[Antibiotics and pseudomembranous colitis].
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Anti-Bacterial Agents↗
Biomedical subjects
F Narducci
Publications and source records attributed to F Narducci.
A double-blind, short-term clinical trial of pirenzepine in duodenal ulcer.
The effectiveness of pirenzepine in the treatment of duodenal ulcer was assessed in a double-blind clinical trial in comparison with placebo. Twenty-nine of 30 patients satisfactorily completed the trial. There was endoscopic ulcer healing in 4 of 14 pirenzepine treated patients (29%) after 2 weeks of treatment and in 11 of 14 (79%) after 6 weeks. There was no healing in 15 patients treated with placebo after 2 weeks and there were two ulcers healed after 6 weeks. The difference between pirenzepine and placebo was significant in both 2nd and 6th week. Duodenitis (evaluated by endoscopy) markedly improved in the pirenzepine grouu after 2 (4 of 9 patients) and after 6 weeks of treatment (8 of 9), while no, or only slight, improvement was observed in 8 of 8 patients in the placebo group. When evaluated by ulcer symptom relief and antacid tablet comsumption, pirenzepine proved to be considerable more efficacious than the placebo. The results of this study demonstrate that pirenzepine promoted duodenal ulcer healing, that it markedly improved peptic duodenitis and promoted rapid regression of symptomatology in parallel with endoscopic findings.
Adolescent↗
Pirenzepine in the treatment of gastric ulcer. A double-blind short-term clinical trial.
The effectiveness of pirenzepine in the treatment of gastric ulcer was assessed in a double-blind 6 weeks' clinical trial in comparison with placebo. After 2 weeks of treatment 1 patient in each group showed a complete healing of gastric ulcer. After 6 weeks of treatment 9 out of 10 patients in the pirenzepine group (90%) and 4 out of 10 patients in the placebo group (40%) healed (P less than 0.05). The relief of ulcer symptoms was significantly better in the pirenzepine group than in the placebo group. From the second week on, the pirenzepine-treated patients stopped taking antacid while placebo-treated patients went on taking it (P less than 0.02). The results of this study demonstrated that pirenzepine promotes gastric ulcer healing and induces a rapid regression of ulcer symptoms.
Adolescent↗
[Transendoscopic retrograde cholangiography in the diagnosis of primary sclerosing cholangitis. Study of 6 cases].
Primary sclerosing cholangitis (PSC) is a rare disease of unknown etiology characterized by severe chronic inflammation, fibrosis and stenosis of variable length of the extra and/or intrahepatic biliary ducts in the absence of recent operative trauma, biliary stones, cancer or infection. Diagnosis has been made only at operation. The introduction of endoscopic retrograde cholangiography (ERC) offers the possibility of preoperative diagnosis. Six cases of PSC diagnosed by ERC are presented. Characteristic roentgenologic findings include strictures of variable length of extra and intrahepatic biliary ducts, beaded appearance and decreased arborization of intrahepatic biliary tree. The roentgenological anatomy of biliary tree at ERC influence the subsequent therapy, i.e. surgical therapy is indicated if a drainage can be performed above the site of the stenosis, while medical therapy (steroids and/or immunosuppressive drugs) is the choice when intrahepatic biliary tree is involved.
Adult↗
[Evaluation of transendoscopic retrograde cholangio-pancreatography in 151 jaundiced patients].
Endoscopic retrograde cholangiopancreatography was performed for possible obstruction of the extra-hepatic bile ducts in 151 patients with jaundice. The endoscope findings (9 cases) and the retrograde cholangiopancreatogram (127 cases) provided a final diagnosis in 131 cases. A correct surgical indication was obtaines in a further 5 cases (90% diagnostic success overall). In 19 cases, unnecessary exploratory laparotomy was avoided by the demonstration of normal extrahepatic ducts. No complications were noted. It is concluded that this technique is virtually free from risks and offers prompt diagnosis in subjects with jaundice. This, of course, has a significant influence on the subsequent treatment.
Adult↗
[Diagnostic value of retrograde cholangiopancreatography by transendoscopic route].
Endoscopic retrograde cholangiopancreatography (ERCP) is essential in the diagnosis of pancreatic disease, jaundice and in post-cholecystectomy syndromes, as well as in cases where cholecystography and i.v. cholangiography fail to explain disturbances that strongly suggest bile duct involvement. Its confirmation of clinically established pancreatic disease is much more positive than that given by scintiscanning and multiple superselective arteriography. Unlike the latter, it also permits the differential diagnosis of chronic pancreatitis, cancer of the pancreas, pseudocysts, etc. and distinguishes medical and surgical pancreatitis (stenosis, proteinaceous calculi, and obstructing pseudocysts). Differential diagnosis of progressive jaundice on clinical grounds or with the aid of ordinary means of examination is sometimes unsatisfactory. ERCP clearly distinguishes medical and surgical forms, so that exploratory laparotomy is not needed in subjects with liver-cell forms. It also shows the nature, site and extent of extrahepatic obstruction, and points to the organic cause in 79% of cases of postcholecystectomy syndrome. Right hypochondrial pain or intermittent jaundice and negative cholecystography and i.v. cholangiography is a further indication, since ERCP will reveal disease of the pancreas or bile ducts (cholelithiasis, choledocholithiasis, sclerosing cholangitis, etc). It is also useful in the diagnosis of cirrhosis, abscess, echinococcus cyst and primary or secondary cancer in cases where needle biopsy and-or arteriography are either contra-indicated or inconclusive.
Biliary Tract Diseases↗
An unusual case of biliary dyskinesia demonstrated by endoscopic retrograde cholangiography.
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Adult↗
Can Mirizzi syndrome be classified into acute and chronic form? An endoscopic retrograde cholangiography (ERC) study.
Three cases of Mirizzi syndrome (partial mechanical obstruction of the common hepatic duct owing to compression by a stone impacted in the cystic duct or gallbladder neck, or due to the inflammatory reaction resulting from compression) are reported. The roentgen features at endoscopic retrograde cholangiography (ERC) are discussed. As there are two causes for obstruction, compression or chronic fibrosing reaction resulting from compression, two characteristic X-ray findings and two operating techniques, the authors contend that Mirizzi syndrome should be classified as acute or chronic.
Acute Disease↗
Dopamine uptake by platelets in hepatic encephalopathy; evidence for a possible depletion of brain dopamine.
A decrease in H3-dopamine uptake was demonstrated in the blood platelets of 22 hepatic encephalopathy (HE) patients when compared to that of patients with liver cirrhosis, but without HE, and controls. There was a direct correlation between the stage of HE and the decrease in H3-dopamine uptake. As blood platelets have characteristics similar to neurons which contain amines, they have been proposed as a model for the study of amine metabolism in neurological, as well as liver diseases. A defective dopamine uptake by the HE platelets suggests that a similar biochemical derangement is, also, present in the nerve cells of the dopaminergic system. This could account for the clinical evidence of extrapiramidal dysfunction and the arousal effect of levodopa in HE. Platelets from 10 cirrhosis, but HE-free, patients had a dopamine uptake which was intermediate between the HE patients and controls. When octopamine was added at the same concentrations as in serum of HE patients, the blood platelets from five controls showed a decrease in dopamine uptake proportional to the concentration of octopamine added. Octopamine may impair dopamine uptake by platelets from HE patients.
Adult↗
Surgical staging of early invasive epithelial ovarian tumors.
Early stage epithelial ovarian carcinoma is defined pathologically as a tumor strictly limited to one or both ovaries without any extra-ovarian disease (i.e., Stage IA or B of the International Federation of Gynecology and Obstetrics (FIGO) classification). This diagnosis can be obtained only after an exhaustive surgical staging procedure, performed as soon as the diagnosis of epithelial invasive ovarian carcinoma is established. This staging surgery currently encompasses a peritoneal cytology, the thorough inspection of all the visceral and parietal peritoneal surfaces with biopsy of any abnormality, total abdominal hysterectomy and bilateral salpingo-oophorectomy (TAH + BSO), random peritoneal biopsies, omentectomy, appendectomy and bilateral pelvic and para-aortic lymphadenectomies, up to the left renal vein. The results of this staging procedure and its indications are discussed. In all of the cases, the radical removal of the pathologic adnexa is indicated, along with the complete peritoneal and retroperitoneal staging. While fertility-sparing surgery (avoiding hysterectomy and contralateral adnexectomy, if possible) seems to be safe for young women, a TAH + BSO is the rule for the others. Adjuvant chemotherapy can be omitted in well-differentiated tumors with a negative staging operation, but currently it remains indicated in all other cases. Indeed, the ultimate goal in early stage ovarian carcinoma is to not impair by inadequate management the high chance of a cure.
Carcinoma↗
[Endometrial cancer: what's new?].
OBJECTIVES: New and much debated data of the endometrial cancer concerning the preoperative assessment of myometrial invasion, the surgical staging, and the adjuvant treatment. PATIENTS AND METHODS: Medline (1998-2002): searching for "endometrial carcinoma". RESULTS: The pap smears are useful when it is difficult to have a transvaginal ultrasonography or an MRI. We can perform the pap smears and the endometrial biopsy in the clinic. If a patient has pap smears with malignant cells or elevated preoperative CA 125, it probably is a cancer with poor prognostic factors. Surgical staging with abdominal and node evaluation is necessary. The MRI seems to be the best preoperative imaging because we have information about adnexal and abdominal metastases, pelvic or aortic nodes and the invasion of the myometrium. So it gives us information on the surgical route, and provides indication for a lymphadenectomy. The surgical staging is a part of the treatment of the endometrial cancer: an exploration of the peritoneal cavity, a pelvic lymphadenectomy, a para-aortic lymphadenectomy if the pelvic nodes are positive or if there are factors of bad prognosis (deep stage IC, grade 3, adnexal or abdominal involvement, serous carcinoma of the endometrium). It can be performed if technical conditions are correct. The adjuvant teletherapy in the documented stage IpN0 (surgical staging with pelvic lymphadenectomy) does not seem to be necessary. But we can perform an adjuvant brachytherapy (high-dose rate if it is possible) in patients with a high local recurrence (stage IC, stage I with grade 3, stage IB grade 2). CONCLUSION: The preoperative MRI is useful choosing the surgical approach, and the depth of the myometrial invasion, which can be an indication for a pelvic lymphadenectomy. The surgical staging must be a part of the treatment of the endometrial cancer. So the adjuvant teletherapy in patients with stage IpN0 documented should not be used.
Adenocarcinoma↗
[Changes in the level of erythrocyte phosphorylated compounds in patients with hepatic encephalopathy].
Automated ion exchange chromatography was used to compare red cell phosphorylates in clinically healthy subjects and 6 patients with hepatic encephalopathy. Significant changes in the distribution of these compounds were noted, including a marked increase in total acid-soluble content (particularly 2.3 DPG, R5P, 3MPG and G16DP) and a sharp fall in ATP. Increased 2.3 DPG explained the rightward shift of the haemoglobin dissociation curve seen in cirrhosis of the liver, but does not seem to fit in with enhanced blood ammonia. Deep-seated changes in red cell energy metabolism may have the same pathogenesis as the CNS metabolic change observed in hepatic encephalopathy.
Adenine Nucleotides↗
[Changes in the Q-T interval in the acute phase of myocardial infarct].
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Electrocardiography↗