Biomedical subjects
Publications and source records attributed to N Scopinaro.
When paired data are considered and unpaired results are compared with controls, it appears that no significant changes of gastric histomorphology occur following biliopancreatic diversion.
Biliopancreatic diversion is a very effective method for weight reduction. In some instances it is too effective and needs to be revised.
Urine and stool total nitrogen was measured using the Carlo Erba Strumentazione NA 1500 nitrogen analyzer. Determinations were carried out on 10 mcl, 20 mcl and 50 mcl urine samples and on 20-50 mg stool samples. Both urine and stool data distributions were normal, thus indicating the reliability of the method. The NA and the classic Kjeldahl method gave very close results in the same urine specimen; slight and not significant differences were found in stool analysis, most likely caused by the poor homogeneity of the material. Due to the automation, they very short analysis time, the accuracy and the reproducibility of the results, NA 1500 can be used in clinical practice for nitrogen balance studies by direct measurement of losses.
The degree of hepatic steatosis and percentage total nitrogen content were evaluated simultaneously in a group of obese patients and after bypass surgery for obesity. The straight line relationship between sample weight and gas chromatographic response integrals shows that samples had the same water content. The higher concentration of total nitrogen in patients with higher levels of steatosis and the inverse correlation between degree of adipose infiltration and degree of total nitrogen, when water content is the same, suggest that the total liver parenchyma nitrogen concentration closely reflects the structural protein content.
Morphologic and functional adaptations of the functioning intestine were evaluated in 41 patients before and after biliopancreatic bypass for morbid obesity. This surgical procedure diverts pancreatobiliary secretions via the duodenum and the jejunum into the colon, the remaining small intestine being anastomosed to the stomach after antrectomy. In the proximal ileum there was an 80% increase of the height of villi; the specific activities of maltase, sucrase, and aminopeptidase in brush border membranes remained unaffected, and that of lactase tended to decrease. In the distal ileum villi heights increased only by 58%, and disaccharidase activities (except for maltase) were slightly enhanced. In the colon the mucosa displayed, in some patients, focal appearance of true villi, and brush border enzyme activities increased concomitantly. We conclude that biliopancreatic bypass induces an adaptation of all intestinal segments of the functioning intestine; this adaptation tends to compensate for the shortening of the gut continuity.
The body composition of 12 obese patients was assessed. The dilution method was used to assess the total areas of sodium and water. Total potassium was measured indirectly using the following formula: total potassium = R X total body water-total body sodium, where R represents the contents in a whole blood sample. Both fat and muscle mass were found to be increased in the obese subjects. Examination of the total sodium/total water ratio and the relationship between weight and muscle mass, cellular mass and total fat showed the dimensional increase was harmonious.
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Cell mediated immunity was evaluated in vivo by means of the Multitest system in subjects at least one year after biliopancreatic bypass. Quantitative delayed hypersensitivity values were not significantly different between control, obese and partial biliopancreatic bypass subjects, while they were significantly (P less than 0.001) reduced in subjects who had total biliopancreatic bypass. The results demonstrate that cell-mediated immunity is not affected by partial biliopancreatic bypass, but that on the contrary, a severe immunosuppression follows total biliopancreatic bypass. A positive correlation between serum albumin concentration and Multitest score was found in all the operated patients.
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The Multitest System, a new standardized method for evaluating delayed hypersensitivity and cell mediated immunity was carried out before surgery and throughout the postoperative care in subjects undergoing gastrointestinal surgery. In all patients significantly depressed cutaneous reactions were found in the first day after operation. Immunosuppression lasted more than four days when postoperative infection has set up, while in uneventful patients delayed hypersensitivity has returned to preoperative values from the fourth day. It would be suggested that Multitest System data in fourth postoperative day could identify subjects with uneventful recovery after surgery.
Bone histomorphometry and vitamin D status were investigated in 41 patients studied 1-5 yr after partial or total biliopancreatic bypass. Metabolic bone disease, characterized by defective mineralization, decreased bone formation rate, and increased surface extent of resorption, was present in 30 patients (73%). Nine patients (22%) were hypocalcemic, but serum 25-hydroxyvitamin D concentrations were normal in all 41 patients. We conclude that metabolic bone disease is common after biliopancreatic bypass and usually occurs in the absence of simple vitamin D deficiency. The pathogenesis of the bone disease is unclear.
Delayed hypersensitivity was evaluated by means of Multitest System in 50 healthy Italian adults. Results were checked for homogeneity, comparability and reliability assays. Strict antigen and technique standardization warranted closely homogeneous results. Booster effect did not occur. Data evaluation was not depending on individual reader. Multitest System appears to be the most reliable method to evaluate delayed hypersensitivity and cellular immunity in man.
Pancreatic secretions have been shown to be important in zinc absorption in experimental animals. Recently, complete surgical diversion of biliary and pancreatic secretions from the functioning small intestine has been utilized in Europe to treat morbid obesity. To determine the importance of pancreatic secretions in zinc absorption in the human, we measured hair and serum zinc levels in 14 patients having undergone complete biliopancreatic bypass 12-56 months earlier and compared these values with those obtained from 11 patients subjected to only partial biliopancreatic bypass as well as to six morbidly obese controls. No differences were observed in either hair or serum zinc levels between any of these groups of patients. Pancreatic secretions do not appear to be necessary for adequate zinc absorption in humans.
On 100 patients undergoing gastrointestinal surgery, relationships between preoperative Multitest findings of delayed hypersensitivity and postoperative infectious complications were investigated. Multitest preoperative quantitative data, due to its strict antigen potency and standardization of technique, have shown to be reliable in excluding postoperative infections and they are also a good indicator in predicting them.
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Serum cholic and chenodeoxycholic acid conjugates were measured in fasting conditions and after meals in 14 patients with bile acid malabsorption due to ileal resection. Mean serum fasting levels of both primary bile acids did not differ from the controls. After meals, serum cholic acid peaks were lower in patients with ileal resection than in control subjects (p less than 0.001), while chenodeoxycholic acid peaks were reduced in colectomised patients (p less than 0.01). In the sera from patients with ileal resection, the glycine/glycine + taurine ratio for cholic and chenodeoxycholic acid increased (p less than 0.001) from morning to evening, and glycine/glycine + taurine ratio for chenodeoxycholic acid was significantly (p less than 0.01) different from the controls in the sera collected in the evening. The results are consistent with the concept of a better intestinal conservation of chenyl, mainly of the glycine conjugated from, than of cholylconjugates, in patients with ileal resection; this is probably because of passive absorption in the intestine. The postprandial peaks of serum cholic acid conjugates may therefore be regarded as a test of ileal dysfunction, while peaks of chenodeoxycholic acid conjugates suggest colonic impairment.
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