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Biomedical subjects

P J Malè

Publications and source records attributed to P J Malè.

At least 19 recordsLinked to original sources
PubMed1986

[Choice and modalities of the treatment of biliary lithiasis].

Western life-style and an older population make gallstones, "silent" or otherwise, a commoner problem than in the past. Whilst symptomatic gallstones should be treated surgically, "silent" gallstones usually remain that way and do not require prophylactic cholecystectomy. However, if common bile duct stones have been demonstrated or only suspected, surgery is the treatment of choice even in the absence of symptoms. Surgical mortality is very low at less than 1% for cholecystectomy and bile duct exploration. These figures apply to a population of whom half are over 70 years of age. Chemical dissolution of cholesterol gallstones is only of use in a small minority of patients, notably those at high surgical risk or who refuse surgery. Endoscopic sphincterotomy is useful as primary treatment in cases of cholangitis and gallstone-associated pancreatitis, and often allows removal of bile duct stones in inoperable patients.

Age Factors↗
PubMed1986

Effects of single daily doses of a pyridil-2-tetrahydrothiophene derivative (40749 RP) on 24 hour H+ activity, nocturnal acid output, gastrin and pepsinogen I profiles in duodenal ulcer patients.

40749 RP is a pyridil-2-tetrahydrothiophene derivative, belonging to a new class of gastric antisecretory drugs. We compared its effects on gastric secretion with cimetidine. Intragastric acidity, nocturnal acid output, gastrin and pepsinogen-I profiles were measured in patients with duodenal ulcer in clinical remission. A single dose of 100 mg 40749 RP reduced median 24 h gastric acidity as effectively as cimetidine 1000 mg given as four divided doses, 0.63 vs 1.6 mmol/l. Continued treatment with 40749 RP for 10 days reduced the median 24 h gastric acidity even further, to 0.006 mmol/l (p less than 0.001) and significantly increased fasting concentrations of gastrin and pepsinogen-I (p = 0.02). The incremental gastrin secretion to a standard meal was significantly increased after 10 days treatment with 40749 RP when compared with the first day of 40749 RP, or with cimetidine. These results show that 40749 RP exerts a powerful inhibitory effect on gastric acid secretion after a single 100 mg dose, and that this inhibitory effect increases with continued administration.

Adult↗
PubMed1985

Mephenytoin hydroxylation polymorphism: characterization of the enzymatic deficiency in liver microsomes of poor metabolizers phenotyped in vivo.

The rate of 4-hydroxylation and of N-demethylation of S- and R-mephenytoin was determined in liver microsomes of 13 extensive (EM) and two poor (PM) metabolizers of mephenytoin. Detailed kinetic studies were performed in microsomes of eight EMs and the two PMs. Microsomal mephenytoin metabolism in PMs was characterized by an increased Km (150.6 and 180.6 vs. a mean [+/- SD] 37.8 +/- 9.6 mumol/L S-mephenytoin in 8 EMs), a decreased maximum rate of metabolism for S-mephenytoin hydroxylation (0.76 and 0.69 vs 4.85 +/- 1.65 nmol 4-hydroxymephenytoin per milligram protein per hour), and loss of stereoselectivity for the hydroxylation of the R- and S-enantiomers of mephenytoin (R/S ratio: 1.10 and 0.76 vs. 0.11 +/- 0.04 in 13 EMs). The formation of 4-OH-mephenytoin from R-mephenytoin and the demethylation reaction remained unaffected. These results support our hypothesis that the mephenytoin polymorphism is caused by a partial or complete absence or inactivity of a cytochrome P-450 isozyme with high affinity for S-mephenytoin.

Adult↗
PubMed1984

Azathioprine-associated acute pancreatitis in the course of chronic active hepatitis.

We have described a 22-year-old man with an HBsAg-positive chronic active hepatitis who developed an attack of pancreatitis during the course of treatment with prednisone and azathioprine. Clinical and biochemical abnormalities subsided when azathioprine was stopped and reappeared after rechallenge with the drug. Azathioprine-associated acute pancreatitis is well recognized mostly during treatment of Crohn's disease and after renal transplantation. This adverse effect should, therefore, also be kept in mind during the treatment of chronic active hepatitis.

Acute Disease↗
PubMed1984

The effects of biliary obstruction on excretion of cefoperazone in the rat.

A study has been carried out on the influence of biliary obstruction on the elimination of cefoperazone (CPZ), an antibiotic mainly excreted in the bile. Rats were submitted to ligature of the common bile duct, given CPZ 100 mg/kg i.m., and killed 1 to 72 h afterwards. At death, measurements were made of CPZ concentrations in the serum, liver, lung, striated muscle, kidney, urine, intestinal wall and intestinal contents. The results were compared with those found in intact and in sham operated rats. Biliary obstruction led to a prolongation of the time taken for CPZ to disappear from the serum and markedly changed the way in which the drug was excreted. The amount of the drug excreted in the urine was 88% in the presence of biliary obstruction compared with 6% in intact rats and 14% in sham operated rats. The amount of CPZ in the small intestine 1 h after injection was very high in sham operated rats but only minimal amounts were found at this time in the presence of biliary obstruction. However, from 6 h after the injection, large amounts of CPZ were found in the intestinal contents despite the presence of biliary obstruction. In conclusion, in the presence of biliary obstruction, CPZ is eliminated by a combination of urinary and intestinal (non-biliary) excretion.

Animals↗
PubMed1983

[Effect of various types of liver diseases on the behavior of cefoperazone].

Cefoperazone is a third generation cephalosporin mainly excreted by the biliary route. Hepatic dysfunction may have a pronounced effect on its pharmacokinetic behaviour. Sixty liver patients (acute viral hepatitis, alcoholic fatty liver and liver cirrhosis), without overt renal disease, have been studied and compared to controls. In liver disease the total clearance of cefoperazone is markedly decreased by reduction of extrarenal clearance, which is variable for each type of liver injury. Renal clearance does not change or may even increase, when hypoalbuminemia is present and compensates the reduction in extrarenal clearance.

Adult↗
PubMed1983

[Continuous electrocardiography monitoring during esophago-gastro-duodenoscopy].

Continuous ECG recording has been carried out during oesophagogastroduodenoscopy without premedication in 44 unselected patients. 8 of whom had cardiac diseases. Thirty-six had sinus tachycardia. Supraventricular and ventricular ectopic beats occurred in 11 patients, 5 of whom had cardiopathy. Two patients without known cardiac disease or rhythm disturbance developed a transient attack of paroxysmal atrial fibrillation. In both cases the fibrillation occurred against the background of a slow basal sinus rhythm which was considered to be the result of vagal stimulation. All arrhythmias were transient and symptom-free, but their occurrence poses problem of the indication for premedication before upper gastrointestinal endoscopy.

Adolescent↗
PubMed1983

Pseudotumoral enterocolitis and massive eosinophilia.

We report a seven year history of a 23 year old woman born in the Antilles, with pseudotumoral enterocolitis and massive eosinophilia. In 1973 she developed a haemorrhagic colitis with massive peripheral eosinophilia of up to 60000/mm3. Medical treatment, mainly corticosteroids, failed to control the disease. The patient temporarily improved after colectomy and remained in remission for two years. In 1978 the disease recurred in the rectum and small intestine with formation of tumour-like granulomata and massive infiltration by eosinophils, unresponsive to corticosteroids. Intestinal blood and protein loss continued until death seven years after onset. In spite of exhaustive investigation, no parasites, allergens, or other aetiological agents could be found. As only the gut was infiltrated, the hypereosinophilic syndrome could be excluded. The enterocolitis here described does not correspond to an eosinophilic gastroenteritis, nor to other known inflammatory bowel diseases and to our knowledge has not been reported previously.

Adult↗
PubMed1978

[Isolated ulcer of the small intestine. Abnormal structures in the intestinal wall].

Four years after abdominal trauma, an intestinal loop was resected in a 19-year-old male due to persistent abdominal pain, rectal bleeding, and the suspicion of tumor. A typical ischemic ulcer was found. The resected loop showed, moreover, two peculiar histological features which, to the best of our knowledge, have not been described in the literature: 1. smooth muscle sleeves surrounding intraparietal arteries; 2. entero-mesenteric smooth muscle bands. It is suggested that these muscular structures could, when contracted, provoke arterial stenoses and contribute to the formation of the ulcer.

Adult↗