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Biomedical subjects

G Gasbarrini

Publications and source records attributed to G Gasbarrini.

At least 397 records · Page 22Linked to original sources
PubMed1994

The effects of levosulpiride on gastric and gall-bladder emptying in functional dyspepsia.

BACKGROUND: 50% of patients with functional dyspepsia have delayed gastric emptying. Levosulpiride is an orthopramide drug that stimulates gastrointestinal motility. Aim of our study was to evaluate the effect of levosulpiride on symptoms and gastric and gall-bladder emptying, in dyspeptic patients. METHODS: Thirty adult patients, treated for 20 days with levosulpiride (75 mg/day) or placebo, were evaluated in a randomized double-blind study. Symptoms were assessed by a cumulative index and overall intensity (visual analogue line). Gastric and gall-bladder emptying were evaluated by epigastric impedance (liquid meal) and real-time ultrasonography (mixed meal). RESULTS: Levosulpiride, with respect to placebo, accelerated the mean gastric half-emptying time of liquids (P < 0.05), gastric emptying (P < 0.001 at 180 min; P < 0.05 at 240 min), and gall-bladder emptying (P < 0.05 at 60 and 120 min) emptying after a solid-liquid mixed meal. Both the mean cumulative index (P < 0.05) and the overall intensity (P < 0.025) of dyspeptic symptoms were reduced significantly by levosulpiride. CONCLUSIONS: Our results showed that levosulpiride can be usefully employed in patients affected by functional dyspepsia.

Adult↗
PubMed1994

Osteonecrosis of the femoral head in refractory coeliac disease.

Osteonecrosis has been described occurring in many clinical conditions that require steroid administration. Mechanisms by which steroids produce osteonecrosis are not well known and the importance of the underlying disease has been recently emphasized. We report on a 48-year-old woman with coeliac disease who developed osteonecrosis of the femoral head after being treated with steroids for non-response to gluten withdrawal. We stress the possible role of osteoporosis and osteomalacia, frequently found in patients with coeliac disease, in the pathogenesis of this complication, and advise using drugs other than steroids in the treatment of refractory coeliac disease.

Celiac Disease↗
PubMed1994

Subclinical coeliac disease: an anthropometric assessment.

OBJECTIVES: To evaluate the prevalence of malnutrition in patients with untreated coeliac disease (CD) according to their pattern of presentation, and the effect of gluten-free diet (GFD) upon nutritional status. DESIGN: Cohort prospective study. SETTING: All subjects were seen at the outpatient 'malabsorption' clinic of the Department of Medical Pathology I, University of Bologna (referral centre), Bologna. SUBJECTS: Eighty consecutive patients with CD (48 with classical and 32 with subclinical presentation), 15 patients with dermatitis herpetiformis (DH) and 40 healthy volunteers (members of the hospital staff). MAIN OUTCOME MEASURES: The nutritional status was evaluated by anthropometric measurements (percentage of ideal body weight for height and sex, percentage of standard triceps skinfold thickness and percentage of ideal arm-muscle circumference). RESULTS: The overall prevalence of malnutrition in our series of CD patients was 53%. Prevalence of malnutrition (actual body weight less than 90% of the ideal) was significantly higher in classical coeliacs (67%) than in subclinical ones (31%, P < 0.002), in patients with DH (13%, P < 0.0003) and in healthy volunteers (13%, P < 0.0001). At diagnosis, percentage values of ideal body weight, triceps skinfold thickness and arm-muscle circumference were significantly lower (P < 0.0001, P < 0.0002 and P < 0.0003, respectively) in classical coeliacs (84.5 +/- 10.6, 71.2 +/- 28.1 and 87.1 +/- 10.8, respectively) than in subclinical coeliacs (95.5 +/- 9.1, 105.6 +/- 41.0 and 94.8 +/- 10.6, respectively). After GFD, 33% of classical and only 3% of subclinical coeliacs were still malnourished. CONCLUSIONS: Prevalence of malnutrition in CD is lower than was previously thought. CD patients with classical presentation may require a longer period of GFD to achieve a significant improvement of their nutritional status, with respect to those with subclinical presentation, probably because of a greater extent of intestinal damage. Finally, a careful evaluation of dietary habits is usually sufficient to identify incomplete adherence to GFD as the reason for nonimprovement of the nutritional status in patients with CD.

Adult↗
PubMed1994

Serological screening of coeliac disease: choosing the optimal procedure according to various prevalence values.

The aim of this study was to select the best approach for screening coeliac disease patients among populations with different grades of disease prevalence. The diagnostic performance was assessed of class A and G antigliadin antibodies and class A antiendomysium antibodies in 93 consecutive outpatients with suspected malabsorption, 44 of whom (47%) had coeliac disease according to duodenal histological tests. Class G antigliadin antibodies provided the worst diagnostic values, whereas a high diagnostic validity was found for the other two tests. The positive predictive value corrected for the disease prevalence expected in coeliac disease relatives (5%) and the general population (0.2%) fell to 30% and < 2% respectively for class A antigliadin antibodies, whereas it remained 100% for antiendomysium antibodies in both situations, providing an optimal value for their use as a screening test and as a valid alternative to duodenal biopsy when this is not feasible. The high cost of anti-endomysium antibodies and the invasive nature of duodenal biopsy prevent them being used widely as screening procedures. A cost effective two step approach was simulated measuring class A antigliadin antibodies in all subjects of the target population (first step), and performing a confirmation test (antiendomysium antibodies or duodenal biopsy) only in subjects positive for antigliadin antibodies. The results show that such a procedure should be recommended only for subjects with an expected low disease prevalence--that is, 5% for coeliac disease relatives and 0.2% for the general population--as the positive predictive value was always 100% with an acceptable false negative rate (6% and 11% respectively), irrespective of which of the two confirmation tests was used. This approach avoids the use of the confirmation test in 63% and 89% of subjects respectively for the two levels of prevalence, resulting in a considerable reduction of the cost. Patients seen for suspected malabsorption with an expected high prevalence of coeliac disease should not have such a serological screening procedure. In conclusion, antigliadin antibodies are useful to screen for asymptomatic coeliac disease in non-hospital communities if antiendomysium anti-bodies are used as a confirmation test: the latter is reasonable valid alternative to duodenal biopsy.

Adolescent↗
PubMed1994

Nodular regenerative hyperplasia of the liver: ultrasonographic appearance and echo-guided bioptic diagnosis.

Nodular regenerative hyperplasia of the liver is characterized by multiple and usually small nodules of hyperplastic hepatocytes surrounded by compressed atrophic liver cells. Given the small size of nodules and the preserved framework, the imaging techniques often show a normal liver and blind percutaneous biopsy is misinterpreted. The Authors report two cases of nodular regenerative hyperplasia diagnosed by ultrasound and percutaneous echoguided biopsy.

Biopsy, Needle↗
PubMed1994

Eosinophilic gastroenteritis in a patient with large-cell anaplastic lung carcinoma: a paraneoplastic syndrome?

A 39-year-old man was hospitalized with abdominal pain and diarrhoea. The total eosinophil count was 11,800/dL; the jejunal biopsy showed diffuse and patchy eosinophils and plasma cell infiltration of the lamina propria; symptoms and hypereosinophilia disappeared after steroid therapy. Two months later the symptoms reappeared together with left supraclavicular lymphnode enlargement. The chest X-ray showed a mass within the left lung apex. Lymph node biopsy showed metastases from large-cell anaplastic carcinoma. The possibility of eosinophilic gastroenteritis as a paraneoplastic manifestation is discussed.

Adult↗
PubMed1994

Reliability of rectal epithelial kinetic patterns as an intermediate biomarker of colon cancer.

The use of biomarkers to assess cancer risk is based on the model of cancer as a multistep process; such markers are assumed to reflect an early stage in this process. A valid biomarker of risk must therefore show differential expression in normal and high-risk subjects, as well as quantitative correlation with the stage of carcinogenesis. It should also be easy to detect in small tissue specimens and responsive to modulation by chemopreventive agents. Cell proliferation is one of the most widely investigated markers of cancer risk. Case-control studies have shown that epithelial cell proliferation parameters, assessed in rectal mucosal biopsies by means of in vitro autoradiographic or immunohistochemical techniques, can discriminate between populations with normal and high risks for colon cancer. However, we recently reviewed rectal biopsies from 152 subjects (43 controls, 84 with adenomas, 25 resected for colon cancer) processed for in vitro 3H-thymidine autoradiography, and attempted to correlate various proliferative parameters with clinical and pathological variables by means of multiple regression analysis. Elevations of total crypt labeling indices (LIs), particularly upper crypt LIs, were significantly associated with the presence of adenomatous polyps, although subsequent linear discriminant analysis revealed that the accuracy of LIs in discriminating between polyp patients and controls was actually quite low. However, we have also found that upper crypt LIs are reliable predictors of adenomatous polyp recurrence. Repeated evaluations of rectal proliferative indices over a 2-year post-polypectomy follow-up of 40 patients with colonic adenomas revealed substantial stability.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenoma↗
PubMed1994

The possible role of breath methane measurement in detecting carbohydrate malabsorption.

To evaluate the possibility that measurement of breath methane (CH4) enhances the accuracy of breath hydrogen (H2) testing to diagnose carbohydrate malabsorption, breath CH4 concentration of healthy subjects was studied. Fasting breath CH4 concentration measured three times over a 30-minute period in 44 CH4-producing volunteers ranged from 5 to 120 ppm. Fluctuation of breath CH4 excretion exceeded 100% increase over fasting in 1 of 9 subjects who ingested a nonabsorbable, carbohydrate-free solution. Out of 13 subjects who had a false negative breath H2 response to lactulose, 11 had a CH4 percentage increase greater than 100%. In 11 of 32 lactose-intolerant patients with a negative breath H2 test, CH4 percentage increase after lactose challenge was greater than 100%. These data suggested that in methanogenic individuals, breath CH4 measurement might enhance the accuracy of H2 breath testing in detecting carbohydrate malabsorption.

Adult↗
PubMed1994

A rare case of peritoneal mesothelioma in a male with ascites.

Mesothelial lesions can present significant diagnostic problems. An accurate identification of the lesion is important in deciding what course of action to follow, as well as what the required treatment will be. We report the case of a man with untreatable ascites. Four years after the first symptom appeared, the patient suddenly began to lose weight. The CT scan showed a thickening of the peritoneal profile; a diffuse lesion of the mesothelium was then observed at laparotomy. Histological examination led to a diagnosis of malignant mesothelioma in a well-differentiated mesothelial lesion with diffuse involvement of the serosa of the small intestine and the lesser omentum.

Ascites↗
PubMed1994

Early and late changes in fasting and absorptive plasma amino acids and ammonia after distal splenorenal shunt in cirrhosis.

Levels of plasma amino acids, ammonia, glucagon and insulin and their 5-hr responses to a protein feeding were evaluated before and sequentially (3 mo and 1 yr) after distal splenorenal shunt in 10 patients with cirrhosis belonging to Child-Pugh's class A or B. An index of glucagon effectiveness (plasma glucose/glucagon) was also calculated. These parameters were related to liver test results, portal vein diameter and mental state, and they were compared with those found in seven patients undergoing sclerotherapy of esophageal varices with comparable liver function (control group). Liver test results and levels of plasma insulin did not change in either group. Shunt significantly increased levels of fasting tyrosine, methionine, ornithine, arginine, histidine, ammonia and glucagon with respect to the control group; it also significantly decreased levels of leucine, valine, glucagon effectiveness and portal vein diameter. The elevation of levels of tyrosine, ammonia and the sum of arginine and ornithine was correlated directly with the increase in glucagon and inversely with the decline in glucagon effectiveness. Tyrosine increase was also correlated with the reduction of portal vein diameter. One shunted patient showed mild hepatic encephalopathy. Protein feeding did not worsen the mental state of patients before and after the operation. Surgery significantly increased the 5-hr response to the meal of gluconeogenic amino acids; its rise was again correlated with the changes in glucagon plasma levels and effectiveness. Although the absorptive levels of plasma ammonia were significantly higher 1 yr after surgery, its 5-hr response barely rose. In cirrhotic patients with a relatively preserved liver function, distal splenorenal shunt progressively worsened the fasting plasma profile of nitrogen compounds and the response to protein ingestion of gluconeogenic amino acids. The decline of portal blood flow and glucagon effectiveness may be causal factors. Despite this, the "cerebral" tolerance to a moderate oral load of protein was not reduced by surgery.

Adult↗
PubMed1993

Elevated interleukin-8 serum concentrations in beta-thalassemia and graft-versus-host disease.

Neutrophil chemotactic and functional defects occur in beta-thalassemia and in patients after bone marrow transplantation (BMT). Interleukin-8 (IL-8) is a novel chemotactic and activating peptide for neutrophils and can be detected in the circulation. IL-8 serum concentrations were evaluated in 30 beta-thalassemic patients before and after BMT. Serial samples from 16 patients were also studied. Fourteen sera from healthy children, 43 patients with chronic viral hepatitis, 16 patients on chronic transfusion treatment for various hematologic disorders, and 28 healthy adults were studied as controls. IL-8 was evaluated by an enzyme-linked immunosorbent assay. Patients with beta-thalassemia had higher IL-8 concentrations than did normal controls, patients with liver disease, and patients on chronic transfusion. beta-Thalassemic patients with severe liver siderosis and fibrosis had the highest IL-8 concentrations. After BMT in patients with successful engraftment, IL-8 concentrations decreased significantly. In contrast, in patients with acute graft-versus-host disease (GVHD), IL-8 concentrations were not statistically different from the concentrations found before BMT and were higher than in patients with no complications and patients with graft rejection. IL-8 may play a part in the immune dysregulation that occurs in beta-thalassemia and may be involved in the immune mechanisms leading to GVHD.

Adolescent↗
PubMed1993

Prognostic indicators in patients with cirrhosis and hepatocellular carcinoma undergoing surgical resection.

A retrospective study was performed in order to identify factors significantly associated with operative mortality and post-operative complications in 114 patients with liver cirrhosis who underwent resection surgery for single hepatocarcinoma nodules (diameter < or = 7 cm) from 1980 to 1992. Vascular thrombosis, extrahepatic spread of the tumor, ascites, advanced cirrhosis, severe cardio-pulmonary disease, and renal failure were exclusion criteria. Forty-one pre-operative (demographic, clinical, laboratory, and histopathological features) and two peri-operative variables (amount of blood transfused and duration of operation) were cross tabulated using chi 2 test with operative mortality and post-operative complications, which were taken as end-point variables. Stepwise logistic regression analysis was then employed in order to define factors independently associated with end-point variables. Only partial thromboplastin time abnormality was significantly (P = 0.003) and independently associated with operative mortality. The length of the operation and the period during which surgery was carried out (1980-1986 and 1987-1992) were significantly (P < 0.001) and independently associated with the occurrence of at least one post-operative complication. The results suggest that the use of more restrictive selection criteria do not make it possible to lower operative mortality, although the coagulative status should be better assessed. Minimizing surgical stress and optimizing post-operative medical care are crucial for preventing post-operative complications.

Adult↗
PubMed1993

Prevalence and consistency of low breath H2 excretion following lactulose ingestion. Possible implications for the clinical use of the H2 breath test.

The clinical use of the H2 breath test is limited by the finding that a variable fraction of the population fails to excrete appreciable H2 during colonic carbohydrate fermentation. Therefore, we assessed the ability to increase breath H2 excretion in 371 patients (224 female, 147 male) by administering the nonabsorbable sugar lactulose. Following 12g of lactulose, 27% of 94 patients did not increase their breath H2 concentration over 20 ppm and were considered low H2 excretors. Ingestion of 20 g of lactulose in 277 patients yielded a frequency of low H2 excretors of 14%. Six of 10 patients that were low H2 excretors after 12g of lactulose increased their breath H2 levels over 20 ppm when tested with 20g. In 35 patients tested with the same amount of lactulose on two separate occasions, the subject frequently altered his or her H2 producing status over a period of a few weeks. Low H2 excretors had a significantly higher breath CH4 concentration, both fasting (22 +/- 34 ppm) and after lactulose (51 +/- 58 ppm) compared to the remaining patients (5 +/- 13 ppm and 16 +/- 40 ppm, respectively). While the mean age of low excretors (54 +/- 17 years) was significantly higher than the others (44 +/- 17 years), no difference was found for sex prevalence and stool pH. This study demonstrates that respiratory H2 excretion following lactulose ingestion is not consistent and suggests that the application of too restrictive criteria could lead to improper interpretation of the H2 breath test.

Adult↗
PubMed1993

Severe hepatic failure occurring with T61 ingestion in an attempted suicide. Early recovery with the use of intravenous infusion of reduced glutathione.

A case of acute hepatic failure following ingestion of the veterinary euthanasia drug T61 is described. Presenting symptoms were drowsiness, disorientation, muscle hypertonia, and upper limb myoclonus, which faded within a few hours. Two days later, acute liver failure occurred, manifested as encephalopathy, jaundice, and a severe coagulopathy. The hepatic damage was thought to be due to the solvent dimethylformamide, which is the only known hepatotoxin included in the preparation utilized in the suicide attempt. High-dose (1.2 g/day) intravenous reduced glutathione was administered, with a rapid improvement of liver function. The patient was discharged after 17 days. Normalization of all liver function tests was achieved within two months. The favorable outcome in this case stands in contrast to the report of a previous case of lethal T61-induced hepatic failure. Although a different amount of dimethylformamide was ingested in each case (0.45 vs 0.60 ml/kg body wt) and individual differences in susceptibility to the effects of the hepatotoxic agent may have played a major role in these two cases, it is not unlikely that the infusion of high doses of glutathione to our patient contributed to her survival and hepatic recovery.

Adult↗
PubMed1993

Renal sodium retention during upright posture in preascitic cirrhosis.

BACKGROUND: Renal sodium handling in preascitic cirrhosis is not clearly defined. This issue was addressed by evaluating renal sodium metabolism with different postures. METHODS: Renal function and plasma atrial natriuretic factor (ANF), aldosterone, and norepinephrine levels were determined after 2 hours of standing and 30, 60, and 120 minutes after taking up the supine position in 10 patients and 10 healthy subjects. RESULTS: When upright, patients' glomerular filtration rate and plasma ANF and norepinephrine levels did not differ from those of controls. Conversely, renal sodium excretion was reduced. Plasma aldosterone levels, which were slightly elevated, inversely correlated with renal sodium excretion. In the supine position, natriuresis increased by 308% +/- 99% in patients and 113% +/- 29% in controls (P = 0.016), so that it no longer differed between the two groups. Plasma norepinephrine and aldosterone levels decreased to a similar extent in controls and cirrhotics, whereas the increase in plasma ANF level was greater in patients. The changes in natriuresis correlated with those in plasma ANF levels and plasma aldosterone-ANF ratios in both controls and patients. CONCLUSIONS: Aldosterone-dependent sodium retention develops in preascitic cirrhosis during standing. The supine position is the means whereby standing-induced sodium retention can be balanced.

Adult↗
PubMed1993

Detection of malabsorption of low doses of carbohydrate: accuracy of various breath H2 criteria.

BACKGROUND: Although the accuracy of breath H2 testing to detect malabsorption of small (< 50 g) doses of carbohydrate has never been evaluated, studies suggest that its accuracy is limited by a high prevalence of "H2 nonproducers." The aim of this study was to determine the accuracy of H2 breath testing in the detection of malabsorption of 10 g of carbohydrate. METHODS: In 55 healthy subjects, we determined the ability of breath H2 measurements to distinguish between the ingestion of 10 g of a nonabsorbable carbohydrate (lactulose) and two control meals, a nonabsorbable electrolyte solution or glucose (10 g). RESULTS: The conventional criterion of a 20 ppm increase in breath H2 had 100% specificity but failed to identify lactulose malabsorption in 47% and 24% of subjects at 4 and 8 hours of testing. In contrast, a breath H2 of > 6 ppm at 5 or 6 hours had near perfect specificity and sensitivity. A sum of breath H2 at 5, 6, and 7 hours of > 15 ppm yielded perfect separation between lactulose and control solutions. CONCLUSIONS: True "H2 nonproducers" are extremely rare. Using appropriate criteria, breath H2 testing provides a very accurate means of identifying malabsorption of low doses of carbohydrate.

Adult↗