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L Trevisani

Publications and source records attributed to L Trevisani.

At least 37 records · Page 2Linked to original sources
PubMed1998

A four-day low dose triple therapy regimen for the treatment of Helicobacter pylori infection.

OBJECTIVE: The current guidelines recommend 1-wk triple therapy regimens for eradicating H. pylori infection. Until now, shorter regimens have scarcely been investigated. Azithromycin is a new generation macrolide antibiotic with unusual and favorable pharmacokinetics, and seems to be a very promising agent for innovative anti-H. pylori regimens. We assessed the efficacy and tolerability of a new 4-day low dose triple therapy in comparison with a well established 1-wk triple therapy in the treatment of Helicobacter pylori infection. METHODS: One hundred-sixty consecutive patients with biopsy-proven H. pylori infection were randomized to receive lansoprazole 30 mg b.i.d. on days 1-4, azithromycin 500 mg u.i.d. on days 2-4, and tinidazole 2000 mg u.i.d. on day 3 (LAT group), or 7 days of triple therapy of omeprazole 20 mg u.i.d., clarithromycin 250 mg b.i.d., and tinidazole 500 mg b.i.d. (OCT group). Patients with gastric or duodenal active ulcer received proton pump inhibitors for an additional 4 wk. H. pylori eradication was defined as negative of both rapid urease test and histology on biopsies taken from the gastric body and antrum at least 1 month after the end of treatment. RESULTS: Seven patients in the LAT group and four in the OCT group were lost to follow-up. No significant difference in either efficacy or tolerability was observed between the two regimens. Active ulcers healed in 97.8% of cases with LAT and in 100% of cases with OCT. The eradication rate was 80.8% in the LAT group and 85.5% in the OCT group, considering the per-protocol results, and 73.3% and 81.2%, respectively, considering the intention-to-treat results. Side effects occurred in one LAzT patient and in two OCT patients; they were mild and did not interfere with compliance. CONCLUSION: The new proposed ultrashort triple therapy, including lansoprazole, low dose azithromycin for 3 days, and a single dose of tinidazole, appears to be a very effective anti-H. pylori regimen, a simpler, cheaper, well-tolerated, and equally effective alternative to 1-wk triple therapy.

2-Pyridinylmethylsulfinylbenzimidazoles↗
PubMed1998

Usefulness of brushing urease test for diagnosis of Helicobacter pylori infection.

BACKGROUND AND AIMS: Gastric brushing cytology is an accurate technique for rapidly detecting Helicobacter pylori infection, but it is not routinely employed since the presence of personnel experienced in this field, is necessary in the endoscopy suite. To evaluate the diagnostic usefulness of rapid urease test carried out on cytological brushing. PATIENTS: A total of 143 consecutive patients with suspected Helicobacter pylori infection, referred for elective gastroscopy. METHODS: For each patient, 2 brushings were carried out and 4 biopsies were taken from antral mucosa during gastroscopy. The former brushing was smeared on a slide, and stained by a rapid staining set for blood smears. The latter was used for rapid urease test, by shaking the brush into the urea broth. Two biopsies were used for rapid urease test and two for histologic examination. Histology was considered as the gold standard. RESULTS: Of 143 patients, 73 were diagnosed as Helicobacter pylori infected using histology. Six brushing slides were inadequate due to insufficient cytology material. Biopsy-rapid urease test and brushing-rapid urease test had similar sensitivity (87.3% vs 83.5%), specificity (98.4% vs 96.8%) and overall accuracy (92.3% vs 89.5%). In 62 Helicobacter pylori infected patients, both rapid urease test techniques were positive. Brushing-rapid urease test became positive in a significantly shorter time than biopsy-rapid urease test (22 +/- 54 minutes vs 39 +/- 63 minutes; p < 0.01). CONCLUSIONS: Brushing-rapid urease test is as accurate as biopsy-rapid urease test in detecting Helicobacter pylori infection, but it is significantly faster. Special care should be taken to carry out brushing adequately, to minimize the occurrence of false negatives.

Adult↗
PubMed1997

Touch cytology. A reliable and cost-effective method for diagnosis of Helicobacter pylori infection.

A variety of reliable methods are available for detecting Helicobacter pylori (Hp) during upper gastrointestinal endoscopy. We evaluated the clinical utility and cost-effectiveness of rapid urease test (RUT), touch cytology (TC), and histology (H). Two hundred thirty-eight consecutive patients (178 without previous medical treatment and 60 formerly treated with anti-Hp therapy) were tested for Hp infection by RUT, TC, and H (H&E stain). The infection status for each patient was established by a concordance of two test results. The time to carry out the three tests and their cost were also calculated. Sensitivity of TC (100%) was significantly higher than that of RUT (86.8%; P < 0.001), but not than that of H (94.9%). RUT was significantly more specific than H (100% vs 95.6%; P < 0.05), but not than TC (96.4%). Hp infection was more frequent in the patients with chronic active gastritis than in those with chronic nonactive gastritis (P < 0.001). No Hp infection was detected in absence of chronic antral inflammation. RUT resulted the cheapest method and H the most expensive; TC is faster and cheaper than H. When additional information about the severity of mucosal damage or the presence of cell atypias is not necessary, histologic examination can be omitted, and a cost-effective strategy for assessing Hp status might consist in taking two antral biopsies, the former for performing RUT and the latter for preparing a slide by TC, which should be stained and examined only when the RUT result is negative.

Adult↗
PubMed1997

Short-term low-dose triple therapy with azithromycin, metronidazole and lansoprazole appears highly effective for the eradication of Helicobacter pylori.

BACKGROUND: Although the OCN (omeprazole, clarithromycin and nitroimidazoles) short-term low-dose regimens are regarded as 'the standard' in the treatment of Helicobacter pylori infection, azithromycin is a new-generation, acid-stable macrolide which may prove particularly useful for a new short-term low-dose triple therapy regimen. OBJECTIVE: To further improve OCN eradication treatments by reducing both the number of pills and the total cost. METHODS: A new short-term low-dose triple therapy (LAM) using lansoprazole 30 mg once a day for 1 week, azithromycin 500 mg once a day for 3 days, and metronidazole 250 mg twice a day for the same 3 days, was administrated to 60 patients presenting with H. pylori-positive gastritis with or without peptic ulcer, and compared with the classic 'Bazzoli regimen' (OCT: omeprazole, clarithromycin, tinidazole) in 60 matched patients. H. pylori infection before and after therapy was evaluated by a rapid urease test, conventional histology and toluidine-stained semi-thin sections. Three biopsies from the corpus and three from the antrum were taken during endoscopical examination before and 7-8 weeks after discontinuation of the treatment. Patient compliance, drug tolerance and drug costs were also taken into consideration. RESULTS: H. pylori infection was eradicated 7-8 weeks after treatment in 56 of the 60 patients in the LAM group (93.3%), and in 52 of the 57 patients in the OCT group who completed the treatment (91.2%), with no statistical difference. When gastric or duodenal ulceration was present, ulcer healing was observed in all cases. CONCLUSION: The new proposed short-term low-dose triple therapy (LAM) appears to be as effective as the OCT for the eradication of H. pylori infection. The new treatment, however, seems to have advantages in terms of drug tolerance, patient compliance and therapy cost.

2-Pyridinylmethylsulfinylbenzimidazoles↗
PubMed1997

CD4-positive T-lymphocytes infiltrate the bronchial mucosa of patients with Sjögren's syndrome.

To investigate the degree and the type of inflammation in the bronchial mucosa in patients with Sjögren's syndrome, we examined lobar bronchial biopsies obtained from 10 patients with Sjögren's syndrome (six with primary and four with secondary) and eight control subjects. Histochemistry with hematoxylin-eosin was performed both to identify the number of mononuclear cells and eosinophils and to measure the thickness of the basement membrane. Immunohistochemistry was performed to identify neutrophils (neutrophil-elastase), macrophages (CD68), and T-lymphocyte subpopulations (CD4 and CD8) in the submucosa. Subjects with Sjögren's syndrome presented a greater number of CD4-positive T-lymphocytes than did the normal control subjects (p = 0.0129). Instead, eosinophils, neutrophils, macrophages, CD8 positive T-lymphocytes, and basement membrane thickness were similar in the two groups. There were no differences in cell counts between patients with primary and those with secondary Sjögren's syndrome and between symptomatic and asymptomatic patients. No correlation was found between cell counts, symptoms, lung volumes, and disease duration. This study has shown that patients with Sjögren's syndrome have an increased number of CD4 positive T-lymphocytes in the bronchial mucosa outside of the bronchial glands, supporting the concept that, in the airways. Sjögren's syndrome involves also extraglandular tissues.

Adult↗
PubMed1996

Misoprostol and omeprazole in the prevention of chemotherapy-induced acute gastroduodenal mucosal injury. A randomized, placebo-controlled pilot study.

BACKGROUND: Chemotherapy (CT) may induce acute mucosal injury to the stomach and duodenum, but its prevention has been scarcely investigated. METHODS: One hundred and eighty-two cancer patients with normal stomach and duodenum or having fewer than 3 erosions, selected to be treated with cyclophosphamide, methotrexate, and 5-fluorouracil (CMF) (77 breast carcinoma patients) or 5-fluorouracil (5-FU) (105 colon carcinoma patients), were randomly assigned to prophylactic treatment with misoprostol, 400 micrograms twice a day; omeprazole, 20 mg once a day; or placebo, 1 tablet twice a day. Seven days after the end of the second source of CT, all patients underwent control esophagogastroduodenoscopy. Endoscopic findings were quantified on the basis of an arbitrary score: 0 = normal; 1 = less than 3 erosions; 2 = 3-15 erosions; 3 = more than 15 erosions or ulcer; 4 = giant ulcer (greatest dimension of more than 2 cm) or multiple ulcers with cumulative greatest dimension exceeding 2 cm. RESULTS: Mean score increased significantly in the placebo and misoprostol groups, either after CMF (P < 0.001 and P < 0.05, respectively) or after 5-FU (P < 0.001 for both), whereas it did not in the omeprazole group. Gastric and duodenal ulcers were significantly less frequent in patients receiving omeprazole than in those receiving placebo (P < 0.05 after both CMF and 5-FU). No significant difference was observed between placebo and misoprostol. Omeprazole was significantly more effective than placebo and misoprostol in reducing the frequency and degree of the endoscopic worsening, either after CMF or after 5-FU (P < 0.05 for both CT regimens). Epigastric pain and/or heartburn were significantly less frequent in patients receiving omeprazole than in those receiving placebo (P < 0.01) or misoprostol (P < 0.001). CONCLUSIONS: The strong and prolonged inhibition of gastric acid production induced by omeprazole seems to be effective in preventing chemotherapy-induced gastroduodenal mucosal injury. Further trials are necessary to verify whether such a prevention of endoscopically observed injury can translate into prevention of clinically significant injury.

Adult↗
PubMed1996

Cost analysis of long-term feeding by percutaneous endoscopic gastrostomy in cancer patients in an Italian health district.

The aim of this study was to evaluate prospectively the cost of long-term feeding by percutaneous endoscopic gastrostomy (PEG). Cost analysis was carried out in 34 head and neck cancer patients, followed from the time of PEG placement to the death or the end of the study. Three main items were considered: (a) PEG placement (on an inpatient basis), subdivided into five subitems: the Freka FK-07 gastrostomy kit, materials and anaesthetic drugs used, antibiotics and antisecretory drugs, gastroscope amortization expenses and staff; (b) nutrition, considering the costs of enteral-feeding products, nutrition container and flexible tube connecting the container to the PEG; (c) patient care, dividing the patients into three groups: outpatients, home-care patients and outpatients shifting to home care during the follow-up. All patients had one medical and two nursing visits/month, and, if necessary, immediate additional access to a physician or nurse. The mean daily cost per patient of long-term feeding via PEG was obtained by adding up the mean daily costs per patient of the three items, and was compared with that of feeding via nasogastric tube, calculated in 11 patients using the same criteria. No procedure-related death nor periprocedural major or minor complications were observed. The 60-day mortality was 3/34. Seventeen patients were always seen on an outpatient basis and 8 were followed by our home-care unit: 9 outpatients shifted to home care during the follow-up. The mean duration of PEG use was 180.5 days (range 47-639). Two wound infections, treated with antibiotics, occurred during the follow-up. The mean daily costs of placement, nutrition and patient care were (Italian Iiras) L 2500, 24 510 and 1880 respectively (Deutschemarks: DM 2.08, 20.42 and 1.56), for a total mean daily cost of L 28,890 (DM 24.06), slightly higher than that of feeding via a nasogastric tube (L 27,340; DM 22.78). On the basis of the improved quality of life, as well as from the economic point of view, PEG can be considered the procedure of choice for enteral feeding of cancer patients, provided that a reasonably long survival can be expected.

Aged↗
PubMed1996

Percutaneous endoscopic gastrostomy placement using the pull-through or push-through techniques: is the second pass of the gastroscope necessary?

BACKGROUND AND STUDY AIMS: The pull-through and push-through techniques widely used for placing a percutaneous endoscopic gastrostomy (PEG) require two passes of the gastroscope. The second pass is considered necessary to assess the correct positioning of the internal bumper. The aim of the present study was to verify whether the second pass is in fact necessary, or whether it could be omitted in most cases. PATIENTS AND METHODS: Eighty patients undergoing pull-through or push-through PEG placement were included in this prospective study, and were randomly assigned to two groups. In the first group, two passes of the gastroscope were carried out, while in the second group the second pass was omitted and the position of the internal bumper was manually assessed by finger palpation of the abdominal wall after the feeding tube had been pulled out through the abdomen. If finger palpation was not considered satisfactory, a control gastroscopy was carried out. In the other cases, plain radiographs of the abdomen were carried out within six hours of the procedure. RESULTS: Thirty-nine patients underwent two-pass PEG placement, and 41 received one-pass PEG placement. In one patient who had a one-pass procedure, the finger palpation was not considered satisfactory; however, a control gastroscopy showed that the internal bumper was correctly placed. In all other one-pass PEG patients, plain radiography of the abdomen showed that the internal bumper was at an adequate distance from the abdominal wall. No major or minor complications associated with the procedure were observed in either group. Bowel sounds reappeared within 24 hours of the procedure in all patients except for one in the two-pass group, in whom they reappeared after 36 hours. One wound infection, treated with systemic antibiotics, occurred in each group within 30 days of the PEG placement. The procedure time saved in the one-pass PEG group averaged 1.5 minutes. CONCLUSIONS: One-pass PEG placement appears to be as safe as the classic pull-through and push-through PEG methods, and can be used routinely to make the procedure quicker and reduce the discomfort for the patient, as well as reducing the risks and costs associated with the second pass of the gastroscope. A control gastroscopy can be reserved for patients with morbid obesity, or for cases in which finger palpation is not considered satisfactory.

Adult↗
PubMed1996

Cytokeratin tumor marker levels in bronchial washing in the diagnosis of lung cancer.

STUDY OBJECTIVE: The monitoring of serum concentrations of Cyfra 21-1, tumor polypeptide antigen (TPA), and tissue polypeptide specific antigen (TPS) has been demonstrated to be useful in the clinical treatment of patients with lung cancer. This study was planned to evaluate the clinical usefulness of the assay of these tumor markers on bronchial washing (BW) fluid and to compare it with serum assay in patients with neoplastic and nonneoplastic disease. STUDY DESIGN: Serum and BW fluid levels of Cyfra 21-1, TPA, and TPS were measured in 40 subjects (10 control subjects, 11 with chronic bronchitis, 10 with squamous cell lung cancer, and 9 with nonsquamous cell lung cancer) undergoing diagnostic bronchoscopy. BW was performed using 25 mL of pyrogen-free saline solution instilled through the working channel of the bronchoscope, and successively aspirated. The quantity of the fluid recovered was measured and used for the assay of albumin, Cyfra 21-1, TPA, and TPS. RESULTS: Mean BW concentrations of Cyfra 21-1, TPA, and TPS concentrations were significantly higher than serum concentrations (p < 0.01). Serum Cyfra 21-1, TPA, and TPS concentrations were significantly lower in controls and in those with chronic bronchitis than in patients with epidermoid and nonepidermoid carcinoma (p < 0.01). No difference in serum concentrations of the three markers was observed between controls and patients with chronic bronchitis. On the contrary, BW Cyfra 21-1 and TPA concentrations were significantly higher in those with chronic bronchitis and in cancer patients than in controls (p < 0.01), whereas they did not differ between patients with chronic bronchitis and cancer patients. No significant difference in BW TPS concentration was observed among the four groups. Sensitivity and specificity of the BW markers in diagnosing lung cancer were as follows: 68.4% and 61.9% for Cyfra 21-1; 68.4% and 66.6% for TPA; and 57.9% and 66.6% for TPS. CONCLUSIONS: BW fluid concentrations of Cyfra 21-1 and TPA are increased in patients with chronic bronchitis and in patients with lung cancer. Being unable to distinguish malignant from nonmalignant inflammatory conditions, the measurement of airway concentrations of such markers has a too-low specificity to be considered useful in diagnosing malignant abnormalities of the lung.

Adult↗
PubMed1996

Endoscopic aspects of gastroduodenal mucosa due to NSAIDs.

The role of endoscopy in NSAID-related gastroduodenal pathologies is reviewed. If an accepted and largely used algorithm in which the role of endoscopy is exactly identified is not available, current strategy for the management of gastroduodenal toxicity gives indication for endoscopy immediately after the onset of symptoms, anaemia and evidence of bleeding, overt or occult. The endoscopic patterns of lesions in patients taking NSAID are characteristics patterns of erosive and ulcerative lesions. Endoscopy can recognize early lesions, allowing us to prevent a more advanced mucosal damage.

Aged↗
PubMed1996

Ultrastructural damage of gastric epithelium in patients taking NSAIDs.

As far as concerns ultrastructural lesions in the gastric epithelium following NSAIDs, a review has been made of existing data and ideas for future research concerning the ultrastructural field are advanced. Specific ultrastructural damage of the gastric epithelial cells has been recognized in patients taking NSAIDs: this pattern of damage appears characterized by a proliferative phenomen of "desquamation" of contiguous epithelial cells. Studies in animal models indicate that the first-level of epithelial damage involves a mitochondrial derangement and an alteration of tight junctions and cytoskeletal. The length of time of local drug action on the gastric mucosa could be the reason for the characteristic morphological presentation seen in vivo. If ulcers are the result of an imbalance between cell necrosis and cell regeneration, the high progression speed of cell necrosis to contiguous cells should play a basic role in the genesis of ulcers.

Animals↗
PubMed1995

Histological findings in gastric mucosa in patients treated with non-steroidal anti-inflammatory drugs.

AIMS: To identify distinguishing and general histological features related to the use of non-steroidal anti-inflammatory drugs (NSAID). METHODS: Slides from gastric antral biopsies of 50 patients with osteoarthritis taking NSAID were compared with slides from antral biopsies of 50 control cases matched for age, sex, and race. Semithin sections stained with toluidine blue were used. RESULTS: Chronic gastritis was seen in 76% of the patients taking NSAID and in 58% of the control cases; active inflammation was detected in 10% of the NSAID treated patients and in 24% of the control cases, and it appeared closely related with Helicobacter pylori infection. Some histological features common to all slides of patients taking NSAID were recognised. These consisted of focal erosions of the gastric epithelium and macroerosions, and they seemed to represent successive steps of a process of "desquamation". CONCLUSIONS: Some distinguishing morphological aspects appeared prominent; it is suggested that these may be related to the pathogenesis of NSAID linked peptic ulceration. On the other hand, epithelial damage due to NSAID appears very different from that due to Helicobacter pylori, another important factor involved in the aetiopathogenesis of peptic disease.

Adult↗
PubMed1995

Usefulness of coagulation markers in staging of gastric cancer.

Thirty-six patients with nonmucinous adenocarcinoma of the stomach, candidates for surgical laparotomy, were studied to evaluate the presence and extent of coagulation disorders in gastric cancer. They were staged according to TNM cancer staging (T: extent of primary tumor; N: lymph node involvement; M: presence of metastases), and a blood sample was collected before surgery. Platelets, platelet factor four (PF4), beta-thromboglobulin (BTG), activated partial thromboplastine time (APTT), prothrombin time (PT), factors five (V) and seven (VII), fibrinogen, cross-linked fibrin degradation products (XDP), fibrinopeptide-A (Fp-A), and antithrombin three (AT III) were assayed. Only fibrinogen, Fp-A, PF4, and factors V and VII were increased in more than 50% of patients. Fibrinogen and Fp-A were positively correlated with T(r = 0.29, p < p < 0.05; and r = 0.35, p < 0.05; respectively), whereas the other parameters did not show any statistically significant relationship with T, N, and M. Considering the subgroups including only the patients with pathological values, Fp-A (31 patients) was positively correlated with N (r = 0.4, p < 0.05), PF4 (25 patients) showed a positive correlation with T and N (r = 0.42, p < 0.05; r = 0.46, p < 0.05; respectively), and a significantly higher median in the presence than in the absence of metastases (median in the M+ subgroup: 42.7 ng/ml, range 38.6 to 102.8; median in the M- subgroup: 33.7, range 20.3 to 85; p < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Adenocarcinoma↗
PubMed1995

[A case of a patient with multiple primary neoplasms: ileal leiomyosarcoma and bronchial carcinoid].

Small bowel leiomyosarcoma and lung carcinoid are uncommon neoplasms, and the association of these two neoplasms has never been reported in the literature. In the present article we report the case of a man who developed carcinoid of the lung three years after being operated for leiomyosarcoma of the small intestine. The short time elapsed between the two diagnoses adds further interest to this case.

Bronchial Neoplasms↗