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Biomedical subjects

M Petrillo

Publications and source records attributed to M Petrillo.

At least 55 records · Page 3Linked to original sources

The influence of colloidal bismuth subcitrate on duodenal ulcer relapse.

Antisecretory drugs, although able to promote ulcer healing, have been shown to be unable to modify the course of ulcer disease. Relapse rates after short-term cures and after prophylactic long-term therapy are equivalent to those observed during placebo treatment. Conversely, evidence shows that colloidal bismuth subcitrate (CBS)--by means of a mechanism as yet unclear--reduces the risk of ulcer relapse after a short cure for acute disease. This has been shown in several controlled trials and in two studies on duodenal ulcer patients undertaken by our group. Our experience has shown that 12 months after treatment the relapse rate in patients treated with CBS only during the acute phase was: a) equivalent to that observed in patients whose acute ulcers had healed with cimetidine and had thereafter been treated prophylactically with cimetidine 400 mg at night (69% versus 68%), and b) significantly lower than that of patients whose ulcers had healed with ranitidine and who were subsequently placed under medical observation (67% versus 84%; P less than 0.05). It is concluded that CBS is a valid alternative in the prophylactic treatment of duodenal ulcer.

Bismuth

Colloidal bismuth subcitrate and ranitidine in the short-term treatment of benign gastric ulcer. An endoscopically controlled trial.

Colloidal bismuth subcitrate (CBS) in the form of a chewable tablet has been compared with ranitidine in the short-term treatment of benign gastric ulcers. Eighty patients were admitted to this randomised single blind study. Endoscopic control was carried out after 4 weeks, and after 8 weeks when healing was incomplete or had not occurred at the 4-week examination. After 1 month of therapy the healing rates were 70% with CBS and 62.5% with ranitidine (P = not significant). At two months the corresponding cure rates were 87.5% and 79%, respectively (P = not significant). Antacid consumption was higher in the group treated with ranitidine, but the difference was not statistically significant. Patient cooperation was good and similar in the two groups. These findings confirm that CBS, in tablet form, is at least as effective as ranitidine in the acute treatment of benign gastric ulcers.

Adult

Effect of nifedipine on gastric acid secretion and gastrin release in man.

The role of nifedipine in inducing the blockage of calcium slow channels in the smooth muscle cell of the esophagus is well known. The aim of our study was to evaluate the action nifedipine exerts upon acid secretion and gastrin release stimulated by intragastric titration with a peptone meal (pH 5.5) in 7 healthy adult males. Percentage gastrin variations were constantly lower after oral administration of 20 mg nifedipine than with placebo. However, IGO values were shown to be not significantly different (9.3 +/- 1.8 vs 8.4 +/- 2.1 ng. min/ml). No variations in acid output were observed throughout the entire examination period (120 min). In our experience, therefore, nifedipine - under experimental conditions - proved unable to interfere with gastric secretion, probably due to the absence of specific receptors on the parietal and antral cell.

Adult

Comparison of pirenzepine and carbenoxolone in the treatment of chronic gastric ulcer. A double-blind endoscopic trial.

The purpose of the present study was to compare the effectiveness of pirenzepine and carbenoxolone in accelerating the healing of chronic gastric ulcer. Sixty-six out-patients with endoscopically proven gastric ulcer, without major systemic diseases, were admitted to the study. Patients were randomly allocated to either pirenzepine, 50 mg three times a day for 6 weeks, or carbenoxolone, 100 mg three times a day for one week followed by 50 mg three times a day for the remaining five weeks. At 6 weeks, the ulcers had healed in 20 out of 34 patients (59%) treated with pirenzepine, and in 15 out of 29 patients (52%) treated with carbenoxolone. Symptomatic improvement was similar with both drugs. Some major side effects (oedema, hypokalaemia and hypertension) occurred in approximately 30% of patients treated with carbenoxolone; of those receiving pirenzepine 25% complained of minor symptoms (e.g. dry mouth, headache, tachycardia). It is concluded that pirenzepine and carbenoxolone are of similar, but rather limited, efficacy in speeding the healing of chronic gastric ulcer, but show important differences with respect to tolerability.

Anti-Ulcer Agents

Long-term treatment with cimetidine does not essentially affect the hypothalamic-pituitary-gonadal axis in man.

The effect of cimetidine maintenance treatment on gonadal function has been assessed by seminal analysis plus prolactin and gonadotropin blood level concentrations. Nine patients, all with duodenal ulcer, 5 of whom had received 400 mg cimetidine at night for 18, 3 for 24 and 1 for 36 months, were studied. All patients were presumably fertile, having fathered a child born not more than 3 years before the start of cimetidine treatment. In all patients two seminal analyses were performed and blood specimens were obtained for radioimmunoassay estimation of FSH, LH and prolactin concentrations both in basal conditions and 20', 30' and 60' after the i.v. injection of Gn-RH (100 micrograms) and TRH (200 micrograms). All but one patient, in whom mild oligoasthenozoospermia was detected, had normal sperm counts and motility; moreover hormonal levels both in basal conditions and after releasing factor stimulation were found to be similar to those observed in a control group. Cimetidine maintenance treatment has no effect on sexual activity, the quality of seminal fluid or the pituitary secretion of gonadotropins or prolactin.

Cimetidine

A double-blind endoscopic study with De-Nol tablets and cimetidine for duodenal ulcer.

In a double-blind, double-dummy comparison of short-term ulcer healing, involving 50 patients treated with either De-Nol tablets (four times daily) or cimetidine tablets (400 mg, twice daily), no statistical difference in healing rates was observed after 8 weeks' treatment. There was, however, a numerical trend in favour of De-Nol (De-Nol, 100% healed; cimetidine, 88% healed). Statistical significance in favour of De-Nol was observed, however, in the reduction of antacid tablet consumption and relief of ulcer pain. No unwanted side effects were observed with either drug. This trial indicates that De-Nol and cimetidine are equally effective and useful in the short-term treatment of duodenal ulcer.

Adult

[Diagnostic value of echography in the study of thyroid nodules. Ultrasonographic and histological findings on 103 "cold" nodules].

This study examines the accuracy of ultrasonic scanning in the recognition of malignancy in 103 "cold" thyroid nodules. All nodules underwent to surgical ablation and to histopathological examination. 10 nodules were cistic, 72 solid and 21 mixed cistic-solid on echography. None of the cistic nodules showed malignant disease while six carcinomas were present in solid nodules and one (a papillary cancer) in a mixed cistic-solid lesion. However we were unable to find echographic abnormalities pathognomonic for malignancy. Only in one case (an undifferentiated carcinoma which involved adjacent blood vessels) the diagnosis of malignant tumour was made before operation; in the other cases the echo patterns of the carcinomatous nodules were similar to those observed in benign nodules. Similar ultrasonic findings were also seen in the various types of thyroid cancer (3 follicular, 2 papillary, 1 medullary, 1 undifferentiated) a part the papillary carcinoma which appeared as cistic-solid lesion. Our data seem to limit the diagnostic value of echography in the detection of malignant thyroid nodules, nevertheless they confirm the benignancy of echografically cistic nodules.

Adenoma

Pirenzepine versus cimetidine in duodenal ulcer. A double-blind, placebo-controlled, short-term clinical trial.

90 patients with active duodenal ulcer were admitted to a double-blind trial to compare the effects of pirenzepine (150 mg/daily), cimetidine (1 g/daily) and placebo on the healing of duodenal ulcer. 5 patients did not complete the trial. In 21 of 29 patients (72%) receiving pirenzepine and in 21 of 28 (75%) of those receiving cimetidine, the ulcers had healed after 4 weeks of treatment compared with 10 of 28 (36%) patients receiving placebo (p less than 0.01). Symptomatic improvement and reduction of antacid consumption were significantly more marked in the pirenzepine- and cimetidine-treated groups than in the placebo group. Tolerability of drugs was good. The results show that pirenzepine is as effective as cimetidine for the treatment of duodenal ulcer.

Adult

Long-term treatment of duodenal ulcer with pirenzepine. A double-blind, placebo-controlled trial.

Sixty out-patients with duodenal ulcers that were healed at the end of a 4-week treatment with pirenzepine, cimetidine or placebo were admitted to a double-blind placebo-controlled trial to study the effectiveness of pirenzepine (100 mg/daily) in preventing recurrence of ulcers. Six patients did not complete the trial. After 12 months of treatment 15 of the 26 patients had recurrences in the pirenzepine-treated group and 27 of the 28 in the placebo group. The difference is highly significant (X2 = 9.570, P less than 0.01). The tolerability of pirenzepine was good.

Adult

Pirenzepine in the treatment of peptic ulcer disease. Review and commentary.

The published world literature on the efficacy of pirenzepine, a new anti-muscarinic agent, in the treatment of gastric and duodenal ulcer is reviewed. In 12 prospective randomized double-blind placebo controlled studies pirenzepine was administered to 475 duodenal ulcer patients with an incidence of endoscopically proven healing of 74% when the daily dosage of the drug was 100 or 150 mg but of only 55% if the dosage of the drug was 75 mg or less. In 4 randomized double-blind placebo-controlled studies in which 84 patients with gastric ulcer were admitted, the healing rates were similar (50% when daily dosage of pirenzepine was 75 mg or less, 72% when the dosage ranged from 100 to 150 mg). When pirenzepine was compared to carbenoxolone or to cimetidine in the treatment of gastric and duodenal ulcer respectively, results obtained were comparable. Side-effects reported have been rare and of minor importance. Pirenzepine appears to be an effective drug for the short-term treatment of duodenal ulcer. More data are required for an assessment of short-term therapy of gastric ulcer and long-term maintenance treatment.

Anti-Ulcer Agents

Gastroscopy in elderly patients.

The results of oesophago-gastro-duodenoscopy in 630 consecutive elderly patients, age 65 years or over, were reviewed in order to asses the efficacy, safety and acceptability of the technique in this age group. The study showed that the use of endoscopy is attended by relatively few contra-indications, that considerations restricting its use are also relatively few, and that endoscopy can be invaluable in confirming or refuting the diagnosis of malignancy and in detecting bleeding lesions. It was also shown that, in this age group, the use of endoscopy can be of vital importance in expanding or qualifying radiological data. Special attention was paid to gastric lesions caused by anti-inflammatory treatment. The overall incidence in this series was 37%, and this correlated very closely with the incidence of 31% previously documented by the same authors in a middle-aged population of rheumatic patients. It is concluded that endoscopy is of indisputable value in facilitating the diagnosis and treatment of gastro-intestinal disorders in the elderly.

Aged