Biomedical subjects

D Lorusso

Publications and source records attributed to D Lorusso.

At least 37 records · Page 2Linked to original sources

PubMed1995

Gallbladder motility before and after Billroth II gastric resection.

The aim of this study was to determine the effect of Billroth II gastric resection (BII) without vagotomy on gallbladder contraction in response to meal and CCK-OP infusion. Fourteen duodenal ulcer patients were studied before surgery and six months postoperatively. Gallbladder volume was measured by real-time ultrasonography. After surgery, there was a significant increase in fasting gallbladder volume (P < 0.05). Postprandial gallbladder emptying was not significantly affected by gastrectomy apart from a trend towards a shorter t1/2 and a larger ejection volume. In addition, postoperative gallbladder relaxation was more pronounced at time 120 min. In response to cholecystokinin-octapeptide (CCK-OP) infusion, there was a significant decrease of t1/2 after BII and a prolonged contraction with a significantly reduced gallbladder volume. Our data show that the gallbladder response both to meal and CCK-OP infusion is modified after BII and a larger postoperative gallbladder volume may play a role in the pathogenesis of gallstone disease after gastric surgery.

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PubMed1995

[Effects of gastric resection by the Billroth II technic on reflux esophagitis associated with duodenal or pyloric ulcer].

Although duodenal ulcer and reflux esophagitis may frequently co-exist, it is not clear whether surgery for duodenal ulcer associated with reflux esophagitis should not be associated with anti-reflux plastic surgery. The authors make a retrospective evaluation of the prevalence of reflux esophagitis (endoscopic diagnosis) in a consecutive series of 633 patients undergoing elective gastric resection according to Billroth II for duodenal or pyloric ulcer during the period 1974-1992 and assess the effects of surgery on co-existent esophagitis. The prevalence of reflux esophagitis associated with duodenal or pyloric ulcer was 12.3%. In patients in whom stenosis represented the indication for ulcer surgery, the prevalence of esophagitis was 20%, whereas it was 5% in those operated because of failure to respond to medical therapy of hemorrhage (p = 0.000001). In 95% of patients, controlled endoscopically 6 months after surgery, Billroth II gastric resection led to the resolution or improvement of associated esophagitis. The authors conclude that by eliminating the main pathological factors of reflux esophagitis associated with duodenal ulcer (hypersecretion of gastric acid, impeded gastric emptying) gastric resection is sufficient to achieve the resolution of esophagitis.

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PubMed1995

Surgical management of reflux esophagitis associated with duodenal ulcer.

The prevalence of associated reflex esophagitis and the effects of surgery for ulcer on coexistent esophagitis were assessed in 687 patients operated on for duodenal or pyloric ulcer. Eighty-one patients (12%) had a preoperative endoscopic diagnosis of reflux esophagitis. The association resulted to be more frequent in patients with pyloric or bulbar stenosis than in patients without stenosis (20% vs 5%, p = 0.000001). Billroth II gastric resection, performed in most cases, caused the healing or the improvement of esophagitis in 95% of cases as demonstrated at endoscopy 6 months after surgery, particularly in 98% of patients with pyloric or bulbar stenosis and in 80% of patients without stenosis (p = 0.05). Therefore, gastric resection, eliminating the main pathogenetic factors of reflux esophagitis associated with pyloric or bulbar stenosis (gastric acid hypersecretion, impaired gastric emptying), assures the healing of esophagitis in most cases. However, anomalies in Lower Esophageal Sphincter function might play an important role in the pathogenesis of reflux esophagitis in duodenal ulcer patients without stenosis. In these patients, on the basis of manometric and pH monitoring data, it may be useful to associate an anti-reflux procedure or a duodenal diversion with a gastric resection in presence of Lower Esophageal Sphincter hypotonia.

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PubMed1995

[Ulcerative rectocolitis: review of clinical characteristics in patients with distal colitis and extended colitis].

Ulcerative colitis is an inflammatory disease which, starting from the rectum, affects more or less extended tracts of the colon. Given that distal and extended forms are generally described as a single nosological entity, the authors aimed to verify whether there are any clinical differences between the two groups of patients with varying extents of disease. A retrospective review was made of data relating to 189 patients suffering from ulcerative colitis observed over a 90-months period. Only 111 cases were included in the study: all patients had undergone an endoscopic and histological diagnosis with a follow-up of over one year. Seventy-eight patients (41.26%) were excluded from the study because they had been lost during follow-up, or follow-up had lasted less than one year, or it had not been possible to perform pancolonoscopy. The 111 patients examined were subdivided into 2 groups: one (39 patients) with distal colitis, namely involving the rectum or recto-sigmoid, and the other (72 patients) with more extended disease. The extension of disease was evaluated on the basis of histological findings. The mean follow-up was 5 years and 11 months. The two groups were comparable for age, sex, number of annual attacks, maximum duration of disease-free periods, clinical evolution, predominant symptoms, extraintestinal symptoms and surgical treatment. Results were processed using Student's t test and the chi-square test.(ABSTRACT TRUNCATED AT 250 WORDS)

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PubMed1995

Maternal ultrasound bone density in normal pregnancy.

OBJECTIVES: The aim of the study was to investigate the effect of pregnancy on maternal bone mineral density by an ultrasound device. STUDY METHODS: Two hundred and thirty consecutive healthy pregnant women were evaluated by ultrasound densitometry during the 1st (n=45), the 2nd (n=56) and the 3rd (n=129) trimester of pregnancy, measuring the velocity (SoS) and frequency attenuation (BUA) of an ultrasound wave as it passes through the os calcis. Speed of sound (SoS) and Broadband Ultrasound Attenuation (BUA) values are combined in order to express a relational variable (Stiffness), indicator of bone quality. RESULTS: Statistically significant reductions in SoS, BUD and Stiffness values were observed during the 3rd trimester vs the 1st and the 2nd trimesters. Negative statistically significant relations were found between the gestational age and ultrasound densitometry parameters. CONCLUSION: A linear reduction of ultrasound bone density was observed throughout pregnancy, reaching a statistical significance in the 3rd trimester, when the greatest calcium transfer from the mother to the fetus occurs.

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PubMed1994

[The palliative surgery of periampullary neoplasms. Our experience].

The increased incidence of peri-ampullar neoplasia and the low percentage of cases in which radical surgery is possible fuel interest in the use of palliative treatment for this pathology. The authors report their 10-year experience of palliative surgery for peri-ampullar cancer and evaluate immediate and long-term results. Between January 1980 and December 1990 the authors operated 91 patients with peri-ampullar carcinoma (head of the pancreas, Vater's ampulla, terminal choledochus). Eight (9%) underwent radical surgery and 83 (91%) underwent palliative surgery. The distribution of cases according to tumour origin in the latter group was as follows: head of the pancreas 60 cases (72%); intra-pancreatic choledochus 13 (16%); Vater's ampulla 10 (12%). The most frequent symptoms were pain (70%) and jaundice (63%). The mean interval between the appearance of symptoms and diagnosis was 1 month (range: 5 days-12 months). The most frequently performed biliodigestive derivative surgery was cholecystojejunostomy (72% of cases). Complications were observed in 18% of cases. Mortality was 12%. Mean survival was 5 months (range: 2-43 months). The recent use of endoscopic techniques for the treatment of jaundice in patients with inoperable peri-ampullar carcinoma now requires prospective studies to compare these techniques with surgery.

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PubMed1994

Duodenogastric reflux and gastric mucosal cell proliferation after cholecystectomy or Billroth II gastric resection.

OBJECTIVES AND METHODS: Twelve patients to be undergone cholecystectomy and 4 patients to be undergone Billroth II gastric resection were examined before and after surgery in order to evaluate the association between duodenogastric reflux and gastric mucosal cell proliferation. Duodenogastric reflux was assessed by measuring the concentration of bile acids in gastric juice and expressed as fasting bile reflux in mumol/h. Gastric mucosal cell proliferation was assessed by measuring the concentration of polyamines (putrescine, spermidine and spermine) in biopsy specimens and expressed in mumol/g of tissue. RESULTS: The median increase in fasting bile reflux was 34 mumol/h after cholecystectomy and 238 mumol/h after Billroth II gastric resection (P = 0.008). After cholecystectomy the median value of putrescine levels in antrum was 39 mumol/g, whereas after Billroth II gastric resection putrescine levels in pre-anastomotic area was 79.5 mumol/g (P = 0.008). There was a positive correlation between fasting bile reflux and putrescine levels either in antrum (r = 0.37, P = 0.04) or body (r = 0.48, P = 0.006). CONCLUSIONS: The increase in cell proliferation activity of gastric mucosa after Billroth II gastric resection might explain the increased risk for cancer of gastric remnant.

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PubMed1994

[The clinical aspects of 49 cases of early gastric cancer].

Forty-nine consecutive patients with early gastric cancer (EGC), observed from January 1978 to December 1992 in the Surgery Department of our Institute, were included in a retrospective study. The EGC prevalence in the overall cases of gastric cancer was 11%. This frequency was 8% in the period 1978-1985 and 15% in the period 1986-1992. All patients underwent gastroscopy with gastric biopsy, but only in 35 cases (72%) was a preoperative diagnosis of gastric cancer possible. In the remaining 14 cases only the histological examination of surgical specimens made possible a definitive diagnosis. A subtotal gastrectomy was carried out in 36 cases (73%), a total gastrectomy in 12 cases (25%) while only in one case (2%) was a superior polar resection carried out. The postoperative morbidity was 5% and mortality was 2%. The median survival was 61 months and, at the moment, 41 patients are alive and free from disease. Our data confirm the favourable prognosis of EGC compared to the advanced gastric cancer. We think it useful to carry out a routine gastroscopy when there are symptoms related to the upper abdomen in order to make an early diagnosis of gastric cancer.

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PubMed1993

Influence of the method of digestive tract reconstruction on gallstone development after total gastrectomy for gastric cancer.

The aim of this study was to evaluate whether total gastrectomy performed for gastric cancer leads to an increased risk of cholelithiasis and whether the method of reconstruction of the digestive tract influences that risk. A total of 102 patients who had undergone total gastrectomy for gastric cancer between 1980 and 1990 were studied. The preoperative prevalence of cholelithiasis was 4% in men and 12% in women. Eighty-seven patients (85%) without gallstones before surgery were reexamined after gastrectomy. The postoperative prevalence of cholelithiasis in this group was 36% in men and 19% in women. Before surgery, the difference between the expected frequency of cholelithiasis (calculated on the basis of the data of a community survey) and the observed frequency was not statistically significant (p > 0.05) either in men or women. After surgery, the observed frequency of gallstones was significantly higher than the expected frequency in men (p < 0.0001) but not in women (p = 0.06). The risk of cholelithiasis was significantly higher in patients with Roux-en-Y reconstruction (n = 55) than in those with jejunal interposition (n = 32) (log-rank test, p = 0.03), and that risk was independent of age, sex, and body mass index.

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PubMed1993

[Morbidity and mortality after elective Billroth II gastric resection in duodenal ulcer. Authors' experience].

A retrospective study was carried out those patients who underwent elective Billroth II gastric resection for pyloric or duodenal ulcer at the Surgical Division of the Scientific Institute of Gastroenterology of Castellana Grotte between 1974 and 1989. The aim of the study was to asses the incidence of postoperative morbidity and mortality. A total of 526 patients were included in the study (mean age 49 years +/- 12 years; 451 males (86%) and 75 females (14%). Morbidity was 20.7% and mortality 1.5%. These findings are in line with those reported in the literature and confirm that gastric resection for duodenal ulcer, even when performed electively, has a far from negligible morbidity and mortality rate. It is well known that, in comparison to more conservative operations such as vagotomy, gastric resection for peptic ulcer presents a high rate of postoperative morbidity and mortality, but a lower incidence of ulcerous recidivation. Unless there are valid preoperative criteria on which to base the choice of one or other techniques, the surgeon will usually choose the method with which the is most familiar. until studies have been carried out to identify the risk factors leading to postoperative morbidity and mortality, the authors suggest that gastric resection is reserved for those patients presenting a low operative risk.

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PubMed1992

[Postoperative morbidity and mortality in patients undergoing additional cholecystectomy during digestive surgery].

A retrospective case-control study was carried out to assess whether additional cholecystectomy in patients undergoing digestive surgery caused increased postoperative morbidity and mortality. During the period 1983-90, 70 patients underwent cholecystectomy at the same time as other surgery (25 gastric resections, 23 colon resections, 17 total gastrectomies, 2 fundoplicatio using Nissen's technique, 2 cases of Heller's operation, 1 truncular vagotomy and pyloroplasty). These cases were matched for sex, age (+/- 5 years) and type of primary operation with 70 controls (patients without additional cholecystectomy). Complications were significantly more frequent among the former group compared to controls (28.6% vs 11.4%, p = 0.02), in particular in the group of patients undergoing colon resection (34.8% vs 8.7%, p = 0.04). The frequencies of reoperation and mortality were also higher in patients undergoing additional cholecystectomy than in controls (10% vs 1.4%), but the difference was not statistically significant (p = 0.06). In conclusion, additional cholecystectomy during digestive surgery increases the risk of postoperative complications, in particular in colorectal surgery.

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PubMed1992

[Cholecystectomy and duodenogastric reflux].

With the aim of evaluating whether cholecystectomy causes an increase in duodenogastric reflux (DGR) 34 patient (12 males and 22 females, mean age 50 years) were examined before and 6 months after cholecystectomy. DGR was evaluated by assaying total and individual biliary acids in gastric juice and was expressed as fasting bile reflux (FBR) in mumol/h. The histology of gastric mucosa in endoscopic biopsies taken from the antrum and body was also analysed. FBR of total biliary acids rose from 2.4 mumol/h before surgery to 41.33 mumol/h after cholecystectomy (p = 0.000). A significant increase was observed for all the individual biliary acids. Histological tests of gastric mucosa revealed an increased percentage of chronic atrophic gastritis of the antrum following cholecystectomy. Histological conditions in the body were unaltered. The results of this study show that there is a significant increase in DGR (months after cholecystectomy together with increased histological damage to the mucosa of the antrum. Further studies are necessary in order to evaluate whether the two phenomena are related.

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PubMed1992

A prospective study on duodenogastric reflux and on histological changes in gastric mucosa after cholecystectomy.

The authors carried out a prospective study to evaluate variations with time in postcholecystectomy duodenogastric reflux (expressed as "fasting bile reflux" in mumol/h) and in gastric mucosal damage. Ten patients underwent (before cholecystectomy, 6 months after surgery and after a median period of 4 years from surgery) a gastric drainage to assess total (enzymatic method) and single (high performance liquid chromatography) intragastric bile acids, and a gastroscopy with biopsies of the antrum and gastric body to assess histological damage to the mucosa. The results showed that there was a progressive increase in the fasting bile reflux of total bile acids with time (precholecystectomy median value 0.295 mumol/h; 6 months control median value 12.045 mumol/h; late control medial value 19.9 mumol/h; Friedman test, P = 0.0022). Examination of the gastric mucosa at the three moments of the study showed that histological damage worsened progressively. In fact chronic atrophic gastritis of the antrum was present in 10 percent of cases before surgery and in 50 percent 4 years after, and the prevalence of chronic superficial gastritis of the body progressed from 0 to 40 percent. Studies on larger groups of patients are necessary to evaluate whether these two phenomena are correlated.

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PubMed1991

[Reconstruction of the digestive tract after total gastrectomy. A comparison of Roux anastomosis with Nakayama's beta-anastomosis].

Digestive tract reconstruction following total gastrectomy can be classified into two types according to whether the duodenal tract is excluded or preserved. Two groups of patients who underwent digestive tract reconstruction excluding the duodenal tract following total gastrectomy due to cancer were compared retrospectively: Nakayama's anastomosis was used in 20 patients (57%), and a Roux-en-Y anastomosis was performed in 15 (43%). The main technical difference between the two groups consists in the distance between esophagojejunostomy and jejunojejuno anastomosis: 20 cm in the case of Nakayama's technique and 50 cm in the case of the Roux-en-Y reconstruction. Results showed that 40% of patients with Roux-en-Y anastomoses were asymptomatic compared to 60% of patients with Nakayama's beta-anastomosis (chi-square test, p = 0.36). The most frequent symptom in patients with Roux-en-Y reconstructions was a feeling of postprandial fullness (33%), whereas pyrosis (25%) was the most common compliant in patients with Nakayama's reconstruction. Endoscopy revealed the presence of esophagitis in 35% of patients with Nakayam's beta-anastomosis compared to 6.5% in patients with Roux-en-Y anastomosis (chi-square test, p = 0.012). Results confirm that a minimum distance of at least 50 cm between the esophagojejunal and jejunojejunal anastomoses is decisive in reducing the frequency of reflux esophagitis after total gastrectomy.

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PubMed1990

Duodenogastric reflux and gastric histology after cholecystectomy with or without sphincteroplasty.

Sixteen patients who had undergone cholecystectomy plus sphincteroplasty, 14 cholecystectomized patients and ten control patients were studied to evaluate whether differences existed in duodenogastric reflux and whether these were related to morphological damage of the gastric mucosa. Duodenogastric bile reflux during fasting was evaluated by measuring the concentration of total bile acids (by an enzymatic method) and single bile acids in the gastric juice by high performance liquid chromatography. The damage was evaluated histologically by systematic endoscopic biopsy of the antrum and body of the stomach. There was a statistically significant difference in fasting bile reflux between the three groups (Kruskal-Wallis test, P less than 0.001), and the group that underwent cholecystectomy plus sphincteroplasty had a significantly higher median value than the cholecystectomized group (P less than 0.05) and the control group (P less than 0.01). The distribution of chronic antral atrophic and superficial gastritis was different in the three groups (chi 2 test, P less than 0.005). Chronic atrophic gastritis was associated with cholecystectomy plus sphincteroplasty (P less than 0.01), while chronic superficial gastritis was more frequent in cholecystectomized patients. These results suggest that there may be more duodenogastric reflux after cholecystectomy plus sphincteroplasty than after cholecystectomy alone, and that there may be a correlation between the amount of duodenogastric reflux and the severity of mucosal damage.

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PubMed1990

Cholelithiasis in inflammatory bowel disease. A case-control study.

Cholelithiasis is considered an extraintestinal manifestation of Crohn's ileitis but has not been associated with ulcerative colitis. To evaluate if an increased risk of cholelithiasis exists in patients with ulcerative colitis, biliary ultrasonography was performed on 159 patients with inflammatory bowel disease, 114 patients with ulcerative colitis, and 45 patients with Crohn's disease. A control population of 2453 residents of the town near the authors' institute was also studied. An echographic survey of gallstones was performed on the control subjects, who participated in the Multicentrica Italiana Colelitiasi (MICOL). Seventeen patients with inflammatory bowel disease had gallstones (10.7 percent), 11 patients with ulcerative colitis had gallstones (9.6 percent), and 6 patients with Crohn's disease had gallstones (13.3 percent). In the control population, diagnosis of cholelithiasis was made in 239 subjects (9.7 percent). An estimate of the relative risk (odds ratio) of gallstones in ulcerative colitis and Crohn's disease and also in 4 subgroups formed on the basis of the extent of disease (total ulcerative colitis, partial ulcerative colitis, Crohn's disease with ileitis, Crohn's disease without ileitis) with respect to the general population was calculated using logistic regression with gallstones, sex, age, and body mass index as independent variables and inflammatory bowel disease as a dependent variable. The author's findings show an increased risk of gallstones in both patients with Crohn's disease (odds ratio = 3.6; 95 percent confidence limits = 1.2 - 10.4; P = 0.02) and patients with ulcerative colitis (odds ratio = 2.5; 95 percent confidence limits = 1.2 - 5.2; P = 0.01). The risk was highest in patients with Crohn's disease involving the distal ileum (odds ratio = 4.5; 95 percent confidence limits = 1.5 - 14.1; P = 0.009) and in patients with total ulcerative colitis extending to the cecum (odds ratio = 3.3; 95 percent confidence limits = 1.3 - 8.6; P = 0.01). These results confirm that there is an increased risk of gallstones in Crohn's ileitis but they show that there also exists an increased risk in patients with total ulcerative colitis.

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PubMed1990

Duodenogastric reflux of bile acids, gastrin and parietal cells, and gastric acid secretion before and 6 months after cholecystectomy.

In order to evaluate the effect of cholecystectomy on the gastric mucosa, the duodenogastric reflux of total and single bile acids, the number of parietal and gastrin cells, and the volume of gastric acid secretion were examined in 15 patients with gallstones and functioning gallbladders before and 6 months after cholecystectomy. The duodenogastric reflux of the total bile acids increased from a mean preoperative value of 1.9 mumol/hour to a mean postoperative value of 21 mumol/hour (p = 0.008). The duodenogastric reflux of all single bile acids increased after cholecystectomy, with a higher increase in glycoconjugated compared with tauroconjugated bile acids. The parietal cells decreased from a mean preoperative value of 82.8 to a mean postoperative value of 68.7 (p = 0.05), whereas there was only a mild increase in the number of gastrin cells; the output of gastric acid remained unchanged. The variation of the gastrin cells before and after cholecystectomy was negatively correlated only with the variation of taurocholic acid (r = -0.50, p = 0.05), while the variation of the parietal cells was mildly correlated with all single bile acids (r = 0.35-0.50, 0.05 less than p less than 0.02). These findings show an increased duodenogastric reflux of bile acids 6 months after cholecystectomy with a mild morphologic alteration of the gastric mucosa.

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PubMed1989

[Cholecystectomy and adenomatous polyps of the colorectum].

The possible correlation between cholecystectomy and adenomatous polyps of the colorectum is evaluated by means of a retrospective study of 2 groups of patients: 90 patients subjected to endoscopic removal of one or more adenomatous polyps of the colon-rectum (histological diagnosis) and 90 control patients paired by sex and age, hospitalised for benign pathology and selected from among those submitted to totally negative colonoscopy. Ten patients (11.1%) were submitted to cholecystectomy among those with adenomatous polyps, 5 (5.5%) in the control group. Subdividing patients by sex women evidenced a relative risk of 5 (O.R. = 5/1, degree of confidence 95% = 0.7-33.4) but the figure was not statistically significant. For males, on the other hand, the relative risk was 1 (O.R. = 5/4). It is concluded that cholecystectomy may be considered a risk factor for the development of adenomas of the colon-rectum in females.

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