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G Manes

Publications and source records attributed to G Manes.

52 records · Page 3Linked to original sources
PubMed1995

Effect of pancreatic ductal and parenchymal changes on exocrine function in chronic pancreatitis.

The effect of pancreatic ductal and parenchymal changes on exocrine pancreatic function was analyzed prospectively in 75 patients with chronic pancreatitis (CP). Endoscopic retrograde pancreatography (ERP), computed tomography (CT), and serum pancreolauryl test (PLT) were performed to evaluate the degree of ductal, parenchymal, and functional changes, respectively. Results were evaluated by stepwise multivariate logistic regression and are expressed as the odds ratio (OR). A strong association was found between the degree of ductal changes in ERP and the degree of exocrine functional impairment (OR = 5.8). However, the association between the degree of parenchymal changes in CT and the degree of pancreatic dysfunction was weaker and was clearly confounded by the degree of ductal changes. On the basis of these findings, we suggest that the development of exocrine pancreatic functional impairment in patients with CP depends primarily on the degree of ductal changes, while parenchymal abnormalities play a less important role.

Adult↗
PubMed1995

Early prediction of aetiology and severity of acute pancreatitis by serum amylase and lipase assays.

OBJECTIVE: To evaluate whether simple pancreatic enzyme assays are useful in the early assessment of aetiology and prognosis of acute pancreatitis. DESIGN: A retrospective clinical study. SETTING: Department of Internal Medicine with a Pancreatic Disease Centre. PATIENTS: The study included 246 patients with acute pancreatitis admitted to our Unit within the first 24 hours from the onset of disease. Amylase and lipase serum levels and lipase/amylase ratio were evaluated. RESULTS: Serum amylase was higher in patients with necrotizing pancreatitis than oedematous and biliary pancreatitis than alcoholic (p < 0.009 and p < 0.05 respectively), but a high degree of overlap between values was found. No differences were noted in lipase serum levels. Lipase/amylase ratio was not different between patients with alcoholic and nonalcoholic pancreatitis. CONCLUSIONS: Evaluation of serum amylase and lipase is not useful for assessing aetiology and severity of acute pancreatitis, although amylase may be higher in severe and biliary forms.

Acute Disease↗
PubMed1995

Rare presentation of endocrine pancreatic tumour: a case of glucagonoma without necrolytic migratory erythema?

The case of a 61-year-old woman with a probable pancreatic glucagonoma in reported. The clinical peculiarity of this case is the lack of the characteristic necrolytic migratory erythema (NME); the patient presented asthenia, weight loss and hyperglycemia. Ultrasonography, CT-scan and arterography showed a irregular pancreatic mass and secondary diffuse hepatic lesions. Fine needle aspiration cytology with immunohistochemistry and glucagon serum levels yielded to the diagnosis. Surgical treatment was not proposed because of the advanced stage of the disease; therefore, chemotherapy (streptozotocin, 5-fluorouracil) was performed. During a 16-month follow-up period the patient did not develop NME.

Female↗
PubMed1994

Is increased pancreatic pressure related to pain in chronic pancreatitis?

In this study, we investigated the relationship between pain and pancreatic pressure in patients with chronic pancreatitis (CP). We studied 12 patients with CP undergoing surgery and five controls with cancer of the pancreatic tail. CP was staged on the basis of morphological (ERP) and functional (serum-pancreolauryl test) criteria. Patients kept daily records of the intensity of pain on a linear analog scale. Intraoperatively, pressure within the pancreas was assessed by the introduction of a fine needle into the pancreatic parenchyma connected to a pressure transducer. In controls, pressure was determined in macroscopically normal tissue in the head of the pancreas. Pancreatic pressure was significantly higher in CP than in controls (29.9 +/- 3.1 vs 7.2 +/- 1.1 mmHg, p < 0.001). No relationship was found between the pain score and the pancreatic pressure. Pressure was positively correlated with ductal changes (r = 0.831; p < 0.001), but not with exocrine function of the pancreas. Postoperatively, pancreatic pressure fell by 15.3% in four patients with CP in whom pressure assessment was repeated after surgical decompression. We conclude that pancreatic parenchyma pressure is not closely related to pain in CP.

Adult↗
PubMed1994

[Serum pancreatic enzymes in patients with chronic renal failure on hemodialysis and in transplant patients].

OBJECTIVE: The aim of this study was to evaluate which of serum pancreatic enzymes was less influenced by chronic renal failure (CRF). MATERIALS AND METHODS: 40 patients with CRF undergoing hemodialysis (A group) and 24 renal transplant patients (B group) were considered. None of these patients showed clinical and instrumental findings of exocrine pancreas disease. Total amylase (T Amy), pancreatic isoamylase (P Amy), lipase (L) and Elastase-1 (E-1) were measured (in A group immediately before hemodialysis). RESULTS: In A group T Amy and P Amy showed a significant correlation with serum creatinine level. In A group T Amy serum levels were increased in 65% of cases, P Amy in 72.5%, L in 47.5%, E-1 in 10%; in B group T Amy serum levels were increased in 41.6%, P Amy in 20.1%, L in 8.3% and E-1 in 4.1%. Statistical comparison showed a significantly lower percentages in B group considering P Amy (p < 0.001) and L (p = 0.003). CONCLUSIONS: Our data suggest that E-1 is the only pancreatic enzyme whose specificity is not limited by CRF and thereby may be of value in the diagnosis of the exocrine pancreatic disease in patients with CRF on hemodialysis.

Adolescent↗
PubMed1994

Early prognostic assessment of acute pancreatitis with sterile necrosis. A perspective clinical study.

In an attempt to early assess the prognosis of acute pancreatitis with sterile necrosis, we have perspectively studied 40 patients with necrotizing acute pancreatitis and sterile necrosis in the first 48 hours of disease. As prognostic parameters, we have considered the computed tomography score according to Balthazar, simplified prognostic criteria according to Agarwal, Glasgow criteria and C reactive protein. Patients were divided in A group, 5 patients who died, and B group, 35 patients who survived. Computed tomography score, simplified prognostic criteria and Glasgow criteria were significantly higher in A group than B (9.5 +/- 1 vs 6.3 +/- 1.9, 3.6 +/- 0.5 vs 1.2 +/- 1.2 and 5.4 +/- 1.7 vs 2.7 +/- 1.9 respectively); conversely, C reactive protein serum levels did not show significantly difference in the two groups. We conclude that the extension of pancreatic and extrapancreatic necrosis, as measured by computed tomography, as well as the failure of extrapancreatic organs and the development of systemic and metabolic complications, as assessed by simplified prognostic score and Glasgow criteria, are the most important determinant of prognosis in necrotizing acute pancreatitis with sterile necrosis.

Acute Disease↗
PubMed1993

Assessment of the fibrogenetic activity in chronic pancreatitis. The role of circulating levels of extracellular matrix components.

Determination of circulating levels of extracellular matrix components has been proposed as a reliable method to assess the activity of fibrogenetic processes. Therefore, we aimed to analyze circulating levels of laminin, fibronectin, and procollagen III peptide (PIIIP) in patients with chronic pancreatitis (CP) and to correlate them with the morphological and functional stage, and duration of the disease. Thirty patients with CP and 18 healthy controls were studied. Serum PIIIP concentrations (RIA), but not fibronectin (RID) and laminin (RIA), were abnormally high in 8 patients with CP. No correlation was found between circulating levels of extracellular matrix components and both functional and morphological stage and duration of CP. Nevertheless, patients with elevated serum PIIIP levels tend to have a more advanced CP (morphological and functional changes) than those with normal levels after a similar duration of the disease. We hypothesize that whereas functional and morphological findings reflect the cumulative effect of chronic inflammation on the pancreas, serum PIIIP concentrations would reflect the activity of the fibrogenetic process within the gland at the time of sampling. The results shown in the present study may be considered a starting point for longitudinal studies that examine the relationship between serum PIIIP or other markers for fibrogenetic activity and evolution of CP.

Adult↗
PubMed1987

Aldosterone and the mobilization of energy.

Aldosterone diminishes the ability to endure starvation. Its exogenous administration to adrenalectomized rats advances the onset of hypothermia and death. The impairment seems to lie in an inability to mobilize energy stores fully: animals given the steroid are unable to lose weight at a normal rate. The findings help to establish the significance of mineralocorticoids in the regulation of energy exchange and solve some theoretical questions as to their general mode of action.

Adrenalectomy↗
PubMedDate not supplied

Manometric and pH-metric features in gastro-oesophageal reflux disease patients with and without Helicobacter pylori infection.

BACKGROUND: The role of Helicobacter pylori in the pathogenesis and evolution of gastro-oesophageal reflux disease is still debated. AIM: To investigate the impact of Helicobacter pylori infection on the oesophageal function and on intra-gastric and intra-oesophageal pH in patients with gastro-oesophageal reflux. METHODS: Fifty patients with non-complicated-gastro-oesophageal reflux disease classified according to Savary-Miller in: grade O, n=24; grade 1, n=19; grade 2, n=6; grade 3, n=1. Of these patients, 24 were Helicobacter pylori positive and 26 negative. Patients underwent, on two different days, stationary oesophageal manometry and 24-hour gastro-oesophageal pH-metry. RESULTS: No difference was observed between Helicobacter pylori infected and non-infected individuals with regard to lower oesophageal sphincter function, oesophageal peristalsis and gastrooesophageal reflux. These parameters were more impaired in individuals with erosive gastro-oesophageal reflux disease but this result was not dependent on the Helicobacter pylori status. Helicobacter pylori did not influence the pattern of gastric pH; however, considering only individuals with non-erosive gastro-oesophageal reflux disease, gastric pH was significantly higher in infected individuals, who, histologically, also showed a corpus predominant gastritis. CONCLUSIONS: In patients with gastro-oesophageal reflux disease, Helicobacter pylori does not affect the oesophageal motility or the gastro-oesophageal reflux. These parameters are strictly related to the severity of gastro-oesophageal reflux disease as assessed at endoscopy. In patients with non-erosive gastro-oesophageal reflux disease, a corpus predominant Helicobacter pylori gastritis could be responsible for the less severe gastro-oesophageal reflux.

Adult↗
PubMedDate not supplied

Effect of cisapride on gastric sensitivity to distension, gastric compliance and duodeno-gastric reflexes in healthy humans.

BACKGROUND AND AIMS: Visceral hypersensitivity and impaired gastric relaxation after the ingestion of a meal are frequent features in patients with functional dyspepsia. Cisapride improves dyspeptic symptoms. The study aims to evaluate whether cisapride influences gastric sensitivity to distension as well as gastric compliance and duodenogastric reflexes. PATIENTS AND METHODS: Eight healthy males were studied on two different days, each after 7 days' treatment either with placebo or cisapride 10 mg qid in randomized order. A spherical bag connected to a barostat was placed in the gastric fundus and an 8-lumen manometric catheter was positioned with 4 side holes in antrum and 4 in duodenum. During a phase II of the migrating motor complex, the intragastric bag was inflated at a constant pressure 1 mm Hg above the intra-abdominal pressure and the gastric volume was measured during intraduodenal infusion of lipids and citric acid at different rates. Once the stomach returned to the basal volume, the bag was distended according to two different protocols until subjects reported discomfort. Antroduodenal motility was measured throughout the study. RESULTS: Intraduodenal infusion of lipids and citric acid caused relaxation of gastric fundus. Relaxation was similar for lipids and acid (203 +/- 30 vs 199 +/- 43 ml), and was not influenced by cisapride and infusion rate. Cisapride did not influence gastric sensitivity to distension (10 +/- 1.5 vs 9.7 +/- 1.3 mm Hg) and gastric compliance (52.7 +/- 1.2 vs 49.8 +/- 1.8 ml/mm Hg). The antral motor index significantly decreased following infusion of acid and lipids with placebo but not with cisapride. CONCLUSIONS: Cisapride inhibits the physiological duodenoantral reflexes but does not influence either the mechanical properties of the gastric fundus nor the gastric sensitivity to distension.

Adult↗
PubMedDate not supplied

Chronic pancreatitis: diagnosis and staging.

Chronic pancreatitis is a dynamic disease characterized on one side by a progressive destruction of the pancreatic parenchyma and change in the architecture of the gland and on the other by the impairment of its function. Diagnosis of chronic pancreatitis may be a quite easy or a very difficult attempt according to the severity and evolutive stage of disease. In fact, while most patients presents with a typical history of alcohol abuse, recurrent abdominal pain and steatorrhea, in the late stage of disease it is not rare to see patients with symptoms and signs which may be not typical for pancreatitis. A large number of morphological and functional methods has been developed to allow an easy and early diagnosis of disease. However, while in the advanced stages of disease, where pancreatic insufficiency, calcifications, or pseudocysts are present, diagnosis is easy and most of the procedures show high sensitivity and specificity, in the early disease the degree of pancreatic dysfunction and structural change are too small to be detected by current methods. The present article aims to evaluate the different morphological and functional methods with their advantages and shortcomings, as well as to establish their role in the diagnostic assessment of chronic pancreatitis.

Cholangiopancreatography, Endoscopic Retrograde↗
PubMedDate not supplied

[Pain in chronic pancreatitis: recent pathogenetic findings].

Pain is the major symptom in chronic pancreatitis. Its intensity frequently necessitates partial or complete pancreatectomy. The mechanisms of pain are not yet fully understood and, thereby, the therapeutic management is still controversial. Possible causes of pain include outflow obstruction with increased ductal and parenchymal pressure within the pancreas, and inflammatory involvement of intrapancreatic nerve fibres. Possible extrapancreatic causes are common bile duct and duodenal stenosis. The first theory has recently been substantiated by the demonstration of a definite relationship between intrapancreatic pressure, as measured intraoperatively, and intensity of pain. Infiltration of inflammatory cells around the nerves together with an increase in the number of nerve fibres in the fibrotic pancreatic tissue has been proposed as a possible cause of pain in chronic pancreatitis. Moreover, immunohistological studies have shown that the amount of neurotransmitters, such as substance P, is increased in afferent pancreatic nerves. Stenosis of the common bile duct and duodenum has been reported to be associated with severe abdominal pain. Common bile duct and duodenal stenosis in chronic pancreatitis may be caused by extension of fibrosis and active inflammation of the pancreas within the wall of duodenum and bile duct. This article updates the different pathogenetic mechanisms in pancreatic pain and the current therapeutic possibilities with their advantages and shortcomings.

Chronic Disease↗