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R Pellicano

Publications and source records attributed to R Pellicano.

At least 19 recordsLinked to original sources
PubMed2006

Prevention of intrahepatic hepatocarcinoma recurrence in patients with viral cirrhosis: two potential options.

Mortality due to hepatocellular carcinoma (HCC) is still high, because of its development in liver with impaired function due to underlying cirrhosis, of its chemoresistance and of its high rate of recurrence. Liver transplantation is considered the most efficacious treatment for patients with HCC. However, the low availability of organs limits the offer of this option to all candidates. Furthermore, liver transplantation is not lacking in risk of tumour recurrence. Other curative options include surgical resection and ablation using percutaneous techniques. Such approaches give similar and satisfactory survival rates, providing that patient selection is optimal in terms of tumour size and liver function. Since even in the presence of a radical therapeutic result this cancer maintains a high tendency for local recurrence, it is very important to explore the adjuvant ways to increase the disease-free survival in patients surgically treated. Treatment with interferon a and intrahepatic injection of (131)-Iodine labelled lipiodol ((131)I-Lipiodol) are instead showing encouraging results. This review presents a concise update on this issue.

Antiviral Agents↗
PubMed2006

Transmission of Helicobacter pylori: are there evidences for a fecal-oral route?

Helicobacter pylori (H. pylori) infection spreads from person-to-person, however the precise mode of transmission (oral-oral, fecal-oral or gastro-gastric) is hitherto not known. Gaining understanding into the spread of the bacterium might be useful in identifying high-risk populations, especially in areas that have high rates of gastric malignancies or peptic ulcer. In this review, the authors analyze the aspects concerning the plausibility for the fecal-oral route on the basis of the available data.

Animals↗
PubMed2006

[Non-invasive diagnosis of Helicobacter pylori infection in the 2006 clinical practice].

At present, 2 approaches are used to detect Helicobacter pylori (H. pylori): invasive, if based on biopsies taken during endoscopy, and non-invasive, if they do not rely on endoscopic approach. A 3rd option is offered by the string test, that employs an invasive non-endoscopic strategy. The present review attempts to update on the diagnostic non-invasive approaches to patients in the clinical setting. Non-invasive tests include urea breath test (UBT), antigen stool assay, serology, and ''doctor's tests''. The choice of the methods depends on the situation, for example, the clinical circumstances, the diagnostic accuracy, the costs of the testing strategy, and the availability of the tests in the respective area. According to European guidelines, UBT and antigen stool assay are recommended in patients without alarm symptoms or under 45 years of age, at low risk of malignancy in the test and treat strategy. Confirmation of H. pylori eradication following treatment should be tested by UBT; the stool antigen assay is the alternative if the former is not available.

Antigens, Bacterial↗
PubMed2006

[Invasive diagnosis of Helicobacter pylori infection in the 2006 clinical practice].

Currently, different approaches are employed to detect the presence of Helicobacter pylori (H. pylori): invasive, if based on biopsies performed during endoscopy (urease test, histology, culture, polymerase chain reaction), and non-invasive, if endoscopy is not carried out. Another option is offered by the invasive non-endoscopic methods (string test). An update on the diagnostic invasive approaches to patients in the clinical setting is presented in this review. Although non-invasive tests are preferred, important information can be gained from histology, the unique technique which permits the evaluation of the status of the mucosa, and from culture, that allows strain typing and tests for antibiotic susceptibility. Until today, polymerase chain reaction has had a limited application in the clinical practice and the role of non-endoscopic methods needs to be better clarified in the future.

Bacteriological Techniques↗
PubMed2006

[Gastric cancer and Helicobacter pylori: an interdisciplinary point of view].

Gastric carcinogenesis involves a slow but continuous, stepwise evolution from superficial gastritis to glandular atrophy, metaplasia, dysplasia, and finally, to adenocarcinoma. In 1994, the International Agency for Research on Cancer defined Helicobacter pylori (H. pylori) as a group I carcinogen. Evidence supporting a causal association has been demonstrated by epidemiological data as well as by experimental animal models. The process of carcinogenesis, which may well extend over decades, provides an excellent opportunity for prevention or early detection of the events preceding development of the neoplasm. This is especially true because, at present, H. pylori can be readily treated. Despite this, the prognosis for gastric cancer is poor and, in most industrialised countries, the survival is only 10% after 5 years from diagnosis. The sole exception is Japan where this malignancy is often identified at an early stage when cure by radical surgery is more probable.

Adenocarcinoma↗
PubMed2006

Role of Helicobacter pylori infection in peptic ulcer haemorrhage.

AIM: In spite of the diffusion of endoscopic treatment, mortality rate due to peptic ulcer haemorrhage (PUH) remains high. Helicobacter pylori (H. pylori) infection and nonsteroidal anti-inflammatory drugs (NSAIDs) are the 2 main aetiological factors, but their interactive role is controversial. The aim of this study was to determine both the prevalence of H. pylori infection and NSAIDs consumption in PUH and their prognostic importance. METHODS: In a prospective study, 41 consecutive patients (33 males, 8 females) admitted for PUH were recruited. H. pylori status was investigated both by measuring specific antibodies in serum and by histological detection on gastric biopsies obtained after one month from bleeding. In case of doubt, either a 13C urea breath test, or a stool antigen test were associated. All patients were treated with medical therapy associated to endoscopic treatment in most severe cases. RESULTS: Sixteen patients were infected from H. pylori (group A), 12 had a history of NSAIDs consumption (group B), and 13 had both risk factors (group C). The median duration of hospitalisation was 7 days for each group and correlated with age (P<0.04). Severity of PUH (high risk of rebleeding) was higher in group A (13/16; 81%) and group C (9/13; 69%), with respect to group B (6/12; 50%). This difference was not significant. CONCLUSIONS: H. pylori infection has a predominant role in causing PUH as well as in the prognosis and clinical course of this condition. Hence, it is important to determine H. pylori status in every patient with PUH.

Adult↗
PubMed2006

Zollinger-Ellison syndrome in 2006: concepts from a clinical point of view.

Zollinger-Ellison syndrome (ZES) is characterised by peptic ulcers of the upper gastrointestinal tract failing to heal despite maximal medical therapy, diarrhoea and marked gastric acid hypersecretion associated with a gastrin-secreting tumour (gastrinoma). ZES might be associated with multiple endocrine neoplasia type 1. The main diagnostic features are hypergastrinemia and acid hypersecretion. When these parameters give borderline results, provocation test (with secretin or calcium) may be required. To identify the localisation of gastrinoma several imaging techniques have been proposed. Somatostatin receptor scintigraphy is capable to localise the tumour in 80% of the cases and to identify it even in anatomic sites other than pancreas and duodenum. Endoscopic ultrasonography has a sensitivity as high as 79-93% and a specificity of 93%. The 2 main principal therapeutic strategies are to control both the gastric acid hypersecretion and the growth of the neoplasia. Proton pump inhibitors (PPIs) are the drugs of choice for patients with ZES. Furthermore, safety of PPIs in the maintenance therapy has been proven both in short- and in long-term studies. The best surgical treatment is excision of gastrinoma before metastatic spread has occurred. Somatostatin-analogues can reduce both gastric acid hypersecretion and serum gastrin levels. Moreover, they have an antiproliferative effect. Chemotherapy, interferon and embolisation are indicated in rapidly evolving tumours or in cases in which the tumoral symptoms cannot be treated by other approaches.

Antineoplastic Agents↗
PubMed2006

Treatment of irritable bowel syndrome. A case control experience.

AIM: As optimal therapy for irritable bowel syndrome (IBS) remains elusive, current approach to therapy is based on symptomatic treatment. With this case-control experience we wanted to determine the beneficial effect in IBS patients of a dietary integrator (IBS Active), composed of L-tryptophan, inulin, angelica, vegetal charcoal, vitamin PP, group B vitamins (B1, B2, B6) and probiotics (Lactobacillus sporogenes, Lactobacillus acidophilus, Streptococcus thermophilus). METHODS: The treatment group comprised 37 patients (11 men and 27 women; mean age, 44.3+/-5.1 years) given IBS Active (440 mg bid) over a mean period of 6 months (range, 5-8). The control group comprised 28 patients (6 men and 22 women; mean age, 48.6+/-3.7 years) who were instructed to continue their customary therapy for 6 months (range, 5-7). All subjects were assessed for the presence of abdominal pain and/or distension, constipation, diarrhea and alternating constipation and diarrhea. RESULTS: Compared with baseline values, the reduction in abdominal pain in the treatment group was 62% (P<0.0001), 55% (P<0.0001) in abdominal distension, 58% (P=0.05) in constipation, 33% (P=0.3) in diarrhea, and 62% (P=0.01) in alternation constipation and diarrhea. Compared with baseline values, no statistically significant reduction in symptoms was found in the control group. Post-treatment comparison between the two groups showed that the study product had reduced symptoms and that the difference was statistically significant for abdominal pain (P<0.000001), abdominal distension (P=0.003) and constipation (P=0.03). CONCLUSIONS: The use of IBS Active led to a significant improvement in pain symptoms, abdominal distension and regulation of bowel movement in IBS patients. Further study is needed to evaluate the long-term benefit of the study product.

Abdominal Pain↗
PubMed2006

Absence of gene mutations in a case of concomitant presence of carcinoid of the ampulla of vater pheochromocytoma and Von Recklinghausen disease.

The rare association between Von Recklin-ghausen's disease (VRD) and tumours other than in central nervous system is well recognized. However, the concomitance of VRD, a carcinoid of the ampulla of Vater, and a pheochromocytoma has been described very rarely in literature. Furthermore, the possible role of the genes usually involved in multiple endocrine neoplasia (MEN) syndromes, in this association, is unclear. We report the case of a patient affected by VRD and extra-adrenal pheochromocytoma, operated on in the past for a carcinoid of the ampulla of Vater. To determine if genes involved in MEN syndromes might play a role in this particular triad, we investigated the presence of somatic or germline mutations in the RET proto-oncogene and menin gene by non isotopic polymerase chain reaction single stranded conformation polymorphism (PCR-SSCP) and heteroduplex gel electro-phoresis. The results demonstrated that no somatic or germline mutations in the MEN-1 and MEN-2 genes were involved in the pathogenesis of these tumours.

Adult↗
PubMed2006

Stem cells and Helicobacter-induced gastric cancer: where do we stand at the end of 2006.

The process of carcinogenesis, which may well extend over decades, provides an excellent opportunity for early detection and intervention to prevent development of gastric cancer. Evidence supporting a causal association between such tumour and Helicobacter infection has been demonstrated by epidemiological data, ecologic studies and, in experimental animal models. Lately, an increasing amount of evidences point out to bone marrow stem cells (BMSC) as target of neoplastic transformation. The term BMSC includes a heterogenous group of cells that both in vivo and in vitro studies, have shown to have plasticity, with their ability to acquire features of mesoderm, ectoderm and endoderm. In the gastric setting, a recent experiment in C57BL/6 mice has permitted to show that BMSC are the cell of origin of Helicobacter-induced gastric cancer. Based on these results, a model for epithelial cancer by which chronic inflammation leads to tissue injury and with time, to tissue stem cell failure, has been proposed. This phenomenon would induce the recruitment and engraftment of BMSC into the tissue stem cell niche. During differentiation, BMSC fail to regulate growth programme appropriately and progress through stages of metaplasia and dysplasia. Due to several reasons, in humans, data are conflicting. Further studies may shed light on the molecular bases of gastric lesions, leading to the development of preventive strategies.

Animals↗
PubMed2006

Updated review (2006) on Helicobacter pylori as a potential target for the therapy of ischemic heart disease.

UNLABELLED: Despite knowledge about the classical risk factors for ischemic heart disease (IHD) has increased, all the differences in morbidity as well as mortality from this disease cannot be fully explained. Hence the importance of looking for other causal mechanisms. Numerous infectious agents have been linked to IHD and among these also Helicobacter pylori (H. pylori). However, a number of studies have reported conflicting RESULTS: The present review attempts to highlight on the update pertaining a potential etiologic role of H. pylori infection in the pathogenesis of IHD. Some new evidences have emerged in the last years in literature. While epidemiological approach seems to confirm previous uncertainties (hypothetical role of the bacterium in the acute phase), experiments have demonstrated the presence of bacterial DNA in the plaque. Furthermore, the most encouraging evidence of a possible association emerges from an intervention small trial showing a significant reduction of coronary events after H. pylori eradication. Because IHD is the outcome of a multiciplity of factors, many of which with only a limited individual effect, complete understanding of causation is difficult. It may be possible to identify some factors, such as H. pylori, the effects of which are large enough to be potential target for prevention. This is of major public health importance, since the eradication of the infection is easy and certainly much less expensive than long-term treatment for other risk factors. Prospective population-based studies and interventional trials, focusing on the advantage of the eradication of H. pylori infection on the prevention or the reduction of recurrence in subjects with IHD, should be performed in order to provide support of a causal relationship. This represents a promising direction for future studies.

Anti-Bacterial Agents↗
PubMed2005

Autoimmune manifestations during interferon therapy in patients with chronic hepatitis C: the hepatologist's view.

In face of numerous benefits induced by therapy based on interferon (IFN) associated with ribavirin for the treatment of chronic hepatitis C, there is an increasing concern regarding its tolerance, which can, in some cases, reduce the quality of life as well as compliance of patients. Among the less common side effects, there are the autoimmune ones which can be globally divided into appearance or increase in titres of auto-antibodies and/or manifestation of overt autoimmune pathologies. Whereas the former may concern more than 50% of treated subjects, the latter is reported in only 1-2% of patients under therapy. Thyroid dysfunction represents the well-studied autoimmune disorder. The presence of pre-existing anti-thyroid antibodies and being of female sex, constitute relevant risk factors for the development of a disease involving this gland. Often the treatment of thyropathy must be continuous in spite of IFN discontinuation because the disturbance usually does not abate with stopping antiviral therapy. Some observations have pointed out to the fact that IFN can lead to the development of insulin-dependent diabetes mellitus. Sometimes, during, as well as after IFN treatment, the appearance of anti-islet cell antibodies has been shown, but its interrelationship with the development of disease is uncertain. While being treated with IFN for chronic hepatitis C, the finding of non-organ specific antibodies at baseline can increase the likelihood of the development of autoimmune hepatitis. However, their presence does not constitute an absolute contraindication to the treatment, except in case of high titre. Other disorders, such as a lupus erythematosus-like syndrome, haemolytic anaemia, and immune-mediated thrombocytopenia have been reported. In conclusion, although the presence of auto-antibodies is considered to be an epiphenomenon without pathogenic significance in most patients suffering from chronic hepatitis C, it poses a problem when they need to be treated with IFN. This antiviral drug can induce or exacerbate a multitude of autoimmune-related disorders, however, clinically overt immune-mediated diseases are rare and affect a subset of subjects who have an underlying autoimmune diathesis.

Antiviral Agents↗
PubMed2005

[Intestinal metaplasia, dysplasia, gastric cancer and Helicobacter pylori: epidemiological observations].

Gastric cancer (GC) is the world's second leading cause of cancer-related mortality, and carries a bad prognosis. In 1994, Helicobacter pylori (H. pylori) has been classified by the International Agency for Research on Cancer as a group I carcinogen. There are increasing indications that this infection is associated with both the initiation and progress of gastric carcinoma and lymphoma. Evidence supporting a causal association has been demonstrated by epidemiological data and in experimental animal models. Despite this, there is still lack of final conclusion regarding the association between the infection and the malignancy due both to marked geographic variations and heterogeneity in study designs. Given the high rate of morbidity and mortality associated with GC, any means of reducing the occurrence of the disease or increase its early detection is most desirable. In this paper, the epidemiological aspects on the evidence of a causal relationship between H. pylori and GC are discussed. Prospective cohort studies and interventional trials focused on the effects of H. pylori eradication on lesions predisposing to GC should be performed in order to provide further data.

Adenocarcinoma↗
PubMed2005

Association between Crohn's disease and Conn's syndrome. A report of two cases.

The natural history of Crohn's disease (CD) is characterised by periods of remission followed by phases of flares. Persistent or intractable diarrhoea may be associated with ileal disease or arise following ileal resection, resulting in potassium depletion. Medical therapy with steroids presents troublesome side-effects (e.g. hypertension). Conn's syndrome, caused by unilateral aldosterone-producing adenoma, is characterised by clinical features including hypokalaemia and hypertension. Thus, CD and Conn's syndrome may have an overlap of manifestations, and up to now, the simultaneous occurrence of these conditions has not been described. We report here 2 cases of association between CD and Conn's syndrome.

Adrenalectomy↗
PubMed2005

Chronic anaemia and adhesion molecules in patients with liver cirrhosis. A preliminary report.

AIM: The aim of our study was to investigate circulating levels of intercellular adhesion molecule-1 (sICAM-1) and vascular cellular adhesion molecule-1 (sVCAM-1) in cirrhotic patients, with and without chronic anaemia, to establish whether there was a relationship between inflammatory activity and anaemia. METHODS: We investigated 14 anaemic (mean hemoglobin value 10.65+/-1.06 g/dL) and 14 non anaemic (mean hemoglobin value 13.8+/-0.89 g/dL) subjects affected by virus C-related liver cirrhosis comparable for sex, age and degree of liver dysfunction such as expressed by Child-Pugh classification. Circulating sICAM-1 and sVCAM-1 were measured by EIA commercial kit (R&D System Co, Abington, UK) and mean+/- standard deviation values in two groups were compared by t-test and Kruskall-Wallis test. RESULTS: Mean+/-standard deviation sICAM-1 was 35.06+/-4.06 ng/mL in anaemic and 23.39+/- 6.1 ng/mL in non anaemic cirrhotic patients. Mean+/-standard deviation sVCAM-1 was 47.66+/-8.18 ng/mL in anaemic 31.77+/-6.08 ng/mL in non anaemic patients, respectively. Statistical analysis showed a significant difference between the two groups both in sICAM-1 (p=0.01) and sVCAM-1 (p=0.03) values. CONCLUSIONS: Our study show that chronic anaemia, in liver cirrhosis, is associated to a greater increase of circulating adhesion molecules and suggests that inflammation may contribute to persistence of anaemic state, worsening the outcome of cirrhotic patients.

Aged↗