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Biomedical subjects

L Barbara

Publications and source records attributed to L Barbara.

At least 199 records · Page 11Linked to original sources

Efficacy of addition of exogenous lactase to milk in adult lactase deficiency.

The efficacy of lactase by Kluyveromyces lactis in hydrolyzing milk lactose and reducing milk intolerance symptoms was tested in 52 proved lactose malabsorbers. The enzyme was added to milk administered to the patients, and H2 breath excretion (as an index of carbohydrate malabsorption), was determined by gas chromatograph technique, and milk intolerance symptoms were recorded. H2 mean excretion was 78.3 +/- 5.49 ppm after administration of intact whole milk 500 ml (test A), 43.5 +/- 4.99 ppm when lactase 2000 U was added to milk 500 ml immediately before administration (test B); 36.7 +/- 5.01 ppm when milk 500 ml was incubated for 12 h with lactase 1000 U (test C), and 29.7 +/- 4.35 ppm when the incubation was prolonged for 24 h (test D). Symptoms score was: test A = 5.85 +/- 0.56, test B = 3.71 +/- 0.45, test C = 2.77 +/- 0.63, test D = 1.7 +/- 0.68. A correlation index of r = 0.44 (p less than 0.01) was obtained between reduction in H2 mean excretion and reduction in symptoms score of a single individual. The addition of this lactase to milk seems to be effective in correcting lactose malabsorption, thus representing a convenient approach in milk intolerance.

Adult↗

Lactose malabsorption in adult patients with Crohn's disease.

In order to evaluate, in adult patients with Crohn's disease (CD), the prevalence of lactose malabsorption and intolerance, and the percentage who can tolerate a physiologic amount of milk in their diet, we tested 37 patients with CD (19 with intestinal resection, and 18 without) and 67 healthy controls (C) with the H2-breath test after they had ingested increasing loads of lactose as 10% solution (12.5 g, 25 g, and 50 g). Patients with malabsorption after the 12.5-g dose were tested further with 250 ml of milk. In the total group of patients and in the subgroup of those with resection, the prevalence of malabsorption was higher than in controls at all lactose loads; in patients who had not undergone resection, no significant difference was observed with the 12.5-g dose. Eleven of 18 patients who were malabsorbers with the 12.5-g dose had malabsorption also with 250 ml milk; however, only three of them (8% of the total group) experienced symptoms of intolerance. We conclude that, in adult patients with CD, 1) the prevalence of lactose malabsorption is increased, 2) in patients who have undergone intestinal resection, malabsorption occurs at a lower dose of the sugar than in patients who did not, and 3) since only 8% of patients experienced symptoms of intolerance after the ingestion of milk 250 ml, this amount can be empirically inserted in the daily diet of an adult with CD.

Adolescent↗

Impact of endoscopic ultrasonography on diagnosis and treatment of primary gastric lymphoma.

Endoscopic ultrasonography (EUS) allows a visualization in vivo of the gastric wall. Five ultrasonic layers of different echogenicities are displayed; each corresponds to a precise anatomic structure. In gastric diseases this layering evidently changes. In 10 patients with suspected primary gastric lymphoma, EUS showed a characteristic thickening of the second, the second and third layers, or a diffuse, transmural thickening of the entire wall. A precise correlation between the longitudinal and depth infiltration observed at EUS and the surgical finding was seen in all patients. In three cases in which the preoperative bioptic diagnosis was erroneous (two gastritis and one carcinoma) EUS showed a characteristic echographic pattern for lymphoma, which was confirmed at surgery. There was agreement also, in EUS and surgical findings in all patients, about involvement of neighbor organs. It seems possible that in the future EUS could play an important role in detecting, staging, and planning treatment of lymphoma and other gastric tumors.

Adult↗

Sonographic evaluation of the portal venous system after elective endoscopic sclerotherapy of esophageal varices.

In order to evaluate possible changes in the portal venous system after endoscopic sclerosis of esophageal varices, 25 cirrhotic patients underwent abdominal ultrasonography before the first session of sclerotherapy and after eradication of esophageal varices had been achieved. The caliber of the portal, splenic, and superior mesenteric veins was measured sonographically in each case. Sonographic results were compared statistically before and after sclerotherapy. Neither evidence of significant variations in the caliber of the portal veins nor thrombotic obliteration was seen. These results support the view that sclerotherapy has no significant negative side effects on the portal venous system.

Endoscopy↗

Urinary zinc excretion in Crohn's disease.

In order to study the reliability of urinary zinc levels as an index of zinc metabolism and status in Crohn's disease, we evaluated plasma and urinary zinc concentrations, urinary 3-methylhistidine excretion, and Crohn's disease activity index (CDAI) in 42 patients affected by Crohn's disease. Plasma zinc correlated directly with albuminemia (P = 0.01) and inversely with CDAI (P = 0.001). Urinary zinc excretion correlated with urinary 3-methylhistidine (P = 0.001) and plasma zinc levels (P = 0.01), and inversely with CDAI (P = 0.05). However, from multiple regression analysis, it was found that zincemia is influenced by CDAI and not by albumin, whereas zincuria is related to urinary 3-methylhistidine and plasma zinc, and not to CDAI. Our conclusion is that, in Crohn's disease, zincuria can be an index of zinc status when used together with measurements of lean body mass and turnover and factors influencing plasma ultrafiltrable zinc fraction.

Adolescent↗

Effect of somatostatin 14 on pure human pancreatic secretion.

While it is well known that large doses of somatostatin inhibit human pancreatic enzyme secretion, it is still unknown whether low doses are also effective and whether the peptide is able to inhibit bicarbonate production. Eight subjects with external transduodenal drainage of the main pancreatic duct performed after biliary tract surgery were studied. Somatostatin was infused at progressively increasing rates of 0.05, 0.15, 0.45, and 1.35 micrograms/kg/hr, for 30 min/dose, during pancreatic stimulation with secretin, 25 ng/kg/hr, and cerulein, 10 ng/kg/hr. Somatostatin, at the dose of 0.05 microgram/kg/hr (shown to produce blood levels similar to those measured after a meal) did not affect pancreatic secretion in any of the subjects. The successive three higher doses caused a significant and dose-dependent inhibition of protein concentration and output and of bicarbonate output. Bicarbonate concentration was slightly but significantly reduced only by the two highest doses of somatostatin. At each dose level, the inhibition of protein output was much more marked than the inhibition of bicarbonate output. The maximal inhibition of protein output (at 1.35 micrograms/kg/hr somatostatin) was 73.9 +/- 5.4%, and that of bicarbonate output was 55.9 +/- 6.4%. The results demonstrate that: (1) the administration of somatostatin at a low dose level does not affect human exocrine pancreatic secretion, at least under the experimental conditions of this study; and (2) the administration of larger doses of somatostatin inhibits pancreatic secretion of both protein and bicarbonate dose-dependently. The inhibitory effect on protein output is significantly greater than that on water and bicarbonate production.

Adult↗

Efficacy of 5-aminosalicylic acid enemas versus hydrocortisone enemas in ulcerative colitis.

A controlled trial has been carried out in order to compare the efficacy of enemas containing a high dosage of 5-ASA (4 g) versus enemas containing hydrocortisone 100 mg. The trial was conducted on 86 patients, 44 of whom received 5-ASA and 42 received hydrocortisone. The results were favorable in terms of clinical, sigmoidoscopic, and histologic criteria for 5-ASA treatment. Other aspects have been investigated, such as retrograde spread of enemas which have been shown to reach the left colon. No nephrotoxicity was detected. The long term experience confirmed the preliminary positive results.

Aminosalicylic Acids↗

Insulin as a factor of increased androgen production in women with obesity and polycystic ovaries.

To evaluate the possible role of moderate hyperinsulinemia on abnormal androgen secretion, we examined 4 age and weight-matched groups of obese subjects: 2 groups of women with normal menses whose fasting insulin (IRI) levels were less than or equal to 20 microU/ml (OB-I) or greater than or equal to 40 microU/ml (OB-I) and 2 groups of women with polycystic ovaries who were similarly grouped. All subjects underwent an oral glucose tolerance test, blood sex hormone determination and multiple LH determinations. Compared to OB, OB-PCO women showed significantly higher values of LH, androgen and estrogen concentrations. OB-I and OB-II showed similar hormonal patterns. On the contrary, OB-PCO-II presented significantly (p less than 0.05) higher androstenedione concentrations (348.7 +/- 129.9 ng/dl) (m +/- SD) than OB-PCO-I women (237.0 +/- 73.7 ng/dl). These differences were evident despite similar plasma LH concentrations. In conclusion, these results suggest that insulin may be a factor amplifying LH-dependent androgen secretion in hyperandrogenized women with obesity and PCO.

Androgens↗

Effect of albumin on taurocholate uptake kinetics in rat liver.

Isolated rat livers were perfused in a single pass with increasing doses of taurocholate with and without albumin in the perfusion media. The kinetics of taurocholate uptake were thus evaluated. In all the experiments, taurocholate uptake showed Michaelis-Menten kinetics. Increasing the albumin concentration in the medium resulted in an increase in the Km, without effect on the Vmax.. When taurocholate and albumin were kept constant (20:1 molar ratio), the Vmax. was significantly lower than in the other experiments. These data suggest that taurocholate uptake shows saturation in the absence of albumin and that albumin reduces taurocholate uptake.

Animals↗

Relationship between morphological changes detected by ultrasonography and pancreatic exocrine function in chronic pancreatitis.

We have studied the degree of pancreatic secretory alterations assessed by secretin-cerulein test (S-C) in relation to various morphological changes detected by real-time ultrasonography (US) in 42 patients affected by chronic pancreatitis. Exocrine insufficiency was found in 41 patients (97.6%), while morphological alterations were detected in 32 (76.1%). In the 10 patients with normal US, a mild or moderate exocrine insufficiency was present. Significant negative linear correlations of decreasing volumes of duodenal aspirate (r = 0.528, p less than 0.001) and output of bicarbonate (r = 0.635, p less than 0.001), lipase (r = 0.583, p less than 0.001), and chymotrypsin (r = 0.592, p less than 0.001) were found with increasing ultrasonographic alterations. However, a wide overlap was found in the secretory behavior in the various categories of change as determined by ultrasound. Hence, the attempt to predict exocrine function on the basis of morphological alterations proved unsuccessful.

Adult↗

Serum pancreatic enzyme behavior during the course of acute pancreatitis.

The variations of serum levels of amylase, pancreatic isoamylase, lipase, trypsinogen, and elastase 1 were evaluated in 21 patients with acute pancreatitis. The patients were studied for a mean period of 7 consecutive days (range 5-12 days) after admission to the hospital. On the day of onset of acute pancreatitis, all enzyme levels were abnormally high; pancreatic isoamylase showed the greatest increase compared with its upper normal limit, whereas the increase increment for elastase 1 was the lowest. Subsequently, all enzyme levels except elastase 1 decreased in a parallel fashion. On the eighth day of the study only elastase 1 levels were above normal values in all patients examined, while abnormally high values of lipase were found in 85% of the patients, trypsinogen in 58% of the patients, pancreatic isoamylase in 43%, and total amylase in 23%. These results indicate that, for the early diagnosis of acute pancreatitis, the determination of any of these enzymes is equally efficient, but that elastase 1 is the most sensitive marker of acute pancreatic damage in later stages of the disease.

Acute Disease↗

Effect of chronic administration of cisapride on gastric emptying of a solid meal and on dyspeptic symptoms in patients with idiopathic gastroparesis.

In a double blind crossover comparison with placebo, the effects of cisapride (10 mg tid for two weeks), a non-antidopaminergic gastrointestinal prokinetic drug, on gastric emptying times and on symptoms were evaluated in 12 patients with chronic idiopathic dyspepsia and gastroparesis. Gastric emptying was studied by a radioisotopic gamma camera technique. The test meal was labelled in the solid component (99mTc-sulphur colloid infiltrated chicken liver). Nine symptoms (nausea, belching, regurgitations, vomiting, postprandial drowsiness, early satiety, epigastric pain or burning, heartburn) were graded weekly on a questionnaire. Cisapride was significantly more effective than placebo in shortening the t1/2 of gastric emptying (p2 = 0.04), but no significant difference was observed between the two treatments with regard to the improvement of total symptom score (p2 = 0.09). No side effects were reported during the study.

Adult↗

Primary gastric lymphoma versus gastric carcinoma: endoscopic US evaluation.

Endoscopic ultrasonography (US) enables high-resolution imaging of the stomach and can demonstrate the different layers of the gastric wall. It has therefore been proposed for use in evaluating the extension of gastric neoplasms. It was performed in nine patients with primary gastric non-Hodgkin lymphoma and in 36 with gastric carcinoma. The US and pathologic findings were correlated in three surgical specimens of gastric lymphoma. Three different US patterns were found in gastric lymphomas: a polypoid pattern (two cases), localized (two cases) or extended (five cases) hypoechoic infiltration, and thickening with superficial ulcerations. Infiltration was confined to the second and third layers of the gastric wall in six cases and was transmural in three. The study of the gastric lymphoma specimens confirmed the accuracy of US in demonstrating the extent of infiltration. Gastric carcinomas had a more echogenic pattern and a different trend of diffusion, with no extended longitudinal hypoechoic infiltration of the superficial layers or extended hypoechoic transmural infiltration.

Adult↗