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Biomedical subjects

S Mattioli

Publications and source records attributed to S Mattioli.

At least 19 recordsLinked to original sources
PubMed1992

Indications for 24-hour gastric pH monitoring with single and multiple probes in clinical research and practice.

The methodology of prolonged gastric pH monitoring has not yet been standardized with regard to the number and position of pH probes. Twenty-seven healthy volunteers and 11 patients affected by nonulcer dyspepsia have been submitted to 24-hr ambulatory simultaneous pH monitoring of the distal esophagus, fundus, and antrum. Fundic and antral pH profiles have been compared and causes of pH variations (pH > 4) identified. Both in healthy volunteers and dyspeptic patients, percentile curves of fundic and antral pH were statistically different in more than one of the daily periods considered (24-hr, postprandial, interdigestive, nocturnal). Percent time of duodenogastric reflux is significantly higher in the antrum than in the fundus in both groups. Modalities of gastric alkalinization secondary to food or duodenogastric reflux were different for the fundus and for the antrum both in healthy and dyspeptic subjects and between the two groups. These differences suggest that single and multiple pH monitoring of the stomach have different indications, and the position of the probes should vary according to the purpose of the test.

Adult↗
PubMed1991

[Monitoring esophageal pressure: comparison of various methods and a unique solution].

Ambulatory monitoring of intraesophageal pressure requires probes and techniques which are different from those used in the laboratory approach. In particular the perfusion system for the measurement of the pressure is not suitable and the development of alternative solutions is mandatory. In this perspective an accurate analysis of the theoretical basis of different methods is necessary in order to avoid incorrect results and difficulties in the subsequent phase of analysis. A prototype probe, which is based on inextensible thin plastic balloons filled with oil or saline, was tested in comparison with traditional (perfused) and microtransducer systems to outline the positive and negative aspects of the solution. The results were satisfactory as regards linear output and frequency response up to 5 Hz for the prototype probe and even superior, for instance, to the response of the perfused system to applied pressure, whose curves of the four open tips resulted different, and to the response of Millar transducer. The new prototype probe seems to be adequate to the clinical and research needs.

Equipment Design↗
PubMed1991

[Intraoperative esophageal manometry].

Intraoperative manometry has been proposed as a supportive procedure during the execution of anti-reflux operations and in the surgical treatment of achalasia. This procedure is not necessary in preparing anti-reflux plasty such as Belsey or Nissen, the outcome of which depends mostly on the correct execution of the surgical technique. Utilization of intra-operative manometry provides considerable benefits during the surgical treatment of achalasia, both when executing the extra-mucous myotomy and for the correct preparation of the anti-reflux plasty according to Dor, which is associated to it. Manometric control has made it possible to define the various anatomical components that, at both the esophageal and gastric levels, constitute the area which functionally corresponds to the lower esophageal sphincter and therefore a correct execution of the myotomy. As demonstrated by the follow-up study of our surgical patients, the intraoperative manometric measurement of the strain and of the length of the anti-reflux plasty is the determining factor affecting outcome over time. The pressure is apt to decrease even 5 year after surgery; maintaining given length and strain standards when executing the plasty can prevent delayed complications, such as esophagitis from gastro-esophageal reflux.

Esophageal Achalasia↗
PubMed1991

[Definition of a normal tracing in pH monitoring].

The adoption of specific criteria for the reading of tracings, together with a comparison of the results obtained during the course of patient tests with the thresholds of normality calculated in groups of healthy volunteers, are required to determine the normality or abnormality of pH monitoring. From such comparisons performed among groups of healthy volunteers, selected especially on the basis of age or nationality, it was found that age bears no significant influence in calculating the parameters pertinent to pH monitoring. On the other hand, different dietary and life habits could be responsible for a few, albeit limited, discrepancies, such as, for instance, the number of recorded occurrences of gastro-esophageal acid reflux. Use of esophago-gastric pH monitoring, which makes it possible to identify both acid and non-acid gastro-esophageal reflux (mixed and alkaline), authorizes the diagnosis of that limited number of patients in whom this latter component of reflux only exceeds normal limits (3.3%) and an improved definition of the clinical picture in a larger share of patients (20%). Use of different statistical methods to calculate the thresholds of normalcy does not substantially improve the sensitivity of the examination, changing the thresholds by a few tenths of a unit and the fact that the examination is slightly over, or slightly under, the threshold being of ineffectual clinical significance. The study of the correlation between symptoms and pH monitoring events seems a valid interpretative criterion of these tests and capable of improving the diagnostic efficiency of the examination (0.88) when combined with mathematical evaluation.

Adult↗
PubMed1991

A simple method to detect contaminating peptides and amino acids in large-scale ganglioside preparations.

A reverse-phase liquid chromatography method was developed to analyse the presence of contaminating peptides and amino acids in large-scale monosialoganglioside preparations. Samples were hydrolysed under controlled conditions and derivatized with phenylisothiocyanate. PTC-amino acids were then separated and identified by HPLC. The sensitivity of the method allowed detection of a least 50 pmoles of amino acid per mg of ganglioside with excellent reproducibility and little or no interference of by-products derived from hydrolysis of the glycosphingolipid. The response was consistently linear for each amino acid within the examined analytical range. The ease and speed of performance make this method a useful tool for rapidly monitoring large-scale extraction and purification processes of biologicals obtained from natural sources.

Amino Acid Sequence↗
PubMed1991

Lithotripsy with a Q-switched alexandrite laser system. Preliminary in vivo and in vitro results.

An alexandrite laser system which emits a wavelength of 750 nm, has recently been proposed as a substitute for the pulsed-dye laser (504 nm) for laser lithotripsy. We have carried out in vitro lithotripsy trials in order to evaluate the efficiency of a flashlamp pumped Q-switched alexandrite laser. In the first experiment, we compared the Q-switched alexandrite laser to the pulsed-dye laser with respect to their effectiveness in fragmentizing urinary and model stones (HMT target stones). In the second experiment, we evaluated the effect of Q-switched alexandrite radiation on the urinary wall (bladder, ureter, renal pelvis and liver) of animals (Wistar rats and rabbits) under general anesthesia. In conclusion, the alexandrite laser system is comparable to the pulsed dye laser. The 750-nm wavelength involves minimal risk of damage to the urinary tract and constitutes a safe alternative, especially during blind lithotripsy. It is a compact solid-state system, with no toxic chemical agents as laser material.

Animals↗
PubMed1991

[Imaging techniques in the staging of carcinoma of the esophagus].

Forty-four patients affected with thoracic esophageal carcinoma underwent preoperative CT to evaluate the value of this method in both staging and assessing the resectability of esophageal tumors. The authors compared the CT findings with intraoperative macroscopic ones, pathologic, and bronchoscopic results in mid-high neoplasms. CT staging criteria were drawn from a careful review of literature and from personal experience. Thirty-nine patients were submitted to surgery, and esophagectomy was possible in 34 of them. CT diagnostic accuracy was higher in proximal esophageal tumors than in sub-bronchial ones; as for the surgical choice, CT provided fundamental guidelines, especially if the choice was a blunt esophagectomy where it is important to exclude tumoral involvement of the airways (accuracy: 82.6%) or of the aorta (accuracy: 89.7%). CT staging accuracy was limited by the low sensitivity of the method in detecting lymphatic (local: 66.6%, distant: 64.2%) and hepatic metastases. Combined thoraco-abdominal CT, tracheobronchoscopy and liver US, besides MR imaging and endoscopic US, allow a better preoperative evaluation of esophageal carcinomas.

Adenocarcinoma↗
PubMed1990

Ambulatory 24-hr pH monitoring of esophagus, fundus, and antrum. A new technique for simultaneous study of gastroesophageal and duodenogastric reflux.

A method for outpatient 24-hr simultaneous recording of pH in the distal esophagus, fundus, and antrum was developed in order to detect acid, alkaline, alkalacid gastroesophageal reflux, and duodenogastric reflux and to study these phenomena in patients complaining of gastroesophageal reflux and dyspepsia related symptoms. Two hundred ninety-four studies were performed in 42 healthy volunteers and 237 patients. Three-probe ambulatory 24-hr esophagogastric pH monitoring applicability, tolerability, and capability to determine a relationship between symptoms which occurred during the tests, gastroesophageal reflux, and duodenogastric reflux episodes were assessed. Eighty-nine percent of the three-probe esophagogastric pH studies were easily performed. The examination was tolerated well by 86.1% of the patients and poorly by 13.9%. A temporal correlation between symptoms and pH activities was recognized in 61.3% when the esophageal tracing was considered (acid gastroesophageal reflux recording) and in 95.6% when the three pH traces were simultaneously interpreted. Alkalacid gastroesophageal reflux and duodenogastric reflux total percentage times were significantly higher in patients complaining of dyspeptic symptoms than in patients only affected by typical gastroesophageal symptoms. Three-probe 24-hr ambulatory esophagogastric pH monitoring is a simple, well-tolerated test that should be routinely adopted for the study of patients complaining of unclear upper gastrointestinal tract symptomatology.

Adolescent↗
PubMed1989

Reliability of 24-hour home esophageal pH monitoring in diagnosis of gastroesophageal reflux.

Twenty-four-hour home esophageal pH monitoring is proposed in order to study gastroesophageal reflux (GER) so that prolonged use of costly hospital equipment and staff can be curtailed and the diagnostic accuracy of the examination improved. Eighty-six patients affected by GER symptoms and 20 healthy volunteers underwent 24-hr home esophageal pH monitoring, x-rays, and endoscopy of the upper gastrointestinal tract to investigate reliability of outpatient recording. Fifteen more patients consecutively underwent out- and inpatient recording to detect possible differences between these methods in the two daily periods. Outpatient monitoring was well tolerated in 94.7% of the patients; 14.3% of them markedly reduced their routine activities. The range of normality of outpatient recording does not differ from that of inpatients. In the 15 patients who consecutively underwent out- and inpatient monitoring, no significant differences were reported. The sensitivity of 24-hr home esophageal pH recording is 0.85, the specificity 1, the accuracy for negative prediction 0.68, and the accuracy for positive prediction 1. The reliability of 24-hr home esophageal pH monitoring is comparable to inpatient recording. It allows hospital cost reduction and is also better tolerated by patients but has not greatly improved the diagnostic accuracy of the gastroesophageal reflux pH monitoring.

Adult↗
PubMed1989

Peripheral venous nutrition in surgical patients: techniques, indications and results.

Peripheral venous nutrition (PVN) has been proposed to avoid complications resulting from central venous catheterization in surgical patients. Using lipid emulsions 3 standard diets (with final osmolarity not higher than 900 mOsm/1, non-protein calories from 1675 to 2177, electrolytes 110 mEq, Cal/N ratio from 130/1 to 170/1) were worked out. They are suitable for total nutrition of non-hypercatabolic patients and for nutritional postoperative maintenance of patients undergoing major digestive tract surgery. The three diets were tested in 118 patients. Frequency and type of phlebitis and the nutritional status before and after treatment were evaluated in patients submitted to PVN and in 2 groups of 10 patients who received S-D5W infusions and Protein Sparing Nutrition (N = 12.8 g, total Cal. = 690, electrolytes = 110 mEq, osmolarity = 493 mOsm/l, pH = 7) in the postoperative period. Frequency of phlebitis was significantly lower in PVN patients than in control groups. 15 day treatment did not increase the frequency of phlebitis. In medium-term treated patients the mean daily nitrogen balance was always positive. Perioperative PVN achieved a statistically significant reduction of nitrogen losses with respect to PSN and S-DSW infusion.

Adult↗
PubMed1987

Effects of pregnancy on cardiac function and myosin enzymology in the rat.

Previous studies of cardiac function during pregnancy, while suggesting that this condition is associated with improved myocardial contractility, have been biased by the altered in vivo loading conditions. Therefore, we have investigated intrinsic cardiac function and contractile protein biochemistry during pregnancy in isolated rat hearts under controlled loading conditions. Animals were impregnated and studied after 1 and 3 wk and 2-3 days postpartum (gestation 21 days). The data show that hearts from pregnant animals (at 3 wk) had improved contractile performance as manifested by an 11% increase in fractional shortening, a 20% increase in velocity of circumferential fiber shortening, and an upward-shifted force-velocity relationship. These findings were paralleled by a 16% increase in Ca2+-activated myosin and an 11% increase in actin-activated ATPase activities. Thus pregnancy in the rat is associated with slightly improved cardiac contractility and biochemistry. This may relate directly to the hormonal status of the pregnant animal or to the effects of chronic volume overload.

Actins↗
PubMed1987

Pathophysiology and natural history of acquired short esophagus.

The choice of therapy--whether medical or surgical--for patients with gastroesophageal reflux (GER) is often a subject of debate. After a period in which surgery was almost the exclusive mode of treatment in patients with severe complications resulting from GER or in patients who did not respond to medical therapy, long-term follow-up showed that in 20 cases of GER in which only medical treatment was given, a progressive shortening of the esophagus--frequently in the absence of esophagitis--had developed. To investigate the pathophysiology of acquired short esophagus, we studied 34 patients--20 from the initial group and 14 who already had this condition. Clinical assessment consisted of interview, radiologic examination of the upper digestive tract, endoscopic and histologic examinations, and 24-hour home esophagogastric pH monitoring. We noted that acid GER causes shortening in the presence of severe mucosal lesions, while "nonacid" GER--a combination of gastric, pancreatic, and hepatic secretions--causes shortening of the esophagus even without evident mucosal lesions. Symptom evaluation, acid GER pH recording, and endoscopy are not sufficient for determination of the current choice of therapy. It is also important to quantify GER that results from the mixing of gastric and biliopancreatic secretions with use of the esophagogastric pH recording. This should reduce the possibility of silent shortening of the esophagus.

Adult↗
PubMed1987

Surgical therapy in "early gastric cancer".

Regarding early gastric cancer (E.G.C.) some authors propose total gastrectomy while others believe that partial resection is the best solution especially when the site is in the distal portion. The histological characteristics of E.G.C. in 49 patients were examined: 95.9% of the EGCs were found in the antropyloric region and 4.1% in the corpus-fundus. 47 patients were submitted to distal gastrectomy and 2 to total gastrectomy due to localization in the fundus. The overall survival rate after 5 yrs. is 83%. The incidence of the antropyloric localization, the rarity of metastases to the lymph node stations of the 2nd and 3rd level, the way in which intramural spread, occurs and, above all, the optimal survival rate obtained after partial resection, indicate that partial gastrectomy for distal gastric tumors is a radical operation, with a low surgical mortality rate, followed by a prolonged symptom-free survival.

Adenocarcinoma↗
PubMed1986

Behaviour of basement membrane antigens in gastric and colorectal cancer. Immunohistochemical study.

Eighty gastric and colorectal lesions including cases of dysplasia and carcinoma were studied by immunohistochemical techniques to investigate the behaviour of laminin, type IV collagen and fibronectin. Their distribution was examined on frozen and formalin-fixed, paraffin-embedded samples. In the same lesions, interruption, fragmentation and absence of basement membrane (BM) antigen-staining were observed. Carcinomas with well differentiated glandular structures were always surrounded by a well defined BM as in normal, non-pathological tissues. On the contrary, undifferentiated areas arranged in nests or sheets were usually negative for laminin and type IV collagen. Anomalous BM staining was strictly related to the degree of differentiation of tumor tissue, while no correlation existed between carcinoma staging and BM antigen presence, either in gastric or colorectal neoplasms. Immunostaining with antibody against type IV collagenase showed a massive positivity in the early gastric carcinomas examined, while in colorectal cancer only granulocytes showed it.

Antigens↗
PubMed1979

[Treatment of cancer of the breast with Patey's modified radical mastectomy].

Patey's operation was used to treat breast cancer in 658 cases between 1956 and 1976 at the Bologna University Surgical Clinic. Follow-up in 562 cases revealed 5-yr and 10-yr survival rates substantially similar to those obtained by Halsted and others. It is felt that the type of operation used is of relative importance for survival, since breast cancer is dependent on other factors that require careful appraisal in each case.

Breast Neoplasms↗
PubMed1979

[Diagnosis of chronic reflux esophagitis. Role of endoscopic and histological examination].

Fibroendoscopic and histobioptic study of the distal oesophageal mucosa has been carried out in a series of patients suffering from gastro-oesophageal regurgitation. The regurgitation condition was verified and its extent established by means of anamnestic, spot-fluorographic and manometric-pHmetric investigations. On the basis of the analysis of relations between the extent of the oesophagitis assessed on the basis of endoscopy and that arising out of microscopic examination of the biopsy, it is concluded that there is no complete correspondence between the two techniques insofar as endoscopy can give false positive or false negative results. On the basis of these results and of those of functional investigations, histology is considered desirable even when the oesophageal mucosa is normal, if there are clinical and/or laboratory signs of gastro-oesophageal regurgitation.

Adult↗
PubMed1979

Exocrine pancreatic function after total gastrectomy.

The secretion of bicarbonate, lipase, and chymotrypsin into the duodenum in response to exogenous stimulation with secretin, 1 CU/kg-h, plus caerulein, 100 ng/kg-h, was investigated in 12 patients, on an average, 20.7 months after total gastrectomy and in 14 control subjects. The secretion of bicarbonate and lipase was significantly lower in patients than in controls. The reduction in outputs compared with the control values was 47.9%, 38.7%, and 24.2% respectively for bicarbonate, lipase, and chymotrypsin. Eight of the 12 patients (67%) had steatorrhoea. No significant correlation was found between this parameter and lipase output. It is concluded that the exocrine pancreatic function is impaired in the majority of patients subjected to total gastrectomy. The impairment, which particularly affects bicarbonate and lipase, is generally mild to moderate.

Adult↗