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Biomedical subjects

V Alvisi

Publications and source records attributed to V Alvisi.

At least 37 records · Page 2Linked to original sources
PubMed1996

Repeated bile acid therapy for the long-term management of cholesterol gallstones.

BACKGROUND/AIMS: Following non-surgical treatment, cholesterol gallstones recur in a high proportion of patients, and recurrence cannot be predicted nor effectively prevented. Our aim was to test prospectively the viability and the efficacy of repeated bile acid therapy, in which recurrent stones are diagnosed at an early stage by regular ultrasound monitoring and promptly retreated, as a strategy for the management of these patients in clinical practice. METHODS: One hundred and seventy-two consecutive patients were recruited upon achieving complete gallstone dissolution using non-surgical therapy (bile acids or lithotripsy plus bile acids), and followed up at 6-monthly intervals by ultrasound scan. Gallstone recurrence was promptly treated by a combination of ursodeoxycholic acid plus chenodeoxycholic acid (5 mg/kg per day each) for a period of 2 years, or less if complete redissolution was achieved. Median follow-up period was 34 months (range 6-70). RESULTS: Forty-five patients had gallstone recurrence; of these, 39 underwent one or more repeated courses of bile acid therapy (follow-up data available in 27). Gallstone recurrence rate was 15% at 1 year and 47% at 5 years. Average annual redissolution rate of recurrent gallstones (intention to treat) was 41%. The proportion of gallstone-free patients in the whole population was 88%, 84%, 77%, 78%, 75% at 1-5 years, respectively, and rose to > 90% at 3 years onwards in patients with single primary stones. CONCLUSIONS: We conclude that repeated bile acid therapy maintains the majority of patients gallstone free, and is therefore an effective long-term management strategy, especially in patients with primary single gallstones.

Adolescent↗
PubMed1996

Bioavailability of a controlled release formulation of ursodeoxycholic acid in man.

Several controlled release formulations of ursodeoxycholic acid (UDCA) are currently available. However, none of these results in an optimal bioavailability of the active ingredient as a function of the absorption windows for bile acids found at the gastroduodenal level. Nonsaturated passive absorption of bile acids occurs at these sites, while absorption in the rest of the intestinal tract is less consistent as it is limited by the presence of carriers. These considerations led to the development of an original delayed-release formulation of UDCA using the bioadhesive technique. This allows a longer residence time at the appropriate sites and hence a higher passive absorption of UDCA. The results of this pharmacokinetic study, which compared the new formulation with a traditional pH-dependent sequential release formulation, demonstrated that the new formulation had a greater area under the curve (AUC) during a 24 h period, when compared with that of the reference drug, reaching statistically significant values (p < 0.01) within the first 12 h.

Adolescent↗
PubMed1996

Cholesterol vesicles in areas of gastric metaplasia of gallbladder epithelium.

Gastric metaplasia is a frequent epithelial change in gallbladder of lithiasic patients. Particles consistent with cholesterol-containing vesicles were searched in areas overlying gastric metaplastic cells, in gastric metaplastic cells, in areas overlying normal-looking epithelial cells and in normal-looking epithelial cells in 25 patients with radiolucent calculi and 10 control patients undergoing cholecystectomy for other reasons. Important trends were found confirming the peculiar role of mucous layer adherent to metaplastic gallbladder epithelium in beginning the nucleation process and interesting pictures concerning the formation of uni- and multilamellar vesicles in these "nucleating areas" were seen.

Adult↗
PubMed1996

Endoscopic aspects of gastroduodenal mucosa due to NSAIDs.

The role of endoscopy in NSAID-related gastroduodenal pathologies is reviewed. If an accepted and largely used algorithm in which the role of endoscopy is exactly identified is not available, current strategy for the management of gastroduodenal toxicity gives indication for endoscopy immediately after the onset of symptoms, anaemia and evidence of bleeding, overt or occult. The endoscopic patterns of lesions in patients taking NSAID are characteristics patterns of erosive and ulcerative lesions. Endoscopy can recognize early lesions, allowing us to prevent a more advanced mucosal damage.

Aged↗
PubMed1996

Ultrastructural damage of gastric epithelium in patients taking NSAIDs.

As far as concerns ultrastructural lesions in the gastric epithelium following NSAIDs, a review has been made of existing data and ideas for future research concerning the ultrastructural field are advanced. Specific ultrastructural damage of the gastric epithelial cells has been recognized in patients taking NSAIDs: this pattern of damage appears characterized by a proliferative phenomen of "desquamation" of contiguous epithelial cells. Studies in animal models indicate that the first-level of epithelial damage involves a mitochondrial derangement and an alteration of tight junctions and cytoskeletal. The length of time of local drug action on the gastric mucosa could be the reason for the characteristic morphological presentation seen in vivo. If ulcers are the result of an imbalance between cell necrosis and cell regeneration, the high progression speed of cell necrosis to contiguous cells should play a basic role in the genesis of ulcers.

Animals↗
PubMed1996

Therapy of NSAIDs-induced gastropathy.

NSAID-induced gastropathy is the most frequent side effect due to NSAID use. The resulting clinical event is usually of little significance and only in a small percentage of cases results in serious side effects. Nevertheless, the large worldwide use of NSAIDs makes, even a rare side effect, numerically consistent. The pathogenesis of NSAID-induced gastropathy is related to two main mechanisms: an initial topical effect which is pH dependent and a systemic effect which is, more slowly developing, and mainly correlated to the inhibition of prostaglandin synthesis. The therapy of NSAID-gastropathy is almost completely identified with the therapy of NSAID ulceration because of its frequent relation to the development of potentially serious complications. In the case of symptomatic ulcer development the first therapeutic step is NSAID suspension and, in such a case all "antiulcer" drugs are efficient. When the NSAID can not be discontinued, omeprazole seems to be the most efficient drug; H2 blockers can promote ulcer healing but at a slower rate; sucralfate shows an efficacy similar to H2 blockers; misoprostol is useful in the prevention of NSAID-gastropathy. However, it is not so efficient in the treatment of established lesions and shows poor efficacy in the reduction of dyspeptic symptoms. For each one of these drugs it is necessary to obtain further data.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed1995

Comparison of serum total sialic acid, C-reactive protein, alpha 1-acid glycoprotein and beta 2-microglobulin in patients with non-malignant bowel diseases.

Total sialic acid (TSA), C-reactive protein (CRP); alpha 1 acid glycoprotein (alpha 1-AG), and beta 2-microglobulin were determined in 84 patients affected by non-malignant intestinal diseases, Crohn's disease (CD) and ulcerative colitis (UC), active and in remission; non-ulcerative proctosigmoiditis; diverticulosis; diverticulitis (ie, inflammatory complication of diverticulosis). Only in patients with acute phase CD, TSA was statistically higher than those in remission, as well as in controls. In patients with acute CD and in those with diverticulitis, CRP was significantly higher than in the controls. alpha 1-AG was found significantly increased in acute UC and CD patients versus the respective groups in remission, as well as versus controls. Moreover, alpha 1-AG was higher in patients with diverticulitis. beta 2-microglobulin did not differ in any group of patients. In five patients with CD in acute phase, investigated before and during the pharmacological treatment (5-aminosalycilic acid and steroids), CRP values fell into the normal range after the second week of therapy, whereas TSA values reached the higher limit of the normal range after the third week, except for two CD patients with a larger location (ileocolonic) of the disease. The results are briefly discussed.

Adolescent↗
PubMed1995

Histological findings in gastric mucosa in patients treated with non-steroidal anti-inflammatory drugs.

AIMS: To identify distinguishing and general histological features related to the use of non-steroidal anti-inflammatory drugs (NSAID). METHODS: Slides from gastric antral biopsies of 50 patients with osteoarthritis taking NSAID were compared with slides from antral biopsies of 50 control cases matched for age, sex, and race. Semithin sections stained with toluidine blue were used. RESULTS: Chronic gastritis was seen in 76% of the patients taking NSAID and in 58% of the control cases; active inflammation was detected in 10% of the NSAID treated patients and in 24% of the control cases, and it appeared closely related with Helicobacter pylori infection. Some histological features common to all slides of patients taking NSAID were recognised. These consisted of focal erosions of the gastric epithelium and macroerosions, and they seemed to represent successive steps of a process of "desquamation". CONCLUSIONS: Some distinguishing morphological aspects appeared prominent; it is suggested that these may be related to the pathogenesis of NSAID linked peptic ulceration. On the other hand, epithelial damage due to NSAID appears very different from that due to Helicobacter pylori, another important factor involved in the aetiopathogenesis of peptic disease.

Adult↗
PubMed1995

Oral cromolyn sodium in comparison with elimination diet in the irritable bowel syndrome, diarrheic type. Multicenter study of 428 patients.

BACKGROUND: In a significant number of patients affected by the irritable bowel syndrome, an adverse reaction to food is proposed to be a causative factor. A diet that eliminates the offending foods is the obvious treatment for such adverse reactions. Compliance with a dietetic regimen is often poor and sometimes not completely free from risks. METHODS: Since the diarrheic type of irritable bowel syndrome seems mainly affected by food intolerance, and previous observations suggested that oral cromolyn sodium is effective in such patients, a multicenter therapeutic trial in the diarrheic type of irritable bowel syndrome was carried out in 346 of 409 patients with this disease, to evaluate the effects of oral cromolyn sodium and compare its efficacy with that of an elimination diet. RESULTS: Symptoms related to the irritable bowel syndrome improved in 60% of patients treated with elimination diet and in 67% of those treated with oral cromolyn sodium (1500 mg/day) for 1 month. Moreover, in both groups clinical results were significantly better in the patients positive to the skin prick test than in the negative ones. CONCLUSIONS: These results confirm the high prevalence of adverse reactions to foods in diarrheic irritable bowel syndrome and the usefulness of cromolyn sodium treatment in these patients.

Administration, Oral↗
PubMed1994

Placebo-controlled comparison of spirapril at 6, 12 and 24 mg/day in mild to severe essential hypertension.

In a double-blind, parallel-group study, 260 patients with mild to severe essential hypertension were randomized to treatment with placebo or spirapril at 6, 12 or 24 mg once daily for 6 weeks. When blood pressures were measured at the end of the dosing interval (trough), all spirapril regimens had produced similar reductions in sitting systolic and diastolic blood pressures (siSBP/siDBP) which were significantly greater than those observed in placebo-treated patients. There were no relevant changes in resting heart rate in any of the study groups. At the study endpoint, the mean reductions in siSBP/siDBP were 14.9/11.5 mmHg with spirapril at 6 mg, 15.4/12.0 mmHg with spirapril at 12 mg and 17.8/12.4 mmHg with spirapril at 24 mg/day vs. 3.1/3.6 mmHg with placebo. In a subgroup of 122 patients, blood pressure was recorded at the end of the dosing interval and during the 8 hours immediately postdose to monitor the peak effects on blood pressure. All spirapril dosages produced similar reductions at peak with a mean decrease of siDBP of approximately 20 mmHg in comparison to baseline values vs 6-7 mmHg with placebo. The trough:peak ratios for 6, 12 and 24 mg all lay between 60% and 90% for siSBP and siDBP, indicating that most of the peak effect was maintained at trough. Spirapril was well tolerated; the adverse event profile was not different from that with placebo, and no dose-related adverse events were observed.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1993

Ultrastructural patterns of Helicobacter pylori.

Ultrastructural morphology of the bacterial bodies was studied in 40 Helicobacter pylori positive cases. Two bacterial patterns were identified, which were associated with different modes of contact with the epithelial cells and possibly with different stages of the natural history of the infection.

Bacterial Adhesion↗
PubMed1993

Influence of oral contraceptives on fasting gallbladder volume.

A total of 615 healthy fertile women (518 pill users and 97 non-users) were examined by real-time ultrasonography for fasting gallbladder volume, gallstones and biliary dysmorphism. None of the six examined combinations of oral contraceptives appeared to influence fasting gallbladder volume significantly. When fasting gallbladder volumes were reanalyzed according to the presence or absence of recognized biliary risk factors, significant modifications were detected, in both pill users and non-users. These changes related only to age and parity. Relative risks of cholelithiasis and biliary dysmorphism were not affected by contraceptive treatment.

Adolescent↗
PubMed1991

Influence of the thyroid on exocrine pancreatic function.

Exocrine pancreatic function was studied in 15 patients with hypothyroidism and 15 healthy subjects by means of the amino acid consumption test, a new tubeless test based on the measurement of plasma amino acid uptake by the pancreas during pancreatic enzyme synthesis stimulation. Nine of the 15 patients were also studied after they had become euthyroid following thyroxine treatment. Pancreatic function was significantly reduced in patients with hypothyroidism compared with healthy subjects. Treatment with thyroxine restored pancreatic function to normal. In two additional hypothyroid patients studied by means of duodenal intubation, pancreatic secretion of both bicarbonate and enzymes was found to be significantly decreased. It was concluded that the thyroid gland plays an essential role in maintaining the functional integrity of the exocrine pancreas in humans.

Adult↗