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Biomedical subjects

V Speranza

Publications and source records attributed to V Speranza.

At least 37 records · Page 2Linked to original sources
PubMed1992

Serum neuron-specific enolase in diagnosis and follow-up of gastrointestinal neuroendocrine tumors.

Neuron-specific enolase (NSE), the glycolytic isoenzyme of the enolase gamma-gamma dimer, is a specific marker for the diffuse neuroendocrine system and derivative tumors (NET). Serum levels of NSE were measured in 39 patients with NET of the gastrointestinal tract (including 3 gastric and 13 intestinal carcinoid tumors, 6 gastrinomas, 3 insulinomas, 1 glucagonoma, 2 mixed islet cell tumors, 11 neuroendocrine pancreatic carcinomas), in 15 healthy subjects and in 15 nonendocrine gastric, pancreatic, and intestinal tumors. Thirty-six of the 39 patients had elevated circulating levels of NSE, 2 insulinomas and 1 gastrinoma had values below 12 ng/ml like healthy subjects and nonendocrine tumors. No significant difference of serum NSE was found between 23 'functioning' and 16 'nonfunctioning' NET. Fourteen of the NET were malignant, and NSE circulating values were significantly higher than those of nonmalignant forms. After curative surgery serum NSE decreased significantly. NSE can be considered a reliable marker in the differential diagnosis between endocrine and nonendocrine neoplasms, in the clinical detection of silent endocrine tumors and in the follow-up of NET.

Adolescent↗
PubMed1990

Early complications after surgery for Crohn's disease.

A group of 212 patients operated upon for Crohn's disease were studied and the early postoperative complications with related problems were assessed. The morbidity was 28.3 per cent, 60 patients had at least one complication, mainly of septic nature. The mortality was 3.3 per cent (7 patients), sepsis and deep vein thrombosis with pulmonary embolism were the most common causes of death. Postoperative complications were significantly higher (39.7%) (p less than 0.001) in patients with a pre-operative nutritional deficit and in those who had urgent surgery (44.4%) (p less than 0.001). Among patients with pre-operative sepsis, the morbidity was also higher (34.6%), but was not significant. Peri-anastomotic complications (dehiscence, abscess, fistula, bleeding) were apparently more frequent (45.4%) in patients with histological residual Crohn's disease at macroscopically free resection margins although this contrasts with previous series. A proper pre-operative diagnostic approach, adequate peri-operative protein-caloric repletion, antibiotic therapy, prevention of thromboembolism and elective surgery, are still the primary tools in reducing the morbidity and mortality after surgery for Crohn's disease.

Adolescent↗
PubMed1989

Heterotopic gastric mucosa of the rectum--characterization of endocrine and mucin-producing cells by immunocytochemistry and lectin histochemistry. Report of a case.

Heterotopic gastric mucosa in the rectum is particularly uncommon; only 23 cases have been reported to date. Moreover, no studies have been done on the neuroendocrine apparatus and glycoprotein production of the heterotopic mucosa. This study reports on a 13-year-old boy, admitted with rectal bleeding and persistent tenesmus. An ulcerative lesion was found on colonoscopy; biopsies revealed a fundic-type gastric tissue. Medical therapy (H2-blockers) promptly healed the rectal ulcer; surgical excision of the heterotopia was performed with complete and permanent relief of symptoms (3-year follow-up). Immunocytochemistry (PAP) revealed 5-Ht and somatostatin cells in the gastric-type mucosa, as in the normal human stomach. These cells also were present in the surrounding rectal epithelium where PYY-enteroglucagon cells were detected, which were absent in the heterotopic tissue. Mucin histochemistry showed PAS-positive cells also strongly stained by LA lectin in the heterotopic tissue, differentiating the rectal epithelium that remained unstained. Therefore, the morphofunctional status (endocrine cells and mucins) of the gastric heterotopia was almost identical to its orthotopic counterpart, confirming the hypothesis that endocrine cells and mucin-producing cells differentiate their metabolic products according to the anatomic and functional activity of the epithelium where they grow.

Adolescent↗
PubMed1989

[Recurrence after intestinal resection for Crohn's disease].

Although recurrence is one of the major problems in the surgical management of a patient with Crohn disease, the factors that influence recurrence rate remain controversial. To elucidate some of this controversy, the records of a consecutive series of 100 patients, who underwent resectional surgery for Crohn's disease, were analyzed to evaluate the effect of several clinical and histologic features on the recurrence rate. In this study, recurrence was defined as clinical and or laboratory findings of re-emergent disease confirmed by objective means after resection of all lesions. Recurrence rate seems lower in colitis than ileitis or ileocolitis, but this data did not reach statistic significance; the site of recurrence was conditioned by the initial location of the disease and the extent of resection into healthy tissue above and below the lesions and the histological findings of section lines did not modify the risk of recurrence. In conclusion the recurrence is almost inevitable. The multifactorial aspect of the recurrence cannot be ignored, however some clinical factors were more closely related to the recurrence. A part from Crohn's colitis, type of surgery (radical vs limited resection) had little chance of minimizing the risk of recurrence.

Actuarial Analysis↗
PubMed1989

Small bowel angiodysplasia in association with Crohn's ileitis. A case report.

A case of a female patient affected by Crohn's ileitis associated with small bowel angiodysplasia is reported. Despite a good clinical and laboratory response to steroid therapy the patient showed an unexplained hypochromic microcytic anemia. At laparotomy Crohn's ileitis as well as an angiodysplastic lesion were found. Both lesions were resected in continuity. During a 2-year follow-up the patient did not show anemia despite pregnancy. It is suggested that the angiodysplastic lesion was the possible cause of hypochromic anemia and that the patient should have been operated on before, based on her recurrent anemia.

Adult↗
PubMed1989

[Pharmacokinetics of the biliary excretion of some chemotherapeutic agents in patients with biliary disease].

The authors have assessed the concentration of 7 antibiotics in the bile of patients undergoing biliary surgery or carriers of a T tube in the common bile duct. 1 hour preoperatively, 122 patients were administered with the following chemotherapeutic agents: Cefoxitin 2 g i.v.; Cefamandole 2 g i.v.; Ceftriaxone 1 g i.v.; Clindamycin 600 mg i.v.; Amikacin 500 mg i.v.; Gentamycin 160 mg i.v.; Norfloxacin 400 mg by mouth; 30 patients showed obstructive jaundice or obstructed cystic duct. Samples of bile were withdrawn from gallbladder and common bile duct. The same antibiotics were administered to 81 patients carrying a T tube. Samples of bile and serum were collected at baseline and every 30 minutes for 4 hours and subsequently at 12 and 24 hours following administration. 18 patients showed altered liver function tests. The chemotherapeutic agents were tested by the microbiological assay as well as by HPLC. Mean concentration in the gallbladder bile was: Cefoxitin 209 +/- 86 micrograms/ml; Cefamandole 436 +/- 108 micrograms/ml; Ceftriaxone 482.7 +/- 214.84 micrograms/ml; Clindamycin 64 +/- 22 micrograms/ml; Amikacin 5 +/- 1.4 micrograms/ml; Gentamycin 4 +/- 2 micrograms/ml; Norfloxacin 22 +/- 14 micrograms/ml. In the bile of jaundiced patients or with non-visualized gallbladder no antibiotics were detected.(ABSTRACT TRUNCATED AT 250 WORDS)

Anti-Bacterial Agents↗
PubMed1988

Neuroendocrine innervation of the hepatic vessels in the rat and in man.

An extensive array of nerve fibers ramify around the afferent blood vessels of the liver and the extrahepatic and intrahepatic biliary pathways, and are thought to be involved in regulation of blood flow. Although the role of sympathetic innervation is established, little is known about the location or role of regulatory peptidergic innervation in the liver. We examined the anatomic distribution of a wide variety of regulatory peptides and several neural antigens by in situ immunohistochemistry in the rat and in man. A rich peptidergic plexus of nerve fibers and ganglion cells was observed around the arterial vessels in both species, with intense immunoreactivity for neuron-specific enolase, neurofilaments, neuropeptide Y, substance P, and vasoactive intestinal polypeptide. S-100 protein immunoreactivity was seen principally in large nerve bundles, suggesting that the majority of nerves in this area were unmyelinated. In contrast, the portal vessels revealed very little peptidergic innervation. No staining was observed with antibodies directed against insulin, glucagon, gastrin, serotonin, met-enkephalin-Arg-Gly-Leu, cholecystokinin, or growth hormone. These findings indicate the presence of a rich, although selective, peptidergic plexus surrounding afferent hepatic blood vessels. This plexus may play an important role in regulation of hepatic blood flow.

Animals↗
PubMed1988

Manometric measurement of human sphincter of Oddi length.

Length of biliary (CBD) and/or pancreatic (PD) sphincter of Oddi (SO) was measured during perendoscopic or intraoperative manometry in 21 control subjects and in 46 patients with biliary disease. When the high resting pressure (HPZ) and the phasic wave zone (PAZ) were considered, SO length was, in the control group, 9.5 +/- 0.5 mm (M +/- SE) and 9.4 +/- 0.6 mm at the level of the CBD-SO, and 7.7 +/- 0.6 mm and 6.9 +/- 0.5 mm at the level of the PD-SO. The physiological sphincter length appeared substantially shorter than the anatomical one, as reported in the literature. No significant differences were found between controls and patients with CBD stones. Endoscopic sphincterotomy without manometry reduced mean sphincter length length of the sphincterotomy was tailored to the manometric findings. Surgical partial sphincterotomy reduced sphincter length by only 46.7 +/- 10.3%.

Adult↗
PubMed1988

Cefotetan versus cefoxitin in the treatment of patients with biliary sepsis assessed by a biliary sepsis score.

The authors carried out a study to assess the efficacy of an antibiotic treatment (cefotetan or cefoxitin) in 22 stratified patients with biliary sepsis, at low and high risk. The severity of sepsis was assessed by a biliary sepsis score (B.S.S.). No significant difference in results was observed between the two treatments in low-risk groups (cefotetan 80%, cefoxitin 75% satisfactory), while the difference between the high risk groups was significant (cefotetan 75%, cefoxitin 40% satisfactory). In the low risk group it can be stated that better nutritional and immunological status provide adequate host defences and that the antibiotic treatment is less important in determining surgical outcome. In high risk patients the efficacy of an antibiotic, cefotetan in this case, can significantly improve clinical results.

Aged↗
PubMed1988

Diagnostic and therapeutic problems of non perianal fistulas and abscesses in Crohn's disease.

Problems related to the appearance of non perianal fistulas and abscesses are examined in a series of 204 patients operated on for Crohn's disease. Incidence of these complications was 34.3% (70 cases); one or more fistulas were present in 54 patients, associated with abscesses in 13, while abscesses alone were present in 3. The highest incidence was observed in the male sex, in patients over 50 years, and in the presence of stenosing Crohn's lesions (P less than 0.001). On the contrary, the primary site of Crohn's disease does not seem to affect significantly their appearance. The clinical suspect of fistulas or abscesses should be supported with radiographic, endoscopic, echographic and scintiscan findings, even though about 7.2% of fistulas are diagnosed only intraoperatively. Surgical treatment is the most suitable therapeutic management; however enteroenteric and mesenteric fistulas are only relative indications for surgery. TPN is suitable for postoperative enteric fistulas (5 cases). Postoperative morbidity is not different in patients with or without such complications at surgery. Long-term prognosis of non perianal fistulas and abscesses is related only to recurrences of Crohn's disease and their anatomopathologic evolution.

Abscess↗