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Biomedical subjects

O Pieramico

Publications and source records attributed to O Pieramico.

36 records · Page 2Linked to original sources
PubMed1993

Clinical utility of the serum pancreolauryl test in diagnosis and staging of chronic pancreatitis.

Indirect pancreatic function tests are frequently used in the clinical routine as complementary tools for the diagnosis of chronic pancreatitis (CP) because of their noninvasiveness and simplicity. We analyzed the clinical efficacy and routine application of a modified serum pancreolauryl test (PLT) in the diagnosis and staging of CP. We studied a total of 90 patients with CP diagnosed by endoscopic retrograde pancreatography and 54 patients with extrapancreatic gastrointestinal disorders as controls. Sensitivity and specificity of the serum PLT in the diagnosis of CP were 82% and 91%, respectively, using a value of 4.5 micrograms/ml as cutoff. In the diagnosis of patients with mild to moderate morphological changes of CP, the sensitivity of the serum PLT (52%) was improved by the concomitant analysis of serum pancreatic amylase in a logistic model (70%). Serum PLT closely correlated with the degree of pancreatic ductal abnormalities (p < 0.001), and showed a sensitivity of 81% and specificity of 89% in the staging of CP (mild-moderate vs. marked CP; cutoff 2.5 micrograms/ml). We conclude that the modified serum PLT is a reliable test which should be considered as a first-line option for the diagnosis and follow-up of patients with CP.

Amylases↗
PubMed1993

Gastrointestinal motility in patients with non-ulcer dyspepsia: a role for Helicobacter pylori infection?

Motor disorders of the upper gastrointestinal tract are a frequent finding in patients with non-ulcer dyspepsia (NUD). In this study we attempted to assess whether Helicobacter pylori infection contributes to gastrointestinal motor disorders in NUD. Interdigestive and post-prandial gastrointestinal motility was studied in 46 consecutive patients with NUD and in eight healthy control subjects. Abdominal complaints were assessed by means of a symptom score. Chronic gastritis and H. pylori infection were assessed and graded by histology. Accordingly, patients with NUD were divided into two sub-groups: 18 patients with H. pylori infection and chronic active gastritis and 28 patients without H. pylori infection. The length of the interdigestive motor cycle was not different in patients with NUD (139 +/- 6 min, mean +/- SEM), compared with controls (128 +/- 5.5 min). There was also no difference in the duration of individual phases I, II, and III, either between NUD and controls or between H. pylori-positive and -negative patients. The motility index (MI) of antral phase II also was not changed in NUD patients. Postprandial antral motility was decreased in patients with NUD (MI 6.96 +/- 0.4 vs. 9.7 +/- 0.3 controls; p < 0.025), with no difference between H. pylori-positive and -negative subgroups. It therefore appears unlikely that H. pylori infection plays a primary role in the pathophysiology of antroduodenal motor disorders in NUD.

Adult↗
PubMed1992

Interdigestive gastroduodenal motility and cycling of putative regulatory hormones in severe obesity.

The aim of the present study was to evaluate interdigestive gastrointestinal motility and its coordination with plasma concentrations of motilin and pancreatic polypeptide (PP) in 14 patients with severe obesity and in 10 control subjects with normal body weight. Motor activity of the stomach, duodenum, and proximal jejunum was recorded by using an eight-lumen catheter. Blood samples were drawn for determination of interdigestive motilin and PP plasma concentrations. We observed no difference in total duration of the migrating motor complex (MMC) or of phases I, II, or III of the MMC. Gastric phase-III activity occurred less frequently in severely obese patients (only 15% originating in the stomach) than in controls (65%; p less than 0.01). Plasma motilin concentrations were decreased in obese patients in phase I (127 +/- 17 pg/ml in controls versus 87 +/- 10 pg/ml in obese), in phase II (189 +/- 26 pg/ml controls versus 134 +/- 15 obese) and in phase III (195 +/- 29 pg/ml controls versus 153 +/- 28 pg/ml obese). Peak motilin release occurred in synchrony with phase-III activity and was greater in controls than in obese patients. Plasma PP concentrations did not differ from those of controls during any phase of the MMC. These results further suggest a potential role for motilin in regulating gastrointestinal motor activity and indicate a potential defect in this regulatory mechanism in severe obesity. Whether the relationship between disordered motor activity and motilin release is etiologic with regard to the pathophysiology of obesity remains to be determined.

Adolescent↗
PubMed1992

TRH-immunoreactivity in chronic pancreatitis.

Thyrotropin-releasing hormone (TRH) is abundantly present in the pancreas. We studied the circulating TRH-immunoreactivity (IR) in 27 patients with chronic pancreatitis (CP) and different degrees of exocrine pancreatic insufficiency (EPI), as well as in 23 normal subjects. Furthermore we examined the effect of oral administration of 100 g glucose on peripheral TRH-IR in normal subjects (n = 5) and in patients with severe exocrine insufficiency (SEI, n = 5). Basal TRH-IR plasma levels in the CP group (20.8 +/- 7 fmol/ml, mean +/- SD) were significantly lower (p < 0.005) as compared with the normal subjects (38 +/- 14). TRH-IR plasma levels in patients with CP and SEI (15.8 +/- 3) were significantly lower (p < 0.05) than in patients with normal pancreatic function (28.1 +/- 8), but were no different from those in patients with CP and moderate exocrine insufficiency (18.7 +/- 5). In normal controls TRH-IR rose 120-180 min after glucose ingestion from 33 +/- 5 to 64 +/- 20 fmol/ml, while no increase in TRH-IR levels was observed in patients with SEI. We conclude that circulating TRH-IR levels are mainly of pancreatic origin. Patients with SEI have very low peripheral TRH-IR, indicating that CP does indeed influence TRH-release.

Adult↗
PubMed1992

[Simultaneous sonographic study of postprandial gastric emptying and gallbladder contraction].

Postprandial gastric emptying and gallbladder contraction were assessed in 14 healthy subjects by means of ultrasonography after oral administration of a semi-liquid test meal (250 ml, 1450 kJ). For this purpose, cross-sectional areas of the gastric antrum and gallbladder volume were calculated and recorded over a period of 120 minutes using an annular-array-transducer. The semi-liquid test meal allowed suitable sonographic measurement of cross-sectional areas of the antrum in all 14 subjects. Mean half-time of gastric emptying was 47 minutes (range 17-72 minutes). Mean peak gallbladder contraction was 36% (range 17-60%) of initial volume and mean time to peak contraction was 65 minutes (range 20-120 minutes). The method described was found to be a practical and reliable procedure for the investigation of postprandial gastric emptying and gallbladder contraction. It is therefore of potential interest for application to a variety of clinical questions. A minor drawback involves the relative length and variability of time required for testing, owing to the wide range in the time-course of gastric emptying and gallbladder contraction across subjects. Normal ranges for defined test meals must be established in large control groups.

Adult↗
PubMed1991

[Sonographic study of gallbladder function: exogenous or endogenous stimulation?].

Eleven patients (8 male, 3 female, age 21-53 years) with dyspeptic symptoms and no gastrointestinal organic diseases were studied for their gallbladder contractile function. A comparative sonographic study of gallbladder contraction was performed after exogenous and endogenous stimulation. On day 1, ceruletide was infused at a dose of 2.5 ng/kg/min about 10 minutes. On day 2, a semi-liquid test meal of 1450 kJ (44 kJ% carbohydrates, 24 kJ% protein, 32 kJ% fat) was administered. Gallbladder volume was determined for 30 minutes before and 5, 10, 20, 30, 40, 60, 80, 100 and 120 minutes after both stimulations by means of realtime ultrasonography. Three diameters in two plains were measured for calculation of gallbladder volume. Following ceruletide, peak gallbladder contraction (range 7-48% of initial volume) was observed within 10 (n = 5) or 20 (n = 6) minutes. Following the test meal, peak gallbladder contraction ranged from 27-80% and was observed within 30 to 100 minutes. Variations in time and amount of peak gallbladder contraction does hardly allow to establish normal values. No significant correlation was found between both types of stimulation concerning peak gallbladder contraction or time to peak contraction. We conclude that for the assessment of gallbladder contractility, ceruletide infusion and determination of gallbladder volume after 20 minutes (upper range 48% of initial volume) is the most valuable procedure. Impaired gallbladder contractility can be diagnosed with certainty only after exogenous stimulation.

Adult↗
PubMed1991

[Relations between gastrointestinal interdigestive motility and secretion].

The motility of the upper gastrointestinal tract in the interdigestive state shows a cycling pattern called Migrating Motor Complex (MMC) and is composed by phases I, II and III. Gastric, biliary and pancreatic secretion show cyclical fluctuations during fasting closely associated with the motor activity. The motor and secretory interdigestive activity is regulated by a complex interplay of nerval and humoral mechanisms. Among them, motilin, a gastrointestinal hormone mainly secreted from the duodenum, is supposed to play a central role in the initiation of phase III. Gastric acid secretion, directly or by means of motilin release, may modulate the duration of the MMC and the propagation of phase III in the small intestine. Pancreatic secretion does not initiate phase III but may exert a control on gastric interdigestive motility probably by means of pancreatic polypeptide release. Biliary interdigestive secretion seems to play a little or no role in the control of these phenomena. The coordination of motor and secretory events is likely to be under control of the duodenum.

Animals↗
PubMed1990

Effects of cimetropium bromide on gallbladder contraction in response to oral and intraduodenal olive oil.

To evaluate the influence of the stomach and the cholinergic system on gallbladder contraction induced by physiological stimuli, the reduction in gallbladder volume in 7 healthy volunteers has been studied by real-time ultrasonography after the oral and intraduodenal administration of olive oil, preceded by pretreatment with cimetropium bromide or placebo. After an overnight fast, each subject swallowed 50 ml olive oil or it was administered through a naso-duodenal tube in the proximal duodenum. Cimetropium bromide 5 mg or placebo was given intravenously under double-blind control. After the placebo pretreatment, gallbladder contraction was greater and faster after intraduodenal oil than after oral oil. Cimetropium bromide decreased the extent, velocity and duration of gallbladder contraction induced by intraduodenal olive oil but it only reduced the velocity of the contraction induced by oil given orally. It is concluded that in normal human subjects the stomach modulates the extent and velocity of postprandial gallbladder contraction and that anticholinergic agents antagonize the gastric and duodenal phases of the response of the gallbladder to a meal.

Administration, Oral↗
PubMed1990

Dopamine interrupts gastrointestinal fed motility pattern in humans. Effect on motilin and somatostatin blood levels.

The aim of this study was to investigate the hypothesis that during the postprandial period in humans, dopamine interrupts the gastrointestinal motility pattern through a mechanism that is peptide-mediated. Fourteen normal human subjects were studied by means of intestinal manometry. After recording two consecutive migrating motor complexes a 900-kcal solid-liquid meal was given. In eight subjects 30 min after the meal, placebo or dopamine (5 micrograms/kg/min) was infused for 15 min and then the recording continued for 120 min. In the remaining six subjects dopamine was administered twice with a 90-min interval in between. In three subjects the first dopamine infusion after the meal was preceded by treatment with placebo, the second by domperidone (20 mg intravenous as bolus), in the other three subjects domperidone was given before the first dopamine infusion. Blood samples for the determination of somatostatin and motilin were drawn basally, during, and immediately after dopamine in seven subjects. The results show that dopamine interrupts the fed motility pattern, inhibiting the high antral waves, and activates a duodenal phase III of migrating motor complexes. The pretreatment with domperidone completely prevented the dopamine effect. Plasma levels of motilin increased significantly during dopamine, while somatostatin blood levels did not change. These findings support the hypothesis that a dopaminergic mechanism may modulate the cycling of duodenal motor complex in humans.

Adult↗
PubMed1990

Interdigestive cycling and post-prandial release of pancreatic polypeptide in severe obesity.

Changes in pancreatic polypeptide plasma concentrations have been reported in obesity. It has been suggested that altered PP plasma levels may play a role in the abnormal food intake observed in obesity. Earlier studies, however, have not considered the physiological fluctuations of PP during fasting. We examined PP plasma concentrations in 12 subjects with severe obesity and in 10 normal subjects during the entire cycle of interdigestive motility and after the administration of a standard mixed meal. Obese patients and healthy controls showed similar fluctuations of PP during individual phases of the migrating motor complex (MMC) and reached their peak PP plasma levels (134 +/- 35 (s.e.m.) pg/ml in controls vs 113 +/- 17 pg/ml in obese subjects) during phase III activity. Following the test meal, prompt release of PP occurred which was significantly higher than basal values at each 15 min interval during the first postprandial hour in both controls and obese patients. The integrated PP postprandial response at 60 min did not differ between obese patients (163 +/- 15 pg/ml.h) and controls (198 +/- 37 pg/ml.h; n.s.). A putative causal role for PP in obesity thus seems very unlikely.

Adult↗
PubMed1990

Relationship between pancreatic function and pain in chronic pancreatitis.

The association between pain and exocrine pancreatic function was re-evaluated in 56 patients with chronic pancreatitis to see if residual function of the gland may evoke outflow obstruction resulting in pain. No significant differences were found in the degrees of pancreatic dysfunction among three groups with different degrees of pain (no pain, n = 7; moderate pain, n = 21; and severe pain, n = 28), but patients with more impairment of exocrine pancretic function tended to have less pain. In patients with no pain the mean (SD) peak serum concentration of fluorescein was 2.0 (0.2) micrograms/l, in those with moderate pain it was 2.6 (0.1), and in those with severe pain it was 3.4 (0.1). No significant differences were found between the degree of pain and the duration of the disease, which was 5.5 (0.3) years in the group with no pain, 3.5 (0.2) in patients with moderate pain, and 3.8 (0.1) in those with severe pain. We conclude that outflow obstruction may affect some patients, but is not the only cause of pain. Patients with severe pancreatic dysfunction and steatorrhoea often present with pain, so either obstruction of the residual secretions, or inflammatory activity impinging on nerve endings in fibrotic tissue, may also cause pain. The causes vary, and there is often more than one, so optimal management implies thorough investigation of each patient and long term follow up.

Adult↗
PubMed1990

[The H2-lactulose breath test in the diagnosis of intestinal transit time].

The H2-Lactulose breath test is used to detect small bowel bacterial overgrowth but mainly to evaluate the orocoecal transit time (OCTT) in man. The result of the H2-breath test is influenced by several intestinal and extraintestinal factors that cause a large variability of normal values. By reviewing the possible influencing factors of the breath tests we try to make a contribution to a better judgement of the results as the H2-lactulose breath-test is a simple noninvasive and non-expensive screening in the investigation of gastrointestinal disorders. For evaluating the better dosage of lactulose in gastroenterological routine diagnostic we designed a prospective study. The test was performed in 12 healthy volunteers by ingestion of 10 g and 20 g lactulose to quantitate the OCTT and to evaluate it in normal conditions. We found that the length of transit is related to the dose of lactulose. OCTT was 97.1 +/- 22.4 min. after ingestion of 10 g lactulose, and significantly shorter, 57.1 +/- 16.6 min. after ingestion of 20 g lactulose (p less than or equal to 0.01). The lower dose of lactulose is more suitable for routine diagnostic because of better acceptance despite slower transit time.

Adult↗
PubMed1989

Comparative study of the effects of cimetropium bromide and atropine on human esophageal motor functions.

The effects of atropine and cimetropium bromide, a new antimuscarinic compound with strong spasmolytic properties, were studied on human esophageal motility. Twenty healthy subjects underwent esophageal manometry with continuous monitoring of lower esophageal sphincter pressure (LESP), and of amplitude, duration and velocity of contractions of the esophageal body. After a 30-min basal period, atropine (12 micrograms/kg) or cimetropium (5 mg) were administered as an intravenous bolus in a cross-over random manner and the recording was continued for another 60 min. Twenty minutes after injection, atropine and cimetropium decreased maximally, in a similar extent, both the amplitude of contractions of the esophageal body (-65% of the basal values) and the LESP (-30% of the basal values). The duration and propagation velocity of the esophageal contractions did not change significantly after both drugs. Sixty minutes after injection of cimetropium, the amplitude of contractions of the esophageal body and LESP returned to basal values while atropine still reduced both variables. These findings indicate that cimetropium bromide has an inhibitory effect on LESP and on the amplitude of contractions of the esophageal body similar to atropine, but its action lasts less time.

Adult↗
PubMed1989

Mouth-to-cecum transit time in patients affected by chronic constipation: effect of glucomannan.

Mouth-to-cecum transit time was studied in 13 patients affected by chronic idiopathic constipation and 18 control subjects matched with the constipation group for age, sex, and dietary habits. In a preliminary investigation, all patients showed a prolonged whole gut (oroanal) transit time as measured with radiopaque markers. Mouth-to-cecum transit time was studied through the serial determination of breath H2 after administration of 12 g lactulose diluted in 120 ml water. Breath H2 was measured with a gas analyzer and was determined in parts per million (ppm). Breath H2 after lactulose was also determined in the group with constipation after a 10-day diet that included either glucomannan (1 g tid orally) or placebo administered in a double-blind manner. The results show a statistically significant increase in mouth-to-cecum transit time in the group with constipation, compared with controls, and a return to within the normal range after the 10-day treatment with glucomannan. With placebo, no difference in transit time was noted. We therefore suggest that chronic idiopathic constipation is a disease that involves the whole gut.

Breath Tests↗
PubMed1988

Effect of ketanserin, a selective antiserotoninergic drug, on human anal canal pressure.

The effect of Ketanserin, a new antiserotoninergic drug, on human anal pressure in vivo was investigated. Anal pressure was recorded continuously in 14 normal subjects by a low-compliance water perfused probe with two recording points at the sphincter level. After a 30-min basal tracing Ketanserin (10 mg IV as bolus) or placebo was administered in a double blind manner, and the recording continued for 1 h. The results show that Ketanserin induced a 30% fall in anal pressure soon after its administration which was statistically significant when compared with the placebo (p less than 0.01). This effect lasted up to 40 min of recording and was followed by a return to control values within 1 h.

Adult↗
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↗