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Biomedical subjects

S Vigneri

Publications and source records attributed to S Vigneri.

At least 91 records · Page 5Linked to original sources
PubMed1992

Mealtime versus nighttime acid inhibition. A clinical pharmacological study with ranitidine.

This study was carried out in order to compare the effects of mealtime and bedtime regimens of ranitidine on gastric acidity. Fifteen duodenal ulcer patients in clinical remission were randomized to receive in single-blind fashion either placebo, ranitidine 300 mg at night (2200 hr) or ranitidine 150 mg three times a day given before each of the three daily meals (1800, 0800 and 1200 hr). Over 24 hr, the two active treatments produced a significantly greater acid inhibition than placebo, while the single daily regimen was superior to the three times a day regimen of ranitidine in terms of both rise in pH values (P less than 0.001) and duration of action expressed as time spent above 3.0 pH units (P less than 0.05). The analysis of these two parameters during fractioned periods of the circadian cycle showed that the three divided doses of ranitidine were more effective during the daytime (P less than 0.01) and the evening (P less than 0.001), whereas the bedtime dose of ranitidine was superior during the night (P less than 0.0001). Thus a short-lasting antisecretory action, which is, however, capable of fully controlling the high acidity of postprandial periods, might be the key to understanding the results of several recent clinical trials in which the suppression of daytime gastric acidity has been shown to promote similar or even faster duodenal ulcer healing rates than the suppression of nocturnal acidity.

Adult↗
PubMed1992

Short-term treatment of refractory reflux esophagitis with different doses of omeprazole or ranitidine.

Sixty patients who presented with erosive/ulcerative refractory reflux esophagitis were randomized to receive a 4- to 8-week treatment with omeprazole 20 mg daily, or ranitidine 150 mg twice daily. Patients not healed after treatment were given the same drugs at doubled doses for a second period of equal duration. Patients still unhealed after this received open treatment with omeprazole 20 mg twice daily for a third period of 4 to 8 weeks. Endoscopic assessment and clinical and laboratory evaluation were performed every 4 weeks until there was complete esophageal mucosal repair. After 4 weeks, complete healing was observed in 50% of patients on omeprazole 20 mg daily, compared with 20.7% on ranitidine 150 mg twice per day (p < 0.01). After 8 weeks, the figures were 79.3% versus 34.5% (p < 0.5). With doubled doses after 4 weeks, complete healing was achieved in 96.6% of patients on omeprazole 40 mg daily, compared with 64.2% on ranitidine 300 mg twice per day (p < 0.05). The eight still "refractory" patients (one omeprazole, seven ranitidine) healed completely with 8 more weeks of omeprazole 20 mg twice daily. Patients treated with omeprazole experienced faster relief of heartburn, which disappeared in 60% of patients after 4 weeks, as compared to 21% of patients treated with ranitidine (p < 0.006). Apart from the mode of treatment, the only factor that proved to be related to healing at multivariate analysis was the pretreatment severity of gastroesophageal reflux, as measured by esophageal pH monitoring. Our study confirms that omeprazole, even at a low dosage, is the choice for refractory reflux esophagitis.

Adult↗
PubMed1992

Optimizing the information obtained from continuous 24-hour gastric pH monitoring.

Our objective in performing this study was to determine the best way to summarize experimental data obtained from 24-h continuous intragastric pH-metry. For this purpose, we reviewed 605 circadian intragastric pH recordings performed under different clinical conditions. Included were 82 normal subjects, 126 patients with active duodenal ulcer, 272 ulcer patients in clinical remission treated with a single bedtime dose (at 10 PM) of various H2 antagonists and 125 patients with active ulcer treated with a single morning dose (8 AM) of omeprazole. For each group, we calculated the time spent at different pH levels scaled with 0.1 incremental steps in three different time intervals: 24 h (5 PM to 4:59 PM), daytime (8 AM to 7:59 PM), and nighttime (8 PM to 7:59 AM). Then we calculated the mean and the median pH, as well as the time spent in min greater than 3.0 pH units over a mainly drug-related time window (8 PM to 7:59 AM) for each treatment and its respective placebo group. The mean and the median pH, as well as the time spent in minutes greater than 1.2 pH units over 24 h were also calculated for the untreated groups of normal subjects and duodenal ulcer patients. Considering the individual pH recordings, bi- or plurimodal density distributions of pHs were found in more than 90% of the 605 subjects, no matter the time window and the clinical condition examined, and log-normal distributions were found in only three cases. Considering the groups instead of single pH recordings, conversely, normal subjects and duodenal ulcer patients showed average left-skewed unimodal density distributions, whereas bimodal patterns were the rule in the groups of patients treated with H2 antagonists and omeprazole. The time spent greater than 3.0 pH units was the most powerful acidity index in assessing drug effectiveness in the various subsets of antisecretory compounds, in that the Student's t test values obtained with this variable were almost invariably higher than those obtained with the mean and median pH levels. Also, the time spent greater than 1.2 pH units was the most powerful summary variable in differentiating normal subjects from duodenal ulcer patients (p less than 0.01, compared with the mean and median pH). We conclude that the time spent above a given pH threshold of interest is a more accurate index than the mean and median pH in summarizing gastric acidity changes under all clinical conditions, and this is because it better represents the experimental pH measurements from which it comes.

Circadian Rhythm↗
PubMed1992

Pathophysiology of the gastric microcirculation.

Mucosal blood flow performs an extremely important role in microcirculation wherein alterations necessarily lead to severe gastric and duodenal mucosal lesions. The removal of back-diffused H+ ions through the adaptation of microcirculatory flow represents a valid defence mechanism. The blood flow's inability to contain H+ back-diffusion lies at the bottom of rapid-onset acute mucosal lesions; moreover, it probably contributes to the onset of chronic ulcer in certain areas already precariously supplied, because of the breakdown of the mucosal barrier or a further reduction in blood supply. Portal hypertension leads to altered blood flow in the gastric microcirculation. This haemo-dynamic condition brings about a series of endoscopically evident changes which are probably a consequence of the conspicuous increase in mucosal and submucosal vascular area. This haemodynamic situation may be an aetiopatho-genetic factor in the cirrhotic subject's marked sensitivity to gastric mucosal damage.

Animals↗
PubMed1991

A temporary endoscopic solution that significantly improves the prognosis of Bouveret's syndrome.

We report the case of a 73-year-old woman who was hospitalized for mild abdominal pain after her referral following a diagnostic assessment of acute lithiasic cholecystitis. After the spontaneus regression of her painful symptoms and fever and several days of well-being, her clinically acute abdominal features suddenly showed an obstruction of the upper gastrointestinal tract. An emergency esophagogastroduodenoscopy (EGDS) confirmed that a large gallstone completely obstructed the pylorus as previously demonstrated by an ultrasound examination of the gallbladder. During the course of endoscopy, removal of the gallstone from the duodenum was achieved by pulling it into the stomach; the patient underwent an operation, the gallstone was removed, and the cholecystoduodenal fistula resolved. Postoperative procedures and recovery were rapid and favorable.

Aged↗
PubMed1991

The stomach in liver cirrhosis. Endoscopic, morphological, and clinical correlations.

The stomachs of cirrhotic patients are frequently subject to a number of alterations, detectable by endoscopy, the presence of which indicates a disturbance in the mucosa. Several investigators believe that portal hypertension plays an etiopathogenetic role. Three groups of subjects were studied prospectively: 83 cirrhotic patients with portal hypertension, 53 cirrhotic patients without portal hypertension, and 135 control subjects. Snake skin, scarlatina rash, and petechia were the most frequent endoscopic findings in the cirrhotic patients with portal hypertension (P less than 0.001); these findings were also most frequently present in association with each other in this group. There was no correlation between the endoscopic findings, the clinical gravity of liver cirrhosis (Child-Pugh grade), and the gravity of esophageal varices (Beppu score). There were no characteristic inflammatory findings in the gastric mucosa. Hypergastrinemia was often observed in cirrhotic patients with and without angiodysplasias.

Aged↗
PubMed1991

The duodenum in liver cirrhosis: endoscopic, morphological and clinical findings.

Endoscopic studies were performed to determine whether changes occurred in the duodenum related to portal hypertension in patients with liver cirrhosis. The total of 271 patients studied were subdivided into three groups: 83 patients with liver cirrhosis and portal hypertension, 53 with liver cirrhosis but no portal hypertension, and 135 controls. In the duodenum of cirrhotic patients with portal hypertension several changes were observed on endoscopy that were also present in the other two groups. Atrophy and vascular malformations, however, were present only in the duodenum of cirrhotic patients with portal hypertension, although in only a few patients and with statistical significance only for vascular malformations (p less than 0.01, phi = 0.21). Eleven percent of the patients had more than one endoscopic finding, but the associations of findings were without statistical significance. No statistically significant correlation was observed between the clinical severity of cirrhosis or the severity of esophageal varices and the endoscopic findings. Finally, there was no statistically significant difference between the histological findings of duodenitis in the three groups of patients.

Aged↗
PubMed1991

High-dose famotidine in the maintenance treatment of refractory esophagitis: results of a "medium-term" open study.

Forty-four patients with esophagitis refractory to standard H2-blocker therapy, who had healed after a 4- to 16-wk course with either 20-40 mg omeprazole or ranitidine at doses of 300-600 mg daily in a randomized double-blind study, commenced a 3-month maintenance course of therapy with 40 mg bid famotidine. The aims of this investigation were to assess the effectiveness of this regimen in preventing recurrence of esophagitis lesions and symptoms in this subgroup of patients with therapy-resistant disease and to verify whether patients previously healed with omeprazole have a higher recurrence rate than those healed with ranitidine. The results of the study show that, despite the high dose of famotidine, 48% of patients relapsed within 3 months, a third of whom were asymptomatic. Moreover, previous omeprazole treatment is associated with a significantly higher risk of recurrence.

Adult↗
PubMed1990

[Role of endoscopy in lymphomatous pathology of the digestive tract].

Increasingly frequent reports of lymphoma with a gastro-intestinal primary location have stimulated much interest. Symptomatology has been shown not to be very specific, and scarcely different to that of other gastro-intestinal pathologics, both benign and malignant. The identification of some endoscopic pictures which suggest a lymphomatosic pathology and the possibility of collecting targeted biopsy samples, have placed endoscopy among the most important tests in the diagnostic and staging phase of gastro-intestinal lymphoma. This technique plays an equally important role in the follow-up period, since it allows the therapeutic efficacy of treatment to be assessed and the early identification of possible relapses.

Endoscopy, Gastrointestinal↗
PubMed1990

Aggressive factors or altered protective capacity of the gastric mucosa in chronic liver disease.

This study was conducted to assess the behavior of various parameters involved in mucosal protection (mucus and prostaglandins) and of presumed aggressive factors (hydrochloric acid and Helicobacter (Campylobacter) pylori in 20 patients with chronic liver disease, with or without clinical and instrumental signs of portal hypertension. The two groups of patients showed no difference from controls with respect to gastric acid secretion and the presence of antral Helicobacter pylori. The amount of gastric soluble mucus was reduced and the quality altered in cirrhotic patients with portal hypertension. The mucus of subjects with chronic active liver disease with no gross signs of portal hypertension showed significant qualitative differences from that of normal controls. The prostaglandin E2 concentration in the gastric mucosa was lower than normal in both groups of liver disease patients, but prostaglandin F2 alpha did not appear to differ between patients and controls.

Campylobacter↗
PubMed1989

[Therapy of resistant duodenal ulcer].

Significant progress has been made in the treatment of duodenal ulcers since cimetidine went on the market. Furthermore widespread use of the H2 blockers has enable us to identify a group of patients who take 8-12 weeks to heal, despite effective treatment and who are now known as "slow" or non-responders. In tackling the problem of ulcers resistant to medical treatment, the paper details the possibilities offered by current solutions on the basis of personal experience as well as reports in the literature. The results obtainable by surgery are also assessed with emphasis on the identification of suitable patients for and the appropriate timing of his surgical option. Finally a therapeutic flow-chart providing guidelines for the rational selection of therapeutic strategies that still had to be based on uncodified personal preferences is proposed.

Anti-Ulcer Agents↗
PubMed1987

Prevalence of hepatitis B virus infection in chronic users of hepatotoxic drugs and alcoholic cirrhotic patients.

Anti-HBc prevalence in alcoholics, chronic hepatotoxic drugs users, exposed to both these factors, and not exposed to alcohol and drugs cirrhotic patients was compared. Anti-HBc prevalence was significantly higher both in alcoholics and in hepatotoxic drugs users cirrhotic patients, and no statistically significant difference was found between the prevalence of anti-HBc in these two groups. In male cirrhotic patients the risk of HBV infection was 4.4 times higher in chronic hepatotoxic drugs users, 4.7 times higher in alcoholics, and 6.9 times higher in patients exposed both to alcohol and drugs. These results support the hypothesis that also chronic consumption of hepatotoxic drugs may be associated with a greater prevalence of HBV infection.

Adult↗
PubMed1985

Platelet thromboxane production in liver cirrhosis.

To determine whether platelet prostaglandin production in patients with liver cirrhosis was as impaired as platelet aggregation, serum thromboxane production was studied in 52 patients with liver cirrhosis; 12 patients had consumed more than 80 gr of alcohol/day, for more than ten years; 13 patients had also had diabetes mellitus for more than two years. A reduced thromboxane synthesis by platelets of liver disease patients was observed; the parallel decrease of both platelet thromboxane and serum PGE2 formation may also suggest a decrease in arachidonic acid availability for prostaglandin and thromboxane production. A smaller reduction of thromboxane and PGE2 formation in cirrhotics with diabetes mellitus or chronic alcohol intake was also observed.

Adult↗
PubMed1980

[Carcinoid syndrome due to bronchial adenoma. Observation of a case].

A brief account of certain histopathological and clinical features of bronchial carcinoids is followed by the description of a case of bronchial adenoma marked by the absence of detectable histochemical argentaffinity, the presence of a carcinoid syndrome, and elevated blood 5-HT and urinary 5-HIIA. Attention is drawn to the existence of the syndrome, which is usually absent in biogenic-amine-secreting adenomas of the bronchi, and an explanation for the picture is sought. The conclusion is drawn that 5-HT and 5-HIIA determinations are advisable in all cases of bronchial adenoma, since it is obvious that early diagnosis of a carcinoid syndrome will have repercussions at the therapeutic level.

Adenoma↗
PubMedDate not supplied

Histological and functional recovery in patients with multifocal atrophic gastritis after eradication of Helicobacter pylori infection.

BACKGROUND/AIMS: To assess the effect of Helicobacter pylori eradication on gastric histology and physiology in patients with multifocal atrophic gastritis over 1-year period. PATIENTS: Fourteen consecutive patients with histological evidence of chronic gastritis and Helicobacter pylori infection diagnosed by histology and serology entered this study. Patients with pernicious anaemia, gastric ulcer or carcinoma, duodenal ulcer, reflux oesophagitis and regular intake of nonsteroidal anti-inflammatory drugs were excluded. METHODS: Patients underwent triple anti-Helicobacter treatment for one week, which resulted successful in all subjects on the basis of negative CLO test and histology as well as 50% decrease in IgG antibodies after 4 weeks and 6 months of treatment, respectively. Histological and functional investigations were performed at baseline, 6 and 12 months after Helicobacter pylori eradication. Histological assessment of inflammatory cell infiltrates was performed on multiple biopsy specimens of the corpus and fundus. Functional tests were 24-hour continuous gastric pH-metry, fasting serum gastrin assay and pepsinogen I levels. RESULTS: There was a progressive significant improvement (p < 0.01-0.001) in acute and chronic inflammatory cell infiltrates in the gastric mucosa throughout the 12-month period. Functional recovery with increase in gastric acidity (p < 0.01) and decrease in gastrin and pepsinogen I levels (p < 0.001) was more evident at the 6-month than at the 12-month checkpoint after Helicobacter pylori eradication (p = NS for gastric pH and p < 0.02 for the other two variables) between 6 and 12 months. CONCLUSIONS: Eradication of Helicobacter pylori infection significantly improves the inflammatory status of oxyntic mucosa and this promotes an almost complete functional recovery. However, the non-parallel behaviour of gastric acidity, which was maximal at 6-month checkpoint, and histological parameters which continued to improve throughout the entire 12-month observation period, seems to indicate that removal of acid-inhibitory substances induced by Helicobacter pylori infection was also responsible for the more rapid recovery of gastric secretory function.

Anti-Bacterial Agents↗