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Biomedical subjects

V Speranza

Publications and source records attributed to V Speranza.

At least 73 records · Page 4Linked to original sources
PubMed1983

Elevated plasma levels of vasoactive intestinal polypeptide in short bowel syndrome.

Short bowel syndrome is a complex disease that is almost always seen with diarrhea. VIP is known to act powerfully on gut motility, and elevated VIP plasma levels have been reported in several diarrheal conditions. In this study VIP plasma levels were measured by radioimmunoassay in 8 patients with short bowel syndrome versus 30 healthy control subjects under basal conditions. VIP plasma levels were significantly higher in the short bowel syndrome group (p less than 0.05). The explanations that could account for these elevated levels are (1) an increased gastric acid load in the residual bowel, (2) a compensatory increase in blood supply to the gut, (3) removal of an inhibitory factor arising from the small intestine, or (4) mucosal stress due to unadsorbed food. An etiologic role of VIP in the occurrence of diarrhea in patients with short bowel syndrome seems to be an unproved hypothesis.

Female↗
PubMed1983

Indications, strategy and results of surgical management in 141 cases of Crohn's disease.

Of 200 cases of CD observed in the course of twenty years, 141 (70.5%) have been treated by surgery. At the time of surgery, 6 patients had duodenitis, 87 ileitis, 35 ileocolitis, 9 colitis and 8 proctocolitis. In 4 cases the duodenum and ileum were simultaneously involved. Complications of the disease and failure of medical treatment represented the indications for surgery. Elective surgery was possible in 74.5% of cases. Intestinal resection was performed in all cases except for 6 by-passes (4 for duodenal obstruction) and 3 external derivations (1 ileostomy for perforation, and 2 colostomies: one for colovesical fistula and another for a rectovaginal fistula). Surgical strategy mainly depended on the site, number and extent of lesions, together with complications arising from them. Data from preoperative absorption tests and intraoperative measurements of the small bowel were useful aids in determining whether a resection was to be "radical" or "limited". Overall p.o. mortality was 4.2%. The follow-up (from 2 to 21 years) showed a long-term mortality rate of 5.7%. The rate of recurrences was 55.2%. However surgical management undeniably improved the quality of life, that was in fact good, or fairly good, even in the great majority (81.2%) of patients with recurrences.

Adolescent↗
PubMed1982

Transduodenal papillostomy as a routine procedure in managing choledocholithiasis.

The purpose of this study was to evaluate the results of transduodenal papillostomy as a routine procedure in managing choledocholithiasis in treating common bile duct (CBD) stones. From 1973 to 1978, 117 patients underwent transduodenal papillostomy for CBD lithiasis. The operation was carried out in standard manner, and all patients had preoperative telecholangioscopy, cholangiography, and biliary manometry. The mean age of patients was 53.7 years, and women predominated in a ratio of 4.5:1.0. Papillostomy was performed together with cholecystectomy for CBD stones in 111 patients (group 1). In five patients, we had to perform a choledochotomy to remove the stones after an unsuccessful papillostomy (group 2). Eight patients who previously had cholecystectomies underwent papillostomy for retained or recurrent stones (group 3), and three patients had a choledochoduodenostomy for recurrent stones after a previous cholecystectomy and papillostomy (group 4). Complications included two deaths in group 1 (1.9%). No mortality was observed in groups 2 and 4. Moreover, the overall morbidity was due to six cases of wound infection, one case of postoperative bleeding, one case of phlebitis, and three cases of cholangitis. The mean length of hospital stay was 12.9 days, considering all the groups. Lack of confidence with this procedure may explain the different results reported in the literature for transduodenal papillostomy, which on the basis of this study has been shown to ba a valid alternative to supraduodenal choledochotomy in treating CBD stones.

Adult↗
PubMed1982

Relationship between pancreatic and serum amylase in basal conditions and during stimulation in man. Report of a new intraoperative technique.

The correlation between serum amylase and pancreatic amylase secretion was studied in two patients. Both patients underwent sphincterotomy, and the pancreatic duct was cannulated with a polyethylene tube. The tube was left in place for 15 to 21 days. The rate of amylase secretion over 7 days was studied in response to (1) a standard meal, (2) duodenal acidification, (3) scalar doses of cholecystokinin, (4) scalar doses of secretin, and (5) scalar doses of secretin with simultaneous infusion of cholecystokinin. Blood samples were collected during the tests to measure serum amylase. No significant correlation was shown between blood concentration and output of amylase in any of the tests. Our findings show that under normal conditions serum amylase levels are not influenced by pancreatic secretion and suggest that serum amylase concentration is not related to pancreatic exocrine secretion.

Adult↗
PubMed1981

Studies with bombesin in the Zollinger--Ellison syndrome.

Preliminary data showed that bombesin stimulated serum gastrin levels in patients with the Zollinger-Ellison syndrome (ZES). In this study, the total immunoreactive gastrin and the different molecular forms of gastrin were measured in 16 patients with ZES (11 with proved pancreatic gastrinoma, 2 with proved duodenal gastrinoma and 3 with uncertain tumour localization) following bombesin infusion and following calcium infusion in 13 patients. In all patients with gastrinoma (both pancreatic and duodenal) bombesin augmented serum gastrin levels. In patients with pancreatic gastrinoma calcium infusion was a more potent stimulator of gastrin secretion than bombesin. In the 2 patients with duodenal gastrinoma bombesin was more potent than calcium in stimulating serum gastrin levels with a basal/stimulated gastrin level ratio similar to the ratio found in patients with incomplete antrectomy. These data suggest that gastrin-producing cells from duodenal gastrinomas may be more closely related to the normal antral G cells than to the gastrin-producing cells from pancreatic gastrinomas. Furthermore, the comparison between the basal/calcium and the basal/bombesin stimulated gastrin levels may help in differentiating preoperatively patients with pancreatic gastrinoma from patients with retained antral mucosa. In all the patients studied, bombesin augmented the concentration of all of the gastrin components considered. These data support the hypothesis that G 34, G 17 and the N-terminal G 17 fragment are all present in gastrinomas.

Bombesin↗
PubMed1981

Management and long-term results in patients with two-thirds gastrectomy and stomal ulcer.

In 67 patients with two-thirds gastrectomy and endoscopically proven stomal ulcer, serum gastrin levels were measured under basal conditions and after intravenous infusion of bombesin (15 ng/kg/min), calcium (4 mg/kg/hour) and secretion (2 units/kg). All patients underwent medical or surgical therapy. The long-term results were evaluated according to the Visick grading system (average follow-up, 3.1 years).

Antacids↗
PubMed1981

Cimetidine and antacid prophylaxis of acute upper gastrointestinal bleeding in high risk patients. Controlled, randomized trial.

A randomized, controlled clinical trial was performed to compare the efficacy of prophylactic cimetidine treatment, antacid treatment and no treatment in high risk patients. Sixty patients received cimetidine (200 mg every 6 hours), 52 patients received antacids (Maalox, 10 ml/hour), and 56 patients received no treatment. One hundred thirty-five patients completed the study. Eight patients in the control group and one patient in the antacid-treated group presented with upper gastrointestinal bleeding. No bleeding occurred in the cimetidine-treated group. Patients considered at low risk had no bleeding. Cimetidine or antacid prophylaxis significantly decreased the incidence of upper gastrointestinal bleeding in the high risk patients.

Antacids↗
PubMed1979

Intrahepatic lithiasis. Study of thirty-six cases and review of the literature.

In 2,700 operations for biliary tract stones, intrahepatic lithiasis (stones located proximal to the confluence of the main hepatic ducts) was discovered in 36 patients (1.3 per cent). The diagnosis of intrahepatic lithiasis was determined only via intraoperative chalangiography in thirty-two cases (88.9 er cent); in 23 per cent of our cases of intrahepatic lithiasis, jaundice was never observed. This confirms that intraoperative cholangiography should be performed routinely in every case of biliary lithiasis. The removal of stones was generally performed by an indirect approach (papillostomy and/or choledochotomy). In 16.7 per cent of our cases, a direct approach was indicated. It is extremely important, after removal of calculi, to assure ample bilioenteric flow. Our surgical approach was therefore based mostly on the caliber of the biliary tract. When the tract was dilated less that 2 cm (in 20 cases), choledochohepaticotomy with papillostomy was most often performed (12 cases, 60 per cent). When the dilatation was more that 2 cm (12 cases), Roux-en-Y hepaticojejunostomy was performed in all. There was no operative mortality, although the long-term follow-up results were poor in 9.6 per cent of the cases.

Adolescent↗
PubMed1979

[Anaerobic infections in surgery].

In the past few years the incidence of anaerobes in the aetiology of surgical infections has definitely increased due to a distinct increase in anaerobic flora and to the noticeable improvement in isolation and culture techniques which have drastically decreased the incidence of so-called "sterile pus". The development of the toxi-infective shock due to Gram negative anaerobes, presents the most serious clinical problems, being the shock with the highest mortality rate. A paradigmatic example of shock due to surgical infections is the shock complicating peritonitis. A correct postoperative behaviour includes peritoneal lavage through drainages placed during surgery. The AA. personal experience with 50 hospitalized patients treated surgically and with cefoxitin, a new cephamycin semisynthetic antibiotic resistant to beta-lactamases, is reported.

Anaerobiosis↗
PubMed1978

[The gastric mucosa barrier and gastropathy].

In addition to a layer of mucus, the gastric mucosa barrier is mainly formed of a tight junction consisting of the surface membranes of epithelial cells. It is this that mainly impedes the flowback of H+ ions. Buffers conveyed by the blood neutralise the small numbers of ions that do flow back, even under physiological conditions. Damage to the barrier results in a considerable backflow of ions that enhance acid secretion and release of histamine and other vasoactive substances, so that further mucosal lesions occur. Such damage may be of exogenous or endogenous origin. Alcohol and acetylsalicylic acid are two examples. The latter is undissociated and hence liposoluble in the highly milieu of the stomach and can easily enter the cells and damage them. Severe hypovolaemia, stress and sepsis are instances of endogenous sources of damage. In the final analysis, the damage caused by sepsis is linked to cell anoxia.

Alcoholic Beverages↗