease. Humoral signs of impaired bile flow were found in 20 subjects, 19 of whom had an intra-pancreatic stricture of the CBD. Sixteen of these 19 patients also showed an upstream dilatation and five of them had overt jaundice. A surgical intervention on the biliary tree was carried out in 7 patients, all with a biliary stricture. Six of them also had a CBD dilatation over the stricture (p < 0.02 versus patients without CBD stricture). In conclusion CBD involvement during chronic pancreatitis is quite frequent but poorly predictable and should be checked in all patients with humoral cholestasis in order to prevent further complications.

Adolescent↗
PubMed1994

Prognosis of chronic pancreatitis: an international multicenter study. International Pancreatitis Study Group.

OBJECTIVES: The aim of this study was to determine which factors predict mortality in a cohort of patients with chronic alcoholic and nonalcoholic pancreatitis. Patients with chronic pancreatitis are known to have a reduced life expectancy, but the quantitative relationship between various clinical features and survival is unclear. METHODS: We evaluated survival among 2015 subjects with chronic pancreatitis treated at seven centers located in six countries. RESULTS: Mean age at diagnosis was 46 +/- 13 yr and mean duration of follow-up was 7.4 +/- 6.2 yr. Overall survival at 10 yr was 70% (95% confidence interval (CI), 68-73%) and at 20 yr was 45% (95% CI, 41-49%). Survival was significantly less than in the background population. There were 559 deaths observed among those with chronic pancreatitis compared with an expected number of 157.4, yielding a standardized mortality ratio (SMR) of 3.6 (95% CI, 3.3-3.9). Older subjects and those with alcoholic pancreatitis had a significant reduction in survival. In a multivariate analysis, mortality of middle-aged and older subjects was 2.3 (95% CI, 1.8-2.8) and 6.3 (95% CI, 4.7-8.3) times greater than subjects less than 40 yr at diagnosis. Smoking (hazard ratio, 1.4; 95% CI, 1.0-1.9), drinking (hazard ratio, 1.6; 95% CI, 1.2-2.2), or development of cirrhosis (hazard ratio, 2.5; 95% CI, 2.0-3.2) increased the risk of death during the observation period, but we observed no survival difference in operated vs. nonoperated patients. CONCLUSIONS: Age at diagnosis, smoking, and drinking are major predictors of mortality in patients with chronic pancreatitis.

Age of Onset↗
PubMed1993

Pancreatitis and the risk of pancreatic cancer. International Pancreatitis Study Group.

BACKGROUND: The results of case-control studies and anecdotal reports suggest that pancreatitis may be a risk factor for pancreatic cancer, but there have been no studies of sufficient size and power to assess the magnitude of the relation between these two diseases. METHODS AND RESULTS: We undertook a multicenter historical cohort study of 2015 subjects with chronic pancreatitis who were recruited from clinical centers in six countries. A total of 56 cancers were identified among these patients during a mean (+/-SD) follow-up of 7.4 +/- 6.2 years. The expected number of cases of cancer calculated from country-specific incidence data and adjusted for age and sex was 2.13, yielding a standardized incidence ratio (the ratio of observed to expected cases) of 26.3 (95 percent confidence interval, 19.9 to 34.2). For subjects with a minimum of two or five years of follow-up, the respective standardized incidence ratios were 16.5 (95 percent confidence interval, 11.1 to 23.7) and 14.4 (95 percent confidence interval, 8.5 to 22.8). The cumulative risk of pancreatic cancer in subjects who were followed for at least 2 years increased steadily, and 10 and 20 years after the diagnosis of pancreatitis, it was 1.8 percent (95 percent confidence interval, 1.0 to 2.6 percent) and 4.0 percent (95 percent confidence interval, 2.0 to 5.9 percent), respectively. CONCLUSIONS: The risk of pancreatic cancer is significantly elevated in subjects with chronic pancreatitis and appears to be independent of sex, country, and type of pancreatitis.

Adult↗
PubMed1993

Prospective comparison of C-reactive protein level, Ranson score and contrast-enhanced computed tomography in the prediction of septic complications of acute pancreatitis.

Randomized clinical trials of antibiotic prophylaxis in acute pancreatitis are now warranted in the light of recent evidence of pancreatic penetration of certain antibiotics at therapeutic minimal inhibitory concentrations. The aim of the present prospective clinical study was to investigate whether there are detectable risk factors for pancreatic sepsis in acute pancreatitis that would allow better selection of patients for inclusion in clinical trials. Fifty-nine consecutive patients with acute pancreatitis were recruited and submitted to admission baseline and 48-h determinations of Ranson score, and assay of C-reactive protein at admission and weekly intervals thereafter. Contrast-enhanced computed tomography (CT) was also performed within 24 h of admission. Pancreatic sepsis, defined as infection of pancreatic and/or peripancreatic collections, was demonstrated in all cases by culture of samples obtained by needle aspiration and at laparotomy. Although all prognostic indices correlated significantly with sepsis, multivariate logistic regression analysis showed that the only variables predictive of the risk of subsequent sepsis were the presence and extent of necrosis. Early detection of pancreatic necrosis by CT should be the primary inclusion criterion in future clinical trials of antibiotic prophylaxis in acute pancreatitis.

Acute Disease↗
PubMed1993

Diabetes in chronic alcoholic pancreatitis. Role of residual beta cell function and insulin resistance.

Chronic alcoholic pancreatitis (CAP) is often complicated by the onset of diabetes mellitus. The aim of this study was to assess the residual beta cell function (evaluated by means of the glucagon test) and the mean disposal rate of insulin (with the insulin tolerance test) in 66 CAP patients with or without abnormalities of glucose metabolism and in 19 control subjects. On the basis of our data, we conclude that the glucose metabolism abnormalities in chronic pancreatitis occurs as a result not merely of impaired production of endogenous insulin, but also as result of a combination of the latter together with insulin resistance.

Alcoholism↗
PubMed1993

Gabexate mesilate vs aprotinin in human acute pancreatitis (GA.ME.P.A.). A prospective, randomized, double-blind multicenter study.

The authors report the results of a randomized, double-blind multicenter clinical trial on the use of gabexate mesilate vs aprotinin in the therapy of acute pancreatitis. The size of the study sample and the end points chosen for evaluation of the early systemic complications of the pancreatitis--carefully selected targets for reliable assessment of the efficacy of any protease inhibitor--lead to the conclusion that gabexate mesilate is more efficacious than aprotinin in reducing the early complications of necrotizing acute pancreatitis, if administered within 72 h of onset of symptoms. Its good tolerability means that it can be used safely even at the dose of 3 g/24 h.

Acute Disease↗
PubMed1993

Beneficial effects of the oral administration of vanadyl sulphate on glucose metabolism in senescent rats.

We investigated the effects of the oral administration of vanadyl sulphate (0.5 mg/ml in the drinking water) on glucose homeostasis of 3-month- and 24-month-old rats. Results show that aging is associated with alteration of the oral glucose tolerance test and impairment of the postprandial accumulation of glycogen in skeletal muscles and that the oral administration of vanadyl sulphate rapidly normalizes the inbalance of glucose metabolism in senescent rats. It is suggested that vanadate administration may restore the ability of skeletal muscles of senescent rats to respond to circulating insulin efficiently.

Administration, Oral↗
PubMed1993

Long-term outcome of acute pancreatitis: a prospective study with 118 patients.

118 patients who had recovered from acute pancreatitis underwent endoscopic retrograde pancreatography (ERCP) during a long-term follow-up (mean 4.4 years, range 1-17) to investigate the frequency and features of residual ductal lesions. Oedematous and necrohaemorrhagic pancreatitis occurred in 35 and in 83 patients, respectively. The aetiology was biliary (39 patients), alcoholic (32), biliary-alcoholic (18) and miscellaneous (29). After oedematous pancreatitis, ERCP was normal in 31, showed obstructive pancreatitis in 2 and a slight localized and smooth stricture of the main duct in 2 patients. After necrotizing pancreatitis, 29 patients showed ductal changes without features of chronic pancreatitis, 7 obstructive, 3 chronic calcifying pancreatitis and 44 normal pictures. In 17 patients submitted to two or three ERCPs during a mean 10-year follow-up, the ductal appearance was unchanged in 12, worsened in 3, and improved in 2 patients. The aetiology of pancreatitis and frequency of recurrences was similar in patients with or without scarring lesions. We conclude that residual ductal lesions are common after acute necrotizing pancreatitis.

Acute Disease↗
PubMed1993

The induction of mitochondrial myopathy in the rat by feeding beta-guanidinopropionic acid and the reversibility of the induced mitochondrial lesions: a biochemical and ultrastructural investigation.

The long-lasting depletions of creatine phosphate induced by feeding rats with a beta-guanidinopropionic acid (GPA)-supplemented diet induces specific mitochondrial alterations in skeletal muscles very similar to those observed in human mitochondrial myopathies. The slow-twitch soleus muscle appears to be affected primarily, while the fast-twitch extensor digitorum longus is affected less severely and only after a longer period of treatment (6 months). Changes in the enzyme activities of glucose metabolism appear to be secondary and differ between the two muscles. Withdrawal of GPA from the diet after 2 months of treatment shows that both mitochondrial alterations and biochemical modification are reversible.

Animals↗
PubMed1992

Exocrine and endocrine functional reserve in the course of chronic pancreatitis as studied by maximal stimulation tests.

Thirty patients suffering from chronic alcoholic pancreatitis (18 calcified) were entered into a study of exocrine and endocrine pancreatic function based on two maximal stimulation tests, namely the secretin-cerulein test and the glucagon test with serum assays of C peptide. The glucagon test was also performed in 19 control subjects. In addition, 10 chronic pancreatitis patients and nine controls were subjected to an oral glucose tolerance test (OGTT) with serum insulin determinations. C peptide basal values were decreased only in patients with severe pancreatic exocrine insufficiency (P less than 0.001), while delta C peptide values were also reduced in patients with moderate exocrine insufficiency (P less than 0.001). Lipase output correlated very well with delta C peptide values (P less than 0.001). While serum insulin levels during OGTT and C peptide basal values showed no significant differences between the chronic pancreatitis and control groups, delta C peptide values were significantly reduced in chronic pancreatitis patients (P less than 0.02). Both endocrine and exocrine function are impaired in chronic pancreatitis, as demonstrated by maximal tests, even in early stages of the disease.

Adult↗
PubMed1992

Effects of the administration of thyroid hormone on the plasma levels of atrial natriuretic peptides and on atrial myoendocrine cells in the rat: an immunochemical, ultrastructural, and stereological study.

The effects of an altered thyroidal status on the levels of immunoreactive (ir-) atrial natriuretic peptide (ANP) in serum and in the right and left atria, as well as on the subcellular structures of atrial myoendocrine cells were explored in groups of male Sprague Dawley rats given the vehicle or triiodothyronine in the toxicological dose-range (50 micrograms/100 g bw/day) for 0,5, 1,2,4,7 or 14 days. Plasma levels of ir-ANP were 30% higher in T3-treated rats compared with controls at 0,5 and 1 day after hormone administration and then decreased to levels 30-40% lower than controls at days 2 and 4 to rise again above control values on day 7 and 14. Atrial ir-ANP levels decreased at first both in the right and in the left atria with different latencies (1 and 2 days, respectively) and rose back towards control levels by day 4. Changes in the numerical density of specific granules followed a parallel temporal pattern. An increased in the individual volume of the granules followed was also observed. Investigation into the circulatory effects of T3 administration showed that the heart rate was increased by hour 12 after hormone administration (simultaneously with the early rise in plasma ir-ANP levels) and that blood pressure was increased by day 2.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1992

[The enzymatic activity of adenosine metabolism in the rat heart. The effects of cardiac hypertrophy].

The transmural distribution of the adenosine metabolizing enzyme activities 5'nucleotidase (5'N) and adenosine deaminase (ADA) across the left ventricular wall was explored in rats with heart hypertrophy induced by aortocaval shunt (FAC), or coarctation of the abdominal aorta (S) or by tireotoxicosis (T). FAC caused largest heart hypertrophy with a very short latency (1 day: + 0%, 3.5 days: + 30%, 7 days: + 41%, 21 days: + 49%). A 30% increase in the left ventricle free wall was observed after 3.5, 14 or 28 days of treatment with FAC, T or S respectively. Different changes in enzyme levels and alteration of transmural distribution profiles were observed with the different types of heart hypertrophy. Level of 5'N was decreased with FAC, did not change with T and increased with S; levels of ADA were always increased. The pattern of the transmural distribution of 5'N was affected by S but not by T and FAC, whereas distribution of ADA was not affected by S and T and was altered by FAC transiently.

Adenosine↗
PubMed1992

Lipase latex test for acute abdominal pain: comparison with serum lipase, trypsin, elastase and amylase.

The diagnostic capacity of a semiquantitative latex test for lipase measurement was compared with the measurement of other pancreatic enzymes in 100 consecutive patients admitted to a general hospital for recent onset of severe abdominal pain. Positive results of the test were found in two patients with acute pancreatitis, and in one out of three chronic pancreatitis relapses. The test yielded false-positive results only in two patients who had no apparent pancreatic involvement. A marginal increase in other pancreatic enzymes was found in a few patients with acute biliary or appendicular problems. In conclusion, the lipase latex test can be suggested in an emergency setting as a quick and reliable alternative to serum amylase to rule out a diagnosis of acute pancreatitis.

Abdominal Pain↗
PubMed1992

The menstrual cycle has no effect on gastrointestinal transit time. Evaluation by means of the lactulose H2 breath test.

Gastrointestinal transit time was studied by means of the H2 breath test (after administration of 20 g of lactulose) in 20 healthy women with regular menstrual cycles. The mean transit time measured in the follicular phase of the cycle (M +/- SE = 71.25 +/- 6.69 min) did not differ statistically from that measured in the luteal phase (66.75 +/- 5.49 min). Data were statistically analyzed using Student's t test for paired data and the Wilcoxon Test for non-parametric data. Our results show that, in physiological conditions, female sex hormones do not affect mouth-to-caecum transit time. The H2 breath test is easy to perform and well tolerated; it thus proves particularly suitable for use in women of child-bearing age.

Adult↗
PubMed1991

Variations in time of serum pancreatic enzyme levels in chronic pancreatitis and clinical course of the disease.

Thirty-four patients with chronic calcified pancreatitis were evaluated clinically and biochemically (at a time when painful relapses were not present) every 9 mo for 3 yr; 25 of them were also studied at 4 and 9 yr. Serum elastase-1, trypsin, lipase, and amylase in the same sera were measured at each visit; levels on entry and variations during the study were compared with the clinical and functional data of the patients. On entry, low levels of elastase-1 were found in 11.7% of the patients, high levels in 41.1%; in contrast, high levels of trypsin and lipase were found in only a small number of patients (5.8 and 11.7%, respectively), whereas low levels were present in a substantial number (47.8 and 32.3% for trypsin and lipase, respectively). Over time, we found a significant (p = 0.000002) reduction in elastase-1 levels. Such reduction was not found for trypsin, lipase, or amylase. The reduction of serum elastase-1 was significantly (p less than 0.003) more frequent in patients presenting a reduction in painful relapses than in patients with a stable or increased attach rate; this association was weaker (p less than 0.05) for lipase and trypsin, and absent for amylase. No correlation was found between circulating enzymes and either alcohol consumption or age of patients. In patients with severe exocrine impairment, low levels of elastase were found in only 20% of the cases, whereas trypsin and lipase were reduced in 73.3 and 53.3% of the cases, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Alcohol Drinking↗
PubMed1991

Minoxidil versus nitroglycerin: a prospective double-blind controlled trial in transcutaneous erection facilitation for organic impotence.

A new type of topically applied drug (minoxidil) to facilitate erection is presented. Minoxidil acts directly on arterial smooth muscles via relaxation. This drug (1 ml. of a 2% solution) was studied under strict laboratory conditions in a double-blind controlled trial on 33 patients (4 with neurogenic plus arterial, 10 with neurogenic and 19 with arterial impotence) and compared to placebo and nitroglycerin (2.5 gm. of a 10% ointment). The application sites were the penile shaft (nitroglycerin) or glans penis (minoxidil and placebo). Increases in diameter and rigidity were measured with the RigiScan device and arterial flow was evaluated by conventional Doppler sonography. Side effects were considered as well. This drug proved to be more active than nitroglycerin and placebo in increasing diameter, rigidity and arterial flow of the penis. The highest activity proved to occur in neurogenically impotent patients. Fewer side effects also were found with minoxidil than with nitroglycerin. For these reasons minoxidil is proposed as a long-term therapeutic agent for organic impotence.

Administration, Topical↗