Fecal chymotrypsin assay during H2-blocker treatment.
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Adult↗
Biomedical subjects
M Soresi
Publications and source records attributed to M Soresi.
[Evaluation of the effectiveness of cisapride in the treatment of gastroesophageal reflux].
To evaluate the effectiveness of administration of oral cisapride in patients with gastro-esophageal reflux, we studied 25 children, aged 1 month-7 years (mean 16.2 months) affected with GER. At the time of diagnosis and 8 weeks after treatment, patients were clinically evaluated and underwent a 24-hour continuous esophageal pH-monitoring. After treatment a complete regression of symptoms was observed in 20/25 patients. Moreover we recorded a significant reduction in the percentage of reflux time (p < 0.0001) and in the Jolley score (p < 0.0001), a very accurate scoring system to evaluate the pH-metric tracing, after treatment. It is concluded that cisapride is a useful agent both for the relief of symptoms and for the improvement of pH-metric parameters in children with GER disease.
Child↗
Serum trypsin in chronic renal failure and transplant patients.
The frequency and degree of elevated serum levels of trypsin (T) and correlation with other pancreatic enzymes were determined in several groups of patients with renal disease, i.e., patients with chronic renal failure (CRF), hemodialysis patients (HD), renal transplant recipients (RT), and in a control (C) group. Mean values of T were significantly higher in all other groups than in the C group (p less than 0.0001). A statistically significant correlation between T and creatininemia levels was found only for the RT group (p less than 0.0001). Correlations between T versus pancreatic amylase and T versus lipase activity were found to be statistically significant in the CRF and RT groups (p less than 0.01), but not in the HD group. Most patients in all groups had T values higher than the maximum value observed in the controls and, of them, most had very elevated values. The results suggest that in chronic renal pathology there are frequent and significant increases in serum T levels, circulating in parallel with the other pancreatic enzymes. It is possible that, together with the renal excretion impairment, there could also be subclinical pancreatic damage or a dysfunction of the other means of elimination of T that can be responsible for, or contribute to, the serum increase in the enzyme.
Adult↗
Glycated proteins in elderly type II diabetic patients: role of age and serum protein concentration.
In an attempt to evaluate the clinical significance of fructosamine (F) and glycated haemoglobin (HbA1c) values in elderly diabetic patients, 49 patients with mean age 72.0 years and 58 patients with mean age 51.6 years (control group) were studied. No difference was found in F and HbA1c between the two groups, when the degree and duration of glycaemic failure was equal. However, on extrapolating from the two groups those patients with total protein less than or equal to 6.0 g/dl, it was observed that these subjects had F values significantly lower than the other patients studied (p less than 0.001) although there was no difference in the degree and duration of metabolic failure. It was concluded that F and HbA1c can also be used in elderly patients providing they are normoproteinaemic. In the case of hypoproteinaemics, the F values are underestimated and do not correlate with the other indices of glycaemic control.
Age Factors↗
[Prevalence of biliary lithiasis in chronic liver disease].
The prevalence of cholelithiasis was determined by ultrasound in 168 patients affected by chronic liver disease and compared to 828 subjects of the general population. We found an increase of cholelithiasis in chronic liver patients (p less than 0.004). This difference persisted separating the subjects in males (p less than 0.003) but not in females (p less than 0.08). Examined by age groups, patients demonstrated, like in the control group, an increase of frequency with the increase in age. We did not find any association with BMI, cholesterolemia, triglyceridemia, albuminemia and gammaglobulinemia levels. A significant association was found in the total (p less than 0.003) and indirect (p less than 0.0001) bilirubinemia. Finally, there was no significant association with the etiology of the liver disease. Even though there was a greater association with alcoholic and cryptogenetic liver disease.
Age Factors↗
Chronic pancreatitis in Sicily. Preliminary reports.
The aetiology and clinical characteristics of 42 patients affected with chronic calcifying pancreatitis in a Sicilian population were investigated and compared with a series of other Italian and foreign reports. It was found that the aetiology was 62% alcoholics and 38% idiopathic in origin and that the M/F ratio was 2.5:1. Clinical features as pain, weight loss, pancreatic calcifications, steatorrhea, pseudocysts and associated cirrhosis are significantly more frequent in the group of alcoholics, while cholelithiasis was more frequent in the non-alcoholic group. Two aspects are worth noting in comparison to the north of Italy: a) the lesser frequency of alcoholic forms and b) the high incidence of women.
Adult↗
[Serum PABA test in diabetes mellitus].
The serum values of para-amino-benzoic acid in subjects affected by type II diabetes mellitus, were measured hourly for 6 hours, after oral ingestion of B-T-PABA. These values were compared with those of a control group. The results demonstrate that at 1, 2, 4 and 5 hours, the mean values of the two groups were significantly different: p less than 0.01, p less than 0.002, p less than 0.0001 and p less than 0.005 respectively. Comparing the area under the curve the data did not differ significantly, indicating that at the end of the sixth hours the quantity of PABA absorbed is very similar in the two groups. These results indicate that patients with diabetes seem to have an altered exocrine pancreatic function, which may be due to a reduction in the zymogen stocked in the acinar cells or a lower secretory response to physiological stimulus. This impairment does not affect the digestion and the nutritional state of the patients.
4-Aminobenzoic Acid↗
Prevalence of diabetes mellitus and impaired glucose tolerance in cystic fibrosis.
The aim of this study was to evaluate the prevalence of impaired glucose tolerance or diabetes mellitus in 99 patients (53 M, 46 F; mean age 10.5 +/- 6.9 years), with cystic fibrosis. Glucose tolerance was evaluated in all patients without overt diabetes using the oral glucose tolerance test (OGTT). Six patients showed a pathological OGTT and 2 patients had insulin-requiring diabetes mellitus. The mean age of the patients with impaired glucose tolerance was significantly higher than that of the subjects with normal glucose metabolism (p less than 0.0001). Patients with overt diabetes mellitus were the oldest subjects in the study group.
Adolescent↗
Diagnostic use of fructosamine assay in the control of type II diabetes mellitus.
In an attempt to evaluate the usefulness of fructosamine assay in monitoring type II diabetes, 142 diabetic patients were investigated. Fructosamine values were found to be higher in patients on insulin treatment than on oral hypoglycemic agents. In order to evaluate the metabolic control by using the correlated variations of F, Gm and HbA1c, the patients were subdivided into many control classes: mean values of fructosamine were higher in poorly controlled patients. Fructosamine however correlated better with glycemia in patients with recent variations in metabolic state than HbA1c. It was concluded that fructosamine is a good index for short-term metabolic control, and if used in an integrated fashion with glycemia and HbA1c, can provide further information on the metabolic state of diabetes.
Adult↗
Comparison of BT-PABA test and fecal chymotrypsin measurements in normal subjects and diabetic patients.
A N-benzoil-L-tyrosil-PABA test on 6h urine collection, a plasma PABA assay 2 h after administration and a fecal chymotrypsin assay were performed on 66 patients (36 controls and 30 type 2 diabetic patients on insulin therapy). All patients were hospitalized and without gastrointestinal and renal disease. The mean values of plasmatic PABA and fecal chymotrypsin were significantly lower in the diabetic group than in the controls (p less than 0.025 and p less than 0.01, respectively), although they remained within normal range. But this was not the case for PABA urinary excretion values. This may indicate a slower but more protracted PABA absorption during the third or fourth hour with the result that urinary excretion over 6h is not greatly affected. There was good correlation between fecal chymotrypsin values and both PABA urinary excretion values and serum PABA values, a trend observed both in diabetics (p less than 0.005 and p less than 0.001, respectively) and in controls (p less than 0.001 and p less than 0.005, respectively). This could indicate that even at lower mean levels, the diabetic patients show the same behavior pattern and therefore maintain the same indexes of correlation as the control population. Our results suggest that these indirect, but simple, economical and well-tolerated tests could be considered a valid alternative for investigating pancreatic function especially in those patients that cannot be tested by a Secretin-Cerulein test.
4-Aminobenzoic Acid↗
Prospective study on thyroid autoimmunity and dysfunction related to chronic hepatitis C and interferon therapy.
This study was designed to assess patients with chronic hepatitis C (CHC) for the presence of thyroid autoimmunity and dysfunction, to evaluate the risk of thyroid disorders associated with interferon (IFN) therapy, and to survey the outcome of possible treatment-related thyroid injury. Out of 104 consecutive untreated patients (30 women and 74 men; mean age, 52.7 years), 8 (7.7%) were found seropositive for thyroid autoantibodies (ThyAb), whereas seropositivity in healthy controls was 1/98 (1.3%). The relative increase in risk of developing thyroid autoimmunity associated with CHC was 760% (95% CI, 220-1300%). No patients had abnormalities of thyroid function tests, but on IFN treatment, 3/3 patients showed a rapid over-range rise in circulating thyrotropin, which returned to normal after therapy discontinuation. In the other 5 seropositive patients who refused treatment, thyroid function remained normal. Out of the 58 initially seronegative patients who consented to IFN treatment, 9 (15.5%) developed thyroid autoimmunity. Seven of them (77.7%) had thyroid dysfunction: hypothyroidism in 4 cases, transient thyrotoxicosis in 2 cases. The last patient developed TSH-receptor antibodies and Graves' disease, requiring methimazole therapy. Thyroid function recovered in the former 6 cases following IFN discontinuation. In the 28 initially seronegative patients who refused IFN and participated in a preliminary tauroursodeoxycholic acid trial, antithyroglobulin antibodies alone appeared in one case, but no thyroid dysfunction was observed. The relative risk of thyroid autoimmune disorder associated with IFN therapy was 342% (28-636%). The patients with CHC were unlikely to develop thyroid dysfunction in the absence of IFN therapy, in spite of being ThyAb seropositive. Moreover, a considerable proportion of seronegative patients, when IFN-treated, developed thyroid autoimmunity and then thyroid dysfunction. Both in seropositive and seronegative patients immediate IFN discontinuation normalized thyroid function and hormone replacement therapy was not necessary.
Adult↗
Hemodynamic changes in splanchnic circulation after orthotopic liver transplantation in patients with liver cirrhosis.
BACKGROUND: Liver cirrhosis increases portal vein pressure and alters the splanchnic circulation. With Doppler sonography, we investigated the hemodynamic changes in the portal vein, superior mesenteric artery, hepatic and splenic arteries and spleen size in a group of patients with end-stage liver disease before and after orthotopic liver transplantation (OLT). METHODS: Ten patients (seven male, three female; mean age = 48.8 +/- 7.6 years) who underwent OLT for liver cirrhosis mainly associated with hepatitis C virus infection completed the study. The control group consisted of 10 patients matched by sex and age who had no gastroenterologic or vascular diseases. All patients underwent duplex Doppler sonography (Toshiba SSA 270A with a 3.5-MHz probe) after 24 h of fasting (baseline) and then 6 and 12 months after OLT. The following parameters, expressed as the mean of three measurements, were evaluated: portal flow velocity (PFV), pulsatility index of the superior mesenteric artery (MAPI), resistance indexes of the hepatic (HARI) and splenic (SARI) arteries, and longitudinal diameter of the spleen (LDS). RESULTS: PFV in the pre-OLT phase was significantly lower in the patients than in the controls ( p < 0.0001); it progressively and significantly increased over baseline levels at 6 and 12 months ( p < 0.0001), approaching control values. LDS in the pre-OLT phase was significantly higher than in controls ( p < 0.0001); after OLT, it decreased significantly compared with baseline values ( p < 0.005). The MAPI of patients in the pre-OLT phase was lower than that in controls ( p < 0.0001); post-OLT, it progressively increased and reached values that were significantly above baseline at 12 months ( p < 0.005). In the pre-OLT phase, the HARI and SARI were significantly higher than in controls ( p < 0.04); 6 and 12 months after OLT, those values were significantly below baseline values ( p < 0.001), and there was no significant difference from control values. CONCLUSION: These data show that many of the hemodynamic parameters typical of decompensated cirrhosis improve progressively within 12 months after transplantation.
Blood Flow Velocity↗
Evidence of transient IgA anti-endomysial antibody positivity in a patient with Graves' disease.
BACKGROUND: Anti-endomysial antibodies (EmA) have been shown to have a high specificity and sensitivity in celiac disease (CD) diagnosis, and their use is considered effective in improving the diagnostic accuracy of CD screening. AIMS: To report the clinical details of transient IgA EmA positivity in a patient with Graves' disease. METHODS: We screened 48 patients (7 males, age range 19-79, median 58.3 years) for CD. They were hospitalized for thyroid disorders (30 patients had autoimmune hypothyroidism and 18 had Graves' disease with clinical hyperthyroidism associated with diffuse goitre). CD screening was carried out on all patients by assaying serum anti-gliadin antibodies (AGA) and EmA. RESULTS: None of the 48 patients in our study were positive for IgA and/or IgG-class AGA and none showed IgA deficiency. Only 1 patient was positive for EmA; however, intestinal biopsy in this subject was normal both when thyroiditis was first diagnosed and subsequently after 2 and 3 years. Furthermore, EmA became negative after 2 years. New gastroenterological investigations performed 3 years after the diagnosis confirmed the normal intestinal histology and absorption capacity. Moreover, AGA, EmA and tissue transglutaminase antibodies were negative. CONCLUSIONS: This study underlines the possibility of transient EmA positivity without any signs of CD in patients with autoimmune thyroid disorders.
Aged↗
Clinical evaluation of pancreatitis-associated protein as a serum marker of hepatocellular carcinoma: comparison with alpha-fetoprotein.
This study evaluated the significance of serum pancreatitis-associated protein (PAP) assay, as a marker of hepatocellular carcinoma (HCC), in comparison and combined with alpha-fetoprotein (AFP) assay. Sixty-five patients with HCC, 59 with liver cirrhosis (LC) and 68 asymptomatic controls (C) were studied. PAP and AFP values significantly increased from C to LC and HCC group (p < 0.0001). The area under receiver-operating characteristic (ROC) curve for the two markers was not statistically different. At 100% specificity, ROC analysis gave a cut-off level for AFP of 166 IU/l with 40% sensitivity, and a cut-off level of 240 microg/l for PAP with 23% sensitivity. Diagnostic accuracy of combined AFP and PAP assay was significantly higher than AFP alone. Sensitivity according to tumor size also improved using the combined assay, especially for tumors <5 cm. Stepwise logistic regression indicated that AFP, but not PAP, was associated with an increased risk of developing HCC. These data confirm that PAP production is increased only in some cases of HCC and that the combined PAP and AFP assays do not significantly improve specificity over AFP assay alone. Consequently, PAP assay can only be recommended in cases of justified suspicion of HCC with negative AFP.
Acute-Phase Proteins↗
Lysosomal cathepsins B and L and Stefin A blood levels in patients with hepatocellular carcinoma and/or liver cirrhosis: potential clinical implications.
The serum levels of lysosomal cathepsin B and L and Stefin A, an intracellular inhibitor of these proteolytic enzymes, were determined in patients with hepatocellular carcinoma (HCC) and/or liver cirrhosis (LC) and correlated with some clinical and biochemical parameters of these diseases. Cathepsin B serum levels were increased in HCC and in LC patients as compared to normal subjects (p < 0.001). However no difference was observed between HCC and LC groups. Interestingly, a significant relationship was evidenced between cathepsin B serum content and the grade of severity of cirrhosis (r = 0.41; p < 0.001). Cathepsin L was significantly elevated only in sera of cancer patients as compared to normal subjects or LC patients (p < 0.001) and significantly correlated with the number of malignant lesions (r = 0.49; p = 0.001). Stefin A serum levels were increased in HCC and LC patients as compared to healthy subjects (p < 0.02). However, these levels were significantly higher in the LC group as compared to the HCC group (p < 0.05). In cancer patients, a significant relationship was observed between Stefin A serum content and tumor size (r = 0.35; p < 0.05), number of neoplastic lesions (r = 0.556; p < 0.001) and serum alpha-fetoprotein (r = 0.38; p < 0.01). These data suggest that cathepsin B and L and Stefin A may be potentially useful as additional biochemical parameters to monitor the therapeutic response of these diseases to clinical treatments and to identify patients with cirrhosis developing precancerous lesions.
Adult↗
[Clinical and etiologic features of hepatocarcinoma in Sicily].
Hepatocellular carcinoma is a neoplasia with a high degree of malignancy and a quite unfavorable prognosis, and its frequency has tripled over the last 30 years. The aim of this study was to shed further light on some epidemiological and clinical aspects of hepatocellular carcinoma, on the basis of experience with a wide ranging patient population. We included 179 patients (127 males, 52 females, age range 31-86 years), diagnosed with hepatocellular carcinoma between January 1993 and December 1998. For each patient we recorded age, sex, coexistence and cause of cirrhosis, severity of cirrhosis, stage of hepatocellular carcinoma, serum markers of viral hepatitis (hepatitis B surface antigen and hepatitis C virus antibodies) and serum levels of alpha-fetoprotein. Hepatocellular carcinoma was associated with hepatitis C virus in 72% of patients, with hepatitis B virus in 10%, with combined infection in 3% and with negative viral markers in 15%. Mean age at diagnosis was significantly higher in the hepatitis C virus infection patients than in the combined infection patients (p < 0.04); the male/female ratio was 2.1:1 in the hepatitis C virus and 8:1 in the hepatitis B virus subjects. At hepatocellular carcinoma diagnosis, 175 out of 179 patients had liver cirrhosis with a significantly higher severity in patients with negative viral markers than in those with positive viral markers (p < 0.02). The stage of hepatocellular carcinoma at diagnosis was very advanced: in 103 out of 179 cases (58%) neoplasia was stage IV, with a stage I diagnosis in only 14 out of 179 (8%) cases. All the combined (hepatitis B and C virus) cases were diagnosed at stage IV, while hepatocellular carcinoma cases in patients with negative viral markers were diagnosed at earlier stages (66% stages I-II). Serum alpha-fetoprotein levels were above the normal limit (20 ng/mL) in 72% of patients; however, only 30% (54/179) had alpha-fetoprotein values > 400 ng/mL. These data confirm some previous epidemiological and clinical evidence concerning hepatocellular carcinoma (mean age at diagnosis, male/female ratio, severity of pre-existing liver disease, frequency of an associated hepatitis C and/or hepatitis B virus infection). Data based on such a large population, moreover, aid clarification of some still unresolved points such as the utilization of alpha-fetoprotein values in diagnosing hepatocellular carcinoma.
Adult↗
[Fecal chymotrypsin and steatorrhea in chronic pancreatitis].
The aim of the present study was to evaluate in 56 patients (48 M, 8 F) with chronic pancreatitis: a) the diagnostic validity of fecal chymotrypsin (FCT) assay, performed both on random samples and from previously homogenized samples collected over 3 days; b) the correlation between chymotrypsin and fecal fat excretion. CTF was measured using Kaspar's colorimetric method and fecal fats using the Van de Kamer method. Mean values of chymotrypsin measured on random samples were very similar to those measured on previously homogenized feces, 17.9 +/- 16.7 U/g vs 17.1 +/- 15.3 U/g respectively. There was a highly significant correlation between these values (r = 0.77 p less than 0.0003) and a highly significant inverse correlation between fecal fat and chymotrypsin excretion, both when the latter was measured on random and on previously homogenized samples (p less than 0.0001). FCT assay was fairly good sensitive (54%) for the whole group of patients with chronic pancreatitis, but very good (91%) for the group of patients with steatorrhea. The results show that the fecal chymotrypsin assay on random fecal samples is as valid as that carried out on homogenized feces and that there is a good correlation between fecal chymotrypsin values and steatorrhea of pancreatic origin.
Adult↗
[Serum pancreatic enzymes and fecal chymotrypsin before and after glyco-metabolic control in diabetic patients].
The aim of the present study was to ascertain whether secretory capacity of the pancreas, evaluated by assaying serum total amylase (TA) and pancreatic amylase activity (PA) and fecal chymotrypsin excretion (FCT), is impaired in diabetic and to what extent it is influenced by the degree of glyco-metabolic control. TA, PA and FCT were assayed in 40 patients affected with type II diabetes mellitus in secondary insufficiency, both at hospitalization and after metabolic control assessment; 43 hospitalized patients constituted the control group. A statistically significant difference was found between the metabolic failure phase values of diabetics patients and those of the control group for TA (p less than 0.0005), PA (p less than 0.025) and FCT (p less than 0.0005); between metabolic control phase values and control group fo TA (p less than 0.0005), and FCT (p less than 0.005) but not for PA values. PA values were statistically significant, within diabetic group, before and after metabolic control assessment. A statistically significant result was obtained by correlating C-peptide and FCT values (p less than 0.01), C-peptide and PA values (p less than 0.001); glycaemia and PA values (p less than 0.05). Our data suggest that in diabetic patients there is an impairment in secretory capacity of the pancreas and that the the PA is the more sensitive enzyme to the local levels of insulin.
Amylases↗