Biomedical subjects
Publications and source records attributed to G Mastropaolo.
24-hour oesophageal pH monitoring is a necessary tool to diagnose Gastro-Oesophageal Reflux Disease. The technical characteristics of the available equipments have been improved and standard criteria to identify reflux episodes have been defined, increasing the sensitivity and specificity of the test. The state of the art on the technical features of prolonged pHmetry will be reviewed in this paper.
Gastric emptying half-time was measured in 10 healthy volunteers on two different occasions over a one-week interval, with an identical test meal. The first was the control evaluation, and at the second assessment, psychological stress was induced by the technique of dichotomous listening. Psychological and physiological parameters were assessed before and during the test period. No significant or consistent modifications of gastric-emptying time were induced by the stress procedure. Looking at individual subjects instead of mean values, gastric emptying was unchanged in 5 subjects, slower in 3, and faster in the remaining 2. These 3 groups had different mean values on two subscales of the Sixteen Personality Factor Questionnaire.
Eosinophilic Gastroenteritis (EG) is a poorly understood disorder defined by eosinophilic infiltration of the bowel wall, eosinophilia and gastrointestinal symptoms. The disease's aetiology, course and treatment are not well known. We report two atypical cases of EG: one involving the mucosal layer and another involving the serosal and muscularis layer. The first shows how EG may present with a long history of episodes of intestinal obstruction and malabsorption and how the disease could take a severe course and may be unresponsive to treatment. The second case shows EG presenting as acute abdomen and which subsequently became asymptomatic without therapy, regardless of the fact that peripheral eosinophilia remained present. This case raises the problem of how to treat an asymptomatic patient, what parameters should be considered in order to assess the progress of the disease and the indications for treatment.
Among the various methods used to measure gastric emptying time, scintigraphy is nowadays the technique of choice. Since only few data are available on the operative characteristics of the method, the authors investigated reproducibility, sensitivity, and specificity of a modified scintigraphic technique for the measurement of gastric emptying time. Three groups of subjects--healthy volunteers, patients with functional dyspepsia, and patients with upper gastrointestinal conditions--were administered liquid meals having various standard consistencies (349 tests on the whole). In both healthy volunteers and dyspeptic patients the method had high sensitivity (72%), good specificity (69%), and low intra-subject variation (25%). In all cases, the increase in meal density produced a delay in gastric emptying. Dyspeptic patients had slow gastric emptying of high-fiber meals, while in duodenal ulcer and in atrophic gastritis emptying was significantly faster. The radionuclide method proved valuable in measuring gastric emptying and was useful to confirm the pathogenesis of the various conditions. As for functional and organic pathologic conditions, it allowed treatment efficacy to be evaluated.
Small-cell lung cancer is an infrequent (10%) form of lung cancer which may rarely become apparent with signs of distant metastases. A case is presented where a cholestatic syndrome was the presenting feature of a small-cell lung cancer which was not suspected clinically. The misleading clinical picture, the inaccurate results of ultrasound, ERCP and chest x-ray did not allow the correct diagnosis to be made until post mortem examination. Even according to the published experience, which is reviewed here, this presentation and clinical course appear exceedingly rare.
The frequency of gastrointestinal haemorrhage due to gastric ulcer has been assessed in 254 personally observed patients suffering from this endoscopically verified pathology. 56 patients, namely 22% of the cases, presented haematemesis and/or melena of the ulcerative lesion. This subgroup was compared with 65 patients with endoscopically verified gastric ulcer without previous bleeding episodes from the lesion in their clinical history, in respect of certain epidemiological, clinical and biohumoral features. The purpose of the study was to check the possible existence of clinical and/or physiopathological differences between subjects with bleeding gastric ulcer and the population of non-bleeding ulcer patients. In 80% of patients studied, the gastric ulcerous disease started with digestive haemorrhage and it was not accompanied by dyspeptic-painful symptomatology in 20% of cases. The pain symptomatology does not appear to be influenced by the intake of non-steroid anti-phlogistic drugs. No significant difference emerges between the two groups considered as regards epidemiological features and biohumoral data (PG I, gastrin, B.A.O. and M.A.O.).
The need to change the methods of teaching medical students has become self-evident in the past two decades, and strategies for revision are indicated in the new course curriculum, Tabella XVIII. A modern teaching method is the problem-based learning (PBL) method, which has already been adopted by over 100 medical schools throughout the world. This method can also be a satisfactory tool for teaching gastroenterology to undergraduate students, and its implementation requires only a few resources that are available in most universities. The theoretical principles of the method are illustrated and practical suggestions are given to set up a course in gastroenterology using this method.
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We have observed an adenocarcinoma of the stomach which developed on the site where an apparently benign active gastric ulcer had been diagnosed radiologically 10 and 7 years previously. The patient had complained of recurrent episodes of epigastric pain over ten years, which were well controlled by the medical treatment. The length of clinical history in this patient makes it unlikely that his ulcer was neoplastic at the time of onset. This appears to be, therefore, one of the rare instances of development of a gastric carcinoma on the site of a previously benign peptic ulcer.