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Biomedical subjects

G De Ritis

Publications and source records attributed to G De Ritis.

At least 19 recordsLinked to original sources

Genetic history of cystic fibrosis mutations in Italy. I. Regional distribution.

Earlier analysis of the Italian population showed patterns of genetic differentiation that were interpreted as being the result of population settlements going back to pre-Roman times. DNA disease mutations may be a powerful tool in further testing this hypothesis since the analysis of diseased individuals can detect variants too rare to be resolved in normal individuals. We present data on the relative frequencies of 60 cystic fibrosis (CF) mutations in Italy and the geographical distribution of the 12 most frequent CF mutations screened in 3492 CF chromosomes originating in 13 Italian regions. The 12 most frequent mutations characterize about 73% of the Italian CF chromosomes. The most common mutation, delta F508, has an average frequency of 51%, followed by N1303K and G542X, both with average frequencies around 5%. Multivariate analyses show that the relative frequencies of CF mutations are heterogeneous among Italian regions, and that this heterogeneity is weakly correlated with the geographical pattern of non-DNA 'classical' genetic markers. The northern regions are well differentiated from the central-southern regions and within the former group the western and eastern regions are remarkably distinct. Moreover, Sardinia shows the presence of mutation T338I, which seems absent in any other European CF chromosome. The north-western regions of Italy, characterized by the mutation 1717-1G-->A, were under Celtic influence, while the north-east regions, characterized by the mutations R1162X, 2183AA-->G and 711 + 5G-->A, were under the influence of the Venetic culture.

Cystic Fibrosis↗

Ultrasound measurement of gastric emptying time in patients with cystic fibrosis and effect of ranitidine on delayed gastric emptying.

Intestinal dysmotility is commonly reported in patients with cystic fibrosis (CF); however, gastric motor activity has rarely been investigated. We measured with real-time ultrasonography the antral distention and gastric emptying time of a solid-liquid meal in 29 patients with CF (age range, 5 to 17 years). A significantly prolonged gastric emptying time was present in 26 patients compared with 13 healthy control subjects (age range, 5 to 16 years); an exaggerated antral distention in the fed period was also detected. The patients with CF and delayed gastric emptying were randomly allocated to receive cisapride or ranitidine for 4 weeks. Twelve patients treated with ranitidine and 11 with cisapride completed the trial. There was a marked decrease in gastric emptying time, antral distention, and dyspeptic symptomatic score in patients receiving ranitidine but not in patients treated with cisapride. We conclude that gastric dysmotility is commonly detected in patients with CF and that H2 receptor blockers are more effective than prokinetics in improving dyspeptic symptoms and gastric emptying and distention.

Adolescent↗

[Beta-haemolytic group A streptococcal acute pharyngo-tonsillitis in pediatric patients: a clinical and epidemiological study].

Authors compared the efficacy and safety of 10-day regimen of Cefaclor (CEC), oral suspension, at the dose of 25 mg/kg BID, and Amoxicillin/clavulanic acid (AMC), and Erythromycin (E) both given TID at the dose of 15 mg/kg in the treatment of proven group A beta hemolytic streptococcal pharyngo-tonsillitis. Of the 673 enrolled pediatric patients, 245 were selected and assigned to three groups of treatment (85 received CEC, 78 received AMC and 82 received E) and 217 were evaluated for efficacy. Clinical evaluations were performed on days 5 and 10 of treatment and 20 days after its completion (follow up). Before treatment, on treatment day 10 and at follow up throat swab cultures were performed. In evaluable patients the post-therapy clinical success and bacteriological eradication rate for CEC was 91.8% (68 of 74 evaluable patients); the rate for AMC and E were 90.5% (67/74) and 76.8% (53/69) respectively. At follow up bacteriological eradication was observed in 63 of 68 clinically cured patients (92.6%) in the CEC treatment group; in 64 of 67 (95.5%) in the AMC treatment group and in 49 of 53 (92.4%) in the E treatment group. Adverse events occurred in 24 of 217 (11.05%) treated patients and the incidence of side effects was lower in CEC group. In vitro sensitivity tests showed 37.9% of isolated SBEGA strains resistant to macrolides and 32% of SBEGA strains resistant to tetracycline. In our experience Cefaclor administered BID is as effective and more safe than Amoxicillin/clavulanic acid and more effective than Erythromycin both given TID.

English Abstract↗

Hansenula anomala killer toxin induces secretion and severe acute injury in the rat intestine.

BACKGROUND & AIMS: The yeast Hansenula anomala has been associated with gastrointestinal symptomatology and damage to the intestinal wall in humans. In vitro and in vivo, H. anomala secretes a toxin, killer toxin, which is lethal to other microorganisms. In view of the very high rate of killer phenotype expression recorded for H. anomala strains in nature, this study aimed to investigate the hypothesis that H. anomala killer toxin plays a role in the pathogenesis of H. anomala-induced enteritis. METHODS: Effects of active and heat-inactivated H. anomala killer toxin on intestinal fluid homeostasis and electrolyte balance were investigated in rat small intestine using a standard intestinal perfusion technique. Sections of the perfused jejunum tracts were examined histologically. RESULTS: H. anomala killer toxin induced a significant secretion of water and electrolytes. No significant change was observed when either heat-inactivated H. anomala killer toxin or control growth medium were tested. Histological analysis showed ischemic degeneration of villi and sloughing of surface epithelium in 50% of active H. anomala killer toxin-perfused jejuna. CONCLUSIONS: This paper presents original observations compatible with the hypothesis that H. anomala killer toxin plays a role in the pathogenesis of H. anomala-induced enteritis.

Animals↗

Multivariate prediction of in-hospital mortality associated with surgical procedures.

BACKGROUND: The aims of this prospective multicenter study were to identify variables associated with in-hospital mortality among patients undergoing surgical procedures, to develop a prediction rule, and to statistically validate its reliability. METHODS: Data from 24,654 consecutive informed patients over 15 years of age were collected from 22 surgical centers between January 1989 and December 1990. Using logistic regression analysis separate models were fit for seven surgical disciplines to predict the risk of 30-day in hospital mortality. Variables used to construct the regression models included age, sex, systolic blood pressure, renal dysfunction, hepatic dysfunction, concomitant diseases, severity of surgery, priority of surgery and duration of anesthesia. The performance of the prediction rule was evaluated by computing sensitivity, specificity and predictive values, analyzing the ROC curve and comparing observed with expected deaths. RESULTS: The significance of the independent variables varied within each model. All models significantly predicted the occurrence of in-hospital mortality. At a 0.5 cuptoint of predicted risk sensitivity of prediction rule was 99.89%, positive predictive value 98.51%, and overall predictive value 98.41%, whereas specificity was 7.92% and negative value slightly higher than 50%. The area under the ROC curve was 0.80 (perfect, 1.0). The correlation between observed and expected deaths was 0.99. CONCLUSION: This prediction rule, developed using multicenter data, is characterized by the following advantages: includes only nine variables; can be utilized by seven different surgical disciplines; is highly accurate, and is easily available to clinicals with access to a microcomputer or programmable calculator. This validated multivariate prediction rule would be useful both to calculate the risk of mortality for an individual surgical patient and to contrast observed and expected mortality rates for an institution or a particular clinician.

Adolescent↗

Effect of taurine supplementation on fat and energy absorption in cystic fibrosis.

In 10 children with cystic fibrosis and persisting steatorrhoea, supplementation with taurine (30-40 mg/kg/day) was given for two months as an adjunct to the usual pancreatic enzyme treatment. A three day fat and energy balance was performed in patients with cystic fibrosis, before and after the supplementation, and in seven healthy controls who did not receive taurine. Faecal fat was measured by a gravimetric method and stool energy was determined using a bomb calorimeter. Patients with cystic fibrosis, before and after taurine, and healthy controls received the same fat and energy intake (calculated by a dietitian). In patients with cystic fibrosis taurine did not produce any improvement of steatorrhoea (mean (SD) faecal fat 8.7 (3.3) v 11.2 (7.0) g/day, respectively before and after the supplementation), of faecal energy loss (0.978 (0.468) v 1.133 (0.539) MJ/day), of faecal fat expressed as percent of fat intake (13.4 (5.6) v 15.1 (9.8)%), and of faecal energy expressed as percent of energy intake (9.9 (3.6) v 11.2 (5.7)%). Healthy controls had significant lower fat (3.5 (2.3) g/day) and energy 0.576 (0.355) MJ/day faecal losses. In conclusion, taurine failed to decrease significantly fat and energy losses. Our study does not support the use of taurine supplementation in the nutritional management of cystic fibrosis.

Adolescent↗

Gliadin induced changes in the expression of MHC-class II antigens by human small intestinal epithelium. Organ culture studies with coeliac disease mucosa.

Jejunal biopsies from 16 treated coeliac disease patients and from nine controls were cultured with and without a peptic-tryptic digest of gliadin. Cultures with a peptic-tryptic digest of maize prolamins were also undertaken. Frozen sections of baseline and cultured mucosa were stained by immunofluorescence with an anti-HLA-DR monoclonal antibody. Before culture the villous epithelium from both controls and treated coeliac disease expressed DR molecules while the crypt epithelium did not. When biopsies from treated coeliac disease were cultured with gliadin the expression of DR was enhanced in the crypt epithelium in eight of 14 cultures and in 11 of 14 was reduced or absent on the villous epithelium. No change was observed in control cultures. We conclude that gliadin is capable of inducing HLA-DR on the crypt epithelium of in vitro cultured coeliac disease mucosa, providing indirect evidence that gliadin may activate cell mediated immune mechanisms within the small bowel mucosa. This model could prove useful in identifying the immunogenic sequence(s) of gliadins and related prolamins.

Celiac Disease↗

[Sweat-gland function in patients with X-linked ichthyosis].

Literature reports that patients affected by X-linked ichthyosis (XLI) have a reduction of sweat glands and a decrease of sweat production. The sweat physiology of 28 patients, 14 with XLI, 7 with lamellar ichthyosis, 7 with dominant ichthyosis and 28 control subjects were examined with sweat test, performed by pilocarpine iontophoresis. In the same patients we have performed skin biopsy to evaluate quantitative and qualitative reduction of sweat glands.

Adolescent↗

Amines protect in vitro the celiac small intestine from the damaging activity of gliadin peptides.

Proteins and peptides responsible for the celiac small intestinal lesion inhibit both the enterocyte recovery of in vitro cultured flat celiac mucosa and the in vitro development of fetal rat intestine. They also agglutinate K 562 (S) cells. Using these three in vitro systems (cultured human celiac and rat fetal intestine and cell agglutination), it is shown that several small-molecular-weight amines, mostly the polyamines spermidine and spermine, prevent and reverse K 562 (S) cell agglutination induced by gliadin peptides, whereas they do not prevent cell agglutination induced by concanavalin A and wheat germ agglutinin. Some of these amines also protected in vitro developing fetal rat intestine and flat celiac mucosa from the damaging effect of gliadin peptides. This protective effect may be related to the trophic activity exerted by amines on the intestine and/or the effect of amines on the functions of intestinal brush border or intracellular membranes involved in the intestinal handling of gliadins.

Abdomen↗

Mannan and oligomers of N-acetylglucosamine protect intestinal mucosa of celiac patients with active disease from in vitro toxicity of gliadin peptides.

Wheat flour and other cereals toxic for celiac patients contain an alcohol-soluble protein fraction that, under experimental conditions simulating in vivo protein digestion, yields peptides that agglutinate undifferentiated K 562(S) cells. In contrast, cereals well tolerated in celiac disease (i.e., rice and maize) do not. Furthermore, purified A-gliadin peptides that damage in vitro-cultured flat celiac mucosa are powerful agglutinins for K 562(S) cells, whereas A-gliadin peptides that do not show any adverse in vitro effect on celiac intestine lack agglutinating activity. Mannan, acetylglucosamine, and its oligomers (N,N'-diacetylchitobiose and N,N',N"-triacetylchitotriose) were able to prevent and reverse cell agglutination induced by peptides from all the toxic cereals. Moreover, mannan and N,N',N"-triacetylchitotriose exhibited a protective effect on intestinal mucosa specimens of patients with active celiac disease cultured with wheat protein-derived peptides. These data are consistent with the hypothesis that the agglutinating and toxic peptides are bound by carbohydrates.

Acetylglucosamine↗

Volume and emptying of the gallbladder in patients with cystic fibrosis.

As in cystic fibrosis (CF), gallbladder (GB) hypokinesia might play a role in the high incidence of either cholelithiasis or atrophic and hypoplastic GBs. We studied the contractility of the GB by ultrasonography (US) in 57 CF patients and in 25 age- and sex-matched healthy controls. We evaluated the status of the GB, the GB volume after an overnight fasting and 30 min after the ingestion of a standardized milk meal, the GB contractility (the percentage of reduction, (%R) of the GB volume after a meal), the presence of gallstones, and finally, the span of the liver. In addition, liver function test results were evaluated in the CF group. We concluded that the mean values of GB contractility in CF patients do not differ from those of healthy controls, the most hypokinetic GBs (%R less than 40%) being observed, however, only in the CF group. Gallstones occur in CF patients with a greater frequency than seen in the normal population, even in early childhood. The CF patients' GB mean volumes in fasting conditions are significantly greater than in healthy controls (13.5 +/- 2 versus 8.5 +/- 1.5 cc, p less than 0.0001).

Adolescent↗

Intestinal mucosa of celiacs in remission is unable to abolish toxicity of gliadin peptides on in vitro developing fetal rat intestine and cultured atrophic celiac mucosa.

Subfraction 2R of fraction 9 from a peptic-tryptic-pancreatic digest of wheat gliadin is known to be toxic in vivo to celiac patients. We have found that fractions 9 and 2R inhibit the in vitro development of fetal rat intestine and the increase of enterocyte height occurring in organ culture of atrophic celiac mucosa (0.1-0.5 mg/ml medium). Other peptide fractions of the gliadin digest are devoid of such in vitro effects. Subfraction 2R, after incubation with morphologically normal small intestinal mucosa of celiacs in remission and ultrafiltration, was still very active in both culture systems at low concentration (0.1 mg/ml); on the contrary, subfraction 2R was inactivated after incubation with normal mucosa. These results are compatible with the hypothesis that there is a mucosal defect in handling gliadin peptides in celiac disease, and suggest that there is either a primary (or secondary) enzyme deficiency or some other mechanism operating in the intestinal mucosa of celiac patients in remission.

Animals↗

The use of multiple logistic function to predict surgical risk.

A method for preoperative assessment of surgical risk, in function of several risk factors, was developed using the multiple logistic function, as a model of multivariate statistical analysis. This model has the advantage to express the two considered outcomes (perioperative complications and death) in numerical terms of probability. The data were obtained from 8630 consecutive patients admitted to 62 hospitals located in various regions of Italy. The patients were divided at random into two groups: group A (6040) was used to develop the method, and group B (2590) was used as control. The method is based on the role played by seven risk factors, that were shown to be significantly related to the two outcomes. These factors are age, systolic blood pressure, pathological changes of renal function, presence of concomitant diseases, estimated duration of surgical procedure, type (major or minor) and timing of surgery, (elective, delayed or emergency). The relative and independent role of each of these factors (beta) and the value of constant alpha were estimated by maximum likelihood method. The surgical risk is assessed by solving the multiple logistic equation, and multiplying the beta values by the corresponding individual coded values of the risk factors represented by the various x's. When the method was tested by applying the computed values of alpha and beta's to assess the outcomes in the control group, the predictions resulted highly accurate (r = 0.99). To simplify the calculation of surgical risk, in appendix a computer program in Basic, already predisposed to receive in code the individual values of x's, is reported.

Adolescent↗

Prevention by mannan and other sugars of in vitro damage of rat fetal small intestine induced by cereal prolamin peptides toxic for human celiac intestine.

Peptic-tryptic-cotazym and peptic-tryptic digests were obtained, simulating in vivo protein digestion, from pure "bread" wheat gliadins and from rye, barley, and oats prolamine and tested on small intestine cultures from fetal rats. When tested at a concentration of 0.1 mg of peptides/ml of culture medium the peptic-tryptic-cotazym and peptic-tryptic digests of gliadin and prolamines were very active in slowing in vitro development of fetal rat intestine and in increasing the occurrence and severity of degenerative changes. The ability of some sugars to interfere with inhibition of fetal intestinal morphogenesis induced by these peptides was also tested. Mannan at a concentration of 0.1 mM was effective in allowing intestinal morphogenesis to take place in the presence of prolamine peptic-tryptic-cotazym and prolamine peptic-tryptic digests of the four toxic cereals. Some oligomers of N-acetyl-glucosamine were also effective in blocking the inhibitory effect of "bread" wheat gliadin peptides. These data are compatible with the hypothesis that some sugars may exert a protective effect on the toxic activity of cereal prolamin peptides on the human celiac intestine.

Animals↗

The effect of early feeding on the onset of symptoms in celiac disease.

The appearance of celiac disease in infancy has often been related to the time when gluten is introduced into the diet, and more recently, to the kind of milk received in the early months. This retrospective study attempts to clarify the relation between breast-feeding and gluten introduction to the onset of symptoms of the disease. One hundred forty-six children with celiac disease, aged from 4 months to 11 years, were studied. The timing and types of feeds were recorded as well as the presenting symptoms of the disease. Data were analyzed by nonparametric statistical methods, as well as by parametric analysis after appropriate transformation. Children breast-fed for 3 months or more showed a marked delay in the onset of the disease and a longer latency time from gluten introduction to onset of disease, when compared with bottle-fed children. This relationship was present for both statistical analyses and was unrelated to the age at gluten introduction into the diet. Onset of disease was positively correlated to the duration of breast-feeding and not related to the age at gluten introduction.

Breast Feeding↗

Toxicity mechanisms of wheat and other cereals in celiac disease and related enteropathies.

This paper is a critical appraisal of current theories on the mechanisms of toxicity of wheat and other cereals in celiac disease and some related enteropathies. The "peptidase deficiency," "primary immune defect," and "gluten-lectin" theories on celiac disease are examined and critically discussed on the basis of the relevant data available in 88 references. Special attention has been paid in this review to the nature of the cereal components triggering the appearance of toxic symptoms and signs in celiac disease as well as to underlying action mechanisms. The gluten-lectin theory is the one best able to explain, in addition to celiac disease, some secondary intolerances that may occur in temporarily predisposed individuals as a consequence of several causes, including viral hepatitis and intestinal infections, as well as the occurrence of intestinal lesions in healthy subjects administered very high amounts of gluten.

Animals↗