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C Prantera

Publications and source records attributed to C Prantera.

At least 55 records · Page 3Linked to original sources
PubMed1991

The plain abdominal film accurately estimates extent of active ulcerative colitis.

The aim of our study was to establish whether plain abdominal film can accurately assess the extent of active ulcerative colitis. Ninety-seven ulcerative colitis patients were studied, in whom the extent of the macroscopic lesion was established either by colonoscopy (n = 75) or by resection (n = 22). Of these, 42 had proctosigmoiditis, 12 left-sided colitis, 12 subtotal colitis, and 31 total colitis. Nine well-tested features were used for the radiological classification of lesion extent. The radiologists were not given any clinical information. Seventy-eight patients (80.4%) were correctly classified by plain abdominal film (r = 0.86); the best concordance was achieved for proctosigmoiditis and total colitis (80.9 and 90.3%, respectively). In total colitis the most reliable radiological features were "irregularity of the mucosal edge" and "increased thickness of the colon wall, " which were present in 74.2 and 67.7%, respectively, of the correctly classified patients. The fourfold combination of these two features with "loss of haustral clefts" and "empty right colon" was present only in patients with total colitis, and at least one of these features was present in all but one of them. Conversely, all nine abnormalities were absent in 73.8% of patients with proctosigmoiditis. In conclusion, plain abdominal film is a reliable tool for judging the extent of lesion in active ulcerative colitis. It seems particularly accurate in total colitis, where, in the acute phases, it is most important to avoid invasive examinations.

Adult↗
PubMed1991

Reversible sustained increase of gastrin and gastric acid secretion in a subgroup of duodenal ulcer patients on long-term treatment with H2 antagonists.

We assessed the effect of long-lasting inhibition of gastric acid secretion on basal and meal-stimulated serum gastrin and gastric acid secretion in 37 patients on long-term maintenance treatment with H2 antagonists for severe relapsing and/or complicated duodenal ulcer disease. After a mean of 142 weeks (range, 28-324 weeks) of continuous treatment, gastric acid secretion, basal plasma gastrin, and gastrin response to a test meal were evaluated. All tests were performed a week after drug discontinuation to exclude rapidly reversible hypergastrinemia. Gastrin levels were above the normal range in seven patients (18.9%). After H2 antagonist were stopped for 6 weeks, basal gastrin returned to normal levels in all cases [from a median of 180 (range, 130-350) pg/ml to 58 (25-90) pg/ml] and peak meal-stimulated gastrin significantly decreased from a median of 500 pg/ml to 245 pg/ml (p = 0.02). In patients with hypergastrinemia, the discontinuation of H2 antagonists for 6 weeks led to a significant decrease of gastric acid secretion. Patients who developed hypergastrinemia spent more weeks on full-dose treatment and had more recurrences during therapy. The results of the present investigation demonstrate that a long-lasting inhibition of gastric acid secretion can induce, in a small percentage of patients, a reversible sustained hypergastrinemia and a consequent increase of acid secretion, which conceivably could lead to more frequent relapses of duodenal ulcer disease.

Adolescent↗
PubMed1991

Mycobacteria and subgroups of patients in Crohn's disease.

Some recent studies have proposed a subclassification of Crohn's Disease (CD) on the basis of the pathological picture. In fact CD is a heterogeneous disease, and it is probable that the clinical and pathological disorders we now consider as CD may in the near future be divided into several conditions, probably with different causes as well, including environmental factors. Clinical and pathological similarities to mycobacterial disease, along with recent isolation of mycobacteria from tissues taken from patients with CD, and the recognition of atypical mycobacteria as causative agents of an enteritis pathologically similar to CD, all go to strengthen the hypothesis that these organisms are one of the above environmental factors. Researchers should therefore seek to identify and characterize this subgroup of CD patients who may have mycobacterial disease and to perform trials of antimycobacterial therapy. Analysis of the literature gives some suggestions for identifying this subgroup of patients: i) isolation of atypical mycobacteria from the tissues; ii) presence of high specific antibody levels and increase of same after antimycobacterial therapy; iii) presence of granulomas, and iv) strong suspicion of an environmental factor.

Crohn Disease↗
PubMed1989

Crohn's disease and mycobacteria: two cases of Crohn's disease with high anti-mycobacterial antibody levels cured by dapsone therapy.

Five patients with Crohn's colitis or ileocolitis (CD) refractory to conventional therapy were enrolled in an open trial with dapsone (100 mg/day). This therapy was apparently effective in two out of five patients. In these patients we observed a clinical improvement after one month of therapy and, in the first patient, a complete healing of all the cutaneous and rectal ulcers. In the two responders antibody levels to a soluble extract of M. paratuberculosis (MPSE) were significantly greater than in the three non-responders (P = 0.03); in the first patient, moreover, there was a rise of 39% in antibody titres following the treatment. This rise in antibody levels, that might be expected following death of the pathogen and release of antigen, is similar to that observed after treatment of tuberculosis. Our data suggest that a mycobacterial species or another pathogen that cross-react with those of MPSE, sensitive to dapsone, may in a subset of cases be responsible for the development of CD. This is the first report of clinical cure with an agent active against specific bacterial species, associated with immunologic confirmation of a response.

Adult↗
PubMed1989

Severe ulcerative colitis: a personal point of view.

In the course of their disease about 15% of all ulcerative colitis patients have a severe attack with evidence of systemic toxicity. On the basis of our personal experience of a recent series of 46 patients, and of a review of the literature, several conclusions can be drawn. A number of more severe attacks (28 out of 46 patients in our series), defined as "fulminating" or "toxic" colitis, must be regarded as major determinants of complications and mortality (4.3% in our series). The disease severity and the presence of signs and symptoms of toxicity seem likely to be determined by the amount of colonic tissue involved by inflammation, both in depth and in extent. A number of laboratory abnormalities are frequently found in the acute phase of severe ulcerative colitis, but C-reactive protein appears the most reliable factor reflecting activity and extension of lesion. Patients with increased small intestinal gas and multiple air-fluid levels, seen on the abdominal plain film, even in the absence of megacolon, must be considered to be gravely ill and at high risk of complications and mortality. With regard to timing of surgery, a short period of medical management (72-120 hrs) is justified to exclude an infectious etiology, to prepare the patient for surgery, and to allow for improvement.

Acute Disease↗
PubMed1988

Clinical and laboratory indicators of extent of ulcerative colitis. Serum C-reactive protein helps the most.

We estimated the extent of the inflammatory mucosal lesion by colonoscopy and biopsy in 60 patients with their first attack of ulcerative colitis. Proctitis was found in 12, proctosigmoiditis in 19, left-sided colitis in 10, and extensive colitis in 19. Fourteen clinical variables and laboratory measurements (bowel frequency, stool consistency, rectal bleeding, fecal mucus/pus, temperature, pulse rate, white blood cell count, hematocrit, sedimentation rate, serum iron, serum albumin, serum alpha 2-globulin, serum C-reactive protein, and seromucoids) were determined. All the variables except rectal bleeding and hematocrit were correlated (p less than 0.001) with the extent of colitis. On stepwise discriminant analysis, only C-reactive protein distinguished proctosigmoiditis from more improved the discrimination. Cross-validation by the "jack-knife method" showed that 86.7% of patients were correctly classified, the errors consisting in underestimation of disease in 8/29 patients with extensive colitis.

Adolescent↗
PubMed1987

Prediction of surgery for obstruction in Crohn's ileitis. A study of 64 patients.

The charts of 64 patients with Crohn's ileitis were reviewed to determine what characteristics at the time of first observation at a specialized center were predictive of surgery for irreversible obstruction, using Cox's proportional hazard model. Individual variables which proved significant (P less than 0.01) included age at presentation to the clinic, serum albumin, sedimentation rate, and the presence of radiologic strictures. Patients eventually requiring surgery were older than the rest because of a later date of symptom onset; furthermore, patients with strictures on initial x-rays had not been ill for a longer period of time than those who did not have strictures. These data suggest that fibrosis and stenosis are characteristic of a subgroup of Crohn's patients, rather than being inevitable phases of disease evolution. Multivariate analysis revealed that patients with low serum albumin, high sedimentation rate, and roentgenologic stenosis at first observation were ten times as likely to require surgery for obstruction at 10 years than those without any of these three unfavorable parameters.

Adult↗
PubMed1985

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↗
PubMed1985

Low residue or normal diet in Crohn's disease: a prospective controlled study in Italian patients.

Seventy patients with non-stenosing Crohn's disease were randomly assigned to follow a low residue diet or a normal Italian diet for a mean of 29 months. The two groups were comparable at the onset in various measures of disease severity and diet. Patients complied well with the diet prescriptions, the low residue group eating a mean of 8.1 portions a week of fibre containing foods and the liberalized group a mean of 26.6 portions (p less than 0.005). There was no difference in outcome between the two groups, including symptoms, need for hospitalisation, need for surgery, new complications, nutritional status, or postoperative recurrence. Eighty six per cent of patients eating ad libitum and 65% of patients who avoided roughage eliminated one or more permitted foods because of subjective intolerance. Lifting of dietary restrictions, which results in a more appetizing and nutritious diet, does not cause symptomatic deterioration or precipitate intestinal obstruction in Crohn's disease.

Adult↗
PubMed1984

Relationship between clinical and laboratory parameters and length of lesion in Crohn's disease of small bowel.

The correlation of 22 commonly used clinical and laboratory abnormalities with linear extent of the lesion was studied in 70 patients with Crohn's ileitis, 16 of whom had inactive disease and 54 active disease. Extent was measured radiologically using a well-validated double-contrast technique. In the patients with active disease, lesion length was significantly correlated with weight loss, serum albumin, total protein, and serum iron. In the group without active inflammation, pain and abdominal mass were significantly correlated with lesion extent. No correlation was found between linear extent of lesion and the following: an index of inflammatory activity (New Crohn's Disease Activity Index), several acute-phase reactants, and the components of the complete blood count. Only total protein and serum iron had a significant regression coefficient following a procedure of stepwise regression. No mathematical model was found capable of satisfactorily predicting the length of lesion.

Adolescent↗
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↗
PubMedDate not supplied

Current treatment for prevention of relapse and recurrence in Crohn's disease.

Maintenance of remission induced by medical therapy and prevention of recurrence after intestinal resection are two of the major goals in Crohn's disease treatment. Two main groups of drugs are employed in prevention of relapse and recurrence: sulfasalazine and 5-aminosalicylic derivatives and the group of azathioprine/6-mercaptopurine. Although most clinical trials on the efficacy of sulfasalazine as maintenance therapy of Crohn's disease have given negative results, it could probably be favourably used in remission maintenance of Crohn's colitis. Controlled studies and two reviews have shown that 5-aminosalicylic derivatives are effective in reducing the risk of relapse. Ileitis and ileocolitis respond better than colitis. These drugs are also able to reduce the severity of lesions and of symptoms after surgery. 6-mercaptopurine and azathioprine can be used in more aggressive forms of the disease. The efficacy of this immuno-suppressive therapy is reported in over 70% of patients and the incidence of associated side effects is acceptable, but 6-mercaptopurine and azathioprine act slowly and the long latency period limits the usefulness of these drugs in some patients.

Anti-Inflammatory Agents, Non-Steroidal↗