Papillary stenosis: fact or fiction?
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Ampulla of Vater↗
Biomedical subjects
V Speranza
Publications and source records attributed to V Speranza.
[Current status of the surgical therapy of peptic ulcer].
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Anti-Ulcer Agents↗
Raised plasma concentrations of platelet factor 4 (PF4) in Crohn's disease.
Plasma platelet factor 4 (PF4), secreted by the platelets, is an index of platelet aggregation and thromboembolic risk. The authors assessed PF4 in 20 patients with Crohn's disease (ileitis in 13 patients, ileocolitis in seven) and in 20 healthy volunteers. Disease activity was low (Crohn's Disease Activity Index less than 150) in 11 patients and high in nine. Radioimmunoassay of PF4 using Abbott's Kit was performed on one sample of plasma from each subject (nv less than or equal to 0.324 nmol/ml), (nv less than or equal to 10 ng/ml). A significantly higher concentration of PF4 was found in Crohn's disease patients: 4.625 +/- 1.1 nmol/ml (142.5 +/- 36 ng/ml) than in the control group: 0.189 +/- 0.07 nmol/ml (5.6 +/- 4.8 ng/ml) (Z = 5.396, p less than 0.0001). No correlation was present between PF4 levels and activity, the site of disease, or medical treatment with or without prednisone.
Adult↗
Prostanoids in jejunal biopsy specimens of celiac children with active disease and on challenge diet. Radioimmunologic evaluation.
Prostanoid generation (prostaglandin E2 and thromboxane B2) in jejunal biopsy specimens from celiac patients was evaluated, comparing celiac patients with celiac patients on challenge diet and controls. Generation of prostaglandin E2 in jejunal specimens from 14 children with active celiac disease was significantly higher (341.8 +/- 82.3 ng/g; mean +/- SEM) than that from 7 celiac patients on gluten challenge diet (69.4 +/- 13.2 ng/g) or 8 normal children (92 +/- 23 ng/g) (p less than 0.05). In contrast, thromboxane B2 generation in jejunal specimens from all three groups did not show any statistically significant variation. Our results indicate that prostaglandin E2 generation is not merely related to the activity of clinical symptoms, since patients receiving gluten challenge had prostaglandin E2 levels that did not differ from those of controls.
Adolescent↗
Action of famotidine and ranitidine on prostaglandin E2 (PGE2) content of fundic and duodenal mucosa in duodenal ulcer patients.
PGE2 plays an important role in gastric cytoprotection. Previous experience has shown that H2-blocker drugs may have a role in gastric cytoprotective mechanisms. The effects have been compared of ranitidine and famotidine on PGE2 content in duodenal ulcer patients. Twenty patients were treated for 4 weeks as follows: group A, ranitidine (150 mg twice daily); group B, famotidine (40 mg daily). The patients underwent EGDS before and after therapy. The results show that both famotidine and ranitidine significantly increase the PGE2 content of fundic mucosa (from 112.3 +/- 73 to 210.7 +/- 106 ng/g wet wt and from 109.6 +/- 52.4 to 230.2 +/- 104.6 ng/g wet wt, respectively) in duodenal ulcer patients (p less than 0.01). Similarly, the PGE2 content of duodenal mucosa significantly increases after famotidine treatment (from 51.9 +/- 27.5 to 105.3 +/- 55.6 ng/g wet wt) as well as ranitidine treatment (from 53.8 +/- 24 to 172.6 +/- 72.9 ng/g wet wt) (p less than 0.01). It is concluded that these drugs play an important role in gastric and duodenal cytoprotection.
Adult↗
Recurrence of Crohn's disease after resection. Are there any risk factors?
We report two studies on possible risk factors for postoperative recurrence of Crohn's disease and an extensive literature review. In our retrospective study, 90 patients who had undergone curative resection and anastomosis 1 to 22 years (average 9.3 years) previously were examined. The recurrence rate, calculated by actuarial methods, was 62.2% after 10 years and 86.4% after 15 years. The site of recurrence was clearly related to the initial location of disease (p less than 0.001). However, of the various clinical, pathological, and surgical factors studied, only the preoperative history correlated directly with recurrence (p less than 0.05). The prospective study evaluated the influence on recurrence of microscopic lesions at grossly free margins of ileocecal resection. Twenty-two consecutive patients, operated on for Crohn's disease of the terminal ileum from 6 to 34 months previously (average 24 months), were studied. From the histological grading previously established, recurrence was independent of involvement at both proximal and distal section lines. Therefore, we recommend conservative resection to obtain only grossly uninvolved margins.
Actuarial Analysis↗
Gut endocrine cell population in coeliac disease estimated by immunocytochemistry using a monoclonal antibody to chromogranin.
Abnormalities of gut endocrine responses, as well as changes in the number of different endocrine cell types, have been reported convincingly in coeliac patients. Nevertheless, no estimation of total numbers of gut endocrine cells has yet been made in well defined groups of coeliacs. In this study, we have visualised all endocrine cell types in jejunal biopsies from coeliac patients with active and quiescent disease as well as in controls, using a monoclonal antibody to chromogranin. This protein was purified originally from bovine adrenal medulla and is known to be a reliable marker for all endocrine cells of the gut. The following groups were considered: (a) nine coeliacs with active illness, (b) 10 coeliacs under gluten-free diet, (c) eight coeliacs receiving gluten challenge, (d) five non-coeliacs (controls). Histological (haematoxylin and eosin) and immunocytochemical (peroxidase anti-peroxidase) stains were applied to 3 micron paraffin sections. Quantitative estimation of endocrine cell density was made using four different methods in order to evaluate the results fully (number of cells/mm2, number of cells/visual field, number of cells/8 crypts-villi, number of cells/unit of length of muscularis mucosae). In patient groups (a) and (c), coeliacs with active disease and coeliacs on gluten challenge diet respectively, a significantly higher number of endocrine cells was observed in comparison with normal controls (group d). In group (b) patients, coeliacs on gluten-free diet, no significant changes in the number of endocrine cells were observed in comparison with controls. Our results show that a significant increase in endocrine cell density exists in coeliacs with active illness (groups a and c), in comparison with controls. This condition is resolved in coeliacs receiving a gluten-free diet (group b).
Antibodies, Monoclonal↗
Immunocytochemical study of a trabecular carcinoma of the skin (Merkel cell tumor). Case report.
The existence of different neuroendocrine markers was investigated by immunocytochemistry in a case of Merkel cells tumor. Neuroplastic cells contain NSE,NF,CK and chromogranin A i.r. On the basis of the results the neuroendocrine nature of this uncommon neoplasm of the skin is confirmed and it is suggested that chromogranin A could represent an additional marker for Merkel cells tumors.
Adenocarcinoma↗
Acute cholangitis: diagnostic and therapeutic problems.
A retrospective study was carried out, analyzing the diagnostic and therapeutic problems in 80 patients with acute cholangitis at the time of hospitalization. 23% of the 17 patients with pus in the bile duct showed Reynolds' pentad, which was observed in 10% of patients with nonsuppurative acute cholangitis. Common bile duct lithiasis was responsible in 80% of cases presenting with Reynolds' pentad and in 66% of postoperative mortality. In 75% of patients with tumors, the clinical picture showed a rapid development following PTC. 79% of patients responded positively to antibiotic therapy with subsequent elective surgery, while in 21% of patients who did not respond to antibiotic therapy, biliary drainage was the treatment of choice. Mortality in patients with shock or hypotension was 30% while it was 17% in those undergoing early (less than 72 hours) surgery. On the basis of the results, it is concluded that, since it is not possible to assess preoperatively whether a patient belongs to the group of suppurative acute cholangitis or to that of nonsuppurative acute cholangitis, the different severity of the clinical picture should be based on clinical and biochemical parameters. The most severe developments were observed in common bile duct lithiasis or in patients with tumors who underwent PTC. In case of failure to respond to antibiotic therapy, decompression was shown to be the most suitable treatment. The mortality rate is related to the severity of the clinical picture (presence or not of shock) as well as to a prompt surgical treatment.
Acute Disease↗
Exaggerated response of thyrotropin to thyrotropin-releasing hormone in patients resected for Crohn's ileitis.
We have studied the response of thyrotropin to exogenous thyrotropin-releasing hormone in 13 patients who had previous intestinal resection for Crohn's disease, and in 42 healthy controls. An exaggerated and prolonged response curve was found in eight of the patients and one control (P less than 0.01), while baseline hormone levels were normal in all. These results may be related to the state of iodine deficiency known to develop in inflammatory bowel disease, but the pathophysiology requires further elucidation.
Adult↗
Effect of caerulein in patients with biliary colic pain.
A randomized placebo-controlled double-blind trial was carried out in 24 patients with biliary colic pain in order to evaluate the analgesic effect of caerulein (CRL). Caerulein (1 ng/kg . min infused intravenously over 15 min) showed an analgesic effect that was significantly higher than placebo (p less than 0.001). The analgesic action of CRL was not inhibited by naloxone (0.4 mg intravenously, administered two times). Further, the effect of i.v. CRL or saline on artificially induced biliary tree hypertension was studied in 7 patients with a T-tube common bile duct drainage. During saline intravenous administration, increasing biliary tree pressure resulted in pain in 5 patients, with the threshold for pain being 40 cmH2O. During CRL intravenous infusion, significantly higher perfusion pressures were required to achieve a given common bile duct pressure and the pressure threshold for pain was not reached. Consequently, pain was prevented in all patients. These data suggest that CRL relieves biliary colic pain by reducing biliary tract pressure.
Adult↗
Cefoxitin and cefamandole levels in the human bile.
The bile levels of cefoxitin and cefamandole were studied in 75 patients. The two antibiotics were shown to be present at high concentration and to undergo a rapid metabolization. It is concluded that they represent the antibiotics of choice in the prophylactic and therapeutic treatment of biliary tract infections.
Bile↗
Clinical value of CA 19-9 (carbohydrate antigen) in gastrointestinal adenocarcinoma.
CA 19-9 and CEA serum levels were determined before and 7 days after surgery in 140 patients with gastrointestinal adenocarcinoma, and in 70 patients with gastrointestinal non neoplastic diseases. CA 19-9 test was shown to be positive in 37.9% of colorectal cancer, in 32.6% of gastric cancer and in 77.8% of pancreatic cancer. CA 19-9 test was also shown to be more sensitive for colonic cancer with respect to rectal cancer (40.9% vs. 23.5%). CA 19-9 test is more sensitive and specific than CEA. In particular, the reported results suggest the clinical value of CA 19-9 test in the diagnosis of pancreatic adenocarcinoma and as a suitable parameter in the follow-up of gastrointestinal cancer.
Adenocarcinoma↗
Cancer of the large intestine and previous cholecystectomy: does a relationship really exist?
The possible relationship between cancer of the large intestine and previous cholecystectomy has been studied both experimentally and clinically but the results are contradictory. The present study, carried out in 250 patients undergoing intestinal resection for colorectal cancer and in 200 subjects who underwent cholecystectomy more than 10 years previously (with control groups) did not evidence any statistically significant relation (p = 0.2) between cholecystectomy and cancer of the large intestine. On the basis also of data from the literature, the etiopathogenetic hypotheses of the supporters of such relationship are reviewed and the different factors potentially able to explain the discrepancy between the concordant results of experimental studies and the contrasting ones of the clinical and epidemiologic experiences are examined. From the practical point of view, it is felt that a periodic (once a year) clinical and laboratory (guaiac test) control followed, when necessary, by x-ray/and or endoscopic examination should be carried out in all the patients over the age of 40, cholecystectomized since 10 years of longer, especially if females.
Adult↗
Endocrine cells in intestinal metaplasia of the stomach.
In this study we have investigated the mucin profile and the endocrine cell population in gastric endoscopic biopsies from 22 patients affected by chronic gastritis and intestinal metaplasia and in five surgical specimens of stomachs removed because of intestinal-type carcinoma (4) or peptic ulcer (1). High iron diamine-Alcian blue (HID-Ab) staining and peptide immunocytochemistry (peroxidase anti-peroxidase technique) were used. Forty-one foci of intestinal metaplasia were detected, 15 produced sulphomucins and 26 sialomucins. Of the endocrine cells investigated, gastrin and somatostatin cells were the most frequently observed, while cholecystokinin, glucose-dependent insulinotropic peptide-, secretin- and enteroglucagon-containing cells were also found in the metaplastic areas, but less frequently. No significant correlation was found between the type of mucin and the types of endocrine cells present, the latter usually resembling those normally found in the small intestine. On the basis of these results we conclude that intestinal metaplasia involves mucin- and peptide-producing cells of the stomach in a variable manner, with no correlation between the two.
Adult↗
Neuronal and glial markers in tumours of neuroblastic origin.
The presence and distribution of different neural markers in 30 neuroblastic tumours (neuroblastomas, ganglioneuroblastomas) and 6 non-neuroblastic tumours were investigated by immunocytochemistry. Neuron-specific enolase (NSE), S-100 protein, tyrosine hydroxylase, neurofilaments and glial fibrillary acidic protein (GFAP) were localised in 3 undifferentiated neuroblastic tumours (group A), 12 poorly differentiated tumours (group B) and 15 well differentiated neuroblastic tumours (group C). Non-neuroblastic tumours (3 lymphomas and 3 Ewing sarcomas) showed no immunoreactivity. Tyrosine hydroxylase and, in particular, NSE were found in mature ganglion cells and developing neuroblasts of poorly and well differentiated tumours (groups B and C). S-100 was localised in neuroblasts with slender cytoplasmic processes in the same groups. Neurofilaments were detected in ganglion cells and differentiated neuroblasts (groups B and C) while GFAP was localised in immature neuroblasts of undifferentiated and poorly differentiated tumours (groups A and B). Thus, there are differences in the neural proteins found in neuroblastic tumours and a wide panel of antibodies against neural markers may be a useful tool in the histological assessment of nervous system neoplasms.
Adolescent↗
Hyperplasia of antral G cells in uraemic patients.
In this study we have performed a quantitative analysis of antral gastrin cells in 9 uraemic patients under dialytic treatment compared to a group of 10 chronic gastritis patients with a similar histological degree of gastritis. Immunocytochemistry was carried out on endoscopic biopsies of both groups. Using a computerised image analysing system we showed a significant increase of G-cell density (number of cells/mm2) in uraemic patients compared to non-uraemics (p less than 0.001). These findings provide a further morphological basis for the elevation of gastrin levels in chronic uraemic patients, suggesting the existence of a specific factor inducing G-cell proliferation in these patients.
Adult↗
The role of surgery in the modern treatment of peptic ulcer disease.
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Cimetidine↗