Search PubMed⌕ Search

Biomedical subjects

L Gullo

Publications and source records attributed to L Gullo.

At least 55 records · Page 3Linked to original sources
PubMed1995

Coffee and cancer of the pancreas: an Italian multicenter study.

While cigarette smoking is a well-established risk factor for pancreatic cancer, the role of alcohol, coffee and tea consumption remains controversial. In view of this, and because of the limited information on possible environmental risk factors of pancreatic cancer in Italy, we carried out this study. Five hundred seventy patients with newly diagnosed pancreatic cancer and 570 controls from 14 Italian centers were studied. Using a standardized questionnaire, all were interviewed personally about their smoking habits, as well as habitual alcohol, coffee, and tea consumption throughout their lives prior to clinical onset of the disease. Details were also obtained on exposure to potential occupational carcinogens. A moderate association, statistically significant only in women (odds ratio, 2.18; 95% confidence interval, 1.30-3.68), was found between pancreatic cancer and cigarette smoking, but none was observed with alcohol or tea consumption or with any particular occupational exposure. Consumption of 1 or 2 cups of coffee per day was not associated with increased risk; 3 coffees per day increased the risk, but not significantly (odds ratio, 1.49; 95% confidence interval, 0.97-2.30); with consumption of more than 3 coffees per day the increase in risk was highly significant (odds ratio, 2.53; 95% confidence interval, 1.53-4.18). A statistically significant dose-response relationship (p < 0.001) was observed in each sex. The association between coffee use and pancreatic cancer still held after controlling for potential confounding factors such as cigarette smoking or alcohol use, and when the analysis was restricted to nonsmoking coffee drinkers. The results of this study, one of the largest of its type so far published, suggest that a causal relationship may exist between coffee consumption and pancreatic cancer.

Adult↗
PubMed1995

Alcoholic liver disease in alcoholic chronic pancreatitis: a prospective study.

The prevalence and characteristics of alcoholic liver disease (ALD) in patients with alcohol-induced chronic pancreatitis (AICP) are not well defined. Fifty consecutive patients undergoing surgery for AICP were investigated for evidence of ALD. In addition to preoperative functional and imaging assessment of the liver, all had liver biopsy during surgery. Hepatic biopsy results were as follows: 12 patients had normal liver and 10 minimal aspecific changes; of the remaining 28 patients, 7 had liver cirrhosis, 11 showed features of alcoholic hepatitis, 2 had moderate steatosis, 6 extrahepatic cholestasis, and the remaining 2 had a combination of alcoholic hepatitis and cholestasis. Of the 7 patients with cirrhosis, 3 had oesophageal varices and 2 of these developed ascites in the postoperative period; in the remaining patients with ALD, this disease was subclinical. Patients with ALD consumed significantly (p < 0.005) more alcohol than those without ALD. In patients with cirrhosis, the duration of alcohol consumption (mean 27.6 years, range 18-42 years) was significantly longer (p < 0.05) than in patients without ALD (mean 19.7 years, range 8-36 years). The association of ALD with AICP is much more common than previously believed. The fact that AICP occurs earlier than liver cirrhosis and the fact that many patients stop alcohol consumption after the first attacks of pancreatic pain may explain, at least in part, the apparent rarity with which this association has been indicated by previous studies.

Adolescent↗
PubMed1995

Intraductal papillary-mucinous neoplasm of the pancreas. A clinicopathologic entity.

AIMS: The main clinicomorphologic findings from two new cases of intraductal papillary-mucinous neoplasm of the pancreas were analyzed and discussed. METHODS: Formalin-fixed pancreatic tissues from the more representative areas were routinely stained. An electron microscopic examination was performed in case 2 on glutaraldehyde-fixed tissue fragments. RESULTS: Both patients had a long history of symptoms that was suggestive of chronic pancreatitis. At endoscopic retrograde pancreatography a dilatation of the main duct was observed. Ultrasonography revealed cystic dilatations that were interpreted as pseudocysts. The patients underwent total pancreatectomy. The gross appearance showed no mass, but the pancreas was enlarged and diffusely hard. The cut surface showed micromacrocysts filled with soft friable tissue and mucus. Histological examination revealed diffuse neoplastic papillary proliferations within ectatic and cystically dilated ducts. The lesions exhibited varying grades of atypia and foci of in situ carcinoma. No clear evidence of invasion or lymph node metastases were observed. The nontumorous pancreas showed diffuse and multiple hyperplastic papillary changes in the ductal tree. CONCLUSION: The main clinicopathologic findings of intraductal papillary-mucinous neoplasm of the pancreas have been reported. Our study favors the hypothesis that chronic pancreatitis and/or ductal epithelial papillary hyperplasia may play a role in the pathogenesis of this tumor. We have emphasized the cystic appearance and mucinous features of this neoplasm, and so we suggest the use of the term intraductal papillary-mucinous neoplasm.

Cystadenoma, Mucinous↗
PubMed1995

Is chronic pancreatitis a cause of dyspepsia?

Chronic pancreatitis is commonly included among the organic causes of dyspepsia, however the frequency and characteristics of this association are ill-defined. One-hundred-fifteen consecutive patients with chronic pancreatitis and 85 healthy subjects were interviewed regarding their clinical history, with particular attention to dyspeptic symptoms. Attacks of prolonged upper abdominal pain, recurring at unpredictable intervals and in most cases without identifiable triggering factors, were the most frequent clinical manifestation (108, 94%). During the attacks, many patients (66, 61%) complained of vomiting, which was generally mild and of brief duration. Between the attacks, very few patients (12, 10%) complained of dyspeptic disturbances, mainly postprandial epigastric fullness and abdominal bloating. These complaints were episodic, usually after abundant meals, in 8, and persistent in the remaining 4. Among these 12 patients, there were no significant differences in the frequency of dyspeptic symptoms in relation to the severity of exocrine pancreatic insufficiency. The frequency of dyspeptic complaints among patients (10%) was significantly lower (p < 0.01) than the frequency of dyspeptic symptoms among the controls (25%). The results of this study indicate that, other than recurrent attacks of abdominal pain, dyspeptic symptoms are uncommon in chronic pancreatitis, and that impairment of digestion of pancreatic origin is not a cause of dyspepsia.

Adult↗
PubMed1994

Diabetes and the risk of pancreatic cancer.

BACKGROUND: Diabetes and pancreatic cancer are known to be associated, but the cause of the association and whether diabetes is a risk factor for pancreatic cancer remain controversial. METHODS: A total of 720 patients with pancreatic cancer and 720 control patients from 14 Italian centers were enrolled in the study. All subjects were interviewed personally and in detail about their clinical history. The diagnosis of diabetes was based on criteria recommended by the American Diabetes Association. RESULTS: One hundred sixty-four patients with pancreatic cancer (22.8 percent) and 60 controls (8.3 percent) had diabetes. In the majority of the patients with pancreatic cancer (56.1 percent), diabetes was diagnosed either concomitantly with the cancer (in 40.2 percent), or within two years before the diagnosis of cancer (in 15.9 percent). The association between the two conditions was significant (odds ratio, 3.04; 95 percent confidence interval, 2.21 to 4.17). However, when only patients with diabetes of three or more years' duration were considered, the association was no longer significant (odds ratio, 1.43; 95 percent confidence interval, 0.98 to 2.07). All the patients with pancreatic cancer whose diabetes had been diagnosed before the cancer had non-insulin-dependent diabetes; all but one of the control patients with diabetes had the non-insulin-dependent form of the disease. CONCLUSIONS: Diabetes in patients with pancreatic cancer is frequently of recent onset and is presumably caused by the tumor. Diabetes is not a risk factor for pancreatic cancer.

Adult↗
PubMed1994

Pancreatitis in the elderly.

Inflammatory diseases of the pancreas are not uncommon in the elderly; although acute and chronic pancreatitis in this age group are essentially the same diseases as in younger patients, some features are unique to the old patient. Acute pancreatitis in the elderly is more commonly of gallstone etiology; it is also more likely to have an atypical clinical presentation, making recognition more difficult. In acute necrotizing pancreatitis, the elderly patient has an increased risk of complications including multisystem failure; for this reason, such patients should be more carefully monitored and aggressively treated. Chronic pancreatitis with initial onset older than 60 years is rare in the elderly, and generally without apparent cause; much more commonly, it is seen as the advanced stage of a disease started in youth. Diffuse glandular destruction and resulting severe insufficiency are usually present; thus, rather than pain, the most frequent clinical manifestations are steatorrhea and diabetes. These complications should be adequately treated to avoid malnutrition, which may seriously affect the well-being and quality of life in the elderly.

Acute Disease↗
PubMed1994

Behavior of serum soluble interleukin-2 receptor, soluble CD8 and soluble CD4 in the early phases of acute pancreatitis.

When activated, lymphocytes secrete glycoproteins related to particular surface proteins, including soluble forms of the interleukin-2 receptor (sIL-2R) and of the surface proteins CD4 (sCD4) and CD8 (sCD8). We evaluated the release of these glycoproteins in order to assess the activation of the cellular immune system during the course of acute pancreatitis. Thirty-five patients with acute pancreatitis (22 M, 13 F, mean age 64 years, range 16-97) were studied. The diagnosis was based on typical abdominal pain associated with a twofold increase of serum lipase as well as morphological abnormalities compatible with acute pancreatitis seen at computed tomography and/or ultrasonography. The pancreatitis was of biliary origin in 22 patients, due to alcohol abuse in 8, due to pancreas divisum in 1, due to type IV hyperlipoproteinemia in 1 and of unknown origin in 3. Based on clinical outcome, 22 patients had mild pancreatitis, whereas 13 had severe disease. In all patients serum sIL-2R, sCD4 and sCD8 were determined on admission and daily for the following 5 days using enzyme immunoassay (EIA) techniques. Serum concentrations of sIL-2R and sCD8 were significantly higher in acute pancreatitis patients relative to healthy controls during the entire observation period, whereas sCD4 levels were significantly lower in acute pancreatitis patients than in the control group from the 2nd to the 6th day of observation. Serum sIL-2R concentrations were significantly higher in patients with severe pancreatitis than in those with the mild form of the disease, whereas no differences in serum concentrations of sCD8 and sCD4 were found between patients with mild pancreatitis and those with severe disease.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Disease↗
PubMed1994

CA19-9: the Italian experience.

This article reviews studies of the diagnostic value of CA19-9 determination in pancreatic cancer in Italy. Almost all of these studies show that CA19-9 determination has a good sensitivity in the diagnosis of advanced pancreatic cancer and that its diagnostic accuracy is superior to that of the other serum tumor markers currently available. Although data from patients with early pancreatic cancer are limited, they indicate that the diagnostic value of CA19-9 in these patients is low.

Biomarkers, Tumor↗
PubMed1994

Acute pancreatitis associated with eclampsia: a case report.

This case report describes a 24-yr-old pregnant woman who developed acute pancreatitis while suffering from a severe eclamptic syndrome. Since she had no gallstones or other known aetiological factors of acute pancreatitis, the possibility of an aetiologic role of pancreatic ischaemic changes associated with eclampsia is discussed. From a clinical point of view, acute pancreatitis persisted longer than usual and rendered its management complex.

Acute Disease↗
PubMed1993

Problems in Italy.

Explore the source record for details and available documents.

Career Mobility↗
PubMed1993

Serum amylase and lipase concentrations and lipase/amylase ratio in assessment of etiology and severity of acute pancreatitis.

We studied the behavior of serum amylase and lipase in 66 consecutive patients with acute pancreatitis in order to assess the ability of these tests and of the serum lipase-amylase ratio to establish the etiology and predict the severity of acute pancreatitis. Forty-two patients had biliary acute pancreatitis, 14 had alcoholic acute pancreatitis, and the remaining 10 nonbiliary, nonalcoholic (NBNA) acute pancreatitis. Serum amylase and lipase were abnormally high in all patients. The elevations of both serum amylase and lipase were significantly lower in patients with alcoholic pancreatitis than in those with biliary pancreatitis, although a considerable overlap was observed between the two groups. No statistically significant differences were found between NBNA patients and those with either biliary or alcoholic forms of the disease. The serum lipase-amylase ratios in patients with alcoholic pancreatitis ranged from 0.2 to 5.6, in those with biliary pancreatitis from 0.1 to 7.9, and in those with NBNA pancreatitis from 0.1 to 4.4. These differences were not statistically significant. No differences in serum enzyme levels were observed among patients without apparent imaging signs of acute pancreatitis (N = 20), those with signs of pancreatic edema (N = 36), and those with necrotizing pancreatitis (N = 10). The results indicate that serum amylase and lipase concentrations are not able to establish either the etiology or to predict the severity of acute pancreatitis as assessed by imaging techniques. Furthermore, the serum lipase-amylase ratio is not useful in distinguishing acute episodes of alcoholic from nonalcoholic acute pancreatitis.

Acute Disease↗
PubMed1993

Treatment of pancreatic ascites with somatostatin.

Pancreatic ascites is a rare complication of chronic pancreatitis, whose treatment continues to represent a difficult clinical problem. In this report we describe a case of a patient with chronic pancreatitis and pancreatic ascites who was successfully treated with somatostatin given by continuous intravenous infusion of 1.5 micrograms/kg/h for 2 weeks.

Amylases↗
PubMed1993

Morphologic and functional evaluation of the exocrine pancreas in beta-thalassemia major.

Thirty-nine consecutive patients with beta-thalassemia major and iron overload were studied by ultrasonography and serum pancreatic enzyme determination to assess the frequency and characteristics of pancreatic damage in this condition. The results were compared with those of a matched group of healthy controls. Most of the thalassemic patients had a markedly increased echogenicity of the pancreas and decreased size of the gland (p < 0.001 for both features as compared with controls). Both echogenicity and decreased size of the gland were significantly correlated (p < 0.001) with patient age and duration of transfusional therapy. Serum concentrations of trypsin and lipase were significantly lower (p < 0.02) in patients than in controls. The lowest enzyme values were found in older patients with longer duration of transfusional therapy, who also had the most marked sonographic changes. The results suggest that the exocrine pancreas is structurally and functionally damaged in the majority of thalassemic patients with iron overload.

Adolescent↗
PubMed1993

Indication for pancreatic enzyme treatment in non-pancreatic digestive diseases.

Several studies have shown that exocrine pancreatic function may be impaired in various non-pancreatic digestive diseases. The impairment, however, is usually mild to moderate and generally does not cause malabsorption. In some patients, however, pancreatic insufficiency is severe enough to cause malabsorption, which can be effectively corrected by oral pancreatic extracts.

Digestive System Diseases↗
PubMed1992

Serum pancreatic enzymes in HIV-seropositive patients.

Serum concentrations of trypsin and elastase I were determined in 109 HIV Ab-positive patients (52 asymptomatic HIV-infected patients, 25 with lymphadenopathy syndrome, and 32 with acquired immunodeficiency syndrome) to assess the prevalence of possible pancreatic damage in these patients. Serum trypsin was abnormally elevated in 46 of the 109 patients (42.2%): 19 of the 52 asymptomatic HIV-infected patients (36.6%), 9 of the 25 with lymphadenopathy syndrome (36%), and 18 of the 32 with acquired immunodeficiency syndrome (56.3%). Serum elastase 1 was elevated in 14 of the 109 HIV Ab-positive patients (12.8%): 3 of the 52 asymptomatic HIV-infected patients (5.8%), 3 of the 25 with lymphadenopathy syndrome (12%), and 8 of the 32 with acquired immunodeficiency syndrome (25%). None of the patients with abnormally high serum pancreatic enzyme concentrations had clinically evident pancreatic disease. There was no statistically significant difference in serum levels of trypsin and elastase I between drug addicts and nonaddicts, between alcoholics and nonalcoholics, or between those with cytomegalovirus infection and those without. A significant inverse relationship was found between serum enzyme concentrations and the number of CD4+ lymphocytes. The results of this study show that high levels of serum trypsin and elastase are present in an elevated percentage of patients with acquired immunodeficiency syndrome, suggesting that the pancreas is frequently damaged in this disease. The finding of abnormally high serum enzyme concentrations not only in patients with AIDS, but also in asymptomatic carriers and in patients with lymphadenopathy syndrome suggests an association between HIV infection and the development of pancreatic lesions.

Acquired Immunodeficiency Syndrome↗
PubMed1992

Pancreatic exocrine carcinoma producing adrenocorticotropic hormone.

A rare case of pancreatic exocrine carcinoma with an endocrine component secreting adrenocorticotropic hormone (ACTH) is reported and discussed in relation to other cases previously published. The patient initially presented with a severe form of diabetes, which was treated accordingly. Persistence of hyperglycemia, along with other metabolic alterations and marked hypokalemia, led to the suggestion of abnormal ACTH secretion. In this patient, however, a florid Cushing's syndrome was not observed. The patient also developed hematological alterations, mainly leukopenia and thrombocytopenia, whose origins were unclear. At autopsy, a poorly-defined mass was discovered between the body and tail of the pancreas. Standard histology showed a moderately-differentiated adenocarcinoma. Immunohistochemical analysis of the tumor specimen demonstrated the presence of some neoplastic cells immunoreactive for chromogranin A, neuron-specific enolase and ACTH. These findings are consistent with the existence of an endocrine component within the exocrine carcinoma with ACTH differentiation.

ACTH Syndrome, Ectopic↗
PubMed1992

Study of the effect of neurotensin on meal- and cerulein-induced gallbladder contraction.

We studied the effect of a low dose of neurotensin (2.5 pmol/kg/min) on meal- and cerulein-induced gallbladder contraction in 11 healthy volunteers by means of real-time ultrasonography. Ingestion of a meal caused a significant reduction in gallbladder volume which reached a maximum of 57 +/- 2% of the basal value at 60 min after the meal. The infusion of neurotensin caused a slight but not significant attenuation of the contractile response of the gallbladder to the meal (maximal reduction of 49 +/- 6%). Increasing doses of cerulein (10, 20 and 40 ng/kg/h, for 30 min at each dose) caused progressive reductions in gallbladder volume of 18 +/- 5, 72 +/- 5 and 89 +/- 4% with the three respective doses of cerulein used. The simultaneous administration of neurotensin did not significantly modify the gallbladder response to cerulein. The results indicate that neurotensin, at a dose of 2.5 pmol/kg/min, does not influence the gallbladder contraction stimulated by food or cerulein.

Adult↗