Search PubMed⌕ Search

Biomedical subjects

G Gasbarrini

Publications and source records attributed to G Gasbarrini.

At least 631 records · Page 35Linked to original sources
PubMedDate not supplied

Impairment of recent thymic emigrants in HCV infection.

Hepatitis C Virus (HCV) often has a more favorable course in younger patients. Considering the involution of the thymic function with age, we investigated the output of recent thymic emigrants (RTE) in HCV patients. To evaluate RTE, we used a competitive quantitative PCR in order to determine the percentages of cells with cj-T cell receptor excision circles (TREC). This study was performed in 14 HCV patients at diagnosis and before any anti-HCV treatment. The results obtained in this group were compared to those obtained in a group of age-matched controls. We found that in the 14 HCV patients naive for anti-HCV treatment the mean percentage of cj-TREC was 3%. We could not detect a correlation between the percentages of cj-TREC and age or patients' viremia. In contrast, in the 26 age-matched controls mean percentage of cj-TREC was 5.6% (P=0.01). Our study describes a novel immune defect in HCV patients. Additional studies are needed to get further insight in the possible role of TREC defect in the pathogenesis and prognosis of the disease.

Adult↗
PubMedDate not supplied

Sjogren's syndrome in a celiac patient: searching for environmental triggers.

In the last few years many studies have shown the potential role of different triggers in the pathogenesis of several autoimmune diseases. In particular, in Sjogren's syndrome the presence of a genetic background is considered determining, but environmental factors have recently been described as triggers or precipitators. In this report, we describe the case of a young woman affected by celiac disease in which an Ascaris lumbricoides infestation and estrogen therapy could have played a role in the development of Sjogren's syndrome.

Adult↗
PubMedDate not supplied

Eradication of Helicobacter pylori in routine clinical practice: doubts and uncertainties.

BACKGROUND/AIMS: The aim of this study was to evaluate the overall efficacy of Helicobacter pylori (H. pylori) infection treatment in our routine clinical practice. As proton pump inhibitor-containing regimens offer the advantage of rapid symptom relief and the highest rates of duodenal ulcer healing, we decided to prescribe these regimens to treat H. pylori infection in our daily practice. METHODOLOGY: We prospectively carried out a study of unselected outpatients who were referred to our practices to undergo gastroscopy. The patients assessed as H. pylori-positive (by means of Giemsa stain and rapid urease test) were randomly assigned to one of the following four treatment schedules: omeprazole plus amoxycillin plus tinidazole (OAT) for 2 weeks; omeprazole plus amoxycillin (OA) for 2 weeks; omeprazole plus clarithromycin plus tinidazole (OCT) for 1 week; and, omeprazole plus clarithromycin plus amoxycillin (OCA) for 1 week. H. pylori status was re-assessed at least 2 months time after the end of the therapy when the patients were re-endoscoped. RESULTS: Out of a total of 200 patients returning for a follow-up visit and included in our study, 143 were H. pylori-eradicated, with an inclusive rate of 71.5% only. Side effects occurred in 37 (18%) patients. CONCLUSIONS: In our routine clinical practice, the overall eradication rate of H. pylori infection resulted in a little more than 70% of patients treated. Considering that more and more physicians routinely treat H. pylori infection, and that more and more patients require treatment, the management of this worldwide infection remains problematic.

Adult↗
PubMedDate not supplied

Indicators of genetic damage in alcoholics: reversibility after alcohol abstinence.

BACKGROUND/AIMS: Although a primary carcinogenic role of alcohol is not proven, alcohol abuse is associated with an increased risk of cancer of the upper airways, esophagus and liver. METHODOLOGY: Chromosome aberrations and the presence of micronuclei that reflect two types of genetic damage were analyzed in peripheral blood lymphocytes from 11 alcoholic patients who were heavy smokers and in a fair state of general nutrition and 9 subjects who had abstained from alcohol for at least a year. Ten heavy smokers were studied as healthy controls. RESULTS: Chromosome aberrations and micronuclei in alcoholics showed significantly elevated frequencies compared to the control groups, while in alcohol abstainers the values of all two parameters were similar to the values of the control subjects. CONCLUSIONS: These results show that long-term alcohol intake could induce genetic alterations in synergy with tobacco smoke. Interestingly, this damaging action is reversed by abstinence. Our results call for a further effort to find an eventual diagnostic role for these early genetic damage markers.

Adult↗
PubMedDate not supplied

Different efficacy of alcohol education tools among trainee nurses.

BACKGROUND/AIMS: The evaluation of the efficacy of two different forms of scientific information concerning alcohol-related problems (ARP), among Italian trainee nurses. METHODOLOGY: A specific questionnaire, investigating the awareness of ARP, was distributed to 193 trainee nurses, 158 enrolled in the Italian Red Cross School for Professional Nurses at S. Orsola-Malpighi Hospital in Bologna and 35 enrolled in the Professional Nursing School at the Social Security Institute in the Republic of San Marino, who had attended a scientific meeting on ARP in the last year. Eighty-one nurses (62 belonging to the Red Cross School of Bologna and 19 to the Professional Nursing School of San Marino), had previously been given an information package on ARP (Group A). One hundred twelve subjects (96 belonging to the Red Cross School of Bologna and 16 to the Professional Nursing School of San Marino) did not read the specialized material (Group B). RESULTS: The results showed a statistically significant difference in the percentage of correct answers between Group A (25.98%) and Group B (21.80%). The percentage of correct answers among the Bologna trainee nurses were always significantly lower than that of the San Marino nurses. CONCLUSIONS: These results suggest a scant awareness and interest in ARP among trainee nurses and show that courses and lectures are more effective than scientific printed material.

Adolescent↗
PubMedDate not supplied

Prurigo nodularis (Hyde's prurigo) disclosing celiac disease.

A case of prurigo nodularis (Hyde's prurigo) preceding by 15 years the diagnosis of celiac disease is presented. In particular, the association between the clinical course of prurigo nodularis and the compliance with gluten-free diet is reported and discussed.

Aged↗
PubMedDate not supplied

Structure and function of tight junctions. Role in intestinal barrier.

The tight junctions are narrow belts that circumferentially surround the upper part of the lateral surfaces of the adjacent epithelial cells to create fusion points or "kisses". They are involved in maintaining the cellular polarity and in the establishment of compositionally distinct fluid compartments in the body. Tight junctions are formed by many specific proteins and are connected with the cytoskeleton. In contrast to what might be expected, the intestinal tight junctions are highly dynamic areas and their permeability can change in response to both external and intracellular stimuli. In fact, the tight junctions play an important role in the regulation of the passive transepithelial movement of molecules. A number of signalling molecules have been implicated in the regulation of tight junction function, including Ca++, protein kinase C, G proteins, phospholipase A2 and C. In many intestinal and systemic diseases, changes in intestinal permeability are related to alteration of tight junctions as an expression of intestinal barrier damage. Moreover, permeability of the tight junctions can be modified by bacterial toxins, cytokines, hormones and drugs. A better understanding of tight junction structure, biogenesis and regulation mechanisms should throw further light on the intestinal barrier functions and suggest innovative therapeutic strategies.

Animals↗
PubMedDate not supplied

Minimal endoscopic aspects of gastric low-grade malt-lymphoma.

Low-grade gastric MALT-lymphoma is a neoplasia with a very indolent course and an excellent prognosis. Even if the most common endoscopic findings have described non-specific aspects, often suggestive for benign conditions, the endoscopy reveals a wide range of gastric mucosal changes both at diagnosis and at relapse. We report 2 cases of low-grade gastric MALT-lymphoma in which the diagnosis was made casually because the endoscopic presentation consisted only in mucosal hyperaemia in 1 case and in normal-appearing mucosa of the stomach in the second case. The patients were successfully treated with anti-Helicobacter pylori therapy. At 18 and 12 months of follow-up, respectively, the patients were disease-free. The bland appearance of this disease in some patients may reflect the early diagnosis of the tumor. Even if endoscopy and echoendoscopy often constitute useful and reliable diagnostic procedures, in the early phases of the tumor the histologic evaluation of endoscopic biopsies including immunohistochemistry represent the diagnostic procedure more reliably to detect this neoplasm.

Aged↗
PubMedDate not supplied

Intestinal permeability increases with the severity of abdominal trauma: a comparison between gas liquid chromatographic and enzymatic method.

BACKGROUND/AIMS: Increased intestinal permeability was found in humans after multiple trauma, burn injury and major vascular surgery. However, no data are reported regarding possible correlation between trauma and intestinal permeability degree. This study was undertaken to compare gas-liquid chromatographic and enzymatic method for the evaluation of intestinal permeability impairment in patients after severe abdominal trauma. METHODOLOGY: Five traumatized patients with an injury severity score of more than 24 and 5 cross-matched healthy volunteers were studied. The intestinal permeability was performed using a test solution, containing 10 g lactulose and 5 g mannitol. Gas-liquid chromatographic method was applied to measure sugar standards and 5-hour urine samples and the results were compared with those obtained employing a specific enzymatic method. RESULTS: Linearity of myoinositol, lactulose and mannitol measured by gas-liquid chromatographic method was from 0.2-1 microgram injected. Using the enzymatic method, the response was linear between mannitol concentrations of 0.34 and 5.49 mM. Linearity of lactulose standard was from 0.18-2.92 mM. The gas-liquid chromatographic and enzymatic methods showed a good agreement using the Bland-Altman procedure. The mean lactulose/mannitol ratio was 0.085 +/- 0.025 in patients and 0.009 +/- 0.001 in controls (P < 0.001). The higher the injury severity score (30.8 +/- 5) the larger the ratio of lactulose to mannitol (R2 = 0.74). CONCLUSIONS: The enzymatic method--inexpensive, easy-to-perform and timesaving--is suitable for intestinal permeability studies. An abdominal trauma, without injury requiring surgical operation, modifies the intestinal mucosa permeability possibly favoring passage of bacteria and subsequent sepsis.

Accidents, Traffic↗
PubMedDate not supplied

Six-day therapy with ranitidine bismuth citrate plus low-dose clarithromycin and tinidazole to cure Helicobacter pylori infection.

BACKGROUND/AIMS: Short-term ranitidine bismuth citrate-based triple regimens have been shown to be effective for the eradication of H. pylori. We investigated the efficacy of an eradicating therapy including ranitidine bismuth citrate, low-dose clarithromycin and tinidazole, administered for only 6 days. METHODOLOGY: Forty-five consecutive patients, who underwent gastroscopy for symptoms and were found to be H. pylori-positive, were recruited. They received ranitidine bismuth citrate 400 mg b.i.d. plus clarithromycin 250 mg b.i.d. plus tinidazole 500 mg b.i.d., given for 6 days. The medications given in twice daily doses were taken after meals with an interval of 12 h. The H. pylori status was evaluated by means of histology and rapid urease test on admission, and by 13C-urea breath test alone 8 weeks after treatment. RESULTS: All 45 enrolled patients completed the study. Thirty-nine of 45 patients returned H. pylori-negative (both per protocol and intention-to-treat analysis = 87%; 95% confidence interval = from 73-95%), while 6 of 45 were still H. pylori-positive (13%). Slight or mild side effects occurred in 5/45 patients (11%). CONCLUSIONS: Ranitidine bismuth citrate-based triple therapy, containing low-dose clarithromycin and tinidazole, given for only 6 days, yielded high eradication rates with modest side effects. Regimens based on ranitidine bismuth citrate plus two antibiotics at low dosages, administered for less than 7 days, constitute highly promising strategies for eradication of H. pylori.

Adult↗
PubMedDate not supplied

Liver metastases of endocrine tumour associated with multiple endocrine neoplasia type 1: a sustained response to interferon therapy or a peculiar benign course?

The authors describe the case of a 51-year-old male with Zollinger-Ellison syndrome manifested by epigastralgia, nausea, vomiting, hypergastrinemia and multiple endocrine neoplasia type 1. History included a Billroth II procedure for a perforated duodenal ulcer. Multiple metastatic liver lesions were found that were gastrin-negative and chromogranin-positive. Endoscopy revealed a large ulcerated gastro-jejuno-colonic fistula which was surgically repaired. Pre- and postoperative imaging studies, including the highly sensitive somatostatin-receptor scintigraphic scan using In-pentetreotide, have consistently failed to disclose other tumors. Recent reports indicate that most Zollinger-Ellison syndrome-associated gastrinomas are small, easily overlooked lesions located in the proximal duodenum rather than in the pancreas as formerly believed. In the present patient therapy with omeprazole and alpha-interferon has produced complete remission of the Zollinger-Ellison syndrome and a stabilization of tumor growth has occurred during the last 7 years, allowing the patient to live a normal life. This peculiar response to therapy is discussed.

Humans↗
PubMedDate not supplied

Utility of alpha-fetoprotein (AFP) in the screening of patients with virus-related chronic liver disease: does different viral etiology influence AFP levels in HCC? A study in 350 western patients.

BACKGROUND/AIMS: Dosage of serum AFP (alpha-fetoprotein) is widely used for HCC screening in patients with chronic liver disease. Virus-related chronic liver disease is the main cause of cirrhosis and HCC in Western and Far Eastern countries, but the relationship between viral etiology and AFP levels in HCC is still unclear. The aim of this study was to verify, in Western patients with post-viral chronic liver disease, the usefulness of AFP dosage for the detection of HCC, and the influence of viral etiology on AFP levels in HCC. METHODOLOGY: The study population included 350 patients with post viral chronic liver disease that underwent liver biopsy, serum AFP determination and ultrasound liver evaluation. Seven patients had normal liver histology, 197 had chronic hepatitis, 72 had cirrhosis, and 74 had cirrhosis and HCC. ROC (receiver operating characteristic) analysis was used to assess the best diagnostic AFP threshold value for HCC detection. Logistic regression analysis was performed to individuate independent predictors of HCC diagnosis. RESULTS: No difference was observed in AFP levels between HCV- and HBV-positive patients, neither in the whole population nor in the HCC patients only. ROC area under curve for AFP was 0.801 (95% CI: 0.721-0.867). The analysis individuated a best accurate AFP threshold value for HCC diagnosis of 50 ng/mL. HCC was detected with specificity > or = 95% only for AFP > 100 ng/mL. The sensitivity however was poor (25%). Male sex, age > 60, and AFP were independent predictors of HCC diagnosis. CONCLUSIONS: Serum AFP levels in HCC patients are not influenced by virus B or C hepatitis pattern. AFP dosage should not be used for HCC diagnosis in non-cirrhotic patients. Male patients with cirrhosis should be regarded with a more "aggressive" screening program compared to females.

Biomarkers↗
PubMedDate not supplied

Synchronous gastric adenocarcinoma and MALT lymphoma in a patient with H. pylori infection. Could the two neoplasms share a common pathogenesis?

Low-grade primary MALT (mucosa-associated lymphoid tissue) lymphoma of the stomach is a neoplasm with an indolent course and a good prognosis. Patients with this type of neoplasm seem to have a higher risk for other neoplasms. Of interest is the association of gastric MALT lymphoma with gastric adenocarcinoma of intestinal type. We report the case of a patient, with a history of H. pylori-related gastritis, in whom a diagnosis of synchronous gastric adenocarcinoma of intestinal type and low-grade MALT lymphoma, occurring as collision tumors, was made. The stage procedures confirmed the presence of a locally advanced gastric tumor staged as T3 N1. The patient underwent two cycles of neoadjuvant EEP (etoposide, epirubicin, cisplatin) chemotherapy. After 2 months, a R0 total gastrectomy with D2-lymphoadenectomy was successfully performed. The development of simultaneous primary gastric lymphoma and carcinoma is a rare event. The possible coexistence of both tumors should be kept in mind, especially in patients infected with H. pylori, since a possible etiopathogenetic role of this bacterium has been differently postulated for both disease.

Adenocarcinoma↗
PubMedDate not supplied

Hepatitis C virus infection: other biological fluids than blood may be responsible for intrafamilial spread.

BACKGROUND/AIMS: Several epidemiological studies have shown the existence of other routes of transmission of the hepatitis C virus besides the parenteral one, but the mechanisms involved are not yet understood. The general aim of this study was to evaluate the prevalence of hepatitis C virus infection in family contacts of infected patients and to analyze the possible risk factors and alternative transmission routes. METHODOLOGY: One hundred and thirty-eight relatives of 45 patients (index cases) affected by C virus-related chronic hepatitis were studied. The relatives were 45 spouses, 89 children and 4 cohabitants who underwent detection of serum anti-HCV antibodies; the anti-HCV-positive subjects were tested for serum HCV-RNA. The index cases, all the spouses and only other infected relatives were tested for the presence of HCV-RNA in saliva RESULTS: Antibodies to hepatitis C virus were detected in 5.7% of the family members while 11.1% of the analyzed spouses were serum HCV-RNA-positive. HCV-RNA was found in 44% of the examined saliva and 39% of these were found serum HCV-RNA-negative. The prevalence of hepatitis C virus among household contacts, excluding cases with previous parenteral exposure, was 3.6%. CONCLUSIONS: The epidemiological data on the intrafamilial spread of hepatitis C virus may be underestimated owing to the existence of infected relatives serum-negative but saliva-positive for the presence of the virus. The whole of these observations suggests a possible role of biological fluids in intrafamilial spread of hepatitis C virus.

Adult↗
PubMedDate not supplied

Prevalence and clinical presentation of subclinical/silent celiac disease in adults: an analysis on a 12-year observation.

BACKGROUND/AIMS: In recent years, an increased incidence of subclinical/silent celiac disease has been reported. Thus, we herein describe the prevalence and the clinical presentation of subclinical/silent celiac disease in 252 consecutive diagnosed celiac patients. METHODOLOGY: From 1988 to 1999 we diagnosed 252 celiac patients (74M and 178F, mean age: 27.9 yrs; range: 15-65 yrs, F/M ratio: 2.4). 144 patients were referred to us due to gastrointestinal symptoms, while 108 were referred to us from other specialists due to unexplained or unresponsive disease. All patients underwent both total immunoglobulin A and antigliadin antibodies antiendomysium antibody and evaluation, followed by gastrointestinal endoscopy with duodenal histological examination. RESULTS: 144 (57.14%) and 108 (42.86%) patients showed classical and subclinical/silent celiac disease, respectively. The most frequent extraintestinal marker of subclinical celiac disease were iron-deficiency anemia (27.77%), alopecia and dermatitis herpetiformis (11.36%), osteoporosis (6.81%) and recurrent aphtous stomatitis (5.68%), while first-degree relatives (30%), Basedow's disease (25%) and insulin-dependent diabetes (20%) were the most frequent in silent celiac disease. CONCLUSIONS: This study confirms the extremely polymorphic nature of this condition that can affect several organs and apparatus without gastrointestinal symptoms. However, a more precise description of subclinical/silent celiac disease can only emerge from screening studies on general populations.

Adolescent↗
PubMedDate not supplied

Efficacy and tolerability of antibiotics in patients undergoing H. pylori eradication.

BACKGROUND/AIMS: Helicobacter pylori (H. pylori) infection is one of the most common gastrointestinal diseases. An increasing number of people undergo different treatment options. Unfortunately, H. pylori therapy may be troublesome for drug side effects and inefficacious for resistance to antibiotics. METHODOLOGY: One hundred and ninety-three (193) H. pylori-positive patients were randomly assigned to one of the following 7-day treatments: Group A (N = 64): amoxicillin, clarithromycin and rabeprazole; Group B (N = 64): tinidazole, clarithromycin and ranitidine bismuth citrate; Group C (N = 65): tinidazole, clarithromycin and rabeprazole Eradication was assessed by 13C-Urea Breath Test 6-8 weeks after the end of the therapy. Not-eradicated patients underwent a second cycle with tinidazole, tetracycline, bismuth and rabeprazole. All patients were asked to complete a validated questionnaire regarding presence and intensity of drug side effects. RESULTS: One hundred and eighty-eight out of the 193 H. pylori-positive patients (96%) completed therapy. No significant difference in eradication rates was observed among the three groups both in intention to treat analysis and in per protocol analysis. No significant difference in incidence of side effects occurred among groups after the first-line regimens: 48% in group A, 44% in group B and 46% in group C. Twenty-two out of the 193 enrolled subjects (11%) were not eradicated after the first-line therapy. Among them, 86% were successfully eradicated by the tinidazole, tetracycline, bismuth and rabeprazole therapy. Moreover, during quadruple therapy, a higher prevalence and intensity of side effects than in each one of the groups submitted to the first-line triple therapy was observed. CONCLUSIONS: This study shows that triple rabeprazole-based eradicating regimens are effective and safe. Incidence of side effects seems low and similar in different three-drug regimens used. Quadruple therapy, which appear highly efficacious as a second line therapy, is associated with a significantly higher incidence of side effects when compared to first-line treatment.

Adult↗
PubMedDate not supplied

An apparent idiopathic case of relapsing acute pancreatitis.

We describe a case of relapsing acute pancreatitis apparently idiopathic in a 55-year-old man. The patient did not smoke and was a modest and irregular drinker of wine. Endoscopic retrograde cholangiopancreatography showed an initial dilatation of secondary ducts like a chronic pancreatitis of class I of Cremer. Ultrasound and computed tomography resulted negative for pancreatic lesions. In the follow-up however, magnetic resonance cholangiopancreatography detected the presence of an intraductal mucin-hypersecreting neoplasm, a duct-ectatic mucinous cystic tumor of the pancreas, in the uncinate process. This is a benign lesion clearly recognized nowadays by magnetic resonance cholangiopancreatography, because this radiological technique shows the grape-like clusters of cystic lesions in secondary ducts communicating with the main duct on the same plane. The radiological picture above excludes a malignant lesion and a biopsy specimen is not required. Furthermore, an intraductal mucin-hypersecreting neoplasm of the pancreas does not require an immediate surgical resection because of its slow evolution and can be followed-up. Conversely cystoadenocarcinoma spreads in peripheral ducts and does not communicate with the Wirsung duct. It requires both surgical resection and a biopsy specimen for histological diagnosis. In the last episode of acute pancreatitis, a sphincterotomy was performed at endoscopic retrograde cholangiopancreatography and our patient had no more pain for one year.

Acute Disease↗