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Biomedical subjects

D Stimac

Publications and source records attributed to D Stimac.

33 records · Page 2Linked to original sources
PubMed1998

Omeprazole, azithromycin and either amoxycillin or metronidazole in eradication of Helicobacter pylori in duodenal ulcer patients.

BACKGROUND: Azithromycin is a new generation, acid stable, macrolide antibiotic that achieves remarkably high concentrations in gastric tissue (above the minimal inhibitory concentration for Helicobacter pylori) after oral administration. AIM: To establish whether azithromycin plus omeprazole in association with either amoxycillin or metronidazole are useful in curing H. pylori infection in patients with a duodenal ulcer. METHODS: One hundred patients with active duodenal ulcers and H. pylori infection were treated with omeprazole (days 1-10, 40 mg b.d.; days 11-24, 40 mg o.m.; days 25-42, 20 mg o.m.) plus azithromycin 500 mg o.m. for the first 6 days. Patients were randomly assigned to receive either amoxycillin 1 g b.d. (OAzA group: n = 50) or metronidazole 400 mg t.d.s. (OAzM group: n = 50) during the first 10 days of treatment. H. pylori status was determined by urease test and histology before the treatment and 6 weeks after completion of therapy. RESULTS: Ninety-seven patients completed the study. H. pylori infection was eradicated in 85% (41/48) of patients in the OAzA group (intention-to-treat analysis 82%) vs. 74% (36/49) of patients in the OAzM group (intention-to-treat analysis: 72%) (N.S.). All ulcers had healed after 6 weeks of omeprazole treatment. Side-effects, usually minor, were recorded in 13% (OAzA group) and 47% (OAzM group) of patients (P < 0.001), but therapy was discontinued for only one patient in the OAzA group (N.S.). CONCLUSION: Ten days of treatment with omeprazole plus (for the first 6 days) azithromycin and either amoxycillin or metronidazole provides effective regimens to cure H. pylori infection in patients with duodenal ulcer disease.

Adult↗
PubMed1998

Eyebrow keyhole approach in vascular neurosurgery.

The authors review their experience in the surgery of intracranial aneurysms via an eyebrow keyhole approach. The eyebrow keyhole approach presumes a skin incision in the lateral two-thirds of the eyebrow followed by small supraorbital craniotomy (15 x 25 mm). Using this approach and an intraoperative endoscope for better visualisation of the aneurysmal neck, the authors operated on thirty-seven patients with forty intracranial aneurysms. There was no mortality, postoperative recovery was fast, and the cosmetic effect was excellent. Advantages and possibilities of this approach are discussed and results are presented. The authors recommend this approach as a minimal invasive surgery procedure in the treatment of intracranial aneurysms. When performed by experienced vascular neurosurgeons this approach is neither more difficult for the surgeon nor more dangerous for the patient than any other standard craniotomy procedure. According to the authors' present results, surgery of intracranial aneurysm via an eyebrow keyhole approach is the method of choice when performed by an experienced vascular neurosurgeon.

Adolescent↗
PubMed1998

A scoring system for early differentiation of the etiology of acute pancreatitis.

BACKGROUND: The purpose of this study was to find a new scoring system for early differentiation between the two commonest etiologies of acute pancreatitis (biliary and alcoholic), because biliary pancreatitis can be treated early by endoscopic sphincterotomy, whereas such treatment is unnecessary in alcoholics. METHODS: One hundred and forty-five patients satisfied the requirements for participation in the study and were divided into groups A (alcoholic pancreatitis) and B (biliary pancreatitis). Seven variables (serum and urine amylase, aspartate aminotransferase (ASAT), alanine aminotransferase (ALAT), alkaline phosphatase (ALP), lipase/amylase (L/A) ratio, and erythrocyte mean corpuscular volume (MCV)) that differed in a statistically significant manner between patients of the two groups were included in the scoring system. Each parameter was counted as 0 or 1 on the basis of its values, so the patients reached scores from 0 to 7. RESULTS: Scores > or =4 (P < 0.0001) were consistently present in biliary pancreatitis, whereas alcoholics scored <4, with a sensitivity of 92.04% and a specificity of 93.75%. CONCLUSIONS: Our new scoring system could be important in the early diagnosis of the etiology of acute pancreatitis in a manner that is non-invasive, easy to calculate, inexpensive, and readily available.

Acute Disease↗
PubMed1998

Infection with Helicobacter pylori and long-term use of non-steroidal antiinflammatory drugs.

The use of nonsteroidal anti inflammatory drugs (NSAID) is associated with an increased risk of peptic ulcer and of ulcer complications. However, the relation between Helicobacter pylori infection and gastroduodenal damage associated with NSAID use is unclear. This study investigated the prevalence of Helicobacter pylori infection in patients with arthritis (n = 85) taking NSAID, trying to find out whether the patients taking NSAID and infected with H. pylori were more likely to have dyspepsia, mucosal damage or chronic active gastritis than those without H. pylori infection. H. pylori was identified by biopsy, rapid urease test and histologic test. Dispeptic symptoms were assessed according to a standardized questionnaire. Gastroduodenal mucosal damage was graded endoscopically (using a modified Lanza scale) and the diagnosis of chronic gastritis was based on the histologic criteria of the Sydney system. The frequency of H. pylori infection was found to increase with age. No statistically significant difference was observed in the presence of damage to gastroduodenal mucosa between the patients with and without H. pylori infection. H. pylori infection was found to be associated with an increased frequency and severity of dyspeptic symptoms in patients with arthritis taking long-term NSAID. Chronic active gastritis was only present in patients with H. pylori infection. H. pylori infection was shown to be associated with an increased frequency and severity of dyspeptic symptoms in patients with arthritis on long-term NSAID therapy, without causing an increased damage to gastroduodenal mucosa.

Adult↗
PubMed1998

Omeprazole, azithromycin and amoxicillin or amoxicillin plus clavulanic acid in eradication of Helicobacter pylori in duodenal ulcer disease.

Treatment with omeprazole (OME), azithromycin (AZI) and amoxicillin (AMO) resulted in encouraging Helicobacter pylori cure rates in pilot and control studies. The aim of this study was to establish whether OME + AZI in combination with either AMO or ACA (amoxicillin plus clavulanic acid) are effective in curing H. pylori infection. A hundred patients with active duodenal ulcer and H. pylori infection were treated with OME (day 1-10: 2 x 40 mg/day, day 11-24: 40 mg/day, day 25-42: 20 mg/day) plus AZI 500 mg/day for the first 6 days. Patients were randomly assigned to either AMO 2 x 1000 mg/day (group A, n = 50) or ACA 2 x 1250 mg/day (group B, n = 50) during the first 10 days of treatment. H. pylori status was determined by urease test and histology before and 6 weeks after completion of therapy. Ninety-five patients completed the study. H. pylori infection was eradicated in 85.4% (41/48) patients from group A (intention-to-treat (ITT) analysis: 82%) versus 91.5% (43/47) patients from group B (ITT) analysis: 86%) (NS). All ulcer had healed after 42 days of omeprazole treatment. Side effects, usually minor, were recorded in 12.5% (group A) and 14.9% (group B) of patients (NS). Therapy had to be discontinued in two patients (one in group A and one group B) only. Ten-days treatment with OME and AZI (for the first 6 days) with AMO or ACA are simple and highly effective regimens to cure H. pylori infection in patients with duodenal ulcer disease.

Adult↗
PubMed1997

Lansoprazole versus omeprazole in the treatment of reflux esophagitis.

To evaluate the therapeutic potential of the newly developed proton pump inhibitor lansoprazole in patients with reflux esophagitis (grade I and II according to Savary Müller criteria), the authors performed a single blind, randomized clinical trial comparing 20 mg omeprazole and 30 mg lansoprazole, involving 60 patients at two clinical hospitals. The treatment period was or 8 weeks, and main efficacy variables were healing of endoscopic changes and relief of reflux symptoms. No significant difference in terms of healing and relief of reflux symptoms was found either after 4 or after 8 weeks of treatment. In conclusion, 30 mg lansoprazole daily was found to be safe and effective therapy comparable to omeprazole in the short-term treatment for reflux esophagitis (grade I and II).

2-Pyridinylmethylsulfinylbenzimidazoles↗
PubMed1996

Acute gastrointestinal bleeding due to Meckel's diverticulum heterotopic gastric mucosa.

Meckel's diverticulum is the most common congenital anomaly of the gastrointestinal tract occurring in approximately 2% of the population. In our retrospective study, we analyzed 58 surgical specimens of Meckel's diverticulum operated on in our hospital. Heterotopic gastric mucosa was found in ten. Aim of this study was to establish the aetiopathogenesis of inflammation and consequent haemorrhage in Meckel's diverticulum with heterotopic gastric mucosa. Some studies showed that Helicobacter-like bacteria could play an important role in determining local phlogosis in heterotopic gastric mucosa of Meckel's diverticulum, however, none were found in our biopsy specimens. Analyzing patients with acute intestinal haemorrhage (4 out of 10 with heterotopic gastric mucosa) in Meckel's diverticulum a history of previous oral administration of NSAID's was positive in 3 of them. Although in the recent literature there were few case reports on the use of NSAID's and bleeding from Meckel's diverticulum, our results suggest that even short-term use, in small quantities, of NSAID's can play an important role in determining acute bleeding from Meckel's diverticulum with heterotopic gastric mucosa.

Acute Disease↗
PubMed1996

Biochemical parameters in the early differentiation of the etiology of acute pancreatitis.

OBJECTIVES: We undertook a retrospective study to define the usefulness of various biochemical parameters in differentiation between alcoholic and nonalcoholic acute pancreatitis. METHODS: One hundred sixty-seven patients were divided into groups A (alcoholic pancreatitis) and NA (nonalcoholic pancreatitis). Group NA was further subdivided into groups B (biliary pancreatitis) and NANB (nonalcoholic, nonbiliary pancreatitis). The values of serum and urine amylase, serum lipase, AST, ALT, alkaline phosphatase, gamma glutamyl transferase, bilirubin, lipase/amylase ratio, and erythrocyte mean corpuscular volume were investigated. RESULTS: Serum amylase, ALT, AST, alkaline phosphatase (p < 0.001), and urine amylase (p < 0.01) were significantly lower in patients with alcoholic pancreatitis. Erythrocyte mean corpuscular volume and lipase/amylase ratio were significantly higher in patients with alcoholic pancreatitis (p < 0.001). There were no differences in lipase, bilirubin, and gamma glutamyl transferase between patients with alcoholic pancreatitis and those with nonalcoholic pancreatitis. Multivariate analysis showed that a combination of three variables (lipase/amylase ratio, erythrocyte mean corpuscular volume, and alkaline phosphatase) differentiated between alcoholic and nonalcoholic pancreatitis. CONCLUSIONS: Various biochemical parameters used together and with other clinical features can help in the early differentiation between alcoholic and nonalcoholic acute pancreatitis.

Acute Disease↗
PubMed1995

Bone turnover in homozygous beta 2-microglobulin knock-out mice does not differ from that of their heterozygous littermates.

beta 2-Microglobulin is a constituent of the class I major histocompatibility complex (MHC) molecule and crucial for its normal function in cell recognition. It has also been isolated from bone and shown to regulate bone metabolism and to be altered in various bone diseases. In order to further investigate the role of the immune system in bone metabolism, we studied basic properties of bone physiology in beta 2-microglobulin-deficient mice created by the technique of gene knock-out. Ten week-old male offspring homozygous (non-functional class I MHC molecule) or heterozygous (functional class I MHC molecule) for beta 2-microglobulin knock-out gene did not differ in the following measures of bone turnover: femur length, dry and ash weight and calcium content, serum calcium concentration and alkaline phosphatase activity, total vertebral tissue area, trabecular bone volume, osteid surface, osteoclast surface and mineral apposition rate. These data indicate that the bone turnover in beta 2-microglobulin-deficient mice is appropriate for the stage of their skeletal maturation.

Animals↗
PubMed1995

Biomechanical features of axial injuries to the lower limbs and to the pelvic ring by motor car collisions.

By frontal car collision, passengers are exposed, commonly, by dynamic deceleration force, applied to the lower limb and acting in the direction of the femoral shaft axis. This force could be transmitted from the foot, or from the knee to the hip joint, resulting in typical fractures of the femoral shaft, upper part of the femur as of the acetabulum. The authors have described radiological feature and three dimensional definition of these fractures as well as their ergonomic characteristics. The purpose of this study was to explain biomechanical etiology of acetabular and proximal fractures of the femur. This analysis may be useful in prevention of these fractures.

Accidents, Traffic↗
PubMedDate not supplied

Gastric epithelium proliferation in early Hp+ and Hp- gastritis: a flow cytometry study.

BACKGROUND: Helicobacter pylori increases cellular turn-over causing hyperproliferation and possible assumption of neoplastic characteristics by the gastric epithelial cells. To verify whether patients at risk of cancer can be identified at the very first stages of gastric disease, we studied a sample of patients affected by early Hp+ and Hp- gastritis by flow cytometry and assessed the methods commonly adopted to study gastric cell proliferation. METHODS: 48 fresh biopsies taken from the gastric antrum and body of 24 patients who had undergone endoscopy for dyspepsia, and 48 paraffin-embedded antrum and body biopsies taken from the files of our Department were studied by flow-cytometry. The following markers and parameters were considered: S-phase, proliferation index, PCNA and ploidy. RESULTS: No correlation was found between Hp+ or Hp- gastritis and gastric cell proliferation and no cases of aneuploidy were observed. Gastric proliferation was found to vary depending on the methods, markers and type of biopsy employed. Furthermore, proliferation expressed by PCNA was significantly different in antrum and body. CONCLUSIONS: The commonly studied proliferation markers do not allow the early detection of patients at risk of gastric cancer by flow cytometry. Proliferation differences between body and antrum must be taken into account in the investigation of gastric diseases.

Adult↗
PubMedDate not supplied

Proliferating cell nuclear antigen (PCNA) as a prognostic factor for colorectal cancer.

PCNA (proliferating cell nuclear antigen) is a cell cycle related protein that is maximally elevated in late G1 and S-phase of proliferating cells. 114 biopsy specimens of colorectal cancer were immunolabeled with PC 10 which specifically recognizes PCNA; Dukes' staging and histological grading were estimated for each case. All patients were followed-up for at least 60 months or to death. All data were analysed by the computer program NCSS (Number Cruncher Statistical System). According to the results, PCNA-index may be considered an independent prognostic factor for colorectal cancer; it may also be helpful in supporting the therapeutic strategies based only on Dukes' stage.

Colorectal Neoplasms↗
PubMedDate not supplied

Duodenal obstruction from chronic pancreatitis.

The fibrosclerosing process of the pancreas in the chronic pancreatitis may constrict not only the pancreatic duct but also the bile duct, splenoportal venous system and duodenum. In our retrospective study we analysed 24 patients with duodenal obstruction associated with chronic pancreatitis. Duodenal obstruction was suspected whenever repeated vomiting occurred or large volumes of nasogastric aspirate were obtained. The diagnosis was confirmed by barium meal and endoscopic examination. Duodenal obstruction was relieved by gastrojejunostomy in eight patients, gastrojejunostomy and vagotomy in eight patients, gastroduodenostomy and vagotomy in two patients, vagotomy with Finney pyloroplasty in one patient, duodenoplasty with vagotomy in one patient and Whipple procedure in four patients. We concluded that vagotomy and gastroenterostomy are the procedures of choice. Bypass surgery is helpful to relieve the obstruction of the common bile duct and pancreatic duct. Whipple procedure should be reserved for the small duct form of chronic pancreatitis and for the cases in which there is high suspicion of malignancy.

Adult↗
PubMedDate not supplied

Diagnosis and treatment of liver hydatid disease.

BACKGROUND/AIMS: Human echinococcosis is endemic in some areas of the world, including Mediterranean countries. The liver is the most frequent seat of echinococcosis, involved in about 70% of cases. Because there is still no effective medical therapy, surgery remains the treatment of choice. METHODOLOGY: Twenty-seven patients operated on for liver hydatid disease between 1990 and 1995 were analyzed and compared with results obtained from a study undertaken at our clinic between 1960 and 1988. RESULTS: The diagnosis was established by typical case history, clinical features and laboratory tests, of which imaging methods proved most informative. Radical procedures (total pericystectomy and liver resection) seem to be too aggressive for treatment. Marsupialization and drainage were mostly abandoned, because of high morbidity rates. CONCLUSIONS: Among surgical procedures used at our clinic, evacuation of the cyst with partial excision of the pericyst and omentoplasty resulted in the lowest morbidity and, thereupon, the shortest post-operative hospital stay and the best clinical results.

Adult↗