Biomedical subjects

G Misciagna

Publications and source records attributed to G Misciagna.

At least 37 records · Page 2Linked to original sources

PubMed1994

[The effect of ursodeoxycholic acid in patients with liver cirrhosis and chronic hypertransaminasemia].

The aim of the study was to evaluate the effect of ursodeoxycholic acid (UDCA) oral administration on alanine aminotransferases (ALT) levels in cirrhotic patients with chronic hypertransaminasemia. Ninety consecutive patients with histologically proven liver cirrhosis and ALT levels higher than twice the upper limit of normal for at least six months, were admitted to the study. All the patients were treated with UDCA 10 mg/kg/day for one year. At the end of this period they were randomized to placebo or to continue UDCA therapy for three further months. ALT levels were evaluated before the beginning of UDCA therapy, at twelve and fifteen months by standard methods. After 12 months of UDCA, ALT decreased significantly (-39 UI, 95% confidence intervals -27 to -52 UI). At the 15 th month ALT did not vary with respect to its values at the 12th month in 36 patients randomized to continue UDCA, while it increased significantly in patients taking the placebo (+11 UI 95% confidence intervals +2 to +19). The results of this study suggest that UDCA is effective in controlling the biochemical activity of the liver disease in cirrhotic patients.

Adult↗

PubMed1993

Familial risk of colo-rectal cancer in a low incidence area in southern Italy.

The risk of colo-rectal cancer (CRC) in subjects with a positive family history (FH+) for malignancy has been assessed by means of a case-control study carried out between 1987-89 in an area of about 215,000 inhabitants in Southern Italy. One hundred and nineteen CRC cases were compared with 119 sex- and age-frequency matched population controls. Detailed pedigrees were collected at the family homes of both cases and controls. The odds ratio (OR) of CRC, adjusted by means of logistic regression for age, sex and number of first-degree relatives, increased with the number of any kinds of cancers in first-degree relatives with a significant linear trend (p = 0.042), while there was no risk with a FH+ for digestive cancer excluding CRC or for other cancers excluding large bowel and digestive organs. The OR (and 95% confidence interval) for CRC was 5.9 (1.64-21.23) for at least one first-degree relative with CRC. After a mutual adjustment between CRC and the other cancers in the families of cases and controls, the risk of CRC with a FH+ for other cancers did not change, revealing a strong association (p = 0.002) for CRC alone. From the analysis of the family history of cancer in the case group, the relative frequency of families that satisfied the criteria for so-called hereditary non-polyposic colo-rectal cancer (HNPCC) was 2.6%. The increased relative risk of CRC observed only in families with FH+ for CRC is a supportive finding for organizing and planning prevention and genetic counselling for these families, whose members should be referred for further assessment.

Aged↗

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.

Adult↗

PubMed1993

Endogenous sex hormones and cholesterol gallstones: a case-control study in an echographic survey of gallstones.

In a population survey of gallstones, the serum levels of hormones of the pituitary-gonadal axis and the sex hormone-binding globulin (SHBG) were compared in subjects with cholesterol gallstones and in a control group. In 84 subjects who entered the survey, echographic gallstones that had been identified at the survey, turned out to be radiolucent or mixed (predominantly of cholesterol) at subsequent x-ray. The controls were without gallstones at echography, matched to the cases for potential confounders of the association sex hormones-cholelithiasis. Testosterone (T) 17-beta-estradiol (E2), 17-OH progesterone (P), and SHBG were dosed by radioimmunoassay; follicle-stimulating hormone (FSH), luteinizing hormone (LH), and prolactin (Prl) by dissociation-enhanced lanthanide fluoro immunoassay (DELFIA). Men with gallstones had lower LH than controls (n = 34, median difference = -0.62 mU/ml, 95% confidence interval (CI) -1.20 to -0.26 mU/ml, paired sign test, p = 0.003). Premenopausal women in the luteal phase of the menstrual cycle with gallstones had higher E2 than controls (n = 7, median difference: +117, pg/ml, 95% CI: +10 to +218 pg/ml, p = 0.008). Postmenopausal women had lower LH than controls (n = 35, median difference = -4.57 mU/ml, 95% CI -9.5 to -1.0 mU/ml, p = 0.04). No other hormones showed statistically significant differences between cases and controls, in either males or females. The findings of this exploratory study in subjects with radiolucent and mixed gallstones suggest that men and postmenopausal women have lower LH, and premenopausal women in the luteal phase of the cycle have higher E2, than controls.

Adult↗

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.

Adult↗

PubMed1992

[Development of an integrated system of family medicine--pathologic anatomy service to start epidemiologic studies on tumors occurring in an area of southern Italy. First results].

In Italy there are eight tumor Population-Based Registries (PBRs) that publish incidence data, and only one of them (Ragusa) provides data for Southern Italy. Usually, PBRs are based on data collection from Pathologists and medical records. Our integrated system differentiates from traditional PBRs because the information comes from the General Practitioners (GPs) and is completed with the diagnosis provided by the Pathologists (Ps). During two years we have registered 1,057 new cancers on a middle period population of 212,644. GPs and Ps signed 395 and 879 incident cases, respectively. GPs alone provided 16.8%, Ps alone 62.6%, and either source 20.6% of total cases. After excluding non melanotic skin cancers and bladder carcinoma, the GPs-Ps integrated system counted 828 new cases in two years. These incidence data are the first in our region (Puglia). The 178 cases signed by GPs alone should have been lost if the informations of our PBR had been based only on local Ps' records. Moreover, 94 of GPs cases (11% of total cancers registered) were subjects who moved outside the area for diagnosis and treatment. Even if this article evaluates the effect of under-registration attributable to Ps or GPs, the cancer incidence data and the active involvement of GPs indicate that they could be usefully involved in the registration of cancer data.

Epidemiologic Methods↗

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.

Adult↗

PubMed1992

[Factors influencing the effect of ursodeoxycholic acid therapy in chronic hypertransaminasemia].

The aim of this work was to detect, in patients with chronic hypertransaminasemia (CH), the factors associated with the changes of ALT serum levels after one year of 10 mg/Kg/die ursodeoxycholic acid (UDCA). One hundred and twenty two consecutive patients with ALT values more than twice the normal upper limit for at least six months were admitted to the study. At the liver biopsy 82 patients were affected by liver cirrhosis (LC), 7 by chronic persistent hepatitis (CPH), and 14 by chronic active hepatitis (CAH). Nineteen patients were classified as unspecified chronic liver disease (UCLD) due to biopsy refusal. Five patients (4 LC and 1 UCLD) did not finish the study. Before and after the beginning of the treatment ALT and the other routine tests of liver function were determined in serum by routine laboratory methods. In all the diagnosis a decrease of ALT was observed after one year UDCA therapy. Particularly, in cirrhotic patients a reduction of 40% in the ALT serum levels was detected (baseline m +/- ds 98 +/- 55 UI, one year transaminase decrease -39 UI with 95% C.I. -27 UI to -52 UI). Furthermore in liver cirrhosis there was an increase of serum albumin (baseline m +/- ds 3.5 +/- 0.6, one year albumin increase +0.2 gr with 95% I.C. +0.1 gr to +0.3 gr). The decrease of ALT showed an inverse association (p < 0.05) with the presence of antibodies to hepatitis C virus and with diagnosis of CAH, and a direct one with the basal values of ALT.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1991

Prevalence of pigment gallstones in sheep.

In a survey of 666 sheep at a slaughterhouse, gallstones (concretions with a diameter greater than or equal to 1 mm) were found in the gallbladder of 50 sheep (7.5%), sludge (concretions with a diameter less than 1 mm) was found in 9 sheep (1.4%), and sludge plus gallstones were found in 7 sheep (1.1%). Gallstones and sludge were associated, and were more frequent in lambs and females, compared with adults and males. Qualitative analysis of the stones revealed all to be pigment (bilirubin) stones. There was a statistically significant increase of biliary bilirubin (total and indirect quota) only in sheep with gallstones plus sludge, compared with control sheep without sludge or gallstones. Concentrations of bilirubin, cholesterol, phospholipids, total and single bile aids, and total and ionized calcium were similar in the bile of sheep with gallstones, sludge, or both and control sheep. Bacteriologic analysis of the bile in 10 sheep with gallstones and 10 controls revealed bacteria in 50% of the first group and in 75% of the second group (Escherichia coli in all sheep and Salmonella spp also in 1 sheep with gallstones). These findings confirm our earlier findings of a high prevalence of black pigment gallstones in sheep. On that basis, we suggest that gallstones are associated with high total bilirubin concentration in the bile, and deconjugating bacteria are common in the biliary tract of these animals.

Animals↗

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.

Adult↗

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.

Adult↗

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.

Adult↗

PubMed1990

Relationships between environmental and genetic risk factors in the aetiology of diseases and problems in the interpretation of case-control and cohort studies. Cholelithiasis as a model.

Gallstones are used as a model to individuate some theoretical grounds which can produce different outcomes between case-control or cohort epidemiologic studies and ecological studies. Incongruities take place when several independent causes are involved in the aetiology of a disease. These occur particularly when genetic and environmental causes are present and the latter bring out the disease in subjects bearing the genetic alteration. Under these circumstances (very frequent in the aetiology of chronic diseases) case-control or cohort studies are more likely to discover genetic risk factors of diseases since they compare subjects within a population that have more genetic than environmental differences. On the other hand, ecological studies tend to indicate environmental risk factors of diseases since they confront populations most often with greater environmental differences than genetic differences.

Case-Control Studies↗

PubMed1989

Serum and bile lipid levels in a postmenopausal woman after percutaneous and oral natural estrogens.

17 beta-Estradiol was administered for 4 weeks percutaneously (5 mg/day) and, after a 6-week period to allow the drug to wash out, orally (2 mg/day) to a postmenopausal woman in whom a Kerr tube had been placed because of an iatrogenic lesion of the common bile duct. After both methods of administration, there was an increase in the biliary cholesterol concentration, but after oral administration, bile flow also increased and cholesterol crystals appeared in the bile. The percutaneous method of estradiol administration in postmenopausal women seems to be less dangerous for the biliary tract.

Administration, Cutaneous↗

PubMed1989

Cigarette smoking and ulcerative colitis. A case control study.

In order to examine the relationship between cigarette smoking and ulcerative colitis (UC), we carried out a case-control study of smoking habits in 84 patients with UC and in two different types of controls: 84 taken from a hospital population and 84 from the general population, matched to the cases for age, sex, school education and social class. Non-smokers were found to have a greater UC risk than smokers in both internal controls (Odds ratio = 4.6, 95% CL = 1.8-11.7) and external controls (OR = 10, 95% CL = 3.6-26.9). There was a larger number of ex-smokers among patients with UC than among the controls. Evaluations at the time of disease onset also demonstrated that ex-smokers had a greater relative risk. Furthermore, 84% of the ex-smoker patients had stopped smoking before the onset of symptoms. Conditional multiple logistic regression with the introduction of alcohol (wine) and coffee as additional variable factors to age, sex, education and social class confirmed the independent protective effect of smoking on UC (OR for internal controls = 4.2, 95% CL = 1.7-10.2, OR for external controls = 5.7, 95% CL = 2.3-14.1). These results indicate that non-smokers and especially ex-smokers of cigarettes have a greater risk of UC, and thus confirm the results of other studies.

Adolescent↗

PubMed1988

Spontaneous cholelithiasis in sheep: prevalence survey and analysis of gallstones and bile.

In an abattoir survey of the consecutive series of 206 sheep at a local slaughterhouse, gallstones (concretions with a diameter equal to or greater than 1 mm) were found in the gall bladder of 24 animals. There were stones in 19 out of 146 adult sheep and in 5 out of 60 lambs, with the higher frequency in the male sex in both groups. Qualitative analysis of the stones showed that all of them were pigment (bilirubin) stones. There was no statistically significant difference (paired t test, P greater than 0.05) between the amounts of biliary cholesterol, phospholipids, bile acids and total and indirect bilirubin in 12 sheep with gallstones and 12 control sheep without gallstones, paired for age, sex and day of slaughter.

Age Factors↗

PubMed1988

Cholelithiasis after Billroth II gastric resection.

We evaluate whether Billroth II (BII) gastric resection is a predisposing condition in the formation of gallstones. In our department radiologic and echographic imaging is a routine examination before abdominal surgery. From 1980 to 1985, 202 patients underwent cholecystography or ultrasonography before BII gastric resections for peptic ulcers. The prevalence of cholelithiasis in a random sample of the population of the town near our institution was used to calculate the expected frequency of gallstones. The comparison of the expected and the observed frequencies of cholelithiasis in these patients did not show any statistically significant difference between men and women. All these patients were recalled for a follow-up of the long-term effects of gastric surgery, and 66% (133/202) returned and were examined. They underwent ultrasonography of the biliary tract. Again the observed and the expected (obtained as before) frequencies of cholelithiasis were compared. A statistically significant difference was apparent in male patients. We conclude that BII gastric resection could be a predisposing factor in the formation of gallstones in men.

Adult↗

PubMed1987

Gallstones and uterine fibroids.

In a series published in 1961, an unusual frequency of hysterectomies for uterine leiomyomas (fibroids) was reported in women with gallstones. The purpose of this study was to confirm the association between gallstones and uterine leiomyomas with a patient control study and to investigate its physiopathologic basis comparing the cholesterol saturation of bile in women with gallstones, in women with leiomyomas but no gallstones and in those in the control group with no gallstones or leiomyomas. Patients admitted to the surgical department have, routinely, echography of the gallbladder before and manual exploration of the pelvic floor during surgical intervention. For the first part of the study, we collected information concerning the diagnosis of leiomyomas from the operating room registers and about the diagnosis of gallstones from the clinical records. In 1982, 42 of 139 women operated upon consecutively for gallstones and five of 69 operated upon for other diseases of the gastrointestinal tract had leiomyomas, a statistically significant difference (chi-square test, p less than 0.001). This difference persisted stratifying women with gallstones and those in the control group for age. In the second part of the study, we examined the bile collected at duodenal drainage after gallbladder stimulation with cholecystokinin, in 11 young women with radiolucent gallstones (echography and cholecystography), in ten women with leiomyomas (gynecologic examination and pelvic echography) but no gallstones (echography) and in 11 women with no leiomyomas (gynecologic examination or pelvic echography) or gallstones (echography). Cholesterol, phospholipids and total bile acids in the biliary tract were analyzed with standardized enzymatic methods. The cholesterol saturation index of the biliary tract was higher in patients with leiomyomas than in those in the control group (Wilcoxon rank sum test, p less than 0.01) and similar to that of women with radiolucent gallstones. These data suggest that gallstones and leiomyomas are associated diseases, probably sharing a common cause.

Adult↗