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Biomedical subjects

C Mansi

Publications and source records attributed to C Mansi.

At least 55 records · Page 3Linked to original sources
PubMed1995

Circadian acidity pattern in gastric ulcers at different sites.

OBJECTIVE: Continuous intragastric pH monitoring was used in a large group of gastric ulcer patients to assess whether the 24-h acidity pattern varies in relation to the ulcer location within the stomach and to assess whether there is a circadian rhythm of pH fluctuations in this disease. METHODS: One hundred and thirty-three consecutive patients (79 male and 54 female, mean age 53 yr) with endoscopically and histologically proven benign gastric ulcer and 131 healthy subjects (70 male and 61 female, mean age 48 yr) were studied with a pH minielectrode positioned in the gastric corpus. Ulcer patients were divided into four subgroups in relation to the crater site: 1) above the angulus (n = 23); 2) angularis (n = 42); 3) antral (n = 26); and 4) prepyloric (n = 42). RESULTS: Subgroups 1 and 2 are characterized by significantly lower acidity (p < 0.0001) than healthy subjects for every time segment examined (24-h, day and night). Antral ulcers are less acidic than normal for both the total 24-h period (p < 0.01) and the night period (p < 0.0001), whereas prepyloric ulcers are less acidic for the night only (p < 0.01). In all subgroups of gastric ulcer, the acidity is higher during the evening than the night. CONCLUSIONS: The circadian acidity of gastric ulcer patients is significantly lower than normal, and this is particularly true during the nocturnal period. There is a gradient of gastric acidity that increases progressively as the lesion approximates to the pylorus. The well known circadian rhythm of gastric acidity with relatively higher acid levels during the evening than the night was maintained in all of the gastric ulcer subgroups we created.

Adult↗
PubMed1994

Bolus infusion of famotidine: effects on gastric pH by repeated 12-hour doses of 20 mg in postoperative patients.

This study was carried out to assess the efficacy of intravenous (IV) famotidine in suppressing gastric secretion over a 48-hour period. Twenty postoperative patients requiring a nasogastric tube received famotidine 20 mg IV every 12 hours and gastric pH was measured continuously by means of an indwelling probe. A baseline recording was performed over the first 4 hours and then the drug was infused every 12 hours (q12h) over a 15-minute period for the subsequent 48 hours. The mean pH value achieved during each time segment under active treatment was significantly higher (P < .001) than the mean basal value. Also the density distributions of minutes spent at the various pH units confirm that famotidine is highly effective (P < .001) in raising and maintaining gastric pH above 4.0 units during most of the drug-related period (44 hours). It can be concluded that repeated intravenous boli of famotidine 20 mg every 12 hours allow us to obtain an effective control of intragastric acidity. The antisecretory action is consistent over the total 48-hour period examined and therefore the use of intermittent infusion of famotidine seems to be advisable, as opposed to the recommended continuous IV administration of cimetidine and ranitidine. There is, however, a considerable intersubject variability in the antisecretory response to the drug.

Adolescent↗
PubMed1994

Antisecretory effects of three omeprazole regimens for maintenance treatment in duodenal ulcer.

This study was carried out to assess the antisecretory effects and their possible changes over time of three different dose regimens of omeprazole that could be proposed for maintenance treatment in duodenal ulcer. Forty-five patients with endoscopically proven duodenal ulcer were studied by means of 24-hr gastric pH-metry both in basal conditions and on the fifth day of acute treatment with omeprazole 20 mg in the morning. Ulcers healed after four weeks (in three cases after eight weeks) and afterwards, 15 patients were randomized to receive orally at 0800 hr in single-blind fashion omeprazole 10 mg daily (group A), 15 to receive omeprazole 40 mg on Saturday and Sunday followed by a five-day period without medication (group B), and 15 to receive omeprazole 20 mg every other day (group C) for up to three months. On the 20th and 80th days of these maintenance treatments 24-hr gastric pH-metry was repeated to assess the antisecretory effectiveness of each regimen over a two-month period. In patients of group B these tests began at 1700 hr on Friday, the last of five days off treatment, and in those of group C at 1700 hr of the day off medication. All three dose regimens of omeprazole were able to raise pH values significantly (P < 0.01-0.001) compared to basal levels. Omeprazole 20 mg every other day was more effective (P < 0.01) than omeprazole 40 mg weekend, but did not differ significantly from omeprazole 10 mg daily. The durations of acid inhibition (pH > 3.0 units/24 hr) were 12.44, 10.00, and 17.38 hr with groups A, B, and C, respectively. There was no significant difference between the pH profiles of the 20th and 80th days with every dose regimen. It is concluded that all three dose regimens of omeprazole are effective in reducing gastric acidity and their pharmacodynamic action does not change with time. Therefore they are suitable to be assessed in large clinical trials aimed at verifying the prevention of duodenal ulcer recurrence for longer periods.

Administration, Oral↗
PubMed1993

Hormonal therapy of pancreatic carcinoma. Rationale and perspectives.

Exocrine pancreas carcinoma is still diagnosed at a relatively late stage, so that only a few cases can be cured by surgery. Therefore, it is desirable that an effective medical therapy be found first to stall the development of the disease and second to improve the life conditions of patients. On the basis of recent discoveries, a new therapeutic approach seems to derive from hormone manipulation. The growth of pancreatic carcinoma appears to be stimulated by various factors, such as Epidermal Growth Factor (EGF) and Insulin-like Growth Factor I (IGF-I), and by various hormones, such as androgens and cholecystokinin. Several studies performed on cell lines and on animal models of pancreatic carcinoma demonstrated an antitumoral effect of certain antihormones and of somatostatin. Taking such studies as a premise, the first clinical studies were finally started in patients suffering from nonoperable pancreatic cancer. Results are still partial and contradictory, but such research is certainly worthy of further study along the lines already taken.

Animals↗
PubMed1993

Are clinical patterns of dyspepsia a valid guideline for appropriate use of endoscopy? A report on 2253 dyspeptic patients.

We studied 2253 consecutive dyspeptic patients, without clinical evidence of organic disease, who were referred to our open access endoscopy service. The aim was to assess whether the various clinical patterns of dyspepsia can be considered a valid guideline for the appropriate use of endoscopy. According to the symptomatological patterns, our patients were defined as sufferers from 1) ulcer-like (973 patients), 2) reflux-like (857), and 3) dysmotility-like dyspepsia (423). In our patient population, which reflects the general population of our city, the dysmotility-like type of dyspepsia was the least frequent (19%), whereas the ulcer-like (43%) and the reflux-like (38%) dyspepsia were almost equivalent. A negative endoscopy (35.7%) occurred significantly (p < 5 x 10(-4)) more often in dysmotility-like than in ulcer-like (26.3%) and reflux-like dyspepsia (25.7%). Furthermore, in dysmotility-like dyspepsia, we observed no malignancies in patients less than 60 yr old, and no gastric ulcers in patients less than 50 yr old. In the latter subgroup of patients (under 50 yr), duodenal ulcers and esophagitis were rare (occurring in only one and five, respectively, out of 145 patients). In ulcer-like and reflux-like dyspepsia, abnormal endoscopic findings occurred frequently (in 73.5% and 74.1%, respectively), and no relationship with patients' age was observed. Our data indicate that patients under 50 yr old with dysmotility-like dyspepsia can be considered a kind of population for which endoscopy is inappropriate. However, because the prevalence of dysmotility-like dyspepsia was 19% (423/2253) in our patient sample, and only 7.15% of them were under 50 yr old (161/2253), we can obtain only a small percentage of reduction in endoscopic service load if the guideline of age < 50 yr is adopted.

Adult↗
PubMed1993

Antisecretory effect of three premeal doses of cimetidine 400 mg versus a single morning dose of omeprazole 20 mg: pathophysiological implications for duodenal ulcer treatment.

The success of omeprazole in the healing of duodenal ulcer has been attributed to its profound and almost around-the-clock inhibition of acid, but the relevance of reducing meal-stimulated acid secretion exclusively has recently been emphasized in several clinical trials. For this reason, we used 24-h continuous intragastric pH monitoring to compare the pharmacodynamic effects of placebo, three fractioned premeal doses of cimetidine 400 mg and omeprazole 20 mg mane. Fifteen patients with duodenal ulcer in clinical remission were randomized to receive the above medications in single-blind fashion on three separate occasions, at least 2 wk apart. Both active regimens produced higher pH values (p < 0.05-0.001) than placebo, but omeprazole was much more effective than cimetidine (p < 0.01-0.001) during the various time intervals analyzed (24 h, evening, nighttime, daytime). The greater effectiveness of omeprazole was confirmed by its longer-lasting antisecretory action, insofar as the drug increased gastric pH above 3.0 units for about 21 h, whereas the daytime cimetidine regimen maintained this threshold for 7.30 h (p < 0.001) over the circadian cycle. As these markedly different pharmacodynamic effects have been proven to produce similar fast rates of duodenal ulcer healing in clinical trials, it is reasonable to assume that a small but well addressed reduction of gastric acidity can ensure the same therapeutic benefit as a strong and continuous acid inhibition. In this light, the acid peaks in response to meals seem to be important pathophysiological events, whose control is sufficient to permit quick ulcer healing.

Adult↗
PubMed1993

Open access endoscopy: a large-scale analysis of its use in dyspeptic patients.

We examined 2,253 consecutive dyspeptic patients referred to our endoscopy service by general practitioners ("open" group) and hospital clinicians ("clinic" group) to study the prevalence of the various endoscopic findings according to patient age and the route of endoscopic referral. The results obtained are representative of that specific population. Normal endoscopic findings progressively lessened as patients' age increased, and the overall rate was as low as 26.5% in the open and 30.3% in the clinic groups. Erosive prepyloric changes and duodenitis were the most frequently noted abnormalities in patients < 40 years of age (16.9% and 20.1%, respectively, in the open and 11.6% and 14.2% in the clinic groups). Chronic gastritis was prevalent in patients > 60 years of age. Duodenal ulcer decreased from 9.7% (open) and 18% (clinic) in patients < 40 to 2% and 1.1% in patients > 60. No malignancy was found in patients < 40, while only approximately 1% of those < 60 had neoplasms. All our endoscopic findings, both in the open and the clinic groups, were not significantly different. No significant differences in symptoms were observed among patients with different endoscopic findings. We conclude that (a) endoscopy is really useful only in a small group of patients < 40 years of age; (b) individual symptoms alone have a poorly discriminant diagnostic power; and (c) restriction of open access endoscopy is not justified.

Adolescent↗
PubMed1990

Patterns of dyspepsia in patients with no clinical evidence of organic diseases.

We studied 2000 dyspeptic patients with no obvious signs of organic disease at their first examination, in order to (1) verify how many diagnoses of idiopathic dyspepsia had really been made after exhaustive diagnostic procedures and (2) evaluate the diagnostic power of the symptoms in distinguishing organic from idiopathic dyspepsia. This latter was considered only when no structural abnormalities were found. In all the other cases, a distinction was made between "related" and "associated" organic dyspepsia according to whether or not there was a certain relationship between the abnormalities and the dyspeptic symptoms. The patients were referred to us as follows: (1) spontaneously, (2) sent by physicians collaborating with us, (3) referred to our open access endoscopic service. The results show the frequency of idiopathic dyspepsia was 26%, whereas associated structural abnormalities were present in 45.4%. Obvious organic causes of dyspepsia were seen in 28.6% (24% benign and 4.6% malignant diseases). When considered separately, no symptom alone allows a correct diagnosis. The simultaneous evaluation of the symptoms with linear discriminant analysis distinguishes between idiopathic and organic dyspeptic patients in about 70% of the cases. A higher discrimination percentage in about 70% of the cases. A higher discrimination percentage could probably be obtained using a wider range of clinical parameters and/or a more complex statistical analysis of the interrelationships which exist between the clinical symptoms and the final diagnosis.

Adolescent↗
PubMed1990

Trophic response and morphological changes in pancreas of caerulein treated rats: dose and time dependent effects.

The present study was performed to determine the effect of the duration of chronic caerulein administration given at different doses, on the rat pancreas. Four groups of rats, one treated with 0.9% NaCl (control) and the others with caerulein 2, 5 and 10 micrograms/Kg twice a day i.p. were used. After a treatment period of 15, 30 and 60 days, 6 rats from each group were anesthetized, the pancreas was removed, and growth and composition of pancreatic tissue were determined. Small samples were taken for histological examination. Caerulein induced pancreatic hyperplasia and hypertrophy. The dose of caerulein used and the length of the treatment did not significantly modify the trophic effect. Focal perivascular and periductular lymphomonocytic infiltrates associated with cellular abnormalities were seen at 30 and 60 days. The results suggest that 1) the trophic effect of caerulein is not dose-and-time dependent and 2) morphological abnormalities can appear during long term treatment with CCK analogous.

Amylases↗
PubMed1988

Different effects of intraperitoneal or subcutaneous administration of H2-antagonists on pancreatic response to chronic administration of caerulein in rats.

This study deals with the effect of H2-receptor antagonists on pancreatic response to chronic administration of caerulein. Caerulein was administered alone or combined with cimetidine, ranitidine or famotidine twice a day in various regimes. At the end of treatment, pure pancreatic juice was collected after hormonal stimulation. Then, the rats were killed, and growth and composition of the pancreatic tissue were determined. Caerulein increased pancreatic weight and enzyme content as well as volume and enzyme activity of pancreatic juice. When given alone the three H2-receptor antagonists were totally ineffective. Both ranitidine and famotidine, but not cimetidine, significantly reduced pancreatic response to chronic administration of caerulein only when given intraperitoneally together with caerulein. On the contrary, separate applications of caerulein and ranitidine (or famotidine) did not influence caerulein-stimulated pancreatic growth or enzyme secretion. Moreover, in rats treated both intraperitoneally and subcutaneously with caerulein, the H2-antagonists reduced the pancreatic response only partially and in proportion to the intraperitoneal dose of caerulein. The responsiveness of pancreatic tissue to subcutaneous caerulein was not modified. The results suggest that H2-receptor antagonists induce (1) impaired uptake of caerulein when given together with peptide, but (2) have no specific inhibitory effect on pancreatic response to caerulein.

Animals↗
PubMed1986

Leucovorin rescue of enteric lesions induced by high-dose methotrexate: a time-related study in mice.

In this study, different groups of mice were treated with a single high-dose of methotrexate or with a leucovorin-methotrexate association, and the changes in structure and cell types of the small intestine were studied histologically. The results suggested that leucovorin rescue diminished the degree of mitotic abatement induced by methotrexate in the first days after treatment, with better preservation of enteric structures and the cell type ratio.

Animals↗
PubMed1986

Comparative study of percutaneous and peroperative fine-needle aspirations in the diagnosis of pancreatic cancer.

A consecutive series of 51 patients with suspected pancreatic cancer were studied in order to evaluate the contribution of cytologic data in establishing a definitive diagnosis of the tumor. A percutaneous ultrasonically-guided, and a peroperative fine-needle, aspiration were performed in 26 and 29 patients, respectively; 4 cases underwent both methods. Final histologic diagnosis in surgical or autopsy specimens showed cancer of the pancreas in 41 cases and chronic pancreatitis in 10. Cytology was successful in 33/41 cancer patients (80.5%): percutaneous aspiration was positive in 15/20 (75%) cases, and peroperative aspiration in 18/25 (72%). The difference between the two methods was not significant. Neither technique gave false positives in chronic pancreatitis. In none of the 51 patients was relevant morbidity reported. These cytological studies are at present accurate and mostly safer than histologic examinations. In particular ultrasound-guided percutaneous aspiration should be given precedence, since it provides preoperative confirmation of the tumor, thus obviating the need for exploratory laparotomy.

Adult↗
PubMed1985

Pulmonary toxicity in mice after high-dose methotrexate administration with and without leucovorin rescue.

Interstitial lung lesions were induced in mice by high-dose methotrexate with high frequency. They appeared early after treatment; their onset, evolution and recovery parallelled those of lesions to the hemopoietic tissues and the intestine. The pathogenesis of methotrexate lung toxicity in mice is discussed. Leucovorin rescue was ineffective in preventing the lung lesions induced by high-dose methotrexate.

Animals↗
PubMed1984

Evaluation of a new tumor-associated antigen in pancreatic cancer.

This study was carried out to assess the diagnostic accuracy of a new gastrointestinal cancer antigen ( GICA ) defined by a monoclonal antibody. Its sensitivity and specificity were assayed in a group of patients with different pancreatic diseases (10 acute pancreatitis, 27 chronic pancreatitis, 22 cancers of the pancreas) and in 29 normal individuals. The concentration of GICA was always inferior to 37 units/ml (our discriminant limit between cancer and noncancer patients) both in cases with chronic pancreatitis and in healthy subjects. Increased levels of the antigen were found in 16/22 (72.7%) pancreatic cancer patients and in 3/10 (33.3%) cases with acute pancreatitis. The assay was within the normal range in 2 (28.6%) out of 7 cancers judged resectable. The test is simple and rapid, but its relative sensitivity and the frequent elevation of GICA in other adenocarcinomas of the gastrointestinal tract make it unsuitable for screening programs in pancreatic cancer. Even its use for early diagnosis of cancer of the pancreas does not seem promising. The major finding of our study is the lack of false-positives in patients with chronic pancreatitis and therefore the usefulness of this test in differentiating preoperatively between chronic inflammation and cancer of the gland. Frequent increase of the marker in patients with acute pancreatitis is not yet clear.

Adenocarcinoma↗
PubMed1983

Failure of new diagnostic aids in improving detection of pancreatic cancer at a resectable stage.

This study was undertaken to verify whether new diagnostic tools (angiography, endoscopic retrograde cholangiopancreatography, ultrasonography, and computed tomography) have improved the detection of pancreatic cancer at a resectable stage. Two groups of patients with histologically ascertained cancer of the pancreas were examined. The first consisted of 54 cases investigated before the clinical application of the four above-mentioned techniques and the second of 74 cases investigated thereafter. Cancer resectability was judged by a surgical team at the time of laparotomy according to preestablished criteria. No significant difference was found between the number of resections and other procedures in the two groups. On the other hand exploratory laparotomies performed exclusively for diagnostic purposes were significantly (P less than 0.01) reduced in the second group. On the basis of these results one may conclude that new diagnostic aids are useful and reliable in the preoperative detection of pancreatic cancer, but their introduction into clinical practice has not permitted an earlier diagnosis of the disease and therefore there has been no important increase in its resectability.

Adult↗